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1.
eNeuro ; 5(1)2018.
Article in English | MEDLINE | ID: mdl-29445770

ABSTRACT

Economic decision-making is disrupted in individuals with gambling disorder, an addictive behavior observed in Parkinson's disease (PD) patients receiving dopaminergic therapy. The subthalamic nucleus (STN) is involved in the inhibition of impulsive behaviors; however, its role in impulse control disorders and addiction is still unclear. Here, we recorded STN local field potentials (LFPs) in PD patients with and without gambling disorder during an economic decision-making task. Reaction times analysis showed that for all patients, the decision whether to risk preceded task onset. We compared then for both groups the STN LFP preceding high- and low-risk economic decisions. We found that risk avoidance in gamblers correlated with larger STN LFP low-frequency (<12-Hz) fluctuations preceding task onset. In particular, the amplitude of low-frequency LFP fluctuations carried significant information about future decisions. Decisions of patients not affected by gambling disorder were instead not correlated with pretask STN LFP. Our results suggest that STN activity preceding task onset affects risk decisions by preemptively inhibiting attraction to high but unlikely rewards in favor of a long-term payoff.


Subject(s)
Gambling/physiopathology , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Subthalamic Nucleus/physiopathology , Adult , Aged , Avoidance Learning/physiology , Cohort Studies , Decision Making/physiology , Deep Brain Stimulation , Female , Humans , Male , Middle Aged , Parkinson Disease/therapy , Reaction Time , Time Factors
2.
JDR Clin Trans Res ; 2(3): 304-311, 2017 Jul.
Article in English | MEDLINE | ID: mdl-28879250

ABSTRACT

Distress tolerance, the degree to which one is able to cope with and endure negative emotional states, has been broadly applied to understand and treat a variety of health (including behavioral) problems, but little is known about its role in oral health care and specifically dental care-related fear and anxiety, making it a novel construct in the oral health care literature. This cross-sectional study examined distress tolerance as a possible predictor of dental fear and anxiety among a sample of adults with and without diagnoses of dental phobia, investigated possible differences in levels of distress tolerance between adults with and without dental phobia, and determined possible associations between distress tolerance and fear of pain, anxiety sensitivity, and depression. Using 52 volunteers (n = 31, dental phobia group; n = 21, healthy comparison group), this investigation used self-report measures of distress tolerance, fear of pain, anxiety sensitivity, dental fear, and depression. The Anxiety Disorders Interview Schedule, a semi-structured interview, was used to assess for dental phobia and other psychological disorders. Distress tolerance significantly predicted dental fear and anxiety, even after controlling for age, sex, fear of pain, anxiety sensitivity, and depression. In addition, the dental phobia group had lower distress tolerance than the healthy comparison group. Distress tolerance was significantly associated with fear of pain, anxiety sensitivity, and depression. Findings indicate that low distress tolerance plays a unique and distinct role as a possible mechanism in the genesis of dental care-related fear and anxiety and phobia and may exacerbate the experience of other states, including fear of pain and anxiety sensitivity. Knowledge Transfer Statement: Results indicate that patients who have a lower ability to tolerate emotional and physical distress may have higher levels of dental care-related fear and anxiety and even dental phobia, as well as associated sequelae (e.g., avoidance of dental care). Treatment of highly fearful dental patients may helpfully include a focus on increasing distress tolerance.

4.
Eur J Neurol ; 22(3): 426-e32, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25382808

ABSTRACT

BACKGROUND AND PURPOSE: There is increasing evidence that deep brain stimulation (DBS) of the globus pallidus internus (GPi) is effective in patients with idiopathic or inherited generalized dystonia. There is comparatively less experience about the effects of GPi DBS on acquired dystonia, particularly dystonia due to cerebral palsy (DCP). Clinical and demographic outcome predictors for DBS in dystonia syndromes are also poorly defined. Our aim was to examine the efficacy and safety of GPi DBS for the treatment of generalized DCP. METHODS: Fifteen patients with DCP up to 6.2 years after DBS surgery were studied. Only mild limb spasticity or mild static brain magnetic resonance imaging abnormalities were acceptable for inclusion. Dystonia severity and disability were assessed by the Burke-Fahn-Marsden dystonia rating scale (BFMDRS), and health-related quality of life was assessed by the Short Form General Health Survey (SF-36) scale. The amount of energy delivered was calculated, and adverse events and side effects were collected. RESULTS: At last follow-up, BFMDRS motor score improved on average by 49.5%, and the disability score improved by 30%. Health-related quality of life improved in most patients. Age at implant, age at onset and disease duration did not correlate to outcome, whilst higher pre-operative dystonia severity and occurrence of spasticity were associated with poorer outcome. The patients received a stable amount of energy after the first 2 years post-implant and throughout all the observation period. There were few serious adverse events or side effects. CONCLUSIONS: The outcome was encouraging in the majority of DCP patients, with a stable outlook and a good safety profile.


