Relationship Between Electrode Position and Clinical Efficacy of Subthalamic Nucleus Deep Brain Stimulation and Motor Symptoms of Parkinson's Disease

Abstract Objectives To investigate the relationship between the position of bilateral STN-DBS location of active contacts and clinical efficacy of STN-DBS in the motor symptoms of Parkinson’ disease (PD) patients. Methods We retrospectively analyzed the clinical data of 57 patients with PD who underwent bilateral STN-DBS from March 2018 to December 2018. UPDRS III scores, LEDD, PDQ-39 scores before operation and within 6 months after operation were determined. The location of activate contacts and volume of tissue activated (VTA) in the Montreal Neurological Institute (MNI) space, and their correlation with the rate of improvement of motor symptoms（UPDRS-Ⅲ score improvement rate）were examined. Results After 6 months of follow up, the UPDRS-Ⅲ scores of 57 patients（Med-off） were improved by 55.4±18.9% (P＜0.001) compared with that before operation. The improvement rate of PDQ-39 score [(47.4±23.2)%, (P<0.001)] and the reduction rate of LEDD [(40.1±24.3)% , (P<0.01)] at 6 months post surgery were positively correlated with the improvement rate of motor symptoms（Med-off）(PDQ-39:r=0.461, P＜0.001; LEDD:r=0.354, P=0.007)，the rate of improvement of UPDRS Ⅲ (Med-off) and the Z-axis coordinate of the active contact in the MNI space were positively correlated (left side:r=0.349,P=0.008;right eide:r=0.369,P=0.005). In the MNI space,there was no correlation between the UPDRS-Ⅲ score improvement rate (Med-off) at 6 months after operation and bilateral VTA in the STN motor subregion,STN associative subregion and STN limbic subregion of the active electrode contacts of 57 patients(all P>0.05).At 6 months after surgery, the difference between the Z-axis coordinate in the different improvement rate subgroups（＜25%, 25% to 50%, and＞50%） in the MNI space was statistically significant (left side: P=0.030; right side: P=0.024). In the MNI space, there was no statistically significant difference between the 3 groups in the VTA of the active electrode contacts (all P>0.05). Conclusions STN-DBS could improve the motor symptoms of PD patients and improved the quality of life. The closer the active stimulation contacts is to the dorsolateral sensorimotor area of STN, the better effect the DBS has on the motor symptoms of PD patients.

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Relationship between electrode position of deep brain stimulation and motor symptoms of Parkinson’s disease

BMC Neurology ◽

10.1186/s12883-021-02148-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Feng Zhang ◽

Feng Wang ◽

Weiguo Li ◽

Ning Wang ◽

Chunlei Han ◽

...

Keyword(s):

Quality Of Life ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Electrode Position ◽

Motor Symptoms ◽

Improvement Rate ◽

Significant Difference ◽

Quality Of Life Scale ◽

Stn Dbs

Abstract Background To investigate the relationship between the position of bilateral STN-DBS location of active contacts and the clinical efficacy of STN-DBS on motor symptoms in Parkinson’s disease (PD) patients. Methods Retrospectively analyze the clinical data of 57 patients with PD who underwent bilateral STN-DBS from March 2018 to December 2018. Unified Parkinson’s Disease Rating Scale-Part III (UPDRS-III) score, levodopa equivalent day dose (LEDD), Parkinson’s Disease Quality of Life Scale (PDQ-39) before operation and within 6 months after operation, determine the location of activated contacts and volume of tissue activated (VTA) in the Montreal Neurological Institute (MNI) space, and analyze their correlation with the improvement rate of motor symptoms (UPDRS-III score improvement rate). Results After 6 months of follow up, the UPDRS-III scores of 57 patients (Med-off) were improved by 55.4 ± 18.9% (P<0.001) compared with that before operation. The improvement rate of PDQ-39 scores [(47.4 ± 23.2)%, (P < 0.001)] and the reduction rate of LEDD [(40.1 ± 24.3)%, (P < 0.01)] at 6 months postoperation were positively correlated with the improvement rate of motor symptoms (Med-off)(PDQ-39:r = 0.461, P<0.001; LEDD: r = 0.354, P = 0.007), the improvement rate of UPDRS-III (Med-off) and the Z-axis coordinate of the active contact in the MNI space were positively correlated (left side: r = 0.349,P = 0.008;right side: r = 0.369,P = 0.005). In the MNI space, there was no correlation between the UPDRS-III scores improvement rate (Med-off) at 6 months after operation and bilateral VTA in the STN motor subregion, STN associative subregion and STN limbic subregion of the active electrode contacts of 57 patients (all P > 0.05). At 6 months after surgery, the difference between the Z-axis coordinate in the different improvement rate subgroups(<25, 25 to 50%, and>50%) in the MNI space was statistically significant (left side: P = 0.030; right side: P = 0.024). In the MNI space, there was no statistically significant difference between the groups in the VTA of the electrode active contacts (all P > 0.05). Conclusion STN-DBS can improve the motor symptoms of PD patients and improve the quality of life. The closer the stimulation is to the STN dorsolateral sensorimotor area, the higher the DBS is to improve the motor symptoms of PD patients.

