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Oslin SJ, Shi HH, Conner AK. Preventing Sudden Cessation of Implantable Pulse Generators in Deep Brain Stimulation: A Systematic Review and Protocol Proposal. Stereotact Funct Neurosurg 2024; 102:127-134. [PMID: 38432221 DOI: 10.1159/000535880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/14/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) requires a consistent electrical supply from the implantable pulse generator (IPG). Patients may struggle to monitor their IPG, risking severe complications in battery failure. This review assesses current literature on DBS IPG battery life management and proposes a protocol for healthcare providers. METHODS A literature search using four databases identified best practices for DBS IPG management. Studies were appraised for IPG management guidelines, categorized as qualitative, quantitative, or both. RESULTS Of 408 citations, only seven studies were eligible, none providing clear patient management strategies. Current guidelines lack specificity, relying on clinician suggestions. CONCLUSION Limited guidelines exist for IPG management. Specificity and adaptability to emerging technology are crucial. The findings highlight the need for specificity in patients' needs and adaptability to emerging technology in future studies. To address this need, we developed a protocol for DBS IPG management that we have implemented at our own institution. Further research is needed for effective DBS IPG battery life management, preventing therapy cessation complications.
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Affiliation(s)
- Spencer J Oslin
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA,
| | - Helen H Shi
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA
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2
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Talati P, Luccarelli J. Changes in deep brain stimulation surgeries between 2019 and 2020: A national inpatient sample analysis. World Neurosurg X 2023; 20:100234. [PMID: 37456689 PMCID: PMC10338353 DOI: 10.1016/j.wnsx.2023.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Background Deep brain stimulation (DBS) surgery is a neurosurgical procedure that implants electrodes into the brain to treat a variety of neurological and psychiatric conditions. The COVID-19 pandemic resulted in significant disruptions in elective surgeries, but the impact on DBS surgeries remains largely unknown. Methods The National Inpatient Sample (NIS), an all-payors database of inpatient hospitalizations in the US, was queried for DBS implantation procedural codes in 2019 and 2020. Results There were a total of 7,625 hospitalizations (95% CI: 6,664 to 8,586) for the implantation of a DBS lead in the 2019 NIS, which reduced by 11.9% to 6,715 hospitalizations (95% CI: 5,872 to 7,558) in the 2020 NIS. Procedural numbers declined in March 2020, with a peak 92.7% decline in volume in April of 2020 relative to 2019. Case numbers for July through December 2020 were 96.1% of the 2019 volume. Overall patient demographics and primary discharge diagnoses for hospitalizations involving DBS implantation were similar in the two study years. Conclusions Surgical volume for DBS implantation reduced by 92.7% in April of 2020 relative to 2019, which is among the highest declines reported for any surgical procedure. While procedural volume increased in the second half of 2020, this did not make up for the reduction in procedures earlier in the year, highlighting the disruption in DBS surgeries in 2020.
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Affiliation(s)
- Pratik Talati
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - James Luccarelli
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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3
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Teimouri M, Motififard M, Lalehzar SS, Hatami S, Raeisi S. Total hip arthroplasty revision etiologies: a cross-sectional study in Isfahan, Iran. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:70. [PMID: 36353340 PMCID: PMC9639710 DOI: 10.4103/jrms.jrms_959_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Complications after primary total hip arthroplasty (THA) are the most common reason for revision. Due to the high prevalence of revision surgery, we investigated the frequency of postprimary THA complications and related risk factor revision surgery. MATERIALS AND METHODS This is a cohort study that was performed in 2011-2019 on all patients who underwent primary THA surgery re-admitted to the Kashani and Saadi Hospital affiliated to Isfahan University of Medical Science, Iran, due to some complications after THA. Demographic and basic data were collected from patient's medical documents. Harris hip score (HHS) was calculated for all patients 6 months after the last surgery. The obtained data were analyzed using SPSS software version 21. Appropriate statistical tests were conducted to compare the results between the study groups. RESULTS Among 1260 patients who underwent primary THA, 1006 of them entered the study after applying the exclusion criteria. Thirty nine patients were under revision, 53.8% had prosthesis infection, 56.4% had instability, 6% had aseptic loosening, and 30.8% had periprosthetic fracture. Odds ratio for the above complications were 45.5, 45, 6.4, and 15.5, respectively. HHS postoperatively was also significantly (P < 0.001) higher in patients without revision. No correlation between gender or surgeon experience and revision was detected; however wound discharge (P < 0.001), body mass index (BMI) (P = 0.003), and Infection during hospitalization (P < 0.001) affect revision rate significantly. All four postsurgery complications, i.e., instability, postoperative prothesis infections, periprosthetic fractures, and aseptic loosening, significantly increased the risk of revision (P < 0.001, for all). CONCLUSION Instability, prosthetic infections, periprosthetic fractures, and aseptic loosening were the most common causes for increasing revision rates after THA, respectively. Higher BMI, persistent wound discharge, and nosocomial infections during the first hospitalization also increased the rate of revision after primary THA.
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Affiliation(s)
- Mehdi Teimouri
- Department of Orthopedic Surgery, School of Medicine, Isfahan, Iran
| | - Mehdi Motififard
- Department of Orthopedic Surgery, School of Medicine, Isfahan, Iran
| | - Sahar Sadat Lalehzar
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Hatami
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Raeisi
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Mameli F, Zirone E, Capetti B, Mellace D, Ferrucci R, Franco G, Di Fonzo A, Barbieri S, Ruggiero F. Changes in non-motor symptoms in patients with Parkinson's disease following COVID-19 pandemic restrictions: A systematic review. Front Psychol 2022; 13:939520. [PMID: 35936298 PMCID: PMC9355666 DOI: 10.3389/fpsyg.2022.939520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/27/2022] [Indexed: 11/22/2022] Open
Abstract
This review discussed the effects of the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on the psychological wellbeing of people with Parkinson's disease (PD) focusing specifically on depressive symptoms, anxiety levels, sleep, and quality of life (QoL). Together with motor symptoms, psychological symptoms are common and disabling conditions in the clinical course of PD becoming a relevant topic as a result of the lockdown measure due to alter their everyday life. We searched on PubMed online electronic databases for English articles published between January 2020 and 31 December 2021. Twenty-eight relevant studies were found and included in the review. Heterogeneous data emerged from the topics analyzed. Overall, data from depression studies showed significant depressive symptoms if the patient was analyzed longitudinally or vs. a control group consisting in healthy subjects, while these differences become minimal when the control group is a family member. Differently, in most of the studies reviewed there is no evidence of a statistically significant impact on anxiety disorders, nor on the quality of sleep. Conversely, PD patients showed a statistically significant negative impact of QoL compared with control groups or other neurological conditions. Although these findings must be interpreted carefully in the light of the studies' limitations, both in methodology and design, collectively our review showed that COVID-19 pandemic has had negative effects on the mental health of people with PD, due to disruption of healthcare services, loss of usual activities and supports and reduction in physical activity.
