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1.
Jens Volkmann MD Alberto Albanese MD Jaime Kulisevsky MD Aana‐Lena Tornqvist PhD Jean‐Luc Houeto MD Bernard Pidoux MD Anne‐Marie Bonnet MD Alexandre Mendes MD Alim‐Louis Benabid MD Valerie Fraix PhD Nadege Van Blercom PhD Jing Xie MD José Obeso MD Maria Cruz Rodriguez‐Oroz MD Jurge Guridi MD Alfons Schnitzler MD Lars Timmermann MD Alexandre A. Gironell MD Juan Molet MD Benta Pascual‐Sedano MD Stig Rehncrona MD Elena Moro MD Anthony C. Lang MD Andres M. Lozano MD Anna Rita Bentivoglio MD Massimo Scerrati MD Maria Fiorella Contarino MD Luigi Romito MD Marc Janssens PhD Yves Agid MD 《Movement disorders》2009,24(8):1154-1161
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. © 2009 Movement Disorder Society 相似文献
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Ken Nakamura Chadwick W Christine Philip A Starr William J Marks 《Movement disorders》2007,22(5):619-626
Deep brain stimulation (DBS) is an effective treatment for selected patients with disabling Parkinson's disease (PD). The two main targets are the subthalamic nucleus (STN) and the globus pallidus internus (GPi), although it has not been established whether stimulation at one target is superior to the other. This prospective randomized study assessed the effects of unilateral DBS of the STN versus GPi on fine motor skills in 33 patients with advanced PD. Stimulation of either the STN (18 subjects) or GPi (15 subjects) in the off medication state significantly improved movement time and dexterity, but had little or no effect on reaction time. Overall, the extent of improvement did not differ between the two targets. The degree of improvement in movement time, but not dexterity, was correlated with the extent of preoperative medication responsiveness. Our findings suggest that DBS of the STN or GPi results in a similar improvement in hand movements at short-term follow-up. Preoperative medication responsiveness predicts improvement in some but not other motor tasks. 相似文献
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Asha Kishore MD DM Ravimohan Rao MS MCh Syam Krishnan MD DM Dilip Panikar MS MCh Gangadhara Sarma MA Mathuranath Pavagada Sivasanakaran MD DM Sankara Sarma PhD 《Movement disorders》2010,25(14):2438-2444
Reports of long‐term effects of subthalamic (STN) stimulation for Parkinson's disease (PD) are few, mostly open‐label evaluations and from Western centers. We used single‐blind and open‐label motor, cognitive and quality of life (QOL) evaluations to study the effects of bilateral STN stimulation in 45 patients over 5 years. Our patients showed a stable and substantial reduction in the cardinal signs of PD, motor fluctuations, and dyskinesias but less so for axial signs. The reduction in medications and the intensity of electrical stimulation needed also remained stable during follow up. Although the total QOL and its parkinsonism and social components showed sustained benefits till 5 years, the gains in emotional and systemic subsets were short lasting. Global scores for mood and cognition did not show significant worsening. Benefits of STN stimulation on the cardinal signs, motor complications, and QOL of advanced PD were substantial and sustained till 5 years. The initial benefits in axial motor signs and emotional and psychological aspects of QOL did not show similar stability. In general, the procedure had insignificant impact on cognition and mood. This is the first report of STN stimulation in Asian patients with PD. © Movement Disorder Society 相似文献
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Luigi M. Romito MD PhD Maria Fiorella Contarino MD Nicola Vanacore MD Anna Rita Bentivoglio MD PhD Massimo Scerrati MD Alberto Albanese MD 《Movement disorders》2009,24(4):555-561
Stimulation of the subthalamic nucleus (STN) is an effective treatment for advanced Parkinson's disease (PD), but the medication requirements after implant are poorly known. We performed a long‐term prospective evaluation of 20 patients maintained at stable dopaminergic therapy for 5 years after bilateral STN implants, who were evaluated 6 months, 1 year, 3 years, and 5 years after surgery. We measured, during the entire observation period, the effect of deep brain stimulation on motor and functional outcome measures, the levodopa equivalent daily dose and the total electrical energy delivered. At 5 years, the UPDRS motor score had improved by 54.2% and levodopa equivalent dose was reduced by 61.9%, compared with preimplant. Dopaminergic medication remained stable during the observation period, but energy was progressively increased over time. Rest tremor, rigidity, gait, lower and upper limb akinesia, and total axial score were improved in decreasing order. Postural stability and speech improved transiently, whereas on‐period freezing of gait, motor fluctuations and dyskinesias recovered durably. Functional measures did not show improvement in autonomy and daily living activities after STN implant. Chronic STN stimulation allows to replace for dopaminergic medications in the long‐term at the expense of an increase of the total energy delivered. This is associated with marked improvement of motor features without a matching benefit in functional measures. © 2008 Movement Disorder Society 相似文献
