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Introduction: Restrictive anorexia nervosa (AN) is associated with distorted perception of body shape, previously linked to hypoactivity and reduced excitability of the right inferior parietal lobe (rIPL). Here, we investigated the impact of high‐frequency repetitive transcranial magnetic stimulation (HF rTMS) of the rIPL on body shape perception in patients with AN. Methods: Seventeen patients with AN (median [Q1_Q3] age, 35 [27_39] years; disease duration, 12 [6_18] years) were randomly assigned to receive real or sham HF (10 Hz) rTMS of the rIPL over a period of 2 weeks, comprising 10 sessions. The primary outcome measure was the Body Shape Questionnaire (BSQ). Secondary outcomes included eating disorder symptoms, body mass index, mood, anxiety, and safety. Data collection were done at baseline, post‐rTMS, and at 2 weeks and 3 months post‐rTMS. Results: Following both real and sham rTMS of the rIPL, no significant differences were observed in body shape perception or other parameters. Both real and sham rTMS interventions were deemed safe and well tolerated. Notably, serious adverse events were associated with the underlying eating and mood disorders, resulting in hospitalization for undernutrition (five patients) or suicidal attempts (two patients). Conclusion: This pilot study does not support the use of rTMS of the rIPL as an effective method for improving body shape perception in individuals with the restrictive form of AN. Further research is warranted to comprehensively explore both the clinical and neurophysiological effects of HF rTMS in this population. [ABSTRACT FROM AUTHOR]

Background: The study aimed to determine whether improved muscle strength after 12 weeks of neuromuscular electrical stimulation (NMES) of plantar and dorsiflexors could result in better limits of stability in older adults. Methods: Twenty-seven participants were divided into a control group and a neuromuscular home-based training group. The training group performed a 3-month long NMES training of both plantar and dorsiflexors. Ankle flexor strength and limits of stability were measured. A mediation analysis was conducted to determine whether the NMES effect on the limits of stability was mediated by increased strength. Results: The NMES training increased plantar flexor strength (+47%; β = 0.217, P =.02), and this increase predicted the anterior limits of stability improvement (+27%; β = 0.527, P =.02). The effect of the NMES on the limits of stability was fully mediated by the plantar flexor strength increase (indirect effect: β = 0.1146; 95% confidence interval, 0.020–0.240). Conclusion: It seems that NMES improves the limits of stability through its positive effect on muscle strength. NMES may be utilized in fall-prevention programs. [ABSTRACT FROM AUTHOR]

Background and purpose: Repetitive transcranial magnetic stimulation (rTMS) has been proposed to treat functional neurological disorders. Here, the aim was to assess the efficacy of rTMS to treat functional paralysis in a controlled randomized trial. Methods: Patients received two sessions of active or sham 0.25 Hz rTMS (60 stimuli each), with a 1‐day interval, applied over the motor cortex contralateral to the paralysis. The primary outcome was the number of patients with an increase in motor score between baseline and after the second rTMS session, rated by two investigators blinded to the treatment allocation. Secondary outcomes were changes in global and fine motor scores between groups after rTMS, and the occurrence of adverse events. Results: Sixty‐two patients (46 female; mean [SD] age, 35.2 [13.9] years) were enrolled and randomized. Thirteen out of 32 (41%) and 11/30 (37%) patients had increased motor strength after active or sham rTMS, respectively (p = 0.80). Changes in both global and fine motor scores after rTMS relative to baseline were also not significantly different between treatment groups (median difference in the global motor score 0.62 [0.83] and 0.37 [0.61], and in the fine motor scores 0.12 [0.18] and 0.08 [0.11], in active and sham rTMS groups, respectively; p = 0.14). Six serious adverse events, consisting of three cephalalgia in the active group and two cephalalgia and one asthenia in the sham group, were observed. Conclusions: Two sessions of sham or active low frequency rTMS were effective to improve functional paralysis, suggesting a placebo effect of this non‐invasive brain stimulation technique. [ABSTRACT FROM AUTHOR]

