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Five-Year Outcomes of Bilateral Subthalamic Nucleus Stimulation in Japanese Patients with Parkinson’s Disease

Advances in Parkinson's Disease 2015年第2期4卷 21-27页

作者： Atsushi Umemura Miwako Miyata yuichi oka Kenji Okita Genko Oyama Yasushi Shimo Nobutaka Hattori Department of Research and Therapeutics for Movement Disorders Juntendo University Graduate School of Medicine Tokyo Japan Department of Neurosurgery Juntendo University Graduate School of Medicine Tokyo Japan Health Assistant Information Technology Course Department of Human Care Engineering Faculty of Health Science Nihon Fukushi University Aichi Japan Department of Neurosurgery Nagoya City University Graduate School of Medicine Nagoya Japan Department of Neurology Nagoya City University Graduate School of Medicine Nagoya Japan Department of Neurology Juntendo University Graduate School of Medicine Tokyo Japan

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is widely performed for medically refractory Parkinson’s disease (PD). Several western studies have examined the long-term outcomes of STN DBS. However, the long-term outcomes in Japanese patients have not been reported. Methods: We studied the long-term outcomes of STN DBS in Japanese patients with PD. Fifty-five consecutive patients treated with bilateral STN DBS were followed for 5 years after surgery. Each patient underwent Unified Parkinson’s Disease Rating Scale assessments preoperatively and 1 and 5 years after surgery. Results: Twelve patients (22%) were lost to follow up within 5 years. Among them, 7 died and 5 became bed ridden because of PD deterioration. In the 43 patients followed for 5 years, STN DBS significantly improved motor function. The cardinal motor symptoms of tremor, rigidity, and bradykinesia in medication-on periods were significantly better than baseline 5 years after DBS. However, axial motor symptoms of speech, gait and postural stability gradually deteriorated and significantly worsened 5 years after DBS. Motor complications, including dyskinesia and motor fluctuations, significantly improved after DBS with a marked reduction in dopaminergic medication. These effects were maintained 5 years after DBS. Frequently, persisting adverse effects included apraxia of eyelid opening and dysarthria. Conclusions: STN DBS significantly improved motor symptoms in patients with advanced PD. These effects were maintained over 5 years in most patients. However, some showed rapid PD progression even after STN DBS. Other treatments for the axial symptoms and disease progression are needed in long-term PD treatment.

关键词： Deep Brain Stimulation Subthalamic Nucleus Parkinson’s Disease Long-Term Outcome Adverse Effect

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Factors affecting early decline of executive function after subthalamic nucleus stimulation in Parkinson’s disease

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Advances in Parkinson's Disease 2013年第3期2卷 75-80页

作者： Atsushi Umemura yuichi oka Rika Tsuboi Sonoko Fujii Yoko Shimizu Kenji Okita Noriyuki Matsukawa Kazuo Yamada Department of Neurology Nagoya City University Graduate School of Medicine Nagoya Japan Department of Neurosurgery Nagoya City University Graduate School of Medicine Nagoya Japan Department of Rehabilitation Medicine Nagoya City University Graduate School of Medicine Nagoya Japan Department of Research and Therapeutics for Movement Disorders Juntendo University School of Medicine Tokyo Japan Department of Neurosurgery Nagoya City University Graduate School of Medicine Nagoya Japan

Subthalamic nucleus deep brain stimulation (STN DBS) is an effective treatment for medically refractory Parkinson’s disease (PD). However, a minority of patients develop cognitive problems, particularly a decline of executive function in the early period after STN DBS. Although this problem is usually transient, it may cause social maladjustment. We investigated factors affecting early decline of executive function after STN-DBS. Fifty-seven patients whose preoperative global cognitive screening was normal (MMSE score;28 or more) were enrolled in this study. Executive function was evaluated with the Trail-Making Test (TMT) preoperatively and 1-month after surgery. We considered a patient to have decline in executive function if the TMT (B-A) was prolonged more than 30 seconds after STN DBS. Among 57 patients, 25 patients were categorized as having decline of executive function. Univariate analysis revealed that high preoperative UPDRS III motor score in the medication-off period and a depressive state evaluated with BDI-II correlated significantly with decline in executive function. Multiple logistic regression analysis revealed that the only significant independent variable related to early decline of executive function was the preoperative BDI-II score. Postoperative factors such as active contact location or dopaminergic medication reduction had no relation with the decline of executive function. Even in cognitively well-selected patients, STN DBS causes early decline in executive function in a significant number of patients. Preoperative simple cognitive screening alone could not predict early decline in executive function. More detailed neuropsychological evaluation, including mood status, should be undertaken before surgery.

关键词： Parkinson’s Disease Deep Brain Stimulation Subthalamic Nucleus Executive Function

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Primary malignant pericardial mesothelioma with difficult antemortem diagnosis:A case report

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World Journal of Clinical Cases 2022年第33期10卷 12380-12387页

作者： Naoya oka yuichi Orita Chikage Oshita Hirofumi Nakayama Hiroki Teragawa Department of Clinical Immunology and Rheumatology Hiroshima University HospitalHiroshima 734-8551Japan Department of Cardiovascular Medicine JR Hiroshima HospitalHiroshima 732-0057Japan Department of Pathology JR Hiroshima HospitalHiroshima 732-0057Japan

BACKGROUND Primary malignant pericardial mesothelioma(PMPM)is an extremely rare malignant tumor,and it is difficult to diagnose definitively before *** present a case in which PMPM was diagnosed at *** consider this case to be highly suggestive and report it *** SUMMARY A 78-year-old male presented with transient loss of consciousness and *** transient loss of consciousness was considered to result from complications of diastolic dysfunction due to pericardial disease,fever with dehydration,and paroxysmal atrial *** cardiography(UCG)and computed tomography showed cardiac enlargement and high-density pericardial *** considered pericardial disease to be the main pathogenesis of this *** magnetic resonance imaging and gadolinium contrast-enhanced T1-weighted images showed thick staining inside and outside the *** biopsy was considered to establish a definitive diagnosis,but the patient and his family refused further treatment and examinations,and the patient was followed *** noticed a thickening of the pericardium and massive changes in the pericardium on UCG over *** performed an autopsy 60 h after the patient died of *** staining of the autopsy tissue showed an epithelial-like arrangement in the pericardial tumor,and immunostaining showed positive and negative factors for the diagnosis of *** on these findings,the final diagnosis of PMPM was *** PMPM has a poor prognosis,and early diagnosis and treatment are *** temporal echocardiographic findings may provide a clue for the diagnosis of PMPM.

关键词： Primary malignant pericardial mesothelioma Antemortem diagnosis Pericardial disease Temporal echocardiographic Case report

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