Unilateral subdural motor cortex stimulation improves essential tremor but not Parkinson's disease
Identifieur interne : 000208 ( PascalFrancis/Checkpoint ); précédent : 000207; suivant : 000209Unilateral subdural motor cortex stimulation improves essential tremor but not Parkinson's disease
Auteurs : Elena Moro [Canada] ; Jason M. Schwalb [Canada, États-Unis] ; Panida Piboolnurak [Canada, États-Unis] ; Yu-Yan W. Poon [Canada] ; Clement Hamani [Canada] ; Serena W. Hung [Canada, États-Unis] ; Tamara Arenovich [Canada] ; Anthony E. Lang [Canada] ; Robert Chen [Canada] ; Andres M. Lozano [Canada]Source :
- Brain [ 0006-8950 ] ; 2011.
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- Pascal (Inist)
English descriptors
Abstract
Epidural motor cortex stimulation has been reported to be effective in treating some movement disorders. Nevertheless, clinical results have been variable and no double-blinded evaluations have been reported. The aim of this study was to investigate efficacy and safety of unilateral subdural motor cortex stimulation in patients with essential tremor and Parkinson's disease. Six patients with essential tremor and five parkinsonian patients were selected. Craniotomy was performed under local anaesthesia with conscious sedation. A four contact electrode (Resume II model 3587, Medtronic, Inc) was positioned on the motor cortex, after identification of the area with direct monopolar cortical stimulation. Soon after surgery, a variety of different settings of stimulation were assessed using standard rating scales to select the optimal stimulation parameters. The effects of chronic stimulation were evaluated in both groups of patients after 3 months (double-blinded fashion) and 1 year (open fashion). In essential tremor, contralateral hand tremor scores significantly improved (P=0.04) with stimulation during the double-blinded study, whereas in Parkinson's disease, there were no changes in the OFF medication/on stimulation motor scores compared with off stimulation. At 1 year, tremor was improved by stimulation in two out of three patients with essential tremor available at follow-up, whereas no improvement was observed in the five parkinsonian patients. One parkinsonian patient had a cortical venous infarct. Three other patients had self-limiting seizures with aggressive trials of stimulation in the period of dosage selection. These findings suggest that unilateral subdural motor cortex stimulation may be useful for contralateral hand tremor in selected patients with essential tremor but was not effective in improving parkinsonian signs in our series.
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en" level="a">Unilateral subdural motor cortex stimulation improves essential tremor but not Parkinson's disease</title><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Schwalb, Jason M" sort="Schwalb, Jason M" uniqKey="Schwalb J" first="Jason M." last="Schwalb">Jason M. Schwalb</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Neurosurgery, Henry Ford Health System</s1><s2>West Bloomfield, MI 48322</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>West Bloomfield, MI 48322</wicri:noRegion></affiliation></author><author><name sortKey="Piboolnurak, Panida" sort="Piboolnurak, Panida" uniqKey="Piboolnurak P" first="Panida" last="Piboolnurak">Panida Piboolnurak</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medical College</s1><s2>New York, NY 10021</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>New York, NY 10021</wicri:noRegion></affiliation></author><author><name sortKey="Poon, Yu Yan W" sort="Poon, Yu Yan W" uniqKey="Poon Y" first="Yu-Yan W." last="Poon">Yu-Yan W. Poon</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Hung, Serena W" sort="Hung, Serena W" uniqKey="Hung S" first="Serena W." last="Hung">Serena W. Hung</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurology, Medical