Effects of subthalamic nucleus deep brain stimulation on sweating function in Parkinson's disease

Trachani, Eftichia; Constantoyannis, Constantine; Sirrou, Vassiliki; Kefalopoulou, Zinovia; Markaki, Elli; Chroni, Elisabeth

doi:10.1016/j.clineuro.2009.11.015

Cited by 38 publications

(35 citation statements)

References 31 publications

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“…Firstly, a direct modulation of basal ganglia-thalamo-cortical loops has been discussed by which, e.g., autonomic centers of the thalamus, lateral frontal, and anterior cingulate cortex could be modulated thus leading to improvements of symptoms like sweating and bladder control 36,39 .…”

Section: Resultsmentioning

confidence: 99%

Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease

et al. 2016

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BACKGROUND STN-DBS is well established to improve motor symptoms and quality of life in patients with PD. While non-motor symptoms are crucial for quality of life in these patients, only neuropsychiatric and neuropsychological symptoms have been systematically studied in a longitudinal design thus far. However, these are only a part of the spectrum of non-motor symptoms in PD. We hypothesized that STN-DBS is associated with a beneficial effect on a range of non-motor symptoms. METHODSIn this multicenter, open, prospective, international study we investigated non-motor effects of STN-DBS in "real-life" use. We evaluated Non-motor Symptom Scale, and Questionnaire, PD Questionnaire-8, Scales for Outcomes of PD motor examination and complications, and activities of daily living preoperatively and at 6 months follow-up in 60 consecutive patients (35 male, mean age: 61.64 ±7.84 years, mean disease duration: 10.45 ±4.22 years) undergoing STN-DBS. RESULTSAll outcomes improved significantly at 6 months follow-up (PD Questionaire-8, p=0.006; activities of daily living, p=0.012; all others, p<0.001; Wilcoxon signedrank, respectively paired t-test; Bonferroni-correction). Post-hoc analyses of Nonmotor Symptom Scale domains showed a significant reduction of sleep/fatigue and miscellaneous domains (p≤0.001), perceptual problems/hallucinations (p=0.036), and urinary (p=0.018) scores. Effect sizes were "moderate" effect for Non-motor Non-motor effects of subthalamic DBS -5 -Symptom Scale, and motor complications, "large" for motor examination, and "small" for other outcomes. CONCLUSIONSThis study provides first evidence that bilateral STN-DBS improves non-motor burden in patients with PD and opens the door to a more balanced evaluation of DBS outcomes. Further randomized studies are needed to confirm these findings and compare DBS non-motor effects to other therapies such as infusion based treatments of advanced PD.

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Section: Resultsmentioning

confidence: 99%

Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease

et al. 2016

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“…Wolz et al 24 found no change after immediate stimulation; 24 whereas Dafsari et al 23 found significant improvement in hyperhidrosis at 6-month follow-up. 23 In another 6-month study including 19 patients, Trachani et al 17 indicated that there was subjective improvement in sweating, however, no objective reduction in hyperhidrosis was demonstrated. 17 These studies were limited by the small number of included subjects, and offer class III evidence that DBS probably does not worsen sweating spells.…”

Section: Dbs Effect On the Autonomic Domainmentioning

confidence: 99%

“…First, adjacent regions near the STN, for example, the pedunculopontine nucleus, could be modulated by DBS, thus resulting in beneficial effects on sleep. 16 Second, a modulation of BG circuitry may result in effects on autonomic centers of the thalamus, projecting to the anterior cingulate and lateral frontal cortex with beneficial effects of symptoms like sweating 17 and bladder control. 18 …”

Section: The Pathopysiology Of Nms and Dbsmentioning

confidence: 99%

The effect of deep brain stimulation on the non-motor symptoms of Parkinson’s disease: a critical review of the current evidence

