The relationships between three-axis accelerometer measures of physical activity and motor symptoms in patients with Parkinson's disease: a single-center pilot study.

BACKGROUND: Various wearable devices for objectively evaluating motor symptoms of patients with Parkinson's disease (PD) have been developed. Importantly, previous studies have suggested protective effects of physical activity in PD. However, the relationships between conventional clinical ratings for PD and three-axis accelerometer measures of physical activity (e.g., daily physical activity levels [PAL] or metabolic equivalents of task [METs]) are still unclear, particularly for METs. In the current study, we sought to elucidate these relationships on a daily basis, and to clarify optimal predictors for clinical states on a 30-min basis. METHODS: Patients who were hospitalized for adjustment of drugs or deep brain stimulation were enrolled. Using waist-worn three-axis accelerometers, PAL and METs parameter data were obtained and compared with UPDRS-3[On] and symptom diary data. We extracted data from the patients' best and worst days, defined by the best and worst UPDRS-3[On] scores, respectively. Thus, 22 data sets from 11 patients were extracted. We examined the correlations and produced scatter plots to represent the relationships, then investigated which METs parameters and activity patterns were the best predictors for "On" and "dyskinesia". RESULTS: The parameter "mean METs value within the 95-92.5 percentile range on a day (95-92.5 percentile value)" exhibited the strongest correlation with conventional daily clinical ratings (Rho: - 0.799 for UPDRS-3[On], 0.803 for On hours [p < 0.001]). Scatter plots suggested that PAL tended to have higher values in patients with involuntary movement. However, METs parameters focusing on higher METs seemed to alleviate this tendency. We clarified that "time over 2.0 METs" and "time over 1.5 METs" could be predictors for "On" and "dyskinesia" on a 30-min basis, respectively (AUROC: 0.779 and 0.959, 95% CI: 0.733-0.824 and 0.918-1.000). The specificity and sensitivity of the optimal activity pattern for "On" were 0.858 and 0.621. CONCLUSIONS: This study suggested feasible activity patterns and METs parameters for objective evaluation of motor symptoms on a 30-min or daily basis. Three-axis accelerometer measures focusing on higher METs may be appropriate for evaluating physical activity. Further larger-scale studies are necessary to clarify the validity, reliability, and clinical utility of these objective measures.

Early detection of speech and voice disorders in Parkinson's disease patients treated with subthalamic nucleus deep brain stimulation: a 1-year follow-up study.

We previously reported that Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS) had distinct phenotypes of speech and voice disorders: hypokinetic dysarthria, stuttering, breathy voice, strained voice, and spastic dysarthria. However, changes over time remain unclear. In the present study, 32 consecutive PD patients were assessed before and up to 1 year after surgery (PD-DBS). Eleven medically treated PD patients were also assessed (PD-Med). Speech, voice, motor, and cognitive functions were evaluated. At baseline, the incidence of hypokinetic dysarthria (63% of PD-DBS vs. 82% of PD-Med), stuttering (50% vs. 45%), breathy voice (66% vs. 73%), and strained voice (3% vs. 9%) was similar between groups. At 1 year, a slight but significant deterioration in speech intelligibility (p < 0.001) and grade of dysphonia (p = 0.001) were observed only in PD-DBS group compared with baseline. During the follow-up, stuttering (9% vs. 18%) and breathy voice (13% vs. 9%) emerged in PD-DBS and PD-Med, but strained voice (28%) and spastic dysarthria (44%) emerged only in PD-DBS. After the stimulation was stopped, strained voice and spastic dysarthria improved in most patients, while stuttering and breathy voice improved in a minority of patients. These findings indicate that the most common DBS-induced speech and voice disorders are strained voice and spastic dysarthria and that STN-DBS potentially aggravates stuttering and breathy voice. An improved understanding of these types of disorders may help detect speech and voice deteriorations during the early phase and lead to appropriate treatments.

Distinct phenotypes of speech and voice disorders in Parkinson's disease after subthalamic nucleus deep brain stimulation.