Background While transient loss of consciousness is a frequent presenting symptom, differential diagnosis between syncope and epilepsy can be challenging. Misdiagnosis of epilepsy leads to important psychosocial consequences and eliminates the opportunity to treat patient's true condition. Case summary A 39-year-old woman presenting with recurrent seizures since her childhood was referred to neurological consultation. Electroencephalograms (EEGs) and magnetic resonance imaging previously performed were normal. A sleep-deprived video-EEG was performed and highlighted after 12 h of sleep deprivation a progressive dropping of the heart rate followed by a complete heart block without ventricular escape rhythm and asystole for about 30 s. Her EEG recording later showed diffuse slow waves traducing a global cerebral dysfunction and suffering. The diagnosis of vaso-vagal syncope with predominant cardioinhibitory response was made and a dual-chamber pacemaker with rate-drop response algorithm was implanted. After a 2 years of follow-up, the patient remained free of syncope. Discussion Patients presenting with loss of consciousness and convulsion are often diagnosed with epilepsy despite normal EEGs. In patients presenting with recurrent seizures with unclear diagnosis of epilepsy or in a situation of drug-resistant epilepsy, syncope diagnosis should always be considered and a risk stratification is necessary. The benefit of pacemaker implantation in patients with recurrent vaso-vagal syncope is still very controversial. Only patients presenting with spontaneous asystole should be considered for pacemaker implantation in case of recurrent vaso-vagal syncope. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Given the need to detect subclinical changes in brain health that sometimes occur with aging in apparently healthy older adults, we assessed whether bimanual gesture imitation performance, simple to assess clinically, can detect age effects and alterations in cognition, olfaction, and movement. DESIGN: Cross‐sectional study. SETTING: Baltimore Longitudinal Study of Aging. PARTICIPANTS: Men and women, aged 22 to 101 years, without cognitive impairment, dementia, stroke, Parkinson disease, resting tremor, abnormal muscle tone, or abnormal coordination (N = 507). MEASUREMENTS: Bimanual gesture imitation was measured using a test validated in older adults. We assessed (1) cognition, including verbal memory, executive function, attention, visuospatial ability, visuoperceptual speed, and language; (2) manual dexterity with the Purdue Pegboard Test; (3) olfaction, using the 16‐item Sniffin' Sticks Identification Test; (4) upper extremity motor function, using a computer‐based finger tapping test; and (5) lower extremity motor function, including 6‐meter usual and rapid gait speeds, 400‐meter walk time, Health ABC Physical Performance Battery, and total standing balance time. Cross‐sectional associations between bimanual gesture imitation performance and each measure were examined using linear regression after adjustment for age, sex, race, education, and body mass index. Models with mobility measures also adjusted for height. RESULTS: Higher gesture imitation performance was associated with younger age. After adjustment, a worse score was associated with worse olfaction, executive function, and visuospatial ability. Gesture imitation score was not associated with other cognitive measures or motor function. CONCLUSION: In persons without clinically detectable neurological conditions, poor bimanual gesture imitation is associated with other indicators of brain health, including olfaction and selected cognitive function domains. Bimanual gesture imitation may be useful clinically to detect subtle brain changes in apparently healthy older adults. J Am Geriatr Soc 67:2581–2586, 2019 [ABSTRACT FROM AUTHOR]

• Weight gain after STN stimulation in PD is not related to digestive motility changes. • Weight gain after STN stimulation is related to decreased resting energy expenditure. • Weight gain after STN stimulation is related to a more medial electrode location. [ABSTRACT FROM AUTHOR]

