Abstract
Objective
To compare the cognitive and behavioural effects of unilateral pallidotomy and bilateral subthalamic nucleus (STN) stimulation.
Methods
After baseline examination 34 patients were randomly assigned to unilateral pallidotomy (4 left-sided, 10 right-sided) or bilateral STN stimulation (n=20). At baseline and six and twelve months after surgery we administered neuropsychological tests of language, memory, visuospatial function, mental speed and executive functions. Also a depression rating scale, and self and proxy ratings of memory and dysexecutive symptoms were administered.
Results
Six months after surgery, the STN group and the pallidotomy group differed significantly in change from baseline in number of errors on two tests of executive functioning. After 12 months the STN group reported less positive affect compared with baseline than the pallidotomy group. One patient in the STN group showed an overall cognitive deterioration due to complications.
Conclusions
Although we need larger groups to draw firm conclusions, our results suggest that bilateral STN stimulation has slightly more negative effects on executive functioning than unilateral pallidotomy.
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References
Alegret M, Junque C, Valldeoriola F, Vendrell P, Pilleri M, Rumia J, Tolosa E (2001) Effects of bilateral subthalamic stimulation on cognitive function in Parkinson disease. Arch Neurol 58:1223–1227
Burchiel KJ, Anderson V, Favre J, Hammerstad JP (1999) Comparison of Pallidal and Subthalamic Nucleus Deep Brain Stimulation for Advanced Parkinson’s Disease: Results of a Randomized, Blinded Pilot Study. Neurosurgery 45:1375–1384
Crook III TH, Larrabee GJ (1990) A self-rating scale for evaluating memory in everyday life. Psychol Aging 5:48–57
Dowmes JJ, Sharp HM, Costall BM, Sagar HJ, Howe J (1993) Alternating fluency in Parkinson’s disease. Brain 116:887–902
Dujardin K, Defebvre L, Krystkowiak P, Blond S, Destee A (2001) Influence of chronic bilateral stimulation of the subthalamic nucleus on cognitive function in Parkinson’s disease. J Neurol 248:603–611
Esselink R, De Bie R, de Haan RJ, Lenders M, Nijsen P, Staal MJ, Smeding H, Schuurman PR, Bosch DA, Speelman JD (2004) Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD. A randomized trial. Neurology 62:201–207
Flowers KA, Robertson C (1985) The effect of Parkinson’s disease on the ability to maintain a mental set. J Neurol Neurosurg Psychiatry 48:517–529
Funkiewiez A, Ardouin C, Krack P, Fraix V, Van Blercom N, Xie J, Moro E, Benabid A, Pollak P (2003) Acute Psychotropic Effects of Bilateral Subthalamic Nucleus Stimulation and Levodopa in Parkinson’s Disease. Mov Disord 18:524–530
Gironell A, Kulisevsky J, Rami L, Fortuny N, Garcia-Sanchez C, Pascual-Sedano B (2003) Effects of pallidotomy and bilateral subthalamic stimulation on cognitive function in Parkinson disease. A controlled comparative study. J Neurol 250:917–923
Green J, Barnhart H (2000) The impact of lesion laterality on neuropsychological change following posterior pallidotomy: a review of current findings. Brain Cogn 42:379–398
Gronwall D (1977) Paced Auditory Serial-Addition Task: a measure of recovery from concussion. Percept Motor Skills 44:367–373
Houeto JL, Mesnage V, Mallet L, Pillon B, Gargiulo M, Tezenas du Moncel S, Bonnet AM, Pidoux B, Dormont D, Cornu P, Agid Y (2002) Behavioural disorders, Parkinson’s disease and subthalamic stimulation. J Neurol Neurosurg Psychiatry 72:701–707
Kaplan E, Goodglass H, Weintraub S (1983) Boston Naming Test. Philadelphia, Lea and Febiger
Krack P, Kumar R, Ardouin C, Limousin-Dowsey P, McVickerr J, Benabid AL, Pollak P (2001) Mirthful laughter induced by Subthalamic Nucleus Stimulation. Mov Disord 16:867–875
Lacritz LH, Cullum CM, Frol AB, Dewey Rjr, Giller CA (2000) Neuropsychological outcome following unilateral stereotactic pallidotomy in intractable Parkinson’s disease. Brain Cogn 42:364–378
Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid AL (1998) Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 339:1105–1111
Luteijn F, van der Ploeg FAE (1998) Groninger intelligentie test (Dutch Intelligence test). Lisse, the Netherlands, Swets and Zeitlinger
Mattis S (1973) Dementia Rating Scale professional manual. Odessa, Florida, USA, Psychological Assessment Resources, Inc
McNair DM, Lorr M, Droppleman LF (1981) EDITS manual for the Profile of Mood States. San Diego, CA, Educational and Industrial Service
Montgomery SA, Asberg M (1979) A new depression scale designed to be sensitive to change. Br J Psychiatry 134:382–389
Morrison CE, Borod JC, Perrine K, Beric A, Brin MF, Rezai A, Kelly P, Sterio D, Germano I, Weisz D, Olanow CW (2004) Neuropsychological functioning following bilateral subthalamic nucleus stimulation in Parkinson’s disease. Arch Clin Neuropsychol 19:165–181
Nelson HE (1991) The revised National Adult Reading Test manual. Windsor, UK, NFER-Nelson
Perozzo P, Rizzone M, Bergamasco B, Castelli L, Lanotte M, Tavella A, Torre E, Lopiano L (2001) Deep brain stimulation of subthalamic nucleus: behavioural modifications and familiar relations. Neurol Sci 22:81–82
Pillon B, Ardouin C, Damier P, Krack P, Houeto JL, Klinger H, Bonnet AM, Pollak P, Benabid AL, Agid Y (2000) Neuropsychological changes between “off” and “on” STN or GPi stimulation in Parkinson’s disease. Neurol 55:411–418
Pocock SJ, Simon R (1975) Sequential treatment assignment with balancing for prognostic factors in the controlled clinical trial. Biometrics 31:103–115
Ponds R, Jolles J (1996) Memory complaints in elderly people: the role of memory abilities, metamemory, depression, and personality. Educat Gerontol 22:341–357
Reitan RM (1992) Trail Making Test Manual for administration and scoring. Tucson, AZ, Reitan Neuropsychological Laboratory
Rey A (1964) L’examen clinique en psychologie. Paris, France, Presses Universitaires de France
Rosen WG (1980) Verbal fluency in aging and dementia. J Clin Neuropsychol 2:135–146
Rothman KJ (1990) No adjustments are needed for multiple comparisons. Epidemiology 1:43–46
Saint-Cyr JA, Trépanier LL (2000) Neuropsychological Assessment of Patients for Movement Disorder Surgery. Mov Disord 15:771–783
Saint-Cyr JA, Trépanier LL, Kumar R, Lozano AM, Lang AE (2000) Neuropsychological consequences of chronic bilateral stimulation of the subthalamic nucleus in Parkinson’s disease. Brain 123:2091–2108
Schmand B, De Bie R, Koning-Haanstra M, de Smet JS, Speelman JD, van Zomeren AH (2000) Unilateral pallidotomy in PD. A controlled study of cognitive and behavioral effects. Neurol 54:1058–1064
Schmand B, Lindeboom J, van Harskamp F (1992) Nederlandse leestest voor volwassenen (Dutch adult reading test). Lisse, the Netherlands, Swets and Zeitlinger
Schroeder U, Kuehler A, Lange KW, Haslinger B, Tronnier V, Krause M, Pfister R, Boecker H, Ceballos-Bauman AO (2003) Subthalamic nucleus stimulation affects a frontotemporal network: a pet study. Ann Neurol 54:445–450
Stroop JR (1935) Studies of interference in serial verbal reactions. J Exp Psychol 18:643–662
Tatemichi TK, Desmond DW, Prohovnik I, Cross DT, Gropen TI, Mohr JP, Stern Y (1992) Confusion and memory loss from capsular genu infarction: A thalamocortical disconnection syndrome? Neurology 42:1966–1979
Volkmann J, Allert N, Voges J, Weiss PH, Freund HJ, Sturm V (2001) Safety and efficacy of pallidal and subthalamic nucleus stimulation in advanced PD. Neurology 56:548–551
Watson D, Clark LA (1988) Development and validation of brief measures of positive and negative affect: the PANAS scales. J Personal Soc Psychol 54:1063–1070
Wilson BA, Alderman N, Burgess PW, Emslie H, Evans JJ (1996) Behavioural Assessment of the Dysexecutive Syndrome. Bury St. Edmunds,UK, Thames Valley Test Company
Witt K, Pulkowski U, Herzog J, Lorenz D, Hamel W, Deuschl G, Krack P (2004) Deep Brain Stimulation of the Subthalamic Nucleus Improves Cognitive flexibility but Impairs Response Inhibition in Parkinson Disease. Arch Neurol 61:697–700
Woods SP, Fields JA, Tröster AI (2002) Neuropsychological sequelae of subthalamic nucleus deep brain stimulation in Parkinson’s disease: a critical review. Neuropsychol Rev 12:111–126
York MK, Levin HS, Grossman RG, Hamilton WJ (1999) Neuropsychological outcome following unilateral pallidotomy. [Review] [75 refs]. Brain 122:2209–2220
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Smeding, H.M.M., Esselink, R.A.J., Schmand, B. et al. Unilateral pallidotomy versus bilateral subthalamic nucleus stimulation in PD. J Neurol 252, 176–182 (2005). https://doi.org/10.1007/s00415-005-0628-z
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DOI: https://doi.org/10.1007/s00415-005-0628-z