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Analysis of Contact Position for Subthalamic Nucleus Deep Brain Stimulation-Induced Hyperhidrosis

Parkinson s Disease ◽

10.1155/2019/8180123 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Chunhui Yang ◽

Yiqing Qiu ◽

Xi Wu ◽

Jiali Wang ◽

Yina Wu ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Control Group ◽

Electrode Position ◽

Improvement Rate ◽

Number Of Patients ◽

Significant Difference ◽

Stn Dbs ◽

Deep Brain

Objectives. To analyze the hyperhidrosis neural network structure induced by subthalamic nucleus (STN) - deep brain stimulation (DBS). Materials and Methods. Patients with Parkinson’s disease treated with STN-DBS in Changhai Hospital between July 1, 2015, and December 1, 2016, were analyzed retrospectively. Using records of side effects of the intraoperative macrostimulation test, patients with skin sweats were selected as the sweating group. Based on the number of cases in the sweating group, the same number of patients was randomly selected from other STN-DBS patients without sweating to form the control group. The study standardized electrode position with Lead-DBS software to Montreal Neurological Institute (MNI) standard stereotactic space to compare the differences in three-dimensional coordinates of activated contacts between groups. Results. Of 355 patients, 11 patients had sweats during intraoperative macrostimulation tests. There was no significant difference in the preoperative baseline information and the postoperative UPDRS-III improvement rate (Med-off, IPG-on) between groups. Contacts inducing sweat were more medial (X-axis) (11.02 ± 0.69 mm vs 11.98 ± 0.84 mm, P=0.00057) and more upward (Z-axis) (−7.15 ± 1.06 mm VS −7.98 ± 1.21 mm, P=0.032) than those of the control group. The straight-line distance between the center of the sweat contact and the nearest voxel of the red nucleus was closer than that of the control group (2.72 ± 0.65 mm VS 3.76 ± 0.85 mm, P=0.00012). Conclusions. STN-DBS-induced sweat indicated that the contact was at superior medial of STN.

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Clinical Significance of PLIF in Restoring L4-S1 Segmental Lordosis of 2-level Isthmic Spondylolisthesis

10.21203/rs.3.rs-198135/v1 ◽

2021 ◽

Author(s):

Jing-Yu Wang ◽

Fu-Sheng Liu ◽

Jing Li ◽

Xiao-Bin Wang

Keyword(s):

