RESUMEN
BACKGROUND/AIM: The prevalence of cognitive symptoms in recently diagnosed Parkinson's disease (PD) patients may be as high as 60%. We report a novel deep brain stimulation (DBS) strategy targeting both motor and cognitive symptoms. METHODS: A PD patient diagnosed with mild cognitive impairment underwent DBS surgery targeting the globus pallidus interna (GPi; to treat motor symptoms) and the nucleus basalis of Meynert (NBM; to treat cognitive symptoms) using a single electrode per hemisphere. RESULTS: Compared to baseline, 2-month follow-up after GPi stimulation was associated with motor improvements, whereas partial improvements in cognitive functions were observed 3 months after the addition of NBM stimulation to GPi stimulation. CONCLUSION: This case explores an available alternative for complete DBS treatment in PD, stimulating 2 targets at different frequencies with a single electrode lead.
Asunto(s)
Núcleo Basal de Meynert , Disfunción Cognitiva , Estimulación Encefálica Profunda/métodos , Globo Pálido , Destreza Motora , Anciano , Cognición , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/cirugía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Although deep brain stimulation (DBS) of the dorsolateral subthalamic nucleus (STN) is a well-established surgical treatment for patients with Parkinson disease (PD), there is still controversy about the relationship between the functional segregation of the STN and clinical outcomes. OBJECTIVE: To correlate motor and neuropsychological (NPS) outcomes with the overlap between the volume of activated tissue (VAT) and the tractography-defined regions within the STN. METHODS: Retrospective study evaluating 13 patients with PD treated with STN-DBS. With the aid of tractography, the STN was segmented into 4 regions: smaSTN (supplementary motor area STN), m1STN (primary motor area STN), mSTN (the sum of the m1STN and the smaSTN segments), and nmSTN (non-motor STN). We computed the overlap coefficients between these STN regions and the patient-specific VAT. The VAT outside of the STN was also calculated. These coefficients were then correlated with motor (Unified Parkinson's Disease Rating Scale, UPDRS III) and NPS outcomes. RESULTS: Stimulation of the mSTN segment was significantly correlated with UPDRS III and bradykinesia improvement. Stimulation of the smaSTN segment, but not the m1STN one, had a positive correlation with bradykinesia improvement. Stimulation of the nmSTN segment was negatively correlated with the improvement in rigidity. Stimulation outside of the STN was correlated with some beneficial NPS effects. CONCLUSION: Stimulation of the tractography-defined motor STN, mainly the smaSTN segment, is positively correlated with motor outcomes, whereas stimulation of the nmSTN is correlated with poor motor outcomes. Further validation of these results might help individualize and optimize targets prior to STN-DBS.
Asunto(s)
Estimulación Encefálica Profunda/métodos , Enfermedad de Parkinson/terapia , Núcleo Subtalámico/fisiopatología , Anciano , Femenino , Marcadores Fiduciales , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Corteza Motora/fisiopatología , Enfermedad de Parkinson/diagnóstico por imagen , Estudios Retrospectivos , Núcleo Subtalámico/diagnóstico por imagen , Resultado del TratamientoRESUMEN
BACKGROUND: Impulsivity and dopamine dysregulation syndrome are frequent complications of treatment in Parkinson's disease (PD). METHODS: We assessed the effect of jejunal levodopa infusion (JLI) on behavioral symptoms in 8 PD patients with motor complications and severe impulsivity and dopamine dysregulation syndrome (DDS), which had not be controlled before by adjusting oral medications. The infusion was delivered during 15 hours (daily dose 1007.2 ± 302.5 mg) and stopped at night time. Patients were reassessed after 25 ± 9 weeks of treatment with a stable dose of jejunal l-dopa. RESULTS: Off periods and dyskinesias decreased by 27% and 20,7% respectively, compared to baseline. DDS and all types of impulse control disorders (ICDs) improved in all patients, with nearly complete symptom resolution. Punding improved in all 5 patients but disappeared completely in only 1. CONCLUSIONS: Our experience suggests that l-dopa infusion has a positive effect on both motor complications and behavioral disorders. This treatment approach deserves further controlled studies.
