Selecting deep brain stimulation or infusion therapies in advanced Parkinson’s disease: an evidence-based review

Volkmann, Jens; Albanese, Alberto; Antonini, Angelo; Chaudhuri, K. Ray; Clarke, Carl E; Bie, Rob M.A. de; Deuschl, Günther; Eggert, Karla; Houeto, Jean Luc; Kulisevsky, Jaime; Nyholm, Dag; Odin, Per; Østergaard, Karen; Poewe, Werner; Pollak, Pierre; Rabey, J. M.; Rascol, Olivier; Růžička, Evžen; Samuel, Michael; Speelman, Hans; Sydow, Olof; Valldeoriola, Francesc; Linden, Chris van der; Oertel, Wolfgang H.

doi:10.1007/s00415-012-6798-6

Cited by 128 publications

(165 citation statements)

References 85 publications

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“…Moreover, unnecessary treatment costs need to be avoided. For the management of advanced PD (when intractable levodopa-induced motor complications develop) invasive techniques, including deep-brain stimulation, stereotactic neurosurgery or other ablative treatments, and subcutaneous apomorphine therapy or intraduodenal levodopa infusion, are available (22,23). Experimental therapies have tried to restore striatal dopamine in PD patients by gene-based and cell-based approaches.…”

Section: Treatment and Prognosismentioning

confidence: 99%

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

et al. 2017

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Learning Objectives: On successful completion of this activity, participants should be able to (1) describe the clinical demand and rationale for differential diagnosis in parkinsonism, (2) recognize and differentiate the disease-specific patterns of regional glucose metabolism associated with Parkinson disease and the different atypical parkinsonian syndromes, and (3) identify regional metabolic changes that predict cognitive decline in Parkinson disease.Financial Disclosure: Dr. Meyer receives support from GE and Piramal for a research study outside the present topic. The authors of this article have indicated no other relevant relationships that could be perceived as a real or apparent conflict of interest. CME Credit: SNMMI is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing education for physicians. SNMMI designates each JNM continuing education article for a maximum of 2.0 AMA PRA category 1 credits. Physicians should claim only credit commensurate with the extent of their participation in the activity. For CE credit, SAM, and other credit types, participants can access this activity through the SNMMI website (http://www.snmmilearningcenter.org) through December 2020.Accurate differential diagnosis of parkinsonism is of paramount therapeutic and prognostic importance. In addition, with the development of invasive therapies and novel disease-specific therapies, strategies for patient enrichment in trial populations are of growing importance. Imaging disease-specific patterns of regional glucose metabolism with PET and 18 F-FDG allows for a highly accurate distinction between Parkinson disease (PD) and atypical parkinsonian syndromes, including multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration. On the basis of a preliminary metaanalysis of currently available studies with inclusion of multiple disease groups, we estimated that the diagnostic sensitivity and specificity for visual PET readings supported by voxel-based statistical analyses for diagnosis of atypical parkinsonian syndromes are 91.4% and 90.6%, respectively. The diagnostic specificity of 18 F-FDG PET for diagnosing multiple-system atrophy, progressive supranuclear palsy, and corticobasal degeneration was consistently shown to be high (.90%), whereas sensitivity was more variable (.75%). It is increasingly acknowledged that cognitive impairment represents a major challenge in PD, with mild cognitive impairment being a prodromal stage of PD with dementia (PDD). In line with clinical and neuropsychologic studies, recent PET studies demonstrated that posterior cortical dysfunction in nondemented PD patients precedes cognitive decline and the development of PDD by several years. Taken together, the current literature underscores the utility of 18 F-FDG PET for diagnostic evaluation of parkinsonism and the promising role of 18 F-FDG PET for assessment and risk stratification of cognitive impairment in PD.

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Section: Treatment and Prognosismentioning

confidence: 99%

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

et al. 2017

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“…However, there is still no consensus on exactly how such treatment should be administered. Evidence‐based reviews conclude that there are different well‐documented treatment strategies, but there is no evidence that one strategy should be chosen over another 7, 8, 9, 10, 11, 12, 75. Therefore, it is important to treat each patient individually.…”

Section: Discussionmentioning

confidence: 99%

“…However, at present no direct comparative data support the use of one device‐aided therapy over another. An evidence‐based review has been published, but this only provides recommendations as to which patients could be candidates for each of the device‐aided treatments, and it can only to some extent help choosing one single therapy for a particular patient 75. Both indications and contraindications may limit the available options.…”

