Deep brain stimulation in early Parkinson's disease: enrollment experience from a pilot trial.

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus is an accepted therapy for advanced Parkinson's disease (PD). In animal models, pharmacologic ablation and stimulation of the subthalamic nucleus have resulted in clinical improvement and, in some cases, improved survival of dopaminergic neurons. DBS has not been studied in the early stages of PD, but early application should be explored to evaluate safety, efficacy, and the potential to alter disease progression. METHODS: We are conducting a prospective, randomized, single-blind clinical trial of optimal drug therapy (ODT) compared to medication plus DBS (ODT + DBS) in subjects with Hoehn & Yahr Stage II idiopathic PD who are without motor fluctuations or dementia. We report here subject screening, enrollment, baseline characteristics, and adverse events. RESULTS: 30 subjects (average age 60 ± 6.9 years, average duration of medicine 2.1 ± 1.3 years, average UPDRS-III scores 14.9 on medication and 27.0 off medication) are enrolled in the ongoing study. Twelve of 15 subjects randomized to DBS experienced perioperative adverse events, the majority of which were related to the procedure or device and resolved without sequelae. Frequently reported adverse events included wound healing problems, headache, edema, and confusion. CONCLUSION: This report demonstrates that subjects with early stage PD can be successfully recruited, consented and retained in a long-term clinical trial of DBS. Our ongoing pilot investigation will provide important preliminary safety and tolerability data concerning the application of DBS in early stage PD.

Occurrence of depressive symptoms in Shy-Drager syndrome.

We investigated the frequency and severity of depressive symptoms among patients with Shy-Drager Syndrome (SDS) and correlated depression with the extent of the patients' disability. Data were collected from 15 patients and their spouse caregivers through a mailed questionnaire. The patients were asked to complete the Beck Depression Inventory (BDI) questionnaire, while caregivers were asked to complete the self-assessment Parkinson's Disease Disability Scale and The Northwestern University Disability Scale for Parkinson's Disease. Data were statistically analyzed using descriptive statistics and Pearson-Product moment correlations. The prevalence of depressive symptoms was 85.7%; 28.6% of SDS patients scored in the moderately to severely depressed range. There was no significant correlation between the severity of depressive symptoms and disability (r = 0.02, p = 0.94) and the ability to perform activities of daily living (r = 0.0, p = 1.0). The prevalence of depressive symptoms in patients with SDS is common. The patient's level of depression does not correlate with physical disability. Pharmacologic management and interventions aimed at increasing active coping methods should improve quality of life.

Podiatric medical education. A view into the next century.

The authors examine the future of podiatric medicine through an analysis of the characteristics of students presently enrolled in the colleges of podiatric medicine and the characteristics of college graduates from 1990 to 1995. Specific attention is also given to a number of critical issues surrounding graduate podiatric medical education. The authors conclude that despite a growing number of challenges awaiting podiatric medical education, the present complement of students and graduates of the colleges of podiatric medicine appear to offer the public reasonable expectations for quality foot care.

Oxprenolol plus ethanol causes no central nervous system depression--a comparison with lorazepam plus ethanol.

Oxprenolol, a fat-soluble beta-adrenergic blocker, promoted as an anxiolytic agent to alleviate peripheral symptoms associated with anxiety, and lorazepam, a 1,4-benzodiazepine anxiolytic drug, may both depress central nervous system (CNS) function. It is generally accepted that ethanol, when concurrently ingested, potentiates the CNS-depressant effects of drugs. The effects on CNS function of oxprenolol, lorazepam and placebo alone and in combination with ethanol were determined by a Leeds Psychomotor Tester and we concluded that oxprenolol in combination with ethanol is less hazardous to people operating power tools/machines or driving motor vehicles than the combination of lorazepam with ethanol.