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Baldermann JC, Hardenacke K, Hu X, Köster P, Horn A, Freund HJ, Zilles K, Sturm V, Visser-Vandewalle V, Jessen F, Maintz D, Kuhn J. Neuroanatomical Characteristics Associated With Response to Deep Brain Stimulation of the Nucleus Basalis of Meynert for Alzheimer's Disease. Neuromodulation 2017; 21:184-190. [PMID: 28653404 DOI: 10.1111/ner.12626] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/16/2017] [Accepted: 05/04/2017] [Indexed: 01/18/2023]
Abstract
OBJECTIVES First reports on the application of deep brain stimulation (DBS) of the Nucleus basalis of Meynert (NBM) showed feasibility and safety of the intervention in patients with Alzheimer´s disease. However, clinical effects vary and the mechanisms of actions are still not well understood. The aim of this study was to characterize neuroimaging changes that are associated with the responsiveness to the treatment. MATERIALS AND METHODS We examined preoperative T1-weighted MR images of ten patients with Alzheimer's disease (AD) treated with DBS of the NBM and correlated the clinical outcome with volumetric differences of cortical thickness. Subsequently, we sought to identify brain regions that carry out the clinical effects by correlating the outcome with streamlines connected to the volume of activated tissue. Clinical assessments at baseline, 6 and 12 months after the intervention included the AD Assessment Scale as well as the mini mental status examination. RESULTS A fronto-parieto-temporal pattern of cortical thickness was found to be associated with beneficial outcome. Modulation of streamlines connected to left parietal and opercular cortices was associated with better response to the intervention. CONCLUSION Our results indicate that patients with less advanced atrophy may profit from DBS of the NBM. We conclude that beneficial effects of the intervention are related to preserved fronto-parieto-temporal interplay.
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Affiliation(s)
- Juan Carlos Baldermann
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Katja Hardenacke
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Xiaochen Hu
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Phillip Köster
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
| | - Andreas Horn
- Department of Neurology, Charité - University Medicine (CVK), Berlin, Germany
| | | | - Karl Zilles
- Research Centre Juelich, Institute of Neuroscience and Medicine, Juelich, Germany.,University Hospital of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - Volker Sturm
- Department of Stereotactic and Functional Neurosurgery, University of Cologne, Cologne, Germany
| | | | - Frank Jessen
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - David Maintz
- Department for Radiology, University of Cologne, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne, Cologne, Germany
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Baldermann J, Hardenacke K, Zilles K, Freund HJ, Visser-Vandewalle V, Sturm V, Jessen F, Kuhn J. EP 17. Preserved frontoparietal brain morphology correlates with beneficial response to deep brain stimulation of the Nucleus basalis of Meynert in patients with Alzheimer’s disease. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2016.05.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hardenacke K, Hashemiyoon R, Visser-Vandewalle V, Zapf A, Freund HJ, Sturm V, Hellmich M, Kuhn J. Deep Brain Stimulation of the Nucleus Basalis of Meynert in Alzheimer's Dementia: Potential Predictors of Cognitive Change and Results of a Long-Term Follow-Up in Eight Patients. Brain Stimul 2016; 9:799-800. [PMID: 27522168 DOI: 10.1016/j.brs.2016.05.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/30/2016] [Indexed: 12/28/2022] Open
Affiliation(s)
- K Hardenacke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - R Hashemiyoon
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - V Visser-Vandewalle
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - A Zapf
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - H J Freund
- Research Centre Juelich, Institute of Neuroscience and Medicine (INM-1), Juelich, Germany
| | - V Sturm
- Department of Neurosurgery, University Clinic of Würzburg, Würzburg, Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - J Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany.
