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Semin Neurol 2017; 37(02): 205-214
DOI: 10.1055/s-0037-1601893
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Current Practice and the Future of Deep Brain Stimulation Therapy in Parkinson's Disease

Leonardo Almeida
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Wissam Deeb
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Chauncey Spears
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Enrico Opri
2   Biomedical Engineering, University of Florida, Gainesville, Florida
,
Rene Molina
2   Biomedical Engineering, University of Florida, Gainesville, Florida
,
Daniel Martinez-Ramirez
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Aysegul Gunduz
2   Biomedical Engineering, University of Florida, Gainesville, Florida
,
Christopher W. Hess
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
,
Michael S. Okun
1   Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, Gainesville, Florida
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2017 (online)

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Abstract

Deep brain stimulation (DBS) is an effective therapy for Parkinson's disease patients experiencing motor fluctuations, medication-resistant tremor, and/or dyskinesia. Currently, the subthalamic nucleus and the globus pallidus internus are the two most widely used targets, with individual advantages and disadvantages influencing patient selection. Potential DBS patients are selected using the few existing guidelines and the available DBS literature, and many centers employ an interdisciplinary team review of the individual's risk–benefit profile. Programmed settings vary based on institution- or physician-specific protocols designed to maximize benefits and limit adverse effects. Expectations should be realistic and clearly defined during the evaluation process, and each bothersome symptom should be addressed in the context of building the risk–benefit profile. Current DBS research is focused on improved symptom control, the development of newer technologies, and the improved efficiency of stimulation delivery. Techniques deliver stimulation in a more personalized way, and methods of adaptive DBS such as closed-loop approaches are already on the horizon.

Keywords

Parkinson's disease - deep brain stimulation - closed-loop
 

  • References

  • 1 Martinez-Ramirez D, Hu W, Bona AR, Okun MS, Wagle Shukla A. Update on deep brain stimulation in Parkinson's disease. Transl Neurodegener 2015; 4: 12 . doi: 10.1186/s40035-015-0034-0
    CrossrefPubMedGoogle Scholar
  • 2 Bronstein JM, Tagliati M, Alterman RL , et al. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol 2011; 68 (2) 165-171
    CrossrefPubMedGoogle Scholar
  • 3 Gildenberg PL. Spiegel and Wycis - the early years. Stereotact Funct Neurosurg 2001; 77 (1-4): 11-16
    CrossrefPubMedGoogle Scholar
  • 4 Hariz MI, Blomstedt P, Zrinzo L. Deep brain stimulation between 1947 and 1987: the untold story. Neurosurg Focus 2010; 29 (2) E1 . doi: 10.3171/2010.4.FOCUS10106
    PubMedGoogle Scholar
  • 5 Schwalb JM, Hamani C. The history and future of deep brain stimulation. Neurotherapeutics 2008; 5 (1) 3-13
    CrossrefPubMedGoogle Scholar
  • 6 Miocinovic S, Somayajula S, Chitnis S, Vitek JL. History, applications, and mechanisms of deep brain stimulation. JAMA Neurol 2013; 70 (2) 163-171
    CrossrefPubMedGoogle Scholar
  • 7 Benabid AL, Pollak P, Louveau A, Henry S, de Rougemont J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson disease. Appl Neurophysiol 1987; 50 (1-6): 344-346
    PubMedGoogle Scholar
  • 8 Benabid AL, Pollak P, Seigneuret E, Hoffmann D, Gay E, Perret J. Chronic VIM thalamic stimulation in Parkinson's disease, essential tremor and extra-pyramidal dyskinesias. Acta Neurochir Suppl (Wien) 1993; 58: 39-44
    PubMedGoogle Scholar