Background: Idiopathic Parkinson's disease (IPD) has a long preclinical phase.Research Question: This study assesses data on prediagnostic markers of IPD from a longitudinal, natural history study of aging.Methods: Participants were selected from the database of the Baltimore Longitudinal Study of Aging, and included 10 prediagnosed IPD cases (eight men and two women) and 30 age and sex matched healthy controls. Patients with prediagnosed IPD had already had an assessment for IPD 2.6 ± 1.3 years (range 1.0-5.3 years) before the actual diagnosis, including: gait speed (six-meter corridor walk), spatio-temporal gait parameters using Vicon motion capture, balance, upper-limb motor skills, neuropsychological profile, and non-motor symptoms.Results: Prediagnosed IPD cases compared to controls had slower gait speed (Δ=-0.13 m.s-1, p = 0.03) due to shorter step length (Δ=-5 cm, p = 0.004), worse visuospatial ability (card rotation test, Δ=-42, p = 0.0001) and worse executive function (category fluency test, Δ=-2.6, p = 0.04).Significance: Our findings identify dimensions that merit further study as prediagnostic markers of Idiopathic Parkinson's disease to identify patients who might benefit from future neuroprotective therapy in order to delay, or prevent, clinical manifestations. [ABSTRACT FROM AUTHOR]

Introduction: Despite extensive testing, the efficacy of low-frequency (1 Hz) repetitive transcranial magnetic stimulation (rTMS) of temporo-parietal targets for the treatment of auditory verbal hallucinations (AVH) in patients with schizophrenia is still controversial, but promising results have been reported with both high-frequency and neuronavigated rTMS. Here, we report a double-blind shamcontrolled study to assess the efficacy of high-frequency (20 Hz) rTMS applied over a precise anatomical site in the left temporal region using neuronavigation. Methods: Fifty-nine of 74 randomized patients with schizophrenia or schizoaffective disorders (DSM-IV R) were treated with rTMS or sham treatment and fully evaluated over 4 weeks. The rTMS target was determined by morphological MRI at the crossing between the projection of the ascending branch of the left lateral sulcus and the superior temporal sulcus (STS). Results: The primary outcome was response to treatment, defined as a 30% decrease of the Auditory Hallucinations Rating Scale (AHRS) frequency item, observed at 2 successive evaluations. While there was no difference in primary outcome between the treatment groups, the percentages of patients showing a decrease of more than 30% of AHRS score (secondary outcome) did differ between the active (34.6%) and sham groups (9.1%) (P = .016) at day 14. Discussion: This controlled study reports negative results on the primary outcome but demonstrates a transient effect of 20 Hz rTMS guided by neuronavigation and targeted on an accurate anatomical site for the treatment of AVHs in schizophrenia patients. [ABSTRACT FROM AUTHOR]

Gait control is a complex movement, relying on spinal, subcortical, and cortical structures. The presence of deficits in one or more of these structures will result in changes in gait automaticity and control, as is the case in several neurodegenerative diseases, such as Alzheimer's disease (AD) and Parkinson's disease (PD). By reviewing recent findings in this field of research, current studies have shown that gait performance assessment under dual-task conditions could contribute to predict both of these diseases. Such suggestions are relevant mainly for people at putatively high risk of developing AD (i.e., older adults with mild cognitive impairment subtypes) or PD (i.e., older adults with either Mild Parkinsonian signs or LRRK2 G2019S mutation). Despite the major importance of these results, the type of cognitive task that should be used as a concurrent secondary task has to be selected among the plurality of tasks proposed in the literature. Furthermore, the key aspects of gait control that represent sensitive and specific "gait signatures" for prodromal AD or PD need to be determined. In the present perspective article, we suggest the use of a Stroop interference task requiring inhibitory attentional control and a set-shifting task requiring reactive flexibility as being particularly relevant secondary tasks for challenging gait in prodromal AD and PD, respectively. Investigating how inhibition and cognitive flexibility interfere with gait control is a promising avenue for future research aimed at enhancing early detection of AD and PD, respectively. [ABSTRACT FROM AUTHOR]

