A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease

Boogers, Alexandra; Fasano, Alfonso

doi:10.1002/mds.29656

Cited by 7 publications

(2 citation statements)

References 33 publications

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“…One study suggested a significant improvement in cardiovascular symptoms, using a self-report questionnaire, in PD patients after 6 months of GPi-DBS and not STN-DBS [35]. Of note, GPi-DBS patients had more severe baseline cardiovascular symptoms, in line with real-world practice, where GPi-DBS is proposed for frailer elderly patients, with poorer cognition and more comorbid conditions, including orthostatic hypertension [60]. Although a moderate effect size is reported by the authors, validation of this single report is needed.…”

Section: Discussionmentioning

confidence: 82%

Short term cardiovascular symptoms improvement after deep brain stimulation in patients with Parkinson's disease: a systematic review

Cucinotta,

Swinnen,

Makovac

et al. 2024

J Neurol

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Background Autonomic dysfunction is common and disabling in Parkinson's disease (PD). The effects of deep brain stimulation (DBS) on the cardiovascular system in PD remain poorly understood. We aimed to assess the effect of DBS on cardiovascular symptoms and objective measures in PD patients. Methods We conducted a systematic literature search in PubMed/MEDLINE. Results 36 out of 472 studies were included, mostly involving DBS of the subthalamic nucleus, and to a lesser extent the globus pallidus pars interna and pedunculopontine nucleus. Seventeen studies evaluated the effect of DBS on patient-reported or clinician-rated cardiovascular symptoms, showing an improvement in the first year after surgery but not with longer-term follow-up. DBS has no clear direct effects on blood pressure during an orthostatic challenge (n = 10 studies). DBS has inconsistent effects on heart rate variability (n = 10 studies). Conclusion Current evidence on the impact of DBS on cardiovascular functions in PD is inconclusive. DBS may offer short-term improvement of cardiovascular symptoms in PD, particularly orthostatic hypotension, which may be attributed to dopaminergic medication reduction after surgery. There is insufficient evidence to draw conclusions on the direct effect of DBS on blood pressure and heart rate variability.

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Section: Discussionmentioning

confidence: 82%

Short term cardiovascular symptoms improvement after deep brain stimulation in patients with Parkinson's disease: a systematic review

Cucinotta,

Swinnen,

Makovac

et al. 2024

J Neurol

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“…In their viewpoint article Boogers and Fasano reflect on their 'Transatlantic' view on target selection for deep brain stimulation (DBS) in Parkinson's disease (PD). 1 Their key point is that the European obsession with subthalamic nucleus (STN) DBS for PD is too limited and that DBS of the internal part of the globus pallidus (GPi) has several advantages that are often neglected. Their article is another contribution to the long debate about optimal target selection for DBS in PD.…”

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confidence: 99%

Comment on: “A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease”

Beudel

2024

Movement Disorders

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We recently published an invited editorial on the article by Domen et al reporting on cognitive safety of cannabis products in Parkinson's disease (PD). Briefly, they conducted a randomized, controlled trial to determine whether cannabidiol (CBD)/ Δ9-tetrahydocannabinol (THC) products improved PD motor symptoms and assessed for potential impact on cognition using a battery of neuropsychological tests. Treatment was associated with less benefit from practice on a verbal fluency test and increased reporting of adverse cognitive events. Results from the primary motor outcome are pending. Our editorial highlighted the methodological strengths and importance of their work. As PD clinicians, we wondered whether two important questions could be addressed by this study: (1) is risk of adverse impact of CBD/THC on cognition dependent on cognitive status (ie, "normal" vs. mild impairment or dementia)? (2) What is the overall impact of CBD/THC on cognition in PD? We were most pleased that the authors responded to our editorial and addressed our questions. Unfortunately, although their study sample included PD patients with cognitive impairment, there were not enough impaired individuals to examine whether this had bearing on side effects. However, in a well-executed follow-up analysis, they found that placebo appreciated greater overall improvement via practice effect than treatment, with a medium to large effect size. This finding aligns with subjective reporting of adverse cognitive events. Thanks to the efforts of Domen and colleagues, we now have solid empirical evidence to inform PD patients about potential cognitive risks associated with CBD/THC. We look forward to reading results on the motor functioning to see whether there are benefits to justify the risks.

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Quality of Life after Deep Brain Stimulation in Parkinson's Disease: Does the Target Matter?

Murcia Carretero,

Petermann,

Debove

et al. 2024

Movement Disord Clin Pract

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BackgroundDeep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an accepted therapy for Parkinson's disease (PD) with disabling motor complications. For elderly patients with poorer cognition and postural instability, GPi has been proposed as the preferable DBS target based on expert opinion, arguing GPi‐DBS may be less complicated by depression, apathy, worsened verbal fluency, and executive dysfunction, resulting in greater improvement in quality of life (QoL). However, data supporting such patient‐tailored approach are lacking.ObjectivesThe aims were to analyze whether the DBS target influences QoL in a PD cohort and a matched subgroup of frail patients with poor cognitive status and reduced postural stability, and whether other factors affect the QoL outcomes.MethodsIn this retrospective study, we analyzed a single‐center cohort of 138 PD patients who received bilateral STN‐DBS (117) or GPi‐DBS (21) using the mentioned approach for target selection. All patients underwent standardized clinical evaluations of motor‐ and nonmotor signs as well as QoL before and 1 year after surgery.ResultsDBS of both targets improved motor signs, dyskinesias, and pain. QoL improved without significant difference between the targets, but with a trend for greater improvement across all QoL domains in favor of the STN, even in an STN subgroup matched to the GPi group.ConclusionOur results contradict the prevailing belief that GPi‐DBS is superior in frail PD patients with cognitive decline and postural instability, questioning the proposed patient‐tailored approach of DBS target selection. Further studies are needed for a data‐driven approach.

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A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease

Cited by 7 publications

References 33 publications

Short term cardiovascular symptoms improvement after deep brain stimulation in patients with Parkinson's disease: a systematic review

Short term cardiovascular symptoms improvement after deep brain stimulation in patients with Parkinson's disease: a systematic review

Comment on: “A Transatlantic Viewpoint on the Role of Pallidal Stimulation for Parkinson's Disease”

Quality of Life after Deep Brain Stimulation in Parkinson's Disease: Does the Target Matter?

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