scholarly journals How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson’s disease?

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254504
Author(s):  
Patrick Pearce ◽  
Kristian Bulluss ◽  
San San Xu ◽  
Boaz Kim ◽  
Marko Milicevic ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Subthalamic Nucleus ◽  
Learning Effect ◽  
Cross Sectional Study ◽  
Brain Shift ◽  
Location Error ◽  
Cross Sectional ◽  
Stn Dbs ◽  
The Ideal

Introduction The efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson’s disease (PD) depends on how closely electrodes are implanted relative to an individual’s ideal stimulation location. Yet, previous studies have assessed how closely electrodes are implanted relative to the planned location, after homogenizing data to a reference. Thus here, we measured how accurately electrodes are implanted relative to an ideal, dorsal STN stimulation location, assessed on each individual’s native imaging. This measure captures not only the technical error of stereotactic implantation but also constraints imposed by planning a suitable trajectory. Methods This cross-sectional study assessed 226 electrodes in 113 consecutive PD patients implanted with bilateral STN-DBS by experienced clinicians utilizing awake, microelectrode guided, surgery. The error (Euclidean distance) between the actual electrode trajectory versus a nominated ideal, dorsal STN stimulation location was determined in each hemisphere on native imaging and predictive factors sought. Results The median electrode location error was 1.62 mm (IQR = 1.23 mm). This error exceeded 3 mm in 28/226 electrodes (12.4%). Location error did not differ between hemispheres implanted first or second, suggesting brain shift was minimised. Location error did not differ between electrodes positioned with (48/226), or without, a preceding microelectrode trajectory shift (suggesting such shifts were beneficial). There was no relationship between location error and case order, arguing against a learning effect. Discussion/Conclusion The proximity of STN-DBS electrodes to a nominated ideal, dorsal STN, stimulation location is highly variable, even when implanted by experienced clinicians with brain shift minimized, and without evidence of a learning effect. Using this measure, we found that assessments on awake patients (microelectrode recordings and clinical examination) likely yielded beneficial intraoperative decisions to improve positioning. In many patients the error is likely to have reduced therapeutic efficacy. More accurate methods to implant STN-DBS electrodes relative to the ideal stimulation location are needed.

scholarly journals White matter integrity and cognition in Parkinson's disease: a cross-sectional study

BMJ Open ◽  
2014 ◽  
Vol 4 (1) ◽  
pp. e003976 ◽  
Author(s):  
Eirik Auning ◽  
Veslemøy Krohn Kjærvik ◽  
Per Selnes ◽  
Dag Aarsland ◽  
Astrid Haram ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
White Matter ◽  
Cross Sectional Study ◽  
White Matter Integrity ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Self-Reported Efficacy of Cannabis and Other Complementary Medicine Modalities by Parkinson’s Disease Patients in Colorado

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Taylor Andrew Finseth ◽  
Jessica Louise Hedeman ◽  
Robert Preston Brown ◽  
Kristina I. Johnson ◽  
Matthew Sean Binder ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Support Groups ◽  
Legal Status ◽  
Cross Sectional Study ◽  
Recent Change ◽  
High Rate ◽  
Cross Sectional ◽  
Metro Area ◽  
Cam Use

Introduction. Complementary and alternative medicine (CAM) is frequently used by Parkinson’s disease (PD) patients. We sought to provide information on CAM use and efficacy in PD patients in the Denver metro area with particular attention to cannabis use given its recent change in legal status.Methods. Self-administered surveys on CAM use and efficacy were completed by PD patients identified in clinics and support groups across the Denver metro area between 2012 and 2013.Results. 207 patients (age69±11; 60% male) completed the survey. Responses to individual CAM therapy items showed that 85% of respondents used at least one form of CAM. The most frequently reported CAMs were vitamins (66%), prayer (59%), massage (45%), and relaxation (32%). Self-reported improvement related to the use of CAM was highest for massage, art therapy, music therapy, and cannabis. While only 4.3% of our survey responders reported use of cannabis, it ranked among the most effective CAM therapies.Conclusions. Overall, our cross-sectional study was notable for a high rate of CAM utilization amongst PD patients and high rates of self-reported efficacy across most CAM modalities. Cannabis was rarely used in our population but users reported high efficacy, mainly for nonmotor symptoms.

