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Deep brain stimulation in the caudal zona incerta in patients with essential tremor: effects on cognition 1 year after surgery
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.ORCID-id: 0000-0002-7063-9710
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper. Unit of Functional Neurosurgery, UCL Institute of Neurology, London, United Kingdom.
2021 (Engelska)Ingår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 134, nr 1, s. 208-215Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: The ventral intermediate nucleus (VIM) of the thalamus is currently the established target in the use of deep brain stimulation (DBS) to treat essential tremor (ET). In recent years, the caudal zona incerta (cZi), a brain target commonly used during the lesional era, has been revived as the primary target in a number of DBS studies that show evidence of the efficacy of cZi targeting in DBS treatment for controlling the symptoms of ET. The authors sought to obtain comprehensive neuropsychological data and thoroughly investigate the cognitive effects of cZi targeting in patients with ET treated with DBS.

METHODS: Twenty-six consecutive patients with ET who received DBS with cZi as the target at our department from December 2012 to February 2017 were included in this study. All patients were assessed using a comprehensive neuropsychological test battery covering the major cognitive domains both preoperatively and 12 months postoperatively.

RESULTS: The results show no major adverse effects on patient performance on the tests of cognitive function other than a slight decline of semantic verbal fluency.

CONCLUSIONS: This study indicates that the cZi is a safe target from a cognitive perspective in the treatment of ET with DBS.

Ort, förlag, år, upplaga, sidor
American Association of Neurological Surgeons (AANS) , 2021. Vol. 134, nr 1, s. 208-215
Nyckelord [en]
zona incerta, essential tremor, deep brain stimulation, cognition, functional neurosurgery
Nationell ämneskategori
Neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-170465DOI: 10.3171/2019.9.JNS191646ISI: 000616580000008PubMedID: 31860827Scopus ID: 2-s2.0-85098275783OAI: oai:DiVA.org:umu-170465DiVA, id: diva2:1428572
Tillgänglig från: 2020-05-06 Skapad: 2020-05-06 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Ingår i avhandling
1. Cognitive effects of deep brain stimulation: focus on caudal zona incerta for essential tremor and Parkinson´s disease, and on bed nucleus of stria terminalis for obsessive compulsive disorder
Öppna denna publikation i ny flik eller fönster >>Cognitive effects of deep brain stimulation: focus on caudal zona incerta for essential tremor and Parkinson´s disease, and on bed nucleus of stria terminalis for obsessive compulsive disorder
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Kognitiva effekter av deep brain stimulation (djup hjärnstimulering) : fokus på caudal zona incerta vid essentiell tremor och Parkinsons sjukdom, samt på bed nucleus stria terminalis vid tvångssyndrom
Abstract [en]

Preserved cognition is an important determinant for perceived Quality of Life (QoL) and has been found to be essential in order to translate improvements in primary symptoms following Deep Brain Stimulation (DBS) into activities of daily living that drive QoL. Therefore, it is important to evaluate not only the clinical improvement, but also the cognitive impact of DBS.

The aim of this thesis was to evaluate the cognitive effects of DBS in a new target, the caudal Zona incerta (cZi), which has shown promising results in patients with both Parkinson’s Disease (PD) and Essential Tremor (ET). Given that this is a novel target, the effects on cognition were lacking in the literature. In the same manner, the cognitive effects in patients with Obsessive-Compulsive Disorder (OCD) receiving DBS in the Bed Nucleus of Stria Terminalis (BNST) lacked long-term follow-up.

The main findings from the studies included in this thesis, suggest that DBS in the cZi in patients with PD and ET, and in the BNST in patients with OCD, does not generate any major cognitive effects and can be considered safe from a cognitive perspective.However, subtle effects involving aspects of executive function may be present following cZi DBS in patients with PD. Significant results concerned primarily a decrease in selective attention and aspects of inhibition. cZi DBS in patients with ET generated fewer cognitive effects, including a decrease in semantic verbal fluency 12 months after DBS in the cZi. fMRI results evaluating the effects of cZi DBS on brain activity during a working memory task, did not show any significant changes when DBS was ON or OFF. This study also revealed a significant Task-x-DBS interaction, with faster response times during DBS ON relative to DBS OFF for the more cognitively demanding “manipulation” task. In OCD patients with BNST DBS, improved results on the Color-Word Inhibition/switching subtest were found, indicating a possible improvement in cognitive flexibility. However, there was a decrease of performance in visuo-spatial learning at 12 months after surgery.

The studies in patients with PD and ET were the first to report comprehensive neuropsychological data regarding cZi DBS. The fMRI study was the first in patients with ET treated with cZi DBS, focusing on cognitive effects during a working memory task in on/off DBS conditions. The OCD study was the first to report long-term data on cognitive effects after BNST DBS. By showing that DBS in these targets does not produce any major cognitive side effects, valuable knowledge in terms of safety has been added. This will hopefully contribute to increased treatment options in DBS.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå University, 2023. s. 79
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2226
Nyckelord
Deep brain stimulation. Neuropsychology. Cognition. Parkinson’s disease. Essential tremor. Obsessive-compulsive disorder. Caudal zona incerta. Bed nucleus of stria terminalis. Functional MRI.
Nationell ämneskategori
Neurovetenskaper
Forskningsämne
neurologi
Identifikatorer
urn:nbn:se:umu:diva-204361 (URN)978-91-7855-995-4 (ISBN)978-91-7855-996-1 (ISBN)
Disputation
2023-03-03, Hörsal D, målplan T, plan 9, Norrlands universitetssjukhus, Umeå, 09:00 (Engelska)
Opponent
Handledare
Anmärkning

Oregelbunden paginering / Various pagings.

Tillgänglig från: 2023-02-10 Skapad: 2023-02-02 Senast uppdaterad: 2023-02-08Bibliografiskt granskad

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Philipson, JohannaBlomstedt, PatricHariz, Marwan

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