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Affiliation(s)
- Francesca Mameli
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- *Correspondence: Francesca Mameli
| | - Eleonora Zirone
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Benedetta Capetti
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Denise Mellace
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberta Ferrucci
- “Aldo Ravelli” Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan, Milan, Italy
| | - Giulia Franco
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessio Di Fonzo
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sergio Barbieri
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabiana Ruggiero
- Department of Neuroscience and Mental Health, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Helvaci Yilmaz N, Bolluk Kilic B, Zirh TA, Aslan AS, Hanoglu L. Parkinson’s Disease and the COVID-19 Pandemic: Do Quarantine Affect the Motor and Non-Motor Symptoms of Patients with and without Deep Brain Stimulation? HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2022.8225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Frey J, Cagle J, Johnson KA, Wong JK, Hilliard JD, Butson CR, Okun MS, de Hemptinne C. Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches. Front Neurol 2022; 13:825178. [PMID: 35356461 PMCID: PMC8959612 DOI: 10.3389/fneur.2022.825178] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and “connectomics” will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kara A. Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Justin D. Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher R. Butson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- *Correspondence: Coralie de Hemptinne
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Demleitner AF, Wolff AW, Erber J, Gebhardt F, Westenberg E, Winkler AS, Kolbe-Busch S, Chaberny IF, Lingor P. Best practice approaches to outpatient management of people living with Parkinson's disease during the COVID-19 pandemic. J Neural Transm (Vienna) 2022; 129:1377-1385. [PMID: 35244753 PMCID: PMC8895054 DOI: 10.1007/s00702-022-02484-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
Abstract
The prevalence of Parkinson’s disease (PD) is rising, rendering it one of the most common neurodegenerative diseases. Treatment and monitoring of patients require regular specialized in- and outpatient care. Patients with PD are more likely to have a complicated disease course if they become infected with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Regular in-hospital appointments place these patients at risk of exposure to SARS-CoV-2 due to travel and contact with other patients and staff. However, guidelines for the management of outpatients with PD during times of increased risk of infection are currently lacking. These are urgently needed to conduct risk–benefit evaluations to recommend the best medical treatment. This article discusses best practice approaches based on the current literature, as suggested by the multidisciplinary Network of University Medicine (NUM) in Germany. These include measures such as mask-wearing, hand hygiene, social distancing measures, and appropriate testing strategies in outpatient settings, which can minimize the risk of exposure. Furthermore, the urgency of appointments should be considered. Visits of low urgency may be conducted by general practitioners or via telemedicine consultations, whereas in-person presentation is required in case of moderate and high urgency visits. Classification of urgency should be carried out by skilled medical staff, and telemedicine (telephone or video consultations) may be a useful tool in this situation. The currently approved vaccines against SARS-CoV-2 are safe and effective for patients with PD and play a key role in minimizing infection risk for patients with PD.
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Affiliation(s)
- Antonia F Demleitner
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas W Wolff
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johanna Erber
- Department of Internal Medicine II, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Friedemann Gebhardt
- Department of Hospital Hygiene, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Erica Westenberg
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Global Health, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrea S Winkler
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Global Health, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, School of Medicine, University of Oslo, Oslo, Norway
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Paul Lingor
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany.
- DZNE, German Center for Neurodegenerative Diseases, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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8
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Treatment paradigms in Parkinson's Disease and Covid-19. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 165:135-171. [PMID: 36208898 PMCID: PMC9148185 DOI: 10.1016/bs.irn.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
People with Parkinson's Disease (PwP) may be at higher risk for complications from the Coronavirus Disease 2019 (Covid-19) due to older age and to the multi-faceted nature of Parkinson's Disease (PD) per se, presenting with a variety of motor and non-motor symptoms. Those on advanced therapies may be particularly vulnerable. Taking the above into consideration, along with the potential multi-systemic impact of Covid-19 on affected patients and the complications of hospitalization, we are providing an evidence-based guidance to ensure a high standard of care for PwP affected by Covid-19 with varying severity of the condition. Adherence to the dopaminergic medication of PwP, without abrupt modifications in dosage and frequency, is of utmost importance, while potential interactions with newly introduced drugs should always be considered. Treating physicians should be cautious to acknowledge and timely address any potential complications, while consultation by a neurologist, preferably with special knowledge on movement disorders, is advised for patients admitted in non-neurological wards. Non-pharmacological approaches, including the patient's mobilization, falls prevention, good sleep hygiene, emotional support, and adequate nutritional and fluid intake, are essential and the role of telemedicine services should be strengthened and encouraged.
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Siddiqui MS, Jimenez-Shahed J, Mari Z, Walter BL, De Jesus S, Panov F, Schwalb JM, York MK, Sarva H, Bertoni JM, Patel N, Zhang L, McInerney J, Rosenow JM. North American survey on impact of the COVID-19 pandemic shutdown on DBS care. Parkinsonism Relat Disord 2021; 92:41-45. [PMID: 34688029 PMCID: PMC8522505 DOI: 10.1016/j.parkreldis.2021.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 09/14/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
Background The initial COVID-19 pandemic shutdown led to the canceling of elective surgeries throughout most of the USA and Canada. Objective This survey was carried out on behalf of the Parkinson Study Group (PSG) to understand the impact of the shutdown on deep brain stimulation (DBS) practices in North America. Methods A survey was distributed through RedCap® to the members of the PSG Functional Neurosurgical Working Group. Only one member from each site was asked to respond to the survey. Responses were collected from May 15 to June 6, 2020. Results Twenty-three sites participated; 19 (83%) sites were from the USA and 4 (17%) from Canada. Twenty-one sites were academic medical centers. COVID-19 associated DBS restrictions were in place from 4 to 16 weeks. One-third of sites halted preoperative evaluations, while two-thirds of the sites offered limited preoperative evaluations. Institutional policy was the main contributor for the reported practice changes, with 87% of the sites additionally reporting patient-driven surgical delays secondary to pandemic concerns. Pre-post DBS associated management changes affected preoperative assessments 96%; electrode placement 87%; new implantable pulse generator (IPG) placement 83%; IPG replacement 65%; immediate postoperative DBS programming 74%; and routine DBS programming 91%. Conclusion The COVID-19 pandemic related shutdown resulted in DBS practice changes in almost all North American sites who responded to this large survey. Information learned could inform development of future contingency plans to reduce patient delays in care under similar circumstances.