scholarly journals The “Gender Factor” in Wearing-Off among Patients with Parkinson’s Disease: A Post Hoc Analysis of DEEP Study

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Delia Colombo ◽  
Giovanni Abbruzzese ◽  
Angelo Antonini ◽  
Paolo Barone ◽  
Gilberto Bellia ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Cross Sectional Study ◽  
Motor Symptom ◽  
Cross Sectional ◽  
Post Hoc Analysis ◽  
Increased Risk ◽  
Wearing Off ◽  
Gender Factor ◽  
Post Hoc

Background. The early detection of wearing-off in Parkinson disease (DEEP) observational study demonstrated that women with Parkinson’s disease (PD) carry an increased risk (80.1%) for wearing-off (WO). This post hoc analysis of DEEP study evaluates gender differences on WO and associated phenomena.Methods. Patients on dopaminergic treatment for ≥1 year were included in this multicenter observational cross-sectional study. In a single visit, WO was diagnosed based on neurologist assessment as well as the use of the 19-item wearing-off questionnaire (WOQ-19); WO was defined for scores ≥2. Post hoc analyses were conducted to investigate gender difference for demographic and clinical features with respect to WO.Results. Of 617 patients enrolled, 236 were women and 381 were men. Prevalence of WO was higher among women, according to both neurologists’ judgment (61.9% versus 53.8%,P=0.045) and the WOQ-19 analysis (72.5% versus 64.0%,P=0.034). In patients with WO (WOQ-19), women experienced ≥1 motor symptom in 72.5% versus 64.0% in men and ≥1 nonmotor symptom in 44.5% versus 36.7%, in men.Conclusions. Our results suggest WO as more common among women, for both motor and nonmotor symptoms. Prospective studies are warranted to investigate this potential gender-effect.

scholarly journals Caregiver Burden for Patients Diagnosed with Parkinson’s Disease: A Cross-sectional Study from Southern India

2020 ◽  
Author(s):  
Arun Kurupath ◽  
Praveen Arathil ◽  
Rahul Bansal
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Caregiver Burden ◽  
Significant Positive Correlation ◽  
Mmse Score ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Positive Correlation ◽  
Updrs Score

Introduction: Parkinson’s Disease (PD) is a progressive neurodegenerative disorder where the individual over time needs more and more assistance from their caregivers to carry on their life and that causes increasing burden on the caregiver. The burden for the caregiver is affecting them physically, mentally and also on a socioeconomic level. Aim: To examine the factors related to caregiver burden in caregivers of Parkinson’s patients. Materials and Methods: This was a cross-sectional study conducted in Parkinson’s clinic of a Tertiary Care Hospital of Kochi, on 100 Parkinsonism patients and their respective caregivers. Patients were assessed using the Unified PD Rating Scale (UPDRS), Hoehn and Yahr Scale (H&Y) and Mini-Mental State Examination (MMSE). Caregivers were assessed using Zerit’s Caregiver Burden inventory (CBI). Semi structured questionnaire was administered for socio-demographic details. Non parametric tests were done to examine the correlation among various variables. Results: Among the patients and caregivers, mean age was 70.65±7.30 and 67.31±8.56, respectively. Among the patient’s majority were males (n=74) while among caregivers, majority were females (n=73). Mean duration of disease was 6.79±2.68 years, mean caregiver burden score was 65.05±21.79, mean UPDRS score was 21.89±8.74 and had significant positive correlation with caregiver burden. Mean MMSE score was 17.19±4.91. The disease duration and UPDRS score had a significant positive correlation with caregiver burden score. MMSE score had significant negative correlation with caregiver burden score. Conclusion: This study concludes that a patient’s Parkinsonism related disability accounts for majority of caregiver burden. An early identification of factors contributing to stress in caregivers will help to avoid its persistency leading to a better insight in the caregiving role and thus in-patient care.

scholarly journals Intraoperative Characterization of Subthalamic Nucleus-to-Cortex Evoked Potentials in Parkinson’s Disease Deep Brain Stimulation

2021 ◽  
Vol 15 ◽  
Author(s):  
Lila H. Levinson ◽  
David J. Caldwell ◽  
Jeneva A. Cronin ◽  
Brady Houston ◽  
Steve I. Perlmutter ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Evoked Potentials ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
High Frequency ◽  
Therapeutic Effects ◽  
Stn Dbs ◽  
Deep Brain

