- Email: [email protected]
P7.16 Joints kinematics and ataxia of lower limbs during walking in essential tremor is differentially modulated by thalamic stimulation
14th ECCN / 4th ICTMS/DCS full field stimulation and TMG on quadriceps components, femoral biceps, gastrocnemian muscles and tibialis anterior. Results: We recorded high values of wave N75 latencies in subgroup A. The delays of the P100 wave were presented in both subgroups. In our study, the contraction time as TMG parameter recorded higher values in posterior muscular group of the thigh and anterior muscular group of the shank. After analyzing muscular displacement and relaxation time, we observed a higher muscle tonus in all muscular groups we tested, especially in gastrocnemian. The ratio direct/converse correlation is high in VEP/TMG correlations. Conclusions: We have used original testing methods for the first time in our country such as tensiomyography to explore MS patients, simultaneously completing an analysis by correlating the results of the investigations, to both create a new diagnosis algorithm and predict the evolution of balance and gait disorders at these patients. P7.14 Use of Type A botulinum toxin for chronic low back pain treatment in Parkinsonian patients R. Di Giacopo1 , A. Guidubaldi1 , T. Ialongo1 , A. Bentivoglio1 Department of Neuroscience Catholic University, Rome, Italy
1
Introduction: Chronic low back pain (cLBP) is an important cause of disability in aged people. It does appear that Type A Botulinum Toxin (BoNT-A) is useful for cLBP management in those patients failing firstline treatment, specially when they have muscle tension. So the BoNT-A can represent a new possibility in Parkinson’s disease patients who often present LBP and trunk dystonia. None study investigating BoNT-A for pain treatment in this patients however exists. Objective: To evaluate the efficacy and side effect of BoNT-A for cLBP therapy in Parkinsonian patients. Methods: We enrolled 9 patients. The inclusion criteria consisted of LBP of more than six months, failure to respond to at least two major medications, ability to fill in a questionnaire; the exclusion criteria consisted of MRI showing lesion requiring urgent intervention. By electromyography, Dysport® BoNT-A was injected into the paraspinal muscles at three to four levels (between L2 and S1) bilaterally. The dose per site varied from 80 to 20 UI. Pain visual analogue scale (VAS), Oswestry Low Back Pain Questionnaire (OLBPQ) and perceived functional status (EQ-5D) were assessed at baseline, and at 1, 4 and 16 weeks after the first inoculation. Results: At 4 weeks 6/9 patients reported pain relief and reduced their analgesic therapy. The change in mean VAS and OLBPQ was significant compared to baseline and remained so over four months in 2/6 patients. 4/6 patients required re-injection after four months. No side effects were noted. Conclusions: BoNT-A seems an effective option for cLBP treatment in our cohort. Because the BoNT-A dose employed (Dysport® 240 UI) was more lower compared that utilised in literature (Botox® 200 500 UI), BoNT-A efficacy seems depending not only on normalisation of muscular hyperactivity, but also on normalisation of excessive muscle spindle activity, and inhibition of the release of neuropeptides by the nociceptor both in peripheral tissues and central nervous system P7.15 The motor and cognitive effects of extradural motor cortex stimulation for Parkinson’s disease: a 1-year prospective open-label study A.R. Bentivoglio1 , A. Fasano1 , C. Piano1 , F. Soleti1 , A. Daniele1 , M. Zinno1 , C. Piccinini1 , C. De Simone1 , T. Tufo1 , M. Meglio1 , B. Cioni1 1 Dipartimento di Neuroscienze, UCSC, Rome, Italy Introduction: Primary motor cortex is part of the cortical-basal ganglia loops, representing an “alternative” target for the surgical treatment of Parkinson’s disease (PD). To date, hundred patients have been treated with EMCS, with conflicting results. Objective: To report the motor and cognitive effects of unilateral EMCS in patients affected by PD up to 1 year after the surgical procedure. Methods: This is a prospective open-label study on PD patients with unilateral EMCS and 1 year follow-up. Surgical procedure was performed under general anaesthesia by placing over the motor cortex a quadripolar electrode strip connected to an implantable pulse generator sited in the subclavear region. Subjects were prospectively evaluated by means of PDQL (quality of life QL), UPDRS-II (daily life activities) UPDRS-III (motor section) and IV (complications of medical therapy).
