[Show abstract][Hide abstract] ABSTRACT: The present study investigated the neuropsychological effects of bilateral deep brain stimulation (DBS) on subthalamic nucleus (STN) in Chinese-Cantonese patients with idiopathic Parkinson's disease (PD). Twenty-seven patients were prospectively recruited from the Movement Disorder Clinic at the Hong Kong Prince of Wales Hospital. Neuropsychological evaluations were performed at baseline, 6 and 12 months following the DBS procedure. Assessment battery included standardized tests on global cognitive function, verbal memory, non-verbal memory, confrontation naming, visuospatial organization, attention and executive functions. Anxiety and depressive symptoms were measured by two self-reported questionnaires. Results demonstrated diminished performance on a category fluency task that occurred at 6 months post-operatively and persisted at 12-month re-evaluation; 29.6-33.3 % of patients showed reduction of more than 1 SD (standard deviation) at post-operative measure. Conversely, performance on an immediate recall task in a verbal memory test was found to improve significantly at the same time point and persisted through 12 months after surgery; 22.2-25.9 % showed an improvement (≥1 SD). Psychologically, anxiety symptoms were statistically decreased and the significant reduction occurred at 12 months after surgery. Patients who reported a moderate to severe level of anxiety reduced from 51.9 to 18.5 %. Our findings concurred with most evidences on the effects of STN-DBS on verbal fluency; on the other hand, we demonstrated improvement of immediate verbal memory that warranted further investigation.
[Show abstract][Hide abstract] ABSTRACT: Since the first deep brain stimulation (DBS) performed for movement disorder more than a decade ago, DBS has become a standard operation for advanced Parkinson's disease. Its indications are expanding to areas of dystonia, psychiatric conditions and refractory epilepsy. Additionally, a new set of DBS-related complications have arisen. Many teams found a slow learning curve from this complication-prone operation. We would like to investigate complications arising from 100 DBS electrode insertions and its prevention.
We performed an audit in all DBS patients for operation-related complications in our centre from 1997 to 2008. Complications were classified into operation-related, hardware-related and stimulation-related. Operation-related complications included intracranial haemorrhages and electrode malposition. Hardware-related complications included fracture of electrodes, electrode migration, infection and erosion. Stimulation-related complications included sensorimotor conditions, psychiatric conditions and life-threatening conditions.
From 1997 to the end of 2008, 100 DBS electrodes were inserted in 55 patients for movement disorders, mostly for Parkinsons disease (50 patients). There was one symptomatic cerebral haemorrhage (1%) and two electrode malpositions (2%). Meticulous surgical planning, use of microdriver and a reliable electrode anchorage device would minimise this group of complications. There were two electrode fractures, one electrode migration and one pulse-generator infection which contributed to the hardware-related complication rate of 5%. There were no sensorimotor or life-threatening complications in our group. However, three patients suffered from reversible psychiatric symptoms after DBS.
DBS is, on the one hand, an effective surgical treatment for movement disorders. On the other hand, it is a complication-prone operation. A dedicated "Movement Disorder Team" consisting of neurologists, neurophysiologists, functional neurosurgeons, neuropsychologists and nursing specialists is essential. Liaison among team members in peri-operative periods and postoperative care is the key to avoiding complications and having a successful patient outcome.
Asian Journal of Surgery 10/2009; 32(4):258-63. DOI:10.1016/S1015-9584(09)60404-8 · 0.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The frequency of LRRK2 Gly2385Arg mutation in Hong Kong Chinese with early-onset (age < or =45 years) Parkinson's disease was identified and compared with late-onset patients (age >50 years) and controls. The mutation prevalence were 8.8, 8.3, and 0% for early-onset, late-onset, and controls, respectively. The mean age of onset among LRRK2 G2385R carriers was 42.7 years old for early-onset compared to 74.3 for late-onset patients. LRRK2 G2385R mutation appears to be as prevalent among early-onset as late-onset patients.
[Show abstract][Hide abstract] ABSTRACT: Our aim was to characterise PARK2 mutations and clinical features in Hong Kong Chinese with early-onset Parkinson's disease. Subjects were recruited from two major hospitals. Detailed data included demographics, age of onset, duration of disease, neurological manifestations, complications and disease severity. Genetic analysis for PARK2 mutations was performed. Thirty-four patients were recruited (mean age of onset = 39 years; mean duration of disease = 10 years). Seven patients reported a family history. The salient clinical manifestations were resting tremor (33/34), bradykinesia (33/34), rigidity (30/34), postural instability (20/34), good response to L-dopa (33/34), asymmetry at onset (31/34) and sleep benefit (12/34). Motor complications were reported in a significant number of patients, and depression was the most common nonmotor complication. Five patients were identified to have PARK2 mutations. Two sisters were compound heterozygotes for an insertion and a deletion, a novel and rare 1 bp insertion/nonsense mutation c1378_1379insG (exon 12) and the entire deletion of exon 7. Another patient was homozygous for the entire deletion of exon 6. Two carriers were identified, one with a T1321C (Cys441Arg) missense mutation in exon 12 and another with a snp within intron 4. Our study reviewed a higher prevalence of PARK2 mutations in Chinese than that previously documented. A compound heterozygous mutation within two sisters with significant differences in age of onset and phenotypic manifestations suggest that modifier affects may be present in this family.
[Show abstract][Hide abstract] ABSTRACT: Acute stroke patients with large artery occlusive disease (LAOD) have a distinct pathophysiology and may respond differently to anticoagulation treatments. We compared the efficacy of a low-molecular-weight heparin (LMWH), nadroparin calcium, with aspirin in Asian acute stroke patients with LAOD.
Acute ischaemic stroke patients with onset of symptoms less than 48 h and LAOD (diagnosed by transcranial doppler imaging, carotid duplex scan, or magnetic resonance angiography) were recruited. Patients were randomly assigned to receive either subcutaneous nadroparin calcium 3800 anti-factor Xa IU/0.4 mL twice daily or oral aspirin 160 mg daily for 10 days, and then all received aspirin 80-300 mg once daily for 6 months. This study is registered at www.strokecenter.org/trials (number 493).
Among 603 patients recruited, 353 (180 LMWH, 173 aspirin) had LAOD (300 had intracranial LAOD only, 42 had both intracranial and extracranial disease, and 11 had extracranial disease only). The proportion of patients with good outcomes at 6 months (Barthel index >or=85) was 73% in the LMWH group and 69% in the aspirin group (absolute risk reduction 4%; 95% CI -5 to 13). Analysis of prespecified secondary outcome measures showed a benefit in outcome for LMWH versus aspirin on the modified Rankin scale dichotomised at 0-1 (odds ratio 1.55, 95% CI 1.02-2.35). Haemorrhagic transformation of infarct and severe adverse events were similar in both groups. Post-hoc analyses of patients without LAOD, and all treated patients, showed similar proportions with a good outcome in aspirin and LMWH groups (78%vs 79% and 73%vs 75%, respectively).
Overall, the results do not support a significant benefit of LMWH over aspirin in patients with LAOD. The benefits indicated in most outcome measures warrant further investigation into the use of anticoagulation for acute stroke in patients with large artery atherosclerosis, particularly in intracranial atherosclerosis.
The Lancet Neurology 05/2007; 6(5):407-13. DOI:10.1016/S1474-4422(07)70079-0 · 21.90 Impact Factor