 |
 |
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/> >