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Objectives To investigate the effect of caudal zona incerta-deep brain stimulation (c Zi- DBS) on word-level speech intelligibility in patients with Parkinson's disease, under both an optimal listening condition and a simulated more naturalistic listening condition. Materials and methods Spoken single words were extracted from read samples collected from 10 bilaterally implanted patients with PD pre- and post-c Zi- DBS. Intelligibility was assessed through a transcription task performed by 32 naive listeners under two listening conditions: (i) with low-amplitude conversational speech added as background and (ii) with no added background noise. The listeners′ responses were scored in terms of agreement with the intended words. Results Post-operatively, the total intelligibility score was significantly lower when c Zi stimulation was switched on compared with off, for both listening conditions (with and without added background noise). Intelligibility was also significantly lower on stimulation compared with preoperative recordings, but only when assessed in the listening condition without background noise. The listening condition with added background noise resulted in significantly lower intelligibility scores compared with the no added noise condition for all stimulation conditions. Conclusions The results of this study indicate that c Zi- DBS in patients with PD can be detrimental to word-level speech intelligibility. [ABSTRACT FROM AUTHOR]

Objective In patients with Parkinson's disease ( PD), deep brain stimulation of the subthalamic nucleus ( STN DBS) is well recognized in improving limb function, but the outcome on swallowing function has rarely been studied. The aim of this work was to evaluate the effect of STN DBS on pharyngeal swallowing function in patients with PD using self-estimation and fiberoptic endoscopic evaluation of swallowing. Methods Eleven patients (aged 41-72, median 61 years) were evaluated preoperatively and at 6 and 12 months after STN DBS surgery. All patients were evaluated with self-estimation on a visual analogue scale, and eight of them with a fiberoptic endoscopic examination with a predefined swallowing protocol including Rosenbek's Penetration- Aspiration Scale, Secretion Severity Scale, preswallow spillage, pharyngeal residue, and pharyngeal clearance. Results The self-assessments of swallowing function revealed a subjective improvement with STN DBS stimulation, whereas the data from the swallowing protocol did not show any significant effect of the STN DBS treatment itself. The prevalence of aspiration was not affected by the surgery. Conclusions The results show that swallowing function was not negatively affected by STN DBS and the risk of aspiration did not increase. Self-estimation of swallowing function showed a subjective improvement due to stimulation. [ABSTRACT FROM AUTHOR]

Objectives Restless legs syndrome ( RLS) has a high prevalence in the general population. Treatment with intrathecal morphine has been shown to be successful in a small number of patients. Our aim was to quantify the effect on RLS-related symptoms, health and quality of life in three patients treated with intrathecal morphine. Materials and Methods Three patients with medically refractory RLS received an implanted pump for delivery of intrathecal morphine. Severity of RLS and self-assessed health were rated using the International Restless Legs Syndrome Study Group ( IRLSSG) rating scale and the Short Form health survey ( SF-36). Assessments were made preoperatively and after 6 months of follow-up. Results Preoperatively two patients had very severe RLS, scoring 35 and 36 on the IRLSSG rating scale, and one patient had severe RLS (score, 26). All three patients were free of symptoms of RLS post-operatively and also at the 6-month follow-up. The daily doses of intrathecal morphine ranged from 73 to 199 µg. Results from the SF-36 health survey showed that all three patients had a better physical health compared to before surgery. Conclusion Intrathecal morphine may be efficient in the treatment for medically refractory RLS. All three patients became completely free of symptoms, and there was also improvement in self-perceived overall health. [ABSTRACT FROM AUTHOR]

Objectives Endoscopic transthoracic sympathectomy ( ETS) is a surgical procedure used to improve Quality of Life ( QoL) in patients with treatment resistant palmar hyperhidrosis ( PHH). The aim of this study was to test the hypothesis that low preoperative scores on The Everyday Life Questionnaire ( EDLQ) would predict QoL improvement after surgery. Materials and methods Pre- and post-operative QoL scores from a series of 30 consecutive patients who underwent ETS at our institution were analyzed. Results Preoperative QoL scores was a significant predictor of post-operative improvement across all dimensions covered by the questionnaire. Conclusion Preoperative low QoL can be used as a guide in selecting patients with most improved QoL after ETS. [ABSTRACT FROM AUTHOR]

Objective The purpose of the present study was to examine whether there was a negative effect of caudal Zona Incerta deep brain stimulation (c ZI DBS) on pharyngeal swallowing function in Parkinson's patients (PD). There are no former reports including swallowing and c ZI DBS. Methods Eight patients (aged 49-71 years; median 62) were evaluated pre- and post-operatively, at 6 and 12 months after DBS surgery. Evaluation tools were fiberoptic endoscopic evaluation of swallowing examinations and patients' self-assessments of their swallowing function including a visual analog scale and quality-of-life-related questions. The swallowing protocol included Rosenbek's Penetration- Aspiration Scale, Secretion Severity Scale and parameters for preswallow spillage, pharyngeal residue, and pharyngeal clearance. Results There was no clear-cut effect of neurostimulation post-operatively at 6 and 12 months on any of the swallowing parameters except for the preswallow spillage that was slightly worsened in the stimulation on condition 12 months post-operatively. The answers to the self assessment questions did not vary significantly. Conclusions The effect of the stimulation on the swallowing function varied among individuals, but the overall outcome was that c ZI DBS did not seem to have a negative influence on swallowing function in the eight patients studied. [ABSTRACT FROM AUTHOR]

Blomstedt P, Sjöberg RL, Hansson M, Bodlund O, Hariz MI. Deep brain stimulation in the treatment of depression. To present the technique of deep brain stimulation (DBS) and to evaluate the studies conducted on DBS in the treatment of therapy-refractory major depressive disorder (MDD). A review of the literature on DBS in the treatment of MDD was conducted. The results of DBS in MDD have been presented in 2 case reports and 3 studies of 47 patients operated upon in 5 different target areas. Positive effects have been presented in all studies and side effects have been minor. DBS in the nucleus accumbens resulted in a mean reduction of Hamilton depression rating scale (HDRS) of 36% after 1 year and 30% of the 10 patients achieved remission. DBS in the internal capsule/ventral striatum resulted in a reduction of 44% after 1 year, and at the last evaluation after in mean 2 years, 40% of the 15 patients were in remission. The 20 patients with subcallosal cingulated gyrus DBS had a reduction of HDRS of 52% after 1 year, and 35% were within 1 point from remission or in remission. DBS is a promising treatment for therapy-refractory MDD. The published experience is, however, limited, and the method is at present an experimental therapy. [ABSTRACT FROM AUTHOR]

Objective – To study the sympathetically mediated effects of transthoracic endoscopic sympathicotomy (TES) in the treatment of severe primary palmar hyperhidrosis. Materials and methods – The effects of TES, on sympathetic ganglia at the thoracic level of 2–3, finger blood flow, temperature, and on heat and cold provocation were investigated. Middle cerebral artery (MCA) blood flow velocities were studied by transcranial Doppler. Results – The finger blood flow increased by about 700% after TES and finger temperature by 7.0 ± 0.5°C. Several autonomic reflexes were dramatically affected. A finger pulp-shrinking test showed a major decrease after surgery. MCA mean blood flow velocities were not affected by TES. Conclusions – Besides the high success rate of good clinical effect of TES on palmar hyperhidrosis, major effects on local blood flow and temperature are elicited by TES. Complex autonomic reflexes are also affected. The patient should be completely informed before surgery of the side effects elicited by TES. [ABSTRACT FROM AUTHOR]

Objectives – To report long-term effects of thalamic deep brain stimulation (DBS) on activities of daily living (ADL) and health-related quality of life (HRQoL) in patients with essential tremor (ET). Materials and methods – Nineteen consecutive patients were evaluated at baseline, at a mean of 1 year, then at a mean of 7 years after DBS using Tremor Rating Scale, Mini Mental Test, ADL Taxonomy, Nottingham Health Profile, Life Satisfaction Checklist, Visual Analogue Scale and interview. Results – There was a decrease of DBS efficacy on tremor between 1 and 7 years post-operatively. The marked improvement in ADL at 1 year was no longer sustained at long-term, except for the ability to eat. Social life remained improved. Conclusion – Although there is a decrease of DBS effect on tremor at 7 years, and even though further ageing and co-morbidities may impact on the well-being of patients, there is still relevant benefit of DBS on few aspects of ADL and HRQoL in patients with ET. [ABSTRACT FROM AUTHOR]

Background – Pallidal deep brain stimulation (DBS) of globus pallidus internus (Gpi) has emerged as an effective treatment for dystonia. The experience is however limited concerning focal dystonias and to date only a few cases of pallidal DBS in the treatment of Meige syndrome have been published. Methods/results – We here present a patient with Meige syndrome in whom unilateral pallidal DBS failed to improve the axial symptoms, but bilateral stimulation resulted in a major improvement. The Burke-Fahn-Marsden score (BFM) improved by 71.5% and the patient’s blepharospasm was abolished. Conclusions – The results suggest bilateral pallidal DBS may be an effective treatment for Meige syndrome. [ABSTRACT FROM AUTHOR]

Objective – Swedish snuff is a particular form of non-smoking tobacco with high nicotine content. It is unknown whether this form of tobacco is a risk factor similar to smoking for suffering subarachnoid haemorrhage (SAH). In the present study we report our finding concerning smoking and snuff as risk factors for the disease. Method – We analysed 120 consecutive patients with SAH regarding consumption of tobacco, in order to evaluate if snuff also is associated with an increased risk of SAH. Results – The relative risk of SAH was about 2.5 times higher for smokers compared with the background population. Consumption of snuff was not associated with an increased risk. Conclusions – It seems unlikely that nicotine is solely responsible for the rupture of cerebral aneurysms. The final cause of the increased risk for suffering SAH has to be sought in other factors associated with tobacco smoking. [ABSTRACT FROM AUTHOR]