The effects of bilateral Subthalamic Nucleus Deep Brain Stimulation (STN DBS) on cognition in Parkinson disease

Heo, Jae-Hyeok; Lee, Kyoung Min; Paek, Sun Ha; Kim, Min Jeong; Lee, Jee Young; Kim, Ji Young; Cho, Soo Young; Lim, Yong Beom; Kim, Mi Ryoung; Jeong, Soo; Jeon, Beom S.

doi:10.1016/j.jns.2008.06.010

Cited by 102 publications

(73 citation statements)

References 44 publications

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“…A published nonrandom trial reported that mood function (also based on BDI-II) was not significantly altered after STN DBS. 23 According to our analysis, GPi and STN DBS were associated with a significant reduction of PD symptoms. Thus, GPi DBS may be beneficial to treat severe mood symptoms.…”

Section: Discussionmentioning

confidence: 69%

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease

Liu

Li²,

Tan³

et al. 2014

JNS

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Object Deep brain stimulation (DBS) is the surgical procedure of choice for patients with advanced Parkinson disease (PD). The globus pallidus internus (GPi) and the subthalamic nucleus (STN) are commonly targeted by this procedure. The purpose of this meta-analysis was to compare the efficacy of DBS in each region. Methods MEDLINE/PubMed, EMBASE, Web of Knowledge, and the Cochrane Library were searched for English-language studies published before April 2013. Results of studies investigating the efficacy and clinical outcomes of DBS of the GPi and STN for PD were analyzed. Results Six eligible trials containing a total of 563 patients were included in the analysis. Deep brain stimulation of the GPi or STN equally improved motor function, measured by the Unified Parkinson's Disease Rating Scale Section III (UPDRSIII) (motor section, for patients in on- and off-medication phases), within 1 year postsurgery. The change score for the on-medication phase was 0.68 (95% CI – 2.12 to 3.47, p > 0.05; 5 studies, 518 patients) and for the off-medication phase was 1.83 (95% CI – 3.12 to 6.77, p > 0.05; 5 studies, 518 patients). The UPDRS Section II (activities of daily living) scores for patients on medication improved equally in both DBS groups (p = 0.97). STN DBS allowed medication dosages to be reduced more than GPi DBS (95% CI 129.27–316.64, p < 0.00001; 5 studies, 540 patients). Psychiatric symptoms, measured by Beck Depression Inventory, 2nd edition scores, showed greater improvement from baseline after GPi DBS than after STN DBS (standardized mean difference −2.28, 95% CI −3.73 to −0.84, p = 0.002; 3 studies, 382 patients). Conclusions GPi and STN DBS improve motor function and activities of daily living for PD patients. Differences in therapeutic efficacy for PD were not observed between the 2 procedures. STN DBS allowed greater reduction in medication for patients, whereas GPi DBS provided greater relief from psychiatric symptoms. An understanding of other symptomatic aspects of targeting each region and long-term observations on therapeutic effects are needed.

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Section: Discussionmentioning

confidence: 69%

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease

Liu

Li²,

Tan³

et al. 2014

JNS

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“…This is surprising in the light of influential proposals that the STN inhibits or suspends selected actions before being enacted while a 'brake' is applied to allow alternative candidate actions to be more appropriately considered or appraised (Frank, 2006;Frank and Claus, 2006;Swann et al, 2011). Still other neuropsychological investigations have suggested that STN DBS impairs aspects of conditional associative learning and verbal learning (Heo et al, 2008;Saint-Cyr et al, 2000). All of this evidence might suggest that STN DBS should have had its largest impact on the loss-chasing while patients were unfamiliar with the game.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, increased activity within the anterior cingulate cortex following STN DBS may mediate inhibitory response problems in PD patients while reductions in the activity of the anterior cingulate cortex may drive problems in verbal learning (Kalbe et al, 2009). STN DBS is also associated with impairments in selection tasks that are known to depend upon functions of the anterior cingulate cortex, such as the Stroop test of selective attention (Alegret et al, 2004;Carter et al, 2000;Heo et al, 2008;Klempirova et al, 2007). We propose that STN DBS in PD patients further disrupts the functioning of a circuit incorporating the anterior cingulate cortex and STN (Levy et al, 1997) that tags the reward values of candidate behaviours (Rushworth et al, 2004).…”

Section: Stn Dbs and The Neuropsychology Of Loss-chasing Behaviourmentioning

confidence: 99%

Deep brain stimulation of the subthalamic nucleus transiently enhances loss-chasing behaviour in patients with Parkinson's Disease

