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Barnikol TT, Pawelczyk NBA, Barnikol UB, Kuhn J, Lenartz D, Sturm V, Tass PA, Freund HJ. Changes in apraxia after deep brain stimulation of the nucleus basalis Meynert in a patient with Parkinson dementia syndrome. Mov Disord 2010; 25:1519-20. [PMID: 20629167 DOI: 10.1002/mds.23141] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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102
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Barbe MT, Liebhart L, Runge M, Pauls KAM, Wojtecki L, Schnitzler A, Allert N, Fink GR, Sturm V, Maarouf M, Timmermann L. Deep brain stimulation in the nucleus ventralis intermedius in patients with essential tremor: habituation of tremor suppression. J Neurol 2010; 258:434-9. [PMID: 20927533 DOI: 10.1007/s00415-010-5773-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 11/27/2022]
Abstract
In patients with essential tremor (ET) already treated with chronic deep brain stimulation (DBS) of the nucleus ventralis intermedius (VIM) we investigated whether optimization of stimulation parameters could improve clinical tremor suppression, and whether this putative effect could be sustained over time. Twenty-three ET patients with VIM-DBS participated in the prospective study. All electrode contacts were tested systematically and stimulation parameters were optimized over the course of 2 days. Clinical tremor rating scale (TRS) was videotaped before, directly after the optimization and at a 10 weeks follow-up and evaluated blindly and independently by two clinicians. For stimulation effect optimization we increased the number of active contacts whereas the total charge applied to the tissue was kept constant. TRS hemi-body scores decreased significantly after optimization. At the 10 weeks follow-up, however, the improvement had faded and was no longer significant. The activities of daily living (ADL) remained significantly improved. Systematic optimization of VIM-DBS parameters in ET patients leads to a short term improvement which habituates over time. Our results provide further evidence for a tolerance effect in chronic VIM stimulation thereby suggesting that frequently alternating stimulation protocols should be tested in future studies of ET patients treated with VIM-DBS.
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Schneider F, Reske M, Finkelmeyer A, Wojtecki L, Timmermann L, Brosig T, Backes V, Amir-Manavi A, Sturm V, Habel U, Schnitzler A. Predicting acute affective symptoms after deep brain stimulation surgery in Parkinson's disease. Stereotact Funct Neurosurg 2010; 88:367-73. [PMID: 20861660 DOI: 10.1159/000319046] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 07/06/2010] [Indexed: 11/19/2022]
Abstract
The current study aimed to investigate predictive markers for acute symptoms of depression and mania following deep brain stimulation (DBS) surgery of the subthalamic nucleus for the treatment of motor symptoms in Parkinson's disease (PD). Fourteen patients with PD (7 males) were included in a prospective longitudinal study. Neuropsychological tests, psychopathology scales and tests of motor functions were administered at several time points prior to and after neurosurgery. Pre-existing psychopathological and motor symptoms predicted postoperative affective side effects of DBS surgery. As these can easily be assessed, they should be considered along with other selection criteria for DBS surgery.
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Reck C, Himmel M, Florin E, Maarouf M, Sturm V, Wojtecki L, Schnitzler A, Fink GR, Timmermann L. Coherence analysis of local field potentials in the subthalamic nucleus: differences in parkinsonian rest and postural tremor. Eur J Neurosci 2010; 32:1202-14. [DOI: 10.1111/j.1460-9568.2010.07362.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vernaleken I, Kuhn J, Janouschek H, Raptis M, Neuner I, Lenartz D, Schaefer WM, Sturm V, Gründer G. Acute and chronic effects of bithalamic deep brain stimulation on dopaminergic transmission. Neuroimage 2010. [DOI: 10.1016/j.neuroimage.2010.04.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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107
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Kuhn J, Hardenacke K, Möller M, Gründler T, Lenartz D, Huff W, Klosterkötter J, Sturm V. Deep brain stimulation of the nucleus accumbens is effective for the treatment of severe alcohol dependence. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1251004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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108
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Maarouf M, El Majdoub F, Bührle C, Voges J, Lehrke R, Kocher M, Hunsche S, Treuer H, Sturm V. Pineal parenchymal tumors. Management with interstitial iodine-125 radiosurgery. Strahlenther Onkol 2010; 186:127-34. [PMID: 20339824 DOI: 10.1007/s00066-010-2096-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 11/26/2009] [Indexed: 01/31/2023]
Abstract
