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2.341 EARLY, POSTOPERATIVE MICROLESION EFFECT AS A PREDICTOR OF SUBTHALAMIC DEEP BRAIN STIMULATION EFFECTIVENESS FOR PARKINSON'S DISEASE
Tuesday, 13 December 2011 / Parkinsonism and Related Disorders 18S2 (2012) S81–S159
2.338 DEEP BRAIN STIMULATION IN 10 PATIENTS WITH SEVERE GILLES DE LA TOURETTE SYNDROME J. Li. Functional Neurosurgery, Xuanwu Hospital, Beijing, China Objective: To evaluate outcome of High-frequency deep brain stimulation (DBS) of the globus pallidus internus (GPi) for severe Gilles de la Tourette syndrome (GTS). Methods: 10 cases of GTS who were resistant to at least 6 months of standard and innovative treatments, as well as to psychobehavioural techniques, underwent DBS. DBS was placed bilaterally globus pallidus internus (GPi). Patients were evaluated after surgery, using Yale Global Tic Severity Scale (YRTSS) from 2 months to24 months. Results: All patients responded well to DBS, although to differing degrees (28.2–80.0%). The duration of follow-up assessments ranged from 2 to 24 months. Except for two erosions and/or infections cases, there were no serious permanent adverse effects. Conclusion: DBS is a useful and safe treatment for severe GTS. The results of ours and previous DBS reports suggest that the GPi may be a good DBS target for GTS. 2.339 TERMINOLATERAL NEURORRAPHY IN NERVE INJURIES C.E. Cavalcanti, A.C. Ribeiro. Neurology/Neurosurgery, General Hospital, S˜ ao Luis, Brazil A tremendous amount of progress as taken place in the field of peripheral nerve surgery in the last decades. The transoperative eletrophysiological monitoring and the development of the surgical microscope have resulted in significant improvement in the results of the nerve repair. But until today, the terminolateral neurorraphy is still the basic principle of the nerve reconstruction technique. However, more studies are needed before extrapolating result to human nerve suture. 2.340 FACTORS PREDICTING OF THE EFFICACY OF STN-DBS FOR ELDERLY PARKINSON’S DISEASE Y. Suzuki1 , K. Ogawa1 , H. Shiota1 , S. Kamei1 , H. Oshima2 , C. Fukaya2 , T. Yamamoto2 , Y. Katayama2 . 1 Division of Neurology, Department of Medicine, Nihon University School of Medicine, 2 Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan Subthalamic nucleus deep-brain stimulation (STN-DBS) effectively improves motor function in Parkinson’s disease (PD) patients who respond poorly to pharmacological management. Generally, an age of 65 years or less is thought to be an indication for surgery; however, STN-DBS is also feasible in the elderly. The efficacy of STN-DBS varies from patient to patient. We studied the factors that predict the rate of improvement following STN-DBS in elderly PD patients. Since 2002, the Nihon University Itabashi Hospital has been performing STN-DBS for PD patients 70 years of age or older. These patients were classified into the following four groups using the rate of improvement assessed by the off-period Unified Parkinson’s Disease Rating Scale (UPDRS) part III score (postoperative score/pre-operative score): Group A (up to 10%: no change), Group B (between 10% and 25%: mild improvement), Group C (between 25% and 35%: moderate improvement), and Group D (over 35%: marked improvement). Age, morbidity duration, pre-operative LED, and pre-operative UPDRS part II and III scores were used as criteria. The group showing marked improvement following STN-DBS had a shorter duration of morbidity than the group with no change, and had lower on-period pre-operative UPDRS part II and III scores. This suggests that these factors could be predictors of the rate of improvement following STN-DBS in elderly PD patients.
