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Lequin MB, Verbaan D, Schuurman PR, Tasche S, Peul WC, Vandertop WP, Bouma GJ. The long-term outcome of revision microdiscectomy for recurrent sciatica. Eur Spine J 2024:10.1007/s00586-024-08199-5. [PMID: 38512504 DOI: 10.1007/s00586-024-08199-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 12/29/2023] [Accepted: 02/17/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE To study the long-term outcome of revision microdiscectomy after classic microdiscectomy for lumbosacral radicular syndrome (LSRS). METHODS Eighty-eight of 216 patients (41%) who underwent a revision microdiscectomy between 2007 and 2010 for MRI disc-related LSRS participated in this study. Questionnaires included visual analogue scores (VAS) for leg pain, RDQ, OLBD, RAND-36, and seven-point Likert scores for recovery, leg pain, and back pain. Any further lumbar re-revision operation(s) were recorded. RESULTS Mean (SD) age was 59.8 (12.8), and median [IQR] time of follow-up was 10.0 years [9.0-11.0]. A favourable general perceived recovery was reported by 35 patients (40%). A favourable outcome with respect to perceived leg pain was present in 39 patients (45%), and 35 patients (41%) reported a favourable outcome concerning back pain. The median VAS for leg and back pain was worse in the unfavourable group (48.0/100 mm (IQR 16.0-71.0) vs. 3.0/100 mm (IQR 2.0-5.0) and 56.0/100 mm (IQR 27.0-74.0) vs. 4.0/100 mm (IQR 2.0-17.0), respectively; both p < 0.001). Re-revision operation occurred in 31 (35%) patients (24% same level same side); there was no significant difference in the rate of favourable outcome between patients with or without a re-revision operation. CONCLUSION The long-term results after revision microdiscectomy for LSRS show an unfavourable outcome in the majority of patients and a high risk of re-revision microdiscectomy, with similar results. Based on also the disappointing results of alternative treatments, revision microdiscectomy for recurrent LSRS seems to still be a valid treatment. The results of our study may be useful to counsel patients in making appropriate treatment choices.
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Affiliation(s)
- M B Lequin
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands.
| | - D Verbaan
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Saskia Tasche
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
| | - W C Peul
- Department of Neurosurgery, University Neurosurgical Center Holland, UMC | HMC | HAGA, Leiden, The Hague, The Netherlands
| | - W P Vandertop
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G J Bouma
- Department of Neurosurgery, Amsterdam University Medical Centers Location Acadamic Medical Center, Neurosurgery, Meibergdreef 9, 1105 EZ, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Neurosurgery, OLVG, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands
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Sisodia V, Malekzadeh A, Verwijk E, Schuurman PR, de Bie RMA, Swinnen BEKS. Bidirectional Interplay between Deep Brain Stimulation and Cognition in Parkinson's Disease: A Systematic Review. Mov Disord 2024. [PMID: 38429947 DOI: 10.1002/mds.29772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/23/2023] [Revised: 02/07/2024] [Accepted: 02/20/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is efficacious for treating motor symptoms in Parkinson's disease (PD). OBJECTIVES The aim is to evaluate the evidence regarding DBS effectiveness after postoperative cognitive deterioration, the impact of preoperative cognition on DBS effectiveness, and the impact of DBS on cognition. METHODS Literature searches were performed on MEDLINE, EMBASE, and CENTRAL (Cochrane library). Primary outcomes were OFF-drug Unified Parkinson Disease Rating Scale Part III score and cognitive test scores. RESULTS DBS effectiveness did not differ in patients with postoperative declining compared to stable cognition (n = 5 studies). Preoperative cognition did not influence DBS effectiveness (n = 1 study). DBS moderately decreased verbal fluency compared to the best medical treatment (n = 24 studies), which may be transient. CONCLUSION DBS motor effectiveness in PD does not appear to be influenced by cognition. DBS in PD seems cognitively safe, except for a moderate decline in verbal fluency. Further research is warranted. © 2024 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Vibuthi Sisodia
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjan Malekzadeh
- Medical Library, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Esmée Verwijk
- Department of Medical Psychology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
- Department of Psychology, Brain and Cognition, University of Amsterdam, Amsterdam, Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, Netherlands
| | - Rob M A de Bie
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart E K S Swinnen
- Department of Neurology, Amsterdam UMC, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
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Zoon TJC, van Rooijen G, Contarino MF, van der Gaag S, Zutt R, van Asseldonk JT, van den Munckhof P, Schuurman PR, Denys DAJP, de Bie RMA. A multicenter double-blind randomized crossover study comparing the impact of dorsal subthalamic nucleus deep brain stimulation versus standard care on apathy in Parkinson's disease: a study protocol. Trials 2024; 25:104. [PMID: 38308317 PMCID: PMC10837902 DOI: 10.1186/s13063-024-07938-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Neuroimaging studies suggest an association between apathy after deep brain stimulation (DBS) and stimulation of the ventral part of the subthalamic nucleus (STN) due to the associative fibers connected to the non-motor limbic circuits that are involved in emotion regulation and motivation. We have previously described three patients with severe apathy that could be fully treated after switching stimulation from a ventral electrode contact point to a more dorsal contact point. OBJECTIVES To determine whether more dorsal stimulation of the STN decreases apathy compared to standard care in a multicenter randomized controlled trial with a crossover design. METHODS We will include 26 patients with a Starkstein Apathy Scale (SAS) score of 14 or more after subthalamic nucleus (STN) deep brain stimulation (DBS) for refractory Parkinson's disease. This is a multicenter trial conducted in two teaching hospitals and one university medical center in the Netherlands after at least 3 months of STN DBS. Our intervention will consist of 1 month of unilateral dorsal STN stimulation compared to treatment as usual. The primary outcome is a change in SAS score following 1 month of DBS on the original contact compared to the SAS score following 1 month of DBS on the more dorsal contact. Secondary outcomes are symptom changes on the Movement Disorders Society-Unified Parkinson's Disease Rating Scale motor part III, Montgomery-Åsberg Depression Rating Scale, 39-item Parkinson's disease questionnaire, Parkinson's disease impulsive-compulsive disorders questionnaire, changes in levodopa-equivalent daily dosage, apathy rated by the caregiver, and burden and quality of life of the caregiver. TRIAL REGISTRATION ClinicalTrials.gov NL8279. Registered on January 10, 2020.
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Affiliation(s)
- T J C Zoon
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands.
| | - G van Rooijen
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | | | - R Zutt
- HagaZiekenhuis, the Hague, the Netherlands
| | | | | | - P R Schuurman
- Department of Neurosurgery, Amsterdam UMC, Amsterdam, the Netherlands
| | - D A J P Denys
- Department of Psychiatry, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
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Buijink AWG, de Vries S, Schuurman PR, van Iperen A, Dijk JM. Parkinsonism after uncal herniation-an overlooked false localizing sign? Mov Disord Clin Pract 2024. [PMID: 38173285 DOI: 10.1002/mdc3.13964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/08/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Affiliation(s)
- Arthur W G Buijink
- Department of Neurology, Amsterdam University Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Stefanie de Vries
- Department of Neurology, Amsterdam University Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Deptartment of Neurosurgery, Amsterdam University Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - Andries van Iperen
- Daan Theeuwes Center for Intensive Neurorehabilitation, Woerden, The Netherlands
| | - Joke M Dijk
- Department of Neurology, Amsterdam University Medical Center, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
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D’Haens G, Eberhardson M, Cabrijan Z, Danese S, van den Berg R, Löwenberg M, Fiorino G, Schuurman PR, Lind G, Almqvist P, Olofsson PS, Tracey KJ, Hanauer SB, Zitnik R, Chernoff D, Levine YA. Neuroimmune Modulation Through Vagus Nerve Stimulation Reduces Inflammatory Activity in Crohn's Disease Patients: A Prospective Open-label Study. J Crohns Colitis 2023; 17:1897-1909. [PMID: 37738465 PMCID: PMC10798868 DOI: 10.1093/ecco-jcc/jjad151] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND AIMS Crohn's disease [CD] is a debilitating, inflammatory condition affecting the gastrointestinal tract. There is no cure and sustained clinical and endoscopic remission is achieved by fewer than half of patients with current therapies. The immunoregulatory function of the vagus nerve, the 'inflammatory reflex', has been established in patients with rheumatoid arthritis and biologic-naive CD. The aim of this study was to explore the safety and efficacy of vagus nerve stimulation in patients with treatment-refractory CD, in a 16-week, open-label, multicentre, clinical trial. METHODS A vagus nerve stimulator was implanted in 17 biologic drug-refractory patients with moderately to severely active CD. One patient exited the study pre-treatment, and 16 patients were treated with vagus nerve stimulation [4/16 receiving concomitant biologics] during 16 weeks of induction and 24 months of maintenance treatment. Endpoints included clinical improvement, patient-reported outcomes, objective measures of inflammation [endoscopic/molecular], and safety. RESULTS There was a statistically significant and clinically meaningful decrease in CD Activity Index at Week 16 [mean ± SD: -86.2 ± 92.8, p = 0.003], a significant decrease in faecal calprotectin [-2923 ± 4104, p = 0.015], a decrease in mucosal inflammation in 11/15 patients with paired endoscopies [-2.1 ± 1.7, p = 0.23], and a decrease in serum tumour necrosis factor and interferon-γ [46-52%]. Two quality-of-life indices improved in 7/11 patients treated without biologics. There was one study-related severe adverse event: a postoperative infection requiring device explantation. CONCLUSIONS Neuroimmune modulation via vagus nerve stimulation was generally safe and well tolerated, with a clinically meaningful reduction in clinical disease activity associated with endoscopic improvement, reduced levels of faecal calprotectin and serum cytokines, and improved quality of life.
