RESUMO
BACKGROUND: A patient controller (PC) is an optional device for patients with deep brain stimulation (DBS) to have limited control of their stimulator system. OBJECTIVES: We investigated the impact of a PC on DBS safety, most notably the handling/prevention of unexpected DBS failure in patients with Parkinson's disease (PD). METHODS: PD patients with subthalamic DBS were educated in the use of a PC. After a first impulse generator (IPG) replacement, data on the use of the PC were obtained from the patients' records and by a patient questionnaire. RESULTS: A total of 27 patients with IPG replacements after 4.4 ± 0.8 years (118.8 patient-years) were included. Thirteen patients transiently used the PC to optimize stimulation amplitudes. Eighteen patients reported events when they used the PC to ensure DBS being on. No accidental switch off by environmental electromagnetism was confirmed. In contrast, 4 patients accidentally turned the IPG off with the PC. Sixteen patients regularly checked the IPG battery but only 1 patient noted a low battery status before quarterly control visits. Of the 27 patients, 26 had anticipated and only 1 an unanticipated IPG replacement. CONCLUSIONS: A PC is not needed for patient safety. However, in some patients, a PC is helpful to optimize stimulation amplitudes and to increase the patients' own perception of safety.
Assuntos
Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Autocuidado/métodos , Núcleo Subtalâmico/fisiologia , Idoso , Estimulação Encefálica Profunda/normas , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Autocuidado/normas , Inquéritos e QuestionáriosRESUMO
The effect of stereotactic thalamotomy was assessed with pre- and postoperative functional magnetic resonance imaging (fMRI) under motor stimulation. A patient with unilateral essential tremor (ET) of the left arm underwent stereotactically guided thalamotomy of the right ventral intermediate thalamic nucleus (VIM). FMRI was done directly before and after surgery on a 1.5-Tesla scanner. The stimulation paradigm was maintainance of the affected arm in an extended position and hand clenching being performed in a block design manner. Statistical analysis was done with Brain Voyager 2000. After thalamotomy the tremor diminished completely. As a difference between the pre- and postoperative fMRI, a significant activation was found in the VIM contralateral to the activation site, adjacent to the inferior olivary nucleus contralateral to the activation site and in the dorsal cingulum. In conclusion, fMRI can detect the functional effect of thalamotomy for tremor treatment. Direct postoperative fMRI provides a sufficient method for estimating the effect of thalamotomy immediately after intervention. The importance of the intermediate thalamic nucleus and the olivary nucleus in tremor generation is supported by our findings.
Assuntos
Tremor Essencial/cirurgia , Imageamento por Ressonância Magnética , Técnicas Estereotáxicas , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-IdadeRESUMO
Recently, a pathological oscillatory network at 10 Hz including several motor areas was described in patients with idiopathic Parkinson's disease (PD). In 7 PD patients, we tested the clinical effect of subthalamic nucleus (STN) stimulation at varying frequencies 1 to 3 years after implantation of electrodes. STN stimulation at 10 Hz induced significant worsening of motor symptoms, especially akinesia, compared with no stimulation and therapeutic stimulation (> or =130 Hz). This finding indicates the clinical relevance of pathological 10 Hz synchronization in PD.
