Abstract

Parkinson’s disease (PD) is the second most common neurodegenerative and progressive neurological disorder characterized by tremors, rigidity, bradykinesia, and postural instability. Changes of disease in PD pathophysiology are observed in melanin-containing dopaminergic cells in the substantia nigra. While neuronal loss and gliosis are observed in this region, the remaining neurons may contain cytoplasmic inclusions called Lewy bodies. Deep Brain Stimulation (DBS), is the method of application with the highest patient satisfaction among device-assisted treatments in advanced PD. The DBS method is frequently preferred in cases where the disease progresses, drug treatment does not respond, and freezing and on-off dyskinesias begin. The most preferred method among these is subthalamic nucleus (STN) DBS. DBS treatment improves not only motor symptoms but also non-motor symptoms. The success of DBS is based on adequate response to levodopa, appropriate patient selection, successful neuroanatomical and radiological localization of the target area, and a team experienced in motion sickness. Many studies are being conducted to understand the mechanism of action of deep brain stimulation, the effectiveness of which has been proven by various studies. The excitation and suppressive effects provided by the electrodes are processed with a complex neuronal network and clinical results are obtained. In this article, deep brain stimulation tricks, choosing appropriate patients, and mechanisms of action in Parkinson’s disease will be summarized.

Keywords: Parkinson’s disease, Deep brain stimulation, neurosciences

Copyright and license

Copyright © 2023 The Author(s). This is an open-access article published by Bolu İzzet Baysal Training and Research Hospital under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Akünal Türel C, Arıcan M. Deep brain stimulation in idiopathic Parkinson’s disease. Northwestern Med J. 2023;3(1):56-61. https://doi.org/10.54307/NWMJ.2023.96967

References

  1. Dawson TM, Dawson VL. Molecular pathways of neurodegeneration in Parkinson’s disease. Science. 2003; 302(5646): 819-22. https://doi.org/10.1126/science.1087753
  2. Rubino FA. Gait disorders: Recognition of classic types. In: Adler CH, Ahlskog JE, eds. Parkinson’s Disease and Movement Disorders: Diagnosis and Treatment. Totowa: Humana Press; 2000: 411-25. https://doi.org/10.1007/978-1-59259-410-8_33
  3. Parkinson J. An essay on the shaking palsy. 1817. J Neuropsychiatry Clin Neurosci. 2002; 14(2): 223-36; discussion 222. https://doi.org/10.1176/jnp.14.2.223
  4. Jankovic J. Parkinson Disease and Other Movement Disorders. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff’s Neurology in Clinical Practice. E-Book. Elsevier Health Sciences; 2021: 1498-534.
  5. Jankovic J, Sherer T. The future of research in Parkinson disease. JAMA Neurol. 2014; 71(11): 1351-2. https://doi.org/10.1001/jamaneurol.2014.1717
  6. Stoker TB, Barker RA. Recent developments in the treatment of Parkinson’s Disease. F1000Res. 2020; 9: F1000 Faculty Rev-862. https://doi.org/10.12688/f1000research.25634.1
  7. İnce Günal D. Deep Brain Stimulation in Parkinson’s Disease: Candidate Selection. J Park Dis Mov Disord. 2016; 19(1-2): 1-4. https://doi.org/10.5606/phhb.dergisi.2016.01
  8. Ulutabanca H. Derin Beyin Stimülasyonu: Yeni Teknikler ve Teknolojiler. Türk Nöroşirürji Derg 2021; 31(3): 343-7.
  9. Connolly BS, Lang AE. Pharmacological treatment of Parkinson disease: a review. JAMA. 2014; 311(16): 1670-83. https://doi.org/10.1001/jama.2014.3654
  10. Armstrong MJ, Okun MS. Diagnosis and Treatment of Parkinson Disease: A Review. JAMA. 2020; 323(6): 548-60. https://doi.org/10.1001/jama.2019.22360
  11. Coffey RJ. Deep brain stimulation devices: a brief technical history and review. Artif Organs. 2009; 33(3): 208-20. https://doi.org/10.1111/j.1525-1594.2008.00620.x
  12. Pool JL. Psychosurgery in older people. J Am Geriatr Soc. 1954; 2(7): 456-66. https://doi.org/10.1111/j.1532-5415.1954.tb02138.x
  13. Heath RG. Electrical self-stimulation of the brain in man. Am J Psychiatry 1963; 120(6): 571-7. https://doi.org/10.1176/ajp.120.6.571
  14. Litvan I, Chesselet MF, Gasser T, et al. The etiopathogenesis of Parkinson disease and suggestions for future research. Part II. J Neuropathol Exp Neurol. 2007; 66(5): 329-36. https://doi.org/10.1097/nen.0b013e318053716a
  15. Heath RG. Modulation of emotion with a brain pacemamer. Treatment for intractable psychiatric illness. J Nerv Ment Dis. 1977; 165(5): 300-17. https://doi.org/10.1097/00005053-197711000-00002
  16. Blomstedt P, Hariz MI. Deep brain stimulation for movement disorders before DBS for movement disorders. Parkinsonism Relat Disord. 2010; 16(7): 429-33. https://doi.org/10.1016/j.parkreldis.2010.04.005
  17. Demiryurek BE. Deep brain stimulation in Parkinson s disease: The selection of appropriate patient candidate. J Bionic Mem. 2021; 1(1): 1-5. https://doi.org/10.53545/jbm.2021175566
  18. Uhlhaas PJ, Singer W. Neural synchrony in brain disorders: relevance for cognitive dysfunctions and pathophysiology. Neuron. 2006; 52(1): 155-68. https://doi.org/10.1016/j.neuron.2006.09.020
  19. Wallace BA, Ashkan K, Heise CE, et al. Survival of midbrain dopaminergic cells after lesion or deep brain stimulation of the subthalamic nucleus in MPTP-treated monkeys. Brain. 2007; 130(Pt 8): 2129-45. https://doi.org/10.1093/brain/awm137
  20. Durdağ E, Kocabıçak E. DBS in Parkinson’s Disease: Mechanisms of Action. Türk Nöroşir Derg 2021; 31(3): 271-7.
  21. Türel CA. Idiopatic Parkinson’s Disease and Parkinsonism. In: Parlar H, ed. Health & Science 2021-II; 2021: 49-58.
  22. Welter ML, Houeto JL, Bonnet AM, et al. Effects of high-frequency stimulation on subthalamic neuronal activity in parkinsonian patients. Arch Neurol. 2004; 61(1): 89-96. https://doi.org/10.1001/archneur.61.1.89
  23. Ünal Y. Deep brain stimulation: Practice, Follow-up, Difficult-to-treat patients. Parkinson Hast Harek Boz Derg. 2018; 21(1-2): 12-21.
  24. Tutuncu M. Peripheral Silent Period In Cervical and Generalized Dystonia. Dicle Tıp Derg. 2021; 48(1): 205-11. https://doi.org/10.5798/dicletip.888781
  25. Yakşi E, Yaşar MF, Türel CA, Balcı M. Are static posturography-assisted biofeedback exercises effective in Parkinson’s disease? Arq Neuropsiquiatr. 2022; 80(9): 935-43. https://doi.org/10.1055/s-0042-1755325