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Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression
CLINICAL VIGNETTE: A 67-year-old female with advanced Parkinson’s disease (PD), medically refractory tremor, and a history of significant depression presented for evaluation of deep brain stimulation (DBS) candidacy. CLINICAL DILEMMA: Traditionally, the subthalamic nucleus (STN) has been preferred o...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Columbia University Libraries/Information Services
2017
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395677/ https://www.ncbi.nlm.nih.gov/pubmed/28428905 http://dx.doi.org/10.7916/D8KD23NZ |
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author | Patel, Amar S. |
author_facet | Patel, Amar S. |
author_sort | Patel, Amar S. |
collection | PubMed |
description | CLINICAL VIGNETTE: A 67-year-old female with advanced Parkinson’s disease (PD), medically refractory tremor, and a history of significant depression presented for evaluation of deep brain stimulation (DBS) candidacy. CLINICAL DILEMMA: Traditionally, the subthalamic nucleus (STN) has been preferred over the globus pallidus interna (GPi) as a DBS target for PD patients with levodopa-responsive fluctuations in rigidity and akinesia, for whom tremor is also a significant source of impairment. However, STN stimulation is avoided in patients with a significant pre-surgical history of mood disorder. CLINICAL SOLUTION: Bilateral DBS of the GPi led to significant short-term improvement in PD motor symptoms, including significant tremor reduction. GAP IN KNOWLEDGE: There is insufficient evidence to support or refute clinicians’ traditional preference for STN stimulation in treating refractory PD tremor. Similarly, the available evidence for risk of worsening depression and/or suicidality after STN DBS is mixed. Both questions require further clarification to guide patient and clinician decision-making. |
format | Online Article Text |
id | pubmed-5395677 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Columbia University Libraries/Information Services |
record_format | MEDLINE/PubMed |
spelling | pubmed-53956772017-04-20 Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression Patel, Amar S. Tremor Other Hyperkinet Mov (N Y) DBS Case Files CLINICAL VIGNETTE: A 67-year-old female with advanced Parkinson’s disease (PD), medically refractory tremor, and a history of significant depression presented for evaluation of deep brain stimulation (DBS) candidacy. CLINICAL DILEMMA: Traditionally, the subthalamic nucleus (STN) has been preferred over the globus pallidus interna (GPi) as a DBS target for PD patients with levodopa-responsive fluctuations in rigidity and akinesia, for whom tremor is also a significant source of impairment. However, STN stimulation is avoided in patients with a significant pre-surgical history of mood disorder. CLINICAL SOLUTION: Bilateral DBS of the GPi led to significant short-term improvement in PD motor symptoms, including significant tremor reduction. GAP IN KNOWLEDGE: There is insufficient evidence to support or refute clinicians’ traditional preference for STN stimulation in treating refractory PD tremor. Similarly, the available evidence for risk of worsening depression and/or suicidality after STN DBS is mixed. Both questions require further clarification to guide patient and clinician decision-making. Columbia University Libraries/Information Services 2017-04-11 /pmc/articles/PMC5395677/ /pubmed/28428905 http://dx.doi.org/10.7916/D8KD23NZ Text en © 2017 Patel. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution–Noncommerical–No Derivatives License, which permits the user to copy, distribute, and transmit the work provided that the original author and source are credited; that no commercial use is made of the work; and that the work is not altered or transformed. |
spellingShingle | DBS Case Files Patel, Amar S. Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression |
title | Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression |
title_full | Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression |
title_fullStr | Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression |
title_full_unstemmed | Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression |
title_short | Deep Brain Stimulation Target Selection in an Advanced Parkinson’s Disease Patient with Significant Tremor and Comorbid Depression |
title_sort | deep brain stimulation target selection in an advanced parkinson’s disease patient with significant tremor and comorbid depression |
topic | DBS Case Files |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5395677/ https://www.ncbi.nlm.nih.gov/pubmed/28428905 http://dx.doi.org/10.7916/D8KD23NZ |
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