BACKGROUND AND OBJECTIVES: The intricate relationship between deep brain stimulation (DBS) in Parkinson's disease (PD) and cognitive impairment has lately garnered substantial attention. The presented study evaluated pre-DBS structural and microstructural cerebral patterns as possible predictors of future cognitive decline in PD DBS patients. METHODS: Pre-DBS MRI data in 72 PD patients were combined with neuropsychological examinations and follow-up for an average of 2.3 years after DBS implantation procedure using a screening cognitive test validated for diagnosis of mild cognitive impairment in PD in a Czech population - Dementia Rating Scale 2. RESULTS: PD patients who would exhibit post-DBS cognitive decline were found to have, already at the pre-DBS stage, significantly lower cortical thickness and lower microstructural complexity than cognitively stable PD patients. Differences in the regions directly related to cognition as bilateral parietal, insular and cingulate cortices, but also occipital and sensorimotor cortex were detected. Furthermore, hippocampi, putamina, cerebellum and upper brainstem were implicated as well, all despite the absence of pre-DBS differences in cognitive performance and in the position of DBS leads or stimulation parameters between the two groups. CONCLUSIONS: Our findings indicate that the cognitive decline in the presented PD cohort was not attributable primarily to DBS of the subthalamic nucleus but was associated with a clinically silent structural and microstructural predisposition to future cognitive deterioration present already before the DBS system implantation.

• MeSH
• hluboká mozková stimulace * škodlivé účinky   MeSH
• kognitivní dysfunkce * etiologie   diagnostické zobrazování   patofyziologie   patologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie * metody   MeSH
• neuropsychologické testy MeSH
• nucleus subthalamicus * diagnostické zobrazování   MeSH
• Parkinsonova nemoc * terapie   diagnostické zobrazování   patologie   MeSH
• senioři MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

BACKGROUND: Symmetric biphasic pulses have been shown to acutely increase the therapeutic window of ventralis intermedius deep brain stimulation (Vim-DBS) for essential tremor (ET) compared to cathodic pulses. Acute supratherapeutic stimulation can induce ataxic side effects in Vim-DBS. OBJECTIVE: To investigate the effect on tremor, ataxia and dysarthria of 3 h of biphasic stimulation in patients with DBS for ET. METHODS: A randomized, doubled-blind, cross-over design was used to compare standard cathodic pulses with symmetric biphasic pulses (anode-first) during a 3-h period per pulse shape. During each 3-h period, all stimulation parameters were identical, except for the pulse shape. Tremor (Fahn-Tolosa-Marin Tremor Rating Scale), ataxia (International Cooperative Ataxia Rating Scale) and speech (acoustic and perceptual measures) were assessed hourly during the 3-h periods. RESULTS: Twelve ET patients were included. During the 3-h stimulation period, tremor control was equivalent between the two pulse shapes. Biphasic pulses elicited significantly less ataxia than cathodic pulses (p = 0.006). Diadochokinesis rate of speech was better for the biphasic pulse (p = 0.048), but other measures for dysarthria were not significantly different between the pulses. CONCLUSION: Symmetric biphasic pulses induce less ataxia than conventional pulses after 3 h of stimulation DBS in ET patients.

• MeSH
• ataxie etiologie   MeSH
• dysartrie etiologie   MeSH
• elektrody MeSH
• esenciální tremor * terapie   etiologie   MeSH
• hluboká mozková stimulace * škodlivé účinky   MeSH
• lidé MeSH
• nuclei ventrales thalami chirurgie   MeSH
• tremor etiologie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

BACKGROUND: DYT6 dystonia belongs to a group of isolated, genetically determined, generalized dystonia associated with mutations in the THAP1 gene. CASE PRESENTATION: We present the case of a young patient with DYT6 dystonia associated with a newly discovered c14G>A (p.Cys5Tyr) mutation in the THAP1 gene. We describe the clinical phenotype of this new mutation, effect of pallidal deep brain stimulation (DBS), which was accompanied by two rare postimplantation complications: an early intracerebral hemorrhage and delayed epileptic seizures. Among the published case reports of patients with DYT6 dystonia, the mentioned complications have not been described so far. CONCLUSIONS: DBS in the case of DYT6 dystonia is a challenge to thoroughly consider possible therapeutic benefits and potential risks associated with surgery. Genetic heterogeneity of the disease may also play an important role in predicting the development of the clinical phenotype as well as the effect of treatment including DBS. Therefore, it is beneficial to analyze the genetic and clinical relationships of DYT6 dystonia.

