Implantation of electrodes in the subthalamic nucleus (STN) for deep brain stimulation is a well-... more Implantation of electrodes in the subthalamic nucleus (STN) for deep brain stimulation is a well-established method to ameliorate motor symptoms in patients suffering from Parkinson’s disease (PD). This study investigated the pathophysiology of rest and postural tremor in PD. In 14 patients with PD, we recorded intraoperatively local field potentials (LFPs) in the STN (at different recording depths) and electromyographic signals (EMGs) of the contralateral forearm. Using coherence analysis we analysed tremor epochs both at rest and hold conditions in patients of the akinetic-rigid or of the tremor-dominant PD subtype. Data analysis revealed significant LFP–EMG coherence during periods of rest and postural tremor. However, strong differences between both tremor types were observed: local maxima (cluster) of rest and postural tremor did not match. Additionally, during rest tremor coherence occurred significantly more frequently at single tremor frequency than at double tremor frequency in tremor-dominant as well as in akinetic-rigid patients. In contrast, during postural tremor in patients with akinetic-rigid PD coherence was predominantly at double tremor frequency. The data suggest a specific topography of ‘tremor clusters’ for rest and postural tremor. Furthermore, we presume that the same tremor mechanisms exist in patients with tremor-dominant and akinetic-rigid PD, but to different degrees.
Stroke like episodes can occur by cortical compression due to changes in intracranial pressure. W... more Stroke like episodes can occur by cortical compression due to changes in intracranial pressure. We report a patient after left hemicraniectomy who presented transient speech arrest after sleeping on the left side. We propose that mechanical compression of the left inferior or superior frontal gyrus led to this episode similar to a major mass effect due to an unprotected brain surface after hemicraniectomy.
The mechanism and time course of emotional side effects of subthalamic deep brain stimulation in ... more The mechanism and time course of emotional side effects of subthalamic deep brain stimulation in Parkinson's disease are a matter for discussion. We report a 53-month follow-up of a patient with affective lability. Postoperative lesion plus bilateral stimulation strongly influenced mood in the first week in terms of laughing behavior, while voltage changes had only minor long-term impact up to 37 months on negative emotion, possibly caused by the right electrode stimulating the subthalamic nucleus and adjacent fiber tracts involving the internal capsule. Thus we conclude that affective lability can occur with different temporal dynamics of microlesion, and early and chronic stimulation.
Hintergrund Ziel der prospektiven Fragebogenstudie war es, Entscheidungsmotive bei Parkinson-Pati... more Hintergrund Ziel der prospektiven Fragebogenstudie war es, Entscheidungsmotive bei Parkinson-Patienten und deren Angehörigen zu ermitteln, die maßgeblich die Einstellung zu der tiefen Hirnstimulation (THS) bestimmen und die es bei der ärztlichen Aufklärung zu berücksichtigen gilt. Material und Methoden Der Fragebogen wurde bundesweit an registrierte Mitglieder der Deutschen Parkinson-Vereinigung versandt. Es wurden patienten- und angehörigenspezifische Daten sowie Angaben zu Informationsquellen, Bedenken und Erwartungen zur THS erfasst. Ergebnisse Insgesamt 582 Patienten und 476 Angehörige beantworteten den Fragebogen, wobei 96% der Patienten und 91% der Angehörigen über die THS informiert waren. Während ein Großteil der Befragten konkrete Erwartungen in Bezug auf die THS hatte, bestanden bei nahezu zwei Dritteln Bedenken; die weitaus häufigsten bezogen sich dabei auf direkte Operationskomplikationen und eine durch die Operation induzierte Symptomverschlechterung. Die Anzahl der realistischen Erwartungen von Patienten und Angehörigen korrelierte hoch signifikant mit einer positiven Bewertung der THS, wohingegen Bedenken und eine unrealistische Erwartung der Angehörigen mit einer ablehnenden Einstellung gegenüber der Operation verbunden war. Schlussfolgerung Die Ergebnisse dieser Studie zeigen, dass Patienten und Angehörige, die in einer Selbsthilfegruppe organisiert sind, zwar einen relativen hohen Informationsgrad hinsichtlich der tiefen Hirnstimulation besitzen, für die Akzeptanz des Verfahrens jedoch eine frühzeitige Aufklärung über die THS vom Arzt sowie das Eingehen auf individuelle Bedenken notwendig ist. Background The aim of this questionnaire-based study was to determine the decision-making motives from Parkinson’s patients and their family members for deep brain stimulation (DBS), which are crucial for the attitude towards this therapy and which should be considered during the clinical interview. Material and methods The questionnaire was sent out nationwide to members of the German Parkinson Association. Patient and family specific data as well as information sources, doubts and expectations with respect to DBS were assessed. Results A total of 582 patients and 476 family members answered the questionnaire, revealing that 96% of the patients and 91% of the family members already possessed information regarding DBS. While a large proportion of interviewees had specific expectations concerning DBS, more than two thirds expressed concerns regarding DBS; the most frequent with respect to intraoperative complications and stimulation-induced worsening of symptoms. The quantity of realistic patients and family expectations significantly correlated with a positive evaluation of DBS and doubts as well as unrealistic expectations of family members correlated with a negative attitude towards the operation. Conclusions The findings suggest that patients and their relatives organized in support groups indeed possess detailed information regarding DBS. However, for the acceptance of the treatment a timely elucidation about DBS as well as responding to the individual concerns by the consulting physician is essential.
