STN DBS of Advanced Parkinson's Disease Experienced in a Specialized Monitoring Unit with a Prospective Protocol

OBJECTIVE: In the evaluation of patients with Parkinson's disease (PD), most neurologists only see their patients during a limited period of their fluctuating 24-hour-a-day lives. This study aimed to assess the short-term outcome of STN stimulation for patients with advanced PD evaluated in a 24-hour monitoring unit for movement disorder (MUMD) using a prospective protocol. METHODS: Forty-two patients with advanced PD consecutively treated with bilateral STN stimulation using multi-channel microelectrode recording were included in this study. All patients were evaluated using a 24-hour MUMD with a video recording/editing system and were evaluated with a prospective protocol of the Unified Parkinson's Disease Rating Scale, Hoehn and Yahr Staging, Schwab and England Activities of Daily Living, levodopa equivalent daily dose (LEDD), Short Form-36 Health Survey, and neuropsychological tests. Magnetic resonance (MR) images of the brain were performed prior to and six months after surgery. RESULTS: All patients were evaluated at three and six months after surgery. There was a rapid and significant improvement of the motor symptoms, especially in tremor and rigidity, after STN stimulation with low morbidity. Dyskinesia was markedly decreased with much lowered LEDD values by 50% after STN stimulation. 1.5T MR images were safely taken according to the manufacturer's guidelines at six months after surgery without any adverse effects in 41 patients treated with STN stimulations. CONCLUSION: Evaluations in a 24-hour monitoring unit could reduce the dose of medication efficiently to an optimal level with patients'comfort and improve the clinical symptoms in harmony with STN stimulation.

Responses of Lumbar Spinomesencephalic Tract Neurons to Antidromic Activation of Spinocervical Tract Neurons

OBJECTIVE: Morphological studies have demonstrated that the spinocervical tract (SCT) neurons have their target cells not only in the lateral cervical nucleus (LCN) but also within the lumbosacral segments of the spinal cord. The study is aimed at investigating the possibility of collateral segmental actions of SCT neurons upon spinomesencephalic tract (SMT) neurons in the lumbar spinal cord. METHODS: Extracellular microelectrode recordings were made from lumbar (L3-L6) spinomesencephalic tract (SMT) neurons on adult male cats antidromically activated by stimulation of midbrain. The effects of stimulating dorsolateral funiculus (DLF) were recorded at cervical cord at C3 and rostral C1 levels, below and above the termination of SCT axons in LCN. RESULTS: Thirty-nine cells responded to the stimulation of cervical DLF stimulation. Among them thirty-four cells that showed excitatory responses, twenty-three cells were more excited by the stimulation at C3 and five cells by the C1 stimulation, and six cells showed similar responses to C3 and C1 stimulations. Inhibitory responses were recorded in five. Four inhibited cells showed their inhibitory responses to both C3 and C1 stimulation, and one cell was inhibited by C3 stimulation. Histologically, the location of recording sites of SMT cells responding to stimulation of upper cervical DLF was widely distributed in the lamina II-VII of gray matter inhibitory responses were found in lamina V-VII CONCLUSION: These results suggest that there is a functional coupling between the SCT and SMT neurons, and that the linkage might be formed either segmentally between SMT neurons and axon collaterals of SCT neurons or suprasegmentally via cells in the lateral cervical neurons with axons descending to the lumbar cord.

Microelectrode Recording-Guided Deep Brain Stimulation in Patients with Movement Disorders

OBJECTIVE: The authors analyzed the findings of microelectrode recording data and reported the surgical outcomes of movement disorder patients. METHODS: Since February 2000, the authors have used DBS for the movement disorders. We evaluated 4 patients who were followed more than 12 months after operation. One patient with essential tremor was treated with thalamic stimulation and three patients with idiopathic advanced Parkinson's disease with bilateral subthalamic nucleus stimulation. The electrodes were inserted under microelectrode recording. Clinical assessments were performed preoperatively and postoperatively by neurologist. RESULTS: All features of parkinsonian symptoms improved and the greatest benefit occurred in off-time and ADL. Interestingly our three patients with advanced Parkinson's disease did not have off-time after bilateral stimulation of subthalamic nucleus. There were no adverse side effects related to microelectrode recording or DBS procedure in all 4 patients. In our results of microelectrode recording of subthalamic nucleus, subthalamus showed higher firing rate than that of substantia nigra pars reticularis. Mean burst frequency of subthalamic nucleus was much higher than that of substantia nigra pars reticularis. CONCLUSION: The first trials of DBS in Korea also demonstrated favorable outcomes for movement disorders.

Microelectrode guided stereotactic surgery for Parkinson's disease / 中国微创外科杂志

ObjectiveTo evaluate the clinical effects of microelectrode guided stereotactic pallidotomy and/or thalamotomy and deep brain stimulation (DBS) in the management of Parkinson's disease.MethodsA total of 510 patients with P arkinson's disease underwent stereotactic operations and 30 patients underwent D BS from April 1999 to March 2003. The 510 cases consisted of 385 cases of poster oventral pallidotomy (PVP), 91 cases of ventral intermedius (Vim) thalamotomy, 1 2 cases of PVP together with Vim thalamotomy on the same side, 8 cases of PVP on both sides at the same time, 10 cases of PVP on both sides at different times, and 4 cases of PVP on one side while Vim thalamotomy on the other at different t imes. Of the 30 cases of DBS (unilateral, 18 cases; bilateral, 12 cases), target s were located in subthalamic nucleus(STN) in 29 cases and ventralis intermedius nucl eus in 1 case.ResultsUnified Parkinson's disease rating scal e (UPDRS) scores were recorded postoperatively. Of the 510 cases, during the “off” and “on” stat es, symptoms improved by 47 3% and 38 7%, respectively. “On-off” phenomena a nd m otor symptoms disappeared. Follow-up information with a mean of 11 6 months in 2 20 cases revealed excellent outcomes in 130 cases (59 1%), improved in 75 (34 1%), a nd no change in 15 (6 8%). Of the 30 cases of DBS, during the “off” and “on ” state s, symptoms improved by 45 2% and 25 7%, respectively. All the 30 patients wer e followed for a mean of 10.3 months. No parameter adjustment was needed after 1 p ostoperative month in 18 cases, while the adjustment after operation was require d in the remaining 12 cases.ConclusionsPallidotomy is much m ore effective th an thalamotoy in Parkinson's patients with tremor. DBS can effectively control t he patient's motor symptoms.

Inhibitory effects of levo-phenoprolamine hydrochloride on experimental arrhythmias / 中国药理学通报

AIM To investigate the effects of levo phenoprolamine hydrochloride [ levo 1 (2,6 dimethylphenoxy) 2 (3,4 dimethoxyphenyl ethylamino) propane hydrochloride] [ l DDPH([?]D 25 1 08)]on experimental arrhythmias. on experimental arrhythmias. METHODS Intravenous administration of ouabain, aconitine or CaCl 2 induced arrhythmias in rats or guinea pigs; Microelectrode recording was used to record action potential; Whole cell patch clamp technique was used to record L type calcium current ( I Ca,L ). RESULTS ① l DDPH 50 mg?kg -1 inhibited the ventricular arrhythmias induced by intravenous injection of ouabain in guinea pigs or aconitine and CaCl 2 in rats. ② l DDPH 30 ?mol?L -1 shortened 50% action potential duration (APD 50 ) and prolonged effective refractory period (ERP) ( n =6, P