المؤلفون: Meagen Salinas, Umar Yazdani, Austin Oblack, Bradley McDaniels, Nida Ahmed, Bilal Haque, Nader Pouratian, Shilpa Chitnis

المصدر: Therapeutic Advances in Neurological Disorders, Vol 17 (2024)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429

الوصف: Introduction: Deep brain stimulation (DBS) is an established therapy for Parkinson’s disease (PD) that can significantly improve motor symptoms and quality of life. Despite its effectiveness, little is known about patient perceptions of DBS. Objectives: To evaluate patient perceptions of DBS for PD, focusing on understanding, satisfaction, and factors influencing their outlook. This study aims to enhance patient education and counseling by identifying key determinants of patient perceptions. Design: A patient survey. Methods: We surveyed 77 PD patients who had undergone DBS at multiple centers using a comprehensive questionnaire. The questionnaire included questions on demographic information, disease history, and detailed understanding about the indications for DBS, side effects, outlook, and other common misconceptions. We summarize data using measures of central tendency and dispersion appropriate to the data type (categorical, continuous, proportional) and model relationships among variables using fractional and linear regression methods. Results: Participants had a median age of 66 years, were predominantly male (66%), Caucasian (90%), well-educated (79% with at least college degrees), and had a disease duration of greater than 5 years (97%). They conveyed good understanding of the signs and symptoms addressed by DBS across the motor and non-motor domains and associated side effects. Regression analysis identified age, disease duration, and education level as key determinants of patient understanding and outlook of DBS. Conclusion: Our study provides a detailed understanding of patient perceptions of DBS for PD, including the benefits, challenges, and misconceptions. Our findings underscore the importance of identifying the causes of disparities in patient knowledge and perceptions regarding DBS to tailor patient counseling and ensure optimal treatment outcomes.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/1756-2864Test

الوصول الحر: https://doaj.org/article/5e98277ec51f46d0b12ba9105d6d8ef2Test

المؤلفون: Aparna Wagle Shukla, Shilpa Chitnis, Irene A. Malaty, Pam Zeilman

المصدر: Dystonia, Vol 2 (2023)

مصطلحات موضوعية: dystonia, tremor, deep brain stimulation, SCA17, globus pallidus, Neurology. Diseases of the nervous system, RC346-429, Diseases of the musculoskeletal system, RC925-935

الوصف: Background: Spinocerebellar ataxia 17 (SCA17) is a rare autosomal dominant trinucleotide disorder. There are no effective therapies for addressing the clinical symptoms of SCA17.Case report: We describe a 46-year-old male who presented with symptoms of generalized dystonia and focal arm tremors manifesting during adolescence. He underwent bilateral globus pallidus (GPi) DBS surgery that led to notable improvements in dystonia and tremor symptoms, impacting his quality of life. At the time of surgery, he did not show cerebellar ataxia features; however, these began to manifest 2 years after DBS surgery. He subsequently underwent genetic testing that confirmed the SCA17 diagnosis. Currently, at 13 years of follow-up, although the ataxia has continued to worsen, DBS therapy has led to persistent improvements in dystonia, tremor, and many aspects of quality of life.Discussion: The current case indicates that DBS is a promising symptomatic therapy for dystonia and tremor in SCA17.

وصف الملف: electronic resource

العلاقة: https://www.frontierspartnerships.org/articles/10.3389/dyst.2023.11363/fullTest; https://doaj.org/toc/2813-2106Test

الوصول الحر: https://doaj.org/article/ad1a07ece0b54f668510ebc7cbed8c15Test

المؤلفون: D. Campbell Dewey, Shilpa Chitnis, Morgan C. McCreary, Ashley Gerald, Chadrick H. Dewey, Alexander Pantelyat, Ted M. Dawson, Liana S. Rosenthal, Richard B. Dewey

المصدر: Frontiers in Neurology, Vol 13 (2022)

مصطلحات موضوعية: Parkinson's disease, gait, balance, disease progression, clinical trials, Neurology. Diseases of the nervous system, RC346-429

