| 1. |
- Volkmann, Jens, et al.
(författare)
-
Long-Term Effects of Pallidal or Subthalamic Deep Brain Stimulation on Quality of Life in Parkinson's Disease
- 2009
-
Ingår i: Movement Disorders. - : Wiley. - 0885-3185. ; 24:8, s. 1154-1161
-
Tidskriftsartikel (refereegranskat)abstract
- We assessed the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) or internal pallidum (GPi-DBS) on health-related quality of life (HrQoL) in patients with advanced Parkinson's disease participating in a previously reported multicenter trial. Sickness Impact Profile (SIP) questionnaires were available for analysis in a Subgroup of n = 20/20 patients with GPi-DBS and n = 45/49 patients with STN-DBS at baseline, 6 and 36 months. The SIP provides a physical dimension and a psychosocial dimension sum score and 12 category scores: Alertness/Intellectual Behavior (AIB), Ambulation (A), Body Care and Movement (BCM), Communication (C), Eating (E), Emotional Behavior (EB), Home Management (HM), Mobility (M), Recreation and Pastimes (RP), Sleep and Rest (SR), Social Interaction (SI), and Work (W). Motor functioning was assessed by means of the Unified Parkinson's Disease Rating Scale and diaries. At 6 months significant improvements in off-period motor symptoms and activities of daily living were paralleled by significant reductions in the total, physical, and psychosocial SIP score in both treatment groups. At 3 years, sustained improvements were observed in the physical dimension score, BCM, E, M, RP after STN-DBS and M, SI after GPi-DBS. All other SIP subscores approached baseline values, but were still the same or better (except C) whereas motor functioning remained stable after 36 months. STN-DBS and GPi-DBS led to significant early improvements in HrQoL. Despite sustained motor improvements many of these initial benefits were lost after 3 years. This may reflect either progression of the disease or adaptive changes in the subjective perception of health-related wellbeing over time. (C) 2009 Movement Disorder Society
|
|
| 2. |
- Hagell, Peter, et al.
(författare)
-
Testing the SF-36 in Parkinson's disease : Implications for reporting rating scale data.
- 2008
-
Ingår i: Journal of Neurology. - : Springer Science and Business Media LLC. - 1432-1459 .- 0340-5354. ; 255:2, s. 246-254
-
Tidskriftsartikel (refereegranskat)abstract
- Rating scales are increasingly the primary outcome measures in clinical trials. However, clinically meaningful interpretation of such outcomes requires that the scales used satisfy basic requirements (scaling assumptions) within the data. These are rarely tested. The SF-36 is the most widely used patient-reported rating scale. Its scaling assumptions have been challenged in neurological disorders but remain untested in Parkinson's disease (PD).We therefore tested these by analyzing SF-36 data from 202 PD patients (54% men; mean age 70) to determine if it was legitimate to report scores for the eight SF-36 scales and its two summary measures of physical and mental health, and if those scores were reliable and valid. Results supported generation of the eight SF-36 scale scores and their reliabilities were generally good (>/= 0.74 in all but one instance). However, we found limitations that question the meaningfulness of four scales and other limitations that restrict the ability of four scales to detect change in clinical trials (floor/ceiling effects, 19.6-46.2 %). The two SF-36 summary measures were not found to be valid indicators of physical and mental health. This study demonstrates important limitations of the SF-36 and provides the first evidence- based guidelines for its use in PD. The limitations of the SF-36 demonstrated here may explain some unexpected findings in previous studies. However, the main implication is a general one for the clinical research community regarding requirements for reporting rating scale endpoints. Specifically, investigators should routinely provide scale evaluations based on data from within major clinical trials.
