ABSTRACT
The current diagnosis of Parkinson's disease (PD) is based on a subjective assessment by the specialist. The monitoring of the tremor that presents in the hand index fingers in a patient with Parkinson's is one of the most important parameters to diagnose the evolution of the disease in an objective manner. This research analyze the tremor in the hand index fingers of patients with PD with medication and without medication. A sensor based in a triaxial accelerometer was used to acquire the data produced by the acceleration changes of parkinsonian tremor in the case of three activities: postural tremor, action tremor and rest tremor. Acquired data were processed in Matlab; the data were filtered and the spectral power density (PSD) was estimated with the Burg periodogram. It has been verified that the system presented in this article can accurately detect the parkinsonian tremors of the patients evaluated, additionally has been found that with the medication the tremors do not disappear completely, these remained with the same frequencies of PD but with a very small amplitude.
Subject(s)
Parkinson Disease , Tremor , Acceleration , Fingers , HumansABSTRACT
UNLABELLED: The objective of this study was to evaluate the changes in the concentrations of certain brain metabolites in 13 patients with Parkinson's disease before and after bilateral subthalamic nucleus (STN DBS). The N-acetylaspartate (NAA)/choline (Chol), NAA/creatine (Cr), Chol/Cr ratios were determined by single voxel Proton magnetic resonance spectroscopy ((1)H-MRS) studies on 1.0T unit using short TE stimulated echo acquisition mode (STEAM) sequence. Spectra were obtained from the right and left globus pallidus, and left fronto-basal cortex. The patients were also assessed according to the UPDRS part III, in the "medication-on and off" conditions. CONCLUSIONS: after STN DBS cortical NAA/Cho, NAA/Cr ratios increased significantly, which were highly correlated with the significant improvements of the UPDRS scores.
Subject(s)
Deep Brain Stimulation/methods , Magnetic Resonance Spectroscopy , Parkinson Disease/therapy , Subthalamic Nucleus/metabolism , Aged , Aspartic Acid/metabolism , Choline/metabolism , Creatine/metabolism , Female , Humans , Male , Middle Aged , ProtonsABSTRACT
OBJECTIVE: Authors evaluated the therapeutic effect of the MRI and microelectrodeguided stereotactic pallido- and pallido-thalamotomy in 33 patients with Parkinson's disease (PD), whose symptoms were refractory to pharmacological therapy. MATERIAL AND METHODS: The patients were evaluated according to the internationally standardized rating scales (UPDRS part II, III, Schawb & England, Hoehn & Yahr, and Fahn) at six timepoints: before the operation, and 2 days, 3, 6, 9 and 12 months postoperatively. The patients were divided into 2 groups. Those in group A had relief of all main parkinsonian symptoms after pallidotomy including tremor. The patients in group B had no relief of tremor after pallidotomy. For them the pallidotomy was completed by thalamotomy in the same sitting, which had resulted in cessation of tremor. RESULTS: The following results were obtained by using the UPDRS part III: after pallidotomy "On state" mean: preoperative 51.2, postoperative at 2nd day 29.5 at 3, 6 and 9th month 26, and at 12th month 28.7. "Off state" mean: preoperative 64.3, postoperative at 2nd day 31.6, at 3, 6 and 9th month 26, and at 12th months 30.5. After pallidothalamotomy "On state" mean: preoperative 43.5, postoperative at 2nd day 27.9, at 3rd month 22.9, at 6th month 22.8, and at 9 and 12th month 24.5. "Off state" mean: preoperative 62.6, postoperative at 2nd day 38, at 3rd month 30, at 6th month 31,8 and at 9 and 12th month 33.8. CONCLUSIONS: For those patients, whose tremor was not successfully controlled by pallidotomy, the combined pallido-thalamotomy was effective. The clinical symptomps, according to the rating scales, improved significantly in both groups (student t: P<0.0001), but bilateral lesioning carried higher surgical morbidity.
