Subthalamic deep brain stimulation in patients with a previous pallidotomy
Identifieur interne : 003170 ( Main/Curation ); précédent : 003169; suivant : 003171Subthalamic deep brain stimulation in patients with a previous pallidotomy
Auteurs : William G. Ondo [États-Unis] ; Yavuz Silay [États-Unis] ; Mike Almaguer [États-Unis] ; Joseph Jankovic [États-Unis]Source :
- Movement Disorders [ 0885-3185 ] ; 2006-08.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Homme.
English descriptors
- KwdEn :
- Adult, Aged, Antiparkinson Agents (therapeutic use), Deep Brain Stimulation, Deep brain stimulation, Functional Laterality, Human, Humans, Levodopa (therapeutic use), Middle Aged, Motor Cortex (physiopathology), Nervous system diseases, Pallidotomy, Parkinson Disease (drug therapy), Parkinson Disease (physiopathology), Parkinson Disease (surgery), Parkinson Disease (therapy), Parkinson disease, Parkinson's disease, Thalamus, deep brain stimulation, pallidotomy.
- MESH :
- chemical , therapeutic use : Antiparkinson Agents, Levodopa.
- drug therapy : Parkinson Disease.
- physiopathology : Motor Cortex, Parkinson Disease.
- surgery : Parkinson Disease.
- therapy : Parkinson Disease.
- Adult, Aged, Deep Brain Stimulation, Functional Laterality, Humans, Middle Aged, Pallidotomy, Thalamus.
Abstract
The safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients who have had a previous unilateral pallidotomy is not clear. We identified 10 patients (9 male) at the Baylor College of Medicine Parkinson's Disease Center who underwent STN DBS after prior unilateral pallidotomy. Demographics, efficacy as determined by off Unified Parkinson's Disease Rating Scale (UPDRS) part III scores, and levodopa equivalent dosing were analyzed. We then compared these to an age‐ and sex‐matched group of 25 DBS patients who had no prior pallidotomy. After their initial pallidotomy (mean age, 51.8 ± 10.8 years), the mean UPDRS motor off medicine scores improved from 51.3 ± 14.3 to 34.9 ± 12.8, and the UPDRS dyskinesia score improved from 1.8 ± 1.0 to 0.8 ± 0.7. Their STN DBS off UPDRS motor scores (mean age, 56.0 ± 10.2 years) improved by 16.0% from 53.1 ± 9.7 (range, 42–68) to 44.6 ± 11.1 (range, 25–67). In contrast, the UPDRS off motor scores in a control group of 25 DBS patients improved by 49.9%, from 49.7 ± 11.1 to 25.7 ± 18.9, (16.0% vs. 49.9%; P < 0.001). Changes in UPDRS dyskinesia scores were similar in both groups. AE thought to be related to the STN DBS following pallidotomy included worse dysarthria (three) and worse balance (two). STN DBS patients with prior pallidotomy had less improvement in UPDRS off motor score compared to other STN DBS patients, despite relatively good outcomes immediately after their pallidotomy. This may be partially due to a selection bias, but it may also indicate that prior pallidotomy is a negative predictor of outcome of STN DBS and should be considered in patient selection. © 2006 Movement Disorder Society
Url:
DOI: 10.1002/mds.20920
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<front><div type="abstract" xml:lang="en">The safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients who have had a previous unilateral pallidotomy is not clear. We identified 10 patients (9 male) at the Baylor College of Medicine Parkinson's Disease Center who underwent STN DBS after prior unilateral pallidotomy. Demographics, efficacy as determined by off Unified Parkinson's Disease Rating Scale (UPDRS) part III scores, and levodopa equivalent dosing were analyzed. We then compared these to an age‐ and sex‐matched group of 25 DBS patients who had no prior pallidotomy. After their initial pallidotomy (mean age, 51.8 ± 10.8 years), the mean UPDRS motor off medicine scores improved from 51.3 ± 14.3 to 34.9 ± 12.8, and the UPDRS dyskinesia score improved from 1.8 ± 1.0 to 0.8 ± 0.7. Their STN DBS off UPDRS motor scores (mean age, 56.0 ± 10.2 years) improved by 16.0% from 53.1 ± 9.7 (range, 42–68) to 44.6 ± 11.1 (range, 25–67). In contrast, the UPDRS off motor scores