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Effect of Pallidal Stimulation on Sleep Outcomes and Related Brain Connectometries in Patients With Parkinson's Disease
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- Sleep difficulties are reported in the majority of patients with Parkinson's disease (PD) and are difficult to treat. This retrospective study investigated whether globus pallidus internus deep brain stimulation ameliorates or deteriorates sleep quality in patients with PD by analyzing sleep outcomes at the 2-year follow-up visit (N = 32). The results showed heterogeneity in sleep improvement among patients with PD. Further structural connectivity analyses showed that stimulation of the left sensorimotor globus pallidus internus was significantly associated with sleep improvement, but the improvement was contingent upon avoiding stimulation of fibers connected to the left hippocampus.
- These findings suggest that using a connectometric approach to deep brain stimulation programming results in better sleep quality in patients with PD.
abstract
This abstract is available on the publisher's site.
Access this abstract nowSleep difficulties affect up to 98% of Parkinson's disease (PD) patients and are often not well treated. How globus pallidus internus (GPi)-DBS could help is less understood. We retrospectively analyzed sleep outcomes in 32 PD patients after GPi-DBS with a two-year follow-up. We observed high heterogeneity in sleep response to pallidal stimulation: 16 patients showed clinically meaningful improvement, 9 had minor changes, and 7 experienced worsened sleep quality, with no overall significant change on the Parkinson's Disease Sleep Scale-2 (P = 0.19). Further analysis revealed that stimulation of the left sensorimotor GPi was significantly associated with sleep improvement. Fiber tracts from the left sensorimotor GPi to the bilateral sensorimotor cortex, right GPi, brainstem, and bilateral cerebellum were linked to better sleep, while projections to the left hippocampus correlated with worsened sleep. These findings may guide personalized GPi-DBS lead placement to optimize sleep outcomes in PD.
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The effect of pallidal stimulation on sleep outcomes and related brain connectometries in Parkinson's disease
NPJ Parkinsons Dis 2024 Nov 04;10(1)212, Z Zheng, D Liu, H Fan, H Xie, Q Zhang, G Qin, Y Jiang, F Meng, Z Yin, A Yang, J ZhangFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Sleep disturbances, affecting up to 98% of patients with Parkinson’s disease, remain a challenging nonmotor symptom. This study provides a novel perspective on the role of globus pallidus internus (GPi) deep brain stimulation (DBS) in addressing these challenges. Although previous research has extensively covered subthalamic nucleus DBS, the effects of GPi DBS on sleep are less explored. The report by Zheng and colleagues published in npj Parkinson's Disease this month helps bridge this gap by identifying the heterogeneity of sleep outcomes linked to pallidal stimulation.
The study may also be seen as a prime example of how critical electrode localizations are in DBS studies and why the lack of localization may sometimes lead to false negative trial results. In the present study, there was no significant difference on the Parkinson’s Disease Sleep Scale-2 after GPi DBS at a group level. Without carrying out electrode localizations, this would have been the main message of the study.
However, visualization of active electrode contacts in patients that did improve and did not improve clearly showed a clear anatomical clustering pattern that is visible without the need for statistical metrics (compare figure 3 panels b and c/d). Namely, active contacts of patients who improved clustered on the motor region of the GPi, whereas the ones that did not improve were more predominantly located in the globus pallidus externus. Indeed, the authors showed that the degree of overlap between stimulation volumes and the GPi (and mainly the sensorimotor and posterior parietal regions of it) were significantly correlated with sleep improvements.
The authors also showed that sleep improvement was correlated with the degree of overlaps with specific fiber bundles. However, these insights should likely rather be interpreted as epiphenomena of localizations because the pallidum does not receive strong direct cortical projections — the identified tracts might work as biomarkers but may represent false positive connections that are often found on diffusion MRI–based tractograms.
In summary, the authors should be applauded for shedding light on the relationships between the location of pallidal DBS and the improvement of sleep in patients with Parkinson’s disease. These insights may help guide optimal stimulation settings, especially and foremost in patients with suboptimal sleep quality.