S93 Results: Nine patients met the inclusion criteria. No adverse effect related to the surgical procedure or stimulation and no cognitive decline occurred. EMCS induced a marginal but significant QL improvement: baseline PDQL (81.1±17.8) was increased at month 3 (112.1±28.6; p = 0.03), month 6 (103.1±18.6; p = 0.02), and month 12 (100.7±20.5, p = 0.02). The UPDRS-II “Walking” score at month 3, 6 and 12 and “freezing of gait” at month 6 and 12 were significantly reduced as compared to baseline. In medication OFF, the total UPDRS motor score at baseline was reduced by 14.1% (p = 0.01), 23.3% (p = 0.04), 19.9% (p = 0.02), and 13.2% (p = 0.01), at month 1, 3, 6, and 12, respectively. The improvement was mostly related to the effect on axial and contralateral scores. In ON condition, EMCS failed to affect any of the outcome measurements. The UPDRS-IV total score was reduced by 40.8% (p = 0.05), 42.1% (p = 0.04) and 35.5% (p = 0.03) at month 1, 3 and 12, respectively. A significant effect on dyskinesias score emerged at month 1 and 3 as compared to baseline. The levodopa equivalent daily dose after surgery was reduced by 6.3%, 2.5%, 13.5%, and 2.5% at 1, 3, 6 and 12 months, respectively (significant at month 6, p = 0.02). Conclusion: EMCS is a safe procedure. After 12 months, the patients achieved a significant improvement of the motor condition with a specific effect on the axial performance and a slight reduction of dyskinesias, leading to a significant impact on the quality of life. P7.16 Joints kinematics and ataxia of lower limbs during walking in essential tremor is differentially modulated by thalamic stimulation A. Fasano1 , J. Herzog2 , J. Raethjen2 , F.E.M. Rose2 , M. Muthuraman2 , J. Volkmann2 , D. Falk3 , R. Elble4 , G. Deuschl2 1 Dipartimento di Neuroscienze, UCSC, Rome, Italy, 2 Department of Neurology, Christian-Albrechts-University, Kiel, Germany, 3 Department of Neurosurgery, Christian-Albrechts-University, Kiel, Germany, Kiel, Germany, 4 Department of Neurology, Southern Illinois U. School of Medicine, Springfield, United States Introduction: Patients in advanced stages of Essential Tremor (ET) regularly exhibit gait ataxia, impaired balance control and imprecise foot placement resembling patients with cerebellar deficits. Objectives: To elucidate the impact on cerebellar-like gait difficulties in ET patients of thalamic deep brain stimulation (thalamic DBS), a surgical therapy of otherwise intractable ET. Methods: Eleven ET patients (five women; age 69.8±3.9; disease duration 24.4±11.2 years; follow-up after surgery 24.7±20.3 months) were evaluated during the following conditions: stimulation off (STIM-OFF), stimulation on (STIM-ON), and supra-therapeutic stimulation (STIM-ST). Ten age-matched healthy controls (HC) served as comparison group. Locomotion was kinematically analysed using a three-dimensional optoelectronic motion analysis system. Established clinical and kinesiologic measures of ataxia were computed. Results: During STIM-OFF, the patients exhibited ataxia of foot trajectories and lower limb joints, which improved during STIM-ON and worsened again during STIM-ST. In the whole group, DBS improved ankle rotation and reduced leg stiffness (compensating the impaired dynamic stability). Moreover, in a subgroup of ET patients with more severe disease, thalamic DBS caused normalisation of kinematic variability and joint range of rotation, compared to STIM-OFF and STIM-ST. These improvements in ataxia were not a function ofrelated to reduced tremor improvement in the lower limbs or torso. Conclusion: Cerebellar dysfunction in ET patients can be differentially modulated with optimal versus supra-therapeutic stimulation. The cerebellar movement disorder of ET is due to a typical cerebellar deficit, not to trembling extremities. We hypothesize that DBS affects two major regulating circuits: the cortico-thalamo-cortical loop for tremor reduction and the cerebello-thalamo-cortical pathway for ataxia reduction (STIM-ON) and induction (STIM-ST).