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Affiliation(s)
- Mustafa S Siddiqui
- Department of Neurology, Wake Forest School of Medicine, 1 Medical Center, Boulevard, Winston-Salem, NC, 27157, USA.
| | - Joohi Jimenez-Shahed
- Icahn School of Medicine at Mount Sinai, 1000 10th Ave., Suite 10c, New York, NY, 10019, USA.
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, 888 W Bonneville Ave, Las Vegas, NV, 89117, USA.
| | | | - Sol De Jesus
- Pennsylvania State University - Milton S. Hershey Medical Center, 30 Hope Drive, Suite 2800 P.O. Box 859, Mail Code EC037, Hershey, PA, 17033, USA.
| | - Fedor Panov
- Mount Sinai Medical Center, 1000 10th Ave, Suite 10C, Brooklyn, NY, 11217, USA.
| | - Jason M Schwalb
- Henry Ford Medical Group, 6777 West Maple Road, West Bloomfield, MI, 48322, USA.
| | - Michele K York
- Baylor College of Medicine, 7200 Cambridge St, 9th Floor, Houston, TX, 77030, USA.
| | - Harini Sarva
- Weill Cornell Medicine, 428 E 72nd Street, STE 400, NY, NY, 10021, USA.
| | - John M Bertoni
- University of Nebraska Medical Center, 988440 Nebraska Medical Center, Omaha, NE, 68198, USA.
| | - Neepa Patel
- Rush University Medical Center, 1725 West Harrison St. Suite 755, Chicago, IL, 60612, USA.
| | - Lin Zhang
- UCDavis, 4860 Y Street, ACC Building, Suite 3700, Sacramento, CA, 95817, USA.
| | - James McInerney
- Penn State Health, Milton S. Hershey Medical Center, Department of Neurosurgery, 30 Hope Drive, EC110, Hershey, PA, 17033, USA.
| | - Joshua M Rosenow
- Northwestern University Feinberg School of Medicine Department of Neurosurgery, 676 N St. Clair St, Suite 2210, Chicago, IL, USA.
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Luck T, Kusyk DM, Whiting D. Headache as a Presenting Symptom of Deep Brain Stimulator Generator Failure. Cureus 2021; 13:e16726. [PMID: 34471578 PMCID: PMC8402882 DOI: 10.7759/cureus.16726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 12/04/2022] Open
Abstract
While a headache can have a wide variety of clinical presentations, it may occasionally be a red flag for underlying pathology that should prompt further investigation. Here, we present a case report demonstrating headache as an uncommon symptom of deep brain stimulation (DBS) device failure and discuss its clinical significance in the rapidly expanding list of current indications of DBS treatment. A 61-year-old female underwent bilateral hypothalamic DBS implantation for refractory morbid obesity. After a successful course involving significant weight loss, the patient began to experience worsening of her chronic headaches, refractory to her existing regiment. On interrogation, her generator was found to be depleted and its subsequent replacement led to a near total resolution of her headaches. This represents one of the few reported instances of headache as a sign of device failure in DBS treatment, thus adding to the wide possibility of headache presentations and their underlying pathology.
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Affiliation(s)
- Trevor Luck
- Department of Neurological Surgery, Drexel University College of Medicine, Philadelphia, USA
| | - Dorian M Kusyk
- Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, USA
| | - Donald Whiting
- Department of Neurological Surgery, Allegheny Health Network, Pittsburgh, USA
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11
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Duffley G, Lutz BJ, Szabo A, Wright A, Hess CW, Ramirez-Zamora A, Zeilman P, Chiu S, Foote KD, Okun MS, Butson CR. Home Health Management of Parkinson Disease Deep Brain Stimulation: A Randomized Clinical Trial. JAMA Neurol 2021; 78:972-981. [PMID: 34180949 DOI: 10.1001/jamaneurol.2021.1910] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance The travel required to receive deep brain stimulation (DBS) programming causes substantial burden on patients and limits who can access DBS therapy. Objective To evaluate the efficacy of home health DBS postoperative management in an effort to reduce travel burden and improve access. Design, Settings, and Participants This open-label randomized clinical trial was conducted at University of Florida Health from November 2017 to April 2020. Eligible participants had a diagnosis of Parkinson disease (PD) and were scheduled to receive DBS independently of the study. Consenting participants were randomized 1:1 to receive either standard of care or home health postoperative DBS management for 6 months after surgery. Primary caregivers, usually spouses, were also enrolled to assess caregiver strain. Interventions The home health postoperative management was conducted by a home health nurse who chose DBS settings with the aid of the iPad-based Mobile Application for PD DBS system. Prior to the study, the home health nurse had no experience providing DBS care. Main Outcomes and Measures The primary outcome was the number of times each patient traveled to the movement disorders clinic during the study period. Secondary outcomes included changes from baseline on the Unified Parkinson's Disease Rating Scale part III. Results Approximately 75 patients per year were scheduled for DBS. Of the patients who met inclusion criteria over the entire study duration, 45 either declined or were excluded for various reasons. Of the 44 patients enrolled, 19 of 21 randomized patients receiving the standard of care (mean [SD] age, 64.1 [10.0] years; 11 men) and 23 of 23 randomized patients receiving home health who underwent a minimum of 1 postoperative management visit (mean [SD] age, 65.0 [10.9] years; 13 men) were included in analysis. The primary outcome revealed that patients randomized to home health had significantly fewer clinic visits than the patients in the standard of care arm (mean [SD], 0.4 [0.8] visits vs 4.8 [0.4] visits; P < .001). We found no significant differences between the groups in the secondary outcomes measuring the efficacy of DBS. No adverse events occurred in association with the study procedure or devices. Conclusions and Relevance This study provides evidence supporting the safety and feasibility of postoperative home health DBS management. Trial Registration ClinicalTrials.gov Identifier: NCT02474459.
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Affiliation(s)
- Gordon Duffley
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City.,Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Barbara J Lutz
- School of Nursing, University of North Carolina-Wilmington, Wilmington
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee
| | - Adrienne Wright
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Christopher W Hess
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Pamela Zeilman
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Shannon Chiu
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Christopher R Butson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City.,Department of Biomedical Engineering, University of Utah, Salt Lake City.,Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville.,Departments of Neurology, Neurosurgery, and Psychiatry, University of Utah, Salt Lake City
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12
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Cartella SM, Terranova C, Rizzo V, Quartarone A, Girlanda P. Covid-19 and Parkinson's disease: an overview. J Neurol 2021; 268:4415-4421. [PMID: 34313818 PMCID: PMC8313415 DOI: 10.1007/s00415-021-10721-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 06/26/2021] [Accepted: 07/20/2021] [Indexed: 12/17/2022]
Abstract
In March 2020, WHO declared Covid-19 outbreak pandemic. There has been increasing evidence that frail, old, multi-pathological patients are at greater risk of developing severe Covid-19 infection than younger, healthy ones. Covid-19's impact on Parkinson's Disease (PD) patients could be analysed through both the influence on PD patients' health and their risk of developing severe Covid-19, and the consequences of lockdown and restrictive measures on mental and cognitive health on both patients and caregivers. Moreover, there are critical issues to be considered about patients' care and management through an unprecedented time like this. One important issue to consider is physiotherapy, as most patients cannot keep exercising because of restrictive measures which has profoundly impacted on their health. Lastly, the relationship between PD and Sars-Cov2 may be even more complicated than it seems as some studies have hypothesized a possible Covid-19-induced parkinsonism. Hereby, we review the state of the art about the relationship between Covid-19 and Parkinson's Disease, focusing on each of these five points.
