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Original Articles
Development of Clinical Milestones in Parkinson’s Disease After Bilateral Subthalamic Deep Brain Stimulation
Jed Noel A. Ong, Jung Hwan Shin, Seungho Jeon, Chan Young Lee, Han-Joon Kim, Sun Ha Paek, Beomseok Jeon
J Mov Disord. 2022;15(2):124-131.   Published online May 26, 2022
DOI: https://doi.org/10.14802/jmd.21106
  • 2,558 View
  • 139 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Objective
Deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson’s disease (PD) patients does not halt disease progression, as these patients will progress and develop disabling non-levodopa responsive symptoms. These features may act as milestones that represent the overall functionality of patients after DBS. The objective of this study was to investigate the development of clinical milestones in advanced PD patients who underwent bilateral STN-DBS.
Methods
The study evaluated PD patients who underwent STN-DBS at baseline up to their last follow-up using the Unified Parkinson’s Disease Rating Scale and Hoehn and Yahr scale. The symptoms of hallucinations, dysarthria, dysphagia, frequent falls, difficulty walking, cognitive impairment and the loss of autonomy were chosen as the clinical milestones.
Results
A total of 106 patients with a mean age of 47.21 ± 10.52 years at disease onset, a mean age of 58.72 ± 8.74 years at surgery and a mean disease duration of 11.51 ± 4.4 years before surgery were included. Initial improvement of motor symptoms was seen after the surgery with the appearance of clinical milestones over time. Using the moderately disabling criteria, 81 patients (76.41%) developed at least one clinical milestone, while 48 patients (45.28%) developed a milestone when using the severely disabling criteria.
Conclusion
STN-DBS has a limited effect on axial and nonmotor symptoms of the PD patients, in contrast to the effect on motor symptoms. These symptoms may serve as clinical milestones that can convey the status of PD patients and its impact on the patients and their caregivers. Therefore, advanced PD patients, even those treated with bilateral STN-DBS, will still require assistance and cannot live independently in the long run.

Citations

Citations to this article as recorded by  
  • Unveiling the Impact of Outpatient Physiotherapy on Specific Motor Symptoms in Parkinson’s Disease: A Prospective Cohort Study
    Yuta Terasawa, Koki Ikuno, Shintaro Fujii, Yuki Nishi, Emi Tanizawa, Sachio Nabeshima, Yohei Okada
    Brain & Neurorehabilitation.2023;[Epub]     CrossRef
Long-term Effects of Bilateral Subthalamic Deep Brain Stimulation on Postural Instability and Gait Difficulty in Patients with Parkinson’s Disease
Hae-Won Shin, Mi Sun Kim, Sung Reul Kim, Sang Ryong Jeon, Sun Ju Chung
J Mov Disord. 2020;13(2):127-132.   Published online May 29, 2020
DOI: https://doi.org/10.14802/jmd.19081
  • 6,090 View
  • 210 Download
  • 7 Web of Science
  • 8 Crossref
AbstractAbstract PDF
Objective
The long-term effects of bilateral subthalamic nucleus deep brain stimulation (STN-DBS) on postural instability and gait difficulty (PIGD) in patients with Parkinson’s disease (PD) remain unclear. In this study, we aimed to evaluate the longterm effects of STN-DBS surgery on PIGD symptoms in patients with advanced-stage PD. Methods This study included 49 consecutively included patients with PD who underwent bilateral STN-DBS. The Unified Parkinson’s Disease Rating Scale (UPDRS) scores and subscores for PIGD were assessed at baseline and at 1, 3, and 5 years postoperatively. The PIGD subscore was divided into PIGD-motor and PIGD-activities of daily living (ADL) scores according to parts III and II of the UPDRS, respectively. Results The PIGD-motor and PIGD-ADL scores at the “medication-off” state improved at 3 and 5 years, respectively. Overall, the UPDRS III and II scores at “medication-off” improved at 5 years. The UPDRS IV score also significantly improved and the levodopa equivalent daily dosage decreased at all follow-ups. Finally, the PIGD-motor score at baseline was able to predict long-term improvement in the PIGD-motor score at the 5-year follow-up. Conclusion The STN-DBS has both short- and long-term effects on PIGD, as well as overall motor function, in patients with advanced PD. The degree of PIGD at the preoperative evaluation can be used to predict long-term outcomes after STN-DBS surgery.

Citations

Citations to this article as recorded by  
  • Effects of subthalamic nucleus deep brain stimulation using different frequency programming paradigms on axial symptoms in advanced Parkinson’s disease
    Yifeng Cheng, Guangrui Zhao, Lei Chen, Deqiu Cui, Chunjuan Wang, Keke Feng, Shaoya Yin
    Acta Neurochirurgica.2024;[Epub]     CrossRef
  • Long-term motor outcomes of deep brain stimulation of the globus pallidus interna in Parkinson's disease patients: Five-year follow-up
    Yun Su Hwang, Sungyang Jo, Seung Hyun Lee, Nayoung Kim, Mi-Sun Kim, Sang Ryong Jeon, Sun Ju Chung
    Journal of the Neurological Sciences.2023; 444: 120484.     CrossRef
  • Smartwatch gait coordination index: New measure for human gait utilizing smartwatch sensor
    Sumin Han, Rob Paul
    Medicine.2023; 102(12): e33267.     CrossRef
  • WITHDRAWN: Laterality and frequency settings of subthalamic nucleus DBS for Parkinson's disease: A systematic review and network meta-analysis
    Rajiv Dharnipragada, Lalitha S. Denduluri, Anant Naik, Mario Bertogliat, Matthew Awad, Salman Ikramuddin, Michael C. Park
    Parkinsonism & Related Disorders.2023; : 105455.     CrossRef
  • Frequency settings of subthalamic nucleus DBS for Parkinson's disease: A systematic review and network meta-analysis
    Rajiv Dharnipragada, Lalitha S. Denduluri, Anant Naik, Mario Bertogliat, Matthew Awad, Salman Ikramuddin, Michael C. Park
    Parkinsonism & Related Disorders.2023; 116: 105809.     CrossRef
  • Unlocking potential: low frequency subthalamic nucleus stimulation enhances executive function in Parkinson’s disease patients with postural instability/gait disturbance
    Guofan Qin, Hutao Xie, Lin Shi, Baotian Zhao, Yifei Gan, Zixiao Yin, Yichen Xu, Xin Zhang, Yaojing Chen, Yin Jiang, Quan Zhang, Jianguo Zhang
    Frontiers in Neuroscience.2023;[Epub]     CrossRef
  • The Role of Microelectrode Recording in Deep Brain Stimulation Surgery for Parkinson’s Disease: A Systematic Review and Meta-Analysis
    R. Saman Vinke, Martin Geerlings, Ashok K. Selvaraj, Dejan Georgiev, Bastiaan R. Bloem, Rianne A.J. Esselink, Ronald H.M.A. Bartels
    Journal of Parkinson's Disease.2022; 12(7): 2059.     CrossRef
  • Axial impairment and falls in Parkinson’s disease: 15 years of subthalamic deep brain stimulation
    Alessandro Zampogna, Francesco Cavallieri, Francesco Bove, Antonio Suppa, Anna Castrioto, Sara Meoni, Pierre Pélissier, Emmanuelle Schmitt, Amélie Bichon, Eugénie Lhommée, Andrea Kistner, Stephan Chabardès, Eric Seigneuret, Valerie Fraix, Elena Moro
    npj Parkinson's Disease.2022;[Epub]     CrossRef
Brief communication
Rescue Levodopa/Carbidopa Intestinal Gel for Secondary Deep Brain Stimulation Failure
Juan Miguel Pilar Bautista, Genko Oyama, Maierdanjiang Nuermaimaiti, Satoko Sekimoto, Fuyuko Sasaki, Taku Hatano, Kenya Nishioka, Masanobu Ito, Atsushi Umemura, Yuji Ishibashi, Yasushi Shimo, Nobutaka Hattori
J Mov Disord. 2020;13(1):57-61.   Published online January 31, 2020
DOI: https://doi.org/10.14802/jmd.19051
  • 5,939 View
  • 154 Download
  • 6 Web of Science
  • 6 Crossref
AbstractAbstract PDF
Objective
The long-term efficacy of deep brain stimulation (DBS) for motor fluctuations in advanced Parkinson’s disease (PD) has been well established; however, motor fluctuations may recur over time despite multiple adjustments of DBS settings and medications.
Methods
We conducted a retrospective chart review of three patients for whom levodopa-carbidopa intestinal gel (LCIG) was additionally administered as a rescue therapy for secondary DBS failure due to the recurrence of motor fluctuations.
Results
The three patients had advanced PD with a disease duration of 14–19 years, and had undergone DBS for motor fluctuations refractory to standard medical management. LCIG was administered to the patients because of symptom recurrence years after DBS and provided complementary effects in all patients.
Conclusion
The cases presented here show that rescue LCIG therapy may be a complementary treatment option for patients with post-DBS advanced PD who have a recurrence of troublesome motor complications.

Citations

Citations to this article as recorded by  
  • Nationwide Retrospective Analysis of Combinations of Advanced Therapies in Patients With Parkinson Disease
    Dominik Pürner, Mohammad Hormozi, Daniel Weiß, Michael T. Barbe, Hannah Jergas, Tino Prell, Eileen Gülke, Monika Pötter-Nerger, Björn Falkenburger, Lisa Klingelhöfer, Pia K. Gutsmiedl, Bernhard Haslinger, Angela M. Jochim, Andreas Wolff, Nils Schröter, Mi
    Neurology.2023;[Epub]     CrossRef
  • Combining Device‐Aided Therapies in Parkinson's Disease: A Case Series and a Literature Review
    Iro Boura, Nikolaos Haliasos, Ιrene‐Areti Giannopoulou, Dimitrios Karabetsos, Cleanthe Spanaki
    Movement Disorders Clinical Practice.2021; 8(5): 750.     CrossRef
  • Combined and Sequential Treatment with Deep Brain Stimulation and Continuous Intrajejunal Levodopa Infusion for Parkinson’s Disease
    Daniël van Poppelen, Annelie N.M. Tromp, Rob M.A. de Bie, Joke M. Dijk
    Journal of Personalized Medicine.2021; 11(6): 547.     CrossRef
  • Personalised Advanced Therapies in Parkinson’s Disease: The Role of Non-Motor Symptoms Profile
    Valentina Leta, Haidar S. Dafsari, Anna Sauerbier, Vinod Metta, Nataliya Titova, Lars Timmermann, Keyoumars Ashkan, Michael Samuel, Eero Pekkonen, Per Odin, Angelo Antonini, Pablo Martinez-Martin, Miriam Parry, Daniel J. van Wamelen, K. Ray Chaudhuri
    Journal of Personalized Medicine.2021; 11(8): 773.     CrossRef
  • Parkinson’s Kinetigraph in the Selection of Levodopa-Carbidopa Intestinal Gel for Motor Fluctuations Refractory to Deep Brain Stimulation
    Yassine Noui, Monty Adam Silverdale, Julian Evans, Lucy Partington-Smith, Christopher Kobylecki
    Journal of Movement Disorders.2021; 14(3): 239.     CrossRef
  • The Choice Between Advanced Therapies for Parkinson’s Disease Patients: Why, What, and When?
    Joke M. Dijk, Alberto J. Espay, Regina Katzenschlager, Rob M.A. de Bie, Bastiaan R. Bloem, Patrik Brundin
    Journal of Parkinson's Disease.2020; 10(s1): S65.     CrossRef
Original Articles
Pilot Study for Considering Subthalamic Nucleus Anatomy during Stimulation Using Directional Leads
Takashi Asahi, Kiyonobu Ikeda, Jiro Yamamoto, Hiroyuki Tsubono, Shuji Sato
J Mov Disord. 2019;12(2):97-102.   Published online April 5, 2019
DOI: https://doi.org/10.14802/jmd.18054
  • 6,483 View
  • 204 Download
  • 9 Web of Science
  • 9 Crossref
AbstractAbstract PDF
Objective
Directional leads are used for deep brain stimulation (DBS). Two of the four contacts of the leads are divided into three parts, enabling controlled stimulation in a circumferential direction. The direction of adverse effects evoked by DBS in the subthalamic nucleus (STN) and stimulation strategies using directional leads were evaluated. Methods Directional leads were implanted into the bilateral STN of six parkinsonian patients (1 man, 5 women; mean age 66.2 years). The contact centers were located within the upper border of the STN, and the locations were identified electrically using microrecordings. Adverse effects were evaluated with electrical stimulation (30 μs, 130 Hz, limit 11 mA) using the directional part of each lead after surgery, and the final stimulation direction was investigated. Unified Parkinson’s disease rating scale (UPDRS) scores were evaluated before and after DBS. Results Fifty-six motor and four sensory symptoms were evoked by stimulation; no adverse effect was evoked in 14 contacts. Motor and sensory symptoms were evoked by stimulation in the anterolateral direction and medial to posterolateral direction, respectively. Stimulation in the posteromedial direction produced adverse effects less frequently. The most frequently used contacts were located above the STN (63%), followed by the upper part of the STN (32%). The mean UPDRS part III and dyskinesia scores decreased after DBS from 30.2 ± 11.7 to 7.2 ± 2.9 and 3.3 ± 2.4 to 0.5 ± 0.8, respectively. Conclusion The incidence of adverse effects was low for the posteromedial stimulation of the STN. Placing the directional part of the lead above the STN may facilitate the control of dyskinesia.

