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Short- and long-term cognitive effects of deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson's disease
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper.
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.
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2021 (Engelska)Ingår i: Journal of Neurosurgery, ISSN 0022-3085, E-ISSN 1933-0693, Vol. 134, nr 2, s. 357-365Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: A growing number of studies are showing positive effects of deep brain stimulation (DBS) in the caudal zona incerta (cZi) in various tremor disorders, as well as motor symptoms of Parkinson’s disease (PD). The focus of the present study was to evaluate short- and long-term cognitive effects of bilateral cZi DBS in patients with PD.

METHODS: Twenty-five nondemented patients with advanced PD were recruited to participate in a randomized trial of cZi DBS versus best medical treatment (BMT). The patients in the BMT group were offered surgery after 6 months. Neuropsychological evaluations focusing on assessing verbal and visuospatial memory, attention, and executive function were conducted at baseline and at 6 and 24 months after surgery. Self-reported measures of depression, anxiety, and change in "frontal" behaviors were also completed at all assessment points.

RESULTS: Bilateral cZi DBS in patients with PD generated few adverse cognitive effects. At the short-term follow-up after 6 months, no differences were found between patients randomized to BMT and patients randomized to DBS with regard to most of the cognitive domains assessed. A transient improvement in anxiety was, however, found in the surgical group. At the long-term follow-up 24 months after cZi DBS, no major changes in global cognitive functioning were found, although a decline in attention and self-reported executive function was noted.

CONCLUSIONS: With the exception of a decline in attention and self-reported executive function, bilateral cZi DBS for PD in appropriately screened patients appears to be generally safe with regard to cognitive function, both in the short- and long-term perspective.

Ort, förlag, år, upplaga, sidor
American Association of Neurological Surgeons (AANS) , 2021. Vol. 134, nr 2, s. 357-365
Nyckelord [en]
zona incerta, Parkinson's disease, deep brain stimulation, neuropsychology, cognition, functional neurosurgery
Nationell ämneskategori
Neurologi
Forskningsämne
neurologi
Identifikatorer
URN: urn:nbn:se:umu:diva-170467DOI: 10.3171/2019.12.JNS192654ISI: 000646422100005PubMedID: 32032954Scopus ID: 2-s2.0-85100240654OAI: oai:DiVA.org:umu-170467DiVA, id: diva2:1428574
Tillgänglig från: 2020-05-06 Skapad: 2020-05-06 Senast uppdaterad: 2023-05-03Bibliografiskt 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, PatricFredricks, AnnaHariz, MarwanStenmark Persson, Rasmus

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