Subject(s)
Cerebral Palsy/complications , Deep Brain Stimulation/methods , Dystonia/therapy , Globus Pallidus , Adolescent , Adult , Dystonia/etiology , Female , Follow-Up Studies , Globus Pallidus/surgery , Humans , Male , Middle Aged , Time Factors , Treatment Outcome , Young Adult
5.
J Neurol Neurosurg Psychiatry ; 86(5): 562-4, 2015 May.
Article in English | MEDLINE | ID: mdl-25012201

ABSTRACT

OBJECTIVE: To document the occurrence of impulse control behaviours (ICBs) in patients with Parkinson's disease after 3 years of continuous deep brain stimulation (DBS) of the subthalamic nucleus (STN). METHODS: Detailed neurological and ICB assessments were performed before STN DBS and up to 3 years after implant. RESULTS: 13 out of 56 patients (23.2%) had ICBs at baseline; they took higher doses of dopamine agonists (DAA). Three years after implant 11 had fully remitted with a 60.8% reduction of DAA medication; the remaining two, who had a similar medication reduction, had only compulsive eating, having recovered from hypersexuality. Six of the 43 patients without ICBs at baseline (14%) developed transient de novo ICBs after implant; none of them had ICBs at the 3-year observation. CONCLUSIONS: ICBs were abolished in patients 3 years after STN DBS and DAA dosages were lowered. New ICBs may occur after implant and are transient in most cases. Compulsive eating may be specifically related to STN stimulation.


Subject(s)
Deep Brain Stimulation , Disruptive, Impulse Control, and Conduct Disorders/complications , Disruptive, Impulse Control, and Conduct Disorders/therapy , Parkinson Disease/psychology , Parkinson Disease/therapy , Subthalamic Nucleus/physiology , Disruptive, Impulse Control, and Conduct Disorders/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Parkinson Disease/complications , Prospective Studies
6.
Parkinsonism Relat Disord ; 20(4): 376-81, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24508574

ABSTRACT

BACKGROUND: Deep Brain Stimulation of the Subthalamic Nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD), but only few studies investigated its long-term efficacy. Furthermore, little is known about the role of PD-subtype on STN-DBS long-term outcome. OBJECTIVE: To report the results of a long-term follow-up (mean 11 years, range 10-13) on 26 patients bilaterally implanted in two centres. METHODS: Patients were assessed preoperatively and 1, 5 and 11 years after the implant by the Unified Parkinson's Disease Rating Scale (UPDRS) and a battery of neuropsychological tests. Stimulation parameters, drugs dosages, non-motor symptoms and adverse events were also recorded. RESULTS: At 11 years, stimulation significantly improved the motor symptoms by 35.8%, as compared to the preoperative off-state. Motor complications were well controlled, with a 84.6% improvement of dyskinesias and a 65.8% improvement of motor fluctuations. Despite this, the UPDRS-II-on score worsened by 88.5%, mainly for the worsening of poorly levodopa-responsive symptoms. More than 70% of the patients performed in the normal range in most of the neuropsychological tests, despite the development of dementia in 22.7%. Age at disease onset, axial subscore in off-condition and presence of REM behaviour disorder at baseline were found to be associated with a higher risk of developing disability over time. CONCLUSIONS: Our study confirms the long-term safety and efficacy of STN-DBS in PD. Nevertheless, the functionality of patients worsens over time, mainly for the onset and progression of levodopa-resistant and non-motor symptoms. The role of PD-subtype seems to be relevant in the long-term outcome.