OBJECTIVES: To elucidate the phenotypes and pathophysiology of speech and voice disorders in Parkinson's disease (PD) with subthalamic nucleus deep brain stimulation (STN-DBS). METHODS: We conducted a cross-sectional study on 76 PD patients treated with bilateral STN-DBS (PD-DBS) and 33 medically treated PD patients (PD-Med). Speech and voice functions, electrode positions, motor function and cognitive function were comprehensively assessed. Moreover, speech and voice functions were compared between the on-stimulation and off-stimulation conditions in 42 PD-DBS patients. RESULTS: Speech and voice disorders in PD-DBS patients were significantly worse than those in PD-Med patients. Factor analysis and subsequent cluster analysis classified PD-DBS patients into five clusters: relatively good speech and voice function type, 25%; stuttering type, 24%; breathy voice type, 16%; strained voice type, 18%; and spastic dysarthria type, 17%. STN-DBS ameliorated voice tremor or low volume; however, it deteriorated the overall speech intelligibility in most patients. Breathy voice did not show significant changes and stuttering exhibited slight improvement after stopping stimulation. In contrast, patients with strained voice type or spastic dysarthria type showed a greater improvement after stopping stimulation. Spastic dysarthria type patients showed speech disorders similar to spastic dysarthria, which is associated with bilateral upper motor neuron involvement. Strained voice type and spastic dysarthria type appeared to be related to current diffusion to the corticobulbar fibres. CONCLUSIONS: Stuttering and breathy voice can be aggravated by STN-DBS, but are mainly due to aging or PD itself. Strained voice and spastic dysarthria are considered corticobulbar side effects.

Characteristic laryngoscopic findings in Parkinson's disease patients after subthalamic nucleus deep brain stimulation and its correlation with voice disorder.

Speech and voice disorders are one of the most common adverse effects in Parkinson's disease (PD) patients treated with subthalamic nucleus deep brain stimulation (STN-DBS). However, the pathophysiology of voice and laryngeal dysfunction after STN-DBS remains unclear. We assessed 47 PD patients (22 treated with bilateral STN-DBS (PD-DBS) and 25 treated medically (PD-Med); all patients in both groups matched by age, sex, disease duration, and motor and cognitive function) using the objective and subjective voice assessment batteries (GRBAS scale and Voice Handicap Index), and laryngoscopy. Laryngoscopic examinations revealed that PD-DBS patients showed a significantly higher incidence of incomplete glottal closure (77 vs 48 %; p = 0.039), hyperadduction of the false vocal folds (73 vs 44 %; p = 0.047), anteroposterior hypercompression (50 vs 20 %; p = 0.030) and asymmetrical glottal movement (50 vs 16 %; p = 0.002) than PD-Med patients. On- and off-stimulation assessment revealed that STN-DBS could induce or aggravate incomplete glottal closure, hyperadduction of the false vocal folds, anteroposterior hypercompression, and asymmetrical glottal movement. Incomplete glottal closure and hyperadduction of the false vocal folds significantly correlated with breathiness and strained voice, respectively (r = 0.590 and 0.539). We should adjust patients' DBS settings in consideration of voice and laryngeal functions as well as motor function.

[Mood States in outpatients with lesional epilepsy at the neurosurgical clinic and improvement in mood States after lamotrigine addiction].

