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3.216 Impact of chronic deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease
S166
Wednesday, 12 December 2007
med on 27, med off 56.2, UPDRS IV 9.8, S-E med on 60.1, med off 32.3, LEDD (Levodopa Equivalent Daily Dose) 1457 mg. Follow-up: UPDRS I scores don’t significantly modify. UPDRS II med on: significant improvement (p = 0.001) between baseline up to 4 years; UPDRS II med off: significant improvement between baseline up to 4 years (p = 0.001). UPDRS III med on: significant improvement between baseline up to 4 years (p = 0.007), with a trend in the next follow-up; UPDRS III med off: significant improvement between baseline up to 7 years (p = 0.001). UPDRS IV: significant improvement between baseline up to 7 years (p < 0, 0001). S-E med on: significant improvement between baseline up to 4 years (p = 0.0001); S-E med off: significant improvement between baseline and 7 years (p = 0.0001). LEDD: significant reduction between baseline up to 4 years (p = 0.0001). Conclusion: STN DBS is an efficacious treatment for a selected population of PD patients. The marked improvement in motor function observed postoperatively is sustained up to seven years after DBS. 3.216 Impact of chronic deep brain stimulation of the subthalamic nucleus in advanced Parkinson’s disease S.-M. Cheon1° , H.-S. Kim, M.-J. Park, J.-Y. Joo, J.-W. Kim Korea, Republic of
1 Busan,
Objective: To assess the influence of STN DBS in advanced PD patients on objective and subjective assessment of parkinsonian motor and nonmotor aspects. Method: Ten consecutive PD patients (3 males, age 54.5±5.6 years, duration of disease 17.4±7.8 years) were thoroughly evaluated with DBS program, which included autonomic symptom questionnaire and assessment of the quality of life (QoL), cognitive (Seoul neuropsychological screening battery, trail making test, Wisconsin card sorting test), psychiatric (Minnesota multiphasic personality inventory, symptom checklist-90-revised, Beck anxiety inventory, Beck depression inventory, Maudsley obsessional compulsive inventory) and parkinsonian aspects, and the results were compared before and after (mean 11.4 months) STN DBS. Results: The results showed great improvement in the parkinsonian motor aspects (improved ‘on’, ‘off ’, and dystonia time, improved part III and IV scores of unified Parkinson’s disease rating scale [UPDRS] at ‘off ’ state, reduction in dose and frequency of medication), but there were no changes in non-motor aspects (UPDRS part I and autonomic questionnaire) after STN DBS. Assessment of daily living (UPDRS part II and Schwab and England activity of daily living) showed no difference and the results of QoL showed some improvement (in the parkinsonian subpart) but didn’t reach statistical significance. Cognitive and psychiatric assessment showed no significant changes. Conclusion: The authors could confirm that STN DBS was safe in cognitive and psychiatric aspects, and such a great modality in the management of motor symptoms of advanced PD patients, but patients did not feel significant improvement in their daily living. These results might suggest that non-motor symptoms have a great impact on daily living in PD patients following STN DBS. 3.217 What influences the quality of life in Parkinsonian patients after subthalamic DBS? F. Tamma1° , E. Caputo, G. Rodolfi, S. Molteni, M. Egidi, P. Rampini, M. Locatelli, F. Cogiamanian, A. Priori 1 Milano, Italy Objective: While a constant motor improvement can be achieved after Subthalamic Deep Brain Stimulation (DBS-STN) in advanced parkinsonian patients, measures of Quality of Life usually detect uneven improvement. We investigated which features influenced the long-term outcome in our population of DBS-STN treated patients. Method: The first 57 consecutive parkinsonian patients operated on at our Center were evaluated at baseline (T0) and at 12-months followup (T12), by means of UPDRS, stand–walk–sit (SWS) timed-test, PDQ39, apathy scale. A personality test (Big 5) was available for 30 patients.
Results: All patients showed UPDRS III improvement (p < 0.001) comparing T0medoff versus T12medoffstimon conditions. PDQ39 showed similar results (p < 0.001), but 11 out of 57 pts didn’t improve at T12. According to PDQ39 outcome, the whole population was splitted into group B (Better or improved) and group W (stable or Worsened). All PDQ39 subitems improved at T12 in group B, while motor, emotional well-being and social support subitems worsened at T12 in group W. Among UPDRS III subitems, analysis showed no significant correlation with B and W groups. Nonetheless a trend for gait (subitem 29) and SWS (p < 0.051) worsening was detected in group W. Big 5 questionnaires: 7 patients entered group W and 23 group B; group W patients showed lower scores in “Accommodation” domain, in its subdomain “cooperativity” and in the subdomain “impulse control” of the domain “Need for stability”. Apathy increased compared with baseline (p = 0.019 in 53 patients), but only patients with a major antiparkinsonian drug reduction reached statistical significance (p = 0.007). Conclusion: Gait difficulties and some aspects of personality seem to influence PDQ39 outcome. Selection of candidate can be improved by recognizing at pre-op stage subtle walking or balance disturbances, that could unravel the progression of the disease. Low accommodating, poorly cooperative people, focused on personal needs, with little impulse control could emphasize partial failure and underestimate improvement. Their follow-up may turn into a hard medical management.
