Long-term efficacy and mortality in Parkinson's disease patients treated with subthalamic stimulation.

BACKGROUND: The objective of this study was to examine the clinical outcome and mortality of long-term deep brain stimulation of the subthalamic nucleus in advanced Parkinson's disease. METHODS: We included all 144 patients (mean age, 60.3 years; mean disease duration, 11.0 years) treated in our center from 2001 to 2007. RESULTS: Twelve months after surgery, the off-medication Unified Parkinson's Disease Rating Scale motor score was reduced by a mean of 53%, and the annual increase after surgery was 3.2 points. The daily dose of dopaminergic medication was reduced by a mean of 49% and increased only marginally during follow-up. Twelve of the 144 patients died in the study period, including 2 suicides (1.4%). Survival was 97% after 3 years and 90% after 5 years. CONCLUSIONS: The study confirms the stable efficacy of long-term subthalamic stimulation in selected patients with advanced Parkinson's disease. Throughout the study the patient characteristics at time of surgery changed, with less severe disease and shorter disease duration toward the end of the study period.

[Treatment of movement disorders with deep brain stimulation]. / Behandling av bevegelsesforstyrrelser med dyp hjernestimulering.

BACKGROUND: Deep brain stimulation is an established symptomatic treatment of movement disorders such as Parkinson's disease, tremor conditions and dystonia when medical treatment fails. We here present a review of indications and results for this treatment. We also present data om the activity related to patients with Parkinson's disease in a representative year and data on implantations performed Rikshospitalet University Hospital in the period 1999-2007. MATERIAL AND METHODS: The manuscript is based on non-systematic searches in PubMed, clinical experience, and internal statistics on implantations and clinical visits carried out at our centre. RESULTS AND INTERPRETATION: 243 procedures were performed in our clinic in the period; 187 for Parkinson's disease, 37 for tremor and 19 for dystonia. The vast majority of patients have been implanted with bilateral electrodes, and the targets were the subthalamic nucleus, the thalamus and the internal segment of globus pallidus. Studies have demonstrated that deep brain stimulation is an effective treatment of selected patients with Parkinson's disease, tremors and primary dystonia. Many of these patients have no other efficient treatment options. Patients should be referred for preoperative assessment when symptoms of their movement disorder can no longer be treated sufficiently with medical therapies and when their quality of life is impaired. A broad and careful evaluation of patients' symptoms and findings is important for correct patient selection for this treatment.

[Vagal nerve stimulation in children with drug-resistant epilepsy]. / Vagusnervestimulering hos barn med farmakoresistent epilepsi.

BACKGROUND: To evaluate the clinical efficacy and side effects of vagal nerve stimulation (VNS) in Norwegian children with difficult-to-treat epilepsy. MATERIAL AND METHODS: We have performed an open retrospective study of 60 children with pharmaco-resistant epilepsy who had a VNS implantation between October 1996 and May 2003. The effects and side effects of VNS were evaluated on the basis of the medical records and a questionnaire filled in by the patients and/or their relatives. RESULTS: Forty-six patients (77%), 25 females and 21 males, aged 4-16 years at the time of implantation, filled in the questionnaire. All patients had tried > or = 6 antiepileptic drugs prior to the implantation. Five of them had undergone resective epilepsy surgery. After a mean of 2.5 years of follow up, 33 patients (72 %) reported positive effects of VNS. Twenty-nine patients (63%) reported decreased seizure frequency and/or less severe seizures, 20 (43%) achieved > or = 50 % seizure reduction, but only two became seizure free. Sixteen (35%) experienced a shorter and milder postictal phase. In 10 patients (22%) the need of diazepam treatment to terminate seizures was considerably reduced. Twenty-eight of the children (61%) experienced a positive effect of magnet activation. Twenty-three patients (50%) reported minor and waning side effects. Because most of the patients (32) had their antiepileptic medication changed after the implantation, the results should be interpreted with caution. CONCLUSIONS: A majority of the patients (72%) reported positive effects on seizure frequency and/or epilepsy-related symptoms. The side effects were modest. Our findings support previous reports about VNS being an effective additional treatment in children with refractory epilepsy.

