- Email: [email protected]
Transcranial direct current stimulation in the treatment of essential tremor
e130
Abstracts / Parkinsonism and Related Disorders 22 (2016) e87ee141
P 3.049. RESEARCH ON NEUROPSYCHIATRIC SYMPTOMS IN PATIENTS WITH ESSENTIAL TREMOR AND PARKINSON’S DISEASE IN LATVIAN POPULATION
P 3.051. IMPACT OF AN INTERDISCIPLINARY DEEP BRAIN STIMULATION SCREENING MODEL ON POST-SURGICAL COMPLICATIONS IN ESSENTIAL TREMOR PATIENTS
Ligita Smeltere 1, Vladimirs Kuznecovs 2, Roberts Smelters 3. 1 Health Centre 4, Consultation for Parkinson's Disease and Other Movement Disorder, Riga, Latvia; 2 Medical Faculty of University of Latvia, Riga Centre of Psychiatry and Addiction Disorders, Riga, Latvia; 3 Health Centre 4, Riga, Latvia
Masa-Aki Higuchi 1, Michael Okun 2, Yoshio Tsuboi 1. 1 Department of Neurology, Fukuoka University, Fukuoka, Japan; 2 Department of Neurology, University of Florida, Gainesville, United States
Objectives: The aim of the research was to investigate the most common psychiatric symptoms e depression, anxiety and social phobia as its part, and their link with motor symptoms in 40 Essential tremor (ET), 35 Parkinson’s disease (PD) patients and compare them with 39 people of the control group (CG). Methods: ET and PD patients were examined by doing a detailed neurological investigation. All participants completed 5 self-assessment questionnaires: DASS, BDI-II, SIAS, SPS and STAI, which where complemented with clinical interviews. Results: Using BDI, depression of different degrees had been ascertained in 79.49% of the ET patients, 91.18% of the PD group, 66.67% of the CG. Using SIAS>36, SPS>26 tests cut-off score, social anxiety (phobia) was diagnosed in 35% of the ET patients, 25.71% of the PD patients, 7.69% of the CG. The scores were higher when also taking into account mild or partial symptoms of social anxiety: ET 50%, PD 42.86%, CG 20.51%. Anxiety and depression did not correlate with the severity of tremor in the ET patients, while the PD patients had moderate correlation (r¼0.66; p<0.001) between the severity of depression and Hoehn &Yahr stage. The ET patients did not reveal correlation between the severity of tremor and anxiety during social contacts - SIAS (p¼0.18), however, there exists moderate correlation with social phobia scale SPS (rs¼0.35; p¼0.02). Conclusions: The sample of ET and PD patients revealed high comorbidity of psychiatric illnesses. P 3.050. TRANSCRANIAL DIRECT CURRENT STIMULATION IN THE TREATMENT OF ESSENTIAL TREMOR Nesrin Helvaci Yilmaz 1, Burcu Polat 1, Lutfu Hanoglu 1. Neurology, Istanbul Medipol University, Istanbul, Turkey
1
Department of
Objectives: Cerebellar transcranial magnetic stimulation (TMS) has been shown to reduce the severity of essential tremor (ET) in the previous studies. We aimed to investigate the effects of transcranial direct current stimulation (tDCS) (non-invasive, more easily applicable method than TMS) in patients with ET. Methods: We included 6 (3 women and 3 men) drug-discontinued ET patients above 18 years of age. The ET Rating Assessment Scale (TETRAS) and Activities of Daily Living (ADL) scale for ET were administered. tDCS was applied by using a device utilizing 35 cm2 electrodes. Anodal stimulation was applied to the dorsolateral and prefrontal areas and cathodal stimulation was applied to cerebellar hemispheres, at 2 mA for 20 minutes in 10 consecutive sessions with a 2-day break between the first and second 5-day sessions. One month following the initial course of therapy, 5 more tDCS sessions were administered in an every-other-day fashion. TETRAS and ADL scales were readministered. Friedman's test was used to assess the entirety of the time course. Results: A significant improvement was observed in TETRAS and ADL scores at the end of 50 days (p¼0.015, p¼0.024 respectively). The difference between pre-treatment TETRAS scores and after 50 days and 5 additional tDCS sessions was statistically significant (p¼0.039). Conclusions: Our study found marked improvement in neurologic examination and daily activities in ET patients who received tDCS to the cerebellar hemispheres. Long-term study protocols with larger numbers of patients are required.
