Objective: The study proposed a new Deep Brain Stimulation (DBS) approach in Parkinson´s disease (PD): the Globus pallidus pars interna (GPi) + Nucleus Basalis of Meynert (NBM) using a lead by side to treat motor and non-motor symptoms in PD.

Background: DBS in patients with PD improves motor symptoms but it does not point at the cognitive aspects of the disease. In fact, the presence of significant cognitive impairment is an exclusionary criterion for DBS targeting either the Subthalamic Nucleus (STN) or the GPi. Previous studies have evaluated the benefit of the NBM stimulation in Alzheimer´s disease (Kuhn et al., 2015) and in PD (Freund et al., 2009, Gratwicke et al., 2018) with limited benefits.

Method: A 68-years-old male patient with Parkinson´s disease underwent a GPi+NBM-DBS surgery at the Hospital Clínico San Carlos. His symptoms initiated 7 years before surgery with tremor, pain and general slowness. At the time of the surgery, the patient presented end-of- dose fluctuations, dyskinesia, hallucinations induced by dopaminergic medication and cognitive deterioration (26/30 in MMSE). MRI scan indicated the beginning of temporal cortical atrophy. Two eight-contact Boston Scientific® (Valencia, CA) leads were implanted bilaterally. DBS trajectory planification targeted both GPi and NBM using the same directional electrode. Once GPi was targeted, the electrodes were advanced 2.4 mm along the trajectory in order to stimulate the NBM with the most distal contact. Complete neuropsychological assessment was conducted at baseline, after 2 (GPi ON) and 5 months (GPi + NBM ON) of stimulation.

Results: After 2 months of GPi stimulation the patient improved the UPDRS-III & reduced LED intake in 16.81% respect to baseline, accompanied of impaired scores in almost all neuropsychological tests. The evaluation conducted after 3 months of combined GPi+NBM stimulation showed no changes in UPDRS. Regarding cognition, scores related with executive functions and memory reached baseline level and attentional function improved at a general level.

Conclusion: This novel DBS approach treats both motor and cognitive symptoms in PD through a single lead trajectory targeting both the GPi and the NBM. This approach showed no significant side effects and improved certain cognitive functions in a patient with baseline mild cognitive impairment, who would been excluded under current protocols.

References: 1 Saint-Cyr JA, Albanese A: STN DBS in PD: selection criteria for surgery should include cognitive and psychiatric factors. Neurology 2006;66:1799–1800. 2 Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A, Horak FB, Okun MS, Foote KD, Krack P, et al.: Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. Arch Neurol 2011;68:165. 3 Hariz MI, Rehncrona S, Quinn NP, Speelman JD, Wensing C; Multicenter Advanced Parkinson’s Disease Deep Brain Stimulation Group: Multicenter study on deep brain stimulation in Parkinson’s disease: an independent assessment of reported adverse events at 4 years. Mov Disord 2008;23:416–421. 4 Rothlind JC, York MK, Carlson K, Luo P, Marks WJ, Weaver FM, Stern M, Follett K, Reda D; CSP-468 Study Group: Neuropsychological changes following deep brain stimulation surgery for Parkinson’s disease: comparisons of treatment at pallidal and subthalamic targets versus best medical therapy. J Neurol Neurosurg Psychiatry 2015;86:622–629. 5 Boel JA, Odekerken VJ, Schmand BA, Geurtsen GJ, Cath DC, Figee M, van den Munckhof P, de Haan RJ, Schuurman PR, de Bie RM; NSTAPS study group: Cognitive and psychiatric outcome 3 years after globus pallidus pars interna or subthalamic nucleus deep brain stimulation for Parkinson’s disease. Parkinsonism Relat Disord 2016;33:90–95. 6 Freund HJ, Kuhn J, Lenartz D, Mai JK, Schnell T, Klosterkoetter J, Sturm V: Cognitive functions in a patient with Parkinson-dementia syndrome undergoing deep brain stimulation. Arch Neurol 2009;66:781–785. 7 Kuhn J, Hardenacke K, Shubina E, Lenartz D, Visser-Vandewalle V, Zilles K, Sturm V, Freund HJ: Deep brain stimulation of the nucleus basalis of Meynert in early stage of Alzheimer’s dementia. Brain Stimul 2015;8:838–839. 8 Gratwicke J, Zrinzo L, Kahan J, Peters A, Beigi M, Akram H, Hyam J, Oswal A, Day B, Mancini L, et al.: Bilateral deep brain stimulation of the nucleus basalis of Meynert for Parkinson disease dementia. JAMA Neurol 2018;75:169–178. 9 Folstein MF, Folstein SE, McHugh PR: “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–98.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/dbs-for-parkinson-dementia-syndrome-stimulation-of-both-globus-pallidus-internus-the-nucleus-basalis-of-meynert-using-the-same-electrode-lead/