• MeSH
• DNA vazebné proteiny genetika   MeSH
• dystonické poruchy * genetika   terapie   MeSH
• dystonie * genetika   terapie   MeSH
• hluboká mozková stimulace * škodlivé účinky   MeSH
• jaderné proteiny genetika   MeSH
• lidé MeSH
• proteiny regulující apoptózu genetika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

This case report presents a 54-year-old Parkinson´s disease patient who underwent a DBS implantation to the subthalamic nuclei bilaterally. Shortly after the operation, the subcutaneous pocket of the generator filled with a liquid. Repeated aspirations did not show any bacterial contamination, and an infection was not found. In the sample, a beta-trace protein was detected that proved the presence of cerebrospinal fluid. A lumbar drain was immediately placed, and a chest compression bandage was fastened for 7 days. After removing the lumbar drain and the compression bandage, no additional liquid was observed, and the wound healed without any other complication. We present an unusual adverse event related to DBS surgery and suggest an effective treatment that has led to uncomplicated healing.

• MeSH
• drenáž metody   MeSH
• hluboká mozková stimulace škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• nucleus subthalamicus chirurgie   MeSH
• Parkinsonova nemoc diagnóza   chirurgie   MeSH
• pooperační komplikace etiologie   chirurgie   MeSH
• retrospektivní studie MeSH
• únik mozkomíšního moku etiologie   chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• kazuistiky MeSH
• práce podpořená grantem MeSH

Pallidal deep-brain stimulation of the internal globus pallidus (GPi-DBS) is an effective treatment for dystonia. However, GPi-DBS may cause important stimulation-induced side effects such as hypokinetic dysarthria, which is particularly manifested by articulation rate abnormalities. However, little data regarding the effect of the location of the electrode and stimulation parameters for pallidal stimulation on articulation rate in dystonia is available. Speech data were acquired from 18 dystonic patients with GPi-DBS and 18 matched healthy controls. Each of dystonic patients was tested twice within 1 day in both the GPi-DBS ON and GPi-DBS OFF stimulation conditions. Compared to healthy controls, the decreased diadochokinetic rate and slower articulation rate in dystonic patients were observed in both stimulation conditions. No significant differences in speech rate measures between stimulation conditions were detected with no relation to contact localization and stimulation intensity. Our findings do not support the use articulation rate as a surrogate marker of stimulation-induced changes to the speech apparatus in dystonia.

• MeSH
• dospělí MeSH
• dysartrie etiologie   MeSH
• dystonické poruchy terapie   MeSH
• globus pallidus * MeSH
• hluboká mozková stimulace škodlivé účinky   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• analgezie * metody   škodlivé účinky   MeSH
• bolest * chirurgie   farmakoterapie   patofyziologie   MeSH
• chronická bolest * chirurgie   farmakoterapie   terapie   MeSH
• elektrická stimulace * metody   přístrojové vybavení   škodlivé účinky   MeSH
• fyzikální stimulace metody   škodlivé účinky   MeSH
• hluboká mozková stimulace metody   škodlivé účinky   MeSH
• implantabilní neurostimulátory * MeSH
• implantované elektrody MeSH
• lidé MeSH
• management bolesti MeSH
• míšní stimulace metody   MeSH
• motorické korové centrum MeSH
• nezvladatelná bolest terapie   MeSH
• periferní nervy MeSH
• přímá transkraniální stimulace mozku metody   MeSH
• výběr pacientů MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• přehledy MeSH

Bolesť hlavy je pomerne častým neurologickým symptómom a môže mať mnoho príčin. Podľa ICHD-3 (The International Classification of Headache Disorders 3rd edition) sa delí do troch skupín: primárne bolesti hlavy, sekundárne bolesti hlavy a bolestivé kraniálne neuropatie a iné bolesti tváre a hlavy. Farmakologická liečba primárnych bolestí hlavy je často náročná, nedostatočne účinná a prináša so sebou aj časté nežiaduce účinky. V posledných rokoch sa u pacientov s chronickými primárnymi bolesťami hlavy aplikujú do praxe neurostimulačné metódy, ktoré zahŕňajú neinvazívne a miniinvazívne techniky, ako aj hlbokú mozgovú stimuláciu, ktorá je využívaná predovšetkým v liečbe chronickej cluster headache rezistentnej na liečbu.

