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Ozturk O, Akcakaya NH, Akcakaya MO. Combined thalamic and pallidal deep brain stimulation in diabetic hemiballism/hemichorea. Neurocirugia (Astur : Engl Ed) 2024:S2529-8496(24)00018-2. [PMID: 38588801 DOI: 10.1016/j.neucie.2024.03.005] [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] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 03/07/2024] [Indexed: 04/10/2024]
Abstract
Hemiballism/Hemichorea (HH) is a hyperkinetic movement disorder observed mostly after cerebrovascular diseases in elderly patients. Even though the improvement in symptoms would be maintained without treatment, in rare cases, lesioning or DBS (deep brain stimulation) surgery provide a chance on relieving the severe involuntary movements. HH is a more rarely reported entity as a diabetic complication and we encountered very few cases treated with surgical intervention for diabetic HH. A 75-year-old female patient with type-II diabetes mellitus was admitted for left-sided disabling involuntary movement despite being medically treated for six months. A GPi (globus pallidus internus) and thalamic Vim (ventral intermediate) nucleus targeted DBS surgery was performed. Complete resolution was achieved with combined stimulation at 1.7 mA of thalamic Vim nucleus and 2.4 mA of GPi. Combined stimulation of thalamic Vim nucleus and GPi resulted in an effective treatment method for HH secondary to diabetes in our case. Even if the rarity of the cases treated surgically withholds us to come to a certain conclusion, it provides a new option to treat HH to our experience.
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Affiliation(s)
- Onur Ozturk
- Department of Neurosurgery, Acibadem Taksim Hospital, Istanbul, Turkey.
| | - Nihan Hande Akcakaya
- Department of Neurology, Demiroglu Bilim University Medicine Faculty, Istanbul, Turkey
| | - Mehmet Osman Akcakaya
- Department of Neurosurgery, Gayrettepe Florence Nightingale Hospital, Istanbul, Turkey
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Salari M, Etemadifar M, Zali A, Aminzade Z, Navalpotro-Gomez I, Tehrani Fateh S. Covid-19 in Parkinson's Disease treated by drugs or brain stimulation. Neurologia 2024; 39:254-260. [PMID: 38553103 DOI: 10.1016/j.nrleng.2021.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/08/2021] [Indexed: 04/02/2024] Open
Abstract
PURPOSE Covid-19 has affected all people, especially those with chronic diseases, including Parkinson's Disease (PD). Covid-19 may affect both motor and neuropsychiatric symptoms of PD patients. We intend to evaluate different aspects of Covid-19 impact on PD patients. METHODS 647 PD patients were evaluated in terms of PD-related and Covid-19-related clinical presentations in addition to past medical history during the pandemic through an online questioner. They were compared with an age-matched control group consist of 673 individuals and a sample of the normal population consist of 1215 individuals. RESULTS The prevalence of Covid-19 in PD patients was 11.28%. The mortality was 1.23% among PD patients. The prevalence of Covid-19 in PD patients who undergone Deep Brain Stimulation (DBS) was 18.18%. No significant association was found between the duration of disease and the prevalence of Covid-19. A statistically significant higher prevalence of Covid-19 in PD patients who had direct contact with SARS-CoV-19 infected individuals was found. No statistically significant association has been found between the worsening of motor symptoms and Covid-19. PD patients and the normal population may differ in the prevalence of some psychological disorders, including anxiety and sleeping disorders, and Covid-19 may affect the psychological status. CONCLUSION PD patients possibly follow tighter preventive protocols, which lead to lower prevalence and severity of Covid-19 and its consequences in these patients. Although it seems Covid-19 does not affect motor and psychological aspects of PD as much as it was expected, more accurate evaluations are suggested in order to clarify such effects.
