Subthalamic deep brain stimulation in patients with a previous pallidotomy.
Identifieur interne : 001676 ( Ncbi/Checkpoint ); précédent : 001675; suivant : 001677Subthalamic deep brain stimulation in patients with a previous pallidotomy.
Auteurs : William G. Ondo [États-Unis] ; Yavuz Silay ; Mike Almaguer ; Joseph Jankovic [États-Unis]Source :
- Movement disorders : official journal of the Movement Disorder Society [ 0885-3185 ] ; 2006.
English descriptors
- KwdEn :
- Adult, Aged, Antiparkinson Agents (therapeutic use), Deep Brain Stimulation, Functional Laterality, Humans, Levodopa (therapeutic use), Middle Aged, Motor Cortex (physiopathology), Pallidotomy, Parkinson Disease (drug therapy), Parkinson Disease (physiopathology), Parkinson Disease (surgery), Parkinson Disease (therapy), Thalamus.
- 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.
DOI: 10.1002/mds.20920
PubMed: 16673406
Affiliations:
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Ondo</name><affiliation wicri:level="2"><nlm:affiliation>Department of Neurology, Baylor College of Medicine, Houston, Texas, USA. wondo@bcm.tmc.edu</nlm:affiliation><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></author><author><name sortKey="Almaguer, Mike" sort="Almaguer, Mike" uniqKey="Almaguer M" first="Mike" last="Almaguer">Mike Almaguer</name></author><author><name sortKey="Jankovic, Joseph" sort="Jankovic, Joseph" uniqKey="Jankovic J" first="Joseph" last="Jankovic">Joseph Jankovic</name><affiliation><country>États-Unis</country><placeName><settlement type="city">Houston</settlement><region type="state">Texas</region></placeName><orgName type="university" n="3">Baylor College of Medicine</orgName></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2006">2006</date><idno type="doi">10.1002/mds.20920</idno><idno type="RBID">pubmed:16673406</idno><idno type="pmid">16673406</idno><idno type="wicri:Area/PubMed/Corpus">002C58</idno><idno type="wicri:Area/PubMed/Curation">002C58</idno><idno type="wicri:Area/PubMed/Checkpoint">002A76</idno><idno type="wicri:Area/Ncbi/Merge">001676</idno><idno type="wicri:Area/Ncbi/Curation">001676</idno><idno type="wicri:Area/Ncbi/Checkpoint">001676</idno></publicationStmt><sourceDesc><biblStruct><analytic><title 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"><nlm:affiliation>Department of Neurology, Baylor College of Medicine, Houston, Texas, USA. wondo@bcm.tmc.edu</nlm:affiliation><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></author><author><name sortKey="Almaguer, Mike" sort="Almaguer, Mike" uniqKey="Almaguer M" first="Mike" last="Almaguer">Mike Almaguer</name></author><author><name sortKey="Jankovic, Joseph" sort="Jankovic, Joseph" uniqKey="Jankovic J" first="Joseph" last="Jankovic">Joseph Jankovic</name><affiliation><country>États-Unis</country><placeName><settlement type="city">Houston</settlement><region type="state">Texas</region></placeName><orgName type="university" n="3">Baylor College of Medicine</orgName></affiliation></author></analytic><series><title level="j">Movement disorders : official journal of the Movement Disorder Society</title><idno type="ISSN">0885-3185</idno><imprint><date when="2006" type="published">2006</date></imprint></series></biblStruct></sourceDesc></fileDesc><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>Thalamus</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></textClass></profileDesc></teiHeader><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></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Texas</li></region><settlement><li>Houston</li></settlement><orgName><li>Baylor College of Medicine</li></orgName></list><tree><noCountry><name sortKey="Almaguer, Mike" sort="Almaguer, Mike" uniqKey="Almaguer M" first="Mike" last="Almaguer">Mike Almaguer</name><name sortKey="Silay, Yavuz" sort="Silay, Yavuz" uniqKey="Silay Y" first="Yavuz" last="Silay">Yavuz Silay</name></noCountry><country name="États-Unis"><region name="Texas"><name sortKey="Ondo, William G" sort="Ondo, William G" uniqKey="Ondo W" first="William G" last="Ondo">William G. Ondo</name></region><name sortKey="Jankovic, Joseph" sort="Jankovic, Joseph" uniqKey="Jankovic J" first="Joseph" last="Jankovic">Joseph Jankovic</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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