Nature 414, 173-179 (2001) This Article described patterns of labelling observed in olfactory cortex when a transneuronal tracer was co-expressed with single odorant receptor genes in the mouse olfactory epithelium. During efforts to replicate and extend this work, we have been unable to reproduce the reported findings. Moreover, we have found inconsistencies between some of the figures and data published in the paper and the original data. We have therefore lost confidence in the reported conclusions. We regret any adverse consequences that may have resulted from the paper's publication.
Background: Achieving optimal results following deep brain stimulation (DBS) typically involves several months of programming sessions. The Graphical User Interface for DBS Evaluation (GUIDE) study explored whether a visual programming system could help clinicians accurately predetermine ideal stimulation settings in DBS patients with Parkinson's disease. Methods: A multicenter prospective, observational study was designed that utilized a blinded Unified Parkinson's Disease Rating Scale (UPDRS)-III examination to prospectively assess whether DBS settings derived using a neuroanatomically based computer model (Model) could provide comparable efficacy to those determined through traditional, monopolar review-based programming (Clinical). We retrospectively compared the neuroanatomical regions of stimulation, power consumption and time spent on programming using both methods. Results: The average improvement in UPDRS-III scores was 10.4 ± 7.8 for the Model settings and 11.7 ± 8.7 for the Clinical settings. The difference between the mean UPDRS-III scores with the Model versus the Clinical settings was 0.26 and not statistically significant (p = 0.9866). Power consumption for the Model settings was 48.7 ± 22 μW versus 76.1 ± 46.5 μW for the Clinical settings. The mean time spent programming using the Model approach was 31 ± 16 s versus 41.4 ± 29.1 min using the Clinical approach. Conclusion: The Model-based DBS settings provided similar benefit to the Clinical settings based on UPDRS-III scores and were often arrived at in less time and required less power than the Clinical settings.
Background:Subthalamic nucleus deep brain stimulation is effective in reducing motor symptoms in appropriately selected patients with Parkinson's disease. We identified factors that contribute to poor outcomes during early, middle and late stages of stimulation management in a series of patients that were referred for troubleshooting poor outcomes.Methods:We performed a retrospective review of 50 patients with bilateral STN DBS seen in our movement disorders clinic with unsatisfactory clinical response and/or patient dissatisfaction with deep brain stimulation outcome. All patients underwent a systematic evaluation to assess the primary cause of suboptimal outcome including lead position, hardware integrity, patient selection, patient expectations, effective use of stimulation settings, and pre- and postoperative levodopa responsive symptoms. The data was also analyzed by duration of stimulation to determine if these factors varied by stage of DBS management.Results:Our series included patients implanted 4-68 months. We identified the following primary factors impacting outcome: Suboptimal stimulation settings (52%), disease progression (16%), inappropriate patient selection (10%), hardware damage (8%), lead malposition (8%), met expected motor outcomes (6%). Lead revision surgery occurred in 14%. Reversible factors accounted for dissatisfaction in 74%. Suboptimal stimulation was the dominant factor affecting outcomes in early and long-term management phases.Conclusion:STN DBS outcomes can be improved even years after implantation. Stimulation parameters warrant investigation throughout the continuum of DBS management as a reversible cause of poor outcomes.
Deep brain stimulation (DBS) is an effective therapy for advanced Parkinson's disease patients. Successful DBS outcomes depend on appropriate patient selection, surgical placement of the lead, intact hardware systems, optimal programming, and medical management. Despite its importance, there is little guidance in reference to hardware monitoring, hardware troubleshooting, and patient management. Technical manuals produced by the hardware manufacturer (Medtronic, Minneapolis, MN) are not presented in an applied clinical format, making impedance and current measurements difficult to interpret when the results are not straightforward. We present four patients with evolving DBS hardware complications that occurred during long-term follow-up, that shaped our clinical protocol for long-term care management and hardware troubleshooting.
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