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2.
Indian J Dent Res ; 31(2): 315-317, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32436915

RESUMO

Primary orthostatic tremor (POT) is a rare movement disorder of unknown pathophysiology, characterized by fast tremor affecting a specific part of the body. The present paper reports a case of POT in mandible, discussing the approach and management. A 37-year-old male patient complained of involuntary mandibular movements, with onset 6 years ago, with no history of precipitating event. Usually, tremors were not present during patient's mastication or phonation. The oscillations presented rhythmically and symmetrically, with high frequency and low range of motion. Surface electromyography revealed an electromyographic discharge pattern bilaterally in the masseters, presenting a mean frequency of 13 Hz, and a predominance of postural type. Based on the history and clinical characteristics and electromyography, a diagnosis of POT was made. Several treatments have been employed over the years. Currently, the patient is being treated with buspirone hydrochloride 10 mg/day with a significant reduction of tremors. It can be concluded that knowledge of the characteristics of this condition is essential for the elaboration of a correct diagnosis and the better management of POT patients.


Assuntos
Tontura , Tremor , Adulto , Eletromiografia , Humanos , Masculino , Mandíbula
5.
Medicine (Baltimore) ; 99(11): e19518, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176101

RESUMO

INTRODUCTION: The incidence of Hashimoto's thyroiditis among patients who have Turner syndrome (TS) has increased, but Graves' disease (GD) in patients with TS is rarely reported. Here we report a rare case of TS with GD accompanied by hypogonadotropic hypogonadism. PATIENT CONCERNS: We report the case of a 16-year-old girl who complained nervousness, fatigue, marasmus, heat intolerance, sweating, palpitation, and tremor lasting for more than a month. She had no medical history. DIAGNOSIS: TS was diagnosed of the results of karyotyping demonstrated a gene karyotype of 46, X, i (X)(q10). GD was also diagnosed in this patient following the detection of thyroid function analysis. INTERVENTIONS: Methimazole was administered after identification of GD. Due to the absence of secondary sex characteristics, the patient was given a conjugated estrogen preparation for 1 year, followed by the addition of estradiol cyproterone tablets for the onset of menstruation. OUTCOMES: The hyperthyroidism symptoms of the patient had improved both clinically and laboratory tests after methimazole therapy. She was treated with estrogen and estradiol cyproterone, and the uterus and secondary sexual characteristics of the patient developed during 1 year follow-up. CONCLUSION: TS generally presents as hypergonadotropic hypogonadism. However, hypogonadotropic hypogonadism cannot completely exclude TS. The diagnosis of this disease depends on chromosomal examination. The disease should be detected and treated as early as possible to improve life quality of the patient.


Assuntos
Doença de Graves/diagnóstico , Síndrome de Turner/diagnóstico , Adolescente , Antitireóideos/uso terapêutico , Diagnóstico Diferencial , Fadiga/etiologia , Feminino , Doença de Graves/complicações , Humanos , Cariotipagem , Metimazol/uso terapêutico , Tremor/etiologia , Síndrome de Turner/complicações , Síndrome de Turner/genética
6.
Cancer Radiother ; 24(2): 166-173, 2020 Apr.
Artigo em Francês | MEDLINE | ID: mdl-32220562

RESUMO

Stereotactic radiosurgery (SRS) is a non-invasive technique that enables to create brain focal lesions with a high precision and localization. Thus, functional brain disorders can be treated by SRS in case of pharmacoresistance or inoperability. To date, treatment of trigeminal neuralgia is the most described and known indication. Other indications will be developed in the future like movement disorders, refractory epilepsy, obsessive compulsive disorder and severe depression. We present here a review of actual and future indications of functional brain SRS with their level of evidence. All these SRS treatments have to be strictly conducted by trained teams with an excellent collaboration between radiation physicists, medical physicists, neurosurgeons, neurologists, psychiatrists and probably neuroradiologists.