Section: Selection Of Advanced Treatmentmentioning

confidence: 99%

Algorithms for the treatment of motor problems in Parkinson's disease

Dietrichs

Odin

2017

Acta Neurol Scand

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Several different strategies are effective for medical treatment of motor problems in Parkinson's disease (PD). Many guidelines and evidence‐based reviews are available, but there is no documentation or consensus in favor of just one treatment strategy. This review presents two algorithms that may be helpful when deciding how to treat a PD patient at various stages of the disease. The first algorithm suggests one way to treat PD from the first onset of motor symptoms. It is largely based on treatment recommendations from the Scandinavian countries and Germany. The other algorithm is meant as assistance for choosing among the different device‐aided treatments for advanced PD. There is not sufficient comparative data to recommend one particular line of treatment, neither in early PD nor in advanced disease with motor complications. Individualized treatment is needed for each patient. The current algorithms only represent an alternative for aiding treatment decisions.

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“…Volkmann et al 23 6 class I studies; Consistent evidence of benefit for dyskinesias and motor fluctuations. Evidence was considered insufficient for apomorphine infusion and levodopa duodenal pump.…”

Section: Gpi: 19 Pts Improvement In Updrs-iii;mentioning

confidence: 99%

Decisions about deep brain stimulation therapy in Parkinson’s disease

Brandão

Grippe²,

Modesto³

et al. 2018

Arq. Neuro-Psiquiatr.

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Parkinson' s disease (PD), a hypokinetic movement disorder characterized by the classic tetrad of bradykinesia, rest tremor, plastic rigidity, and postural disturbances 1,2 , is a neurodegenerative disorder with an increasing impact on the Brazilian social and healthcare system, mirroring known demographic-epidemiological changes such as aging of the population and widening of the apex of the age pyramid 3,4 . Considering a prevalence of 3.3% in those aged 65 or older in the Brazilian population 5 , the country has at least 200,000 patients living with the disorder, a definitive challenge to the public health system. ABSTRACTParkinson's disease can be treated surgically in patients who present with motor complications such as fluctuations and dyskinesias, or medically-refractory disabling tremor. In this review, a group of specialists formulated suggestions for a preoperative evaluation protocol after reviewing the literature published up to October 2017. In this protocol, eligibility and ineligibility criteria for surgical treatment were suggested, as well as procedures that should be carried out before the multidisciplinary therapeutic decisions. The review emphasizes the need to establish "DBS teams", with professionals dedicated specifically to this area. Finally, surgical target selection (subthalamic nucleus or globus pallidus internus) is discussed briefly, weighing the pros and cons of each target.Keywords: Parkinson disease; deep brain stimulation; reference standards; basal ganglia; neurosurgical procedures. RESUMOA doença de Parkinson pode ser tratada cirurgicamente em pacientes que desenvolveram complicações motoras, como flutuações e discinesias, ou tremores refratários ao uso de medicação. Nesta revisão, um grupo de especialistas formulou sugestões para um protocolo de avaliação pré-operatória, depois de revisar a literatura publicada até outubro de 2017. Neste protocolo, são sugeridos critérios de elegibilidade e inadmissibilidade para tratamento cirúrgico, bem como procedimentos que devem ser realizados antes das decisões terapêuticas multidisciplinares. A revisão enfatiza a necessidade de estabelecer "equipes de DBS", com profissionais dedicados especialmente a esta área. Ao final, a seleção do alvo cirúrgico (núcleo subtalâmico ou globo pálido interno) é discutida brevemente, ponderando prós e contras de cada escolha.Palavras-chave: doença de Parkinson; estimulação cerebral profunda; padrões de referência; gânglios da base; procedimentos neurocirúrgicos.

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Selecting deep brain stimulation or infusion therapies in advanced Parkinson’s disease: an evidence-based review

Cited by 128 publications

References 85 publications

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

Algorithms for the treatment of motor problems in Parkinson's disease

Decisions about deep brain stimulation therapy in Parkinson’s disease

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Selecting deep brain stimulation or infusion therapies in advanced Parkinson’s disease: an evidence-based review

Cited by 128 publications

References 85 publications

18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

18F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

Algorithms for the treatment of motor problems in Parkinson's disease

Decisions about deep brain stimulation therapy in Parkinson’s disease

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Product

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¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment

¹⁸F-FDG PET in Parkinsonism: Differential Diagnosis and Evaluation of Cognitive Impairment