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Patel E, Ramaiah P, Mamaril-Davis JC, Bauer IL, Koujah D, Seideman T, Kelbert J, Nosova K, Bina RW. Outcome differences between males and females undergoing deep brain stimulation for treatment-resistant depression: systematic review and individual patient data meta-analysis. J Affect Disord 2024; 351:481-488. [PMID: 38296058 DOI: 10.1016/j.jad.2024.01.251] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Treatment-resistant depression (TRD) occurs more commonly in women. Deep brain stimulation (DBS) is an emerging treatment for TRD, and its efficacy continues to be explored. However, differences in treatment outcomes between males and females have yet to be explored in formal analysis. METHODS A PRISMA-compliant systematic review of DBS for TRD studies was conducted. Patient-level data were independently extracted by two authors. Treatment response was defined as a 50 % or greater reduction in depression score. Percent change in depression scores by gender were evaluated using random-effects analyses. RESULTS Of 737 records, 19 studies (129 patients) met inclusion criteria. The mean reduction in depression score for females was 57.7 % (95 % CI, 64.33 %-51.13 %), whereas for males it was 35.2 % (95 % CI, 45.12 %-25.23 %) (p < 0.0001). Females were more likely to respond to DBS for TRD when compared to males (OR = 2.44, 95 % CI 1.06, 1.95). These differences varied in significance when stratified by DBS anatomical target, age, and timeframe for responder classification. LIMITATIONS Studies included were open-label trials with small sample sizes. CONCLUSIONS Our findings suggest that females with TRD respond at higher rates to DBS treatment than males. Further research is needed to elucidate the implications of these results, which may include connectomic sexual dimorphism, depression phenotype variations, or unrecognized symptom reporting differences. Methodological standardization of outcome scales, granular demographic data, and individual subject outcomes would allow for more robust comparisons between trials.
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Affiliation(s)
- Ekta Patel
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Priya Ramaiah
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | | | - Isabel L Bauer
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Dalia Koujah
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Travis Seideman
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - James Kelbert
- University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Kristin Nosova
- Department of Neurosurgery, Banner University Medical Center/University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA
| | - Robert W Bina
- Department of Neurosurgery, Banner University Medical Center/University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.
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Eser P, Kocabicak E, Bekar A, Temel Y. Insights into neuroinflammatory mechanisms of deep brain stimulation in Parkinson's disease. Exp Neurol 2024; 374:114684. [PMID: 38199508 DOI: 10.1016/j.expneurol.2024.114684] [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: 09/30/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
Parkinson's disease, a progressive neurodegenerative disorder, involves gradual degeneration of the nigrostriatal dopaminergic pathway, leading to neuronal loss within the substantia nigra pars compacta and dopamine depletion. Molecular factors, including neuroinflammation, impaired protein homeostasis, and mitochondrial dysfunction, contribute to the neuronal loss. Deep brain stimulation, a form of neuromodulation, applies electric current through stereotactically implanted electrodes, effectively managing motor symptoms in advanced Parkinson's disease patients. Deep brain stimulation exerts intricate effects on neuronal systems, encompassing alterations in neurotransmitter dynamics, microenvironment restoration, neurogenesis, synaptogenesis, and neuroprotection. Contrary to initial concerns, deep brain stimulation demonstrates antiinflammatory effects, influencing cytokine release, glial activation, and neuronal survival. This review investigates the intricacies of deep brain stimulation mechanisms, including insertional effects, histological changes, and glial responses, and sheds light on the complex interplay between electrodes, stimulation, and the brain. This exploration delves into understanding the role of neuroinflammatory pathways and the effects of deep brain stimulation in the context of Parkinson's disease, providing insights into its neuroprotective capabilities.
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Affiliation(s)
- Pinar Eser
- Bursa Uludag University School of Medicine, Department of Neurosurgery, Bursa, Turkey.
| | - Ersoy Kocabicak
- Ondokuz Mayis University, Health Practise and Research Hospital, Neuromodulation Center, Samsun, Turkey
| | - Ahmet Bekar
- Bursa Uludag University School of Medicine, Department of Neurosurgery, Bursa, Turkey
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, Maastricht, the Netherlands
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Buccilli B. Exploring new horizons: Emerging therapeutic strategies for pediatric stroke. Exp Neurol 2024; 374:114701. [PMID: 38278205 DOI: 10.1016/j.expneurol.2024.114701] [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: 09/29/2023] [Revised: 12/31/2023] [Accepted: 01/23/2024] [Indexed: 01/28/2024]
Abstract
Pediatric stroke presents unique challenges, and optimizing treatment strategies is essential for improving outcomes in this vulnerable population. This review aims to provide an overview of new, innovative, and potential treatments for pediatric stroke, with a primary objective to stimulate further research in this field. Our review highlights several promising approaches in the realm of pediatric stroke management, including but not limited to stem cell therapy and robotic rehabilitation. These innovative interventions offer new avenues for enhancing functional recovery, reducing long-term disability, and tailoring treatments to individual patient needs. The findings of this review underscore the importance of ongoing research and development of innovative treatments in pediatric stroke. These advancements hold significant clinical relevance, offering the potential to improve the lives of children affected by stroke by enhancing the precision, efficacy, and accessibility of therapeutic interventions. Embracing these innovations is essential in our pursuit of better outcomes and a brighter future for pediatric stroke care.
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Affiliation(s)
- Barbara Buccilli
- Icahn School of Medicine at Mount Sinai, Department of Neurosurgery, 1 Gustave L. Levy Pl, New York, NY 10029, United States of America.
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Baláž M, Filip P, Bočková M, Feitová V, Říha I, Hrabovský D, Chrastina J. Successful asymmetrical deep brain stimulation using right subthalamic and left pallidal electrodes in a patient with Parkinson's disease. Br J Neurosurg 2024; 38:356-360. [PMID: 33475016 DOI: 10.1080/02688697.2021.1876210] [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: 01/23/2019] [Revised: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Despite the best efforts of neurologists, the results of pharmacotherapy in the late stages of Parkinson's disease are often disappointing and accompanied by debilitating side effects. Under these circumstances, deep brain stimulation is a viable treatment option. The aim of the meticulous pre-surgical planning is not only precise electrode implantation, but also the avoidance of intraoperative vascular conflicts potentially causing intracerebral bleeding. MATERIAL AND METHODS In this report, we present a patient with early-onset Parkinson's disease whose cerebral vascular anatomy precluded standard bilateral subthalamic nucleus electrode implantation. Initially, right subthalamic stimulation alone provided a very mild clinical benefit that was not reflected in the patient's quality of life. In this patient, an unusual configuration of intracerebral electrodes with right subthalamic and left pallidal stimulation electrodes was applied 15 months after the initial subthalamic electrode implantation. RESULTS The procedure has had a highly beneficial long-term effect without any significant complications. The greatest improvement was noted using the setting 1.8 V, 130 Hz, 90 μs at the right side (STN) and 3.7 V, 130 Hz, 120 μs at the left side (GPi). This allowed the patient to return to his daily life activities. CONCLUSIONS The reported case provides a new perspective of treatment possibilities in complex functional neurosurgical cases requiring exceptional individualisation of the treatment approach.
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Affiliation(s)
- Marek Baláž
- Medical Faculty, First Department of Neurology, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Pavel Filip
- Medical Faculty, First Department of Neurology, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Martina Bočková
- Medical Faculty, First Department of Neurology, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Věra Feitová
- Medical Faculty, Department of Imaging Techniques, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Ivo Říha
- Medical Faculty, Department of Neurosurgery, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Dušan Hrabovský
- Medical Faculty, Department of Neurosurgery, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
| | - Jan Chrastina
- Medical Faculty, Department of Neurosurgery, St. Anne's Hospital and Masaryk University, Brno, Czech Republic
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Florence TJ, Bari A, Vivas AC. Functional Stimulation and Imaging to Predict Neuromodulation of Chronic Low Back Pain. Neurosurg Clin N Am 2024; 35:191-197. [PMID: 38423734 DOI: 10.1016/j.nec.2023.11.004] [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] [Indexed: 03/02/2024]
Abstract
Back pain is one of the most common aversive sensations in human experience. Pain is not limited to the sensory transduction of tissue damage; rather, it encompasses a range of nervous system activities including lateral modulation, long-distance transmission, encoding, and decoding. Although spine surgery may address peripheral pain generators directly, aberrant signals along canonical aversive pathways and maladaptive influence of affective and cognitive states can result in persistent subjective pain refractory to classical surgical intervention. The clinical identification of who will benefit from surgery-and who will not-is increasingly grounded in neurophysiology.
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Affiliation(s)
- Timothy J Florence
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA
| | - Ausaf Bari
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA
| | - Andrew C Vivas
- UCLA Neurosurgery, 300 Stein Plaza Driveway, Suite 562, Los Angeles, CA 90095, USA.
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Wu X, Xue T, Pan S, Xing W, Huang C, Zhang J, Zhao G. Pallidal versus subthalamic deep brain stimulation for Meige syndrome: A systematic review and meta-analysis. Heliyon 2024; 10:e27945. [PMID: 38510025 PMCID: PMC10950702 DOI: 10.1016/j.heliyon.2024.e27945] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 03/22/2024] Open
Abstract
Background Globus pallidus internus (GPi) and subthalamic nucleus (STN) are two common deep brain stimulation (DBS) targets. This meta-analysis was to compared the efficacy and safety of these two DBS targets for the treatment of Meige syndrome (MS). Methods A systematic search was performed using EMBASE, MEDLINE, the Cochrane Library, and ClinicalTrials.gov to identify DBS trials for MS. Review Manager 5.3 was used to perform meta-analysis and the mean difference (MD) was analyzed and calculated with a random effect model. Pearson's correlation coefficients and meta-regression analyses were utilized to identify relevant predictive markers. Results Twenty trials involving 188 participants with GPi-DBS and 110 individuals with STN-DBS were eligible. Both groups showed improvement of the Burke-Fahn-Marsden Dystonia Rating Scale-Movement (BFMDRS-M) and Disability (BFMDRS-D) scores (BFMDRS-M: MD = 10.57 [7.74-13.41] for GPi-DBS, and MD = 8.59 [4.08-13.11] for STN-DBS; BFMDRS-D: MD = 5.96 [3.15-8.77] for GPi-DBS, and MD = 4.71 [1.38-8.04] for STN-DBS; all P < 0.001) from baseline to the final follow-up, while no notable disparity in improvement rates was observed between them. Stimulation-related complications occurrence was also similar between two groups (38.54 ± 24.07% vs. 43.17 ± 29.12%, P = 0.7594). Simultaneously, preoperative BFMDRS-M score and disease duration were positively connected with the relative changes in BFMDRS-M score at the final visit. Conclusion Both GPi-DBS and STN-DBS are effective MS therapies, with no differences in efficacy or the frequency of stimulation-related problems. Higher preoperative scores and longer disease duration probably predict greater improvement.
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Affiliation(s)
- Xin Wu
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
| | - Tao Xue
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shiqing Pan
- A6 East in Department of Anesthesiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Weikang Xing
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
| | - Chuanjun Huang
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guozheng Zhao
- Department of Neurosurgery, Suzhou Ninth People's Hospital, Suzhou, Jiangsu Province, China
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Kleis P, Paschen E, Häussler U, Haas CA. Low frequency stimulation for seizure suppression: Identification of optimal targets in the entorhinal-hippocampal circuit. Brain Stimul 2024; 17:S1935-861X(24)00053-6. [PMID: 38531502 DOI: 10.1016/j.brs.2024.03.017] [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: 01/18/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Mesial temporal lobe epilepsy (MTLE) with hippocampal sclerosis (HS) is a common form of drug-resistant focal epilepsy in adults. Treatment for pharmacoresistant patients remains a challenge, with deep brain stimulation (DBS) showing promise for alleviating intractable seizures. This study explores the efficacy of low-frequency stimulation (LFS) on specific neuronal targets within the entorhinal-hippocampal circuit in a mouse model of MTLE. OBJECTIVE /Hypothesis: Our previous research demonstrated that LFS of the medial perforant path (MPP) fibers in the sclerotic hippocampus reduced seizures in epileptic mice. Here, we aimed to identify the critical neuronal population responsible for this antiepileptic effect by optogenetically stimulating presynaptic and postsynaptic compartments of the MPP-dentate granule cell (DGC) synapse at 1 Hz. We hypothesize that specific targets for LFS can differentially influence seizure activity depending on the cellular identity and location within or outside the seizure focus. METHODS We utilized the intrahippocampal kainate (ihKA) mouse model of MTLE and targeted specific neural populations using Channelrhodopsin2 (ChR2) and stereotactic optic fiber implantation. We recorded intracranial neuronal activity from freely moving chronically epileptic mice with and without optogenetic LFS up to three hours. RESULTS We found that LFS of MPP fibers in the sclerotic hippocampus effectively suppressed epileptiform activity while stimulating principal cells in the MEC had no impact. Targeting DGCs in the sclerotic septal or non-sclerotic temporal hippocampus with LFS did not reduce seizure numbers but shortened the epileptiform bursts. CONCLUSION Presynaptic stimulation of the MPP-DGC synapse within the sclerotic hippocampus is critical for seizure suppression via LFS.
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Affiliation(s)
- Piret Kleis
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Enya Paschen
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; Faculty of Biology, University of Freiburg, Freiburg, Germany
| | - Ute Häussler
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany
| | - Carola A Haas
- Experimental Epilepsy Research, Department of Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, Freiburg, Germany; BrainLinks-BrainTools Center, University of Freiburg, Freiburg, Germany.