College of Wisconsin</s1><s2>Milwaukee, WI 53226</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Milwaukee, WI 53226</wicri:noRegion></affiliation></author><author><name sortKey="Arenovich, Tamara" sort="Arenovich, Tamara" uniqKey="Arenovich T" first="Tamara" last="Arenovich">Tamara Arenovich</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Biostatistical Consulting Service, Clinical Research Department, Centre for Addiction and Mental Health</s1><s2>Toronto, M5T 1 R8</s2><s3>CAN</s3><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 1 R8</wicri:noRegion></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">11-0320384</idno><date when="2011">2011</date><idno type="stanalyst">PASCAL 11-0320384 INIST</idno><idno type="RBID">Pascal:11-0320384</idno><idno type="wicri:Area/PascalFrancis/Corpus">000306</idno><idno type="wicri:Area/PascalFrancis/Curation">000957</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">000208</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">000208</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Unilateral subdural motor cortex stimulation improves essential tremor but not Parkinson's disease</title><author><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Schwalb, Jason M" sort="Schwalb, Jason M" uniqKey="Schwalb J" first="Jason M." last="Schwalb">Jason M. Schwalb</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Department of Neurosurgery, Henry Ford Health System</s1><s2>West Bloomfield, MI 48322</s2><s3>USA</s3><sZ>2 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>West Bloomfield, MI 48322</wicri:noRegion></affiliation></author><author><name sortKey="Piboolnurak, Panida" sort="Piboolnurak, Panida" uniqKey="Piboolnurak P" first="Panida" last="Piboolnurak">Panida Piboolnurak</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medical College</s1><s2>New York, NY 10021</s2><s3>USA</s3><sZ>3 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>New York, NY 10021</wicri:noRegion></affiliation></author><author><name sortKey="Poon, Yu Yan W" sort="Poon, Yu Yan W" uniqKey="Poon Y" first="Yu-Yan W." last="Poon">Yu-Yan W. Poon</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Hung, Serena W" sort="Hung, Serena W" uniqKey="Hung S" first="Serena W." last="Hung">Serena W. Hung</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Neurology, Medical College of Wisconsin</s1><s2>Milwaukee, WI 53226</s2><s3>USA</s3><sZ>6 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Milwaukee, WI 53226</wicri:noRegion></affiliation></author><author><name sortKey="Arenovich, Tamara" sort="Arenovich, Tamara" uniqKey="Arenovich T" first="Tamara" last="Arenovich">Tamara Arenovich</name><affiliation wicri:level="1"><inist:fA14 i1="06"><s1>Biostatistical Consulting Service, Clinical Research Department, Centre for Addiction and Mental Health</s1><s2>Toronto, M5T 1 R8</s2><s3>CAN</s3><sZ>7 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 1 R8</wicri:noRegion></affiliation></author><author><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><affiliation wicri:level="4"><inist:fA14 i1="02"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, M5T 2S8</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author></analytic><series><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Brain</title><title level="j" type="abbreviated">Brain</title><idno type="ISSN">0006-8950</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Motor cortex</term><term>Nervous system diseases</term><term>Parkinson disease</term><term>Subdural</term><term>Tremor</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Tremblement</term><term>Maladie de Parkinson</term><term>Pathologie du système nerveux</term><term>Sousdural</term><term>Cortex moteur</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Epidural motor cortex stimulation has been reported to be effective