Journal of Movement Disorders

Brief communication

Monitoring Cognitive Functions During Deep Brain Stimulation Interventions by Real Time Neuropsychological Testing: Ilaria Guarracino, Christian Lettieri, Massimo Mondani, Stanislao D’Auria, Giovanni Sciacca, Flavia Lavezzi, Miran Skrap, Serena D’Agostini, Gian Luigi Gigli, Mariarosaria Valente, Barbara Tomasino; J Mov Disord. 2024;17(4):442-446. Published online September 23, 2024; DOI: https://doi.org/10.14802/jmd.24102

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Abstract PDF Supplementary Material: Objective
We monitored cognition in 14 Parkinson’s disease (PD) patients during deep brain stimulation (DBS) surgery when the electrode was positioned at the target subthalamic nucleus (STN) (i.e., the STN motor area).
Methods
We present the DBS-real-time neuropsychological testing (DBS-RTNT) protocol and our preliminary experience with it; we also compared the intraoperative patient performance with the baseline data.
Results
Compared with the baseline data, patients undergoing DBS-RTNT in the target area demonstrated a significantly decreased performance on some tasks belonging to the memory and executive function domains. Patients undergoing right hemisphere DBS-RTNT had significantly lower short-term memory and sequencing scores than did patients undergoing left hemisphere DBS-RTNT.
Conclusion
PD patient cognitive performance should be monitored during DBS surgery, as STN-DBS may induce changes. These preliminary data contribute to improving our understanding of the anatomo-functional topography of the STN during DBS surgery, which will enable the identification of the best site for producing positive motor effects without causing negative cognitive and/or emotional changes in individual patients in the future. In principle, medications (i.e., patients who underwent surgery in a levodopa-off state) could have influenced our results; therefore, future studies are needed to address the possible confounding effects of levodopa use.

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

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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

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Abstract 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
Subthalamic deep brain stimulation in advanced Parkinson’s disease using the STarFix system
Amr Elnaggar, Ahmad Elshanawany, Ahmad Ebrahim Elgheriany, Mahmoud Hasan Ragab, Ahmad Radwan Nouby
Egyptian Journal of Neurosurgery.2024;[Epub] CrossRef
Individual Structural Covariance Network Predicts Long-Term Motor Improvement in Parkinson Disease with Subthalamic Nucleus Deep Brain Stimulation
Yu Diao, Hutao Xie, Yanwen Wang, Baotian Zhao, Anchao Yang, Jianguo Zhang
American Journal of Neuroradiology.2024; 45(8): 1106. CrossRef
Circular walking is useful for assessing the risk of falls in early progressive supranuclear palsy
Masahiro Ohara, Kosei Hirata, Taiki Matsubayashi, Qingmeng Chen, Kaoru Shimano, Ryoichi Hanazawa, Akihiro Hirakawa, Takanori Yokota, Takaaki Hattori
Journal of Neurology.2024; 271(9): 6349. 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

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Abstract 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

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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

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Abstract 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

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Directional deep brain stimulation electrodes in Parkinson’s disease: meta-analysis and systematic review of the literature
Victor Hvingelby, Fareha Khalil, Flavia Massey, Alexander Hoyningen, San San Xu, Joseph Candelario-McKeown, Harith Akram, Thomas Foltynie, Patricia Limousin, Ludvic Zrinzo, Marie T Krüger
Journal of Neurology, Neurosurgery & Psychiatry.2025; 96(2): 188. CrossRef
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

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Abstract PDF Supplementary 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
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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
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Cumhuriyet Medical Journal.2017; 39(3): 509. CrossRef

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