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Noreik M, Kuhn J, Hardenacke K, Lenartz D, Bauer A, Bührle CP, Häussermann P, Hellmich M, Klosterkötter J, Wiltfang J, Maarouf M, Freund HJ, Visser-Vandewalle V, Sturm V, Schulz RJ. Changes in Nutritional Status after Deep Brain Stimulation of the Nucleus Basalis of Meynert in Alzheimer's Disease--Results of a Phase I Study. J Nutr Health Aging 2015; 19:812-8. [PMID: 26412285 DOI: 10.1007/s12603-015-0595-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The progression of Alzheimer's disease (AD) is associated with impaired nutritional status. New methods, such as deep brain stimulation (DBS), are currently being tested to decrease the progression of AD. DBS is an approved method in the treatment of Parkinson's disease, and its suitability for the treatment of AD patients is currently under experimental investigation. To evaluate the advantages and disadvantages of this new treatment, it is important to assess potential side effects of DBS regarding the nucleus basalis of Meynert; this new treatment is thought to positively affect cognition and might counteract the deterioration of nutritional status and progressive weight loss observed in AD. This study aims to assess the nutritional status of patients with AD before receiving DBS of the nucleus basalis of Meynert and after 1 year, and to analyze potential associations between changes in cognition and nutritional status. DESIGN A 1-year phase I proof-of-concept study. SETTING The Department of Psychiatry and Psychotherapy at the University of Cologne. PARTICIPANTS We assessed a consecutive sample of patients with mild to moderate AD (n=6) who fulfilled the inclusion criteria and provided written informed consent. INTERVENTION Bilateral low-frequency DBS of the nucleus basalis of Meynert. MEASUREMENTS Nutritional status was assessed using a modified Mini Nutritional Assessment, bioelectrical impedance analysis, a completed 3-day food diary, and analysis of serum levels of vitamin B12 and folate. RESULTS With a normal body mass index (BMI) at baseline (mean 23.75 kg/m²) and after 1 year (mean 24.59 kg/m²), all but one patient gained body weight during the period of the pilot study (mean 2.38 kg, 3.81% of body weight). This was reflected in a mainly stable or improved body composition, assessed by bioelectrical impedance analysis, in five of the six patients. Mean energy intake increased from 1534 kcal/day (min 1037, max 2370) at baseline to 1736 kcal/day (min 1010, max 2663) after 1 year, leading to the improved fulfillment of energy needs in four patients. The only nutritional factors that were associated with changes in cognition were vitamin B12 level at baseline (Spearman's rho = 0.943, p = 0.005) and changes in vitamin B12 level (Spearman's rho = -0.829, p = 0.042). CONCLUSION Patients with AD that received DBS of the nucleus basalis of Meynert demonstrated a mainly stable nutritional status within a 1-year period. Whether DBS is causative regarding these observations must be investigated in additional studies.
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Affiliation(s)
- M Noreik
- M. Noreik, University of Cologne, Medical Faculty, Geriatrics Department, Cologne, Germany,
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Kuhn J, Hardenacke K, Shubina E, Lenartz D, Visser-Vandewalle V, Zilles K, Sturm V, Freund HJ. Deep Brain Stimulation of the Nucleus Basalis of Meynert in Early Stage of Alzheimer's Dementia. Brain Stimul 2015; 8:838-9. [PMID: 25991080 DOI: 10.1016/j.brs.2015.04.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 03/26/2015] [Accepted: 04/07/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Jens Kuhn
- University of Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany.
| | - Katja Hardenacke
- University of Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Elena Shubina
- University of Cologne, Department of Psychiatry and Psychotherapy, Cologne, Germany
| | - Doris Lenartz
- University of Cologne, Department of Functional Neurosurgery and Stereotaxy, Cologne, Germany
| | | | - Karl Zilles
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
| | - Volker Sturm
- University Clinic of Würzburg, Department of Neurosurgery, Würzburg, Germany
| | - Hans-Joachim Freund
- Institute of Neuroscience and Medicine (INM-1), Research Centre Juelich, Juelich, Germany
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Lee H, Kuhn J, Hardenacke K, Gruendler T, Schueller T, Sturm V, Fell J, Axmacher N. Effects of deep brain stimulation of the nucleus basalis of Meynert in EEG resting-state oscillatory power and phase synchronization. Brain Stimul 2015. [DOI: 10.1016/j.brs.2015.01.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Kuhn J, Hardenacke K, Lenartz D, Gruendler T, Ullsperger M, Bartsch C, Mai JK, Zilles K, Bauer A, Matusch A, Schulz RJ, Noreik M, Bührle CP, Maintz D, Woopen C, Häussermann P, Hellmich M, Klosterkötter J, Wiltfang J, Maarouf M, Freund HJ, Sturm V. Deep brain stimulation of the nucleus basalis of Meynert in Alzheimer's dementia. Mol Psychiatry 2015; 20:353-60. [PMID: 24798585 DOI: 10.1038/mp.2014.32] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/06/2014] [Accepted: 02/24/2014] [Indexed: 11/09/2022]
Abstract
Cholinergic neurons of the medial forebrain are considered important contributors to brain plasticity and neuromodulation. A reduction of cholinergic innervation can lead to pathophysiological changes of neurotransmission and is observed in Alzheimer's disease. Here we report on six patients with mild to moderate Alzheimer's disease (AD) treated with bilateral low-frequency deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM). During a four-week double-blind sham-controlled phase and a subsequent 11-month follow-up open label period, clinical outcome was assessed by neuropsychological examination using the Alzheimer's Disease Assessment Scale-cognitive subscale as the primary outcome measure. Electroencephalography and [(18)F]-fluoro-desoxyglucose positron emission tomography were, besides others, secondary endpoints. On the basis of stable or improved primary outcome parameters twelve months after surgery, four of the six patients were considered responders. No severe or non-transitional side effects related to the stimulation were observed. Taking into account all limitations of a pilot study, we conclude that DBS of the NBM is both technically feasible and well tolerated.
