Neurosurgery in Parkinson’s disease: the doctor is happy, the patient less so?

Agid, Yves; Schüpbach, Michaël; Gargiulo, Marcela; Mallet, Luc; Houeto, J. L.; Béhar, C.; Maltête, David; Mesnage, Valérie; Welter, Michael

doi:10.1007/978-3-211-45295-0_61

Cited by 153 publications

(194 citation statements)

References 10 publications

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“…Evaluation of motivated behaviours in Parkinson's disease along the lines of functioning in apathetic versus appetitive behavioural modes appears to be meaningful both on clinical and neurobiological grounds. The change from preoperative overall functioning in appetitive mode, to postoperative overall functioning in an apathetic one after STN DBS in patients with Parkinson's disease may largely explain the reported situation of a discrepancy between the opinion of the neurologist who is happy with objective motor improvement of his patient and the patient himself who may be less happy and regret his preoperative hyperdopaminergic state (Agid et al, 2006). Postoperative hypodopaminergia is not an inevitable fate (see Case 1, Supplementary material).…”

Section: Decrease In Non-motor Fluctuations and Underlying Mechanismsmentioning

confidence: 94%

Subthalamic stimulation in Parkinson’s disease: restoring the balance of motivated behaviours

Lhommée

Klinger

Thobois

et al. 2012

Brain

252

287

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Addictions to dopaminergic drugs or to pleasant behaviours are frequent and potentially devastating neuropsychiatric disorders observed in Parkinson's disease. They encompass impulse control disorders, punding and dopamine dysregulation syndrome. A relationship with dopaminergic treatment is strongly suggested. Subthalamic stimulation improves motor complications and allows for drastic reductions in medication. This treatment might, therefore, be considered for patients with behavioural addictions, when attempts to reduce dopaminergic medication have failed. However, conflicting data have reported suppression, alleviation, worsening or new onset of behavioural addictions after subthalamic stimulation. Non-motor fluctuations are also a disabling feature of the disease. We prospectively investigated behaviour in a cohort of 63 patients with Parkinson's disease, before and 1 year after subthalamic stimulation using the Ardouin scale, with systematic evaluation of functioning in overall appetitive or apathetic modes, non-motor fluctuations, dopaminergic dysregulation syndrome, as well as behavioural addictions (including impulse control disorders and punding) and compulsive use of dopaminergic medication. Defined drug management included immediate postoperative discontinuation of dopamine agonists and reduction in levodopa. Motor and cognitive statuses were controlled (Unified Parkinson's Disease Rating Scale, Mattis Dementia Rating Scale, frontal score). After surgery, the OFF medication motor score improved ( À 45.2%), allowing for a 73% reduction in dopaminergic treatment, while overall cognitive evaluation was unchanged. Preoperative dopamine dysregulation syndrome had disappeared in 4/4, behavioural addictions in 17/17 and compulsive dopaminergic medication use in 9/9 patients. New onset of levodopa abuse occurred in one patient with surgical failure. Non-motor fluctuations were significantly reduced with improvements in off-dysphoria (P 4 0.001) and reduction in on-euphoria (P 4 0.001). There was an inversion in the number of patients functioning in an overall appetitive mode (29 before versus 2 after surgery, P 4 0.0001) to an overall apathetic mode (3 before versus 13 after surgery, P 5 0.05). Two patients attempted suicide. Improvement in motor fluctuations is linked to the direct effect of stimulation on the sensory-motor subthalamic territory, while improvement in dyskinesias is mainly explained by an indirect effect related to the decrease in dopaminergic drugs. Our data suggest that non-motor fluctuations could similarly be directly alleviated through stimulation of the non-motor subthalamic territories, and hyperdopaminergic side effects might improve mainly due to the decrease in dopaminergic medication. We show an overall improvement in neuropsychiatric symptomatology and propose that disabling non-motor fluctuations, dopaminergic treatment abuse and drug-induced behavioural addictions in Parkinson's disease may be considered as new indications for subthalamic stimulation.

