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Jacques Favre - One of the best experts on this subject based on the ideXlab platform.
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bilateral contemporaneous posteroventral pallidotomy for the treatment of parkinson s disease neuropsychological and neurological side effects report of four cases and review of the literature
Journal of Neurosurgery, 1999Co-Authors: J Ghika, F Ghikaschmid, H Fankhauser, G Assal, Francois Vingerhoets, Alberto Albanese, Julien Bogousslavsky, Jacques FavreAbstract:The authors report the underestimated cognitive, mood, and behavioral complications in patients who have undergone bilateral contemporaneous pallidotomy, as seen in their early experience with functional neurosurgery for Parkinson's disease (PD) that is accompanied by severe motor fluctuations before pallidal stimulation. Four patients, not suffering from dementia, with advanced (Hoehn and Yahr Stages III-IV), medically untreatable PD featuring severe "on-off" fluctuations underwent bilateral contemporaneous posteroventral pallidotomy (PVP). All patients were evaluated according to the Core Assessment Program for Intracerebral Transplantations (CAPIT) protocol without positron emission tomography scans but with additional neuropsychological cognitive, mood, and behavior testing. For the first 3 to 6 months Postoperatively, all patients showed a mean improvement of motor scores on the Unified Parkinson's Disease Rating Scale (UPDRS), in the best "on" (21%) and worst "off" (40%) UPDRS III motor subscale, a mean 30% improvement in the UPDRS II activities of daily living (ADL) subscore, and 60% on the UPDRS IV complications of treatment subscale. Dyskinesia disappeared almost completely, and the mean daily duration of the off time was reduced by an average of 60%. Despite these good results in the CAPIT scores, one patient experienced a partially regressive corticobulbar syndrome with dysphagia, dysarthria, and increased drooling. No emotional lability was found in this patient, but he did demonstrate severe bilateral Postoperative pretarsal blepharospasm (apraxia of eyelid opening), which interfered with walking and which required treatment with high-dose subcutaneous injections of botulinum toxin. No patient showed visual field defects or hemiparesis, but Postoperative Depression, changes in personality, behavior, and executive functions were seen in two individuals. Postoperative abulia was reported by the family of one patient, who lost his preoperative aggressiveness and drive in terms of ADL, speech, business, family life, and hobbies, and became more sleepy and fatigued. One patient reported Postoperative mental automatisms, such as compulsive mental counting, and circular thoughts and reasoning during off phases; Postoperative Depression was found in two patients. However, none of the patients demonstrated these symptoms during intraoperative microelectrode stimulation. These findings are compatible with previous reports on bilateral pallidal lesions. A progressive lowering of UPDRS subscores was seen after 12 months, consistent with the progression of the disease. Bilateral simultaneous pallidotomy may be followed by emotional, behavioral, and cognitive deficits such as Depression, obsessive-compulsive disorders, and loss of psychic autoactivation-abulia, as well as disabling corticobulbar dysfunction and apraxia of eyelid opening, in addition to previously described motor and visual field deficits, which make this surgery undesirable even though significant improvement in motor deficits can be achieved.
Andréas Hartmann - One of the best experts on this subject based on the ideXlab platform.
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Optimal target localization for subthalamic stimulation in patients with Parkinson disease
Neurology, 2014Co-Authors: Marie-laure Welter, Michael Schüpbach, Virginie Czernecki, Carine Karachi, Sara Fernandez-vidal, Jean-louis Golmard, Giulia Serra, Soledad Navarro, Arlette Welaratne, Andréas HartmannAbstract:To further determine the causes of variable outcome from deep brain stimulation of the subthalamic nucleus (DBS-STN) in patients with Parkinson disease (PD). Data were obtained from our cohort of 309 patients with PD who underwent DBS-STN between 1996 and 2009. We examined the relationship between the 1-year motor, cognitive, and psychiatric outcomes and (1) preoperative PD clinical features, (2) MRI measures, (3) surgical procedure, and (4) locations of therapeutic contacts. Pre- and Postoperative results were obtained in 262 patients with PD. The best motor outcome was obtained when stimulating contacts were located within the STN as compared with the zona incerta (64% vs 49% improvement). Eighteen percent of the patients presented a Postoperative cognitive decline, which was found to be principally related to the surgical procedure. Other factors predictive of poor cognitive outcome were perioperative confusion and psychosis. Nineteen patients showed a stimulation-induced hypomania, which was related to both the form of the disease (younger age, shorter disease duration, higher levodopa responsiveness) and the ventral contact location. Postoperative Depression was more frequent in patients already showing preoperative depressive and/or residual axial motor symptoms. In this homogeneous cohort of patients with PD, we showed that (1) the STN is the best target to improve motor symptoms, (2) Postoperative cognitive deficit is mainly related to the surgery itself, and (3) stimulation-induced hypomania is related to a combination of both the disease characteristics and a more ventral STN location.
Helen Winefield - One of the best experts on this subject based on the ideXlab platform.