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Affiliation(s)
- J Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - K Hardenacke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - D Lenartz
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - T Gruendler
- 1] Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany [2] Faculty of Economics, Otto-von-Guericke University Magdeburg, Magdeburg, Germany [3] Center for Behavioral Brain Sciences, Magdeburg, Germany
| | - M Ullsperger
- 1] Center for Behavioral Brain Sciences, Magdeburg, Germany [2] Institute of Psychology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - C Bartsch
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - J K Mai
- Department of Neuroanatomy, University of Düsseldorf, Düsseldorf, Germany
| | - K Zilles
- 1] Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany [2] University Hospital of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Aachen, Germany
| | - A Bauer
- 1] Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany [2] Department of Neurology, Medical Faculty, University of Düsseldorf, Düsseldorf, Germany
| | - A Matusch
- Institute of Neuroscience and Medicine, Research Centre Juelich, Juelich, Germany
| | - R-J Schulz
- University of Cologne, Department of Geriatrics and St. Marien-Hospital, Cologne, Germany
| | - M Noreik
- University of Cologne, Department of Geriatrics and St. Marien-Hospital, Cologne, Germany
| | - C P Bührle
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
| | - D Maintz
- University of Cologne, Department for Radiology, Cologne, Germany
| | - C Woopen
- University of Cologne, Research Unit Ethics, Institute for the History of Medicine and Medical Ethics, Cologne, Germany
| | - P Häussermann
- LVR Clinic Cologne, Department of Gerontopsychiatry, Cologne, Germany
| | - M Hellmich
- University of Cologne, Institute of Medical Statistics, Informatics and Epidemiology, Cologne, Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - J Wiltfang
- Department of Psychiatry and Psychotherapy, University Medical Center (UMG), Georg-August-University, Göttingen, Germany
| | - M Maarouf
- Department of Stereotaxy and Functional Neurosurgery, Klinikum Merheim, Cologne, Germany
| | - H-J Freund
- Department of Neuroanatomy, University of Düsseldorf, Düsseldorf, Germany
| | - V Sturm
- Department of Functional Neurosurgery and Stereotaxy, University of Cologne, Cologne, Germany
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Hardenacke K, Shubina E, Bührle CP, Zapf A, Lenartz D, Klosterkötter J, Visser-Vandewalle V, Kuhn J. Deep brain stimulation as a tool for improving cognitive functioning in Alzheimer's dementia: a systematic review. Front Psychiatry 2013; 4:159. [PMID: 24363647 PMCID: PMC3850165 DOI: 10.3389/fpsyt.2013.00159] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation (DBS) is an established, in selected cases therapeutically effective, non-lesional treatment method delivering current rectangular pulses into dysfunctional brain structures via chronically implanted stimulation electrodes. DBS is a recognized method applied in movement disorders and is increasingly evaluated as a possible therapeutic option for psychiatric diseases such as refractory obsessive-compulsive disorders, Gilles de la Tourette syndrome, major depression, and substance-related addiction. Latest research indicates that DBS may be a method for improving cognitive functions in Alzheimer's dementia (AD). Translational data in healthy and AD animals appear to support this notion. Nevertheless, many aspects remain unclear, particularly with regard to the optimal target structure. The objective of this review is to present a systematic overview regarding published research on DBS and cognitive functioning in animal and human studies as well as to provide a systematic overview of the feasibility and efficacy of the treatment. We describe three studies investigating the effects of DBS in patients with dementia, using either the fornix or the nucleus basalis of Meynert (NBM) as a target. In total, we identified 25 animal studies with 10 brain structures being targeted: fornix, NBM, anterior caudate nucleus, dorsal striatum, anterior thalamic nucleus, midline thalamic nuclei, central thalamus, lateral hypothalamus, hippocampus (entorhinal cortex, perforant path), and amygdala. Considering the wide and diverse spectrum of targets, we add to this review a supposition about possible underlying mechanisms of operation and recommendations for further research.
