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Deep Brain Stimulation in Parkinson's disease and essential tremor Outcome and experiences from patients' and spouses' perspectives

Törnqvist, Anna Lena LU (2005)
Abstract
The treatment related effects and personalized goal fulfilment of Deep Brain Stimulation (DBS) have been assessed in studies with different designs. The brain targets included the thalamus for medically intractable tremor in Parkinson's disease (PD) or essential tremor (ET) and the subthalamicus for reducing hypo-, bradykinesia, tremor, rigidity and dystonia in PD.



A Swedish multi-center study showed that the tremor reduction in PD and ET was sustained (p<0.025) for 6 to 7 years. Thalamic and subthalamic DBS also improved the patients? everyday life at a 12-month follow-up. Patients could perform activities they had pre-operatively formulated as goals, with a total or partial overall fulfilment. In spite of a 53% drug... (More)
The treatment related effects and personalized goal fulfilment of Deep Brain Stimulation (DBS) have been assessed in studies with different designs. The brain targets included the thalamus for medically intractable tremor in Parkinson's disease (PD) or essential tremor (ET) and the subthalamicus for reducing hypo-, bradykinesia, tremor, rigidity and dystonia in PD.



A Swedish multi-center study showed that the tremor reduction in PD and ET was sustained (p<0.025) for 6 to 7 years. Thalamic and subthalamic DBS also improved the patients? everyday life at a 12-month follow-up. Patients could perform activities they had pre-operatively formulated as goals, with a total or partial overall fulfilment. In spite of a 53% drug reduction, the patients treated with subthalamic DBS could perform basic transfers in a similar speed as pre-operatively and perceived improved health.



The effect of subthalamic DBS on the intelligibility of speech showed that the DBS settings were of importance for the speech. Higher amplitude and faster rates increased the risk of impaired intelligibility in patients with PD who perceived speech impairments.



Subthalamic DBS had a positive influence on the couples? social life. In contrast to pre-operatively, patients and spouses could perform social activities of their own choice. Non-motor symptoms that were pre-operatively just mentioned caused annoyance in the post-operative period. These remaining symptoms were preferred relative to the pre-operative PD condition.



The results of these studies can be used in pre-operative information for future patients, as well as in the post-operative support of the patients and their spouses. (Less)
Abstract (Swedish)
Popular Abstract in Swedish

Den här avhandlingen har behandlingsresultaten av permanent djupelektrod stimulering i hjärnan (Deep Brain Stimulation, DBS) undersökts ur såväl symptomminsknings som patients och närståendes perspektiv.



DBS behandling innebär att en elektrod med fyra poler opereras in i hjärnan genom ett litet hål i skallbenet, och den kopplas till pulsgivardosa. Hela systemet är dolt under huden. Behandlingen är inte botande, och symptomminskningen åstadkoms av att ett elektriskt fält som programmeras efter operationen.



Sammanfattningsvis visar avhandlingen att DBS i thalamus reducerar skakningar vid Parkinsons sjukdom (PS) och essentiell tremor (ET) i mer än 6 år.... (More)
Popular Abstract in Swedish

Den här avhandlingen har behandlingsresultaten av permanent djupelektrod stimulering i hjärnan (Deep Brain Stimulation, DBS) undersökts ur såväl symptomminsknings som patients och närståendes perspektiv.



DBS behandling innebär att en elektrod med fyra poler opereras in i hjärnan genom ett litet hål i skallbenet, och den kopplas till pulsgivardosa. Hela systemet är dolt under huden. Behandlingen är inte botande, och symptomminskningen åstadkoms av att ett elektriskt fält som programmeras efter operationen.



