1
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Zaino ML, Schadt CR, Callen JP, Owen LG. Pyoderma Gangrenosum: Diagnostic Criteria, Subtypes, Systemic Associations, and Workup. Dermatol Clin 2024; 42:157-170. [PMID: 38423678 DOI: 10.1016/j.det.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Pyoderma gangrenosum (PG) is an inflammatory neutrophilic dermatosis with variable clinical features. The classic presentation is an ulceration with an erythematous to violaceous undermined border. Extracutaneous manifestations may occur. Associated systemic diseases include inflammatory bowel disease, inflammatory arthritides, and hematologic disorders. The pathophysiologic mechanism of disease is not completely known but likely related to the cumulative impact of inflammation, immune-mediated neutrophilic dysfunction, and genetic predisposition. Incidence is between 3 and 10 people per million but may be greater due to under recognition. In this article, we will discuss the diagnostic criteria, disease subtypes, systemic associations, and workup.
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Affiliation(s)
- Mallory L Zaino
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA.
| | - Courtney R Schadt
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
| | - Jeffrey P Callen
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
| | - Lafayette G Owen
- Department of Dermatology, University of Louisville, 3810 Springhurst Boulevard, Suite 200, Louisville, KY, USA
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2
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Sheriff S, Bahrami S, Schadt CR. Annular Erythematous Eruption in a Pediatric Patient. JAMA Dermatol 2024; 160:468-469. [PMID: 38381410 DOI: 10.1001/jamadermatol.2023.4984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
An 11-year-old girl presented in autumn with an asymptomatic rash on her arms, face, and legs of a 3-week duration. What is your diagnosis?
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Affiliation(s)
- Samar Sheriff
- Department of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Soon Bahrami
- Department of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky
- University of Louisville Pathology and Laboratory Medicine, Louisville, Kentucky
| | - Courtney R Schadt
- Department of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky
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3
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Abstract
This case report describes erythematous patches on the face that involved the nasolabial folds, as well as numerous skin-colored homogenous waxy papules on the arms, neck, and trunk.
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Affiliation(s)
- Alia Ahmadi
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Ashlee Margheim
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Courtney R Schadt
- Division of Dermatology, University of Louisville, Louisville, Kentucky
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4
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Durbin A, Callen JP, Schadt CR. Proton pump inhibitor-induced subacute cutaneous lupus erythematosus. Dermatol Ther 2022; 35:e15959. [PMID: 36284259 DOI: 10.1111/dth.15959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Abigail Durbin
- University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Jeffrey P Callen
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Courtney R Schadt
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky, USA
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5
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Jones J, Callen JP, Schadt CR. 31911 Postsurgical atypical mycobacterial infection misdiagnosed as pyoderma gangrenosum. J Am Acad Dermatol 2022. [DOI: 10.1016/j.jaad.2022.06.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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6
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Redding A, Margheim A, Schadt CR. Dermatitis Herpetiformis Flare After Excess Ingestion of Eggs. JAAD Case Rep 2022; 29:156-157. [PMID: 36267650 PMCID: PMC9576532 DOI: 10.1016/j.jdcr.2022.09.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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7
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Perna DL, Callen JP, Schadt CR. Association of Treatment With Secukinumab With Exacerbation of Dermatomyositis in a Patient With Psoriasis. JAMA Dermatol 2022; 158:454-456. [PMID: 35171205 DOI: 10.1001/jamadermatol.2021.6011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Danielle L Perna
- University of Louisville School of Medicine, Louisville, Kentucky.,Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Jeffrey P Callen
- University of Louisville School of Medicine, Louisville, Kentucky.,Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Courtney R Schadt
- University of Louisville School of Medicine, Louisville, Kentucky.,Division of Dermatology, University of Louisville, Louisville, Kentucky
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8
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Affiliation(s)
- Samar Sheriff
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Jeffrey P Callen