Sagittal Plane ◽

Pearson Correlation ◽

Isthmic Spondylolisthesis ◽

Improvement Rate ◽

Clinical Prognosis ◽

Vas Score ◽

Score Improvement ◽

Significant Difference ◽

Sagittal Parameters

Abstract Background: Spinal and pelvic sagittal plane balance is closely related to good clinical prognosis, so in the treatment of 2-level isthmic spondylolisthesis, attention should be paid not only to adequate nerve decompression, but also to the correction of lumbosacral sagittal plane parameters. The purpose of this study was to observe the clinical prognosis and sagittal parameters of patients with isthmic spondylolisthesis treated with PLIF, and to find out the risk factors leading to poor prognosis. Methods: From January 2006 to August 2018, the clinical data of patients with 2-level isthmic spondylolisthesis treated with PLIF in the Second Xiangya Hospital of Central South University were retrospectively collected. The clinical symptoms (JOA score and VAS score) and the sagittal parameters of lumbosacral segment (PI, PT, LL, L4-S1 SL, LDI, PI-LL, LL and L4-S1 SL) were recorded before operation, immediately after operation and at the last follow-up. According to the improvement rate of JOA score, the patients were divided into two subgroups, poor(P) group and good(G) group. The parameters within and between the two subgroups were compared. Meanwhile, Pearson correlation analysis was conducted between sagittal parameters and JOA score improvement rate.Results: A total of 52 patients were enrolled in this study, the average age was (59.96 ±9.11) years, and the mean follow-up time was (31.88 ±8.37) months. Group G (n = 37) and group P (n = 15). In terms of clinical symptom improvement and sagittal plane parameters, except PI, the other parameters of the patients were improved compared with those before operation, and the difference was statistically significant. In the intra-group comparison, except PI, other indexes in group G were significantly improved, while in group P, there was no significant difference in PI, LL, L4-S1 SL, LDI, PI-LL before and after operation. In the comparison between groups, there was no significant difference in baseline data between group G and group P; postoperative VAS score(back pain) in group G was lower than that in group P, but there was no significant difference in VAS score( leg pain); in terms of JOA score and JOA score improvement rate, group G was significantly better; △L4-S1 SL ,L4-S1 SL and LDI were larger in group G, and the proportion of patients with normal LDI was higher than that in group P. Pearson correlation analysis showed that postoperative △L4-S1 SL, LDI and L4-S1 SL were positively correlated with JOA improvement rate. 2 patients with failed internal fixation occurred in group P, and the postoperative LDI was less than 50%. Conclusion: PLIF is an effective method for the treatment of 2-level isthmic spondylolisthesis. ΔL4-S1 SL, L4-S1 SL and good LDI may be important sagittal parameters affecting the clinical prognosis of L4 and L5 isthmus spondylolisthesis.

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Mid-and Long-term Clinical Efficacy Analysis of Carotid Artery Stenosis Treated With Carotid Endarterectomy

10.21203/rs.3.rs-52925/v1 ◽

2020 ◽

Author(s):

Yanhua Wan ◽

Yiran Li ◽

Jiasheng Xu ◽

Shasha Wan ◽

Riwei Wang ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Clinical Efficacy ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

Cerebral Stroke ◽

Improvement Rate ◽

Efficacy Analysis ◽

Significant Difference

Abstract Objective: To explore the mid-and long-term clinical efficacy analysis of carotid artery stenosis treated with carotid endarterectomy.Methods: Retrospective analysis of 89 cases of patients with carotid artery stenosisundergoing carotid endarterectomy from our center from Jan,2013 to June,2017. To gather the hospitalization data of patients including the general information, the past medical history, preoperative conditions, the situation during surgery, postoperative situations. All the patients were followed up from 16 months to 63 months, and to make survival analysis on the follow-up status.Results：Among the 89 cases, 22cases of mild stenosis ,67cases of severe stenosis. 5 cases had postoperation wound hemorrhage or hematoma, 2 cases of cranial nerve injury, 2cases of cerebral stroke. Among the 62 cases of symptomatic carotid artery stenosis,48cases have been improved in term of their clinical symptoms with improvement rate of 77.4%. The Nonparametric test of mRS scores before and after surgery showed that there was significant difference in the preoperative and postoperative scores（P<0.05）.Conclusion: The mid-and long-term clinical efficacy of carotid artery stenosis treated with carotid endarterectomy is good. The previous history of coronary heart disease and peripheral vascular diseases are the influence factors for the mid- and long-term adverse outcomes after carotid endarterectomy.

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Clinical effect analysis of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04564-3 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Zhi-Wei Wang ◽

Zheng Wang ◽

Yan-Hong Zhou ◽

Jia-Yuan Sun ◽

Wen-Yuan Ding ◽

...

Keyword(s):