Subject(s)
Deep Brain Stimulation/methods , Parkinson Disease/therapy , Subthalamic Nucleus/physiopathology , Aged , Disease Progression , Follow-Up Studies , Humans , Middle Aged , Parkinson Disease/physiopathology , Time
7.
J Dent Educ ; 77(11): 1402-12, 2013 Nov.
Article in English | MEDLINE | ID: mdl-24192405

ABSTRACT

Social networking applications have become an established means of communication; applications that did not exist ten years ago are now used daily. Social media can be used for a myriad of reasons including instructional tools to supplement learning. This project was designed to assess the usage of social media applications by dental school faculty members and identify the types of accounts they prefer. Four hundred forty-three full-time dental and dental hygiene faculty members from five U.S. dental schools were invited to complete a twelve-item online survey regarding their social media usage. The response rate was 50 percent (n=221). Of the respondents, nearly half were dentists, and 62 percent were ≥51 years of age. Facebook was the most popular social network, reportedly used by 111 respondents. The most often reported frequency of use was weekly (20.4 percent, n=221); users indicated utilizing a network primarily for personal rather than professional purposes. However, 37 percent of the respondents reported not using any social media. The most frequently cited barriers to the use of social media were time (48 percent) and privacy concerns (48 percent). Although few would dispute the influence social media has on today's students, the suitability and appropriateness of social media technology and its integration into dental curricula require further evaluation.


Subject(s)
Education, Dental , Faculty, Dental , Social Media/statistics & numerical data , Adult , Communication Barriers , Curriculum , Educational Technology , Humans , Middle Aged , Surveys and Questionnaires , United States
8.
Gen Dent ; 61(2): 32-6; quiz 37, 2013.
Article in English | MEDLINE | ID: mdl-23454319

ABSTRACT

This study sought to determine the levels of blood contamination found in and/or on used dental anesthetic cartridges and to measure antibacterial effects after exposure to a local anesthetic solution. The study analyzed a total of 1000 used cartridges from an oral surgery clinic, containing 1 of 3 anesthetic types. Blood testing included visual observations (using a dissecting microscope) and chemical analyses. From each cartridge, either 0.5 ml of residual anesthetic solution or a combination of anesthetic solution plus added saline was removed. Using reagent strip dipsticks, the solutions were analyzed for minute amounts of blood. Visual examinations were scored on a positive or negative scale. In addition, 4 types of bacteria were mixed with lidocaine or phosphate buffered saline (PBS) for up to 30 days, and viable cell counts decreases were measured for the 2 solutions. A majority of the cartridges evaluated contained lidocaine, and while only 7 of the 1000 cartridges examined contained visible blood, the reagent strips detected blood in more than 76% of all cartridges. Lidocaine and PBS produced similar bacterial death rates. The authors concluded that blood contamination levels in the absence of pronounced antibacterial activity indicate that dental anesthetic cartridges could be considered a potential type of regulated medical waste.


Subject(s)
Anesthesia, Dental/instrumentation , Anti-Bacterial Agents/pharmacology , Blood Chemical Analysis/methods , Blood/drug effects , Dental Waste/analysis , Equipment Contamination/statistics & numerical data , Lacticaseibacillus casei/isolation & purification , Medical Waste Disposal/legislation & jurisprudence , Mycobacterium bovis/isolation & purification , Staphylococcus aureus/isolation & purification
9.
Neurology ; 77(12): 1191-7, 2011 Sep 20.
Article in English | MEDLINE | ID: mdl-21900627