Implantation of electrodes in the subthalamic nucleus (STN) for deep brain stimulation is a well-... more Implantation of electrodes in the subthalamic nucleus (STN) for deep brain stimulation is a well-established method to ameliorate motor symptoms in patients suffering from Parkinson’s disease (PD). This study investigated the pathophysiology of rest and postural tremor in PD. In 14 patients with PD, we recorded intraoperatively local field potentials (LFPs) in the STN (at different recording depths) and electromyographic signals (EMGs) of the contralateral forearm. Using coherence analysis we analysed tremor epochs both at rest and hold conditions in patients of the akinetic-rigid or of the tremor-dominant PD subtype. Data analysis revealed significant LFP–EMG coherence during periods of rest and postural tremor. However, strong differences between both tremor types were observed: local maxima (cluster) of rest and postural tremor did not match. Additionally, during rest tremor coherence occurred significantly more frequently at single tremor frequency than at double tremor frequency in tremor-dominant as well as in akinetic-rigid patients. In contrast, during postural tremor in patients with akinetic-rigid PD coherence was predominantly at double tremor frequency. The data suggest a specific topography of ‘tremor clusters’ for rest and postural tremor. Furthermore, we presume that the same tremor mechanisms exist in patients with tremor-dominant and akinetic-rigid PD, but to different degrees.
Stroke like episodes can occur by cortical compression due to changes in intracranial pressure. W... more Stroke like episodes can occur by cortical compression due to changes in intracranial pressure. We report a patient after left hemicraniectomy who presented transient speech arrest after sleeping on the left side. We propose that mechanical compression of the left inferior or superior frontal gyrus led to this episode similar to a major mass effect due to an unprotected brain surface after hemicraniectomy.
The mechanism and time course of emotional side effects of subthalamic deep brain stimulation in ... more The mechanism and time course of emotional side effects of subthalamic deep brain stimulation in Parkinson's disease are a matter for discussion. We report a 53-month follow-up of a patient with affective lability. Postoperative lesion plus bilateral stimulation strongly influenced mood in the first week in terms of laughing behavior, while voltage changes had only minor long-term impact up to 37 months on negative emotion, possibly caused by the right electrode stimulating the subthalamic nucleus and adjacent fiber tracts involving the internal capsule. Thus we conclude that affective lability can occur with different temporal dynamics of microlesion, and early and chronic stimulation.
Hintergrund Ziel der prospektiven Fragebogenstudie war es, Entscheidungsmotive bei Parkinson-Pati... more Hintergrund Ziel der prospektiven Fragebogenstudie war es, Entscheidungsmotive bei Parkinson-Patienten und deren Angehörigen zu ermitteln, die maßgeblich die Einstellung zu der tiefen Hirnstimulation (THS) bestimmen und die es bei der ärztlichen Aufklärung zu berücksichtigen gilt. Material und Methoden Der Fragebogen wurde bundesweit an registrierte Mitglieder der Deutschen Parkinson-Vereinigung versandt. Es wurden patienten- und angehörigenspezifische Daten sowie Angaben zu Informationsquellen, Bedenken und Erwartungen zur THS erfasst. Ergebnisse Insgesamt 582 Patienten und 476 Angehörige beantworteten den Fragebogen, wobei 96% der Patienten und 91% der Angehörigen über die THS informiert waren. Während ein Großteil der Befragten konkrete Erwartungen in Bezug auf die THS hatte, bestanden bei nahezu zwei Dritteln Bedenken; die weitaus häufigsten bezogen sich dabei auf direkte Operationskomplikationen und eine durch die Operation induzierte Symptomverschlechterung. Die Anzahl der realistischen Erwartungen von Patienten und Angehörigen korrelierte hoch signifikant mit einer positiven Bewertung der THS, wohingegen Bedenken und eine unrealistische Erwartung der Angehörigen mit einer ablehnenden Einstellung gegenüber der Operation verbunden war. Schlussfolgerung Die Ergebnisse dieser Studie zeigen, dass Patienten und Angehörige, die in einer Selbsthilfegruppe organisiert sind, zwar einen relativen hohen Informationsgrad hinsichtlich der tiefen Hirnstimulation besitzen, für die Akzeptanz des Verfahrens jedoch eine frühzeitige Aufklärung über die THS vom Arzt sowie das Eingehen auf individuelle Bedenken notwendig ist. Background The aim of this questionnaire-based study was to determine the decision-making motives from Parkinson’s patients and their family members for deep brain stimulation (DBS), which are crucial for the attitude towards this therapy and which should be considered during the clinical interview. Material and methods The questionnaire was sent out nationwide to members of the German Parkinson Association. Patient and family specific data as well as information sources, doubts and expectations with respect to DBS were assessed. Results A total of 582 patients and 476 family members answered the questionnaire, revealing that 96% of the patients and 91% of the family members already possessed information regarding DBS. While a large proportion of interviewees had specific expectations concerning DBS, more than two thirds expressed concerns regarding DBS; the most frequent with respect to intraoperative complications and stimulation-induced worsening of symptoms. The quantity of realistic patients and family expectations significantly correlated with a positive evaluation of DBS and doubts as well as unrealistic expectations of family members correlated with a negative attitude towards the operation. Conclusions The findings suggest that patients and their relatives organized in support groups indeed possess detailed information regarding DBS. However, for the acceptance of the treatment a timely elucidation about DBS as well as responding to the individual concerns by the consulting physician is essential.
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Papers by Lars Wojtecki