Deep Brain Stimulation in the Treatment of Parkinson’s Disease DOI Open Access

Heeya Shah,

Omer Usman,

Habib Ur Rehman

et al.

Cureus, Journal Year: 2022, Volume and Issue: unknown

Published: Sept. 3, 2022

Parkinson's disease (PD) is a common progressive neurodegenerative movement disorder. The cardinal feature of neuronal degeneration causing dopamine deficit in the brain which leads to host clinical features patient. However, consensus over specific criteria for diagnosis remains be established. does not have cure yet, but variety diagnostic and treatment protocols been developed years with primary focus on pharmacological therapy. Anti-parkinsonian drugs such as levodopa lose their efficacy time are needed higher doses inevitably progresses. An alternative therapy deep stimulation (DBS). Deep involves transcranial placement unilateral or bilateral (wires) most commonly sub-thalamic nucleus globus pallidus interna by stereotactic surgery. Given multiple hypotheses explaining different effects DBS sometimes conflicting mechanisms, it difficult pinpoint exact way operates. Nevertheless, has proven significantly effective. DBS, although being cost-effective measure patients, without limitations. A careful selection patients required preoperatively that determines response tolerance patients. This review aims summarize current literature hypothesized criteria, advantages its

Language: Английский

Treatment Options for Motor and Non-Motor Symptoms of Parkinson’s Disease DOI Creative Commons
Frank Church

Biomolecules, Journal Year: 2021, Volume and Issue: 11(4), P. 612 - 612

Published: April 20, 2021

Parkinson’s disease (PD) usually presents in older adults and typically has both motor non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss the mid-brain substantia nigra pars compacta region. Outlined here an integrative medicine health strategy that highlights five treatment options for people with (PwP): rehabilitate, therapy, restorative, maintenance, surgery. Rehabilitating begins following diagnosis throughout any additional processes, especially vis-à-vis consulting physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either dopamine precursor levodopa (with carbidopa) or agonist, compounds preserve residual dopamine, other specific motor/non-motor-related compounds. Restorative strenuous aerobic exercise programs can be neuroprotective. Maintenance complementary alternative substances potentially support protect brain microenvironment. Finally, surgery, including deep stimulation, pursued when PwP fail to respond positively options. There currently no cure PD. In conclusion, best treating hope slow progression strive achieve stability neuroprotection. The ultimate goal management program improve quality-of-life person disease.

Language: Английский

Citations

179
How Does Deep Brain Stimulation Change the Course of Parkinson's Disease? DOI
Philipp Mahlknecht, Thomas Foltynie, Patricia Limousin

et al.

Movement Disorders, Journal Year: 2022, Volume and Issue: 37(8), P. 1581 - 1592

Published: May 12, 2022

A robust body of evidence from randomized controlled trials has established the efficacy deep brain stimulation (DBS) in reducing off time and dyskinesias levodopa-treated patients with Parkinson's disease (PD). These effects go along improvements on period motor function, activities daily living, quality life. In addition, subthalamic DBS is effective controlling drug-refractory PD tremor. Here, we review available data long-term observational follow-up studies DBS-treated to re-examine persistence life benefits evaluate progression, major disability milestones, survival. Although there consistent over 5-10 years beyond showing sustained improvement control, impact overall progression less clear. Whether reduces or delays development later non-motor milestones comparison best medical management strategies difficult answer by uncontrolled follow-up, but are signals suggesting that may delay some late-stage including psychosis, falls, institutionalization, also slightly prolongs survival compared matched medically managed patients. observations could be attributable function reduction medication-induced side effects, whereas no clinical direct underlying progression. © 2022 The Authors. Movement Disorders published Wiley Periodicals LLC behalf International Parkinson Disorder Society.

Language: Английский

Citations

61
Is physical therapy recommended for people with parkinson’s disease treated with subthalamic deep brain stimulation? a delphi consensus study DOI Creative Commons
Matteo Guidetti, Sara Marceglia, Tommaso Bocci

et al.