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
| | - Courtney R Schadt
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, Kentucky
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9
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Affiliation(s)
- Mallory L Foster
- University of Louisville School of Medicine, Louisville, Kentucky
| | | | - Courtney R Schadt
- Division of Dermatology, University of Louisville, Louisville, Kentucky
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10
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Foster ML, Jones JM, Schadt CR. Epidermolytic Hyperkeratosis. JAMA Dermatol 2021; 157:1114. [PMID: 34287626 DOI: 10.1001/jamadermatol.2021.2325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mallory L Foster
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Jordan M Jones
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Courtney R Schadt
- Division of Dermatology, University of Louisville, Louisville, Kentucky
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11
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Perna D, Margheim A, Schadt CR. Radiation-induced morphea and dystrophic calcinosis cutis of the breast. Int J Dermatol 2021; 60:e373-e375. [PMID: 33650142 DOI: 10.1111/ijd.15483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Danielle Perna
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Ashlee Margheim
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Courtney R Schadt
- Division of Dermatology, University of Louisville, Louisville, KY, USA
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12
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Abstract
Numerous drugs have been linked to the induction or exacerbation of systemic cutaneous lupus erythematosus (SCLE). This report presents the third case of the biologic abatacept as an exacerbating medication for SCLE. A 73-year old woman with a remote history of subacute cutaneous lupus and rheumatoid arthritis, well controlled on hydroxychloroquine, presented with worsening annular erythematous, slightly scaly plaques on her forearms and hands. She had been started on abatacept a month prior. She was diagnosed with SCLE exacerbated by abatacept given the clinical findings, time course, and skin biopsy with interface dermatitis. Her skin eruption cleared completely several months later after discontinuing abatacept and switching to tociluzumab, while remaining on hydroxychloroquine. This case highlights the need to consider abatacept as a potential exacerbating medication for SCLE in any patient with a new photodistributed papulosquamous eruption.
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Affiliation(s)
| | - Jeffrey P Callen
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, USA
| | - Courtney R Schadt
- Division of Dermatology, Department of Medicine, University of Louisville, Louisville, USA
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13
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Margheim A, Schadt CR, Callen JP. Multiple drugs as inducing or exacerbating agents in subacute cutaneous lupus erythematosus. Int J Dermatol 2020; 60:643-644. [PMID: 33128457 DOI: 10.1111/ijd.15290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 10/06/2020] [Indexed: 02/04/2023]
Affiliation(s)
- Ashlee Margheim
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Courtney R Schadt
- Division of Dermatology, University of Louisville, Louisville, KY, USA
| | - Jeffrey P Callen
- Division of Dermatology, University of Louisville, Louisville, KY, USA
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14
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Abner SM, Isaac A, Schadt CR. Tylosis in a Patient With Howel-Evans Syndrome: Management With Acitretin. Cutis 2020. [DOI: 10.12788/cutis.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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15
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Edelman A, Wetzel M, Owen C, Schadt CR, Callen JP. Xanthomas heralding pediatric coronary artery disease. JAAD Case Rep 2020; 6:753-754. [PMID: 32715071 PMCID: PMC7369508 DOI: 10.1016/j.jdcr.2020.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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16
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Rosman IS, Schadt CR, Samimi SS, Rosenbach M. Approaching the dermatology residency application process during a pandemic. J Am Acad Dermatol 2020; 83:e351-e352. [PMID: 32702459 PMCID: PMC7371582 DOI: 10.1016/j.jaad.2020.07.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/09/2022]
Affiliation(s)
- Ilana S Rosman
- Division of Dermatology, Washington University School of Medicine, St. Louis, Missouri.
| | - Courtney R Schadt
- Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Sara S Samimi
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Margheim A, Spaulding R, Schadt CR. Trigeminal Trophic Syndrome: A Cause of Dysesthesia and Persistent Facial Ulceration. Am J Med 2020; 133:685-686. [PMID: 31981488 DOI: 10.1016/j.amjmed.2019.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/01/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Ashlee Margheim
- University of Louisville School of Medicine, Louisville, Ky.
