ABSTRACT
Conclusion:
Many studies have reported substantial improvements in parameters obtained by polysomnography, while only one study has reported that sleep was not normalized although subjective sleep quality was increased. In our study, except for shortening in the REM sleep period, no significant improvement in PSG parameters was observed. The effect of bilateral STB-DBS on sleep is still one of the controversial issues and waits to be demonstrated in the larger series.
Results:
Eight patients were included in our study; the mean age was calculated as 53.6±4.1 years. When pre- and postoperation PSG parameters were compared, the total sleep time was decreased, however it was not found statistically significant (p=0.840). REM sleep latancy was significantly shortened postoperatively (p=0.003). It was observed that other PSG parameters measuring the macro- and micro-structure of sleep did not change significantly (p>0.050).
Materials and Methods:
Inclusion criteria were determined as the presence of a clinical diagnosis of idiopathic PD, being 70 years and below, having at least 5 years of disease duration, and being a suitable candidate for STN DBS surgery. Patients were excluded from the study in the presence of dementia or psychiatric disturbances, cardiac pacemaker, and history of cerebrovascular disease. Our study was approved by Local Ethical Committe of Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, and signed consent form was obtained from participants.
Objective:
Deep brain stimulation (DBS) intended to bilateral subthalamic nucleus (STN) used in the Parkinson’s disease (PD) has been reported to lead improved subjective sleep quality, increased sleep efficiency, decreased wakefulness time after sleep, and increased total sleep time. On this basis, we aimed to evaluate the sleep structure and quality by polysomnographic (PSG) investigation parameters in patients diagnosed with idiopathic PD who were planned to undergo bilateral STN-DBS.
Keywords:
Parkinson’s disease, subthalamic deep brain stimulation, polysomnography
References
1Shahed J, Jankoviç J. Motor symptoms in Parkinson’s disease. In: Koller WC, Melamed E (eds). Handbook of Clinical Neurology, Parkinson’s disease and related disorders, Elselvier B.V, 2007;83:329-42.
2Kakkar AK, Dahiya N. Management of Parkinsons disease: Current and future pharmacotherapy. Eur J Pharmacol 2015;750:74-81.
3Lees AJ, Hardy J, Revesz T. Parkinson’s disease. Lancet 2009;373:2055-66.
4Benabid AL, Pollak P, Louveau A, Henry S, de Rougement J. Combined (thalamotomy and stimulation) stereotactic surgery of the VIM thalamic nucleus for bilateral Parkinson Disease. Appl Neurophysiol 1987;50:344-6.
5Gündüz A, Aydın S, Apaydın H, Kızıltan G, Ertan S, Abuzayed B, Oğuz S, Yağcı S. Hareket Bozukluklarında Derin Beyin Uyarımı. Parkinson Hastalığı ve Hareket Bozuklukları Dergisi 2011;14:26-41.
6Özhan MÖ, Süzer MA, Eşkin MB, Çaparlar C, Atik B, Özdener KM, Özışık P, Savaş A. Parkinson hastalığının tedavisi için derin beyin stimülasyonu uygulamasındaki anestezi deneyimlerimiz: retrospektif klinik araştırma. J Anesthesia 2012;20:86-91.
7Fukaya C, Yamamato T. Deep Brain Stimulation of Parkinson’s Disease. Recent Trends and Future Direction. Neurol Med Chir (Tokyo) 2014;55:422-431.
8Johnson MD, Miocinovic S, McIntyre CC, Vitek JL. Mechanisms and targets of deep brain stimulation in movement disorders. Neurotherapeutics 2008;5:294-308.
9Benabid AL, Pollak P, Gross C, Hoffmann D, Benazzouz A, Gao DM, Laurent A, Gentil M, Perret J. Acute and long-term effects of subthalamic nucleus stimulation in Parkinson’s disease. Stereotact Funct Neurosurg 1994;2:76-84.
10Krack P, Batir A, Van Blercom N, Chabardes S, Fraix V, Ardouin C, Koudsie A, Limousin PD, Benazzouz A, LeBas JF, Benabid AL, Pollak P. Five year follow-up of bilateral stimulation of the subtalamic nucleus in advances Parkinson’s disease. N Engl J Med 2003;349:1925-34.
11Capecci M, Riccuiti RA, Burini D, Bombace VG, Provinciali L, Iacoangeli M, Scerrati M, Ceravolo MG. Functional improvement after subthalamic stimulation in Parkinson’s disease: a non-equivalent controlled study with 12-24 month follow-up. J Neurol Neurosurg Psychiatry 2005;76:769-74.
12Munhoz RP, Cerasa A, Okun MS. Surgical treatment of dyskinesia in Parkinson’s disease. Front Neurol 2014;5:65.
13Limousin P, Krack P, Pollak P, Benazzouz A, Ardouin C, Hoffmann D, Benabid AL. Electrical stimulation of the subthalamic nucleus in advanced Parkinson’s disease. N Engl J Med 1998:339:1105-11.
