Current Research Reviews Archives

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Our Current Research Reviews ("CRR") is designed to summarize the most recent research on DBS to the general public in a comprehensive, yet simplified fashion. Due to copyright laws we are not allowed to put full articles on the website, but we want to provide the reader with understandable snippets of what is going on in the research world.  The CRR will be updated monthly to keep you informed of further insights into DBS therapy, including DBS advances, limitations, strengths, and weaknesses.  We try to monitor "hot topics" in research and provide such information to our readers.

The idea for our CRR is structured after the valuable service that Joe Bruman offered to the Parkinson's community. In 1994, when the Web was in its infancy, Joe began publishing an easy-to-read overview of published science and medical news on Parkinson's disease. He updated it monthly until his death in 2003. We acknowledge Joe's contribution, and our researchers are continuing his tradition for the DBS community. As Joe has eloquently stated on his site, "CRR items describe current work which may or may NOT prove to be important. Each one is just a piece of the big PD jigsaw puzzle. … CRR provides an inkling of where we are, what lies ahead."

A few other points are noteworthy:

  1. Should you desire a copy of the full article, the articles that we review are available most often for a fee (ranges from $15-50) online or through medical or public libraries (fees will vary).  The fees are set up by the journal in which it is published. DBS4PD.org or The Parkinson Alliance is not affiliated with these journals, and we do not receive any money from the purchase of any article.
  2. We provide a link to a website (www.pubmed.com) that will help the reader find the article online.  If you go to www.pubmed.com through the link on our website to search for an article in which you are interested, you should be brought directly to that article's information.  Usually on the upper left hand area of the screen there will be 1-2 buttons that will say something to the effect of "click here to read" or "full text pdf," and the name of the journal will be listed.  Click on one of those buttons and you should be redirected to the journals website (e.g. Neurology, Movement Disorders, etc). 
  3. Most of the journal websites are pretty self explanatory on how to order the journal and are upfront about their fees.  It may be possible to order the article through your local library, which will vary from library to library.  Some hospitals may also allow patients to make a copy of an article that is available in their medical libraries.  This will also vary per hospital, and you can find out about a hospital's resources by asking the hospital libraries directly.

The information contained in our CRR is for educational purposes only and is not intended as medical advice.

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Research Review Archives

Current Research Review — Mar/Apr 2017

Journal of Parkinson's Disease

Hariz GM, Limousin P, Hamberg K.J. "DBS means everything - for some time". Patients' Perspectives on Daily Life with Deep Brain Stimulation for Parkinson's Disease. Journal of Parkinson's Disease, 2016 Mar 17;6(2):335-47. doi: 10.3233/JPD-160799

Click here to read a longer version of this review.

Introduction:   Parkinson’s disease (PD) is a common neurological condition that has motor symptoms, nonmotor symptoms, and greatly impacts of quality of life (QoL) of individuals with PD.  There is great heterogeneity of how long each person will have PD as well as what specific symptoms he or she has.  Medication frequently alleviates symptoms early in the disease but as it progresses medication efficacy wanes and some individuals undergo deep brain stimulation (DBS).  Frequently individuals have positive motoric outcomes after DBS but there can be some nonmotor symptoms that affect one’s QoL which varies greatly based on many factors.  The authors of this study discuss that attempting to quantify QoL after DBS by using standardized measures (e.g. UPDRS and PDQ39) likely minimizes the actual challenges that individuals experience due to the great heterogeneity of symptoms and feelings of each individual with PD.  Therefore, they used a qualitative narrative approach to looking at patients’ perspectives about QoL after DBS for PD. 

Method:  Forty-Two Swedish individuals (11 women) with PD were interviewed (1-2 hours; home, hospital, phone) after undergoing DBS for PD (range was 6 months to 8 years post-surgery).  The interviewers were not a part of the treatment teams from any of the surgery sites which may have allowed the people with PD (PWP) to openly and honestly discuss their opinions.  Open ended questions were used to try and understand how DBS affected them in their day to day lives.  Sample questions are available in the article.  

Results:  Mean age of diagnosis was 52 and most had PD for about 11 years (range was 2-30 years).  The mean age at the time of the DBS surgery was 61, most were in a relationship and at least high school educated.  Most surgical targets were bilateral STN or unilateral Zi.  

The authors looked at many details as well as themes from the interviews and found that tremor was the most common symptom and most troublesome before surgery.  Other motor symptoms proved problematic as well (“slowness, stiffness, cramps, and dyskinesias”).  Nonmotor symptoms were also reported including gait and balance issues, pain, speech problems, sleep issues, fatigue, stress intolerance, and swallowing challenges.  About two thirds of the PWP thought that they experienced a “marked improvement” since the DBS while another 32% thought there was a “moderate to small” impact.  A small percentage (7.5) thought they had a small to marked deterioration.  About half of the PWP experienced adverse side effects after DBS (e.g. speech, gait and balance, memory).  A little under half reported no adverse events at all.

Many of the PWP accepted the adverse side effects as they knew such was possible in exchange for improvement in their motor control and reduction in disabling tremors and cramps.  There were multiple quotes from the PWP such as their ability to complete ADLs and participate in the daily lives greatly improved after DBS.  Individuals reported being more social and less isolated due to reduced tremors.  Multiple comments were made that DBS greatly improved QoL.  The authors also evaluated three individuals that thought the side effects were worse as compared to the gain in motor symptoms.  Interestingly each of the individuals described that their preoperative symptoms were mild as compared to the other group that found their symptoms very prominently.  

The PWP interviewed were also very clear that they knew their PD would progress regardless of DBS.  Many were of the impression that the DBS gave them a bit more time of being functional but that they would get worse and continue to need the PD medications.  

Conclusion:  Most interviewees were happy with the outcomes of their DBS as it related to impacting their daily lives.  Many pointed to tremor as being very disabling even if it is not considered so in the medical community.  DBS gave them less tremors, more freedom to move, participate in tasks as they used to, and that the results were temporary as their disease would progress.  The narrative and qualitative approach to this article is a good one and that it truly listens to each individual and provided a richness in comments as well as individual specific concerns.  The article provides many quotes and comments from the interviewees and is well worth a read for that reason alone!



Click here for the PubMed Abstract