ABSTRACT
BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus is an accepted therapy for advanced Parkinson's disease (PD). In animal models, pharmacologic ablation and stimulation of the subthalamic nucleus have resulted in clinical improvement and, in some cases, improved survival of dopaminergic neurons. DBS has not been studied in the early stages of PD, but early application should be explored to evaluate safety, efficacy, and the potential to alter disease progression. METHODS: We are conducting a prospective, randomized, single-blind clinical trial of optimal drug therapy (ODT) compared to medication plus DBS (ODT + DBS) in subjects with Hoehn & Yahr Stage II idiopathic PD who are without motor fluctuations or dementia. We report here subject screening, enrollment, baseline characteristics, and adverse events. RESULTS: 30 subjects (average age 60 ± 6.9 years, average duration of medicine 2.1 ± 1.3 years, average UPDRS-III scores 14.9 on medication and 27.0 off medication) are enrolled in the ongoing study. Twelve of 15 subjects randomized to DBS experienced perioperative adverse events, the majority of which were related to the procedure or device and resolved without sequelae. Frequently reported adverse events included wound healing problems, headache, edema, and confusion. CONCLUSION: This report demonstrates that subjects with early stage PD can be successfully recruited, consented and retained in a long-term clinical trial of DBS. Our ongoing pilot investigation will provide important preliminary safety and tolerability data concerning the application of DBS in early stage PD.
Subject(s)
Deep Brain Stimulation , Parkinson Disease/therapy , Patient Selection , Aged , Female , Humans , Male , Middle Aged , Pilot Projects , Single-Blind MethodABSTRACT
Academic achievement within a child psychiatric sample was examined as a function of six variables: IQ, socioeconomic status, age, sex, neuropsychological status, and the severity of behavioral disturbance. As expected, the results revealed a different pattern of predictors than what is generally the case of normal school-aged children. The results underscored the importance of neuropsychological factors, more than IQ and demographic variables, in understanding the academic deficits often seen in children with significant mental and emotional disturbance.
Subject(s)
Achievement , Intelligence , Learning Disabilities/psychology , Mental Disorders/psychology , Adolescent , Child , Child Behavior Disorders/psychology , Female , Humans , Male , Mood Disorders/psychologyABSTRACT
The concept of major depressive disorder in childhood and adolescence is reviewed and it is suggested that contemporary enthusiasm for this diagnosis may have outrun the evidence that it is a distinct categorical entity. To test the hypothesis that major depression is not a qualitatively distinct disorder in adolescence, but rather a continuously distributed, noncategorical syndrome, the behavioral rating scales (CBCL-P) of 216 hospitalized adolescent patients were analyzed first by principal components analysis and then by cluster analysis. Three behavioral syndromes were isolated by principal components analysis. Of three groups of patients identified by a subsequent cluster analysis, one was consistent with the concept of a categorically distinct "nuclear" depression. However, a noncategorical continuously distributed depressive syndrome appears to affect a larger number of patients in this age group, and the "nuclear" disorder may be less prevalent than is currently assumed. One explanation of these findings would combine a categorical model of nuclear depression with a dimensional model of dysthymia.
Subject(s)
Depressive Disorder/diagnosis , Psychological Tests , Adjustment Disorders/diagnosis , Adolescent , Bipolar Disorder/diagnosis , Depressive Disorder/psychology , Female , Humans , Male , Psychometrics , Psychotic Disorders/diagnosisABSTRACT
The behavioral manifestations of neuropsychological impairment were examined in a sample of hospitalized boys with psychiatric disorders. The presence of neuropsychological deficits was found to be associated with more extensive behavior problems regardless of factors such as IQ, socioeconomic status, and whether there was a documented history of brain injury. However, the relationship applied specifically to younger as opposed to older subjects, and mainly involved internalizing rather than externalizing behavior problems. The results are taken to suggest that the behavioral manifestations of neuropsychological impairment may change with development.
ABSTRACT
The Discriminant Equation (DE) represents a recently developed system for screening neuropsychological abnormality in older children. The DE was subjected to cross-validation on a sample of 82 child and adolescent psychiatric patients referred for a comprehensive neuropsychological assessment. An overall hit rate of 79.3% correct classification was found which supported the validity of the DE in predicting neuropsychological impairment. The findings are discussed in relation to population characteristics and the nature of the criterion to be predicted as they may affect the application of neuropsychological screening procedures.
