Subthalamic deep brain stimulation: clinical and neuropsychological outcomes in mild cognitive impaired parkinsonian patients

Merola, Aristide; Rizzi, Laura; Artusi, Carlo Alberto; Zibetti, Maurizio; Rizzone, Mario Giorgio; Romagnolo, Alberto; Bernardini, Andrea; Lanotte, Michele; Lopiano, Leonardo

doi:10.1007/s00415-014-7414-8

Cited by 32 publications

(42 citation statements)

References 30 publications

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“…When comparing to other studies with DBS, dementia was present in four of 14 patients (29%) after more than 9 years . In a larger study from the same group the estimated median time to develop dementia was 9.5 years , very similar to our results. In a third study one of 20 patients (5%) developed dementia after 8 years and in a fourth study three of 18 patients (17%), the latter though from a total cohort of 41 patients with major dropouts .…”

Section: Discussionsupporting

confidence: 89%

“…After 10 years 30% had died, similar to findings both in the Toronto study , with a follow‐up time of 10 years of 41 patients and 12 dead, as well as 21% in the Torino study with a follow‐up time of more than 9 years in only 14 of 47 patients. In a recent study of 184 patients from the same Torino group mortality was approximately 15% after >5 years . In the Rome study three deaths occurred; these were part of a group of 12 patients followed for only 27.4 ± 19 months.…”

Section: Discussionmentioning

confidence: 94%

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Surviving 10 years with deep brain stimulation for Parkinson's disease – a follow‐up of 79 patients

Henriksen

Johnsen

Sunde

et al. 2014

Euro J of Neurology

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Survival of 70% after a mean of 25 years of PD including 10 years with DBS illustrates that this is a selected group of PD patients. The prevalence of dementia steadily increased after surgery as expected from disease progression and can be an early event. Compared with the few similar long-term studies, the present study presents a larger cohort followed at the same DBS center for a longer period of time and none was lost to follow-up, making conclusions more valid. The present findings are of significant prognostic help for the patient, caregiver and physician when treatment with DBS has to be decided.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 94%

Surviving 10 years with deep brain stimulation for Parkinson's disease – a follow‐up of 79 patients

Henriksen

Johnsen

Sunde

et al. 2014

Euro J of Neurology

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show abstract

“…DBS provides many of the same benefits as medication, including reduction/elimination of tremors and rigidity and improved motor functioning, cardinal symptoms of PD . However, PD is a progressive disease, and many other symptoms of PD continue to worsen despite DBS, including cognitive decline, gait and balance impairment, autonomic issues including orthostatic hypotension, dysphagia, and speech problems . The modest survival advantage seen in our DBS cohort suggests that there may be an advantage to maintaining motor function.…”

Section: Discussionmentioning

confidence: 81%

“…Rocha and colleagues and Ngene and colleagues reported that patients with DBS in their cohorts died of vascular events, such as stroke, and respiratory infections. Merola and colleagues followed 184 patients with DBS for more than 5 years and reported pneumonia as the most common cause of death. Interestingly, pneumonia was relatively infrequent in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Survival in patients with Parkinson's disease after deep brain stimulation or medical management

et al. 2017

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“…Immediate cognitive deficits after DBS procedures may be observed and the risk appears to be increased in PD patients already exhibiting cognitive impairments at baseline [71, 72]. Usually postoperative decline is worst in the first months following STN surgery and may improve in the ensuing months [73, 74].…”

Section: Discussionmentioning

confidence: 99%

Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences

et al. 2017

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Background and objectiveThe extent to which deep brain stimulation (DBS) can improve quality of life may be perceived as a permanent trade-off between neurological improvements and complications of therapy, comorbidities, and disease progression.Patients and methodsWe retrospectively investigated 123 consecutive and non-preselected patients. Indications for DBS surgery were Parkinson's disease (82), dystonia (18), tremor of different etiology (21), Huntington's disease (1) and Gilles de la Tourette syndrome (1). AEs were defined as any untoward clinical occurrence, sign or patient complaint or unintended disease if related or unrelated to the surgical procedures, implanted devices or ongoing DBS therapy.ResultsOver a mean/median follow-up period of 4.7 years (578 patient-years) 433 AEs were recorded in 106 of 123 patients (86.2%). There was no mortality or persistent morbidity from the surgical procedure. All serious adverse events (SAEs) that occurred within 4 weeks of surgery were reversible. Neurological AEs (193 in 85 patients) and psychiatric AEs (78 in 48 patients) were documented most frequently. AEs in 4 patients (suicide under GPI stimulation, weight gain >20 kg, impairment of gait and speech, cognitive decline >2 years following surgery) were severe or worse, at least possibly related to DBS and non reversible. In PD 23.1% of the STN-stimulated patients experienced non-reversible (or unknown reversibility) AEs that were at least possibly related to DBS in the form of impaired speech or gait, depression, weight gain, cognitive disturbances or urinary incontinence (severity was mild or moderate in 15 of 18 patients). Age and Hoehn&Yahr stage of STN-simulated PD patients, but not preoperative motor impairment or response to levodopa, showed a weak correlation (r = 0.24 and 0.22, respectively) with the number of AEs.ConclusionsDBS-related AEs that were severe or worse and non-reversible were only observed in PD (4 of 82 patients; 4.9%), but not in other diseases. PD patients exhibited a significant risk for non-severe AEs most of which also represented preexisting and progressive axial and non-motor symptoms of PD. Mild gait and/or speech disturbances were rather frequent complaints under VIM stimulation. GPI stimulation for dystonia could be applied with negligible DBS-related side effects.

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Subthalamic deep brain stimulation: clinical and neuropsychological outcomes in mild cognitive impaired parkinsonian patients

Cited by 32 publications

References 30 publications

Surviving 10 years with deep brain stimulation for Parkinson's disease – a follow‐up of 79 patients

Surviving 10 years with deep brain stimulation for Parkinson's disease – a follow‐up of 79 patients

Survival in patients with Parkinson's disease after deep brain stimulation or medical management

Adverse events in deep brain stimulation: A retrospective long-term analysis of neurological, psychiatric and other occurrences

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