Two cases of unexpected long-term improvement of Parkinson's disease after subthalamic nucleus deep brain stimulation removal
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S. H. Wong*a, P. R. Eldridgeb, A. Duffya, S. H. Fox*c, T. R. K. Varmab & N. A. Fletcheraa Departments of Neurology1b Neurosurgery2, The Walton Centre, Liverpool, UKc Movement Disorders Clinic, University of Toronto, Toronto Western Hospital, Ontario, CanadaKeywords:
Subthalamic Nucleus
Movement Disorders
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Deep brain stimulation (DBS) represents a major advance in the treatment of Parkinson’s disease (PD). As more neurosurgeons enter this field, technical descriptions of implantation techniques are needed. Here we present our technical approach to subthalamic nucleus (STN) and globus pallidus internus (GPi) DBS implantation, based on 180 STN implants and 75 GPi implants. The essential steps in DBS implantation are magnetic resonance imaging (MRI)-guided stereotactic localization, confirmation of the motor territory of the target nucleus with microelectrode mapping, and intra-operative test stimulation to determine voltage thresholds for stimulation-induced adverse effects. Lead locations are documented by postoperative MRI in all cases.
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Objective To explore the effect and the operative method for Parkinson's disease(PD) by deep brain stimulation(DBS).Methods We studied 20 patients with PD in whom electrodes were implanted unilaterally or bilaterally in the subthalamic nucleus(STN) under microelectrode guidance and surgiplan system of the location. 20 were followed and evaluated for at least 6 months after surgery. Results After the electrical stimulation of the STN for 15 patients unilaterally and 5 bilaterally, the patients' scores for ADL and motor examination scores were decrease significantly respectively(P0.01). The mean dose of dopaminergic drugs was reduced. No severe permanent operative complications was found.Conclusions Electrical stimulation of the STN is safe and effective treatment for PD. The severity of many symptoms decreases by adjusting the parameter and the dose of levodapa can be reduced.
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Abstract Deep brain stimulation of the subthalamic nucleus is an effective treatment for the motor symptoms of Parkinson's disease. Although a range of psychiatric and behavioral problems have been documented following deep brain stimulation, the short‐term effects of subthalamic nucleus stimulation on patients' mood have only been investigated in a few studies. Our aim was to compare self‐reported mood in Parkinson's patients with deep brain stimulation of the subthalamic nucleus ON versus OFF. Twenty‐three Parkinson's patients with bilateral deep brain stimulation of the subthalamic nucleus and 11 unoperated Parkinson's patients completed a mood visual analogue scale twice. Operated patients were tested with deep brain stimulation of the subthalamic nucleus both ON and OFF. All were assessed on medication. The operated Parkinson's group reported feeling significantly better coordinated, stronger, and more contented with deep brain stimulation ON compared to OFF. Fourteen of the 16 mood scales changed in a positive direction when deep brain stimulation of the subthalamic nucleus was ON. When changes in motor scores were taken into account, the operated patients still reported feeling better‐coordinated, but also less gregarious with stimulation ON. Unoperated Parkinson's patients showed no differences on any of these measures between their 2 ratings. Short‐term changes in deep brain stimulation of the subthalamic nucleus have a small and mostly positive effect on mood, which may be partly related to improvements in motor symptoms. The implications for day‐to‐day management of patients with deep brain stimulation of the subthalamic nucleus are discussed. © 2012 Movement Disorder Society
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S. H. Wong*a, P. R. Eldridgeb, A. Duffya, S. H. Fox*c, T. R. K. Varmab & N. A. Fletcheraa Departments of Neurology1b Neurosurgery2, The Walton Centre, Liverpool, UKc Movement Disorders Clinic, University of Toronto, Toronto Western Hospital, Ontario, Canada
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Movement Disorders
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