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Paul Sauleau MD PhD Emmanuelle Leray MD Tiphaine Rouaud MD Sophie Drapier MD Dominique Drapier MD PhD Sophie Blanchard MD Gwenolla Drillet Julie Péron PhD Marc Vérin MD PhD 《Movement disorders》2009,24(14):2149-2155
To compare body mass index (BMI) and daily energy intake (DEI) after subthalamic versus pallidal deep brain stimulation (DBS). Weight gain following DBS in Parkinson's disease patients remains largely unexplained and no comparison of subthalamic and pallidal (GPi) stimulation has yet been performed. BMI and DEI, dopaminergic drug administration and motor scores were recorded in 46 patients with PD before STN (n = 32) or GPi (n = 14) DBS and 3 and 6 months after. At M6, BMI had increased by an average of 8.4% in the STN group and 3.2% in the GPi group. BMI increased in 28 STN and 9 GPi patients. This increase was significantly higher in the STN group (P < 0.048) and the difference remained significant after adjustment for reduced dopaminergic medication; 28.6% of GPi patients were overweight at 6 months (14.3% preoperatively) versus 37.5% of STN patients (21.9% preoperatively). Changes in BMI were negatively correlated with changes in dyskinesia in the GPi–DBS group. Food intake did not change in the two groups, either quantitatively or qualitatively. Frequent weight gain, inadequately explained by motor improvement or reduced dopaminergic drug dosage, occurred in subthalamic DBS patients. The difference between groups suggests additional factors in the STN group, such as homeostatic control center involvement. © 2009 Movement Disorder Society 相似文献
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Short pulse width in subthalamic stimulation in Parkinson's disease: a randomized,double‐blind study 下载免费PDF全文
Walid Bouthour MD Jennifer Wegrzyk PhD Shahan Momjian MD Julie Péron PhD Vanessa Fleury MD Emilie Tomkova Chaoui Judit Horvath MD Colette Boëx PhD Christian Lüscher MD Pierre R. Burkhard MD Paul Krack MD PhD André Zacharia MD 《Movement disorders》2018,33(1):169-173
Background: We investigated the acute effect of short pulse widths on the therapeutic window in subthalamic nucleus deep brain stimulation in Parkinson's disease. Methods: We assessed 10 PD patients with STN‐DBS at a 60‐µs pulse width. We randomly and double‐blindedly applied 10‐ to 50‐µs pulse widths. The principal outcome was the therapeutic window (difference between the amplitude thresholds for visible muscle contraction and for best rigidity control). The secondary outcome was the charge per pulse (which reflects the efficiency of the stimulation) needed to control rigidity. Two‐way analysis of variance and pairwise t tests were applied. Results: The therapeutic window widened when the pulse width shortened (r = ?0.45; P < 0.001), and charge per pulse was reduced (P < 0.05). Conclusions: This randomized, double‐blind study showed that shorter pulse widths widen the therapeutic window of STN‐DBS in PD without increasing the electrical charge required to obtain the same acute clinical benefit. © 2017 International Parkinson and Movement Disorder Society 相似文献
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Marwan I. Hariz MD PhD Stig Rehncrona MD PhD Niall P. Quinn MD Johannes D. Speelman MD PhD Carin Wensing 《Movement disorders》2008,23(3):416-421
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. © 2007 Movement Disorder Society 相似文献
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Dyskinesia‐inducing lead contacts optimize outcome of subthalamic stimulation in Parkinson's disease
Walid Bouthour Matthieu Breau Astrid Kibleur Andr Zacharia Emilie Tomkova Chaoui Vanessa Fleury Damien Benis Shahan Momjian Julien Bally Christian Lüscher Paul Krack Pierre R. Burkhard 《Movement disorders》2019,34(11):1728-1734
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Michael W M Schüpbach Marie Laure Welter Anne Marie Bonnet Alexis Elbaz Brandon R Grossardt Valerie Mesnage Jean Luc Houeto David Maltête Luc Mallet Walter A Rocca Alain Mallet Yves Agid 《Movement disorders》2007,22(2):257-261
