1
|
Ghorbani M, Keykhosravi E, Vatanparast M, Elyassirad D, Golchin N, Mirsardoo H, Hasanpour M. Traumatic middle meningeal artery aneurysm: a case report. Neurochirurgie 2024; 70:101545. [PMID: 38417248 DOI: 10.1016/j.neuchi.2024.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 03/01/2024]
Abstract
INTRODUCTION Traumatic intracranial aneurysms are rare, making up about 1% of all intracranial aneurysms. They can happen due to direct injury or blunt force, with the middle cerebral artery being the most frequent site. The middle meningeal artery (MMA) is the main artery that supplies the cranial dura mater, and, because of its location, is susceptible to damage after trauma. This article reported an unusual case of giant post-traumatic MMA pseudoaneurysm. CASE A 45 year-old man was referred to our department with a history of craniectomy. He complained of non-specific headache, but neurological examination was normal. A follow-up brain CT scan identified a right temporal fossa hyperdense mass. Digital subtraction angiography diagnosed a traumatic MMA aneurysm. The patient was treated with preoperative aneurysm embolization and surgical resection. DISCUSSION Traumatic MMA aneurysm is a rare presentation after head trauma. It can manifest as epidural hematoma, subdural hematoma or intraparenchymal hematoma, and sometimes resembles the present case, which was discovered incidentally. CONCLUSION Pseudoaneurysm is a rare complication of MMA trauma, with late presentation. It should be considered in patients with history of traumatic brain injury and temporal fossa extra-axial mass lesion with vascular characteristics.
Collapse
Affiliation(s)
- Mohammad Ghorbani
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Mahsa Vatanparast
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daniel Elyassirad
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Navid Golchin
- Iran University of Medical Sciences, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Hojjat Mirsardoo
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Mohammad Hasanpour
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran.
| |
Collapse
|
2
|
Hasanpour M, Golchin N, Mirsardoo H, Alagha A, Elyassirad D, Keykhosravi E. Pseudoaneurysm formation after placement of a FRED flow diverter stent in a patient with iatrogenic ICA injury during transsphenoidal surgery: A case report. Neurochirurgie 2024; 70:101520. [PMID: 38056410 DOI: 10.1016/j.neuchi.2023.101520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Affiliation(s)
- Mohammad Hasanpour
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Navid Golchin
- Iran University of Medical Sciences, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Hojjat Mirsardoo
- Iran University of Medical Sciences, Division of Vascular and Endovascular Neurosurgery, Department of Neurosurgery, School of Medicine, Tehran, Iran
| | - Ahmad Alagha
- Department of Neurosurgery, Salamat-Farda Hospital, Tehran, Iran
| | - Daniel Elyassirad
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
3
|
Samadian M, Bani MA, Golchin N, Mardani MA, Head JS, Arazpour M. Effects of Two Different Hip-Knee-Ankle-Foot Orthoses on Postural Stability in Subjects with Spinal Cord Injury: A Pilot Study. Asian Spine J 2018; 13:96-102. [PMID: 30326698 PMCID: PMC6365790 DOI: 10.31616/asj.2017.0283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 06/19/2018] [Indexed: 11/29/2022] Open
Abstract
Study Design Pilot study. Purpose Evaluation of two different hip-knee-ankle-foot orthoses (HKAFOs; medial linkage reciprocating gait orthosis [MLRGO] and isocentric reciprocating gait orthosis [IRGO]) using gait and postural stability analysis in four subjects with spinal cord injury (SCI). Overview of Literature To the best of our knowledge, no study has evaluated postural stability in subjects with SCI when using MLRGO and IRGO. Methods The relative efficacy of each orthosis was evaluated with relevant gait parameters, and an assessment of postural stability and sway during usage was made. Each analysis was conducted following an appropriate period of training and acclimatization. The gait parameters employed in the study were walking speed, cadence, and endurance; these were recorded and analyzed using current, validated methods. Postural stability was assessed using a verified force plate measurement system, and a modified Falls Efficacy Scale (mFES) was used for the measurement of postural sway and the perceived fear of falling. Results Walking speed, cadence, and endurance increased with the use of both HKAFOs. When the two types of HKAFOs were compared, all the parameters showed a slight (but not significant) increase with the use of MLRGO compared with the use of IRGO. In contrast, there were slight but insignificant improvements in postural sway with the use of IRGO. However, although there were no significant differences between the two sets of mFES scores, there was a slightly reduced fear of falling with the use of MLRGO compared with the use of IRGO in the static standing position. Conclusions It is noteworthy that meaningful interpretations of results can only be drawn if a larger sample is employed. This pilot study showed no significant data; however, the results indicate that the use of MLRGO is superior to that of IRGO in terms of potential improvement in the mobility and confidence levels of subjects with SCI.