PURPOSE To evaluate the efficacy of interstitial radiosurgery (IRS) for pineal parenchymal tumors (PPTs). PATIENTS AND METHODS 18 consecutively admitted patients (twelve male and six female, age range 6-68 years, median age 34 years) with PPTs (eight pineocytomas, ten malignant PPTs) were treated at the authors' institution with IRS using stereotactically guided iodine-125 seed implantation ((125)I-IRS) as either primary or salvage therapy. The cumulative tumor surface dose ranged from 40 to 64 Gy. Adjuvant radiotherapy of the whole brain or the craniospine was done in patients with grade III and grade IV PPT. The median follow-up period was 57.4 months (range 6-134 months). RESULTS Overall actuarial 5- and 8-year survival rates after IRS were 100% and 86% for pineocytomas, and the overall actuarial 5-year survival rate was 78% for high-grade PPTs. Follow-up magnetic resonance imaging showed complete remission in 72% (13/18) and partial remission in 28% (5/18) of the cases. One patient developed an out-of-field relapse 4 years after partial remission of a pineocytoma, which had already been treated with IRS. There was no treatment-related mortality. Treatment-related morbidity occurred in two patients only. CONCLUSION This study indicates that stereotactic (125)I-IRS for the management of PPTs is quite efficient and safe. Due to the low rate of side effects, IRS may develop into an attractive alternative to microsurgery in de novo diagnosed pineocytomas. In malignant PPTs, IRS may be routinely applied in a multimodality treatment schedule supplementary to conventional irradiation.
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Kuhn J, Gründler TOJ, Lenartz D, Sturm V, Klosterkötter J, Huff W. Deep brain stimulation for psychiatric disorders. DEUTSCHES ARZTEBLATT INTERNATIONAL 2010; 107:105-13. [PMID: 20221269 DOI: 10.3238/arztebl.2010.0105] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 08/27/2009] [Indexed: 01/24/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS), an established treatment for some movement disorders, is now being used experimentally to treat psychiatric disorders as well. In a number of recently published case series, DBS yielded an impressive therapeutic benefit in patients with medically intractable psychiatric diseases. METHODS This review of the use of DBS to treat psychiatric disorders is based on literature retrieved from a selective Pubmed search for relevant keywords, reference works on the topic, and the authors' own research. RESULTS Studies have been performed on the use of DBS to treat medically intractable obsessive-compulsive disorder, depressive disorders, and Tourette syndrome. The case numbers in the cited publications were small, yet at least some of them involved a methodologically sound investigation. Thus, in some studies, the strength of the effect was controlled with a double-blinded interval in which the stimulation was turned off. In general, the primary symptoms were found to improve markedly, by 35% to 70%, although not all patients responded to the treatment. Adverse effects of DBS were very rare in most studies and could usually be reversed by changing the stimulation parameters. CONCLUSIONS The results of DBS for psychiatric disorders that have been published to date are encouraging. They open up a new perspective in the treatment of otherwise intractable disorders. Nonetheless, the efficacy, mechanism of action, and adverse effects of DBS for this indication still need to be further studied in methodologically adequate trials that meet the highest ethical standard.
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Florin E, Gross J, Reck C, Maarouf M, Schnitzler A, Sturm V, Fink GR, Timmermann L. Causality between local field potentials of the subthalamic nucleus and electromyograms of forearm muscles in Parkinson's disease. Eur J Neurosci 2010; 31:491-8. [PMID: 20105231 DOI: 10.1111/j.1460-9568.2010.07083.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective treatment for Parkinson's disease, although its precise mechanisms remain poorly understood. To gain further insight into the mechanisms underlying deep brain stimulation, we analysed the causal relationship between forearm muscle activity and local field potentials derived from the subthalamic nucleus. In 19 patients suffering from Parkinson's disease of the akinetic-rigid subtype, we calculated the squared partial directed coherence between muscles of the contralateral forearm and the subthalamic nucleus or zona incerta during both a rest and a hold condition of the arm. For both recording regions, data analysis revealed that, during the rest condition, electromyographic activity was significantly more often 'Granger-causal' for the local field potentials than the opposite causation. In contrast, during the hold condition, no significant difference was found in the occurrence of causalities. Contrary to the existing basal ganglia model and the current concept of Parkinson's disease pathophysiology, we found the subthalamic nucleus to receive more 'afferences' than it emitted 'efferences', suggesting that its role is more complex than a simple driving nucleus in the basal ganglia loop. Therefore, the effect of deep brain stimulation in the subthalamic nucleus could, at least in part, result from a blockade of pathological afferent input.