in a control group of 25 DBS patients improved by 49.9%, from 49.7 ± 11.1 to 25.7 ± 18.9, (16.0% vs. 49.9%; P < 0.001). Changes in UPDRS dyskinesia scores were similar in both groups. AE thought to be related to the STN DBS following pallidotomy included worse dysarthria (three) and worse balance (two). STN DBS patients with prior pallidotomy had less improvement in UPDRS off motor score compared to other STN DBS patients, despite relatively good outcomes immediately after their pallidotomy. This may be partially due to a selection bias, but it may also indicate that prior pallidotomy is a negative predictor of outcome of STN DBS and should be considered in patient selection. © 2006 Movement Disorder Society</div>
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<front><div type="abstract" xml:lang="en">The safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients who have had a previous unilateral pallidotomy is not clear. We identified 10 patients (9 male) at the Baylor College of Medicine Parkinson's Disease Center who underwent STN DBS after prior unilateral pallidotomy. Demographics, efficacy as determined by off Unified Parkinson's Disease Rating Scale (UPDRS) part III scores, and levodopa equivalent dosing were analyzed. We then compared these to an age- and sex-matched group of 25 DBS patients who had no prior pallidotomy. After their initial pallidotomy (mean age, 51.8 ± 10.8 years), the mean UPDRS motor off medicine scores improved from 51.3 ± 14.3 to 34.9 ± 12.8, and the UPDRS dyskinesia score improved from 1.8 ± 1.0 to 0.8 ± 0.7. Their STN DBS off UPDRS motor scores (mean age, 56.0 ± 10.2 years) improved by 16.0% from 53.1 ± 9.7 (range, 42-68) to 44.6 ± 11.1 (range, 25-67). In contrast, the UPDRS off motor scores in a control group of 25 DBS patients improved by 49.9%, from 49.7 ± 11.1 to 25.7 ± 18.9, (16.0% vs. 49.9%; P < 0.001). Changes in UPDRS dyskinesia scores were similar in both groups. AE thought to be related to the STN DBS following pallidotomy included worse dysarthria (three) and worse balance (two). STN DBS patients with prior pallidotomy had less improvement in UPDRS off motor score compared to other STN DBS patients, despite relatively good outcomes immediately after their pallidotomy. This may be partially due to a selection bias, but it may also indicate that prior pallidotomy is a negative predictor of outcome of STN DBS and should be considered in patient selection.</div>
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<idno type="doi">10.1002/mds.20920</idno>
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<sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Subthalamic deep brain stimulation in patients with a previous pallidotomy</title>
<author><name sortKey="Ondo, William G" sort="Ondo, William G" uniqKey="Ondo W" first="William G." last="Ondo">William G. Ondo</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Neurology, Baylor College of Medicine, Houston, Texas</wicri:regionArea>
<placeName><region type="state">Texas</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Silay, Yavuz" sort="Silay, Yavuz" uniqKey="Silay Y" first="Yavuz" last="Silay">Yavuz Silay</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Neurology, Baylor College of Medicine, Houston, Texas</wicri:regionArea>
<placeName><region type="state">Texas</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Almaguer, Mike" sort="Almaguer, Mike" uniqKey="Almaguer M" first="Mike" last="Almaguer">Mike Almaguer</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Neurology, Baylor College of Medicine, Houston, Texas</wicri:regionArea>
<placeName><region type="state">Texas</region>
</placeName>
</affiliation>
</author>
<author><name sortKey="Jankovic, Joseph" sort="Jankovic, Joseph" uniqKey="Jankovic J" first="Joseph" last="Jankovic">Joseph Jankovic</name>
<affiliation wicri:level="2"><country xml:lang="fr">États-Unis</country>
<wicri:regionArea>Department of Neurology, Baylor College of Medicine, Houston, Texas</wicri:regionArea>