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Section: Decrease In Non-motor Fluctuations and Underlying Mechanismsmentioning

confidence: 94%

Subthalamic stimulation in Parkinson’s disease: restoring the balance of motivated behaviours

Lhommée

Klinger

Thobois

et al. 2012

Brain

252

287

View full text Add to dashboard Cite

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“…7,8 Despite studies demonstrating the positive benefits of DBS on motor symptoms and quality of life, [9][10][11] some have provocatively argued that patients may not be as pleased with the outcomes of DBS as the treating physicians. 12,13 This satisfaction gap suggests that SCR measures may not fully capture patients' goals with respect to outcome and argues for the need for a more systematic assessment of patients' individually defined goals for DBS and patients' perceived satisfaction with DBS in addressing those goals.…”

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confidence: 99%

Insights gleaned by measuring patients' stated goals for DBS

et al. 2017

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Objective: To report prospective repeated measures data detailing the perceived benefit of deep brain stimulation (DBS) on the most commonly cited symptom and activity goals identified by patients with Parkinson disease.Methods: Fifty-two participants were recruited from a consecutive series. Participants completed a semi-structured interview soliciting their symptom and behavioral goals and corresponding visual analog scales measuring perceived symptom severity and limits to goal attainment. Severity ratings were completed prior to and at 2 times following DBS. Changes in severity over time were assessed using a mixed effects linear model. The pattern of relationships between the severity ratings and standard clinical research (SCR) measures routinely administered were examined using Pearson correlations. Results:The most common symptom goals were improvements in tremor, gait, and nonmotor symptoms, whereas the most frequent behavioral goals related to interpersonal relationships, work, and avocational pursuits. Most severity ratings were significantly correlated with each other but not with the SCR measures. Significant improvements were evident on all SCR measures after DBS. Participants' severity ratings for their symptom and behavioral goals improved significantly over time although not all severity ratings changed in the same manner.Conclusions: These data illustrate that improvements in participants' individually defined goals were evident over time and that some of these improvements occurred in areas in which the benefits associated with DBS are not as well-documented. The participants' severity ratings were not redundant with SCR measures, suggesting that novel and potentially important information can be gleaned by systematically assessing patients' goals.

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“…The surveys addressed the decision-making process of patients, disciplines involved in the DBS procedure, target 4 preferences of centers, exclusion criteria, risk-evaluation, outcome-analysis, expert-opinions about characterization, incidence and causes of "personality changes" following DBS, and a possible "satisfaction gap" (Agid et al 2006;Kluger et al 2011). Furthermore, the surveys collected data that allows for assessing the referral practice, trends for novel indications, and the experts' opinions with respect to controversial DBS issues.…”

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confidence: 99%

Ethical Focal Points in the International Practice of Deep Brain Stimulation

et al. 2014

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Deep brain stimulation (DBS) is a standard therapy for several movement disorders, and the list of further indications that are investigated is growing rapidly. We performed two surveys among DBS experts (n1D 113) and centers (n2D 135) to identify ethical focal points in the current global practice of DBS. The data indicate a mismatch between the patients' fears and the frequencies of the suspected side effects, a significant "satisfaction gap," signs of improvements of outcome, habituation effects in terms of involved disciplines, a growing spectrum of novel indications that partly conflicts with the experts' success probability ratings, and differences in the density of supply between countries that might affect the future development of DBS. We formulate ethical recommendations with regard both to patient-related practices (e.g., recruitment, assurance of alternatives) and to institutional development (e.g., measures for quality assurance and for the development of novel DBS indications).

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Neurosurgery in Parkinson’s disease: the doctor is happy, the patient less so?

Cited by 153 publications

References 10 publications

Subthalamic stimulation in Parkinson’s disease: restoring the balance of motivated behaviours

Subthalamic stimulation in Parkinson’s disease: restoring the balance of motivated behaviours

Insights gleaned by measuring patients' stated goals for DBS

Ethical Focal Points in the International Practice of Deep Brain Stimulation

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