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Bishay AE, Lyons AT, Koester SW, Paulo DL, Liles C, Dambrino RJ, Feldman MJ, Ball TJ, Bick SK, Englot DJ, Chambless LB. Global Economic Evaluation of the Reported Costs of Deep Brain Stimulation. Stereotact Funct Neurosurg 2024:1-17. [PMID: 38513625 DOI: 10.1159/000537865] [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: 10/04/2023] [Accepted: 02/13/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION Despite the known benefits of deep brain stimulation (DBS), the cost of the procedure can limit access and can vary widely. Our aim was to conduct a systematic review of the reported costs associated with DBS, as well as the variability in reporting cost-associated factors to ultimately increase patient access to this therapy. METHODS A systematic review of the literature for cost of DBS treatment was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Embase databases were queried. Olsen & Associates (OANDA) was used to convert all reported rates to USD. Cost was corrected for inflation using the US Bureau of Labor Statistics Inflation Calculator, correcting to April 2022. RESULTS Twenty-six articles on the cost of DBS surgery from 2001 to 2021 were included. The median number of patients across studies was 193, the mean reported age was 60.5 ± 5.6 years, and median female prevalence was 38.9%. The inflation- and currency-adjusted mean cost of the DBS device was USD 21,496.07 ± USD 8,944.16, the cost of surgery alone was USD 14,685.22 ± USD 8,479.66, the total cost of surgery was USD 40,942.85 ± USD 17,987.43, and the total cost of treatment until 1 year of follow-up was USD 47,632.27 ± USD 23,067.08. There were no differences in costs observed across surgical indication or country. CONCLUSION Our report describes the large variation in DBS costs and the manner of reporting costs. The current lack of standardization impedes productive discourse as comparisons are hindered by both geographic and chronological variations. Emphasis should be put on standardized reporting and analysis of reimbursement costs to better assess the variability of DBS-associated costs in order to make this procedure more cost-effective and address areas for improvement to increase patient access to DBS.
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Affiliation(s)
- Anthony E Bishay
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | | | - Stefan W Koester
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Danika L Paulo
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Campbell Liles
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Robert J Dambrino
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael J Feldman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Tyler J Ball
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah K Bick
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dario J Englot
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Lola B Chambless
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Farokhniaee A, Palmisano C, Del Vecchio Del Vecchio J, Pezzoli G, Volkmann J, Isaias IU. Gait-related beta-gamma phase amplitude coupling in the subthalamic nucleus of parkinsonian patients. Sci Rep 2024; 14:6674. [PMID: 38509158 PMCID: PMC10954750 DOI: 10.1038/s41598-024-57252-2] [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: 06/15/2023] [Accepted: 03/15/2024] [Indexed: 03/22/2024] Open
Abstract
Analysis of coupling between the phases and amplitudes of neural oscillations has gained increasing attention as an important mechanism for large-scale brain network dynamics. In Parkinson's disease (PD), preliminary evidence indicates abnormal beta-phase coupling to gamma-amplitude in different brain areas, including the subthalamic nucleus (STN). We analyzed bilateral STN local field potentials (LFPs) in eight subjects with PD chronically implanted with deep brain stimulation electrodes during upright quiet standing and unperturbed walking. Phase-amplitude coupling (PAC) was computed using the Kullback-Liebler method, based on the modulation index. Neurophysiological recordings were correlated with clinical and kinematic measurements and individual molecular brain imaging studies ([123I]FP-CIT and single-photon emission computed tomography). We showed a dopamine-related increase in subthalamic beta-gamma PAC from standing to walking. Patients with poor PAC modulation and low PAC during walking spent significantly more time in the stance and double support phase of the gait cycle. Our results provide new insights into the subthalamic contribution to human gait and suggest cross-frequency coupling as a gateway mechanism to convey patient-specific information of motor control for human locomotion.
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Affiliation(s)
- AmirAli Farokhniaee
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy.
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy.
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Jasmin Del Vecchio Del Vecchio
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Gianni Pezzoli
- Fondazione Grigioni Per Il Morbo Di Parkinson, Via Gianfranco Zuretti 35, 20125, Milano, Italy
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Ioannis U Isaias
- Parkinson Institute Milan, ASST G. Pini CTO, Via Bignami 1, 20126, Milano, Italy
- Department of Neurology, University Hospital of Würzburg, and Julius Maximilian University of Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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Sarva H, Rodriguez-Porcel F, Rivera F, Gonzalez CD, Barkan S, Tripathi S, Gatto E, Ruiz PG. The role of genetics in the treatment of dystonia with deep brain stimulation: Systematic review and Meta-analysis. J Neurol Sci 2024; 459:122970. [PMID: 38520940 DOI: 10.1016/j.jns.2024.122970] [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: 01/28/2024] [Revised: 03/15/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Dystonia is a movement disorder characterized by sustained or intermittent muscle contractions that lead to involuntary postures or repetitive movements. Genetic mutations are being increasingly recognized as a cause of dystonia. Deep brain stimulation (DBS) is one of the limited treatment options available. However, there are varying reports on its efficacy in genetic dystonias. This systematic review of the characteristics of genetic dystonias treated with DBS and their outcomes aims to aid in the evaluation of eligibility for such treatment. METHODS We performed a PUBMED search of all papers related to genetic dystonias and DBS up until April 2022. In addition to performing a systematic review, we also performed a meta-analysis to assess the role of the mutation on DBS response. We included cases that had a confirmed genetic mutation and DBS along with pre-and post-operative BFMDRS. RESULTS Ninety-one reports met our inclusion criteria and from them, 235 cases were analyzed. Based on our analysis DYT-TOR1A dystonia had the best evidence for DBS response and Rapid-Onset Dystonia Parkinsonism was among the least responsive to DBS. CONCLUSION While our report supports the role of genetics in DBS selection and response, it is limited by the rarity of the individual genetic conditions, the reliance on case reports and case series, and the limited ability to obtain genetic testing on a large scale in real-time as opposed to retrospectively as in many cases.
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Affiliation(s)
- Harini Sarva
- Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medicine, 428 E72nd Street, Suite 400, NY, NY 10021, USA.
| | | | - Francisco Rivera
- CEMIC University Institute, School of Medicine, Department of Pharmacology, Buenos Aires, Argentina
| | - Claudio Daniel Gonzalez
- CEMIC University Institute, School of Medicine, Department of Pharmacology, Buenos Aires, Argentina
| | - Samantha Barkan
- Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medicine, 428 E72nd Street, Suite 400, NY, NY 10021, USA
| | - Susmit Tripathi
- Parkinson's Disease and Movement Disorders Institute, Weill Cornell Medicine, 428 E72nd Street, Suite 400, NY, NY 10021, USA
| | - Emilia Gatto
- Instituto de Neurociencias Buenos Aires, INEBA, Facultad de Medicina, Universidad de Buenos Aires, Argentina
| | - Pedro Garcia Ruiz
- Movement Disorders Unit, Department of Neurology, Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
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Liu R, Zhu G, Wu Z, Gan Y, Zhang J, Liu J, Wang L. Temporal interference stimulation targets deep primate brain. Neuroimage 2024; 291:120581. [PMID: 38508293 DOI: 10.1016/j.neuroimage.2024.120581] [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: 01/06/2024] [Revised: 03/10/2024] [Accepted: 03/17/2024] [Indexed: 03/22/2024] Open
Abstract
Temporal interference (TI) stimulation, a novel non-invasive stimulation strategy, has recently been shown to modulate neural activity in deep brain regions of living mice. Yet, it is uncertain if this method is applicable to larger brains and whether the electric field produced under traditional safety currents can penetrate deep regions as observed in mice. Despite recent model-based simulation studies offering positive evidence at both macro- and micro-scale levels, the absence of electrophysiological data from actual brains hinders comprehensive understanding and potential application of TI. This study aims to directly measure the spatiotemporal properties of the interfered electric field in the rhesus monkey brain and to validate the effects of TI on the human brain. Two monkeys were involved in the measurement, with implantation of several stereo-electroencephalography (SEEG) depth electrodes. TI stimulation was applied to anesthetized monkeys using two pairs of surface electrodes at differing stimulation parameters. Model-based simulations were also conducted and subsequently compared with actual recordings. Additionally, TI stimulation was administered to patients with motor disorders to validate its effects on motor symptoms. Through the integration of computational electric field simulation with empirical measurements, it was determined that the temporally interfering electric fields in the deep central regions are capable of attaining a magnitude sufficient to induce a subthreshold modulation effect on neural signals. Additionally, an improvement in movement disorders was observed as a result of TI stimulation. This study is the first to systematically measure the TI electric field in living non-human primates, offering empirical evidence that TI holds promise as a more focal and precise method for modulating neural activities in deep regions of a large brain. This advancement paves the way for future applications of TI in treating neuropsychiatric disorders.
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Affiliation(s)
- Ruobing Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Zhengping Wu
- School of Innovations, Sanjiang University, Nanjing, PR China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, PR China
| | - Jiali Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China
| | - Liang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, PR China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, PR China.
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Tiefenbach J, Ritzi T Yu J, Kondylis ED, Floden D, Baker KB, Fernandez HH, Machado AG. Loss of Efficacy in Ventral Intermediate Nucleus Stimulation for Essential Tremor. World Neurosurg 2024:S1878-8750(24)00430-3. [PMID: 38508382 DOI: 10.1016/j.wneu.2024.03.045] [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: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE The primary aim of this study is report long-term outcomes associate with deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) performed at our institution. We further aimed to elicit the factors associated with loss of efficacy, and to discuss the need for exploring and establishing reliable rescue targets. METHODS To study long-term outcomes, we performed a retrospective chart review and extracted tremor scores of forty-three patients who underwent VIM DBS lead implantation for ET at our center. We further evaluated factors that could influence outcomes over time, including demographics, body mass index, duration of follow-up, degree of parenchymal atrophy indexed by the global cortical atrophy scale, and third ventricular width. RESULTS In this cohort, tremor scores on the latest follow-up (median 52.7 months) were noted to be worse than initial postoperative scores in 56% of DBS leads. Furthermore, 14% of leads were associated with clinically significant loss of benefit. Factors including the length of time since the lead implantation, age at the time of surgery, sex, body mass index, pre-operative atrophy, and third ventricular width were not predictive of long-term outcomes. CONCLUSION Our study identified a substantial subgroup of VIM-DBS patient who experienced a gradual decline in treatment efficacy over time. We propose that this phenomenon can be attributed primarily to habituation and disease progression. Furthermore, we discuss the need to establish reliable and effective rescue targets for this sub-population of patients, with ventral-oralis complex (Vo) and dentate nucleus (Dn) emerging as potential candidates.
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Affiliation(s)
- Jakov Tiefenbach
- Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, OH, United States.
| | - Jeryl Ritzi T Yu
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Efstathios D Kondylis
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Darlene Floden
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Kenneth B Baker
- Department of Neuroscience, Lerner Research Institute, Cleveland Clinic, OH, United States
| | - Hubert H Fernandez
- Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Andre G Machado
- Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
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13
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Calvano A, Kleinholdermann U, Heun AS, Bopp MHA, Nimsky C, Timmermann L, Pedrosa DJ. Structural connectivity of low-frequency subthalamic stimulation for improving stride length in Parkinson's disease. Neuroimage Clin 2024; 42:103591. [PMID: 38507954 DOI: 10.1016/j.nicl.2024.103591] [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: 01/19/2024] [Revised: 03/07/2024] [Accepted: 03/13/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND A reduction in stride length is considered a key characteristic of gait kinematics in Parkinson's disease (PD) and has been identified as a predictor of falls. Although low-frequency stimulation (LFS) has been suggested as a method to improve gait characteristics, the underlying structural network is not well understood. OBJECTIVE This study aims to investigate the structural correlates of changes in stride length during LFS (85 Hz). METHODS Objective gait performance was retrospectively evaluated in 19 PD patients who underwent deep brain stimulation (DBS) at 85 Hz and 130 Hz. Individual DBS contacts and volumes of activated tissue (VAT) were computed using preoperative magnetic resonance imaging (MRI) and postoperative computed tomography (CT) scans. Structural connectivity profiles to predetermined cortical and mesencephalic areas were estimated using a normative connectome. RESULTS LFS led to a significant improvement in stride length compared to 130 Hz stimulation. The intersection between VAT and the associative subregion of the subthalamic nucleus (STN) was associated with an improvement in stride length and had structural connections to the supplementary motor area, prefrontal cortex, and pedunculopontine nucleus. Conversely, we found that a lack of improvement was linked to stimulation volumes connected to cortico-diencephalic fibers bypassing the STN dorsolaterally. The robustness of the connectivity model was verified through leave-one-patient-out, 5-, and 10-fold cross cross-validation paradigms. CONCLUSION These findings offer new insights into the structural connectivity that underlies gait changes following LFS. Targeting the non-motor subregion of the STN with LFS on an individual level may present a potential therapeutic approach for PD patients with gait disorders.
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Affiliation(s)
- Alexander Calvano
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | - Urs Kleinholdermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | | | - Miriam H A Bopp
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Christopher Nimsky
- Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany; Department of Neurosurgery, Philipps-University Marburg, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany
| | - David J Pedrosa
- Department of Neurology, Philipps-University Marburg, Marburg, Germany; Center of Mind, Brain and Behaviour, Philipps-University Marburg, Marburg, Germany.
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Baumgartner ME, Qiu L, Philipp LR, Galligan K, Halpern C, Kennedy BC. Technological advances in pediatric epilepsy surgery. Curr Probl Pediatr Adolesc Health Care 2024:101588. [PMID: 38494391 DOI: 10.1016/j.cppeds.2024.101588] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Affiliation(s)
| | - Liming Qiu
- Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Lucas R Philipp
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, USA
| | - Kathleen Galligan
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Casey Halpern
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA
| | - Benjamin C Kennedy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Neurosurgery, University of Pennsylvania, Philadelphia, USA; Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, USA.
