Freezing and hypokinesia of gait induced by stimulation of the subthalamic region

Tommasi, Giorgio; Lopiano, Leonardo; Zibetti, Maurizio; Cinquepalmi, A.; Fronda, Chiara; Bergamasco, B.; Ducati, Alessandro; Lanotte, Michele

doi:10.1016/j.jns.2007.03.002

Cited by 52 publications

(34 citation statements)

References 30 publications

(52 reference statements)

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“…Moreover, disabling side effects may be associated with the stimulation of this area. Worsening bradykinesia and freezing have been reported and possibly correlate with the stimulation of the pallidothalamic fibers [31,32,33]. Similarly, dysarthria and postural instability have also been described and correlated to the possible diffusion of current to the cerebellothalamic tract and on the other hand by blocking levodopa effects [34].…”

Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Fiechter¹,

Nowacki²,

Oertel³

et al. 2017

Stereotact Funct Neurosurg

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Background: Subthalamic nucleus (STN) stimulation has been recognized to control resting tremor in Parkinson disease. Similarly, thalamic stimulation (ventral intermediate nucleus; VIM) has shown tremor control in Parkinson disease, essential, and intention tremors. Recently, stimulation of the posterior subthalamic area (PSA) has been associated with excellent tremor control. Thus, the optimal site of stimulation may be located in the surrounding white matter. Aims: The objective of this work was to investigate the area of stimulation by determining the contact location correlated with the best tremor control in STN/VIM patients. Methods: The mean stimulation site and related volume of tissue activated (VTA) of 25 tremor patients (STN or VIM) were projected on the Morel atlas and compared to stimulation sites from other tremor studies. Results: All patients showed a VTA that covered ≥50% of the area superior and medial to the STN or inferior to the VIM. Our stimulation areas suggest involvement of the more lateral and superior part of the dentato-rubro-thalamic tract (DRTT), whereas targets described in other studies seem to involve the DRTT in its more medial and inferior part when it crosses the PSA. Conclusions: According to anatomical and diffusion tensor imaging data, the DRTT might be the common structure stimulated at different portions within the PSA/caudal zona incerta.

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Section: Discussionmentioning

confidence: 99%

Deep Brain Stimulation for Tremor: Is There a Common Structure?

Fiechter¹,

Nowacki²,

Oertel³

et al. 2017

Stereotact Funct Neurosurg

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“…850 STN stimulation may improve off-period, but not on-period, freezing of gait, similar to levodopa. 852 Rare cases have also been described of freezing induced by DBS performed in the region of the STN, but improved by repositioning of the electrode, 853 suggesting that targets in the vicinity of the STN can modulate freezing. Caffeine has been reported to benefit some patients with the akinetic (as opposed to the trembling) type of freezing, presumably because of A2A antagonism, 854 but tolerance tends to develop and this is not a practical solution to the problem.…”

mentioning

confidence: 99%

The scientific and clinical basis for the treatment of Parkinson disease (2009)

Olanow¹,

Stern²,

Sethi³

2009

Neurology

773

658

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Parkinson disease (PD) is an age-related neurodegenerative disorder that affects as many as 1-2% of persons aged 60 years and older. With the aging of the population, the frequency of PD is expected to increase dramatically in the coming decades. Current therapy is largely based on a dopamine replacement strategy, primarily using the dopamine precursor levodopa. However, chronic treatment is associated with the development of motor complications, and the disease is inexorably progressive. Further, advancing disease is associated with the emergence of features such as freezing, falling, and dementia which are not adequately controlled with dopaminergic therapies. Indeed, it is now appreciated that these nondopaminergic features are common and the major source of disability for patients with advanced disease. Many different therapeutic agents and treatment strategies have been evaluated over the past several years to try and address these unmet medical needs, and many promising approaches are currently being tested in the laboratory and in the clinic. As a result, there are now many new therapies and strategic approaches available for the treatment of the different stages of PD, with which the treating physician must be familiar in order to provide patients with optimal care. This monograph provides an overview of the management of PD patients, with an emphasis on pathophysiology, and the results of recent clinical trials. It is intended to provide physicians with an understanding of the different treatment options that are available for managing the different stages of the disease and the scientific rationale of the different approaches. 1 PD is the second most common neurodegenerative disorder, with an average age at onset of about 60 years. An estimated 5 million people throughout the world have PD, with 1 million individuals each in the United States and in Europe with the disorder. PD affects approximately 0.3% of the population and 1% to 2% of those older than 60 years.2 With the aging of the population and the substantial increase in the number of at-risk individuals older than 60 years, it is anticipated that the prevalence of PD will increase dramatically in the coming decades.

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“…This could suggest current diffusion to the pallidothalamic tract located in the zona incerta region dorsally, and medially in relation to the STN (Obeso et al, 2000;Parent and Parent, 2004;Brodsky et al, 2006;Tommasi et al, 2007;Gallay et al, 2008). This effect is also found with pallidal stimulation when the electrode is located in the ansa lenticularis (Bejjani et al, 1997;Krack et al, 1998b).…”

mentioning

confidence: 79%

“…However, after surgery an increase in freezing of gait can be observed. This can be the result either of an overly drastic reduction of dopaminergic treatment, or of current diffusion to efferent fibers of the internal pallidum (Tommasi et al, 2007). Lowering the frequency of stimulation to 60 or 80 Hz has been proposed as a strategy for the improvement of postoperative freezing of gait (Moreau et al, 2008;Tagliati, 2008;Ricchi et al, 2012).…”

Section: Chronic Issuesmentioning

confidence: 99%