gms | German Medical Science

62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

07. - 11. Mai 2011, Hamburg

Specific fine motor skill tasks as well as UPDRS III items respond to STN-DBS in Parkinson's disease

Meeting Abstract

  • M. Lange - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Janzen - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg
  • J. Schlaier - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • A. Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • U. Bogdahn - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg
  • R. Lürding - Klinik und Poliklinik für Neurologie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. Polnische Gesellschaft für Neurochirurgen. 62. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Polnischen Gesellschaft für Neurochirurgen (PNCH). Hamburg, 07.-11.05.2011. Düsseldorf: German Medical Science GMS Publishing House; 2011. DocP 092

DOI: 10.3205/11dgnc313, URN: urn:nbn:de:0183-11dgnc3134

Veröffentlicht: 28. April 2011

© 2011 Lange et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Objective: STN-DBS is superior to oral medication in advanced Parkinson’s Disease (PD) concerning ON-time and quality of life (QoL) [1]. STN-DBS alone (OFF-medication) improves motor function about as well as medication alone [2] and postoperatively the L-Dopa-equivalent-dose can be reduced significantly [1], [3], [4]. We used 3 specific tasks to examine whether STN-DBS has an impact on strength and fine motor skills in the stim-ON/med-ON condition compared to the med-ON condition preoperatively.

Methods: The data (grooved pegboard-test, Tap-board-test, dynamometer, UPDRS III, L-Dopa-equivalence-dose) from 13 patients (mean age 62.6 y, mean disease duration 12.7 y; 6 female, 7 male) were analyzed retrospectively. Results were compared between the preoperative and the 1-year postoperative test.

The dynamometer is a tool to measure grip-strength in kilograms. The standard values differ depending on age, gender and handedness. For the grooved pegboard test patients have to fill a pegboard with profiled metal pins. This requires accurate targeting of the hole and turning the pin around its axis into the right orientation. The seconds needed to fill all holes are counted. In the tapping board test the tapping frequency of the index fingers is determined in five 10-second intervals.

Results: The mean UPDRS III was 55.8 (practically defined OFF) and 17 (ON after standardized L-Dopa challenge) preoperatively. One year post-OP (12 patients) it was 10.1 (med-ON/stim-ON). The mean L-Dopa-equivalence-dose changed from 876.1 mg (11 patients) to 465.4 mg (53%). The raw data of the motor performance were transformed into z-scores in order to obtain comparability of the preoperative performance with the postoperative data over all ages. The mean z-scores were within normal ranges in pre-and postoperative tapping speed, lower than one standard deviation in pre- and postoperative hand power, and lower than two standard deviations in hand coordination (grooved pegboard) in comparison to normative data. No significant postoperative losses in motor function were found.

Conclusions: Motor improvement and medication reduction are in accordance with larger randomized clinical trials [1], [3], [4]. Although the dopaminergic medication could be reduced by 47% postoperatively, performance in the fine motor skill task, strength and UPDRS III showed no significant decline. Therefore, we conclude that STN-DBS in PD has the same effect on these specific tasks as on the UPDRS III score.


References

1.
Deuschl G, Schade-Brittinger C, Krack P, et al. A randomized trial of deep-brain stimulation for Parkinson's disease. N Engl J Med. 2006;355:896-908.
2.
Charles PD, Van Blercom N, Krack P, et al. Predictors of effective bilateral subthalamic nucleus stimulation for PD. Neurology. 2002;59:932-4.
3.
Deep-brain stimulation of the subthalamic nucleus or the pars interna of the globus pallidus in Parkinson's disease. N Engl J Med. 2001;345:956-63.
4.
Follett KA, Weaver FM, Stern M, et al. Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med. 2010;362:2077-91.