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Affiliation(s)
- Geert D’Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michael Eberhardson
- Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Zeljko Cabrijan
- Division of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
- Division of Gastroenterology, University of Applied Health Sciences, Zagreb, Croatia
- Josip Juraj Strossmayer University of Osijek School of Medicine, Osijek, Croatia
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, Italy
- Department of Gastroenterology and Endoscopy, University Vita-Salute San Raffaele, Milano, Italy
| | - Remco van den Berg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark Löwenberg
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, VIta-Salute San Raffaele Hospital, Milan, Italy
- IBD Unit, Department of Gastroenterology and Digestive Endoscopy, San Camillo-Forlanini Hospital, Rome, Italy
| | | | - Göran Lind
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Almqvist
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden
- Neurosurgery Stockholm AB, Stockholm, Sweden
| | - Peder S Olofsson
- Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
- Feinstein Institutes for Medical Research, Manhasset, New York
| | - Kevin J Tracey
- Feinstein Institutes for Medical Research, Manhasset, New York
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Stephen B Hanauer
- Division of Gastroenterology and Hepatology, Northwestern University–Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ralph Zitnik
- SetPoint Medical, Valencia, California, USA
- Valerio Consulting, Santa Barbara, California, USA
| | | | - Yaakov A Levine
- Department of Medicine, Karolinska Institutet, Solna, Sweden
- Department of Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
- SetPoint Medical, Valencia, California, USA
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Bot M, Pauwels R, van den Munckhof P, de Win M, Odekerken VJJ, Beudel M, Dijk J, de Bie RMA, Schuurman PR. The Fast Gray Matter Acquisition T1 Inversion Recovery Sequence in Deep Brain Stimulation: Introducing the Rubral Wing for Dentato-Rubro-Thalamic Tract Depiction and Tremor Control. Neuromodulation 2023; 26:1705-1713. [PMID: 35088745 DOI: 10.1016/j.neurom.2021.11.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/26/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The dentato-rubro-thalamic tract (DRT) is currently considered as a potential target in deep brain stimulation (DBS) for various types of tremor. However, tractography depiction can vary depending on the included brain regions. The fast gray matter acquisition T1 inversion recovery (FGATIR) sequence, with excellent delineation of gray and white matter, possibly provides anatomical identification of rubro-thalamic DRT fibers. OBJECTIVE This study aimed to evaluate the FGATIR sequence by comparison with DRT depiction, electrode localization, and effectiveness of DBS therapy. MATERIALS AND METHODS In patients with DBS therapy because of medication-refractory tremor, the FGATIR sequence was evaluated for depiction of the thalamus, red nucleus (RN), and rubro-thalamic connections. Deterministic tractography of the DRT, electrode localization, and tremor control were compared. The essential tremor rating scale was used to assess (hand) tremor. Tremor control was considered successful when complete tremor suppression (grade 0) or almost complete suppression (grade 1) was observed. RESULTS In the postoperative phase, we evaluated 14 patients who underwent DRT-guided DBS: 12 patients with essential tremor, one with tremor-dominant Parkinson disease, and one with multiple sclerosis, representing 24 trajectories. Mean follow-up was 11.3 months (range 6-19 months). The FGATIR sequence provided a clear delineation of a hypointense white matter tract within the hyperintense thalamus. In coronal plane, this tract was most readily recognizable as a "rubral wing," with the round RN as base and lateral triangular convergence. The deterministic DRT depiction was consistently situated within the rubral wing. The number of active contacts located within the DRT (and rubral wing) was 22 (92%), of which 16 (73%) showed successful tremor control. CONCLUSIONS The FGATIR sequence offers visualization of the rubro-thalamic connections that form the DRT, most readily recognizable as a "rubral wing" in coronal plane. This sequence contributes to tractographic depiction of DRT and provides a direct anatomical DBS target area for tremor control.
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Affiliation(s)
- Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
| | - Rik Pauwels
- Department of Neurosurgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Maartje de Win
- Department of Radiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Joke Dijk
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
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Kremer NI, Roberts MJ, Potters WV, Dilai J, Mathiopoulou V, Rijks N, Drost G, van Laar T, van Dijk JMC, Beudel M, de Bie RMA, van den Munckhof P, Janssen MLF, Schuurman PR, Bot M. Dorsal subthalamic nucleus targeting in deep brain stimulation: microelectrode recording versus 7-Tesla connectivity. Brain Commun 2023; 5:fcad298. [PMID: 38025271 PMCID: PMC10664414 DOI: 10.1093/braincomms/fcad298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/02/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023] Open
Abstract
Connectivity-derived 7-Tesla MRI segmentation and intraoperative microelectrode recording can both assist subthalamic nucleus targeting for deep brain stimulation in Parkinson's disease. It remains unclear whether deep brain stimulation electrodes placed in the 7-Tesla MRI segmented subdivision with predominant projections to cortical motor areas (hyperdirect pathway) achieve superior motor improvement and whether microelectrode recording can accurately distinguish the motor subdivision. In 25 patients with Parkinson's disease, deep brain stimulation electrodes were evaluated for being inside or outside the predominantly motor-connected subthalamic nucleus (motor-connected subthalamic nucleus or non-motor-connected subthalamic nucleus, respectively) based on 7-Tesla MRI connectivity segmentation. Hemi-body motor improvement (Movement Disorder Society Unified Parkinson's Disease Rating Scale, Part III) and microelectrode recording characteristics of multi- and single-unit activities were compared between groups. Deep brain stimulation electrodes placed in the motor-connected subthalamic nucleus resulted in higher hemi-body motor improvement, compared with electrodes placed in the non-motor-connected subthalamic nucleus (80% versus 52%, P < 0.0001). Multi-unit activity was found slightly higher in the motor-connected subthalamic nucleus versus the non-motor-connected subthalamic nucleus (P < 0.001, receiver operating characteristic 0.63); single-unit activity did not differ between groups. Deep brain stimulation in the connectivity-derived 7-Tesla MRI subthalamic nucleus motor segment produced a superior clinical outcome; however, microelectrode recording did not accurately distinguish this subdivision within the subthalamic nucleus.
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Affiliation(s)
- Naomi I Kremer
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Mark J Roberts
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht 6211 LK, The Netherlands
| | - Wouter V Potters
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - José Dilai
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Varvara Mathiopoulou
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Niels Rijks
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Gea Drost
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Teus van Laar
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - J Marc C van Dijk
- Department of Neurosurgery, University of Groningen, University Medical Center Groningen, Groningen 9713 GZ, The Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Marcus L F Janssen
- Department of Clinical Neurophysiology, Maastricht University Medical Center, Maastricht 6229 HX, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam 1105 AZ, The Netherlands
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8
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Zoon TJC, Mathiopoulou V, van Rooijen G, van den Munckhof P, Denys DAJP, Schuurman PR, de Bie RMA, Bot M. Apathy following deep brain stimulation in Parkinson's disease visualized by 7-Tesla MRI subthalamic network analysis. Brain Stimul 2023; 16:1289-1291. [PMID: 37619890 DOI: 10.1016/j.brs.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Apathy is reported after subthalamic nucleus deep brain stimulation (STN DBS) and associated with a decreased quality of life in Parkinson's disease (PD) patients. Recent studies hypothesized that the location of active DBS contact point relative to the STN subdivisions (motor, associative and limbic) could be related to an increase of apathy. METHODS 22 PD-patients that underwent STN DBS between January 2019 and February 2020 were divided in an apathy and non-apathy group using the change in the Starkstein Apathy Scale (SAS) after six months of DBS. For both groups the location of DBS electrodes was determined based on 7T MRI subthalamic network analysis, enabling visualization of the subdivisions and their projections relative to the active contact point. MDS-UPDRS III scores were included to evaluate DBS effect. RESULTS In six patients a post-DBS increase in apathy score was assessed, versus 16 non-apathy patients. Network analysis showed that active contacts in apathy patients were more often positioned in or close to the area within the STN with high density of surrounding projections to associative cortex areas than in non-apathy patients; 63% apathy versus 42% (P = 0.02). The density of surrounding motor projections was lower in the group with increased apathy (18%) than in the group without increased apathy (38%, P = 0.01). Motor UPDRS improvement for the apathy group was 39% and for the non-apathy group 58% (n.s.) CONCLUSION: This new approach in patient-specific subthalamic 7T MRI network analysis visualized an anatomical connectivity substrate for apathy in DBS, with active electrode contacts predominantly in the associative STN.
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Affiliation(s)
- T J C Zoon
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.
| | - V Mathiopoulou
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - G van Rooijen
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - P van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - D A J P Denys
- Department of Psychiatry, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - M Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
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Oudijn MS, Linders JTW, Lok A, Schuurman PR, van den Munckhof P, van Elburg AA, van Wingen GA, Mocking RJT, Denys D. Neural effects of deep brain stimulation on reward and loss anticipation and food viewing in anorexia nervosa: a pilot study. J Eat Disord 2023; 11:140. [PMID: 37605212 PMCID: PMC10440869 DOI: 10.1186/s40337-023-00863-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a severe and life-threatening psychiatric disorder. Initial studies on deep brain stimulation (DBS) in severe, treatment-refractory AN have shown clinical effects. However, the working mechanisms of DBS in AN remain largely unknown. Here, we used a task-based functional MRI approach to understand the pathophysiology of AN. METHODS We performed functional MRI on four AN patients that participated in a pilot study on the efficacy, safety, and functional effects of DBS targeted at the ventral limb of the capsula interna (vALIC). The patients and six gender-matched healthy controls (HC) were investigated at three different time points. We used an adapted version of the monetary incentive delay task to probe generic reward processing in patients and controls, and a food-specific task in patients only. RESULTS At baseline, no significant differences for reward anticipation were found between AN and HC. Significant group (AN and HC) by time (pre- and post-DBS) interactions were found in the right precuneus, right putamen, right ventral and medial orbitofrontal cortex (mOFC). No significant interactions were found in the food viewing task, neither between the conditions high-calorie and low-calorie food images nor between the different time points. This could possibly be due to the small sample size and the lack of a control group. CONCLUSION The results showed a difference in the response of reward-related brain areas post-DBS. This supports the hypotheses that the reward circuitry is involved in the pathogenesis of AN and that DBS affects responsivity of reward-related brain areas. Trial registration Registered in the Netherlands Trial Register ( https://www.trialregister.nl/trial/3322 ): NL3322 (NTR3469).
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Affiliation(s)
- M S Oudijn
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J T W Linders
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A Lok
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P van den Munckhof
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A A van Elburg
- Faculty of Social Sciences, University of Utrecht, Utrecht, The Netherlands
| | - G A van Wingen
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R J T Mocking
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - D Denys
- Department of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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10
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Boon LI, Potters WV, Hillebrand A, de Bie RMA, Bot M, Richard Schuurman P, van den Munckhof P, Twisk JW, Stam CJ, Berendse HW, van Rootselaar AF. Magnetoencephalography to measure the effect of contact point-specific deep brain stimulation in Parkinson's disease: A proof of concept study. Neuroimage Clin 2023; 38:103431. [PMID: 37187041 PMCID: PMC10197095 DOI: 10.1016/j.nicl.2023.103431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/26/2023] [Accepted: 05/07/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for disabling fluctuations in motor symptoms in Parkinson's disease (PD) patients. However, iterative exploration of all individual contact points (four in each STN) by the clinician for optimal clinical effects may take months. OBJECTIVE In this proof of concept study we explored whether magnetoencephalography (MEG) has the potential to noninvasively measure the effects of changing the active contact point of STN-DBS on spectral power and functional connectivity in PD patients, with the ultimate aim to aid in the process of selecting the optimal contact point, and perhaps reduce the time to achieve optimal stimulation settings. METHODS The study included 30 PD patients who had undergone bilateral DBS of the STN. MEG was recorded during stimulation of each of the eight contact points separately (four on each side). Each stimulation position was projected on a vector running through the longitudinal axis of the STN, leading to one scalar value indicating a more dorsolateral or ventromedial contact point position. Using linear mixed models, the stimulation positions were correlated with band-specific absolute spectral power and functional connectivity of i) the motor cortex ipsilateral tot the stimulated side, ii) the whole brain. RESULTS At group level, more dorsolateral stimulation was associated with lower low-beta absolute band power in the ipsilateral motor cortex (p = .019). More ventromedial stimulation was associated with higher whole-brain absolute delta (p = .001) and theta (p = .005) power, as well as higher whole-brain theta band functional connectivity (p = .040). At the level of the individual patient, switching the active contact point caused significant changes in spectral power, but the results were highly variable. CONCLUSIONS We demonstrate for the first time that stimulation of the dorsolateral (motor) STN in PD patients is associated with lower low-beta power values in the motor cortex. Furthermore, our group-level data show that the location of the active contact point correlates with whole-brain brain activity and connectivity. As results in individual patients were quite variable, it remains unclear if MEG is useful in the selection of the optimal DBS contact point.
