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Varying time-course of effects of high frequency stimulation of sub-regions of the globus pallidus in patients with Parkinson's Disease

Angeli, A; Akram, H; Zacharia, A; Limousin, P; Hariz, M; Zrinzo, L; Foltynie, T; (2015) Varying time-course of effects of high frequency stimulation of sub-regions of the globus pallidus in patients with Parkinson's Disease. Parkinsonism & Related Disorders , 21 (6) pp. 597-602. 10.1016/j.parkreldis.2015.03.019. Green open access

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Abstract

Introduction: Deep brain stimulation of the globus pallidus can be a highly effective treatment for patients with Parkinson's disease (PD), experiencing Levodopa-induced-dyskinesia (LID). Stimulation programming can focus simply on eliminating dyskinesia, or can also attempt to relieve the rigidity, tremor or akinesia of PD itself. / Methods: In this study, we explored whether additional benefit on the “off” symptoms and signs of PD, could be achieved in post-operative PD patients with good LID control, by making further adjustment to existing stimulation parameters directed towards the more superior electrode contacts, located in the Globus Pallidus pars externa (GPe). / Results: Acutely, GPe-DBS led to clear improvement in the akinesia, rigidity and tremor of PD in the off-medication state compared with Globus Pallidus pars interna (GPi) DBS (p = 0.003), however this was accompanied by the development of off-medication dyskinesia. Combined GPi–GPe DBS allowed maintained improvement but without dyskinesia. Follow up of patients over the subsequent 6–12 weeks showed gradual loss of this initial improvement. Switching back to GPi-DBS alone provided greater improvement in off medication symptoms than had been observed using the same GPi-DBS setting, 6–12 weeks previously. / Conclusions: Benefits on the off-medication symptoms of PD obtained acutely with GPe-DBS are in general not sustained. Similarly, the effects of GPi-DBS on the off medication symptoms of PD, can evolve over short periods of time presumably as a result of changes in network-wide neuronal plasticity. These clinical observations provide further insight into DBS mechanism of action, and can also help inform optimal methods of GPi-DBS programming.

Type: Article
Title: Varying time-course of effects of high frequency stimulation of sub-regions of the globus pallidus in patients with Parkinson's Disease
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.parkreldis.2015.03.019
Publisher version: http://dx.doi.org/10.1016/j.parkreldis.2015.03.019
Language: English
Additional information: This article is published under a Creative Commons Attribution Non-commercial Non-derivative 4.0 International licence (CC BY-NC-ND 4.0). This licence allows you to share, copy, distribute and transmit the work for personal and non-commercial use providing author and publisher attribution is clearly stated. Further details about CC BY licences are available at http://creativecommons.org/licenses/by/4.0.
Keywords: Deep brain stimulation, GPe, GPi, Globus pallidus, Parkinson's disease
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Clinical and Movement Neurosciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > UCL Queen Square Institute of Neurology > Department of Neuromuscular Diseases
URI: https://discovery.ucl.ac.uk/id/eprint/1466062
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