Favourable motor outcome in four cases and minor motor benefit complicated by dysarthria in one case. An additional aim was to evaluate effects on non-motor symptoms, including possible cognitive and neuropsychiatric symptoms. Search terms and the PubMed search were planned by two authors T.
All titles and abstracts were reviewed by one investigator T. Full texts were obtained for appropriate studies or if the relevance of an article was uncertain. The inclusion criteria for the selected studies were as follows: 1 a human study, 2 genetic PD patients treated with DBS, and 3 English language. NOS includes selection, comparability, and exposure or outcome. The scale ranged from 0 to 11 stars, with the highest rating representing the greatest quality.
Six months or more was a limit for the adequate follow-up time. Pre- and postoperative evaluation was thought to be accomplished if the outcome was reported properly with percentage improvement of the UPDRS-III score or verbally. A total score of 0—3 was considered to indicate to poor quality; 4—7, moderate quality; and 8—11, good quality.
The outcome was reported in 73 patients The motor outcome was mostly favourable in patients with LRRK2 mutation. Both patients with the p. The outcome appeared poor in patients with p. The outcome was reported in 57 patients Six patients in three different studies were reported to have modest or poor outcomes. Samples partially consisted of same patients in two studies [ 14 , 15 ]. The outcome was reported in 30 patients Eighteen patients were reported to have favourable, three patients moderate and nine patients poor long-term motor outcomes.
Favourable motor outcome was reported in four cases and minor motor benefit complicated by dysarthria in one case. Favourable motor outcome was observed in three patients and moderate outcome in one case. One patient developed imbalance, gait impairment, dysarthria, and behavioral changes after operation and mental deterioration was documented a few years later. GS mutation [ 7 ], may even have better outcome than the general PD population. However, the reported LRRK2 cases of p. RG, p.
TS and p. NH c. Despite good motor outcome, GBA mutation carriers may develop cognitive impairment after DBS faster than patients without mutations. SNCA patients commonly develop cognitive and neuropsychiatric problems [ 8 ]. While the motor benefit from DBS may initially be clear, the rapid non-motor progression may lessen the sum value for the quality of life.
The issue could be the level of damage at the time of implantation, and earlier DBS in these patients might possibly provide different outcomes. Preoperative response to levodopa is the best single predictor of the postoperative outcome of DBS [ 64 ]. This indicator appears useful also in patients with monogenic mutations and the response was reported in practically all included studies. Another relevant predictor is the localization of DBS electrodes [ 65 ]. Unfortunately, there were studies, which did not report DBS targets and most studies lacked information about lead positioning.
As the literature expands in the future, the effect of targets and lead positioning should be investigated in more detail. Hence it remains ambiguous whether there are any relevant differences of clinical outcome between STN and GPi stimulation in monogenic PD. Most patients benefit from STN-DBS, at least in the short-term; however, the current evidence does not support or is questionable for DBS implantation for patients with p.
TS or p. JK: 1C, 3B. EP: 1C, 3B. MM: 1C, 3B. AA: 1C, 3B. No targeted funding reported. Financial disclosures of all authors for the preceding 12 months. Skip to main content Skip to sections. Advertisement Hide. Download PDF. Journal of Neurology pp 1—15 Cite as. Open Access.
Deep Brain Stimulation for Parkinson's | APDA
First Online: 18 January Open image in new window. Table 1 The data extracted from the included studies. GS NA RG 29—55 41—65 STN bilat. GS 43—57 50—69 STN bilat. TS mutation Gaig et al. RG and p. GR 28 39 STN bilat. GS 49 56 STN bilat. YC 43 48 STN bilat. No changes in neuropsychological test parameters 6 months postoperatively Breit et al. RM 42 60 STN bilat.
Deep Brain Stimulation for Parkinson’s Disease With Early Motor Complications
PINK1 mutation p. GBA carriers developed also a significant cognitive impairment Lesage et al. A53E 42 46 STN bilat. Response for motor fluctuations remained satisfactory but the cognitive and mental state of the patient deteriorated to a state of practical immobility Perandones et al. DN 49 60 STN bilat.
DN 42 55 STN bilat. No reported cognitive problems Borellini et al. GS 50 59 STN bilat. VG 31 61 STN bilat. Mental deterioration was documented a few years later Dufournet et al. Table 2 Summary of key findings according to the mutated gene. Funding No targeted funding reported. Conflicts of interest The authors declare that they have no conflict of interest.
Weaver FM, Follett K, Stern M et al Bilateral deep brain stimulation vs best medical therapy for patients with advanced Parkinson disease: a randomized controlled trial. Neurobiol Aging NH mutation. Nakahara K, Ueda M, Yamada K et al Juvenile-onset parkinsonism with digenic parkin and PINK1 mutations treated with subthalamic nucleus stimulation at 45 years after disease onset. Capecci M, Passamonti L, Annesi F et al Chronic bilateral subthalamic deep brain stimulation in a patient with homozygous deletion in the parkin gene.
Parkinsonism Relat Disord. GPi deep brain stimulation for tremor suppression in Parkinson disease: a systematic review and meta-analysis. Personalised recommendations. Cite article How to cite? ENW EndNote. Share article. Sayad et al. Greenbaum et al. Angeli et al. The electrodes deliver tiny electrical pulses to these brain regions. This allows the brain to maintain normal movement activity with a lower dose of levodopa. The electrodes are connected by a wire to a pulse generator that is implanted under the skin in the chest.
The electrodes and the wire are also under the skin, so that no part is visible externally. DBS does not usually increase the peak benefits derived from a dose of levodopa— the best levodopa response before DBS is a good indicator of the best response after DBS.
DBS does not provide most patients benefit for their non-motor symptoms, such as depression, sleep disturbance, or anxiety. DBS also does not usually improve postural instability or walking problems. If a symptom you have does not respond to levodopa, it is not likely to respond to DBS. DBS is a surgical procedure.
As with any surgery there are some risks associated with it. Some of the risks of DBS include infection and bleeding. Your neurosurgeon may discuss some additional risks with you. Studies have shown that any risks are relatively small, but they should be kept in mind when considering DBS. Before considering DBS, it is very important to be evaluated by a movement disorder specialist a neurologist who is highly trained in treating PD. Often, medication adjustments and other treatment changes can offer significant benefits and may delay the need for surgery.