Functional anatomy of subthalamic nucleus stimulation in Parkinson disease.

OBJECTIVE: We developed a novel method to map behavioral effects of deep brain stimulation (DBS) across a 3-dimensional brain region and to assign statistical significance after stringent type I error correction. This method was applied to behavioral changes in Parkinson disease (PD) induced by subthalamic nucleus (STN) DBS to determine whether these responses depended on anatomical location of DBS. METHODS: Fifty-one PD participants with STN DBS were evaluated off medication, with DBS off and during unilateral STN DBS with clinically optimized settings. Dependent variables included DBS-induced changes in Unified Parkinson Disease Rating Scale (UPDRS) subscores, kinematic measures of bradykinesia and rigidity, working memory, response inhibition, mood, anxiety, and akathisia. Weighted t tests at each voxel produced p images showing where DBS most significantly affected each dependent variable based on outcomes of participants with nearby DBS. Finally, a permutation test computed the probability that this p image indicated significantly different responses based on stimulation site. RESULTS: Most motor variables improved with DBS anywhere in the STN region, but several motor, cognitive, and affective responses significantly depended on precise location stimulated, with peak p values in superior STN/zona incerta (quantified bradykinesia), dorsal STN (mood, anxiety), and inferior STN/substantia nigra (UPDRS tremor, working memory). INTERPRETATION: Our method identified DBS-induced behavioral changes that depended significantly on DBS site. These results do not support complete functional segregation within STN, because movement improved with DBS throughout, and mood improved with dorsal STN DBS. Rather, findings support functional convergence of motor, cognitive, and limbic information in STN.

Development and testing of the Preeclampsia Prenatal Symptom-Monitoring Checklist (PPSMC).

BACKGROUND AND PURPOSE: Preeclampsia, a common disorder of unknown origin, presents with signs and symptoms that can be subtle, making assessment and intervention challenging. The purpose of this study was to refine the psychometric properties of an instrument designed to assess a comprehensive range of preeclampsia symptoms. METHODS: Testing of the Preeclampsia Prenatal Symptom-Monitoring Scale (PPSMC) was accomplished through a retrospective, correlational, and comparative study of 100 postpartum women with preeclampsia and gestational hypertension. RESULTS: The initial 17-item Cronbach's alpha was .73; reliability of the current 11-item PPSMC increased to .77. Content validity index for the PPSMC (17 items) was .88; for the PPSMC (11 items), .93. Exploratory factor analysis, known group comparisons, and predictive validity lend beginning support of the instrument's construct validity. CONCLUSION: This instrument may be useful in examining in greater detail the symptomatology of women with preeclampsia in practice and research settings.

Stress, symptoms, self-monitoring confidence, well-being, and social support in the progression of preeclampsia/gestational hypertension.

OBJECTIVE: To investigate the relationships of psychological stress, preeclampsia/gestational hypertension symptoms, confidence in self-monitoring, well-being, and perceived social support with preeclampsia/gestational hypertension disease progression in outpatient women. Women with mild and severe preeclampsia/gestational hypertension were compared for differences in these variables. DESIGN: A retrospective, correlational, and comparative design. SETTING: Postpartum units of three urban hospitals in Philadelphia, Pennsylvania. PARTICIPANTS: One hundred postpartum women with preeclampsia/gestational hypertension. MAIN OUTCOME MEASURES: Psychological stress measured by the Perceived Stress Scale, preeclampsia/gestational hypertension symptoms by the Preeclampsia/Gestational Hypertension Checklist, confidence in self-monitoring by the Self-Confidence in Self-Monitoring Scale, well-being by the Index of Well-Being, and social support by the Interpersonal Support Evaluation List. RESULTS: Women with worsening/severe preeclampsia/gestational hypertension reported a significantly higher number of symptoms than women with mild preeclampsia/gestational hypertension (p= .02). Psychological stress was significantly higher (p= .04) in women with worsening/severe preeclampsia/gestational hypertension. There were no differences in well-being, self-confidence in self-monitoring, or perceived social support between women with mild preeclampsia/gestational hypertension and those with worsening preeclampsia/gestational hypertension. CONCLUSION: Worsening/severe preeclampsia/gestational hypertension was associated with increasing psychological stress and a higher number of preeclampsia/gestational hypertension symptoms.