Limits...
Effect of Subthalamic Deep Brain Stimulation on Levodopa-Induced Dyskinesia in Parkinson's Disease.

Kim JH, Chang WS, Jung HH, Chang JW - Yonsei Med. J. (2015)

Bottom Line: The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients.Group 2 was further divided by the location of DBS leads.Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

View Article: PubMed Central - PubMed

Affiliation: Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on levodopa-induced peak-dose dyskinesia in patients with Parkinson's disease (PD).

Materials and methods: A retrospective review was conducted on patients who underwent STN DBS for PD from May 2000 to July 2012. Only patients with levodopa-induced dyskinesia prior to surgery and more than 1 year of available follow-up data after DBS were included. The outcome measures included the dyskinesia subscore of the Unified Parkinson's Disease Rating Scale (UPDRS) part IV (items 32 to 34 of UPDRS part IV) and the levodopa equivalent daily dose (LEDD). The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients. Group 2 was further divided by the location of DBS leads.

Results: Of the 100 patients enrolled, 67 were in Group 1, while those remaining were in Group 2. Twelve months after STN DBS, Groups 1 and 2 showed improvements of 61.90% and 57.14%, respectively, in the dyskinesia subscore. Group 1 was more likely to experience dyskinesia suppression; however, the association between the groups and dyskinesia suppression was not statistically significant (p=0.619). In Group 2, dyskinesia was significantly decreased by stimulation of the area above the STN in 18 patients compared to stimulation of the STN in 15 patients (p=0.048).

Conclusion: Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

No MeSH data available.


Related in: MedlinePlus

Schematic illustration of the electrode insertion site as described in Hamani, et al.36 The 0 and 1 contacts were located in the STN, whereas the 2 and 3 contacts were located in the area above the STN including the zona incerta. AL, ansa lenticularis; CP, cerebral peduncle; FF, Field of Forel; GPe, globus pallidus externus; GPi, globus pallidus internus; H1, H1 Field of Forel (thalamic fasciculus); IC, internal capsule; LF, lenticular fasciculus (H2); PPN, pedunculopontine nucleus; Put, putamen; SN, substantia nigra; STN, subthalamic nucleus; Thal, thalamus; ZI, zona incerta.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4541661&req=5

Figure 1: Schematic illustration of the electrode insertion site as described in Hamani, et al.36 The 0 and 1 contacts were located in the STN, whereas the 2 and 3 contacts were located in the area above the STN including the zona incerta. AL, ansa lenticularis; CP, cerebral peduncle; FF, Field of Forel; GPe, globus pallidus externus; GPi, globus pallidus internus; H1, H1 Field of Forel (thalamic fasciculus); IC, internal capsule; LF, lenticular fasciculus (H2); PPN, pedunculopontine nucleus; Put, putamen; SN, substantia nigra; STN, subthalamic nucleus; Thal, thalamus; ZI, zona incerta.

Mentions: Under local anesthesia, implantation of the DBS electrodes was performed bilaterally in all patients using a Leksell stereotactic frame and magnetic resonance imaging (MRI; Philips MR System Achieva, Eindhoven, the Netherlands)-guided targeting with Surgiplan (Elekta, Stockholm, Sweden). Initial values for STN localization were 12 mm lateral, 2 mm posterior, and 4 mm inferior to the mid-point between the anterior and posterior commissures. Single-track microelectrode recording (MER) using the Microdrive System (Medtronic, Inc., Minneapolis, MN, USA) was performed, and cell activity was recorded starting from 15 mm above the STN target. After the precise localization of the target point, DBS electrodes (Medtronic 3387; Minneapolis, MN, USA) with four contact points were placed in such a way that the tip of the electrode was located on the ventral boundary of the STN, passing through the center of the STN. Each contact of the DBS electrode was 1.5 mm long, and the contacts were 1.5 mm apart from each other. Based on the MER results, electrodes were positioned and labeled as follows: 0 and 1, STN; 2 and 3, the area above the STN (Fig. 1). After satisfactory outcomes during test stimulations, the position of each electrode was verified by postoperative MRI or computed tomography that was merged with the preoperatively planned target and trajectory. If the actual electrode position was acceptable, the DBS electrodes were connected to an implantable pulse generator (IPG) placed in the subclavicular area under general anesthesia. The patients underwent a single-stage operation in which both DBS electrode insertion and IPG implantation were performed on the same day. An efficacy test was performed about 1 month after surgery. Over the next 1-2 months, the contact and stimulation parameters were optimized to obtain maximum clinical benefit and minimal side effects.


Effect of Subthalamic Deep Brain Stimulation on Levodopa-Induced Dyskinesia in Parkinson's Disease.

