SPECT and PET analysis of subthalamic stimulation in Parkinson’s disease: analysis using a manual segmentation

Haegelen, Claire; García-Lorenzo, Daniel; Jeune, Florence Le; Péron, Julie Anne; Gibaud, Bernard; Riffaud, Laurent; Brassier, G.; Barillot, Christian; Vérin, Marc; Morandi, Xavier

doi:10.1007/s00415-009-5327-8

Cited by 19 publications

(12 citation statements)

References 36 publications

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“…[6] Regional PD related covariance patterns have been reported on FDG PET imaging with DBS in both the ON and OFF state. [38] However, we did not see any differences in network activity when comparing the ON hemisphere to the OFF hemisphere in this case. These findings suggest that chronic DBS may not induce metabolic changes in the motor circuits in psychogenic movement disorder.…”

Section: Discussioncontrasting

confidence: 53%

Deep brain stimulation of a patient with psychogenic movement disorder

Langevin¹,

Skoch²,

Sherman³

2016

Surg Neurol Int

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Background:The long-term safety of deep brain stimulation (DBS) is an important issue because new applications are being investigated for a variety of disorders. Studying instances where DBS was inadvertently implanted in patients without a movement disorder may provide information about the safety of the therapy. We report the case of a patient with a psychogenic movement disorder treated with deep brain stimulation (DBS).Case Description:The patient presented at our clinic after 5 years of chronic DBS of the subthalamic nucleus (STN) for presumed Parkinson's disease. A dopamine transporter (DAT) scan (DaTscan) showed normal DAT distribution in the striatum. A positron emission tomography (PET) scan showed no abnormal metabolic patterns. Further psychiatric and neurological evaluations revealed that the patient was suffering from a psychogenic movement disorder. The patient displayed no sign or symptom from the stimulation, and DBS did not lead to any benefits or side effects for this patient.Conclusion:We argue that the absence of side effects, the normal DaTscan, and PET scan after 5 years of chronic stimulation illustrate the safety of DBS on neural tissue.

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Section: Discussioncontrasting

confidence: 53%

Deep brain stimulation of a patient with psychogenic movement disorder

Langevin¹,

Skoch²,

Sherman³

2016

Surg Neurol Int

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“…Both resting state and motor task paradigms were investigated using regional cerebral blood flow (rCBF) measurements (87, 88) or by quantifying glucose metabolism (89, 90). These studies showed a decreased activation during STN stimulation at resting state in comparison to no stimulation state in premotor cortex (PMC), dorsolateral prefrontal cortex (DLPFC), SMA and anterior cingulate cortex (ACC) and increased metabolism during task in DLPFC, rostral SMA and ACC (88).…”

Section: Network Effects Of Dbsmentioning

confidence: 99%

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

et al. 2018

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L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.

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“…Support for fiber activation as a critical mechanism of DBS is provided by the clinical beneficial effects obtained by stimulation of fiber paths in a wide range of disorders, such as the dentate‐rubro‐thalamic (DRT) tract in tremor, as well as the internal capsule in OCD and subgenual cingulate white matter in treatment‐resistant depression (TRD) . Yet, stimulation of subcortical nuclear structures such as the subthalamic nucleus and globus pallidus internus in PD clearly cause widespread effect, as illustrated by cerebral blood flow changes in the cortex . It seems that the mechanism cannot embody solely one hypothesis or the other, but more of a combination of the two.…”

Section: Introductionmentioning

confidence: 99%

Deep Brain Stimulation: Are Astrocytes a Key Driver Behind the Scene?

Fenoy¹,

Goetz

Chabardès

et al. 2014

CNS Neurosci Ther

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Despite its widespread use, the underlying mechanism of deep brain stimulation (DBS) remains unknown. Once thought to impart a "functional inactivation", there is now increasing evidence showing that DBS actually can both inhibit neurons and activate axons, generating a wide range of effects. This implies that the mechanisms that underlie DBS work not only locally but also at the network level. Therefore, not only may DBS induce membrane or synaptic plastic changes in neurons over a wide network, but it may also trigger celllular and molecular changes in other cells, especially astrocytes, where together the glial-neuronal interactions may explain effects that are not clearly rationalized by simple activation/inhibition theories alone. Recent studies suggest that 1) High frequency stimulation (HFS) activates astrocytes and leads to the release of gliotransmitters that can regulate surrounding neurons at the synapse; 2) Activated astrocytes modulate synaptic activity and increase axonal activation; 3) Activated astrocytes can signal further astrocytes across large networks, contributing to observed network effects induced by DBS; 4) Activated astrocytes can help explain the disparate effects of activation and inhibition induced by HFS at different sites; 5) Astrocytes contribute to synaptic plasticity through long-term potentiation (LTP) and depression (LTD), possibly helping to mediate the long term effects of DBS; and 6) DBS may increase delta-opioid receptor activity in astrcoytes to confer neuroprotection. Together, the plastic changes in these glial-neuronal interactions network-wide likely underlie the range of effects seen, from the variable temporal latencies to observed effect to global activation patterns. This article reviews recent research progress in the literature on how astrocytes play a key role in DBS efficacy.

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SPECT and PET analysis of subthalamic stimulation in Parkinson’s disease: analysis using a manual segmentation

Cited by 19 publications

References 36 publications

Deep brain stimulation of a patient with psychogenic movement disorder

Deep brain stimulation of a patient with psychogenic movement disorder

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

Deep Brain Stimulation: Are Astrocytes a Key Driver Behind the Scene?

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