RESUMO
OBJECTIVE: During the surgical procedure of deep brain stimulation (DBS), insertion of an electrode in the subthalamic nucleus (STN) frequently causes a temporary improvement of motor symptoms, known as the microlesion effect (MLE). The objective of this study was to determine the correlation between the intraoperative MLE and the clinical effect of DBS. MATERIALS AND METHODS: Thirty Parkinson's disease (PD) patients with Movement Disorder Society (MDS) Unified Parkinson's Disease Rating Scale (UPDRS) part III (MDS-UPDRS III) scores during bilateral STN-DBS implantation were included in this retrospective study. MDS-UPDRS III subscores (resting tremor, rigidity, and bradykinesia) of the contralateral upper extremity were used. During surgery, these subscores were assessed directly before and after insertion of the electrode. Also, these subscores were determined in the outpatient clinic after 11 weeks on average (on-stimulation). All assessments were performed in an off-medication state (at least 12 hours of medication washout). RESULTS: Postinsertion MDS-UPDRS motor scores decreased significantly compared to preinsertion scores (p < 0.001 for both hemispheres). The MLE showed a positive correlation with the clinical effect of DBS in both hemispheres (rho = 0.68 for the primarily treated hemisphere, p < 0.001, and rho = 0.59 for the secondarily treated hemisphere, p < 0.01). CONCLUSION: The MLE has a clinically relevant correlation with the effect of DBS in PD patients. These results suggest that the MLE can be relied upon as evidence of a clinically effective DBS electrode placement.
Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson , Núcleo Subtalâmico , Humanos , Doença de Parkinson/tratamento farmacológico , Estudos Retrospectivos , Estimulação Encefálica Profunda/métodos , Resultado do Tratamento , Núcleo Subtalâmico/cirurgiaRESUMO
OBJECTIVE: To evaluate the efficacy of the Groningen Parkinson Short-Stay (GPSS) treatment, a short-term and intensive clinical intervention, on delaying the definitive nursing home placement of patients with Parkinson's disease. DESIGN: Retrospective cohort study. METHOD: We included 65 patients with Parkinson's disease, of whom 39 were men and 26 were women with a mean age of 72 years (range: 43-88), who in 2009 were admitted to the GPSS ward of nursing home Maartenshof in Groningen, the Netherlands, for six weeks. The primary outcome measure was the number of patients who were able to live independently at home after discharge. The secondary outcome measures were changes in medication, change in cognitive performance and the duration of being able to live independently at home. RESULTS: After treatment on the GPSS ward, 49 patients could return home. Patients with a Mini-Mental State Examination (MMSE) score < 26 showed a significant increase of 2.5 points (14%, p = 0.003) after treatment. The frontal lobe functions, measured with the Frontal Assessment Battery, showed a significant increase of 1.3 points (11%, p = 0.024). In 31 (76%) patients, the dopaminergic medication was underdosed; after increasing the dosage, the clinical symptoms improved. In 10 (53%) psychotic patients, the dosage of atypical antipsychotics was increased. After an average follow-up period of 16.5 months (range: 10.0-24.5), 38 patients (63%) were still living at home. CONCLUSION: Treatment at the GPSS ward postpones a definitive nursing home placement. An important factor in this is the optimisation of medication for motor, behavioural and cognitive functioning. This treatment should be used more widely for patients in the end stages of Parkinson's disease.