Clinical Effect ◽

Clinical Effects ◽

Cross Sectional ◽

Improvement Rate ◽

Duration Of Symptoms ◽

Residual Rate ◽

Score Improvement ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background To explore the clinical effect of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF. Methods A retrospective study was conducted on the clinical data of 142 patients with TOLF and laminectomy who underwent spine surgery at XXX Medical University from January 2003 to January 2018. According to whether the laminectomy was combined with instrumentation, the patients were divided into two groups: group A (laminectomy alone (LA), n = 77) and group B (laminectomy with instrumentation (LI), n = 65). Comparisons of possible influencing factors of demographic variables and operation-related variables were carried out between the two groups. In this study, the clinical effects of LA and LI in the treatment of TOLF were discussed. Thus, we explored the clinical effect of LA and LI in the treatment of TOLF. Results In terms of demographics, there was a statistically significant difference in BMI between group A and group B (P < 0.05). The differences in age, sex, smoking, drinking, heart disease, hypertension and diabetes were not statistically significant (P > 0.05). In terms of preoperative symptoms, there was a significant difference in gait disturbance, pain in the LE, and urination disorder between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). In terms of operation-related variables, there was a significant difference in the preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT, shape on the sagittal MRI, operation time, pre-mJOA, post-mJOA at 1 year, and leakage of cerebrospinal fluid between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). The preoperative average JOA score of group A was 6.37 and that of group B was 5.19. In group A, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.87, 8.23 and 8.26, respectively, and the average JOA score improvement rate was 32.79 %, 38.32 and 38.53 %, respectively. In group B, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.74, 8.15 and 8.29, respectively, and the average JOA score improvement rate was 39.15 %, 46.86 and 47.12 %, respectively. Conclusions Currently, there is no consensus on whether instrumentation is needed after laminectomy for TOLF. We found that for patients with a long duration of gait disturbance, urination disorder, preoperative duration of symptoms, intramedullary signal change on MRI, dural ossification, residual rate of cross-sectional spinal canal area on CT less than 60 %, and shape on the sagittal MRI being beak and low, pre-mJOA had better clinical effects after LI as compared to those after LA, and the incidence of perioperative complications was lower.

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Comparison of the clinical efficacy of two fixation methods combined with OLIF in the treatment of lumbar spondylolisthesis

10.21203/rs.3.rs-346686/v1 ◽

2021 ◽

Author(s):

Xinliang Zhang ◽

Yunshan Guo ◽

Yibing Li

Keyword(s):

Clinical Efficacy ◽

Screw Fixation ◽

Fusion Rate ◽

Imaging Data ◽

Fixation Methods ◽

Post Surgery ◽

Significant Difference ◽

Group A ◽

Group B ◽

Lumbar Spondylolisthesis

Abstract Background To observe the clinical efficacy of an anterior single rob-screw fixation (ASRSF) combined with the oblique lumbar intervertebral fusion (OLIF) approach compared with a posterior percutaneous screw fixation(PPSF) combined with OLIF in the treatment of lumbar spondylolisthesis. Methods This is a retrospective case-control study. Patients with lumbar spondylolisthesis treated with either ASRSF combined with OLIF or PPSF combined with OLIF from January 2016 to January 2018 were enrolled in this study. None of the patients had posterior decompression. The visual analog scale (VAS) and Oswestry dysfunction index (ODI) were used for clinical efficacy assessment. The pre- and post-operational disc height, height of foramen, subsidence and migration of cages, fusion rate, and surgery-related complications were compared between the two groups. Results Fifty-three patients were included in this single-center study. According to the fixation methods, patients were divided into the ASRSF group (group A, 25 cases) and the PPSF group (group B, 28 cases). There was no statistical difference in surgery-related complications between groups. There was a significant difference in the VAS score at 1 week post-surgery(2.3 ± 0.5Vs3.5 ± 0.4, P = 0.01), and 3 months post-operation (2.2 ± 0.3VS 3.0 ± 0.3, P = 0.01). Comparison of post-operative imaging data showed that there was a significant difference in the height of the foramen between groups at 3 months post-surgery(18.1 ± 2.3 mm Vs 16.9 ± 1.9 mm, P = 0.04). At 24 months post-surgery, the ODI was 12.65 ± 3.6 in group A and 19.1 ± 3.4 in group B (P = 0.01). Twelve months after surgery, the fusion rate in group A was 72.0% and78.6% in group B (not statistically significant, P = 0.75). Fusions were identified in all patients at 24 months post-surgery. Conclusion Compared to PPSF, ASRSF combined with OLIF for lumbar spondylolisthesis can reduce post-operative low back pain in the early stages, maintain the height of the foramen superiorly, and improve the performance of lumbar function.

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Clinical effect analysis of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF: a multicentre retrospective study

10.21203/rs.3.rs-250977/v1 ◽

2021 ◽

Author(s):

Zhe Wei Wang ◽

Zheng Wang ◽

Yan Hong Zhou ◽

Jia Yuan Sun ◽

Wen Yuan Ding ◽

...

