Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease

Bove, Francesco; Mulas, Delia; Cavallieri, Francesco; Castrioto, Anna; Chabardès, Stéphan; Meoni, Sara; Schmitt, Emmanuelle; Bichon, Amélie; Stasio, Enrico Di; Kistner, Andrea; Pélissier, Pierre; Chevrier, Eric; Seigneuret, Éric; Krack, Paul; Fraix, Valérie; Moro, Elena

doi:10.1212/wnl.0000000000012246

Cited by 90 publications

(83 citation statements)

References 40 publications

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“…One might argue that optimization of DBS parameters should have yielded better results than in our cohort but, over the 12-year period, attempts of adjustments did not provide significant improvement in the remaining patients. This was also reported by others [ 9 ].…”

Section: Discussionsupporting

confidence: 90%

“…In a new retrospective analysis of the Grenoble cohort [ 9 ], Bove and colleagues reported a sustained benefit of STN-DBS beyond 15 years in 51 patients, not only on motor function but also on global quality of life (QoL). One explanation for this discrepancy was the much younger age of their patients at the time of surgery (51 ± 8.5 years old), even if the disease duration was similar (11.3 ± 3.8 years) to ours.…”

Section: Discussionmentioning

confidence: 99%

“…Another study [ 8 ] compared evolution of a group of patients treated with STN-DBS versus best medical treatment over a relatively long period but range of follow-up was variable (4–11 years). A very recent monocentric retrospective analysis [ 9 ] of 51 STN-DBS patients followed up to 15 years after surgery indicates that time spent with dyskinesia and “off” condition remained significantly shorter than before surgery. However, there was no control group.…”

Section: Introductionmentioning

confidence: 99%

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Subthalamic deep brain stimulation versus best medical treatment: a 12-year follow-up

et al. 2022

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Purpose Electrical stimulation of the sub-thalamic nucleus (STN-DBS) is well established to alleviate motor fluctuations in advanced Parkinson’s disease but little is known about its very long-term efficacy. Methods We followed over 12 years 15 parkinsonian patients having undergone STN-DBS and compared them to a matched group of 14 patients with best medical drug therapy. All had been considered as good candidates for surgery. They were allocated to each group depending on their own decision. Results After 12 years, mortality rates were similar in both groups. In the DBS group, best “on” UPDRS III scores (on medications, on stimulation) remained significantly better and dyskinesia shorter and weaker than in the drug-treated group (on medication only). Yet, looking at independent life and quality of life (QoL) evaluated with PDQ39, no significant difference could be observed between groups at the end of follow-up, probably due to development of dopa- and stimulation-resistant motor and non-motor symptoms like falls, freezing, dementia, apathy and depression, the latter two more frequent in the DBS group. Conclusion Drug- and DBS-resistant symptoms and signs occur more often after long disease evolution and in elder patients. It might be why differences in QoL between both groups no longer existed after twelve years as, compared to other studies, our patients were older at inclusion.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Subthalamic deep brain stimulation versus best medical treatment: a 12-year follow-up

et al. 2022

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“…It is noteworthy that hypomania was elicited in ∼30% of patients with PD during the acute stimulation in our study. The prevalence was similar to a recent report that demonstrated the occurrence of impulsive control disorders and psychosis was 47 and 25%, respectively (Bove et al, 2021).…”

Section: Limitations and Further Clinical Applicationssupporting

confidence: 90%

Theta Oscillations at Subthalamic Region Predicts Hypomania State After Deep Brain Stimulation in Parkinson's Disease

Chen

et al. 2021

Front. Hum. Neurosci.

