- Email: [email protected]
3.233 Unilateral stimulation of subthalamic nucleus for Parkinson disease
S170
Wednesday, 12 December 2007
Results: Eight couples (median age 60 years) were included in the analysis. All patients were men. DBS reduced the symptoms and the intake of anti PD drugs with (md) 57% and they reported good mobility 85% of the day. Preoperatively did the majority of couples with sorrow, experience that the patients’ speech had deteriorated during the course of PD and they perceived it to be more impaired postoperatively. It was however not regarded as a major problem in the domestic family life. The couples who only had noticed slight PD influence on the speech before surgery, perceived unchanged speech after surgery. The intelligibility of speech was of great importance for the well-being in daily life. Stress as well as end-of-dose state were by both the patients and their wives regarded to have negative impact on the speech. Thus, based on a mutual agreement was the wife most often the speaker of the family. Conclusion: The speech was perceived as more impaired postoperatively by the couples who already had experienced speech problem preoperatively. However, the postoperatively speech problems were not regarded to change the couples’ communication within the family negatively as they often did before surgery.
3.230 Exercise performance in Parkinson’s disease before and 3 months after DBS-STN operation H.U. Jørgensen1° , L. Simonsen, L. Werdelin, S. Rusborg, A. Løkkegaard Denmark
1 Copenhagen,
Objective: To establish whether DBS-STN treatment improve exercise performance in Parkinson patients. Method: 8 patients with IPD (7 male, 1 female) were studied before and 3 months after DBS-STN operation. Maximum oxygen uptake was determined on an electrically braked cycle ergometer initially at 30 W and then, essentially, at a 30 W increase in load every 2 min until exhaustion. Oxygen uptake and carbon dioxide output were measured continuously using facemask and breath-by-breath technique. 12 lead ECG was measured continuously during the test. The peak values were compared to a normal data base (Wasserman). Tests were performed at least 1 12 h after last meal and in best attainable “on” condition prior DBS-STN operation and 3 months post. The Parkinson symptoms were assessed by Unified Parkinson’s disease Rating Scale (UPDRS). Results: Due to ongoing analyses of data no data are ready at present. Data will be presented at the meeting. Conclusion: Conclusions will be presented at the meeting.
Conclusion: Unilateral STN DBS is an effective and safe treatment for selected patients with advanced PD. Unilateral STN DBS provides improvement of contralateral motor symptoms of PD as well as quality of life, reduces requirements for medication, and possibly enhances mental flexibility. This method of surgical treatment may be associated with a reduced risk and may provide an alternative to bilateral STN DBS for PD, especially in older patients or patients with asymmetry of parkinsonism.
3.232 Bilateral effects of unilateral deep brain stimulation N. Kovacs1° , I. Balas, C. Llumiguano, L. Kellenyi, F. Nagy, J. Janszky Hungary
1 Pecs,
Objective: To evaluate the possibility of active tremor reduction on the non-target side during unilateral thalamic deep brain stimulation. Background: It is unanswered whether unilateral deep brain stimulator (DBS) has only contralateral or bilateral effects on tremor. Previous studies demonstrated a clinically irrelevant improvement on the non-target side after thalamic DBS implantation, which was considered as the result of mechanical effects alone. Method: 14 consecutive patients underwent unilateral Vim DBS implantation because of drug-resistant tremor were included in the study (8 tremor dominant Parkinson’s disease, 7 essential tremor, 1 tremor of other origin – mitochondrial encephalomyopathy). All of them previously underwent contralateral thalamotomy. Simultaneous bilateral triaxial accelerometry, surface electromyography (sEMG) and video recordings were performed. After at least 12 hour-long drug withdrawal, the rest and postural tremor had been recorded in both stimulation on and stimulation off states for at least 1 hour-long interval. Besides, Fahn–Tolosa–Marin tremor rating scale was applied in both conditions. Results: Having turned off the stimulation, postural-kinetic tremor developed on both the target and the non-target side in only one case. The co-recording of accelerometry and sEMG proved tremor related muscle activation behind this phenomenon on both sides. After turning on the stimulation, the postural-kinetic tremor of both sides disappeared suggesting bilateral effect of the unilateral Vim DBS. Conclusion: In a relatively small group of patients, we were able to find a case where the unilateral DBS probably had bilateral tremor reductive effect. However, in the majority of patients only contralateral effect could be demonstrated.
3.231 Brain stimulation in Parkinson disease
3.233 Unilateral stimulation of subthalamic nucleus for Parkinson disease
1 Kharkov,
I. Fedotova1° , V. Fedotov Ukraine
1 Nagoya,
Objective: The object of this study was to assess the results of unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for management of advanced Parkinson’s disease (PD). Method: A clinical series of 40 patients (mean age 68 years, range 47−75 years) with medically intractable PD, who were undergoing unilateral magnetic resonance imaging-targeted, electrophysiologically guided STN DBS. The mean follow-up period was 12 months. Results: Statistically significant improvement was observed in the Unified Parkinson’s disease Rating Scale (UPDRS) Part II score (19%), the total UPDRS Part III score (29%), the contralateral UPDRS Part III score (59%), and scores for axial motor features (15%), contralateral tremor (80%), rigidity (54%), bradykinesia (58%), and dyskinesia (77%), as well as the Parkinson’s disease Quality of Life questionnaire score (11%) in the onstimulation state compared with baseline. Ipsilateral symptoms improved by approximately 20% or less. The daily levodopa-equivalent dose was reduced by 24% (p = 0.021). Neuropsychological tests revealed an improvement in mental flexibility and a trend toward reduced letter fluency. There were no permanent surgical complications. Of the 21 participants with symmetrical disease, five required implantation of the DBS unit on the second side.
Objective: Bilateral stimulation of the subthalamic nucleus (STN) is considered to provide the consistent benefit against the motor symptom of Parkinson’s disease (PD). Nevertheless, bilateral surgical procedures are more invasive than unilateral procedures and associated with an increased risk of side effect. The object of this study was to assess the efficacy and safety of unilateral STN stimulation for advanced PD. Method: Fifty-six patients (mean age 62 years, aged from 45 to 78 years) with parkinsonian symptoms history of 12.1 years in average underwent unilateral stimulation of STN (left-sided procedures: 38 cases, right-sided procedure: 18 cases, respectively). The mean follow-up period lasted 18 months. Patients were assessed by the Unified PD Rating Scale (UPDRS) and home diaries. Results: The improvement rates were; in the Levodopa-off/stimulationon UPDRS part II score (24%) and part III score (42%), the contralateral side (68%), score for axial motor feature (22%), contralateral tremor (85%), rigidity (72%), bradykinesia (62%), and dyskinesia (65%) and ipsilateral symptoms (12%), compared with the baseline levodopa-off score. Eight cases out of forty with symmetrical disease underwent a second surgery 6 to 13 months after unilateral stimulation surgery. Daily levodopa-equivalent
Y. Kajita1° , S. Takebayashi, S. Fujitani, J. Yoshida Japan
Poster Presentations: Neurosurgical Interventions and TMS dose was reduced by 21.6% (from 592.1 mg to 461.4 mg). Psychiatric adverse effect attended with stimulation was observed in four cases (7%). There was no other side effects related this procedure. Conclusion: Unilateral stimulation of STN may provide a sufficient benefit in quality of life as well as improvement of contralateral motor symptom. Our study indicates that unilateral procedure is safe and efficacious treatment in treating some patients with PD in whom bilateral deep brain stimulation may be too aggressive.
S171
0 Hz (by 70.4±35.8%, p = 0.038 and 81.5±48.2%, p = 0.043, respectively; Figure 1B).
3.234 Unilateral deep brain stimulation of thalamic nuclei for treatment of intractable tremor of Parkinson’s disease A. Singh1° , V. Dixit, V. Rajakrishnan Delhi, India
1 New
Objective: The study of outcome after unilateral thalamic stimulation to treat intractable tremor in Parkinson disease. The surgical technique, qualitative, and quantitative tremor assessment, complications and side effects are studied. Method: 37 patients suffering Parkinson’s disease-related tremor underwent stereotactically implantation of an electrode in the ventro-intermedius nuclei of thalamus, and connected to programmed stimulator. Stereotactic neurosurgery has made it possible to access the region of the basal ganglia, thalamus, and subthalamic nucleus, and can offer important solutions 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’s 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.