<placeName><region type="state">Texas</region>
</placeName>
<placeName><settlement type="city">Houston</settlement>
<region type="state">Texas</region>
</placeName>
<orgName type="university" n="3">Baylor College of Medicine</orgName>
</affiliation>
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<monogr></monogr>
<series><title level="j">Movement Disorders</title>
<title level="j" type="sub">Official Journal of the Movement Disorder Society</title>
<title level="j" type="abbrev">Mov. Disord.</title>
<idno type="ISSN">0885-3185</idno>
<idno type="eISSN">1531-8257</idno>
<imprint><publisher>Wiley Subscription Services, Inc., A Wiley Company</publisher>
<pubPlace>Hoboken</pubPlace>
<date type="published" when="2006-08">2006-08</date>
<biblScope unit="vol">21</biblScope>
<biblScope unit="issue">8</biblScope>
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<idno type="ArticleID">MDS20920</idno>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Antiparkinson Agents (therapeutic use)</term>
<term>Deep Brain Stimulation</term>
<term>Functional Laterality</term>
<term>Humans</term>
<term>Levodopa (therapeutic use)</term>
<term>Middle Aged</term>
<term>Motor Cortex (physiopathology)</term>
<term>Pallidotomy</term>
<term>Parkinson Disease (drug therapy)</term>
<term>Parkinson Disease (physiopathology)</term>
<term>Parkinson Disease (surgery)</term>
<term>Parkinson Disease (therapy)</term>
<term>Parkinson's disease</term>
<term>Thalamus</term>
<term>deep brain stimulation</term>
<term>pallidotomy</term>
</keywords>
<keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Antiparkinson Agents</term>
<term>Levodopa</term>
</keywords>
<keywords scheme="MESH" qualifier="drug therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="physiopathology" xml:lang="en"><term>Motor Cortex</term>
<term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="surgery" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>Parkinson Disease</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adult</term>
<term>Aged</term>
<term>Deep Brain Stimulation</term>
<term>Functional Laterality</term>
<term>Humans</term>
<term>Middle Aged</term>
<term>Pallidotomy</term>
<term>Thalamus</term>
</keywords>
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<front><div type="abstract" xml:lang="en">The safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in patients who have had a previous unilateral pallidotomy is not clear. We identified 10 patients (9 male) at the Baylor College of Medicine Parkinson's Disease Center who underwent STN DBS after prior unilateral pallidotomy. Demographics, efficacy as determined by off Unified Parkinson's Disease Rating Scale (UPDRS) part III scores, and levodopa equivalent dosing were analyzed. We then compared these to an age‐ and sex‐matched group of 25 DBS patients who had no prior pallidotomy. After their initial pallidotomy (mean age, 51.8 ± 10.8 years), the mean UPDRS motor off medicine scores improved from 51.3 ± 14.3 to 34.9 ± 12.8, and the UPDRS dyskinesia score improved from 1.8 ± 1.0 to 0.8 ± 0.7. Their STN DBS off UPDRS motor scores (mean age, 56.0 ± 10.2 years) improved by 16.0% from 53.1 ± 9.7 (range, 42–68) to 44.6 ± 11.1 (range, 25–67). In contrast, the UPDRS off motor scores in a control group of 25 DBS patients improved by 49.9%, from 49.7 ± 11.1 to 25.7 ± 18.9, (16.0% vs. 49.9%; P < 0.001). Changes in UPDRS dyskinesia scores were similar in both groups. AE thought to be related to the STN DBS following pallidotomy included worse dysarthria (three) and worse balance (two). STN DBS patients with prior pallidotomy had less improvement in UPDRS off motor score compared to other STN DBS patients, despite relatively good outcomes immediately after their pallidotomy. This may be partially due to a selection bias, but it may also indicate that prior pallidotomy is a negative predictor of outcome of STN DBS and should be considered in patient selection. © 2006 Movement Disorder Society</div>
</front>
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