Postoperative rehabilitation after deep brain stimulation surgery for movement disorders.

Deep brain stimulation (DBS) is a highly efficient, evidence-based therapy for a set of neurological and psychiatric conditions and especially movement disorders such as Parkinson's disease, essential tremor and dystonia. Recent developments have improved the DBS technology. However, no unequivocal algorithms for an optimized postoperative care exist so far. The aim of this review is to provide a synopsis of the current clinical practice and to propose guidelines for postoperative and rehabilitative care of patients who undergo DBS. A standardized work-up in the DBS centers adapted to each patient's clinical state and needs is important, including a meticulous evaluation of clinical improvement and residual symptoms with a definition of goals for neurorehabilitation. Efficient and complete information transfer to subsequent caregivers is essential. A coordinated therapy within a multidisciplinary team (trained in movement disorders and DBS) is needed to achieve the long-range maximal efficiency. An optimized postoperative framework might ultimately lead to more effective results of DBS.

Altered tonic and phasic cortisol secretion following unilateral stroke.

Evidence is accumulating that cerebral laterality appears to be an important feature in the regulation of the stress response with the right hemisphere being closely linked to stress-regulatory systems, including the hypothalamic-pituitary-adrenal (HPA) axis. Although some animal and human data support this hypothesis, studies on brain damaged patients yet failed to substantiate laterality effects on cortisol secretion. The aim of this study was to examine whether unilateral stroke differentially affects tonic and phasic response characteristics of the HPA axis, and to evaluate the impact of intrahemispheric lesion location. Basal morning cortisol levels and phasic responses towards a mentally challenging task were examined in 32 stroke patients with left-sided (LH; n=18) or right-sided (RH; n=14) infarctions and 30 healthy controls matched for age and gender. Only LH, but not RH patients displayed increased morning cortisol levels when compared to controls. In contrast, phasic reactions were blunted in the combined patient group with RH patients showing the most distinct decline. More anterior located lesions were associated with reduced phasic, but not tonic cortisol measures. This relationship appeared to be particularly pronounced in RH patients. Results support the conclusion that the central regulation of cortisol secretion is under excitatory control of the right hemisphere and can be interpreted within a framework of asymmetrical regulation of the stress response. Left- and right-sided strokes may differentially affect response patterns of the HPA axis, a stress-regulatory system that is associated with effective protection against disease and external challenges.