TY  - JOUR
A1  - Lange, Florian
A1  - Steigerwald, Frank
A1  - Malzacher, Tobias
A1  - Brandt, Gregor Alexander
A1  - Odorfer, Thorsten Michael
A1  - Roothans, Jonas
A1  - Reich, Martin M.
A1  - Fricke, Patrick
A1  - Volkmann, Jens
A1  - Matthies, Cordula
A1  - Capetian, Philipp D.
T1  - Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming
JF  - Frontiers in Neurology
N2  - Objectives: Deep brain stimulation (DBS) programming is based on clinical response testing. Our clinical pilot trial assessed the feasibility of image-guided programing using software depicting the lead location in a patient-specific anatomical model.
Methods: Parkinson's disease patients with subthalamic nucleus-DBS were randomly assigned to standard clinical-based programming (CBP) or anatomical-based (imaging-guided) programming (ABP) in an 8-week crossover trial. Programming characteristics and clinical outcomes were evaluated.
Results: In 10 patients, both programs led to similar motor symptom control (MDS-UPDRS III) after 4 weeks (medicationOFF/stimulationON; CPB: 18.27 ± 9.23; ABP: 18.37 ± 6.66). Stimulation settings were not significantly different, apart from higher frequency in the baseline program than CBP (p = 0.01) or ABP (p = 0.003). Time spent in a program was not significantly different (CBP: 86.1 ± 29.82%, ABP: 88.6 ± 29.0%). Programing time was significantly shorter (p = 0.039) with ABP (19.78 ± 5.86 min) than CBP (45.22 ± 18.32).
Conclusion: Image-guided DBS programming in PD patients drastically reduces programming time without compromising symptom control and patient satisfaction in this small feasibility trial.
KW  - directional deep brain stimulation
KW  - image-guided programming
KW  - subthalamic nucleus
KW  - chronic stimulation
KW  - randomized controlled double-blind study
KW  - Parkinson's disease
Y1  - 2021
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249634
SN  - 1664-2295
VL  - 12
ER  - 
TY  - JOUR
A1  - Mencacci, Niccoló E.
A1  - Isaias, Ioannis U.
A1  - Reich, Martin M.
A1  - Ganos, Christos
A1  - Plagnol, Vincent
A1  - Polke, James M.
A1  - Bras, Jose
A1  - Hersheson, Joshua
A1  - Stamelou, Maria
A1  - Pittman, Alan M.
A1  - Noyce, Alastair J.
A1  - Mok, Kin Y.
A1  - Opladen, Thomas
A1  - Kunstmann, Erdmute
A1  - Hodecker, Sybille
A1  - Münchau, Alexander
A1  - Volkmann, Jens
A1  - Samnick, Samuel
A1  - Sidle, Katie
A1  - Nanji, Tina
A1  - Sweeney, Mary G.
A1  - Houlden, Henry
A1  - Batla, Amit
A1  - Zecchinelli, Anna L.
A1  - Pezzoli, Gianni
A1  - Marotta, Giorgio
A1  - Lees, Andrew
A1  - Alegria, Paulo
A1  - Krack, Paul
A1  - Cormier-Dequaire, Florence
A1  - Lesage, Suzanne
A1  - Brice, Alexis
A1  - Heutink, Peter
A1  - Gasser, Thomas
A1  - Lubbe, Steven J.
A1  - Morris, Huw R.
A1  - Taba, Pille
A1  - Koks, Sulev
A1  - Majounie, Elisa
A1  - Gibbs, J. Raphael
A1  - Singleton, Andrew
A1  - Hardy, John
A1  - Klebe, Stephan
A1  - Bhatia, Kailash P.
A1  - Wood, Nicholas W.
T1  - Parkinson’s disease in GTP cyclohydrolase 1 mutation carriers
JF  - Brain
N2  - GTP cyclohydrolase 1, encoded by the GCH1 gene, is an essential enzyme for dopamine production in nigrostriatal cells. Loss-of-function mutations in GCH1 result in severe reduction of dopamine synthesis in nigrostriatal cells and are the most common cause of DOPA-responsive dystonia, a rare disease that classically presents in childhood with generalized dystonia and a dramatic long-lasting response to levodopa. We describe clinical, genetic and nigrostriatal dopaminergic imaging ([(123)I]N-ω-fluoropropyl-2β-carbomethoxy-3β-(4-iodophenyl) tropane single photon computed tomography) findings of four unrelated pedigrees with DOPA-responsive dystonia in which pathogenic GCH1 variants were identified in family members with adult-onset parkinsonism. Dopamine transporter imaging was abnormal in all parkinsonian patients, indicating Parkinson's disease-like nigrostriatal dopaminergic denervation. We subsequently explored the possibility that pathogenic GCH1 variants could contribute to the risk of developing Parkinson's disease, even in the absence of a family history for DOPA-responsive dystonia. The frequency of GCH1 variants was evaluated in whole-exome sequencing data of 1318 cases with Parkinson's disease and 5935 control subjects. Combining cases and controls, we identified a total of 11 different heterozygous GCH1 variants, all at low frequency. This list includes four pathogenic variants previously associated with DOPA-responsive dystonia (Q110X, V204I, K224R and M230I) and seven of undetermined clinical relevance (Q110E, T112A, A120S, D134G, I154V, R198Q and G217V). The frequency of GCH1 variants was significantly higher (Fisher's exact test P-value 0.0001) in cases (10/1318 = 0.75%) than in controls (6/5935 = 0.1%; odds ratio 7.5; 95% confidence interval 2.4-25.3). Our results show that rare GCH1 variants are associated with an increased risk for Parkinson's disease. These findings expand the clinical and biological relevance of GTP cycloydrolase 1 deficiency, suggesting that it not only leads to biochemical striatal dopamine depletion and DOPA-responsive dystonia, but also predisposes to nigrostriatal cell loss. Further insight into GCH1-associated pathogenetic mechanisms will shed light on the role of dopamine metabolism in nigral degeneration and Parkinson's disease.
KW  - DOPA-responsive-dystonia
KW  - GCH1
KW  - Parkinson's disease
KW  - dopamine
KW  - exome sequencing
Y1  - 2014
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-121268
VL  - 137
IS  - 9
ER  -