| | - Robert Spaulding
- Division of Dermatology, University of Louisville, Louisville, Ky
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18
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Veasey EC, Schadt CR. Photosensitivity in Cutaneous Lupus. JAMA Dermatol 2019; 155:1417. [PMID: 31596428 DOI: 10.1001/jamadermatol.2019.2769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Elizabeth C Veasey
- School of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky
| | - Courtney R Schadt
- School of Medicine, Division of Dermatology, University of Louisville, Louisville, Kentucky
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19
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Margheim A, Schadt CR. Unilateral hyperhidrosis secondary to brainstem meningioma producing mass effect. Dermatol Online J 2019; 25:13030/qt905497s9. [PMID: 32045150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023] Open
Abstract
Unilateral hyperhidrosis of neurological origin has been associated with head trauma, cerebral palsy, spinal cord injury, peripheral neuropathy, lesions of the hypothalamus, and cerebral or brainstem strokes. In this report, we describe a 61-year-old man with isolated sweating on the left side of his entire body. A right-sided brainstem meningioma producing mass effect is suspected as the underlying etiology.
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Affiliation(s)
- Ashlee Margheim
- University of Louisville School of Medicine, Louisville, KY.
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20
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Margheim A, Schadt CR. Unilateral hyperhidrosis secondary to brainstem meningioma producing mass effect. Dermatol Online J 2019. [DOI: 10.5070/d32511046144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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21
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Affiliation(s)
- Virginia Kartha
- Department of Dermatology, University of Louisville, Louisville, Kentucky
| | - Luisa Franco
- Department of Medicine (Division of Nephrology), University of Louisville, Louisville, Kentucky
| | - Susan Coventry
- Department of Pathology, University of Louisville, Louisville, Kentucky.,Norton Children's Hospital, Louisville, Kentucky
| | - Kenneth McLeish
- Department of Medicine (Division of Nephrology), University of Louisville, Louisville, Kentucky
| | - Dawn J Caster
- Department of Medicine (Division of Nephrology), University of Louisville, Louisville, Kentucky
| | - Courtney R Schadt
- Department of Dermatology, University of Louisville, Louisville, Kentucky
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22
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Abstract
The skin is often the herald of an underlying systemic illness, and gastrointestinal malignancies can present in numerous ways in the skin. Paraneoplastic phenomenon, such as acanthosis nigricans and tripe palm, may be the first indicator of a gastrointestinal malignancy. In addition, gastrointestinal cancers can metastasize to the skin, as described in the well-known Sister Mary Joseph's nodule. Inflammatory systemic conditions such as dermatomyositis and multicentric reticulohistiocytosis can be associated with underlying malignancy. Finally, in numerous genetic syndromes with underlying malignancies, such as Muir-Torre, recognition of the skin signs leads to early diagnosis and screening.
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23
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Haselden VN, Malone JC, Schadt CR. Bruising in a man in his 60s. JAMA Dermatol 2014; 150:1109-10. [PMID: 25102952 DOI: 10.1001/jamadermatol.2014.981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Virginia N Haselden
- Medical student at University of Louisville School of Medicine, Louisville, Kentucky
| | - Janine C Malone
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky
| | - Courtney R Schadt
- Division of Dermatology, University of Louisville School of Medicine, Louisville, Kentucky
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24
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Abstract
Bexarotene is a retinoid that specifically binds retinoid X receptors and has numerous effects on cellular growth and differentiation. It is approved for the treatment of cutaneous T cell lymphoma both topically and systemically. Adverse effects include hyperlipidemia, central hypothyroidism, and neutropenia with bexarotene capsules, and an irritant dermatitis with bexarotene gel. With aggressive management of these potential side effects, bexarotene is an additional option in the armamentarium for management of cutaneous T cell lymphoma.