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Affiliation(s)
- M Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Etemadifar
- Department of Functional Neurosurgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Chancellery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z Aminzade
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - I Navalpotro-Gomez
- Servicio de Neurología, Hospital del Mar-Parc de Salut Mar, IMIM, Barcelona, Spain
| | - S Tehrani Fateh
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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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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Chuang TC, Tan JQ, Chen SM. Comparison of intraoperative imaging guided versus microelectrode recording guided deep brain stimulation for Parkinson's disease: A meta-analysis. Neurocirugia (Astur : Engl Ed) 2023; 34:228-237. [PMID: 36931932 DOI: 10.1016/j.neucie.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/12/2022] [Indexed: 03/17/2023]
Abstract
BACKGROUND Traditionally, most centers would use microelectrode recording (MER) to refine targeting in deep brain stimulation (DBS) surgery. In recent years, intraoperative imaging (IMG) guided DBS has become an alternative way to verify lead placement. Currently, there is still controversy surrounding the necessity of MER or IMG for DBS. This meta-analysis aims to explore lead accuracy, clinical efficacy and safety between IMG and MER guided DBS for Parkinson's disease (PD). METHODS PubMed, Embase, Web of Science, Cochrane Library were searched up to Mar, 2021 for studies reporting comparisons between IMG and MER guided DBS for PD. Subgroup analysis was conducted to assess effects of different IMG technology and DBS targeting site. RESULTS Six studies, comprising of 478 patients were included in our analysis. The mean difference between the two implantation techniques in stereotactic accuracy, lead passes per trajectory, improvement% of Unified Parkinson's Disease Rating Scale part III and levodopa equivalent daily dose were -0.45 (95% confidence interval, CI=-1.11 to 0.20), -0.18 (95% CI=-0.41 to 0.06), 3.40 (95% CI=-5.36 to 12.16), and 5.00 (95% CI=-1.40 to 11.39), respectively. No significant differences were observed in each adverse event and operation/procedure time between the two implantation techniques. CONCLUSIONS Both IMG and MER guided DBS offered effective control of motor symptoms for PD. Besides, IMG guided is comparable to MER guided DBS, in terms of safety, accuracy and efficiency. It is recommended for each hospital to select DBS guidance technology based on available resources and equipment.
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Affiliation(s)
- Tsung-Che Chuang
- Department of Primary Medicine, Shuang-Ho Hospital, New Taipei, Taiwan
| | - Jia-Qi Tan
- Department of Primary Medicine, Shuang-Ho Hospital, New Taipei, Taiwan
| | - Shu-Mei Chen
- Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurosurgery, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
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de Oliveira F, Vaz R, Chamadoira C, Rosas MJ, Ferreira-Pinto MJ. Bilateral deep brain stimulation of the subthalamic nucleus: Targeting differences between the first and second side. Neurocirugia (Astur : Engl Ed) 2023:S2529-8496(22)00100-9. [PMID: 36775743 DOI: 10.1016/j.neucie.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/18/2022] [Indexed: 02/12/2023]
Abstract
INTRODUCTION AND OBJECTIVES Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a recognized treatment for drug-refractory Parkinson's disease (PD). However, the therapeutic success depends on the accuracy of targeting. This study aimed to evaluate potential accuracy differences in the placement of the first and second electrodes implanted, by comparing chosen electrode trajectories, STN activity detected during microelectrode recording (MER), and the mismatch between the initially planned and final electrode positions on each side. MATERIALS AND METHODS In this retrospective cohort study, we analyzed data from 30 patients who underwent one-stage bilateral DBS. For most patients, three arrays of microelectrodes were used to determine the physiological location of the STN. Final target location depended also on the results of intraoperative stimulation. The choice of central versus non-central channels was compared. The Euclidean vector deviation was calculated using the initially planned coordinates and the final position of the tip of the electrode according to a CT scan taken at least a month after the surgery. RESULTS The central channel was chosen in 70% of cases on the first side and 40% of cases on the second side. The mean length of high-quality STN activity recorded in the central channel was longer on the first side than the second (3.07±1.85mm vs. 2.75±1.94mm), while in the anterior channel there were better MER recordings on the second side (1.59±2.07mm on the first side vs. 2.78±2.14mm on the second). Regarding the mismatch between planned versus final electrode position, electrodes on the first side were placed on average 0.178±0.917mm lateral, 0.126±1.10mm posterior and 1.48±1.64mm inferior to the planned target, while the electrodes placed on the second side were 0.251±1.08mm medial, 0.355±1.29mm anterior and 2.26±1.47mm inferior to the planned target. CONCLUSION There was a tendency for the anterior trajectory to be chosen more frequently than the central on the second side. There was also a statistically significant deviation of the second electrodes in the anterior and inferior directions, when compared to the electrodes on the first side, suggesting that another cause other than brain shift may be responsible. We should therefore factor this during planning for the second implanted side. It might be useful to plan the second side more anteriorly, possibly reducing the number of MER trajectories tested and the duration of surgery.
