Current Practice and the Future of Deep Brain Stimulation Therapy in Parkinson's Disease

Almeida, Leonardo; Deeb, Wissam; Spears, C. Chauncey; Opri, Enrico; Molina, Rene; Martínez-Ramírez, Daniel; Gündüz, Ayşegül; Hess, Christopher W.; Okun, Michael S.

doi:10.1055/s-0037-1601893

Cited by 25 publications

(9 citation statements)

References 79 publications

(113 reference statements)

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“…23 patients with Parkinson's Disease (PD) and two with Essential Tremor undergoing implantation of a DBS electrode in the subthalamic nucleus (STN) volunteered for the study and gave written informed consent (see Table S1 ). Surgical indications for DBS followed established guidelines [ 64 ]. This study was approved by the Institutional Review Board of Cedars-Sinai Medical Center.…”

Section: Star⋆methodsmentioning

confidence: 99%

Novelty-Sensitive Dopaminergic Neurons in the Human Substantia Nigra Predict Success of Declarative Memory Formation

et al. 2018

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Summary The encoding of information into long-term declarative memory is facilitated by dopamine. This process depends on hippocampal novelty signals, but it remains unknown how midbrain dopaminergic neurons are modulated by declarative-memory-based information. We recorded individual substantia nigra (SN) neurons and cortical field potentials in human patients performing a recognition memory task. We found that 25% of SN neurons were modulated by stimulus novelty. Extracellular waveform shape and anatomical location indicated that these memory-selective neurons were putatively dopaminergic. The responses of memory-selective neurons appeared 527 ms after stimulus onset, changed after a single trial, and were indicative of recognition accuracy. SN neurons phase locked to frontal cortical theta-frequency oscillations, and the extent of this coordination predicted successful memory formation. These data reveal that dopaminergic neurons in the human SN are modulated by memory signals and demonstrate a progression of information flow in the hippocampal-basal ganglia-frontal cortex loop for memory encoding.

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Section: Star⋆methodsmentioning

confidence: 99%

Novelty-Sensitive Dopaminergic Neurons in the Human Substantia Nigra Predict Success of Declarative Memory Formation

et al. 2018

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“…First, patient expectation and satisfaction may play an important role here. Some patients may not receive significant benefit on total motor function, but addressing the problems of concern can greatly enhance their satisfaction and QOL score [ 7 , 24 ]. SLR can accurately reflect improvements in major symptoms without being affected by the less-concerning items in UPDRS-III and thus can be more sensitive in judging a patient's possible QOL change [ 25 ].…”

Section: Discussionmentioning

confidence: 99%

Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment

et al. 2021

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Background. The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson’s disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa response (SLR) in predicting postoperative improvement in different PD motor subtypes. Methods. Studies were split into a training set (147 patients) and a validation set (304 patients). We retrospectively collected data from 147 patients who received the Unified Parkinson’s Disease Rating Scale- (UPDRS-) III and the Parkinson’s Disease Questionnaire- (PDQ-) 39 evaluation. Patients were classified into tremor-dominant (TD), akinetic-rigid-dominant (AR), and mixed (MX) groups. Clinically important difference (CID) was employed to dichotomize DBS effects. For patients in each subtype group from the training set, we used the correlation and receiver operator characteristic (ROC) curve analyses to explore the strength of their relations. Areas under the curve (AUCs) were calculated and compared through the DeLong test. Results developed from the training set were applied into the validation set to predict postoperative improvement in different PD motor subtypes. Results. In the validation cohort, TLR significantly correlated with postoperative motor ( p < 0.001 ) and quality of life (QOL) ( p < 0.001 ) improvement in the MX group. The AUC between TLR and UPDRS-III (TU) is 0.800. The AUC between TLR and PDQ-39 (TP) is 0.770. An associated criterion in both TU and TP is around 50%. In the AR group, strong correlation was only found in SLR and PDQ-39 (SP) ( p < 0.001 ). And the AUC of SP is significantly larger than that in TLR and PDQ-39 (TP) ( p = 0.034 ). An associated criterion in SP is around 37%. No significant correlation was found in the TD group. Conclusions. We provide a more accurate judgment for LDCT. TLR strongly correlated with postoperative UPDRS-III and PDQ-39 improvement in MX patients. A TLR > 50 % may indicate a higher possibility of clinically meaningful benefits from STN-DBS comparing to medication only. SLR can well predict QOL improvement in AR patients. Similarly, a SLR > 37 % may indicate a higher possibility of clinically significant benefits from STN-DBS. LDCT provides limited information for TD patients.

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“…This has led to a burst in investigations centered on novel waveforms aimed at probing the underlying neural circuitry and improving therapy. Several studies report promising results by incorporating elements of square biphasic pulses ( 50 , 51 ), bursting, passive-discharge ( 8 ), spatial desynchronization ( 52 ), and pseudo-randomization ( 53 ). Improved circuit infrastructure incorporated in next generation IPGs is essential to test these patterns beyond acute settings.…”

Section: Status Of Key Technological Advances In Neuromodulation Therapymentioning

confidence: 99%

Digital Health Integration With Neuromodulation Therapies: The Future of Patient-Centric Innovation in Neuromodulation

Pathak

Greenleaf

Metman

et al. 2021

Front. Digit. Health

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Digital health can drive patient-centric innovation in neuromodulation by leveraging current tools to identify response predictors and digital biomarkers. Iterative technological evolution has led us to an ideal point to integrate digital health with neuromodulation. Here, we provide an overview of the digital health building-blocks, the status of advanced neuromodulation technologies, and future applications for neuromodulation with digital health integration.

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Current Practice and the Future of Deep Brain Stimulation Therapy in Parkinson's Disease

Cited by 25 publications

References 79 publications

Novelty-Sensitive Dopaminergic Neurons in the Human Substantia Nigra Predict Success of Declarative Memory Formation

Novelty-Sensitive Dopaminergic Neurons in the Human Substantia Nigra Predict Success of Declarative Memory Formation

Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson’s Disease Motor Subtypes: A More Accurate Judgment

Digital Health Integration With Neuromodulation Therapies: The Future of Patient-Centric Innovation in Neuromodulation

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