People with epilepsy have a high incidence of mood disorders that may affect their quality of life. Lamotrigine(LTG)is one of the antiepileptic drugs that are commercially available in Japan these days and its mood-stabilizing qualities were well known. First, 66 outpatients with epilepsy were evaluated for changes in mood states by the Profile of Mood States(POMS)and the Japanese-edition Beck Depression Inventory-Second Edition(BDI-II)on self report. The POMS questionnaire includes 30 items that address six components of mood. At baseline, one third of the outpatients with epilepsy had mood problems compared by POMS health reference. The mean BDI-II baseline score was 14.9±10.1, and one third of these epilepsy patients exhibited moderate or severe depression. Second, in the twelve patients with epilepsy, LTG was added to other antiepileptic drugs, and the POMS and BDI-II were administered at baseline and after addiction to LTG. 4 out of 8(50%)patients with simple partial seizure and 5 out of 8(62.5%)patients after the adjunctive therapy experienced at least a 50% reduction in the number of seizures compared with the self-reported baseline before the adjunctive therapy. The component scores of Depression-Dejection, Anger-Hostility and Confusion-Bewilderment in POMS were statistically improved in these patients completing adjunctive LTG(pared t-test, p<0.05). In these patients, the mean BDI-II baseline score was 25.8±13.1. Following administration of LTG, there was a significant decrease in the mean BDI-II scores(15.0±6.6)between baseline and the end of adjunctive LTG. This study suggests that, in addition to seizure control, LTG may have a mood-stabilizing effect and improve the quality of life in patients with epilepsy.

[Efficacy of tramadol/acetaminophen medication for central post-stroke pain].

OBJECTIVE: Central post-stroke pain(CPSP)is the most difficult type of central neuropathic pain to control with medical treatment. Opioids are commonly used for chronic neuropathic pain, but their efficacy in treating central neuropathic pain, particularly CPSP, is not clear. Tramadol is an opioid analgesic that, in combination with acetaminophen, has been approved since 2011 for the treatment of non-cancer pain in Japan. In this study we evaluated the efficacy of tramadol/acetaminophen medication for CPSP. METHODS: We retrospectively reviewed nine cases of CPSP that received oral tramadol/acetaminophen medication. All cases received tramadol/acetaminophen medication after first taking pregabalin then antidepressant medication. Pain levels were assessed before tramadol/acetaminophen medication began and one month after a maintenance dose was reached, using a visual analogue scale(VAS)and the McGill pain questionnaire(MPQ). RESULTS: The mean dose of tramadol was 121±61.6 mg/day. Tramadol/acetaminophen medication was effective in reducing pain in seven of nine cases(77.8%). The VAS improved 32.9±13.8% from pre-to post-medication, and the MPQ improved from 15.4±9.1 pre-medication to 8.1±4.7 post-medication(p<0.05). These effects continued 9.3±4.5 months during follow up periods. Side effects were observed in six cases(one severe, one moderate, two mild, two transient), but medication was continued in eight cases. CONCLUSION: Oral tramadol/acetaminophen medication was effective at reducing pain levels in patients with CPSP, and is a medication option for the treatment of CPSP.

Mechanical Thrombectomy for Basilar Artery Occlusion with a Type 1 Persistent Proatlantal Artery: A Case Report and Literature Review.

Objective: Persistent proatlantal artery (PPA) is a primitive carotid-vertebrobasilar anastomosis (CVA); acute ischemic stroke due to basilar artery (BA) occlusion via a PPA is extremely rare. Case Presentation: An 84-year-old female developed disturbance of consciousness (Glasgow Coma Scale E2V1M5) and quadriparesis with a National Institutes of Health Stroke Scale score of 35. Head CT revealed early ischemic changes in the right temporal lobe, and a hyperdense vessel sign in the BA. Cerebral angiography showed that the left vertebral artery (VA) did not originate from the left subclavian artery or aortic arch. A left common carotid artery angiogram showed the presence of the left PPA originating from the left external carotid artery. Mechanical thrombectomy (MT) with contact aspiration using a Penumbra 5MAX ACE 60 aspiration catheter was performed, and successful recanalization was achieved after clot retrieval in the first attempt (thrombolysis in cerebral infarction scale 2b). MRI performed the following day, however, revealed a newly developed large hemorrhagic infarction in the pons, with no improvement in her symptoms (modified Rankin Scale score of 5 at 90 days). Conclusion: Although MT achieved successful recanalization of the BA via the PPA, her clinical symptoms did not improve, probably because of poor collateral circulation or the long length of the occlusion. In patients with acute vertebro-BA occlusion, if the VA does not originate from the subclavian artery or aortic arch, the presence of a primitive CVA should be considered.