الوصف: Parkinson's disease (PD) results in progressively worsening gait and balance dysfunction that can be measured using computerized devices. We utilized the longitudinal database of the Parkinson's Disease Biomarker Program to determine if baseline gait and balance measures predict future rates of symptom progression. We included 230, 222, 164, and 177 PD subjects with 6, 12, 18, and 24 months of follow-up, respectively, and we defined progression as worsening of the following clinical parameters: MDS-UPDRS total score, Montreal Cognitive Assessment, PDQ-39 mobility subscale, levodopa equivalent daily dose, Schwab and England score, and global composite outcome. We developed ridge regression models to independently estimate how each gait or balance measure, or combination of measures, predicted progression. The accuracy of each ridge regression model was calculated by cross-validation in which 90% of the data were used to estimate the ridge regression model which was then tested on the 10% of data left out. While the models modestly predicted change in outcomes at the 6-month follow-up visit (accuracy in the range of 66–71%) there was no change in the outcome variables during this short follow-up (median change in MDS-UPDRS total score = 0 and change in LEDD = 0). At follow-up periods of 12, 18, and 24 months, the models failed to predict change (accuracy in the held-out sets ranged from 42 to 60%). We conclude that this set of computerized gait and balance measures performed at baseline is unlikely to help predict future disease progression in PD. Research scientists must continue to search for progression predictors to enhance the performance of disease modifying clinical trials.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/articles/10.3389/fneur.2022.1041014/fullTest; https://doaj.org/toc/1664-2295Test

الوصول الحر: https://doaj.org/article/e08f654a3f204c6dbf2ba3fe7299fa75Test

المؤلفون: Meagen R. Salinas, Elizabeth J. Chambers, Travis Ho, Pravin Khemani, DaiWai M. Olson, Sonja Stutzman, Shilpa Chitnis

المصدر: Clinical Parkinsonism & Related Disorders, Vol 3, Iss , Pp 100038- (2020)

مصطلحات موضوعية: Parkinson's disease, Patient education, Questionnaire design, Health education, Neurology. Diseases of the nervous system, RC346-429

الوصف: Background: As the 2nd most common neurodegenerative disorder, Parkinson's disease (PD) affects over 1 million Americans. Treatment is complex and may include pharmacotherapy, rehabilitative measures, and surgical intervention. A comprehensive understanding of the patient's perceptions about PD is a vital step towards improving health literacy and clinical outcomes. Methods: KnowPD is a web-based survey with Likert responses for a cross-sectional, nonrandomized study to assess patients' knowledge of PD symptoms, medications, deep brain stimulation (DBS), rehabilitation, and other factors relevant to disease management. Results: Of the 98 subjects surveyed, 90% agreed they had sufficient knowledge of PD. However, in this cohort, 82% incorrectly believed levodopa stops working as the disease progresses, 77% erroneously thought DBS improves balance and reduces falls, and,

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S2590112520300062Test; https://doaj.org/toc/2590-1125Test

الوصول الحر: https://doaj.org/article/8a2c81c752cd4d3ab47613393f68cc4eTest

المؤلفون: Vibhash D. Sharma, Samarpita Sengupta, Shilpa Chitnis, Amy W. Amara

المصدر: Frontiers in Neurology, Vol 9 (2018)

مصطلحات موضوعية: sleep-wake disturbances, deep brain stimulation, subthalamic nucleus, Parkinson disease, sleep-wake pathophysiology, Neurology. Diseases of the nervous system, RC346-429

الوصف: Sleep-wake disturbances are common non-motor manifestations in Parkinson Disease (PD). Complex pathophysiological changes secondary to neurodegeneration in combination with motor symptoms and dopaminergic medications contribute to development of sleep-wake disturbances. The management of sleep complaints in PD is important as this symptom can affect daily activities and impair quality of life. Deep brain stimulation (DBS) is an effective adjunctive therapy for management of motor symptoms in PD. However, its effect on non-motor symptoms including sleep-wake disturbances is not widely understood. In this article, we reviewed studies assessing the effect of DBS at various therapeutic targets on sleep-wake disturbances. Of the studies examining the role of DBS in sleep-wake disturbances, the effect of subthalamic nucleus stimulation is most widely studied and has shown improvement in sleep quality, sleep efficiency, and sleep duration. Although, studies investigating changes in sleep with stimulation of thalamus, globus pallidus interna, and pedunculopontine nucleus are limited, they support the potential for modulation of sleep-wake centers with DBS at these sites. The mechanism by which DBS at different anatomical targets affects sleep-wake disturbances in PD is unclear and may involves multiple factors, including improved motor symptoms, medication adjustment, and direct modulation of sleep-wake centers.

