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from: WE MOVE 9/21/04 DBS for PD and Dystonia: Long-Term Results http://www.imakenews.com/wemove/e_article000306159.cfm?x=b3yHMp9,b1Qs8yH9 Efficacy of deep brain stimulation of the subthalamic nucleus in Parkinson’s disease after 4 years of surgery: Double-blind and open-label evaluation MC Rodriguez-Oroz, I Zamarbide, J Guride, MR Palmero, J Obeso J Neurol Neurosurg Psychiatry 2004;75:1382-1385 Ten consecutive PD patients who had undergone STN DBS 4 years prior were recruited for long-term follow-up study. Patients ceased medications overnight, and the stimulator was turned off for three hours before randomization. Patients were then randomized to either an additional 2 hours off stimulation followed by two hours on, or vice versa, with evaluation at the end of each period. Akinesia, rigidity, and axial symptoms improved by approximately 40% on stimulation, and tremor improved by 55%. Results did not differ between patients in the on-off vs. off-on groups. Six patients correctly guessed their sequence assignment. Compared to baseline, open-label off-medication UPDRS was reduced by approximately two thirds at both one- and four-year evaluations in this cohort. The authors state, “The overall conclusion is that 4 years after surgery, motor severity and disability are less incapacitating than at baseline, despite the progressive and severe nature of the underlying disease process.” A report on another very long-term follow-up for STN DBS is archived at http://www.mdvu.org/emove/article.asp?ID=524 Subthalamic nucleus stimulation in advanced Parkinson’s disease: Blinded assessments at one-year follow-up B Ford, L Winfield, SL Pullman, SJ Frucht, Y Du, P Greene, JH Cheringal, Q Yu, LJ Cote, S Fahn, GM McKhann II, RR Goodman J Neurol Neurosurg Psychiatry 2004;75:1255-1259 Blinded videotape evaluation of 30 PD patients one year after receiving STN DBS showed a 30% improvement in motor scores compared to the baseline off-medication state. Improvement for patients with baseline tremor was twice that of those without tremor. While the average improvement was 30%, the range was from 74% improvement to 20% worsening, with only 12 patients improving more than 30%. Hoehn and Yahr scores and ADL scores did not change in either the on- of off-medication state. Mean daily off time was reduced from 7.25 hours to 2.25 hours. Serious complications included subdural hematoma (2), intracerebral hemorrhage (1), and infection (3). In addition, a patient with factor XII deficiency experienced an ischemic stroke and chest wall hematoma. Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: Long-term results P Coubes, L Cif, HE Fertit, S Hemm, N Vayssiere, S Serrat, MC Picot, S Tuffery, M Claustres, B Echenne, P Frerebeau J Neurosurg 2004;101:189-194 Thirty-one patients with primary generalized dystonia received bilateral electrode implantation to the GPi. Fourteen patients were DYT1-positive; 12 were adults, and 19 were children. Burke-Fahn-Marsden Dystonia Rating Scale clinical scores fell from 59.1 preoperatively to 17.7 at 3 months, and 12.9 at 2 years. Magnitude of improvement was slightly better for children than adults. BFMDRS functional scores fell from 16.5 at baseline to 8.8 3 months, and 6.3 at 2 years, with no significant difference due to age or DYT1 status. In several cases in which the pulse generator had to be turned off for other reasons, symptoms recurred within 1 week. The authors attribute the relatively higher clinical improvement in children to chronic deterioration in health from prolonged untreated dystonia, which they view as an argument for early intervention for this condition. A report on previous results from this group isarchived at http://www.mdvu.org/emove/article.asp?ID=528 ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn