Parkinson disease patients performance in Theory of Mind (ToM) and decision-making tasks with and without Deep Brain Stimulation (DBS) / Desempeño de pacientes con Parkinson con y sin estimulación cerebral profunda (ECP) en Teoría de la Mente (ToM) y toma de decisiones

Abstract: Background: Patients with Parkinson's Disease (PD) show non-motor symptoms, such as cognitive impairment, disrupting executive functions, and mood alterations. Two processes currently researched in these areas are the Theory of Mind (ToM) and the decision-making in PD patients. The ToM is the ability to identify mental states (affective or cognitive) in others, and it is a necessary skill for successful communication in social situations. The decision-making process is researched in PD patients due to alterations in dopaminergic pathways involved in cortico-striatal circuits. These pathways have been linked to cognitive functions. Both processes could be altered in PD patients after the deep brain stimulation (DBS) therapy. Objective: To compare the performance of PD patients (with and without DBS) and healthy controls (HC) in the Theory of Mind and decision-making tasks. Methods: We applied to three groups of patients (PD, n = 4; PD-DBS, n = 5 and HC, n = 5) the Yoni task to identify affective and cognitive features in ToM and the Iowa Gambling Task (IGT) in decision-making. Results: There were no differences across the PD groups in ToM both in the affective and cognitive features. Regarding the decision-making, we obtained results consistent with previous findings, with PD patients showing impairments in this process. Conclusions: Some results suggest that DBS therapy affected PD patients' performance in decision-making when compared to the healthy control group. Our results describe some non-motor changes due to DBS often seen in PD patients.

Resumen: Los pacientes con enfermedad de Parkinson (EP) muestran síntomas no motores, como deterioro cognitivo, alteración de las funciones ejecutivas y alteraciones del estado de ánimo. Dos procesos que se investigan actualmente en este tipo de pacientes son la Teoría de la Mente (ToM) y la toma de decisiones. La Teoría de la Mente es la capacidad de identificar los estados mentales (afectivos o cognitivos) en los demás, y es una habilidad necesaria para la comunicación exitosa en situaciones sociales. El proceso de toma de decisiones se investiga en los pacientes con EP debido a las alteraciones en las vías dopaminérgicas implicadas en los circuitos corticoestriatales, las cuales se han vinculado a las funciones cognitivas. Ambos procesos podrían estar alterados en los pacientes con EP después de la terapia de estimulación cerebral profunda (ECP). Con el objetivo de comparar el rendimiento de pacientes con EP (con y sin ECP) y controles sanos (HC) en teoría de la mente y tareas de toma de decisiones, aplicamos a tres grupos de pacientes (PD, n = 4; PD-DBS, n = 5 y HC, n = 5) la tarea de Yoni para identificar las características afectivas y cognitivas en TM y la Tarea de Juego de Iowa (IGT) en la toma de decisiones. No hubo diferencias entre los grupos de EP en TM tanto en las características afectivas como en las cognitivas. En cuanto a la toma de decisiones, obtuvimos resultados consistentes con los hallazgos anteriores, con pacientes con EP que mostraron impedimentos en este proceso. Algunos resultados sugieren que la terapia de ECP afectó el desempeño de los pacientes con EP en la toma de decisiones cuando se comparó con el grupo de control sano. Nuestros hallazgos describen algunos cambios no motores debidos a la ECP que se observan a menudo en los pacientes con EP.

Imaging law of postoperative electrode locations in deep brain stimulation for Parkinson's disease / 上海交通大学学报（医学版）

Objective:To explore the potential regularity and cause of the differences between magnetic resonance imaging (MRI) and computed tomography (CT) presenting electrodes after deep brain stimulation (DBS) for Parkinson's disease (PD), in order to provide reference for optimizing clinical decision. Methods:Forty-nine PD patients who underwent DBS treatment in Department of Functional Neurosurgery of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from Jan. 2016 to Dec. 2017 were selected. CT images were acquired 3-5 days after surgery and MRI images were acquired during 3-6 months by the follow-up of regular programming. The fused images of short-term CT combined with preoperative MRI and long-term MRI respectively were compared to show the difference by the tip contact positions of electrodes. Results:A total of 50 groups of postoperative CT fused images and MRI images were obtained. The space differences of the two types of images were 1.36 (0.98, 1.70) mm (P=0.021) and 1.28 (0.99, 1.88) mm (P=0.006), on the right and left electrodes, respectively. Bilateral electrodes in both short-term and long-term images had a tendency to move to the medial, rear, and bottom part of the brain. Conclusion:The potential tendency in shifts of DBS electrodes can provide reference for establishing the brain drift model and optimizing the position of the implanted electrode.