[Dual lead spinal cord stimulation using octad lead for central post-stroke pain].

Spinal cord stimulation (SCS) has become the preferred option for neurosurgical management of several intractable pains. To evaluate effects of dual lead SCS using two quad leads for central post-stroke pain (CPSP), we retrospectively reviewed eight consecutive patients with CPSP who underwent SCS. Six (75%) of eight patients obtained more than 50% pain relief during test stimulation, and the efficacies continued for about 12 months in five (83%) of six patients. There were no significant complications. SCS is less invasive neurostimulation treatment and provides pain relief for some cases of CPSP.

Pilocytic astrocytoma of the optic nerve with intracystic hemorrhage in an adult: illustrative case.

BACKGROUND: Optic pathway gliomas are uncommon, accounting for 3-5% of childhood brain tumors, and are mostly classified as pilocytic astrocytomas (PAs). PAs of the optic nerve are particularly rare in adults. OBSERVATIONS: The authors presented the case of PA of the left optic nerve in a 49-year-old woman along with detailed pathological and molecular analyses and sequential magnetic resonance imaging. The tumor had progressed during 5 years of follow-up along with cyst formation and intracystic hemorrhage; it had a thick capsule and contained xanthochromic fluid. The boundary between tumor and optic nerve was unclear. B-type Raf kinase (BRAF) V600E point mutations or translocations, IDH1-R132H mutations, loss of alpha-thalassemia/mental retardation X-linked, and 1p/19q codeletion were negative. LESSONS: BRAF alterations in pediatric PAs of the optic nerve are less frequent than those observed in PAs in other lesions; the same molecular pattern was observed in the adult case, without changes in BRAF. Surgical management should be indicated only in cases with severely impaired vision or disfigurement because there is no clear border between the tumor and optic nerve. Further discussion is needed to optimize the treatment for adult optic pathway gliomas, including radiotherapy, chemotherapy, and molecular-targeted therapies, in addition to surgical intervention.

Mechanical Thrombectomy for Azygos Anterior Cerebral Artery Occlusion: A Case Report and Literature Review.

Objective: Azygos anterior cerebral artery (ACA) is a well-known anomaly of the second segment of the ACA. Although cases of intracerebral aneurysms related to this anomaly have been reported, acute ischemic stroke (AIS) related to the azygos ACA is extremely rare. Case Presentation: An 84-year-old man developed disturbance of consciousness (Glasgow Coma Scale [GCS] E3V1M5), quadriparesis and aphasia, with a National Institutes of Health Stroke Scale (NIHSS) score of 32. Magnetic resonance imaging (MRI) showed no early ischemic changes, although a head magnetic resonance angiogram (MRA) demonstrated a single A2 trunk without any A3 branches that were suspected bilateral ACA occlusions. Mechanical thrombectomy for the occluded A2 trunk with contact aspiration using a Penumbra 4MAX aspiration catheter was performed, and the clot was retrieved and complete recanalization was achieved after two attempts (Thrombolysis in Cerebral Infarction scale 3) without any complications (onset to recanalization time: 187 min). The final angiogram demonstrated the recanalization of the single A2 and bilateral A3 branches, so we diagnosed as azygos ACA occlusion. MRI performed the next day revealed several small infarctions in bilateral frontal lobes, but ischemic symptoms gradually improved. NIHSS score decreased to two in 2 weeks and modified Rankin Scale (mRS) score at 90 days was one. Conclusion: In this case, occlusion of the azygos ACA led to a large ischemic penumbra that spread widely and bilaterally in the ACA area, resulting in sudden onset of severe ischemic symptoms, including quadriparesis and aphasia. However, due to complete and rapid recanalization with contract aspiration, a large part of the ACA territory bilaterally was salvaged and the patient recovered extremely well.