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Affiliation(s)
- S M Cartella
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - C Terranova
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - V Rizzo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - A Quartarone
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - P Girlanda
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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13
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Palmese CA, Wyman-Chick KA, Racine C, Pollak LE, Lin G, Farace E, Tran B, Floden D, Bobholz J, Turner TH, York MK. Assessment of deep brain stimulation candidacy during the COVID-19 pandemic: Lessons learned and future directions for neuropsychologists. Clin Neuropsychol 2021; 36:72-84. [PMID: 34030595 DOI: 10.1080/13854046.2021.1929496] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Neuropsychological assessment is integral to the pre-surgical deep brain stimulation (DBS) workup for patients with movement disorders. The COVID-19 pandemic quickly affected care access and shifted healthcare delivery, and neuropsychology has adapted successfully to provide tele-neuropsychological (teleNP) DBS evaluations during this time, thus permanently changing the landscape of neuropsychological practice. Method: In this paper, we discuss the lessons learned from the pandemic and we offer care management guidelines for teleNP and in-person evaluations of pre-DBS populations, with exploration of the feasibility of the different approaches for uninterrupted care access. Results: We summarize the strengths and weaknesses of these care models and we provide future directions for the state of clinical neuropsychological practice for DBS programs, with implications for broader patient populations. Conclusions: A better understanding of these dynamics will inform and educate the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19 and beyond.
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Affiliation(s)
- C A Palmese
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - K A Wyman-Chick
- HealthPartners Struthers Parkinson's Center, Twin Cities, MN, USA
| | - C Racine
- Dept of Neurological Surgery, University of California at San Francisco, San Francisco, CA, USA
| | | | - G Lin
- Harvard Medical School, Boston, MA, USA
| | - E Farace
- Departments of Public Health Sciences and Neurosurgery, Penn State University, Hershey, PA, USA
| | - B Tran
- Dept of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - D Floden
- Psychiatry & Psychology, Cleveland Clinic, Cleveland, OH, USA
| | - J Bobholz
- Medical College of Wisconsin, Green Bay, WI, USA
| | - T H Turner
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - M K York
- Baylor College of Medicine, Houston, TX, USA
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14
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York MK, Farace E, Pollak L, Floden D, Lin G, Wyman-Chick K, Bobholz J, Palmese CA, Racine C, Tran B, Turner TH, Jimenez-Shahed J. The global pandemic has permanently changed the state of practice for pre-DBS neuropsychological evaluations. Parkinsonism Relat Disord 2021; 86:135-138. [PMID: 34049812 PMCID: PMC8119389 DOI: 10.1016/j.parkreldis.2021.04.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/05/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022]
Abstract
The evaluation and management of patients with movement disorders has evolved considerably due to the COVID-19 pandemic, including the assessment of candidates for deep brain stimulation (DBS) therapy. Members of the Neuropsychology Focus Group from the Parkinson Study Group Functional Neurosurgical Working Group met virtually to discuss current practices and solutions, build consensus, and to inform the DBS team and community regarding the complexities of performing DBS neuropsychological evaluations during COVID-19. It is our viewpoint that the practice of neuropsychology has adapted successfully to provide tele-neuropsychological pre-DBS evaluations during the global pandemic, thus permanently changing the landscape of neuropsychological services.
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Affiliation(s)
- M K York
- Baylor College of Medicine, Houston, TX, USA.
| | - E Farace
- Pennsylvania State University, Hersey, PA, USA
| | - L Pollak
- Massachusetts General, Boston, MA, USA
| | - D Floden
- Cleveland Clinic, Cleveland, OH, USA
| | - G Lin
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - K Wyman-Chick
- HealthPartners Struthers Parkinson's Center, Twin Cities, MN, USA
| | - J Bobholz
- Medical College of Wisconsin, Green Bay, WI, USA
| | - C A Palmese
- The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - C Racine
- University of California at San Francisco, San Francisco, CA, USA
| | - B Tran
- University of Pennsylvania, Philadelphia, PA, USA
| | - T H Turner
- Medical University of South Carolina, Charleston, SC, USA
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15
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Zhang C, Zhang J, Qiu X, Zhang Y, Lin Z, Huang P, Pan Y, Storch EA, Sun B, Li D. Deep Brain Stimulation for Parkinson's Disease During the COVID-19 Pandemic: Patient Perspective. Front Hum Neurosci 2021; 15:628105. [PMID: 33867957 PMCID: PMC8046912 DOI: 10.3389/fnhum.2021.628105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/08/2021] [Indexed: 12/02/2022] Open
Abstract
Background Public health guidelines have recommended that elective medical procedures, including deep brain stimulation (DBS) surgery for Parkinson’s disease (PD), should not be scheduled during the coronavirus (COVID-19) pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded. Methods We administered a newly developed phone questionnaire to 20 consecutive patients with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients’ experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care. Results Most of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic. Conclusion The COVID-19 pandemic has considerably impacted medical care and patients’ lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place.
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Affiliation(s)
- Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | - Jing Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xian Qiu
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yingying Zhang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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16
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Esper CD, Scorr L, Papazian S, Bartholomew D, Esper GJ, Factor SA. Telemedicine in an Academic Movement Disorders Center during COVID-19. J Mov Disord 2021; 14:119-125. [PMID: 33725762 PMCID: PMC8175806 DOI: 10.14802/jmd.20099] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/06/2020] [Indexed: 01/19/2023] Open
Abstract
Objective Telemedicine has rapidly gained momentum in movement disorder neurology during the coronavirus disease (COVID-19) pandemic to preserve clinical care while mitigating the risks of in-person visits. We present data from the rapid implementation of virtual visits in a large, academic, movement disorder practice during the COVID-19 pandemic. Methods We describe the strategic shift to virtual visits and retrospectively examine elements that impacted the ability to switch to telemedicine visits using historical prepandemic in-person data as a comparator, including demographics, distance driven, and diagnosis distribution, with an additional focus on patients with deep brain stimulators. Results A total of 686 telemedicine visits were performed over a five-week period (60% of those previously scheduled for in-office visits). The average age of participants was 65 years, 45% were female, and 73% were Caucasian. Men were more likely to make the transition (p = 0.02). Telemedicine patients lived farther from the clinic than those seen in person (66.47 km vs. 42.16 km, p < 0.001), age was not associated with making the switch, and patient satisfaction did not change. There was a significant shift in the distribution of movement disorder diagnoses seen by telemedicine compared to prepandemic in-person visits (p < 0.001). Patients with deep brain stimulators were more likely to use telemedicine (11.5% vs. 7%, p < 0.001). Conclusion Telemedicine is feasible, viable and relevant in the care of movement disorder patients, although health care disparities appear evident for women and minorities. Patients with deep brain stimulators preferred telemedicine in our study. Further study is warranted to explore these findings.
