Asunto(s)
Incontinencia Fecal/terapia , Plexo Lumbosacro , Estimulación Eléctrica Transcutánea del Nervio/métodos , Vejiga Urinaria Hiperactiva/terapia , Electrodos , Humanos , Estimulación Eléctrica Transcutánea del Nervio/efectos adversos , Estimulación Eléctrica Transcutánea del Nervio/instrumentación , Resultado del TratamientoRESUMEN
OBJECTIVES: To assess the efficacy of bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) in patients with advanced Parkinson's disease previously reliant on apomorphine as their main antiparkinsonian medication. METHODS: Seven patients with motor fluctuations despite optimal medical treatment given as predominantly apomorphine infusion (n=6), or intermittent apomorphine injections (n=1) underwent bilateral STN DBS using frameless stereotactic surgery. Standard assessments of parkinsonism and motor fluctuations, using Unified Parkinson's Disease Rating Scale (UPDRS) were performed before and six months after surgery. Assessments were performed both on and off medication, and postoperative with the stimulators switched on and off. RESULTS: Bilateral STN DBS improved motor scores (UPDRS III) by 61% when off medication (p<0.05). Clinical fluctuations (UPDRS IV items 36-39) were reduced by 46.2% (p<0.05). Total daily apomorphine dose was reduced by 68.9% (p<0.05) and apomorphine infusion via a pump was no longer required in four patients. There were no operative complications. Two patients required treatment for hallucinations postoperatively but there was no significant change in mini-mental state examination. CONCLUSIONS: In patients with advanced Parkinson's disease, previously reliant on apomorphine, bilateral STN DBS is an effective treatment to reduce motor fluctuations and enable a reduction in apomorphine use.
Asunto(s)
Antiparkinsonianos/administración & dosificación , Apomorfina/administración & dosificación , Terapia por Estimulación Eléctrica , Actividad Motora/fisiología , Destreza Motora/fisiología , Enfermedad de Parkinson/terapia , Núcleo Subtalámico/fisiopatología , Anciano , Terapia Combinada , Dominancia Cerebral/fisiología , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Electrodos Implantados , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Actividad Motora/efectos de los fármacos , Destreza Motora/efectos de los fármacos , Examen Neurológico/efectos de los fármacos , Enfermedad de Parkinson/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND: Traditional methods for localisation of target nuclei for deep brain stimulation (DBS) have used brain atlas co-ordinates for initial targeting. It is now possible to visualise the subthalamic nucleus (STN) on magnetic resonance imaging (MRI) and determine the individual variability of its position. METHODS: The present study was performed in patients undergoing STN DBS for Parkinson's disease. The STN was directly targeted from axially obtained MRI and verified with microelectrode recordings. Postoperatively, the most effective contact was identified for each patient, and its position was calculated. RESULTS: Fifty electrodes were inserted in 25 patients. The target position varied considerably in relation to the mid-commissural point. The mean effective contact position lies just dorsal to the location of the STN in a standard brain atlas. CONCLUSION: The STN varies in position, and can be accurately targeted from MRI alone.