GLORIA

GEOMAR Library Ocean Research Information Access

Ihre E-Mail wurde erfolgreich gesendet. Bitte prüfen Sie Ihren Maileingang.

Leider ist ein Fehler beim E-Mail-Versand aufgetreten. Bitte versuchen Sie es erneut.

Vorgang fortführen?

Exportieren
  • 1
    Online-Ressource
    Online-Ressource
    S. Karger AG ; 2004
    In:  Stereotactic and Functional Neurosurgery Vol. 82, No. 2-3 ( 2004), p. 104-114
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 82, No. 2-3 ( 2004), p. 104-114
    Kurzfassung: 〈 i 〉 Objective: 〈 /i 〉 Over the last decade neurosurgery has reemerged as a valid therapy for patients with advanced Parkinson’s disease. Previously, we have addressed safety and efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS). In this study, we extended these observations and analyzed factors that affect surgical outcome and its predictive value. 〈 i 〉 Methods: 〈 /i 〉 Thirty-nine patients were enrolled in an open-label prospective protocol designed to evaluate safety and efficacy of bilateral STN DBS in patients with advanced Parkinson’s disease between January 1999 and July 2002. Electrodes were stereotactically implanted with electrophysiological conformation of the target location. All patients were evaluated in the medication ‘off’ and ‘on’ state preoperatively and at 3, 6, and 12 months after surgery in medication ‘on’ and ‘off’ as well as in the stimulation ‘off’ and ‘on’ state. Tests included Unified Parkinson’s Disease Rating Scales (UPDRS) as well as timed tests. All data was analyzed by means of Analysis of Variance. For outcome prediction, correlation and linear regression analyses were utilized. Stimulation produced significant improvements in all ‘off’ mediation conditions, resulting in a 42% improvement in UPDRS III score at 12 months compared to the preoperative status. Stimulation in conjunction with medication did not produce any significant change when compared to the preoperative medication ‘on’ state. Dyskinesia, motor fluctuations, and duration of ‘off’ periods were significantly reduced with stimulation. Significant outcome predictor variables were age, preoperative percent change of UPDRS III score from medication ‘off’ to medication ‘on’ state, and the duration of disease. 〈 i 〉 Conclusions: 〈 /i 〉 Bilateral STN DBS produces robust improvements in parkinsonian motor symptoms. Surgical outcome can reliably be predicted.
    Materialart: Online-Ressource
    ISSN: 1011-6125 , 1423-0372
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2004
    ZDB Id: 1483576-9
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 2
    In: Movement Disorders, Wiley, Vol. 21, No. 6 ( 2006-06-06), p. 746-753
    Kurzfassung: We evaluated the long‐term effects of subthalamic nucleus (STN) stimulation on health‐related quality of life (HRQL) in patients with advanced Parkinson's disease (PD). STN stimulation improves motor function and decreases medication requirements in patients with advanced PD. The impact of STN stimulation on HRQL is less well established, especially beyond 1 year after surgery. We report HRQL outcomes for 18 patients with advanced PD. Patients were evaluated with the Parkinson's Disease Questionnaire‐39 (PDQ‐39), the Medical Outcome Study Short Form (SF‐36), and the EuroQol visual analogue scale (VAS) before surgery, 6 months postoperatively, and at a long‐term follow‐up visit (mean, 35.9 months; range, 18–57 months after surgery). Preoperative scores on HRQL measures were compared to results obtained at short‐ and long‐term follow‐up evaluations. The VAS and all domains of the PDQ‐39 except for cognition, communication, and social support showed marked improvements at 6 months after surgery. At the long‐term follow‐up, there were sustained improvements in the VAS (63% improvement; P = 0.0009) and