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Tass P, Smirnov D, Karavaev A, Barnikol U, Barnikol T, Adamchic I, Hauptmann C, Pawelcyzk N, Maarouf M, Sturm V, Freund HJ, Bezruchko B. The causal relationship between subcortical local field potential oscillations and Parkinsonian resting tremor. J Neural Eng 2010; 7:16009. [DOI: 10.1088/1741-2560/7/1/016009] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mueller U, Voges J, Galazky I, Heldmann M, Heinze HJ, Sturm V, Bogerts B. FC03-02 - Deep brain stimulation of the nucleus accumbens in treatment resistant alcohol addiction - a novel treatment option? Eur Psychiatry 2010. [DOI: 10.1016/s0924-9338(10)70188-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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113
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Sauner D, Runge M, Poggenborg J, Maarouf M, Sturm V, Treuer H, Hunsche S. Multimodal Localization of Electrodes in Deep Brain Stimulation: Comparison of Stereotactic CT and MRI with Teleradiography. Stereotact Funct Neurosurg 2010; 88:253-8. [DOI: 10.1159/000315463] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 02/25/2010] [Indexed: 11/19/2022]
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Huff W, Lenartz D, Schormann M, Lee SH, Kuhn J, Koulousakis A, Mai J, Daumann J, Maarouf M, Klosterkötter J, Sturm V. Unilateral deep brain stimulation of the nucleus accumbens in patients with treatment-resistant obsessive-compulsive disorder: Outcomes after one year. Clin Neurol Neurosurg 2009; 112:137-43. [PMID: 20006424 DOI: 10.1016/j.clineuro.2009.11.006] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 11/09/2009] [Accepted: 11/11/2009] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the effects of unilateral deep brain stimulation (DBS) in the right nucleus accumbens in patients with obsessive-compulsive disorder (OCD). Predominantly bilateral stimulation of the anterior limb of the internal capsule was utilized. METHODS The study was designed as a double-blind sham-controlled crossover study. Patients received 3 months of deep brain stimulation followed by 3 months of sham stimulation, or vice versa. Subsequently, stimulation was continued unblinded for all patients. The primary outcome measure was the severity level of OCD, measured using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Secondary outcome measures were depressive symptoms, anxiety, psychological symptom severity, global functioning, quality of life, and cognitive function. RESULTS The mean Y-BOCS scores decreased significantly from 32.2 (+/-4.0) at baseline to 25.4 (+/-6.7) after 12 months (p=0.012). Five out of ten patients showed a decrease of more than 25%, indicating at least a partial response. One patient showed a decrease in Y-BOCS severity greater than 35%. Similarly, depression, global functioning and quality of life improved within one year. In contrast, anxiety, global symptom severity and cognitive function showed no significant changes. In general, DBS was well-tolerated. CONCLUSIONS DBS of the unilateral right nucleus accumbens showed encouraging results in patients with treatment-resistant OCD. Five out of ten patients reached at least a partial response after the first year.
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Müller UJ, Sturm V, Voges J, Heinze HJ, Galazky I, Heldmann M, Scheich H, Bogerts B. Successful treatment of chronic resistant alcoholism by deep brain stimulation of nucleus accumbens: first experience with three cases. PHARMACOPSYCHIATRY 2009; 42:288-91. [PMID: 19924591 DOI: 10.1055/s-0029-1233489] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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116
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Vernaleken I, Kuhn J, Lenartz D, Raptis M, Huff W, Janouschek H, Neuner I, Schaefer WM, Gründer G, Sturm V. Bithalamical deep brain stimulation in tourette syndrome is associated with reduction in dopaminergic transmission. Biol Psychiatry 2009; 66:e15-7. [PMID: 19709645 DOI: 10.1016/j.biopsych.2009.06.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2009] [Accepted: 06/13/2009] [Indexed: 02/07/2023]
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Hauptmann C, Roulet JC, Niederhauser JJ, Döll W, Kirlangic ME, Lysyansky B, Krachkovskyi V, Bhatti MA, Barnikol UB, Sasse L, Bührle CP, Speckmann EJ, Götz M, Sturm V, Freund HJ, Schnell U, Tass PA. External trial deep brain stimulation device for the application of desynchronizing stimulation techniques. J Neural Eng 2009; 6:066003. [PMID: 19837998 DOI: 10.1088/1741-2560/6/6/066003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
In the past decade deep brain stimulation (DBS)-the application of electrical stimulation to specific target structures via implanted depth electrodes-has become the standard treatment for medically refractory Parkinson's disease and essential tremor. These diseases are characterized by pathological synchronized neuronal activity in particular brain areas. We present an external trial DBS device capable of administering effectively desynchronizing stimulation techniques developed with methods from nonlinear dynamics and statistical physics according to a model-based approach. These techniques exploit either stochastic phase resetting principles or complex delayed-feedback mechanisms. We explain how these methods are implemented into a safe and user-friendly device.