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Affiliation(s)
- Lennard I Boon
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurology, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam, The Netherlands.
| | - Wouter V Potters
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Arjan Hillebrand
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands; Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Maarten Bot
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, The Netherlands
| | - Jos W Twisk
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Cornelis J Stam
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and MEG Center, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Neuroscience, Systems and Network Neuroscience, Amsterdam, The Netherlands
| | - Henk W Berendse
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Neurology, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC location University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Neuroscience, Brain Imaging, Amsterdam, The Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands
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11
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Sisodia V, Swinnen BEKS, Dijk JM, Verwijk E, van Rooijen G, Lemstra AW, Schuurman PR, de Bie RMA. Protocol of a randomized controlled trial investigating Deep Brain Stimulation for MOtor symptoms in patients with Parkinson's disease DEmentia (DBS-MODE). BMC Neurol 2023; 23:160. [PMID: 37085773 PMCID: PMC10120102 DOI: 10.1186/s12883-023-03142-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/13/2022] [Accepted: 02/19/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for disabling motor symptoms of Parkinson's disease (PD) that persist despite optimal pharmacological treatment. Currently, DBS is not performed if there is concomitant significant cognitive impairment based on concerns of cognitive deterioration, higher complication rate and less functional improvement. However, this has not been investigated so far. METHODS A single center, prospective, randomized, open-label, blinded end-point (PROBE design) pilot clinical trial is being performed. Patients are eligible for the trial if they have PD dementia (PDD), are able to provide informed consent, and experience disabling motor response fluctuations, bradykinesia, dyskinesia, or painful dystonia, despite optimal pharmacological treatment. In total 44 patients will be randomized to either STN-DBS accompanied by best medical treatment (DBS group) or to best medical treatment alone (BMT group). The primary outcome measure is the change from baseline to 30 weeks on the Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III score in a standardized off-drug phase. The main secondary outcome measures consist of scales assessing cognitive aspects of daily living, neuropsychiatric symptoms and impulsive compulsive disorders. Additional secondary outcome measures include motor signs during on-drug phase, dyskinesia, motor fluctuations, cognitive performance, (severe) adverse events, treatment satisfaction, and caregiver burden. Patients will be followed during 52 weeks after randomization. DISCUSSION The Deep Brain Stimulation for MOtor symptoms in patients with Parkinson's disease DEmentia (DBS-MODE) trial directly compares the effectiveness and safety of DBS with BMT in patients with PDD. TRIAL REGISTRATION The DBS-MODE trial has been registered in the International Clinical Trial Registry Platform (NL9361) on the 24th of March 2021 ( https://trialsearch.who.int/Trial2.aspx?TrialID=NL9361 ).
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Affiliation(s)
- V Sisodia
- Amsterdam UMC location University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - B E K S Swinnen
- Amsterdam UMC location University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - J M Dijk
- Amsterdam UMC location University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
| | - E Verwijk
- Amsterdam UMC location University of Amsterdam, Medical Psychology, Amsterdam, Netherlands
| | - G van Rooijen
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Psychiatry, Amsterdam, Netherlands
| | - A W Lemstra
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, Neurology, De Boelelaan, 1117, Amsterdam, Netherlands
| | - P R Schuurman
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands
- Amsterdam UMC location University of Amsterdam, Neurosurgery, Amsterdam, Netherlands
| | - R M A de Bie
- Amsterdam UMC location University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, Netherlands.
- Amsterdam Neuroscience, Neurodegeneration, Amsterdam, Netherlands.
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12
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Bangel KA, Bais M, Eijsker N, Schuurman PR, van den Munckhof P, Figee M, Smit DJA, Denys D. Acute effects of deep brain stimulation on brain function in obsessive-compulsive disorder. Clin Neurophysiol 2023; 148:109-117. [PMID: 36774324 DOI: 10.1016/j.clinph.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 06/20/2022] [Revised: 12/08/2022] [Accepted: 12/24/2022] [Indexed: 01/24/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective treatment for refractory obsessive-compulsive disorder (OCD) yet neural markers of optimized stimulation parameters are largely unknown. We aimed to describe (sub-)cortical electrophysiological responses to acute DBS at various voltages in OCD. METHODS We explored how DBS doses between 3-5 V delivered to the ventral anterior limb of the internal capsule of five OCD patients affected electroencephalograms and intracranial local field potentials (LFPs). We focused on theta power/ phase-stability, given their previously established role in DBS for OCD. RESULTS Cortical theta power and theta phase-stability did not increase significantly with DBS voltage. DBS-induced theta power peaks were seen at the previously defined individualized therapeutic voltage. Although LFP power generally increased with DBS voltages, this occurred mostly in frequency peaks that overlapped with stimulation artifacts limiting its interpretability. Though highly idiosyncratic, three subjects showed significant acute DBS effects on electroencephalogram theta power and four subjects showed significant carry-over effects (pre-vs post DBS, unstimulated) on LFP and electroencephalogram theta power. CONCLUSIONS Our findings challenge the presence of a consistent dose-response relationship between stimulation voltage and brain activity. SIGNIFICANCE Theta power may be investigated further as a neurophysiological marker to aid personalized DBS voltage optimization in OCD.
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Affiliation(s)
- Katrin A Bangel
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Institute of Neuroscience, The Medical School, Newcastle University, NE2 4HH, UK; Department of Medical Physics and Clinical Engineering, Royal Victoria Infirmary, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne NE1 4LP, UK; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - Melisse Bais
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Nadine Eijsker
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands
| | - P Richard Schuurman
- Amsterdam University Medical Centers, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Amsterdam University Medical Centers, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Martijn Figee
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Dirk J A Smit
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands.
| | - Damiaan Denys
- Amsterdam University Medical Centers, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, the Netherlands; Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, the Netherlands; The Netherlands Institute for Neuroscience, Amsterdam, the Netherlands
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13
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Fridgeirsson EA, Bais MN, Eijsker N, Thomas RM, Smit DJA, Bergfeld IO, Schuurman PR, van den Munckhof P, de Koning P, Vulink N, Figee M, Mazaheri A, van Wingen GA, Denys D. Patient specific intracranial neural signatures of obsessions and compulsions in the ventral striatum. J Neural Eng 2023; 20. [PMID: 36827705 DOI: 10.1088/1741-2552/acbee1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/03/2022] [Accepted: 02/24/2023] [Indexed: 02/26/2023]
Abstract
Objective. Deep brain stimulation is a treatment option for patients with refractory obsessive-compulsive disorder. A new generation of stimulators hold promise for closed loop stimulation, with adaptive stimulation in response to biologic signals. Here we aimed to discover a suitable biomarker in the ventral striatum in patients with obsessive compulsive disorder using local field potentials.Approach.We induced obsessions and compulsions in 11 patients undergoing deep brain stimulation treatment using a symptom provocation task. Then we trained machine learning models to predict symptoms using the recorded intracranial signal from the deep brain stimulation electrodes.Main results.Average areas under the receiver operating characteristics curve were 62.1% for obsessions and 78.2% for compulsions for patient specific models. For obsessions it reached over 85% in one patient, whereas performance was near chance level when the model was trained across patients. Optimal performances for obsessions and compulsions was obtained at different recording sites.Significance. The results from this study suggest that closed loop stimulation may be a viable option for obsessive-compulsive disorder, but that intracranial biomarkers are patient and not disorder specific.Clinical Trial:Netherlands trial registry NL7486.
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Affiliation(s)
- Egill A Fridgeirsson
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Melisse N Bais
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Nadine Eijsker
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Rajat M Thomas
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Dirk J A Smit
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Figee
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Ali Mazaheri
- School of Psychology, University of Birmingham, Birmingham, United Kingdom.,Centre for Human Brain Health, University of Birmingham, Birmingham, United Kingdom
| | - Guido A van Wingen
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Neuroscience, Amsterdam, The Netherlands.,The Netherlands institute for Neuroscience, an Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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14
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Hariz M, Bronstein JM, Cosgrove GR, de Bie RMA, DeLong MR, Gross RE, Krack P, Krauss JK, Lang AE, Lees AJ, Lozano AM, Obeso JA, Schuurman PR, Vitek JL. Concerns About the European Academy's Recommendations and Guidelines Regarding Pallidotomy for Parkinson's Disease. Mov Disord 2023; 38:509-511. [PMID: 36047463 DOI: 10.1002/mds.29210] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Jeff M Bronstein
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - G Rees Cosgrove
- Neurosurgery Department at The Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital & University of Toronto, Toronto, Ontario, Canada
| | - Andrew J Lees
- UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Fundación Hospitales de Madrid, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain
- University CEU-San Pablo, Madrid, Spain
| | | | - Jerold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
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15
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Stam MJ, van Wijk BCM, Sharma P, Beudel M, Piña-Fuentes DA, de Bie RMA, Schuurman PR, Neumann WJ, Buijink AWG. A comparison of methods to suppress electrocardiographic artifacts in local field potential recordings. Clin Neurophysiol 2023; 146:147-161. [PMID: 36543611 DOI: 10.1016/j.clinph.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 07/14/2022] [Revised: 10/06/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022]
Abstract
OBJECTIVE Local field potential (LFP) recordings from deep brain stimulation (DBS) electrodes are often contaminated with electrocardiographic (ECG) artifacts that hinder the detection of disease-specific electrical brain activity. METHODS Three ECG suppression methods were evaluated: (1) QRS interpolation of the Perceive toolbox, (2) template subtraction, and (3) singular value decomposition (SVD). LFPs were recorded with the Medtronic PerceptTM PC system in nine Parkinson's disease patients with stimulation OFF ("OFF-DBS"; anode disconnected) and ON at 0 mA ("ON-DBS 0 mA"; anode connected). Findings were verified with simulated ECG-contaminated time series. RESULTS ECG artifacts were present in 10 out of 18 ON-DBS 0 mA recordings. All ECG suppression methods drastically reduced artifact-induced beta band (13-35 Hz) power and at least partly recovered the beta peak and beta burst dynamics. Using external ECG recordings and lengthening artifact epoch length improved the performance of the suppression methods. Increasing epoch length, however, elevated the risk of flattening the beta peak and losing beta burst dynamics. CONCLUSIONS The SVD method formed the preferred trade-off between artifact cleaning and signal loss, as long as its parameter settings are adequately chosen. SIGNIFICANCE ECG suppression methods enable analysis of disease-specific neural activity from signals affected by ECG artifacts.
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Affiliation(s)
- M J Stam
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - B C M van Wijk
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands; Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - P Sharma
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Department of Electrical Engineering and Information Technology, Otto von Guericke University, Magdeburg, Germany
| | - M Beudel
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - D A Piña-Fuentes
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands
| | - W-J Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A W G Buijink
- Department of Neurology, Amsterdam University Medical Centers, Amsterdam Neuroscience, University of Amsterdam, Amsterdam, The Netherlands.
