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      A Meta-Analysis of the Effect of Subthalamic Nucleus-Deep Brain Stimulation in Parkinson's Disease-Related Pain

      systematic-review

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          Abstract

          Pain from Parkinson's disease (PD) is a non-motor symptom affecting the quality of life and has prevalence of 20–80%. However, it is unclear whether subthalamic nucleus deep brain stimulation (STN–DBS), a well-established treatment for PD, is effective forPD-related pain. Thus, the objective of this meta-analysis was to investigate the efficacy of STN-DBS on PD-related pain and explore how its duration affects the efficacy of STN-DBS. A systematic search was performed using PubMed, Embase, and the Cochrane Library. Nine studies included numerical rating scale (NRS), visual analog scale (VAS), or non-motor symptom scale (NMSS) scores at baseline and at the last follow-up visit and therefore met the inclusion criteria of the authors. These studies exhibited moderate- to high-quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. Random effect meta-analysis revealed a significant change in PD-related pain as assessed by NMSS, NRS, and VAS ( P <0.01). Analysis of the short and long follow-up subgroups indicated delayed improvement in PD-related pain. These findings (a) show the efficacy of STN-DBS on PD-related pain and provide higher-level evidence, and (b) implicate delayed improvement in PD-related pain, which may help programming doctors with supplement selecting target and programming.

          Systematic Review Registration: This study is registered in Open Science Framework ( DOI: 10.17605/OSF.IO/DNM6K).

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          Most cited references39

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          Hold your horses: impulsivity, deep brain stimulation, and medication in parkinsonism.

          Deep brain stimulation (DBS) of the subthalamic nucleus markedly improves the motor symptoms of Parkinson's disease, but causes cognitive side effects such as impulsivity. We showed that DBS selectively interferes with the normal ability to slow down when faced with decision conflict. While on DBS, patients actually sped up their decisions under high-conflict conditions. This form of impulsivity was not affected by dopaminergic medication status. Instead, medication impaired patients' ability to learn from negative decision outcomes. These findings implicate independent mechanisms leading to impulsivity in treated Parkinson's patients and were predicted by a single neurocomputational model of the basal ganglia.
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            Pathophysiology of somatosensory abnormalities in Parkinson disease.

            Changes in sensory function that have been described in patients with Parkinson disease (PD) can be either 'pure' disorders of conscious perception such as elevations in sensory threshold, or disorders of sensorimotor integration, in which the interaction between sensory input and motor output is altered. In this article, we review the extensive evidence for disrupted tactile, nociceptive, thermal and proprioceptive sensations in PD, as well as the influences exerted on these sensations by dopaminergic therapy and deep brain stimulation. We argue that abnormal spatial and temporal processing of sensory information produces incorrect signals for the preparation and execution of voluntary movement. Sensory deficits are likely to be a consequence of the dopaminergic denervation of the basal ganglia that is the hallmark of PD. A possible mechanism to account for somatosensory deficits is one in which disease-related dopaminergic denervation leads to a loss of response specificity, resulting in transmission of noisier and less-differentiated information to cortical regions. Changes in pain perception might have a different explanation, possibly involving disease-related effects outside the basal ganglia, including involvement of peripheral pain receptors, as well as structures such as the periaqueductal grey matter and non-dopaminergic neurotransmitter systems.
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              Deep brain stimulation induced normalization of the human functional connectome in Parkinson’s disease

              Deep brain stimulation has local effects on the target structure, but also global effects via distributed brain networks. Horn et al. show that modulating the activity of the subthalamic nucleus in patients with Parkinson’s disease normalizes signatures of widespread network connectivity towards those found in healthy controls.
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                Author and article information

                Contributors
                Journal
                Front Hum Neurosci
                Front Hum Neurosci
                Front. Hum. Neurosci.
                Frontiers in Human Neuroscience
                Frontiers Media S.A.
                1662-5161
                01 July 2021
                2021
                : 15
                : 688818
                Affiliations
                [1] 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University , Beijing, China
                [2] 2Beijing Key Laboratory of Neurostimulation , Beijing, China
                Author notes

                Edited by: Giovanni Mirabella, University of Brescia, Italy

                Reviewed by: Mirko Filippetti, University of Verona, Italy; Antonio Suppa, Sapienza University of Rome, Italy; Enrica Olivola, University of Rome Tor Vergata, Italy

                *Correspondence: Anchao Yang yang.anchao@ 123456163.com

                This article was submitted to Motor Neuroscience, a section of the journal Frontiers in Human Neuroscience

                †These authors have contributed equally to this work and share first authorship

                Article
                10.3389/fnhum.2021.688818
                8281028
                34276330
                691ec26d-e01f-4bb2-bfee-fe6dcdc51b69
                Copyright © 2021 Diao, Bai, Hu, Yin, Liu, Meng, Yang and Zhang.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 31 March 2021
                : 31 May 2021
                Page count
                Figures: 7, Tables: 3, Equations: 0, References: 39, Pages: 11, Words: 6111
                Categories
                Human Neuroscience
                Systematic Review

                Neurosciences
                parkinson diseases,pain,follow-up,deep brain stimulation,meta-analysis
                Neurosciences
                parkinson diseases, pain, follow-up, deep brain stimulation, meta-analysis

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