S Kelm

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Publications (2)1.36 Total impact

  • Article: Rehabilitation von Parkinson-Patienten mit Tiefenhirnstimulation
    N. Allert, C. Dohle, J.W. Horn, S. Kelm, H. Kirsch, P.N. Nolte, W. Weirich, H. Karbe
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    ABSTRACT: HintergrundDie Tiefenhirnstimulation des Nucleus subthalamicus stellt eine wirksame Therapieoption für Patienten mit fortgeschrittener Parkinson-Krankheit dar. Eine wachsende Zahl von Patienten wird nach der Ersteinstellung stationär rehabilitativ behandelt. Die Bedeutung einer weiteren Stimulator- und Medikamenteneinstellung für diese Rehabilitationsbehandlung ist unklar. Patienten und MethodenDiese retrospektive Analyse schloss Parkinson-Patienten ein, die innerhalb von 3 Monaten nach Elektrodenimplantation eine stationäre Rehabilitationsbehandlung mit systematischem Algorithmus zur Verbesserung der Stimulationswirkung durchliefen. Untersucht wurden (1) die vorgenommenen Änderungen der Stimulationsparameter und der Medikation sowie (2) der Einfluss auf die mit dem Barthel-Index bestimmte Alltagskompetenz. ErgebnisseInsgesamt 95Patienten wurden 20,4±10,7Tage nach der Operation über 29,0±11,2Tage rehabilitativ behandelt. Technische Dysfunktionen fanden sich bei 3 (3,1%) Patienten und eine Elektrodendislokation bei einer Patientin (1,1%). An 7,3±4,0 Tagen erfolgten teils mehrfache Änderungen der Stimulationsparameter. Bis zur Entlassung wurden die Stimulationsamplituden signifikant von 2,1±0,8V auf 3,0±0,8V erhöht. Zudem wurden bei 70 (73,7%) Patienten aktive Stimulationskontakte gegenüber der Aufnahmeeinstellung geändert. Die mittlere L-Dopa-Äquivalenzdosis sank von 529±290mg/Tag auf 300±277mg/Tag. Der Barthel-Index stieg signifikant um 10,3±12,4 Punkte. SchlussfolgerungEine weitere Stimulator- und Medikamenteneinstellung nach der Ersteinstellung im primären Zentrum stellt einen wichtigen Bestandteil der stationären Rehabilitationsbehandlung von Parkinson-Patienten mit Tiefenhirnstimulation dar. BackgroundDeep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an important therapeutic option in patients with advanced Parkinson’s disease (PD). An increasing number of patients are referred for hospital rehabilitation after initial programming. The role of further DBS and medication adjustments for this rehabilitation therapy is uncertain. MethodsThis study was a retrospective analysis of a hospital rehabilitation program with a systematic algorithm to improve DBS efficacy in PD patients referred within 3 months after electrode implantation. This study analyzed (1) changes of stimulation parameters and medication and (2) changes in the performance of activities of daily living as measured by the Barthel index. ResultsAfter an average of 20.4±10.7 days following surgery 95 PD patients were hospitalized for an average rehabilitation period of 29.0±11.2 days. Technical dysfunctions were found in 3 (3.1%) patients and a bilateral electrode dislocation in 1 (1.1%) patient. Stimulation parameters were adjusted on 7.3±4.0 days, sometimes with several adjustments on the same day. Until discharge the stimulation amplitude was significantly increased from 2.1±0.8V to 3.0±0.8V. Moreover, in 70 (73.7%) patients active stimulation contacts were changed. The mean levodopa equivalent dosage decreased from 529±290mg/die to 300±277mg/die. The Barthel index increased significantly by 10.3±12.4 points. ConclusionFurther DBS and medication adjustments play an important role for hospital rehabilitation of PD patients after initial DBS programming in DBS centers. SchlüsselwörterTiefenhirnstimulation–Nucleus subthalamicus–Morbus Parkinson–Rehabilitation–Alltagskompetenz KeywordsDeep brain stimulation–Nucleus subthalamicus–Parkinson disease–Rehabilitation–Activities of daily living
    Der Nervenarzt 05/2012; 82(4):462-467. · 0.68 Impact Factor
  • Article: [Rehabilitation of Parkinson's patients with deep brain stimulation. Experiences of the Neurological Rehabilitation Center Godeshöhe].
    N Allert, C Dohle, J W Horn, S Kelm, H Kirsch, P N Nolte, W Weirich, H Karbe
    [show abstract] [hide abstract]
    ABSTRACT: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an important therapeutic option in patients with advanced Parkinson's disease (PD). An increasing number of patients are referred for hospital rehabilitation after initial programming. The role of further DBS and medication adjustments for this rehabilitation therapy is uncertain. This study was a retrospective analysis of a hospital rehabilitation program with a systematic algorithm to improve DBS efficacy in PD patients referred within 3 months after electrode implantation. This study analyzed (1) changes of stimulation parameters and medication and (2) changes in the performance of activities of daily living as measured by the Barthel index. After an average of 20.4±10.7 days following surgery 95 PD patients were hospitalized for an average rehabilitation period of 29.0±11.2 days. Technical dysfunctions were found in 3 (3.1%) patients and a bilateral electrode dislocation in 1 (1.1%) patient. Stimulation parameters were adjusted on 7.3±4.0 days, sometimes with several adjustments on the same day. Until discharge the stimulation amplitude was significantly increased from 2.1±0.8 V to 3.0±0.8 V. Moreover, in 70 (73.7%) patients active stimulation contacts were changed. The mean levodopa equivalent dosage decreased from 529±290 mg/die to 300±277 mg/die. The Barthel index increased significantly by 10.3±12.4 points. Further DBS and medication adjustments play an important role for hospital rehabilitation of PD patients after initial DBS programming in DBS centers.
    Der Nervenarzt 04/2011; 82(4):462-7. · 0.68 Impact Factor

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