Reversing cognitivemotor impairments in Parkinsons disease patients using a computational modelling approach to deep brain stimulation programming
Identifieur interne : 000437 ( Main/Exploration ); précédent : 000436; suivant : 000438Reversing cognitivemotor impairments in Parkinsons disease patients using a computational modelling approach to deep brain stimulation programming
Auteurs : Anneke M. M. Frankemolle [États-Unis, Pays-Bas] ; Jennifer Wu [États-Unis] ; Angela M. Noecker [États-Unis] ; Claudia Voelcker-Rehage [Allemagne] ; Jason C. Ho [États-Unis] ; Jerrold L. Vitek [États-Unis] ; Cameron C. Mcintyre [États-Unis] ; Jay L. Alberts [États-Unis]Source :
- Brain [ 0006-8950 ] ; 2010-03.
Abstract
Deep brain stimulation in the subthalamic nucleus is an effective and safe surgical procedure that has been shown to reduce the motor dysfunction of patients with advanced Parkinsons disease. Bilateral subthalamic nucleus deep brain stimulation, however, has been associated with declines in cognitive and cognitivemotor functioning. It has been hypothesized that spread of current to nonmotor areas of the subthalamic nucleus may be responsible for declines in cognitive and cognitivemotor functioning. The aim of this study was to assess the cognitivemotor performance in advanced Parkinsons disease patients with subthalamic nucleus deep brain stimulation parameters determined clinically (Clinical) to settings derived from a patient-specific computational model (Model). Data were collected from 10 patients with advanced Parkinsons disease bilaterally implanted with subthalamic nucleus deep brain stimulation systems. These patients were assessed off medication and under three deep brain stimulation conditions: Off, Clinical or Model based stimulation. Clinical stimulation parameters had been determined based on clinical evaluations and were stable for at least 6 months prior to study participation. Model-based parameters were selected to minimize the spread of current to nonmotor portions of the subthalamic nucleus using Cicerone Deep Brain Stimulation software. For each stimulation condition, participants performed a working memory (n-back task) and motor task (force tracking) under single- and dual-task settings. During the dual-task, participants performed the n-back and force-tracking tasks simultaneously. Clinical and Model parameters were equally effective in improving the Unified Parkinsons disease Rating Scale III scores relative to Off deep brain stimulation scores. Single-task working memory declines, in the 2-back condition, were significantly less under Model compared with Clinical deep brain stimulation settings. Under dual-task conditions, force tracking was significantly better with Model compared with Clinical deep brain stimulation. In addition to better overall cognitivemotor performance associated with Model parameters, the amount of power consumed was on average less than half that used with the Clinical settings. These results indicate that the cognitive and cognitivemotor declines associated with bilateral subthalamic nucleus deep brain stimulation may be reversed, without compromising motor benefits, by using model-based stimulation parameters that minimize current spread into nonmotor regions of the subthalamic nucleus.
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DOI: 10.1093/brain/awp315
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Stokes Cleveland VA Medical Centre, Cleveland, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation><affiliation><wicri:noCountry code="no comma">E-mail: albertj@ccf.org</wicri:noCountry></affiliation></author></analytic><monogr></monogr><series><title level="j">Brain</title><idno type="ISSN">0006-8950</idno><idno type="eISSN">1460-2156</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2010-03">2010-03</date><biblScope unit="volume">133</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="746">746</biblScope><biblScope unit="page" to="761">761</biblScope></imprint><idno type="ISSN">0006-8950</idno></series><idno type="istex">20EDF06FAFF668BEB4D35C4330E462F5B961AC7B</idno><idno type="DOI">10.1093/brain/awp315</idno><idno type="ArticleID">awp315</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Deep brain stimulation in the subthalamic nucleus is an effective and safe surgical procedure that has been shown to reduce the motor dysfunction of patients with advanced Parkinsons disease. Bilateral subthalamic nucleus deep brain stimulation, however, has been associated with declines in cognitive and cognitivemotor functioning. It has been hypothesized that