La Enfermedad de Parkinson: Etiología, Tratamientos y Factores Preventivos / Parkinson Disease: Etiology, Treatments and Preventive Factors

La enfermedad de Parkinson (EP) es la patología neurodegenerativa motora con mayor incidencia a nivel mundial, cuyas causas aún no son claras. Actualmente no existe cura, pero es posible contar con diferentes tratamientos que permiten aliviar algunos de sus síntomas y enlentecer su curso. Debido a la gran cantidad de informaciones, en ocasiones contradictorias sobre los llamados "factores de riesgo" (entendidos éstos como situaciones que pueden exacerbar la posibilidad de aparición de la enfermedad, incluyendo desde la predisposición familiar hasta la exposición prolongada a substancias exógenas), en esta revisión se pretende ofrecer una panorámica actual sobre factores asociados a la aparición de EP Se revisan también algunos tratamientos que buscan contrarrestar la pérdida de la función dopaminérgica de la substancia nigra (SN) y algunas de las aproximaciones terapéuticas tanto farmacológicas, como por estimulación cerebral profunda (ECP) o por implante celular. Se revisan también investigaciones sobre el potencial terapéutico de compuestos con alta especificidad a receptores colinérgicos (nAChRs) y antagonistas de receptores de adenosina, específicamente del subtipo A2A. Posiblemente durante las próximas décadas, nuestro conocimiento en epigenética pueda arrojar nuevas luces sobre esta interacción, así como sobre las relaciones entre ciertas líneas de microbios intestinales y aparición de EP. En este momento, la alternativa terapéutica que ofrece mayor eficacia es la ECP, sin embargo, a futuro se espera que el desarrollo de nuevas estrategias de implante cerebral pueda ofrecer una cura real de la EP.

Parkinson's disease (PD) is the most prevalent neurodegenerative motor pathology worldwide, the causes of which are still unclear. Currently there is no cure, but it is possible to have different treatments that allow to alleviate some of its symptoms and slow its course. Due to the large amount of information, sometimes contradictory, about the so-called "risk factors" (understood as situations that may exacerbate the possibility of the onset of the disease, from family predisposition to prolonged exposure to exogenous substances), in this review aims to provide a current overview of factors associated with the occurrence of PD. We also review some treatments that seek to counteract the loss of the dopaminergic function of the substance nigra (SN) and some of the therapeutic approaches both pharmacologically, by deep brain stimulation (DBS) or by cellular implantation. Also reviewed investigations on the therapeutic potential of compounds with high specificity to cholinergic receptors (nAChRs) and adenosine receptor antagonists, specifically the A2A subtype. Possibly, during the next decades, our knowledge in epigenetics may shed new light on this interaction, as well as on the relationships between certain lines of intestinal microbes and onset of PD. At this time, the most effective therapeutic alternative is DBS; however, in the future it is expected that the development of new brain implant strategies may offer a real cure for PD.

Thalamic Deep Brain Stimulation for Deafferentation Pain: Case Report

Deep Brain Stimulation(DBS) analgesia is known to be an effective method of otherwise intractable chronic pain. The authors report a case of thalamic DBS for the relief of recurred deafferentation pain after DREZotomy. The patient was a 53-year-old female who had presented with neuropathic pain on right shoulder and upper extremity, owing to previous brachial plexus injury. She underwent DREZotomy on C3-C5 level with resultant pain relief, but symptom recurred 3 months after surgery. The authors performed left VPL nucleus stimulation, and good relief of the pain was achieved. We reviewed the pertinent literature, and discussed pathophysiology, clinical result of the DBS on deafferentation pain.

Microelectrode Recording-Guided Deep Brain Stimulation in Patients with Movement Disorders

OBJECTIVE: The authors analyzed the findings of microelectrode recording data and reported the surgical outcomes of movement disorder patients. METHODS: Since February 2000, the authors have used DBS for the movement disorders. We evaluated 4 patients who were followed more than 12 months after operation. One patient with essential tremor was treated with thalamic stimulation and three patients with idiopathic advanced Parkinson's disease with bilateral subthalamic nucleus stimulation. The electrodes were inserted under microelectrode recording. Clinical assessments were performed preoperatively and postoperatively by neurologist. RESULTS: All features of parkinsonian symptoms improved and the greatest benefit occurred in off-time and ADL. Interestingly our three patients with advanced Parkinson's disease did not have off-time after bilateral stimulation of subthalamic nucleus. There were no adverse side effects related to microelectrode recording or DBS procedure in all 4 patients. In our results of microelectrode recording of subthalamic nucleus, subthalamus showed higher firing rate than that of substantia nigra pars reticularis. Mean burst frequency of subthalamic nucleus was much higher than that of substantia nigra pars reticularis. CONCLUSION: The first trials of DBS in Korea also demonstrated favorable outcomes for movement disorders.