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2.323 DEEP BRAIN STIMULATION OF THE DORSAL STRIATUM FOR TINNITUS
Tuesday, 13 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S81–S159
Conclusions: DBS has evolved significantly during the past decade in China. There are still several problems. The advent of Chinese homemade DBS hardware, multidisciplinary cooperation and the establishment of guidelines and regulations for DBS will improve the application of this surgical treatment in China. 2.323 DEEP BRAIN STIMULATION OF THE DORSAL STRIATUM FOR TINNITUS S.W. Cheung1 , P.S. Larson2 . 1 Otolaryngology-Head and Neck Surgery, 2 Neurosurgery, University of California, San Francisco, CA, USA Background: Deep brain stimulation (DBS) of the basal ganglia is emerging as a candidate therapeutic modality for tinnitus, a phantom sensory disorder manifested by auditory percepts in the absence of external correlates. The predominant neuromodulatory treatment approach is to alter central auditory dysfunctional hyperactivity, plastic change or synchronized oscillations that may underlie tinnitus perception. An alternative treatment approach is to modulate phantom auditory gating function of the dorsal striatum. Objective: To demonstrate DBS of the dorsal striatum modulates perception of auditory phantoms. Methods: Two acute human electrical stimulation experiments in area LC, a locus of the caudate nucleus positioned at its anterior body, were performed in 11 interactive adult subjects undergoing surgery to treat movement disorders. Tinnitus loudness was rated on a 0 to 10 scale, sound quality was described qualitatively, and spatial location was referenced to the ears. Results: Short-term area LC stimulation suppressed tinnitus loudness to a nadir of at least 2 and controllably triggered new phantom tones, clicks, and frequency modulated sounds. Current results suggest the dorsal striatum may play an important role in gating potential auditory phantoms for perceptual awareness. A conceptual basal ganglia model of phantom percept gate control is proposed. Conclusion: Striatal dysfunction may be a critical feature of bothersome tinnitus. DBS neuromodulation of area LC to treat auditory phantoms could confer healthy restrictive dorsal striatal gate function to reject potential auditory phantoms. Clinical trials are needed to evaluate safety and efficacy of long-term area LC neuromodulation for tinnitus. 2.324 THE BILATERAL STN-DBS CAN IMPROVE MOTOR AND NON-MOTOR SYMPTOMS IN MODERATE AND ADVANCED PD PATIENTS: A TWO-YEAR FOLLOW-UP STUDY X. Fu1 , J. Liu2 , Y. Liu1 , W. Xian1 , J. Chen1 , Y. Zheng1 , H. Zhou1 , Y. He1 , J. Li1 , Z. Liu1 , Z. Pei1 , L. Chen1 . 1 Department of Neurology, 2 Department of Neurology Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Objectives: To study the impact of the bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on motor, quality of life, mood, sleep, cognition and the dosage of antiparkinsonian medication in moderate or advanced Parkinson’s disease (PD) patients 2 years after surgery. Methods: Patients undergoing bilateral STN-DBS surgery were assessed according to UPDRS, Hoehn & Yahr stage, PDQ-39, PDSSCV, HAMA and HAMD, Mini-MMSE and the dosage of dopaminergic drugs a week before surgery and 2 years after surgery. Results: 14 patients (8 males and 6 female; age 60.2±8.4 y; duration 9.2±2.9 y) completed 2-year follow-up. They reformed significantly in scores of UPDRSIII, tremor, rigidity, bradykinesia and axis symptom, with the improvement of 36.19%, 28.01%, 49.34%, 14.81% and 25.20% respectively in the on stimulation off medication condition, and 68.59%, 65.41%, 76.41%, 59.69% and 52.66% respectively in the on stimulation on medication state2 years after surgery. For H&Y stage, there was significant
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improvent in the off state 2 years after surgery (P = 0.015), while no significance was found for in the on state. The “off” time during they were awaken reduced from 6.0 h/d before surgery to 3.0 h/d after 2 year (Pfts;= 0.04. The PDQ-39 scores reduced markedly after surgery (P < 0.001). The non-motor symptom including sleep, anxiety, depression and cognition showed mild improvement. The daily dosage of antiparkinsonian medication was significantly reduced by 50.74% after 2 years. Conclusions: Bilateral STN-DBS significantly improve the motor, non-motor symptoms and the life quality of patients with moderate or advanced PD; It also effectively reduce the dosage of antiparkinsonian medication. 2.325 THE BILATERAL STN-DBS CAN IMPROVE MOTOR AND NONMOTOR SYMPTOMS IN PATIENTS OF PARKINSON’S DISEASE: A ONE-YEAR FOLLOW-UP STUDY Y. Liu, X. Fu, W. Xian, Y. Zheng, J. Chen, H. Zhou, Z. Pei, L. Chen. Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Objective: To study the impact of the bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on motor symptoms, quality of life, sleep, cognition and dosage of antiparkinsonian medication in moderate or advanced Parkinson’s disease (PD) patients after 1 year’s surgery. Methods: PD patients who underwent the bilateral STN-DBS surgery in the First Affiliated Hospital of Sun Yat-sun University were assessed according to the UPDRS, H&Y stage, PDQ-39, PDSS-CV, PSQI, MMSE, MoCA-Beijing Version and the dosage of dopaminergic drugs a week before surgery and 1 year after surgery. Results: From Aug-2006 to Jun-2011, 20 PD patients (9 females and 11 males, age 57.95±8.36 y, duration 9.55±2.62 y) had finished the one-year follow-up study. Scores of UPDRSIII, tremor, rigidity, bradykinesia and axis symptom improved 38.85%, 26.22%, 41.81%, 34.92% and 34.63% respectively in the on stimulation off medication condition, and 64.89%, 56.36%, 66.13%, 60.27% and 61.57% respectively in the on stimulation on medication state 1 year after surgery. For the H&Y stage, there was a significant improvement in the off state 1 year after surgery (P < 0.001). The “off” time in the waking state reduced from 4.58 h/d before surgery to 1.56 h/d 1 year after surgery (P = 0.006). The PDQ-39 scores reduced markedly after surgery (p = 0.02). Sleep and cognition showed mild improvement but lack significance in statistical analysis. The daily dosage of antiparkinsonian medication was significantly reduced by 42.50% after 1 year (P < 0.001). Conclusions: Bilateral STN-DBS can significantly improve the motor symptoms and quality of life of patients with moderate or advanced PD, and could effectively reduce the dosage of antiparkinsonian medication. At the same time, and it could improve the non-motor symptoms slightly. 2.326 EFFECTS OF BILATERAL SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION ON IMPULSE CONTROL AND REPETITIVE BEHAVIOR DISORDERS IN PARKINSON’S DISEASE B.S. Jeon, H.-J. Kim. Neurology, Seoul National University Hospital, Seoul, Republic of Korea Introduction: Little is known about the relationship between subthalamic nucleus deep brain stimulation (STN-DBS) and impulse control and repetitive behavior disorders (ICRBs) in Parkinson’s disease (PD). Objective: This study evaluated the change of ICRBs before and after STN-DBS in PD. Design: We recruited the patients who had been implanted bilateral STN-DBS and had been stimulated by DBS at least 12 months from Seoul National University Hospital. Cross-sectional
Conclusions: DBS has evolved significantly during the past decade in China. There are still several problems. The advent of Chinese homemade DBS hardware, multidisciplinary cooperation and the establishment of guidelines and regulations for DBS will improve the application of this surgical treatment in China. 2.323 DEEP BRAIN STIMULATION OF THE DORSAL STRIATUM FOR TINNITUS S.W. Cheung1 , P.S. Larson2 . 1 Otolaryngology-Head and Neck Surgery, 2 Neurosurgery, University of California, San Francisco, CA, USA Background: Deep brain stimulation (DBS) of the basal ganglia is emerging as a candidate therapeutic modality for tinnitus, a phantom sensory disorder manifested by auditory percepts in the absence of external correlates. The predominant neuromodulatory treatment approach is to alter central auditory dysfunctional hyperactivity, plastic change or synchronized oscillations that may underlie tinnitus perception. An alternative treatment approach is to modulate phantom auditory gating function of the dorsal striatum. Objective: To demonstrate DBS of the dorsal striatum modulates perception of auditory phantoms. Methods: Two acute human electrical stimulation experiments in area LC, a locus of the caudate nucleus positioned at its anterior body, were performed in 11 interactive adult subjects undergoing surgery to treat movement disorders. Tinnitus loudness was rated on a 0 to 10 scale, sound quality was described qualitatively, and spatial location was referenced to the ears. Results: Short-term area LC stimulation suppressed tinnitus loudness to a nadir of at least 2 and controllably triggered new phantom tones, clicks, and frequency modulated sounds. Current results suggest the dorsal striatum may play an important role in gating potential auditory phantoms for perceptual awareness. A conceptual basal ganglia model of phantom percept gate control is proposed. Conclusion: Striatal dysfunction may be a critical feature of bothersome tinnitus. DBS neuromodulation of area LC to treat auditory phantoms could confer healthy restrictive dorsal striatal gate function to reject potential auditory phantoms. Clinical trials are needed to evaluate safety and efficacy of long-term area LC neuromodulation for tinnitus. 