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Moreira-Holguín JC, Barahona-Morán DA, Hidalgo-Esmeraldas J, Guzmán-Rochina C. Neuromodulation of the anterior thalamic nucleus as a therapeutic option for difficult-to-control epilepsy. Neurocirugia (Astur : Engl Ed) 2022; 33:182-189. [PMID: 35725219 DOI: 10.1016/j.neucie.2021.04.001] [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: 04/15/2020] [Accepted: 12/16/2020] [Indexed: 06/15/2023]
Abstract
Deep brain stimulation (DBS) consists of the electrical stimulation of the subcortical structures by implanting electrodes connected to a pulse generator. The thalamus, being a structure that has multiple connections with various parts of the central nervous system, is a suitable target for DBS. The anterior thalamic nucleus (ANT) serves as an important relay site for the limbic system by receiving input from the hippocampus and mammillary bodies, and sending input to the cingulate gyrus; thus forming the Papez circuit. Due to these connections, the ANT constitutes an ideal route for the propagation of epileptogenic activity. ANT-DBS has excellent results in the control of complex partial seizures. The vast majority of patients with ANT-DBS have shown a significant reduction in the frequency of their seizures of more than 50%.
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Affiliation(s)
- Juan Carlos Moreira-Holguín
- Servicio de Neurocirugía, Hospital de Especialidades Guayaquil "Dr. Abel Gilbert Pontón", Guayaquil, Ecuador; Escuela de Medicina, Universidad de Guayaquil, Guayaquil, Ecuador.
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Salari M, Etemadifar M, Zali A, Aminzade Z, Navalpotro-Gomez I, Tehrani Fateh S. Covid-19 in Parkinson's Disease treated by drugs or brain stimulation. Neurologia 2021:S0213-4853(21)00123-7. [PMID: 34511276 PMCID: PMC8326006 DOI: 10.1016/j.nrl.2021.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/19/2021] [Accepted: 07/08/2021] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Covid-19 has affected all people, especially those with chronic diseases, including Parkinson's Disease (PD). Covid-19 may affect both motor and neuropsychiatric symptoms of PD patients. We intend to evaluate different aspects of Covid-19 impact on PD patients. METHODS 647 PD patients were evaluated in terms of PD-related and Covid-19-related clinical presentations in addition to past medical history during the pandemic through an online questioner. They were compared with an age-matched control group consist of 673 individuals and a sample of the normal population consist of 1215 individuals. RESULTS The prevalence of Covid-19 in PD patients was 11.28%. The mortality was 1.23% among PD patients. The prevalence of Covid-19 in PD patients who undergone Deep Brain Stimulation (DBS) was 18.18%. No significant association was found between the duration of disease and the prevalence of Covid-19. A statistically significant higher prevalence of Covid-19 in PD patients who had direct contact with SARS-CoV-19 infected individuals was found. No statistically significant association has been found between the worsening of motor symptoms and Covid-19. PD patients and the normal population may differ in the prevalence of some psychological disorders, including anxiety and sleeping disorders, and Covid-19 may affect the psychological status. CONCLUSION PD patients possibly follow tighter preventive protocols, which lead to lower prevalence and severity of Covid-19 and its consequences in these patients. Although it seems Covid-19 does not affect motor and psychological aspects of PD as much as it was expected, more accurate evaluations are suggested in order to clarify such effects.