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16
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Mathiopoulou V, Rijks N, Caan MWA, Liebrand LC, Ferreira F, de Bie RMA, van den Munckhof P, Schuurman PR, Bot M. Utilizing 7-Tesla Subthalamic Nucleus Connectivity in Deep Brain Stimulation for Parkinson Disease. Neuromodulation 2023; 26:333-339. [PMID: 35216874 DOI: 10.1016/j.neurom.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/23/2021] [Revised: 12/17/2021] [Accepted: 01/10/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a highly effective surgical treatment for patients with advanced Parkinson disease (PD). Combining 7.0-Tesla (7T) T2- and diffusion-weighted imaging (DWI) sequences allows for selective segmenting of the motor part of the STN and, thus, for possible optimization of DBS. MATERIALS AND METHODS 7T T2 and DWI sequences were obtained, and probabilistic segmentation of motor, associative, and limbic STN segments was performed. Left- and right-sided motor outcome (Movement Disorders Society Unified Parkinson's Disease Rating Scale) scores were used for evaluating the correspondence between the active electrode contacts in selectively segmented STN and the clinical DBS effect. The Bejjani line was reviewed for crossing of segments. RESULTS A total of 50 STNs were segmented in 25 patients and proved highly feasible. Although the highest density of motor connections was situated in the dorsolateral STN for all patients, the exact partitioning of segments differed considerably. For all the active electrode contacts situated within the predominantly motor-connected segment of the STN, the average hemi-body Unified Parkinson's Disease Rating Scale motor improvement was 80%; outside this segment, it was 52% (p < 0.01). The Bejjani line was situated in the motor segment for 32 STNs. CONCLUSION The implementation of 7T T2 and DWI segmentation of the STN in DBS for PD is feasible and offers insight into the location of the motor segment. Segmentation-guided electrode placement is likely to further improve motor response in DBS for PD. However, commercially available DBS software for postprocessing imaging would greatly facilitate widespread implementation.
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Affiliation(s)
| | - Niels Rijks
- Department of Neurosurgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Matthan W A Caan
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Luka C Liebrand
- Department of Biomedical Engineering and Physics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Francisca Ferreira
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, University College London Institute of Neurology, London, UK
| | - Rob M A de Bie
- Department of Neurology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | - Maarten Bot
- Department of Neurosurgery, Amsterdam UMC, Amsterdam, The Netherlands.
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17
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Hariz M, Lang AE, Bronstein JM, Cosgrove GR, de Bie RMA, DeLong MR, Gross RE, Krack P, Krauss JK, Lees AJ, Lozano AM, Obeso JA, Schuurman PR, Vitek JL. European Academy of Neurology/Movement Disorder Society European Section's guidelines on pallidotomy for Parkinson's disease: let's remain accurate. Eur J Neurol 2022. [PMID: 36583626 DOI: 10.1111/ene.15667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden.,UCL Queen Square Institute of Neurology, London, UK
| | - Anthony E Lang
- Edmond J Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Jeff M Bronstein
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - G Rees Cosgrove
- Neurosurgery Department, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | | | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Fundación Hospitales de Madrid, Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain.,University CEU-San Pablo, Madrid, Spain
| | | | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
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18
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Boon LI, Potters WV, Zoon TJC, van den Heuvel OA, Prent N, de Bie RMA, Bot M, Schuurman PR, van den Munckhof P, Geurtsen GJ, Hillebrand A, Stam CJ, Rootselaar AFV, Berendse HW. Corrigendum to "Structural and functional correlates of deep brain stimulation-induced apathy in Parkinson's disease". Brain Stimul 2022; 15:1305-1307. [PMID: 36174462 DOI: 10.1016/j.brs.2022.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Lennard I Boon
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Wouter V Potters
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Thomas J C Zoon
- Amsterdam UMC, University of Amsterdam, Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Naomi Prent
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maarten Bot
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - P Richard Schuurman
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gert J Geurtsen
- Amsterdam UMC, University of Amsterdam, Medical Psychology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Arjan Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Cornelis J Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Henk W Berendse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
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19
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Hariz M, Bronstein JM, Cosgrove GR, de Bie RMA, DeLong MR, Gross RE, Krack P, Krauss JK, Lang AE, Lees AJ, Lozano AM, Obeso JA, Schuurman PR, Vitek JL. Concerns about the European Academy's Recommendations and Guidelines Regarding Pallidotomy for Parkinson's Disease. Eur J Neurol 2022; 30:1831-1833. [PMID: 36128760 DOI: 10.1111/ene.15569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- UCL Queen Square Institute of Neurology, London, UK
| | - Jeff M Bronstein
- Department of Neurology, UCLA David Geffen School of Medicine, Los Angeles, California, USA
| | - G Rees Cosgrove
- Neurosurgery Department, The Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Mahlon R DeLong
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert E Gross
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Paul Krack
- Department of Neurology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover, Hannover, Germany
| | - Anthony E Lang
- The Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | | | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - José A Obeso
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Fundación Hospitales de Madrid, HM Hospitales, Hospital Universitario HM Puerta del Sur, Madrid, Spain
- Network Center for Biomedical Research on Neurodegenerative Diseases (CIBERNED), Instituto Carlos III, Madrid, Spain
- University CEU-San Pablo, Madrid, Spain
| | | | - Jerold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
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20
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Bot M, van Rootselaari AF, Odekerken V, Dijk J, de Bie RMA, Beudel M, van den Munckhof P, Schuurman PR. Evaluating and Optimizing Dentato-Rubro-Thalamic-Tract Deterministic Tractography in Deep Brain Stimulation for Essential Tremor. Oper Neurosurg (Hagerstown) 2021; 21:533-539. [PMID: 34562007 DOI: 10.1093/ons/opab324] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 02/05/2021] [Accepted: 07/18/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Dentato-rubro-thalamic tract (DRT) deep brain stimulation (DBS) suppresses tremor in essential tremor (ET) patients. However, DRT depiction through tractography can vary depending on the included brain regions. Moreover, it is unclear which section of the DRT is optimal for DBS. OBJECTIVE To evaluate deterministic DRT tractography and tremor control in DBS for ET. METHODS After DBS surgery, DRT tractography was conducted in 37 trajectories (20 ET patients). Per trajectory, 5 different DRT depictions with various regions of interest (ROI) were constructed. Comparison resulted in a DRT depiction with highest correspondence to intraoperative tremor control. This DRT depiction was subsequently used for evaluation of short-term postoperative adverse and beneficial effects. RESULTS Postoperative optimized DRT tractography employing the ROI motor cortex, posterior subthalamic area (PSA), and ipsilateral superior cerebellar peduncle and dentate nucleus best corresponded with intraoperative trajectories (92%) and active DBS contacts (93%) showing optimal tremor control. DRT tractography employing a red nucleus or ventral intermediate nucleus of the thalamus (VIM) ROI often resulted in a more medial course. Optimal stimulation was located in the section between VIM and PSA. CONCLUSION This optimized deterministic DRT tractography strongly correlates with optimal tremor control. This technique is readily implementable for prospective evaluation in DBS target planning for ET.
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Affiliation(s)
- Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaari
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Vincent Odekerken
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joke Dijk
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | | | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Center, Amsterdam, the Netherlands
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21
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Oudijn MS, Mocking RJT, Wijnker RR, Lok A, Schuurman PR, van den Munckhof P, van Elburg AA, Denys D. Deep brain stimulation of the ventral anterior limb of the capsula interna in patients with treatment-refractory anorexia nervosa. Brain Stimul 2021; 14:1528-1530. [PMID: 34678486 DOI: 10.1016/j.brs.2021.10.387] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/18/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
- M S Oudijn
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands.
| | - R J T Mocking
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - R R Wijnker
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - A Lok
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - P R Schuurman
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - P van den Munckhof
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
| | - A A van Elburg
- Faculty of Social Sciences, University of Utrecht, Utrecht, the Netherlands
| | - D Denys
- Departments of Psychiatry and Neurosurgery, Amsterdam University Medical Centers (AUMC)-Academic Medical Center (AMC), University of Amsterdam (UvA), Amsterdam, the Netherlands
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22
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van den Munckhof P, Bot M, Schuurman PR. Targeting of the Subthalamic Nucleus in Patients with Parkinson's Disease Undergoing Deep Brain Stimulation Surgery. Neurol Ther 2021; 10:61-73. [PMID: 33565018 PMCID: PMC8140007 DOI: 10.1007/s40120-021-00233-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/20/2021] [Indexed: 11/29/2022] Open
Abstract
Precise stereotactic targeting of the dorsolateral motor part of the subthalamic nucleus (STN) is paramount for maximizing clinical effectiveness and preventing side effects of deep brain stimulation (DBS) in patients with advanced Parkinson's disease. With recent developments in magnetic resonance imaging (MRI) techniques, direct targeting of the dorsolateral part of the STN is now feasible, together with visualization of the motor fibers in the nearby internal capsule. However, clinically relevant discrepancies were reported when comparing STN borders on MRI to electrophysiological STN borders during microelectrode recordings (MER). Also, one should take into account the possibility of a 3D inaccuracy of up to 2 mm of the applied stereotactic technique. Pneumocephalus and image fusion errors may further increase implantation inaccuracy. Even when implantation has been successful, suboptimal lead anchoring on the skull may cause lead migration during follow-up. Meticulous pre- and intraoperative imaging is therefore indispensable, and so is postoperative imaging when the effects of DBS deteriorate during follow-up. Thus far, most DBS centers employ MRI targeting, multichannel MER, and awake test stimulation in STN surgery, but randomized trials comparing surgery under local versus general anesthesia and additional studies comparing MER-STN borders to high-field MRI-STN may change this clinical practice. Further developments in imaging protocols and improvements in image fusion processes are needed to optimize placement of DBS leads in the dorsolateral motor part of the STN in Parkinson's disease.
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Affiliation(s)
- Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands.
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
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23
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Boon LI, Potters WV, Zoon TJC, van den Heuvel OA, Prent N, de Bie RMA, Bot M, Schuurman PR, van den Munckhof P, Geurtsen GJ, Hillebrand A, Stam CJ, van Rootselaar AF, Berendse HW. Structural and functional correlates of subthalamic deep brain stimulation-induced apathy in Parkinson's disease. Brain Stimul 2020; 14:192-201. [PMID: 33385593 DOI: 10.1016/j.brs.2020.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/25/2020] [Revised: 11/15/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Notwithstanding the large improvement in motor function in Parkinson's disease (PD) patients treated with deep brain stimulation (DBS), apathy may increase. Postoperative apathy cannot always be related to a dose reduction of dopaminergic medication and stimulation itself may play a role. OBJECTIVE We studied whether apathy in DBS-treated PD patients could be a stimulation effect. METHODS In 26 PD patients we acquired apathy scores before and >6 months after DBS of the subthalamic nucleus (STN). Magnetoencephalography recordings (ON and OFF stimulation) were performed ≥6 months after DBS placement. Change in apathy severity was correlated with (i) improvement in motor function and dose reduction of dopaminergic medication, (ii) stimulation location (merged MRI and CT-scans) and (iii) stimulation-related changes in functional connectivity of brain regions that have an alleged role in apathy. RESULTS Average apathy severity significantly increased after DBS (p < 0.001) and the number of patients considered apathetic increased from two to nine. Change in apathy severity did not correlate with improvement in motor function or dose reduction of dopaminergic medication. For the left hemisphere, increase in apathy was associated with a more dorsolateral stimulation location (p = 0.010). The increase in apathy severity correlated with a decrease in alpha1 functional connectivity of the dorsolateral prefrontal cortex (p = 0.006), but not with changes of the medial orbitofrontal or the anterior cingulate cortex. CONCLUSIONS The present observations suggest that apathy after STN-DBS is not necessarily related to dose reductions of dopaminergic medication, but may be an effect of the stimulation itself. This highlights the importance of determining optimal DBS settings based on both motor and non-motor symptoms.