Objectives: There are currently no standardized criteria for selection of appropriate DBS candidates and to date there has been little hard data to support to use of any singular methods. We aimed to investigate the impact of our interdisciplinary screening process on post-operative unintended hospitalizations (UH) and on quality of life (QOL). Methods: An ET cohort was selected from our institutional DBS database. The interdisciplinary model utilized seven specialties who pre-operatively screened all potential DBS candidates. Concerns raised by each specialty were documented and classified as minor or major. Records were reviewed to identify UH and QOL measurement at a 1 year follow-up interval. Results: Of the 51 cases who received interdisciplinary screening for possible DBS, 44 (86%) were approved for the surgery. Eight (18.2%) of the DBS patients had an UH. The patients with major or minor concerns raised from any specialty service had significantly more UH (75%) when compared to patients without concerns (25.0%) (p < 0.005). The rate of hospitalization decreased and revealed a direct relationship to the “level of concern” raised during screening; ranging from 100% (major concern) to 42% (minor concern) to 7% (no concern) (p¼ 0.001). QoL scores on the SF36 were significantly worsened in patients with UH at 6 (p¼ 0.046) and 12 months (p¼0.027) when compared to baseline scores. No significant difference in TRS scores between UH and non-UH was observed. Conclusions: Concerns raised during interdisciplinary DBS evaluations were significantly related to UH and to a reduced QOL. The interdisciplinary evaluation may help to stratify risk for unintended hospitalization and QOL outcomes. References 1. Martinez-Ramirez D and Okun MS. Rationale and clinical pearls for primary care doctors referring patients for deep brain stimulation. Gerontology 2014;60:38-48. P 3.052. CENTRIFUGAL PROGRESSION OF TDP-43 PATHOLOGY ALONG OLFACTORY PATHWAY IN ALS PATIENTS IN CONTRAST TO CENTRIPETAL PROGRESSION OF ALPHA-SYNUCLEIN PATHOLOGY IN PD PATIENTS Takahiro Takeda 1, Mutsumi Iijima 1, Toshiki Uchihara 2, Charles Duyckaerts 3, Shinichiro Uchiyama 1, Kazuo Kitagawa 1. 1 Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan; 2 Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; 3 Raymond Escourolle Laboratory of Neuropathology, La Salp^ etri ere Hospital, Paris, France Objectives: Odor impairment is one of common symptoms in Parkinson disease. It sometimes occurs in amyotrophic lateral sclerosis (ALS) patients, however, its relationship with TDP-43 pathology has not been fully elucidated. Methods: We studied samples from a series of 43 postmortem ALS cases. The olfactory bulb, anterior olfactory nucleus, periamygdaloid complex/ piriform cortex, hippocampal dentate gyrus and orbital cortex were selected to examine packing density of TDP-43-positive inclusions. Results: Quantitative analyses demonstrated that TDP-43-positive inclusions were most frequent in the hippocampus, least abundant in the olfactory bulb, and had an intermediate density in the primary olfactory cortex. Conclusion: This centrifugal gradient suggests that TDP-43 pathology starts in the hippocampus, spreads into the primary olfactory center and finally reaches the olfactory bulb. TDP-43, tau and alpha-synuclein accumulations appeared independent. This study suggested the hypothesis of
Abstracts / Parkinsonism and Related Disorders 22 (2016) e87ee141
P 3.049. RESEARCH ON NEUROPSYCHIATRIC SYMPTOMS IN PATIENTS WITH ESSENTIAL TREMOR AND PARKINSON’S DISEASE IN LATVIAN POPULATION
P 3.051. IMPACT OF AN INTERDISCIPLINARY DEEP BRAIN STIMULATION SCREENING MODEL ON POST-SURGICAL COMPLICATIONS IN ESSENTIAL TREMOR PATIENTS
Ligita Smeltere 1, Vladimirs Kuznecovs 2, Roberts Smelters 3. 1 Health Centre 4, Consultation for Parkinson's Disease and Other Movement Disorder, Riga, Latvia; 2 Medical Faculty of University of Latvia, Riga Centre of Psychiatry and Addiction Disorders, Riga, Latvia; 3 Health Centre 4, Riga, Latvia
Masa-Aki Higuchi 1, Michael Okun 2, Yoshio Tsuboi 1. 1 Department of Neurology, Fukuoka University, Fukuoka, Japan; 2 Department of Neurology, University of Florida, Gainesville, United States
Objectives: The aim of the research was to investigate the most common psychiatric symptoms e depression, anxiety and social phobia as its part, and their link with motor symptoms in 40 Essential tremor (ET), 35 Parkinson’s disease (PD) patients and compare them with 39 people of the control group (CG). Methods: ET and PD patients were examined by doing a detailed neurological investigation. All participants completed 5 self-assessment questionnaires: DASS, BDI-II, SIAS, SPS and STAI, which where complemented with clinical interviews. Results: Using BDI, depression of different degrees had been ascertained in 79.49% of the ET patients, 91.18% of the PD group, 66.67% of the CG. Using SIAS>36, SPS>26 tests cut-off score, social anxiety (phobia) was diagnosed in 35% of the ET patients, 25.71% of the PD patients, 7.69% of the CG. The scores were higher when also taking into account mild or partial symptoms of social anxiety: ET 50%, PD 42.86%, CG 20.51%. Anxiety and depression did not correlate with the severity of tremor in the ET patients, while the PD patients had moderate correlation (r¼0.66; p<0.001) between the severity of depression and Hoehn &Yahr stage. The ET patients did not reveal correlation between the severity of tremor and anxiety during social contacts - SIAS (p¼0.18), however, there exists moderate correlation with social phobia scale SPS (rs¼0.35; p¼0.02). Conclusions: The sample of ET and PD patients revealed high comorbidity of psychiatric illnesses. P 3.050. TRANSCRANIAL DIRECT CURRENT STIMULATION IN THE TREATMENT OF ESSENTIAL TREMOR Nesrin Helvaci Yilmaz 1, Burcu Polat 1, Lutfu Hanoglu 1. Neurology, Istanbul Medipol University, Istanbul, Turkey
1
Department of
Objectives: Cerebellar transcranial magnetic stimulation (TMS) has been shown to reduce the severity of essential tremor (ET) in the previous studies. We aimed to investigate the effects of transcranial direct current stimulation (tDCS) (non-invasive, more easily applicable method than TMS) in patients with ET. Methods: We included 6 (3 women and 3 men) drug-discontinued ET patients above 18 years of age. The ET Rating Assessment Scale (TETRAS) and Activities of Daily Living (ADL) scale for ET were administered. tDCS was applied by using a device utilizing 35 cm2 electrodes. Anodal stimulation was applied to the dorsolateral and prefrontal areas and cathodal stimulation was applied to cerebellar hemispheres, at 2 mA for 20 minutes in 10 consecutive sessions with a 2-day break between the first and second 5-day sessions. One month following the initial course of therapy, 5 more tDCS sessions were administered in an every-other-day fashion. TETRAS and ADL scales were readministered. Friedman's test was used to assess the entirety of the time course. Results: A significant improvement was observed in TETRAS and ADL scores at the end of 50 days (p¼0.015, p¼0.024 respectively). The difference between pre-treatment TETRAS scores and after 50 days and 5 additional tDCS sessions was statistically significant (p¼0.039). Conclusions: Our study found marked improvement in neurologic examination and daily activities in ET patients who received tDCS to the cerebellar hemispheres. Long-term study protocols with larger numbers of patients are required.
Objectives: There are currently no standardized criteria for selection of appropriate DBS candidates and to date there has been little hard data to support to use of any singular methods. We aimed to investigate the impact of our interdisciplinary screening process on post-operative unintended hospitalizations (UH) and on quality of life (QOL). Methods: An ET cohort was selected from our institutional DBS database. The interdisciplinary model utilized seven specialties who pre-operatively screened all potential DBS candidates. Concerns raised by each specialty were documented and classified as minor or major. Records were reviewed to identify UH and QOL measurement at a 1 year follow-up interval. Results: Of the 51 cases who received interdisciplinary screening for possible DBS, 44 (86%) were approved for the surgery. Eight (18.2%) of the DBS patients had an UH. The patients with major or minor concerns raised from any specialty service had significantly more UH (75%) when compared to patients without concerns (25.0%) (p < 0.005). The rate of hospitalization decreased and revealed a direct relationship to the “level of concern” raised during screening; ranging from 100% (major concern) to 42% (minor concern) to 7% (no concern) (p¼ 0.001). QoL scores on the SF36 were significantly worsened in patients with UH at 6 (p¼ 0.046) and 12 months (p¼0.027) when compared to baseline scores. No significant difference in TRS scores between UH and non-UH was observed. Conclusions: Concerns raised during interdisciplinary DBS evaluations were significantly related to UH and to a reduced QOL. The interdisciplinary evaluation may help to stratify risk for unintended hospitalization and QOL outcomes. References 1. Martinez-Ramirez D and Okun MS. Rationale and clinical pearls for primary care doctors referring patients for deep brain stimulation. Gerontology 2014;60:38-48. P 3.052. CENTRIFUGAL PROGRESSION OF TDP-43 PATHOLOGY ALONG OLFACTORY PATHWAY IN ALS PATIENTS IN CONTRAST TO CENTRIPETAL PROGRESSION OF ALPHA-SYNUCLEIN PATHOLOGY IN PD PATIENTS Takahiro Takeda 1, Mutsumi Iijima 1, Toshiki Uchihara 2, Charles Duyckaerts 3, Shinichiro Uchiyama 1, Kazuo Kitagawa 1. 1 Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan; 2 Laboratory of Structural Neuropathology, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; 3 Raymond Escourolle Laboratory of Neuropathology, La Salp^ etri ere Hospital, Paris, France Objectives: Odor impairment is one of common symptoms in Parkinson disease. It sometimes occurs in amyotrophic lateral sclerosis (ALS) patients, however, its relationship with TDP-43 pathology has not been fully elucidated. Methods: We studied samples from a series of 43 postmortem ALS cases. The olfactory bulb, anterior olfactory nucleus, periamygdaloid complex/ piriform cortex, hippocampal dentate gyrus and orbital cortex were selected to examine packing density of TDP-43-positive inclusions. Results: Quantitative analyses demonstrated that TDP-43-positive inclusions were most frequent in the hippocampus, least abundant in the olfactory bulb, and had an intermediate density in the primary olfactory cortex. Conclusion: This centrifugal gradient suggests that TDP-43 pathology starts in the hippocampus, spreads into the primary olfactory center and finally reaches the olfactory bulb. TDP-43, tau and alpha-synuclein accumulations appeared independent. This study suggested the hypothesis of