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Affiliation(s)
- M Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Etemadifar
- Department of Functional Neurosurgery, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Chancellery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Z Aminzade
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - I Navalpotro-Gomez
- Servicio de Neurología, Hospital del Mar-Parc de Salut Mar, IMIM, Barcelona, Spain
| | - S Tehrani Fateh
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Moreira-Holguín JC, Barahona-Morán DA, Hidalgo-Esmeraldas J, Guzmán-Rochina C. Neuromodulation of the anterior thalamic nucleus as a therapeutic option for difficult-to-control epilepsy. Neurocirugia (Astur) 2021; 33:S1130-1473(21)00002-6. [PMID: 33551281 DOI: 10.1016/j.neucir.2020.12.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/17/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Deep brain stimulation (DBS) consists of the electrical stimulation of the subcortical structures by implanting electrodes connected to a pulse generator. The thalamus, being a structure that has multiple connections with various parts of the central nervous system, is a suitable target for DBS. The anterior thalamic nucleus (ANT) serves as an important relay site for the limbic system by receiving input from the hippocampus and mammillary bodies, and sending input to the cingulate gyrus; thus forming the Papez circuit. Due to these connections, the ANT constitutes an ideal route for the propagation of epileptogenic activity. ANT-DBS has excellent results in the control of complex partial seizures. The vast majority of patients with ANT-DBS have shown a significant reduction in the frequency of their seizures of more than 50%.
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Affiliation(s)
- Juan Carlos Moreira-Holguín
- Servicio de Neurocirugía, Hospital de Especialidades Guayaquil «Dr. Abel Gilbert Pontón», Guayaquil, Ecuador; Escuela de Medicina, Universidad de Guayaquil, Guayaquil, Ecuador.
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Fernández-Pajarín G, Sesar Á, Jiménez-Martín I, Ares B, Castro A. Progression and treatment of a series of patients with advanced LRRK2-associated Parkinson's disease. Neurologia 2021; 38:S0213-4853(20)30303-0. [PMID: 33541803 DOI: 10.1016/j.nrl.2020.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION LRRK2 mutations have traditionally been associated with a benign phenotype of Parkinson's disease (PD). Favourable responses to deep brain stimulation (DBS) are reported in the advanced phase. METHODS We performed a retrospective analysis of the clinical characteristics and progression of 13 patients with LRRK2-associated PD (13 with G2019S and one with I1371 V). Nine patients were in the advanced phase, with a mean progression time of 7.2 years before reaching this phase. RESULTS Seven patients underwent bilateral subthalamic DBS implantation, and two received infusion treatment. Patients with mutation G2019S responded excellently to DBS, with Unified Parkinson's disease rating scale (UPDRS) II and III scores improving by 80% at six months. This response was sustained over time. The patient with mutation I1371 V had a severe phenotype of the disease, and presented a moderate response to DBS. Patients with advanced LRRK2-associated PD showed predominantly frontal cognitive involvement, with significant language impairment. CONCLUSIONS In these patients, progression was faster in the advanced stage of the disease. We emphasise the suitability of subthalamic DBS in the management of these patients.
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Affiliation(s)
- G Fernández-Pajarín
- Unidad de Trastornos del Movimiento, Servicio de Neurología. Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España.
| | - Á Sesar
- Unidad de Trastornos del Movimiento, Servicio de Neurología. Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - I Jiménez-Martín
- Unidad de Trastornos del Movimiento, Servicio de Neurología. Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - B Ares
- Unidad de Trastornos del Movimiento, Servicio de Neurología. Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - A Castro
- Unidad de Trastornos del Movimiento, Servicio de Neurología. Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
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Oñate-Cadena N, Cisneros-Otero M, Ruiz-Chow ÁA, Arellano-Reynoso A, Kobayashi-Romero LF, Pérez-Esparza R. Deep-brain stimulation in treatment-resistant obsessive-compulsive disorder: Clinical and molecular neuroimaging correlation. ACTA ACUST UNITED AC 2018; 49:62-65. [PMID: 32081211 DOI: 10.1016/j.rcp.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 05/28/2018] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder is defined by the presence of obsessions and compulsions that cause marked anxiety or distress and has been associated with a disruption in cortico-striato-thalamo-cortical circuitry. After treatment, around 50% of patients continue to experience incapacitating symptoms. Deep-brain stimulation has been shown to be an effective therapeutic alternative to regular treatment. METHODS Case report. CASE PRESENTATION A 54-year-old woman with a diagnosis of treatment-resistant obsessive-compulsive disorder was treated with deep-brain stimulation of the anterior limb of the internal capsule. Molecular imaging before and after the procedure was obtained and correlated with clinical features. CONCLUSIONS Deep-brain stimulation may be a therapeutic alternative to regular care in treatment-resistant obsessive-compulsive disorder and can be correlated to functional changes in suspected anatomical structures.