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15
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Unadkat P, Quevedo J, Soares J, Fenoy A. Opportunities and challenges for the use of deep brain stimulation in the treatment of refractory major depression. Discov Ment Health 2024; 4:9. [PMID: 38483709 PMCID: PMC10940557 DOI: 10.1007/s44192-024-00062-9] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/08/2024] [Indexed: 03/17/2024]
Abstract
Major Depressive Disorder continues to remain one of the most prevalent psychiatric diseases globally. Despite multiple trials of conventional therapies, a subset of patients fail to have adequate benefit to treatment. Deep brain stimulation (DBS) is a promising treatment in this difficult to treat population and has shown strong antidepressant effects across multiple cohorts. Nearly two decades of work have provided insights into the potential for chronic focal stimulation in precise brain targets to modulate pathological brain circuits that are implicated in the pathogenesis of depression. In this paper we review the rationale that prompted the selection of various brain targets for DBS, their subsequent clinical outcomes and common adverse events reported. We additionally discuss some of the pitfalls and challenges that have prevented more widespread adoption of this technology as well as future directions that have shown promise in improving therapeutic efficacy of DBS in the treatment of depression.
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Affiliation(s)
- Prashin Unadkat
- Elmezzi Graduate School of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA
| | - Joao Quevedo
- Center of Excellence On Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Jair Soares
- Center of Excellence On Mood Disorders, Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, (UT Health), Houston, TX, USA
| | - Albert Fenoy
- Elmezzi Graduate School of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA.
- Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA.
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine, Feinstein Institutes for Medical Research, Northwell Health, 805 Northern Boulevard, Suite 100, Great Neck, NY, 11021, USA.
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16
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Chan HH, Mathews ND, Khanna H, Mandava N, Hogue O, Machado AG, Baker KB. The role of dorsolateral striatum in the effects of deep cerebellar stimulation-mediated motor recovery following ischemic stroke in rodents. Exp Neurol 2024; 376:114751. [PMID: 38484864 DOI: 10.1016/j.expneurol.2024.114751] [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: 10/06/2023] [Revised: 02/18/2024] [Accepted: 03/10/2024] [Indexed: 03/18/2024]
Abstract
Despite great advances in acute care and rehabilitation, stroke remains the leading cause of motor impairment in the industrialized world. We have developed a deep brain stimulation (DBS)-based approach for post-stroke rehabilitation that has shown reproducible effects in rodent models and has been recently translated to humans. Mechanisms underlying the rehabilitative effects of this novel therapy have been largely focused on the ipsilesional cortex, including cortical reorganization, synaptogenesis, neurogenesis and greater expression of markers of long-term potentiation. The role of subcortical structures on its therapeutic benefits, particularly the striatum, remain unclear. In this study, we compared the motor rehabilitative effects of deep cerebellar stimulation in two rodent models of cerebral ischemia: a) cortical ischemia; and b) combined striatal and cortical ischemia. All animals underwent the same procedures, including implantation of the electrodes and tethered connections for stimulation. Both experimental groups received four weeks of continuous lateral cerebellar nucleus (LCN) DBS and each was paired with a no stimulation, sham, group. Fine motor function was indexed using the pasta matrix task. Brain tissue was harvested for histology and immunohistochemical analyses. In the cortical-only ischemia, the average pasta matrix performance of both sham and stimulated groups reduced from 19 to 24 pieces to 7-8 pieces following the stroke induction. At the end of the four-week treatment, the performance of stimulated group was significantly greater than that of sham group (14 pieces vs 7 pieces, p < 0.0001). Similarly, in the combined cortical and striatal ischemia, the performance of both sham and stimulated groups reduced from 29 to 30 pieces to 7-11 pieces following the stroke induction. However, at the end of the four-week treatment, the performance of stimulated group was not significantly greater than that of sham group (15 pieces vs 11 pieces, p = 0.452). In the post-mortem analysis, the number of cells expressing CaMKIIα at the perilesional cortical and striatum of the LCN DBS treated animals receiving cortical-only stroke elevated but not those receiving cortical+striatal stroke. The current findings suggested that the observed, LCN DBS-enhanced motor recovery and perilesional plasticity may involve striatal mechanisms.
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Affiliation(s)
- Hugh H Chan
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Nicole D Mathews
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Hemen Khanna
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Nymisha Mandava
- Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Olivia Hogue
- Department of Quantitative Health Sciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA
| | - Andre G Machado
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic, USA
| | - Kenneth B Baker
- Department of Neurosciences, Cleveland Clinic Lerner Research Institute, Cleveland, OH, USA; Neurological Institute, Cleveland Clinic, USA.
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Colditz M, Heard T, Silburn P, Coyne T. Do Antibiotic-Impregnated Envelopes Prevent Deep Brain Stimulation Implantable Pulse Generator Infections? A Prospective Cohort Study. Stereotact Funct Neurosurg 2024:1-4. [PMID: 38461818 DOI: 10.1159/000536478] [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: 04/14/2023] [Accepted: 01/15/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Infection after deep brain stimulation (DBS) implanted pulse generator (IPG) replacement is uncommon but when it occurs can cause significant clinical morbidity, often resulting in partial or complete DBS system removal. An antibiotic absorbable envelope developed for cardiac implantable electronic devices (IEDs), which releases minocycline and rifampicin for a minimum of 7 days, was shown in the WRAP-IT study to reduce cardiac IED infections for high-risk cardiac patients. We aimed to assess whether placing an IPG in the same antibiotic envelope at the time of IPG replacement reduced the IPG infection rate. METHODS Following institutional ethics approval (UnitingCare HREC), patients scheduled for IPG change due to impending battery depletion were prospectively randomised to receive IPG replacement with or without an antibiotic envelope. Patients with a past history of DBS system infection were excluded. Patients underwent surgery with standard aseptic neurosurgical technique [J Neurol Sci. 2017;383:135-41]. Subsequent infection requiring antibiotic therapy and/or IPG removal or revision was recorded. RESULTS A total of 427 consecutive patients were randomised from 2018 to 2021 and followed for a minimum of 12 months. No patients were lost to follow-up. At the time of IPG replacement, 200 patients received antibiotic envelope (54 female, 146 male, mean age 72 years), and 227 did not (43 female, 184 male, mean age 71 years). The two groups were homogenous for risk factors of infection. The IPG replacement infection rate was 2.1% (9/427). There were six infections, which required antibiotic therapy and/or IPG removal, in the antibiotic envelope group (6/200) and three in the non-envelope group (3/227) (p = 0.66). CONCLUSION This prospective randomised study did not find that an antibiotic envelope reduced the IPG infection rate in our 427 patients undergoing routine DBS IPG replacement. Further research to reduce IPG revisions and infections in a cost-effective manner is required.
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Affiliation(s)
- Michael Colditz
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Tomas Heard
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Silburn
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Terry Coyne
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Abdulbaki A, Wöhrle JC, Blahak C, Weigel R, Kollewe K, Capelle HH, Bäzner H, Krauss JK. Somatosensory evoked potentials recorded from DBS electrodes: the origin of subcortical N18. J Neural Transm (Vienna) 2024:10.1007/s00702-024-02752-8. [PMID: 38456947 DOI: 10.1007/s00702-024-02752-8] [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: 09/24/2023] [Accepted: 01/30/2024] [Indexed: 03/09/2024]
Abstract
The different peaks of somatosensory-evoked potentials (SEP) originate from a variety of anatomical sites in the central nervous system. The origin of the median nerve subcortical N18 SEP has been studied under various conditions, but the exact site of its generation is still unclear. While it has been claimed to be located in the thalamic region, other studies indicated its possible origin below the pontomedullary junction. Here, we scrutinized and compared SEP recordings from median nerve stimulation through deep brain stimulation (DBS) electrodes implanted in various subcortical targets. We studied 24 patients with dystonia, Parkinson's disease, and chronic pain who underwent quadripolar electrode implantation for chronic DBS and recorded median nerve SEPs from globus pallidus internus (GPi), subthalamic nucleus (STN), thalamic ventral intermediate nucleus (Vim), and ventral posterolateral nucleus (VPL) and the centromedian-parafascicular complex (CM-Pf). The largest amplitude of the triphasic potential of the N18 complex was recorded in Vim. Bipolar recordings confirmed the origin to be close to Vim electrodes (and VPL/CM-Pf) and less close to STN electrodes. GPi recorded only far-field potentials in unipolar derivation. Recordings from DBS electrodes located in different subcortical areas allow determining the origin of certain subcortical SEP waves more precisely. The subcortical N18 of the median nerve SEP-to its largest extent-is generated ventral to the Vim in the region of the prelemniscal radiation/ zona incerta.
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Affiliation(s)
- Arif Abdulbaki
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Johannes C Wöhrle
- Department of Neurology, Katholisches Klinikum Koblenz Montabaur, Koblenz, Germany
| | - Christian Blahak
- Department of Neurology, Ortenau Klinikum Lahr-Ettenheim, Lahr, Germany
- Department of Neurology, Medical Faculty Mannheim, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralf Weigel
- Department of Neurosurgery, Sankt Katharinen Hospital, Frankfurt, Germany
| | - Katja Kollewe
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - H Holger Capelle
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Hansjörg Bäzner
- Department of Neurology, Katharinenhospital Stuttgart, Stuttgart, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Cheng Y, Zhao G, Chen L, Cui D, Wang C, Feng K, Yin S. Effects of subthalamic nucleus deep brain stimulation using different frequency programming paradigms on axial symptoms in advanced Parkinson's disease. Acta Neurochir (Wien) 2024; 166:124. [PMID: 38457027 DOI: 10.1007/s00701-024-06005-1] [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: 07/31/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND In advanced Parkinson's disease (PD), axial symptoms are common and can be debilitating. Although deep brain stimulation (DBS) significantly improves motor symptoms, conventional high-frequency stimulation (HFS) has limited effectiveness in improving axial symptoms. In this study, we investigated the effects on multiple axial symptoms after DBS surgery with three different frequency programming paradigms comprising HFS, low-frequency stimulation (LFS), and variable-frequency stimulation (VFS). METHODS This study involved PD patients who had significant preoperative axial symptoms and underwent bilateral subthalamic nucleus (STN) DBS. Axial symptoms, motor symptoms, medications, and quality of life were evaluated preoperatively (baseline). One month after surgery, HFS was applied. At 6 months post-surgery, HFS assessments were performed, and HFS was switched to LFS. A further month later, we conducted LFS assessments and switched LFS to VFS. At 8 months after surgery, VFS assessments were performed. RESULTS Of the 21 PD patients initially enrolled, 16 patients were ultimately included in this study. Regarding HFS, all axial symptoms except for the Berg Balance Scale (p < 0.0001) did not improve compared with the baseline (all p > 0.05). As for LFS and VFS, all axial symptoms improved significantly compared with both the baseline and HFS (all p < 0.05). Moreover, motor symptoms and medications were significantly better than the baseline (all p < 0.05) after using LFS and VFS. Additionally, the quality of life of the PD patients after receiving LFS and VFS was significantly better than at the baseline and with HFS (all p < 0.0001). CONCLUSION Our findings indicate that HFS is ineffective at improving the majority of axial symptoms in advanced PD. However, both the LFS and VFS programming paradigms exhibit significant improvements in various axial symptoms.
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Affiliation(s)
- Yifeng Cheng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Lei Chen
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Deqiu Cui
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Chunjuan Wang
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Keke Feng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
| | - Shaoya Yin
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
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Cummins DD, Sandoval-Pistorius SS, Cernera S, Fernandez-Gajardo R, Hammer LH, Starr PA. Physiological effects of dual target DBS in an individual with Parkinson's disease and a sensing-enabled pulse generator. Parkinsonism Relat Disord 2024; 122:106089. [PMID: 38460490 DOI: 10.1016/j.parkreldis.2024.106089] [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: 12/29/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/11/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or globus pallidus (GP) is an established therapy for Parkinson's disease (PD). Novel DBS devices can record local field potential (LFP) physiomarkers from the STN or GP. While beta (13-30 Hz) and gamma (40-90 Hz) STN and GP LFP oscillations correlate with PD motor severity and with therapeutic effects of treatments, STN-GP interactions in electrophysiology in patients with PD are not well characterized. METHODS Simultaneous bilateral STN and GP LFPs were recorded in a patient with PD who received bilateral STN-DBS and GP-DBS. Power spectra in each target and STN-GP coherence were assessed in various ON- and OFF-levodopa and DBS states, both at rest and with voluntary movement. RESULTS OFF-levodopa and OFF-DBS, beta peaks were present at bilateral STN and GP, coincident with prominent STN-GP beta coherence. Levodopa and dual-target-DBS (simultaneous STN-DBS and GP-DBS) completely suppressed STN-GP coherence. Finely-tuned gamma (FTG) activity at half the stimulation frequency (62.5 Hz) was seen in the STN during GP-DBS at rest. To assess the effects of movement on FTG activity, we recorded LFPs during instructed movement. We observed FTG activity in bilateral GP and bilateral STN during contralateral body movements while on GP-DBS and ON-levodopa. No FTG was seen with STN-DBS or dual-target-DBS. CONCLUSION Dual-target-DBS and levodopa suppressed STN-GP coherence. FTG throughout the basal ganglia was induced by GP-DBS in the presence of levodopa and movement. This bilateral STN-FTG and GP-FTG corresponded with the least severe bradykinesia state, suggesting a pro-kinetic role for FTG.
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Affiliation(s)
- Daniel D Cummins
- School of Medicine, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, United States.
| | - Stephanie S Sandoval-Pistorius
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
| | - Stephanie Cernera
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
| | - Rodrigo Fernandez-Gajardo
- Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
| | - Lauren H Hammer
- Department of Neurology, University of California San Francisco, 1651 4th Street, East Care Center, San Francisco, CA, 94143, United States
| | - Philip A Starr
- School of Medicine, University of California San Francisco, 533 Parnassus Ave, San Francisco, CA, 94143, United States; Department of Neurological Surgery, University of California San Francisco, 505 Parnassus Ave, Rm M779, San Francisco, CA, 94143, United States
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Vissani M, Bush A, Lipski WJ, Fischer P, Neudorfer C, Holt LL, Fiez JA, Turner RS, Richardson RM. Spatiotemporally-specific cortical-subthalamic coupling differentiates aspects of speech performance. bioRxiv 2024:2023.10.18.562969. [PMID: 37905141 PMCID: PMC10614892 DOI: 10.1101/2023.10.18.562969] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Speech provides a rich context for exploring human cortical-basal ganglia circuit function, but direct intracranial recordings are rare. We recorded electrocorticographic signals in the cortex synchronously with single units in the subthalamic nucleus (STN), a basal ganglia node that receives direct input from widespread cortical regions, while participants performed a syllable repetition task during deep brain stimulation (DBS) surgery. We discovered that STN neurons exhibited spike-phase coupling (SPC) events with distinct combinations of frequency, location, and timing that indexed specific aspects of speech. The strength of SPC to posterior perisylvian cortex predicted phoneme production accuracy, while that of SPC to perirolandic cortex predicted time taken for articulation Thus, STN-cortical interactions are coordinated via transient bursts of behavior-specific synchronization that involves multiple neuronal populations and timescales. These results both suggest mechanisms that support auditory-sensorimotor integration during speech and explain why firing-rate based models are insufficient for explaining basal ganglia circuit behavior.