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Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment for the motor impairments of patients with advanced Parkinson's disease. However, mood or behavioral changes, such as mania, hypomania, and impulsive disorders, can occur postoperatively. It has been suggested that these symptoms are associated with the stimulation of the limbic subregion of the STN. Electrophysiological studies demonstrate that the low-frequency activities in ventral STN are modulated during emotional processing. In this study, we report 22 patients with Parkinson's disease who underwent STN DBS for treatment of motor impairment and presented stimulation-induced mood elevation during initial postoperative programming. The contact at which a euphoric state was elicited by stimulation was termed as the hypomania-inducing contact (HIC) and was further correlated with intraoperative local field potential recorded during the descending of DBS electrodes. The power of four frequency bands, namely, θ (4–7 Hz), α (7–10 Hz), β (13–35 Hz), and γ (40–60 Hz), were determined by a non-linear variation of the spectrogram using the concentration of frequency of time (conceFT). The depth of maximum θ power is located approximately 2 mm below HIC on average and has significant correlation with the location of contacts (r = 0.676, p < 0.001), even after partializing the effect of α and β, respectively (r = 0.474, p = 0.022; r = 0.461, p = 0.027). The occurrence of HIC was not associated with patient-specific characteristics such as age, gender, disease duration, motor or non-motor symptoms before the operation, or improvement after stimulation. Taken together, these data suggest that the location of maximum θ power is associated with the stimulation-induced hypomania and the prediction of θ power is frequency specific. Our results provide further information to refine targeting intraoperatively and select stimulation contacts in programming.

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“…Previous studies have suggested that the effects of CSAI on dyskinesia are transient [29,30]. The effects of STN DBS on dyskinesia seem to be significant and last longer [19,31]. AIMS score also evaluates the dyskinesia in Parkinson's disease.…”

Section: Discussionmentioning

confidence: 99%

Continuous Subcutaneous Apomorphine Infusion in Advanced Parkinson’s Disease: A Systematic Review

Gaire¹,

Kafle

Bastakoti³

et al. 2021

Cureus

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Parkinson's disease (PD), a neurodegenerative disorder, is caused due to the loss of dopaminergic neurons in substantia nigra pars compacta, and it mainly affects the motor function of the diseased individual. The most effective treatment for PD to date is levodopa, the precursor molecule for dopamine which ultimately helps overcome the loss of dopamine in the brain. However, long-term levodopa therapy significantly impairs patients' quality of life by causing various disabling motor and non-motor complications. We conducted this study intending to review the available literature that has compared the efficacy and safety of continuous subcutaneous apomorphine infusion (CSAI) with other available treatment options like deep brain stimulation, intestinal levodopa gel, and oral dopaminergic agents. We searched PubMed, Embase, and Scopus databases using the appropriate search strategy. The studies which compared the safety and efficacy of continuous subcutaneous apomorphine infusion to other available treatment options in advanced Parkinson's disease were included in our study. The bias assessment of the studies was done using Cochrane Risk of Bias 2.0 tool for randomized controlled trials, Risk of Bias In Non-Randomized Studies -of Interventions (ROBINS-I) tool for non-randomized interventional studies, and Joanna Briggs Institute Critical Appraisal tools (JBI) for cohort studies. We included eight articles in our systematic review including a randomized controlled trial. None of the included studies had a high risk of bias. We found that in patients with advanced Parkinson's, CSAI demonstrated definite improvement in off-time duration. CSAI has also been shown to improve various non-motor functions, including neuropsychiatric problems in these patients. CSAI has demonstrated safety and efficacy in patients with advanced Parkinson's disease. However, the decision-making is multifactorial. Hence, further studies are required that directly compare the available treatment options with one another and study their overall effects on patients' quality of life.

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Long-term Outcomes (15 Years) After Subthalamic Nucleus Deep Brain Stimulation in Patients With Parkinson Disease

Cited by 90 publications

References 40 publications

Subthalamic deep brain stimulation versus best medical treatment: a 12-year follow-up

Subthalamic deep brain stimulation versus best medical treatment: a 12-year follow-up

Theta Oscillations at Subthalamic Region Predicts Hypomania State After Deep Brain Stimulation in Parkinson's Disease

Continuous Subcutaneous Apomorphine Infusion in Advanced Parkinson’s Disease: A Systematic Review

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