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Affiliation(s)
- Nelcy Oñate-Cadena
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Marcela Cisneros-Otero
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Ángel Alberto Ruiz-Chow
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Alfonso Arellano-Reynoso
- Departamento de Neurocirugía, Programa de Neurocirugía Funcional, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Luis Fabian Kobayashi-Romero
- Laboratorio de Investigación en Adicciones, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México
| | - Rodrigo Pérez-Esparza
- Departamento de Neuropsiquiatría, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México; Laboratorio de Investigación en Adicciones, Instituto Nacional de Neurología y Neurocirugía, Tlalpan, Ciudad de México, México.
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García-Ruiz PJ, Feliz-Feliz C, Ayerbe Gracia J, Matías Arbelo J, Salvador C, Val Fernández JD, García-Caldentey J. [Deep brain stimulation in parkinsonian patients with dopa intolerance]. Neurocirugia (Astur) 2017; 29:213-215. [PMID: 29089239 DOI: 10.1016/j.neucir.2017.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 08/08/2017] [Revised: 08/28/2017] [Accepted: 09/17/2017] [Indexed: 11/20/2022]
Abstract
Deep brain stimulation (DBS) is at present, a useful treatment for patients with advanced Parkinson's disease and motor complications. The crucial step toward consistent DBS outcomes remains careful patient selection; several conditions must be fulfilled including excellent levo dopa response. We report two cases of early onset Parkinson's disease with severe intolerance to levo dopa but excellent and sustained response to DBS. DBS can be a useful alternative for parkinsonian patients with severe intolerance to levo dopa, provided a positive acute response to levo dopa or apomorphine is obtained.
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Affiliation(s)
| | | | | | - José Matías Arbelo
- Servicio de Neurología, Hospital Universitario Insular, Las Palmas de Gran Canaria, España
| | - Carlos Salvador
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, España
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Vázquez-Bourgon J, Martino J, Sierra Peña M, Infante Ceberio J, Martínez Martínez MÁ, Ocón R, Menchón JM, Crespo Facorro B, Vázquez-Barquero A. Deep brain stimulation and treatment-resistant obsessive-compulsive disorder: A systematic review. Rev Psiquiatr Salud Ment (Engl Ed) 2019; 12:37-51. [PMID: 28676437 DOI: 10.1016/j.rpsm.2017.05.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 04/05/2017] [Accepted: 05/15/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION At least 10% of patients with Obsessive-compulsive Disorder (OCD) are refractory to psychopharmacological treatment. The emergence of new technologies for the modulation of altered neuronal activity in Neurosurgery, deep brain stimulation (DBS), has enabled its use in severe and refractory OCD cases. The objective of this article is to review the current scientific evidence on the effectiveness and applicability of this technique to refractory OCD. METHOD We systematically reviewed the literature to identify the main characteristics of deep brain stimulation, its use and applicability as treatment for obsessive-compulsive disorder. Therefore, we reviewed PubMed/Medline, Embase and PsycINFO databases, combining the key-words 'Deep brain stimulation', 'DBS' and 'Obsessive-compulsive disorder' 'OCS'. The articles were selected by two of the authors independently, based on the abstracts, and if they described any of the main characteristics of the therapy referring to OCD: applicability; mechanism of action; brain therapeutic targets; efficacy; side-effects; co-therapies. All the information was subsequently extracted and analysed. RESULTS The critical analysis of the evidence shows that the use of DBS in treatment-resistant OCD is providing satisfactory results regarding efficacy, with assumable side-effects. However, there is insufficient evidence to support the use of any single brain target over another. Patient selection has to be done following analyses of risks/benefits, being advisable to individualize the decision of continuing with concomitant psychopharmacological and psychological treatments. CONCLUSIONS The use of DBS is still considered to be in the field of research, although it is increasingly used in refractory-OCD, producing in the majority of studies significant improvements in symptomatology, and in functionality and quality of life. It is essential to implement random and controlled studies regarding its long-term efficacy, cost-risk analyses and cost/benefit.
