Parkinsonism & related disorders
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The specific effect of DBS at high frequency, discovered during a VIM thalamotomy, was extended to the older targets of ablative neurosurgery such as the pallidum, for tremor in Parkinson's disease (PD), dyskinesias, essential tremor, as well as the internal capsule to treat psychiatric disorders (OCD). A second wave of targets came from basic research, enabled by the low morbidity, reversibility, and adaptability of DBS. ⋯ Serendipity and a scientific approach have provided several instances where targets have produced unexpected effects (such as STN in OCD), as well as limbic effects observed during attempts at VMH stimulation for obesity: this might offer a novel way to treat mild cognitive impairment, or memory deficits reported in Alzheimer's disease. While these might provide solutions for as yet unsolved problems, attention must be paid to ethical considerations.
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Parkinsonism Relat. Disord. · Jan 2012
ReviewDeep brain stimulation of globus pallidus interna, subthalamic nucleus, and pedunculopontine nucleus for Parkinson's disease: which target?
Deep brain stimulation (DBS) is an accepted therapy for people with Parkinson's disease (PD) motor symptoms that are refractory to pharmacologic therapy. Standard DBS targets are globus pallidus interna (GPi) and subthalamic nucleus (STN). The pedunculopontine nucleus (PPN) is being investigated as a novel target. ⋯ Each target offers relative advantages. Further studies are needed to better define the roles of each target, particularly PPN. Choice of target should be individualized according to providers' preferences and patients' needs.
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Parkinsonism Relat. Disord. · Jan 2012
ReviewTandem deep brain stimulation--challenging new structural targets for Parkinson's disease.
Deep brain stimulation (DBS) targets for Parkinson's disease have been limited to neuronal regions wherein lesions have produced beneficial effects. Improvements in imaging allow placement in small and novel targets. Additionally, due to the ability of impulse generators to accommodate multiple electrodes, simultaneous stimulation in multiple neuronal regions is possible. ⋯ I hypothesize that tandem DBS, targeting the STN/GPi and fornix/hypothalamus and/or hippocampus may have a positive impact on improving cognitive function and/or reducing risk for subsequent dementia with Lewy bodies/Parkinson dementia. Such targets also pose potential negative ramifications. Nevertheless, given the tremendous disability produced by dementia, new structural targets require systematic study.
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Parkinsonism Relat. Disord. · Jan 2012
ReviewClinical management of pain and fatigue in Parkinson's disease.
Pain and fatigue are part of the phenomenological spectrum of Parkinson's disease (PD). These non-motor symptoms can be as troublesome as motor symptoms, impact activities of daily living, and are often underdiagnosed. ⋯ We review here the clinical manifestations and management of these non-motor symptoms. Their resolution can be challenging, as there is insufficient evidence concerning effective treatment options.
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Parkinsonism Relat. Disord. · Jan 2012
Unilateral subthalamic nucleus deep brain stimulation improves sleep quality in Parkinson's disease.
Sleep disturbances are common in Parkinson's disease (PD). Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is superior to best medical therapy in the treatment of motor symptoms in advanced PD, and observational studies suggest that bilateral STN DBS improves sleep in these patients as well. Unilateral STN DBS also improves motor function in PD, but its effects on sleep have not been extensively investigated. ⋯ This prospective case series study provides evidence that unilateral STN DBS improves subjective sleep quality in patients with PD at up to 6 months post-operatively as measured by the PSQI.