ABSTRACT

OBJECTIVE: Neurophysiologic studies demonstrated that patients with primary torsion dystonia (PTD) and with psychogenic dystonia (Psy-D) share similar abnormalities in the motor system. In this study, we evaluated somatosensory function in Psy-D by testing temporal discrimination threshold (TDT), and compared the results with those obtained in patients with PTD. METHODS: TDT of tactile stimuli was assessed in 10 patients with Psy-D, 10 patients with PTD, and 16 control subjects. The 2 groups of patients were matched for age, gender, disease duration, and distribution of dystonia. Tactile stimuli consisted of pairs of non-noxious electrical shocks delivered to the right or left hand at interstimulus interval increasing from 0 to 400 msec, in 10-msec steps. TDT was defined as the value at which subjects recognized the 2 stimuli as asynchronous. RESULTS: TDT was higher in Psy-D and PTD compared to control subjects, for both the right and the left hand. In a subgroup of patients with unilateral dystonia (Psy-D = 4, PTD = 5), TDT did not differ between the affected and the unaffected side in both groups of patients. Disease duration was not correlated to the increased TDT value. CONCLUSIONS: Our study suggests an impaired processing of somatosensory inputs in both Psy-D and PTD. These abnormalities might represent a neurophysiological trait predisposing to develop a dystonic posture triggered by psychiatric and psychological factors.


Subject(s)
Discrimination, Psychological/physiology , Dystonic Disorders/physiopathology , Sensory Thresholds/physiology , Time Perception/physiology , Touch/physiology , Adult , Dystonic Disorders/diagnosis , Dystonic Disorders/psychology , Electric Stimulation/methods , Female , Humans , Male , Middle Aged , Young Adult
10.
Eur J Neurol ; 18(5): 772-7, 2011 May.
Article in English | MEDLINE | ID: mdl-21159067

ABSTRACT

BACKGROUND: Dopamine neurotransmission plays a key role in several brain activities, including motor, cognitive, and behavioral functions. Parkinson's disease (PD) typically begins with asymmetrical motor features related to asymmetrical dopamine denervation. This study was designed to examine whether distinct cognitive, behavioral, and personality features are related to this asymmetry. METHODS: Fifty-six patients with mild PD and lateralized motor features were grouped according to dominant side of motor features and evaluated using a neuropsychological assessment focused on attention and executive functions, impulse control disorders, and personality inventory. RESULTS: There were no differences in neuropsychological functions between patients with right and left lateralized PD, but differences occurred in personality features. Patients with motor impairment predominant on the left-hand side had prevalence of hypomania and conversion profile. CONCLUSIONS: This study suggests that side dominance of dopaminergic denervation may be related to personality features in patients with PD that could influence behavioral aspects.


Subject(s)
Functional Laterality/physiology , Mental Disorders/classification , Mental Disorders/diagnosis , Parkinson Disease/physiopathology , Parkinson Disease/psychology , Personality Disorders/classification , Personality Disorders/diagnosis , Aged , Humans , Male , Mental Disorders/etiology , Middle Aged , Parkinson Disease/complications , Personality Disorders/etiology
11.
J Oral Rehabil ; 36(5): 346-61, 2009 May.
Article in English | MEDLINE | ID: mdl-19382299

ABSTRACT

Parafunctional masticatory activity, such as the tooth clenching and grinding that is associated with bruxism, is encountered by clinicians in many disciplines, including dentistry, neurology and psychiatry. Despite this, little is known about the neurological basis for these activities. To identify the brain network engaged in such complex oromotor activity, functional magnetic resonance imaging (fMRI) was used to elucidate the brain activation patterns of 20 individuals (10 males and 10 females, mean s.d. age of 26.3+/-4.1 years) with (parafunctional, PFx group, 5M/5F) and without (normal functional, NFx group, 5 M/5F) self-reported parafunctional grinding and clenching habits during clenching and grinding tasks. Subject group classification was based on: (i) self-reported history, (ii) clinical examination, (iii) evaluation of dental casts and (iv) positive responses to the temporomandibular disorder (TMD) History Questionnaire [Dworkinand LeResche, Journal of Craniomandibular Disorders, (1992) 6:301]. While subjects performed these oromotor tasks, each wore a custom-designed oral appliance minimizing head motion during imaging. Mean per cent signal changes showed significant between group differences in motor cortical (supplementary motor area, sensorimotor cortex and rolandic operculum) and subcortical (caudate) regions. Supplementary motor area data suggest that motor planning and initiation, particularly during the act of clenching, are less prominent in individuals with oromotor parafunctional behaviours. The overall extent of activated areas was reduced in subjects with self-reported parafunctional masticatory activity compared with the controls. This study's methodology and findings provide an initial step in understanding the neurological basis of parafunctional masticatory activities that are relevant for therapeutic research applications of temporomandibular joint and muscle disorders and associated comorbidities.