Assuntos
Epilepsia/radioterapia , Radiocirurgia/métodos , Tremor/radioterapia , Neuralgia do Trigêmeo/radioterapia , Transtorno Depressivo Maior/terapia , Epilepsia/etiologia , Humanos , Transtorno Obsessivo-Compulsivo/terapia , Doença de Parkinson/complicações , Doença de Parkinson/radioterapia , Radiocirurgia/efeitos adversos , Radiocirurgia/tendências , Dosagem Radioterapêutica , Esclerose/complicações , Resultado do Tratamento , Tremor/etiologia , Neuralgia do Trigêmeo/diagnóstico por imagem
7.
Neurology ; 94(10): e1073-e1084, 2020 03 10.
Artigo em Inglês | MEDLINE | ID: mdl-32047071

RESUMO

OBJECTIVE: To assess longitudinal tremor outcomes with ventral intermediate nucleus deep brain stimulation (VIM DBS) in patients with dystonic tremor (DT) and to compare with DBS outcomes in essential tremor (ET). METHODS: We retrospectively investigated VIM DBS outcomes for 163 patients followed at our center diagnosed with either DT or ET. The Fahn-Tolosa-Marin tremor rating scale (TRS) was used to assess change in tremor and activities of daily living (ADL) at 6 months, 1 year, 2-3 years, 4-5 years, and ≥6 years after surgery. RESULTS: Twenty-six patients with DT and 97 patients with ET were analyzed. Compared to preoperative baseline, there were significant improvements in TRS motor up to 4-5 years (52.2%; p = 0.032) but this did not reach statistical significance at ≥6 years (46.0%, p = 0.063) in DT, which was comparable to the outcomes in ET. While the improvements in the upper extremity tremor, head tremor, and axial tremor were also comparable between DT and ET throughout the follow-up, the ADL improvements in DT were lost at 2-3 years follow-up. CONCLUSION: Overall, tremor control with VIM DBS in DT and ET was comparable and remained sustained at long term likely related to intervention at the final common node in the pathologic tremor network. However, the long-term ADL improvements in DT were not sustained, possibly due to inadequate control of concomitant dystonia symptoms. These findings from a large cohort of DT indicate that VIM targeting is reasonable if the tremor is considerably more disabling than the dystonic features. CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that VIM DBS improves tremor in patients with DT or ET.


Assuntos
Estimulação Encefálica Profunda , Distúrbios Distônicos/terapia , Tremor Essencial/terapia , Avaliação de Resultados em Cuidados de Saúde , Tremor/terapia , Núcleos Ventrais do Tálamo , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Distúrbios Distônicos/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença , Tremor/etiologia
8.
World Neurosurg ; 137: 286-290, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32084623

RESUMO

BACKGROUND: Hypertrophic olivary degeneration (HOD) is very rare type of degeneration that causes hypertrophy rather than atrophy. The classical presentation of HOD is palatal myoclonus. However, HOD may rarely present with Holmes tremor (HT). HT is unusual symptomatic tremor characterized by combination of rest and intention tremor. It has been reported in small case series, so far. CASE DESCRIPTION: In this study, a man aged 62 years with HOD and HT spreading to the upper and lower extremities after pontine-midbrain hemorrhage due to cavernoma was presented. CONCLUSIONS: Although pontine-midbrain hemorrhage may cause HT in the late period, HOD can be revealed on magnetic resonance imaging. Tract anatomy, especially the Guillain-Mollaret triangle, should be considered to explain the relationship between HT and HOD.


Assuntos
Neoplasias do Tronco Encefálico/complicações , Hemangioma Cavernoso do Sistema Nervoso Central/complicações , Hemorragias Intracranianas/etiologia , Núcleo Olivar/diagnóstico por imagem , Degeneração Retrógrada/etiologia , Tremor/etiologia , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Hipertrofia , Hemorragias Intracranianas/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pedúnculo Cerebelar Médio/diagnóstico por imagem , Núcleo Olivar/patologia , Ponte/diagnóstico por imagem , Núcleo Rubro/diagnóstico por imagem , Degeneração Retrógrada/diagnóstico por imagem , Degeneração Retrógrada/patologia , Tomografia Computadorizada por Raios X , Tremor/diagnóstico por imagem
9.
Zhonghua Yi Xue Za Zhi ; 100(3): 207-212, 2020 Jan 21.
Artigo em Chinês | MEDLINE | ID: mdl-32008288