3.218 Surgical treatment improving quality of life in Parkinson’s disease A. Singh1° , M. Bajpai, J. Vadra, V. Rajakrishnan, S. Singh Delhi, India
1 New
Objective: The study of outcome after unilateral thalamic stimulation (Deep Brain Stimulation) to treat intractable tremor of Parkinson’s disease. The surgical technique, qualitative, and quantitative tremor assessment, complication and side effect are studied. Method: 37 patients having tremor of Parkinson diseases underwent stereotactically implantation of electrode in ventro intermedius nuclei of thalamus and connected to programmed stimulator. Stereotactic neurosurgery has made it possible to access to the region of basal ganglia, thalamus, and subthalamic nucleus can be important solution for many patients with Parkinson’s disease not responding to drugs. Preoperative qualitative and quantitative assessment of tremor was compared with those obtained after surgery. Results: The statistical analysis demonstrated significant improvement of tremor in contralateral upper and lower limb (p < 0.001). Ipsilateral arm and postural tremor also improved (p < 0.01). In parkinson disease tremor but not bradykinesia and rigidity was suppressed. Administration of L-dopa was decreased by 40% in 29 patients. Conclusion: Unilateral thalamic stimulation is reversible, adaptable, and predictable procedure which avoids complications of cognitive deficit seen in patients with thalamotomy and should replace thalamotomy in regular surgical treatment of Parkinson. Thus deep brain stimulation of thalamus improving quality of life in patients by reducing tremor in Parkinson’s disease.
3.219 Body weight and body mass index changes after subthalamic nucleus deep brain stimulation in Parkinson’s disease S.-R. Kim1° , S.-J. Chung, M.-J. Kim, M.-S. Kim, M.-C. Lee Korea, Republic of
1 Seoul,
Objective: Weight gain has been reported to occur after subthalamic nucleus (STN) DBS in PD. To investigate the clinical characteristics and determining factors of body weight and body mass index (BMI) changes after STN DBS in PD patients.
Wednesday, 12 December 2007
med on 27, med off 56.2, UPDRS IV 9.8, S-E med on 60.1, med off 32.3, LEDD (Levodopa Equivalent Daily Dose) 1457 mg. Follow-up: UPDRS I scores don’t significantly modify. UPDRS II med on: significant improvement (p = 0.001) between baseline up to 4 years; UPDRS II med off: significant improvement between baseline up to 4 years (p = 0.001). UPDRS III med on: significant improvement between baseline up to 4 years (p = 0.007), with a trend in the next follow-up; UPDRS III med off: significant improvement between baseline up to 7 years (p = 0.001). UPDRS IV: significant improvement between baseline up to 7 years (p < 0, 0001). S-E med on: significant improvement between baseline up to 4 years (p = 0.0001); S-E med off: significant improvement between baseline and 7 years (p = 0.0001). LEDD: significant reduction between baseline up to 4 years (p = 0.0001). Conclusion: STN DBS is an efficacious treatment for a selected population of PD patients. The marked improvement in motor function observed postoperatively is sustained up to seven years after DBS. 3.216 Impact of chronic deep brain stimulation of the subthalamic nucleus in advanced Parkinson’s disease S.-M. Cheon1° , H.-S. Kim, M.-J. Park, J.-Y. Joo, J.-W. Kim Korea, Republic of
1 Busan,
Objective: To assess the influence of STN DBS in advanced PD patients on objective and subjective assessment of parkinsonian motor and nonmotor aspects. Method: Ten consecutive PD patients (3 males, age 54.5±5.6 years, duration of disease 17.4±7.8 years) were thoroughly evaluated with DBS program, which included autonomic symptom questionnaire and assessment of the quality of life (QoL), cognitive (Seoul neuropsychological screening battery, trail making test, Wisconsin card sorting test), psychiatric (Minnesota multiphasic personality inventory, symptom checklist-90-revised, Beck anxiety inventory, Beck depression inventory, Maudsley obsessional compulsive inventory) and parkinsonian aspects, and the results were compared before and after (mean 11.4 months) STN DBS. Results: The results showed great improvement in the parkinsonian motor aspects (improved ‘on’, ‘off ’, and dystonia time, improved part III and IV scores of unified Parkinson’s disease rating scale [UPDRS] at ‘off ’ state, reduction in dose and frequency of medication), but there were no changes in non-motor aspects (UPDRS part I and autonomic questionnaire) after STN DBS. Assessment of daily living (UPDRS part II and Schwab and England activity of daily living) showed no difference and the results of QoL showed some improvement (in the parkinsonian subpart) but didn’t reach statistical significance. Cognitive and psychiatric assessment showed no significant changes. Conclusion: The authors could confirm that STN DBS was safe in cognitive and psychiatric aspects, and such a great modality in the management of motor symptoms of advanced PD patients, but patients did not feel significant improvement in their daily living. These results might suggest that non-motor symptoms have a great impact on daily living in PD patients following STN DBS. 3.217 What influences the quality of life in Parkinsonian patients after subthalamic DBS? F. Tamma1° , E. Caputo, G. Rodolfi, S. Molteni, M. Egidi, P. Rampini, M. Locatelli, F. Cogiamanian, A. Priori 1 Milano, Italy Objective: While a constant motor improvement can be achieved after Subthalamic Deep Brain Stimulation (DBS-STN) in advanced parkinsonian patients, measures of Quality of Life usually detect uneven improvement. We investigated which features influenced the long-term outcome in our population of DBS-STN treated patients. Method: The first 57 consecutive parkinsonian patients operated on at our Center were evaluated at baseline (T0) and at 12-months followup (T12), by means of UPDRS, stand–walk–sit (SWS) timed-test, PDQ39, apathy scale. A personality test (Big 5) was available for 30 patients.
Results: All patients showed UPDRS III improvement (p < 0.001) comparing T0medoff versus T12medoffstimon conditions. PDQ39 showed similar results (p < 0.001), but 11 out of 57 pts didn’t improve at T12. According to PDQ39 outcome, the whole population was splitted into group B (Better or improved) and group W (stable or Worsened). All PDQ39 subitems improved at T12 in group B, while motor, emotional well-being and social support subitems worsened at T12 in group W. Among UPDRS III subitems, analysis showed no significant correlation with B and W groups. Nonetheless a trend for gait (subitem 29) and SWS (p < 0.051) worsening was detected in group W. Big 5 questionnaires: 7 patients entered group W and 23 group B; group W patients showed lower scores in “Accommodation” domain, in its subdomain “cooperativity” and in the subdomain “impulse control” of the domain “Need for stability”. Apathy increased compared with baseline (p = 0.019 in 53 patients), but only patients with a major antiparkinsonian drug reduction reached statistical significance (p = 0.007). Conclusion: Gait difficulties and some aspects of personality seem to influence PDQ39 outcome. Selection of candidate can be improved by recognizing at pre-op stage subtle walking or balance disturbances, that could unravel the progression of the disease. Low accommodating, poorly cooperative people, focused on personal needs, with little impulse control could emphasize partial failure and underestimate improvement. Their follow-up may turn into a hard medical management.
3.218 Surgical treatment improving quality of life in Parkinson’s disease A. Singh1° , M. Bajpai, J. Vadra, V. Rajakrishnan, S. Singh Delhi, India
1 New
Objective: The study of outcome after unilateral thalamic stimulation (Deep Brain Stimulation) to treat intractable tremor of Parkinson’s disease. The surgical technique, qualitative, and quantitative tremor assessment, complication and side effect are studied. Method: 37 patients having tremor of Parkinson diseases underwent stereotactically implantation of electrode in ventro intermedius nuclei of thalamus and connected to programmed stimulator. Stereotactic neurosurgery has made it possible to access to the region of basal ganglia, thalamus, and subthalamic nucleus can be important solution for many patients with Parkinson’s disease not responding to drugs. Preoperative qualitative and quantitative assessment of tremor was compared with those obtained after surgery. Results: The statistical analysis demonstrated significant improvement of tremor in contralateral upper and lower limb (p < 0.001). Ipsilateral arm and postural tremor also improved (p < 0.01). In parkinson disease tremor but not bradykinesia and rigidity was suppressed. Administration of L-dopa was decreased by 40% in 29 patients. Conclusion: Unilateral thalamic stimulation is reversible, adaptable, and predictable procedure which avoids complications of cognitive deficit seen in patients with thalamotomy and should replace thalamotomy in regular surgical treatment of Parkinson. Thus deep brain stimulation of thalamus improving quality of life in patients by reducing tremor in Parkinson’s disease.
3.219 Body weight and body mass index changes after subthalamic nucleus deep brain stimulation in Parkinson’s disease S.-R. Kim1° , S.-J. Chung, M.-J. Kim, M.-S. Kim, M.-C. Lee Korea, Republic of
1 Seoul,
Objective: Weight gain has been reported to occur after subthalamic nucleus (STN) DBS in PD. To investigate the clinical characteristics and determining factors of body weight and body mass index (BMI) changes after STN DBS in PD patients.