Subject(s)
Brain/physiopathology , Bruxism/physiopathology , Adult , Artifacts , Brain Mapping/methods , Female , Head Movements , Humans , Image Interpretation, Computer-Assisted/methods , Magnetic Resonance Imaging/methods , Male , Mastication/physiology , Motor Cortex/physiopathology , Pilot Projects , Temporomandibular Joint Disorders/physiopathology , Young Adult
12.
Acta Neurochir Suppl ; 101: 13-21, 2008.
Article in English | MEDLINE | ID: mdl-18642628

ABSTRACT

Extradural motor cortex stimulation has been employed in cases of Parkinson's disease (PD), fixed dystonia (FD) and spastic hemiparesis (SH) following cerebral stroke. Symptoms of PD are improved by EMCS: results were evaluated on the basis of the UPDRS and statistically analysed. In PD EMCS is less efficacious than bilateral subthalamic nucleus (STN) stimulation, but it may be safely employed in patients not eligible for deep brain stimulation (DBS). The most rewarding effect is the improvement, in severely affected patients, of posture and gait. FD, unresponsive to bilateral pallidal stimulation, has been relieved by EDMS. In SH reduction of spasticiy by EMCS allows improvement of the motor function.


Subject(s)
Deep Brain Stimulation/methods , Dystonic Disorders/therapy , Motor Cortex/physiopathology , Muscle Spasticity/therapy , Parkinson Disease/therapy , Aged , Aged, 80 and over , Deep Brain Stimulation/statistics & numerical data , Dose-Response Relationship, Radiation , Electric Stimulation , Female , Follow-Up Studies , Humans , Italy , Male , Middle Aged , Quality of Life , Time Factors , Treatment Outcome
14.
J Neurol Neurosurg Psychiatry ; 78(3): 248-52, 2007 Mar.
Article in English | MEDLINE | ID: mdl-16690696

ABSTRACT

AIM: To assess the long-term cognitive and behavioural outcome after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients affected by Parkinson's disease, with a 5-year follow-up after surgery. METHODS: 11 patients with Parkinson's disease treated by bilateral DBS of STN underwent cognitive and behavioural assessments before implantation, and 1 and 5 years after surgery. Postoperative cognitive assessments were carried out with stimulators turned on. RESULTS: A year after surgery, there was a marginally significant decline on a letter verbal fluency task (p = 0.045) and a significant improvement on Mini-Mental State Examination (p = 0.009). 5 years after surgery, a significant decline was observed on a letter verbal fluency task (p = 0.007) and an abstract reasoning task (p = 0.009), namely Raven's Progressive Matrices 1947. No significant postoperative change was observed on other cognitive variables. No patient developed dementia 5 years after surgery. A few days after the implantation, two patients developed transient manic symptoms with hypersexuality and one patient developed persistent apathy. CONCLUSION: The decline of verbal fluency observed 5 years after implantation for DBS in STN did not have a clinically meaningful effect on daily living activities in our patients with Parkinson's disease. As no patient developed global cognitive deterioration in our sample, these findings suggest that DBS of STN is associated with a low cognitive and behavioural morbidity over a 5-year follow-up, when selection criteria for neurosurgery are strict.


Subject(s)
Cognition Disorders , Deep Brain Stimulation , Parkinson Disease/therapy , Subthalamic Nucleus/physiology , Aged , Bipolar Disorder/etiology , Deep Brain Stimulation/adverse effects , Female , Follow-Up Studies , Humans , Male , Mental Status Schedule , Middle Aged , Mood Disorders/etiology , Patient Selection
15.
Acta Neurochir Suppl ; 99: 13-9, 2006.
Article in English | MEDLINE | ID: mdl-17370756

ABSTRACT

Since 1995, at the Istituto Nazionale Neurologico "Carlo Besta" in Milan (INNCB,) 401 deep brain electrodes were implanted to treat several drug-resistant neurological syndromes (Fig. 1). More than 200 patients are still available for follow-up and therapeutical considerations. In this paper our experience is reviewed and pioneered fields are highlighted. The reported series of patients extends the use of deep brain stimulation beyond the field of Parkinson's disease to new fields such as cluster headache, disruptive behaviour, SUNCt, epilepsy and tardive dystonia. The low complication rate, the reversibility of the procedure and the available image guided surgery tools will further increase the therapeutic applications of DBS. New therapeutical applications are expected for this functional scalpel.


