Research Insights Archive
November 1, 2006 – A Randomized Trial of Deep-Brain Stimulation for Parkinson’s Disease
Deuschl, G.,Schade-Brittinger C, Krack P, Volkmann J, Schafer H, Botzel K, Daniels C, Deutschlander A, Dillmann U, Eisner W, Gruber D, Hamel W, Herzog J, Hilker R, Klebe S, Kloss M, Koy J, Krause M, Kupsch A, Lorenz D, Lorenzl S, Mehdorn HM, Moringlane JR A Randomized Trial of Deep-Brain Stimulation for Parkinson’s Disease , 355, 9, 896-908Click here to read the abstract.
September 1, 2006 – Subthalamic nucleus stimulation: improvements in outcome with reprogramming
Moro, Poon, Lozano, Saint-Cyr, & Lang Subthalamic nucleus stimulation: improvements in outcome with reprogramming , Arch Neurol. 2006 Jul 10; Epub ahead of printNote from the reviewers at The Parkinson Alliance: The following Current Science Review was made intentionally lengthy as it is our opinion that the area of DBS programming is a vital challenge to the PD community and this article expressly addresses these concerns. We hope that you read it with as much interest as we did.Click here to read the abstract.
Schupbach, W. et al Stimulation of the subthalamic nucleus in Parkinson’s disease: a 5 year follow up , 2005 Dec;76(12):1640-4This article discusses the results of 37 patients with PD that underwent bilateral DBS-STN at a clinic in France. Patients were evaluated at 1 month prior to surgery and 6, 24, and 60 months after surgery. They had strict criteria for inclusion of patients for surgery and had attrition of 6 patients by the end of the study (5 deaths, 1 relocated). They found that the patients had more motor improvement with stimulation and levodopa combined versus either treatment alone. They also found less dyskinesias and less need for levodopa, but that the benefit decreased across time. Patients also had improvement in their activities of daily living at the 6 month point, which was lost at the later testing times. Scores on depression and cognitive screening remained the same across testing through 24 months, but performance on a cognitive screening measure began to worsen at the 60 month evaluation. Their patients did not experience permanent adverse events during the 5 year trial but had various transient events (e.g. emotional fluctuations, urinary retention, eyelid opening difficulties, weight gain). A total of 13 stimulators had to be replaced in the group of patients due to low power (anticipated or experienced) in the battery. The authors listed multiple side effects of intermittent stimulation due to the battery. One of the limitations of this article was that there was no control group of patients with PD to compare to those who underwent DBS-STN. The authors suggest that regardless of a control group there was sustained improvement five years after DBS-STN. They also suggested the possibility of neuroprotective factors of DBS-STN but noted the literature is mixed and mostly completed on animal models. They concluded by suggesting more long term studies to measure the efficacy and possible protective factors of DBS-STN.Click here to read the abstract.
July 1, 2006 – Deep-brain stimulation in Parkinson’s disease: long-term efficacy and safety – What happened this year
Benabid AL, Chabardes S, Seigneuret E Deep-brain stimulation in Parkinson’s disease: long-term efficacy and safety – What happened this year , 2005 Dec; 18(6):623-30Click here to read the abstract.
April 1, 2006 – Anesthesia for functional neurosurgery: review of complications
Journal of Neurosurgical AnesthesiologyVenkatraghavan, L., Manninen P, Mak P, Lukitto K, Hodaie M, Lozano A. (2006) Anesthesia for functional neurosurgery: review of complications Journal of Neurosurgical Anesthesiology, Jan;18(1):64-7The purpose of this study was to evaluate anesthesia difficulties that may occur during functional neurosurgery, such as in DBS. They found that 16% of their patients had intraoperative complications, including seizures (most common), severe headache, vomiting, shortness of breath, hypertension, and drowsiness. A small number of their patients experienced neurological changes, including speech difficulties, fluctuating level of consciousness (later found to have a small bleed at site of electrode), and one experienced a large bleed in the brain (this pt had a poor outcome). After surgery complications included, intracranial bleed (n=4), confusion (2), seizure (1), neurological deficit (3), and a cerebrospinal fluid leak (1). They concluded that their anesthesia method was successful in all but two of the patients and that most of their patients did not require sedation during their procedure. They highly suggested early awareness and monitoring of patient’s breathing, blood pressure, and fluid management by the anesthesiologist during surgery to avoid intra and postoperative complications. They indicated that the anesthesiologist should treat any difficulties early to avoid additional complications. They also noted the importance of a multidisciplinary treatment team to make sure that patient’s are correctly selected for this procedure to minimize any complications. Click here to read the abstract.