Citations

Citations to this article as recorded by  
  • Directional deep brain stimulation in the management of Parkinson’s disease: efficacy and constraints—an analytical appraisal
    Mayara Tszesnioski Maçaneiro, Ana Clara Azevedo, Bruna Maurício Poerner, Milena Dangui da Silva, Andrei Koerbel
    Neurosurgical Review.2024;[Epub]     CrossRef
  • Globus pallidus internus versus subthalamic nucleus deep brain stimulation for isolated dystonia: A 3‐year follow‐up
    Suzhen Lin, Yimei Shu, Chencheng Zhang, Lingbing Wang, Peng Huang, Yixin Pan, Jianqing Ding, Bomin Sun, Dianyou Li, Yiwen Wu
    European Journal of Neurology.2023; 30(9): 2629.     CrossRef
  • Three-dimensional gait analysis of the effect of directional steering on gait in patients with Parkinson's disease
    Satoko Sekimoto, Genko Oyama, Kotatsu Bito, Masaru Tsuchiya, Sho Kikuchi, Baku Takimoto, Toshiki Ichihashi, Juan Miguel P. Bautista, Maierdanjiang Nuermaimaiti, Fuyuko Sasaki, Ryota Nakamura, Hirokazu Iwamuro, Masanobu Ito, Atsushi Umemura, Nobutaka Hatto
    Parkinsonism & Related Disorders.2023; 114: 105770.     CrossRef
  • Surgical Strategy for Directional Deep Brain Stimulation
    Hiroshi MASUDA, Hiroshi SHIROZU, Yosuke ITO, Masafumi FUKUDA, Yukihiko FUJII
    Neurologia medico-chirurgica.2022; 62(1): 1.     CrossRef
  • Do directional deep brain stimulation leads rotate after implantation?
    Marie T. Krüger, Yashar Naseri, Fabian Cavalloni, Peter C. Reinacher, Georg Kägi, Johannes Weber, Deborah Brogle, Oliver Bozinov, Stefan Hägele-Link, Florian Brugger
    Acta Neurochirurgica.2021; 163(1): 197.     CrossRef
  • Stimulation-Induced Dyskinesia After Subthalamic Nucleus Deep Brain Stimulation in Patients With Meige Syndrome
    Ning Wang, Kailiang Wang, Qiao Wang, Shiying Fan, Zonghui Fu, Feng Zhang, Lin Wang, Fangang Meng
    Neuromodulation: Technology at the Neural Interface.2021; 24(2): 286.     CrossRef
  • Deep brain stimulation programming strategies: segmented leads, independent current sources, and future technology
    Bhavana Patel, Shannon Chiu, Joshua K. Wong, Addie Patterson, Wissam Deeb, Matthew Burns, Pamela Zeilman, Aparna Wagle-Shukla, Leonardo Almeida, Michael S. Okun, Adolfo Ramirez-Zamora
    Expert Review of Medical Devices.2021; 18(9): 875.     CrossRef
  • Deep-Brain Stimulation for Essential Tremor and Other Tremor Syndromes: A Narrative Review of Current Targets and Clinical Outcomes
    Christian Iorio-Morin, Anton Fomenko, Suneil K. Kalia
    Brain Sciences.2020; 10(12): 925.     CrossRef
  • Dyskinesia‐inducing lead contacts optimize outcome of subthalamic stimulation in Parkinson's disease
    Walid Bouthour, Matthieu Béreau, Astrid Kibleur, André Zacharia, Emilie Tomkova Chaoui, Vanessa Fleury, Damien Benis, Shahan Momjian, Julien Bally, Christian Lüscher, Paul Krack, Pierre R. Burkhard
    Movement Disorders.2019; 34(11): 1728.     CrossRef
Comparison of Pallidal and Subthalamic Deep Brain Stimulation in Parkinson’s Disease: Therapeutic and Adverse Effects
Ho-Sung Ryu, Mi-Sun Kim, Sooyeoun You, Mi-Jung Kim, Young Jin Kim, Juyeon Kim, Kiju Kim, Sun Ju Chung
J Mov Disord. 2017;10(2):80-86.   Published online May 8, 2017
DOI: https://doi.org/10.14802/jmd.17001
  • 8,376 View
  • 255 Download
  • 6 Web of Science
  • 7 Crossref
AbstractAbstract PDFSupplementary Material
Objective
To compare the therapeutic and adverse effects of globus pallidus interna (GPi) and subthalamic nucleus (STN) deep brain stimulation (DBS) for the treatment of advanced Parkinson’s disease (PD).
Methods
We retrospectively analyzed the clinical data of patients with PD who underwent GPi (n = 14) or STN (n = 28) DBS surgery between April 2002 and May 2014. The subjects were matched for age at surgery and disease duration. The Unified Parkinson’s Disease Rating Scale (UPDRS) scores and levodopa equivalent dose (LED) at baseline and 12 months after surgery were used to assess the therapeutic effects of DBS. Adverse effects were also compared between the two groups.
Results
At 12 months, the mean changes in the UPDRS total and part I–IV scores did not differ significantly between the two groups. However, the subscores for gait disturbance/postural instability and dyskinesia were significantly more improved after GPi DBS than those after STN DBS (p = 0.024 and 0.016, respectively). The LED was significantly more reduced in patients after STN DBS than that after GPi DBS (p = 0.004). Serious adverse effects did not differ between the two groups (p = 0.697).
Conclusion
The patients with PD showed greater improvement in gait disturbance/postural instability and dyskinesia after GPi DBS compared with those after STN DBS, although the patients had a greater reduction in LED after STN DBS. These results may provide useful information for optimal target selection for DBS in PD.