2.324 THE BILATERAL STN-DBS CAN IMPROVE MOTOR AND NON-MOTOR SYMPTOMS IN MODERATE AND ADVANCED PD PATIENTS: A TWO-YEAR FOLLOW-UP STUDY X. Fu1 , J. Liu2 , Y. Liu1 , W. Xian1 , J. Chen1 , Y. Zheng1 , H. Zhou1 , Y. He1 , J. Li1 , Z. Liu1 , Z. Pei1 , L. Chen1 . 1 Department of Neurology, 2 Department of Neurology Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Objectives: To study the impact of the bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on motor, quality of life, mood, sleep, cognition and the dosage of antiparkinsonian medication in moderate or advanced Parkinson’s disease (PD) patients 2 years after surgery. Methods: Patients undergoing bilateral STN-DBS surgery were assessed according to UPDRS, Hoehn & Yahr stage, PDQ-39, PDSSCV, HAMA and HAMD, Mini-MMSE and the dosage of dopaminergic drugs a week before surgery and 2 years after surgery. Results: 14 patients (8 males and 6 female; age 60.2±8.4 y; duration 9.2±2.9 y) completed 2-year follow-up. They reformed significantly in scores of UPDRSIII, tremor, rigidity, bradykinesia and axis symptom, with the improvement of 36.19%, 28.01%, 49.34%, 14.81% and 25.20% respectively in the on stimulation off medication condition, and 68.59%, 65.41%, 76.41%, 59.69% and 52.66% respectively in the on stimulation on medication state2 years after surgery. For H&Y stage, there was significant
S147
improvent in the off state 2 years after surgery (P = 0.015), while no significance was found for in the on state. The “off” time during they were awaken reduced from 6.0 h/d before surgery to 3.0 h/d after 2 year (Pfts;= 0.04. The PDQ-39 scores reduced markedly after surgery (P < 0.001). The non-motor symptom including sleep, anxiety, depression and cognition showed mild improvement. The daily dosage of antiparkinsonian medication was significantly reduced by 50.74% after 2 years. Conclusions: Bilateral STN-DBS significantly improve the motor, non-motor symptoms and the life quality of patients with moderate or advanced PD; It also effectively reduce the dosage of antiparkinsonian medication. 2.325 THE BILATERAL STN-DBS CAN IMPROVE MOTOR AND NONMOTOR SYMPTOMS IN PATIENTS OF PARKINSON’S DISEASE: A ONE-YEAR FOLLOW-UP STUDY Y. Liu, X. Fu, W. Xian, Y. Zheng, J. Chen, H. Zhou, Z. Pei, L. Chen. Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China Objective: To study the impact of the bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) on motor symptoms, quality of life, sleep, cognition and dosage of antiparkinsonian medication in moderate or advanced Parkinson’s disease (PD) patients after 1 year’s surgery. Methods: PD patients who underwent the bilateral STN-DBS surgery in the First Affiliated Hospital of Sun Yat-sun University were assessed according to the UPDRS, H&Y stage, PDQ-39, PDSS-CV, PSQI, MMSE, MoCA-Beijing Version and the dosage of dopaminergic drugs a week before surgery and 1 year after surgery. Results: From Aug-2006 to Jun-2011, 20 PD patients (9 females and 11 males, age 57.95±8.36 y, duration 9.55±2.62 y) had finished the one-year follow-up study. Scores of UPDRSIII, tremor, rigidity, bradykinesia and axis symptom improved 38.85%, 26.22%, 41.81%, 34.92% and 34.63% respectively in the on stimulation off medication condition, and 64.89%, 56.36%, 66.13%, 60.27% and 61.57% respectively in the on stimulation on medication state 1 year after surgery. For the H&Y stage, there was a significant improvement in the off state 1 year after surgery (P < 0.001). The “off” time in the waking state reduced from 4.58 h/d before surgery to 1.56 h/d 1 year after surgery (P = 0.006). The PDQ-39 scores reduced markedly after surgery (p = 0.02). Sleep and cognition showed mild improvement but lack significance in statistical analysis. The daily dosage of antiparkinsonian medication was significantly reduced by 42.50% after 1 year (P < 0.001). Conclusions: Bilateral STN-DBS can significantly improve the motor symptoms and quality of life of patients with moderate or advanced PD, and could effectively reduce the dosage of antiparkinsonian medication. At the same time, and it could improve the non-motor symptoms slightly. 2.326 EFFECTS OF BILATERAL SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION ON IMPULSE CONTROL AND REPETITIVE BEHAVIOR DISORDERS IN PARKINSON’S DISEASE B.S. Jeon, H.-J. Kim. Neurology, Seoul National University Hospital, Seoul, Republic of Korea Introduction: Little is known about the relationship between subthalamic nucleus deep brain stimulation (STN-DBS) and impulse control and repetitive behavior disorders (ICRBs) in Parkinson’s disease (PD). Objective: This study evaluated the change of ICRBs before and after STN-DBS in PD. Design: We recruited the patients who had been implanted bilateral STN-DBS and had been stimulated by DBS at least 12 months from Seoul National University Hospital. Cross-sectional