scholarly journals Earlier Intervention with Deep Brain Stimulation for Parkinson’s Disease

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Gerson Suarez-Cedeno ◽  
Jessika Suescun ◽  
Mya C. Schiess
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Therapeutic Benefit ◽  
Current Application ◽  
Fda Approval ◽  
Best Medical Therapy ◽  
Disease Stages ◽  
Deep Brain

Neuromodulation of subcortical areas of the brain as therapy to reduce Parkinsonian motor symptoms was developed in the mid-twentieth century and went through many technical and scientific advances that established specific targets and stimulation parameters. Deep Brain Stimulation (DBS) was approved by the FDA in 2002 as neuromodulation therapy for advanced Parkinson’s disease, prompting several randomized controlled trials that confirmed its safety and effectiveness. The implantation of tens of thousands of patients in North America and Europe ignited research into its potential role in early disease stages and the therapeutic benefit of DBS compared to best medical therapy. In 2013 the EARLY-STIM trial provided Class I evidence for the use of DBS earlier in Parkinson’s disease. This finding led to the most recent FDA approval in patients with at least 4 years of disease duration and 4 months of motor complications as an adjunct therapy for patients not adequately controlled with medications. This following review highlights the historical development and advances made overtime in DBS implantation, the current application, and the challenges that come with it.

scholarly journals Subthalamic deep brain stimulation versus best medical therapy for l-dopa responsive pain in Parkinson’s disease

Pain ◽  
2013 ◽  
Vol 154 (8) ◽  
pp. 1477-1479 ◽  
Author(s):  
Oguzkan Sürücü ◽  
Heide Baumann-Vogel ◽  
Mechtild Uhl ◽  
Lukas L. Imbach ◽  
Christian R. Baumann
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Medical Therapy ◽  
Brain Stimulation ◽  
Best Medical Therapy ◽  
Deep Brain

Utility of GPI+VIM dual-lead deep brain stimulation for Parkinson’s disease patients with significant residual tremor on medication

2021 ◽  
pp. 1-7
Author(s):  
Adel Azghadi ◽  
Megan M. Rajagopal ◽  
Kelsey A. Atkinson ◽  
Kathryn L. Holloway
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Number Of Patients ◽  
Scale Scores ◽  
Dual Lead ◽  
Best Medical Therapy ◽  
Deep Brain

OBJECTIVE Randomized controlled trials have demonstrated that deep brain stimulation (DBS) of both the globus pallidus internus (GPI) and subthalamic nucleus (STN) for Parkinson’s disease (PD) is superior to the best medical therapy. Tremor is particularly responsive to DBS, with reports of 70%–80% improvement. However, a small number of patients do not obtain the expected response with both STN and GPI targets. Indeed, the authors’ patient population had a similar 81.2% tremor reduction with a 9.6% failure rate. In an analysis of these failures, they identified patients with preoperative on-medication tremor who subsequently received a GPI lead as a subpopulation at higher risk for inadequate tremor control. Thereafter, STN DBS was recommended for patients with on-medication tremor. However, for the patients with symptoms and comorbidities that favored GPI as the target, dual GPI and ventral intermediate nucleus of the thalamus (VIM) leads were proposed. This report details outcomes for those patients. METHODS This is a retrospective review of patients with PD who met the criteria for and underwent simultaneous GPI+VIM DBS surgery from 2015 to 2020 and had available follow-up data. The preoperative Unified Parkinson’s Disease Rating Scale scores were obtained with the study participants on and off their medication. Postoperatively, the GPI lead was kept on at baseline and scores were obtained with and without VIM stimulation. RESULTS Thirteen PD patients with significant residual preoperative tremor on medication underwent simultaneous GPI+VIM DBS surgery (11 unilateral, 2 bilateral). A mean 90.6% (SD 15.0%) reduction in tremor scores was achieved with dual GPI+VIM stimulation compared to a 21.8% (SD 71.9%) reduction with GPI stimulation alone and a 30.9% (SD 37.8%) reduction with medication. Although rigidity and bradykinesia reductions were accomplished with just GPI stimulation, 13 of the 15 hemispheres required VIM stimulation to achieve excellent tremor control. CONCLUSIONS GPI+VIM stimulation was required to adequately control tremor in all but 2 patients in this series, substantiating the authors’ hypothesis that, in their population, medication-resistant tremor does not completely respond to GPI stimulation. Dual stimulation of the GPI and VIM proved to be an effective option for the patients who had symptoms and comorbidities that favored GPI as a target and had medication-resistant tremor.

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