European Academy of Neurology/Movement Disorder Society‐European Section Guideline on the Treatment of Parkinson's Disease: I. Invasive Therapies

Movement Disorders, Journal Year: 2022, Volume and Issue: 37(7), P. 1360 - 1374

Published: July 1, 2022

ABSTRACT Background and Purpose This update of the treatment guidelines was commissioned by European Academy Neurology section Movement Disorder Society. Although these treatments are initiated usually in specialized centers, general neurologist should know therapies their place pathway. Methods Grading Recommendations Assessment, Development, Evaluation (GRADE) methodology used to assess spectrum approved interventions including deep brain stimulation (DBS) or lesioning with different techniques (radiofrequency thermocoagulation, radiosurgery, magnetic resonance imaging–guided focused ultrasound surgery [MRgFUS] following targets: subthalamic nucleus [STN], ventrolateral thalamus, pallidum internum [GPi]). Continuous delivery medication subcutaneously (apomorphine pump) through percutaneous ileostomy (intrajejunal levodopa/carbidopa pump [LCIG]) also included. Changes motor features, health‐related quality life (QoL), adverse effects, further outcome parameters were evaluated. based on high‐class evidence graded three gradations. If only lower class available but topic felt be high importance, clinical consensus guideline task force gathered. Results Two research questions have been answered eight recommendations five statements. Invasive reserved for specific patient groups situations mostly advanced stage Parkinson's disease (PD). Interventions may considered special profiles, which mentioned text. Therapy effects reported as change compared current medical treatment. STN‐DBS is best‐studied intervention PD fluctuations not satisfactorily controlled oral medications; it improves symptoms QoL, offered eligible patients. GPi‐DBS can offered. For early fluctuations, likely improve symptoms, QoL DBS people without fluctuations. LCIG an apomorphine sufficiently managed treatments. Unilateral MRgFUS STN distinctly unilateral within registries. Clinical reached statements: Radiosurgery gamma radiation cannot recommended, radiofrequency thermocoagulation treatment‐resistant thalamus resistant tremor recommended if other options available, medication‐resistant registries, recommended. Conclusions Evidence invasive heterogeneous. Only some a strong scientific basis. They differ profile tested groups. © 2022 The Authors. Disorders published Wiley Periodicals LLC behalf International Parkinson

Language: Английский

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Medical, surgical, and physical treatments for Parkinson's disease

The Lancet, Journal Year: 2024, Volume and Issue: 403(10423), P. 305 - 324

Published: Jan. 1, 2024

Language: Английский

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Device profile of the percept PC deep brain stimulation system for the treatment of Parkinson’s disease and related disorders

Expert Review of Medical Devices, Journal Year: 2021, Volume and Issue: 18(4), P. 319 - 332

Published: March 25, 2021

Several software and hardware advances in the field of deep brain stimulation (DBS) have been realized recent years devices from three manufacturers are available. The Percept™ PC platform (Medtronic, Inc.) enables sensing, latest innovation. Clinicians should be familiar with differences devices, technologies to deliver optimized patient care.Areas covered: In this device profile, sensing capabilities described, system differentiated other available platforms. development preceding Activa™ PC+S research platform, an investigational simultaneously sense signals provide therapeutic stimulation, is provided place appropriate context.Expert opinion: offers unique diary functions as a means refine track symptoms correlate them neurophysiologic characteristics. Additional features enhance experience DBS, including 3 T magnetic resonance imaging compatibility, wireless telemetry, smaller thinner battery increased longevity. Future work will needed illustrate clinical utility added value using optimize DBS therapy. Patients implanted ready access future technology developments.

Language: Английский

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European Academy of Neurology/Movement Disorder Society ‐ European Section guideline on the treatment of Parkinson's disease: I. Invasive therapies

European Journal of Neurology, Journal Year: 2022, Volume and Issue: 29(9), P. 2580 - 2595

Published: July 6, 2022

This update of the treatment guidelines was commissioned by European Academy Neurology and section Movement Disorder Society. Although these treatments are initiated usually in specialized centers, general neurologist practitioners taking care PD patients should know therapies their place pathway.Grading Recommendations Assessment, Development, Evaluation (GRADE) methodology used to assess spectrum approved interventions including deep brain stimulation (DBS) or lesioning with different techniques (radiofrequency thermocoagulation, radiosurgery, magnetic resonance imaging-guided focused ultrasound surgery [MRgFUS] following targets: subthalamic nucleus [STN], ventrolateral thalamus, pallidum internum [GPi]). Continuous delivery medication subcutaneously (apomorphine pump) through percutaneous ileostomy (intrajejunal levodopa/carbidopa pump [LCIG]) also included. Changes motor features, health-related quality life (QoL), adverse effects, further outcome parameters were evaluated. based on high-class evidence graded three gradations. If only lower class available but topic felt be high importance, clinical consensus guideline task force gathered.Two research questions have been answered eight recommendations five statements. Invasive reserved for specific patient groups situations mostly advanced stage Parkinson's disease (PD). Interventions may considered special profiles, which mentioned text. Therapy effects reported as change compared current medical treatment. STN-DBS is best-studied intervention fluctuations not satisfactorily controlled oral medications; it improves symptoms QoL, offered eligible patients. GPi-DBS can offered. For early fluctuations, likely improve symptoms, QoL DBS people without fluctuations. LCIG an apomorphine sufficiently managed treatments. Unilateral MRgFUS STN distinctly unilateral within registries. Clinical reached statements: Radiosurgery gamma radiation cannot recommended, radiofrequency thermocoagulation treatment-resistant thalamus resistant tremor recommended if other options available, medication-resistant registries, recommended.Evidence invasive heterogeneous. Only some a strong scientific basis. They differ profile tested groups.

Language: Английский

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Combining Multimodal Biomarkers to Guide Deep Brain Stimulation Programming in Parkinson Disease

Neuromodulation Technology at the Neural Interface, Journal Year: 2022, Volume and Issue: 26(2), P. 320 - 332

Published: Feb. 24, 2022

Deep brain stimulation (DBS) programming of multicontact DBS leads relies on a very time-consuming manual screening procedure, and strategies to speed up this process are needed. Beta activity in subthalamic nucleus (STN) local field potentials (LFP) has been suggested as promising marker index optimal contacts patients with Parkinson disease.In study, we investigate the advantage algorithmic selection combination multiple resting movement state features from STN LFPs imaging markers predict three relevant clinical parameters (clinical efficacy, therapeutic window, side-effect threshold).STN were recorded at rest during voluntary movements 27 hemispheres. Resting- movement-state frequency bands (alpha, low beta, high gamma, fast oscillations [HFO]) used outcome parameters. Subanalyses included an anatomical sweet spot additional feature.Both resting- contributed prediction, (fast) gamma activity, resting/movement-modulated beta movement-modulated HFO being most predictive. With proposed algorithm, best contact for can be identified probability almost 90% after considering half lead contacts, it outperforms use single marker. The electrophysiological further improve prediction.LFP-guided based efficient approach routine patients.

Language: Английский

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Off-time Treatment Options for Parkinson’s Disease

Neurology and Therapy, Journal Year: 2023, Volume and Issue: 12(2), P. 391 - 424

Published: Jan. 12, 2023

Motor fluctuations (MF) are deemed by patients with Parkinson's disease (PD) as the most troublesome feature resulting from increasing impairment in responsiveness to dopaminergic drug treatments. MF characterized loss of a stable response levodopa over nychthemeron reappearance motor (and non-motor) parkinsonian clinical signs at various moments during day and night. They normally appear after few years treatment variable, though overall severity, course. The armamentarium first-line options has widened last decade new once-a-daily compounds, including catechol O-methyltransferase inhibitor – Opicapone-, two MAO-B inhibitors plus channel blocker Zonisamide Safinamide one amantadine extended-release formulation ADS5012. In addition apomorphine injection or oral dispersible tablets, which have been available for long time, on-demand therapies such sublingual inhaled formulations recently shown efficacy rescue Off-time treatment. When management becomes difficult spite oral/on-demand options, more complex should be considered, surgical, i.e. deep brain stimulation, device-aided pump systems delivering continuous subcutaneous intestinal formulation. Older less commonly used ablative techniques (radiofrequency pallidotomy) may also effective while there is still scarce data regarding reduction using lesional approach, magnetic resonance-guided focused ultrasound. choice between different advanced shared decision that consider physician opinion on contraindication/main target symptom, patients' preference, caregiver's availability together public health socio-economic environment. right/first add-on matter debate well proper time an therapy considered. this narrative review, we discuss all above cited aspects PD, their phenomenology, management, means pharmacological therapies, on-going trials future research perspectives.

Language: Английский

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Levodopa-Induced Dyskinesias in Parkinson’s Disease: An Overview on Pathophysiology, Clinical Manifestations, Therapy Management Strategies and Future Directions

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(13), P. 4427 - 4427

Published: June 30, 2023

Since its first introduction, levodopa has become the cornerstone for treatment of Parkinson’s disease and remains leading therapeutic choice motor control therapy so far. Unfortunately, subsequent appearance abnormal involuntary movements, known as dyskinesias, is a frequent drawback. Despite deep knowledge this complication, in terms clinical phenomenology temporal relationship during regimen, less clear about pathophysiological mechanisms underpinning it. As progresses, specific oscillatory activities both cortical basal ganglia neurons variation metabolism, dopamine receptor stimulation pattern turnover rate, underlie dyskinesia onset. This review aims to provide global overview on levodopa-induced focusing pathophysiology, manifestations, management strategies future directions.

Language: Английский

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Phospholipids and Cholesterol Determine Molecular Mechanisms of Cytotoxicity of α-Synuclein Oligomers and Fibrils

ACS Chemical Neuroscience, Journal Year: 2024, Volume and Issue: 15(2), P. 371 - 381

Published: Jan. 2, 2024

Progressive loss of dopaminergic (DA) neurons in the substantia nigra pars compacta, hypothalamus, and thalamus is a hallmark Parkinson's disease. Neuronal death linked to abrupt aggregation α-synuclein (α-Syn), small membrane protein that regulates cell vesicle trafficking. α-Syn rate, as well secondary structure toxicity fibrils, could be uniquely altered by lipids. However, molecular mechanisms determine such remarkable difference fibrils formed presence lipids remain unclear. In this study, we used set assays mechanism which phosphatidylcholine (PC), cardiolipin (CL), cholesterol (Cho) exert toxicity. We found rat cells exposed different drastically magnitudes dynamics unfolded response (UPR) endoplasmic reticulum (ER) mitochondria (MT). Specifically, α-Syn:CL were cause strongest, whereas absence had lowest magnitude UPR response. also opposite ER- MT-UPR responses aggregates. These results suggest facing severe ER stress, suppress response, enabling maximal ATP production restore their normal physiological function. findings help better understand complex amyloid aggregates ultimately find neuroprotective drug candidates will able spread

Language: Английский

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Brain–Computer Interfaces for Communication in Patients with Disorders of Consciousness: A Gap Analysis and Scientific Roadmap

Neurocritical Care, Journal Year: 2024, Volume and Issue: 41(1), P. 129 - 145

Published: Jan. 29, 2024

Language: Английский

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Invasive therapies for Parkinson’s disease: an adapted excerpt from the guidelines of the German Society of Neurology

Journal of Neurology, Journal Year: 2025, Volume and Issue: 272(3)

Published: Feb. 22, 2025

Abstract Background Parkinson’s disease (PD) is characterized by hypokinetic motor symptoms, tremor, and various non-motor symptoms with frequent fluctuations of in advanced stages. Invasive therapies, such as deep brain stimulation (DBS), ablative continuous subcutaneous or intrajejunal delivery dopaminergic drugs via pump therapies are available for the management this complex symptomatology may also impact symptoms. The recent update clinical guideline on PD German Neurological Society (Deutsche Gesellschaft für Neurologie e.V.; DGN) offers clear guidance indications applications these treatment options. Methods committee formulated diagnostic questions invasive structured them according to PICOS framework (Population–Intervention–Comparisons–Outcome–Studies). A systematic literature review was conducted. Questions were addressed using findings from consented committee. Results Specific recommendations given regarding (i) optimal timing starting (ii) application DBS, (iii) use PD, (iv) procedures, selecting most appropriate therapy individual patient characteristics. Conclusion This an adapted excerpt chapters novel PD. Clear options provided.

Language: Английский

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