Subthalamic nucleus (STN) stimulation improves motor disability and quality of life in patients with advanced Parkinson's disease (PD). Short-term mortality is low, but little is known about long-term mortality. We assessed mortality and causes of death in 171 consecutive PD patients treated by STN stimulation. Surgery was performed after a median lagtime of 13 years from PD onset at a median age of 57 years. The median follow-up after surgery was 41 months. Sixteen patients died 8 to 83 months after neurosurgery. Poorer cognitive function was the only predictive factor for mortality (standardized mortality ratio = 2.9; 95% confidence interval [CI], 1.6-4.7; P < 0.0001). Based on a historical comparison of 118 operated patients with 39 nonoperated patients from a different population, survival among operated patients was not better (hazard ratio = 1.2; 95% CI, 0.7-2.1). 相似文献
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Most effective stimulation site in subthalamic deep brain stimulation for Parkinson's disease. 总被引:5,自引:0,他引:5
Jan Herzog Urban Fietzek Wolfgang Hamel Andre Morsnowski Frank Steigerwald Bettina Schrader Dieter Weinert Gerd Pfister Dieter Müller Hubertus M Mehdorn Günther Deuschl Jens Volkmann 《Movement disorders》2004,19(9):1050-1054
The optimal stimulation site in subthalamic deep brain stimulation (STN-DBS) was evaluated by correlation of the stereotactic position of the stimulation electrode with the electrophysiologically specified dorsal STN border. In a series of 25 electrodes, best clinical results with least energy consumption were found in contacts located in the dorsolateral border zone, whereas contacts within the subthalamic white matter, e.g., zona incerta, were significantly less effective. We suggest that the dorsolateral STN border should be covered by STN-DBS. 相似文献
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Ettore Accolla Elena Caputo Filippo Cogiamanian Filippo Tamma Simona Mrakic-Sposta Sara Marceglia Marcello Egidi Paolo Rampini Marco Locatelli Alberto Priori 《Movement disorders》2007,22(8):1150-1156
We investigated gender-differences in clinical phenomenology and response to deep brain stimulation (DBS) of the subthalamic nucleus (STN) in a group of patients with advanced Parkinson's disease (PD). Thirty-eight consecutive patients with PD (22 men and 16 women), bilaterally implanted for DBS of the STN, were evaluated 1 month before and 11 to 14 months after surgery. Gender differences in severity of the disease (HY and UPDRS), ability in the activities of daily living (ADL, UPDRS II), tremor and rigidity (UPDRS III), bradykinesia (UPDRS III and hand tapping test), levodopa-induced dyskinesias (LIDs, UPDRS IV), and levodopa equivalent daily dosage (LEDD) were analyzed before and after intervention. We found a predominantly male population, with no gender-related differences in age at onset, disease progression rate, or severity of disease. Nevertheless, women had more severe LIDs than men, only before the intervention. Bradykinesia was significantly less responsive to any kind of treatment (pharmacologic and neurosurgical) in women than in men. Finally, although STN-DBS induced similar total benefits in both genders, postoperative assessment suggested that the ADL improved more in women than in men. Women and men with advanced PD appear to differ in some clinical features and in response to dopaminergic and STN-DBS treatment. 相似文献
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Frédéric Macia Caroline Perlemoine Irène Coman Dominique Guehl Pierre Burbaud Emmanuel Cuny Henri Gin Vincent Rigalleau Fran?ois Tison 《Movement disorders》2004,19(2):206-212
Weight, body mass index (BMI) and energy expenditure/energy intake (EE/EI) was studied in 19 Parkinson's disease (PD) patients after subthalamic deep brain stimulation (STN-DBS) versus 14 nonoperated ones. Operated patients had a significant weight gain (WG, + 9.7 +/- 7 kg) and BMI increase (+ 4.7 kg/m2). The fat mass was higher after STN-DBS. Resting EE (REE; offdrug/ON stimulation) was significantly decreased in STN-DBS patients, while their daily energy expenditure (DEI) was not significantly different. A significant correlation was found among WG, BMI increase, and pre-operative levodopa-equivalent daily dose, their reduction after STN-DBS, and the differential REE related to stimulation and the REE in the offdrug/OFF stimulation condition. In conclusion, STN-DBS in PD induces a significant WG associated with a reduction in REE without DEI adjustment. 相似文献