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Affiliation(s)
| | - Laura Scorr
- Department of Neurology, Emory University, Atlanta, GA, USA
| | - Sosi Papazian
- Department of Neurology, Emory University, Atlanta, GA, USA
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17
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Epilepsy and COVID-19: Updated evidence and narrative review. Epilepsy Behav 2021; 116:107785. [PMID: 33515934 PMCID: PMC7805398 DOI: 10.1016/j.yebeh.2021.107785] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak started in Wuhan, China, in late 2019 and rapidly spread globally. Vaccines have recently been developed and are being administered in some countries, but their widespread use is not yet sufficient; the battle against COVID-19 is protracted and people need to adapt to living under the influence of this disease. Epilepsy is a common chronic neurological condition characterized by spontaneous recurrence of unprovoked seizures. Various effects of COVID-19 on epilepsy have been studied in recent months. As clinicians, we need to keep up with daily updates in the evidence regarding interactions between COVID-19 and epilepsy. This review article summarizes the current evidence. Prospective studies on epilepsy and COVID-19 remain lacking. Most articles have comprised case reports, case series, retrospective studies, and recommendations/opinions that do not include data. However, summarizing these articles can identify the demands for research into COVID-19 and epilepsy by clarifying what is known and what remains unclear from current research.
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18
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Telehealth in Neurodegenerative Diseases: Opportunities and Challenges for Patients and Physicians. Brain Sci 2021; 11:brainsci11020237. [PMID: 33668641 PMCID: PMC7917616 DOI: 10.3390/brainsci11020237] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
Telehealth, by definition, is distributing health-related services while using electronic technologies. This narrative Review describes the technological health services (telemedicine and telemonitoring) for delivering care in neurodegenerative diseases, Alzheimer's disease, Parkinson's Disease, and amyotrophic lateral Sclerosis, among others. This paper aims to illustrate this approach's primary experience and application, highlighting the strengths and weaknesses, with the goal of understanding which could be the most useful application for each one, in order to facilitate telehealth improvement and use in standard clinical practice. We also described the potential role of the COVID-19 pandemic to speed up this service's use, avoiding a sudden interruption of medical care.
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19
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Kantzanou M, Korfias S, Panourias I, Sakas DE, Karalexi MA. Deep Brain Stimulation-Related Surgical Site Infections: A Systematic Review and Meta-Analysis. Neuromodulation 2021; 24:197-211. [PMID: 33462954 DOI: 10.1111/ner.13354] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/23/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Over the last decades, the increased use of deep brain stimulation (DBS) has raised concerns about the potential adverse health effects of the treatment. Surgical site infections (SSIs) following an elective surgery remain a major challenge for neurosurgeons. Few studies have examined the prevalence and risk factors of DBS-related complications, particularly focusing on SSIs. OBJECTIVES We systematically searched published literature, up to June 2020, with no language restrictions. MATERIALS AND METHODS Eligible were studies that examined the prevalence of DBS-related SSIs, as well as studies that examined risk and preventive factors in relation to SSIs. We extracted information on study characteristics, follow-up, exposure and outcome assessment, effect estimate and sample size. Summary odds ratios (sOR) and 95% confidence intervals (CI) were calculated from random-effects meta-analyses; heterogeneity and small-study effects were also assessed. RESULTS We identified 66 eligible studies that included 12,258 participants from 27 countries. The summary prevalence of SSIs was estimated at 5.0% (95% CI: 4.0%-6.0%) with higher rates for dystonia (6.5%), as well as for newer indications of DBS, such as epilepsy (9.5%), Tourette syndrome (5.9%) and OCD (4.5%). Similar prevalence rates were found between early-onset and late-onset hardware infections. Among risk and preventive factors, the perioperative implementation of intra-wound vancomycin was associated with statistically significantly lower risk of SSIs (sOR: 0.26, 95% CI: 0.09-0.74). Heterogeneity was nonsignificant in most meta-analyses. CONCLUSION The present study confirms the still high prevalence of SSIs, especially for newer indications of DBS and provides evidence that preventive measures, such as the implementation of topical vancomycin, seem promising in reducing the risk of DBS-related SSIs. Large clinical trials are needed to confirm the efficacy and safety of such measures.
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Affiliation(s)
- Maria Kantzanou
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stefanos Korfias
- Department of Neurosurgery, School of Medicine Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis Panourias
- Department of Neurosurgery, Korgialenio and Mpenakio General Hospital of Athens, Red Cross, Athens, Greece
| | - Damianos E Sakas
- Department of Neurosurgery, School of Medicine Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria A Karalexi
- Department of Hygiene, Epidemiology & Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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20
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von Oertzen TJ, Macerollo A, Leone MA, Beghi E, Crean M, Oztuk S, Bassetti C, Twardzik A, Bereczki D, Di Liberto G, Helbok R, Oreja‐ Guevara C, Pisani A, Sauerbier A, Sellner J, Soffietti R, Zedde M, Bianchi E, Bodini B, Cavallieri F, Campiglio L, Maia LF, Priori A, Rakusa M, Taba P, Moro E, Jenkins TM. EAN consensus statement for management of patients with neurological diseases during the COVID-19 pandemic. Eur J Neurol 2021; 28:7-14. [PMID: 33058321 PMCID: PMC7675361 DOI: 10.1111/ene.14521] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/20/2020] [Accepted: 08/31/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE The recent SARS-CoV-2 pandemic has posed multiple challenges to the practice of clinical neurology including recognition of emerging neurological complications and management of coexistent neurological diseases. In a fast-evolving pandemic, evidence-based studies are lacking in many areas. This paper presents European Academy of Neurology (EAN) expert consensus statements to guide neurologists caring for patients with COVID-19. METHODS A refined Delphi methodology was applied. In round 1, statements were provided by EAN scientific panels (SPs). In round 2, these statements were circulated to SP members not involved in writing them, asking for agreement/disagreement. Items with agreement >70% were retained for round 3, in which SP co-chairs rated importance on a five-point Likert scale. Results were graded by importance and reported as consensus statements. RESULTS In round one, 70 statements were provided by 23 SPs. In round two, 259/1061 SP member responses were received. Fifty-nine statements obtained >70% agreement and were retained. In round three, responses were received from 55 co-chairs of 29 SPs. Whilst general recommendations related to prevention of COVID-19 transmission had high levels of agreement and importance, opinion was more varied concerning statements related to therapy. CONCLUSION This is the first structured consensus statement on good clinical practice in patients with neurological disease during the COVID-19 pandemic that provides immediate guidance for neurologists. In this fast-evolving pandemic, a rapid response using refined Delphi methodology is possible, but guidance may be subject to change as further evidence emerges.
