Erika,

I asked the same question of Chris van der Linde last month and he replied
as follows:

>Dear Jane,
>
>Out of 50 patients we have performed three STN stimulations on MSA patients
>(two from Holland and on from Belgium.).  Theoretically we thought it
>wouldn't work, but the famliy and the patients insisted, because there was
>no alternative.  All three patients had one specific form of MSA without the
>presence of dementia, hypotension, cerebellar disturbances (problems with
>your balance, not related to parkinsonism) or serious eye movement problems
>.  None responded to medication.  The diagnosis is called Multiple System
>Atrophy (MSA) of the striatonigral type.
>
>All patients improved after surgery with respect to the stiffness and
>slowness. The voice has not changed.   Initially, we found some gait
>improvement, but this was not sustained and worsened in two patients 6
>months after surgery. Yet, they feel better because they can use their hands
>better and have become more independent, regardless of the gait problem.
>When switsching off the stimulation, the patients worsen dramatically and
>are totally dependent.
>
>Thus, there is certainly a response, but the gait may not be influenced by
>the stimulation.
>Therefore, it may be worth while to further investigate the STN or other
>form of DBS in MSA of the striatonigral type.
>
>Regards,
>
>Chris van der Linden, M.D.

At 07:36 AM 11/17/1999 +1030, you wrote:
>from erika
>Thanks for the PMID Janet.
>
>If I read it correctly the apomorhine test can be used to predict the
>outcome of DBS in persons with IDP. In this particular test the person with
>MSA was accurately predicted to NOT benefit from the DBS. Yes?
>My question is do any listfolk know of anyone with MSA who has had DBS and
>what the outcome was?
>Comments from Dr. Van der Linden?
>
>I know I should perhaps go to the Shy-Drager list for this, but have not
>changed over (yet).
>I kind'a like this list but don't think I could manage keeping up with two
>lists.
>
>BTW  this list with kerfuffles, heated discussions etc. seems to me to be
>like the sea
>
>it ebbs and flows and
>storms stir up the sand and weeds
>and all the while the fishes feed......
>
>(well, at least most of our 1800, cause we're still here)      :-)
>                        Love, Erika.
>
>-----Original Message-----
>From: janet paterson <[log in to unmask]>
>To: [log in to unmask] <[log in to unmask]>
>Date: Tuesday, November 16, 1999 2:52 AM
>Subject: PMID: 10552237: Can apomorphine test predict STN outcome?
>
>
>>Apomorphine test: a predictor for motor responsiveness
>>to deep brain stimulation of the subthalamic nucleus.
>>
>>The value of the apomorphine test as a predictor of the clinical outcome of
>deep brain stimulation of the subthalamic nucleus (STN) was evaluated in
>patients with advanced idiopathic Parkinson's disease (IPD) or multiple
>system atrophy (MSA).
>>
>>13 IPD patients with severe diurnal fluctuations and 1 MSA patient not
>responding to dopaminergic drugs were assessed with the Unified Parkinson's
>Disease Rating Scale (UPDRS) and the timed finger tapping test (FTT),
>measured preoperatively on and off apomorphine and postoperatively on and
>off STN stimulation.
>>
>>UPDRS motor items 20-25 were assessed intraoperatively on and off STN
>stimulation when the clinically effective target was approached.
>>
>>The motor response to immediate intraoperative and long-term STN
>stimulation was correlated with results of the apomorphine test.
>>
>>The response to immediate intraoperative STN stimulation was accurately
>predicted by apomorphine challenge in all 13 IPD patients.
>>
>>Clinical outcome following long-term STN stimulation was correlated
>significantly with preoperative changes due to apomorphine measured with the
>UPDRS motor scores (r = 0.7125, P < 0.01) and FTT (r = 0.9276, P < 0.001).
>>
>>Moreover, comparison of long-term STN stimulation to preoperative drug
>treatment displayed a significant reduction in the duration of off-phases
>and a significant increase in the duration of on-phases.
>>
>>However, in the single patient with MSA no beneficial response was obtained
>either to apomorphine or to STN stimulation intraoperatively and during the
>postoperative externalized test period.
>>
>>Our results indicate that the apomorphine test can predict the outcome of
>immediate and long-term STN stimulation and may help in the selection of
>candidates for surgery.
>>
>>
>>J Neurol 1999 Oct 25;246(10):907-913
>>Pinter MM, Alesch F, Murg M, Helscher RJ, Binder H
>>Neurological Hospital Maria Theresien Schlossel, Vienna, Austria
>>PMID: 10552237
>>
>><http://www.ncbi.nlm.nih.gov/PubMed/>
>