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Affiliation(s)
- Matteo Vissani
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Alan Bush
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Witold J. Lipski
- Department of Neurobiology, Systems Neuroscience Center and Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - Petra Fischer
- School of Physiology, Pharmacology & Neuroscience, University of Bristol, University Walk, BS8 1TD Bristol, United Kingdom
| | - Clemens Neudorfer
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
| | - Lori L. Holt
- Department of Psychology, The University of Texas at Austin, Austin, TX 78712 USA
| | - Julie A. Fiez
- Department of Psychology, University of Pittsburgh, Pittsburgh 15260, PA, USA
| | - Robert S. Turner
- Department of Neurobiology, Systems Neuroscience Center and Center for Neuroscience, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02115, USA
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Zhang M, Yang L, Li Z, Fei F, Zhou Y, Jiang D, Zheng Y, Cheng H, Wang Y, Xu C, Fang J, Wang S, Chen Z, Wang Y. Low-frequency stimulation in the zona incerta attenuates seizure via driving GABAergic neuronal activity. Neurobiol Dis 2024; 192:106424. [PMID: 38290566 DOI: 10.1016/j.nbd.2024.106424] [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: 11/19/2023] [Revised: 01/15/2024] [Accepted: 01/26/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Managing refractory epilepsy presents a significant a substantial clinical challenge. Deep brain stimulation (DBS) has emerged as a promising avenue for addressing refractory epilepsy. However, the optimal stimulation targets and effective parameters of DBS to reduce seizures remian unidentified. OBJECTIVES This study endeavors to scrutinize the therapeutic potential of DBS within the zona incerta (ZI) across diverse seizure models and elucidate the associated underlying mechanisms. METHODS We evaluated the therapeutic potential of DBS with different frequencies in the ZI on kainic acid (KA)-induced TLE model or M1-cortical seizures model, pilocarpine-induced M1-cortical seizure models, and KA-induced epilepsy model. Further, employing calcium fiber photometry combined with cell-specific ablation, we sought to clarified the causal role of ZI GABAergic neurons in mediating the therapeutic effects of DBS. RESULTS Our findings reveal that DBS in the ZI alleviated the severity of seizure activities in the KA-induced TLE model. Meanwhile, DBS attenuated seizure activities in KA- or pilocarpine-induced M1-cortical seizure model. In addition, DBS exerts a mitigating influence on KA induced epilepsy model. DBS in the ZI showed anti-seizure effects at low frequency spectrum, with 5 Hz exhibiting optimal efficacy. The low-frequency DBS significantly increased the calcium activities of ZI GABAergic neurons. Furthermore, selective ablation of ZI GABAergic neurons with taCasp3 blocked the anti-seizure effect of low-frequency DBS, indicating the anti-seizure effect of DBS is mediated by the activation of ZI GABAergic neurons. CONCLUSION Our results demonstrate that low-frequency DBS in the ZI attenuates seizure via driving GABAergic neuronal activity. This suggests that the ZI represents a potential DBS target for treating both hippocampal and cortical seizure through the activation of GABAergic neurons, thereby holding therapeutic significance for seizure treatment.
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Affiliation(s)
- Mengdi Zhang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Zhejiang Rehabilitation Medical Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Lin Yang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China
| | - Zhongxia Li
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Fan Fei
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Yuan Zhou
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Dongxiao Jiang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Yuyi Zheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Hui Cheng
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Yu Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Cenglin Xu
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China
| | - Jiajia Fang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Shuang Wang
- Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China
| | - Zhong Chen
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
| | - Yi Wang
- Key Laboratory of Neuropharmacology and Translational Medicine of Zhejiang Province, School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou 310053, PR China; Zhejiang Rehabilitation Medical Center, The Third Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, PR China; Epilepsy Center, Department of Neurology, Second Affiliated Hospital & Forth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310058, China.
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Oslin SJ, Shi HH, Conner AK. Preventing Sudden Cessation of Implantable Pulse Generators in Deep Brain Stimulation: A Systematic Review and Protocol Proposal. Stereotact Funct Neurosurg 2024:1-8. [PMID: 38432221 DOI: 10.1159/000535880] [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: 09/09/2023] [Accepted: 12/14/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) requires a consistent electrical supply from the implantable pulse generator (IPG). Patients may struggle to monitor their IPG, risking severe complications in battery failure. This review assesses current literature on DBS IPG battery life management and proposes a protocol for healthcare providers. METHODS A literature search using four databases identified best practices for DBS IPG management. Studies were appraised for IPG management guidelines, categorized as qualitative, quantitative, or both. RESULTS Of 408 citations, only seven studies were eligible, none providing clear patient management strategies. Current guidelines lack specificity, relying on clinician suggestions. CONCLUSION Limited guidelines exist for IPG management. Specificity and adaptability to emerging technology are crucial. The findings highlight the need for specificity in patients' needs and adaptability to emerging technology in future studies. To address this need, we developed a protocol for DBS IPG management that we have implemented at our own institution. Further research is needed for effective DBS IPG battery life management, preventing therapy cessation complications.
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Affiliation(s)
- Spencer J Oslin
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA,
| | - Helen H Shi
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Andrew K Conner
- Department of Neurosurgery, University of Oklahoma, Health Sciences Center, Oklahoma City, Oklahoma, USA
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Dos Santos B, Vaz R, Braga AC, Rito M, Lucas D, Chamadoira C. Intracerebral hemorrhage after deep brain stimulation surgery guided with microelectrode recording: analysis of 297 procedures. Neurocirugia (Astur : Engl Ed) 2024; 35:79-86. [PMID: 37865159 DOI: 10.1016/j.neucie.2023.09.001] [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] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/13/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVES Report the incidence of symptomatic and asymptomatic intracerebral hemorrhage (ICH) in patients submitted to deep brain stimulation (DBS) guided with microelectrode recording (MER) with further analysis of potential risk factors, both inherent to the patient and related to the pathology and surgical technique. METHODS We performed a retrospective observational study. 297 DBS procedures were concluded in 277 patients in a single hospital centre between January 2010 and December 2020. All surgeries were guided with MER. We analysed the incidence of symptomatic and asymptomatic ICH and its correlation to age, sex, diagnosis, hypertension and perioperative hypertension, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, and number of MER trajectories. RESULTS There were a total of 585 electrodes implanted in 277 patients. 16 ICH were observed, of which 6 were symptomatic and 10 asymptomatic, none of which incurred in permanent neurological deficit. The location of the hemorrhage varied between cortical and subcortical plans, always in relation with the trajectory or the final position of the electrode. The incidence of symptomatic ICH per lead-implantation was 1%, and the CT-scan demonstrated asymptomatic ICH in 1.7% more patients. Male patients or with hypertension are 2.7 and 2.2 times more likely to develop ICH, respectively. However, none of these characteristics has been shown to have a statistically significant association with the occurrence of ICH, as well as age, diagnosis, diabetes, dyslipidaemia, antiplatelet drugs, anatomic target, number of MER trajectories and perioperative hypertension. CONCLUSIONS MER-guided DBS is a safe technique, with low incidence of ICH and no permanent deficits in our study. Hypertension and male sex seem to be risk factors for the development of ICH in this surgery. Nevertheless, no statistically significant factors were found for the occurrence of this complication.
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Affiliation(s)
| | - Rui Vaz
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | | | - Manuel Rito
- Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | - Diana Lucas
- Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
| | - Clara Chamadoira
- Faculty of Medicine of the University of Porto (FMUP), Porto, Portugal; Neurosurgery Department, Centro Hospitalar Universitário de São João (CHUSJ), Porto, Portugal
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Tordjman L, Lagha-Boukbiza O, Anheim M, Tranchant C, Bourgin P, Ruppert E. Restless legs syndrome in the dominant Parkinson's side related to subthalamic deep-brain stimulation. Sleep Med 2024; 115:174-176. [PMID: 38367359 DOI: 10.1016/j.sleep.2024.02.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Restless legs syndrome (RLS) has an increased estimated prevalence in patients with Parkinson's disease (PS). RLS frequently mimics symptoms intrinsic to PD, such as motor restlessness, contributing to making its diagnosis challenging in this population. We report the case of a patient with new-onset RLS following subthalamic deep-brain stimulation (DBS-STN). We assessed symptoms using suggested immobilization test (SIT) with both DBS-STN activated and switched off. CASE DESCRIPTION A 59-year-old man with idiopathic PD developed disabling RLS following DBS-STN at age 58, with PD onset at 50 manifesting as left arm tremor. Despite improved motor symptoms during the month following surgery, the patient experienced left leg discomfort at rest, transiently alleviated by movements due to an irrepressible urge to move, and worsened at night. Symptoms had no temporal relationship with oral dopa-therapy and disappeared when DBS-STN was deactivated. A 1 h SIT assessed motor behavior with irrepressible urge to move, as well as sensory symptoms by visual analog scale. After 30 m DBS-STN was switched off followed by the appearance of tremor in the left arm while both motor and sensory symptoms of RLS disappeared in the left leg. DISCUSSION The mechanisms of DBS-STN's impact on RLS remain controversial. We hypothesize the DBS-STN to induce in our patient a hyperdopaminergic tone. DBS-induced and DBS-ameliorated RLS represent interesting conditions to further understand the pathophysiology of RLS. Moreover, the present observation suggests that SIT can be a valuable tool to assess RLS in PD patients before and after DBS-STN in future prospective studies.
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Affiliation(s)
- Lionel Tordjman
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, 1 Place de L'Hôpital, F-67000, Strasbourg, France
| | - Ouhaïd Lagha-Boukbiza
- Department of Neurology, Movement Disorders Clinic, University Hospital of Strasbourg, 1 Place de L'Hôpital, F-67000, Strasbourg, France
| | - Mathieu Anheim
- Department of Neurology, Movement Disorders Clinic, University Hospital of Strasbourg, 1 Place de L'Hôpital, F-67000, Strasbourg, France
| | - Christine Tranchant
- Department of Neurology, Movement Disorders Clinic, University Hospital of Strasbourg, 1 Place de L'Hôpital, F-67000, Strasbourg, France
| | - Patrice Bourgin
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, 1 Place de L'Hôpital, F-67000, Strasbourg, France; Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, 8 Allée Du Général Rouvillois, F-67000, Strasbourg, France
| | - Elisabeth Ruppert
- CIRCSom (International Research Center for ChronoSomnology) & Sleep Disorders Center, University Hospital of Strasbourg, 1 Place de L'Hôpital, F-67000, Strasbourg, France; Institute for Cellular and Integrative Neurosciences, CNRS UPR 3212 & Strasbourg University, 8 Allée Du Général Rouvillois, F-67000, Strasbourg, France.
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Zhang DY, Pearce JJ, Petrosyan E, Borghei A, Byrne RW, Sani S. Minimizing pneumocephalus during deep brain stimulation surgery. Clin Neurol Neurosurg 2024; 238:108174. [PMID: 38422743 DOI: 10.1016/j.clineuro.2024.108174] [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: 12/07/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery is an effective treatment for movement disorders. Introduction of intracranial air following dura opening in DBS surgery can result in targeting inaccuracy and suboptimal outcomes. We develop and evaluate a simple method to minimize pneumocephalus during DBS surgery. METHODS A retrospective analysis of prospectively collected data was performed on patients undergoing DBS surgery at our institution from 2014 to 2022. A total of 172 leads placed in 89 patients undergoing awake or asleep DBS surgery were analyzed. Pneumocephalus volume was compared between leads placed with PMT and leads placed with standard dural opening. (112 PMT vs. 60 OPEN). Immediate post-operative high-resolution CT scans were obtained for all leads placed, from which pneumocephalus volume was determined through a semi-automated protocol with ITK-SNAP software. Awake surgery was conducted with the head positioned at 15-30°, asleep surgery was conducted at 0°. RESULTS PMT reduced pneumocephalus from 11.2 cm3±9.2 to 0.8 cm3±1.8 (P<0.0001) in the first hemisphere and from 7.6 cm3 ± 8.4 to 0.43 cm3 ± 0.9 (P<0.0001) in the second hemisphere. No differences in adverse events were noted between PMT and control cases. Lower rates of post-operative headache were observed in PMT group. CONCLUSION We present and validate a simple yet efficacious technique to reduce pneumocephalus during DBS surgery.