in treating some movement disorders. Nevertheless, clinical results have been variable and no double-blinded evaluations have been reported. The aim of this study was to investigate efficacy and safety of unilateral subdural motor cortex stimulation in patients with essential tremor and Parkinson's disease. Six patients with essential tremor and five parkinsonian patients were selected. Craniotomy was performed under local anaesthesia with conscious sedation. A four contact electrode (Resume II model 3587, Medtronic, Inc) was positioned on the motor cortex, after identification of the area with direct monopolar cortical stimulation. Soon after surgery, a variety of different settings of stimulation were assessed using standard rating scales to select the optimal stimulation parameters. The effects of chronic stimulation were evaluated in both groups of patients after 3 months (double-blinded fashion) and 1 year (open fashion). In essential tremor, contralateral hand tremor scores significantly improved (P=0.04) with stimulation during the double-blinded study, whereas in Parkinson's disease, there were no changes in the OFF medication/on stimulation motor scores compared with off stimulation. At 1 year, tremor was improved by stimulation in two out of three patients with essential tremor available at follow-up, whereas no improvement was observed in the five parkinsonian patients. One parkinsonian patient had a cortical venous infarct. Three other patients had self-limiting seizures with aggressive trials of stimulation in the period of dosage selection. These findings suggest that unilateral subdural motor cortex stimulation may be useful for contralateral hand tremor in selected patients with essential tremor but was not effective in improving parkinsonian signs in our series.</div></front></TEI><inist><standard h6="B"><pA><fA01 i1="01" i2="1"><s0>0006-8950</s0></fA01><fA03 i2="1"><s0>Brain</s0></fA03><fA05><s2>134</s2></fA05><fA06><s3>p. 7</s3></fA06><fA08 i1="01" i2="1" l="ENG"><s1>Unilateral subdural motor cortex stimulation improves essential tremor but not Parkinson's disease</s1></fA08><fA11 i1="01" i2="1"><s1>MORO (Elena)</s1></fA11><fA11 i1="02" i2="1"><s1>SCHWALB (Jason M.)</s1></fA11><fA11 i1="03" i2="1"><s1>PIBOOLNURAK (Panida)</s1></fA11><fA11 i1="04" i2="1"><s1>POON (Yu-Yan W.)</s1></fA11><fA11 i1="05" i2="1"><s1>HAMANI (Clement)</s1></fA11><fA11 i1="06" i2="1"><s1>HUNG (Serena W.)</s1></fA11><fA11 i1="07" i2="1"><s1>ARENOVICH (Tamara)</s1></fA11><fA11 i1="08" i2="1"><s1>LANG (Anthony E.)</s1></fA11><fA11 i1="09" i2="1"><s1>CHEN (Robert)</s1></fA11><fA11 i1="10" i2="1"><s1>LOZANO (Andres M.)</s1></fA11><fA14 i1="01"><s1>Movement Disorders Centre, Division of Neurology, Department of Medicine, University of Toronto, Toronto Western Hospital, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>1 aut.</sZ><sZ>3 aut.</sZ><sZ>4 aut.</sZ><sZ>6 aut.</sZ><sZ>8 aut.</sZ><sZ>9 aut.</sZ></fA14><fA14 i1="02"><s1>Department of Neurosurgery, Toronto Western Hospital, University of Toronto, University Health Network</s1><s2>Toronto, M5T 2S8</s2><s3>CAN</s3><sZ>2 aut.</sZ><sZ>5 aut.</sZ><sZ>10 aut.</sZ></fA14><fA14 i1="03"><s1>Department of Neurosurgery, Henry Ford Health System</s1><s2>West Bloomfield, MI 48322</s2><s3>USA</s3><sZ>2 aut.</sZ></fA14><fA14 i1="04"><s1>Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medical College</s1><s2>New York, NY 10021</s2><s3>USA</s3><sZ>3 aut.</sZ></fA14><fA14 i1="05"><s1>Department of Neurology, Medical College of Wisconsin</s1><s2>Milwaukee, WI 53226</s2><s3>USA</s3><sZ>6 aut.</sZ></fA14><fA14 i1="06"><s1>Biostatistical Consulting Service, Clinical Research Department, Centre for Addiction and Mental Health</s1><s2>Toronto, M5T 1 R8</s2><s3>CAN</s3><sZ>7 aut.