Summary Electroencephalographic (EEG) abnormalities have been reported during migraine attacks but their spatial and temporal distributions are not well known. We report the temporospatial dynamics of EEG during the full duration of a migraine attack with aura in a 19-year-old woman. She experienced episodes of hemiplegic migraine since the age of 2.5 years, with right hemibody paralysis preceded by visual symptoms. She reported severe pain of the right hemibody just before hemiplegia that was enventually suggestive of possible epileptic seizure, justifying diagnostic video-EEG monitoring. Sporadic hemiplegic migraine was diagnosed in the absence of family history. EEG was normal at the beginning of visual aura. After 15 minutes, posterior slow waves appeared over the migrainous hemisphere, spreading progressively towards anterior regions: first the central region (5 minutes after onset of contralateral hemiplegia), then the frontal region and over both hemispheres. A new de novo mutation was identified in the SCN1A gene. [ABSTRACT FROM AUTHOR]

Abstract: During walking, the body center of mass oscillates along the vertical plane. Its displacement is highest at mid-swing and lowest at terminal swing during the transition to double support. Its vertical velocity (CoMv) has been observed to increase as the center of mass falls between mid- and late swing but is reduced just before double support. This suggests that braking of the center of mass is achieved with active neural control. We tested whether this active control deteriorates with aging (Experiment 1) and during a concurrent cognitive task (Experiment 2). At short steps of <.4m, CoMv control was low and similar among all age groups. All groups braked the CoMv at longer steps of >.4m but older subjects did so to a lesser extent. During the cognitive task, young subjects increased CoMv control (i.e. increase in CoMv braking) while maintaining step length and walking speed. Older subjects on the other hand, did not increase CoMv control but rather maintain it by reducing both step length and walking speed. These results suggest that active braking of the CoM during the transition to double support predominates in steps >.4m. It could be a manifestation of the balance control system, since the braking occurs at late stance where body weight is being shifted to the contralateral side. The active braking mechanism also appears to require some attentional resource. In aging, reducing step length and speed are strategic to maintaining effective center of mass control during the transition to double support. However, the lesser degree of control in older adults indicates a true age-related deficit. [Copyright &y& Elsevier]

Background: During gait, the braking index represents postural control, and consequently, the risk of falls. Previous studies based their determination of the braking index during the first step on kinetic methods using force platforms, which are highly variable. This study aimed to investigate whether determining the braking index with a kinematic method, through 3D motion capture, provides more precise results. Methods: Fifty participants (20 to 40 years) performed ten trials in natural and fast gait conditions. Their braking index was estimated from their first step simultaneously using a force platform and VICON motion capture system. The reliability of each braking index acquisition method was assessed by intraclass correlation coefficients, standard error measurements, and the minimal detectable change. Results: Both kinetic and kinematic methods allowed good to excellent reliability and similar minimum detectable changes (10%). Conclusion: Estimating the braking index through a kinetic or a kinematic method was highly reliable. [ABSTRACT FROM AUTHOR]

