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Background: Effects of subthalamic nucleus deep brain stimulation (STN-DBS) on neuropsychiatric symptoms of Parkinson's disease (PD) remain debated. Sensor technology might help to objectively assess behavioural changes after STN-DBS. Case presentation: 5 PD patients were assessed 1 before and 5 months after STN-DBS with the Movement Disorders Society Unified Parkinson's Disease Rating Scale part III in the medication ON (plus postoperatively stimulation ON) condition, the Montreal Cognitive Assessment, the Questionnaire for Impulsive-Compulsive Behaviors in Parkinson's Disease Rating Scale present version, the Hospital Anxiety and Depression Scale and the Starkstein Apathy Scale. Steps taken per hour, nighttime spent in bed and time spent outside were monitored with a smartwatch and ambient sensors placed in patient homes for an average of 20 days pre- and postoperatively. Postoperative improvement in ICDs and concomitant anxious-depressive symptoms was observed in 3 patients and was accompanied by a decrease in steps taken per hour, as well as an increase in nighttime spent in bed. In the two patients without baseline ICDs, mild anxiety and apathy improved postoperatively, and no new neuropsychiatric symptoms occurred. Steps taken per hour did not decrease in these cases and nighttime spent in bed improved in one of the patients, but decreased in the other, who had experienced pain during OFF-phases at night before STN-DBS. Conclusion: Changes in neuropsychiatric symptoms are associated with distinct activity patterns after STN-DBS, and wearable and ambient sensors may aid to capture those gradual shifts in behavior. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusions Impulse control disorders (ICD) are common side effects of dopaminergic treatment in Parkinson's disease (PD). Whereas some studies show a reduction in ICD after subthalamic nucleus deep brain stimulation (STN‐DBS), others report worsening of ICD or impulsivity.The aim was to study ICD in the context of STN‐DBS using an objective measure of decision‐making.Ten PD patients performed an effort‐based decision‐making task alongside neuropsychiatric and cognitive evaluation before and 4 months after STN‐DBS. Further, 33 PD patients underwent the same experimental procedures just once after an average 40 months of chronic STN‐DBS. Participants were examined preoperatively in the medication on state and postoperatively in the medication on/stimulation ON state. Mixed linear models were used to assess the impact of ICD and STN‐DBS on acceptance rate and decision time in the task while controlling for motor symptom burden, cognitive measures, and dopaminergic medication.Results revealed an increased willingness to exert high levels of effort in return for reward in patients with ICD, but acceptance rate was not modulated by chronic STN‐DBS. Further, ICD, cognitive processing speed, and STN‐DBS were all identified as positive predictors for faster decision speed. ICD scores showed a tendency to improve 4 months after STN‐DBS, without an increase in apathy scores.Chronic STN‐DBS and ICD facilitate effort‐based decision‐making by speeding up judgment. Furthermore, ICD enhances the willingness to exert high levels of effort for reward. Both STN‐DBS and dopaminergic medication impact motivated behavior and should be titrated carefully to balance neuropsychiatric symptoms. [ABSTRACT FROM AUTHOR]

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) is an accepted therapy for Parkinson's disease (PD) with disabling motor complications. For elderly patients with poorer cognition and postural instability, GPi has been proposed as the preferable DBS target based on expert opinion, arguing GPi‐DBS may be less complicated by depression, apathy, worsened verbal fluency, and executive dysfunction, resulting in greater improvement in quality of life (QoL). However, data supporting such patient‐tailored approach are lacking. Objectives: The aims were to analyze whether the DBS target influences QoL in a PD cohort and a matched subgroup of frail patients with poor cognitive status and reduced postural stability, and whether other factors affect the QoL outcomes. Methods: In this retrospective study, we analyzed a single‐center cohort of 138 PD patients who received bilateral STN‐DBS (117) or GPi‐DBS (21) using the mentioned approach for target selection. All patients underwent standardized clinical evaluations of motor‐ and nonmotor signs as well as QoL before and 1 year after surgery. Results: DBS of both targets improved motor signs, dyskinesias, and pain. QoL improved without significant difference between the targets, but with a trend for greater improvement across all QoL domains in favor of the STN, even in an STN subgroup matched to the GPi group. Conclusion: Our results contradict the prevailing belief that GPi‐DBS is superior in frail PD patients with cognitive decline and postural instability, questioning the proposed patient‐tailored approach of DBS target selection. Further studies are needed for a data‐driven approach. [ABSTRACT FROM AUTHOR]

Objective: Deep brain stimulation (DBS) of the posterior subthalamic area (PSA) is an alternative to thalamic DBS for the treatment of essential tremor (ET). The dentato-rubro-thalamic tract (DRTT) has recently been proposed as the anatomical substrate underlying effective stimulation. For clinical purposes, depiction of the DRTT mainly depends on diffusion tensor imaging (DTI)-based tractography, which has some drawbacks. The objective of this study was to present an accurate targeting strategy for DBS of the PSA based on anatomical landmarks visible on MRI and to evaluate clinical effectiveness., Methods: The authors performed a retrospective cohort study of a prospective series of 11 ET patients undergoing bilateral DBS of the PSA. The subthalamic nucleus and red nucleus served as anatomical landmarks to define the target point within the adjacent PSA on 3-T T2-weighted MRI. Stimulating contact (SC) positions with reference to the midcommissural point were analyzed and projected onto the stereotactic atlas of Morel. Postoperative outcome assessment after 6 and 12 months was based on change in Tremor Rating Scale (TRS) scores., Results: Actual target position corresponded to the intended target based on anatomical landmarks depicted on MRI. The total TRS score was reduced (improved) from 47.2 ± 15.7 to 21.3 ± 10.7 (p < 0.001). No severe complication occurred. The mean SC position projected onto the PSA at the margin of the cerebellothalamic fascicle and the zona incerta., Conclusions: Targeting of the PSA based on anatomical landmarks representable on MRI is reliable and leads to accurate lead placement as well as good long-term clinical outcome.