Hypothyroidism-induced Reversible Encephalopathy as a Cause of Aggravation of Parkinsonism and Myoclonus in Parkinson’s Disease

Background: Myoclonus and encephalopathy are unusual in patients with Parkinson’s disease (PD). Case report: We describe the case of a 59-year-old male with PD who developed myoclonus and encephalopathy. Underlying hypothyroidism was revealed after admission and treated with levothyroxine. Myoclonus and encephalopathy were completely resolved following thyroid hormone replacement. Discussion: Hypothyroidism can cause reversible myoclonus and encephalopathy along with unusual aggravation of parkinsonism symptoms in patients with PD

Patient selected goals and satisfaction after bilateral subthalamic nucleus deep brain stimulation in Parkinson\u27s disease.

Assessing patient goals is crucial in understanding patient centered outcomes and satisfaction. However, patient goals may change throughout treatment. Our objective is to identify the changes in patient-selected goals of Parkinson\u27s disease (PD) patients undergoing bilateral subthalamic nucleus deep brain stimulation (STN-DBS) and examine the relationship among patient-selected goal achievement, standard DBS outcome measures, and overall patient satisfaction. Seventy-five patients undergoing bilateral STN-DBS listed three patient-selected goals before surgery. After six months, patients were asked to restate the three goals and to rate the degree of goal achievement and the overall satisfaction of surgery. The three most frequently selected goals were dyskinesia , gait disorder , and medication off duration . After six months, 80.0% of patients could not accurately recall their pre-DBS goals. Dyskinesia was the most consistently selected goal, more patients selected tremor and less medication at post-DBS compared to pre-DBS, and less patients selected gait disorder at post-DBS compared to pre-DBS. 74.7% of patients reported overall satisfaction by stating they were very much or much better after surgery . Patient satisfaction significantly correlated with goal achievement (r = 0.640; p \u3c 0.001). Interestingly, change in UPDRS motor scores did not correlate with patient satisfaction (r = 0.100; p = 0.395). Although recalled goals do not accurately represent the pre-surgical goals, the achievement score for recalled goals significantly correlated with patient satisfaction. Patient goals change due to many reasons. Therefore, follow-up patient counseling to discuss goals and outcomes is important in improving patient satisfaction after STN-DBS

Long-Term Clinical Outcome of Internal Globus Pallidus Deep Brain Stimulation for Dystonia.

BACKGROUND:GPi (Internal globus pallidus) DBS (deep brain stimulation) is recognized as a safe, reliable, reversible and adjustable treatment in patients with medically refractory dystonia. OBJECTIVES:This report describes the long-term clinical outcome of 36 patients implanted with GPi DBS at the Neurosurgery Department of Seoul National University Hospital. METHODS:Nine patients with a known genetic cause, 12 patients with acquired dystonia, and 15 patients with isolated dystonia without a known genetic cause were included. When categorized by phenomenology, 29 patients had generalized, 5 patients had segmental, and 2 patients had multifocal dystonia. Patients were assessed preoperatively and at defined follow-up examinations postoperatively, using the Burke-Fahn-Marsden dystonia rating scale (BFMDRS) for movement and functional disability assessment. The mean follow-up duration was 47 months (range, 12-84). RESULTS:The mean movement scores significantly decreased from 44.88 points preoperatively to 26.45 points at 60-month follow up (N = 19, P = 0.006). The mean disability score was also decreased over time, from 11.54 points preoperatively to 8.26 points at 60-month follow up, despite no statistical significance (N = 19, P = 0.073). When analyzed the movement and disability improvement rates at 12-month follow up point, no significant difference was noted according to etiology, disease duration, age at surgery, age of onset, and phenomenology. However, the patients with DYT-1 dystonia and isolated dystonia without a known genetic cause showed marked improvement. CONCLUSIONS:GPi DBS is a safe and efficient therapeutic method for treatment of dystonia patients to improve both movement and disability. However, this study has some limitations caused by the retrospective design with small sample size in a single-center

Bilateral Deep Brain Stimulation of the Subthalamic Nucleus under Sedation with Propofol and Fentanyl

<div><p>Awakening during deep brain stimulation (DBS) surgery may be stressful to patients. The aim of the current study was to evaluate the effect on MER signals and their applicability to subthalmic nucleus (STN) DBS surgery for patients with Parkinson’s disease (PD) under sedation with propofol and fentanyl. Sixteen consecutive patients with PD underwent STN-DBS surgery with propofol and fentanyl. Their MER signals were achieved during the surgery. To identify the microelectrodes positions, the preoperative MRI and postoperative CT were used. Clinical profiles were also collected at the baseline and at 6 months after surgery. All the signals were slightly attenuated and contained only bursting patterns, compared with our previous report. All electrodes were mostly located in the middle one third part of the STN on both sides of the brain in the fused images. Six months later, the patients were improved significantly in the medication-off state and they met with less dyskinesia and less off-duration. Our study revealed that the sedation with propofol and fentanyl was applicable to STN-DBS surgery. There were no significant problems in precise positioning of bilateral electrodes. The surgery also improved significantly clinical outcomes in 6-month follow-up.</p></div

The location of electrodes on brain atlas.

<p>Based on the CT-MRI fusion images of the preoperative brain MRI and postoperative brain CT scan taken one month after surgery. The figure shows location of the electrodes plotted onto the human brain atlas of Schaltenbrand and Wahren.</p

Typical bursting patterns from microelectrode recording.

<p>Typical bursting patterns from microelectrode recording.</p

Characteristics of signals on microelectrode recording.

<p>Characteristics of signals on microelectrode recording.</p

Overall movement and disability scales in the patients with <i>DYT</i>-1 dystonia, PKAN, and tardive dystonia.

<p>Patients with <i>DYT</i>-1 dystonia showed an abrupt decrease in motor and disability scores, and a sustained improved state during the follow-up period. Patients with <i>PKAN</i> had relatively higher motor and disability scores preoperatively. But some patients showed substantial improvement in motor score over time; 2 patients acquired improvement which appeared even after postoperative 12 months without resetting (indicated as asterisks). Tardive dystonia patients experienced no considerable improvement in motor and disability scores, except for 1 patient. (PKAN: pantothenate kinase-associated neurodegeneration)</p

Clinical Outcome of bilateral subthalamic nucleus deep brain stimulation under sedation.

<p>Clinical Outcome of bilateral subthalamic nucleus deep brain stimulation under sedation.</p