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Abboud H, Genc G, Saad S, Thompson N, Oravivattanakul S, Alsallom F, Yu XX, Floden D, Gostkowski M, Ahmed A, Ezzeldin A, Marouf HM, Mansour OY, Fernandez HH. Factors Associated With Postoperative Confusion and Prolonged Hospital Stay Following Deep Brain Stimulation Surgery for Parkinson Disease. Neurosurgery 2020; 86:524-529. [PMID: 31432068 DOI: 10.1093/neuros/nyz316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Several patient and disease characteristics are thought to influence DBS outcomes; however, most previous studies have focused on long-term outcomes with only a few addressing immediate postoperative course. OBJECTIVE To evaluate predictors of immediate outcomes (postoperative confusion and length of postoperative hospitalization) following deep brain stimulation surgery (DBS) in Parkinson disease (PD) patients. METHODS We conducted a retrospective study of PD patients who underwent DBS at our institution from 2006 to 2011. We computed the proportion of patients with postoperative confusion and those with postoperative hospitalization longer than 2 d. To look for associations, Fisher's exact tests were used for categorical predictors and logistic regression for continuous predictors. RESULTS We identified 130 patients [71% male, mean age: 63 ± 9.1, mean PD duration: 10.7 ± 5.1]. There were 7 cases of postoperative confusion and 19 of prolonged postoperative hospitalization. Of the 48 patients with tremors, none had postoperative confusion, whereas 10.1% of patients without tremors had confusion (P = .0425). Also, 10.2% of patients with preoperative falls/balance-dysfunction had postoperative confusion, whereas only 1.6% of patients without falls/balance-dysfunction had postoperative confusion (P = .0575). For every one-unit increase in score on the preoperative on-UPDRS III/MDS-UPDRS III score, the odds of having postoperative confusion increased by 10% (P = .0420). The following factors were noninfluential: age, disease duration, dyskinesia, gait freezing, preoperative levodopa-equivalent dose, number of intraoperative microelectrode passes, and laterality/side of surgery. CONCLUSION Absence of tremors and higher preoperative UPDRS III predicted postoperative confusion after DBS in PD patients. Clinicians' awareness of these predictors can guide their decision making regarding patient selection and surgical planning.
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Affiliation(s)
- Hesham Abboud
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio.,Parkinson's and Movement Disorder Center, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio.,Department of Neurology, Alexandria University, Alexandria, Egypt
| | - Gencer Genc
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Saira Saad
- Parkinson's and Movement Disorder Center, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Nicolas Thompson
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio.,Neurological Institute, Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, Ohio
| | | | - Faisal Alsallom
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Xin Xin Yu
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Darlene Floden
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Michal Gostkowski
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Anwar Ahmed
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio
| | - Ayman Ezzeldin
- Department of Neurology, Alexandria University, Alexandria, Egypt
| | - Hazem M Marouf
- Department of Neurology, Alexandria University, Alexandria, Egypt
| | - Ossama Y Mansour
- Department of Neurology, Alexandria University, Alexandria, Egypt
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Chen T, Mirzadeh Z, Chapple KM, Lambert M, Evidente VGH, Moguel-Cobos G, Oravivattanakul S, Mahant P, Ponce FA. Intraoperative test stimulation versus stereotactic accuracy as a surgical end point: a comparison of essential tremor outcomes after ventral intermediate nucleus deep brain stimulation. J Neurosurg 2017; 129:290-298. [PMID: 29027853 DOI: 10.3171/2017.3.jns162487] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Ventral intermediate nucleus deep brain stimulation (DBS) for essential tremor is traditionally performed with intraoperative test stimulation and conscious sedation, without general anesthesia (GA). Recently, the authors reported retrospective data on 17 patients undergoing DBS after induction of GA with standardized anatomical coordinates on T1-weighted MRI sequences used for