Headache is one of the most common neurological symptoms and may have many causes. According to the ICHD-3 (The InternationalClassification of Headache Disorders 3rd edition), they are divided into three groups: primary headaches, secondaryheadaches, and painful cranial neuropathy and other facial pain and headaches. Pharmacological treatment of primary headachesis often difficult, insufficient and ineffective, and often carries various side effects. Recently, neurostimulation methods involvingnon-invasive and mini-invasive techniques, as well as deep brain stimulation, are used in patients with chronic primary headaches,which is used primarily in the treatment of chronic resistant cluster headache.

• MeSH
• bolesti hlavy * diagnóza   klasifikace   terapie   MeSH
• chronická bolest diagnóza   etiologie   terapie   MeSH
• cluster headache diagnóza   etiologie   terapie   MeSH
• elektrostimulační terapie * metody   trendy   MeSH
• ganglia parasympatická MeSH
• hluboká mozková stimulace klasifikace   metody   škodlivé účinky   MeSH
• lidé MeSH
• migréna * diagnóza   terapie   MeSH
• pulsní radiofrekvenční terapie metody   trendy   MeSH
• statistika jako téma MeSH
• transkutánní elektrická neurostimulace klasifikace   metody   škodlivé účinky   MeSH
• týlní lalok účinky léků   MeSH
• vestibulární aparát patofyziologie   účinky léků   MeSH
• Check Tag
• lidé MeSH

BACKGROUND: Although pallidal deep brain stimulation (GPi-DBS) is an effective treatment for dystonia, it may cause important stimulation-induced side-effects such as hypokinetic dysarthria or stuttering. However, the reasons behind the occurrence of these side-effects remain unknown. OBJECTIVE: To objectively investigate the impact of GPi-DBS on patients with dystonia on speech fluency, intelligibility, and key aspects of hyperkinetic and hypokinetic dysarthria. METHODS: Speech was systematically evaluated in 19 dystonic patients with GPi-DBS. Each patient was tested twice within one day in both the GPi-DBS ON and GPi-DBS OFF stimulation conditions. A control sample of 19 matched healthy speakers underwent the same speech assessment. RESULTS: We observed an improvement of hyperkinetic dysarthria symptoms in 47% and an aggravation of hypokinetic dysarthria symptoms in 26% of patients with the GPi-DBS switched ON. A higher stimulus intensity was found in a group of patients in whom the hypokinetic dysarthria worsened with the GPi-DBS ON when compared to other dystonic patients (p = 0.02). Furthermore, we revealed a significant increase of dysfluent words in the GPi-DBS ON when compared to OFF condition (p = 0.001) associated with the shorter distance of the active contact localization along the medio-lateral direction (r = -0.70, p = 0.005). CONCLUSION: This study provides evidence of dualistic effects of GPi-DBS on speech in dystonia manifested as an improvement of hyperkinetic or a deterioration of hypokinetic dysarthria. Our findings suggest that lower stimulation parameters and placement of active contacts more laterally in the internal globus pallidus should be preferred to avoid the possible side effects of hypokinetic dysarthria and dysfluency.

• MeSH
• dospělí MeSH
• dystonie patofyziologie   terapie   MeSH
• globus pallidus fyziologie   MeSH
• hluboká mozková stimulace škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• poruchy řeči etiologie   patofyziologie   terapie   MeSH
• průřezové studie MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

Úvod: Je popísaných viacero komplikácií hlbokej mozgovej stimulácie. Súvisia so zavedením elektród do cieľovej štruktúry, stimuláciou alebo poruchou implantovaného materiálu. Medzi menej často popísané komplikácie patria cievne nehemoragické komplikácie, akými sú vznik vazospazmu a ischemického infarktu v okolí elektródy. Cieľ: Analýza skupiny pacientov s klinicky významnými nehemoragickými cerebrovaskulárnymi komplikáciami počas operácie, resp. v časovej súvislosti so zavedením elektród hlbokej mozgovej stimulácie. Materiál a metódy: Retrospektívna analýza 58 po sebe nasledujúcich operácií hlbokej mozgovej stimulácie subthalamického jadra a globus pal­lidus internus v rokoch 2009–2016 s identifikáciou skupiny pacientov s nehemoragickou cievnou komplikáciou. Analyzované boli rizikové faktory vzniku týchto komplikácií. Výsledky: Pozorovali sme prípad pa­cienta so vznikom ischémie subkortikálne v okolí elektród hlbokej mozgovej stimulácie a ďalších štyroch pacientov s akútnym rozvojom neurologických príznakov, akými sú centrálna lézia n. facialis, hemiparéza, prechodná somnolencia a pooperačná psychomotorická pasivita. Spolu bol výskyt nehemoragických cievnych komplikácií pozorovaný v sledovanom súbore u 8,6 % pacientov. Záver: Nehemoragické cievne komplikácie okrem ich prejavu v podobe ischemického infarktu s korelátom na pooperačných zobrazovacích vyšetreniach sú pravdepodobne častejšie v podobe transientných príhod peroperačne bez korelátu na pooperačných zobrazovacích vyšetreniach. Predpokladaným mechanizmom vzniku je navodenie vazospazmu.