وصف الملف: electronic resource

العلاقة: https://www.frontiersin.org/article/10.3389/fneur.2018.00697/fullTest; https://doaj.org/toc/1664-2295Test

الوصول الحر: https://doaj.org/article/db02b2ff09f0479c8bf363da5a513ef1Test

المؤلفون: Shazia Mirza, Umar Yazdani, Richard Dewey III, Neepa Patel, Richard B. Dewey, Svjetlana Miocinovic, Shilpa Chitnis

المصدر: Parkinson's Disease, Vol 2017 (2017)

مصطلحات موضوعية: Neurology. Diseases of the nervous system, RC346-429

الوصف: Deep Brain Stimulation (DBS) has revolutionized the lives of patients of Parkinson disease, offering therapeutic options to those not benefiting entirely from medications alone. With its proven track record of outperforming the best medical management, the goal is to unlock the full potential of this therapy. Currently, the Globus Pallidus Interna (GPi) and Subthalamic Nucleus (STN) are both viable targets for DBS, and the choice of site should focus on the constellation of symptoms, both motor and nonmotor, which are key determinants to quality of life. Our article sheds light on the specific advantages and drawbacks of the two sites, highlighting the need for matching the inherent properties of a target with specific desired effects in patients. UT Southwestern Medical Center has a robust and constantly evolving DBS program and the narrative from our center provides invaluable insight into the practical realities of DBS. The ultimate decision in selecting a DBS target is complex, ideally made by a multidisciplinary team, tailored towards each patient’s profile and their expectations, by drawing upon scientific evidence coupled with experience. Ongoing research is expanding our knowledge base, which should be dynamically incorporated into an institute’s DBS paradigm to ensure that patients receive the optimal therapy.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2090-8083Test; https://doaj.org/toc/2042-0080Test

الوصول الحر: https://doaj.org/article/0a35045ad8ae40c38569f5fce11c56ffTest

المؤلفون: Richard B Dewey, Padraig E O'Suilleabhain, Manjit Sanghera, Neepa Patel, Pravin Khemani, Laura H Lacritz, Shilpa Chitnis, Louis A Whitworth

المصدر: PLoS ONE, Vol 11, Iss 10, p e0164154 (2016)

مصطلحات موضوعية: Medicine, Science

الوصف: To develop a process to improve patient outcomes from deep brain stimulation (DBS) surgery for Parkinson disease (PD), essential tremor (ET), and dystonia.We employed standard quality improvement methodology using the Plan-Do-Study-Act process to improve patient selection, surgical DBS lead implantation, postoperative programming, and ongoing assessment of patient outcomes.The result of this quality improvement process was the development of a neuromodulation network. The key aspect of this program is rigorous patient assessment of both motor and non-motor outcomes tracked longitudinally using a REDCap database. We describe how this information is used to identify problems and to initiate Plan-Do-Study-Act cycles to address them. Preliminary outcomes data is presented for the cohort of PD and ET patients who have received surgery since the creation of the neuromodulation network.Careful outcomes tracking is essential to ensure quality in a complex therapeutic endeavor like DBS surgery for movement disorders. The REDCap database system is well suited to store outcomes data for the purpose of ongoing quality assurance monitoring.

وصف الملف: electronic resource

العلاقة: http://europepmc.org/articles/PMC5053513?pdf=renderTest; https://doaj.org/toc/1932-6203Test

الوصول الحر: https://doaj.org/article/4f461b5b340546b6ad4f492065c9c09cTest