Spinal cord stimulation for gait impairment in Parkinson Disease: scoping review and mechanistic considerations.

OBJECTIVE: Advanced Parkinson's Disease (PD) is associated with Parkinson's Disease gait impairment (PDg), which increases the risk for falls and is often treatment-refractory. Subthalamic nucleus (STN) and globus pallidus pars interna (GPi) deep brain stimulation (DBS) often fails to improve axial symptoms like PDg. Spinal cord stimulation (SCS) has been suggested to improve PDg. SCS may benefit PDg by disrupting pathologic beta-oscillations and hypersynchrony in cortico-striatal-thalamic circuits to override excessive inhibition of brainstem locomotor regions. SCS may potentially improve locomotion by acting at any of these levels, either alone or in combination. METHODS: We conducted a comprehensive literature search and scoping review, identifying 106 patients in whom SCS was evaluated for PDg. RESULTS: Among the identified patients, 63% carried a pain diagnosis. Overall, the most common stimulation location was thoracic (78%), most commonly T9-T10. Burst (sub-perception) was the most common stimulation modality (59%). Prior treatment with DBS was used in 25%. Motor outcomes were assessed by the Unified Parkinson Disease Rating Scale (UPDRS) III-motor, UPDRS, the Timed Up and Go (TUG), and/or 10-/20-meter walking tests.Among these patients, 95 (90%) had PDg amelioration and improved motor outcomes. CONCLUSIONS: Despite small sample sizes, patient heterogeneity, and unblinded evaluations complicating interpretations of efficacy and safety, SCS may be beneficial for at least a subset of PDg. Further research is required to clarify the role of SCS for PDg and the patients most suitable to benefit from this intervention.

Health consequences of involuntary exposure to benzene following a flaring incident at British Petroleum refinery in Texas City.

OBJECTIVE: Environmental exposure to benzene can lead to deleterious effects on many biological systems including blood-forming organs, liver, and kidneys. The authors sought to investigate the health consequences of benzene exposure following a flaring incident that occurred at the British Petroleum (BP) refinery in Texas City, TX. SUBJECTS AND PARTICIPANTS: A cohort of subjects who were exposed to a daily sustained release of toxic chemicals including more than 7,711 kg (17,000 lb) of benzene for a total duration of 40 days due to BP's flaring incident. INTERVENTIONS: Not applicable to an observational study. METHODS: Subjects who underwent physical and clinical evaluation between June 2010 and October 2012 were included. Demographic and clinical laboratory data were collected and analyzed. Hematologic data such as white blood cell (WBC) counts, platelet counts, hemoglobin, hematocrit, blood urea nitrogen (BUN), and creatinine levels in the serum were evaluated. In addition, data on alkaline phosphatase (ALP), aspartate amino transferase (AST), and alanine amino transferase (ALT) levels in the serum were examined. Urinary phenol was evaluated as a benzene metabolite. The outcomes were compared between exposed and unexposed patients. RESULTS: A total of 200 subjects (benzene exposed, n = 100 and unexposed, n = 100) were included. Benzene exposed subjects showed significantly higher levels of WBC (×10(3) per µL) count (8.6 ± 5.4 vs 6.5 ± 2.0, p = 0.0003) and platelet (×10(3) per µL) count (291.3 ± 82.7 vs 264.1 ± 74.0, p = 0.0076) compared with the unexposed subjects. ALP (IU/L) was significantly elevated in the benzene exposed subjects compared with the unexposed subjects (121.2 ± 73.7 vs 65.4 ± 23.6, p = 0.000). Similarly, benzene exposed subjects had significantly higher levels of AST (IU/L) compared with unexposed subjects (23.4 ± 11.8 vs 19.5 ± 8.9, p = 0.0089). CONCLUSION: This retrospective pilot study found that environmental benzene exposure from the BP's flaring incident appears to pose significant health risks including specific alteration of blood cells and liver enzymes, indicating that subjects exposed to benzene may be at a higher risk of developing hepatic or blood related disorders.