</sZ></fA14><fA20><s1>2096-2105</s1></fA20><fA21><s1>2011</s1></fA21><fA23 i1="01"><s0>ENG</s0></fA23><fA43 i1="01"><s1>INIST</s1><s2>998</s2><s5>354000190474150180</s5></fA43><fA44><s0>0000</s0><s1>© 2011 INIST-CNRS. All rights reserved.</s1></fA44><fA45><s0>1/2 p.</s0></fA45><fA47 i1="01" i2="1"><s0>11-0320384</s0></fA47><fA60><s1>P</s1></fA60><fA61><s0>A</s0></fA61><fA64 i1="01" i2="1"><s0>Brain</s0></fA64><fA66 i1="01"><s0>GBR</s0></fA66><fC01 i1="01" l="ENG"><s0>Epidural motor cortex stimulation has been reported to be effective in treating some movement disorders. Nevertheless, clinical results have been variable and no double-blinded evaluations have been reported. The aim of this study was to investigate efficacy and safety of unilateral subdural motor cortex stimulation in patients with essential tremor and Parkinson's disease. Six patients with essential tremor and five parkinsonian patients were selected. Craniotomy was performed under local anaesthesia with conscious sedation. A four contact electrode (Resume II model 3587, Medtronic, Inc) was positioned on the motor cortex, after identification of the area with direct monopolar cortical stimulation. Soon after surgery, a variety of different settings of stimulation were assessed using standard rating scales to select the optimal stimulation parameters. The effects of chronic stimulation were evaluated in both groups of patients after 3 months (double-blinded fashion) and 1 year (open fashion). In essential tremor, contralateral hand tremor scores significantly improved (P=0.04) with stimulation during the double-blinded study, whereas in Parkinson's disease, there were no changes in the OFF medication/on stimulation motor scores compared with off stimulation. At 1 year, tremor was improved by stimulation in two out of three patients with essential tremor available at follow-up, whereas no improvement was observed in the five parkinsonian patients. One parkinsonian patient had a cortical venous infarct. Three other patients had self-limiting seizures with aggressive trials of stimulation in the period of dosage selection. These findings suggest that unilateral subdural motor cortex stimulation may be useful for contralateral hand tremor in selected patients with essential tremor but was not effective in improving parkinsonian signs in our series.</s0></fC01><fC02 i1="01" i2="X"><s0>002B17</s0></fC02><fC02 i1="02" i2="X"><s0>002B17G</s0></fC02><fC03 i1="01" i2="X" l="FRE"><s0>Tremblement</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="ENG"><s0>Tremor</s0><s5>01</s5></fC03><fC03 i1="01" i2="X" l="SPA"><s0>Temblor</s0><s5>01</s5></fC03><fC03 i1="02" i2="X" l="FRE"><s0>Maladie de Parkinson</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="ENG"><s0>Parkinson disease</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="02" i2="X" l="SPA"><s0>Parkinson enfermedad</s0><s2>NM</s2><s5>02</s5></fC03><fC03 i1="03" i2="X" l="FRE"><s0>Pathologie du système nerveux</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="ENG"><s0>Nervous system diseases</s0><s5>03</s5></fC03><fC03 i1="03" i2="X" l="SPA"><s0>Sistema nervioso patología</s0><s5>03</s5></fC03><fC03 i1="04" i2="X" l="FRE"><s0>Sousdural</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="ENG"><s0>Subdural</s0><s5>09</s5></fC03><fC03 i1="04" i2="X" l="SPA"><s0>Subdural</s0><s5>09</s5></fC03><fC03 i1="05" i2="X" l="FRE"><s0>Cortex moteur</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="ENG"><s0>Motor cortex</s0><s5>10</s5></fC03><fC03 i1="05" i2="X" l="SPA"><s0>Corteza motora</s0><s5>10</s5></fC03><fC07 i1="01" i2="X" l="FRE"><s0>Encéphale</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="ENG"><s0>Encephalon</s0><s5>37</s5></fC07><fC07 i1="01" i2="X" l="SPA"><s0>Encéfalo</s0><s5>37</s5></fC07><fC07 i1="02" i2="X" l="FRE"><s0>Système nerveux central</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="ENG"><s0>Central nervous system</s0><s5>38</s5></fC07><fC07 i1="02" i2="X" l="SPA"><s0>Sistema