OBJECTIVEThis review examines the evidence that deep brain stimulation (DBS) has extensive impact on nonmotor symptoms (NMSs) of patients with Parkinson's disease (PD).

DATA SOURCESWe retrieved information from the PubMed database up to September, 2015, using various search terms and their combinations including PD, NMSs, DBS, globus pallidus internus (GPi), subthalamic nucleus (STN), and ventral intermediate thalamic nucleus.

STUDY SELECTIONWe included data from peer-reviewed journals on impacts of DBS on neuropsychological profiles, sensory function, autonomic symptoms, weight changes, and sleep disturbances. For psychological symptoms and cognitive impairment, we tried to use more reliable proofs: Random, control, multicenter, large sample sizes, and long period follow-up clinical studies. We categorized the NMSs into four groups: those that would improve definitively following DBS; those that are not significantly affected by DBS; those that remain controversial on their surgical benefit; and those that can be worsened by DBS.

RESULTSIn general, it seems to be an overall beneficial effect of DBS on NMSs, such as sensory, sleep, gastrointestinal, sweating, cardiovascular, odor, urological symptoms, and sexual dysfunction, GPi-DBS may produce similar results; Both STN and Gpi-DBS are safe with regard to cognition and psychology over long-term follow-up, though verbal fluency decline is related to DBS; The impact of DBS on behavioral addictions and dysphagia is still uncertain.

CONCLUSIONSAs the motor effects of STN-DBS and GPi-DBS are similar, NMSs may determine the target choice in surgery of future patients.

Deep Brain Stimulation ; Globus Pallidus ; surgery ; Humans ; Male ; Parkinson Disease ; surgery ; therapy ; Subthalamic Nucleus ; surgery

From May, 2000 to June, 2001, 27 patients with Parkinson disease (PD), including 10 cases of rigidity, 13 cases of tremor, 4 cases of rigidity and tremor, were treated by microelectrode-guided technique. Among them, phlebotomy was carried out in 17 cases and thalamotomy in 10 cases. All the targets of lesion were anatomically located by using MR and neurophysiological signals on microelectrode. Our results showed that the efficiency of microelectrode-guided technique for treatment of PD was 98%. The postoperative unified parkinson disease rating scale were 12.3 +/- 9.1 and 13.2 +/- 8.9 respectively, which significantly improved as compared with those before operation. It was concluded that by recognizing special electrical signals in neurons microelectrode-guided neuropsychological techniques can locate target at cellular level, which overcomes the individual difference in anatomy and function, and allow more accuracy, safety and efficiency of operation. This is especially true of PD patients who fail to respond to medical treatment.
Magnetic Resonance Imaging ; *Microelectrodes ; Parkinson Disease/*surgery ; Stereotaxic Techniques ; Thalamus/surgery

Animals ; Cell Transplantation ; methods ; Humans ; Parkinson Disease ; surgery ; Pigment Epithelium of Eye ; cytology ; physiology ; Positron-Emission Tomography

To observe the effects of heterograft of glomus cells of carotid body on hemiparkinsonian rat models, rats with unilateral 6-hydroxydopamine (6-OHDA)-induced lesions of the right dopaminergic neurons of substantia nigra received intrastriatal glomus cells heterograft. Apomorphine-induced rotation was monitored for 30 min at various time points after grafting. The striata were cut and examined for dopamine content by HPLC and for immunohistochemical staining of tyrosine hydroxylase positive neurons (TH+) at the end of the experiments. The results showed that apomorphine-induced rotational behavior was significantly reduced for 12 weeks and the dopamine contents were significantly elevated after grafting (P < 0.01), and TH+ cells survived better. The present study demonstrates that intrastriatal heterograft of glomus cells within carotid body in rats with 6-OHDA-elicited lesions could reduce apomorphine-induced rotational behavior and elevate the dopamine contents and numbers of TH+ cell surviving within striatum, and can serve as a new and effective alternative for Parkinson disease.
Carotid Body/*cytology ; Carotid Body/transplantation ; *Cell Transplantation ; Dopamine/*metabolism ; Neurons/metabolism ; Parkinson Disease/metabolism ; Parkinson Disease/*surgery ; Random Allocation ; Rats, Sprague-Dawley ; Stereotaxic Techniques ; Transplantation, Heterologous