Background: There are different complications described in deep brain stimulation. They are associated with electrode implantation, stimulation and hardware failure. Vasospasm and ischemic infarction around electrode are less often described complications. Objective: Analysis of group of patients with clinically significant vascular non-hemorrhagic complications intraoperatively or in the temporal context with deep brain stimulation electrode implantation. Methods: Retrospective analysis of 58 consecutive deep brain stimulation operations of subthalamic nucleus and globus pallidus internus from 2009 to 2016 with identification of the group of patients with vascular non- hemorrhagic complication. Risk factors for the development of these complications were analyzed. Results: We observed the case of patient with developement of subcortical ischaemia around electrode of deep brain stimulation and another four patients with acute onset of neurological symptoms such as central lesion of facial nerve, hemiparesis, transient somnolence and postoperative psychomotor passivity. Occurence of vascular non-hemorrhagic complications in the patient population was 8.6%. Conclusion: Vascular non-hemorrhagic complications in addition to their presentation in the form of ischemic infarction with correlate on postopreative imaging occur probably more frequently as perioperative transient accidents without correlate on postoperative imaging. Assumed mechanism of their developement is vasospasm.

• MeSH
• hluboká mozková stimulace * škodlivé účinky   využití   MeSH
• intrakraniální vazospazmus etiologie   MeSH
• ischemie mozku * diagnostické zobrazování   etiologie   MeSH
• lidé MeSH
• mozkový infarkt * diagnostické zobrazování   etiologie   MeSH
• peroperační komplikace etiologie   MeSH
• retrospektivní studie MeSH
• rizikové faktory MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

INTRODUCTION: Early postoperative mental changes are the most frequent problem after bilateral subthalamic electrode implantation. The study aims to find an association between them and factors related to patient, disease and surgery, including the size of the third ventricle as brain atrophy marker. MATERIAL AND METHODS: The study included 80 patients with bilateral subthalamic electrodes implanted for motor complications of Parkinson's disease (PD). Patients' age, disease and motor complications duration, medication, neuropsychological tests, surgical reports, third ventricle length (intercommissural distance) and width (intermammillary distance) were analysed. RESULTS: Early mental alterations requiring treatment were observed in 25.0% of patients with higher age being significant predictor. The duration of PD motor complications, L DOPA equivalent dose, DSR Mattis, third ventricle length and width were not statistically significant predictors. The incidence of postoperative mental alteration with intermammillary distance > 8 mm was 60%. The percentage of left sided electrodes implanted in anterior trajectory is significantly higher in patients with early mental changes. CONCLUSIONS: Higher age is a risk factor for early postoperative mental changes, but not disease, late motor complications duration and parameters describing third ventricular size except the excessive intermammillary distance. Left sided electrode implanted in anterior position is a risk factor.

• MeSH
• antiparkinsonika aplikace a dávkování   terapeutické užití   MeSH
• duševní poruchy etiologie   psychologie   MeSH
• hluboká mozková stimulace škodlivé účinky   MeSH
• implantované elektrody MeSH
• levodopa aplikace a dávkování   terapeutické užití   MeSH
• lidé středního věku MeSH
• lidé MeSH
• magnetická rezonanční tomografie MeSH
• neuropsychologické testy MeSH
• nucleus subthalamicus * diagnostické zobrazování   MeSH
• Parkinsonova nemoc diagnostické zobrazování   chirurgie   MeSH
• pooperační komplikace psychologie   MeSH
• rizikové faktory MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• třetí mozková komora MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH