BP and MG reviewed the clinical aspects of DBS surgery. 0000144714 00000 n
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Detailed exploration of STN and GPi connections and their somatotopy, which is still missing in humans, would further enhance the outcome of dopaminergic and neurostimulation treatments. 0000021559 00000 n
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Neurol., 27 August 2018
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Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.The principal pathological characteristic of Parkinson's disease (PD) is the progressive death of the pigmented neurons of the substantia nigra pars compacta (SNc) diagnosed by symptoms including bradykinesia/akinesia, rigidity, postural abnormalities and tremor (Medically intractable motor fluctuations and tremor are independent indications for DBS in PD, in which the electrodes are most commonly implanted in the subthalamic nucleus (STN) or globus pallidus internus (GPi) (Parkinsonian symptoms appear when brain levels of dopamine are reduced by 70–80% (L-DOPA is given with carbidopa or benserazide, drugs which do not cross the BBB but inhibit DOPA decarboxylase in peripheral tissues (Dopamine is produced in the ventral tegmental area and pars compacta of SN and acts through anatomically segregated but functionally connected pathways (The midbrain dopaminergic systems project mainly to the striatum and the cortex but also to the thalamus, amygdala, hippocampus and globus pallidus (GP). 0000135732 00000 n
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All those involved in the process including patients themselves need to have realistic expectations after surgery. 0000150623 00000 n
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The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. 0000147065 00000 n
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In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. 0000142325 00000 n
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In some studies, it has been shown that age and disease duration are not predictive for the post-operative motor outcome (From the surgical point of view, eligible candidates for the DBS procedure should be in a satisfactory general and cognitive condition. Supplementary All authors discussed the manuscript and agreed to the final version.The study was supported by the German Research Council SFB 1193, SFB-TR-128 and Medtronic GmbH (study 080958/2015/OTIG).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The authors thank Cheryl Ernest for proofreading and editing the manuscript. 0000140159 00000 n
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Patients should be made fully aware that DBS is not able to cure the disease but it is able to optimize mainly the motor symptoms, henceforth, the quality of life.A detailed initial evaluation is needed in a movement disorder center to determine whether the patient will benefit from DBS. 0000138727 00000 n
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Even though there is no difference in motor function outcomes for performing the surgery awake or under general anesthesia (Concerning the implantation of the DBS system itself, accuracy and safety are the most important factors to ensure a good patient outcome. Pivotal trial design: DUODOPA vs oral levodopa/carbidopa IR1,2 12-Week, randomized, double-blind, double-dummy, active-controlled, multicenter study† DUODOPA + Oral placebo (n=37; 35 completed) Placebo enteral suspension via pump + oral levodopa/carbidopa IR (n=34; 31 completed) Conversion to oral levodopa/carbidopa IR while continuing 0000138581 00000 n
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18.45 Meeting in the lobby & departure for the restaurant. 0000010502 00000 n
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Several animal studies have shown support for the hypothesis of direct cortical activation during STN-DBS (Several hypotheses exist regarding how DBS acts on neural elements (Figure A network perspective on brain structure and function, accounting for the interaction and anatomical connections between regions, offers a potentially valuable framework for the study of physiological brain functioning and for identification of relevant pathological abnormalities at the systemic level. 0000083512 00000 n
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Both resting state and motor task paradigms were investigated using regional cerebral blood flow (rCBF) measurements (Studies in STN-DBS patients using functional MRI (fMRI) are limited because of safety concerns and imaging artifacts (Even though the target for DBS consists of gray matter structures, DBS predominantly activates the axons rather than cell bodies (Oscillations at multiple frequencies may reflect information processing in the neural networks (An excessive synchronization in beta band was identified between the basal ganglia and the motor cortex in PD patients (The resting tremor in PD is thought to be driven by certain oscillators in the brain (The clinical benefit of levodopa has not been doubted since its description (The optimal time for starting levodopa therapy in the clinical practice is still a matter of debate.