1
Introduction: Chronic low back pain (cLBP) is an important cause of disability in aged people. It does appear that Type A Botulinum Toxin (BoNT-A) is useful for cLBP management in those patients failing firstline treatment, specially when they have muscle tension. So the BoNT-A can represent a new possibility in Parkinson’s disease patients who often present LBP and trunk dystonia. None study investigating BoNT-A for pain treatment in this patients however exists. Objective: To evaluate the efficacy and side effect of BoNT-A for cLBP therapy in Parkinsonian patients. Methods: We enrolled 9 patients. The inclusion criteria consisted of LBP of more than six months, failure to respond to at least two major medications, ability to fill in a questionnaire; the exclusion criteria consisted of MRI showing lesion requiring urgent intervention. By electromyography, Dysport® BoNT-A was injected into the paraspinal muscles at three to four levels (between L2 and S1) bilaterally. The dose per site varied from 80 to 20 UI. Pain visual analogue scale (VAS), Oswestry Low Back Pain Questionnaire (OLBPQ) and perceived functional status (EQ-5D) were assessed at baseline, and at 1, 4 and 16 weeks after the first inoculation. Results: At 4 weeks 6/9 patients reported pain relief and reduced their analgesic therapy. The change in mean VAS and OLBPQ was significant compared to baseline and remained so over four months in 2/6 patients. 4/6 patients required re-injection after four months. No side effects were noted. Conclusions: BoNT-A seems an effective option for cLBP treatment in our cohort. Because the BoNT-A dose employed (Dysport® 240 UI) was more lower compared that utilised in literature (Botox® 200 500 UI), BoNT-A efficacy seems depending not only on normalisation of muscular hyperactivity, but also on normalisation of excessive muscle spindle activity, and inhibition of the release of neuropeptides by the nociceptor both in peripheral tissues and central nervous system P7.15 The motor and cognitive effects of extradural motor cortex stimulation for Parkinson’s disease: a 1-year prospective open-label study A.R. Bentivoglio1 , A. Fasano1 , C. Piano1 , F. Soleti1 , A. Daniele1 , M. Zinno1 , C. Piccinini1 , C. De Simone1 , T. Tufo1 , M. Meglio1 , B. Cioni1 1 Dipartimento di Neuroscienze, UCSC, Rome, Italy Introduction: Primary motor cortex is part of the cortical-basal ganglia loops, representing an “alternative” target for the surgical treatment of Parkinson’s disease (PD). To date, hundred patients have been treated with EMCS, with conflicting results. Objective: To report the motor and cognitive effects of unilateral EMCS in patients affected by PD up to 1 year after the surgical procedure. Methods: This is a prospective open-label study on PD patients with unilateral EMCS and 1 year follow-up. Surgical procedure was performed under general anaesthesia by placing over the motor cortex a quadripolar electrode strip connected to an implantable pulse generator sited in the subclavear region. Subjects were prospectively evaluated by means of PDQL (quality of life QL), UPDRS-II (daily life activities) UPDRS-III (motor section) and IV (complications of medical therapy).