Collapse
Affiliation(s)
- Mohammad Samadian
- Skull Base Research Center, Loghman Hakim Hospital, Tehran, Iran.,Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Monireh Ahmadi Bani
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Navid Golchin
- Department of Neurosurgery, Firuzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mardani
- Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - John S Head
- Institute for Health and Social Care Research, Faculty of Health and Social Care, University of Salford, Salford, UK
| | - Mokhtar Arazpour
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| |
Collapse
|
4
|
Daryabor A, Arazpour M, Golchin N. Efficacy of Corrective Surgery for Gait and Energy Expenditure in Patients with Scoliosis: A Literature Review. Asian Spine J 2018; 12:951-965. [PMID: 30213180 PMCID: PMC6147879 DOI: 10.31616/asj.2018.12.5.951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 04/17/2018] [Indexed: 11/23/2022] Open
Abstract
The aim of this literature review was to evaluate selected original papers that measured gait parameters and energy expenditure in idiopathic scoliosis (IS) treated with surgical intervention. IS is a progressive growth disease that affects spinal anatomy, mobility, and left–right trunk symmetry. Consequently, IS can modify human gait. Spinal fusions remain the primary approach to correcting scoliosis deformities, thereby halting progression. Using the population intervention comparison outcome measure framework and selected keywords, 15 studies that met the inclusion criteria were selected. Alteration of spatial and temporal variables in patients with IS was contradictory among the selected studies. Ankle and foot kinematics did not change after surgery; however, pelvic and hip frontal motions increased and pelvic rotation decreased following surgery. Patients with IS continued to show excessive energy expenditure following surgery in the absence of a physical rehabilitation protocol. Spinal surgery may be considered for gait improvement and IS treatment. There were inadequate data regarding the effect of corrective surgery on the kinetics, energy expenditure, and muscle activity parameters.
Collapse
Affiliation(s)
- Aliyeh Daryabor
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Student Research Commute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mokhtar Arazpour
- Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Department of Orthotics and Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Navid Golchin
- Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
5
|
Maleki M, Badri S, Shayestehepour H, Arazpour M, Farahmand F, Mousavi ME, Abdolahi E, Farkhondeh H, Head JS, Golchin N, Mardani MA. Design and analysis of an original powered foot clearance creator mechanism for walking in patients with spinal cord injury. Disabil Rehabil Assist Technol 2018. [PMID: 29529903 DOI: 10.1080/17483107.2018.1447610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND The aim of this study was to assess the performance of an original powered foot clearance creator (PFCC) mechanism worn in conjunction with an isocentric reciprocal gait orthosis (IRGO) and evaluate its effect on trunk compensatory movements and spatiotemporal parameters in nine healthy subjects. METHOD A PFCC motorized mechanism was designed that incorporated twin sole plates, the movements of which enabled increased toe to floor clearance during swing phase. A prototype was constructed in combination with an IRGO, and hence was re-named as an IRGO-PFCC orthosis. The effects of IRGO-PFCC usage on the spatiotemporal parameters and trunk compensatory movements during walking were then analyzed under two conditions, firstly with the PFCC 'active' i.e., with the motorized device functioning, and secondly inactive, where floor clearance was standard. RESULTS Ambulating with IRGO-PFCC orthosis resulted in reduction in the spatiotemporal parameters of gait (speed of walking, cadence and stride length) in nine healthy subjects. Walking with IRGO-PFCC orthosis led to significant differences in lateral (p = .007) and vertical (p = .008) trunk compensatory movements. In other words, through using IRGO-PFCC orthosis, the lateral and vertical trunk compensatory movements decreased by 51.32% and 42.7%, respectively. CONCLUSION An adapted PFCC mechanism, with a relatively small motor and power supply could effectively increase toe to floor clearance during swing phase and thereby decrease trunk compensatory motions and potentially improve energy consumption. Implications for rehabilitations •The High rejection rates of reciprocal gait orthoses are related to the increasing in energy expenditure and burden loads on the upper limb joints during walking following trunk compensatory movements.•An original powered foot clearance creator mechanism was designed and constructed to assisting floor clearance capability and reduce trunk compensatory movements in subjects with spinal cord injury during swing phase of gait.•This original powered foot clearance creator mechanism by using moveable soleplates and motorized actuation could decrease the trunk compensatory motions during the ambulation of nine healthy subjects.•More experiments are needed to investigate this mechanism on trunk compensatory movements of SCI subjects.
