Journal ArticleDOI
Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial
Vincent J. J. Odekerken,Teus van Laar,Michiel J. Staal,Arne Mosch,Carel F.E. Hoffmann,Peter C G Nijssen,Guus N. Beute,Jeroen P. P. van Vugt,Mathieu W.P.M. Lenders,M. Fiorella Contarino,Marieke S J Mink,Lo J. Bour,Pepijn van den Munckhof,Ben Schmand,Rob J. de Haan,P. Richard Schuurman,Rob M.A. de Bie +16 more
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TLDR
The findings suggest that STN could be the preferred target for DBS in patients with advanced Parkinson's disease, and no statistically significant difference was found in either of the primary outcomes.Abstract:
Summary Background Patients with advanced Parkinson's disease often have rapid swings between mobility and immobility, and many respond unsatisfactorily to adjustments in pharmacological treatment. We assessed whether globus pallidus pars interna (GPi) deep brain stimulation (DBS) gives greater functional improvement than does subthalamic nucleus (STN) DBS. Methods We recruited patients from five centres in the Netherlands who were aged 18 years or older, had idiopathic Parkinson's disease, and had, despite optimum pharmacological treatment, at least one of the following symptoms: severe response fluctuations, dyskinesias, painful dystonias, or bradykinesia. By use of a computer-generated randomisation sequence, we randomly assigned patients to receive either GPi DBS or STN DBS (1:1), applying a minimisation procedure according to drug use (levodopa equivalent dose vs ≥1000 mg) and treatment centre. Patients and study assessors (but not those who assessed adverse events) were masked to treatment allocation. We had two primary outcomes: functional health as measured by the weighted Academic Medical Center Linear Disability Scale (ALDS; weighted by time spent in the off phase and on phase) and a composite score for cognitive, mood, and behavioural effects up to 1 year after surgery. Secondary outcomes were symptom scales, activities of daily living scales, a quality-of-life questionnaire, the occurrence of adverse events, and drug use. We used the intention-to-treat principle for all analyses. This trial is registered with www.controlled-trials.com, number ISRCTN85542074. Findings Between Feb 1, 2007, and March 29, 2011, we enrolled 128 patients, assigning 65 to GPi DBS and 63 to STN DBS. We found no statistically significant difference in either of our primary outcomes: mean change in weighted ALDS (3·0 [SD 14·5] in the GPi group vs 7·7 [23·2] in the STN group; p=0·28) and the number of patients with cognitive, mood, and behavioural side-effects (36 [58%] of 62 patients in the GPi group vs 35 [56%] of 63 patients in the STN group; p=0·94). Secondary outcomes showed larger improvements in off-drug phase in the STN group compared with the GPi group in the mean change in unified Parkinson's disease rating scale motor examination scores (20·3 [16·3] vs 11·4 [16·1]; p=0·03), the mean change in ALDS scores (20·3 [27·1] vs 11·8 [18·9]; p=0·04), and medication (mean levodopa equivalent drug reduction: 546 [SD 561] vs 208 [521]; p=0·01). We recorded no difference in the occurrence of adverse events between the two groups. Other secondary endpoints showed no difference between the groups. Interpretation Although there was no difference in our primary outcomes, our findings suggest that STN could be the preferred target for DBS in patients with advanced Parkinson's disease. Funding Stichting Internationaal Parkinson Fonds, Prinses Beatrix Fonds, and Parkinson Vereniging.read more
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Journal ArticleDOI
Deep brain stimulation.
TL;DR: Deep brain stimulation is clinically effective in improving motor function of essential tremor, Parkinson's disease and primary dystonia and in relieving obsessive-compulsive disorder.
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Direct and indirect pathways of basal ganglia: a critical reappraisal
TL;DR: A model in which intrastriatal connections are critical and the two pathways are structurally and functionally intertwined is proposed, in which all MSNs might either facilitate or inhibit movement depending on the form of synaptic plasticity expressed at a certain moment.
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International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease
Susan H. Fox,Regina Katzenschlager,Shen-Yang Lim,Brandon R. Barton,Rob M.A. de Bie,Klaus Seppi,Miguel Coelho,Cristina Sampaio +7 more
TL;DR: The objective of this review was to update evidence‐based medicine recommendations for treating motor symptoms of Parkinson's disease with new recommendations for treatment of central nervous system symptoms.
Journal ArticleDOI
Toward defining deep brain stimulation targets in MNI space: A subcortical atlas based on multimodal MRI, histology and structural connectivity.
Siobhan Ewert,Siobhan Ewert,Philip Plettig,Ningfei Li,Ningfei Li,M. Mallar Chakravarty,M. Mallar Chakravarty,D. Louis Collins,Todd M. Herrington,Andrea A. Kühn,Andreas Horn,Andreas Horn +11 more
TL;DR: A composite atlas based on manual segmentations of a multimodal high resolution brain template, histology and structural connectivity is presented that can be used to segment DBS targets in single subjects, yielding more accurate results compared to priorly published atlases.
Journal ArticleDOI
Mechanisms of deep brain stimulation.
TL;DR: Deep brain stimulation is widely used for the treatment of movement disorders including Parkinson's disease, essential tremor, and dystonia and, to a lesser extent, certain treatment-resistant neuropsychiatric disorders including obsessive-compulsive disorder.
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