in several domains of the PDQ‐39 [mobility: 20%, P = 0.01; activities of daily living (ADL): 29%, P = 0.005; emotional well‐being: 26%, P = 0.02; stigma: 43%, P = 0.003; and bodily discomfort: 35%, P = 0.007]. At the long‐term evaluation, only the vitality domain of the SF‐36 was significantly improved from baseline (16%; P = 0.01). In this selected group of patients, many of the short‐term gains in HRQL persist beyond 18 months after STN implantation. Benefits in nonmotor aspects of HRQL such as bodily discomfort and stigma appear to be among the most durable. © 2006 Movement Disorder Society
    Materialart: Online-Ressource
    ISSN: 0885-3185 , 1531-8257
    URL: Issue
    RVK:
    Sprache: Englisch
    Verlag: Wiley
    Publikationsdatum: 2006
    ZDB Id: 2041249-6
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 3
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 82, No. 4 ( 2004), p. 153-155
    Kurzfassung: We describe 2 patients with advanced Parkinson’s disease (PD) treated with bilateral deep brain stimulation of the subthalamic nucleus in whom unilateral stimulator battery depletion resulted in the rapid appearance of disabling PD symptoms (severe rigidity, bradykinesia and gait difficulty). Both patients did not respond to high doses of dopaminergic medications and were restored to their previous level of function only with battery replacement. One patient developed a deep vein thrombosis and pulmonary emboli as a result of prolonged immobility. Although extreme worsening of PD secondary to battery depletion may be rare, such patients should have their stimulators replaced promptly.
    Materialart: Online-Ressource
    ISSN: 1011-6125 , 1423-0372
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2004
    ZDB Id: 1483576-9
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 4
    Online-Ressource
    Online-Ressource
    Elsevier BV ; 1994
    In:  Biological Psychiatry Vol. 35, No. 1 ( 1994-1), p. 3-15
    In: Biological Psychiatry, Elsevier BV, Vol. 35, No. 1 ( 1994-1), p. 3-15
    Materialart: Online-Ressource
    ISSN: 0006-3223
    RVK:
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 1994
    ZDB Id: 1499907-9
    SSG: 12
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 5
    Online-Ressource
    Online-Ressource
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2008
    In:  Journal of Neurosurgery Vol. 109, No. 4 ( 2008-10), p. 625-634
    In: Journal of Neurosurgery, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 109, No. 4 ( 2008-10), p. 625-634
    Kurzfassung: Obesity is a growing global health problem frequently intractable to current treatment options. Recent evidence suggests that deep brain stimulation (DBS) may be effective and safe in the management of various, refractory neuropsychiatric disorders, including obesity. The authors review the literature implicating various neural regions in the pathophysiology of obesity, as well as the evidence supporting these regions as targets for DBS, in order to explore the therapeutic promise of DBS in obesity. The lateral hypothalamus and ventromedial hypothalamus are the appetite and satiety centers in the brain, respectively. Substantial data support targeting these regions with DBS for the purpose of appetite suppression and weight loss. However, reward sensation associated with highly caloric food has been implicated in overconsumption as well as obesity, and may in part explain the failure rates of conservative management and bariatric surgery. Thus, regions of the brain's reward circuitry, such as the nucleus accumbens, are promising alternatives for DBS in obesity control. The authors conclude that deep brain stimulation should be strongly considered as a promising therapeutic option for patients suffering from refractory obesity.
    Materialart: Online-Ressource
    ISSN: 0022-3085 , 1933-0693
    RVK:
    RVK:
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2008
    ZDB Id: 2026156-1
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 6
    Online-Ressource
    Online-Ressource
    Journal of Neurosurgery Publishing Group (JNSPG) ; 2010
    In:  Neurosurgical Focus Vol. 29, No. 2 ( 2010-08), p. E3-
    In: Neurosurgical Focus, Journal of Neurosurgery Publishing Group (JNSPG), Vol. 29, No. 2 ( 2010-08), p. E3-
    Kurzfassung: Deep brain stimulation (DBS) is the treatment of choice for otherwise healthy patients with advanced Parkinson disease who are suffering from disabling dyskinesias and motor fluctuations related to dopaminergic therapy. As DBS is an elective procedure, it is essential to minimize the risk of morbidity. Further, precision in targeting deep brain structures is critical to optimize efficacy in controlling motor features. The authors have already established an operational checklist in an effort to minimize errors made during DBS surgery. Here, they set out to standardize a strict, step-by-step approach to the DBS surgery used at their institution, including preoperative evaluation, the day of surgery, and the postoperative course. They provide careful instruction on Leksell frame assembly and placement as well as the determination of indirect coordinates derived from MR images used to target deep brain structures. Detailed descriptions of the operative procedure are provided, outlining placement of the stereotactic arc as well as determination of the appropriate bur hole location, lead placement using electrophysiology, and placement of the internal pulse generator. The authors also include their approach to preventing postoperative morbidity. They believe that a strategic, step-by-step approach to DBS surgery combined with a standardized checklist will help to minimize operating room mistakes that can compromise targeting and increase the risk of complication.
    Materialart: Online-Ressource
    ISSN: 1092-0684
    Sprache: Unbekannt
    Verlag: Journal of Neurosurgery Publishing Group (JNSPG)
    Publikationsdatum: 2010
    ZDB Id: 2026589-X
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 7
    Online-Ressource
    Online-Ressource
    S. Karger AG ; 2012
    In:  Stereotactic and Functional Neurosurgery Vol. 90, No. 1 ( 2012), p. 51-58
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 90, No. 1 ( 2012), p. 51-58
    Kurzfassung: 〈 i 〉 Background/Aims: 〈 /i 〉 Microelectrode recording (MER) is necessary for precision localization of target structures such as the subthalamic nucleus during deep brain stimulation (DBS) surgery. Attempts to automate this process have produced quantitative 〈 i 〉 temporal trends 〈 /i 〉 (feature activity vs. time) extracted from mobile MER data. Our goal was to evaluate computational methods of generating 〈 i 〉 spatial profiles 〈 /i 〉 (feature activity vs. depth) from temporal trends that would decouple automated MER localization from the clinical procedure and enhance functional localization in DBS surgery. 〈 i 〉 Methods: 〈 /i 〉 We evaluated two methods of interpolation (standard vs. kernel) that generated spatial profiles from temporal trends. We compared interpolated spatial profiles to true spatial profiles that were calculated with depth windows, using correlation coefficient analysis. 〈 i 〉 Results: 〈 /i 〉 Excellent approximation of true spatial profiles is achieved by interpolation. Kernel-interpolated spatial profiles produced superior correlation coefficient values at optimal kernel widths (r = 0.932–0.940) compared to standard interpolation (r = 0.891). The choice of kernel function and kernel width resulted in trade-offs in smoothing and resolution. 〈 i 〉 Conclusions: 〈 /i 〉 Interpolation of feature activity to create spatial profiles from temporal trends is accurate and can standardize and facilitate MER functional localization of subcortical structures. The methods are computationally efficient, enhancing localization without imposing additional constraints on the MER clinical procedure during DBS surgery.
    Materialart: Online-Ressource
    ISSN: 1011-6125 , 1423-0372
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2012
    ZDB Id: 1483576-9
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 8
    Online-Ressource
    Online-Ressource
    S. Karger AG ; 2005
    In:  Stereotactic and Functional Neurosurgery Vol. 83, No. 1 ( 2005), p. 1-5
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 83, No. 1 ( 2005), p. 1-5
    Kurzfassung: Stereotactic deep brain stimulation (DBS) is the surgical treatment of choice for medication-refractory patients with Parkinson’s disease and essential tremor. The subthalamic nucleus and ventral intermediate nucleus of the thalamus appear to be effective targets for electrode placement. Because these targets are small and encased in fiber tracts, their localization can be exceedingly difficult. However, the precision of electrode placement is crucial for obtaining successful results. Currently, surgeons rely on preoperative MRI or CT images to derive stereotactic coordinates for targeting sites such as the subthalamic nucleus and ventral intermediate nucleus of the thalamus coupled with microelectrode recordings during surgery for proper electrode placement. However, it has been argued that the stereotactic head frame produces detrimental artifacts during MRI. We examined MRI images taken from 11 patients undergoing repeat DBS surgery, and determined the coordinates of the previously placed electrode. We then set the Leksell G stereotactic frame to these coordinates and obtained fluoroscope-localizing images. Using MATLAB image analysis tools, we were able to quantify the 3-dimensional error in target localization by measuring the distance from the electrode tip to the targeted coordinate. The mean errors were 0.09 ± 0.34 mm perpendicular, lateral to medial, 0.01 ± 0.32 perpendicular, posterior to anterior, and –0.08 ± 0.33 mm parallel to the electrode, superior to inferior. According to statistical analysis, the error was random and did not seem to move in any predictable fashion. Therefore, we conclude that preoperative MRI images can be safely used in DBS surgery, and they do not negatively affect its accuracy.