indirect targeting. Here, they compare prospectively collected data from essential tremor patients undergoing DBS both with GA and without GA (non-GA). METHODS Clinical outcomes were prospectively collected at baseline and 3-month follow-up for patients undergoing DBS surgery performed by a single surgeon. Stereotactic, euclidean, and radial errors of lead placement were calculated. Functional (activities of daily living), quality of life (Quality of Life in Essential Tremor [QUEST] questionnaire), and tremor severity outcomes were compared between groups. RESULTS Fifty-six patients underwent surgery: 16 without GA (24 electrodes) and 40 with GA (66 electrodes). The mean baseline functional scores and QUEST summary indices were not different between groups (p = 0.91 and p = 0.59, respectively). Non-GA and GA groups did not differ significantly regarding mean postoperative percentages of functional improvement (non-GA, 47.9% vs GA, 48.1%; p = 0.96) or QUEST summary indices (non-GA, 79.9% vs GA, 74.8%; p = 0.50). Accuracy was comparable between groups (mean radial error 0.9 ± 0.3 mm for non-GA and 0.9 ± 0.4 mm for GA patients) (p = 0.75). The mean euclidean error was also similar between groups (non-GA, 1.1 ± 0.6 mm vs GA, 1.2 ± 0.5 mm; p = 0.92). No patient had an intraoperative complication, and the number of postoperative complications was not different between groups (non-GA, n = 1 vs GA, n = 10; p = 0.16). CONCLUSIONS DBS performed with the patient under GA to treat essential tremor is as safe and effective as traditional DBS surgery with intraoperative test stimulation while the patient is under conscious sedation without GA.
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Affiliation(s)
| | | | | | | | | | - Guillermo Moguel-Cobos
- 2Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Srivadee Oravivattanakul
- 2Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
| | - Padma Mahant
- 2Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and
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Patel S, Ojo O, Genc G, Oravivattanakul S, Huo Y, Rasameesoraj T, Wang L, Bena J, Drerup M, Foldvary-Schaefer N, Ahmed A, Fernandez HH. A Computerized Cognitive behavioral therapy Randomized, Controlle d, pilot trial for insomnia in Parkinson Disease ( ACCORD-PD). J Clin Mov Disord 2017; 4:16. [PMID: 28852567 PMCID: PMC5568719 DOI: 10.1186/s40734-017-0062-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 07/27/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Parkinson disease (PD) is associated with a high prevalence of insomnia, affecting up to 88% of patients. Pharmacotherapy studies in the literature addressing insomnia in PD reveal disappointing and inconsistent results. Cognitive behavioral therapy (CBT) is a novel treatment option with durable effects shown in primary insomnia. However, the lack of accessibility and expense can be limiting. For these reasons, computerized CBT for insomnia (CCBT-I) has been developed. The CCBT-I program is a 6-week web-based course consisting of daily "lessons" providing learnable skills and appropriate recommendations to help patients improve their sleep habits and patterns. METHODS We conducted a single-center, pilot, randomized controlled trial comparing CCBT-I versus standardized sleep hygiene instructions to treat insomnia in PD. Twenty-eight subjects with PD experiencing insomnia, with a score > 11 on the Insomnia Severity Index (ISI) were recruited. Based on a 6-point improvement in ISI in treatment group when compared to controls and an alpha = 0.05 and beta of 0.1 (power = 90%) a sample size of 11 patients (on active treatment) were required to detect this treatment effect using a dependent sample t-test. RESULTS In total, 8/14 (57%) subjects randomized to CCBT-I versus 13/14 (93%) subjects randomized to standard education completed the study. Among completers, the improvement in ISI scores was greater with CCBT-I as compared to standard education (-7.9 vs -3.5; p = 0.03). However, in an intention-to-treat analysis, where all enrolled subjects were included, the change in ISI between groups was not significant (-.4.5 vs -3.3; p = 0.48), likely due to the high dropout rate in the CCBT-I group (43%). CONCLUSION This pilot study suggests that CCBT-I can be an effective treatment option for PD patients with insomnia when the course is thoroughly completed. High drop-out rate in our study shows that although effective, it may not be a generalizable option; however, larger studies are needed for further evaluation.