|
|
| 3. |
|
|
| 4. |
- Törnqvist, Anna Lena
(författare)
-
Deep Brain Stimulation in Parkinson's disease and essential tremor Outcome and experiences from patients' and spouses' perspectives
- 2005
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The treatment related effects and personalized goal fulfilment of Deep Brain Stimulation (DBS) have been assessed in studies with different designs. The brain targets included the thalamus for medically intractable tremor in Parkinson's disease (PD) or essential tremor (ET) and the subthalamicus for reducing hypo-, bradykinesia, tremor, rigidity and dystonia in PD. A Swedish multi-center study showed that the tremor reduction in PD and ET was sustained (p<0.025) for 6 to 7 years. Thalamic and subthalamic DBS also improved the patients? everyday life at a 12-month follow-up. Patients could perform activities they had pre-operatively formulated as goals, with a total or partial overall fulfilment. In spite of a 53% drug reduction, the patients treated with subthalamic DBS could perform basic transfers in a similar speed as pre-operatively and perceived improved health. The effect of subthalamic DBS on the intelligibility of speech showed that the DBS settings were of importance for the speech. Higher amplitude and faster rates increased the risk of impaired intelligibility in patients with PD who perceived speech impairments. Subthalamic DBS had a positive influence on the couples? social life. In contrast to pre-operatively, patients and spouses could perform social activities of their own choice. Non-motor symptoms that were pre-operatively just mentioned caused annoyance in the post-operative period. These remaining symptoms were preferred relative to the pre-operative PD condition. The results of these studies can be used in pre-operative information for future patients, as well as in the post-operative support of the patients and their spouses.
|
|
| 5. |
- Törnqvist, Anna Lena, et al.
(författare)
-
Effects of different electrical parameter settings on the intelligibility of speech in patients with Parkinson's disease treated with subthalamic deep brain stimulation.
- 2005
-
Ingår i: Movement Disorders. - : Wiley. - 0885-3185 .- 1531-8257. ; 20:4, s. 416-423
-
Tidskriftsartikel (refereegranskat)abstract
- We evaluated the effects of different electrical parameter settings on the intelligibility of speech in patients with Parkinson's disease (PD) bilaterally treated with deep brain stimulation (DBS) in the subthalamic nucleus (STN). Ten patients treated with DBS for 15 +/- 5 months (mean, SD) with significant (P < 0.01) symptom reduction (Unified Parkinson's Disease Rating Scale III) were included. In the medication off condition, video laryngostroboscopy was performed and then, in random order, 1 1 DBS parameter settings were tested. Amplitude was increased and decreased by 25%, frequency was varied in the range 70 to 185 pps, and each of the contacts was tested separately as a cathode. The patients read a standard running text and five nonsense sentences per setting. A listener panel transcribed the nonsense sentences as perceived and valued the quality of speech on a visual analogue scale. With the patients' normally used settings, there was no significant (P = 0.058) group difference between DBS OFF and ON, but in four patients the intelligibility deteriorated with DBS ON. The higher frequencies or increased amplitude caused significant (P < 0.02) impairments of intelligibility, whereas changing the polarity between the separate contacts did not. The settings of amplitude and frequency have a major influence on the intelligibility of speech, emphasizing the importance of meticulous parameter adjustments when programming DBS to minimize side effects related to speech.
|
|
| 6. |
- Törnqvist, Anna Lena, et al.
(författare)
-
Fulfilment of patients' goals after thalamic deep brain stimulation : a follow-up study.
- 2007
-
Ingår i: Parkinsonism & Related Disorders. - : Elsevier BV. - 1353-8020 .- 1873-5126. ; 13:1, s. 29-34
-
Tidskriftsartikel (refereegranskat)abstract
- Deep brain stimulation (DBS) in the ventrolateral thalamus (VIM) is shown to reduce tremor in essential tremor (ET) and Parkinson's disease (PD). Our aim was to evaluate the results of VIM DBS from the patients' perspective. Sixteen consecutively included patients (8 ET and 8 PD) described their own outcome goals preoperatively and evaluated the fulfillment 1, 6 and 12 months postoperatively. We conclude that the patients could do specific activities that are of importance to them such as eating, drinking and socializing, and perceived either partial or total fulfillment of their goals.
|
|
