Mar 2019 DOI 10.14302/issn.2470-5020.jnrt-19-2630
P. Schwarm FrankCorresponding author
Department of Neurosurgery, Justus-Liebig University Giessen, Giessen, Germany
Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentle stimulation was achieved. The stimulation of the anterior segments in the central position of the electrode in the STN showed no side-effects and allowed a reduction of initial symptoms in an low stimulation amplitude. Despite precise preoperatively planning and intraoperative trial stimulation, side effects of STN stimulation are very common. The application of segmented electrodes permits more options to reduce side effects rather than using ring electrodes. Studies with larger sample sizes are needed to establish the optional DBS electrode.
Sep 2018 DOI 10.14302/issn.2470-5020.jnrt-18-2185
Yilmaz AtillaCorresponding author
Hatay Mustafa Kemal University Medicine Faculty Neurosurgery Department, Hatay, Turkey.
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) provides efficient treatment for the alleviation of motor signs in patients with Parkinson's disease (PD), but more studies about gait and functionality are needed. We aimed to understand whether short-term DBS treatment will can relieve the symptoms of PD patients, specifically we examined its effect on motor-cognitive-complication parameters, fine motor skills and daily living activity (DLA) of these patients. Method: Ten patients from Mustafa Kemal University Neurosurgery Department were recruited. The assessments were made twice, first time preoperatively, which was within one week prior to the surgery, second time postoperatively, which was 55-65 days post treatment. The motor scores, DLA scores, mental scores and complication scores were measured with Unified Parkinson's Disease Rating Scale (UPDRS), fine motor skills measured with The nine-hole peg test (9-HPT), balance measured with Berg Balance Scale (BBS) and falling risk measured with Timed Up and Go Test (TUG). Results: 10 patients (5 female, 5 male) aged between 40-60 (mean=49.44±6.69 years) were included in the study. Duration of the disease’s mean was 5.60 years. We found significant difference between pre-op and post-op results in UPDRS DLA, UPDRS motor, UPDRS complication, UPDRS total score and TUG tests (Table 2). There was no significant difference between preop-postop assessment in UPDRS mental, BBS and 9-HPT results (p>0.05). Discussion: Balance, walk and fine motor impairment occurs almost always in Parkinson’s disease and resulting in difficulties with daily living activities. We found that DBS has positive effect on PD complications, balance and walking abilities. PD patients that have falling risk and multiple motor symptoms may have benefit from DBS.