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Affiliation(s)
- Katja Hardenacke
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Elena Shubina
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Christian Philipp Bührle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne , Cologne , Germany
| | - Alexandra Zapf
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Doris Lenartz
- Department of Stereotactic and Functional Neurosurgery, University of Cologne , Cologne , Germany
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne , Cologne , Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
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Hardenacke K, Kuhn J, Lenartz D, Maarouf M, Mai JK, Bartsch C, Freund HJ, Sturm V. Stimulate or degenerate: deep brain stimulation of the nucleus basalis Meynert in Alzheimer dementia. World Neurosurg 2012; 80:S27.e35-43. [PMID: 23246738 DOI: 10.1016/j.wneu.2012.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 11/16/2012] [Accepted: 12/07/2012] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is a therapeutically effective neurosurgical method originally applied in movement disorders. Over time, the application of DBS has increasingly been considered as a therapeutic option for several neuropsychiatric disorders, including Gilles de la Tourette syndrome, obsessive compulsive disorder, major depression and addiction. Latest research suggests beneficial effects of DBS in Alzheimer dementia (AD). Because of the high prevalence and the considerable burden of the disease, we endeavored to discuss and reveal the challenges of DBS in AD. METHODS Recent literature on the pathophysiology of AD, including translational data and human studies, has been studied to generate a fundamental hypothesis regarding the effects of electrical stimulation on cognition and to facilitate our ongoing pilot study regarding DBS of the nucleus basalis Meynert (NBM) in patients with AD. RESULTS It is hypothesized that DBS in the nucleus basalis Meynert could probably improve or at least stabilize memory and cognitive functioning in patients with AD by facilitating neural oscillations and by enhancing the synthesis of nerve growth factors. CONCLUSIONS Considering the large number of patients suffering from AD, there is a great need for novel and effective treatment methods. Our research provides insights into the theoretical background of DBS in AD. Providing that our hypothesis will be validated by our ongoing pilot study, DBS could be an opportunity in the treatment of AD.
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Affiliation(s)
- Katja Hardenacke
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Abstract
Tourette syndrome (TS) is a neuropsychiatric disorder with typical onset in childhood and characterized by chronic occurrence of motor and vocal tics. The disorder can lead to serious impairments of both quality of life and psychosocial functioning, particularly for those individuals displaying complex tics. In such patients, drug treatment is recommended. The pathophysiology of TS is thought to involve a dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. Congruently, dopamine receptor antagonism of neuroleptics appears to be the most efficacious approach for pharmacological intervention. To assess the efficacy of the different neuroleptics available, a systematic, keyword-related search in PubMed (National Library of Medicine, Washington, DC) was undertaken. Much information on the use of antipsychotics in the treatment of TS is based on older data. Our objective was to give an update and therefore we focused on papers published in the last decade (between 2001 and 2011). Accordingly, the present review aims to summarize the current and evidence-based knowledge on the risk-benefit ratio of both first and second generation neuroleptics in TS.
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Affiliation(s)
- Daniel Huys
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany Head: Prof. Dr. Joachim Klosterkötter
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Huys D, Möller M, Kim EH, Hardenacke K, Huff W, Klosterkötter J, Timmermann L, Woopen C, Kuhn J. Die tiefe Hirnstimulation bei psychiatrischen Erkrankungen. Nervenarzt 2011; 83:1156-68. [DOI: 10.1007/s00115-011-3309-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Skuban T, Hardenacke K, Woopen C, Kuhn J. Informed consent in deep brain stimulation - ethical considerations in a stress field of pride and prejudice. Front Integr Neurosci 2011; 5:7. [PMID: 21559309 PMCID: PMC3085861 DOI: 10.3389/fnint.2011.00007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Accepted: 04/18/2011] [Indexed: 02/01/2023] Open
Affiliation(s)
- Tobias Skuban
- Department of Psychiatry and Psychotherapy, University of Cologne Cologne, Germany
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Kuhn J, Hardenacke K, Möller M, Gründler T, Lenartz D, Huff W, Klosterkötter J, Sturm V. Deep brain stimulation of the nucleus accumbens is effective for the treatment of severe alcohol dependence. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1251004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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