 |
 |
My question is to J.A. Obeso, M.D., C.W. Olanow, M.D., M.C. Rodriguez-Oroz, M.D., P. Krack, M.D.,Is there any experience in doing a DBS of the STN on someone who previously underwentb a bilateral pallidotpmy At 03:39 AM 9/27/2001 +0200, you wrote: >Source: NEJM, Volume 345:956-963 (2001, Number 13) >Date: September 27, 2001 > >http://content.nejm.org/cgi/content/short/345/13/956?query=TOC > >Deep-Brain Stimulation of the Subthalamic Nucleus or the Pars Interna of the >Globus Pallidus in Parkinson's Disease > >The Deep-Brain Stimulation for Parkinson's Disease Study Group >The preparation of this article was overseen by the writing committee (J.A. >Obeso, M.D., C.W. Olanow, M.D., M.C. Rodriguez-Oroz, M.D., P. Krack, M.D., >R. Kumar, M.D., and A.E. Lang, M.D.), who assume responsibility for the >overall content and integrity of the manuscript. > >ABSTRACT > >Background >Increased neuronal activity in the subthalamic nucleus and the pars interna >of the globus pallidus is thought to account for motor dysfunction in >patients with Parkinson's disease. Although creating lesions in these >structures improves motor function in monkeys with induced parkinsonism and >patients with Parkinson's disease, such lesions are associated with >neurologic deficits, particularly when they are created bilaterally. >Deep-brain stimulation simulates the effects of a lesion without destroying >brain tissue. > >Methods >We performed a prospective, double-blind, crossover study in patients with >advanced Parkinson's disease, in whom electrodes were implanted in the >subthalamic nucleus or pars interna of the globus pallidus and who then >underwent bilateral high-frequency deep-brain stimulation. We compared >scores on the motor portion of the Unified Parkinson's Disease Rating Scale >when the stimulation was randomly assigned to be turned on or off. We >performed unblinded evaluations of motor function preoperatively and one, >three, and six months postoperatively. > >Results >Electrodes were implanted bilaterally in 96 patients in the >subthalamic-nucleus group and 38 patients in the globus-pallidus group. >Three months after the procedures were performed, double-blind, crossover >evaluations demonstrated that stimulation of the subthalamic nucleus was >associated with a median improvement in the motor score (as compared with no >stimulation) of 49 percent, and stimulation of the pars interna of the >globus pallidus with a median improvement of 37 percent (P<0.001 for both >comparisons). Between the preoperative and six-month visits, the percentage >of time during the day that patients had good mobility without involuntary >movements increased from 27 percent to 74 percent (P<0.001) with subthalamic >stimulation and from 28 percent to 64 percent (P<0.001) with pallidal >stimulation. Adverse events included intracranial hemorrhage in seven >patients and infection necessitating removal of the leads in two. > >Conclusions >Bilateral stimulation of the subthalamic nucleus or pars interna of the >globus pallidus is associated with significant improvement in motor function >in patients with Parkinson's disease whose condition cannot be further >improved with medical therapy. > >---------------------------------------------------------------------- >To sign-off Parkinsn send a message to: mailto:[log in to unmask] >In the body of the message put: signoff parkinsn ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn