Impact of deep brain stimulation on upper limb akinesia in Parkinson's disease

Abstract

Recent pathophysiological models of Parkinson's disease have led to new surgical approaches to treatment including deep brain stimulation (DBS) and lesioning of basal ganglia structures. Various measures of upper limb akinesia were assessed in 6 patients with bilateral DBS of the internal pallidum and 6 with DBS of the subthalamic nucleus. Stimulation improved a number of aspects of motor function, and particularly movement time, and force production. Time to initiate movements, and to perform repetitive movements also improved but less dramatically. Processes indicating preparatory motor processes showed no significant change. Few significant differences were found between the internal pallidum and subthalamic nucleus groups. In general, the effects of DBS closely parallel previous reports of the effects of dopaminergic medication. It is suggested that disrupted pallidal output in Parkinson's disease interferes with the rate, level, and coordination of force production but has little effect on preparatory processes. The similarity of the effects of subthalamic nucleus and internal pallidum stimulation suggests this disrupted outflow is the most important determinant of upper limb akinesia in Parkinson's disease. The effects of DBS were similar to the effects of unilateral pallidal lesions reported elsewhere. Ann Neurol 1999;45:473–488

Evaluation of healthcare utilization and health status of patients with Parkinson's disease treated with deep brain stimulation of the subthalamic nucleus

“…The improvement of both the motor score (UPDRS III) and the activities of daily living score (UPDRS II), was paralleled by an increase of the Schwab and England score up to 50 % six months after the surgical procedure which reflected the higher level of independence. These data are in accordance with recently published results from clinical studies [7,22,24,27].…”

Involvement of the Basal Ganglia and Cerebellar Motor Pathways in the Preparation of Self-Initiated and Externally Triggered Movements in Humans

“…A greater role of the BG in generating the CNV over the BP is consistent with the increase in CNV (Gerschlager et al, 1999) but not BP (Brown et al, 1999) amplitude with STN DBS. In the CNV paradigm, the warning signal provides a predictable timing cue for the imperative signal.…”

Neuroimaging and therapeutics in movement disorders

“…This observation is consistent with human and animal studies suggesting mechanistic similarities between the two forms of treatment. 55 In aggregate, these results indicate that the expression of disease-related brain networks may constitute a useful biomarker for objectively assessing outcomes in trials of new treatment approaches for PD and other movement disorders.…”