Background: In our stereotactic procedure, intraoperative radiological documentation of electrode localization is performed using the Stereoplan. The aim of the study was to evaluate its accuracy. Patients and Methods: Data of 20 consecutive patients, treated for Parkinson’s disease by implantation of deep brain stimulators into the subthalamic nucleus, were collected prospectively. During surgery, Stereoplan coordinates of the tip of the central macroelectrodes were compared with intended coordinates along the central trajectory at 4 levels: (1) 10 mm above the anatomical target, (2) in the target, (3) in the substantia nigra pars reticulata, and (4) at the depth of contact 1. Before the frame’s removal, Stereoplan coordinates of the contacts of the definitive electrode were compared with postoperative MRI coordinates. The mean of the differences was calculated in the x-, y-, and z-axis. Clinical results at 6 months were recorded.Results: The mean of the differences between Stereoplan coordinates and intended coordinates for the macroelectrodes was lower than 1 mm. A submillimeter difference was also found for the definitive contacts. At 6 months, the Unified Parkinson‘s Disease Rating Scale III score improved by 70.6% compared with the baseline score. Dyskinesia and motor fluctuations decreased by 85.7 and 87%, respectively (p < 0.0001). Conclusion: Stereoplan could be considered an accurate intraoperative radiological system which assures the correct position of the electrode in the anatomical target. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Degenerative processes induce loss of lumbar lordosis and anterior sagittal imbalance (ASI). Optoelectronic study provides kinematic analysis of movement and can also detect ASI. The aim of the present study was to assess gait kinematic modifications induced by ASI. Thirty-five healthy male volunteers were subjected to reversible ASI induced by wearing a kyphotic thermoformed thoracolumbar corset. The deformation was assessed by C7 tilt on EOS (EOS Imaging, Paris, France) full-spine views. Ten optoelectronic gait recordings were made with corset and 10 without. Gait kinematic parameters (stride length, walking speed, rhythm), gait balance parameters (center of mass braking index, stride width, double support time) and spinal sagittal balance parameters (C7T10S1, C7´S1′ and spinal angles) were averaged. Adjusted analysis distinguished direct ASI impact from locomotor factors. The corset-induced ASI produced +15° change in C7 tilt (P < 0.0001), –7.4° in C7T10S1 (P < 0.0001), +66.2 mm in C7´S1′ (P < 0.0001), and +13.1° in spinal angle (P < 0.0001). Radiographic and optoelectronic data correlated significantly. Stride length (P < 0.0001) and rhythm (P = 0.0003) were significantly reduced, contributing to a reduction in walking speed (P < 0.0001), and strongly influencing double support time (β = –0.38; 95% confidence interval [CI]: –0.69; –0.06). Center of mass braking index was significantly reduced (P < 0.0001) and significantly influenced by ASI (β = –0.51; 95% CI: –0.78; –0.28). Stride width was significantly increased by ASI (P < 0.0001), independently of rhythm and stride length. ASI induced by a kyphotic corset was detectable on the optoelectronic system, leading to significant changes in gait kinematics. Locomotor parameters were significantly reduced. Balance parameters were significantly and directly altered by ASI. [ABSTRACT FROM AUTHOR]

Idiopathic Parkinson's disease (PD) has a long preclinical phase during which non-motor symptoms exist but are not specific. The aim of the study is to determine whether subtle gait disorders are prediagnostic markers of PD. Participants were selected from the Baltimore Longitudinal Study of Aging, including 10 prediagnostic PD (8M/2W) and thirty age-matched healthy controls. Prediagnostic PD were assessed for an average of 2.6 ± 1.3 years (range 1.0–5.3 years) before PD diagnosis with: clinical gait and balance assessment (i.e., 6-meter corridor walk at usual and maximal gait speed, semi-tandem stand, tandem stand, and one-leg stand), instrumental gait analysis (VICON ® ), upper-limb motor skills (i.e., Hand Rapid Alternating Movement Test, Finger Tapping Test, and Purdue Pegboard Test), neuropsychological assessment (i.e., processing speed, attention, executive functions, memory, language, and visuo-spatial skills), and non-motor symptoms (orthostatic hypotension, depression, sleep disorders, and urinary symptoms). Prediagnostic IPD showed slower gait speed due to shorter step length compared to controls. They also showed greater gait speed variability, which was correlated with falls. No statistically significant differences were found between the two groups for balance, upper-limb motor skills and non-motor symptoms. Prediagnostic PD showed lower visuospatial ability (Card Rotation Test) than controls. The set of variables that best discriminate between the two groups were age, clinical gait speed, Trail-Making Test Part B, and Card Rotation Test with 100% sensibility and 95.8% specificity. This is the first prospective longitudinal study demonstrating gait changes in prediagnostic idiopathic Parkinson's disease. Previous published studies have recruited high-risk population for PD, as asymptomatic carriers of LRRK2 mutation [1] or patients with rapid eye movement sleep behavior disorder [2,3] . Our findings could potentially be used as prediagnostic markers of IPD to identify those who could benefit from future neuroprotective therapy in order to delay, or even prevent, clinical manifestations. [ABSTRACT FROM AUTHOR]