3.235 Effects of low-frequency stimulation of the subthalamic nucleus on movement in Parkinson’s disease A. Eusebio1° , C.-C. Chen, C.-S. Lu, S.-T. Lee, C.-H. Tsai, P. Limousin, M. Hariz, P. Brown 1 London, United Kingdom Objective: Increasing evidence suggests that excessive synchronization of neural activity within the basal ganglia at low frequencies is a hallmark of Parkinson’s disease (PD). However, few studies have unambiguously linked this activity to movement impairment through direct stimulation of basal ganglia targets at low frequency. Furthermore, these studies have varied in their methodology and findings, so it remains unclear whether stimulation at any or all frequencies 20 Hz impairs movement and if so, whether effects are identical across this broad frequency band. Method: 18 PD patients chronically implanted with deep-brain stimulation (DBS) electrodes in both subthalamic nuclei were stimulated bilaterally at 5, 10 and 20 Hz after overnight withdrawal of their medication and the effects of the DBS on a finger tapping task were compared to performance without DBS (0 Hz). Results: Tapping rate decreased at 5 and 20 Hz compared to 0 Hz (by 11.8±4.9%, p = 0.022 and 7.4±2.6%, p = 0.009, respectively) on those sides with relatively preserved baseline task performance (Figure 1A). Moreover, variability of tapping rate (measured by the coefficient of variation [CV] of the tap intervals) increased at 5 and 10 Hz compared to
Conclusion: The data suggest that the susceptibility of basal ganglia networks to the effects of excessive synchronization may be elevated across a broad low frequency band in parkinsonian patients, although the detailed profile of motor impairment could depend on the precise frequencies at which synchronization occurs.
3.236 Chronic deep brain stimulation of the subthalamic nucleus increases striatal tissue levels of dopamine in naive rats D. Harnack1° , O. Padron, C. van Delden, W. Meissner, R. Morgenstern, A. Kupsch 1 Berlin, Germany Objective: Deep brain stimulation of the subthalamic nucleus (DBS-STN) is a standard therapy in Parkinson’s disease alleviating all
Wednesday, 12 December 2007
Results: Eight couples (median age 60 years) were included in the analysis. All patients were men. DBS reduced the symptoms and the intake of anti PD drugs with (md) 57% and they reported good mobility 85% of the day. Preoperatively did the majority of couples with sorrow, experience that the patients’ speech had deteriorated during the course of PD and they perceived it to be more impaired postoperatively. It was however not regarded as a major problem in the domestic family life. The couples who only had noticed slight PD influence on the speech before surgery, perceived unchanged speech after surgery. The intelligibility of speech was of great importance for the well-being in daily life. Stress as well as end-of-dose state were by both the patients and their wives regarded to have negative impact on the speech. Thus, based on a mutual agreement was the wife most often the speaker of the family. Conclusion: The speech was perceived as more impaired postoperatively by the couples who already had experienced speech problem preoperatively. However, the postoperatively speech problems were not regarded to change the couples’ communication within the family negatively as they often did before surgery.
3.230 Exercise performance in Parkinson’s disease before and 3 months after DBS-STN operation H.U. Jørgensen1° , L. Simonsen, L. Werdelin, S. Rusborg, A. Løkkegaard Denmark
1 Copenhagen,
Objective: To establish whether DBS-STN treatment improve exercise performance in Parkinson patients. Method: 8 patients with IPD (7 male, 1 female) were studied before and 3 months after DBS-STN operation. Maximum oxygen uptake was determined on an electrically braked cycle ergometer initially at 30 W and then, essentially, at a 30 W increase in load every 2 min until exhaustion. Oxygen uptake and carbon dioxide output were measured continuously using facemask and breath-by-breath technique. 12 lead ECG was measured continuously during the test. The peak values were compared to a normal data base (Wasserman). Tests were performed at least 1 12 h after last meal and in best attainable “on” condition prior DBS-STN operation and 3 months post. The Parkinson symptoms were assessed by Unified Parkinson’s disease Rating Scale (UPDRS). Results: Due to ongoing analyses of data no data are ready at present. Data will be presented at the meeting. Conclusion: Conclusions will be presented at the meeting.