spread of current to nonmotor areas of the subthalamic nucleus may be responsible for declines in cognitive and cognitivemotor functioning. The aim of this study was to assess the cognitivemotor performance in advanced Parkinsons disease patients with subthalamic nucleus deep brain stimulation parameters determined clinically (Clinical) to settings derived from a patient-specific computational model (Model). Data were collected from 10 patients with advanced Parkinsons disease bilaterally implanted with subthalamic nucleus deep brain stimulation systems. These patients were assessed off medication and under three deep brain stimulation conditions: Off, Clinical or Model based stimulation. Clinical stimulation parameters had been determined based on clinical evaluations and were stable for at least 6 months prior to study participation. Model-based parameters were selected to minimize the spread of current to nonmotor portions of the subthalamic nucleus using Cicerone Deep Brain Stimulation software. For each stimulation condition, participants performed a working memory (n-back task) and motor task (force tracking) under single- and dual-task settings. During the dual-task, participants performed the n-back and force-tracking tasks simultaneously. Clinical and Model parameters were equally effective in improving the Unified Parkinsons disease Rating Scale III scores relative to Off deep brain stimulation scores. Single-task working memory declines, in the 2-back condition, were significantly less under Model compared with Clinical deep brain stimulation settings. Under dual-task conditions, force tracking was significantly better with Model compared with Clinical deep brain stimulation. In addition to better overall cognitivemotor performance associated with Model parameters, the amount of power consumed was on average less than half that used with the Clinical settings. These results indicate that the cognitive and cognitivemotor declines associated with bilateral subthalamic nucleus deep brain stimulation may be reversed, without compromising motor benefits, by using model-based stimulation parameters that minimize current spread into nonmotor regions of the subthalamic nucleus.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Pays-Bas</li><li>États-Unis</li></country><region><li>Brême (Land)</li><li>Ohio</li></region><settlement><li>Brême</li></settlement></list><tree><country name="États-Unis"><region name="Ohio"><name sortKey="Frankemolle, Anneke M M" sort="Frankemolle, Anneke M M" uniqKey="Frankemolle A" first="Anneke M. M." last="Frankemolle">Anneke M. M. Frankemolle</name></region><name sortKey="Alberts, Jay L" sort="Alberts, Jay L" uniqKey="Alberts J" first="Jay L." last="Alberts">Jay L. Alberts</name><name sortKey="Alberts, Jay L" sort="Alberts, Jay L" uniqKey="Alberts J" first="Jay L." last="Alberts">Jay L. Alberts</name><name sortKey="Alberts, Jay L" sort="Alberts, Jay L" uniqKey="Alberts J" first="Jay L." last="Alberts">Jay L. Alberts</name><name sortKey="Ho, Jason C" sort="Ho, Jason C" uniqKey="Ho J" first="Jason C." last="Ho">Jason C. Ho</name><name sortKey="Mcintyre, Cameron C" sort="Mcintyre, Cameron C" uniqKey="Mcintyre C" first="Cameron C." last="Mcintyre">Cameron C. Mcintyre</name><name sortKey="Mcintyre, Cameron C" sort="Mcintyre, Cameron C" uniqKey="Mcintyre C" first="Cameron C." last="Mcintyre">Cameron C. Mcintyre</name><name sortKey="Mcintyre, Cameron C" sort="Mcintyre, Cameron C" uniqKey="Mcintyre C" first="Cameron C." last="Mcintyre">Cameron C. Mcintyre</name><name sortKey="Noecker, Angela M" sort="Noecker, Angela M" uniqKey="Noecker A" first="Angela M." last="Noecker">Angela M. Noecker</name><name sortKey="Vitek, Jerrold L" sort="Vitek, Jerrold L" uniqKey="Vitek J" first="Jerrold L." last="Vitek">Jerrold L. Vitek</name><name sortKey="Vitek, Jerrold L" sort="Vitek, Jerrold L" uniqKey="Vitek J" first="Jerrold L." last="Vitek">Jerrold L. Vitek</name><name sortKey="Wu, Jennifer" sort="Wu, Jennifer" uniqKey="Wu J" first="Jennifer" last="Wu">Jennifer Wu</name></country><country name="Pays-Bas"><noRegion><name sortKey="Frankemolle, Anneke M M" sort="Frankemolle, Anneke M M" uniqKey="Frankemolle A" first="Anneke M. M." last="Frankemolle">Anneke M. M. Frankemolle</name></noRegion></country><country name="Allemagne"><region name="Brême (Land)"><name sortKey="Voelcker Rehage, Claudia" sort="Voelcker Rehage, Claudia" uniqKey="Voelcker Rehage C" first="Claudia" last="Voelcker-Rehage">Claudia Voelcker-Rehage</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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