Kim JH, Chang WS, Jung HH, Chang JW - Yonsei Med. J. (2015)

Schematic illustration of the electrode insertion site as described in Hamani, et al.36 The 0 and 1 contacts were located in the STN, whereas the 2 and 3 contacts were located in the area above the STN including the zona incerta. AL, ansa lenticularis; CP, cerebral peduncle; FF, Field of Forel; GPe, globus pallidus externus; GPi, globus pallidus internus; H1, H1 Field of Forel (thalamic fasciculus); IC, internal capsule; LF, lenticular fasciculus (H2); PPN, pedunculopontine nucleus; Put, putamen; SN, substantia nigra; STN, subthalamic nucleus; Thal, thalamus; ZI, zona incerta.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541661&req=5

Figure 1: Schematic illustration of the electrode insertion site as described in Hamani, et al.36 The 0 and 1 contacts were located in the STN, whereas the 2 and 3 contacts were located in the area above the STN including the zona incerta. AL, ansa lenticularis; CP, cerebral peduncle; FF, Field of Forel; GPe, globus pallidus externus; GPi, globus pallidus internus; H1, H1 Field of Forel (thalamic fasciculus); IC, internal capsule; LF, lenticular fasciculus (H2); PPN, pedunculopontine nucleus; Put, putamen; SN, substantia nigra; STN, subthalamic nucleus; Thal, thalamus; ZI, zona incerta.
Mentions: Under local anesthesia, implantation of the DBS electrodes was performed bilaterally in all patients using a Leksell stereotactic frame and magnetic resonance imaging (MRI; Philips MR System Achieva, Eindhoven, the Netherlands)-guided targeting with Surgiplan (Elekta, Stockholm, Sweden). Initial values for STN localization were 12 mm lateral, 2 mm posterior, and 4 mm inferior to the mid-point between the anterior and posterior commissures. Single-track microelectrode recording (MER) using the Microdrive System (Medtronic, Inc., Minneapolis, MN, USA) was performed, and cell activity was recorded starting from 15 mm above the STN target. After the precise localization of the target point, DBS electrodes (Medtronic 3387; Minneapolis, MN, USA) with four contact points were placed in such a way that the tip of the electrode was located on the ventral boundary of the STN, passing through the center of the STN. Each contact of the DBS electrode was 1.5 mm long, and the contacts were 1.5 mm apart from each other. Based on the MER results, electrodes were positioned and labeled as follows: 0 and 1, STN; 2 and 3, the area above the STN (Fig. 1). After satisfactory outcomes during test stimulations, the position of each electrode was verified by postoperative MRI or computed tomography that was merged with the preoperatively planned target and trajectory. If the actual electrode position was acceptable, the DBS electrodes were connected to an implantable pulse generator (IPG) placed in the subclavicular area under general anesthesia. The patients underwent a single-stage operation in which both DBS electrode insertion and IPG implantation were performed on the same day. An efficacy test was performed about 1 month after surgery. Over the next 1-2 months, the contact and stimulation parameters were optimized to obtain maximum clinical benefit and minimal side effects.

Bottom Line: The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients.Group 2 was further divided by the location of DBS leads.Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

View Article: PubMed Central - PubMed

Affiliation: Division of Stereotactic and Functional Neurosurgery, Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

Purpose: To evaluate the effect of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on levodopa-induced peak-dose dyskinesia in patients with Parkinson's disease (PD).

Materials and methods: A retrospective review was conducted on patients who underwent STN DBS for PD from May 2000 to July 2012. Only patients with levodopa-induced dyskinesia prior to surgery and more than 1 year of available follow-up data after DBS were included. The outcome measures included the dyskinesia subscore of the Unified Parkinson's Disease Rating Scale (UPDRS) part IV (items 32 to 34 of UPDRS part IV) and the levodopa equivalent daily dose (LEDD). The patients were divided into two groups based on preoperative to postoperative LEDD change at 12 months after the surgery: Group 1, LEDD decrease >15%; Group 2, all other patients. Group 2 was further divided by the location of DBS leads.

Results: Of the 100 patients enrolled, 67 were in Group 1, while those remaining were in Group 2. Twelve months after STN DBS, Groups 1 and 2 showed improvements of 61.90% and 57.14%, respectively, in the dyskinesia subscore. Group 1 was more likely to experience dyskinesia suppression; however, the association between the groups and dyskinesia suppression was not statistically significant (p=0.619). In Group 2, dyskinesia was significantly decreased by stimulation of the area above the STN in 18 patients compared to stimulation of the STN in 15 patients (p=0.048).

Conclusion: Levodopa-induced dyskinesia is attenuated by STN DBS without reducing the levodopa dosage.

No MeSH data available.


Related in: MedlinePlus