RESUMEN
OBJECTIVES: To evaluate changes in sexual well being in a group of patients with Parkinson's disease following deep brain stimulation (DBS) of the subthalamic nucleus (STN). METHODS: 31 consecutive patients with Parkinson's disease (21 men and 10 women), bilaterally implanted for DBS of STN, were evaluated one month before and 9-12 months after surgery. Sexual functioning was assessed using a reduced form of the Gollombok Rust inventory of sexual satisfaction (GRISS). Depression (Beck depression inventory) and anxiety (STAI-X1/X2) were also evaluated. Relations between sexual functioning and modifications in the severity of disease (Hoehn and Yahr stage), reduction in levodopa equivalent daily dosage (LEDD), age, and duration of disease were analysed. RESULTS: While no modifications were found in female patients, male patients reported slightly but significantly more satisfaction with their sexual life after DBS of STN. When only male patients under 60 years old were considered, a greater improvement in sexual functioning was found, though still small. Modifications in depressive symptoms and anxiety, as well as duration of the disease, reduction in LEDD, and improvement in the severity of disease, showed no relation with changes in sexual functioning after DBS of STN. CONCLUSIONS: DBS of STN appears to affect sexual functioning in a small but positive way. Male patients with Parkinson's disease, especially when under 60, appeared more satisfied with their sexual well being over a short term follow up period.
Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedad de Parkinson/terapia , Calidad de Vida , Sexualidad , Núcleo Subtalámico/fisiología , Anciano , Ansiedad , Depresión , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/psicología , Satisfacción del Paciente , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
In the advanced phase of Parkinson's disease (PD), gait disturbances represent one of the main causes of disability. Several studies demonstrated that high-frequency electrical stimulation (HFS) of the subthalamic nucleus (STN) significantly improves the motor symptoms of PD. This study was finalised to quantitatively analyze the effect of STN HFS on gait of PD patients, through a three-dimensional gait analysis system. Ten PD patients were studied, with and without STN HFS. The results demonstrated that STN HFS significantly improves all the main gait parameters in PD patients.
Asunto(s)
Terapia por Estimulación Eléctrica , Marcha , Enfermedad de Parkinson/terapia , Núcleo Subtalámico , Fenómenos Biomecánicos , Estudios de Casos y Controles , Femenino , Humanos , Cinética , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/fisiopatología , Núcleo Subtalámico/fisiopatologíaRESUMEN
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been shown to be an effective therapy for the treatment of advanced Parkinson's disease (PD). Forty-seven patients were bilaterally implanted for STN DBS and clinically evaluated according to the Core Assessment Program for Intracerebral Transplantations before surgery and 3, 12 and 24 months after surgery. Electrical stimulation led to a significant improvement in motor symptoms and in the quality of life, allowing a significant reduction of dopaminergic drugs with a consequent improvement of drug-induced dyskinesias. Statistical differences were observed between UPDRS parts II, III and IV values and daily levodopa dosage in the pre- and postoperative periods, while no differences were evident between the 3 postoperative conditions.
Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedad de Parkinson/terapia , Núcleo Subtalámico , Anciano , Antiparkinsonianos/efectos adversos , Discinesia Inducida por Medicamentos/terapia , Electrodos Implantados , Femenino , Estudios de Seguimiento , Humanos , Levodopa/efectos adversos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/fisiopatología , Calidad de Vida , Núcleo Subtalámico/fisiopatología , Factores de Tiempo , Resultado del TratamientoRESUMEN
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for the motor symptoms of advanced Parkinson's disease (PD). The aim of this study was to assess the effect of the bilateral surgical procedure and STN DBS on the neuropsychological functions. Twenty Parkinson's disease patients underwent a neuropsychological assessment before and 6 months after surgery in four different conditions: medication on (with levodopa) and medication off (without levodopa) during the preoperative period, medication on/stimulation on (levodopa plus stimulators switched on) and medication off/stimulation on (stimulators switched on without levodopa) during the postoperative period. We did not find any significant difference in the four conditions for all the neuropsychological tests, confirming the lack of an overall cognitive decline after surgery. From a neuropsychological point of view, these results seem to indicate that bilateral STN DBS is a safe treatment for advanced PD.
