[Deep brain stimulation of the subthalamic nucleus for parkinson's disease: awake vs asleep]. / Elektrostimulyatsiya subtalamicheskogo yadra pri bolezni Parkinsona: pod narkozom ili v soznanii?

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known to be an effective and safe neurosurgical procedure for Parkinson's disease (PD). Traditionally, awake implantation of stimulation system is carried out using microelectrode registration and intraoperative stimulation. Development of neuroimaging technologies enables direct STN imaging. Therefore, asleep surgery without additional intraoperative verification is possible. This approach reduces surgery time and can potentially decrease the incidence of hemorrhagic and infectious complications. The advantages of one method or another are being discussed. OBJECTIVE: To assess the benefits and limitations of various methods for DBS system implantation for bilateral STN stimulation, to study the issues of stereotaxic accuracy, efficiency and safety of asleep and awake electrode implantation into STN. MATERIAL AND METHODS: We reviewed the articles published in the PubMed database. Searching algorithm included the following keywords: «asleep DBS¼, «Parkinson's disease¼, «subthalamic nucleus¼, «3T MRI¼, «SWI¼, «SWAN¼. RESULTS: There were 31 articles devoted to asleep DBS of STN including 4 meta-analyses, 3 prospective controlled studies, 13 retrospective controlled studies and 11 studies without a control group. CONCLUSION: Asleep implantation of electrodes for DBS of STN can be performed only after a clear imaging of STN boundaries with high-quality MRI.

[Historical view on the pathogenesis and surgical treatment of cervical dystonia]. / Istoriya izucheniya patogeneza i khirurgicheskogo lecheniya tservikal'noi distonii.

In the past few decades, approaches to surgical treatment of dystonia passed through paradigmatic shift. Intradural upper cervical anterior rhizotomy was replaced by selective peripheral denervation with lesser spectrum of side-effects. Such techniques as microvascular decompression of accessory nerve or spinal cord stimulation for cervical dystonia were abandoned due to lack of proven efficacy. Introducing globus pallidus interna (GPi) DBS in 1990's to treat all types of dystonia, including cervical dystonia, was a fundamental factor. With the growing body of knowledge on the pathophysiology of dystonia, GPi DBS appears to be the most expedient, effective and safe method with limited indications to peripheral destructive procedures.

[Deep brain stimulation effect on postural instability and gait disorders in Parkinson's disease]. / Narusheniia khod'by i postural'naia neustoichivost' pri bolezni Parkinsona na fone khronicheskoi stimuliatsii podkorkovykh struktur.

An effect of deep brain stimulation on postural instability and gait disorders in Parkinson's disease S.G. Sultanova, N.V. Fedorova, E.V. Bril, A.A. Gamaleya, A.A. Tomskiy During the last time, surgical treatment of patients with Parkinson's disease has firmly taken its place in the general algorithm for managing patients with this pathology. Deep brain electrostimulation is the most advanced and promising method, which allows the reduction in the severity of main clinical manifestations of the disease, including axial symptoms. It is noted that certain temporal aspects of parkinsonian gait disorder remain therapeutically resistant. Subthalamic nucleus stimulation was also reported to improve levodopa-responsive freezing of gait. In this review, the authors summarize the effects of deep brain stimulation on gait and postural symptoms.

[Effects of bilateral deep brain stimulation in the subthalamic nucleus using two methods of target structure verification]. / Dinamika motornykh simptomov bolezni Parkinsona na fone khronicheskoi dvustoronnei élektrostimuliatsii subtalamicheskogo iadra s ispol'zovaniem dvukh metodik verifikatsii struktury misheni.

AIM: To evaluate the efficacy of deep brain stimulation in the subthalamic nucleus (DBS STN) in patients with Parkinson's disease (PD) using different methods of targeting according to the dynamics of motor symptoms of PD. MATERIAL AND METHODS: The study involved 90 patients treated with DBS STN. In 30 cases intraoperative microelectrode recording (MER) was used. MER was not performed in 30 patients of the comparison group. The control group consisted of 30 patients with PD who received conservative treatment. Hoehn and Yahr scale, Tinetti Balance and Mobility Scale (TBMS), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Quality of Life-39 Scoring System (РDQ-39), Schwab & England ADL Scale were used. Levodopa equivalent daily dose (LEDD, 2010) was calculated for each patient. RESULTS AND CONCLUSION: The effect of DBS STN using intraoperative microelectrode recording on the main motor symptoms, motor complications, walking as well as indicators of quality of life and daily activities was shown. In both DBS STN groups, there was a significant reduction in the LEDD and marked improvement of the control of motor symptoms of PD. A significant reduction in the severity of motor fluctuations (50%) and drug-induced dyskinesia (51%) was observed. Quality of life and daily activity in off-medication condition were significantly improved in both DBS STN groups of patients, irrespective of the method of target planning (75-100%), compared with the control group.

[Syndrome dopamine dysregulation and deep brain stimulation of the subthalamic nucleus in Parkinson's disease]. / Sindrom dofaminovoi dizreguliatsii i khronicheskaia stimuliatsiia subtalamicheskogo iadra pri bolezni Parkinsona.

AIM: Dopamine dysregulation syndrome (DDS) is a complication of the dopaminergic therapy in Parkinson's disease (PD); it is manifested as a compulsive medication use and may have negative impact on patients' social, psychological, and physical functioning. An effect of deep brain stimulation in the subthalamic nucleus (DBS STN) on DDS is not fully understood. Therefore, the degree of DDS during DBS STN in PD patients was evaluated in the study. MATERIAL AND METHODS: The main group included 15 patients with DDS symptoms in the preoperative period. The comparison group consisted of 15 patients without DDS symptoms and the control group consisted of 15 patients who did not undergo surgery. RESULTS AND CONCLUSION: The severity of motor disturbances in the surgery groups has decreased significantly (by 45%). Motor complications during DBS STN in patients with DDS have decreased by 50%; a decrease in the reduction of doses of dopaminergic preparations was noted as well.

[Pharmacotherapy accompanied by deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease]. / Medikamentoznaia terapiia na fone élektrostimuliatsii subtalamicheskogo iadra u patsientov s bolezn'iu Parkinsona.

AIM: To analyze pharmacotherapy accompanied by deep brain stimulation of the subthalamic nucleus. MATERIAL AND METHODS: The study included 54 patients, who underwent bilateral STN DBS from 2003 to 2012. The severity of motor disturbances, activities of daily living and complications of dopaminergic therapy were estimated in accordance with II, III and IV parts of the Unified Parkinson's Disease Rating Scale (UPDRS) before operation and one, three and four years after it. L-dopa equivalent daily dose (LEDD) was assessed along with an analysis of the pharmacotherapy in whole. RESULTS AND CONCLUSION: By the end of the 1st year, the severity of motor disturbances in OFF-period decreased by 52.3% and remained stable for 3 years (51.8%), a slight increase of severity of motor disturbances was observed later, however it didn't reach the pre-operative level. The severity of motor fluctuations and drug-induced dyskinesia fell by 64.9%, 70.7% and 42.7% by the end of the first, third and fourth year of observation. The maximal decrease in LEDD was reached by the end of the 1st year and accounted for 57.7%; by the end of the third and fourth years it was 52.4% and 38.2%, respectively. During the 1st year, 16.7% of patients didn't take levodopa. The dose of pure levodopa decreased by the end of the 1st year by 64.6%, and by 56.7% and 43.7% by the end of the 3rd and 4th years, respectively. Monotherapy by an agonist of dopamine receptors (ADR) was received by 12.9% of patients, thus the share of ADR as part of the combined therapy increased in the postoperative period from 24.1% to 35.2%.

Speech disorders in right-hemisphere stroke.

Clinical practice shows that right-hemisphere cerebral strokes are often accompanied by one speech disorder or another. The aim of the present work was to analyze published data addressing speech disorders in right-sided strokes. Questions of the lateralization of speech functions are discussed, with particular reference to the role of the right hemisphere in speech activity and the structure of speech pathology in right-hemisphere foci. Clinical variants of speech disorders, such as aphasia, dysprosody, dysarthria, mutism, and stutter are discussed in detail. Types of speech disorders are also discussed, along with the possible mechanisms of their formation depending on the locations of lesions in the axis of the brain (cortex, subcortical structures, stem, cerebellum) and focus size.