PURPOSE: Despite the best efforts of neurologists, the results of pharmacotherapy in the late stages of Parkinson's disease are often disappointing and accompanied by debilitating side effects. Under these circumstances, deep brain stimulation is a viable treatment option. The aim of the meticulous pre-surgical planning is not only precise electrode implantation, but also the avoidance of intraoperative vascular conflicts potentially causing intracerebral bleeding. MATERIAL AND METHODS: In this report, we present a patient with early-onset Parkinson's disease whose cerebral vascular anatomy precluded standard bilateral subthalamic nucleus electrode implantation. Initially, right subthalamic stimulation alone provided a very mild clinical benefit that was not reflected in the patient's quality of life. In this patient, an unusual configuration of intracerebral electrodes with right subthalamic and left pallidal stimulation electrodes was applied 15 months after the initial subthalamic electrode implantation. RESULTS: The procedure has had a highly beneficial long-term effect without any significant complications. The greatest improvement was noted using the setting 1.8 V, 130 Hz, 90 μs at the right side (STN) and 3.7 V, 130 Hz, 120 μs at the left side (GPi). This allowed the patient to return to his daily life activities. CONCLUSIONS: The reported case provides a new perspective of treatment possibilities in complex functional neurosurgical cases requiring exceptional individualisation of the treatment approach.
- MeSH
- elektrody MeSH
- hluboká mozková stimulace * metody MeSH
- kvalita života MeSH
- lidé MeSH
- Parkinsonova nemoc * terapie komplikace MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Deep brain stimulation (DBS) is an established method in the treatment of not only Parkinson's disease motor complications but also dystonia and tremor, and there are data supporting the efficacy of DBS in epilepsy and some psychiatric problems. The alleviation of the neurologic problems may enable females of childbearing age to consider pregnancy because of being able to take care of their child. The aim of the study is to provide a review of the data available on the effect of DBS on the course of pregnancy and delivery in patients suffering from diseases amenable for DBS treatment (Parkinson's disease, dystonia, obsessive compulsive disorder, Tourette's syndrome, epilepsy). Although data available in the literature on pregnancy and childbirth in patients with an implanted active DBS system are limited to small case series and case reports, the number of younger patients implanted with DBS systems will potentially require more attention beyond specialized DBS centers. In emergency deliveries, general obstetricians and neurosurgeons should be provided with a protocol to prevent injuries to the implanted system with potentially devastating consequences for the patient.
- MeSH
- dítě MeSH
- dystonie * terapie MeSH
- epilepsie * terapie MeSH
- hluboká mozková stimulace * metody MeSH
- lidé MeSH
- Parkinsonova nemoc * terapie MeSH
- těhotenství MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
The healthcare model is shifting towards integrated care approaches. This new model requires patients to be more closely involved. The iCARE-PD project aims to address this need by developing a technology-enabled, home-based, and community-centered integrated care paradigm. A central part of this project is the codesign process of the model of care, exemplified by the active participation of patients in the design and iterative evaluation of three sensor-based technological solutions. We proposed a codesign methodology used for testing the usability and acceptability of these digital technologies and present initial results for one of them, MooVeo. Our results show the usefulness of this approach in testing the usability and acceptability as well as the opportunity to incorporate patients' feedback into the development. This initiative will hopefully help other groups incorporate a similar codesign approach and develop tools that are well adapted to patients' and care teams' needs.