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a clinically effective tool for treating medically refractory Parkinson’s disease (PD), but its neural mechanisms remain debated. Previous work has demonstrated that STN DBS results in evoked potentials (EPs) in the primary motor cortex (M1), suggesting that modulation of cortical physiology may be involved in its therapeutic effects. Due to technical challenges presented by high-amplitude DBS artifacts, these EPs are often measured in response to low-frequency stimulation, which is generally ineffective at PD symptom management. This study aims to characterize STN-to-cortex EPs seen during clinically relevant high-frequency STN DBS for PD. Intraoperatively, we applied STN DBS to 6 PD patients while recording electrocorticography (ECoG) from an electrode strip over the ipsilateral central sulcus. Using recently published techniques, we removed large stimulation artifacts to enable quantification of STN-to-cortex EPs. Two cortical EPs were observed – one synchronized with DBS onset and persisting during ongoing stimulation, and one immediately following DBS offset, here termed the “start” and the “end” EPs respectively. The start EP is, to our knowledge, the first long-latency cortical EP reported during ongoing high-frequency DBS. The start and end EPs differ in magnitude (p < 0.05) and latency (p < 0.001), and the end, but not the start, EP magnitude has a significant relationship (p < 0.001, adjusted for random effects of subject) to ongoing high gamma (80–150 Hz) power during the EP. These contrasts may suggest mechanistic or circuit differences in EP production during the two time periods. This represents a potential framework for relating DBS clinical efficacy to the effects of a variety of stimulation parameters on EPs.

Prevalence and Associated Factors of Sarcopenia and Frailty in Parkinson’s Disease: A Cross-Sectional Study

Gerontology ◽  
2018 ◽  
Vol 65 (3) ◽  
pp. 216-228 ◽  
Author(s):  
Marina Peball ◽  
Philipp Mahlknecht ◽  
Mario Werkmann ◽  
Kathrin Marini ◽  
Franziska Murr ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Population Based ◽  
Cross Sectional Study ◽  
Prevalence Rates ◽  
Sectional Study ◽  
Cross Sectional ◽  
Tertiary Center

Background: Sarcopenia and frailty are found in up to one-third of the general elderly population. Both are associated with major adverse health outcomes such as nursing home placement, disability, decreased quality of life, and death. Data on the frequency of both syndromes in Parkinson’s disease (PD), however, are very limited. Objective: We aimed to screen for sarcopenia and frailty in PD patients and to assess potential associations of both geriatric syndromes with demographic and clinical parameters as well as quality of life. Methods: In this observational, cross-sectional study, we included 104 PD patients from a tertiary center and 330 non-PD controls from a population-based cohort aged > 65 years. All groups were screened for sarcopenia using the SARC-F score and for frailty using the Clinical Frailty Scale of the Canadian Study of Health and Aging (CSHA CFS). Prevalence rates of sarcopenia and frailty were also assessed in 18 PD patients from a population-based cohort aged > 65 years. Moreover, PD patients from the tertiary center were evaluated for motor and non-motor symptoms, quality of life, and dependency. Results: The prevalence of sarcopenia was 55.8% (95% CI: 46.2–64.9%) in PD patients from the tertiary center and 8.2% (5.7–11.7%; p < 0.001) in non-PD controls. Frailty was detected in 35.6% (27.0–45.2%) and 5.2% (3.2–8.1%; p < 0.001). Prevalence rates for sarcopenia and frailty were 33.3% (16.1–56.4%; p = 0.004) and 22.2% (8.5–45.8%; p = 0.017) in the community-based PD sample. Both sarcopenia and frailty were significantly associated with longer disease duration, higher motor impairment, higher Hoehn and Yahr stages, decreased quality of life, higher frequency of falls, a higher non-motor symptom burden, institutionalization, and higher care levels in PD patients from a tertiary center compared to not affected PD patients (all p < 0.05). Conclusions: Both frailty and sarcopenia are more common in PD patients than in the general community and are associated with a more adverse course of the disease. Future studies should look into underlying risk factors for the occurrence of sarcopenia and frailty in PD patients and into adequate management to prevent and mitigate them.

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