Journal of NeuroEngineering and Rehabilitation, Journal Year: 2025, Volume and Issue: 22(1)

Published: April 10, 2025

Although deep brain stimulation of the subthalamic nucleus (STN-DBS) induces motor benefits in people with Parkinson's disease (PwPD), its effect on axial symptoms (e.g., postural instability, trunk posture alterations) and gait impairments freezing gait) is still ambiguous. Physical therapy (PT) effectively complements pharmacological treatment to improve stability, performance, other dopamine-resistant (e.g. general population PD. Despite positive potential combined PT STN-DBS surgery, scientific results are lacking. We therefore involved worldwide leading experts DBS rehabilitation PwPD a consensus Delphi panel define current level recommendation following surgery. After summarizing few available findings through systematic scoping review, we identified clinically academically experienced clinicians (n = 21) discuss challenges related STN-DBS. A 5-point Likert scale questionnaire was used based thirty-nine questions were designed submitted panel-half considerations STN-DBS, half treatments. low-to-moderate quality data, studies suggested that could dynamic static balance, performance PD receiving Similarly, panellists strongly agreed might help life, it may be prescribed maximize effects stimulation. The physical therapists part multidisciplinary team taking care patients. Also, they conventional PT, but not massage or manual therapy, should because specificity implantation. RCT evidence lacking, upon panel, for can potentially useful clinical improvement. However, more research needed, RCTs well-designed studies. community expand this area create guidelines

Language: Английский

Citations

1
Subthalamic and nigral stimulation for freezing of gait in Parkinson's disease: Randomized pilot trial DOI Creative Commons
Carlo Alberto Artusi, Claudia Ledda, Silvia Gallo

et al.

Journal of Parkinson s Disease, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 17, 2025

Freezing of gait (FoG) is a debilitating symptom Parkinson's disease (PD) with limited response to dopaminergic medication and subthalamic deep brain stimulation (STN-DBS). Substantia nigra pars reticulata (SNr) could improve FoG. To analyze the effect combined STN-SNr at different frequencies on We performed double-blind, cross-over, randomized pilot trial involving STN-DBS treated PD patients Participants received: high-frequency (HF) (S), HF-STN SNr (C1), low-frequency (LF) (C2), for one month each. The primary endpoint was score change in New-Freezing-of-Gait-Questionnaire (NFOG-Q). Secondary analyses were motor complications, axial symptoms, daily living activities, psychiatric sleep, patient preference. Fifteen received least stimulation. No significant difference NFOG-Q scores found between S, C1, C2; one-third showed clinically improvement (≥8 points) stimulations. Motor complications improved significantly C1 C2 (C1-S: 3.6 ± 3.8 vs. 4.9 3.8, p = 0.046; C2-S: 2.7 3.1 0.005). 80% preferred while blinded. All adverse events manageable. Our study did not prove statistically stimulation; however, experienced meaningful FoG improvement, majority maintain both safe effective addressing improving sleep quality, highlighting importance further exploration into effects

Language: Английский

Citations

0
Device-assisted therapies for Parkinson disease. DOI
Nadia Mouchaileh, Jillian M. Cameron

PubMed, Journal Year: 2025, Volume and Issue: 48(1), P. 10 - 17

Published: Feb. 1, 2025

Device-assisted therapies for Parkinson disease include apomorphine continuous subcutaneous infusion, levodopa intestinal gel infusion and deep brain stimulation. These have a role in managing motor fluctuations dyskinesias people with advanced when symptoms are inadequately controlled oral transdermal treatments. Subcutaneous of or the least invasive device-assisted therapies. Levodopa is delivered via surgically placed tube. Deep stimulation involves implanting electrodes into specific target regions basal ganglia to modulate activity. Selecting an appropriate therapy depends on individual factors such as age, comorbidities, symptom severity patient preferences. Initiation management require neurologist multidisciplinary involvement, typically specialist movement disorder centre. Primary care clinicians play crucial ongoing support using these therapies, including monitoring adverse effects communicating services.

Language: Английский

Citations

0
Deep brain stimulation in progressive supranuclear palsy: a dead-end story? A narrative review DOI
Gabriele Bellini, Giulia Di Rauso, Lorenzo Fontanelli

et al.

Journal of Neural Transmission, Journal Year: 2025, Volume and Issue: unknown

Published: March 24, 2025

Language: Английский

Citations

0
Managing impulse control and related behavioral disorders in Parkinson’s disease: where we are in 2025? DOI
Leonardo Rigon,

Carmelo Fogliano,

К. Ray Chaudhuri

et al.

Expert Review of Neurotherapeutics, Journal Year: 2025, Volume and Issue: unknown

Published: March 28, 2025

Introduction Impulse control and related behavioral disorders (ICBDs) commonly complicate Parkinson's disease (PD) course. The ICBDs spectrum encompasses two groups of conditions, with distinct pathophysiology: proper 'impulse (ICDs)' (e.g. gambling) the 'ICDs (ICDs-RD)' punding). Behavioral disturbances are associated dopamine replacement therapies. significantly affect quality life patients caregivers, making their management essential for reducing overall burden PD.