- MeSH
- digitální technologie * MeSH
- lidé MeSH
- Parkinsonova nemoc * terapie MeSH
- technologie MeSH
- učení MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Cieľom štúdie bolo poukázať na prínos nových invazívnych terapeutických postupov v liečbe pokročilých štádií Parkinsonovej choroby (PCh) v porovnaní s klasickou perorálnou farmakoterapiou. Výsledky boli získané zo súboru 43 pacientov s PCh, z ktorých 39 % podstúpilo klasickú terapiu pozostávajúcu z perorálnych antiparkinsoník, 23 % pacientov užívalo intestinálny gél obsahujúci levodopou (Duodopa), 19 % pacientov malo indikovanú apomorfínovú subkutánnu pumpu a 19 % pacientov podstúpilo hĺbkovú mozgovú stimuláciu (DBS). Väčšina pacientov mala pokročilejšie štádiá PCh, štádium 4 podľa Hoehnovej a Yahra (1967). Výsledky práce ukazujú zlepšenie stavu po nasadení nového terapeutického postupu u väčšiny pacientov v porovnaní s klasickou terapiou. Pozitívny vplyv bol zaznamenaný aj v zníženej potrebe užívania liekov per os, kde bol zaznamenaný signifikantný pokles pri všetkých nových terapeutických postupoch. Taktiež bol zaznamenaný pozitívny účinok v redukcii off stavov u pacientov. V prípade Duodopy a DBS došlo k skráteniu off periódy o 50 % a pri apomorfínovej pumpe o 40 %. Pacienti tiež hlásili zlepšenie niektorých symptómov ochorenia ako tremor či rigidita, zatiaľ čo dyskinézy naďalej predstavujú výzvu. Na základe získaných výsledkov sa môže konštatovať, že nové terapeutické postupy pri PCh umožnia zvládnuť symptómy typické pre pokročilé štádia ochorenia, ktoré by bez týchto postupov viedli k invalidite, čo je hlavným dôvodom ich indikácie. U pacientov s pomalšou progresiou ochorenia v skorých štádiách je klasická forma terapie perorálnymi antiparkinsonikami stále zlatým štandardom. Dôvodom je nielen ich relatívna účinnosť, ale aj lepšia ekonomická dostupnosť, nakoľko nové postupy sú spojené s vysokými finančnými nákladmi a v rámci verejného zdravotného poistenia môžu byť v Slovenskej republike použité len na základe rozhodnutia revízneho lekára.
The aim of the study was to point out the contribution of new invasive therapeutic procedures in the treatment of advanced stages of Parkinson’s disease (PD) in comparison with classical oral pharmacotherapy. Data originated from a group of 43 patients with PD, 39% (17) with classic treatment, 23% (10) with intestinal gel of methyl ester levodopa (Duodopa), 19% (8) of patients were using subcutaneous delivery of apomorphine (APO) and the same quantity of patients had undergone deep brain stimulation (DBS). Majority of patients had advanced stages of PD, stage 4, by standards of Hoehn and Yahr scale (Hoehn and Yahr, 1967). Research observed improvement in majority of patients with novel treatments. A positive effect was also noted in the reduced need for oral therapy, where there was a significant decrease in all new therapies. Benefits were observed in the amount of antiparkinsonic drugs taken per os, where we observed reduction in all new therapies. A positive effect of the new therapeutic approaches in reducing “off” periods in patients has also been noted. In the case of Duodopa and DBS, the ”off” period was shortened up to 50% and in the apomorphine pump up to 40%. Patients also reported reduction of some symptoms like rigidity, tremor and bradykinesis while dyskinesis still remains suba challenge. On the basis of the obtained results, it can be concluded that new therapeutic procedures for PCh will make it possible to manage symptoms typical of advanced stages of the disease, which without these procedures would lead to disability, which is the main reason for their indication. However, in early stages, well responding patients or in slow progressing disease oral antiparkinsonics are remaining as golden standard of treatment. This is not just due to good response but also because these classic drug formulations are significantly less expensive. In Slovakia, novel treatments are accessible through healthcare insurance only after secondary revision by insurance company doctors.
- Klíčová slova
- Duodopa, apomorfínová pumpa,
- MeSH
- apomorfin aplikace a dávkování terapeutické užití MeSH
- fixní kombinace léků MeSH
- hluboká mozková stimulace metody MeSH
- implantabilní infuzní pumpy MeSH
- karbidopa farmakologie terapeutické užití MeSH
- klinická studie jako téma MeSH
- levodopa farmakologie terapeutické užití MeSH
- lidé MeSH
- Parkinsonova nemoc * terapie MeSH
- Check Tag
- lidé MeSH
- MeSH
- lidé MeSH
- Parkinsonova nemoc * komplikace terapie MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
BACKGROUND: In this study we evaluated the impact of location of deep brain stimulation electrode active contact in different parts of the subthalamic nucleus on improvement of non-motor symptoms in patients with Parkinson's disease. METHODS: The subthalamic nucleus was divided into two (dorsolateral/ventromedial) and three (dorsolateral, medial, ventromedial) parts. 37 deep brain stimulation electrodes were divided according to their active contact location. Correlation between change in non-motor symptoms before and one and four months after deep brain stimulation electrode implantation and the location of active contact was made. RESULTS: In dividing the subthalamic nucleus into three parts, no electrode active contact was placed ventromedially, 28 active contacts were located in the medial part and 9 contacts were placed dorsolaterally. After one and four months, no significant difference was found between medial and dorsolateral positions. In the division of the subthalamic nucleus into two parts, 13 contacts were located in the ventromedial part and 24 contacts were placed in the dorsolateral part. After one month, significantly greater improvement in the Non-motor Symptoms Scale for Parkinson's disease (P=0.045) was found on dorsolateral left-sided stimulation, but no significant differences between the ventromedial and dorsolateral positions were found on the right side. CONCLUSION: This study demonstrated the relationship between improvement of non-motor symptoms and the side (hemisphere, left/right) of the deep brain stimulation electrode active contact, rather than its precise location within specific parts of the subthalamic nucleus in patients treated for advanced Parkinson's disease.