Conclusion: Unilateral STN DBS is an effective and safe treatment for selected patients with advanced PD. Unilateral STN DBS provides improvement of contralateral motor symptoms of PD as well as quality of life, reduces requirements for medication, and possibly enhances mental flexibility. This method of surgical treatment may be associated with a reduced risk and may provide an alternative to bilateral STN DBS for PD, especially in older patients or patients with asymmetry of parkinsonism.
3.232 Bilateral effects of unilateral deep brain stimulation N. Kovacs1° , I. Balas, C. Llumiguano, L. Kellenyi, F. Nagy, J. Janszky Hungary
1 Pecs,
Objective: To evaluate the possibility of active tremor reduction on the non-target side during unilateral thalamic deep brain stimulation. Background: It is unanswered whether unilateral deep brain stimulator (DBS) has only contralateral or bilateral effects on tremor. Previous studies demonstrated a clinically irrelevant improvement on the non-target side after thalamic DBS implantation, which was considered as the result of mechanical effects alone. Method: 14 consecutive patients underwent unilateral Vim DBS implantation because of drug-resistant tremor were included in the study (8 tremor dominant Parkinson’s disease, 7 essential tremor, 1 tremor of other origin – mitochondrial encephalomyopathy). All of them previously underwent contralateral thalamotomy. Simultaneous bilateral triaxial accelerometry, surface electromyography (sEMG) and video recordings were performed. After at least 12 hour-long drug withdrawal, the rest and postural tremor had been recorded in both stimulation on and stimulation off states for at least 1 hour-long interval. Besides, Fahn–Tolosa–Marin tremor rating scale was applied in both conditions. Results: Having turned off the stimulation, postural-kinetic tremor developed on both the target and the non-target side in only one case. The co-recording of accelerometry and sEMG proved tremor related muscle activation behind this phenomenon on both sides. After turning on the stimulation, the postural-kinetic tremor of both sides disappeared suggesting bilateral effect of the unilateral Vim DBS. Conclusion: In a relatively small group of patients, we were able to find a case where the unilateral DBS probably had bilateral tremor reductive effect. However, in the majority of patients only contralateral effect could be demonstrated.
3.231 Brain stimulation in Parkinson disease
3.233 Unilateral stimulation of subthalamic nucleus for Parkinson disease
1 Kharkov,
I. Fedotova1° , V. Fedotov Ukraine
1 Nagoya,
Objective: The object of this study was to assess the results of unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for management of advanced Parkinson’s disease (PD). Method: A clinical series of 40 patients (mean age 68 years, range 47−75 years) with medically intractable PD, who were undergoing unilateral magnetic resonance imaging-targeted, electrophysiologically guided STN DBS. The mean follow-up period was 12 months. Results: Statistically significant improvement was observed in the Unified Parkinson’s disease Rating Scale (UPDRS) Part II score (19%), the total UPDRS Part III score (29%), the contralateral UPDRS Part III score (59%), and scores for axial motor features (15%), contralateral tremor (80%), rigidity (54%), bradykinesia (58%), and dyskinesia (77%), as well as the Parkinson’s disease Quality of Life questionnaire score (11%) in the onstimulation state compared with baseline. Ipsilateral symptoms improved by approximately 20% or less. The daily levodopa-equivalent dose was reduced by 24% (p = 0.021). Neuropsychological tests revealed an improvement in mental flexibility and a trend toward reduced letter fluency. There were no permanent surgical complications. Of the 21 participants with symmetrical disease, five required implantation of the DBS unit on the second side.