Collapse
Affiliation(s)
- Maryam Maleki
- a Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran.,b Orthotics and Prosthetics Department , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran.,c Student Research Commute , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Samaneh Badri
- d Department of Mechanical Engineering , Sharif University of Technology , Tehran , Islamic Republic of Iran.,e Javad Movafaghian Research Center for Intelligent NeuroRehabilitation Technologies , Tehran , Islamic Republic of Iran
| | - Hamed Shayestehepour
- d Department of Mechanical Engineering , Sharif University of Technology , Tehran , Islamic Republic of Iran.,e Javad Movafaghian Research Center for Intelligent NeuroRehabilitation Technologies , Tehran , Islamic Republic of Iran
| | - Mokhtar Arazpour
- a Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran.,b Orthotics and Prosthetics Department , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran.,c Student Research Commute , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Farzam Farahmand
- d Department of Mechanical Engineering , Sharif University of Technology , Tehran , Islamic Republic of Iran.,e Javad Movafaghian Research Center for Intelligent NeuroRehabilitation Technologies , Tehran , Islamic Republic of Iran
| | - Mohamad Ebrahim Mousavi
- b Orthotics and Prosthetics Department , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| | - Ehsan Abdolahi
- d Department of Mechanical Engineering , Sharif University of Technology , Tehran , Islamic Republic of Iran.,e Javad Movafaghian Research Center for Intelligent NeuroRehabilitation Technologies , Tehran , Islamic Republic of Iran
| | - Hasan Farkhondeh
- d Department of Mechanical Engineering , Sharif University of Technology , Tehran , Islamic Republic of Iran.,e Javad Movafaghian Research Center for Intelligent NeuroRehabilitation Technologies , Tehran , Islamic Republic of Iran
| | - John S Head
- f Institute for Health & Social Care Research (IHSCR) , Faculty of Health & Social Care, University of Salford , Salford , UK
| | - Navid Golchin
- g Department of Neurosurgery, Firoozgar Hospital , Iran University of Medical Sciences , Tehran , Iran
| | - Mohammad Ali Mardani
- b Orthotics and Prosthetics Department , University of Social Welfare and Rehabilitation Sciences , Tehran , Islamic Republic of Iran
| |
Collapse
|
6
|
Arazpour M, Ahmadi Bani M, Baniasad M, Samadian M, Golchin N. Design, construction, and evaluation of "sensor lock": an electromechanical stance control knee joint. Disabil Rehabil Assist Technol 2017; 13:226-233. [PMID: 28350511 DOI: 10.1080/17483107.2017.1306591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIM Most currently-available stance control knee ankle foot orthoses (SCKAFOs) still need full knee extension to lock the knee joint, and they are still noisy, bulky, and heavy. Therefore, the aim of this study was to design, construct, and evaluate an original electromechanical SCKAFO knee joint that could feasibly solve these problems, and thus address the problems of current stance control knee joints with regards to their structure, function, cosmesis, and cost. METHOD Ten able-bodied (AB) participants and two (knee ankle foot orthosis) KAFO users were recruited to participate in the study. A custom SCKAFO with the same set of components was constructed for each participant. Lower limb kinematics were captured using a 6-camera, video-based motion analysis system. RESULTS For AB participants, significant differences were found between normal walking and walking with the SCKAFO for temporal-spatial parameters and between orthoses with two modes of knee joints in the healthy subjects. Walking with stance control mode produced greater walking speed and step length, greater knee flexion during swing, and less pelvic obliquity than walking with a locked knee, for both AB and KAFO users. CONCLUSIONS The feasibility of this new knee joint with AB people was demonstrated. Implications for rehabilitation Stance control knee ankle foot orthoses (SCKAFOs) are designed to stop knee flexion in stance phase and provide free knee movement during swing phase of walking. Due to their high cost, size, excessive weight, and poor performance, few SCKAFO were optimal clinically and commercially. The feasibility of the new knee joint with able-bodied people and poliomyelitis subjects was demonstrated.
Collapse
Affiliation(s)
- Mokhtar Arazpour
- a Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,b Iranian Research Center on Aging , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran.,c Orthotics and Prosthetics Department , University of Social Welfare and Rehabilitation Science , Tehran , Islamic Republic of Iran
| | - Monireh Ahmadi Bani
- a Pediatric Neurorehabilitation Research Center , University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mina Baniasad
- d Mechanical Engineering Department , Sharif University of Technology , Tehran , Iran
| | - Mohammad Samadian
- e Department of Neurosurgery , Loghman Hakim hospital, Shahid Beheshti University of Medical Sciences , Tehran , Iran
| | - Navid Golchin
- f Department of Neurosurgery , Firuzgar Hospital, Iran University of Medical Sciences , Tehran , Iran
| |
Collapse
|
7
|
Golchin N, Ramak Hashem SM, Abbas Nejad E, Noormohamadi S. Timing of surgery for aneurysmal subarachnoid hemorrhage. Acta Med Iran 2012; 50:300-304. [PMID: 22837081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54±13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46±9.36 vs. 22.5±7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.
