Search Results

You are looking at 1 - 2 of 2 items for

  • Author or Editor: Brian G. Wilhelmi x
Clear All Modify Search
Restricted access

Nikolas R. Monteferrante, Brian G. Wilhelmi, Margaret Lambert and Francisco A. Ponce

OBJECTIVE

Deep brain stimulation (DBS) is a well-established therapy for treating neurological movement disorders. Some patients who have received DBS therapy have noticed significant weight gain. Further investigation into correlations between patient characteristics and weight gain following DBS device implantation, which the authors here have done, will provide physicians with useful clinical information.

METHODS

The authors performed a retrospective study of patients with Parkinson’s disease (PD) and essential tremor (ET) who had received DBS therapy in the period from 2012 to 2017. Patient weights had been recorded preoperatively and at 3, 6, and 12 months postoperatively. These data were used to compare patient characteristics, including diagnosis, body mass index (BMI), sex, levodopa equivalent dose (LED), and change in Unified Parkinson’s Disease Rating Scale (UPDRS) score. For PD patients, a quantile multivariate regression analysis was used to examine whether significant correlations existed between several of these patient characteristics, as well as age and weight gain following implantation.

RESULTS

PD patients had gained a significant amount of weight at 3 months (mean [SE] 2.66 [0.428] kg, p < 0.001), 6 months (3.64 [0.492] kg, p < 0.001), and 12 months (4.18 [0.540] kg, p < 0.001) after DBS placement. Patients who had undergone subthalamic nucleus (STN) DBS device placement gained, on average, more weight than the patients with globus pallidus internus (GPi) placement at both 6 months (mean 2.558 [1.020] kg, p = 0.01) and 12 months (2.358 [1.130] kg, p = 0.04). BMI in the STN cohort was greater than that in the GPi cohort at 6 months (mean difference [SE] 2.60 [1.127] kg/m2, p = 0.02) and at 12 months (2.36 [1.112] kg/m2, p = 0.04). A reduction in LED was negatively correlated with weight change at 6 months (r = −0.33, p < 0.001) and 12 months (r = −0.41, p < 0.001). There was no weight gain correlated with DBS therapy for ET.

CONCLUSIONS

PD patients experienced a significant change in weight over time after DBS therapy, whereas ET patients did not. PD patients with an STN target site experienced greater weight gain, on average, than those with a GPi target site. Furthermore, there was a significant increase in BMI at 6 and 12 months in patients with an STN target compared to that in patients with a GPi target. PD patients whose LED was reduced after DBS gained more weight at 6 and 12 months after surgery than the patients whose LED was kept at the same level or increased.

Restricted access

Aaron A. Cohen-Gadol, Brian G. Wilhelmi, Frederic Collignon, J. Bradley White, Jeffrey W. Britton, Denise M. Cambier, Teresa J. H. Christianson, W. Richard Marsh, Fredric B. Meyer and Gregory D. Cascino

Object

The authors reviewed the long-term outcome of focal resection in a large group of patients who had intractable partial nonlesional epilepsy, including mesial temporal lobe sclerosis (MTS), and who were treated consecutively at a single institution. The goal of this study was to evaluate the long-term efficacy of epilepsy surgery and the preoperative factors associated with seizure outcome.

Methods

This retrospective analysis included 399 consecutive patients who underwent epilepsy surgery at Mayo Clinic in Rochester, Minnesota, between 1988 and 1996. The mean age of the patients at surgery was 32 ± 12 years (range 3–69 years), and the mean age at seizure onset was 12 ± 11 years (range 0–55 years). There were 214 female (54%) and 185 male (46%) patients. The mean duration of epilepsy was 20 ±12 years (range 1–56 years). The preceding values are given as the mean ± standard deviation.

Of the 399 patients, 237 (59%) had a history of complex partial seizures, 119 (30%) had generalized seizures, 26 (6%) had simple partial seizures, and 17 (4%) had experienced a combination of these. Preoperative evaluation included a routine and video-electroencephalography recordings, magnetic resonance imaging of the head according to the seizure protocol, neuropsychological testing, and a sodium amobarbital study. Patients with an undefined epileptogenic focus and discordant preoperative studies underwent an intracranial study. The mean duration of follow up was 6.2 ± 4.5 years (range 0.6–15.7 years). Seizure outcome was categorized based on the modified Engel classification. Time-to-event analysis was performed using Kaplan–Meier curves and Cox regression models to evaluate the risk factors associated with outcomes.

Among these patients, 372 (93%) underwent temporal and 27 (7%) had extratemporal resection of their epileptogenic focus. Histopathological examination of the resected specimens revealed MTS in 113 patients (28%), gliosis in 237 (59%), and normal findings in 49 (12%). Based on the Kaplan–Meier analysis, the probability of an Engel Class I outcome (seizure free, auras, or seizures related only to medication withdrawal) for the overall patient group was 81% (95% confidence interval [CI] 77–85%) at 6 months, 78% (CI 74–82%) at 1 year, 76% (CI 72–80%) at 2 years, 74% (CI 69–78%) at 5 years, and 72% (CI 67–77%) at 10 years postoperatively. The rate of Class I outcomes remained 72% for 73 patients with more than 10 years of follow up. If a patient was in Class I at 1 year postoperatively, the probability of seizure remission at 10 years postoperatively was 92% (95% CI 89–96%); almost all seizures occurred during the 1st year after surgery. Factors predictive of poor outcome from surgery were normal pathological findings in resected tissue (p = 0.038), male sex (p = 0.035), previous surgery (p < 0.001), and an extratemporal origin of seizures (p < 0.001).

Conclusions

The response to epilepsy surgery during the 1st follow-up year is a reliable indicator of the long-term Engel Class I postoperative outcome. This finding may have important implications for patient counseling and postoperative discontinuation of anticonvulsant medications.