Keyword(s):

Clinical Effect ◽

Cross Sectional ◽

Improvement Rate ◽

Duration Of Symptoms ◽

Residual Rate ◽

Score Improvement ◽

Signal Change ◽

Significant Difference ◽

Group A ◽

Group B

Abstract Background To explore the clinical effect of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF.Methods A retrospective study was conducted on the clinical data of 142 patients with TOLF and laminectomy in the Spine surgery of the XXX Medical University from January 2003 to January 2018. According to whether the laminectomy was combined with instrumentation, the patients were divided into two groups: group A (laminectomy alone LA, n = 77) and group B (laminectomy with instrumentation LI, n = 65). Comparison possible influencing factors of demographic variables and operation-related variables between the two groups. In this study, the clinical effects of laminectomy alone and laminectomy with instrumentation in the treatment of TOLF were discussed. Thus to explore the clinical effect of LA and LI in the treatment of TOLF.Results In terms of demographics, there was a statistically significant difference in BMI between group A and Group B (P < 0.05). The differences in Age, Sex, Smoking, Drinking, Heart disease, Hypertension and Diabetes were not statistically significant (P༞0.05). In terms of preoperative symptoms, there was significant difference in Gait disturbance, Pain in LE,Urination disorder between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). In terms of operation-related variables, there was significant difference in Preoperative duration of symptoms, Intramedullary signal change on MRI, Dural ossification, Residual rate of cross-sectional spinal canal area on CT, Shape on the sgittal MRI, Operation time, Pre-mJOA, Post-mJOA at 1 year,Leakage of cerebrospinal fluid between group A and group B (P < 0.05), but there was no significant difference in other variables between the two groups (P > 0.05). The preoperative average JOA score of group A was 6.37, and that of group B was 5.19. In group A, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.87, 8.23 and 8.26, respectively, and the average JOA score improvement rate was 32.79%, 38.32% and 38.53%, respectively. In group B, the average JOA score at 6 months, 1 year and 2 years after surgery was 7.74, 8.15 and 8.29, respectively, and the average JOA score improvement rate was 39.15%, 46.86% and 47.12%, respectively.Conclusions Currently, there was no consensus on whether instrumentation is needed after laminectomy for TOLF. We found that for patients with long duration of Gait disturbance, Urination disorder, Preoperative duration of symptoms, Intramedullary signal change on MRI, Dural ossification, Residual rate of cross-sectional spinal canal area on CT less than 60%, Shape on the sgittal MRI as Beak and low Pre-mJOA had better clinical effect after LI than that LA, and the incidence of perioperative complications was lower.

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Bilateral high-frequency stimulation in the subthalamic nucleus for the treatment of Parkinson disease: correlation of therapeutic effect with anatomical electrode position

Journal of Neurosurgery ◽

10.3171/jns.2002.96.2.0269 ◽

2002 ◽

Vol 96 (2) ◽

pp. 269-279 ◽

Cited By ~ 208

Author(s):

Jürgen Voges ◽

Jens Volkmann ◽

Niels Allert ◽

Ralph Lehrke ◽

Athanasios Koulousakis ◽

...

Keyword(s):

Clinical Improvement ◽

Subthalamic Nucleus ◽

High Frequency ◽

High Frequency Stimulation ◽

Electrode Position ◽

Motor Symptoms ◽

Active Electrode ◽

Content Type ◽

Frequency Stimulation ◽

Fine Print

Object. The goal of this study was to relate the degree of clinical improvement and that of energy consumption to the anatomical position of electrode poles used for long-term stimulation. Methods. The authors conducted a retrospective analysis of 15 consecutive patients in whom targeting of the subthalamic nucleus (STN) had been performed using ventriculography, three-dimensional (3D) magnetic resonance (MR) imaging, and 3D computerized tomography, together with macrostimulation and teleradiographic control of the electrode position. In these patients the follow-up period ranged from 6 to 12 months. Postoperative improvement in contralateral motor symptoms, which was assessed by assigning a lateralized motor subscore of the Unified Parkinson's Disease Rating Scale (UPDRS), and stimulus intensity required for optimal treatment results were correlated with the intracerebral position of the active electrode pole. Bilateral high-frequency stimulation of the STN improved the UPDRS motor score during the medication-off period by an average of 60.5% compared with that at baseline. Repeated transfer of stereotactic coordinates from postoperative teleradiography to treatment-planning MR images documented the proper localization of the most distal electrode pole (pole 0) in the targeted STN. Nevertheless, in most cases the best clinical improvement was achieved using electrode poles that were located several millimeters above the electrode tip. If the relative improvement in motor symptoms was correlated with the required electrical energy for chronic stimulation, the best coefficient was observed for active electrode poles projecting onto white matter dorsal to the STN. Conclusions. This observation makes blocking or activation of large fiber connections arising in the STN or running nearby more likely than electrical interference with cell bodies inside the STN. Anatomical correlates may be the pallidothalamic bundle (including Field H of Forel and the thalamic fascicle), the pallidosubthalamic tract, and/or the zona incerta.

