Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson's disease with severe motor fluctuations: a 2-year follow-up review

Ghika, Joseph; Villemure, Jean‐Guy; Fankhauser, Heinz; Favre, Jacques; Assal, G; Ghika-Schmid, Florence

doi:10.3171/jns.1998.89.5.0713

Cited by 233 publications

(175 citation statements)

References 43 publications

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“…Eleven of them 3,22,36,52,61,67,69,70,73,76,78 presented data in a non-comparable way, with a total of 52 references allowing quantitative analysis.…”

Section: Methodsmentioning

confidence: 99%

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

et al. 2014

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RESUMOIntrodução: A estimulação cerebral profunda (ECP) é eficaz na doença de Parkinson (DP) avançada, melhorando sintomas motores, flutuações e a qualidade de vida. No entanto, têm sido reportados efeitos adversos psiquiátricos, mas de uma forma variável e não padronizada. O objectivo deste artigo é analisar e sumarizar a evidência publicada sobre sintomas depressivos e ansiedade em doentes com DP após ECP, através de revisão sistemática e meta-análise. Material e Métodos: A PubMed foi pesquisada até Maio 2012 para identificar os estudos que avaliaram sintomas depressivos e ansiedade em doentes com doença de Parkinson submetidos a estimulação cerebral profunda bilateral do núcleo subtalâmico (NST) ou globo pálido interno (GPi). Foram feitas meta-análises com modelo de efeitos aleatórios para grupos de pelo menos três estudos homogéneos em relação ao desenho e instrumentos utilizados. Resultados: Foram selecionadas 63 referências; 98,4% continham dados relativos a escalas de avaliação de depressão e 38,1% relativos a ansiedade. Dois estudos não discriminavam o alvo usado; nos restantes 61 foi feita avaliação de curto prazo em 37 (60,7%), de médio prazo em 36 (59,0%) e de longo prazo em 5 (8,2%). Foram encontrados dados sobre variação pré/pós operatória em 57 (93,4%) estudos e 16 (26,2%) continham dados comparando ECP-NST versus outros grupos: ECP-GPi (n = 4 estudos, 25,0%), elegíveis para cirurgia (n = 6, 37,5%), e tratamento médico (n = 7, 43,8%). Discussão: É aparente a melhoria de depressão e ansiedade após ECP, sobretudo a curto prazo, efeito que tende a esbater-se em avaliações posteriores. Em relação à depressão a ECP-NST mostrou-se superior ao tratamento médico, mas não em comparação com o grupo de controlo elegível para cirurgia. Verificou-se o resultado oposto para a ansiedade, uma vez que os resultados favorecem o tratamento médico sobre a ECP-NST, e esta sobre o grupo de elegíveis para cirurgia. Não é evidente a superioridade de um alvo sobre o outro, mas os dados favorecem ligeiramente o GPi para ambos os tipos de sintomas. Conclusões:O padrão e curso dos sintomas depressivos e ansiedade após ECP na DP não são claros, mas ambos parecem melhorar no curto prazo, especialmente a depressão após a ECP-NST. Os resultados são bastante heterogéneos. Devem ser promovidos esforços no sentido de haver padronização de procedimentos de avaliação nos vários centros. Palavras-chave: Doença de Parkinson; Estimulação Cerebral Profunda; Ansiedade; Depressão; Meta-Análise. ABSTRACT Introduction: Deep brain stimulation (DBS) is effective in advancedParkinson's disease (PD), improving motor symptoms, fluctuations and quality of life. However, adverse psychiatric outcomes have been reported, albeit variably and in an unstandardized fashion. We aimed to summarize the published evidence on the outcomes of anxiety and depressive symptoms in Parkinson's disease patients following DBS, through systematic review and meta-analysis. Material and Methods: PubMed was searched until May 2012 to identify studies assessing anxiety and...

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“…Eleven of them 3,22,36,52,61,67,69,70,73,76,78 presented data in a non-comparable way, with a total of 52 references allowing quantitative analysis.…”

Section: Methodsmentioning

confidence: 99%

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

et al. 2014

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“…This technique is deep brain stimulation (DBS), and refers to the stereotaxic placement of unilateral or bilateral electrodes in target brain regions connected to a permanently implanted neurostimulator, which electrically stimulates that brain region (Schlaepfer and Lieb, 2005). Today, DBS is widely used as a treatment for symptoms of Parkinson's disease (Ghika et al, 1998;Greenberg and Rezai, 2003;McClelland et al, 2005). In these patients, electrodes are placed in the subthalamic nucleus or the globus pallidus internus, and provide immediate recovery to otherwise debilitating motor symptoms.…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression

Schläepfer

Cohen

Frick

et al. 2007

Neuropsychopharmacol

919

561

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Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression.Because a prominent clinical feature of depression is anhedoniaFthe inability to experience pleasure from previously pleasurable activitiesFand because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive symptomatology in otherwise treatment-resistant depression. Three patients suffering from extremely resistant forms of depression, who did not respond to pharmacotherapy, psychotherapy, and electroconvulsive therapy, were implanted with bilateral DBS electrodes in the nucleus accumbens. Stimulation parameters were modified in a double-blind manner, and clinical ratings were assessed at each modification. Additionally, brain metabolism was assessed 1 week before and 1 week after stimulation onset. Clinical ratings improved in all three patients when the stimulator was on, and worsened in all three patients when the stimulator was turned off. Effects were observable immediately, and no side effects occurred in any of the patients. Using FDG-PET, significant changes in brain metabolism as a function of the stimulation in fronto-striatal networks were observed. No unwanted effects of DBS other than those directly related to the surgical procedure (eg pain at sites of implantation) were observed. Dysfunctions of the reward systemFin which the nucleus accumbens is a key structureFare implicated in the neurobiology of major depression and might be responsible for impaired reward processing, as evidenced by the symptom of anhedonia. These preliminary findings suggest that DBS to the nucleus accumbens might be a hypothesis-guided approach for refractory major depression. Neuropsychopharmacology (2008) 33, 368-377; doi:10.1038/sj.npp.1301408; published online 11 April 2007 Keywords: deep brain stimulation; major depression; anhedonia; nucleus accumbens; brain stimulation; Cg25 INTRODUCTIONTraditional methods of alleviating depression largely stem from serendipitous observations of antidepressant effects of substances such as iproniazid (originally developed as a treatment for tuberculosis) or imipramine (originally developed as a treatment for schizophrenia). In particular, increasing levels of monoamine neurotransmitters in the synaptic cleft are associated with improvements of depressive symptoms. This insight led to a more targeted drug discovery process, resulting in drugs with fewer side effects, such as SSRIs. These medication treatments, in conjunction with certain methods of psychotherapy and electroconvulsive therapy, are effective at alleviating depressive symptomatology in most patients (Andrews and Nemeroff, 1994;Mann, 2005). However, these treatments do not work for all patients. A sizable minority of patients does not respond. Indeed, twelve percent of patients suffering from major depression have a poor outcome even after 5 years of treatment (Keller et al, 1992). Patien...

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“…Por tanto, no deberíamos de concluir que la estimulación del GPi pudiera ser superior clínicamente a largo plazo al ser comparada con la estimulación del NST hasta no obtener nuevos datos en este sentido 50 . Otros estudios, por el contrario, publicados en esta línea, han mostraron también una pérdida de eficacia de los pacientes intervenidos con GPi-DBS a largo plazo 21,29,62 . Así Volkmann y cols en 11 pacientes tratados con GPi-DBS bilateral a los 5 años describieron que el beneficio inicial obtenido, tanto motor como sobre las fluctuaciones motoras, disminuyó durante los años de seguimiento e incluso, cuatro pacientes del grupo fueron tratados con estimulación en el NST 62 .…”

Section: Efecto De La Cirugía En El "Off" Medicaciónunclassified

“…Así Volkmann y cols en 11 pacientes tratados con GPi-DBS bilateral a los 5 años describieron que el beneficio inicial obtenido, tanto motor como sobre las fluctuaciones motoras, disminuyó durante los años de seguimiento e incluso, cuatro pacientes del grupo fueron tratados con estimulación en el NST 62 . Otros autores también reportaron un grupo de pacientes con una mejoría motora inicial tras GPi-DBS que a los 2 años de la cirugía, redujo su eficacia en los diferentes parámetros de las escalas de evaluación y mejoraron tras una nueva cirugía con NST-DBS 21,29 .…”

Section: Efecto De La Cirugía En El "Off" Medicaciónunclassified

Revisión crítica de la estimulación subtalámica en la enfermedad de Parkinson

Guridi¹,

Rodríguez-Oroz²,

Clavero³

et al. 2009

Neurocirugía

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ResumenLos autores realizan una revisión crítica de la estimulación del núcleo subtalámico (NST) en la enfermedad de Parkinson (EP) a largo plazo (3-5 años). La estimulación del NST produce una mejoría significativa de la parte motora de la escala UPDRS (Unified Parkinson Disease Rating Scale) sin medicación a los 3-5 años de la cirugía. Los resultados muestran que los beneficios obtenidos tanto en el temblor, la rigidez, la bradicinesia y las disquinesias, así como la reducción de la medicación están mantenidos significativamente a largo plazo. Otros signos de la enfermedad como la marcha y la estabilidad postural no se mantienen al comparar los beneficios al año de la cirugía. Un porcentaje alto de pacientes intervenidos muestra un deterioro cognitivo durante el seguimiento que puede estar relacionado con la propia evolución de la enfermedad. La conclusión es que la estimulación bilateral del NST continúa siendo efectiva a largo plazo pero debería considerarse la cirugía en un momento más precoz de la evolución de la enfermedad.PALABRAS CLAVE: Núcleo subtalámico. Enfermedad de Parkinson. Estimulación cerebral profunda. Estimulación subtalámica. Critical review of the subthalamic stimulation in Parkinson´s disease SummaryThe authors critically review subthalamic nucleus (STN) stimulation for Parkinson´s disease (PD) at long follow-up (3-5 years). Subthalamic stimulation induce a significant improvement during the "off" medication in the assessment motor score UPDRS (Unified Parkinson Disease Rating Scale) 3-5 years after surgery. Results show that the benefits obtained in tremor, rigidity, bradykinesia, dyskinesias induced by medication and levodopa reduction are significantly maintained during long term. The improvement in other clinical signs as gait and postural stability at long follow-up are not maintained comparing with the benefits obtained one year after surgery. A high percentage of patients show a cognitive disturbance during the follow-up period that may be correlated with the disease progression. The conclusion is that bilateral STN stimulation is an effective treatment for PD patients at long term but it should be considered earlier in the course of PD.

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Efficiency and safety of bilateral contemporaneous pallidal stimulation (deep brain stimulation) in levodopa-responsive patients with Parkinson's disease with severe motor fluctuations: a 2-year follow-up review

Cited by 233 publications

References 43 publications

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

Depression and Anxiety Following Deep Brain Stimulation in Parkinson’s Disease: Systematic Review and Meta-Analysis

Deep Brain Stimulation to Reward Circuitry Alleviates Anhedonia in Refractory Major Depression

Revisión crítica de la estimulación subtalámica en la enfermedad de Parkinson

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