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Affiliation(s)
- Lennard I Boon
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands.
| | - Wouter V Potters
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Thomas J C Zoon
- Amsterdam UMC, University of Amsterdam, Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Odile A van den Heuvel
- Amsterdam UMC, Vrije Universiteit Amsterdam, Psychiatry, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Naomi Prent
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maarten Bot
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - P Richard Schuurman
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gert J Geurtsen
- Amsterdam UMC, University of Amsterdam, Medical Psychology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Arjan Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Cornelis J Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Henk W Berendse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, De Boelelaan, 1117, Amsterdam, the Netherlands
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24
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Fridgeirsson EA, Figee M, Luigjes J, van den Munckhof P, Schuurman PR, van Wingen G, Denys D. Deep brain stimulation modulates directional limbic connectivity in obsessive-compulsive disorder. Brain 2020; 143:1603-1612. [PMID: 32352147 PMCID: PMC7241947 DOI: 10.1093/brain/awaa100] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 01/12/2020] [Accepted: 03/16/2020] [Indexed: 01/07/2023] Open
Abstract
Deep brain stimulation is effective for patients with treatment-refractory obsessive-compulsive disorder. Deep brain stimulation of the ventral anterior limb of the internal capsule rapidly improves mood and anxiety with optimal stimulation parameters. To understand these rapid effects, we studied functional interactions within the affective amygdala circuit. We compared resting state functional MRI data during chronic stimulation versus 1 week of stimulation discontinuation in patients, and obtained two resting state scans from matched healthy volunteers to account for test-retest effects. Imaging data were analysed using functional connectivity analysis and dynamic causal modelling. Improvement in mood and anxiety following deep brain stimulation was associated with reduced amygdala-insula functional connectivity. Directional connectivity analysis revealed that deep brain stimulation increased the impact of the ventromedial prefrontal cortex on the amygdala, and decreased the impact of the amygdala on the insula. These results highlight the importance of the amygdala circuit in the pathophysiology of obsessive-compulsive disorder, and suggest a neural systems model through which negative mood and anxiety are modulated by stimulation of the ventral anterior limb of the internal capsule for obsessive-compulsive disorder and possibly other psychiatric disorders.
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Affiliation(s)
- Egill Axfjord Fridgeirsson
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Figee
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Judy Luigjes
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition, University of Amsterdam, Amsterdam, The Netherlands.,The Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
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25
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Holewijn RA, Bot M, van den Munckhof P, Schuurman PR. Implementation of Intraoperative Cone-Beam Computed Tomography (O-arm) for Stereotactic Imaging During Deep Brain Stimulation Procedures. Oper Neurosurg (Hagerstown) 2020; 19:E224-E229. [PMID: 32392290 PMCID: PMC7530565 DOI: 10.1093/ons/opaa110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/05/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Intraoperative cone-beam computed tomography (iCBCT) allows for rapid 3-dimensional imaging. However, it is currently unknown whether this imaging technique offers sufficient accuracy for stereotactic registration during deep brain stimulation (DBS) procedures. OBJECTIVE To determine the accuracy of iCBCT, with the O-arm O2 (Medtronic), for stereotactic registration by comparing this modality to stereotactic magnetic resonance imaging (MRI). METHODS All DBS patients underwent a preoperative non-stereotactic 3 Tesla MRI, stereotactic 1.5 Tesla MRI, stereotactic O-arm iCBCT, postimplantation O-arm iCBCT, and postoperative conventional multidetector computed tomography (CT) scan. We compared stereotactic (X, Y, and Z) coordinates of the anterior commissure (AC), the posterior commissure (PC), and midline reference (MR) between stereotactic MRI and iCBCT. For localisation comparison of electrode contacts, stereotactic coordinates of electrode tips were compared between the postoperative multidetector CT and iCBCT. RESULTS A total of 20 patients were evaluated. The average absolute difference in stereotactic coordinates of AC, PC, and MR was 0.4 ± 0.4 mm for X, 0.4 ± 0.4 mm for Y, and 0.7 ± 0.5 mm for Z. The average absolute difference in X-, Y-, and Z-coordinates for electrode localisation (N = 34) was 0.3 ± 0.3 mm, 0.6 ± 0.3 mm, and 0.6 ± 0.6 mm. These differences were small enough not to be considered clinically relevant. CONCLUSION Stereotactic MRI and O-arm iCBCT yield comparable coordinates in pre- and postoperative imaging. Differences found are below the threshold of clinical relevance. Intraoperative O-arm CBCT offers rapid stereotactic registration and evaluation of electrode placement. This increases patient comfort and neurosurgical workflow efficiency.
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Affiliation(s)
- Rozemarije A Holewijn
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Maarten Bot
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Amsterdam University Medical Centers, Academic Medical Center (AMC), Amsterdam, The Netherlands
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26
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Liebrand LC, Natarajan SJ, Caan MWA, Schuurman PR, van den Munckhof P, de Kwaasteniet B, Luigjes J, Bergfeld IO, Denys D, van Wingen GA. Distance to white matter trajectories is associated with treatment response to internal capsule deep brain stimulation in treatment-refractory depression. Neuroimage Clin 2020; 28:102363. [PMID: 32755802 PMCID: PMC7396898 DOI: 10.1016/j.nicl.2020.102363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/04/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022]
Abstract
Stimulation closer to tracts was associated with better outcome in DBS for depression. Lead placement was consistent across (non)responders w.r.t. anatomical landmarks. Tractography-guided surgery needed to ensure tracts lie within activated tissue.
Background Deep brain stimulation (DBS) is an innovative treatment for treatment-refractory depression. DBS is usually targeted at specific anatomical landmarks, with patients responding to DBS in approximately 50% of cases. Attention has recently shifted to white matter tracts to explain DBS response, with initial open-label trials targeting white matter tracts yielding much higher response rates (>70%). Objective/Hypothesis Our aim was to associate distance to individual white matter tracts around the stimulation target in the ventral anterior limb of the internal capsule to treatment response. Methods We performed diffusion magnetic resonance tractography of the superolateral branch of the medial forebrain bundle and the anterior thalamic radiation in fourteen patients that participated in our randomized clinical trial. We combined the tract reconstructions with the postoperative images to identify the DBS leads and estimated the distance between tracts and leads, which we subsequently associated with treatment response. Results Stimulation closer to both tracts was significantly correlated to a larger symptom decrease (r = 0.61, p = 0.02), suggesting that stimulation more proximal to the tracts was beneficial. Biophysical modelling indicated that 37.5% of tracts were even outside the volume of activated tissue. There was no difference in lead placement with respect to anatomical landmarks, which could mean that differences in treatment response were driven by individual differences in white matter anatomy. Conclusions Our results suggest that deep brain stimulation of the ventral anterior limb of the internal capsule could benefit from targeting white matter bundles. We recommend acquiring diffusion magnetic resonance data for each individual patient.
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Affiliation(s)
- Luka C Liebrand
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands.
| | - Samuel J Natarajan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands
| | - Matthan W A Caan
- Amsterdam UMC, University of Amsterdam, Department of Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, Netherlands
| | - P Richard Schuurman
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, Amsterdam, Netherlands
| | - Bart de Kwaasteniet
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands
| | - Judy Luigjes
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands
| | - Isidoor O Bergfeld
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands
| | - Damiaan Denys
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands; Netherlands Institute for Neuroscience, Royal Academy of Arts and Sciences, Meibergdreef 47, Amsterdam, Netherlands
| | - Guido A van Wingen
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, Netherlands; Amsterdam Brain and Cognition, Nieuwe Achtergracht 129 B, Amsterdam, Netherlands
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Boon LI, Hillebrand A, Potters WV, de Bie RMA, Prent N, Bot M, Schuurman PR, Stam CJ, van Rootselaar AF, Berendse HW. Motor effects of deep brain stimulation correlate with increased functional connectivity in Parkinson's disease: An MEG study. Neuroimage Clin 2020; 26:102225. [PMID: 32120294 PMCID: PMC7049661 DOI: 10.1016/j.nicl.2020.102225] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/27/2020] [Accepted: 02/20/2020] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established symptomatic treatment in Parkinson's disease, yet its mechanism of action is not fully understood. Locally in the STN, stimulation lowers beta band power, in parallel with symptom relief. Therefore, beta band oscillations are sometimes referred to as "anti-kinetic". However, in recent studies functional interactions have been observed beyond the STN, which we hypothesized to reflect clinical effects of DBS. Resting-state, whole-brain magnetoencephalography (MEG) recordings and assessments on motor function were obtained in 18 Parkinson's disease patients with bilateral STN-DBS, on and off stimulation. For each brain region, we estimated source-space spectral power and functional connectivity with the rest of the brain. Stimulation led to an increase in average peak frequency and a suppression of absolute band power (delta to low-beta band) in the sensorimotor cortices. Significant changes (decreases and increases) in low-beta band functional connectivity were observed upon stimulation. Improvement in bradykinesia/rigidity was significantly related to increases in alpha2 and low-beta band functional connectivity (of sensorimotor regions, the cortex as a whole, and subcortical regions). By contrast, tremor improvement did not correlate with changes in functional connectivity. Our results highlight the distributed effects of DBS on the resting-state brain and suggest that DBS-related improvements in rigidity and bradykinesia, but not tremor, may be mediated by an increase in alpha2 and low-beta functional connectivity. Beyond the local effects of DBS in and around the STN, functional connectivity changes in these frequency bands might therefore be considered as "pro-kinetic".
