Background:After Deep Brain Stimulation (DBS) for Parkinson’s disease (PD), patients often do not report the level of satisfaction anticipated. This misalignment can relate to patients’ expectations for an invasive treatment, and insufficient knowledge of DBS’s effectiveness in relieving motor and non-motor symptoms (NMS). Patient satisfaction depends on expectations and goals for treatment. We hypothesized that improving patient education with a patient-centered shared decision-making tool emphasizing autonomy would improve patient satisfaction and clinical outcome.Method:We developed a computer application (DBS-Edmonton app), allowing PD patients to input their symptoms, and to learn how effective DBS addresses their prioritized symptoms. Sixty-two volunteers referred for DBS used the DBS-Edmonton app. DBS-related knowledge and patient-perceptions of the DBS-Edmonton app were assessed with pre- and post-use questionnaires. Fourteen of 24 patients who proceeded to DBS achieved optimization at 6 months. Perceived functional improvement was assessed and compared with 12 control DBS patients who did not use the DBS-Edmonton app.Results:All 62 volunteers considered the DBS-Edmonton app helpful and would recommend it to others. There was improved knowledge about how NMS and axial symptoms respond to DBS. Post-operatively, there was no significant difference in symptoms improvement assessed by standard scales between groups. Volunteers who used DBS-Edmonton app had greater satisfaction (P=0.014).Conclusion:This interventional study showed that DBS-Edmonton app improved DBS-related knowledge and patient satisfaction, independent of objective motor outcome. It may assist patients in deciding to proceed to DBS, and can be easily incorporated into practice to improve patient satisfaction post-DBS.
Holmes tremor (HT), also known as midbrain, rubral, or cerebellar pathway outflow tremor, occurs due to disturbances of the cerebellothalamic pathway. This tremor is usually related to lesions in the midbrain peduncular region involving the superior cerebellar peduncle, red nucleus, and possibly the nigrostriatal circuitry. Common etiologies resulting in HT include tumor, ischemia, and demyelination. We report a case of progressive left sided HT in an otherwise healthy male with additional symptoms of parkinsonism, hypoesthesia, right oculomotor nerve palsy, cognitive dysfunction and hypersomnolence. Imaging investigations revealed a right sided thalamic and midbrain glioma. Dopamine transport imaging demonstrated significant dopaminergic denervation in the right caudate and putamen. The degree of striatal dopamine transporter deficiency was more severe than expected in a Parkinson’s disease patient. A trial of dopaminergic agent resulted in significant improvement of the tremor and associated symptoms. Interruption of the nigrostriatal pathway can occur in cases of HT due to midbrain peduncular lesion. The striatal dopaminergic function imaging may have a role in assessing pre-synaptic dopamine dysfunction and guiding treatment.
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