Kurtis

Rajah

Delgado

et al. 2017

npj Parkinson's Disease

120

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The benefit of deep brain stimulation (DBS) in controlling the motor symptoms of Parkinson’s disease is well established, however, the impact on the non-motor symptoms (NMS) remains to be elucidated, although the growing investigative efforts are promising. This article reviews the reported data and considers the level of evidence available with regard to the effect of DBS on NMS total burden and on the cognitive, neuropsychiatric, sleep, pain, dysautonomic, and weight domains. Multiple case series suggest that DBS improves the burden of NMS by reducing prevalence, intensity, and non-motor fluctuations. There is level I evidence on the effect of DBS on cognition and mood. Slight cognitive decline has been reported in most class I studies, although the functional effect is probably minimal. Two randomized prospective studies reported no change in depression while improvement of anxiety has been reported by a class I trial. Prospective cohort studies point to improvement of hyperdopaminergic behaviors, such as impulse control disorders, while others report that hypodopaminergic states, like apathy, can appear after DBS. There is only class III evidence supporting the benefit of DBS on other NMS such as nocturnal sleep, pain, dysautonomia (urinary, gastrointestinal, cardiovascular, and sweating), and weight loss. Although preliminary results are promising, randomized prospectively controlled trials with NMS as primary end points are necessary to further explore the effect of DBS on these often invalidating symptoms and offer conclusions about efficacy.

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“…Severe drenching sweats occur commonly as an end-of-dose 'off' phenomenon in patients with advanced disease and these may be satisfactorily controlled with adequate DRT [Pursiannen et al 2007]. STN-DBS has been reported to ameliorate sweating during 'off' periods in patients with by 66%, 6 months after surgery [Trachani et al 2010] and markedly reduce the fluctuations [Witjas et al 2007]. The effect of DBS on sweating abnormalities occurring during the dopaminergic drug 'on' state has not been studied as yet.…”

Section: Autonomic Dysfunctionmentioning

confidence: 99%

Nonmotor outcomes in Parkinson’s disease: is deep brain stimulation better than dopamine replacement therapy?

Borgohain¹,

Kandadai²,

Jabeen³

et al. 2011

Ther Adv Neurol Disord

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Nonmotor symptoms are an integral part of Parkinson's disease and cause significant morbidity. Pharmacological therapy helps alleviate the disease but produces nonmotor manifestations. While deep brain stimulation (DBS) has emerged as the treatment of choice for motor dysfunction, the effect on nonmotor symptoms is not well known. Compared with pharmacological therapy, bilateral subthalamic nucleus (STN)-DBS or globus pallidum interna (GPi)-DBS has significant beneficial effects on pain, sleep, gastrointestinal and urological symptoms. STN-DBS is associated with a mild worsening in verbal fluency while GPi-DBS has no effect on cognition. STN-DBS may improve cardiovascular autonomic disturbances by reducing the dose of dopaminergic drugs. Because the motor effects of STN-DBS and GPi-DBS appear to be similar, nonmotor symptoms may determine the target choice in surgery of future patients.Keywords: Parkinson's disease, deep brain stimulation, dopaminergic drugs, globus pallidum interna deep brain stimulation, nonmotor symptoms, pharmacological therapy, subthalamic nucleus deep brain stimulation IntroductionThe pathology of Parkinson's disease (PD) extends far beyond the nigrostriatal system and results in nonmotor symptoms coexisting with motor symptoms. Nonmotor symptoms can precede motor symptoms by years and are common in all stages of PD.They cause significant morbidity [Lim and Lang, 2010] and are often under recognized by health professionals [Parsons et al. 2006]. They can be divided into four domains: neuropsychiatric, autonomic, sleep and sensory dysfunction [Lim and Lang, 2010].

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Effects of subthalamic nucleus deep brain stimulation on sweating function in Parkinson's disease

Cited by 38 publications

References 31 publications

Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease

Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's Disease

The effect of deep brain stimulation on the non-motor symptoms of Parkinson’s disease: a critical review of the current evidence

Nonmotor outcomes in Parkinson’s disease: is deep brain stimulation better than dopamine replacement therapy?

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