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This article is from Surgical Neurology International , volume 4 . Abstract Background:: Subthalamic nucleus deep brain stimulation is effective in reducing motor symptoms in appropriately selected patients with Parkinson's disease. We identified factors that contribute to poor outcomes during early, middle and late stages of stimulation management in a series of patients that were referred for troubleshooting poor outcomes. Methods:: We performed a retrospective review of 50 patients with bilateral STN DBS seen in our movement disorders clinic with unsatisfactory clinical response and/or patient dissatisfaction with deep brain stimulation outcome. All patients underwent a systematic evaluation to assess the primary cause of suboptimal outcome including lead position, hardware integrity, patient selection, patient expectations, effective use of stimulation settings, and pre- and postoperative levodopa responsive symptoms. The data was also analyzed by duration of stimulation to determine if these factors varied by stage of DBS management. Results:: Our series included patients implanted 4-68 months. We identified the following primary factors impacting outcome: Suboptimal stimulation settings (52%), disease progression (16%), inappropriate patient selection (10%), hardware damage (8%), lead malposition (8%), met expected motor outcomes (6%). Lead revision surgery occurred in 14%. Reversible factors accounted for dissatisfaction in 74%. Suboptimal stimulation was the dominant factor affecting outcomes in early and long-term management phases. Conclusion:: STN DBS outcomes can be improved even years after implantation. Stimulation parameters warrant investigation throughout the continuum of DBS management as a reversible cause of poor outcomes.

This article is from PLoS ONE , volume 9 . Abstract Background/Aims: Deep brain stimulation (DBS) implant infection is a feared complication, as it is difficult to manage and leads to increased patient morbidity. We wanted to assess the frequency and possible risk factors of DBS related infections at our centre. In the purpose of evaluating treatment options, we also analyzed treatment, and the clinical and microbiological characteristics of the infections. Methods: Electronic medical records of all patients undergoing DBS surgery at our centre, from 2001 through 2010, were retrospectively reviewed. Results: Of the 588 procedures performed 33 (5.6%) led to an infection. Some patients underwent several procedures, thus 32 out of totally 368 patients (8.7%), and 19 out of 285 patients (6.7%) who received primary lead implantation, developed an infection. Most infections (52%) developed within the first month and 79% within three months. In the majority of the infections (79%) hardware removal was performed. Staphylococcus aureus infections were the most frequent (36%), and more likely to have earlier onset, pus formation, a more aggressive development and lead to hardware removal. No risk factors were identified. Conclusions: Our results indicate that infections with more severe symptoms and growth of staphylococcus aureus should be treated with local hardware removal and antibiotic therapy. In other infections, an initial trial of antibiotic treatment could be considered. New knowledge about the microbiology of DBS related infections may lead to more effective antimicrobial treatment.

This article is from Indian Journal of Anaesthesia , volume 58 . Abstract A 63-year-old man with severe Parkinson's disease (PD) who had been implanted with deep brain stimulators into both sides underwent radical nephrectomy under general anaesthesia with standard monitoring. Deep brain stimulation (DBS) is an alternative and effective treatment option for severe and refractory PD and other illnesses such as essential tremor and intractable epilepsy. Anaesthesia in the patients with implanted neurostimulator requires special consideration because of the interaction between neurostimulator and the diathermy. The diathermy can damage the brain tissue at the site of electrode. There are no standard guidelines for the anaesthetic management of a patient with DBS electrode in situ posted for surgery.

This article is from Indian Journal of Anaesthesia , volume 58 . Abstract A 63-year-old man with severe Parkinson's disease (PD) who had been implanted with deep brain stimulators into both sides underwent radical nephrectomy under general anaesthesia with standard monitoring. Deep brain stimulation (DBS) is an alternative and effective treatment option for severe and refractory PD and other illnesses such as essential tremor and intractable epilepsy. Anaesthesia in the patients with implanted neurostimulator requires special consideration because of the interaction between neurostimulator and the diathermy. The diathermy can damage the brain tissue at the site of electrode. There are no standard guidelines for the anaesthetic management of a patient with DBS electrode in situ posted for surgery.

1Plastic Age

By Percy Marks

The Plastic Age (1924) is a novel by Percy Marks, which tells the story of co-eds at a fictional college called Sanford. With contents that covered or implied hazing, partying, and "petting", the book sold well enough to be the second best-selling novel of 1924. The following year, it was adapted into a film of the same name, starring Clara Bow. (Introduction from Wikipedia)

2Little Busybodies: The Life of Crickets, Ants, Bees, and Others

By Jeannette Augustus Marks and Julia Moody

These short stories about crickets, ants, bees, beetles and other little busybodies are intended by the two authors to show their children the wonderland of insectcs if we just take the time to look closely. "We hope that you will realize that more wonderful than the most wonderful fairy story ever told is the marvel of the created life of these little insects; we want you to come to know something of their joys and troubles; we want you to learn how to be kind to them, and how they may be useful to you; and we want you to find out for yourselves the places they take in the great plan of creation." The authors speak to their own children in each story and through them to children of all ages to come. A fun book so jump right in! Don't let the crickets have all the fun. - Summary by The authors and phil chenevert

3Early English Hero Tales

By Jeannette Augustus Marks

Supposing you were asked to enter a Great Palace? And within that palace, you were told, were more than a thousand golden doors? And those doors opened into rooms and upon gardens and balconies, all of which were the most beautiful of palace rooms and gardens? And some were more beautiful than anything the world had ever known before? Do you think you would go through the gate to that palace? And if you were told that in the palace were lamps so bright that they lighted not only the palace, but cast a glow over the whole world? And that these lamps hung from chains the ends of which you could not see, just as Pryderi was not able to see the ends of the hanging golden chains in the palace which he entered? And once within the Great Palace you were not only better for being there, but also happier and stronger and more beautiful, and never any more could you be lonely? It sounds like an Aladdin's lamp, does it not, which, once seen and touched, could bring so much beauty and power into our lives! Indeed, it is Aladdin's lamp—the lamp of men's minds and souls. And the Great Palace is the Palace of English Literature. - Summary by From the introduction