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The role of Depression and anxiety symptoms in hospital readmissions after cardiac surgery
Journal of Behavioral Medicine, 2008Co-Authors: Phillip J. Tully, Robert A. Baker, Deborah Turnbull, Helen WinefieldAbstract:The objective of this study was to determine the association between Depression, anxiety and general stress symptoms with hospital readmissions after coronary artery bypass graft surgery. Two hundred and twenty six coronary artery bypass graft patients completed baseline self-report measures of Depression, anxiety and stress and 222 patients completed these measures after surgery on the hospital ward. The hospital readmission outcomes at six months were analyzed using multivariable proportional hazard models. When analyzed as continuous variables in multivariable analyses, preoperative anxiety and Postoperative Depression predicted readmissions independent of medical covariates. In multivariable analyses with dichotomized anxiety, Depression and stress, more than two-fold increase in readmission risk was attributable to preoperative anxiety and Postoperative Depression, independent of covariates. These results lend further support to previous research that has shown the symptoms of Depression and anxiety are associated with morbidity following coronary artery bypass graft surgery. The findings highlight the need to develop suitable interventions for anxiety and Depression among coronary artery bypass graft surgery patients.
Brian J Neuman - One of the best experts on this subject based on the ideXlab platform.
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friday september 28 2018 10 45 am 12 00 pm abstracts how should we measure our success 185 perioperative Depression and anxiety correlate with patient reported outcomes in spine surgery
The Spine Journal, 2018Co-Authors: Rafa Rahman, Alvaro Ibaseta, Jay S Reidler, Richard L Skolasky, David B Cohen, Daniel M Sciubba, Khaled M Kebaish, Brian J NeumanAbstract:BACKGROUND CONTEXT Multiple studies have demonstrated that patients present with psychiatric symptoms prior to spine surgery and that psychiatric distress has a negative impact on patient-reported outcomes (PROs). However, how the preoperative to Postoperative progression of Depression or anxiety correlate with PROs is unknown. PURPOSE To identify patterns of preoperative to Postoperative Depression and anxiety progression in spine surgery patients, and to compare PROs across Depression and anxiety progression groups. STUDY DESIGN/SETTING Retrospective review of spine surgery patients at the Johns Hopkins Hospital. PATIENT SAMPLE A total of 240 spine patients. OUTCOME MEASURES Patient-Reported Outcomes Measurement Information System (PROMIS) Computerized Adaptive Test (CAT) scores in Depression, Anxiety, Pain Interference, Physical Function, Sleep Disturbance, and Satisfaction with Participation in Social Roles. METHODS PROMIS Depression, Anxiety, Pain Interference, Physical Function, Sleep Disturbance, and Satisfaction with Participation in Social Roles were assessed in 240 spine patients preoperatively and at 3 months Postoperatively. Patients were stratified based on perioperative progression of Depression or anxiety scores using American Psychiatric Association PROMIS guidelines into Persistent, Postoperatively-Improved, Postoperatively-Developed, or No Psychiatric Distress. Multivariate regressions compared changes in PROs, adjusting for age, race, gender, smoking status, working status, income level, education level, and baseline outcomes scores. RESULTS Of the 240 patients (avg. age: 58.4 years; 87% White, 8% African American, 5% Other; 45% male), 26.5% had preoperative Depression, of whom 52% Postoperatively improved. 44.2% had preoperative anxiety, of whom 21% Postoperatively improved. Of patients with no preoperative Depression, 9% Postoperatively developed Depression, and of those with no preoperative anxiety, 11% Postoperatively developed anxiety. Patients whose Depression persisted had similar preoperative Depression scores to patients whose Depression improved. Similar results were observed with anxiety. Persistently Depressed patients had less improvement (p CONCLUSIONS Many patients saw Postoperative improvement of preoperative Depression or anxiety, perhaps from alleviation of spine pathology. Patient-reported outcomes (PROs) are worse in those with Postoperative Depression (persistent or newly developed), or newly developed anxiety. Postoperative Depression or anxiety may have a greater effect on PROs than preoperative psychiatric distress.
Alun H Davies - One of the best experts on this subject based on the ideXlab platform.
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factors impacting on patient perception of procedural success and satisfaction following treatment for varicose veins
British Journal of Surgery, 2016Co-Authors: Sarah Onida, Joseph Shalhoub, H M Moore, K S Head, T R A Lane, Alun H DaviesAbstract:Background Patient-reported outcome measures (PROMs) have been collected from patients undergoing varicose vein treatments in the National Health Service since 2009. The aim of this retrospective cohort study was to examine PROMs for varicose vein interventions, characterizing factors that might predict patient-reported perception of procedural success and satisfaction. Methods Centrally compiled PROMs data for varicose vein procedures carried out from 2009 to 2011 were obtained from the Hospital Episode Statistics data warehouse for England. As data were not distributed normally, non-parametric statistical tests were employed. Results Data for 35 039 patient episodes (62·8 per cent women) were available for analysis. Some 23·4 per cent of patients reported a degree of anxiety or Depression before treatment; a formal diagnosis of Depression was present in 7·8 per cent. Quality of life, measured by generic EQ-5D-3L™ index and the Aberdeen Varicose Vein Questionnaire (AVVQ) improved after intervention by 11·7 per cent (0·77 to 0·86) and 40·1 per cent (18·95 to 11·36) respectively. No significant improvement was found in EQ-5D™ visual analogue scale scores. There was a significant improvement in self-perceived anxiety or Depression after the intervention (P < 0·001, McNemar–Bowker test). Both preoperative and Postoperative Depression or anxiety had a statistically significant relationship with self-reported success and satisfaction (both P < 0·001, χ2 test). Conclusion This analysis of PROMs is evidence that treatment of varicose veins improves quality of life, and anxiety or Depression. Preoperative and Postoperative anxiety or Depression scores impact on patient-perceived success and satisfaction rates.