Clinical Neuroscience

[Earlier and more efficiently: the role of deep brain stimulation for parkinson’s disease preserving the working capabilities]

DELI Gabriella1, BALÁS István1, KOMOLY Sámuel1, DÓCZI Tamás2,3, JANSZKY József1,3, ASCHERMANN Zsuzsanna1, NAGY Ferenc1,4, BOSNYÁK Edit1, KOVÁCS Norbert1,3

NOVEMBER 20, 2015

Clinical Neuroscience - 2015;68(11-12)

DOI: https://doi.org/10.18071/isz.68.384

[Background – The recently published “EarlyStim” study demonstrated that deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD) with early fluctuations is superior to the optimal pharmacological treatment in improving the quality of life and motor symptoms, and preserving sociocultural position. Our retrospective investigation aimed to evaluate if DBS therapy was able to preserve the working capabilities of our patients. Methods – We reviewed the data of 39 young (<60 years-old) PD patients who underwent subthalamic DBS implantation at University of Pécs and had at least two years follow-up. Patients were categorized into two groups based on their working capabilities: Patients with active job (“Job+” group, n=15) and retired patients (without active job, “Job-” group, n=24). Severity of motor symptoms (UPDRS part 3), quality of life (EQ-5D) and presence of active job were evaluated one and two years after the operation. Results – As far as the severity of motor symptoms were concerned, similar (approximately 50%) improvement was achieved in both groups. However, the postoperative quality of life was significantly better in the Job+ group. Majority (12/15, 80%) of Job+ group members were able to preserve their job two years after the operation. However, only a minimal portion (1/24, 4.2%) of the Job- group members was able to return to the world of active employees (p<0.01, McNemar test). Conclusion – Although our retrospective study has several limitations, our results fit well with the conclusions of “EarlyStim” study. Both of them suggest that with optimal timing of DBS implantation we may preserve the working capabilities of our patients.]

AFFILIATIONS

  1. Pécsi Tudományegyetem, Neurológiai Klinika, Pécs
  2. Pécsi Tudományegyetem, Idegsebészeti Klinika, Pécs
  3. MTA-PTE Klinikai Idegtudományi Képalkotó Kutatócsoport, Budapest
  4. Kaposi Mór Megyei Kórház, Neurológiai Osztály, Kaposvár

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[Introduction – Mentalization is the ability to attribute mental states (intentions, desires, thoughts, emotions) to others, and hence to predict their behaviour. This ability fundamentally determines our participation in social relationships and adaptation to society. A significant proportion of the disorders of the central nervous system (CNS) affects those brain structures and neurotransmitter systems that play a role in the mentalizing processes. Accordingly, a number of CNS disorders may be associated with mentalizing deficits, which may affect the outcome of these diseases. Here, we review recent research on mentalizing abilities in neurological diseases. Methods – An internet database search was performed to identify publications on the subject. Results – Sixty-two publications in English corresponded to the search criteria. These publications reported impaired mentalization in several neurological disorders (e.g. epilepsy, Parkinson’s disease, multiple sclerosis, dementias, traumatic brain injury). Discussion – The results indicate that a number of neurological disorders associate with mentalizing deficit. This deficit is often present in the early stages of the diseases and has a prognostic value, which in turn emphasizes the importance of the early detection and adequate rehabilitation.]

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[Background and purpose – Many studies confirm the relationship between attachment disturbances and (the severity of) eating disorders, however among them only one Hungarian study can be found. The exact predisposing traits of attachment and the strength of relationship is still uncleared. Our aim was to explore these aspects. Methods – Study was based on a cross-sectional nationally representative survey, called „Hungarostudy 2013” (N=2000, 46.9% males, mean age 46.9 years, SD=18.24 years). Measures: Sociodemographic and self-reported anthropometric data (weight and height), short Hungarian version of Relationship Scale Questionnaire, SCOFF questionnaire and short Hungarian version of Beck Depression Inventory. Results – The frequency of risk for eating disorders (anorexia or bulimia nervosa) was 3.9% (N=76) among the respondents (N=1860). Attachment anxiety was significantly higher in the risk for eating disorders group (t(1888)=-3.939, p<0.001), and significantly predicted the risk for eating disorders after adjusting for the potential background variables (OR=1.09, p=0.040). Detachment was not a significant predictor of risk for eating disorders (OR=0.98, p=0.515). Younger age (OR=0.97, p<0.001), higher level of depression (OR=1.09, p<0.001) and higher body mass index (OR=1.08, p<0.001) were also significant cross-sectional predictors of risk for eating disorders. The explained variance of the model was 10.7%. Conclusion – The study supported, that higher attachment anxiety is associated with the increased risk of eating disorders, with a possible therapeutic relevance. Assessment of attachment’s further aspects and creating multivariable models are required for more thorough understanding and optimising of intervention points.]

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