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Tong Y, Cho S, Wenzel A, Duan Z, Coenen V, Dobrossy M. Shaped by Neuronal Stimulation: Anatomical and physiological impact of multimodal medial forebrain bundle stimulation. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Al-Fatly B, Tödt I, Tischer M, Neimat J, Hedera P, Wong J, Okun M, Nowacki A, Aziz T, Prokop T, Coenen V, Bargiotas P, Lachenmayer L, Helmers AK, Paschen S, Kühn A, Horn A, Fox M, Becktepe J, Deuschl G. Optimal deep brain stimulation connectivity to treat Holmes tremor. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Abstract
Die invasive Hirnstimulation (tiefe Hirnstimulation [THS], „deep brain stimulation“ [DBS]) ist mittlerweile ein etabliertes Therapieverfahren bei einer Reihe neurologischer Erkrankungen insbesondere Bewegungsstörungen. Die Anzahl der mit einer THS versorgten Patienten steigt stetig, die technische Entwicklung der THS-Systeme schreitet voran und neue Indikationen werden aktuell in Studien überprüft. Im folgenden Beitrag soll ein Überblick über die aktuellen Indikationen und ein Ausblick auf zukünftige Entwicklungen der THS bei Bewegungsstörungen und psychiatrischen Erkrankungen gegeben werden.
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Affiliation(s)
- Stephan Klebe
- Klinik für Neurologie, Universitätsmedizin Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Volker Coenen
- Abteilung Stereotaktische und Funktionelle Neurochirurgie, Klinik für Neurochirurgie, Neurozentrum, Universitätsklinikum Freiburg, Breisacher Str. 64, 79106, Freiburg, Deutschland
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Doostkam S, Würtemberger U, Coenen V, Urbach H, Prinz M, Taschner CA. Freiburg Neuropathology Case Conference: : Blurred Vision and Headaches in a 15-year-old Boy. Clin Neuroradiol 2020; 30:879-884. [PMID: 33230629 PMCID: PMC7728650 DOI: 10.1007/s00062-020-00973-4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- S Doostkam
- Department of Neuropathology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - U Würtemberger
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - V Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Urbach
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany
| | - M Prinz
- Department of Neuropathology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - C A Taschner
- Department of Neuroradiology, Medical Centre-University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacherstraße 64, 79106, Freiburg, Germany.
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Reich MM, Horn A, Lange F, Roothans J, Paschen S, Runge J, Wodarg F, Pozzi NG, Witt K, Nickl RC, Soussand L, Ewert S, Maltese V, Wittstock M, Schneider GH, Coenen V, Mahlknecht P, Poewe W, Eisner W, Helmers AK, Matthies C, Sturm V, Isaias IU, Krauss JK, Kühn AA, Deuschl G, Volkmann J. Probabilistic mapping of the antidystonic effect of pallidal neurostimulation: a multicentre imaging study. Brain 2020; 142:1386-1398. [PMID: 30851091 DOI: 10.1093/brain/awz046] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [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: 10/01/2018] [Revised: 12/12/2018] [Accepted: 01/08/2019] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation of the internal globus pallidus is a highly effective and established therapy for primary generalized and cervical dystonia, but therapeutic success is compromised by a non-responder rate of up to 25%, even in carefully-selected groups. Variability in electrode placement and inappropriate stimulation settings may account for a large proportion of this outcome variability. Here, we present probabilistic mapping data on a large cohort of patients collected from several European centres to resolve the optimal stimulation volume within the pallidal region. A total of 105 dystonia patients with pallidal deep brain stimulation were enrolled and 87 datasets (43 with cervical dystonia and 44 with generalized dystonia) were included into the subsequent 'normative brain' analysis. The average improvement of dystonia motor score was 50.5 ± 30.9% in cervical and 58.2 ± 48.8% in generalized dystonia, while 19.5% of patients did not respond to treatment (<25% benefit). We defined probabilistic maps of anti-dystonic effects by aggregating individual electrode locations and volumes of tissue activated (VTA) in normative atlas space and ranking voxel-wise for outcome distribution. We found a significant relation between motor outcome and the stimulation volume, but not the electrode location per se. The highest probability of stimulation induced motor benefit was found in a small volume covering the ventroposterior globus pallidus internus and adjacent subpallidal white matter. We then used the aggregated VTA-based outcome maps to rate patient individual VTAs and trained a linear regression model to predict individual outcomes. The prediction model showed robustness between the predicted and observed clinical improvement, with an r2 of 0.294 (P < 0.0001). The predictions deviated on average by 16.9 ± 11.6 % from observed dystonia improvements. For example, if a patient improved by 65%, the model would predict an improvement between 49% and 81%. Results were validated in an independent cohort of 10 dystonia patients, where prediction and observed benefit had a correlation of r2 = 0.52 (P = 0.02) and a mean prediction error of 10.3% (±8.9). These results emphasize the potential of probabilistic outcome brain mapping in refining the optimal therapeutic volume for pallidal neurostimulation and advancing computer-assisted planning and programming of deep brain stimulation.
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Affiliation(s)
- Martin M Reich
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany.,Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Florian Lange
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | - Jonas Roothans
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | | | - Fritz Wodarg
- University Kiel, Department of Radiology, Germany
| | - Nicolo G Pozzi
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | - Karsten Witt
- University Kiel, Department of Neurology, Germany.,University Oldenburg, Department of Neurology, Germany
| | - Robert C Nickl
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Louis Soussand
- Beth Israel Deaconess Medical Center, Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Siobhan Ewert
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Virgina Maltese
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | - Gerd-Helge Schneider
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | - Volker Coenen
- Freiburg University Medical Center, Department of Stereotactic and Functional Neurosurgery, Germany
| | | | - Werner Poewe
- Department of Neurology, Innsbruck Medical University, Austria
| | - Wilhelm Eisner
- Department of Neurosurgery, Innsbruck Medical University, Austria
| | | | - Cordula Matthies
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Volker Sturm
- Julius-Maximilians-University, Department of Neurosurgery, Germany
| | - Ioannis U Isaias
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
| | | | - Andrea A Kühn
- Charite-Universitätsmedizin Berlin, Movement Disorders and Neuromodulation Unit, Department of Neurology, Germany
| | | | - Jens Volkmann
- Julius-Maximilians-University Würzburg, Department of Neurology, Germany
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Affiliation(s)
- Volker Coenen
- Associate Professor of Neurosurgery, University Hospital Bonn, Germany
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Kronenbürger M, Ilgner J, Habel U, Zobel S, Reinacher P, Coenen V, Wilms H, Kloos M, Kiening K, Daniels C, Herzog J, Pinzker M, Deuschl G, Ackermans L, Temel Y, Visser-Vandervalle V, Schulz JB, Hummel T. Effekte der tiefen Hirnstimulation bei Tourette-Syndrom oder essentiellem Tremor auf das Riechen. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Bürgel U, Mädler B, Honey C, Thron A, Gilsbach J, Coenen V. Fiber Tracking with Distinct Software Tools Results in a Clear Diversity in Anatomical Fiber Tract Portrayal. ACTA ACUST UNITED AC 2009; 70:27-35. [PMID: 19191204 DOI: 10.1055/s-0028-1087212] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Timmann-Braun D, Noth J, Kiening K, Coenen V, Tronnier V, Kronenbuerger M. Klassische Konditionierung des Blinkreflexes beim essentiellen Tremor. Akt Neurol 2007. [DOI: 10.1055/s-2007-987513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kronenbürger M, Brol B, Friedrich A, Fromm C, Coenen V, Kiening K, Tronnier V, Timmann D. Beeinträchtigung der Blinkreflexkonditionierung/des motorischen Lernens beim essentiellen Tremor und Modulation durch die Tiefe Hirnstimulation. Akt Neurol 2006. [DOI: 10.1055/s-2006-953153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kronenbürger M, Heber I, Block F, Fromm C, Rohde I, Rohde V, Coenen V, Noth J, Fimm B. Der Einfluss der Tiefen Hirnstimulation der Basalganglien auf Aufmerksamkeitsfunktionen. Akt Neurol 2006. [DOI: 10.1055/s-2006-953123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Spangenberg P, Coenen V, Gilsbach JM, Rohde V. Virtual placement of posterior C1-C2 transarticular screw fixation. Neurosurg Rev 2005; 29:114-7. [PMID: 16261392 DOI: 10.1007/s10143-005-0003-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2005] [Revised: 08/07/2005] [Accepted: 09/18/2005] [Indexed: 11/25/2022]
Abstract
We wanted to evaluate how often safe and effective posterior C1-C2 transarticular screw placement is realizable when it is performed according to guidelines given in the literature. In 50 adult patients, computerized tomography scan data from C0 to C3 were transformed into a 3D spine model. Virtually, bilateral screws were placed from the medial third of the C2-C3 facet joint towards the rim of the C1 anterior arc parallel to midline. Three categories of virtual screw position were rated: optimal (virtual screw inside the C2 pars interarticularis, transversing the middle third of the atlantoaxial joint, and sparing the vertebral artery canal), suboptimal (virtual screw violating the C2 pars interarticularis, and/or transversing the lower or upper third of the C1-C2 joint, and sparing vertebral artery canal), and unacceptable (virtual screw breaching the vertebral artery canal). Optimal placement was seen in 74, suboptimal placement in 11, and unacceptable locations in 15 sites. We conclude that due to the variability of the anatomy of the upper cervical spine, optimal transarticular C1-C2 screw placement is not possible in up to 26%, and even hazardous in up to 15%.
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Kronenbuerger M, Fromm C, Dafotakis M, Block F, Coenen V, Rohde I, Rohde V. On demand deep brain stimulation for essential tremor: an approach to avoid tolerance? Akt Neurol 2004. [DOI: 10.1055/s-2004-833138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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