RESUMO

Objective: To find more objective evidence and support for clinical classification of Parkinson's disease by means of tremor analysis in patients with early confirmed Parkinson's disease. Methods: A cross-sectional study was conducted to collect 65 patients with early Parkinson's disease treated in the Third Hospital of Peking University from January 2015 to December 2016. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn-Yahr scale (H-Y scale), Mini-mental state examination (MMSE), Hamilton depression scale (HAMD) were recorded in all patients. According to the ratio of UPDRS rigidity score to tremor score, the patients were divided into tremor dominant (TD), postural instability/gait difficulty (PIGD) and mixed types. All patients were examined by tremor analysis and the results were analyzed and compared. Results: Among the 65 patients, the mean age of onset was (63±10) years, the course of disease was (14±8) months. Twenty-one patients were classified to TD group, 28 patients were classified to PIGD type, and 16 patients with mixed type. There was no significant difference in frequency and amplitude of tremor between the three groups (P>0.05), but the proportion of alternating contraction and harmonic resonance of active and antagonistic muscles in TD group was significantly higher (P<0.05). Twenty patients (71.4%) in TD group showed typical Parkinson's disease manifestations in tremor analysis. Only four patients (14.3%) in PIGD group showed the typical manifestations. More patients in PIGD group showed no clear main peak of tremor at rest. Some patients showed 6-8 Hz/sec peak frequency in posture position and simultaneous contraction of the active and antagonist muscles. These two manifestations occured simultaneously in mixed type patients, including 10 cases (62.5%) with typical Parkinson's disease manifestations. Conclusion: As an objective electrophysiological method to evaluate tremor type, tremor analysis can be used as an important assistant method for clinical classification of Parkinson's disease. It can provide information of the pathway of pathological loss in different types and give important hints in prognosis and treatment.


Assuntos
Transtornos Neurológicos da Marcha/fisiopatologia , Doença de Parkinson/classificação , Doença de Parkinson/fisiopatologia , Tremor/fisiopatologia , Idade de Início , Idoso , Estudos Transversais , Feminino , Marcha , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico , Tremor/etiologia
11.
PLoS One ; 15(2): e0225191, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32053612

RESUMO

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a late onset neurodegenerative disorder that is characterized by tremor, cerebellar ataxia, frequent falls, cognitive decline, and progressive loss of motor function. There are currently no approved treatments for this disorder. The purpose of this study was to determine if citicoline was safe for the treatment of tremor and balance abnormalities and to stabilize cognitive decline in patients with FXTAS. Ten participants with diagnosed FXTAS were administered 1000 mg of citicoline once daily for 12 months. Outcome measures and neurological examination were performed at baseline, 3 months, 6 months, and 12 months. The primary outcome was the FXTAS Rating Scale score. Secondary outcomes included change in a battery of neuropsychological tests, an instrumented Timed up and go test, computerized dynamic posturography, 9-hole pegboard test, and balance confidence and psychiatric symptom questionnaires. Safety was also evaluated. Citicoline treatment resulted in minimal adverse events in all but one subject over the course of the study. There was a significant improvement in the Beck Anxiety Inventory (p = 0.03) and the Stroop Color-Word test (p = 0.03), with all other measures remaining stable over the course of 12 months. This open-label pilot trial of citicoline for individuals with FXTAS showed that it is safe and well tolerated in this population. Registration: This trial was registered at ClinicalTrials.gov. Identifier: NCT0219710.


Assuntos
Ataxia/tratamento farmacológico , Citidina Difosfato Colina/administração & dosagem , Síndrome do Cromossomo X Frágil/tratamento farmacológico , Nootrópicos/administração & dosagem , Tremor/tratamento farmacológico , Idoso , Ataxia/diagnóstico , Cognição/efeitos dos fármacos , Citidina Difosfato Colina/efeitos adversos , Feminino , Síndrome do Cromossomo X Frágil/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/efeitos dos fármacos , Testes Neuropsicológicos , Nootrópicos/efeitos adversos , Projetos Piloto , Equilíbrio Postural/efeitos dos fármacos , Índice de Gravidade de Doença , Fatores de Tempo , Estudos de Tempo e Movimento , Resultado do Tratamento , Tremor/diagnóstico
12.
Hum Genet ; 139(2): 227-245, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31919630