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2.341 EARLY, POSTOPERATIVE MICROLESION EFFECT AS A PREDICTOR OF SUBTHALAMIC DEEP BRAIN STIMULATION EFFECTIVENESS FOR PARKINSON’S DISEASE T. Tykocki1 , T. Mandat2 , P. Nauman1 . 1 Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, 2 Department of Neurosurgery, Sklodowska-Curie Memorial Oncology Center, Warsaw, Poland Introduction: Patients treated with bilateral subthalamic deep brain stimulation (STN DBS) for Parkinson’s disease (PD) present clinical improvement in early postoperative period, despite the lack of initiation of the stimulation. The aim of this study was to assess patients’ clinical state before the operation, 48 hours after DBS without stimulation and after 6 months with active DBS using UPDRS part III. Materials and Methods: 74 patients (38 men and 36 women) were treated with bilateral STN DBS for PD. Preoperatively, all patients were evaluated with UPDRS-III, PreON = 26.9±11; preOFF = 51.3±14, daily levodopa dose 1195 mg, ±392, PD duration (12.2±4 years). The mean improvement after pharmacological treatment before operation (OFFpre-ONpre/OFFpre) was 48%. Motor symptoms were evaluated again after 48 hours and 6 months. Results: Mean postoperative reduction, within 48 h, in UPDRS-III ON was 2.5 points (10.2%), [p = 0.051] and OFF 9.2 points (18%) [p < 0.01]. Shorter PD duration correlated positively with a reduction in UPDRS III ON and OFF [p < 0.05]. The mean improvement in ON and OFF in relation to baseline after 6 months with active DBS were 14.6 pts (55.3%) and 28.4 pts (59.4%) respectively. Patients with the improvement rate over 60% in ON and OFF within 48 hours had the best response with DBS at 6 months (over 60%). Conclusion: The study confirms the occurrence of microlesion effect after STN DBS for PD in the early postoperative period. Microlesion effect may serve as a predictor of STN DBS effectiveness. 2.342 MAJOR CAUSES OF POOR SELECTION IN RETROSPECT IN SUBTHALAMIC DEEP BRAIN STIMULATION FOR PARKINSON’S DISEASE B.S. Jeon, H.-J. Kim. Neurology, Seoul National University Hospital, Seoul, Republic of Korea Aims: We examined whether screening of patients for DBS at out center was successful. Methods: Preoperative and postoperative evaluations include the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) Stage, Schwab and England Activities of Daily Living, MiniMental State Examination (MMSE) and Beck Depression Inventory. A poor selection is defined as a failure to maintain functional independence at three years during a DBS-on/medication-on state. Results: The cohort comprises 79 patients with Parkinson’s disease (PD) who underwent bilateral subthalamic nucleus DBS between 2005 and 2008. All had a follow up period of more than three years or until death. Twenty-one patients did not do well for the following reasons: gait disturbance due to freezing in 15 patients, cognitive decline in 5, depression in 3, musculoskeletal problems in 7, and cancer in one patient. The poor selection group was older and in a more advanced stage of PD, based on the preoperative medication-on state. Even the poor selection group did relatively well during the initial two years of follow up, but outcomes deteriorated at three years. Conclusion: We were not able to screen out many patients who did not do well as early as three years after DBS. These data indicate that DBS may not produce a good outcome for an extended period in patients with well-advanced PD. Therefore, DBS should be performed in more advanced stage PD with the understanding that the benefit may not be achieved for an extended period.
2.338 DEEP BRAIN STIMULATION IN 10 PATIENTS WITH SEVERE GILLES DE LA TOURETTE SYNDROME J. Li. Functional Neurosurgery, Xuanwu Hospital, Beijing, China Objective: To evaluate outcome of High-frequency deep brain stimulation (DBS) of the globus pallidus internus (GPi) for severe Gilles de la Tourette syndrome (GTS). Methods: 10 cases of GTS who were resistant to at least 6 months of standard and innovative treatments, as well as to psychobehavioural techniques, underwent DBS. DBS was placed bilaterally globus pallidus internus (GPi). Patients were evaluated after surgery, using Yale Global Tic Severity Scale (YRTSS) from 2 months to24 months. Results: All patients responded well to DBS, although to differing degrees (28.2–80.0%). The duration of follow-up assessments ranged from 2 to 24 months. Except for two erosions and/or infections cases, there were no serious permanent adverse effects. Conclusion: DBS is a useful and safe treatment for severe GTS. The results of ours and previous DBS reports suggest that the GPi may be a good DBS target for GTS. 2.339 TERMINOLATERAL NEURORRAPHY IN NERVE INJURIES C.E. Cavalcanti, A.C. Ribeiro. Neurology/Neurosurgery, General Hospital, S˜ ao Luis, Brazil A tremendous amount of progress as taken place in the field of peripheral nerve surgery in the last decades. The transoperative eletrophysiological monitoring and the development of the surgical microscope have resulted in significant improvement in the results of the nerve repair. But until today, the terminolateral neurorraphy is still the basic principle of the nerve reconstruction technique. However, more studies are needed before extrapolating result to human nerve suture. 2.340 FACTORS PREDICTING OF THE EFFICACY OF STN-DBS FOR ELDERLY PARKINSON’S DISEASE Y. Suzuki1 , K. Ogawa1 , H. Shiota1 , S. Kamei1 , H. Oshima2 , C. Fukaya2 , T. Yamamoto2 , Y. Katayama2 . 1 Division of Neurology, Department of Medicine, Nihon University School of Medicine, 2 Division of Applied System Neuroscience, Department of Advanced Medical Science, Nihon University School of Medicine, Tokyo, Japan Subthalamic nucleus deep-brain stimulation (STN-DBS) effectively improves motor function in Parkinson’s disease (PD) patients who respond poorly to pharmacological management. Generally, an age of 65 years or less is thought to be an indication for surgery; however, STN-DBS is also feasible in the elderly. The efficacy of STN-DBS varies from patient to patient. We studied the factors that predict the rate of improvement following STN-DBS in elderly PD patients. Since 2002, the Nihon University Itabashi Hospital has been performing STN-DBS for PD patients 70 years of age or older. These patients were classified into the following four groups using the rate of improvement assessed by the off-period Unified Parkinson’s Disease Rating Scale (UPDRS) part III score (postoperative score/pre-operative score): Group A (up to 10%: no change), Group B (between 10% and 25%: mild improvement), Group C (between 25% and 35%: moderate improvement), and Group D (over 35%: marked improvement). Age, morbidity duration, pre-operative LED, and pre-operative UPDRS part II and III scores were used as criteria. The group showing marked improvement following STN-DBS had a shorter duration of morbidity than the group with no change, and had lower on-period pre-operative UPDRS part II and III scores. This suggests that these factors could be predictors of the rate of improvement following STN-DBS in elderly PD patients.