S93 Results: Nine patients met the inclusion criteria. No adverse effect related to the surgical procedure or stimulation and no cognitive decline occurred. EMCS induced a marginal but significant QL improvement: baseline PDQL (81.1±17.8) was increased at month 3 (112.1±28.6; p = 0.03), month 6 (103.1±18.6; p = 0.02), and month 12 (100.7±20.5, p = 0.02). The UPDRS-II “Walking” score at month 3, 6 and 12 and “freezing of gait” at month 6 and 12 were significantly reduced as compared to baseline. In medication OFF, the total UPDRS motor score at baseline was reduced by 14.1% (p = 0.01), 23.3% (p = 0.04), 19.9% (p = 0.02), and 13.2% (p = 0.01), at month 1, 3, 6, and 12, respectively. The improvement was mostly related to the effect on axial and contralateral scores. In ON condition, EMCS failed to affect any of the outcome measurements. The UPDRS-IV total score was reduced by 40.8% (p = 0.05), 42.1% (p = 0.04) and 35.5% (p = 0.03) at month 1, 3 and 12, respectively. A significant effect on dyskinesias score emerged at month 1 and 3 as compared to baseline. The levodopa equivalent daily dose after surgery was reduced by 6.3%, 2.5%, 13.5%, and 2.5% at 1, 3, 6 and 12 months, respectively (significant at month 6, p = 0.02). Conclusion: EMCS is a safe procedure. After 12 months, the patients achieved a significant improvement of the motor condition with a specific effect on the axial performance and a slight reduction of dyskinesias, leading to a significant impact on the quality of life. P7.16 Joints kinematics and ataxia of lower limbs during walking in essential tremor is differentially modulated by thalamic stimulation A. Fasano1 , J. Herzog2 , J. Raethjen2 , F.E.M. Rose2 , M. Muthuraman2 , J. Volkmann2 , D. Falk3 , R. Elble4 , G. Deuschl2 1 Dipartimento di Neuroscienze, UCSC, Rome, Italy, 2 Department of Neurology, Christian-Albrechts-University, Kiel, Germany, 3 Department of Neurosurgery, Christian-Albrechts-University, Kiel, Germany, Kiel, Germany, 4 Department of Neurology, Southern Illinois U. School of Medicine, Springfield, United States Introduction: Patients in advanced stages of Essential Tremor (ET) regularly exhibit gait ataxia, impaired balance control and imprecise foot placement resembling patients with cerebellar deficits. Objectives: To elucidate the impact on cerebellar-like gait difficulties in ET patients of thalamic deep brain stimulation (thalamic DBS), a surgical therapy of otherwise intractable ET. Methods: Eleven ET patients (five women; age 69.8±3.9; disease duration 24.4±11.2 years; follow-up after surgery 24.7±20.3 months) were evaluated during the following conditions: stimulation off (STIM-OFF), stimulation on (STIM-ON), and supra-therapeutic stimulation (STIM-ST). Ten age-matched healthy controls (HC) served as comparison group. Locomotion was kinematically analysed using a three-dimensional optoelectronic motion analysis system. Established clinical and kinesiologic measures of ataxia were computed. Results: During STIM-OFF, the patients exhibited ataxia of foot trajectories and lower limb joints, which improved during STIM-ON and worsened again during STIM-ST. In the whole group, DBS improved ankle rotation and reduced leg stiffness (compensating the impaired dynamic stability). Moreover, in a subgroup of ET patients with more severe disease, thalamic DBS caused normalisation of kinematic variability and joint range of rotation, compared to STIM-OFF and STIM-ST. These improvements in ataxia were not a function ofrelated to reduced tremor improvement in the lower limbs or torso. Conclusion: Cerebellar dysfunction in ET patients can be differentially modulated with optimal versus supra-therapeutic stimulation. The cerebellar movement disorder of ET is due to a typical cerebellar deficit, not to trembling extremities. We hypothesize that DBS affects two major regulating circuits: the cortico-thalamo-cortical loop for tremor reduction and the cerebello-thalamo-cortical pathway for ataxia reduction (STIM-ON) and induction (STIM-ST).