Neuromodulation : journal of the International Neuromodulation Society
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Objectives. With respect to postoperative activities of daily living (ADL), we retrospectively investigated associated psychiatric symptoms that influenced beneficial effects of subthalamic nucleus (STN) stimulation in our Japanese patients with Parkinson disease (PD). Materials and Methods. Twenty-five patients underwent bilateral STN stimulation. Pre- and 3 months after the surgery, their parkinsonian symptoms were evaluated with Unified Parkinson Disease Rating Scale (UPDRS) and Schwab-England (S-E) ADL scale. ⋯ Preoperative score for intellectual impairment was only a significant predictor of worse postoperative ADL in "off" state. Conclusions. The markedly lower dose of levodopa may suggest ethnic characteristics of our Japanese patients with respect to tolerance for antiparkinsonian medications. Preoperative manifestation of drug-induced psychosis and cognitive dysfunction were the major factor that strikingly suppressed daily activities after STN stimulation.
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Objectives. Although the load impedance of a pulse generator has a significant effect on battery life, the electrical impedance of contact arrays in spinal cord stimulation (SCS) has not been extensively studied. We sought to characterize the typical impedance values measured from common quadripolar percutaneous SCS contact arrays. Methods. In 36 patients undergoing percutaneous trial stimulation for various chronic pain conditions, bipolar impedance between adjacent contacts of 64 leads with 9 mm center-to-center spacing was measured in two different vertebral level regions, cervical (C3-C7) and lower-thoracic (T7-T12). ⋯ Conclusions. Results from finite-difference mathematical modeling of SCS suggest that the difference in tissue impedance related to vertebral level may be due to the dorsoventral position of the lead in the epidural space. The presence of a larger space between the triangularly shaped dorsal part of the vertebral arch and the round shape of the dural sac in the lower-thoracic region increases the likelihood that the stimulating lead will not make dural contact, and thus "see" an increased impedance from the surrounding epidural fat. This implies that the energy requirements for stimulation in the thoracic region will be higher than in the cervical region, at least during the acute phase of implant.
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Objectives. To study the impact of personality traits on the effect of neurostimulation in patients with chest pain and normal coronary arteries. Materials and Methods. Using the Dutch personality questionnaire, we retrospectively studied the personality traits in 33 patients treated with neurostimulation, either transcutaneous electrical nerve stimulation or spinal cord stimulation after 5 years. Neurostimulation was successful in 21 patients. ⋯ In univariate analyses, low scores at the "social inadequacy" scale and the use of calcium antagonists were associated with beneficial outcome of neurostimulation. In multivariate analysis low scores at the "social inadequacy" scale remained an independent predictor for beneficial neurostimulation outcome, when adjusted for other variables. Conclusion. Personality traits are a determining factor in the evaluation of neurostimulation for patients with chest pain and normal coronary arteries.
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Clinical neurophysiology has always played an important interventional role throughout the perioperative stages in functional neurosurgery. On the one hand, some neurophysiologic procedures have become an integrated part of neurosurgery. On the other hand, in deep brain stimulation, although the surgical electrode implantation is an essential step, the therapeutic effects are actually produced by electrically modulating the physiologic activity of the brain. We review the topic of neurophysiologic intervention in the deep brain stimulation for movement disorders by presenting the evidence derived from our own experiences based on an integrated group located at two hospitals in London and Oxford, UK, and mainly covering tremor caused by multiple sclerosis, Parkinson's disease and dystonia.
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Intrathecal baclofen is presently the most effective treatment for diffuse spasticity whatever the cause. The fact that both spasticity is always accompanied by a degree of muscle weakness and that any antispastic treatment causes a decrease in muscle strength indicate that major attention must be paid in treating spasticity in ambulant patients. Methods. We present here a retrospective study, approved by the insitutional ethics committee, of 22 ambulant spastic patients, selected as homogeneous for disease and disease duration, who were treated with intrathecal baclofen at the Istituto Nazionale Neurologico "C. ⋯ These patients were followed-up for to 15 years of treatment and their clinical assessment was enriched by the evaluation of their functional independence measurement (FIM) before and during treatment. Results. There was improvement in quality of life as measured by the FIM scale; however, an increase in the patient's motor performance could not be detected. Conclusion. Although we did not show any improvement in muscle performance, intrathecal baclofen did improve daily quality of life, even in spastic patients who were able to walk.