Subject(s)
Deep Brain Stimulation/methods , Movement Disorders/therapy , Parkinson Disease/therapy , Attention Deficit and Disruptive Behavior Disorders/therapy , Brain/pathology , Epilepsy/therapy , Humans , Magnetic Resonance Imaging , Movement Disorders/surgery , Pain Management , Parkinson Disease/surgery
17.
Brain ; 128(Pt 10): 2240-9, 2005 Oct.
Article in English | MEDLINE | ID: mdl-15975946

ABSTRACT

Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6-12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n = 49) or globus pallidus internus (GPi, n = 20) included in a multicentre study. Patients were assessed preoperatively and at 1 year and 3-4 years after surgery. The primary outcome measure was the change in the 'off' medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) at 3-4 years. Stimulation of the STN or GPi induced a significant improvement (50 and 39%; P < 0.0001) of the 'off' medication UPDRS-III score at 3-4 years with respect to baseline. Stimulation improved cardinal features and activities of daily living (ADL) (P < 0.0001 and P < 0.02 for STN and GPi, respectively) and prolonged the 'on' time spent with good mobility without dyskinesias (P < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P < 0.001). Comparison of the improvement induced by stimulation at 1 year with 3-4 years showed a significant worsening in the 'on' medication motor states of the UPDRS-III, ADL and gait in both STN and GPi groups, and speech and postural stability in the STN-treated group. Adverse events (AEs) included cognitive decline, speech difficulty, instability, gait disorders and depression. These were more common in patients treated with DBS of the STN. No patient abandoned treatment as a result of these side effects. This experience, which represents the first multicentre study assessing the long-term efficacy of either STN or GPi stimulation, shows a significant and substantial clinically important therapeutic benefit for at least 3-4 years in a large cohort of patients with severe Parkinson's disease.


Subject(s)
Deep Brain Stimulation/methods , Parkinson Disease/therapy , Activities of Daily Living , Adult , Aged , Antiparkinson Agents/adverse effects , Antiparkinson Agents/therapeutic use , Brain/physiopathology , Deep Brain Stimulation/adverse effects , Dyskinesia, Drug-Induced/physiopathology , Dyskinesia, Drug-Induced/therapy , Electrodes, Implanted , Female , Follow-Up Studies , Globus Pallidus/physiopathology , Humans , Levodopa/adverse effects , Levodopa/therapeutic use , Male , Middle Aged , Motor Activity/physiology , Parkinson Disease/drug therapy , Parkinson Disease/physiopathology , Subthalamic Nucleus/physiopathology , Time Factors , Treatment Outcome
18.
Neurology ; 64(11): 1958-60, 2005 Jun 14.
Article in English | MEDLINE | ID: mdl-15955954

ABSTRACT

Mutations in the PINK1 gene cause autosomal recessive parkinsonism characterized by early onset and a variable phenotypic presentation. A patient homozygous for the Ala168Pro mutation has been fully characterized clinically. Apart from onset at age 39 years and the excellent and sustained response to levodopa, all clinical and laboratory features, including SPECT and assessment of autonomic function, were indistinguishable from typical idiopathic Parkinson disease.


Subject(s)
Brain/metabolism , Brain/physiopathology , Mitochondrial Diseases/genetics , Mutation/genetics , Parkinsonian Disorders/genetics , Protein Kinases/genetics , Age of Onset , Brain/diagnostic imaging , Diagnosis, Differential , Dopamine Agents/therapeutic use , Energy Metabolism/genetics , Genetic Predisposition to Disease/genetics , Humans , Italy , Levodopa/therapeutic use , Male , Middle Aged , Mitochondria/genetics , Mitochondrial Diseases/diagnosis , Mitochondrial Diseases/diagnostic imaging , Parkinson Disease/diagnosis , Parkinson Disease/diagnostic imaging , Parkinson Disease/genetics , Parkinsonian Disorders/diagnosis , Parkinsonian Disorders/diagnostic imaging , Phenotype , Shy-Drager Syndrome/complications , Shy-Drager Syndrome/genetics , Shy-Drager Syndrome/physiopathology , Sympathetic Nervous System/physiopathology , Tomography, Emission-Computed, Single-Photon , Treatment Outcome
19.
Forensic Sci Int ; 146 Suppl: S107-11, 2004 Dec 02.
Article in English | MEDLINE | ID: mdl-15639553

