Postoperative management of subthalamic nucleus stimulation for Parkinson's disease

Abstract

Abstract:The postoperative neurologic management of patients with deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson' s disease is a complex dynamic process that involves a progressive increase in stimulation intensity and a parallel decrease in antiparkinsonian medication while assessing the interactions of both treatments. Neurologists responsible for postoperative management of patients receiving STN DBS must have expert knowledge of the electroanatomy of the subthalamic area and be familiar with the medical treatment of motor and nonmotor symptoms, including the management of long-term complications of levodopa treatment. Neurosurgeons who perform DBS need to understand the principles that guide the postoperative adaptation of treatment. This article defines guidelines for setting stimulation parameters, adapting drugs and managing adverse effects.

Changes induced by levodopa and subthalamic nucleus stimulation on parkinsonian speech

“…These exacerbations were interpreted to represent the effects of possible current diffusion outside the target, to neighboring structures such as the corticobulbar fibers. 42 It is noteworthy that frequent discrepancies occurred between clinical ratings and acoustic data, underlying the inconsistent conclusions that assessment of intelligibility and speech subsystems may lead to. 11 Dopaminergic deprivation induced by the nigrostriatal denervation leads to development of parkinsonian signs, 43 including speech impairment.…”

“…52,53 With DBS, current diffusion to the corticobulbar and corticospinal fibers can lead to contractions of facial, tongue, pharyngeal, laryngeal, or respiratory muscles, also resulting in dysarthria. 42 For that reason, as opposed to DBS-induced improvement of limb akinesia, improvement of speech is still debated. 17,37,38,54 -56 STN is generally considered the most efficient target for PD treatment, and beneficial effects on speech components have been observed following STN stimulation.…”

Deep Brain Stimulation for Obsessive-Compulsive Disorder: Subthalamic Nucleus Target

“…To avoid such behavioral side effects, the increase in stimulation parameters is performed in an inpatient setting in our institution in the immediate postsurgical period. Side effects related to current diffusion to surrounding structures in the subthalamic area are the same than those described in PD (17). The final contact for chronic stimulation is chosen based on beneficial effects when present and on the threshold for side effects.…”

Combining functional imaging with brain stimulation in Parkinson's disease

“…This kind of stimulation has also been shown to alter the levels of the neurotransmitters involved in such neuronal defi cits (Strafella et al, 2001(Strafella et al, , 2004. To reach and stimulate subcortical areas that show an abnormal fi ring activity in PD, a surgical approach uses deep brain stimulation (DBS) to continuously apply electrical pulses that relieve PD motor symptoms (Krack et al, 2002;Moro et al, 2010), with variable effects on cognitive symptoms (Campbell et al, 2008). DBS can be applied in different subcortical targets, each with different effi cacy for symptom relief.…”