Language: Английский

Citations

0
Global improvement after deep brain stimulation in Parkinson’s disease: Comparison between patient and clinician perspectives DOI Creative Commons
Pietro Antenucci, Fabiana Colucci, Andrea Gozzi

et al.

Journal of Clinical Neuroscience, Journal Year: 2025, Volume and Issue: 137, P. 111323 - 111323

Published: May 13, 2025

The definition of improvement after Deep Brain Stimulation (DBS) in Parkinson's Disease (PD) remains unclear. neurologist's perspective, based on measurable parameters, may differ from the patient's perception, and both are crucial for therapeutic success. Whether clinical variables influence these differences is unknown. To compare correlation between clinician-assessed (Clinical Global Impression Improvement, CGI) patient-reported (Patient Change, PGIC) DBS identify factors affecting variability. We included patients treated at Ferrara Hospital (2006-2022) with ≥ 1-year follow-up. CGI PGIC were collected that time, their analyzed across demographic subgroups. Among 51 PD patients, rated 21 as "very much improved," "much 9 "minimally primarily MDS-UPDRS III reduction. Agreement was 0.65 (p < 0.001), unaffected by age, gender, disease duration, IPG type, LEDD, medication count, improvement, or stimulation-induced complications. Concordance weaker (k 0.60) higher baseline III, lower IV, less IV greater tablet reduction, fewer outpatient visits. It stronger > 0.70) more follow-ups first year. Clinician-patient agreement moderate, motor symptom amelioration only partially reflecting patients' overall perceived improvement. Various widen gap concordance, particularly subtle according to clinicians, while due stimulation management enhance it. Clinicians must consider perspectives mirror those patient during treatment.

Language: Английский

Citations

0
Preoperative network activity predicts the response to subthalamic DBS for Parkinson’s disease DOI

Prashin Unadkat,

An Vo, Yilong Ma

et al.

Published: May 14, 2025

Abstract Quantitative imaging markers to aid in the selection of Parkinson’s disease (PD) patients for surgical interventions such as subthalamic nucleus deep brain stimulation (STN-DBS) are currently lacking. Using metabolic PET and network analysis we identified validated a treatment-induced topography, termed STN StimNet. Stimulation-mediated changes expression correlated with concurrent motor improvement independent STN-DBS cohorts scanned on off stimulation. Moreover, StimNet measurements local field potentials recorded from STN, whereas intraoperative modulation cortical activity by contributions corresponding regions. These findings suggested that stimulation-mediated clinical responses influenced baseline expression. Indeed, found outcomes following were predicted preoperative measured using or resting state fMRI. To illustrate potential utility these measures selecting optimal candidates DBS surgery, was computed scans 175 PD (0–21 years diagnosis). The resulting values used identify those individuals likely derive meaningful benefit procedure. This approach suggests quantification provides unique information regarding circuitry, which may be useful decision making.

Language: Английский

Citations

0
Preoperative Levodopa Response and Deep Brain Stimulation Effects on Motor Outcomes in Parkinson's Disease: A Systematic Review DOI Open Access
Zhengyu Lin, Chencheng Zhang, Dianyou Li

et al.

Movement Disorders Clinical Practice, Journal Year: 2021, Volume and Issue: 9(2), P. 140 - 155

Published: Nov. 20, 2021

The up-to-date literature systematically reviewing the predictive value of preoperative levodopa responsiveness after deep brain stimulation (DBS) surgery in motor outcomes Parkinson's disease (PD) is lacking.To address this issue patients with PD undergoing bilateral subthalamic nucleus (STN) or globus pallidus interna (GPi) DBS.We used existing PRISMA consensus statement. A comprehensive review from 1993 to May 2021 retrieved PubMed was conducted.The STN-DBS significantly correlated for total score UPDRS-III at both 6- and 12-month follow-ups (P < 0.001). Such correlations were significant controlling age time duration. significance correlation disappeared longer follow-up times. For sub-scores UPDRS-III, a between STN DBS observed rigidity, bradykinesia, axial symptoms, but not tremor = 0.002, 0.010, 0.007, 0.542, respectively). GPi median 12 months 0.030).The current study confirmed prediction short-term outcome (for GPi). respective cardinal disabilities loss its long-term highlighted by study.

Language: Английский

Citations

21