Citations

Citations to this article as recorded by  
  • Long-term motor outcomes of deep brain stimulation of the globus pallidus interna in Parkinson's disease patients: Five-year follow-up
    Yun Su Hwang, Sungyang Jo, Seung Hyun Lee, Nayoung Kim, Mi-Sun Kim, Sang Ryong Jeon, Sun Ju Chung
    Journal of the Neurological Sciences.2023; 444: 120484.     CrossRef
  • The Role of Microelectrode Recording in Deep Brain Stimulation Surgery for Parkinson’s Disease: A Systematic Review and Meta-Analysis
    R. Saman Vinke, Martin Geerlings, Ashok K. Selvaraj, Dejan Georgiev, Bastiaan R. Bloem, Rianne A.J. Esselink, Ronald H.M.A. Bartels
    Journal of Parkinson's Disease.2022; 12(7): 2059.     CrossRef
  • Motor Thalamic Deep Brain Stimulation Alters Cortical Activity and Shows Therapeutic Utility for Treatment of Parkinson’s Disease Symptoms in a Rat Model
    Heidi R. Tucker, Emily Mahoney, Kainat Akhtar, Tzu-Jen Kao, Gianna Mamone, Saisree Mikkilineni, Maya Ravi, Hanel Watkins, Danielle-Lee Terrelonge, Caryn Martin, Kristen Unger, Gabrielle Kim, Kyra Fiber, Megan Gupta, Jonathan Indajang, Eliyahu M. Kochman,
    Neuroscience.2021; 460: 88.     CrossRef
  • Current Knowledge on the Background, Pathophysiology and Treatment of Levodopa-Induced Dyskinesia—Literature Review
    Michał Hutny, Jagoda Hofman, Aleksandra Klimkowicz-Mrowiec, Agnieszka Gorzkowska
    Journal of Clinical Medicine.2021; 10(19): 4377.     CrossRef
  • Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays
    Autumn J. Bullard, Brianna C. Hutchison, Jiseon Lee, Cynthia A. Chestek, Parag G. Patil
    Neuromodulation: Technology at the Neural Interface.2020; 23(4): 411.     CrossRef
  • Long-term Effects of Bilateral Subthalamic Deep Brain Stimulation on Postural Instability and Gait Difficulty in Patients with Parkinson’s Disease
    Hae-Won Shin, Mi Sun Kim, Sung Reul Kim, Sang Ryong Jeon, Sun Ju Chung
    Journal of Movement Disorders.2020; 13(2): 127.     CrossRef
  • Treatment strategies in advanced Parkinson's disease: Review of the literature
    Yıldız Değirmenci
    Cumhuriyet Medical Journal.2017; 39(3): 509.     CrossRef

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