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Affiliation(s)
- T. J. von Oertzen
- Faculty of MedicineJohannes‐Kepler UniversitätLinzAustria
- Department of Neurology 1Kepler UniversitätsklinikumLinzAustria
| | - A. Macerollo
- Walton Centre NHS Foundation TrustLiverpoolUK
- Faculty of Health and Life SciencesUniversity of LiverpoolLiverpoolUK
| | - M. A. Leone
- UO NeurologiaFondazione IRCCS 'Casa Sollievo della Sofferenza'San Giovanni RotondoItaly
| | - E. Beghi
- Department of NeuroscienceIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - M. Crean
- European Academy of NeurologyHead OfficeViennaAustria
| | - S. Oztuk
- Department of NeurologyFaculty of MedicineSelcuk UniversityKonyaTurkey
| | - C. Bassetti
- Department of NeurologyInselspitalUniversity of BernBernSwitzerland
| | - A. Twardzik
- European Academy of NeurologyHead OfficeViennaAustria
| | - D. Bereczki
- Department of NeurologySemmelweis UniversityBudapestHungary
| | - G. Di Liberto
- Department of Pathology and ImmunologyGeneva Faculty of MedicineGenevaSwitzerland
| | - R. Helbok
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - C. Oreja‐ Guevara
- Department of NeurologyHospital Clínico San CarlosMadridSpain
- Departamento de MedicinaFacultad de MedicinaUniversidad Complutense de Madrid (UCM)MadridSpain
- IdISSCMadridSpain
| | - A. Pisani
- NeurologyDepartment of Systems MedicineUniversity of Rome Tor VergataRomeItaly
| | - A. Sauerbier
- Department of NeurologyUniversity Hospital CologneCologneGermany
| | - J. Sellner
- Department of NeurologyLandesklinikum Mistelbach‐GänserndorfMistelbachAustria
- Department of NeurologyChristian Doppler Medical CenterParacelsus Medical UniversitySalzburgAustria
- Department of NeurologyKlinikum rechts der IsarTechnische Universität MünchenMünchenGermany
| | - R. Soffietti
- Division of Neuro‐OncologyDepartment of NeuroscienceUniversity of TurinTurinItaly
| | - M. Zedde
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - E. Bianchi
- Department of NeuroscienceIstituto di Ricerche Farmacologiche Mario Negri IRCCSMilanItaly
| | - B. Bodini
- Department of NeurologySaint‐Antoine HospitalAPHPSorbonne UniversityParisFrance
| | - F. Cavallieri
- Neurology UnitNeuromotor and Rehabilitation DepartmentAzienda USL‐IRCCS di Reggio EmiliaReggio EmiliaItaly
- Clinical and Experimental Medicine PhD ProgramUniversity of Modena and Reggio EmiliaReggio EmiliaItaly
| | - L. Campiglio
- Division of Neurology'Aldo Ravelli' Research CenterDepartment of NeurologyUniversity of Milan and ASST Santi Paolo e CarloMilanItaly
| | - L. F. Maia
- Department of NeurologyCentro Hospitalar Universitário do PortoPortoPortugal
| | - A. Priori
- Division of Neurology'Aldo Ravelli' Research CenterDepartment of NeurologyUniversity of Milan and ASST Santi Paolo e CarloMilanItaly
| | - M. Rakusa
- Department of NeurologyUniversity Medical Centre MariborMariborSlovenia
| | - P. Taba
- Department of Neurology and NeurosurgeryInstitute of Clinical MedicineUniversity of TartuTartuEstonia
| | - E. Moro
- Division of NeurologyCHU of GrenobleGrenoble Alpes UniversityGrenoble Institute of NeurosciencesGrenobleFrance
| | - T. M. Jenkins
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
- Sheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
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21
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Lin Z, Zhang C, Zhang Y, Dai L, Voon V, Li D, Sun B. Deep brain stimulation telemedicine programming during the COVID-19 pandemic: treatment of patients with psychiatric disorders. Neurosurg Focus 2020; 49:E11. [PMID: 33260128 DOI: 10.3171/2020.9.focus20666] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The ongoing coronavirus disease 2019 (COVID-19) pandemic has considerably affected the delivery of postoperative care to patients who have undergone deep brain stimulation (DBS) surgery. DBS teleprogramming technology was developed and deployed in China before the COVID-19 outbreak. In this report, the authors share their experiences with telemedical DBS treatment of patients with psychiatric disorders during the COVID-19 outbreak. METHODS Four patients (2 with obsessive-compulsive disorder, 1 with major depressive disorder, and 1 with anorexia nervosa) underwent DBS surgery at Ruijin Hospital and received continuous postoperative DBS telemedicine case management from January 2020 to July 2020. DBS teleprogramming, individualized psychological support, and medical consultations were provided via the authors' DBS telemedicine platform, which also incorporated a synchronous real-time video communication system. RESULTS Forty-five DBS telemedicine sessions were conducted; there was no unexpected loss of network connection during the sessions. Of these, 28 sessions involved DBS teleprogramming. Adjustments were made to the stimulation voltage, frequency, pulse width, and contact site in 21, 12, 9, and 9 sessions, respectively. Psychological support and troubleshooting were provided during the remaining telemedicine sessions. Modest to substantial clinical improvements after DBS surgery were observed in some but not all patients, whereas stimulation-related side effects were reported by 2 patients and included reversible sleep and mood problems, headache, and a sensation of heat. CONCLUSIONS DBS telemedicine seems to offer a feasible, safe, and efficient strategy for maintaining the delivery of medical care to psychiatric patients during the COVID-19 outbreak. The authors propose that implementation of a comprehensive DBS telemedicine system, which combines DBS teleprogramming with psychological counseling, medical consultations, and medication prescriptions and delivery, could be an efficient and effective approach to manage the mental health and quality of life of patients with psychiatric disorders during future local or global public health crises.