Results of Mechanical Thrombectomy in Patients Aged ≥80 Years.

Objective: The effectiveness of mechanical thrombectomy (MT) for anterior circulation large vessel occlusion (LVO) is controversial in elderly patients. The aim of this study was to evaluate the efficacy of MT in octogenarians. Methods: One hundred and sixty-five patients who underwent MT for anterior circulation LVO between May 2014 and August 2019 at our institution were evaluated. Patients were divided into two groups, the elderly group (≥80 years) and non-elderly group (<80 years), and we compared the effective recanalization rate (Thrombolysis in Cerebral Infarction 2b-3), good outcome rate (modified Rankin Scale 0-2 at 90 days), time from groin puncture to recanalization (P to R), symptomatic intracranial hemorrhage (sICH), and mortality rate between them retrospectively. Eligible patients for MT were judged using the Japanese stroke guidelines, and the selection criteria were more carefully applied to elderly patients. Results: MT was performed on 48 elderly patients (29.1%) and 117 non-elderly patients (70.9%). On the other hand, 10 elderly patients (19.6%) and 5 non-elderly patients (5.4%) did not undergo MT even though they met the inclusion criteria. There were significantly fewer male patients and smokers in the elderly group, but other baseline and clinical characteristics were not significantly different between the groups. Effective recanalization (elderly 93.8% vs non-elderly 91.5%), good outcome (45.8% vs 60.7%), P to R (33.5 minutes vs 33.5 minutes), sICH (2.1% vs 4.3%), and mortality (8.3% vs 2.6%) were not significantly different between the two groups. Conclusion: When recanalization was achieved by strict preoperative evaluation of clinical conditions and imaging, MT may be safe and effective even for octogenarians or older patients.

A Case of Cerebral Tumor Embolism from Extracardiac Lung Cancer Treated by Mechanical Thrombectomy.

Cerebral tumor embolism is a rare cause of acute ischemic stroke, and extracardiac carcinoma is an extremely rare cause. A 34-year-old man who had been diagnosed with lung cancer developed right hemiparesis and aphasia, with the National Institutes of Health Stroke Scale (NIHSS) score of 17. Magnetic resonance imaging (MRI) showed early ischemic change in the insular cortex and frontotemporal lobe and left internal carotid artery (ICA) terminal occlusion was confirmed by magnetic resonance angiogram (MRA). Mechanical thrombectomy (MT) with contact aspiration by a Penumbra ACE 68, followed by combined technique with a stent retriever was performed, and a soft, fragile embolus was retrieved. Finally, good recanalization was achieved (Thrombolysis in Cerebral Infarction [TICI] scale 2b), and on the next day, the right hemiparesis and aphasia were improved. However, the patient's general condition gradually worsened, and 43 days after thrombectomy, he died from respiratory failure. The retrieved embolus was examined pathologically and diagnosed as mucoepidermoid carcinoma of the same type as his lung cancer. Chest computed tomography (CT) showed that tumor invaded the right pulmonary vein and left atrium; these findings suggested that a piece of the tumor in the left atrium flowed into the left ICA and caused the acute ischemic stroke.

Longitudinal Speech Change After Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease Patients: A 2-Year Prospective Study.

BACKGROUND: Speech disorders are among the most common adverse effects after subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) patients. However, longitudinal speech changes after STN-DBS are not fully understood. OBJECTIVE: We performed a two-year prospective study on PD patients who underwent STN-DBS and analyzed changes in speech function to clarify factors predicting for speech deterioration. METHODS: Twenty-five PD patients were assessed before and up to two years after STN implantation. Speech function was evaluated in the on-stimulation condition and 30 min after stimulation cessation using auditory-perceptual assessment. Patients who experienced overall worsening in speech intelligibility or naturalness ≥1 point during follow-up were classified into a deteriorated group (n = 16), with the remaining subjects being classified into a stable group (n = 9). Cognitive and motor functions were also assessed. RESULTS: The stable group had significantly better values of low volume, monoloudness, and asthenic voice subscores of the auditory-perceptual assessment in the on-stimulation condition compared with the off-stimulation condition. Imprecise consonants, excess loudness variation, and strained voice subscores were improved via cessation of stimulation in both groups. Before surgery, the deteriorated group had significantly lower scores in the Stroop Color-Word Test and Digit Span compared to the stable group. CONCLUSIONS: During follow-up, some subscores showed significant worsening in the on-stimulation condition in both groups. However, beneficial effects of STN-DBS on speech appeared to counterbalance negative effects of STN-DBS on speech function only in the stable group. Worse cognitive function may be a potential predictor for speech deterioration after STN-DBS in PD patients.