  • 9 Pötter-Nerger M, Volkmann J. Deep brain stimulation for gait and postural symptoms in Parkinson's disease. Mov Disord 2013; 28 (11) 1609-1615
    CrossrefPubMedGoogle Scholar
  • 10 DeLong MR, Wichmann T. Basal ganglia circuits as targets for neuromodulation in Parkinson disease. JAMA Neurol 2015; 72 (11) 1354-1360
    CrossrefPubMedGoogle Scholar
  • 11 Pollak P, Benabid AL, Gross C , et al. Effets de la stimulation du noyau sous–thalamique dans la maladie de Parkinson. Rev Neurol (Paris) 1993; 149 (3) 175-176
    PubMedGoogle Scholar
  • 12 Bergman H, Wichmann T, DeLong MR. Reversal of experimental parkinsonism by lesions of the subthalamic nucleus. Science 1990; 249 (4975): 1436-1438
    CrossrefPubMedGoogle Scholar
  • 13 Siegfried J, Lippitz B. Bilateral chronic electrostimulation of ventroposterolateral pallidum: a new therapeutic approach for alleviating all parkinsonian symptoms. Neurosurgery 1994; 35 (6) 1126-1129 , discussion 1129–1130
    CrossrefPubMedGoogle Scholar
  • 14 Esselink RAJ, de Bie RMA, de Haan RJ , et al. Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD: a randomized trial. Neurology 2004; 62 (2) 201-207
    CrossrefPubMedGoogle Scholar
  • 15 Blomstedt P, Hariz GM, Hariz MI. Pallidotomy versus pallidal stimulation. Parkinsonism Relat Disord 2006; 12 (5) 296-301
    CrossrefPubMedGoogle Scholar
  • 16 Xu F, Ma W, Huang Y, Qiu Z, Sun L. Deep brain stimulation of pallidal versus subthalamic for patients with Parkinson's disease: a meta-analysis of controlled clinical trials. Neuropsychiatr Dis Treat 2016; 12: 1435-1444
    PubMedGoogle Scholar
  • 17 Deep-Brain Stimulation for Parkinson's Disease Study Group. Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med 2001; 345 (13) 956-963
    CrossrefPubMedGoogle Scholar
  • 18 Rodriguez-Oroz MC, Obeso JA, Lang AE , et al. Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up. Brain 2005; 128 (Pt 10): 2240-2249
    CrossrefPubMedGoogle Scholar
  • 19 Moro E, Lozano AM, Pollak P , et al. Long-term results of a multicenter study on subthalamic and pallidal stimulation in Parkinson's disease. Mov Disord 2010; 25 (5) 578-586
    CrossrefPubMedGoogle Scholar
  • 20 Odekerken VJJ, van Laar T, Staal MJ , et al. Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 2013; 12 (1) 37-44
    CrossrefPubMedGoogle Scholar
  • 21 Odekerken VJJVJJ, Boel JA, Schmand BABA , et al; NSTAPS study group. GPi vs STN deep brain stimulation for Parkinson disease: three-year follow-up. Neurology 2016; 86 (8) 755-761
    CrossrefPubMedGoogle Scholar
  • 22 Follett KA, Weaver FM, Stern M , et al; CSP 468 Study Group. Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 2010; 362 (22) 2077-2091
    CrossrefPubMedGoogle Scholar
  • 23 Okun MS, Fernandez HH, Wu SS , et al. Cognition and mood in Parkinson's disease in subthalamic nucleus versus globus pallidus interna deep brain stimulation: the COMPARE trial. Ann Neurol 2009; 65 (5) 586-595
    CrossrefPubMedGoogle Scholar
  • 24 Diamond A, Shahed J, Jankovic J. The effects of subthalamic nucleus deep brain stimulation on parkinsonian tremor. J Neurol Sci 2007; 260 (1-2): 199-203
    CrossrefPubMedGoogle Scholar
  • 25 Blahak C, Wöhrle JC, Capelle HH , et al. Tremor reduction by subthalamic nucleus stimulation and medication in advanced Parkinson's disease. J Neurol 2007; 254 (2) 169-178
    CrossrefPubMedGoogle Scholar
  • 26 Deuschl G, Schade-Brittinger C, Krack P , et al; German Parkinson Study Group, Neurostimulation Section. A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med 2006; 355 (9) 896-908
    CrossrefPubMedGoogle Scholar
  • 27 Liu Y, Li W, Tan C , et al. Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease. J Neurosurg 2014; 121 (3) 709-718
    CrossrefPubMedGoogle Scholar
  • 28 Sako W, Miyazaki Y, Izumi Y, Kaji R. Which target is best for patients with Parkinson's disease? A meta-analysis of pallidal and subthalamic stimulation. J Neurol Neurosurg Psychiatry 2014; 85 (9) 982-986