Rogers

Wielenberg

Wojtecki

et al. 2011

Experimental Neurology

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a b s t r a c t a r t i c l e i n f oDopaminergic treatments are associated with impulse control disorders such as pathological gambling in a subset of patients with Parkinson's Disease. While deep brain stimulation of the subthalamic nucleus has been reported to reduce symptoms of impulse control disorders in some Parkinson's Disease patients, little is known about its specific effects on gambling behaviour. In this experiment, we investigated the effects of deep brain stimulation of the subthalamic nucleus on one of the central features of pathological gambling: the tendency to chase losses. Loss-chasing is associated with impaired control over gambling behaviour and it is one of the most salient features of pathological gambling as it presents in the clinic. Twenty two patients with advanced idiopathic Parkinson's Disease and chronically implanted subthalamic nucleus electrodes for deep brain stimulation completed a simple laboratory model of loss-chasing behaviour twice: once with and once without stimulation. Exploratory analysis indicated that deep brain stimulation of the subthalamic nucleus increased the value of losses chased by patients with Parkinson's Disease when shifting from off-to on-stimulation. These effects were not attributable to changes in state affect or to the motor impairments produced by the withdrawal of deep brain stimulation of the subthalamic nucleus. The effects of the stimulation on the value of losses chased were more pronounced in female than in male patients and reduced in patients taking dopamine receptor agonists. Collectively, these results suggest that deep brain stimulation of the subthalamic nucleus can transiently alter the evaluation of accumulated losses during gambling episodes in idiopathic Parkinson's Disease.

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“…Parameters such as amplitude and pulse width are associated with improvement in cognitive performance 166 . On the other hand, some authors have shown negative effects related to functions such as verbal fluency and attention 165,167 . In addition, two key factors for assessing the cognitive effects of neuromodulation techniques used as tools for the treatment of depression are: 1) neural network underlying this disorder integrates structures such as prefrontal cortex, amygdala, cingulate and thalamus, and 2) cascading effects resulting from stimulation (topdown and bottom-up regulation according to the type of neuromodulation) 168 .…”

Section: Mdd and Cognitionmentioning

confidence: 99%

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

Brunoni

Teng

Correa³

et al. 2010

Arq. Neuro-Psiquiatr.

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The use of neuromodulation as a treatment for major depressive disorder (MDD) has recently attracted renewed interest due to development of other non-pharmacological therapies besides electroconvulsive therapy (ECT) such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), deep brain stimulation (DBS), and vagus nerve stimulation (VNS). Method: We convened a working group of researchers to discuss the updates and key challenges of neuromodulation use for the treatment of MDD. results: The state-of-art of neuromodulation techniques was reviewed and discussed in four sections: [1] epidemiology and pathophysiology of MDD; [2] a comprehensive overview of the neuromodulation techniques; [3] using neuromodulation techniques in MDD associated with non-psychiatric conditions; [4] the main challenges of neuromodulation research and alternatives to overcome them. Discussion: ECT is the first-line treatment for severe depression. TMS and tDCS are strategies with a relative benign profile of side effects; however, while TMS effects are comparable to antidepressant drugs for treating MDD; further research is needed to establish the role of tDCS. DBS and VNS are invasive strategies with a possible role in treatment-resistant depression. In summary, MDD is a chronic and incapacitating condition with a high prevalence; therefore clinicians should consider all the treatment options including invasive and non-invasive neuromodulation approaches. Key words: comprehensive review, major depressive disorder, ECT, TMS, clinical guidelines.Estratégias de neuromodulação para o tratamento da depressão maior: desafios e recomendações de uma força-tarefa rEsuMo O uso de técnicas de neuromodulação para o tratamento do transtorno depressivo maior (TDM) tem despertado um renovado interesse nos últimos anos com o desenvolvimento de outras intervenções não-farmacólogicas além da eletroconvulsoterapia (ECT), como a estimulação magnética transcraniana (EMT), a estimulação transcraniana por corrente continua (ETCC), a estimulação cerebral profunda (DBS) e a estimulação de nervo vago (VNS). Método: Nós organizamos um grupo de trabalho com vários pesquisadores para discutir os avanços recentes e os principais desafios para o uso da neuromodulação no tratamento os principais desafios da pesquisa na neuromodulação e alternativas para superá-los. Discussão: ECT é o tratamento de primeira linha para depressão grave. EMT e ETCC são estratégias com um perfil benigno de efeitos adversos; contudo, enquanto os efeitos da EMT são comparáveis ao das drogas antidepressivas para o tratamento da TDM, a eficácia da ETCC ainda precisa ser estabelecida por mais pesquisas clínicas. DBS e VNS são intervenções invasivas com um papel possível para a depressão refratária. Em resumo, TDM é uma condição crônica, incapacitante e de alta prevalência; portanto na prática clínica todas as opções de tratamento possíveis, incluindo as farmacológicas e não-farmacológicas, devem ser consideradas. Palavras-chave: artigo de revisão, tra...

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The effects of bilateral Subthalamic Nucleus Deep Brain Stimulation (STN DBS) on cognition in Parkinson disease

Cited by 102 publications

References 44 publications

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease

Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease

Deep brain stimulation of the subthalamic nucleus transiently enhances loss-chasing behaviour in patients with Parkinson's Disease

Neuromodulation approaches for the treatment of major depression: challenges and recommendations from a working group meeting

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