99 research outputs found
Troubles du contrôle des impulsions et syndrome des jambes sans repos dans la maladie de Parkinson : étude transversale
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Sensitivity and specificity of two screening questionnaires for REM sleep behaviour disorder and relationship with REM sleep without atonia in patients with Parkinson's disease
No full textAssociation between impulsive-compulsive behaviors and REM sleep behavior disorder in Parkinson's disease: a video-polysomnographic study
No full textAssociation entre troubles du contrôle des impulsions et trouble du comportement en sommeil paradoxal dans la maladie de Parkinson
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Sensitivity and specificity of the "REM sleep behavior disorder-single-question screen" (RBD-1Q) in Parkinson's disease
No full textA novel assistive method for rigidity evaluation during deep brain stimulation surgery using acceleration sensors
No full textInternational audienceOBJECTIVE Despite the widespread use of deep brain stimulation (DBS) for movementdisorders such as Parkinson's disease (PD), the exact anatomical target responsible for thetherapeutic effect is still a subject of research. Intraoperative stimulation tests by experts consistof performing passive movements of the patient's arm or wrist while the amplitude of thestimulation current is increased. At each position, the amplitude that best alleviates rigidity isidentified. Intrarater and interrater variations due to the subjective and semiquantitative nature ofsuch evaluations have been reported. The aim of the present study was to evaluate the use of anacceleration sensor attached to the evaluator's wrist to assess the change in rigidity, hypothesizingthat such a change will alter the speed of the passive movements. Furthermore, the combinedanalysis of such quantitative results with anatomy would generate a more reproducibledescription of the most effective stimulation sites.METHODS To test the reliability of the method, it was applied during postoperative follow-upexaminations of 3 patients. To study the feasibility of intraoperative use, it was used during 9bilateral DBS operations in patients suffering from PD. Changes in rigidity were calculated byextracting relevant outcome measures from the accelerometer data. These values were used toidentify rigidity-suppressing stimulation current amplitudes, which were statistically comparedwith the amplitudes identified by the neurologist. Positions for the chronic DBS lead implantationthat would have been chosen based on the acceleration data were compared with clinical choices.The data were also analyzed with respect to the anatomical location of the stimulating electrode.RESULTS Outcome measures extracted from the accelerometer data were reproducible forthe same evaluator, thus providing a reliable assessment of rigidity changes during intraoperativestimulation tests. Of the 188 stimulation sites analyzed, the number of sites where rigiditysuppressing amplitudes were found increased from 144 to 170 when the accelerometerevaluations were considered. In general, rigidity release could be observed at significantly loweramplitudes with accelerometer evaluation (mean 0.9 ± 0.6 mA) than with subjective evaluation(mean 1.4 ± 0.6 mA) (p < 0.001). Of 14 choices for the implant location of the DBS lead, only 2were the same for acceleration-based and subjective evaluations. The comparison acrossanatomical locations showed that stimulation in the fields of Forel ameliorates rigidity at similaramplitudes as stimulation in the subthalamic nucleus, but with fewer side effects.CONCLUSIONS This article describes and validates a new assistive method for assessingrigidity with acceleration sensors during intraoperative stimulation tests in DBS procedures. Theinitial results indicate that the proposed method may be a clinically useful aid for optimal DBSlead placement as well as a new tool in the ongoing scientific search for the optimal DBS targetfor PD
Imagerie mentale motrice de la locomotion chez le patient parkinsonien présentant des troubles de la marche
No full textContribution of local field potential to subthalamic nucleus deep brain stimulation in Parkinson's disease
No full textInternational audienceIntroduction: The subthalamic nucleus (STN) is the main target for deep brain stimulation (DBS) in Parkinson’s disease. We analyzed the relationships between magnetic resonance imaging (MRI) anatomy and electrophysiology (local field potential, LFP) done during surgery.Objectives: We hypothesized that the contribution of LFP to neuronal firing rate with detailed MRI anatomy should allow to explore finely anatomo-electrophysiological relationships and also to determine precisely functional surgical targets.Methods:Ten patients with Parkinson’s disease (5F; mean age: 62±4 years; 11±3 years disease duration) underwent bilateral STN DBS surgical procedure.Electrophysiology: 693 LFP recordings in MRI-outlined anatomical structures (Thalamus [Thal], Zona Incerta [ZI], Forel Field [Forel] and STN) were analyzed: Power spectral densities (PSD) from 0 to 100Hz; 1024 frequency values; Normalization: percent of total PSD; Calculation for delta (0-4 Hz), theta (4-7 Hz), alpha (7-13 Hz), beta (13-30 Hz), gamma (30-50 Hz, 50-100 Hz) frequency range. Non-parametric Kruskal-Wallis ANOVA tests were performed followed by pairwise comparisons with adjusted p-value.Results: Percentage of power spectral density for main physiological LFP frequency range was considered for thalamus, ZI, STN and Forel (Figure).Conclusions: This study suggests the interest of LFP to discriminate between structures in the subthalamic region using exploration electrode with patient at rest during DBS surgery. Another part of this study will consist in correlating extracellular neuronal activity and LFP, and analyzing modulations on LFP during voluntary movements of patients
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