Survey of practice preferences in deep brain stimulation surgery in the United States

Howell, Sasha; Tabibian, Borna E.; Mooney, James; Erickson, Nicholas; Walker, Harrison C.; Guthrie, Barton L.; Bentley, J. Nicole

doi:10.1016/j.inat.2021.101463

Cited by 3 publications

(3 citation statements)

References 29 publications

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Section: Methodsmentioning

confidence: 99%

“…Our routine clinical practice is to treat the most severely affected hemibody with unilateral DBS, followed by staged surgery on the opposite side of the brain (when, and if, needed). [24][25][26][27] The same neurosurgeons (B.G., J.N.B. )kjm implanted a 1-3-3-1 directional lead (Boston Scientific Vercise DBS system, Natick MA, USA, FDA IDE# G170063) at the STN target under local anesthesia with the patient fully awake.…”

Section: Surgical Procedures and Stimulation Parametersmentioning

confidence: 99%

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Differential Cognitive Effects of Unilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

Del Bene,

Martin,

Brinkerhoff

et al. 2024

Annals of Neurology

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ObjectiveThe aim of this study was to investigate the cognitive effects of unilateral directional versus ring subthalamic nucleus deep brain stimulation (STN DBS) in patients with advanced Parkinson's disease.MethodsWe examined 31 participants who underwent unilateral STN DBS (left n = 17; right n = 14) as part of an National Institutes of Health (NIH)‐sponsored randomized, double‐blind, crossover study contrasting directional versus ring stimulation. All participants received unilateral DBS implants in the hemisphere more severely affected by motor parkinsonism. Measures of cognition included verbal fluency, auditory‐verbal memory, and response inhibition. We used mixed linear models to contrast the effects of directional versus ring stimulation and implant hemisphere on longitudinal cognitive function.ResultsCrossover analyses showed no evidence for group‐level changes in cognitive performance related to directional versus ring stimulation. Implant hemisphere, however, impacted cognition in several ways. Left STN participants had lower baseline verbal fluency than patients with right implants (t [20.66 = −2.50, p = 0.02]). Verbal fluency declined after left (p = 0.013) but increased after right STN DBS (p < 0.001), and response inhibition was faster following right STN DBS (p = 0.031). Regardless of hemisphere, delayed recall declined modestly over time versus baseline (p = 0.001), and immediate recall was unchanged.InterpretationDirectional versus ring STN DBS did not differentially affect cognition. Similar to prior bilateral DBS studies, unilateral left stimulation worsened verbal fluency performance. In contrast, unilateral right STN surgery increased performance on verbal fluency and response inhibition tasks. Our findings raise the hypothesis that unilateral right STN DBS in selected patients with predominant right brain motor parkinsonism could mitigate declines in verbal fluency associated with the bilateral intervention. ANN NEUROL 2024

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Section: Methodsmentioning

confidence: 99%

Section: Surgical Procedures and Stimulation Parametersmentioning

confidence: 99%

Differential Cognitive Effects of Unilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

Del Bene,

Martin,

Brinkerhoff

et al. 2024

Annals of Neurology

View full text Add to dashboard Cite

show abstract

“…Motor symptom asymmetry is a defining clinical feature of PD. Our routine clinical practice is to treat the most severely affected hemibody with unilateral DBS, followed by staged surgery on the opposite side of the brain (when, and if, needed) [24][25][26][27][28] . The same neurosurgeons (BG, JNB) implanted a 1-3-3-1 directional lead (Boston Scientific Vercise DBS system, Natick MA, USA, FDA IDE# G170063) at the STN target under local anesthesia with the patient fully awake.…”

Section: Surgical Procedures and Stimulation Parametersmentioning

confidence: 99%

Differential cognitive effects of unilateral left and right subthalamic nucleus deep brain stimulation for Parkinson disease