From May, 2000 to June, 2001, 27 patients with Parkinson disease (PD), including 10 cases of rigidity, 13 cases of tremor, 4 cases of rigidity and tremor, were treated by microelectrode-guided technique. Among them, phlebotomy was carried out in 17 cases and thalamotomy in 10 cases. All the targets of lesion were anatomically located by using MR and neurophysiological signals on microelectrode. Our results showed that the efficiency of microelectrode-guided technique for treatment of PD was 98%. The postoperative unified parkinson disease rating scale were 12.3 +/- 9.1 and 13.2 +/- 8.9 respectively, which significantly improved as compared with those before operation. It was concluded that by recognizing special electrical signals in neurons microelectrode-guided neuropsychological techniques can locate target at cellular level, which overcomes the individual difference in anatomy and function, and allow more accuracy, safety and efficiency of operation. This is especially true of PD patients who fail to respond to medical treatment.
Adult ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Microelectrodes ; Middle Aged ; Parkinson Disease ; surgery ; Stereotaxic Techniques ; Thalamus ; surgery

BACKGROUNDParkinson's disease (PD) is an extrapyramidal neurological disorder. Urinary symptoms are frequently present in patients affected by PD. Symptoms such as urgency, frequency, nocturia, and urge incontinence significantly impact the patient's quality of life. We attempted to investigate the urodynamic changes and treatment of male PD patients with voiding dysfunction by means of a review.

METHODSComprehensive urodynamic examinations were performed in 141 male patients with PD associated with voiding dysfunction. Appropriate treatments were given to subgroups that were divided based on test results, and the changes in urodynamic parameters as well as the treatment efficacy were observed.

RESULTSDetrusor hyperreflexia without bladder outlet obstruction (BOO) was observed in 35 patients, who exhibited significant improvements in the international prostate symptom score (IPSS), maximum flow rate (Qmax), bladder volume at the first desire to void, post-void residual (PVR), and bladder compliance. Detrusor hyperreflexia associated with BOO was observed in 59 patients. The patients exhibited significant improvements in IPSS, Qmax, PVR, and bladder compliance. Detrusor dysfunction without BOO was observed in 19 patients, for whom the IPSS and the bladder volume at the first desire to void were improved after treatment. Detrusor dysfunction with BOO was found in 28 patients, with no significant improvement in the urodynamic parameters after the treatment.

CONCLUSIONSUrodynamic examination is recommended for male Parkinson's disease patients with voiding dysfunction. Early and effective treatment can improve the bladder function and quality of life of these patients.

Aged ; Aged, 80 and over ; Humans ; Male ; Middle Aged ; Parkinson Disease ; physiopathology ; surgery ; therapy ; Urination Disorders ; physiopathology ; surgery ; therapy ; Urodynamics

Electrophysiological target localization is the key technology in microelectrode-guided stereotactic neurosurgery for Parkinson's disease (PD). A neuronal discharge signal analysis method based on Hilbert-Huang transform (HHT) was introduced. By decomposing the clinical microelectrode recording (MER) data of PD into intrinsic mode functions (IMFs), the marginal spectrums of IMFs were achieved, and the characteristic factor correlated with brain structure was explored, then the HHT characteristic factor curve of neuronal discharge signals of microelectrode piqure locus could be achieved. The structures of neuronal and boundaries can be distinguished by the characteristic factor curve, and then damage range and damage point can be identified. This method can assist clinicians in ascertaining operation target effectively and researching into the cases of PD.
Electrophysiology ; Humans ; Microelectrodes ; Neurons ; cytology ; physiology ; Neurosurgery ; methods ; Parkinson Disease ; physiopathology ; surgery ; Signal Processing, Computer-Assisted ; Stereotaxic Techniques

Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel and minimally invasive technology. Since the US Food and Drug Administration approved unilateral ventral intermediate nucleus-MRgFUS for medication-refractory essential tremor in 2016, studies on new indications, such as Parkinson's disease (PD), psychiatric diseases, and brain tumors, have been on the rise, and MRgFUS has become a promising method to treat such neurological diseases. Currently, as the second most common degenerative disease, PD is a research hotspot in the field of MRgFUS. The actions of MRgFUS on the brain range from thermoablation, blood-brain barrier (BBB) opening, to neuromodulation. Intensity is a key determinant of ultrasound actions. Generally, high intensity can be used to precisely thermoablate brain targets, whereas low intensity can be used as molecular therapies to modulate neuronal activity and open the BBB in conjunction with injected microbubbles. Here, we aimed to summarize advances in the application of MRgFUS for the treatment of PD, with a focus on thermal ablation, BBB opening, and neuromodulation, in the hope of informing clinicians of current applications.
Humans ; Parkinson Disease/therapy* ; Brain ; Blood-Brain Barrier ; Essential Tremor/surgery* ; Brain Neoplasms ; Magnetic Resonance Imaging/methods* ; Magnetic Resonance Spectroscopy

BACKGROUNDThe accuracy of microelectrode-guided localization can make the operation safe and effective, but only experienced neurosurgeons are capable of performing this operation. A good index to identify neuronal discharges between globus pallidus interna and globus pallidus externa is needed. The aim of this research was to establish a good and practical electrophysiologic index to distinguish neuronal discharge in the interior globus pallidus from neuronal discharge in the exterior globus pallidus region of the brain in Parkinson's disease. The effect of neurons having an atypical discharge on successful surgical localization was also quantitatively evaluated.

METHODSThe study included 30 patients with primary Parkinson's disease who underwent pallidotomy between September 2000 and October 2002. During each pallidotomy, the neuronal discharges in the pallidum and its vicinity were recorded. The recorded spikes were used to calculate the frequency, burst index, pause index, and pause ratio of the single-unit discharge. The interior and exterior globus pallidus regions were compared in terms of frequency, burst index, pause index, and pause ratio. The sensitivity, specificity, false-negative ratio, false-positive ratio, and accuracy of those indices were then evaluated.

RESULTSThe values of frequency, burst index, pause index, and pause ratio in the interior globus pallidus were (96 +/- 43) Hz, 2.31 +/- 1.81, 0.05 +/- 0.05, and 0.27 +/- 0.28, respectively, and in the exterior globus pallidus were (59 +/- 27) Hz, 0.88 +/- 0.63, 0.20 +/- 0.14, and 1.54 +/- 1.17, respectively. Use of the four indices to distinguish the two neuron types produced a sensitivity of 0.84, 0.78, 0.77, and 0.93 with a specificity of 0.64, 0.79, 0.88, and 0.87, respectively. The false-positive ratio was 0.36, 0.21, 0.12, and 0.13 and the false-negative ratio was 0.16, 0.22, 0.23, and 0.07 while the accuracy was 0.72, 0.79, 0.80, and 0.90, respectively.

CONCLUSIONSPause ratio is a relatively reliable index to distinguish neuronal discharges between the interior and exterior globus pallidus regions in Parkinson's disease. The effect of neurons with atypical discharge on the successful surgical localization would be reduced to 10% when the pause ratio is used as the index.

Adult ; Electrophysiology ; Female ; Globus Pallidus ; metabolism ; Humans ; Male ; Microelectrodes ; Middle Aged ; Pallidotomy ; methods ; Parkinson Disease ; metabolism ; surgery

Intraoperative analysis of the position of microelectrode in the globus pallidus only depends on experiences and subjective interpretation of microeletrode recording discharge of neurons during pallidotomy for Parkinson's disease. In this paper is reported a method for objective localization of microeletrode during neurosurgery. This method uses the factor of interspike interval based on microelectrode recordings. It is effective for identifying the change of the globus pallidal organism along the microelectrode pathway and the departure or deviation of the needle-pathway. The classification is consistent with the anatomic structures and the results of neurosurgery. This method can be used as a guide in pallidotomy. Globus pallidus.
Adult ; Aged ; Female ; Globus Pallidus ; surgery ; Humans ; Male ; Microelectrodes ; Middle Aged ; Pallidotomy ; methods ; Parkinson Disease ; surgery ; Stereotaxic Techniques ; Surgery, Computer-Assisted ; methods