Deep brain stimulation in early stage Parkinson's disease: operative experience from a prospective randomised clinical trial

Abstract

Background Recent evidence suggests that STN-DBS may have a disease-modifying effect in early PD. A randomized, prospective study is underway to determine whether STN-DBS in early PD is safe and tolerable. Objectives / Methods Fifteen of thirty early PD patients were randomized to receive STN-DBS implants in an IRB-approved protocol. Operative technique, location of DBS leads, and perioperative adverse events are reported. Active contact used for stimulation in these patients were compared with 47 advanced PD patients undergoing an identical procedure by the same surgeon. Results Fourteen of the 15 patients did not sustain any long-term (> 3 months) complications from the surgery. One subject suffered a stroke resulting in mild cognitive changes and slight right arm and face weakness. The average optimal contact used in symptomatic treatment of early PD patients was: anterior −1.1±1.7mm, lateral 10.7±1.7mm, superior −3.3±2.5mm (AC-PC coordinates). This location is statistically no different (0.77mm, p> 0.05) than the optimal contact used in treatment of 47 advanced PD patients. Conclusions The perioperative adverse events in this trial of subjects with early stage PD are comparable to that reported for STN-DBS in advanced PD. The active contact position used in early PD is not significantly different from that used in late stage disease. This is the first report of the operative experience from a randomized, surgical-versus-best-medical-therapy trial for the early treatment of Parkinson’s disease.

Subthalamic nucleus deep brain stimulation in early stage Parkinson's disease

“…The infection resolved, but the subject did not receive stimulation on the right side for the remainder of the study. Kahn et al 2011 provides a complete list of the perioperative adverse events for this trial [11]. …”

“…All subjects randomized to DBS+ODT were implanted in three stages using the same methodology used as standard of care at Vanderbilt University Medical Center [11]. Four weeks after lead implantation, subjects presented off medication for at least 36 hours for evaluation of the clinical response to stimulation.…”

Calcium imaging of infrared-stimulated activity in rodent brain

“…Future studies that employ two-photon imaging in brain slice and in vivo preparations will be used to address this hypothesis and identify new applications for INS in the brain. This study highlights the utility of INS as a minimally invasive tool that can be used to further our understanding of interactions between neurons and astrocytes in disease processes associated with epilepsy [36], Alzheimer’s disease [37], Parkinson’s disease [38], and other movement disorders [39], and the potential of INS to effectively treat these neurological diseases, such as INS based deep brain stimulation.…”

Neuropsychological Effects of Deep Brain Stimulation in Subjects with Early Stage Parkinson's Disease in a Randomized Clinical Trial

“…The study design ( Fig. 1), inclusion 117 and exclusion criteria (Table 1), and methods related 118 to the recruitment of subjects, informed consent pro-119 cess, surgical and targeting procedures, and follow-up 120 visits have been previously reported [11][12][13][14]. Subjects Charles et al, 2012 [11] and reprinted from Charles et al, 2014 [10] Active participation in another clinical trial for the treatment of PD.…”