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Crespo-Burillo JA, Rivero-Celada D, Saenz-de Cabezón A, Casado-Pellejero J, Alberdi-Viñas J, Alarcia-Alejos R. Deep brain stimulation for patients with Parkinson's disease: Effect on caregiver burden. Neurologia 2016; 33:154-159. [PMID: 27443241 DOI: 10.1016/j.nrl.2016.05.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 05/19/2016] [Accepted: 05/30/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Our aim is to assess the burden on caregivers of patients with Parkinson's disease treated with deep brain stimulation (DBS) compared to those caring for patients at advanced stages and undergoing other treatments. We have also assessed the variables associated with presence of caregiver overload. MATERIAL AND METHODS We included consecutive patients with Parkinson's disease treated with DBS. Our control group included patients in advanced stages of Parkinson's disease undergoing other treatments. Patients were assessed with the following scales: UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn and Yahr, Schwab & England, Barthel, PDQ-39, MoCA, Apathy Evaluation Scale, HADS, and the abbreviated QUIP. Caregiver burden was evaluated with the Zarit caregiver burden interview and their moods were assessed with the HADS scale. RESULTS We included 11 patients treated with DBS and 11 with other treatments. For patients treated with DBS, we observed a better quality of life according to the PDQ-39 questionnaire (P=.028), and a lower score on the HADS anxiety subscale (P=.010). Caregiver overload was observed in 54.5% of the caregivers of patients in both groups (P=1.000); Zarit scores were similar (P=.835). Caregiver overload was associated with higher scores on the caregiver's Apathy Evaluation Scale (P=.048) and on the HADS anxiety subscale (P=.006). CONCLUSION According to our results, treatment with DBS is not associated with lower caregiver burden. Apathy in patients and anxiety in caregivers are factors associated with the appearance of overload.
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Affiliation(s)
- J A Crespo-Burillo
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España.
| | - D Rivero-Celada
- Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España
| | - A Saenz-de Cabezón
- Servicio de Neurofisiología, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Casado-Pellejero
- Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España
| | - J Alberdi-Viñas
- Servicio de Neurocirugía, Hospital Universitario Miguel Servet, Zaragoza, España
| | - R Alarcia-Alejos
- Servicio de Neurología, Hospital Universitario Miguel Servet, Zaragoza, España
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Moliz N, Katati MJ, Iañez B, García A, Yagui E, Horcajadas Á. [Twiddler's syndrome in a patient with obsessive-compulsive disorder treated with deep brain stimulation]. Neurocirugia (Astur) 2014; 26:196-9. [PMID: 25498527 DOI: 10.1016/j.neucir.2014.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 10/27/2014] [Accepted: 11/02/2014] [Indexed: 11/29/2022]
Abstract
Twiddler's syndrome is a rare complication associated with implantable electrical stimulation devices. First described in a patient with a pacemaker, it is a known complication in the field of cardiology. However, it is not so recognised in the world of neurosurgery, in which it has been described in relation to deep brain stimulation (DBS) devices. Characterised by manipulating either consciously or unconsciously the generator of such devices, which causes it to rotate on itself, the syndrome causes the coiling of the wiring of these systems and can lead to their rupture or the displacement of intracranial electrodes. We describe a case of twiddler's syndrome in a patient treated with DBS for obsessive-compulsive disorder, in which clinical deterioration presented after a good initial response. Control radiographs revealed rotation of the wiring system and displacement of the intracranial electrodes.