    Materialart: Online-Ressource
    ISSN: 1011-6125 , 1423-0372
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2005
    ZDB Id: 1483576-9
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 9
    In: Stereotactic and Functional Neurosurgery, S. Karger AG, Vol. 84, No. 5-6 ( 2006), p. 221-227
    Kurzfassung: 〈 i 〉 Background: 〈 /i 〉 In patients with advanced Parkinson’s disease (PD), deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been shown to improve motor function and decrease medication requirements in the short term. However, the long-term benefits of DBS are not yet established. 〈 i 〉 Objective: 〈 /i 〉 It was the aim of this study to evaluate long-term outcomes of patients with PD treated with bilateral DBS of the STN. 〈 i 〉 Design and Methods: 〈 /i 〉 Thirty-three subjects who had bilateral STN DBS were followed prospectively after surgery. We evaluated subjects, using the Unified Parkinson’s Disease Rating Scale (UPDRS), preoperatively, 12 months after surgery and at a long-term follow-up visit. Ratings were performed on and off dopaminergic medications. We compared postoperative UPDRS scores, dyskinesia ratings and medication dosages with preoperative values. 〈 i 〉 Results: 〈 /i 〉 Twenty-seven subjects had evaluations beyond 18 months (median 33.7 months). Total UPDRS scores in the ‘medication-off’ state were improved by 37% (p 〈 0.001) at 12 months and 17.7% (p = 0.0051) at the long-term evaluation. Medication-off state UPDRS part III scores were significantly improved at both 1 year and at the last evaluation (37.6 and 29.3%; p 〈 0.001). Dopaminergic medication requirements were decreased by 35.3% (p 〈 0.001) during the first postoperative year and remained below preoperative levels at the long-term evaluation. Average duration of ‘off’ time remained decreased by about 40% at both 1 year and at the time of last evaluation. Subjects had a sustained reduction in dyskinesia severity (88.6% at 1 year and 68.8% at last evaluation). 〈 i 〉 Conclusions: 〈 /i 〉 In this cohort of subjects with advanced PD, bilateral STN stimulation improved ‘off’ medication motor function, reduced time spent in the medication-off state and reduced medication requirements for up to 4 years after surgery. We conclude that STN DBS is an effective long-term therapy for selected patients with advanced PD.
    Materialart: Online-Ressource
    ISSN: 1011-6125 , 1423-0372
    Sprache: Englisch
    Verlag: S. Karger AG
    Publikationsdatum: 2006
    ZDB Id: 1483576-9
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
  • 10
    In: Parkinsonism & Related Disorders, Elsevier BV, Vol. 11, No. 6 ( 2005-9), p. 403-406
    Materialart: Online-Ressource
    ISSN: 1353-8020
    Sprache: Englisch
    Verlag: Elsevier BV
    Publikationsdatum: 2005
    ZDB Id: 2027635-7
    Standort Signatur Einschränkungen Verfügbarkeit
    BibTip Andere fanden auch interessant ...
Schließen ⊗
Diese Webseite nutzt Cookies und das Analyse-Tool Matomo. Weitere Informationen finden Sie hier...