Molecular hydrogen is protective against 6-hydroxydopamine-induced nigrostriatal degeneration in a rat model of Parkinson's disease.

Molecular hydrogen serves as an antioxidant that reduces hydroxyl radicals, but not the other reactive oxygen and nitrogen species. In the past year, molecular hydrogen has been reported to prevent or ameliorate eight diseases in rodents and one in human associated with oxidative stress. In Parkinson's disease, mitochondrial dysfunction and the associated oxidative stress are major causes of dopaminergic cell loss in the substantia nigra. We examined effects of approximately 50%-saturated molecular hydrogen in drinking water before or after the stereotactic surgery on 6-hydroxydopamine-induced nigrostrital degeneration in a rat model of Parkinson's disease. Methamphetamine-induced behavioral analysis showed that molecular hydrogen prevented both the development and progression of the nigrostrital degeneration. Tyrosine hydroxylase staining of the substantia nigra and striatum also demonstrated that pre- and post-treatment with hydrogen prevented the dopaminergic cell loss. Our studies suggest that hydrogen water is likely able to retard the development and progression of Parkinson's disease.

Staged bilateral deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease.

BACKGROUND: Several investigators have described the efficacy and safety of unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for the treatment of Parkinson's disease (PD). Some patients who underwent unilateral STN DBS required additional surgery on the contralateral side because the unilateral treatment was insufficient. The goal of this study was to assess the efficacy and safety of staged bilateral STN DBS compared to the simultaneous bilateral procedure. METHODS: Ten patients with medically intractable PD underwent staged bilateral STN DBS, and 12 patients underwent a simultaneous bilateral procedure. Clinical assessments were performed preoperatively and 6 months after the last surgery using the Unified Parkinson's Disease Rating Scale (UPDRS), motor and activity of daily living (ADL) subscores, and Hoehn and Yahr stages. FINDINGS: Both the staged and simultaneous groups experienced significant improvement in the UPDRS motor and ADL scores, and the Hoehn and Yahr stages. There were no statistical differences between the two groups in the percent improvement in UPDRS scores. The rate of adverse events in the staged group (20%) was less than that of the simultaneous group (42%), although the difference was not statistically significant. CONCLUSIONS: Both the staged bilateral STN DBS and the simultaneous bilateral procedure are effective and safe treatment options, but the staged bilateral procedure may be regarded as the preferred choice for the treatment of some patients.

Advanced new neurosurgical procedure using integrated system of intraoperative MRI and neuronavigation with multimodal neuroradiological images.

The purpose of this paper is to describe the newly-established technique in the field of neurological surgery for fusion imaging of three-dimensional magnetic resonance image (3D-MRI) and/or three-dimensional computed tomography (3D-CT) for brain tumor surgery. Combining neuronavigation technology and intraoperative MRI, this method remarkably demonstrates spatial relationships of neurovascular structures and/or skull base landmarks and is very useful for intraoperative evaluation of completed neurosurgical operations. Using the navigation system and intraoperative MRI during surgery, it is possible to resect the brain tumor maximally and preserve essential neurological functions. Furthermore, advanced multimodal neuroradiological images such as functional MRI (fMRI), diffusion tensor imaging (DTI), MR spectroscopy (MRS), and positron emission tomography (PET) clearly demonstrate the dominant cortex including the speech center, primary motor gyrus, primary sensory gyrus, and support high-quality operation with less invasive surgery. In conclusion, multimodal neuroradiological images are very useful for invasive noncircumscribed brain tumors such as glioma and, in combination with such highly technological analyses, advanced neurosurgical procedures are possible.