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Affiliation(s)
| | | | | | | | - Yang Huo
- 9500 Euclid Ave/U2, Cleveland, OH 44195 USA
| | | | - Lu Wang
- 9500 Euclid Ave/JJN3, Cleveland, OH 44195 USA
| | - James Bena
- 9500 Euclid Ave/JJN3, Cleveland, OH 44195 USA
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Oravivattanakul S, Benchaya L, Ahmed A, Itin I, Cooper S, Gostkowski M, Rudolph J, Appleby K, Sweeney P, Fernandez HH, Wu G. Reply to Comment on: Dopamine Transporter (DaT) Scan Utilization in a Movement Disorder Center. Mov Disord Clin Pract 2017; 4:155-156. [DOI: 10.1002/mdc3.12403] [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] [Received: 05/09/2016] [Accepted: 05/19/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Srivadee Oravivattanakul
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
- Muhammad Ali Parkinson Center; Barrow Neurological Institute; St. Joseph's Hospital and Medical Center; Phoenix Arizona USA
| | - Lucas Benchaya
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Anwar Ahmed
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Ilia Itin
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Scott Cooper
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Michal Gostkowski
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Joseph Rudolph
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Kristin Appleby
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Patrick Sweeney
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Hubert H. Fernandez
- Center of Neurological Restoration; Department of Neurology; Cleveland Clinic; Cleveland Ohio USA
| | - Guiyun Wu
- Department of Nuclear Medicine; Cleveland Clinic; Cleveland Ohio USA
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Copeland JN, Lieberman A, Oravivattanakul S, Tröster AI. Accuracy of Patient and Care Partner Identification of Cognitive Impairments in Parkinson's Disease-Mild Cognitive Impairment. Mov Disord 2016; 31:693-8. [DOI: 10.1002/mds.26619] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/25/2016] [Accepted: 02/25/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jacquelynn N. Copeland
- Department of Clinical Neuropsychology; Barrow Neurological Institute; Phoenix Arizona USA
| | - Abraham Lieberman
- Department of Neurology and Muhammad Ali Movement Disorders Center; Barrow Neurological Institute; Phoenix Arizona USA
| | - Srivadee Oravivattanakul
- Department of Neurology and Muhammad Ali Movement Disorders Center; Barrow Neurological Institute; Phoenix Arizona USA
| | - Alexander I. Tröster
- Department of Clinical Neuropsychology; Barrow Neurological Institute; Phoenix Arizona USA
- Center for Neuromodulation; Barrow Neurological Institute; Phoenix Arizona USA
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Oravivattanakul S, Benchaya L, Wu G, Ahmed A, Itin I, Cooper S, Gostkowski M, Rudolph J, Appleby K, Sweeney P, Fernandez HH. Dopamine Transporter (DaT) Scan Utilization in a Movement Disorder Center. Mov Disord Clin Pract 2016; 3:31-35. [PMID: 30363515 PMCID: PMC6178596 DOI: 10.1002/mdc3.12261] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 05/15/2015] [Accepted: 05/15/2015] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The aim of this work was to describe utilization patterns of dopamine transporter (DaT) scan and its influence on patient management at a single movement disorders center. DaT scan helps differentiate between neurodegenerative from non-neurodegenerative parkinsonism and essential tremor (ET). It has been recently approved in the United States in 2011. METHODS We conducted a retrospective review of all patients, observed by movement disorders neurologists, who received a DaT scan. Demographic data, medication use, and prescan diagnosis were collected. RESULTS A total of 216 DaT scans were performed at our center from 1 June 2011 to 31 October 2012. A total of 175 scans were included for analysis. Rates of DaT scan utilization varied from 5 to 33 per 100 new patients observed. When our specialists suspected neurodegenerative parkinsonism before the scan (N = 70), the scan was abnormal in 57%. When non-neurodegenerative parkinsonism was prescan diagnosis (N = 46), the scan was normal in 65%. When essential/dystonic tremor was suspected (N = 14), the scan was normal in 79%. When psychogenic disorder was the prescan diagnosis (N = 15), the scan was normal in only 47%. Only 4% of patients with abnormal scan remained off anti-PD medications, whereas 24% of patients with negative scan were still on anti-PD medications. CONCLUSIONS DaT scan utilization among specialists varied greatly. Scan results correlated most when prescan diagnosis was ET than when working diagnosis was neurodegenerative parkinsonism or other non-neurodegenerative parkinsonism. Scan result was least consistent when prescan diagnosis was psychogenic disorder. Finally, DaT scans influenced medical treatment more when it was abnormal, compared to when it was normal.
