| 1. |
- Bjartmarz, Hjalmar, et al.
(författare)
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Comparison of accuracy and precision between frame-based and frameless stereotactic navigation for deep brain stimulation electrode implantation
- 2007
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Ingår i: Stereotactic and Functional Neurosurgery. - : S. Karger AG. - 1011-6125 .- 1423-0372. ; 85:5, s. 235-242
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Tidskriftsartikel (refereegranskat)abstract
- The accuracy and precision of frameless neuronavigation as compared to conventional frame-based stereotaxy for implantation of deep brain stimulation (DBS) electrodes were studied in 14 patients with essential tremor. DBS electrodes were implanted bilaterally in the ventrolateral thalamus [ventrointermediate nucleus ( VIM)] in one procedure. Frameless neuronavigation was used on one side and the conventional frame-based technique on the other. Targeting was guided by MRI and CT imaging. Intraoperative stereotactic plain X-ray verified final electrode positions and electrode deviations from the planned target were measured. Clinical outcome was evaluated with the Essential Tremor Rating Scale. Thirteen of the patients were eligible for measuring electrode deviations and 10 of them were available for a clinical follow-up. Electrode deviations from target were larger using the frameless technique in the mediallateral (x: 1.9 +/- 1.3 mm) and anterior- posterior (y: 0.9 +/- 0.8 mm) directions as compared to the frame-based technique (x: 0.5 +/- 0.5 and y: 0.4 +/- 0.4 mm) but similar in the superior- inferior direction (z). The vector of deviation was 2.5 +/- 1.4 mm with the frameless technique and 1.2 +/- 0.6 with the frame-based technique. The differences were statistically significant (p < 0.05-0.001). The dispersion was larger with the frameless technique as represented by the larger standard deviations in all three planes. At clinical follow-ups, tremor reduction was similar irrespective of the implantation technique. It is concluded that conventional frame-based stereotaxy has higher accuracy/precision for hitting a small brain target than the frameless technique. However, the difference is relatively small and does not influence the clinical result of DBS electrode implantations in the VIM when treating tremor. Copyright (c) 2007 S. Karger AG, Basel
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| 2. |
- Hariz, Marwan I, et al.
(författare)
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Multicenter study on deep brain stimulation in Parkinson's disease: An independent assessment of reported adverse events at 4 years
- 2008
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Ingår i: Movement Disorders. - : Wiley. - 0885-3185. ; 23:3, s. 416-21
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Tidskriftsartikel (refereegranskat)abstract
- Ongoing adverse events (AEs) at 4-years postsurgery in 69 patients with advanced Parkinson's disease (PD) who received deep brain stimulation (DBS) of the subthalamic nucleus (STN) (n = 49) or the internal globus pallidus (GPi) (n = 20), in the framework of a subset of eight centers of a multicenter study, were analyzed by an independent ad hoc committee. At baseline, the patients' age, sex, disease duration, and clinical condition were virtually identical, as was the duration of follow-up. There were 64 AEs reported in 53% of STN DBS patients and eight AEs reported in 35% of GPi DBS patients. Most of the AEs were not deemed severe and were reported to be present "both with and without stimulation." The majority of the AEs affected patients' cognitive, psychiatric and behavioral status, as well as speech, gait, and balance, and most of these AEs occurred in STN DBS patients. When comparing patients who exhibited AEs with those who did not, it was found that in the STN DBS group, the patients with AEs had a longer disease duration, as well as more gait disorders and psychiatric disturbances at baseline.
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| 3. |
- Hariz, Marwan I, et al.
(författare)
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Multicentre European study of thalamic stimulation for parkinsonian tremor : a 6 year follow-up
- 2008
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Ingår i: Journal of neurology, neurosurgery and psychiatry. - : BMJ Group. - 1468-330X .- 0022-3050. ; 79:6, s. 694-699
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate the results of ventral intermediate (Vim) thalamic deep brain stimulation (DBS) in patients with tremor predominant Parkinson's disease (PD) at 6 years post surgery.METHODS: This was a prolonged follow-up study of 38 patients from eight centres who participated in a multicentre study, the 1 year results of which have been published previously. Total scores as well as scores for individual items of the motor part and the disability part of the Unified Parkinson's Disease Rating Scale were used for evaluation.RESULTS: Tremor was still effectively controlled by DBS and appendicular rigidity and akinesia remained stable compared with baseline. Axial scores (speech, gait and postural instability), however, worsened, and in parallel the initial improvement in activities of daily living scores at the 1 year follow-up had disappeared at 6 years, despite sustained improvement of tremor. Remarkably, neither daily doses of dopaminergic medication nor fluctuations and dyskinesias had changed at 6 years compared with baseline in this particular patient group.CONCLUSION: This study confirms that patients with tremor dominant PD who do not present with fluctuations and dyskinesias may have a relatively benign progression of the disease. Vim DBS, although having no effect on akinesia and rigidity, is a relatively lenient surgical procedure and may still have a place for long term symptomatic control of PD tremor in selected patients.
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| 4. |
- Kahlon, Babar, et al.
(författare)
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Is aqueductal stroke volume, measured with cine phase-contrast magnetic resonance imaging scans useful in predicting outcome of shunt surgery in suspected normal pressure hydrocephalus?