April 1, 2006 – Independent patterns of damage within magno-, parvo- and koniocellular pathways in Parkinson’s disease
Annals of NeurologySilva M.F., Faria P., Regateiro F.S., Forjaz V., Januario C., Freire A., Castelo-Branco M. (2005) Independent patterns of damage within magno-, parvo- and koniocellular pathways in Parkinson’s disease Annals of Neurology, Brain. Oct;128(Pt 10):2260-71This was a very detailed article discussing the literature for visual disturbances in patients with PD as well as a study looking at different patterns of visual dysfunction. They began by discussing that there are many ways to measure vision, which contributes to the variability of results amongst studies in the literature. These authors looked at various parts of the eye, down to different cellular levels to determine if vision difficulties in patients with PD were due to age or to the disease itself. The authors found that patients with PD had deficits in all areas of the visual pathway they measured. Disease duration and age were not found to fully explain these findings. They also found that visual dysfunction was related to severity and duration of PD, suggesting deterioration with disease progression as well age. They discussed the various biological causes for vision difficulties due to PD as well as aging.Click here to read the abstract.
April 1, 2006 – Falls in outpatients with Parkinson’s disease: frequency, impact and identifying factors
Journal of NeurosurgeryBalash, Y., Peretz C., Leibovich G., Herman T., Hausdorff J.M., Giladi N. (2005) Falls in outpatients with Parkinson’s disease: frequency, impact and identifying factors Journal of Neurosurgery, 2005 Nov; 252(11):1310-5These researchers wanted to look at frequency of falls and associated factors in patients with PD. They briefly reviewed why studying falls, a gait difficulty with serious complications (physical injury, fears, restriction of activities, and admission to nursing homes) for the patient with PD, is important. They reported approximately 1/3-2/3 of patients with PD experience falls but that associated factors are not as well documented or understood. The authors also looked at cognitive function, depression, general health, activities of daily living, balance, gait, and bladder dysfunction. About a third of the patients in their study had difficulties with falls. The authors also found that urinary incontinence and duration of PD were the only predictors of falling. Additionally, they found that patients prone to falling had worse motor difficulties, depressive symptoms, lower activities of daily living, and identified their health as poorer. Additional they found that if a patient had PD and urinary incontinence, he/she was 6 times more likely to have repeated falls. The authors discussed a limitation to their study including that it was retrospective (asking patients and carers to remember how many falls occurred over the last year may be difficult and inaccurate), which may have lowered the actual number of falls that individuals had. The authors suggested that the actual number of falls in their group may be higher than that reported due to multiple factors. They also encouraged medical professionals and family members to be aware that if a patient with PD has incontinence that they are more likely to have difficulties with falls and may require more fall precautions or associated therapies.Click here to read the abstract.
January 1, 2006 – Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson’s disease
Plaha, P. & Gill, S. (2005) Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson’s disease , Neuroreport. Nov 28; 16(17):1883-7The purpose of this article was to look at stimulation of the pedunculopontine nucleus (PPN) in 2 patients with PD, specifically for better control of gait and postural instability. They found that both patients had improvement in gait, postural instability, and other motor features of PD in both the on and off medication states. The authors noted there were no medical or cognitive complications for either patient. They also discussed the stimulation parameters and found in both patients that lower frequencies worked better than higher frequencies. It should be noted that there was a relatively short follow-up time of these patients and that they should be followed long term to fully evaluate improvement in motor functions as well as other possible long term effects.Click here to read the abstract.
January 1, 2006 – Visualizing the next steps in Parkinson’s disease
Bodis-Wollner I.(2002) Visualizing the next steps in Parkinson’s disease , Aug;59(8):1233-4Click here to read the abstract.
January 1, 2006 – Progressive worsening of spatial and chromatic processing deficits in Parkinson’s disease
Diederich NJ, Raman R, Leurgans S, Goetz CG. (2002). Progressive worsening of spatial and chromatic processing deficits in Parkinson’s disease , Aug;59(8):1249-52Click here to read the abstract.