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Affiliation(s)
- Zhengyu Lin
- 1Department of Neurosurgery and.,2Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- 1Department of Neurosurgery and.,2Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,3Shanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China; and
| | - Yingying Zhang
- 1Department of Neurosurgery and.,2Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lulin Dai
- 1Department of Neurosurgery and.,2Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Valerie Voon
- 4Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Dianyou Li
- 1Department of Neurosurgery and.,2Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- 1Department of Neurosurgery and.,2Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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Piano C, Bove F, Tufo T, Imbimbo I, Genovese D, Stefani A, Marano M, Peppe A, Brusa L, Cerroni R, Motolese F, Di Stasio E, Mazza M, Daniele A, Olivi A, Calabresi P, Bentivoglio AR. Effects of COVID-19 Lockdown on Movement Disorders Patients With Deep Brain Stimulation: A Multicenter Survey. Front Neurol 2020; 11:616550. [PMID: 33391174 PMCID: PMC7772207 DOI: 10.3389/fneur.2020.616550] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The containment measures taken by Italian government authorities during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic caused the interruption of neurological activities of outpatient clinics. Vulnerable patients, as Parkinson's disease (PD) and dystonic patients with deep brain stimulation (DBS), may have an increased risk of chronic stress related to social restriction measures and may show a potential worsening of motor and psychiatric symptoms. Methods: This cross-sectional multicenter study was carried out during the SARS-CoV-2 pandemic and was based on a structured survey administered during a telephone call. The questionnaire was designed to gather motor and/or psychiatric effects of the lockdown and coronavirus disease 2019 (COVID-19) epidemiologic information in PD and dystonic patients with a functioning DBS implant. Results: One hundred four patients were included in the study, 90 affected by PD and 14 by dystonia. Forty-nine patients reported a subjective perception of worsening of global neurological symptoms (motor and/or psychiatric) related to the containment measures. In the multivariate analysis, having problems with the DBS device was the only independent predictor of motor worsening [odds ratio (OR) = 3.10 (1.22–7.91), p = 0.018]. Independent predictors of psychiatric worsening were instrumental activities of daily living (IADL) score [OR = 0.78 (0.64–0.95), p = 0.012] and problems with DBS [OR = 5.69 (1.95–16.62), p = 0.001]. Only one patient underwent nasopharyngeal swabs, both negative, and no patient received a diagnosis of COVID-19. Conclusions: Lockdown restriction measures were associated with subjective worsening of motor and psychiatric symptoms in PD and dystonic patients treated with DBS, and they may have exacerbated the burden of neurological disease and increased the chronic stress related to the DBS management.
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Affiliation(s)
- Carla Piano
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Tufo
- Neurosurgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Isabella Imbimbo
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Danilo Genovese
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Stefani
- Department of System Medicine, Unità Operativa Semplice Dipartimentale (UOSD) Parkinson, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Marano
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Livia Brusa
- Neurology Unit, S. Eugenio Hospital, Rome, Italy
| | - Rocco Cerroni
- Department of System Medicine, Unità Operativa Semplice Dipartimentale (UOSD) Parkinson, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Enrico Di Stasio
- Unit of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marianna Mazza
- Department of Geriatrics, Neuroscience and Orthopedics, Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Daniele
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy.,Neurosurgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Bentivoglio
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
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23
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Bara GA, Maciaczyk J. Should Deep Brain Stimulation Programs Be Halted During the COVID-19 Pandemic? Balancing the Risk of COVID-19 Infection Against the Survival Benefits of DBS. Neuromodulation 2020; 23:1222-1223. [PMID: 33181860 PMCID: PMC8721659 DOI: 10.1111/ner.13309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Gregor A Bara
- Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Jaroslaw Maciaczyk
- Stereotactic and Functional Neurosurgery, Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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24
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Indu Subramanian, Christina L Vaughan. Hoping for the best, planning for the worst: Palliative care approach to Parkinson disease during the COVID-19 pandemic. Parkinsonism Relat Disord 2020; 80:203-205. [PMID: 33046384 PMCID: PMC7537621 DOI: 10.1016/j.parkreldis.2020.09.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/01/2020] [Accepted: 09/28/2020] [Indexed: 12/12/2022]
Abstract
Palliative care emphasizes expertise in handling difficult conversations, discussing patients’ wishes and supporting the caregiver(s). Here we outline the palliative approach of hoping for the best while preparing for the worst in several “what if” scenarios for people with Parkinson disease and their families during the COVID-19 pandemic. Palliative care emphasizes expertise in handling difficult conversations, responding to emotion, and discussing patients' wishes. The palliative approach of hoping for the best while preparing for the worst in several “what if” scenarios during this unprecedented time are described. Proactively approaching the “what-ifs” in the face of uncertainty allows for high quality goals of care and advance care planning.
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Affiliation(s)
- Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; PADRECC, West Los Angeles Veterans Administration, Los Angeles, CA, USA.
| | - Christina L Vaughan
- Departments of Neurology and Medicine, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
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25
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Kuroda N. What should we ask patients with epilepsy on telemedicine during the COVID-19 crisis? A checklist for clinicians. Epilepsy Behav 2020; 111:107184. [PMID: 32512471 PMCID: PMC7247519 DOI: 10.1016/j.yebeh.2020.107184] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 02/03/2023]
Affiliation(s)
- Naoto Kuroda
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA.