Introduction Alzheimer's disease (AD) and Parkinson's disease (PD) are neurodegenerative diseases of increasing prevalence worldwide. In the absence of effective therapy, current research is focused on identifying individuals at high risk, who could be targeted in intervention trials. Today, the field of behavioral neuroscience has emerged as one of the most promising areas of research on this topic. Recently, it has been shown that the exacerbation of gait disorders in dual-task conditions, which involve the concurrent performance of a cognitive task while walking, is a characteristic feature of AD and PD. Objectives This review aims: – to summarize evidence supporting or refuting that the dual-task walking paradigm have added value for early detection of older people at risk for progression to AD or PD; – to propose new dual-task paradigms and markers for more accurate and earlier diagnosis of these diseases. Study selection The following inclusion criteria were used in this review: – used self-paced (comfortable) walking as the primary motor task; – reported gait parameters during both single- and dual-task performance, or dual-tasking effects on gait; – employed secondary cognitive tasks during dual-task walking. Results Dual-task-related gait changes precede the traditional clinical symptoms of AD and PD. Inhibition and flexibility are mostly impaired in preclinical AD and PD, respectively. Strategies in dual-task conditions may differentiate between preclinical AD and PD. A number of issues related to the application of dual-task methodology in gait (e.g., effect of type of cognitive task, choice of gait parameters, complementary use of linear and nonlinear measures) are discussed. Conclusion and perspectives We propose novel dual-task paradigms and markers based on the pathophysiological mechanisms that underlie gait disorders in each disease to advance our knowledge in this innovative area of research. [ABSTRACT FROM AUTHOR]

The lower limb muscle functions of the elderly are known to be preferentially altered by ageing. Traditional training effectively counteracts some of these functional declines but is not always accessible due to its cost and to the accessibility of the training centers and to the incapacities of some seniors to practice some exercises. Neuromuscular electrical stimulation (NMES) could provide an interesting alternative muscle training technique because it is inexpensive and transportable. The aim of this systematic review was to summarize the current evidence on the effect of the use of lower limb NMES as a training technique for healthy elderly rehabilitation. Electronic databases were searched for trials occurring between 1971 (first occurrence of NMES training) and November 2016. Ten published articles were retrieved. Training programs either used NMES alone, or NMES associated with voluntary muscle contraction (NMES +). They either targeted calves or thigh muscles and their training length and intensity were heterogeneous but all studies noted positive effects of NMES on the elderly's functional status. Indeed, NMES efficiently improved functional and molecular muscle physiology, and, depending on the studies, could lead to better gait and balance performances especially among less active elderly. Given the association between gait, balance and the risk of falls among the elderly, future research should focus on the efficiency of NMES to reduce the high fall rate among this population. [ABSTRACT FROM AUTHOR]

Background: While ankle muscles, highly affected by aging, are highly implicated in the changes in gait kinematics and involved in the limitation of seniors' mobility, whether neuromuscular electrical stimulation (NMES) training of these muscles could impact gait kinematics in older adults has not been investigated yet.Research Question: What are the effects of 12 weeks of ankle plantar and dorsiflexors NMES training on strength and gait kinematics in healthy older adults?Methods: Fourteen older adults (73.6 ± 4.9 years) performed a three-time per week, three months long NMES training of both ankle plantar and dorsiflexors. Before and after training, neuromuscular parameters, gait kinematic parameters, and daily physical activity were measured.Results: The participants significantly increased their lower limb muscle mass and their plantar and dorsiflexors isometric strength after training. They reduced the hip abduction/adduction and the pelvic anterior tilt range of motion and variability during gait. However, the participants became less active after the training.Significance: NMES training of ankle muscles, by increasing ankle muscle mass and strength,modified gait kinematics. NMES training of ankle muscles is feasible and effective to lower the hip implication and increment foot progression angle during gait. Further study should determine if this could lower the risk of falling. [ABSTRACT FROM AUTHOR]