Predictive Factors Associated with Pain Relief of Spinal Cord Stimulation for Central Post-stroke Pain.

The efficacy and predictive factors associated with successful spinal cord stimulation (SCS) for central post-stroke pain (CPSP) have yet to be definitively established. Thus, this study evaluated the rates of pain relief found after more than 12 months and the predictive factors associated with the success of SCS for CPSP. The degree of pain after SCS in 18 patients with CPSP was assessed using the Visual Analog Scale preoperatively, at 1, 6 and 12 months after surgery, and at the time of the last follow-up. After calculating the percentage of pain relief (PPR), patients were separated into two groups. The first group exhibited continuing PPR ≥30% at more than 12 months (effect group) while the second group exhibited successful/unsuccessful trials followed by decreasing PPR <30% within 12 months (no effect group). Pain relief for more than 12 months was achieved in eight out of 18 (44.4%) patients during the 67.3 ± 35.5 month follow-up period. Statistically significant differences were found for both the age and stroke location during comparisons of the preoperative characteristics between the two groups. There was a significantly younger mean age for the effect versus the no effect group. Patients with stoke in non-thalamus were significantly enriched in effect group compared with those with stoke in thalamus. Multivariable analysis using these two factors found no statistical differences, suggesting that these two factors might possibly exhibit the same behaviors for the SCS effect. These results suggest that SCS may be able to provide pain relief in young, non-thalamus stroke patients with CPSP.

Staged Deep Brain Stimulation of Ventral Intermediate Nucleus of the Thalamus for Suppression of Essential Tremors.

Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus is a powerful surgical option in the treatment of essential tremors (ETs). However, its therapeutic efficacy depends on the tremor distribution. DBS is highly efficient in the relief of distal appendicular tremor but not other types of tremor. We report a case of staged DBS of ventral intermediate nucleus (VIM) of thalamus for the suppression of ETs.

Clinical correlates of repetitive speech disorders in Parkinson's disease.

OBJECTIVES: This study aimed to explore clinical correlates of repetitive speech disorders in patients with Parkinson's disease (PD). METHODS: This study investigated speech function (Assessment of Motor Speech for Dysarthria and Stuttering Severity Instrument-3), motor function (Unified Parkinson's Disease Rating Scale III [UPDRS-III] and UPDRS-IV), cognitive function (Mini-Mental State Examination [MMSE], Montreal Cognitive Assessment [MoCA], Stroop color-word test, verbal fluency, digit span tests, and line orientation), and activities of daily living of 113 PD patients. Comparison between groups (independent t-tests, Mann-Whitney U tests, or χ2 test) and linear regression analyses were performed to determine clinical correlates of repetitive speech disorders. RESULTS: Totally, 65 patients (57.5%) had repetitive speech disorders. Patients with repetitive speech disorders had significantly worse UPDRS-III (P = .049), MoCA (P = .030), and speech function and higher levodopa equivalent daily dose (LEDD; P = .031) than those without repetitive speech disorders. Males were significantly predominant in patients with repetitive speech disorders (64.6%) compared to those without repetitive speech disorders (18.7%; P < .001). The univariate and subsequent multiple linear regression analyses revealed that the severity of repetitive speech disorders significantly correlated with gender (P < .001), MoCA (P = .006), and speech variables (abnormal rate, P = .007; imprecise consonants, P = .043), independent from disease duration, UPDRS III, and LEDD. CONCLUSIONS: PD patients with repetitive speech disorders had worse motor, cognitive, and speech functions than those without repetitive speech disorders. The most influential factor for repetitive speech disorders might be male gender.