Dataset Information

Adjustment of Subthalamic Deep Brain Stimulation Parameters Improves Wheeze and Dyspnea in Parkinson's Disease.

ABSTRACT: Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for motor features in Parkinson's disease (PD). We present the case of a 56-year-old man with a 17-year history of PD. He underwent bilateral STN-DBS at the age of 51 years because of troublesome dyskinesia and wearing off. His motor features dramatically improved after the operation; however, he developed dysarthria and a refractory wheeze associated with dyspnea due to abnormal hyperadduction of the false vocal fold. By adjusting the stimulation site of STN, his severe wheeze, which was considered to be the result of the unfavorable spread of current to the corticobulbar tract, was significantly improved. This report provides concrete evidence that wheezing is caused by hyperadduction of the false vocal fold as an adverse effect of STN-DBS and can be reversed by adjusting the stimulation site for STN-DBS.

SUBMITTER: Komiya H

PROVIDER: S-EPMC6923763 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Adjustment of Subthalamic Deep Brain Stimulation Parameters Improves Wheeze and Dyspnea in Parkinson's Disease.

Komiya Hiroyasu H Kimura Katsuo K Kishida Hitaru H Kawasaki Takashi T Hamada Koichi K Koizumi Hiroyuki H Ueda Naohisa N Tanaka Fumiaki F

Frontiers in neurology 20191213

Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for motor features in Parkinson's disease (PD). We present the case of a 56-year-old man with a 17-year history of PD. He underwent bilateral STN-DBS at the age of 51 years because of troublesome dyskinesia and wearing off. His motor features dramatically improved after the operation; however, he developed dysarthria and a refractory wheeze associated with dyspnea due to abnormal hyperadduction of the false vocal fold ...[more]

PMID: 31920938

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Project description:Deep brain stimulation of the subthalamic nucleus for Parkinson's disease is an established advanced therapy that addresses motor symptoms and improves quality of life. However, it has also been associated with neuropsychiatric symptoms such as impulsivity and hypomania. When significant, these symptoms can be distressing, necessitating psychiatric intervention. However, a comprehensive analysis of neurocognitive and neuropsychiatric outcomes with reference to the site of subthalamic stimulation has not been undertaken. We examined this matter in a consecutive sample of 64 persons with Parkinson's disease undertaking subthalamic deep brain stimulation. Participants were assessed with a battery of neuropsychiatric instruments at baseline and at repeated postoperative intervals. A psychiatrist identified patients with emergent, clinically-significant symptoms due to stimulation. The site of the active electrode contact and a simulated volume of activated tissue were evaluated with reference to putative limbic, associative and motor subregions of the subthalamic nucleus. We studied anatomical correlates of longitudinal neuropsychiatric change and delineated specific subthalamic regions associated with neuropsychiatric impairment. We tested the ability of these data to predict clinically-significant symptoms. Subthalamic stimulation within the right associative subregion was associated with inhibitory errors on the Excluded Letter Fluency task at 6-weeks (p = 0.023) and 13-weeks postoperatively (p = 0.0017). A cluster of subthalamic voxels associated with inhibitory errors was identified in the right associative and motor subregions. At 6-weeks, clinically-significant neuropsychiatric symptoms were associated with the distance of the active contact to the right associative subregion (p = 0.0026) and stimulation within the right associative subregion (p = 0.0009). At 13-weeks, clinically-significant symptoms were associated with the distance to the right (p = 0.0027) and left (p = 0.0084) associative subregions and stimulation within the right associative subregion (p = 0.0026). Discrete clusters of subthalamic voxels associated with high and low likelihood of postoperative neuropsychiatric symptoms were identified in ventromedial and dorsolateral zones, respectively. When a classifier was trained on these data, clinically-significant symptoms were predicted with an accuracy of 79%. These data underscore the importance of accurate electrode targeting, contact selection and device programming to reduce postoperative neuropsychiatric impairment. The ability to predict neuropsychiatric symptoms based on subthalamic data may permit anticipation and prevention of these occurrences, improving safety and tolerability.

Project description:ObjectivesFirstly, to identify subthalamic region stimulation clusters that predict maximum improvement in rigidity, bradykinesia and tremor, or emergence of side-effects; and secondly, to map-out the cortical fingerprint, mediated by the hyperdirect pathways which predict maximum efficacy.MethodsHigh angular resolution diffusion imaging in twenty patients with advanced Parkinson's disease was acquired prior to bilateral subthalamic nucleus deep brain stimulation. All contacts were screened one-year from surgery for efficacy and side-effects at different amplitudes. Voxel-based statistical analysis of volumes of tissue activated models was used to identify significant treatment clusters. Probabilistic tractography was employed to identify cortical connectivity patterns associated with treatment efficacy.ResultsAll patients responded well to treatment (46% mean improvement off medication UPDRS-III [p < 0.0001]) without significant adverse events. Cluster corresponding to maximum improvement in tremor was in the posterior, superior and lateral portion of the nucleus. Clusters corresponding to improvement in bradykinesia and rigidity were nearer the superior border in a further medial and posterior location. The rigidity cluster extended beyond the superior border to the area of the zona incerta and Forel-H2 field. When the clusters where averaged, the coordinates of the area with maximum overall efficacy was X = -10(-9.5), Y = -13(-1) and Z = -7(-3) in MNI(AC-PC) space. Cortical connectivity to primary motor area was predictive of higher improvement in tremor; whilst that to supplementary motor area was predictive of improvement in bradykinesia and rigidity; and connectivity to prefrontal cortex was predictive of improvement in rigidity.InterpretationThese findings support the presence of overlapping stimulation sites within the subthalamic nucleus and its superior border, with different cortical connectivity patterns, associated with maximum improvement in tremor, rigidity and bradykinesia.

Dataset Information

Adjustment of Subthalamic Deep Brain Stimulation Parameters Improves Wheeze and Dyspnea in Parkinson's Disease.

Publications

Adjustment of Subthalamic Deep Brain Stimulation Parameters Improves Wheeze and Dyspnea in Parkinson's Disease.

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