S151
2.341 EARLY, POSTOPERATIVE MICROLESION EFFECT AS A PREDICTOR OF SUBTHALAMIC DEEP BRAIN STIMULATION EFFECTIVENESS FOR PARKINSON’S DISEASE T. Tykocki1 , T. Mandat2 , P. Nauman1 . 1 Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, 2 Department of Neurosurgery, Sklodowska-Curie Memorial Oncology Center, Warsaw, Poland Introduction: Patients treated with bilateral subthalamic deep brain stimulation (STN DBS) for Parkinson’s disease (PD) present clinical improvement in early postoperative period, despite the lack of initiation of the stimulation. The aim of this study was to assess patients’ clinical state before the operation, 48 hours after DBS without stimulation and after 6 months with active DBS using UPDRS part III. Materials and Methods: 74 patients (38 men and 36 women) were treated with bilateral STN DBS for PD. Preoperatively, all patients were evaluated with UPDRS-III, PreON = 26.9±11; preOFF = 51.3±14, daily levodopa dose 1195 mg, ±392, PD duration (12.2±4 years). The mean improvement after pharmacological treatment before operation (OFFpre-ONpre/OFFpre) was 48%. Motor symptoms were evaluated again after 48 hours and 6 months. Results: Mean postoperative reduction, within 48 h, in UPDRS-III ON was 2.5 points (10.2%), [p = 0.051] and OFF 9.2 points (18%) [p < 0.01]. Shorter PD duration correlated positively with a reduction in UPDRS III ON and OFF [p < 0.05]. The mean improvement in ON and OFF in relation to baseline after 6 months with active DBS were 14.6 pts (55.3%) and 28.4 pts (59.4%) respectively. Patients with the improvement rate over 60% in ON and OFF within 48 hours had the best response with DBS at 6 months (over 60%). Conclusion: The study confirms the occurrence of microlesion effect after STN DBS for PD in the early postoperative period. Microlesion effect may serve as a predictor of STN DBS effectiveness. 2.342 MAJOR CAUSES OF POOR SELECTION IN RETROSPECT IN SUBTHALAMIC DEEP BRAIN STIMULATION FOR PARKINSON’S DISEASE B.S. Jeon, H.-J. Kim. Neurology, Seoul National University Hospital, Seoul, Republic of Korea Aims: We examined whether screening of patients for DBS at out center was successful. Methods: Preoperative and postoperative evaluations include the Unified Parkinson Disease Rating Scale (UPDRS), Hoehn and Yahr (H&Y) Stage, Schwab and England Activities of Daily Living, MiniMental State Examination (MMSE) and Beck Depression Inventory. A poor selection is defined as a failure to maintain functional independence at three years during a DBS-on/medication-on state. Results: The cohort comprises 79 patients with Parkinson’s disease (PD) who underwent bilateral subthalamic nucleus DBS between 2005 and 2008. All had a follow up period of more than three years or until death. Twenty-one patients did not do well for the following reasons: gait disturbance due to freezing in 15 patients, cognitive decline in 5, depression in 3, musculoskeletal problems in 7, and cancer in one patient. The poor selection group was older and in a more advanced stage of PD, based on the preoperative medication-on state. Even the poor selection group did relatively well during the initial two years of follow up, but outcomes deteriorated at three years. Conclusion: We were not able to screen out many patients who did not do well as early as three years after DBS. These data indicate that DBS may not produce a good outcome for an extended period in patients with well-advanced PD. Therefore, DBS should be performed in more advanced stage PD with the understanding that the benefit may not be achieved for an extended period.