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Affiliation(s)
- Daniel Y Zhang
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - John J Pearce
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Edgar Petrosyan
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Alireza Borghei
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard W Byrne
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
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Rifi Z, Remore LG, Tolossa M, Wei W, Sun XR, Bari AA. Somatotopic organization of the ventral nuclear group of the dorsal thalamus: deep brain stimulation for neuropathic pain reveals new insights into the facial homunculus. Brain Struct Funct 2024; 229:349-358. [PMID: 38172466 DOI: 10.1007/s00429-023-02733-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/09/2023] [Indexed: 01/05/2024]
Abstract
Deep Brain Stimulation (DBS) is an experimental treatment for medication-refractory neuropathic pain. The ventral posteromedial (VPM) and ventral posterolateral (VPL) nuclei of the thalamus are popular targets for the treatment of facial and limb pain, respectively. While intraoperative testing is used to adjust targeting of patient-specific pain locations, a better understanding of thalamic somatotopy may improve targeting of specific body regions including the individual trigeminal territories, face, arm, and leg. To elucidate the somatotopic organization of the ventral nuclear group of the dorsal thalamus using in vivo macrostimulation data from patients undergoing DBS for refractory neuropathic pain. In vivo macrostimulation data was retrospectively collected for 14 patients who underwent DBS implantation for neuropathic pain syndromes at our institution. 56 contacts from 14 electrodes reconstructed with LeadDBS were assigned to macrostimulation-related body regions: tongue, face, arm, or leg. 33 contacts from 9 electrodes were similarly assigned to one of three trigeminal territories: V1, V2, or V3. MNI coordinates in the x, y, and z axes were compared by using MANOVA. Across the horizontal plane of the ventral nuclear group of the dorsal thalamus, the tongue was represented significantly medially, followed by the face, arm, and leg most laterally (p < 0.001). The trigeminal territories displayed significant mediolateral distribution, proceeding from V1 and V2 most medial to V3 most lateral (p < 0.001). Along the y-axis, V2 was also significantly anterior to V3 (p = 0.014). While our results showed that the ventral nuclear group of the dorsal thalamus displayed mediolateral somatotopy of the tongue, face, arm, and leg mirroring the cortical homunculus, the mediolateral distribution of trigeminal territories did not mirror the established cortical homunculus. This finding suggests that the facial homunculus may be inverted in the ventral nuclear group of the dorsal thalamus.
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Affiliation(s)
- Ziad Rifi
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA.
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Luigi Gianmaria Remore
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
- University of Milan "LA STATALE", Milan, Italy
| | - Meskerem Tolossa
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Wenxin Wei
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Xiaonan R Sun
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Ausaf A Bari
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Singha S, Dwarakanath S, Yadav R, Holla VV, Kamble N, Tyagi G, Pal PK. Deep brain stimulation in pediatric dystonia: calls for therapeutic realism over nihilism. Childs Nerv Syst 2024; 40:881-894. [PMID: 37875618 DOI: 10.1007/s00381-023-06182-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Pediatric dystonia (PD) has a significant negative impact on the growth and development of the child. This study was done retrospectively to analyze functional outcomes in pediatric patients with dystonia who underwent deep brain stimulation. METHODS In this retrospective analytical study, all the patients of age less than 18 years undergoing deep brain stimulation (DBS) for dystonia between 2012 and 2020 in a single center were analyzed and their functional outcomes were measured by the Burke-Fahn-Marsden-dystonia-rating-scale (BFMDRS). RESULTS A total of 10 pediatric patients were included with a mean age of onset, duration of disease, and age at surgery being 5.75 years, 7.36 years, and 13.11 years, respectively, with a mean follow-up of 23.22 months. The mean pre-DBS motor score was 75.44 ± 23.53 which improved significantly at 6-month and 12-month follow-up to 57.27 (p value 0.004) and 50.38 (p value < 0.001), respectively. Limbs sub-scores improved significantly at both the scheduled intervals. There was a significant improvement in disability at 1-year follow-up with significant improvement in feeding, dressing, and walking components. There was a 27.34% and 36.64% improvement in dystonia with a 17.37% and 28.86% reduction in disability at 6 months and 12 months, respectively. There was a positive correlation between the absolute reduction of the motor score and improvement in disability of the patients at 6 months (rho = 0.865, p value 0.003). CONCLUSIONS DBS in PD has an enormous role in reducing disease burden and achieving a sustainable therapeutic goal.
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Affiliation(s)
- Souvik Singha
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Srinivas Dwarakanath
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India.
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Vikram V Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Gaurav Tyagi
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, 560029, India
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Qiu L, Chang A, Ma R, Strong TV, Okun MS, Foote KD, Wexler A, Gunduz A, Miller JL, Halpern CH. Neuromodulation for the treatment of Prader-Willi syndrome - A systematic review. Neurotherapeutics 2024; 21:e00339. [PMID: 38430811 PMCID: PMC10920723 DOI: 10.1016/j.neurot.2024.e00339] [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: 12/07/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Prader-Willi syndrome (PWS) is a complex, genetic disorder characterized by multisystem involvement, including hyperphagia, maladaptive behaviors and endocrinological derangements. Recent developments in advanced neuroimaging have led to a growing understanding of PWS as a neural circuit disorder, as well as subsequent interests in the application of neuromodulatory therapies. Various non-invasive and invasive device-based neuromodulation methods, including vagus nerve stimulation (VNS), transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), and deep brain stimulation (DBS) have all been reported to be potentially promising treatments for addressing the major symptoms of PWS. In this systematic literature review, we summarize the recent literature that investigated these therapies, discuss the underlying circuits which may underpin symptom manifestations, and cover future directions of the field. Through our comprehensive search, there were a total of 47 patients who had undergone device-based neuromodulation therapy for PWS. Two articles described VNS, 4 tDCS, 1 rTMS and 2 DBS, targeting different symptoms of PWS, including aberrant behavior, hyperphagia and weight. Multi-center and multi-country efforts will be required to advance the field given the low prevalence of PWS. Finally, given the potentially vulnerable population, neuroethical considerations and dialogue should guide the field.
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Affiliation(s)
- Liming Qiu
- Department of Neurosurgery, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Andrew Chang
- Department of Neurosurgery, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Anna Wexler
- Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia, PA, USA
| | - Aysegul Gunduz
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Jennifer L Miller
- Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - Casey H Halpern
- Department of Neurosurgery, University of Pennsylvania Health System, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA.
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30
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Liu TC, Chen YC, Chen PL, Tu PH, Yeh CH, Yeap MC, Wu YH, Chen CC, Wu HT. Removal of electrical stimulus artifact in local field potential recorded from subthalamic nucleus by using manifold denoising. J Neurosci Methods 2024; 403:110038. [PMID: 38145720 DOI: 10.1016/j.jneumeth.2023.110038] [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: 08/14/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective treatment for movement disorders such as Parkinson's disease (PD). However, local field potentials (LFPs) recorded through lead externalization during high-frequency stimulation (HFS) are contaminated by stimulus artifacts, which require to be removed before further analysis. NEW METHOD In this study, a novel stimulus artifact removal algorithm based on manifold denoising, termed Shrinkage and Manifold-based Artifact Removal using Template Adaptation (SMARTA), was proposed to remove artifacts by deriving a template for each stimulus artifact and subtracting it from the signal. Under a low-dimensional manifold assumption, a matrix denoising technique called optimal shrinkage was applied to design a similarity metric such that the template for stimulus artifacts could be accurately recovered. RESULT SMARTA was evaluated using semirealistic signals, which were the combination of semirealistic stimulus artifacts recorded in an agar brain model and LFPs of PD patients with no stimulation, and realistic LFP signals recorded in patients with PD during HFS. The results indicated that SMARTA removes stimulus artifacts with a modest distortion in LFP estimates. COMPARISON WITH EXISTING METHODS SMARTA was compared with moving-average subtraction, sample-and-interpolate technique, and Hampel filtering. CONCLUSION The proposed SMARTA algorithm helps the exploration of the neurophysiological mechanisms of DBS effects.
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Affiliation(s)
- Tzu-Chi Liu
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Mathematics, National Taiwan University, Taipei, Taiwan
| | - Yi-Chieh Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Lin Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Hsun Tu
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chih-Hua Yeh
- College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Neuroradiology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Yi-Hui Wu
- Biomedical Electronics Translational Research Center, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Chiung-Chu Chen
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Hau-Tieng Wu
- Courant Institute of Mathematical Sciences, New York University, New York, USA.
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Díaz Castela M, Prendes Fernández P, Heres Bruck S, Suárez San Martín E, García Fernández C, Sol Álvarez J, Lozano Aragoneses B, Sáiz Ayala A, Santamarta Liébana E, Álvarez Carriles J, González Álvarez L, Blázquez Estrada M. Parkinsonism-hyperpyrexia, a rare consequence of deep brain stimulator malfunction in advanced Parkinson's disease. Clin Park Relat Disord 2024; 10:100246. [PMID: 38444738 PMCID: PMC10912856 DOI: 10.1016/j.prdoa.2024.100246] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
Parkinsonism-hyperpyrexia syndrome (PHS) is a rare neurological emergency that shares clinical features with neuroleptic malignant syndrome. It is usually due to sudden deprivation of dopaminergic treatment, although there are cases related to failure of the deep brain stimulation system.
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Affiliation(s)
| | | | - Sonia Heres Bruck
- Servicio de Neurología, Hospital Universitario Central de Asturias, Spain
| | | | | | - Javier Sol Álvarez
- Servicio de Neurocirugía, Hospital Universitario Central de Asturias, Spain
| | | | - Antonio Sáiz Ayala
- Servicio de Radiodiagnóstico, Hospital Universitario Central de Asturias, Spain
| | | | - Juan Álvarez Carriles
- Neuropsicología. Área de Gestión Clínica de Salud Mental, Hospital Universitario Central de Asturias, Spain
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Tsolaki E, Kashanian A, Chiu K, Bari A, Pouratian N. Connectivity-based segmentation of the thalamic motor region for deep brain stimulation in essential tremor: A comparison of deterministic and probabilistic tractography. Neuroimage Clin 2024; 41:103587. [PMID: 38422832 PMCID: PMC10944185 DOI: 10.1016/j.nicl.2024.103587] [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: 11/13/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Deep brain stimulation (DBS) studies have shown that stimulation of the motor segment of the thalamus based on probabilistic tractography is predictive of improvement in essential tremor (ET). However, probabilistic methods are computationally demanding, requiring the need for alternative tractography methods for use in the clinical setting. The purpose of this study was to compare probabilistic vs deterministic tractography methods for connectivity-based targeting in patients with ET. METHODS Probabilistic and deterministic tractography methods were retrospectively applied to diffusion-weighted data sets in 36 patients with refractory ET. The thalamus and precentral gyrus were selected as regions of interest and fiber tracking was performed between these regions to produce connectivity-based thalamic segmentations, per prior methods. The resultant deterministic target maps were compared with those of thresholded probabilistic maps. The center of gravity (CG) of each connectivity map was determined and the differences in spatial distribution between the tractography methods were characterized. Furthermore, the intersection between the connectivity maps and CGs with the therapeutic volume of tissue activated (VTA) was calculated. A mixed linear model was then used to assess clinical improvement in tremor with volume of overlap. RESULTS Both tractography methods delineated the region of the thalamus with connectivity to the precentral gyrus to be within the posterolateral aspect of the thalamus. The average CG of deterministic maps was more medial-posterior in both the left (3.7 ± 1.3 mm3) and the right (3.5 ± 2.2 mm3) hemispheres when compared to 30 %-thresholded probabilistic maps. Mixed linear model showed that the volume of overlap between CGs of deterministic and probabilistic targeting maps and therapeutic VTAs were significant predictors of clinical improvement. CONCLUSIONS Deterministic tractography can reconstruct DBS thalamic target maps in approximately 5 min comparable to those produced by probabilistic methods that require > 12 h to generate. Despite differences in CG between the methods, both deterministic-based and probabilistic targeting were predictive of clinical improvement in ET.
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Affiliation(s)
- Evangelia Tsolaki
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
| | - Alon Kashanian
- Department of Neurosurgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Kevin Chiu
- Brainlab, Inc., 5 Westbrook Corporate Center, Suite 1000, Westchester, IL 60154, USA
| | - Ausaf Bari
- Department of Neurosurgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Nader Pouratian
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA
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Catalano Chiuvé S, Momjian S, Wolff A, Corniola MV. Effectiveness and reliability of hypnosis in stereotaxy: a randomized study. Acta Neurochir (Wien) 2024; 166:112. [PMID: 38411747 PMCID: PMC10899299 DOI: 10.1007/s00701-024-05943-0] [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: 09/11/2023] [Accepted: 01/04/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Patients suffering from Parkinson's disease (PD) may experience pain during stereotactic frame (SF) fixation in deep brain stimulation (DBS). We assessed the role of hypnosis during the SF fixation in PD patients undergoing awake bilateral subthalamic nucleus (STN) DBS. METHODS N = 19 patients were included (N = 13 males, mean age 63 years; N = 10 allocated to the hypnosis and N = 9 allocated to the control groups). Patients were randomly assigned to the interventional (hypnosis and local anesthesia) or non-interventional (local anesthesia only) groups. The primary outcome was the pain perceived (the visual analogue scale (VAS)). Secondary outcomes were stress, anxiety, and depression, as measured by the perceived stress scale (PSS) and hospital anxiety and depression scale (HADS). Procedural distress was measured using the peritraumatic distress inventory (PDI-13). RESULTS In the hypnosis group, VASmean was 5.6 ± 2.1, versus 6.4 ± 1.2 in the control group (p = 0.31). Intervention and control groups reported similar VASmax scores (7.6 ± 2.1 versus 8.6 ± 1.6 (p = 0.28), respectively). Both groups had similar HADS scores (6.2 ± 4.3 versus 6.7 ± 1.92, p = 0.72 (HADSa) and 6.7 ± 4.2 versus 7.7 ± 3, p = 0.58 (HADSd)), so were the PSS scores (26.1 ± 6.3 versus 25.1 ± 7, p = 0.75). Evolutions of VASmean (R2 = 0.93, 95% CI [0.2245, 1.825], p = 0.03) and PDI-13 scores (R2 = 0.94, 95% CI [1.006, 6.279], p = 0.02) significantly differ over follow-up with patients in the hypnosis groups showing lower scores. CONCLUSION In this unblinded, randomized study, hypnosis does not influence pain, anxiety, and distress during awake SF fixation but modulates pain memory over time and may prevent the integration of awake painful procedures as a bad experience into the autobiographical memory of patients suffering from PD. A randomized controlled study with more data is necessary to confirm our findings.