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26
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Santos-García D, Oreiro M, Pérez P, Fanjul G, Paz González JM, Feal Painceiras MJ, Cores Bartolomé C, Valdés Aymerich L, García Sancho C, Castellanos Rodrigo MDM. Impact of Coronavirus Disease 2019 Pandemic on Parkinson's Disease: A Cross-Sectional Survey of 568 Spanish Patients. Mov Disord 2020; 35:1712-1716. [PMID: 32776601 PMCID: PMC7436468 DOI: 10.1002/mds.28261] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/29/2022] Open
Abstract
Background The aim of this study was to know the impact of the coronavirus disease 2019 (COVID‐19) pandemic on Spanish patients with Parkinson's disease (PD). Methods This is a descriptive, observational, cross‐sectional study. An anonymous online survey with 95 questions was distributed among patients. Responses were collected from 11 May 2020 to 20 July 2020. Results Of a total of 570 questionnaires received, 568 (99.6%) were considered valid for the analysis (mean age, 63.5 ± 12.5 years; 53% females). A total of 553 patients (97.4%) were aware of the COVID‐19 pandemic and 68.8% were concerned about it; 95.6% took preventive measures. A total of 484 patients (85.2%) had no contact with cases of COVID‐19, and only 15 (2.6%) had confirmed COVID‐19. Although up to 72.7% remained active during confinement, 65.7% perceived a worsening of their symptoms. Conclusions Spanish patients with PD perceived the COVID‐19 pandemic with concern and responsibility. More than half experienced worsening of their symptoms during confinement. © 2020 International Parkinson and Movement Disorder Society
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Affiliation(s)
- Diego Santos-García
- Department of Neurology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Mila Oreiro
- Asociación Parkinson Galicia - Coruña, A Coruña, Spain
| | | | | | | | | | - Carlos Cores Bartolomé
- Department of Neurology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Lorena Valdés Aymerich
- Department of Neurology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Carlos García Sancho
- Department of Neurology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
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27
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Prasad S, Holla VV, Neeraja K, Surisetti BK, Kamble N, Yadav R, Pal PK. Impact of Prolonged Lockdown due to COVID-19 in Patients with Parkinson's Disease. Neurol India 2020; 68:792-795. [PMID: 32859814 DOI: 10.4103/0028-3886.293472] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The COVID-19 pandemic has compelled countries to impose lockdowns to curb the spread. As a result of the lockdown and need for health care services to cater to acute diseases on priority, patients with chronic illnesses such as Parkinson's disease (PD) may be facing several difficulties. Aims This study aimed to explore the effects of prolongation of lockdown on patients with PD by evaluating possible problems faced during a lockdown and worsening of symptoms if any. Materials and Methods One hundred patients with PD and their caregivers were contacted. Results We observed a significant increase in problems faced due to this pandemic, specifically, the inability to access health care, and difficulty procuring medication. Patients also reported worsening of motor symptoms. Conclusions The present findings highlight the need for health care systems to consider a plan of action for chronic neurological diseases like PD, which are worsening in the absence of regular hospital visits.
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Affiliation(s)
- Shweta Prasad
- Department of Clinical Neurosciences; Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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28
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Holla VV, Neeraja K, Surisetti BK, Prasad S, Kamble N, Srinivas D, Yadav R, Pal PK. Deep Brain Stimulation Battery Exhaustion during the COVID-19 Pandemic: Crisis within a Crisis. J Mov Disord 2020; 13:218-222. [PMID: 32854480 PMCID: PMC7502301 DOI: 10.14802/jmd.20073] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/05/2020] [Indexed: 12/13/2022] Open
Abstract
Objective The novel coronavirus disease (COVID-19) pandemic and public health measures to control it have resulted in unique challenges in the management of patients with deep brain stimulation (DBS). We report our experience with the management of acute worsening of symptoms due to battery exhaustion in 3 patients with DBS. Methods Patients with DBS for movement disorders who visited the emergency room due to battery exhaustion during the nationwide lockdown from April to May 2020 were included. Results Two patients with subthalamic nucleus-DBS for Parkinson’s disease (PD) and one with globus pallidus interna-DBS for generalized dystonia presented with acute worsening of symptoms due to battery exhaustion. Urgent battery replacement was performed in both patients with PD. The patient with generalized dystonia was managed with medication adjustment as he chose to defer battery replacement. Conclusion DBS battery replacement can be an emergency. Decisions regarding DBS battery replacement should be individualized during this COVID-19 pandemic.
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Affiliation(s)
| | - Koti Neeraja
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Bharath Kumar Surisetti
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Shweta Prasad
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India.,Department of Clinical Neurosciences, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Karnataka, India
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29
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KURODA N. Seven-point Checklist: Have You Prepared Sufficiently for the COVID-19 Crisis in Your Neurosurgery Department? Neurol Med Chir (Tokyo) 2020; 60:411-416. [PMID: 32536659 PMCID: PMC7431874 DOI: 10.2176/nmc.rc.2020-0140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/18/2020] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by severe acute respiratory syndrome coronavirus 2. COVID-19 was initially detected in Wuhan, China, in late 2019, and has now rapidly spread worldwide. Departments of Neurosurgery are required to employ an acute response against this pandemic. In this article, we discuss the important factors that neurosurgeons need to consider when managing their departments during the COVID-19 pandemic. We have summarized perspectives of the articles published on COVID-19, as well as the suggestions from neurosurgical societies in highly infected regions. We have proposed a seven-point checklist for neurosurgery departments: (1) networking among medical institutions; (2) coordinating teams within each institution; (3) prevention of infection within the department; (4) perioperative management; (5) triage; (6) changing subspecialty management protocols; and (7) psychological support for medical staff and patients.
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Affiliation(s)
- Naoto KURODA
- Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University, Detroit, MI, USA
- Department of Neurosurgery, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
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30
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Brown EG, Chahine LM, Goldman SM, Korell M, Mann E, Kinel DR, Arnedo V, Marek KL, Tanner CM. The Effect of the COVID-19 Pandemic on People with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1365-1377. [PMID: 32925107 PMCID: PMC7683050 DOI: 10.3233/jpd-202249] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND The effect of the COVID-19 pandemic on people with Parkinson's disease (PD) is poorly understood. OBJECTIVE To rapidly identify areas of need and improve care in people with PD during the COVID-19 pandemic, we deployed a survey to assess COVID-19 symptoms and the pandemic's effect among those with and without COVID-19. METHODS People with and without PD participating in the online study Fox Insight (FI) were invited to complete a survey between April 23 and May 23, 2020. Among people reporting COVID-19 diagnoses, we compared symptoms and outcomes in people with and without PD. Among people not reporting COVID-19, we assessed access to healthcare and services and PD symptoms. RESULTS 7,209/9,762 active FI users responded (approximately 74% response rate), 5,429 people with PD and 1,452 without PD. COVID-19 diagnoses were reported by 51 people with and 26 without PD. Complications were more frequent in people with longer PD duration. People with PD and COVID-19 experienced new or worsening motor (63%) and nonmotor (75%) symptoms. People with PD not diagnosed with COVID-19 reported disrupted medical care (64%), exercise (21%), and social activities (57%), and worsened motor (43%) and non-motor (52%) symptoms. Disruptions were more common for those living alone, with lower income and non-White race. CONCLUSIONS The COVID-19 pandemic is associated with wide-ranging effects on people with PD, and certain groups may be at particular risk. FI provides a rapid, patient-centered means to assess these effects and identify needs that can be used to improve the health of people with PD.
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Affiliation(s)
- Ethan G. Brown
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | - Lana M. Chahine
- Department of Neurology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Samuel M. Goldman
- Department of Occupational and Environmental Medicine, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | - Monica Korell
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | - Emerald Mann
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
| | | | | | - Kenneth L. Marek
- The Institute for Neurodegenerative Disorders, New Haven, CT, USA
| | - Caroline M. Tanner
- Department of Neurology, Weill Institute for the Neurosciences, University of California San Francisco, & San Francisco VA Health Care System, San Francisco, CA, USA
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