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Affiliation(s)
- Lennard I Boon
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Arjan Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Wouter V Potters
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Naomi Prent
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Maarten Bot
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - P Richard Schuurman
- Amsterdam UMC, University of Amsterdam, Neurosurgery, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Cornelis J Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Clinical Neurophysiology and Magnetoencephalography Centre, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC, University of Amsterdam, Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands
| | - Henk W Berendse
- Amsterdam UMC, Vrije Universiteit Amsterdam, Neurology, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, the Netherlands
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van Poppelen D, Sisodia V, de Haan RJ, Dijkgraaf MGW, Schuurman PR, Geurtsen GJ, Berk AEM, de Bie RMA, Dijk JM. Protocol of a randomized open label multicentre trial comparing continuous intrajejunal levodopa infusion with deep brain stimulation in Parkinson's disease - the INfusion VErsus STimulation (INVEST) study. BMC Neurol 2020; 20:40. [PMID: 32005175 PMCID: PMC6995127 DOI: 10.1186/s12883-020-1621-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/20/2020] [Indexed: 01/03/2023] Open
Abstract
Background Both Deep Brain Stimulation (DBS) and Continuous intrajejunal Levodopa Infusion (CLI) are effective therapies for the treatment of Parkinson’s disease (PD). To our knowledge, no direct head-to-head comparison of DBS and CLI has been performed, whilst the costs probably differ significantly. In the INfusion VErsus STimulation (INVEST) study, costs and effectiveness of DBS and CLI are compared in a randomized controlled trial (RCT) in patients with PD, to study whether higher costs of one of the therapies are justified by superiority of that treatment. Methods A prospective open label multicentre RCT is being performed, with ancillary patient preference observational arms. Patients with PD who, despite optimal pharmacological treatment, have severe response fluctuations, bradykinesia, dyskinesias, or painful dystonia are eligible for inclusion. A total of 66 patients will be randomized. There is no minimal inclusion in the patient preference arms. The primary health economic outcomes are costs per unit on the Parkinson’s Disease Questionnaire-39 (PDQ-39) and costs per unit Quality-Adjusted Life Year (QALY) at 12 months. The main clinical outcome is patient-reported quality of life measured with the PDQ-39 at 12 months. Patients will additionally be followed during 36 months after initiation of the study treatment. Discussion The INVEST trial directly compares the costs and effectiveness of the advanced therapies DBS and CLI. Trial registration Dutch Trial Register identifier 4753, registered November 3rd, 2014; EudraCT number 2014–001501-32, Clinicaltrials.gov: NCT02480803.
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Affiliation(s)
- D van Poppelen
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - V Sisodia
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - R J de Haan
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - M G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - G J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - A E M Berk
- Dutch Parkinson's disease association (Parkinson Vereniging), Kosterijland 12, Bunnik, the Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - J M Dijk
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
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Bot M, Verhagen O, Caan M, Potters WV, Dilai Y, Odekerken VJJ, Dijk JM, de Bie RMA, Schuurman PR, van den Munckhof P. Defining the Dorsal STN Border Using 7.0-T MRI: A Comparison to Microelectrode Recordings and Lower Field Strength MRI. Stereotact Funct Neurosurg 2019; 97:153-159. [PMID: 31430753 DOI: 10.1159/000500109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 10/18/2018] [Accepted: 03/23/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND 7.0-T T2-weighted MRI offers excellent visibility of the subthalamic nucleus (STN), which is used as a target for deep brain stimulation (DBS) in Parkinson's disease (PD). A comparison of 7.0-T MRI to microelectrode recordings (MER) for STN border identification has not been performed. OBJECTIVE To compare representation of STN borders on 7.0-T T2 MRI with the borders identified during MER in patients undergoing DBS for PD and to evaluate whether STN identification on 7.0-T T2 MRI leads to alterations in stereotactic target planning. DESIGN/METHODS STN border identification was done using volumetric 7.0-T T2 MRI acquisitions. This was compared to the STN borders identified by MER. STN target planning was independently performed by 3 DBS surgeons on T2 imaging using 1.5-, 3.0-, and 7.0-T MRI. RESULTS A total of 102 microelectrode tracks were evaluated in 19 patients. Identification of the dorsal STN border was well feasible on 7-T T2, whereas the ventral STN was un-distinguishable from the substantia nigra. The dorsal STN border on MRI was located more dorsal than MER in 73% of trajectories. The average distance from MRI to MER border was 0.9 mm (range -4.4 to +3.5 mm). STN target planning showed high correspondence between the 3 field strengths. CONCLUSION 7.0-T T2 MRI offers the possibility of easy identification of the dorsal border of the STN. However, higher field strength MRI does not change the planning of the target. Compared to MER, the dorsal border on MRI was located more dorsal in the majority of cases, situating MER activity within STN representation.
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Affiliation(s)
- Maarten Bot
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands,
| | - Okker Verhagen
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Matthan Caan
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Wouter V Potters
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Dilai
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Joke M Dijk
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
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Prent N, Potters WV, Boon LI, Caan MWA, de Bie RMA, van den Munckhof P, Schuurman PR, van Rootselaar AF. Distance to white matter tracts is associated with deep brain stimulation motor outcome in Parkinson's disease. J Neurosurg 2019; 133:1-10. [PMID: 31349226 DOI: 10.3171/2019.5.jns1952] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 01/11/2019] [Accepted: 05/01/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus (STN) alleviates motor symptoms in patients with Parkinson's disease (PD). However, the underlying mechanism of tremor suppression is not well understood. Stimulation of white matter tracts, such as the dentatorubrothalamic tract (DRT), might be involved. Also, side effects, including dysarthria, might result from (unwanted) stimulation of white matter tracts in proximity to the STN. The aim of this study was to establish an association between stimulation effect on tremor and dysarthria and stimulation location relative to relevant white matter tracts. METHODS In 35 PD patients in whom a bilateral STN DBS system was implanted, the authors established clinical outcome measures per electrode contact. The distance from each stimulation location to the center of the DRT, corticopontocerebellar tract, pyramidal tract (PT), and medial lemniscus was determined using diffusion-weighted MRI data. Clinical outcome measures were subsequently related to the distances to the white matter tracts. RESULTS Patients with activated contacts closer to the DRT showed increased tremor improvement. Proximity of activated contacts to the PT was associated with dysarthria. CONCLUSIONS Proximity to specific white matter tracts is associated with tremor outcome and side effects in DBS. This knowledge can help to optimize both electrode placement and postsurgical electrode contact selection. Presurgical white matter tract visualization may improve targeting and DBS outcome. These findings are of interest not only for treatment in PD, but potentially also for other (movement) disorders.
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Affiliation(s)
- Naomi Prent
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
| | - Wouter V Potters
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
| | - Lennard I Boon
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
- 2Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Neuroscience
| | - Matthan W A Caan
- 3Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
| | - Rob M A de Bie
- 5Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- 4Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and
| | - P Richard Schuurman
- 4Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience; and
| | - Anne-Fleur van Rootselaar
- 1Department of Neurology and Clinical Neurophysiology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience
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Sidiropoulos C, LeWitt PA, Odekerken VJJ, Schuurman PR, de Bie RMA. GPi vs STN deep brain stimulation for Parkinson disease: Three-year follow-up. Neurology 2019; 87:745-6. [PMID: 27527541 DOI: 10.1212/wnl.0000000000003027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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32
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Verhagen R, Bour LJ, Odekerken VJJ, van den Munckhof P, Schuurman PR, de Bie RMA. Electrode Location in a Microelectrode Recording-Based Model of the Subthalamic Nucleus Can Predict Motor Improvement After Deep Brain Stimulation for Parkinson's Disease. Brain Sci 2019; 9:brainsci9030051. [PMID: 30832214 PMCID: PMC6469020 DOI: 10.3390/brainsci9030051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 02/20/2019] [Accepted: 02/20/2019] [Indexed: 11/17/2022] Open
Abstract
Motor improvement after deep brain stimulation (DBS) in the subthalamic nucleus (STN) may vary substantially between Parkinson’s disease (PD) patients. Research into the relation between improvement and active contact location requires a correction for anatomical variation. We studied the relation between active contact location relative to the neurophysiological STN, estimated by the intraoperative microelectrode recordings (MER-based STN), and contralateral motor improvement after one year. A generic STN shape was transformed to fit onto the stereotactically defined MER sites. The location of 43 electrodes (26 patients), derived from MRI-fused CT images, was expressed relative to this patient-specific MER-based STN. Using regression analyses, the relation between contact location and motor improvement was studied. The regression model that predicts motor improvement based on levodopa effect alone was significantly improved by adding the one-year active contact coordinates (R2 change = 0.176, p = 0.014). In the combined prediction model (adjusted R2 = 0.389, p < 0.001), the largest contribution was made by the mediolateral location of the active contact (standardized beta = 0.490, p = 0.002). With the MER-based STN as a reference, we were able to find a significant relation between active contact location and motor improvement. MER-based STN modeling can be used to complement imaging-based STN models in the application of DBS.
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Affiliation(s)
- Rens Verhagen
- Department of Neurology and Clinical Neurophysiology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
- Department of Neurosurgery, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Lo J Bour
- Department of Neurology and Clinical Neurophysiology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Vincent J J Odekerken
- Department of Neurology and Clinical Neurophysiology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Pepijn van den Munckhof
- Department of Neurosurgery, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - P Richard Schuurman
- Department of Neurosurgery, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, University of Amsterdam, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
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Graat I, Bergfeld IO, de Koning P, Vulink N, Schuurman PR, Denys D, Figee M. Delusions following deep brain stimulation of the nucleus accumbens. Brain Stimul 2019; 12:770-771. [PMID: 30606642 DOI: 10.1016/j.brs.2018.12.973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
- Ilse Graat
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
| | - Isidoor O Bergfeld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pelle de Koning
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nienke Vulink
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - P Richard Schuurman
- Amsterdam Neuroscience, Amsterdam, the Netherlands; Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands; Netherlands Institute for Neurosciences, an Institute of the Royal Dutch Academy of Science, Amsterdam, the Netherlands
| | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Neuroscience, Amsterdam, the Netherlands
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Schüpbach M, Chabardes S, Matthies C, Pollo C, Steigerwald F, Timmermann L, Visser Vandewalle V, Volkmann J, Schuurman PR. Reply to "The paper that wrote itself-a ghost story". Mov Disord 2018; 33:1510-1511. [PMID: 30192032 DOI: 10.1002/mds.27464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 05/24/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
| | | | - Cordula Matthies
- Vice Clinic Director and Head of Functional Neurosurgery, Department of Neurosurgery, Wuerzburg University Hospital, Bavaria, Germany
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Bot M, van den Munckhof P, Schmand BA, de Bie RMA, Schuurman PR. Electrode Penetration of the Caudate Nucleus in Deep Brain Stimulation Surgery for Parkinson's Disease. Stereotact Funct Neurosurg 2018; 96:223-230. [PMID: 30176664 DOI: 10.1159/000489944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 06/05/2017] [Accepted: 05/10/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the possible influence of electrode trajectories penetrating the caudate nucleus (CN) on cognitive outcomes in deep brain stimulation (DBS) surgery for Parkinson's disease (PD). BACKGROUND It is currently unclear how mandatory CN avoidance during trajectory planning is. DESIGN/METHODS Electrode trajectories were determined to be inside, outside, or in border region of the CN. Pre- and postoperative neuropsychological tests of each trajectory group were compared in order to evaluate possible differences in cognitive outcomes 12 months after bilateral STN DBS. RESULTS One hundred six electrode tracks in 53 patients were evaluated. Bilateral penetration of the CN occurred in 15 (28%) patients, while unilateral penetration occurred in 28 (53%). In 19 (36%) patients tracks were located in the border region of the CN. There was no electrode penetration of the CN in 10 (19%) patients. No difference in cognitive outcomes was found between the different groups. CONCLUSION Cognitive outcome was not influenced by DBS electrode tracks penetrating the CN. It is both feasible and sensible to avoid electrode tracks through the CN when possible, considering its function and anatomical position. However, penetration of the CN can be considered without major concerns regarding cognitive decline when this facilitates optimal trajectory planning due to specific individual anatomical variations.