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Affiliation(s)
- Courtney R Schadt
- Medicine (Dermatology), University of Louisville, Louisville, Kentucky
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25
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Abstract
Neutrophilic dermatoses, including Sweet's syndrome, pyoderma gangrenosum, and rheumatoid neutrophilic dermatitis, are inflammatory conditions of the skin often associated with underlying systemic disease. These are characterized by the accumulation of neutrophils in the skin. The associated conditions, potential for systemic neutrophilic infiltration, and therapeutic management of these disorders can be similar. Sweet's syndrome can often be effectively treated with a brief course of systemic corticosteroids. Pyoderma gangrenosum, however, can be recurrent, and early initiation of a steroid-sparing agent is prudent. Second-line treatment for both of these conditions includes medications affecting neutrophil function, in addition to immunosuppressant medications.
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Affiliation(s)
- Courtney R Schadt
- Division of Dermatology, University of Louisville, 310 East Broadway, Louisville, KY 40202, USA.
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27
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Schadt CR, Charles PD, Davis TL, Konrad PE. Thalamotomy, DBS-Vim, and DBS-GPi for generalized dystonia: a case report. Tenn Med 2007; 100:38-9. [PMID: 17378506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Generalized dystonia is a disabling disorder that can severely affect quality of life. Pharmacological treatment is unsatisfactory, and surgical therapy has been the focus for symptom improvement. We present the first case report of a patient with disabling generalized dystonia treated with a thalamotomy and deep brain stimulation of the thalamus and globus pallidus (DBS-Vim, DBS-GPi). His tremor and dystonic symptoms have dramatically improved through combining these surgical interventions.
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Affiliation(s)
- Courtney R Schadt
- Vanderbilt University School of Medicine, Nashville, TN 37212-3375, USA
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28
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Schadt CR, Cox KL, Tramontana MG, Byrne DW, Davis TL, Fang JY, Konrad PE, Padaliya B, Mutter RW, Gill CE, Richardson CR, Charles PD. Depression and intelligence in patients with Parkinson's disease and deep-brain stimulation. J Natl Med Assoc 2006; 98:1121-5. [PMID: 16895282 PMCID: PMC2569473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
The goal of this study is to examine the association of depression with intelligence and education in patients with Parkinson's disease treated with bilateral subthalamic nucleus stimulation (STN-DBS). The literature has been contradictory concerning depression in Parkinson's disease patients. Some studies have shown less depression in Parkinson's disease patients with more education not treated with STN-DBS. Other recently published studies indicate that STN-DBS improves the depression associated with Parkinson's disease. No studies have examined the correlation of these factors with depression in Parkinson's disease patients treated with STN-DBS. We administered the Beck Depression Inventory (BDI) pre- and postoperatively to 21 Parkinson's disease patients (seven women, 14 men, ages 49-75) who underwent STN-DBS. The postoperative scores of the lower 50th percentile (n=8) of the Verbal Comprehensive Index of the Wechsler Adult Intelligence Scale (WAIS-III) decreased significantly (P=0.036), while the upper 50th percentile (n=13) remained nearly constant (P=0.802). Furthermore, as the education increased from highschool to graduate level, patients demonstrated less improvement in depressive symptoms postoperatively. These findings suggest that Parkinson's disease patients with lower intelligence test scores and less education benefit more with regards to depressive symptomatology after STN-DBS than patients with higher scores and education.
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Affiliation(s)
- Courtney R Schadt
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN 37212-3375, USA
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Abstract
Tremor is often a disabling primary condition or secondary to another disorder. No universally effective pharmacological agent exists for the treatment of essential tremor, and patients differ greatly in their response to therapies, thus requiring individualised regimens. Deep brain stimulation is the best option for patients with disabling, drug-resistant essential tremor. Resting tremor in Parkinson's disease is usually not the primary disabling feature, and in most cases, levodopa/carbidopa is satisfactory for many years. Young Parkinson's patients with dominant, disabling tremor benefit from anticholinergics in addition to dopaminergic therapies. However, older Parkinson's patients with more disabling tremor may suffer from dose-dependent side effects, and deep brain stimulation should be considered. This article outlines the available pharmacological agents and treatment considerations for various disabling tremors, including essential tremor and Parkinson's disease.
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