    CrossrefPubMedGoogle Scholar
  • 29 Anderson VC, Burchiel KJ, Hogarth P, Favre J, Hammerstad JP. Pallidal vs subthalamic nucleus deep brain stimulation in Parkinson disease. Arch Neurol 2016; ;•••: 62
    PubMedGoogle Scholar
  • 30 Weaver FM, Follett KA, Stern M , et al; CSP 468 Study Group. Randomized trial of deep brain stimulation for Parkinson disease: thirty-six-month outcomes. Neurology 2012; 79 (1) 55-65
    CrossrefPubMedGoogle Scholar
  • 31 Weaver FM, Follett K, Stern M , et al; CSP 468 Study Group. Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. JAMA 2009; 301 (1) 63-73
    CrossrefPubMedGoogle Scholar
  • 32 Portman AT, van Laar T, Staal MJ, Rutgers AWF, Journee HL, Leenders KL. Chronic stimulation of the subthalamic nucleus increases daily on-time without dyskinesia in advanced Parkinson's disease. Parkinsonism Relat Disord 2006; 12 (3) 143-148
    CrossrefPubMedGoogle Scholar
  • 33 Oyama G, Foote KD, Jacobson IV CE , et al. GPi and STN deep brain stimulation can suppress dyskinesia in Parkinson's disease. Parkinsonism Relat Disord 2012; 18 (7) 814-818
    CrossrefPubMedGoogle Scholar
  • 34 Combs HL, Folley BS, Berry DTR , et al. Cognition and depression following deep brain stimulation of the subthalamic nucleus and globus pallidus pars internus in Parkinson's disease: a meta-analysis. Neuropsychol Rev 2015; 25 (4) 439-454
    CrossrefPubMedGoogle Scholar
  • 35 Dietz J, Noecker AM, McIntyre CC , et al. Stimulation region within the globus pallidus does not affect verbal fluency performance. Brain Stimulat 2013; 6 (3) 248-253
    CrossrefPubMedGoogle Scholar
  • 36 Gervais-Bernard H, Xie-Brustolin J, Mertens P , et al. Bilateral subthalamic nucleus stimulation in advanced Parkinson's disease: five year follow-up. J Neurol 2009; 256 (2) 225-233
    CrossrefPubMedGoogle Scholar
  • 37 York MK, Dulay M, Macias A , et al. Cognitive declines following bilateral subthalamic nucleus deep brain stimulation for the treatment of Parkinson's disease. J Neurol Neurosurg Psychiatry 2008; 79 (7) 789-795
    CrossrefPubMedGoogle Scholar
  • 38 Rothlind JC, Cockshott RW, Starr PA, Marks Jr WJ. Neuropsychological performance following staged bilateral pallidal or subthalamic nucleus deep brain stimulation for Parkinson's disease. J Int Neuropsychol Soc 2007; 13 (1) 68-79
    PubMedGoogle Scholar
  • 39 Smeding HM, Speelman JD, Koning-Haanstra M , et al. Neuropsychological effects of bilateral STN stimulation in Parkinson disease: a controlled study. Neurology 2006; 66 (12) 1830-1836
    CrossrefPubMedGoogle Scholar
  • 40 Kalteis K, Standhardt H, Kryspin-Exner I, Brücke T, Volc D, Alesch F. Influence of bilateral Stn-stimulation on psychiatric symptoms and psychosocial functioning in patients with Parkinson's disease. J Neural Transm (Vienna) 2006; 113 (9) 1191-1206
    CrossrefPubMedGoogle Scholar
  • 41 Kleiner-Fisman G, Herzog J, Fisman DN , et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 2006; 21 (Suppl 14): S290-S304
    CrossrefPubMedGoogle Scholar
  • 42 Erola T, Heikkinen ER, Haapaniemi T, Tuominen J, Juolasmaa A, Myllylä VV. Efficacy of bilateral subthalamic nucleus (STN) stimulation in Parkinson's disease. Acta Neurochir (Wien) 2006; 148 (4) 389-394
    CrossrefPubMedGoogle Scholar
  • 43 Visser-Vandewalle V, van der Linden C, Temel Y , et al. Long-term effects of bilateral subthalamic nucleus stimulation in advanced Parkinson disease: a four year follow-up study. Parkinsonism Relat Disord 2005; 11 (3) 157-165
    CrossrefPubMedGoogle Scholar
  • 44 Massano J, Bronstein JM. Writeclick: neuropsychological outcome after deep brain stimulation for Parkinson disease. Neurology 2016; 86 (16) 1563-1564
    PubMedGoogle Scholar
  • 45 Troche MS, Brandimore AE, Foote KD , et al. Swallowing outcomes following unilateral STN vs. GPi surgery: a retrospective analysis. Dysphagia 2014; 29 (4) 425-431