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Affiliation(s)
- Maarten Bot
- Department of Neurosurgery, Academic Medical Center, Amsterdam, the Netherlands
| | | | - Ben A Schmand
- Department of Psychology, Academic Medical Center, Amsterdam, the Netherlands
| | - Rob M A de Bie
- Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, the Netherlands
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Bergfeld IO, Mantione M, Figee M, Schuurman PR, Lok A, Denys D. Treatment-resistant depression and suicidality. J Affect Disord 2018; 235:362-367. [PMID: 29665520 DOI: 10.1016/j.jad.2018.04.016] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/28/2018] [Accepted: 04/02/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND Thirty percent of patients with treatment-resistant depression (TRD) attempt suicide at least once during their lifetime. However, it is unclear what the attempted and completed suicide incidences are in TRD patients after initiating a treatment, and whether specific treatments increase or decrease these incidences. METHODS We searched PubMed systematically for studies of depressed patients who failed at least two antidepressant therapies and were followed for at least three months after initiating a treatment. We estimated attempted and completed suicide incidences using a Poisson meta-analysis. Given the lack of controlled comparisons, we used a meta-regression to estimate whether these incidences differed between treatments. RESULTS We included 30 studies investigating suicidality in 32 TRD samples, undergoing deep brain stimulation (DBS, n = 9), vagal nerve stimulation (VNS, n = 9), electroconvulsive therapy (ECT, n = 5), treatment-as-usual (n = 3), capsulotomy (n = 2), cognitive behavioral therapy (n = 2), ketamine (n = 1), and epidural cortical stimulation (n = 1). The overall incidence of completed suicides was 0.47 per 100 patient years (95% CI: 0.22-1.00), and of attempted suicides 4.66 per 100 patient years (95% CI: 3.53-6.23). No differences were found in incidences following DBS, VNS or ECT. LIMITATIONS Suicidality is poorly recorded in many studies limiting the number of studies available. CONCLUSIONS The completed and attempted suicide incidences are high (0.47 and 4.66 per 100 patient years respectively), but these incidences did not differ between three end of the line treatments (DBS, VNS or ECT). Given the high suicide risk in TRD patients, clinical trials should consider suicidality as an explicit outcome measure.
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Affiliation(s)
- Isidoor O Bergfeld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands.
| | - Mariska Mantione
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Anja Lok
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands
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ter Horst KW, Lammers NM, Trinko R, Opland DM, Figee M, Ackermans MT, Booij J, van den Munckhof P, Schuurman PR, Fliers E, Denys D, DiLeone RJ, la Fleur SE, Serlie MJ. Striatal dopamine regulates systemic glucose metabolism in humans and mice. Sci Transl Med 2018; 10:10/442/eaar3752. [DOI: 10.1126/scitranslmed.aar3752] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/03/2018] [Indexed: 12/12/2022]
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Bot M, Schuurman PR, Odekerken VJJ, Verhagen R, Contarino FM, De Bie RMA, van den Munckhof P. Deep brain stimulation for Parkinson's disease: defining the optimal location within the subthalamic nucleus. J Neurol Neurosurg Psychiatry 2018; 89:493-498. [PMID: 29353236 DOI: 10.1136/jnnp-2017-316907] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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: 07/19/2017] [Revised: 11/12/2017] [Accepted: 11/20/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Individual motor improvement after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD) varies considerably. Stereotactic targeting of the dorsolateral sensorimotor part of the STN is considered paramount for maximising effectiveness, but studies employing the midcommissural point (MCP) as anatomical reference failed to show correlation between DBS location and motor improvement. The medial border of the STN as reference may provide better insight in the relationship between DBS location and clinical outcome. METHODS Motor improvement after 12 months of 65 STN DBS electrodes was categorised into non-responding, responding and optimally responding body-sides. Stereotactic coordinates of optimal electrode contacts relative to both medial STN border and MCP served to define theoretic DBS 'hotspots'. RESULTS Using the medial STN border as reference, significant negative correlation (Pearson's correlation -0.52, P<0.01) was found between the Euclidean distance from the centre of stimulation to this DBS hotspot and motor improvement. This hotspot was located at 2.8 mm lateral, 1.7 mm anterior and 2.5 mm superior relative to the medial STN border. Using MCP as reference, no correlation was found. CONCLUSION The medial STN border proved superior compared with MCP as anatomical reference for correlation of DBS location and motor improvement, and enabled defining an optimal DBS location within the nucleus. We therefore propose the medial STN border as a better individual reference point than the currently used MCP on preoperative stereotactic imaging, in order to obtain optimal and thus less variable motor improvement for individual patients with PD following STN DBS.
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Affiliation(s)
- Maarten Bot
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rens Verhagen
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Fiorella Maria Contarino
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands.,Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Neurology, Haga Teaching Hospital, Den Haag, The Netherlands
| | - Rob M A De Bie
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, The Netherlands
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Figee M, Schuurman PR, Denys D. [Deep brain stimulation for psychiatric disorders]. Ned Tijdschr Geneeskd 2018; 162:D2333. [PMID: 29676713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
- Deep brain stimulation (DBS) corrects pathological activity of neuropsychiatric brain networks with high frequency current via implanted brain electrodes.- DBS is an effective and safe treatment for therapy-refractory obsessive-compulsive disorder and potentially also for therapy-refractory major depressive disorder.- Experimental psychiatric indications for DBS are Tourette syndrome, addiction, anorexia nervosa, post-traumatic stress disorder, autism and schizophrenia.- DBS influences brain networks that are relevant for a variety of psychiatric symptoms. Potentially, in the future this interventional technique may therefore be deployed more broadly.
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Affiliation(s)
- M Figee
- Academisch Medisch Centrum, Amsterdam
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Linssen RSN, Oudijn MS, Mantione M, van den Munckhof P, Denys D, Schuurman PR. Body Weight Changes after Deep Brain Stimulation for Obsessive-Compulsive Disorder or Depression. Stereotact Funct Neurosurg 2017; 95:348-351. [PMID: 29017175 DOI: 10.1159/000480665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 03/02/2017] [Accepted: 08/23/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND In 2010, we published an often-cited case report describing smoking cessation and substantial weight loss after deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) in an obese patient. To test whether this single observation was also observed in the treated population at large, the weight changes of a larger cohort of patients who underwent DBS for OCD or major depressive disorder (MDD) were studied. RESULTS Data were available for 46 patients (30 OCD and 16 MDD patients; mean age 46.2 years, SD 10.9) with an average baseline body mass index (BMI) of 28.0 (SD 7.3), 26 of whom (57%) were overweight (n = 11), obese (n = 12), or morbidly obese (n = 3). Mean follow-up was 3.8 years (range 10 months to 8.7 years, SD 2.3), after which the average BMI was 28.1 (SD 7.0), not significantly different from baseline. The average BMI of the 15 patients with (morbid) obesity at baseline decreased from 36.8 to 34.6 (ns), while the average BMI of the 31 normal or "only" overweight patients at baseline increased from 23.8 to 25.0 (ns). CONCLUSION There was no significant change in body weight on group level after DBS for either OCD or MDD.
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Affiliation(s)
- Rosalie S N Linssen
- Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
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Holewijn RA, Verbaan D, de Bie RMA, Schuurman PR. General Anesthesia versus Local Anesthesia in StereotaXY (GALAXY) for Parkinson's disease: study protocol for a randomized controlled trial. Trials 2017; 18:417. [PMID: 28882161 PMCID: PMC5590197 DOI: 10.1186/s13063-017-2136-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 08/03/2017] [Indexed: 11/17/2022] Open
Abstract
Background The aim of the study is to investigate if deep brain stimulation (DBS) in the subthalamic nucleus (STN) for Parkinson’s disease (PD) under general anesthesia further improves outcome by lessening postoperative cognitive, mood, and behavioral adverse effects; shorten surgical time and hospital admittance; and produce comparable symptomatic and functional improvement to surgery under local anesthesia. Methods/design The study will be a single-center, prospective, randomized, open-label, blinded endpoint trial comparing DBS under general anesthesia with DBS under local anesthesia. The primary outcome measure is a composite score of the postoperative cognitive, mood, and behavioral adverse effects and will be measured 6 months after surgery. The secondary outcome measures consist of changes in motor symptoms, adverse effects of stimulation and surgical complications, surgical time, functional health, quality of life, patient satisfaction with the outcome of treatment, patient evaluation of the burden of therapy, and medication. A total of 110 patients with advanced PD who are candidates for DBS will be randomized during a 2.5-year period. Discussion The aim of this trial is to further enhance the effectiveness of DBS treatment in PD while reducing the burden of DBS surgery by studying if DBS surgery under general anesthesia results in less cognitive, mood, and behavioral adverse effects compared with surgery under local anesthesia. Trial registration Netherlands Trial Register, NTR5809. Registered on 23 April 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2136-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R A Holewijn
- Department of Neurosurgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - D Verbaan
- Department of Neurosurgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R M A de Bie
- Department of Neurology, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
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Bergfeld IO, Mantione M, Hoogendoorn ML, Horst F, Notten P, Schuurman PR, Denys D. Episodic memory following deep brain stimulation of the ventral anterior limb of the internal capsule and electroconvulsive therapy. Brain Stimul 2017; 10:959-966. [DOI: 10.1016/j.brs.2017.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 07/12/2017] [Accepted: 07/16/2017] [Indexed: 10/19/2022] Open
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Schüpbach WMM, Chabardes S, Matthies C, Pollo C, Steigerwald F, Timmermann L, Visser Vandewalle V, Volkmann J, Schuurman PR. Directional leads for deep brain stimulation: Opportunities and challenges. Mov Disord 2017; 32:1371-1375. [PMID: 28843016 DOI: 10.1002/mds.27096] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 05/03/2017] [Accepted: 06/14/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
- W M Michael Schüpbach
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.,APHP, INSERM, ICM, Centre d'Investigation Clinique CIC 1422, Département de Neurologie, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Cordula Matthies
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Frank Steigerwald
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital of Giessen and Marburg, Marburg, Germany
| | | | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
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Bergfeld IO, Mantione M, Hoogendoorn MLC, Ruhé HG, Horst F, Notten P, van Laarhoven J, van den Munckhof P, Beute G, Schuurman PR, Denys D. Impact of deep brain stimulation of the ventral anterior limb of the internal capsule on cognition in depression. Psychol Med 2017; 47:1647-1658. [PMID: 28179035 DOI: 10.1017/s0033291717000113] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Preliminary studies report no negative and a possible positive impact of deep brain stimulation (DBS) on cognition of patients with treatment-resistant depression (TRD). However, these studies neither controlled for practice effects nor compared active with sham stimulation. METHOD To address these limitations, we compared 25 TRD patients, who underwent DBS of the ventral anterior limb of the internal capsule (vALIC), with 21 healthy controls (HCs) matched on gender, age and education level. Both groups did subtests of the Cambridge Neuropsychological Test Automated Battery assessing verbal and visuospatial memory, attention, cognitive flexibility, psychomotor functioning, planning and object naming. TRD patients were tested 3 weeks prior to DBS surgery (baseline), 3 weeks following surgery (T1) and following 52 weeks of DBS optimization (T2). HCs were tested at baseline, 6 weeks following baseline (T1) and 20-24 weeks following baseline (T2). Subsequently, TRD patients entered a randomized, double-blind crossover phase, in which they were tested in an active and a sham stimulation phase. RESULTS TRD patients did not improve on a test of immediate verbal recognition from baseline to T1, whereas HCs did (group x time: p = 0.001). Both TRD patients and HCs improved over sessions on tests measuring delayed verbal recall, visuospatial memory, planning and object naming (all p < 0.01). Active and sham stimulation did not have an impact on any of the tests differentially. CONCLUSIONS vALIC DBS neither has a lasting positive nor negative impact on cognition in TRD patients. DBS surgery might have a temporary negative effect on verbal memory.
