Biomedical subjects

William Ondo

Publications and source records attributed to William Ondo.

5 recordsLinked to original sources

PubMed2006

VIM deep brain stimulation does not improve pre-existing restless legs syndrome in patients with essential tremor.

The neuroanatomic substrate for restless legs syndrome (RLS) is not known. We implanted deep brain stimulators into the ventralis intermedius nucleus (VIM) of the thalamus in nine subjects for essential tremor (ET) whom all concurrently had RLS. Although the VIM DBS improved tremor, none of the subjects felt there was any meaningful effect on their RLS symptoms. The VIM thalamus, which is involved in ET and Parkinson's disease, does not seem to be primarily involved in RLS.

Aged↗

PubMed2006

International multicenter pilot study of the first comprehensive self-completed nonmotor symptoms questionnaire for Parkinson's disease: the NMSQuest study.

Nonmotor symptoms (NMS) of Parkinson's disease (PD) are not well recognized in clinical practice, either in primary or in secondary care, and are frequently missed during routine consultations. There is no single instrument (questionnaire or scale) that enables a comprehensive assessment of the range of NMS in PD both for the identification of problems and for the measurement of outcome. Against this background, a multidisciplinary group of experts, including patient group representatives, has developed an NMS screening questionnaire comprising 30 items. This instrument does not provide an overall score of disability and is not a graded or rating instrument. Instead, it is a screening tool designed to draw attention to the presence of NMS and initiate further investigation. In this article, we present the results from an international pilot study assessing feasibility, validity, and acceptability of a nonmotor questionnaire (NMSQuest). Data from 123 PD patients and 96 controls were analyzed. NMS were highly significantly more prevalent in PD compared to controls (PD NMS, median = 9.0, mean = 9.5 vs. control NMS, median = 5.5, mean = 4.0; Mann-Whitney, Kruskal-Wallis, and t test, P < 0.0001), with PD patients reporting at least 10 different NMS on average per patient. In PD, NMS were highly significantly more prevalent across all disease stages and the number of symptoms correlated significantly with advancing disease and duration of disease. Furthermore, frequently, problems such as diplopia, dribbling, apathy, blues, taste and smell problems were never previously disclosed to the health professionals.

Aged↗

PubMed2006

Deep brain stimulation: preoperative issues.

Numerous factors need to be taken into account in deciding whether a patient with Parkinson's disease (PD) is a candidate for deep brain stimulation. Patient-related personal factors including age and the presence of other comorbid disorders need to be considered. Neuropsychological and neuropsychiatric concerns relate both to the presurgical status of the patient and to the potential for surgery to result in new problems postoperatively. A number of factors related to the underlying PD need to be considered, including the specific parkinsonian motor indications (e.g., tremor, bradykinesia, gait dysfunction), previous medical therapies, including benefit from current therapy and adverse effects, and past surgical treatments. Definable causes of Parkinsonism, particularly atypical Parkinsonisms, should be considered. Finally, methods of evaluating outcomes should be defined and formalized. This is a report from the Consensus on Deep Brain Stimulation for Parkinson's Disease, a project commissioned by the Congress of Neurological Surgeons and the Movement Disorder Society (MDS). The report has been endorsed by the Scientific Issues Committee of the MDS and the American Society of Stereotactic and Functional Neurosurgery. It outlines answers to a series of questions developed to address all aspects of deep brain stimulation preoperative decision-making.

Brain↗

PubMed2004

Long-term treatment of restless legs syndrome with dopamine agonists.

BACKGROUND: Controlled clinical trials robustly demonstrate the short-term efficacy of dopamine agonists (DA) for restless legs syndrome (RLS), but little is known about the long-term efficacy and long-term adverse events. Augmentation-an increase in the duration, intensity, and anatomy of RLS symptoms-is commonly associated with dopaminergic treatments; however, risk factors for this troubling scenario have not been formally evaluated. OBJECTIVES: To evaluate the long-term efficacy and tolerability of DA for RLS and to evaluate factors that could predict the occurrence of augmentation. METHODS: We queried all subjects seen from 1996 to 2003 and followed up those initiated on any DA by the Baylor College of Medicine Movement Disorders Clinic, Houston, Tex. Patients with Parkinson disease, uremia, or medications that could affect RLS were excluded. Demographics, efficacy, dosing, adverse events, and augmentation were tracked across time. Statistical modeling was used to evaluate for factors that could predict augmentation. RESULTS: After eliminating all patients with RLS who had factors that could affect DA dosing or the accuracy of data, we observed 83 subjects with at least 6 months' use of DA (mean +/- SD, 39.2 +/- 20.9 months). Efficacy was maintained across time but at the expense of moderate but significant increases in doses (P<.01). Adverse events were frequent but usually mild and seldom resulted in discontinuation. Augmentation was frequent (48% of subjects) but usually modest, and it was predicted by a positive family history for RLS and especially the lack of any neuropathy on electromyographic or nerve conduction velocity tests. CONCLUSIONS: Dopamine agonists continued to effectively treat RLS without long-term adverse events but often required adjustments across time. The higher rate of augmentation in familial and nonneuropathic RLS should be considered when initiating therapy.

Dopamine Agonists↗

PubMed2003

Gait and balance disorders.

Gait disorders can be seen in a wide variety of neurologic, musculoskeletal, and medical problems. In all cases, careful examination of gait and balance is paramount to the correct diagnosis. Ancillary gait laboratory analyses are helpful in some occasions. In most cases, treatment depends on the specific diagnosis, although some simple techniques may help poor balance in general. Because treatment is so dependent on the underlying etiology, this article mostly concerns diagnosis and provides descriptive case studies.

Adult↗