Collapse
Affiliation(s)
- Navid Golchin
- Department of Neurosurgery, Firuzgar Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | | | | | | |
Collapse
|
8
|
Criswell S, Perlmutter J, Golchin N, Flores H, Hobson A, Aschner M, Erikson K, Checkoway H, Racette B. Basal ganglia intensity indices and diffusion weighted imaging in manganese-exposed welders. Occup Environ Med 2011. [DOI: 10.1136/oemed-2011-100382.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
9
|
Hashemi SMR, Golchin N, Nejad EA, Noormohamadi S. Timing of surgery for aneurysmal subarachnoid hemorrhage. Acta Med Iran 2011; 49:420-424. [PMID: 21960072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Despite the many studies about timing for surgery in subarachnoid hemorrhage (SAH), the optimum time is still unclear. The aim of this study was to determine the results of early and late surgery for aneurysmal subarachnoid hemorrhage. In this cross-sectional study we evaluated the results of 70 consecutive surgery for aneurysmal subarachnoid hemorrhage in in Firuzgar hospital from 2005 to 2008. Surgery was performed in 50 cases (71.4%) in early period after SAH (first 4 days) and in 20 cases (28.6%) in at least 7 days after SAH. Statitical analysis was done by SPSS software, using Chi-square and t-test. Mean age of patients was 48.54 ± 13.4 years. 41.4% of patients were male and 58.6% were female. Most (77.2%) of patients had clinical grade I or II. 92.9% of aneurysms were single. Hypertension was the most common associated disease (34.3%). The most common site of aneurysms was anterior communicating artery (41.4%), followed by middle cerebral artery (35.7%). The outcome of surgery was favorable in 70% and unfavorable in 30%. Mortality rate was 24.3%. Outcome was favorable in 66% of early surgeries and 80% of late surgeries. There was no statistically significant difference between early and late surgery in terms of complications and outcome. Mean hospital stay of patients in the early surgery group was significantly lower than late group (16.46 ± 9.36 vs. 22.5 ± 7.97 days; P=0.01). The results of early and late surgery for aneurysmal subarachnoid hemorrhage is similar and decision making for timing of surgery should be based on each patient individual clinical conditions, age, size and site of aneurysm.
Collapse
|
10
|
Karimi M, Golchin N, Tabbal SD, Hershey T, Videen TO, Wu J, Usche JWM, Revilla FJ, Hartlein JM, Wernle AR, Mink JW, Perlmutter JS. Subthalamic nucleus stimulation-induced regional blood flow responses correlate with improvement of motor signs in Parkinson disease. Brain 2008; 131:2710-9. [PMID: 18697909 DOI: 10.1093/brain/awn179] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN DBS) improves motor symptoms in idiopathic Parkinson's disease, yet the mechanism of action remains unclear. Previous studies indicate that STN DBS increases regional cerebral blood flow (rCBF) in immediate downstream targets but does not reveal which brain regions may have functional changes associated with improved motor manifestations. We studied 48 patients with STN DBS who withheld medication overnight and underwent PET scans to measure rCBF responses to bilateral STN DBS. PET scans were performed with bilateral DBS OFF and ON in a counterbalanced order followed by clinical ratings of motor manifestations using Unified Parkinson Disease Rating Scale 3 (UPDRS 3). We investigated whether improvement in UPDRS 3 scores in rigidity, bradykinesia, postural stability and gait correlate with rCBF responses in a priori determined regions. These regions were selected based on a previous study showing significant STN DBS-induced rCBF change in the thalamus, midbrain and supplementary motor area (SMA). We also chose the pedunculopontine nucleus region (PPN) due to mounting evidence of its involvement in locomotion. In the current study, bilateral STN DBS improved rigidity (62%), bradykinesia (44%), gait (49%) and postural stability (56%) (paired t-tests: P < 0.001). As expected, bilateral STN DBS also increased rCBF in the bilateral thalami, right midbrain, and decreased rCBF in the right premotor cortex (P < 0.05, corrected). There were significant correlations between improvement of rigidity and decreased rCBF in the SMA (r(s) = -0.4, P < 0.02) and between improvement in bradykinesia and increased rCBF in the thalamus (r(s) = 0.31, P < 0.05). In addition, improved postural reflexes correlated with decreased rCBF in the PPN (r(s) = -0.38, P < 0.03). These modest correlations between selective motor manifestations and rCBF in specific regions suggest possible regional selectivity for improvement of different motor signs of Parkinson's disease.
Collapse
Affiliation(s)
- M Karimi
- Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|