Subthalamic Nucleus Deep Brain Stimulation Does Not Improve Visuo-motor Impairment in Parkinson's Disease

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2013 Jun 19

PMID 23776460

Citations 4

Authors

Simon D Israeli-Korn

Shraga Hocherman

Sharon Hassin-Baer

Oren S Cohen

Rivka Inzelberg

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate how bilateral subthalamic nucleus deep brain stimulation (STN-DBS) affects visuo-motor coordination (VMC) in patients with Parkinson's disease (PD).

Background: VMC involves multi-sensory integration, motor planning, executive function and attention. VMC deficits are well-described in PD. STN-DBS conveys marked motor benefit in PD, but pyscho-cognitive complications are recognized and the effect on VMC is not known.

Methods: Thirteen PD patients with bilateral STN-DBS underwent neurological, cognitive, and mood assessment before VMC testing with optimal DBS stimulation parameters ('on-stimulation') and then, on the same day without any medication changes, after DBS silencing and establishing motor function deterioration ('off-stimulation'). Twelve age-matched healthy controls performed 2 successive VMC testing sessions, with a break of similar duration to that of the PD group. The computer cursor was controlled with a dome-shaped 'mouse' hidden from view that minimized tremor effects. Movement duration, hand velocity, tracking continuity, directional control variables, and feedback utilization variables were measured. MANOVA was performed on (1) clinically measured motor function, (2) VMC performance and (3) mood and attention, looking for main and interaction effects of: (1) group (controls/PD), (2) test-order (controls: first/second, PD: on-stimulation/off-stimulation), (3) path (sine/square/circle) and (4) hand (dominant/non-dominant).

Results: Unified PD Rating Scale (UPDRS) Part III worsened off-stimulation versus on-stimulation (mean: 42.3 versus 21.6, p = 0.02), as did finger tapping (p = 0.02), posture-gait (p = 0.01), upper limb function (p<0.001) and backwards digit span (p = 0.02). Stimulation state did not affect mood. PD patients performed worse in non-velocity related VMC variables than controls (F(5,18) = 8.5, p<0.001). In the control group there were significant main effects of hand (dominant/non-dominant), path (sine/square/circle) and test-order (Test_1/Test_2). In the PD group, hand and path effects, but no test-order (on-stimulation/off-stimulation), were found.

Conclusions: 'Low-level' clinically-measured motor function responds to STN-DBS but 'high-level' motor and cognitive functions relating to VMC may be unresponsive to STN-DBS.

Citing Articles

Reaching and Grasping Movements in Parkinson's Disease: A Review.

Fasano A, Mazzoni A, Falotico E J Parkinsons Dis. 2022; 12(4):1083-1113.

PMID: 35253780 PMC: 9198782. DOI: 10.3233/JPD-213082.

How is cognition in subthalamic nucleus deep brain stimulation Parkinson's disease patients?.

Barboza E Barbosa E, Fichman H Dement Neuropsychol. 2019; 13(4):367-377.

PMID: 31844489 PMC: 6907696. DOI: 10.1590/1980-57642018dn13-040002.

Systematic review of neuropsychological instruments used in subthalamic nucleus deep brain stimulation in Parkinson´s disease patients.

Barboza E Barbosa E, Charchat-Fichman H Dement Neuropsychol. 2019; 13(2):162-171.

PMID: 31285790 PMC: 6601304. DOI: 10.1590/1980-57642018dn13-020004.

Systemic effects of deep brain stimulation on synergic control in Parkinson's disease.

Falaki A, Jo H, Lewis M, OConnell B, De Jesus S, McInerney J Clin Neurophysiol. 2018; 129(6):1320-1332.

PMID: 29573980 PMC: 5938107. DOI: 10.1016/j.clinph.2018.02.126.

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