ABSTRACT

On all sides there is an increasing need for a protocol in speaker recognition analysis. This need arises not only in the scientific word, but corresponds also to a requirement of guarantee and protection of all the individuals involved in criminal lawsuits. This study aims neither to resolve the problem of the protocol and of the fundamental steps in a speaker recognition analysis, nor to impose a precise methodology to be followed, but is an attempt to stir the stagnant waters of the debate on expert report phonic analysis. The most important steps in the realisation of a phonic expertise are outlined as a basis and a starting point for a future protocol to which should follow the establishment of a phonic experts list.


Subject(s)
Forensic Medicine/methods , Recognition, Psychology , Speech , Humans , Linguistics
20.
J Neurosurg Sci ; 47(3): 119-28, 2003 Sep.
Article in English | MEDLINE | ID: mdl-14618124

ABSTRACT

AIM: High frequency stimulation of the subthalamic nucleus (STN) is gaining recognition as a new symptomatic treatment for Parkinson's disease (PD). The first available long-term observations show the stability of the efficacy of this procedure in time. METHODS: Quadripolar leads were implanted bilaterally under stereotactic conditions in the STN of patients with advanced PD. High frequency stimulation was applied for 24 hours a day. Following implant, antiparkinsonian medication was reduced as much as possible and stimulation was gradually increased. The patients were evaluated in the practically defined "off" condition and in the "on" condition using the unified PD rating scale (UPDRS) and the Schwab & England scale. Neuropsychological testing was performed before and after the implant. Thirty-three patients were followed up for at least 3 months and 13 among them until 36 months. RESULTS: The patients had a mean age of 56.8+/-7.1 years and a mean disease duration of 13.8+/-5.5 years; they were followed-up for an average of 25.7+/-13.5 months. At the time of the last available visit, the stimulation amplitude was 2.47+/-0.40 V (the total energy delivered averaged 1.57+/-0.8 microW). The levodopa-equivalent daily dose was reduced by 56.2% (p<0.001). Parkinsonian features were improved in all patients, the greatest changes were seen for tremor, gait, bradykinesia and postural stability, then rigidity and limb akinesia. Compared with the pre-implant conditions, the UPDRS motor score in the "off" condition was improved by 51.6% at the time of the last visit (p<0.001), the UPDRS activities of daily living score was improved by 68.5% (p<0.001), the Schwab & England scale was improved by 196.8% (p<0.001). The neuropsychological data did not show significant changes. Night sleep improved in all patients, due to increased mobility at night. In almost all patients insomnia was resolved. All patients gained weight after surgery with an increase of 11.1% (p<0.001) compared to their pre-implant weight. The most common permanent side effects consisted in hypophonia and dysarthria, transient side effects were increased sexuality and mania, the most common side effects related to stimulation were ballic or choreic dyskinesias. The most common adverse event related to the surgical procedure was transient psychosis; unexplained switching-off of the stimulator was the most common device-related effect. CONCLUSION: This study extends our recently published 3-years FU series. It confirms again that symptomatic efficacy of STN stimulation is retained during the 2(nd) and 3(rd) years following the implant, without any obvious decay of efficacy or need for increase of energy delivered. Improvement of dyskinesias also persists and the procedure is well tolerated. Side effects and adverse events are sometimes severe, but can be managed in most cases. The improvement of daily living activities outweighs by far the motor benefit, indicating that the use of this procedure significantly improves the patients' lifestyle.


Subject(s)
Electric Stimulation Therapy/methods , Parkinson Disease/surgery , Parkinson Disease/therapy , Prostheses and Implants , Subthalamic Nucleus/surgery , Electric Stimulation Therapy/adverse effects , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neuropsychological Tests , Time Factors , Treatment Outcome
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