ABSTRACT
BACKGROUND AND PURPOSE: Deep brain stimulation (DBS) for severe Parkinson's disease (PD) outperforms the best medical treatment in controlling motor symptoms and improving quality of life. Nevertheless disease progression cannot be controlled, and the development of dementia over time is nearly inevitable, often resulting in nursing home placement. Ten-year survival, development of hallucinations, dementia and nursing home placement were examined and adverse events were assessed. METHOD: Patient files were scrutinized from baseline up to 10 years of treatment or death on all 79 PD patients treated with DBS of the subthalamic nucleus from 1998 to 2003 at Aarhus University Hospital. RESULTS: Twenty-four patients died during the follow-up period of 10 years. Age above 60 years at surgery increased mortality 2.3-fold (P = 0.04). Of the 55 surviving patients 29 (53%) were demented and 19 (35%) were in nursing homes. Average time from operation to dementia was 5.6 ± 2.9 years. Hallucinations and nursing home placement were associated with increased mortality. CONCLUSION: Survival of 70% after a mean of 25 years of PD including 10 years with DBS illustrates that this is a selected group of PD patients. The prevalence of dementia steadily increased after surgery as expected from disease progression and can be an early event. Compared with the few similar long-term studies, the present study presents a larger cohort followed at the same DBS center for a longer period of time and none was lost to follow-up, making conclusions more valid. The present findings are of significant prognostic help for the patient, caregiver and physician when treatment with DBS has to be decided.
Subject(s)
Deep Brain Stimulation/methods , Disease Progression , Outcome Assessment, Health Care , Parkinson Disease/therapy , Subthalamic Nucleus , Aged , Dementia/etiology , Female , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in alleviating Parkinson's disease (PD) symptoms (tremor, rigidity and bradykinesia) and may improve gait and postural impairment associated with the disease. However, improvement of gait is not always as predictable as the clinical outcome. This may relate to the type of gait impairment or localization of the active DBS contact. METHODS: The active contact was visualized on peri-operative magnetic resonance imaging in 22 patients with idiopathic PD, consecutively treated with bilateral STN DBS. Stimulation site was grouped as either in the dorsal/ventral STN or medial/lateral hereof and anterior/posterior STN or medial/lateral hereof. The localization was compared with relative improvement of clinical outcome (UPDRS-III). In 10 patients, quantitative gait analyses were performed, and the improvement in gait performance was compared with stimulation site in the STN. RESULTS: Of 44 active contacts, 77% were inside the nucleus, 23% were medial hereof. Stimulation of the dorsal half improved UPDRS-III significantly more than ventral STN DBS (P = 0.02). However, there were no differences between anterior and posterior stimulation in the dorsal STN. Step velocity and length improved significantly more with dorsal stimulation compared with ventral stimulation (P = 0.03 and P = 0.02). Balance during gait was also more improved with dorsal stimulation compared with ventral stimulation. CONCLUSIONS: Deep brain stimulation of the dorsal STN is superior to stimulation of the ventral STN. Possible different effects of stimulation inside the nucleus underline the need for exact knowledge of the active stimulation site position to target the most effective area.
Subject(s)
Deep Brain Stimulation/methods , Magnetic Resonance Imaging/methods , Parkinson Disease/therapy , Subthalamic Nucleus/surgery , Aged , Deep Brain Stimulation/instrumentation , Electrodes, Implanted , Female , Gait Disorders, Neurologic/etiology , Gait Disorders, Neurologic/therapy , Humans , Male , Middle Aged , Monitoring, Intraoperative/instrumentation , Monitoring, Intraoperative/methods , Neural Pathways/anatomy & histology , Neural Pathways/physiology , Neural Pathways/surgery , Neuronavigation/methods , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Stereotaxic Techniques , Subthalamic Nucleus/anatomy & histology , Treatment OutcomeABSTRACT
This study examined the contribution of imagery ability to psychological and physiological responses to stress and relaxation. Individuals (N = 176) participated in two study sessions. In the first session, participants completed the Creative Imagination Scale and were block-randomized to a stress or relaxation condition based on imaging scores. During the second session, stress and mood were assessed before and after participants watched a stressful movie or listened to a relaxation tape. Finger temperature was monitored during the interventions. Changes in temperature and in self-reports of stress and mood indicated that the manipulations were effective. In comparison to low imagers, high imagers reported greater stress after the movie and less stress and negative affect after the relaxation tape. Imagery ability predicted neither levels of negative affect following the stress condition nor changes in positive affect or temperature during the interventions. In the stress condition, expectations of stress partially mediated the relation between imagery ability andpsychological stress. In contrast, expectations of relaxation did not significantly predict responses to the relaxation intervention. These findings suggest that imagery ability is related to greater subjective responses to both stress and relaxation and that, in stressful situations, expectancies may account for some of the effects of imagery ability on perceived stress.