Asunto(s)
Trastornos del Conocimiento/etiología , Terapia por Estimulación Eléctrica/efectos adversos , Terapia por Estimulación Eléctrica/psicología , Enfermedad de Parkinson/psicología , Enfermedad de Parkinson/terapia , Complicaciones Posoperatorias/etiología , Núcleo Subtalámico/cirugía , Factores de Edad , Anciano , Cognición/fisiología , Trastornos del Conocimiento/fisiopatología , Progresión de la Enfermedad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enfermedad de Parkinson/fisiopatología , Complicaciones Posoperatorias/fisiopatología , Núcleo Subtalámico/fisiología , Resultado del TratamientoRESUMEN
Deep brain stimulation of the subthalamic nucleus has been proved to be an effective treatment for advanced Parkinson's disease when therapeutical strategies have failed. A correct selection of candidates for surgery is fundamental to obtain a good clinical effect. In this study we present our protocol of patient selection. In addition we report the data relative to the different causes of exclusion and the clinical efficacy of the electrical stimulation of the subthalamic nucleus at 3 months and 1 year follow-up.
Asunto(s)
Terapia por Estimulación Eléctrica , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/terapia , Selección de Paciente , Núcleo Subtalámico/fisiopatología , Antiparkinsonianos/administración & dosificación , Antiparkinsonianos/efectos adversos , Relación Dosis-Respuesta a Droga , Electrodos Implantados , Femenino , Estudios de Seguimiento , Humanos , Levodopa/administración & dosificación , Levodopa/efectos adversos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
The present study investigated behavioural modifications and familiar relations in a group of 15 parkinsonian patients treated with bilateral deep brain stimulation of the subthalamic nucleus. In 70% of the patients, during the first months after surgery we observed a euphoric mood owing to motor signs amelioration, but a series of problems (fear to come back to the pre-operative condition, sense of failure, slowness in changing the old habits) arose when it was necessary to adjust the parameters of stimulation and the pharmacological therapy to obtain a stable clinical picture. The caregivers showed an aggressive behaviour as reaction to the persistent psychological dependence of the patients. This distressed condition could be the cause of the onset of incomprehensions within the couple.
Asunto(s)
Terapia por Estimulación Eléctrica/efectos adversos , Relaciones Familiares , Enfermedad de Parkinson/psicología , Enfermedad de Parkinson/terapia , Núcleo Subtalámico/fisiopatología , Ansiedad/etiología , Ansiedad/psicología , Cuidadores/psicología , Dopaminérgicos/uso terapéutico , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Terapia por Estimulación Eléctrica/psicología , Electrodos Implantados , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas , Enfermedad de Parkinson/fisiopatología , Calidad de Vida/psicología , Resultado del TratamientoAsunto(s)
Terapia por Estimulación Eléctrica , Enfermedad de Parkinson/complicaciones , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/terapia , Núcleo Subtalámico/cirugía , Anciano , Antiparkinsonianos/uso terapéutico , Humanos , Levodopa/uso terapéutico , Masculino , Enfermedad de Parkinson/tratamiento farmacológicoRESUMEN
An exceptional case of long-standing central pain temporarily relieved by a focal stroke in the primary somatosensory area is reported. This case highlights the focal nature of central pain mechanisms and the possible value of selective subparietal leukotomies in the management of central pain.
Asunto(s)
Infarto Cerebral/fisiopatología , Vértebras Cervicales , Terapia por Estimulación Eléctrica , Microdiálisis/efectos adversos , Neuralgia/fisiopatología , Neuralgia/terapia , Dolor Intratable/fisiopatología , Radiculopatía/fisiopatología , Corteza Somatosensorial/lesiones , Trastornos Somatosensoriales/terapia , Compresión de la Médula Espinal/fisiopatología , Osteofitosis Vertebral/complicaciones , Analgésicos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Quistes Aracnoideos/fisiopatología , Quistes Aracnoideos/cirugía , Cateterismo/efectos adversos , Infarto Cerebral/etiología , Terapia Combinada , Resistencia a Medicamentos , Femenino , Humanos , Enfermedad Iatrogénica , Persona de Mediana Edad , Relajantes Musculares Centrales/uso terapéutico , Neuralgia/tratamiento farmacológico , Dolor Intratable/tratamiento farmacológico , Dolor Intratable/terapia , Radiculopatía/etiología , Corteza Somatosensorial/fisiopatología , Trastornos Somatosensoriales/tratamiento farmacológico , Médula Espinal/fisiopatología , Compresión de la Médula Espinal/etiología , Osteofitosis Vertebral/cirugía , Vértebras TorácicasRESUMEN
In this report, the authors describe a case in which the patient began to experience a supernumerary phantom arm after she received motor cortex stimulation for central pain. The patient had a history of right thalamocapsular stroke. It is speculated that the motor cortex activation triggered a response in the patient's parietal lobe, precipitating perception of the phantom limb. To the authors' knowledge this is the first reported case of its kind.