    CrossrefPubMedGoogle Scholar
  • 46 Volkmann J, Albanese A, Kulisevsky J , et al. Long-term effects of pallidal or subthalamic deep brain stimulation on quality of life in Parkinson's disease. Mov Disord 2009; 24 (8) 1154-1161
    CrossrefPubMedGoogle Scholar
  • 47 van Nuenen BFL, Esselink RAJ, Munneke M, Speelman JD, van Laar T, Bloem BR. Postoperative gait deterioration after bilateral subthalamic nucleus stimulation in Parkinson's disease. Mov Disord 2008; 23 (16) 2404-2406
    CrossrefPubMedGoogle Scholar
  • 48 Okun MS, Tagliati M, Pourfar M , et al. Management of referred deep brain stimulation failures: a retrospective analysis from 2 movement disorders centers. Arch Neurol 2005; 62 (8) 1250-1255
    CrossrefPubMedGoogle Scholar
  • 49 Williams NR, Foote KD, Okun MS. STN vs. GPi deep brain stimulation: translating the rematch into clinical practice. Mov Disord Clin Pract (Hoboken) 2014; 1 (1) 24-35
    CrossrefPubMedGoogle Scholar
  • 50 van der Marck MA, Munneke M, Mulleners W , et al; IMPACT study group. Integrated multidisciplinary care in Parkinson's disease: a non-randomised, controlled trial (IMPACT). Lancet Neurol 2013; 12 (10) 947-956
    CrossrefPubMedGoogle Scholar
  • 51 Morishita T, Rahman M, Foote KD , et al. DBS candidates that fall short on a levodopa challenge test: alternative and important indications. Neurologist 2011; 17 (5) 263-268
    CrossrefPubMedGoogle Scholar
  • 52 Martinez-Ramirez D, Okun MS. Rationale and clinical pearls for primary care doctors referring patients for deep brain stimulation. Gerontology 2014; 60 (1) 38-48
    CrossrefPubMedGoogle Scholar
  • 53 Okun MS, Foote KD. Parkinson's disease DBS: what, when, who and why? The time has come to tailor DBS targets. Expert Rev Neurother 2010; 10 (12) 1847-1857
    CrossrefPubMedGoogle Scholar
  • 54 Verhagen Metman L, Pal G, Slavin K. Surgical treatment of Parkinson's disease. Curr Treat Options Neurol 2016; 18 (11) 49
    CrossrefPubMedGoogle Scholar
  • 55 Volkmann J, Chabardes S, Steinke GK, Carcieri S. is 375 DIRECT DBS: a prospective, multicenter clinical trial with blinding for a directional deep brain stimulation lead. Neurosurgery 2016; 63 (1) (Suppl. 01) 211-212
    PubMedGoogle Scholar
  • 56 Deuschl G, Schüpbach M, Knudsen K , et al. Stimulation of the subthalamic nucleus at an earlier disease stage of Parkinson's disease: concept and standards of the EARLYSTIM-study. Parkinsonism Relat Disord 2013; 19 (1) 56-61
    CrossrefPubMedGoogle Scholar
  • 57 Mestre TA, Espay AJ, Marras C, Eckman MH, Pollak P, Lang AE. Subthalamic nucleus-deep brain stimulation for early motor complications in Parkinson's disease-the EARLYSTIM trial: early is not always better. Mov Disord 2014; 29 (14) 1751-1756
    CrossrefPubMedGoogle Scholar
  • 58 Thobois S, Ardouin C, Lhommée E , et al. Non-motor dopamine withdrawal syndrome after surgery for Parkinson's disease: predictors and underlying mesolimbic denervation. Brain 2010; 133 (Pt 4): 1111-1127
    CrossrefPubMedGoogle Scholar
  • 59 Zibetti M, Torre E, Cinquepalmi A , et al. Motor and nonmotor symptom follow-up in parkinsonian patients after deep brain stimulation of the subthalamic nucleus. Eur Neurol 2007; 58 (4) 218-223
    CrossrefPubMedGoogle Scholar
  • 60 Higuchi MA, Martinez-Ramirez D, Morita H , et al. Interdisciplinary Parkinson's disease deep brain stimulation screening and the relationship to unintended hospitalizations and quality of life. PLoS One 2016; 11 (5) e0153785
    CrossrefPubMedGoogle Scholar
  • 61 Picillo M, Lozano AM, Kou N, Puppi Munhoz R, Fasano A. Programming deep brain stimulation for Parkinson's disease: the Toronto Western Hospital algorithms. Brain Stimulat 2016; 9 (3) 425-437
    CrossrefPubMedGoogle Scholar