Bene

Martin

Brinkerhoff

et al. 2023

Preprint

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ObjectiveTo investigate hemispheric effects of directional versus ring subthalamic nucleus (STN) deep brain stimulation (DBS) surgery on cognitive function in patients with advanced Parkinson’s disease (PD).MethodsWe examined 31 PD patients (Left STN n = 17; Right STN n = 14) who underwent unilateral subthalamic nucleus (STN) DBS as part of a NIH-sponsored randomized, cross-over, double-blind (ring vs directional) clinical trial. Outcome measures were tests of verbal fluency, auditory-verbal memory, and response inhibition. First, all participants were pooled together to study the effects of directional versus ring stimulation. Then, we stratified the groups by surgery hemisphere and studied the longitudinal changes in cognition post-unilateral STN DBS.ResultsRelative to pre-DBS cognitive baseline performances, there were no group changes in cognition following unilateral DBS for either directional or ring stimulation. However, assessment of unilateral DBS by hemisphere revealed a different pattern. The left STN DBS group had lower verbal fluency than the right STN group (t(20.66 = -2.50,p= 0.02). Over a period of eight months post-DBS, verbal fluency declined in the left STN DBS group (p= 0.013) and improved in the right STN DBS group over time (p< .001). Similarly, response inhibition improved following right STN DBS (p= 0.031). Immediate recall did not significantly differ over time, nor was it affected by implant hemisphere, but delayed recall equivalently declined over time for both left and right STN DBS groups (left STN DBSp= 0.001, right STN DBS differ from left STN DBSp= 0.794).ConclusionsDirectional and ring DBS did not differentially or adversely affect cognition over time. Regarding hemisphere effects, verbal fluency decline was observed in those who received left STN DBS, along with the left and right STN DBS declines in delayed memory. The left STN DBS verbal fluency decrement is consistent with prior bilateral DBS research, likely reflecting disruption of the basal-ganglia-thalamocortical network connecting STN and inferior frontal gyrus. Interestingly, we found an improvement in verbal fluency and response inhibition following right STN DBS. It is possible that unilateral STN DBS, particularly in the right hemisphere, may mitigate cognitive decline.

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Long-term safety and efficacy of frameless subthalamic deep brain stimulation in Parkinson’s disease

Genovese,

Bove,

Rigon

et al. 2023

Neurol Sci

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Background Bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) is standard of care for Parkinson’s disease (PD) patients and a correct lead placement is crucial to obtain good clinical outcomes. Evidence demonstrating the targeting accuracy of the frameless technique for DBS, along with the advantages for patients and clinicians, is solid, while data reporting long-term clinical outcomes for PD patients are still lacking. Objectives The study aims to assess the clinical safety and efficacy of frameless bilateral STN-DBS in PD patients at 5 years from surgery. Methods Consecutive PD patients undergoing bilateral STN-DBS with a frameless system were included in this single-center retrospective study. Clinical features, including the Unified Parkinson’s Disease Rating Scale (UPDRS) in its total motor score and axial sub-scores, and pharmacological regimen were assessed at baseline, 1 year, 3 years, and 5 years after surgery. The adverse events related to the procedure, stimulation, or the presence of the hardware were systematically collected. Results Forty-one PD patients undergone bilateral STN-DBS implantation were included in the study and fifteen patients already completed the 5-year observation. No complications occurred during surgery and the perioperative phase, and no unexpected serious adverse event occurred during the entire follow-up period. At 5 years from surgery, there was a sustained motor efficacy of STN stimulation: STN-DBS significantly improved the off-stim UPDRS III score at 5 years by 37.6% (P < 0.001), while the dopaminergic medications remained significantly reduced compared to baseline (− 21.6% versus baseline LEDD; P = 0.036). Conclusions Our data support the use of the frameless system for STN-DBS in PD patients, as a safe and well-tolerated technique, with long-term clinical benefits and persistent motor efficacy at 5 years from the surgery.

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Survey of practice preferences in deep brain stimulation surgery in the United States

Cited by 3 publications

References 29 publications

Differential Cognitive Effects of Unilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

Differential Cognitive Effects of Unilateral Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease

Differential cognitive effects of unilateral left and right subthalamic nucleus deep brain stimulation for Parkinson disease

Long-term safety and efficacy of frameless subthalamic deep brain stimulation in Parkinson’s disease

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