An update on best practice of deep brain stimulation in Parkinson’s disease

Hartmann, Christian; Fliegen, Sabine; Groiss, Stefan Jun; Wojtecki, Lars; Schnitzler, Alfons

doi:10.1177/1756286419838096

Cited by 116 publications

(74 citation statements)

References 153 publications

(224 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Scores on UPDRS motor exam (III) reflected moderate disease severity when tested off dopamine medications. This score improved by 36% when tested “on medication,” a general indicator of potentially good responsivity of PD symptoms to DBS surgery ( Hartmann et al, 2019 ). As a group, scores on indices of depression (BDI-II), apathy (AS), and anxiety (STAI) were below clinical cutoff, though there was substantial variability across participants.…”

Section: Resultsmentioning

confidence: 99%

The UF Deep Brain Stimulation Cognitive Rating Scale (DBS-CRS): Clinical Decision Making, Validity, and Outcomes

Kenney

Rohl

Lopez

et al. 2020

Front. Hum. Neurosci.

View full text Add to dashboard Cite

To more efficiently communicate the results of neuropsychological assessment to interdisciplinary teams, the University of Florida Neuropsychology Service developed a Deep Brain Stimulation-Cognitive Rating Scale (DBS-CRS). This tool condensed results of a 3-h exam into a five-point scale ranging from 1 (least) to 5 (most) cognitive concern for DBS surgery. In this study, we evaluated the role of the DBS-CRS in clinical decisions by the interdisciplinary team to proceed to surgery, its relationship to objective neuropsychological scores, and its predictive utility for clinical outcome. We retrospectively examined 189 patients with Parkinson’s disease who were evaluated for DBS candidacy (mean age 64.8 [ SD 9.2], disease duration 8.9 years [ SD 5.0], UPDRS-Part III off medication 38.5 [ SD 10.5], Dementia Rating Scale-II 135.4 [ SD 6.0]). Approximately 19% of patients did not proceed to surgery, with neuropsychological red flags being the most commonly documented reason (57%). Patients who underwent DBS surgery had significantly better DBS-CRS scores than those who did not ( p < 0.001). The two strongest and unique neuropsychological contributors to DBS-CRS ratings were delayed memory and executive function, followed by language and visuoperception, based on hierarchical linear regression that accounted for 77.2% of the variance. In terms of outcome, DBS-CRS scores were associated with higher quality of life, less severe motor symptoms, and better daily functioning 6 months following DBS surgery. Together, these findings support the construct and predictive validity of the DBS-CRS as a concise tool for effectively communicating pre-DBS cognitive concerns to an interdisciplinary team, thereby aiding decision making in potential DBS candidates.

show abstract

Section: Resultsmentioning

confidence: 99%

The UF Deep Brain Stimulation Cognitive Rating Scale (DBS-CRS): Clinical Decision Making, Validity, and Outcomes

Kenney

Rohl

Lopez

et al. 2020

Front. Hum. Neurosci.

View full text Add to dashboard Cite

show abstract

“…We note that similar phenotypic differences are reported in PD patients undergoing DBS of the STN or GPi, and that such differences reflect predominant symptomatology guiding target selection 59 . It is often argued that the GPi may be a more appropriate target than the STN in patients with existing mild cognitive dysfunction or troublesome dyskinesias 60,61 .…”

Section: Study Limitationsmentioning

confidence: 99%

Neural signatures of pathological hyperdirect pathway activity in Parkinson’s disease

Oswal

Yeh

Neumann

et al. 2020

Preprint

View full text Add to dashboard Cite

Parkinson’s disease (PD) is characterised by the emergence of pathological patterns of oscillatory synchronisation across the cortico-basal-ganglia circuit. The relationship between anatomical connectivity and oscillatory synchronisation within this system remains poorly understood. We address this by integrating evidence from invasive electrophysiology, magnetoencephalography, tractography and computational modelling in patients. Coupling between supplementary motor area (SMA) and subthalamic nucleus (STN) within the high beta frequency (21-30 Hz) range correlated with fibre tract densities between these two structures. Additionally within the STN, non-linear waveform features suggestive of cortical synchronisation correlated with cortico-STN fibre densities. Finally, computational modelling revealed that exaggerated hyperdirect cortical inputs to the STN in the upper beta frequency range can provoke the generation of widespread pathological synchrony at lower beta (13-20 Hz) frequencies. These observations reveal a spectral signature of the hyperdirect pathway at high beta frequencies and provide evidence for its pathophysiological role in oscillatory network dysfunction in PD.One sentence summarySignatures of the hyperdirect pathway and its likely role in pathological network disruption in Parkinson’s disease are identified.

show abstract

“…Tierexperimentelle Untersuchungen legen nahe: als Mechanismus der STN-THS spielt die antidrome Aktivierung des hyperdirekten Fasertrakts zwischen STN und Motorcortex mit resultierender Hemmung pathologisch gesteigerter β-Oszillationen vermutlich eine entscheidende Rolle [7]. Auch bei Parkinson Patienten konnte gezeigt werden, dass die STN-THS mit einer Suppression verstärkter β-Oszillationen im STN einhergeht und diese mit der Besserung von Akinesie und Rigor korreliert [1,8]. Die genauen Mechanismen der STN-THS auf molekularer, zellulärer, lokaler und Netzwerkebene sind jedoch noch weitgehend ungeklärt und aktueller Gegenstand wissenschaftlicher Untersuchungen.…”

Section: Wirkmechanismen Der Ths Des Nucleus Subthalamicus (Stn-ths)unclassified

Tiefe Hirnstimulation bei Morbus Parkinson

Nikolov¹,

Groiss²,

Schnitzler³

2020

Klinische Neurophysiologie

Self Cite

View full text Add to dashboard Cite

Die tiefe Hirnstimulation ist eine etablierte und evidenzbasierte Therapieoption für die Behandlung des fortgeschrittenen Morbus Parkinson. Es handelt sich um eine symptomatische Behandlung mit dem primären Ziel, die Lebensqualität des Patienten zu verbessern. Der operative Eingriff gilt als relativ komplikationsarm.

show abstract

An update on best practice of deep brain stimulation in Parkinson’s disease

Cited by 116 publications

References 153 publications

The UF Deep Brain Stimulation Cognitive Rating Scale (DBS-CRS): Clinical Decision Making, Validity, and Outcomes

The UF Deep Brain Stimulation Cognitive Rating Scale (DBS-CRS): Clinical Decision Making, Validity, and Outcomes

Neural signatures of pathological hyperdirect pathway activity in Parkinson’s disease

Tiefe Hirnstimulation bei Morbus Parkinson

Contact Info

Product

Resources

About