Globus Pallidus Interna or Subthalamic Nucleus Deep Brain Stimulation for Parkinson Disease

Ramirez‐Zamora, Adolfo; Ostrem, Jill L.

doi:10.1001/jamaneurol.2017.4321

Cited by 135 publications

(106 citation statements)

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“…Axial motor symptoms can be improved in some patients, remain unchanged in others, or even worsen in a subset of patients after DBS (Xie et al, 2012;Pötter-Nerger and Volkmann, 2013;Collomb-Clerc and Welter, 2015;Di Giulio et al, 2019). Several factors can affect axial symptoms, including patient characteristics, DBS target, the precise positioning of the electrode within the nucleus and also the stimulation parameters (Tisch et al, 2007;Fasano et al, 2015;Ramirez-Zamora and Ostrem, 2018). The subthalamic nucleus (STN) and globus pallidus internus (GPi) are two common DBS targets utilized for the management of motor fluctuations in PD patients (Ramirez-Zamora and Ostrem, 2018).…”

Section: Introductionmentioning

confidence: 99%

“…Several factors can affect axial symptoms, including patient characteristics, DBS target, the precise positioning of the electrode within the nucleus and also the stimulation parameters (Tisch et al, 2007;Fasano et al, 2015;Ramirez-Zamora and Ostrem, 2018). The subthalamic nucleus (STN) and globus pallidus internus (GPi) are two common DBS targets utilized for the management of motor fluctuations in PD patients (Ramirez-Zamora and Ostrem, 2018). Previous studies have suggested that GPi-DBS might be associated with a milder long-term (more than 2 years) decline of axial signs, such as balance, freezing of gait (Ferraye et al, 2008), and postural instability (St. George et al, 2010;Fasano et al, 2015), while STN-DBS might provide greater improvement of axial motor symptoms in the short term (∼1 year; St.…”

Section: Introductionmentioning

confidence: 99%

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Three-Year Gait and Axial Outcomes of Bilateral STN and GPi Parkinson’s Disease Deep Brain Stimulation

Mei

Eisinger

et al. 2020

Front. Hum. Neurosci.

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Objective: To examine the short-and long-term clinical outcomes of the bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) on gait and axial symptoms in Parkinson's disease (PD) patients. Available data have been inconsistent and mostly short-term regarding the effect of both brain targets on gait and axial symptoms. We aimed to identify potential target specific differences at 3-year follow-up from a large single-center experience. Methods:We retrospectively reviewed short-term (6-month follow-up) and long-term (36-month follow-up) changes in the Unified Parkinson's Disease Rating Scale (UPDRS) Part II and III total scores of 72 PD patients (53 with bilateral STN-DBS and 19 with bilateral GPi-DBS). An interdisciplinary team made target-specific decisions for each DBS patient. We analyzed changes in gait and axial subscores derived from UPDRS II and III.Results: In both the STN-and GPi-DBS cohorts, we observed no significant differences in gait and axial UPDRS derived subscores in the off-med/on stimulation state at long-term follow-up when compared to baseline. On-med axial scores remained similar in the short-term but worsened in both groups (STN, 2.23 ± 3.43, p < 0.001; GPi, 2.53 ± 2.37, p < 0.01) in the long-term possibly due to disease progression. At long-term follow-up, the UPDRS III off-med/on stimulation scores worsened but were persistently improved from baseline in both groups (−9.07 ± 13.9, p < 0.001). Conclusions:The study showed that long-term both STN-and GPi-DBS had a similar effect on gait and axial symptoms in UPDRS derived subscores at 36-month follow-up despite potential baseline differences in criteria for selection of each target. More sophisticated measures of gait and balance beyond the categorical UPDRS score will be needed for future studies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Three-Year Gait and Axial Outcomes of Bilateral STN and GPi Parkinson’s Disease Deep Brain Stimulation

Mei

Eisinger

et al. 2020

Front. Hum. Neurosci.

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“…We note that similar phenotypic differences are reported in PD patients undergoing DBS of the STN or GPi, and that such differences reflect predominant symptomatology guiding target selection 59 . It is often argued that the GPi may be a more appropriate target than the STN in patients with existing mild cognitive dysfunction or troublesome dyskinesias 60,61 .…”

Section: Study Limitationsmentioning

confidence: 99%

Neural signatures of pathological hyperdirect pathway activity in Parkinson’s disease

Oswal

Yeh

Neumann

et al. 2020

Preprint

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Parkinson’s disease (PD) is characterised by the emergence of pathological patterns of oscillatory synchronisation across the cortico-basal-ganglia circuit. The relationship between anatomical connectivity and oscillatory synchronisation within this system remains poorly understood. We address this by integrating evidence from invasive electrophysiology, magnetoencephalography, tractography and computational modelling in patients. Coupling between supplementary motor area (SMA) and subthalamic nucleus (STN) within the high beta frequency (21-30 Hz) range correlated with fibre tract densities between these two structures. Additionally within the STN, non-linear waveform features suggestive of cortical synchronisation correlated with cortico-STN fibre densities. Finally, computational modelling revealed that exaggerated hyperdirect cortical inputs to the STN in the upper beta frequency range can provoke the generation of widespread pathological synchrony at lower beta (13-20 Hz) frequencies. These observations reveal a spectral signature of the hyperdirect pathway at high beta frequencies and provide evidence for its pathophysiological role in oscillatory network dysfunction in PD.One sentence summarySignatures of the hyperdirect pathway and its likely role in pathological network disruption in Parkinson’s disease are identified.

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“…Despite increased understanding of the pathophysiology of LID, there remains a lack of effective therapies to treat disabling LID in the majority of PD patients. Deep brain stimulation of the subthalamic nucleus (STN) or internal globus pallidus (GPi) can significantly reduce or eliminate LID; however, such approaches are only viable in certain individuals (reviewed in Ramirez‐Zamora & Ostrem, ). The pathophysiology of LID and subsequent target identification is well defined using preclinical models, with reports of many strategies resulting in reduced LID.…”

Section: Introductionmentioning

confidence: 99%

Viewpoint: Developing drugs for levodopa‐induced dyskinesia in PD: Lessons learnt, what does the future hold?

Fox

Brotchie

2018

Eur J of Neuroscience

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The drive to develop drugs to treat PD starts and ends with the patient. Herein, we discuss how the experience with drug development for LID has led the field in translational studies in PD with advancing ground‐breaking science via rigorous clinical trial design, to deliver clinical proof‐of‐concepts across multiple therapeutic targets. However, issues remain in advancing drugs efficacious preclinically to the clinic, and future studies need to learn from past successes and failures. Such lessons include implementing better early indicators of tolerability, for instance evaluating non‐motor symptoms in preclinical models; improving patient‐related outcome measures in clinical trials, as well as considering the unique nature of dyskinesia in an individual patient. The field of translational studies needs to become more patient focused to improve successful outcomes.

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Globus Pallidus Interna or Subthalamic Nucleus Deep Brain Stimulation for Parkinson Disease

Cited by 135 publications

References 63 publications

Three-Year Gait and Axial Outcomes of Bilateral STN and GPi Parkinson’s Disease Deep Brain Stimulation

Three-Year Gait and Axial Outcomes of Bilateral STN and GPi Parkinson’s Disease Deep Brain Stimulation

Neural signatures of pathological hyperdirect pathway activity in Parkinson’s disease

Viewpoint: Developing drugs for levodopa‐induced dyskinesia in PD: Lessons learnt, what does the future hold?

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