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Affiliation(s)
- I O Bergfeld
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - M Mantione
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - M L C Hoogendoorn
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - H G Ruhé
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - F Horst
- Department of Psychiatry,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - P Notten
- Department of Psychiatry,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - J van Laarhoven
- Department of Psychiatry,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - P van den Munckhof
- Department of Neurosurgery,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - G Beute
- Department of Neurosurgery,ETZ, location Elisabeth,Tilburg,The Netherlands
| | - P R Schuurman
- Department of Neurosurgery,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
| | - D Denys
- Department of Psychiatry,Academic Medical Center,University of Amsterdam,Amsterdam,The Netherlands
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Witte LP, Odekerken VJJ, Boel JA, Schuurman PR, Gerbrandy-Schreuders LC, de Bie RMA. Does deep brain stimulation improve lower urinary tract symptoms in Parkinson's disease? Neurourol Urodyn 2017; 37:354-359. [PMID: 28464331 DOI: 10.1002/nau.23301] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 01/30/2017] [Accepted: 03/23/2017] [Indexed: 11/09/2022]
Abstract
AIMS To investigate whether deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) or the subthalamic nucleus (STN) improve lower urinary tract symptoms (LUTS) in advanced Parkinson's disease (PD). METHODS An exploratory post-hoc analysis was performed of specific LUTS items of questionnaires used in a randomized clinical trial with 128 patients (NSTAPS study). First, we compared scores on LUTS items at baseline and 12 months for the GPi DBS and STN DBS group separately. Second, we divided the group by sex, instead of DBS location; to assess a possible gender associated influence of anatomical and pathophysiological differences, again comparing scores at baseline and 12 months. Third, we reported on Foley-catheter use at baseline and after 12 months. RESULTS Urinary incontinence and frequency improved after both GPi DBS and STN DBS at 12 months, postoperatively, but this was only statistically significant for the STN DBS group (P = 0.004). The improvements after DBS were present in both men (P = 0.01) and women (P = 0.05). Nocturia and urinary incontinence did not improve significantly after any type of DBS, irrespective of sex. At 12 months, none of the patients had a Foley-catheter. CONCLUSIONS Urinary incontinence and frequency significantly improved after STN DBS treatment in male and female patients with PD. Nocturia and nighttime incontinence due to parkinsonism did not improve after DBS, irrespective of gender.
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Affiliation(s)
- Lambertus P Witte
- Department of Urology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith A Boel
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Rob M A de Bie
- Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Ooms P, Blankers M, Figee M, Bergfeld IO, van den Munckhof P, Schuurman PR, Denys D. Cost-effectiveness of deep brain stimulation versus treatment as usual for obsessive-compulsive disorder. Brain Stimul 2017; 10:836-842. [PMID: 28457837 DOI: 10.1016/j.brs.2017.04.120] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Revised: 03/09/2017] [Accepted: 04/11/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep Brain Stimulation (DBS) is effective for obsessive-compulsive disorder (OCD), but requires expensive medical procedures. To date, no study has examined the cost-effectiveness of DBS for OCD. OBJECTIVE To perform the first economic evaluation of DBS for therapy refractory OCD. METHODS We conducted a 2-year prospective, open cost-effectiveness study, comparing DBS (n = 17) with treatment as usual (TAU) (n = 11), with cost per Quality-Adjusted-Life-Year (QALY) as outcome measure. Apart from the base-case, or primary analysis, we conducted two practice-based scenarios: (1) standard care scenario, without research and innovation costs, and (2) rechargeable scenario, in which we assume the use of a rechargeable battery. Base-case and both scenarios were extrapolated to four years to estimate long-term cost-effectiveness. RESULTS Compared to TAU, DBS provides an additional 0.26 QALY (SD = 0.16). Median cost per QALY gained is estimated at €141,446 for base-case, €115,916 for standard care and €65,394 for the rechargeable scenario. Extending the time-horizon to four years results in a median cost per QALY of €80,313 for base-case, €69,287 for standard care, and turned out to be cost-saving at €4678 per QALY for the rechargeable scenario. Assuming a willingness to pay threshold of €80,000/QALY, DBS, under base-case and standard care had 25% and 35% probability of being more cost-effective than TAU. With the rechargeable scenario and in all scenarios extrapolated to four years, the probability of cost-effectiveness was equal or higher than TAU. CONCLUSIONS This study indicates DBS for OCD is cost-effective in the long-term, especially when rechargeable batteries are taken into account.
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Affiliation(s)
- Pieter Ooms
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Matthijs Blankers
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health Care, Amsterdam, The Netherlands; Trimbos Institute, Utrecht, The Netherlands
| | - Martijn Figee
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands
| | - Isidoor O Bergfeld
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands
| | - Pepijn van den Munckhof
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Damiaan Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Brain and Cognition, Amsterdam, The Netherlands; Netherlands Institute for Neuroscience, An Institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
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Boel JA, Odekerken VJ, Schmand BA, Geurtsen GJ, Cath DC, Figee M, van den Munckhof P, de Haan RJ, Schuurman PR, de Bie RM, Odekerken VJ, Boel JA, van Laar T, van Dijk J, Mosch A, Hoffmann CF, Nijssen PC, van Asseldonk T, Beute GN, van Vugt JP, Lenders MW, Fiorella Contarino M, Bour LJ, Geurtsen GJ, van den Munckhof P, Schmand BA, de Haan RJ, Schuurman PR, de Bie RM. Cognitive and psychiatric outcome 3 years after globus pallidus pars interna or subthalamic nucleus deep brain stimulation for Parkinson's disease. Parkinsonism Relat Disord 2016; 33:90-95. [DOI: 10.1016/j.parkreldis.2016.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/12/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
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Smit JV, Janssen MLF, Engelhard M, de Bie RMA, Schuurman PR, Contarino MF, Mosch A, Temel Y, Stokroos RJ. The impact of deep brain stimulation on tinnitus. Surg Neurol Int 2016; 7:S848-S854. [PMID: 27994936 PMCID: PMC5134112 DOI: 10.4103/2152-7806.194156] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 05/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background: Tinnitus is a disorder of the nervous system that cannot be adequately treated with current therapies. The effect of neuromodulation induced by deep brain stimulation (DBS) on tinnitus has not been studied well. This study investigated the effect of DBS on tinnitus by use of a multicenter questionnaire study. Methods: Tinnitus was retrospectively assessed prior to DBS and at the current situation (with DBS). From the 685 questionnaires, 443 were returned. A control group was one-to-one matched to DBS patients who had tinnitus before DBS (n = 61). Tinnitus was assessed by the tinnitus handicap inventory (THI) and visual analog scales (VAS) of loudness and burden. Results: The THI decreased significantly during DBS compared to the situation prior to surgery (from 18.9 to 15.1, P < .001), which was only significant for DBS in the subthalamic nucleus (STN). The THI in the control group (36.9 to 35.5, P = 0.50) and other DBS targets did not change. The VAS loudness increased in the control group (5.4 to 6.0 P < .01). Conclusion: DBS might have a modulatory effect on tinnitus. Our study suggests that DBS of the STN may have a beneficial effect on tinnitus, but most likely other nuclei linked to the tinnitus circuitry might be even more effective.
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Affiliation(s)
- Jasper V Smit
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Marcus L F Janssen
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Malou Engelhard
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rob M A de Bie
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - P Richard Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Maria F Contarino
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Arne Mosch
- Department of Neurology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Robert J Stokroos
- Department of Ear Nose and Throat/Head and Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
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Bot M, Bour L, de Bie RM, Contarino MF, Schuurman PR, van den Munckhof P. Can We Rely on Susceptibility-Weighted Imaging for Subthalamic Nucleus Identification in Deep Brain Stimulation Surgery? Neurosurgery 2016; 78:353-60. [PMID: 26600278 DOI: 10.1227/neu.0000000000001130] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Susceptibility-weighted imaging (SWI) offers significantly improved visibility of the subthalamic nucleus (STN) compared with traditional T2-weighted imaging. However, it is unknown whether the representation of the nucleus on SWI corresponds to the neurophysiological location of the STN. OBJECTIVE To determine the correlation between the intraoperative electrophysiological activity of the STN and the representation of the nucleus on different magnetic resonance imaging (MRI) sequences used for deep brain stimulation target planning. METHODS At stereotactic target depth, microelectrode recordings (MERs) of typical STN neuronal activity were mapped on 3 different preoperative MRI sequences: 1.5-T SWI, 1.5-T T2-weighted, and 3-T T2-weighted MRI. For each MRI sequence, it was determined whether the MER signal was situated inside or outside the contour of the STN. RESULTS A total of 196 MER tracks in 34 patients were evaluated. In 165 tracks (84%), typical electrophysiological STN activity was measured. MER activity was situated more consistently inside hypointense STN contour representation on 1.5- and 3-T T2-weighted images compared with SWI (99% and 100% vs 79%, respectively). The 21% incongruence of electrophysiological STN activity outside the STN contour on SWI was seen almost exclusively in the anterior and lateral microelectrode channels. CONCLUSION STN representation on SWI does not correspond to electrophysiological STN borders. SWI does not correctly display the lateral part of the STN. When aiming to target the superolateral sensorimotor part of the STN during deep brain stimulation surgery, SWI does not offer an advantage but a disadvantage compared with conventional T2. Future research is needed to determine whether these findings may also apply for high-field SWI.
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Affiliation(s)
- Maarten Bot
- Departments of *Neurosurgery and ‡Neurology and Clinical Neurophysiology, Academic Medical Center, Amsterdam, the Netherlands; §Haga Teaching Hospital, Den Haag, the Netherlands
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Verhagen R, Schuurman PR, van den Munckhof P, Contarino MF, de Bie RMA, Bour LJ. Comparative study of microelectrode recording-based STN location and MRI-based STN location in low to ultra-high field (7.0 T) T2-weighted MRI images. J Neural Eng 2016; 13:066009. [DOI: 10.1088/1741-2560/13/6/066009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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