The long-term development of non-motor problems after STN-DBS.

OBJECTIVES: Stimulation of the subthalamic nucleus (STN-DBS) is an established treatment with long-term beneficial effects on motor symptoms in patients with Parkinson's disease (PD). The long-term development of non-motor problems after STN-DBS is not fully understood. In this study, we have studied how non-motor problems develop in patients with and without STN-DBS. MATERIALS AND METHODS: We collected data from a prospectively followed cohort of patients that had been operated with STN-DBS 6-9 years before final examination and compared our findings to the longitudinal development of non-motor problems in a non-operated, comparable reference population. RESULTS: In general, the non-motor problems of advanced PD seem to develop independently of treatment with STN-DBS. We found that depressions do not worsen after STN-DBS, and the Montgomery and Aasberg Depression Rating Scale score in operated patients was substantially reduced from pre-operatively to post-operatively. Further, fatigue may represent an important unrecognized side effect of long-term stimulation, as fatigue was found to increase rapidly in operated patients already a year after surgery and continued to increase trough the 6- to 9-year follow-up. CONCLUSIONS: The non-motor problems of advanced PD seem to develop independently of treatment with STN-DBS. This may influence the strategy for choice of when to perform this therapy for eligible patients.

Motor symptoms after deep brain stimulation of the subthalamic nucleus.

OBJECTIVES: Stimulation of the subthalamic nucleus (STN-DBS) is an established treatment with long-term beneficial effects on motor symptoms in patients with Parkinson's disease (PD). The efficacy of STN-DBS on non-dopaminergic motor symptoms remains less elucidated. In this study, we have examined short- and long-term impacts of STN-DBS on the development of the postural instability and gait difficulties (PIGD) phenotype, freezing of gait (FOG), and falls. MATERIALS AND METHODS: We collected data from a prospectively followed cohort of patients that had been operated with STN-DBS 6-9 years before final examination and compared our findings to the longitudinal development of the same symptoms in a non-operated, historical reference population. RESULTS: During short-term follow-up after surgery, we observed a marked improvement in mean UPDRS-motor score from 27 to 18. We also found clear improvements in tremor, bradykinesia, rigidity, and PIGD scores. However, 6-9 years after surgery, all patients had a dominating PIGD pattern of parkinsonism and 50% of the patients had developed FOG and/or had become recurrent fallers. The disease development in a group of patients with PD from the presurgery period had a similar trajectory as among the operated patients. In addition, mean annual change of both bradykinesia and PIGD scores was nearly identical in both study groups while tremor and rigidity had a significant better development in the operated patients. CONCLUSIONS: We found that STN-DBS induces an acute improvement of PIGD symptoms. The following long-term development was however characterized by a marked progression of non-dopaminergic symptoms.

[Cerebral metastases treated with stereotaxic gamma radiation. 6-year experience with the "gamma knife" at the Haukeland hospital]. / Hjernemetastaser behandlet med stereotaktisk gammabestråling. Seks års erfaring med bruk av "gammakniven" ved Haukeland Sykehus.

During the last 6 years we have treated 32 patients with 45 metastases to the brain in the Gamma Knife unit. 21 of these were treated exclusively with the Gamma Knife. The remaining 11 patients received radiosurgery for recurrent disease after surgery and whole-brain irradiation (six patients), new metastases after whole-brain irradiation alone (three patients) or for local regrowth after surgery (two patients). The range of tumour volume was 0.1-43.3 cm3 (median 2.4 cm3). Marginal tumour dose was 5-30 Gy (median and mean: 25 Gy) to the 30-70% isodose-volume line according to tumour volume and localization. 19 patients died during the period of follow-up. Only three patients died from their intracranial metastases. Thus, local growth control was achieved in 29 patients. 16 patients died from extracranial manifestations. The average survival time for the patients who died during the observation period was 11 (1-37 months), and the survival time for patients still alive was 10-75 (median 14, average 29) months. Mean observation period for all patients was 17 (1-75) months. Brain metastases are physically and biologically ideal lesions to treat with radiosurgery. Stereotactic radiosurgery applied to radiographically small and distinct metastases is safe, non-invasive and highly effective. The treatment requires only a short stay in hospital, and is much less inconvenient to the patient than open surgery or whole-brain irradiation. Radiosurgery can be used on lesions inaccessible to open neurosurgery or resistant to classical fractionated radiotherapy. Gamma Knife treatment has become our first choice for patients with less than four intracranial metastases with diameters less than 3-3.5 cm.

Infantile fibrosarcoma in the mandible: case report.

A case of an infantile fibrosarcoma in the mandible is described. The primary tumor was seen in a 2.5 yr-old boy. In spite of repeated surgical interventions the tumor recurred five times during a 15-yr period, but no metastases have been observed. The difficulty in arriving at a correct histopathologic diagnosis on an unusual tumor in the oral region is demonstrated by the fact that 16 consulted pathologists suggested a long list of different tumors. The treatment of choice seems to be radical surgery. The patient has remained well and without recurrence for the last 7 yr.

Outer membrane protein pattern of Eubacterium plautii.

The outer membrane SDS-PAGE pattern of Eubacterium plautii was characterized by a large number of surface exposed low- and high-molecular-mass proteins. Silver stainable carbohydrate was not present. The pattern was clearly distinct from those of outer membrane preparations of Eubacterium saburreum and Fusobacterium nucleatum. The results are compatible with a Gram-positive cell wall structure in E. plautii.