Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson's disease

Goodman, Robert; Kim, Brian; McClelland, Shearwood; Senatus, Patrick B.; Winfield, Linda M.; Pullman, Seth L.; Yu, Qiping; Ford, Blair; McKhann, Guy M.

doi:10.1136/jnnp.2005.069161

Cited by 114 publications

(86 citation statements)

References 32 publications

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“…2,3 Empirically, however, STN-DBS is suitable to PD patients who have motor impairments that are characterized by fluctuating periods of immobility (off) and good motor function (on) and that are responsive to dopaminergic agents. 4 In addition, it can reduce the required dosages of dopaminergic medication. While a major role of STN-DBS is thought to be a suppression of the overactivation of STN neurons and a facilitation of excitatory signals to the cerebral cortex, 5 findings in dopaminergic studies have suggested that STN-DBS exerts a facilitatory effect on the dopamine system by boosting motor recovery after treatment.…”

Section: Deep Brain Stimulation (Dbs) Of the Subthalamic Nucleus (Stnmentioning

confidence: 99%

Effect of Subthalamic Nucleus Stimulation during Exercise on the Mesolimbocortical Dopaminergic Region in Parkinson'S Disease: A Positron Emission Tomography Study

Nozaki

Sugiyama

Yagi

et al. 2012

J Cereb Blood Flow Metab

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To elucidate the dynamic effects of deep brain stimulation (DBS) in the subthalamic nucleus (STN) during activity on the dopaminergic system, 12 PD patients who had STN-DBS operations at least 1 month prior, underwent two positron emission tomography scans during right-foot movement in DBS-off and DBS-on conditions. To quantify motor performance changes, the motion speed and mobility angle of the foot at the ankle were measured twice. Estimations of the binding potential of [ 11 C]raclopride (BP ND ) were based on the Logan plot method. Significant motor recovery was found in the DBS-on condition. The STN-DBS during exercise significantly reduced the [ 11 C]raclopride BP ND in the caudate and the nucleus accumbens (NA), but not in the dorsal or ventral putamen. The magnitude of dopamine release in the NA correlated negatively with the magnitude of motor load, indicating that STN-DBS facilitated motor behavior more smoothly and at less expense to dopamine neurons in the region. The lack of dopamine release in the putamen and the significant dopamine release in the ventromedial striatum by STN-DBS during exercise indicated dopaminergic activation occurring in the motivational circuit during action, suggesting a compensatory functional activation of the motor loop from the nonmotor to the motor loop system.

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Section: Deep Brain Stimulation (Dbs) Of the Subthalamic Nucleus (Stnmentioning

confidence: 99%

Effect of Subthalamic Nucleus Stimulation during Exercise on the Mesolimbocortical Dopaminergic Region in Parkinson'S Disease: A Positron Emission Tomography Study

Nozaki

Sugiyama

Yagi

et al. 2012

J Cereb Blood Flow Metab

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“…The calculated incidence of complications associated with laparoscopic bariatric surgery, obtained from the case series, 4,8,10,17,28,38,44,45,52,74,77,82,83,91,120 is summarized in Table 1; complications associated with DBS studies are shown in Table 2. 6,7,9,12,16,20,26,27,31,37,39,47,[55][56][57][58][59][60][61]64,[67][68][69]71,78,80,81,84,[86][87][88][89][96][97]…”

Section: Resultsmentioning

confidence: 99%

Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

Pisapia

Halpern²,

Williams³

et al. 2010

FOC

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Object Roux-en-Y gastric bypass is the gold standard treatment for morbid obesity, although failure rates may be high, particularly in patients with a BMI > 50 kg/m2. With improved understanding of the neuropsychiatric basis of obesity, deep brain stimulation (DBS) offers a less invasive and reversible alternative to available surgical treatments. In this decision analysis, the authors determined the success rate at which DBS would be equivalent to the two most common bariatric surgeries. Methods Medline searches were performed for studies of laparoscopic adjustable gastric banding (LAGB), laparoscopic Roux-en-Y gastric bypass (LRYGB), and DBS for movement disorders. Bariatric surgery was considered successful if postoperative excess weight loss exceeded 45% at 1-year follow-up. Using complication and success rates from the literature, the authors constructed a decision analysis model for treatment by LAGB, LRYGB, DBS, or no surgical treatment. A sensitivity analysis in which major parameters were systematically varied within their 95% CIs was used. Results Fifteen studies involving 3489 and 3306 cases of LAGB and LRYGB, respectively, and 45 studies involving 2937 cases treated with DBS were included. The operative successes were 0.30 (95% CI 0.247–0.358) for LAGB and 0.968 (95% CI 0.967–0.969) for LRYGB. Sensitivity analysis revealed utility of surgical complications in LRYGB, probability of surgical complications in DBS, and success rate of DBS as having the greatest influence on outcomes. At no values did LAGB result in superior outcomes compared with other treatments. Conclusions Deep brain stimulation must achieve a success rate of 83% to be equivalent to bariatric surgery. This high-threshold success rate is probably due to the reported success rate of LRYGB, despite its higher complication rate (33.4%) compared with DBS (19.4%). The results support further research into the role of DBS for the treatment of obesity.

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“…6 According to Binder and colleagues 7 and to other reports, 6,[8][9][10] its incidence is believed to be up to 3.3%, with a 0.6% risk of developing new neurological defi cits. There is a lack of data in the literature concerning electrode displacement as a consequence of such an adverse event.…”

Section: Discussionmentioning

confidence: 97%

Electrode displacement after intracerebral hematoma as a complication of a deep brain stimulation procedure

Servello

Sassi

Bastianello

et al. 2009

NDT

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Objectives: Deep brain stimulation (DBS) is nowadays considered a safe and effective procedure for various movement disorders in which conservative treatments have failed to show signifi cant therapeutic results. One of the most common complications of defi nitive electrode positioning is intraparenchymal hemorrhage. Materials and methods: Authors report the case of a 55-year-old female patient treated for Parkinson's disease in which intraparenchymal hemorrhage developed after DBS procedure, leading to signifi cant (about 8 mm at the neuroradiological controls) displacement of an otherwise correctly positioned DBS electrode. Results: After conservative management, the hematoma spontaneously resolved. Late neuroradiological controls documented correct, symmetrically positioned electrodes, comparable to the immediate postoperative controls. Conclusions: Six months follow-up endpoint results of the DBS treatment were considered satisfying by an independent neurologist, with modest residual neurological defi cits, demonstrating that re-positioning of the electrode was unnecessary in this rare complication.

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Operative techniques and morbidity with subthalamic nucleus deep brain stimulation in 100 consecutive patients with advanced Parkinson's disease

Cited by 114 publications

References 32 publications

Effect of Subthalamic Nucleus Stimulation during Exercise on the Mesolimbocortical Dopaminergic Region in Parkinson'S Disease: A Positron Emission Tomography Study

Effect of Subthalamic Nucleus Stimulation during Exercise on the Mesolimbocortical Dopaminergic Region in Parkinson'S Disease: A Positron Emission Tomography Study

Deep brain stimulation compared with bariatric surgery for the treatment of morbid obesity: a decision analysis study

Electrode displacement after intracerebral hematoma as a complication of a deep brain stimulation procedure

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