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Affiliation(s)
- Sabina Catalano Chiuvé
- Neurology Department, Neuropsychology Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Shahan Momjian
- Faculty of Medicine, Université of Genève, Geneva, Suisse
- Neurosurgery Department, Geneva University Hospitals, Geneva, Switzerland
| | - Adriana Wolff
- Anesthesiology Department, Geneva University Hospitals, Geneva, Switzerland
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Pantovic A, Essert C. Evaluating the impact of reinforcement learning on automatic deep brain stimulation planning. Int J Comput Assist Radiol Surg 2024:10.1007/s11548-024-03078-2. [PMID: 38411781 DOI: 10.1007/s11548-024-03078-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE Traditional techniques for automating the planning of brain electrode placement based on multi-objective optimization involving many parameters are subject to limitations, especially in terms of sensitivity to local optima, and tend to be replaced by machine learning approaches. This paper explores the feasibility of using deep reinforcement learning (DRL) in this context, starting with the single-electrode use-case of deep brain stimulation (DBS). METHODS We propose a DRL approach based on deep Q-learning where the states represent the electrode trajectory and associated information, and actions are the possible motions. Deep neural networks allow to navigate the complex state space derived from MRI data. The chosen reward function emphasizes safety and accuracy in reaching the target structure. The results were compared with a reference (segmented electrode) and a conventional technique. RESULTS The DRL approach excelled in navigating the complex anatomy, consistently providing safer and more precise electrode placements than the reference. Compared to conventional techniques, it showed an improvement in accuracy of 2.3% in average proximity to obstacles and 19.4% in average orientation angle. Expectedly, computation times rose significantly, from 2 to 18 min. CONCLUSION Our investigation into DRL for DBS electrode trajectory planning has showcased its promising potential. Despite only delivering modest accuracy gains compared to traditional methods in the single-electrode case, its relevance for problems with high-dimensional state and action spaces and its resilience against local optima highlight its promising role for complex scenarios. This preliminary study constitutes a first step toward the more challenging problem of multiple-electrodes planning.
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Gao Y, Gao D, Zhang H, Zheng D, Du J, Yuan C, Mingxi Ma, Yin Y, Wang J, Zhang X, Wang Y. BLA DBS improves anxiety and fear by correcting weakened synaptic transmission from BLA to adBNST and CeL in a mouse model of foot shock. Cell Rep 2024; 43:113766. [PMID: 38349792 DOI: 10.1016/j.celrep.2024.113766] [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: 06/09/2023] [Revised: 10/24/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
Deep brain stimulation (DBS) in the basal lateral amygdala (BLA) has been established to correct symptoms of refractory post-traumatic stress disorder (PTSD). However, how BLA DBS operates in correcting PTSD symptoms and how the BLA elicits pathological fear and anxiety in PTSD remain unclear. Here, we discover that excitatory synaptic transmission from the BLA projection neurons (PNs) to the adBNST, and lateral central amygdala (CeL) is greatly suppressed in a mouse PTSD model induced by foot shock (FS). BLA DBS revises the weakened inputs from the BLA to these two areas to improve fear and anxiety. Optogenetic manipulation of the BLA-adBNST and BLA-CeL circuits shows that both circuits are responsible for anxiety but the BLA-CeL for fear in FS mice. Our results reveal that synaptic transmission dysregulation of the BLA-adBNST or BLA-CeL circuits is reversed by BLA DBS, which improves anxiety and fear in the FS mouse model.
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Affiliation(s)
- Yan Gao
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Dawen Gao
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Hui Zhang
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Danhao Zheng
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan Institute of Physics and Mathematics, Wuhan 430071, China
| | - Jun Du
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Chao Yuan
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Mingxi Ma
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Yao Yin
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Jie Wang
- Key Laboratory of Magnetic Resonance in Biological Systems, State Key Laboratory of Magnetic Resonance and Atomic and Molecular Physics, National Center for Magnetic Resonance in Wuhan, Innovation Academy for Precision Measurement Science and Technology, Chinese Academy of Sciences-Wuhan National Laboratory for Optoelectronics, Wuhan Institute of Physics and Mathematics, Wuhan 430071, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiaohui Zhang
- State Key Laboratory of Cognitive Neuroscience & Learning and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Yizheng Wang
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China; National Clinical Research Center for Aging and Medicine, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
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Daquin G, Bonini F. The landscape of drug resistant absence seizures in adolescents and adults: Pathophysiology, electroclinical spectrum and treatment options. Rev Neurol (Paris) 2024:S0035-3787(24)00291-1. [PMID: 38413268 DOI: 10.1016/j.neurol.2023.11.010] [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: 10/02/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024]
Abstract
The persistence of typical absence seizures (AS) in adolescence and adulthood may reduce the quality of life of patients with genetic generalized epilepsies (GGEs). The prevalence of drug resistant AS is probably underestimated in this patient population, and treatment options are relatively scarce. Similarly, atypical absence seizures in developmental and epileptic encephalopathies (DEEs) may be unrecognized, and often persist into adulthood despite improvement of more severe seizures. These two seemingly distant conditions, represented by typical AS in GGE and atypical AS in DEE, share at least partially overlapping pathophysiological and genetic mechanisms, which may be the target of drug and neurostimulation therapies. In addition, some patients with drug-resistant typical AS may present electroclinical features that lie in between the two extremes represented by these generalized forms of epilepsy.
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Affiliation(s)
- G Daquin
- Epileptology and Cerebral Rythmology, AP-HM, Timone hospital, Marseille, France
| | - F Bonini
- Epileptology and Cerebral Rythmology, AP-HM, Timone hospital, Marseille, France; Aix Marseille Univ, Inserm, INS, Inst Neurosci Syst, Marseille, France.
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Wiśniewski K, Gajos A, Zaczkowski K, Szulia A, Grzegorczyk M, Dąbkowska A, Wójcik R, Bobeff EJ, Kwiecień K, Brandel MG, Fahlström A, Bogucki A, Ciszek B, Jaskólski DJ. Overlapping stimulation of subthalamic nucleus and dentato-rubro-thalamic tract in Parkinson's disease after deep brain stimulation. Acta Neurochir (Wien) 2024; 166:106. [PMID: 38403814 DOI: 10.1007/s00701-024-06006-0] [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: 10/25/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) reduces tremor, rigidity, and akinesia. According to the literature, the dentato-rubro-thalamic tract (DRTt) is verified target for DBS in essential tremor; however, its role in the treatment of Parkinson's disease is only vaguely described. The aim of our study was to identify the relationship between symptom alleviation in PD patients and the distance of the DBS electrode electric field (EF) to the DRTt. METHODS A single-center retrospective analysis of patients (N = 30) with idiopathic Parkinson's disease (PD) who underwent DBS between November 2018 and January 2020 was performed. DRTt and STN were visualized using diffusion-weighted imaging (DWI) and tractography protocol of magnetic resonance (MR). The EF was calculated and compared with STN and course of DRTt. Evaluation of patients before and after surgery was performed with use of UPDRS-III scale. The association between distance from EF to DRTt and clinical outcomes was examined. To confirm the anatomical variation between DRTt and STN observed in tractography, white matter dissection was performed with the Klingler technique on ten human brains. RESULTS Patients with EF overlapping STN and DRTt benefited from significant motor symptoms improvement. Anatomical findings confirmed the presence of population differences in variability of the DRTt course and were consistent with the DRTt visualized by MR. CONCLUSIONS DRTt proximity to STN, the main target in PD DBS surgery, confirmed by DWI with tractography protocol of MR combined with proper predefined stimulation parameters may improve efficacy of DBS-STN.
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Affiliation(s)
- K Wiśniewski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland.
| | - A Gajos
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland
| | - K Zaczkowski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - A Szulia
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - M Grzegorczyk
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - A Dąbkowska
- Department of Forensic Medicine, Medical University of Warsaw, Warsaw, Poland
| | - R Wójcik
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - E J Bobeff
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Łódź, Poland
| | - K Kwiecień
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
| | - M G Brandel
- Department of Neurosurgery, University of California, San Diego, San Diego, CA, 92123, USA
| | - A Fahlström
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - A Bogucki
- Department of Extrapyramidal Diseases, Medical University of Łódź, Łódź, Poland
| | - B Ciszek
- Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland
| | - D J Jaskólski
- Department of Neurosurgery and Neurooncology, Medical University of Łódź, Barlicki University Hospital, Łódź, Poland
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Bonda D, Kelly KA, Boop S, Feroze AH, Randle SC, Bindschadler M, Marashly A, Owens J, Lockrow J, Bozarth X, Novotny E, Friedman S, Goldstein HE, Grannan BL, Durfy S, Ojemann JG, Ko AL, Hauptman JS. Deep Brain Stimulation of Bilateral Centromedian Thalamic Nuclei in Pediatric Patients with Lennox-Gastaut Syndrome: An Institutional Experience. World Neurosurg 2024:S1878-8750(24)00312-7. [PMID: 38403017 DOI: 10.1016/j.wneu.2024.02.099] [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: 08/03/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Surgical management of pediatric patients with nonlesional, drug-resistant epilepsy, including patients with Lennox-Gastaut syndrome (LGS), remains a challenge given the lack of resective targets in most patients and shows seizure freedom rates <50% at 5 years. The efficacy of deep brain stimulation (DBS) is less certain in children than in adults. This study examined clinical and seizure outcomes for pediatric patients with LGS undergoing DBS targeting of the centromedian thalamic nuclei (CMTN). METHODS An institutional review board-approved retrospective analysis was performed of patients aged ≤19 years with clinical diagnosis of LGS undergoing bilateral DBS placement to the CMTN from 2020 to 2021 by a single surgeon. RESULTS Four females and 2 males aged 6-19 years were identified. Before surgery, each child experienced at least 6 years of refractory seizures; 4 children had experienced seizures since infancy. All took antiseizure medications at the time of surgery. Five children had previous placement of a vagus nerve stimulator and 2 had a previous corpus callosotomy. The mean length of stay after DBS was 2 days. No children experienced adverse neurologic effects from implantation; the mean follow-up time was 16.3 months. Four patients had >60% reduction in seizure frequency after surgery, 1 patient experienced 10% reduction, and 1 patient showed no change. No children reported worsening seizure symptoms after surgery. CONCLUSIONS Our study contributes to the sparse literature describing CMTN DBS for children with drug-resistant epilepsy from LGS. Our results suggest that CMTN DBS is a safe and effective therapeutic modality that should be considered as an alternative or adjuvant therapy for this challenging patient population. Further studies with larger patient populations are warranted.
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Affiliation(s)
- David Bonda
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Katherine A Kelly
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Scott Boop
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Abdullah H Feroze
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Stephanie C Randle
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Mike Bindschadler
- Center for Respiratory Therapy and Biologics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Ahmad Marashly
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - James Owens
- Department of Pediatrics, Section of Neurology, University of Iowa, Iowa City, Iowa, USA
| | - Jason Lockrow
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Xiuhua Bozarth
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA
| | - Edward Novotny
- Department of Neurology, University of Washington, Seattle, Washington, USA; Division of Pediatric Neurology, Seattle Children's Hospital, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA
| | - Seth Friedman
- Center for Respiratory Therapy and Biologics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Hannah E Goldstein
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Benjamin L Grannan
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jeffrey G Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA
| | - Andrew L Ko
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jason S Hauptman
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA; Neurosciences Center, Seattle Children's Hospital, Seattle, Washington, USA; Division of Neurosurgery, Seattle Children's Hospital, Seattle, Washington, USA.
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Gough M, Mills R, Brechany U, Nicholson C, Jenkins A, Hussain MA. Locating the ventral intermediate thalamic nucleus for deep brain stimulation surgery: analysis of a case series comparing CT and MR targeting. Br J Neurosurg 2024:1-6. [PMID: 38372013 DOI: 10.1080/02688697.2024.2313674] [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: 10/27/2020] [Accepted: 01/27/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) surgery targeting the ventral intermediate thalamic nucleus (Vim) has proven efficacy in the treatment of tremor. AIMS The primary aim is to investigate whether there is a statistically significant difference in patient outcomes when CT-guided targeting of the Vim is compared with MRI-guided targeting. METHODS This is a retrospective study concerning patients undergoing Vim-targeted DBS at the Department of Neurosurgery, Royal Victoria Infirmary in Newcastle (9th August 2012 to 4th January 2019). Fahn-Tolosa-Marin Tremor Scale (FTM TS) and EQ-5D scores were collected from patient notes. Statistical analysis was performed using IBM® SPSS® Statistics Version 24. Independent samples t-tests were used to compare means. RESULTS Independent samples t-test did not reveal a statistically significant difference between CT (n = 10; FTM TS mean = 65.40, SD = 11.40; EQ-5D mean = 39.50, SD = 17.87) and MR (n = 7; FTM TS mean = 60.57, SD = 7.50; EQ-5D mean = 32.14, SD = 9.94) groups in pre-surgery FTM TS (t(15) = 0.977, p = 0.344) and EQ-5D (t(15) = 0.982, p = 0.342) scores. No statistically significant difference between the CT (FTM TS mean = 24.12, SD = 20.47; EQ-5D mean = 75.56, SD = 15.63) and MR (FTM TS mean = 22.86, SD = 6.72; EQ-5D mean = 70.43, SD = 15.48) groups was revealed at 1 year assessment of FTM TS (t(14) = 0.155, p = 0.879) and EQ-5D (t(14) = 0.654, p = 0.524). The median difference between pre- and post-surgery FTM TS and EQ-5D scores in the CT group at 1 year was 43.00 and 35.00, respectively. The MR patient group median difference in pre- and post-surgery at 1 year was 35.00 and 35.00 respectively. CONCLUSION No statistically significant difference between CT and MR image-guided targeting patient groups was detected.
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Affiliation(s)
| | - Russell Mills
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Una Brechany
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Claire Nicholson
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Alistair Jenkins
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
| | - Mohammed Akbar Hussain
- Department of Neurosurgery, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom
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Cao L, Palmisano C, Chen X, Isaias IU, Händel BF. Spontaneous blink-related beta power increase and theta phase reset in subthalamic nucleus of Parkinson patients during walking. Clin Neurophysiol 2024; 161:17-26. [PMID: 38432185 DOI: 10.1016/j.clinph.2024.02.019] [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: 05/30/2023] [Revised: 12/20/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Both blinking and walking are altered in Parkinson's disease and both motor outputs have been shown to be linked in healthy subjects. Additionally, studies suggest an involvement of basal ganglia activity and striatal dopamine in blink generation. We investigated the role of the basal ganglia circuitry on spontaneous blinking and if this role is dependent on movement state and striatal dopamine. METHODS We analysed subthalamic nucleus (STN) activity in seven chronically implanted patients for deep brain stimulation (DBS) with respect to blinks and movement state (resting state and unperturbed walking). Neurophysiological recordings were combined with individual molecular brain imaging assessing the dopamine reuptake transporter (DAT) density for the left and right striatum separately. RESULTS We found a significantly higher blink rate during walking compared to resting. The blink rate during walking positively correlated with the DAT density of the left caudate nucleus. During walking only, spontaneous blinking was followed by an increase in the right STN beta power and a bilateral subthalamic phase reset in the low frequencies. The right STN blink-related beta power modulation correlated negatively with the DAT density of the contralateral putamen. The left STN blink-related beta power correlated with the DAT density of the putamen in the less dopamine-depleted hemisphere. Both correlations were specific to the walking condition and to beta power following a blink. CONCLUSION Our findings show that spontaneous blinking is related to striatal dopamine and has a frequency specific deployment in the STN. This correlation depends on the current movement state such as walking. SIGNIFICANCE This work indicates that subcortical activity following a motor event as well as the relationship between dopamine and motor events can be dependent on the motor state. Accordingly, disease related changes in brain activity should be assessed during natural movement.
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Affiliation(s)
- Liyu Cao
- Department of Psychology and Behavioural Sciences, Zhejiang University, Hangzhou, China; Department of Psychology (III), Julius-Maximilian-University of Würzburg, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
| | - Xinyu Chen
- Department of Psychology (III), Julius-Maximilian-University of Würzburg, Würzburg, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany; Parkinson Institute Milan, ASST G. Pini CTO, Milano, Italy
| | - Barbara F Händel
- Department of Psychology (III), Julius-Maximilian-University of Würzburg, Würzburg, Germany; Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany.
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Saway BF, Palmer C, Hughes C, Triano M, Suresh RE, Gilmore J, George M, Kautz SA, Rowland NC. The evolution of neuromodulation for chronic stroke: From neuroplasticity mechanisms to brain-computer interfaces. Neurotherapeutics 2024; 21:e00337. [PMID: 38377638 DOI: 10.1016/j.neurot.2024.e00337] [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: 10/16/2023] [Revised: 02/05/2024] [Accepted: 02/13/2024] [Indexed: 02/22/2024] Open
Abstract
Stroke is one of the most common and debilitating neurological conditions worldwide. Those who survive experience motor, sensory, speech, vision, and/or cognitive deficits that severely limit remaining quality of life. While rehabilitation programs can help improve patients' symptoms, recovery is often limited, and patients frequently continue to experience impairments in functional status. In this review, invasive neuromodulation techniques to augment the effects of conventional rehabilitation methods are described, including vagus nerve stimulation (VNS), deep brain stimulation (DBS) and brain-computer interfaces (BCIs). In addition, the evidence base for each of these techniques, pivotal trials, and future directions are explored. Finally, emerging technologies such as functional near-infrared spectroscopy (fNIRS) and the shift to artificial intelligence-enabled implants and wearables are examined. While the field of implantable devices for chronic stroke recovery is still in a nascent stage, the data reviewed are suggestive of immense potential for reducing the impact and impairment from this globally prevalent disorder.
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Affiliation(s)
- Brian F Saway
- Department of Neurosurgery, Medical University of South Carolina, SC 29425, USA.
| | - Charles Palmer
- Department of Psychiatry, Medical University of South Carolina, SC 29425, USA
| | - Christopher Hughes
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Matthew Triano
- Department of Neurosurgery, Medical University of South Carolina, SC 29425, USA
| | - Rishishankar E Suresh
- College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Jordon Gilmore
- Department of Bioengineering, Clemson University, Clemson, SC 29634, USA
| | - Mark George
- Department of Psychiatry, Medical University of South Carolina, SC 29425, USA; Ralph H Johnson VA Health Care System, Charleston, SC 29425, USA
| | - Steven A Kautz
- Department of Health Science and Research, Medical University of South Carolina, SC 29425, USA; Ralph H Johnson VA Health Care System, Charleston, SC 29425, USA
| | - Nathan C Rowland
- Department of Neurosurgery, Medical University of South Carolina, SC 29425, USA; MUSC Institute for Neuroscience Discovery (MIND), Medical University of South Carolina, SC 29425, USA
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Shepherd H, Heartshorne R, Osman-Farah J, Macerollo A. Dual target deep brain stimulation for complex essential and dystonic tremor - A 5-year follow up. J Neurol Sci 2024; 457:122887. [PMID: 38295533 DOI: 10.1016/j.jns.2024.122887] [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: 07/17/2023] [Revised: 12/12/2023] [Accepted: 01/11/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Essential tremor (ET) is characterized by action tremor of the upper limbs, head tremor and voice tremor. Dystonic tremor (DT) is produced by muscle contractions in a body affected by dystonia. Deep brain stimulation (DBS) of ventral intermediate nucleus of the thalamus (VIM) is the most well-known advanced treatment for medication-refractory tremor. However, decline in efficacy overtime has led to explore other targets. This study aimed to measure the efficacy of bilateral dual targeting ViM/caudal Zona Incerta (cZI) stimulation on tremor control. A secondary aim was to evaluate if there was a difference in the efficacy between ET and DT. METHODS 36 patients were retrospectively recruited at the Walton NHS Foundation Trust, Liverpool, UK. Patients were assessed pre-operatively, and then at 1-year, 3-years, and 5-years post-operatively with the following scales: Fahn-Tolosa-Marin tremor rating (FTMTR) scale, EuroQol-5D, and Hospital Anxiety and Depression Scale. RESULTS Bilateral ViM-cZI DBS significantly improved overall tremor score by 45.1% from baseline to 3-years post-operatively (p < 0.001). It continued to show improvement in overall FTMTR score by 30.7% at 5-years but this failed to meet significance. However, there was no significant improvement of mood or quality of life (QoL) scores. ET group on average showed a significant better clinical outcome compared to the DT group (p > 0.001). CONCLUSIONS Our study found that bilateral ViM-cZI DBS treatment had a favourable effect on motor symptoms sustained over the 5-years in tremor patients, especially in ET group. There was limited effect on mood and QoL with similar trends in outcomes for both tremor types.
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Affiliation(s)
- Hilary Shepherd
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK; University of Liverpool Medical School, Liverpool, UK.
| | - Rosie Heartshorne
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Jibril Osman-Farah
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK
| | - Antonella Macerollo
- The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, UK; Institute of Systems, Molecular and Integrative Biology, University of Liverpool, UK
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Sajonz BEA, Frommer ML, Reisert M, Blazhenets G, Schröter N, Rau A, Prokop T, Reinacher PC, Rijntjes M, Urbach H, Meyer PT, Coenen VA. Disbalanced recruitment of crossed and uncrossed cerebello-thalamic pathways during deep brain stimulation is predictive of delayed therapy escape in essential tremor. Neuroimage Clin 2024; 41:103576. [PMID: 38367597 PMCID: PMC10944187 DOI: 10.1016/j.nicl.2024.103576] [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: 11/27/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Thalamic deep brain stimulation (DBS) is an efficacious treatment for drug-resistant essential tremor (ET) and the dentato-rubro-thalamic tract (DRT) constitutes an important target structure. However, up to 40% of patients habituate and lose treatment efficacy over time, frequently accompanied by a stimulation-induced cerebellar syndrome. The phenomenon termed delayed therapy escape (DTE) is insufficiently understood. Our previous work showed that DTE clinically is pronounced on the non-dominant side and suggested that differential involvement of crossed versus uncrossed DRT (DRTx/DRTu) might play a role in DTE development. METHODS We retrospectively enrolled right-handed patients under bilateral thalamic DBS >12 months for ET from a cross-sectional study. They were characterized with the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) and Scale for the Assessment and Rating of Ataxia (SARA) scores at different timepoints. Normative fiber tractographic evaluations of crossed and uncrossed cerebellothalamic pathways and volume of activated tissue (VAT) studies together with [18F]Fluorodeoxyglucose positron emission tomography were applied. RESULTS A total of 29 patients met the inclusion criteria. Favoring DRTu over DRTx in the non-dominant VAT was associated with DTE (R2 = 0.4463, p < 0.01) and ataxia (R2 = 0.2319, p < 0.01). Moreover, increasing VAT size on the right (non-dominant) side was associated at trend level with more asymmetric glucose metabolism shifting towards the right (dominant) dentate nucleus. CONCLUSION Our results suggest that a disbalanced recruitment of DRTu in the non-dominant VAT induces detrimental stimulation effects on the dominant cerebellar outflow (together with contralateral stimulation) leading to DTE and thus hampering the overall treatment efficacy.
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Affiliation(s)
- Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Marvin L Frommer
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany; Division of Medical Physics, Department of Diagnostic and Interventional Radiology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Ganna Blazhenets
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Nils Schröter
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Thomas Prokop
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany; Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | - Michel Rijntjes
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Philipp T Meyer
- Department of Nuclear Medicine, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany; Center for Deep Brain Stimulation, University of Freiburg, Germany
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Lee EJ, Aguirre-Padilla DH, Fomenko A, Pawar G, Kapadia M, George J, Lozano AM, Hamani C, Kalia LV, Kalia SK. Reduction of alpha-synuclein oligomers in preclinical models of Parkinson's disease by electrical stimulation in vitro and deep brain stimulation in vivo. Brain Stimul 2024; 17:166-175. [PMID: 38342364 DOI: 10.1016/j.brs.2024.02.005] [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: 09/30/2023] [Revised: 01/25/2024] [Accepted: 02/06/2024] [Indexed: 02/13/2024] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) has been widely used to manage debilitating neurological symptoms in movement disorders such as Parkinson's disease (PD). Despite its well-established symptomatic benefits, our understanding of the mechanisms underlying DBS and its possible effect on the accumulation of pathological proteins in neurodegeneration remains limited. Accumulation and oligomerization of the protein alpha-synuclein (α-Syn) are implicated in the loss of dopaminergic neurons in the substantia nigra in PD, making α-Syn a potential therapeutic target for disease modification. OBJECTIVE We examined the effects of high frequency electrical stimulation on α-Syn levels and oligomerization in cell and rodent models. METHODS High frequency stimulation, mimicking DBS parameters used for PD, was combined with viral-mediated overexpression of α-Syn in cultured rat primary cortical neurons or in substantia nigra of rats. Bimolecular protein complementation with split fluorescent protein reporters was used to detect and quantify α-Syn oligomers. RESULTS High frequency electrical stimulation reduced the expression of PD-associated mutant α-Syn and mitigated α-Syn oligomerization in cultured neurons. Furthermore, DBS in the substantia nigra, but not the subthalamic nucleus, decreased overall levels of α-Syn, including oligomer levels, in the substantia nigra. CONCLUSIONS Taken together, our results demonstrate that direct high frequency stimulation can reduce accumulation and pathological forms of α-Syn in cultured neurons in vitro and in substantia nigra in vivo. Thus, DBS therapy could have a role beyond symptomatic treatment, with potential disease-modifying properties that can be exploited to target pathological proteins in neurodegenerative diseases.
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Affiliation(s)
- Eun Jung Lee
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - David Hernán Aguirre-Padilla
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Neuromodulation and Functional Neurosurgery Program, San Borja Arriarán Hospital, Santiago, Chile; Department of Neurology and Neurosurgery, Medical School, University of Chile, Santiago, Chile; Department of Biomedical Engineering, University Medical Center Groningen, Groningen University, Groningen, Netherlands
| | - Anton Fomenko
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Grishma Pawar
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Minesh Kapadia
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Jimmy George
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Andres M Lozano
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Clement Hamani
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; Sunnybrook Research Institute, Hurvitz Brain Sciences Centre, Toronto, ON, Canada
| | - Lorraine V Kalia
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada; Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Suneil K Kalia
- Krembil Research Institute, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada; CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada.
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Barbosa RP, Moreau C, Rolland AS, Rascol O, Brefel-Courbon C, Ory-Magne F, Bastos P, de Barros A, Hainque E, Rouaud T, Marques A, Eusebio A, Benatru I, Drapier S, Guehl D, Maltete D, Tranchant C, Wirth T, Giordana C, Tir M, Thobois S, Hopes L, Hubsch C, Jarraya B, Corvol JC, Bereau M, Devos D, Fabbri M. The impact of subthalamic deep-brain stimulation in restoring motor symmetry in Parkinson's disease patients: a prospective study. J Neurol 2024:10.1007/s00415-023-12162-7. [PMID: 38334813 DOI: 10.1007/s00415-023-12162-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND OBJECTIVES The impact of subthalamic deep-brain stimulation (STN-DBS) on motor asymmetry and its influence on both motor and non-motor outcomes remain unclear. The present study aims at assessing the role of STN-DBS on motor asymmetry and how its modulation translates into benefits in motor function, activities of daily living (ADLs) and quality of life (QoL). METHODS Postoperative motor asymmetry has been assessed on the multicentric, prospective Predictive Factors and Subthalamic Stimulation in Parkinson's Disease cohort. Asymmetry was evaluated at both baseline (pre-DBS) and 1 year after STN-DBS. A patient was considered asymmetric when the right-to-left MDS-UPDRS part III difference was ≥ 5. In parallel, analyses have been carried out using the absolute right-to-left difference. The proportion of asymmetric patients at baseline was compared to that in the post-surgery evaluation across different medication/stimulation conditions. RESULTS 537 PD patients have been included. The proportion of asymmetric patients was significantly reduced after both STN-DBS and medication administration (asymmetric patients: 50% in pre-DBS MedOFF, 35% in MedOFF/StimON, 26% in MedON/StimOFF, and 12% in MedON/StimON state). Older patients at surgery and with higher baseline UPDRS II scores were significantly less likely to benefit from STN-DBS at the level of motor asymmetry. No significant correlation between motor asymmetry and ADLs (UPDRS II) or overall QoL (PDQ-39) score was observed. Asymmetric patients had significantly higher mobility, communication, and daily living PDQ-39 sub-scores. CONCLUSIONS Both STN-DBS and levodopa lead to a reduction in motor asymmetry. Motor symmetry is associated with improvements in certain QoL sub-scores.
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Affiliation(s)
- Raquel Pinheiro Barbosa
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Caroline Moreau
- Department of Medical Pharmacology, Neurology, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
- Movement Disorders Department, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
| | - Anne Sophie Rolland
- Department of Medical Pharmacology, Neurology, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
- Movement Disorders Department, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Christine Brefel-Courbon
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Fabienne Ory-Magne
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Paulo Bastos
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Amaury de Barros
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Elodie Hainque
- Department of Neurology, NS-PARK/FCRIN Network, France, Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tiphaine Rouaud
- Department of Neurology, NS-PARK/FCRIN Network, Nantes University Hospital, 44093, Nantes Cedex, France
| | - Ana Marques
- Neurology Department, NS-PARK/FCRIN Network, Université Clermont Auvergne, EA7280, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France
| | - Alexandre Eusebio
- Aix Marseille Université, AP-HM, Hôpital de La Timone, Service de Neurologie et Pathologie du Mouvement, and UMR CNRS, Marseille et Versailles, France
| | - Isabelle Benatru
- Service de Neurologie, Centre Expert Parkinson, NS-PARK/FCRIN Network, CIC-INSERM 1402, CHU Poitiers, 86000, Poitiers, France
| | - Sophie Drapier
- Department of Neurology, NS-PARK/FCRIN Network, Rennes University Hospital, CIC-INSERM 1414, 35033, Rennes Cedex, France
| | - Dominique Guehl
- CHU de Bordeaux, Centre Expert Parkinson, Institut des Maladies Neuro-Dégénératives, 33000, Bordeaux, France
| | - David Maltete
- Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, NS-PARK/FCRIN Network, INSERM U1239, Mont-Saint-Aignan, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut de Génétique Et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
- NS-PARK/FCRIN Network, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Thomas Wirth
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut de Génétique Et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
- NS-PARK/FCRIN Network, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Caroline Giordana
- Neurology Department, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Melissa Tir
- Department of Neurology, Expert Centre for Parkinson's Disease, NS-PARK/FCRIN Network, Amiens University Hospital, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie (LNFP) Université de Picardie Jules Verne, University of Picardy Jules Verne (UPJV), Amiens, France
- Department of Neurosurgery, Expert Centre for Parkinson's Disease, NS-PARK/FCRIN Network, Amiens University Hospital, EA 4559 Laboratoire de Neurosciences Fonctionnelles Et Pathologie (LNFP) Université de Picardie Jules Verne, University of Picardy Jules Verne (UPJV), Versailles, France
| | - Stephane Thobois
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux; CNRS, Institut Des Sciences Cognitives, UMR 5229, Bron, France
- NS-PARK/FCRIN Network, Centre Expert Parkinson, Hôpital Neurologique "Pierre Wertheimer", Hospices Civils de Lyon, Lyon, France
| | - Lucie Hopes
- Neurology Department, Nancy University Hospital, 54000, Nancy, France
| | - Cecile Hubsch
- NS-PARK/FCRIN Network, Hôpital Fondation Ophtalmologique A de Rothschild, Unité James Parkinson, 75019, Paris, France
| | - Bechir Jarraya
- Pôle Neurosciences, Foch Hospital, Suresnes, France
- Université de Versailles Paris-Saclay, INSERM U992, CEA Neurospin, Marseille et Versailles, France
| | - Jean Christophe Corvol
- Department of Neurology, NS-PARK/FCRIN Network, France, Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Matthieu Bereau
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030, Besançon Cedex, France
- Université de Franche-Comté, UR LINC 481, F-2500, Besançon, France
| | - David Devos
- Department of Medical Pharmacology, Neurology, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
- Movement Disorders Department, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
| | - Margherita Fabbri
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France.
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Davidson B, Bhattacharya A, Sarica C, Darmani G, Raies N, Chen R, Lozano AM. Neuromodulation techniques - From non-invasive brain stimulation to deep brain stimulation. Neurotherapeutics 2024; 21:e00330. [PMID: 38340524 DOI: 10.1016/j.neurot.2024.e00330] [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: 10/11/2023] [Revised: 01/14/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Over the past 30 years, the field of neuromodulation has witnessed remarkable advancements. These developments encompass a spectrum of techniques, both non-invasive and invasive, that possess the ability to both probe and influence the central nervous system. In many cases neuromodulation therapies have been adopted into standard care treatments. Transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and transcranial ultrasound stimulation (TUS) are the most common non-invasive methods in use today. Deep brain stimulation (DBS), spinal cord stimulation (SCS), and vagus nerve stimulation (VNS), are leading surgical methods for neuromodulation. Ongoing active clinical trials using are uncovering novel applications and paradigms for these interventions.
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Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | | | - Can Sarica
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Nasem Raies
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, ON, Canada; Edmond J. Safra Program in Parkinson's Disease Morton and Gloria Shulman Movement Disorders Clinic, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, ON, Canada.
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Semmler C, Stopic V, Jost ST, Fink GR, Weiss PH, Barbe MT. Preoperative motor deficits and depressive symptoms predict quality of life in patients with Parkinson's disease at different time points after surgery for subthalamic stimulation: a retrospective study. Neurol Res Pract 2024; 6:8. [PMID: 38326916 PMCID: PMC10851535 DOI: 10.1186/s42466-023-00303-2] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 12/11/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND While subthalamic nucleus deep brain stimulation (STN-DBS) improves the quality of life (QoL) of patients with Parkinson's disease (PD), the clinical parameters that predict this improvement remain debated. This retrospective study explored whether preoperative motor, cognitive, and affective parameters predict QoL or its components at 6 and 12 months after STN-DBS surgery. METHODS QoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39) before (baseline), at 6 months (N = 90) and 12 months (N = 63) after STN-DBS surgery. Changes in the PDQ-39 and its subdomains were analysed with Wilcoxon signed-rank tests. In total, seven motor, cognitive, and affective parameters recorded at baseline were used in multiple linear regressions to predict QoL and its subdomains. RESULTS QoL had improved significantly at six months post STN-DBS surgery. After 12 months, this effect remained significant but was less pronounced. At both time points, significant improvements in mobility, activities of daily living, stigma, and bodily discomfort were present. Correlation and linear regression analyses showed that preoperative QoL status and changes in QoL at 6 and 12 months after surgery were driven by preoperative dopaminergic medication, as well as motor (UPDRS-III medOFF and PIGD-subscore medOFF) and affective (HADS anxiety and depression) symptoms. In contrast, preoperative cognitive performance did not predict QoL at any time point. CONCLUSION Data show that preoperative motor and affective symptoms drive both QoL baseline status and changes in QoL after STN-DBS surgery. Thus, these clinical parameters need to be assessed appropriately to provide comprehensive presurgical advice to patients suffering from PD.
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Affiliation(s)
- Carolin Semmler
- Faculty of Medicine, University of Cologne, Cologne, Germany.
- Department of Neurology, University Hospital Cologne, Cologne, Germany.
| | - Vasilija Stopic
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Stefanie T Jost
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Peter H Weiss
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Michael T Barbe
- Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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Schüller T, Huys D, Kohl S, Visser-Vandewalle V, Dembek TA, Kuhn J, Baldermann JC, Smith EE. Thalamic deep brain stimulation for tourette syndrome increases cortical beta activity. Brain Stimul 2024; 17:197-201. [PMID: 38341176 DOI: 10.1016/j.brs.2024.01.011] [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: 06/06/2023] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the thalamus can effectively reduce tics in severely affected patients with Tourette syndrome (TS). Its effect on cortical oscillatory activity is currently unknown. OBJECTIVE We assessed whether DBS modulates beta activity at fronto-central electrodes. We explored concurrent EEG sources and probabilistic stimulation maps. METHODS Resting state EEG of TS patients treated with thalamic DBS was recorded in repeated DBS-on and DBS-off states. A mixed linear model was employed for statistical evaluation. EEG sources were estimated with eLORETA. Thalamic probabilistic stimulation maps were obtained by assigning beta power difference scores (DBS-on minus DBS-off) to stimulation sites. RESULTS We observed increased beta power in DBS-on compared to DBS-off states. Modulation of cortical beta activity was localized to the midcingulate cortex. Beta modulation was more pronounced when stimulating the thalamus posteriorly, peaking in the ventral posterior nucleus. CONCLUSION Thalamic DBS in TS patients modulates beta frequency oscillations presumably important for sensorimotor function and relevant to TS pathophysiology.
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Affiliation(s)
- Thomas Schüller
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, 50935, Cologne, Germany.
| | - Daniel Huys
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, 50935, Cologne, Germany
| | - Sina Kohl
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, 50935, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Surgery, 50935, Cologne, Germany
| | - Till A Dembek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, 50935, Cologne, Germany
| | - Jens Kuhn
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, 50935, Cologne, Germany; Johanniter Hospital Oberhausen, Department of Psychiatry and Psychotherapy & Psychosomatic Medicine, 46145, Oberhausen, Germany
| | - Juan Carlos Baldermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, 50935, Cologne, Germany; University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, 50935, Cologne, Germany; University of Freiburg, Faculty of Medicine and University Hospital Cologne, Department of Psychiatry and Psychotherapy, 79104, Freiburg, Germany
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Mar-Barrutia L, Ibarrondo O, Mar J, Real E, Segalàs C, Bertolín S, Aparicio MA, Plans G, Menchón JM, Alonso P. Sex differences in clinical response to deep brain stimulation in resistant obsessive-compulsive disorder. Span J Psychiatry Ment Health 2024:S2950-2853(24)00013-9. [PMID: 38331320 DOI: 10.1016/j.sjpmh.2024.01.006] [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: 10/06/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an effective alternative to treat severe refractory obsessive-compulsive disorder (OCD), although little is known on factors predicting response. The objective of this study was to explore potential sex differences in the pattern of response to DBS in OCD patients. METHODS We conducted a prospective observational study in 25 patients with severe resistant OCD. Response to treatment was defined as a ≥35% reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score. Logistic regression models were calculated to measure the likelihood of response at short and long-term follow-up by sex as measured by Y-BOCS score. Similar analyses were carried out to study changes in depressive symptomatology assessed with the Hamilton Depression Rating Scale (HDRS). Additionally, effect sizes were calculated to assess clinical significance. RESULTS We did not observe significant clinical differences between men and women prior to DBS implantation, nor in the response after one year of stimulation. At long-term follow-up, 76.9% of men could be considered responders to DBS versus only 33.3% of women. The final response odds ratio in men was 10.05 with significant confidence intervals (88.90-1.14). No other predictors of response were identified. The sex difference in Y-BOCS reduction was clinically significant, with an effect size of 3.2. The main limitation was the small sample size. CONCLUSIONS Our results suggest that gender could influence the long-term response to DBS in OCD, a finding that needs to be confirmed in new studies given the paucity of results on predictors of response to DBS.
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Affiliation(s)
- Lorea Mar-Barrutia
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge Hospital, Barcelona, Spain; Osakidetza Basque Health Service, Araba University Hospital, Department of Psychiatry, Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Oliver Ibarrondo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Spain
| | - Javier Mar
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organisation, Research Unit, Arrasate-Mondragón, Spain; Biodonostia Health Research Institute, Donostia-San Sebastián, Spain; Kronikgune Institute for Health Services Research, Barakaldo, Spain
| | - Eva Real
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge Hospital, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid, Spain
| | - Cinto Segalàs
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge Hospital, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Spain
| | - Sara Bertolín
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge Hospital, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid, Spain
| | | | - Gerard Plans
- Department of Neurosurgery, Hospital de Bellvitge, Barcelona, Spain
| | - José Manuel Menchón
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge Hospital, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Spain
| | - Pino Alonso
- OCD Clinical and Research Unit, Department of Psychiatry, Bellvitge Hospital, Barcelona, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Barcelona, Spain; CIBERSAM (Centro de Investigación en Red de Salud Mental), Carlos III Health Institute, Madrid, Spain; Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Spain.
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O'Keeffe AB, Merla A, Ashkan K. Deep brain stimulation of the subthalamic nucleus in Parkinson disease 2013-2023: where are we a further 10 years on? Br J Neurosurg 2024:1-9. [PMID: 38323603 DOI: 10.1080/02688697.2024.2311128] [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: 08/14/2023] [Accepted: 01/23/2024] [Indexed: 02/08/2024]
Abstract
Deep brain stimulation has been in clinical use for 30 years and during that time it has changed markedly from a small-scale treatment employed by only a few highly specialized centers into a widespread keystone approach to the management of disorders such as Parkinson's disease. In the intervening decades, many of the broad principles of deep brain stimulation have remained unchanged, that of electrode insertion into stereotactically targeted brain nuclei, however the underlying technology and understanding around the approach have progressed markedly. Some of the most significant advances have taken place over the last decade with the advent of artificial intelligence, directional electrodes, stimulation/recording implantable pulse generators and the potential for remote programming among many other innovations. New therapeutic targets are being assessed for their potential benefits and a surge in the number of deep brain stimulation implantations has given birth to a flourishing scientific literature surrounding the pathophysiology of brain disorders such as Parkinson's disease. Here we outline the developments of the last decade and look to the future of deep brain stimulation to attempt to discern some of the most promising lines of inquiry in this fast-paced and rapidly evolving field.
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Affiliation(s)
| | - Anca Merla
- King's College Hospital Department of Neurosurgery, Kings College Hospital, Denmark
| | - Keyoumars Ashkan
- King's College Hospital Department of Neurosurgery, Kings College Hospital, Denmark
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