To further determine the causes of variable outcome from deep brain stimulation of the subthalamic nucleus (DBS-STN) in patients with Parkinson disease (PD).
Data were obtained from our cohort of 309 patients with PD who underwent DBS-STN between 1996 and 2009. We examined the relationship between the 1-year motor, cognitive, and psychiatric outcomes and (1) preoperative PD clinical features, (2) MRI measures, (3) surgical procedure, and (4) locations of therapeutic contacts.
Pre- and postoperative results were obtained in 262 patients with PD. The best motor outcome was obtained when stimulating contacts were located within the STN as compared with the zona incerta (64% vs 49% improvement). Eighteen percent of the patients presented a postoperative cognitive decline, which was found to be principally related to the surgical procedure. Other factors predictive of poor cognitive outcome were perioperative confusion and psychosis. Nineteen patients showed a stimulation-induced hypomania, which was related to both the form of the disease (younger age, shorter disease duration, higher levodopa responsiveness) and the ventral contact location. Postoperative depression was more frequent in patients already showing preoperative depressive and/or residual axial motor symptoms.
In this homogeneous cohort of patients with PD, we showed that (1) the STN is the best target to improve motor symptoms, (2) postoperative cognitive deficit is mainly related to the surgery itself, and (3) stimulation-induced hypomania is related to a combination of both the disease characteristics and a more ventral STN location.
(1) Compensation for serving on a scientific advisory board received from Medtronic. (2) Compensation for serving on a scientific advisory board received from Lundbeck. (3) Compensation for serving on a scientific advisory board received from Aleva.
(1) Reimbursement for travel expenses, funding for travel expenses and speaker honoraria received from Medtronic. (2) Reimbursement for travel expenses, funding for travel expenses and speaker honoraria received from Lundbeck. (3) Reimbursement for travel expenses, funding for travel expenses received from enverdis. (4) Reimbursement for travel expenses received as a member of the Scientific Advisory Panel (dementia and neurology) 2012-2014 of the European College of Neuropsychopharmacology ECNP.
(1) Member of the Editorial Board of European Neurology, since 2009. (2) Member of the Editorial Board of Movement Disorders, 2009-2012.
(1) European Neurological Society (non-profit): funding for travel (2) MJ Fox Fundation (non-profit): Funding for travel (3) Teva / Lundbeck (commercial): funding for travel (4)Novartis Pharma (commercial): funding for travel
Lundbeck , fees for lecture Teva, fees for lecture Novartis pharma, fees for lecture UCB, fees for lecture
(1) Institut national de la Sant� et de la recherche m�dicale (Contrat interface 2011)
(1) French Parkinson's disease association (2) French essential tremor association
travel expenses from the European Neurological Society European Federation of Neurological Society Movement Disorders Society Dystonia Medical Research Foundation
French national funding for clinical research: DRC (PHRC 2006 deep brain stimulation in dystonia, PI); ANR 2009, DHOS-INSERM (neuroimaging in parkinsonism, co- PI
French national funding for clinical research:DRC (PHRC 2006 deep brain stimulation in dystonia, PI); ANR 2009, DHOS-INSERM (neuroimaging in parkinsonism, co- PI;
French Dystonia Foundation (AMADYS and alliance France Dystonie); Essential Tremor Foundation (CERTRE)
ANR Programme Jeunes Chercheurs N� ANR 05 JCJC 0235 01 Mallet 100% 2006-2009 150 000� Inserm Avenir N� RSE 05 030 DSA Mallet 100% 2005-2010 10 000� Programme Hospitalier de Recherche Clinique (PHRC) STOC AP-HP Mallet 10% 2005-2009 130 000� ANR 2006 Neurosciences, Neurologie et Psychiatrie N� ANR-06- NEURO-006-01 BG EMO/PATH Mallet 100% 2006-2010 151 836 � PHRC STIC (DRRC AP-HP) Welter 10% 2005-2013 130 000� PICRI Ile-de-France Mallet 100% 2008 -2012 142 500� ANR DECCA - D�cision, confiance, actions compulsives : les bases neurales de la m�tacognition et de ses dysfonctionnements dans le trouble obsessionnel compulsive Mallet 100% 2010-2014 338 643� STUC - PHRC AOR11036 - etude pilote de SCP chez des usagers de cocaine pr�sentant une d�pendance et des complications s�v�res Mallet 100% 2012-2015 170 000� Grant AP-HP. Etude PRESTOC2. Evaluation de l'effet de la stimulation haute fr�quence du noyau caude, du noyau accumbens, et du noyau sous-thalamique pour le traitement du trouble obsessionnel-compuslif s�v�re et r�sistant. Mallet 100% 2011 � 2013 80 000�
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