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Affiliation(s)
- Nicolás Moliz
- Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves - Hospital de Neurotraumatología, Granada, España.
| | - Majed J Katati
- Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves - Hospital de Neurotraumatología, Granada, España
| | - Benjamín Iañez
- Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves - Hospital de Neurotraumatología, Granada, España
| | - Asunción García
- Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves - Hospital de Neurotraumatología, Granada, España
| | - Eskandar Yagui
- Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves - Hospital de Neurotraumatología, Granada, España
| | - Ángel Horcajadas
- Servicio de Neurocirugía, Hospital Universitario Virgen de las Nieves - Hospital de Neurotraumatología, Granada, España
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López González FJ, Rodríguez Osorio X, Gil-Nagel Rein A, Carreño Martínez M, Serratosa Fernández J, Villanueva Haba V, Donaire Pedraza AJ, Mercadé Cerdá JM. Drug-resistant epilepsy: definition and treatment alternatives. Neurologia 2014; 30:439-46. [PMID: 24975343 DOI: 10.1016/j.nrl.2014.04.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 04/23/2014] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Drug-resistant epilepsy affects 25% of all epileptic patients, and quality of life decreases in these patients due to their seizures. Early detection is crucial in order to establish potential treatment alternatives and determine if the patient is a surgical candidate. DEVELOPMENT PubMed search for articles, recommendations published by major medical societies, and clinical practice guidelines for drug-resistant epilepsy and its medical and surgical treatment options. Evidence and recommendations are classified according to the criteria of the Oxford Centre for Evidence-Based Medicine (2001) and the European Federation of Neurological Societies (2004) for therapeutic actions. CONCLUSIONS Identifying patients with drug-resistant epilepsy is important for optimising drug therapy. Experts recommend rational polytherapy with antiepileptic drugs to find more effective combinations with fewer adverse effects. When adequate seizure control is not achieved, a presurgical evaluation in an epilepsy referral centre is recommended. These evaluations explore how to resect the epileptogenic zone without causing functional deficits in cases in which this is feasible. If resective surgery is not achievable, palliative surgery or neurostimulation systems (including vagus nerve, trigeminal nerve, or deep brain stimulation) may be an option. Other treatment alternatives such as ketogenic diet may also be considered in selected patients.
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Affiliation(s)
- F J López González
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España.
| | - X Rodríguez Osorio
- Complejo Hospitalario Universitario de Santiago, Santiago de Compostela, La Coruña, España
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Teijeiro J, Macías RJ, Maragoto C, García I, Alvarez M, Quintanal NE. [Deep brain recording and length of surgery in stereotactic and functional neurosurgery for movement disorders]. Neurocirugia (Astur) 2014; 25:116-27. [PMID: 24491432 DOI: 10.1016/j.neucir.2013.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 09/10/2013] [Accepted: 10/02/2013] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Our objectives were to study the length of multi-unit recordings (MURs) of brain activity in 20 years of movement disorder neurosurgeries and to determine the number of times in which it was necessary for the teams using single-unit recording (SUR) to explore all the electrode tracks in the simultaneously recorded sites (SRS). MATERIAL AND METHOD This was a retrospective descriptive statistical analysis of MUR length on 4,296 tracks in 952 surgeries. The exclusion criteria were: tracks with fewer than 5 recorded signals, tracks that had a signal length different from the habitual 2s, or there being unusual situations not related to the MUR, as well as the first 20 surgeries of each surgical target. This yielded a total of 3,448 tracks in 805 surgeries. We also determined the number of the total 952 surgeries in which all the tracks in the SURs of the SRS were explored. RESULTS The mean and its confidence interval (P=.05) of time per MUR track were 5.49±0.16min in subthalamic nucleus surgery, 8.82±0.24min in the medial or internal globus pallidus) and 18.51±1.31min in the ventral intermediate nucleus of the thalamus. For the total sum of tracks per surgery, in 75% of cases the total time was less than 39min in subthalamic nucleus, almost 42min in the medial or internal globus pallidus and less than 1h and 17min in ventral intermediate nucleus of the thalamus. All the tracks in the SUR SRS were explored in only 4.2% of the surgeries. CONCLUSIONS The impact of MUR on surgical time is acceptable for this guide in objective localization for surgical targets, without having to use several simultaneous electrodes (not all indispensable in most of the cases). Consequently, there is less risk for the patient.
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