Efficacy of bilateral subthalamic nucleus (STN) stimulation in Parkinson's disease.

BACKGROUND: Deep brain stimulation (DBS) has, for the most part, replaced irreversible stereotactic coagulations in the surgical treatment of advanced Parkinson's disease. This study was undertaken to evaluate the benefits of bilateral STN stimulation related to its potential risks and side effects. METHOD: Twenty-nine consecutive Parkinsonian patients treated with STN-DBS were prospectively followed-up. Effects on Parkinsonian symptoms were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS). The evaluation was performed preoperatively and included postoperative follow-up evaluations at one and twelve months. All evaluations were made during the patient's best on-medication phase and postoperative follow-ups were conducted under both stimulator-on and stimulator-off conditions by a blinded neurologist. A neuropsychologist also evaluated the patients at every visit. FINDINGS: Two patients were excluded from the analysis because of severe surgical complications and three for an infection demanding the removal of the stimulator material. Other complications and side effects were clearly milder and temporary. At twelve months after surgery dyskinesia scores in the UPDRS were 53% lower than preoperative values. The results of the UPDRS motor scores improved 31.4% and activities of daily living (ADL) scores increased 19% compared with the preoperative situation. Also, the daily levodopa dose was 22% lower. Neuropsychological changes were minor, except for some deterioration in verbal fluency. CONCLUSION: The majority of Parkinsonian patients experienced significant and long lasting relief from their motor symptoms and an improvement in ADL functions due to DBS-STN therapy when evaluated at the best on-medication phase.

Long-term prognosis for children with shunted hydrocephalus.

We reviewed the previous medical history and the social status of all patients of Oulu University Central Hospital who had had in the age range 16-26 years shunted hydrocephalus (HC) during childhood. Of 42 patients selected 7 had died and another 5 had been institutionalized for severe mental handicap. Shunts had been changed a total of 103 times in 29 patients still living. The most common reason for a reoperation was blockage. Half of the patients re-examined showed neurological abnormalities or epilepsy. Both the verbal and the nonverbal IQ of the patients remained weak to average. Even though the patients' medical prognosis was fair, their social maturation did not keep up with their physical abilities. One-third were receiving or had received vocational training, but only a few were working. Up to one-quarter of the patients with shunted HC were at home without any meaningful work activities.

Effect of open heart surgery on intellectual performance.

The interrelationship between postoperative psychosis, neurologic symptoms, and changes in tests of cognitive performance have been studied in a series of 60 cardiac valvular patients who underwent open heart surgery. The effects of preoperative psychological, psychiatric, and cardiologic factors on postoperative cognitive changes were analyzed. The investigation period was from five months before up to five months after the operation. There was a general trend towards improvement in intellectual performances. The psychotic group, however, still showed a persisting impairment in some visual and psychomotor tests several months after the surgery. The group with neurologic symptoms showed impairment in one visual test. Of the preoperative variables, mitral valve disease, a high level of hypochondriasis and anxiety, and poor performance in some visual and psychomotor tests predicted postoperative intellectual impairment. The results suggest two types of cerebral complications of open heart surgery. Postoperative psychosis reflects diffuse brain dysfunction manifesting itself in psychological tests long after the clinical symptoms have resolved. The presence of neurologic symptoms refers to a focal or lateralized injury. Both the neurologic and neuropsychologic findings indicate that the right hemisphere may be prone to dysfunction than the left hemisphere.

Neuropsychologic outcome after open-heart surgery.

A neuropsychologic (NP) study was carried out on 49 patients who had had cardiac valvular replacement to investigate the determinants of postoperative outcome. The results were assessed together with operative data and with neurologic and quantitative EEG (QEEG) findings. Of the operative variables, perfusion time and unexpected intraoperative events were the most important factors leading to postoperative NP impairment. Clinical neurologic outcome correlated positively with NP changes. Differences between various cardiologic and age groups were found in the postoperative NP findings. Changes in frequency in QEEG reflected the NP changes more reliably than did amplitude. Significantly one of the tests, a modification of the Stroop color test, was found to be prognostically important, suggesting that it might be possible to construct test batteries of value in predicting high operative risk. The results show that multiparameter investigation using NP testing together with clinical and QEEG follow-up is useful in the assessment of cerebral disorders attributable to open-heart surgery.