[Treating epilepsy]. / Behandling av epilepsi.

Epilepsy is not one single disease but a major symptom in a wide variety of brain disorders, hence better referred to as the epilepsies. Treating epilepsy requires expert knowledge about the disorders themselves and the various treatment options. The basis for optimal treatment is a correct diagnosis of the patient's type epilepsy and identification of seizure-provoking factors. The need for chronic drug treatment must be weighted against possible side effects. Several different drugs may be effective for a given type of seizure or epilepsy but drug effectiveness must be considered in relation to interactions and possible adverse effects. Even with optimal drug treatment, only about two thirds of patients achieve complete seizure control. In selected cases surgical treatment is very effective and should be considered in all patients who do not achieve seizure control within two years after having tried relevant antiepileptic drugs in optimal concentrations.

Consensus on the appropriate use of intrathecal baclofen (ITB) therapy in paediatric spasticity.

Among features of motor disorders in children, spasticity is associated with considerable morbidity and problems in care, particularly in severely affected patients. Intrathecal baclofen (ITB) has been increasingly used as a relatively specific treatment modality for spasticity. To date, most of the evidence for its use in paediatric patients has come from retrospective and uncontrolled studies, although randomised, controlled trials of screening ITB and ITB therapy itself have recently been published. This consensus statement on the use of ITB in paediatric patients with spasticity was developed on the basis of currently available evidence, with the aim of providing information for clinicians, promoting an expert opinion and a consistent approach to the management of these patients and emphasising the need for further prospective, large-scale studies.

Changes in verbal and nonverbal memory following anterior temporal lobe surgery for refractory seizures: effects of sex and laterality.

We studied the effects on verbal and nonverbal memory of anterior temporal lobe (ATL) surgery for epilepsy in 91 patients (46 men, 45 women), all of whom had left-hemisphere dominance for speech. Patients were divided into four groups according to sex and laterality of the excision. The memory tasks were administered shortly before surgery, 6 months postoperatively, and at a 2-year follow-up. Test scores were submitted to repeated-measures analyses of variance. We found that men treated with left temporal resection declined significantly in long-delay verbal memory after surgery, whereas no clear pre- to postoperative sex differences were found with respect to other verbal memory scores. Only the results on long-delay verbal memory confirm previous findings, showing a greater vulnerability of verbal memory to left ATL surgery in men than in women. Women with left temporal excisions obtained particularly poor scores on a long-delay nonverbal memory test preoperatively, but improved their performance on this test significantly after surgery. The seemingly gradual improvement during the 2-year follow-up suggests a plastic process.

Resective surgery for intractable focal epilepsy in patients with low IQ: predictors for seizure control and outcome with respect to seizures and neuropsychological and psychosocial functioning.

PURPOSE: To investigate possible predictive factors for seizure control in a group of children and adults with low IQs (IQ, < or =70) who underwent resective surgery for intractable focal epilepsy and to study outcome with respect to seizures and neuropsychological functioning. We also studied psychosocial outcome in the adult patients. METHODS: Thirty-one patients (eight children younger than 18 years) with a Wechsler Full Scale IQ of 70 or less underwent comprehensive neuropsychological assessments before and 2 years after surgery. Adults also completed the Washington Psychosocial Seizure Inventory (WPSI). Univariate analyses were used to identify variables differentiating between patients who became seizure free and those who did not. Pre- and postoperative test results were compared by t test for dependent samples. RESULTS: Forty-eight percent of the patients became seizure free, 52% of those with temporal lobe resection and 38% of those with extratemporal resection. Only one variable was predictive for seizure outcome: duration of epilepsy. In one third of the patients, who had the shortest duration of epilepsy (<12 years), 80% became seizure free. Significant improvement was seen regarding vocational adjustment in adults (WPSI). Seizure-free adults improved their Full Scale IQ scores. No cognitive changes were found in seizure-free children or in patients who did not become seizure free. CONCLUSIONS: A good seizure outcome was obtained after resective surgery in patients with intractable focal epilepsy and low IQ, provided that treatment was done relatively shortly after onset of epilepsy. No adverse effects were seen on cognitive and psychosocial functioning.