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Association between pre-operative anxiety and/or depression and outcomes following total hip or knee arthroplasty

Journal of Orthopaedic Surgery ◽

10.1177/2309499021992605 ◽

2021 ◽

Vol 29 (1) ◽

pp. 230949902199260

Author(s):

Kurt G Seagrave ◽

Adriane M Lewin ◽

Ian A Harris ◽

Helen Badge ◽

Justine Naylor

Keyword(s):

Knee Arthroplasty ◽

Secondary Analysis ◽

Patient Anxiety ◽

Global Improvement ◽

Total Hip ◽

Time Of Surgery ◽

Post Surgery ◽

Score Improvement ◽

Confounding Variables ◽

Significant Difference

Purpose: While elective primary total hip (THA) and knee (TKA) arthroplasty are effective procedures for addressing the symptoms associated with advanced osteoarthritis, there is evidence to suggest that patient anxiety and depression are linked to poorer outcomes following surgery. Methods: A secondary analysis of prospectively-collected data of people undergoing primary elective THA or TKA for osteoarthritis across 19 hospitals was performed. We assessed outcomes at 1 year post-surgery for people with and without medically treated anxiety and/or depression at the time of surgery (A/D and no-A/D). We used unadjusted and adjusted analyses to compare improvement in Oxford Hip or Knee Scores, the incidences of major post-operative complications, satisfaction and index joint improvement by A/D status. Results: 15.2% (254/1669) of patients were identified with anxiety and/or depression at time of surgery. In the unadjusted analysis, the A/D group had greater mean Oxford score improvement by 2.1 points (95% CI 0.8 to 3.4, p = 0.001), increased major complications (OR 1.39, 95% CI 1.05 to 1.85, p = 0.02), were less likely to report a “much better” global improvement for index joint (OR 0.56, 95% CI 0.38 to 0.83, p = 0.003), and there was no statistically significant difference in the rate of satisfaction with the results of surgery (OR 0.64, 95% CI 0.37 to 1.10, p = 0.10). The adjusted analysis found no significant associations between A/D vs. no-A/D and any of the reported outcomes. Conclusion: After adjustment for confounding variables, people with anxiety and/or depression pre-operatively, compared to those without, have similar outcomes following hip or knee arthroplasty.

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Quantifying the effects of electrode placement and montage on measures of cVEMP amplitude and muscle contraction

Journal of Vestibular Research ◽

10.3233/ves-200033 ◽

2020 ◽

pp. 1-13

Author(s):

Sendhil Govender ◽

Sally M. Rosengren

Keyword(s):

Muscle Contraction ◽

Normal Subjects ◽

Electrode Placement ◽

Electrode Position ◽

Test Results ◽

Vestibular Evoked Myogenic Potential ◽

Active Electrode ◽

Myogenic Potential ◽

Position Errors ◽

Test Outcomes

BACKGROUND: The cervical vestibular evoked myogenic potential (cVEMP) can be affected by the recording parameters used to quantify the response. OBJECTIVE: We investigated the effects of electrode placement and montage on the variability and symmetry of sternocleidomastoid (SCM) contraction strength and cVEMP amplitude. METHODS: We used inter-side asymmetries in electrode placement to mimic small clinical errors in twenty normal subjects. cVEMPs were recorded at three active electrode sites and referred to the distal SCM tendon (referential montages: upper, conventional and lower). Additional bipolar montages were constructed offline to measure SCM contraction strength using closely-spaced electrode pairs (bipolar montages: superior, lower and outer). RESULTS: The conventional montage generally produced the largest cVEMP amplitudes (P < 0.001). SCM contraction strength was larger for referential montages than bipolar ones (P < 0.001). Inter-side electrode position errors produced large variations in cVEMP and SCM contraction strength asymmetries in some subjects, producing erroneous abnormal test results. CONCLUSION: Recording locations affect cVEMP amplitude and SCM contraction strength. In most cases, small changes in electrode position had only minor effects but, in a minority of subjects, the different montages produced large changes in cVEMP and contraction amplitudes and asymmetry, potentially affecting test outcomes.

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