Bladder function in patients with dystonia undergoing deep brain stimulation

INTRODUCTION Neurogenic bladder dysfunction is well described in Parkinson's disease and has a major impact on quality of live. In contrast, little is known about the extent of urinary symptoms in other movement disorders such as dystonia and about the role of the basal ganglia in bladder control.. PATIENTS AND METHODS A consecutive series of 11 patients with severe dystonia undergoing deep brain stimulation (DBS) of the globus pallidus internus was prospectively enrolled. Bladder function was assessed by the International Prostate Symptom Score and urodynamic investigation (UDI) before DBS surgery and afterwards in the conditions with and without DBS. RESULTS In UDI before DBS surgery, detrusor overactivity was found in 36% (4/11) of dystonia patients. With pallidal DBS ON, maximum flow rate significantly decreased, post-void residual significantly increased and detrusor overactivity disappeared.. CONCLUSIONS Pathological urodynamic changes can be found in a relevant percentage of dystonia patients. Pallidal DBS has a relaxing effect on detrusor function indicating a role of the basal ganglia in lower urinary tract control. Thus, a better understanding on how subcortical networks influence lower urinary tract function might open new therapeutic perspectives..

Using MDEFT MRI Sequences to Target the GPi in DBS Surgery.

OBJECTIVE Recent advances in different MRI sequences have enabled direct visualization and targeting of the Globus pallidus internus (GPi) for DBS surgery. Modified Driven Equilibrium Fourier Transform (MDEFT) MRI sequences provide high spatial resolution and an excellent contrast of the basal ganglia with low distortion. In this study, we investigate if MDEFT sequences yield accurate and reliable targeting of the GPi and compare direct targeting based on MDEFT sequences with atlas-based targeting. METHODS 13 consecutive patients considered for bilateral GPi-DBS for dystonia or PD were included in this study. Preoperative targeting of the GPi was performed visually based on MDEFT sequences as well as by using standard atlas coordinates. Postoperative CT imaging was performed to calculate the location of the implanted leads as well as the active electrode(s). The coordinates of both visual and atlas based targets were compared. The stereotactic coordinates of the lead and active electrode(s) were calculated and projected on the segmented GPi. RESULTS On MDEFT sequences the GPi was well demarcated in most patients. Compared to atlas-based planning the mean target coordinates were located significantly more posterior. Subgroup analysis showed a significant difference in the lateral coordinate between dystonia (LAT = 19.33 ± 0.90) and PD patients (LAT = 20.67 ± 1.69). Projected on the segmented preoperative GPi the active contacts of the DBS electrode in both dystonia and PD patients were located in the inferior and posterior part of the structure corresponding to the motor part of the GPi. CONCLUSIONS MDEFT MRI sequences provide high spatial resolution and an excellent contrast enabling precise identification and direct visual targeting of the GPi. Compared to atlas-based targeting, it resulted in a significantly different mean location of our target. Furthermore, we observed a significant variability of the target among the PD and dystonia subpopulation suggesting accurate targeting for each individual patient.

Neogene planktonic foraminifera of ODP Site 130-806

The Neogene biostratigraphy presented here is based on the study of 230 samples through 737 m of pelagic sediment in Hole 806B. Sediment accumulation is interrupted only once in the uppermost lower Miocene (Zone N6), apparently coincident with a widespread deep-sea hiatus. Preservation of planktonic foraminifers through the section ranges from good to moderately poor. One hundred and ten species of planktonic foraminifers were identified; taxonomic notes on most species are included. All of the standard low-latitude Neogene foraminiferal zones are delineated, with the exceptions of Zones N8 and N9 because of a high first occurrence of Orbulina, and Zones N18 and N19 because of a high first occurrence of Sphaeroidinella dehiscens. Good agreement exists between the published account of the variation in planktonic foraminiferal species richness and the rates of diversification and turnover, and measurements of these evolutionary indexes in the record of Hole 806B. The global pattern of change in tropical/transitional species richness is paralleled in Hole 806B, with departures caused by either ecological conditions peculiar to the western equatorial Pacific or by inexactness in the estimation of million-year intervals in Hole 806B. Temporal changes in the relative abundance of taxa in the sediment assemblages, considered in light of their depth habitats, reveal a detailed picture of historical change in the structure of the upper water column over the Ontong Java Plateau. The dominance of surface dwellers (Paragloborotalia kugleri, P. mayeri, Dentoglobigerina altispira, Globigerinita glutinata, and Globigerinoides spp.) throughout the lower and middle Miocene is replaced by a more equitable distribution of surface (D. altispira and Globigerinoides spp.), intermediate (Globorotalia menardii plexus), and deep (Streptochilus spp.) dwellers in the late Miocene, following the closing of the Indo-Pacific Seaway and the initiation of large-scale glaciation in the Antarctic. The shoaling of the thermocline along the equator engendered by these climatic and tectonic events persisted through the Pliocene, when initial increases in the abundance of a new set of shallow, intermediate, and deep dwelling species of planktonic foraminifers coincide with the closing of the Panamanian Seaway.