RESUMO

Fragile X-related disorders are due to a dynamic mutation of the CGG repeat at the 5' UTR of the FMR1 gene, coding for the RNA-binding protein FMRP. As the CGG sequence expands from premutation (PM, 56-200 CGGs) to full mutation (> 200 CGGs), FMRP synthesis decreases until it is practically abolished in fragile X syndrome (FXS) patients, mainly due to FMR1 methylation. Cells from rare individuals with no intellectual disability and carriers of an unmethylated full mutation (UFM) produce slightly elevated levels of FMR1-mRNA and relatively low levels of FMRP, like in PM carriers. With the aim of clarifying how UFM cells differ from CTRL and FXS cells, a comparative proteomic approach was undertaken, from which emerged an overexpression of SOD2 in UFM cells, also confirmed in PM but not in FXS. The SOD2-mRNA bound to FMRP in UFM more than in the other cell types. The high SOD2 levels in UFM and PM cells correlated with lower levels of superoxide and reactive oxygen species (ROS), and with morphological anomalies and depolarization of the mitochondrial membrane detected through confocal microscopy. The same effect was observed in CTRL and FXS after treatment with MC2791, causing SOD2 overexpression. These mitochondrial phenotypes reverted after knock-down with siRNA against SOD2-mRNA and FMR1-mRNA in UFM and PM. Overall, these data suggest that in PM and UFM carriers, which have high levels of FMR1 transcription and may develop FXTAS, SOD2 overexpression helps to maintain low levels of both superoxide and ROS with signs of mitochondrial degradation.


Assuntos
Ataxia/patologia , Metilação de DNA , Proteína do X Frágil de Retardo Mental/metabolismo , Síndrome do Cromossomo X Frágil/patologia , Mitocôndrias/patologia , Proteínas Mitocondriais/metabolismo , Mutação , Proteoma/análise , Tremor/patologia , Ataxia/genética , Ataxia/metabolismo , Estudos de Casos e Controles , Células Cultivadas , Fibroblastos/metabolismo , Fibroblastos/patologia , Proteína do X Frágil de Retardo Mental/genética , Síndrome do Cromossomo X Frágil/genética , Síndrome do Cromossomo X Frágil/metabolismo , Humanos , Masculino , Mitocôndrias/metabolismo , Proteínas Mitocondriais/genética , RNA Interferente Pequeno/genética , Superóxido Dismutase/antagonistas & inibidores , Superóxido Dismutase/genética , Superóxido Dismutase/metabolismo , Tremor/genética , Tremor/metabolismo
13.
Neurology ; 94(6): e639-e650, 2020 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-31937622

RESUMO

OBJECTIVE: To determine whether different phenotypes of cervical dystonia (CD) express different types and levels of somatosensory impairment. METHODS: We assessed somatosensory function in patients with CD with and without tremor (n = 12 each) and in healthy age-matched controls (n = 22) by measuring tactile temporal discrimination thresholds of the nondystonic forearm and proprioceptive acuity in both the dystonic (head/neck) and nondystonic body segments (forearm/hand) using a joint position-matching task. The head or the wrist was passively displaced along different axes to distinct joint positions by the experimenter or through a robotic exoskeleton. Participants actively reproduced the experienced joint position, and the absolute joint position-matching error between the target and the reproduced positions served as a marker of proprioceptive acuity. RESULTS: Tactile temporal discrimination thresholds were significantly elevated in both CD subgroups compared to controls. Proprioceptive acuity of both the dystonic and nondystonic body segments was elevated in patients with CD and tremor with respect to both healthy controls and patients with CD without tremor. That is, tactile abnormalities were a shared dysfunction of both CD phenotypes, while proprioceptive dysfunction was observed in patients with CD with tremor. CONCLUSIONS: Our findings suggest that the pathophysiology in CD can be characterized by 2 abnormal neural processes: a dysfunctional somatosensory gating mechanism involving the basal ganglia that triggers involuntary muscle spasms and abnormal processing of proprioceptive information within a defective corticocerebellar loop, likely affecting the feedback and feedforward control of head positioning. This dysfunction is expressed mainly in CD with tremor.


