Deep Brain Stimulation and Nonmotor Symptoms

Hogg, Elliot; Wertheimer, Jeffrey; Graner, Sarah; Tagliati, Michele

doi:10.1016/bs.irn.2017.05.022

Cited by 26 publications

(17 citation statements)

References 217 publications

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“…STN‐DBS is a powerful therapy for advanced idiopathic Parkinson's disease (PD). Despite its significant effectiveness in treating PD motor symptoms like bradykinesia, rigidity, or tremor, its influence on nonmotor symptoms of the disease is less specific . In PD, nonmotor symptoms occur in various domains, including autonomic function, sleep, apathy, cognition, and mood .…”

mentioning

confidence: 99%

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

et al. 2018

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A BS TRACT: Background: STN-DBS effectively treats motor symptoms of advanced PD. Nonmotor cognitive symptoms, such as impaired impulse control or decision making, may either improve or worsen with DBS. A potential mediating factor of DBS-induced modulation of cognition is the electrode position within the STN with regard to functional subareas of parallel motor, cognitive, and affective basal ganglia loops. However, to date, the volume of tissue activated and weighted stimulation of STN motor versus nonmotor territories are yet to be linked to differential DBS effects on cognition. Objectives: We aim to investigate whether STN-DBS influences risk-reward trade-off decisions and analyze its dependency on electrode placement. Methods: Seventeen PD patients ON and OFF STN-DBS and 17 age-matched healthy controls conducted a sequential decision-making task with escalating risk and reward. We computed the effect of STN-DBS on risk-reward trade-off decisions, localized patients' bilateral electrodes, and analyzed the predictive value of volume of tissue activated in STN motor and nonmotor territories on behavioral change. Results: We found that STN-DBS not only improves PD motor symptoms, but also normalizes overly risk-averse decision behavior in PD. Intersubject variance in electrode location could explain this behavioral change. Specifically, if STN-DBS activated preferentially STN motor territory, patients' risk-reward trade-off decisions more resembled those of healthy controls. Conclusions: Our findings support the notion of convergence of different functional circuits within the STN and imply a positive effect of well-placed STN-DBS on nonmotor cognitive functioning in PD.

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confidence: 99%

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

et al. 2018

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“…As previously said, the nonmotor symptoms in neurodegenerative diseases are only recently coming into focus, as is the effect of DBS on them. Most robust studies come from the research done in Parkinson's disease and from patients whose targets for neuromodulation are STN and GPi; however, research from other diseases and stimulation targets will also be assessed in the coming paragraphs [54].…”

Section: Effects Of Dbs On Nonmotor Symptomsmentioning

confidence: 99%

Deep Brain Stimulation in Non-motor Symptoms of Neurodegenerative Diseases

Vuletić¹,

Rački²,

Chudy³

et al. 2020

Neurostimulation and Neuromodulation in Contemporary Therapeutic Practice

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Deep brain stimulation (DBS) is a functional neuromodulatory technique that involves the use of a neurostimulator to deliver electrical impulses to the brain. It primarily alleviates the motor symptoms in neurodegenerative diseases; however, it has been found beneficial in a multitude of neurological and psychiatric diseases, such as dystonia, essential tremor, Tourette syndrome, intractable pain, epilepsy, treatmentresistant depression, and obsessive-compulsive disorder. Nonmotor symptoms, such as neurobehavioral disorders, autonomic dysfunction, sleep dysfunction, and somatosensory dysfunction, play an important role in neurodegenerative diseases and have a significant impact on the quality of life. The effects of deep brain stimulation on these symptoms are not yet apparent, although early results are promising and warrant future investigations. The main problem in interpretation is the lack of studies in this field, as most have methodological issues or small sample sizes, which limit the strength of the evidence. However, it is clear that DBS has a promising future in the treatment of neurodegenerative diseases in general and will have a vital role in personalized medicine as functional neuroimaging and our understanding of brain physiology improve.2 becoming more apparent that neurostimulations will have an even more critical role in the future as our understanding of brain physiology and pathways improves with novel imaging techniques. This chapter includes the basics of how deep brain stimulation works, what are the nonmotor symptoms in neurodegenerative diseases, and what is the current evidence on the effects of DBS on nonmotor symptoms. Deep brain stimulation 2.1 How does deep brain stimulation work?The system for DBS consists of three key components: an electrode that is placed in specific cerebral structures, an implantable pulse generator (IPG), and an extension that connects the two. Even though the exact mechanism is not yet known, the current hypothesis is that DBS works via excitation and inhibition of neurons and axons that are in proximity of the placed electrode [5]. The desired effect is achieved by changing the frequency of stimulations, as low-frequency stimulations most often excite nearby neurons [1], while high-frequency stimulations reduce local neuronal activity. Details of the implantation procedure are beyond the scope of this chapter, although it is useful to know that it is implanted stereotactically. In most cases, the stimulation is bilateral, although it is possible to stimulate unilaterally as well. The targets for stimulation are deep brain structures, as well as deep white matter tracts.A key benefit of DBS is the ability to adjust stimulations wirelessly via handheld devices to improve symptom relief and reduce possible side effects [5].Currently used method for DBS function is based on an open-loop system, which enables trained physicians to adjust various settings depending on the patient's condition [6]. This works adequately for most patients; however, changes in patien...

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“…Besides motor signs, several non-motor disturbances, e.g. depression, apathy, decline in cognitive functions, hyposmia, sleep disorders as well as autonomic dysfunctions, are commonly observed in PD patients [55]. The influence of DBS of different brain structures on these disorders has been examined less frequently than that on motor signs.…”

Section: Active Target For Dbs Outside the Stn: The Zimentioning

confidence: 99%

“…The influence of DBS of different brain structures on these disorders has been examined less frequently than that on motor signs. In general, DBS has been considered to have a positive impact on them either due to its direct action or because dopaminergic therapy could be reduced [55]. However, a number of non-motor adverse effects after DBS have also been reported [55].…”

Section: Active Target For Dbs Outside the Stn: The Zimentioning

confidence: 99%

Zona incerta as a therapeutic target in Parkinson’s disease

Ossowska

2019

J Neurol

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The zona incerta has recently become an important target for deep-brain stimulation (DBS) in Parkinson's disease (PD). The present review summarizes clinical, animal and anatomical data which have indicated an important role of this structure in PD, and discusses potential mechanisms involved in therapeutic effects of DBS. Animal studies have suggested initially some role of neurons as well as GABAergic and glutamatergic receptors of the zona incerta in locomotion and generation of PD signs. Anatomical data have indicated that thanks to its multiple interconnections with the basal ganglia, thalamus, cerebral cortex, brainstem, spinal cord and cerebellum, the zona incerta is an important link in a neuronal chain transmitting impulses involved in PD pathology. Finally, clinical studies have shown that DBS of this structure alleviates parkinsonian bradykinesia, muscle rigidity and tremor. DBS of caudal zona incerta seemed to be the most effective therapeutic intervention, especially with regard to reduction of PD tremor as well as other forms of tremor.

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Deep Brain Stimulation and Nonmotor Symptoms

Cited by 26 publications

References 217 publications

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

Sensorimotor subthalamic stimulation restores risk‐reward trade‐off in Parkinson's disease

Deep Brain Stimulation in Non-motor Symptoms of Neurodegenerative Diseases

Zona incerta as a therapeutic target in Parkinson’s disease

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