Objective Spinal diseases often induce gait disorders with multifactorial origins such as lumbar pain, radicular pain, neurologic complications, or spinal deformities. However, radiography does not permit an analysis of spinal dynamics; therefore, sagittal balance dynamics during gait remain largely unexplored. This prospective and controlled pilot study assessed the Vicon system for detecting sagittal spinopelvic imbalance, to determine the correlations between optoelectronic and radiographic parameters. Methods Reversible anterior sagittal imbalance was induced in 24 healthy men using a thoracolumbar corset. Radiographic, optoelectronic, and comparative analyses were conducted. Results Corset wearing induced significant variations in radiographic parameters indicative of imbalance; the mean C7-tilt and d/D ratio increased by 15° ± 7.4° and 359%, respectively, whereas the mean spinosacral angle decreased by 16.8° ± 8° (all P < 0.001). The Vicon system detected the imbalance; the mean spinal angle increased by 15.4° ± 5.6° ( P < 0.01), the mean floor projection of the C7S1 vector (C7′S1′) increased by 126.3 ± 51.9 mm ( P < 0.001), and the mean C7-T10-S1 angle decreased by 9.8° ± 3° ( P < 0.001). Variations in C7′S1′ were significantly correlated with d/D ratio (ρ = 0.58; P < 0.05) and C7-tilt (ρ = 0.636; P < 0.05) variations. Conclusions Corset wearing induced radiographically confirmed anterior sagittal imbalance detected using the Vicon system. Optoelectronic C7′S1′ correlated with radiographic C7-tilt and d/D ratio. [ABSTRACT FROM AUTHOR]

Abstract: Backgrounds: Worsening of verbal fluency is reported after subthalamic nucleus deep brain stimulation in Parkinson''s disease. It is postulated that these changes could reflect microlesion consecutive to the surgical procedure itself. Methods: We evaluated verbal fluency, in 26 patients (mean age, 57.9±8.5years; mean disease duration, 11.4±3.5years) both before surgery (baseline) and, after surgery respectively the third day (T3), the tenth day (T10) just after STN implantation before turning on the stimulation and at six months (T180). Results: Number of total words and switches was significantly reduced at T3 and T10, while average cluster size was unchanged. Repeated post-operative neuropsychological testing demonstrated reliable improvement from T3 to T180 on verbal fluency. Conclusion: This study provides evidence of transient verbal fluency decline consecutive to a microlesion effect. Further studies needed to determine a putative relationship between early and long-term verbal fluency impairment. [Copyright &y& Elsevier]

Abstract: Objective: To analyse postoperative pain due to osteoarthritis in patients with Parkinson''s disease submitted to bilateral subthalamic nucleus stimulation. Methods: Fifty-three parkinsonian patients (mean age, 59.9±8.3 years; mean disease duration, 11.5±4.2 years) referred for subthalamic nucleus stimulation were enrolled. Patients were prospectively asked to refer and describe any pain due to osteoarthritis they experienced at any time during the preoperative period and within the 6 postoperative months. Pre-existing pain due to osteoarthritis, therapeutic changes, parkinsonian motor disability and weight gain were assessed as explanatory factors for occurrence pain due to osteoarthritis after surgery. Results: After surgery, thirty patients (57%) complained of pain due to osteoarthritis whereas all demonstrated great functional improvement. Twenty (67%) among the 30 experienced similar pain sensation before surgery. Symptoms occurred rapidly, between 4 and 26 postoperative weeks. Multiple stepwise regression analysis showed that pre-existing pain due to osteoarthritis, 6-month postoperative UPDRS III motor score and axial sub-score improvements in the off-drug/on-stimulation condition were accurate independent predictors of pain due to osteoarthritis after surgery (F(8,41)=2.20, p <0.047). Conclusion: Our results highlight the high prevalence of pain due to osteoarthritis arising shortly after subthalamic implantation. An accurate pain and osteo-articular assessment should be performed preoperatively in parkinsonian candidates for subthalamic nucleus stimulation in order to limit occurrence of complications in the early postoperative period. [Copyright &y& Elsevier]