Sammanfattningsvis visar avhandlingen att DBS i thalamus reducerar skakningar vid Parkinsons sjukdom (PS) och essentiell tremor (ET) i mer än 6 år. Talförståelsen kan påverkas av olika DBS inställningar, och ju högre amplitud eller ju snabbare frekvens som är inställd ju mer försämras talet. Ett år efter operationen kan patienterna utföra de aktiviteter som de själva formulerat som mål för at använda symtom minskningen i sitt vardagliga liv efter både DBS i hjärnans områden thalamus och subthalamus. Målen kunde vara fullt eller delvis uppfyllda. PS patienterna behandlade med DBS i subthalamus kunde också, då de undersöktes med endast DBS behandling, utföra basala förflyttningar i samma hastighet som före operationen med 53% mer medicinering. Även parets sociala liv förbättrades, och de kunde göra de aktiviteter de önskade, men tankspriddhet eller nedsatt initiativförmåga upplevdes som mer irriterande efter operationen än före. Studierna ger en ökad dokumenterad kunskap om effekter så att sjukvården före operationen kan informera om förväntade behandlingseffekter såväl långtids- som i det vardagliga livet. Vidare så bör sjukvården vara mer aktiv med att informera, samt inhämta kunskap om sjukdoms och behandlingsyttringar från patienternas närstående. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Pollak, Pierre, Movement Disorders Unit, dept of Neurology, University Hospital of Grenoble and INSERM U318, Joseph
organization
publishing date
type
Thesis
publication status
published
subject
keywords
goal attainment, speech, social life, spouses, Neurologi, neurophysiology, Neurology, Parkinson's disease, neurofysiologi, neuropsykologi, Deep Brain Stimulation, essential tremor, neuropsychology
pages
78 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Astronomiska institutionens föreläsningssal, sölvegatan 27, Lund
defense date
2006-10-13 09:00:00
ISBN
91-85559-44-X
language
English
LU publication?
yes
additional info
Stig Rehncrona, Bo Johnels, Håkan Widner, Anna Lena Törnqvist, Marwan Hariz and Olof Sydow. 2003. Long-Term Efficacy of Thalamic Deep Brain Stimulation for Tremor: Double-Blind Assessments Movement Disorders, vol 18 pp 163-170.
Anna Lena Törnqvist, Gerd Ahlström, Håkan Widner and Stig Rehncrona. 2006. Fulfilment of patients' goals after thalamic deep brain stimulation: A follow up study vol doi:10.1016/j.parkreldis.2006.06.005 (inpress)
Anna Lena Törnqvist, Maria Nilsson, Gerd Ahlström, Gun-Britt Jarnlo, Håkan Widner and Stig Rehncrona. . The Influence of Subthalamic Deep Brain Stimulation on Basic Transfers, Perception of Health and Goal attainment in patietns with Parkinson's disease (submitted)
Anna Lena Törnqvist, Lucyna Schalén and Stig Rehncrona. 2005. Effects of Different Electrical Parameter Settings on the Intelligibility of Speech in Patients With Parkinson's Disease Treated With Subthalamic Deep Brain Stimulation Movement Disorders, vol 20 pp 416-423.
Anna Lena Törnqvist, Håkan Widner, Stig Rehncrona and Gerd Ahlström. . The impact of subthalamic Deep Brain Stimulation in Parkinson's disease on the social life: the outcome from the couples' perspective (manuscript)
id
327f4249-4311-425f-829e-89df036d10f9 (old id 547241)
date added to LUP
2016-04-01 15:24:56
date last changed
2018-11-21 20:34:19
@phdthesis{327f4249-4311-425f-829e-89df036d10f9,
  abstract     = {{The treatment related effects and personalized goal fulfilment of Deep Brain Stimulation (DBS) have been assessed in studies with different designs. The brain targets included the thalamus for medically intractable tremor in Parkinson's disease (PD) or essential tremor (ET) and the subthalamicus for reducing hypo-, bradykinesia, tremor, rigidity and dystonia in PD.<br/><br>
<br/><br>
A Swedish multi-center study showed that the tremor reduction in PD and ET was sustained (p&lt;0.025) for 6 to 7 years. Thalamic and subthalamic DBS also improved the patients? everyday life at a 12-month follow-up. Patients could perform activities they had pre-operatively formulated as goals, with a total or partial overall fulfilment. In spite of a 53% drug reduction, the patients treated with subthalamic DBS could perform basic transfers in a similar speed as pre-operatively and perceived improved health.<br/><br>
<br/><br>
The effect of subthalamic DBS on the intelligibility of speech showed that the DBS settings were of importance for the speech. Higher amplitude and faster rates increased the risk of impaired intelligibility in patients with PD who perceived speech impairments.<br/><br>
<br/><br>
Subthalamic DBS had a positive influence on the couples? social life. In contrast to pre-operatively, patients and spouses could perform social activities of their own choice. Non-motor symptoms that were pre-operatively just mentioned caused annoyance in the post-operative period. These remaining symptoms were preferred relative to the pre-operative PD condition.<br/><br>
<br/><br>
The results of these studies can be used in pre-operative information for future patients, as well as in the post-operative support of the patients and their spouses.}},
  author       = {{Törnqvist, Anna Lena}},
  isbn         = {{91-85559-44-X}},
  keywords     = {{goal attainment; speech; social life; spouses; Neurologi; neurophysiology; Neurology; Parkinson's disease; neurofysiologi; neuropsykologi; Deep Brain Stimulation; essential tremor; neuropsychology}},
  language     = {{eng}},
  publisher    = {{Department of Clinical Sciences, Lund University}},
  school       = {{Lund University}},
  title        = {{Deep Brain Stimulation in Parkinson's disease and essential tremor Outcome and experiences from patients' and spouses' perspectives}},
  year         = {{2005}},
}