Asunto(s)
Antiparkinsonianos/administración & dosificación , Dopamina/metabolismo , Conducta Impulsiva/tratamiento farmacológico , Conducta Impulsiva/etiología , Levodopa/administración & dosificación , Enfermedad de Parkinson , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/tratamiento farmacológico , Enfermedad de Parkinson/patología , Resultado del TratamientoRESUMEN
Dysfunctional auditory sensory processing has generally been found in schizophrenia and it has been suggested that these deficits might be related to clinical and psychosocial variables. The present study included P50 recordings using a simple-paired click auditory evoked potential paradigm in sixty patients with deficit schizophrenia (DS), sixty patients with nondeficit schizophrenia (NDS), and sixty comparison subjects. The Schedule for the Deficit Syndrome was used to categorize patients as DS or NDS. The two patient groups did not differ in clinical variables, except for higher negative dimension and lower community outcome scores in DS than in NDS patients. There were no differences in P50 ratios between deficit and nondeficit subgroups; compared with normal subjects both groups of schizophrenia patients showed impaired P50 ratios (p<0.0001). This ratio appears to be independent of positive and negative symptoms. However, impairment in P50 gating correlated with poorer community outcome. The data document the existence of early auditory sensory processing abnormalities in DS and NDS, and might suggest that common neuronal network abnormalities underlie both forms of schizophrenia. Deficient P50 gating may be associated with impaired functional outcome in schizophrenia.
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Potenciales Evocados Auditivos/fisiología , Esquizofrenia/diagnóstico , Esquizofrenia/fisiopatología , Psicología del Esquizofrénico , Filtrado Sensorial/fisiología , Adolescente , Adulto , Antipsicóticos/uso terapéutico , Corteza Cerebral/fisiopatología , Electroencefalografía , Potenciales Evocados Auditivos/efectos de los fármacos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Red Nerviosa/fisiopatología , Pronóstico , Escalas de Valoración Psiquiátrica , Valores de Referencia , Esquizofrenia/tratamiento farmacológico , Filtrado Sensorial/efectos de los fármacos , Procesamiento de Señales Asistido por Computador , Resultado del Tratamiento , Adulto JovenRESUMEN
P50 sensory gating deficit has repeatedly been demonstrated in schizophrenia. Studies have produced inconsistent findings with respect to normalization of P50 gating in patients with schizophrenia receiving treatment with different antipsychotics. The current study was designed to determine whether there is a difference in P50 gating in schizophrenia patients treated with first-generation antipsychotics (FGAs) and second-generation antipsychotics (SGAs), including clozapine. P50 evoked potential recordings were obtained from 160 patients with schizophrenia and 77 healthy comparison subjects. Forty-three patients were being treated with clozapine, sixty-eight were taking SGAs (33 risperidone, 21 olanzapine, 11 aripiprazole, and 3 combinations of SGAs) and 49 were being treated with FGAs. Schizophrenia patients exhibited significantly higher P50 ratios than healthy subjects. When patients treated with different antipsychotics were compared, there were no differences in any of the neurophysiological findings. Second-generation antipsychotics were not related to more normal sensory gating in this population of patients with chronic schizophrenia.
Asunto(s)
Antipsicóticos/farmacología , Potenciales Evocados Auditivos/efectos de los fármacos , Reflejo de Sobresalto/efectos de los fármacos , Filtrado Sensorial/efectos de los fármacos , Estimulación Acústica/métodos , Adulto , Análisis de Varianza , Antipsicóticos/uso terapéutico , Electroencefalografía , Potenciales Evocados Auditivos/fisiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Tiempo de Reacción/efectos de los fármacos , Reflejo de Sobresalto/fisiología , Esquizofrenia/tratamiento farmacológico , Adulto JovenRESUMEN
This study forms part of the Spanish Multicenter Normative Studies (NEURONORMA project). Normative data for people aged over 49 years are presented for selected tasks of the visual object and space perception battery (VOSP) and for the judgment of line orientation (JLO) test. Age-adjusted norms were derived from a sample of 341 participants who are cognitively normal and community-dwelling. Age- and education-adjusted norms are also provided. Years of education were modeled on age-scaled scores to derive regression equations that were applied for further demographic adjustments. The normative information provided here should prove useful for characterizing and interpreting individual test performances as well as comparing the scores from these tests with any other test using NEURONORMA norms.
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Envejecimiento/psicología , Pruebas Neuropsicológicas/estadística & datos numéricos , Valores de Referencia , Percepción Espacial , Percepción Visual , Anciano , Anciano de 80 o más Años , Cognición , Escolaridad , Femenino , Evaluación Geriátrica , Humanos , Masculino , Persona de Mediana Edad , Orientación , EspañaRESUMEN
As part of the Spanish Multicenter Normative Studies (NEURONORMA project), we provide age- and education-adjusted norms for the following instruments: verbal span (digits), visuospatial span (Corsi's test), letter-number sequencing (WAIS-III), trail making test, and symbol digit modalities test. The sample consists of 354 participants who are cognitively normal, community-dwelling, and age ranging from 50 to 90 years. Tables are provided to convert raw scores to age-adjusted scaled scores. These were further converted into education-adjusted scaled scores by applying regression-based adjustments. The current norms should provide clinically useful data for evaluating elderly Spanish people. These data may be of considerable use for comparisons with other normative studies. Limitations of these normative data are mainly related to the techniques of recruitment and stratification employed.