Objective: Bilateral stimulation of the subthalamic nucleus (STN) is considered to provide the consistent benefit against the motor symptom of Parkinson’s disease (PD). Nevertheless, bilateral surgical procedures are more invasive than unilateral procedures and associated with an increased risk of side effect. The object of this study was to assess the efficacy and safety of unilateral STN stimulation for advanced PD. Method: Fifty-six patients (mean age 62 years, aged from 45 to 78 years) with parkinsonian symptoms history of 12.1 years in average underwent unilateral stimulation of STN (left-sided procedures: 38 cases, right-sided procedure: 18 cases, respectively). The mean follow-up period lasted 18 months. Patients were assessed by the Unified PD Rating Scale (UPDRS) and home diaries. Results: The improvement rates were; in the Levodopa-off/stimulationon UPDRS part II score (24%) and part III score (42%), the contralateral side (68%), score for axial motor feature (22%), contralateral tremor (85%), rigidity (72%), bradykinesia (62%), and dyskinesia (65%) and ipsilateral symptoms (12%), compared with the baseline levodopa-off score. Eight cases out of forty with symmetrical disease underwent a second surgery 6 to 13 months after unilateral stimulation surgery. Daily levodopa-equivalent
Y. Kajita1° , S. Takebayashi, S. Fujitani, J. Yoshida Japan
Poster Presentations: Neurosurgical Interventions and TMS dose was reduced by 21.6% (from 592.1 mg to 461.4 mg). Psychiatric adverse effect attended with stimulation was observed in four cases (7%). There was no other side effects related this procedure. Conclusion: Unilateral stimulation of STN may provide a sufficient benefit in quality of life as well as improvement of contralateral motor symptom. Our study indicates that unilateral procedure is safe and efficacious treatment in treating some patients with PD in whom bilateral deep brain stimulation may be too aggressive.
S171
0 Hz (by 70.4±35.8%, p = 0.038 and 81.5±48.2%, p = 0.043, respectively; Figure 1B).
3.234 Unilateral deep brain stimulation of thalamic nuclei for treatment of intractable tremor of Parkinson’s disease A. Singh1° , V. Dixit, V. Rajakrishnan Delhi, India
1 New
Objective: The study of outcome after unilateral thalamic stimulation to treat intractable tremor in Parkinson disease. The surgical technique, qualitative, and quantitative tremor assessment, complications and side effects are studied. Method: 37 patients suffering Parkinson’s disease-related tremor underwent stereotactically implantation of an electrode in the ventro-intermedius nuclei of thalamus, and connected to programmed stimulator. Stereotactic neurosurgery has made it possible to access the region of the basal ganglia, thalamus, and subthalamic nucleus, and can offer important solutions 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’s 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.
3.235 Effects of low-frequency stimulation of the subthalamic nucleus on movement in Parkinson’s disease A. Eusebio1° , C.-C. Chen, C.-S. Lu, S.-T. Lee, C.-H. Tsai, P. Limousin, M. Hariz, P. Brown 1 London, United Kingdom Objective: Increasing evidence suggests that excessive synchronization of neural activity within the basal ganglia at low frequencies is a hallmark of Parkinson’s disease (PD). However, few studies have unambiguously linked this activity to movement impairment through direct stimulation of basal ganglia targets at low frequency. Furthermore, these studies have varied in their methodology and findings, so it remains unclear whether stimulation at any or all frequencies 20 Hz impairs movement and if so, whether effects are identical across this broad frequency band. Method: 18 PD patients chronically implanted with deep-brain stimulation (DBS) electrodes in both subthalamic nuclei were stimulated bilaterally at 5, 10 and 20 Hz after overnight withdrawal of their medication and the effects of the DBS on a finger tapping task were compared to performance without DBS (0 Hz). Results: Tapping rate decreased at 5 and 20 Hz compared to 0 Hz (by 11.8±4.9%, p = 0.022 and 7.4±2.6%, p = 0.009, respectively) on those sides with relatively preserved baseline task performance (Figure 1A). Moreover, variability of tapping rate (measured by the coefficient of variation [CV] of the tap intervals) increased at 5 and 10 Hz compared to
Conclusion: The data suggest that the susceptibility of basal ganglia networks to the effects of excessive synchronization may be elevated across a broad low frequency band in parkinsonian patients, although the detailed profile of motor impairment could depend on the precise frequencies at which synchronization occurs.
3.236 Chronic deep brain stimulation of the subthalamic nucleus increases striatal tissue levels of dopamine in naive rats D. Harnack1° , O. Padron, C. van Delden, W. Meissner, R. Morgenstern, A. Kupsch 1 Berlin, Germany Objective: Deep brain stimulation of the subthalamic nucleus (DBS-STN) is a standard therapy in Parkinson’s disease alleviating all