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Affiliation(s)
- Srivadee Oravivattanakul
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
- Barrow Neurological InstitutePhoenixArizonaUSA
| | - Lucas Benchaya
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Guiyun Wu
- Department of Nuclear MedicineCleveland ClinicClevelandOhioUSA
| | - Anwar Ahmed
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Ilia Itin
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Scott Cooper
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Michal Gostkowski
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Joseph Rudolph
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Kristin Appleby
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Patrick Sweeney
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
| | - Hubert H. Fernandez
- Center of Neurological RestorationDepartment of NeurologyCleveland ClinicClevelandOhioUSA
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Genc G, Abboud H, Oravivattanakul S, Alsallom F, Thompson NR, Cooper S, Gostkowski M, Machado A, Fernandez HH. Socioeconomic Status May Impact Functional Outcome of Deep Brain Stimulation Surgery in Parkinson's Disease. Neuromodulation 2015; 19:25-30. [DOI: 10.1111/ner.12324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 04/24/2015] [Accepted: 05/13/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Gencer Genc
- Cleveland Clinic, Neurological Institute; Center for Neurological Restoration; Cleveland OH USA
- Department of Neurology; Gumussuyu Military Hospital; Istanbul Turkey
| | - Hesham Abboud
- Cleveland Clinic, Neurological Institute; Center for Neurological Restoration; Cleveland OH USA
| | | | - Faisal Alsallom
- Cleveland Clinic, Neurological Institute; Center for Neurological Restoration; Cleveland OH USA
| | - Nicolas R. Thompson
- Cleveland Clinic, Neurological Institute; Center for Outcomes Research and Evaluation; Cleveland OH USA
| | - Scott Cooper
- Cleveland Clinic, Neurological Institute; Center for Neurological Restoration; Cleveland OH USA
| | - Michal Gostkowski
- Cleveland Clinic, Neurological Institute; Center for Neurological Restoration; Cleveland OH USA
| | - Andre Machado
- Cleveland Clinic, Neurological Institute; Center for Neurological Restoration; Cleveland OH USA
| | - Hubert H. Fernandez
- Cleveland Clinic, Neurological Institute; Center for Neurological Restoration; Cleveland OH USA
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Abboud H, Floden D, Thompson NR, Genc G, Oravivattanakul S, Alsallom F, Swa B, Kubu C, Pandya M, Gostkowski M, Cooper S, Machado AG, Fernandez HH. Impact of mild cognitive impairment on outcome following deep brain stimulation surgery for Parkinson's disease. Parkinsonism Relat Disord 2015; 21:249-53. [DOI: 10.1016/j.parkreldis.2014.12.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/03/2014] [Accepted: 12/21/2014] [Indexed: 10/24/2022]
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Mehanna R, Machado AG, Oravivattanakul S, Genc G, Cooper SE. Comparing Two Deep Brain Stimulation Leads to One in Refractory Tremor. Cerebellum 2014; 13:425-32. [DOI: 10.1007/s12311-014-0552-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Affiliation(s)
- Srivadee Oravivattanakul
- Department of Radiology, Diagnostic Radiology, University Hospitals Neurological Institute, Cleveland, OH, USA
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Chiowanich P, Kanjanabuch T, Oravivattanakul S, Wiwanitkit V. Prevalence and risk factors of microalbuminuria in patient with diabetic mellitus at northern part referral hospital in Thailand. Diabetes Metab Syndr 2009. [DOI: 10.1016/j.dsx.2009.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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