Assuntos
Propriocepção , Distúrbios Somatossensoriais/fisiopatologia , Torcicolo/fisiopatologia , Tato , Tremor/fisiopatologia , Idoso , Estudos de Casos e Controles , Limiar Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fenótipo , Estimulação Física , Filtro Sensorial , Limiar Sensorial , Distúrbios Somatossensoriais/complicações , Torcicolo/complicações , Tremor/complicações
14.
Nat Commun ; 11(1): 63, 2020 01 02.
Artigo em Inglês | MEDLINE | ID: mdl-31896743

RESUMO

Each vestibular sensory epithelium in the inner ear is divided morphologically and physiologically into two zones, called the striola and extrastriola in otolith organ maculae, and the central and peripheral zones in semicircular canal cristae. We found that formation of striolar/central zones during embryogenesis requires Cytochrome P450 26b1 (Cyp26b1)-mediated degradation of retinoic acid (RA). In Cyp26b1 conditional knockout mice, formation of striolar/central zones is compromised, such that they resemble extrastriolar/peripheral zones in multiple features. Mutants have deficient vestibular evoked potential (VsEP) responses to jerk stimuli, head tremor and deficits in balance beam tests that are consistent with abnormal vestibular input, but normal vestibulo-ocular reflexes and apparently normal motor performance during swimming. Thus, degradation of RA during embryogenesis is required for formation of highly specialized regions of the vestibular sensory epithelia with specific functions in detecting head motions.


Assuntos
Membrana dos Otólitos/embriologia , Ácido Retinoico 4 Hidroxilase/metabolismo , Tretinoína/metabolismo , Animais , Potenciais Evocados/genética , Potenciais Evocados/fisiologia , Feminino , Regulação da Expressão Gênica no Desenvolvimento , Cabeça/fisiopatologia , Camundongos Endogâmicos C57BL , Camundongos Knockout , Osteopontina/metabolismo , Membrana dos Otólitos/citologia , Membrana dos Otólitos/metabolismo , Retinal Desidrogenase/genética , Retinal Desidrogenase/metabolismo , Ácido Retinoico 4 Hidroxilase/genética , Sáculo e Utrículo/citologia , Sáculo e Utrículo/embriologia , Tremor/genética , Tremor/fisiopatologia , Testes de Função Vestibular , Vestíbulo do Labirinto/embriologia , Vestíbulo do Labirinto/metabolismo
15.
World Neurosurg ; 136: 301-304, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31954915

RESUMO

BACKGROUND: Dandy-Walker Syndrome (DWS) is a rare congenital brain malformation characterized by underdevelopment of cerebellar vermis and cystic enlargement of the fourth ventricle and enlargement of the posterior fossa. The cooccurrence of DWS and syringomyelia in adults is very rare. CASE DESCRIPTION: We report a man aged 19 years who presented with a 2-year history of tremor. Magnetic resonance imaging showed cystic dilation of the fourth ventricle, hypoplasia of the cerebellar vermis, and syringomyelia. Posterior fossa decompression and spinal cord ostomy were performed. Tremor was markedly improved and the fourth ventricular and the syringomyelia were reduced in size postoperatively. CONCLUSIONS: Tremor can be a clinical manifestation in patients of DWS concomitant with syringomyelia in adults. Spinal cord ostomy combined with posterior fossa decompression may be an effective approach for alleviation of symptoms and syringomyelia.


Assuntos
Síndrome de Dandy-Walker/complicações , Siringomielia/complicações , Tremor/etiologia , Vermis Cerebelar/diagnóstico por imagem , Vermis Cerebelar/patologia , Fossa Craniana Posterior/cirurgia , Síndrome de Dandy-Walker/diagnóstico por imagem , Descompressão Cirúrgica , Quarto Ventrículo/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Procedimentos Neurocirúrgicos , Estomia , Medula Espinal/cirurgia , Siringomielia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tremor/diagnóstico por imagem , Adulto Jovem
16.
Toxicon ; 176: 10-14, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31965968

RESUMO

The association between tremor and dystonia has been known for many decades. Dystonic tremor is seen in the body part affected with dystonia. Tremor and dystonia can also co-exist in different body parts. Subtle dystonic posturing can be missed in patients with upper limb tremor and these patients are often misdiagnosed as essential tremor. Careful clinical examination and electrophysiology may help in differentiating classical essential tremor from dystonic tremor. Writer's cramp, a common focal hand dystonia can mimic primary writing tremor when the dystonic posturing is subtle. Oral medications have limited therapeutic efficacy. Botulinum toxin is considered as first line therapy for focal limb dystonia and is also effective in the treatment of tremor. Surgical options are reserved for cases refractory to medical therapy. In this review, we summarize the current state of knowledge of focal limb dystonia and tremor with a focus on underlying neurophysiology in these conditions.


Assuntos
Toxinas Botulínicas/uso terapêutico , Distonia/tratamento farmacológico , Tremor/tratamento farmacológico , Distúrbios Distônicos/diagnóstico , Humanos
17.
Sci Rep ; 10(1): 1436, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31996749

RESUMO

The link between dystonia and tremor has been known for decades, but the question of whether they are two separate illnesses or just different manifestations of one disease with the same pathophysiological background remains unanswered. We distinguish two types of tremor in dystonia: dystonic tremor (DT), which appears on the body part affected by dystonia, and tremor associated with dystonia (TAWD), which appears in locations where the dystonia does not occur. In this study, the frequency of occurrence of different forms of tremor was determined by clinical examination in a group of adult-onset isolated cervical dystonia (CD) patients treated with regular local injections of botulinum toxin A in our department. In total, 120 patients were included in the study, of which 70 (58.3%) had DT of the head. TAWD was, in all 14 cases (11.7%), observed on the upper limbs, in the form of static or intentional tremor. The aim of this study was to point out the presence of TAWD as one of the clinical signs of CD. DT occurred in more than half of the patients and appears to be a relatively common part of the clinical picture in patients with CD.


Assuntos
Distonia/epidemiologia , Torcicolo/epidemiologia , Tremor/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , República Tcheca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência
18.
Indian J Pediatr ; 87(3): 169-170, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31984468
20.
World Neurosurg ; 134: e98-e102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31568905

RESUMO

BACKGROUND: Programming deep brain stimulation (DBS) settings in patients with Parkinson disease (PD) is challenging and time consuming because of the vast number of possible parameter combinations. This results in long sessions that can be exhausting for the patients and physicians. GUIDE (Boston Scientific) is a 3-dimensional neuroanatomic visual software that precisely visualizes the location of the DBS electrode in the subthalamic nucleus (STN). The objective of this paper is to compare the duration and clinical effects of traditional trial and error versus GUIDE-assisted DBS programming in 10 patients with PD treated with STN DBS. METHODS: For each patient, neurostimulation parameters were selected with GUIDE to create a stimulation field encompassing the dorsal part of the STN. On programming day, each patient was assessed with both traditional and GUIDE approaches using a crossover design. For GUIDE-assisted sessions, the patients were programmed directly with the DBS settings obtained with the stimulated field model, and if necessary, parameters were adjusted to achieve optimal clinical response. Clinical improvement was assessed with Unified Parkinson's Disease Rating Scale scores for limb bradykinesia, tremor, and rigidity. RESULTS: In 7 patients, DBS settings obtained with GUIDE led to suboptimal clinical improvement and mild adjustments were required. After these adjustments, the magnitude of clinical improvement with the 2 approaches was comparable (P = 0.8219). Programming time with GUIDE was significantly shorter than with the traditional programming approach (P < 0.0001). CONCLUSIONS: Visualization of stimulation fields with GUIDE provides useful information to achieve a clinical improvement comparable with that obtained with the traditional trial and error approach, but with shorter and more efficient programming sessions.


Assuntos
Estimulação Encefálica Profunda , Imageamento Tridimensional , Doença de Parkinson/cirurgia , Software , Adulto , Idoso , Estimulação Encefálica Profunda/métodos , Feminino , Globo Pálido/fisiopatologia , Globo Pálido/cirurgia , Humanos , Imageamento Tridimensional/métodos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Núcleo Subtalâmico/fisiopatologia , Núcleo Subtalâmico/cirurgia , Resultado do Tratamento , Tremor/etiologia , Tremor/cirurgia
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