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Claire Ardouin Valerie Voon Yulia Worbe Nehman Abouazar Virginie Czernecki Hassan Hosseini Antoine Pelissolo Elena Moro Eugénie Lhommée Anthony E Lang Yves Agid Alim-Louis Benabid Pierre Pollak Luc Mallet Paul Krack 《Movement disorders》2006,21(11):1941-1946
Pathological gambling (PG) related to dopaminergic treatment in Parkinson's disease (PD) is part of a spectrum of behavioral disorders called the dopamine dysregulation syndrome (DDS). We describe a series of PD patients with preoperative active PG due to dopaminergic treatment from a total of 598 patients who have undergone surgery for subthalamic nucleus stimulation for disabling motor fluctuations. The patients had systematic open assessment of behavioral symptoms and standardized assessments of motor symptoms, mood, and apathy. Seven patients (6 men, 1 woman; age, 54 +/- 9 years; levodopa equivalent dose, 1,390 +/- 350 mg/day) had preoperative PG over a mean of 7 years, intolerant to reduction in medication. Six had nonmotor fluctuations and four had other behavioral symptoms consistent with a diagnosis of the DDS. After surgery, motor symptoms improved, allowing for 74% reduction of dopaminergic treatment, below the dosage of gambling onset. In all patients, PG resolved postoperatively after 18 months on average (range, 0-48), although transient worsening occurred in two. Improvement paralleled the time course and degree of reduction in dopaminergic treatment. Nonmotor fluctuations, off period dysphoria, and other symptoms of the DDS improved. Two patients developed persistent apathy. In conclusion, PG and other symptoms of the DDS-associated dopaminergic treatment improved in our patients following surgery. Dopaminergic dysregulation commonly attributed to pulsatile overstimulation of the limbic dopaminergic system may be subject to desensitization on chronic subthalamic stimulation, which has a relative motor selectivity and allows for decrease in dopaminergic treatment. 相似文献
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Han‐Joon Kim MD Sun Ha Paek MD PhD Ji‐Young Kim MD Jee‐Young Lee MD Yong Hoon Lim BS Dong Gyu Kim MD PhD Beom S. Jeon MD PhD 《Movement disorders》2009,24(3):329-335
Although bilateral subthalamic deep brain stimulation (STN DBS) provides greater relief from the symptoms of Parkinson's disease (PD) than unilateral STN DBS, it has been suggested that unilateral STN DBS may be a reasonable treatment option in selected patients, especially those with highly asymmetric PD. In previous studies on the effect of unilateral STN DBS, the asymmetry of PD symptoms was not prominent and the mean follow‐up durations were only 3 to 12 months. In this study, we report our findings in a series of 8 patients with highly asymmetric PD who were treated with unilateral STN DBS and were followed for 24 months. Serial changes in Unified Parkinson's Disease Rating Scale (UPDRS) motor score and subscores in the ipsilateral, contralateral, and axial body parts were analyzed. Unilateral STN DBS improved the UPDRS motor score and the contralateral subscore in the on‐medication state for 5 nonfluctuating patients and in the off‐medication state for 3 fluctuating patients. However, the ipsilateral subscore progressively worsened and reversed asymmetry became difficult to manage, which led to compromised medication and stimulator adjustment. At 24 months, all the patients were considering the second‐side surgery. Our results suggest that bilateral STN DBS should be considered even in highly asymmetric PD. © 2008 Movement Disorder Society 相似文献
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Aline Gronchi-Perrin Sarah Viollier Joseph Ghika Pierre Combremont Jean-Guy Villemure Julien Bogousslavsky Pierre R Burkhard Fran?ois Vingerhoets 《Movement disorders》2006,21(9):1465-1468
We investigated the impact of subthalamic nucleus (STN) deep brain stimulation (DBS) on quality of life (QOL) in patients with advanced Parkinson's disease, as self-assessed before and after surgery by completing the Parkinson's Disease Questionnaire (PDQ39). In addition to this prospective evaluation, we asked patients postoperatively to evaluate their preoperative QOL. In the prospective assessment, results showed that patients perceived a general improvement of QOL after the STN DBS. However, when evaluated retrospectively, they tended to overestimate their preoperative functioning, therefore obscuring the improvement found prospectively. This observation highlights the impact of the method used on obtained results when assessing the effects of STN DBS. 相似文献
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Suzhen Lin Yimei Shu Chencheng Zhang Lingbing Wang Peng Huang Yixin Pan Jianqing Ding Bomin Sun Dianyou Li Yiwen Wu 《European journal of neurology》2023,30(9):2629-2640