  • 62 Farris S, Giroux M. Retrospective review of factors leading to dissatisfaction with subthalamic nucleus deep brain stimulation during long-term management. Surg Neurol Int 2013; 4: 69 . doi: 10.4103/2152-7806.112612
    CrossrefPubMedGoogle Scholar
  • 63 Martinez-Ramirez D, Morishita T, Zeilman PR, Peng-Chen Z, Foote KD, Okun MS. Atrophy and other potential factors affecting long term deep brain stimulation response: a case series. PLoS One 2014; 9 (10) e111561
    CrossrefPubMedGoogle Scholar
  • 64 Ughratdar I, Samuel M, Ashkan K. Technological advances in deep brain stimulation. J Parkinsons Dis 2015; 5 (3) 483-496
    PubMedGoogle Scholar
  • 65 Alonso F, Latorre MA, Göransson N, Zsigmond P, Wårdell K. Investigation into deep brain stimulation lead designs: a patient-specific simulation study. Brain Sci 2016; 6 (3) 39
    CrossrefPubMedGoogle Scholar
  • 66 Steigerwald F, Müller L, Johannes S, Matthies C, Volkmann J. Directional deep brain stimulation of the subthalamic nucleus: a pilot study using a novel neurostimulation device. Mov Disord 2016; 31 (8) 1240-1243
    CrossrefPubMedGoogle Scholar
  • 67 Hariz M, Blomstedt P, Zrinzo L. Future of brain stimulation: new targets, new indications, new technology. Mov Disord 2013; 28 (13) 1784-1792
    CrossrefPubMedGoogle Scholar
  • 68 Contarino MF, Brinke TR, Mosch A , et al. How many patients would benefit from steering technology for deep brain stimulation?. Brain Stimulat 2016; 9 (1) 144-145
    CrossrefPubMedGoogle Scholar
  • 69 Akbar U, Raike RS, Hack N , et al. Randomized, blinded pilot testing of nonconventional stimulation patterns and shapes in Parkinson's disease and essential tremor: evidence for further evaluating narrow and biphasic pulses. Neuromodulation 2016; 19 (4) 343-356
    CrossrefPubMedGoogle Scholar
  • 70 de Hemptinne C, Ryapolova-Webb ES, Air EL , et al. Exaggerated phase-amplitude coupling in the primary motor cortex in Parkinson disease. Proc Natl Acad Sci U S A 2013; 110 (12) 4780-4785
    CrossrefPubMedGoogle Scholar
  • 71 Bronte-Stewart H, Barberini C, Koop MM, Hill BC, Henderson JM, Wingeier B. The STN beta-band profile in Parkinson's disease is stationary and shows prolonged attenuation after deep brain stimulation. Exp Neurol 2009; 215 (1) 20-28
    CrossrefPubMedGoogle Scholar
  • 72 Bour LJ, Lourens MAJ, Verhagen R , et al. Directional recording of subthalamic spectral power densities in Parkinson's disease and the effect of steering deep brain stimulation. Brain Stimul 2015; 8 (4) 730-741
    CrossrefPubMedGoogle Scholar
  • 73 De Jesus S, Almeida L, Peng-Chen Z, Okun MS, Hess CW. Novel targets and stimulation paradigms for deep brain stimulation. Expert Rev Neurother 2015; 15 (9) 1067-1080
    CrossrefPubMedGoogle Scholar
  • 74 Swann NC, de Hemptinne C, Miocinovic S , et al. Gamma oscillations in the hyperkinetic state detected with chronic human brain recordings in Parkinson's disease. J Neurosci 2016; 36 (24) 6445-6458
    CrossrefPubMedGoogle Scholar
  • 75 Deeb W, Giordano JJ, Rossi PJ , et al. Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies. Front Integr Neurosci 2016; 10 (November): 38
    PubMedGoogle Scholar
  • 76 Little S, Beudel M, Zrinzo L , et al. Bilateral adaptive deep brain stimulation is effective in Parkinson's disease. J Neurol Neurosurg Psychiatry 2016; 87 (7) 717-721
    CrossrefPubMedGoogle Scholar
  • 77 Ashkan K, Samuel M, Reddy P, Ray Chaudhuri K. The impact of deep brain stimulation on the nonmotor symptoms of Parkinson's disease. J Neural Transm (Vienna) 2013; 120 (4) 639-642
    CrossrefPubMedGoogle Scholar
  • 78 Chieng LO, Madhavan K, Wang MY. Deep brain stimulation as a treatment for Parkinson's disease related camptocormia. J Clin Neurosci 2015; 22 (10) 1555-1561
    CrossrefPubMedGoogle Scholar
  • 79 Shih LC, Vanderhorst VG, Lozano AM, Hamani C, Moro E. Improvement of pisa syndrome with contralateral pedunculopontine stimulation. Mov Disord 2013; 28 (4) 555-556
    CrossrefPubMedGoogle Scholar