Cognitive Effects of Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease with GBA1 Pathogenic Variants.

Autor: Pal GD; Division of Movement Disorders, Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA., Corcos DM; Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois, USA., Metman LV; Parkinson's Disease and Movement Disorders Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA., Israel Z; Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Israel.; Department of Neurosurgery, Hadassah Medical Center, Jerusalem, Israel., Bergman H; Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Israel.; Department of Medical Neurobiology, Institute of Medical Research Israel-Canada (IMRIC), The Hebrew University-Hadassah Medical School, Jerusalem, Israel.; The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel., Arkadir D; Faculty of Medicine, The Hebrew University and Hadassah, Jerusalem, Israel.; Department of Neurology, Hadassah Medical Center, Jerusalem, Israel.
Jazyk: angličtina
Zdroj: Movement disorders : official journal of the Movement Disorder Society [Mov Disord] 2023 Dec; Vol. 38 (12), pp. 2155-2162. Date of Electronic Publication: 2023 Nov 02.
DOI: 10.1002/mds.29647
Abstrakt: Genetic subtyping of patients with Parkinson's disease (PD) may assist in predicting the cognitive and motor outcomes of subthalamic deep brain stimulation (STN-DBS). Practical questions were recently raised with the emergence of new data regarding suboptimal cognitive outcomes after STN-DBS in individuals with PD associated with pathogenic variants in glucocerebrosidase gene (GBA1-PD). However, a variety of gaps and controversies remain. (1) Does STN-DBS truly accelerate cognitive deterioration in GBA1-PD? If so, what is the clinical significance of this acceleration? (2) How should the overall risk-to-benefit ratio of STN-DBS in GBA1-PD be established? (3) If STN-DBS has a negative effect on cognition in GBA1-PD, how can this effect be minimized? (4) Should PD patients be genetically tested before STN-DBS? (5) How should GBA1-PD patients considering STN-DBS be counseled? We aim to summarize the currently available relevant data and detail the gaps and controversies that exist pertaining to these questions. In the absence of evidence-based data, all authors strongly agree that clinicians should not categorically deny DBS to PD patients based solely on genotype (GBA1 status). We suggest that PD patients considering DBS may be offered genetic testing for GBA1, where available and feasible, so the potential risks and benefits of STN-DBS can be properly weighed by both the patient and clinician. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
(© 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)
Databáze: MEDLINE
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