14Amara AW, Watts RL, Walker HC. The effects of deep brain stimulation on sleep in Parkinson’s disease. Ther Adv Neurol Disord 2011;4:15-24.
15Karadeniz D. Parkinsonizm ve Uyku bozuklukları. İçinde: Kaynak H, Ardış S (eds). Uyku Fizyolojisi ve Hastalıkları. İstanbul: Türk Uku Tıbbı Derneği yayını, Güneş Tıp Kitabevi, 2011:395-403.
16Garcia-Borreguero D, Larrosa O, Bravo M. Parkinson’s Disease and Sleep. Sleep Med Rev 2003;7:115-29.
17Arnulf I, Bejjani BP, Garma L, Bonnet AM, Houeto JL, Damier P. Derenne JP, Agid Y. Improvement of sleep architecture in PD with subthalamic nucleus stimulation. Neurology 2000;55:1732-4.
18Chahine LM, Ahmed A, Sun Z. Effects of STN DBS for Parkinson’s disease on restless legs syndrome and other sleep-related measures. Parkinsonism Relat Disord 2011;17:208-11.
19Cicolin A, Lopiano L, Zibetti M, Torre E, Tavella A, Guastamacchia G, Terreni A, Makrydakis G, Fattori E, Lanotte MM, Bergamasco B, Mutani R. Effects of deep brain stimulation of the subthalamic nucleus on sleep architecture in parkinsonian patients. Sleep Med 2004;5:207-10.
20Zibetti M, Torre E, Cinquepalmi A, Rosso M, Ducati A, Bergamasco B, Lanotte MM, Lopiano L. Motor and nonmotor symptom follow-up in parkinsonian patients after deep brain stimulation of the subthalamic nucleus. Eur Neurol 2007;58:218-23.
21Lyons KE, Pahwa R. Effects of bilateral subthalamic nucleus stimulation on sleep, daytime sleepiness, and early morning dystonia in patients with Parkinson disease. J Neurosurg 2006;104:502-5.
22DBS Fast Track Network of Referring Physicians Florida Surgical Questionnaire for Parkinson Disease (FLASQ-PD)© Okun and Foote 2003. Available from: http://mdc.mbi.ufl.edu/UniversityofFloridaDBSFastTrackNetwork.pdf
23Okun MS, Fernandez HH, Pedraza O, Misra M, Lyons KE, Pahwa R, Tarsy D, Scollins L, Corapi K, Friehs GM, Grae J, Romrell J, Foote KD. Development and initial validation of a screening tool for Parkinson disease surgical candidates. Neurology 2004;63:161-3.
24Langston JW, Widner H, Goetz CG, Brooks D, Fahn S, Freeman T, Watts R. Core assesment program for intracerebral transplantations (CAPIT). Mov Disord 1992;7:2-13.
25Defer GL, Widner H, Marie RM, Remy P, Levivier M. Core assesment program for surgical interventional therapies in Parkinson’s disease (CAPSIT-PD). Mov Disord 1999;14:572-84.
26American Academy of Sleep Medicine. International classification of Sleep Disorders, 3nd ed. IL: American Academy of Sleep Medicine, 2014.
27Kim HJ, Jeon B, Paek SH. Nonmotor Symptoms and Subthalamic Deep Brain Stimulation in Parkinson’s Disease. J Mov Disord 2015;8:83-91.
28Iranzo A, Valldeoriola F, Santamaria J, Tolosa E, Rumia J. Sleep symptoms and polysomnographic architecture in advanced Parkinson’s disease after chronic bilateral subthalamic stimulation. J Neurol Neurosurg Psychiatry 2002;72:661-4.
29Monaca C, Ozsancak C, Jacquesson JM, Poirot I, Blond S, Destee A, Guieu JD, Derambure P. Effects of bilateral subthalamic stimulation on sleep in Parkinson’s disease. J Neurol 2004;251:214-8.
30Nishida N, Murakami T, Kadoh K, Tohge R, Yamanegi M, Saiki H, Ueda K, Matsumoto S, Ishikawa M, Takahashi JA, Toda H. Subthalamic nucleus deep brain stimulation restores normal rapid eye movement sleep in Parkinson’s disease. Mov Disord 2011;26:2418-22.
31Dulski J, Shinwelski M, Konkel A, Grabowski K, Libionka W, Waz P, E J S, Slawek J. The impact of subthalamic deep brain stimulation on polysomnographic sleep pattern in patients with Parkinson’s disease - Preliminary report. Neurol Neurochir Pol 2018;52:514-8.
32Merlino G, Lettieri C, Mondani M, Belgrado E, Devigili G, Mucchiut M, Rinaldo S, Craighero C, D’Auria S, Skrap M, Eleopra R. Microsubthalamotomy improves sleep in patients affected by advanced Parkinson’s disease. Sleep Med 2014;15:637-41.