Surgical treatment of levodopa-induced dyskinesia in parkinson's disease

Krishnan, Syam; Pisharady, Krishnakumar Kesava

doi:10.4103/aian.aian_244_17

Cited by 5 publications

(1 citation statement)

References 77 publications

(99 reference statements)

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“…Both targets achieved long-term beneficial effects on motor complications (MDS-UPDRS IV), but the amount of effect was significantly larger in GPi-DBS patients. This finding confirms the well-known greater effectiveness of GPi-DBS in treating l - dopa -induced dyskinesia and provides a specific indication for choosing this target in highly dyskinetic patients [ 20 , 21 ]. Finally, concerning non-motor symptoms and quality of life, we observed a significant long-term improvement only in GPi-DBS patients.…”

Section: Discussionsupporting

confidence: 81%

Deep brain stimulation of globus pallidus internus and subthalamic nucleus in Parkinson’s disease: a multicenter, retrospective study of efficacy and safety

Mainardi,

Ciprietti,

Pilleri

et al. 2023

Neurol Sci

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Background Deep brain stimulation (DBS) is an established therapeutic option in advanced Parkinson’s disease (PD). Literature data and recent guidelines remain inconclusive about the best choice as a target between the subthalamic nucleus (STN) and the globus pallidus internus (GPi). Materials and methods We retrospectively reviewed the clinical efficacy outcomes of 48 DBS-implanted patients (33 STN-DBS and 15 GPi-DBS) at a short- (<1 year from the surgery) and long-term (2–5 years) follow-up. Also, clinical safety outcomes, including postoperative surgical complications and severe side effects, were collected. Results We found no difference between STN-DBS and GPi-DBS in improving motor symptoms at short-term evaluation. However, STN-DBS achieved a more prominent reduction in oral therapy (l-dopa equivalent daily dose, P = .02). By contrast, GPi-DBS was superior in ameliorating motor fluctuations and dyskinesia (MDS-UPDRS IV, P < .001) as well as motor experiences of daily living (MDS-UPDRS II, P = .03). The greater efficacy of GPi-DBS on motor fluctuations and experiences of daily living was also present at the long-term follow-up. We observed five serious adverse events, including two suicides, all among STN-DBS patients. Conclusion Both STN-DBS and GPi-DBS are effective in improving motor symptoms severity and complications, but GPi-DBS has a greater impact on motor fluctuations and motor experiences of daily living. These results suggest that the two targets should be considered equivalent in motor efficacy, with GPi-DBS as a valuable option in patients with prominent motor complications. The occurrence of suicides in STN-treated patients claims further attention in target selection.

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Section: Discussionsupporting

confidence: 81%

Deep brain stimulation of globus pallidus internus and subthalamic nucleus in Parkinson’s disease: a multicenter, retrospective study of efficacy and safety

Mainardi,

Ciprietti,

Pilleri

et al. 2023

Neurol Sci

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Efecto de la combinación palidotomía-subtalamotomía realizada en hemisferios cerebrales opuestos para el tratamiento de los signos motores en la enfermedad de Parkinson

Braña Miranda,

Quintanal Cordero,

Pavón Fuentes

et al. 2024

Neurología

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Improvement of Deep Brain Stimulation in Dyskinesia in Parkinson's Disease: A Meta-Analysis

Liu

Luo

et al. 2019

Front. Neurol.

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Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus internus (GPi) have been proven to be equally effective in improving motor-symptoms for advanced Parkinson's disease (PD) patients. However, it is unclear that which target stimulation is more effective in reducing dyskinesia. We conducted the meta-analysis to evaluate the efficacy of STN and GPi-DBS in the dyskinesia. Methods: A systematic search was performed in PubMed, Embase, and the Cochrane Library databases. Controlled trials about the dyskinesia comparing the efficacy of GPi and STN DBS were included. Clinical data of dyskinesia and levodopa equivalent doses (LED) were collected for the meta-analysis. Results: Eight eligible trials containing a total of 822 patients were included in this meta-analysis. Our results showed that GPi DBS offered a greater reduction of dyskinesia than STN DBS at 12 months after surgery, with an overall pooled SMD of 0.32 (95% CI = 0.06 to 0.59, P = 0.02). Treatment of STN DBS was associated with a greater reduction of LED compared with GPi DBS, with a change score of −320.55 (95% CI = −401.36 to −239.73, P < 0.00001). Conclusion: GPi DBS is superior to reduce dyskinesia than STN DBS at 12 months after surgery for advanced PD patients. Further studies should focus on the different mechanism for dyskinesia reduction by GPi or STN DBS.

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Surgical treatment of levodopa-induced dyskinesia in parkinson's disease

Cited by 5 publications

References 77 publications

Deep brain stimulation of globus pallidus internus and subthalamic nucleus in Parkinson’s disease: a multicenter, retrospective study of efficacy and safety

Deep brain stimulation of globus pallidus internus and subthalamic nucleus in Parkinson’s disease: a multicenter, retrospective study of efficacy and safety

Efecto de la combinación palidotomía-subtalamotomía realizada en hemisferios cerebrales opuestos para el tratamiento de los signos motores en la enfermedad de Parkinson

Improvement of Deep Brain Stimulation in Dyskinesia in Parkinson's Disease: A Meta-Analysis

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