Subject(s)
Microelectrodes , Pallidotomy/methods , Parkinson Disease/surgery , Stereotaxic Techniques , Thalamus/surgery , Brain Mapping , Disability Evaluation , Electric Stimulation Therapy , Electrophysiology , Female , Humans , Male , Middle Aged , Psychomotor Performance , Treatment OutcomeABSTRACT
Objetivo. Los autores valoraron el efecto terapéutico de palidotomía y palido-talamotomía combinada guiada por MR y microelectrodos en 33 pacientes con enfermedad de Parkinson, cuyos síntomas fueron resistentes al tratamiento farmacológico. Material y métodos. Los pacientes fueron evaluados en base a los test estandarizados a nivel internacional que se efectuaron antes y después de la operación: al 2ºdía, así como a lo largo de 12 meses, con un intervalo de 3 meses entre ellos. Los pacientes fueron divididos en dos grupos; en los del grupo "A", los síntomas parkinsonianos, incluso el temblor, disminuyeron después de una palidotomía. En los pacientes del grupo "B", el temblor no disminuyó tras la palidotomía, razón por la cual ésta se complementó con una talamotomía. Resultados. Con la ayuda de la escala UPDRS III se obtuvieron los siguientes resultados: después de la palidotomía en fase on el promedio preoperatorio de 51,2 disminuyó a 29,5 al 2º día, a 26 a los 3, 6 y 9meses, y a 28,7 a los 12 meses después de la operación; en fase off el promedio preoperatorio de 64,3 declinó a 31,6 al 2º día, a 26 a los 3, 6 y 9 meses, y a 30,5 a los12 meses después de la operación. Después de la palidotalamotomía en fase on el promedio preoperatorio de43,5 disminuyó a 27,9 al 2º día, a 22,9 a los 3 meses, a22,8 a los 6 meses, y a 24,5 a los 9 y 12 meses después dela operación. De igual manera, en fase off el promedio preoperatorio de 62,6 declinó a 38 al 2º día, a 30 a los3 meses, a 31,8 a los 6 meses, y a 33,8 a los 9 y 12 meses después de la operación. Conclusión. Para aquellos pacientes, en quienes la palidotomía no fue suficiente en el control del temblor, la palido-talamotomía fue efectiva. Los síntomas clínicos, de acuerdo con las escalas utilizadas, mejoraron significativamente en los dos grupos (student t:P<0,0001); sin embargo, las lesiones bilaterales conllevan un alto riesgo de morbilidad
Objective. Authors evaluated the therapeutic effect of the MRI and microelectrode guided stereotactic pallido- and pallido-thalamotomy in 33 patients with Parkinson's disease (PD), whose symptoms were refractory to pharmacological therapy. Matherial and methods. The patients were evaluated according to the internationally standardized rating scales (UPDRS part II, III, Schawb & England, Hoehn& Yahr, and Fahn) at six time points: before the operation, and 2 days, 3, 6, 9 and 12 months postoperatively. The patients were divided into 2 groups. Those in groupA had relief of all main parkinsonian symptoms after pallidotomy including tremor. The patients in group B had no relief of tremor after pallidotomy. For them the pallidotomy was completed by thalamotomy in the same sitting, which had resulted in cessation of tremor. Results. The following results were obtained by using the UPDRS part III: after pallidotomy "On state" mean: preoperative 51,2, postoperative at 2nd day 29,5at 3, 6 and 9th month 26, and at 12th month 28,7. "Off state" mean: preoperative 64,3, postoperative at 2nd day 31,6, at 3, 6 and 9th month 26, and at 12th months 30,5.After pallidothalamotomy "On state" mean: preoperative43,5, postoperative at 2nd day 27,9, at 3rd month22,9, at 6th month 22,8, and at 9 and 12th month 24,5."Off state" mean: preoperative 62,6, postoperative at2nd day 38, at 3rd month 30, at 6th month 31,8 and at 9and 12th month 33,8.Conclusions. For those patients, whose tremor was not successfully controlled by pallidotomy, the combined pallido-thalamotomy was effective. The clinical symptomps, according to the rating scales, improved significantly in both groups (student t: P<0,0001), butbilateral lesioning carried higher surgical morbidity
Subject(s)
Male , Female , Middle Aged , Humans , Parkinson Disease/surgery , Stereotaxic Techniques , Thalamus/surgery , Globus Pallidus/surgery , Magnetic Resonance Imaging , Treatment Outcome , Follow-Up Studies , MicroelectrodesABSTRACT
The objective of this study was to determine the influence of stereotactic ablative surgical interventions on the time required for the performance of manual tasks (i.e. performance time) in patients with Parkinson's disease (PD). We studied 28 patients after pallidotomy and pallido-thalamotomy who were evaluated at four time: before the operation, and 2 days, 3 and 6 months postoperatively. The speed of performance of handwriting and drawing were assessed by means of a chronometer using certain parts of an international standard scale (modified by Fahn). The patients were also assessed according to the Unified Parkinson's Disease Rating Scale (UPDRS) part III. The patients were divided into two groups. Those in group A had relief of all main Parkinsonian symptoms after pallidotomy including tremor. The patients in group B had no relief of tremor straight after pallidotomy. For them the pallidotomy was completed with thalamotomy in the same sitting, which had resulted in cessation of tremor. The time of performance of the manual tasks diminished significantly in all cases in both groups (Student's t-test: p<0.0001). No complications developed following pallidotomy. Pallido-thalamotomy caused transient adverse effects in two patients, and one patient developed permanent adverse effects such as dysarthria and dysequilibrium. Significant improvements were observed in the speed of handwriting and drawing in both groups, but pallido-thalamotomy was accompanied with complications.
Subject(s)
Neurosurgical Procedures , Parkinson Disease/psychology , Parkinson Disease/surgery , Psychomotor Performance/physiology , Globus Pallidus/surgery , Handwriting , Humans , Neurosurgical Procedures/adverse effects , Prospective Studies , Stereotaxic Techniques , Thalamus/surgeryABSTRACT
INTRODUCTION: Better understanding of the basic mechanism of disorders of movement, together with improvements in surgery and electrophysiological techniques have led to a resurge of interest in the surgical treatment of patients with tremor. Ventrolateral thalamotomy has been considered to be an alternative neurosurgical treatment for disabled persons including those with drug-resistant Parkinson s disease and other types of tremor. PATIENTS AND METHODS: Thirty four of 47 patients had Parkinson s disease (n= 23), essential tremor (n= 4), multiple sclerosis (n= 5), olivopontocerebellar lesion (n= 1) and posttraumatic tremor (n= 1) and did not show satisfactory improvement after drug treatment. The lesions were made in the thalamic nucleus. In 26 patients simultaneous recordings were made of nerve activity in the thalamus and of burst activity. RESULTS: In 23% of the cases the appropriate site for the final lesion could not be determined in accordance with electrostimulation of the empirical objective. In these patients the objective was determined after observation of the electrophysiological activity localized to the burst activity seen during the operation. The patients were followed-up for 6-24 months (average 12 months); 88% of them had no tremor or moderate contralateral tremor. The patients were assessed on a modified Fahn scale. Average scoring fell from a preoperative evaluation of 73.8 points to 34.0 after three months; 30.7 after six months, 32.0 after 9 months, 37.1 after 12 months and 35.2 points after 18 months. CONCLUSION: Of 47 thalamotomies done, 13 (29%) were successful and 5 (10%) maintained their original state, but no cases became worse or had serious complications.
Subject(s)
Parkinson Disease/therapy , Tremor/therapy , Ventral Thalamic Nuclei/surgery , Corpus Striatum/pathology , Corpus Striatum/surgery , Electric Stimulation/methods , Electrocoagulation/methods , Electrodes , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neurosurgical Procedures/methods , Parkinson Disease/diagnosis , Parkinson Disease/surgery , Preoperative Care , Stereotaxic Techniques/instrumentation , Tremor/diagnosis , Tremor/surgery , Ventral Thalamic Nuclei/pathologyABSTRACT
Introducción. El mayor entendimiento del mecanismo fundamental en el trastorno de los movimientos acoplados con el perfeccionamiento en la cirugía y técnicas electrofisiológicas ha conducido al resurgimiento del interés en los tratamientos quirúrgicos en los pacientes con temblor. La talamotomía ventrolateral ha sido considerada como una alternativa en el tratamiento neuroquirúrgico para incapacitados, personas con enfermedad de Parkinson resistente a los fármacos y para otros tipos de temblor. Pacientes y métodos. Trenta y cuatro de 47 pacientes padecían enfermedad de Parkinson (n= 23), temblor esencial (n= 4), esclerosis múltiple (n= 5), olivopontocerebelosa (n= 1), o temblor postraumático (n= 1), los cuales no mejoraron ante la terapia de medicamentos. Las lesiones se realizaron en el núcleo del tálamo (Vim). El registro de la actividad neural se llevó a cabo en el tálamo; al mismo tiempo, se registró la actividad salva (burst) en 26 pacientes. Resultados. En el 23 por ciento de los casos no pudo determinarse cuál es el lugar apropiado para la lesión final de acuerdo con la electroestimulación del objetivo empírico. En estos pacientes el objetivo fue determinado tras la observación de la actividad electrofisiológica localizada en la actividad multiunitaria (burst) durante la operación. Los pacientes tuvieron un seguimiento de 6-24 meses (promedio 12 meses). El 88 por ciento de ellos ya no sufren, o sufren moderadamente, temblor contralateral.Los pacientes fueron evaluados con la escala modificada de Fahn. La puntuación promedio de la evaluación preoperativa declinó de 73,8 puntos a 34,0 a los tres meses, a 30,7 en seis meses, a 32,0 en nueve meses, a 37,1 en 12 meses y a 35,2 puntos a los 18 meses.Conclusión. De las 47 talamotomías, 13 (29 por ciento) han trascendido y 5 (10 por ciento) han mantenido, pero no se detectó empeoramiento ni complicaciones graves (AU)
Subject(s)
Middle Aged , Male , Female , Humans , Stereotaxic Techniques , Tremor , Neurosurgical Procedures , Parkinson Disease , Preoperative Care , Ventral Thalamic Nuclei , Corpus Striatum , Magnetic Resonance Imaging , Electrocoagulation , Electrodes , Electric StimulationABSTRACT
INTRODUCTION: Medial thalamotomy is one of the first stereotactic operations to have been used for neurogenic pain, has a low complication rate and no risk of the development of iatrogenic neurogenic pain. It represents selective local relief for all types of pain, without causing somatosensorial deficit. PATIENTS AND METHODS: We did 39 posteromedial thalamotomies in patients with persistent intractable pain due to various disorders. The pain was assessed pre- and postoperatively on the VAS (Visual Analogic Scale). RESULTS: Half of the patients operated on had relief of pain after thalamotomy. In 84% (n = 39) of our cases this relief occurred on the second day, in 70% (n = 35) after three months, in 63% (n = 27) after six months, in 64% (n = 25) after nine months, in 62% (n = 23) of the patients after 12 months, and in 62% (n = 22) after 24 months. Three patients had temporary complications and one a permanent complication, but this did not make him an invalid. CONCLUSION: Posteromedial stereotactic thalamotomy under MR guidance can provide safe, effective treatment for persistent, intractable pain.