- 2007
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Ingår i: Neurosurgery. - 0148-396X. ; 60:1, s. 124-129
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate clinical usefulness of cerebrospinal fluid stroke volume (SV) assessed in the cerebral aqueduct, via cine phase-contrast magnetic resonance imaging, for predicting outcome after shunt surgery in suspected normal pressure hydrocephalus. METHODS: Thirty-eight patients with suspected normal pressure hydrocephalus were included. SV was assessed using cine phase-contrast magnetic resonance imaging, and kept blinded until postoperative follow-up after 7 +/- 5.8 months (mean the results were standard deviation). Selection to surgery was based on a positive lumbar infusion test or cerebrospinal fluid tap test, and outcome was evaluated with objective tests. RESULTS: Six patients were excluded from SV measurements because of technical difficulties. Eight patients were not operated (negative lumbar infusion test and cerebrospinal fluid tap test). SV in the not operated patients (mean, 66 +/- 53 mu l) did not differ from the operated patients (95 +/- 78 mu l; P = 0.335). Operated patients showed statistically significant improvements in walk (P = 0.020), reaction time (P = 0.006), and memory (P = 0.001) tests. Patients were divided into three groups according to SV range: low (0-50 mu l), middle (51 - 100 mu l), and high (> 100 mu l). No statistically significant (P > 0.05) improvements in any of the objective tests were found in any of the SV the different SV ranges. The numbers of individually improved patients were similar in ranges: six out of seven in the low, nine out of nine in the middle, and five out of eight in the high range. Weak correlations were found between SV and the initial pulse,amplitude (R-s = 0.043; P = 0.014) as well as the plateau pulse amplitude (R-s = 0.043; P = 4) as measured with the lumbar infusion test. CONCLUSION: The data from this Study show no evidence that cine phase-contrast magnetic resonance imaging measurements of SV in the cerebral aqueduct are useful for selecting patients with normal pressure hydrocephalus symptoms to shunt surgery.
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| 5. |
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| 6. |
- Kahlon, Babar, et al.
(författare)
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Long-term outcome in patients with suspected normal pressure hydrocephalus
- 2007
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Ingår i: Neurosurgery. - 0148-396X. ; 60:2, s. 327-332
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To evaluate the outcome of patients with suspected normal pressure hydrocephalus at 6 months and 5 years after shunt Surgery. METHODS: Seventy-five patients (mean age, 72.5 +/- 9 yr), with normal pressure hydrocephalus symptoms were included. Fifty-four patients with positive lumbar infusion and/or cerebrospinal fluid tap tests received a cerebrospinal fluid shunt, whereas 21 patients with negative test results did not undergo operation. Walk, reaction time, memory, and identical forms tests were used as baseline (before surgery) tests and were repeated at short- (6.1 +/- 4.6 mo) and long-term (5.5 +/- 1.4 yr) follow-up evaluations. Activities of daily life functions were assessed using the Barthel index. RESULTS: At the 6-month follow-up examination, 83% of the operated patients improved in gait, 65% improved in reaction time, 46% improved in memory, and 31% improved in identical forms tests; 96% found themselves subjectively improved. Because of unrelated mortality (37%) and declining general health from comorbidity, only 27 patients were available for the 5-year follow-up evaluation. Twenty-three of these patients had been treated with a shunt and had a remaining improvement in close to 40% in gait and reaction time, whereas fewer than 10% had an improvement in cognitive tests. Fifty-six percent reported subjective improvement compared with preoperative findings. More patients (64%) improved if younger than 75 years; for patients older than 75 years, only 11% of the patients improved. The Barthel index was higher (P < 0.05) in improved patients. CONCLUSION: Patients with normal pressure hydrocephalus benefit from shunt surgery for at least 5 years. High mortality rate, comorbidity, and old age hamper good long-term outcome and emphasize the importance of patient selection.
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| 7. |
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| 8. |
- Li, Jia-Yi, et al.
(författare)
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Lewy bodies in grafted neurons in subjects with Parkinson's disease suggest host-to-graft disease propagation.
- 2008
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Ingår i: Nature Medicine. - : Springer Science and Business Media LLC. - 1546-170X .- 1078-8956. ; 14, s. 501-503
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Tidskriftsartikel (refereegranskat)abstract
- Two subjects with Parkinson's disease who had long-term survival of transplanted fetal mesencephalic dopaminergic neurons (11-16 years) developed alpha-synuclein-positive Lewy bodies in grafted neurons. Our observation has key implications for understanding Parkinson's pathogenesis by providing the first evidence, to our knowledge, that the disease can propagate from host to graft cells. However, available data suggest that the majority of grafted cells are functionally unimpaired after a decade, and recipients can still experience long-term symptomatic relief.
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| 9. |
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| 10. |
- Nilsson, Maria H, et al.
(författare)
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Functional balance performance in patients with Parkinson's disease after long-term treatment with subthalamic nucleus high-frequency stimulation
- 2008
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Ingår i: Parkinsonism & Related Disorders. - : Elsevier BV. - 1873-5126 .- 1353-8020. ; 14:4, s. 291-297
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate if functional balance performance in patients with Parkinson's disease (PD) was affected by long-term (3 years) treatment with bilateral subthalamic nucleus (STN) high-frequency stimulation. Thirty-five patients were consecutively included, and 28 patients completed the study (mean age 62 years, SD 6.5). The Berg Balance Scale (BBS) was assessed preoperatively and 1 and 3 years postoperatively (with and without anti-PD medication and with the STN stimulation turned OFF or ON). Although the balance performance of patients with PD decreased over time, the functional balance performance was still positively affected by STN stimulation alone 3 years after surgery.
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