nervioso central</s0><s5>38</s5></fC07><fC07 i1="03" i2="X" l="FRE"><s0>Voie motrice</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="ENG"><s0>Motor pathway</s0><s5>39</s5></fC07><fC07 i1="03" i2="X" l="SPA"><s0>Vía motora</s0><s5>39</s5></fC07><fC07 i1="04" i2="X" l="FRE"><s0>Mouvement involontaire</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="ENG"><s0>Involuntary movement</s0><s5>40</s5></fC07><fC07 i1="04" i2="X" l="SPA"><s0>Movimiento involuntario</s0><s5>40</s5></fC07><fC07 i1="05" i2="X" l="FRE"><s0>Trouble neurologique</s0><s5>42</s5></fC07><fC07 i1="05" i2="X" l="ENG"><s0>Neurological disorder</s0><s5>42</s5></fC07><fC07 i1="05" i2="X" l="SPA"><s0>Trastorno neurológico</s0><s5>42</s5></fC07><fC07 i1="06" i2="X" l="FRE"><s0>Pathologie de l'encéphale</s0><s5>43</s5></fC07><fC07 i1="06" i2="X" l="ENG"><s0>Cerebral disorder</s0><s5>43</s5></fC07><fC07 i1="06" i2="X" l="SPA"><s0>Encéfalo patología</s0><s5>43</s5></fC07><fC07 i1="07" i2="X" l="FRE"><s0>Syndrome extrapyramidal</s0><s5>44</s5></fC07><fC07 i1="07" i2="X" l="ENG"><s0>Extrapyramidal syndrome</s0><s5>44</s5></fC07><fC07 i1="07" i2="X" l="SPA"><s0>Extrapiramidal síndrome</s0><s5>44</s5></fC07><fC07 i1="08" i2="X" l="FRE"><s0>Maladie dégénérative</s0><s5>45</s5></fC07><fC07 i1="08" i2="X" l="ENG"><s0>Degenerative disease</s0><s5>45</s5></fC07><fC07 i1="08" i2="X" l="SPA"><s0>Enfermedad degenerativa</s0><s5>45</s5></fC07><fC07 i1="09" i2="X" l="FRE"><s0>Pathologie du système nerveux central</s0><s5>46</s5></fC07><fC07 i1="09" i2="X" l="ENG"><s0>Central nervous system disease</s0><s5>46</s5></fC07><fC07 i1="09" i2="X" l="SPA"><s0>Sistema nervosio central patología</s0><s5>46</s5></fC07><fN21><s1>220</s1></fN21><fN44 i1="01"><s1>OTO</s1></fN44><fN82><s1>OTO</s1></fN82></pA></standard></inist><affiliations><list><country><li>Canada</li><li>États-Unis</li></country><region><li>Ontario</li></region><settlement><li>Toronto</li></settlement><orgName><li>Université de Toronto</li></orgName></list><tree><country name="Canada"><region name="Ontario"><name sortKey="Moro, Elena" sort="Moro, Elena" uniqKey="Moro E" first="Elena" last="Moro">Elena Moro</name></region><name sortKey="Arenovich, Tamara" sort="Arenovich, Tamara" uniqKey="Arenovich T" first="Tamara" last="Arenovich">Tamara Arenovich</name><name sortKey="Chen, Robert" sort="Chen, Robert" uniqKey="Chen R" first="Robert" last="Chen">Robert Chen</name><name sortKey="Hamani, Clement" sort="Hamani, Clement" uniqKey="Hamani C" first="Clement" last="Hamani">Clement Hamani</name><name sortKey="Hung, Serena W" sort="Hung, Serena W" uniqKey="Hung S" first="Serena W." last="Hung">Serena W. Hung</name><name sortKey="Lang, Anthony E" sort="Lang, Anthony E" uniqKey="Lang A" first="Anthony E." last="Lang">Anthony E. Lang</name><name sortKey="Lozano, Andres M" sort="Lozano, Andres M" uniqKey="Lozano A" first="Andres M." last="Lozano">Andres M. Lozano</name><name sortKey="Piboolnurak, Panida" sort="Piboolnurak, Panida" uniqKey="Piboolnurak P" first="Panida" last="Piboolnurak">Panida Piboolnurak</name><name sortKey="Poon, Yu Yan W" sort="Poon, Yu Yan W" uniqKey="Poon Y" first="Yu-Yan W." last="Poon">Yu-Yan W. Poon</name><name sortKey="Schwalb, Jason M" sort="Schwalb, Jason M" uniqKey="Schwalb J" first="Jason M." last="Schwalb">Jason M. Schwalb</name></country><country name="États-Unis"><noRegion><name sortKey="Schwalb, Jason M" sort="Schwalb, Jason M" uniqKey="Schwalb J" first="Jason M." last="Schwalb">Jason M. Schwalb</name></noRegion><name sortKey="Hung, Serena W" sort="Hung, Serena W" uniqKey="Hung S" first="Serena W." last="Hung">Serena W. Hung</name><name sortKey="Piboolnurak, Panida" sort="Piboolnurak, Panida" uniqKey="Piboolnurak P" first="Panida" last="Piboolnurak">Panida Piboolnurak</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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