- MeSH
- elektrody MeSH
- hluboká mozková stimulace * MeSH
- lidé MeSH
- nucleus subthalamicus * fyziologie MeSH
- Parkinsonova nemoc * terapie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: This study aimed to evaluate whether long-term averaged spectrum (LTAS) descriptors for reading and monologue are suitable to detect worsening of dysarthria in patients with Parkinson's disease (PD) treated with subthalamic nucleus deep brain stimulation (STN-DBS) with potential effect of ON and OFF stimulation conditions and types of connected speech. METHOD: Four spectral moments based on LTAS were computed for monologue and reading passage collected from 23 individuals with PD treated with bilateral STN-DBS and 23 age- and gender-matched healthy controls. Speech performance of patients with PD was compared in ON and OFF STN-DBS conditions. RESULTS: All LTAS spectral moments including mean, standard deviation, skewness, and kurtosis across both monologue and reading passage were able to significantly distinguish between patients with PD in both stimulation conditions and control speakers. The spectral mean was the only LTAS measure sensitive to capture better speech performance in STN-DBS ON, as compared to the STN-DBS OFF stimulation condition (p < .05). Standardized reading passage was more sensitive compared to monologue in detecting dysarthria severity via LTAS descriptors with an area under the curve of up to 0.92 obtained between PD and control groups. CONCLUSIONS: Our findings confirmed that LTAS is a suitable approach to objectively describe changes in speech impairment severity due to STN-DBS therapy in patients with PD. We envisage these results as an important step toward a continuum development of technological solutions for the automated assessment of stimulation-induced dysarthria. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21644798.
- MeSH
- biomedicínský výzkum organizace a řízení MeSH
- hluboká mozková stimulace metody trendy MeSH
- lidé MeSH
- neurodegenerativní nemoci * epidemiologie patologie terapie MeSH
- neurologie * organizace a řízení MeSH
- Parkinsonova nemoc epidemiologie patologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- MeSH
- antiparkinsonika aplikace a dávkování farmakologie klasifikace MeSH
- diferenciální diagnóza MeSH
- levodopa aplikace a dávkování farmakologie klasifikace MeSH
- lidé MeSH
- Parkinsonova nemoc * dějiny diagnóza epidemiologie etiologie farmakoterapie terapie MeSH
- rizikové faktory MeSH
- věkové faktory MeSH
- Check Tag
- lidé MeSH
Advanced research in health science has broadened our view in approaching and understanding the pathophysiology of diseases and has also revolutionised diagnosis and treatment. Ever since the establishment of Braak's hypothesis in the propagation of alpha-synuclein from the distant olfactory and enteric nervous system towards the brain in Parkinson's Disease (PD), studies have explored and revealed the involvement of altered gut microbiota in PD. This review recapitulates the gut microbiome associated with PD severity, duration, motor and non-motor symptoms, and antiparkinsonian treatment from recent literature. Gut microbial signatures in PD are potential predictors of the disease and are speculated to be used in early diagnosis and treatment. In brief, the review also emphasises on implications of the prebiotic, probiotic, faecal microbiota transplantation, and dietary interventions as alternative treatments in modulating the disease symptoms in PD.
- MeSH
- alfa-synuklein metabolismus MeSH
- antiparkinsonika MeSH
- lidé MeSH
- mozek MeSH
- Parkinsonova nemoc * terapie MeSH
- střevní mikroflóra * fyziologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