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Heinze HJ, Heldmann M, Voges J, Hinrichs H, Marco-Pallares J, Hopf JM, Müller UJ, Galazky I, Sturm V, Bogerts B, Münte TF. Counteracting incentive sensitization in severe alcohol dependence using deep brain stimulation of the nucleus accumbens: clinical and basic science aspects. Front Hum Neurosci 2009; 3:22. [PMID: 19750197 PMCID: PMC2741292 DOI: 10.3389/neuro.09.022.2009] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2009] [Accepted: 08/12/2009] [Indexed: 11/13/2022] Open
Abstract
The ventral striatum/nucleus accumbens (NAcc) has been implicated in the craving for drugs and alcohol which is a major reason for relapse of addicted people. Craving might be induced by drug-related cues. This suggests that disruption of craving-related neural activity in the NAcc may significantly reduce craving in alcohol-dependent patients. Here we report on preliminary clinical and neurophysiological evidence in three male patients who were treated with high frequency deep brain stimulation of the NAcc bilaterally. All three had been alcohol-dependent for many years, unable to abstain from drinking, and had experienced repeated relapses prior to the stimulation. After the operation, craving was greatly reduced and all three patients were able to abstain from drinking for extended periods of time. Immediately after the operation but prior to connection of the stimulation electrodes to the stimulator, local field potentials were obtained from the externalized cables in two patients while they performed cognitive tasks addressing action monitoring and incentive salience of drug-related cues. LFPs in the action monitoring task provided further evidence for a role of the NAcc in goal-directed behaviors. Importantly, alcohol-related cue stimuli in the incentive salience task modulated LFPs even though these cues were presented outside of the attentional focus. This implies that cue-related craving involves the NAcc and is highly automatic.
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Pauls KAM, Reck C, Barbe MT, Maarouf M, Sturm V, Fink GR, Timmermann L. Post-traumatic hyperkinesias in patients with Parkinson's disease with stimulation of the subthalamic nucleus. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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120
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Witt K, Daniels C, Krack P, Volkmann J, Pinsker M, Krause M, Tronnier V, Kloss M, Schnitzler A, Wojtecki L, Bötzel K, Danek A, Hilker R, Sturm V, Kupsch A, Karner E, Deuschl G. Baseline characteristics associated with cognitive decline after nucleus subthalamicus-deep brain stimulation for Parkinson's disease. AKTUELLE NEUROLOGIE 2009. [DOI: 10.1055/s-0029-1238851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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121
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Hunsche S, Sauner D, Maarouf M, Poggenborg J, Lackner K, Sturm V, Treuer H. Intraoperative X-ray detection and MRI-based quantification of brain shift effects subsequent to implantation of the first electrode in bilateral implantation of deep brain stimulation electrodes. Stereotact Funct Neurosurg 2009; 87:322-9. [PMID: 19713732 DOI: 10.1159/000235804] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 06/05/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE After implantation of the first electrode in bilateral deep brain stimulation (DBS) lead implantation, brain shift effects in the target region and along the implantation trajectory of the second electrode are quantified with intraoperative magnetic resonance imaging (MRI). We investigated intraoperative X-ray imaging for its feasibility in indirect detection of brain shift. METHODS In 25 patients who underwent bilateral DBS lead implantation, X-ray and MRI were performed before and after implantation of the first electrode. Two parameters of brain shift were assessed with nonrigid free-form deformation field analysis of the MRI data: global brain shift along the anterior and posterior commissure (AC-PC) line and specific brain shift along the implantation trajectory of the second electrode. Pre- and intraoperative X-ray images were geometrically and intensity corrected for detection of significant signal changes through intracranial air accumulation during implantation of the first electrode. RESULTS After implantation of the first electrode, brain shift greater than 1 mm (maximum 1.3 mm) was observed at the AC and brain shift greater than 2 mm (maximum 2.5 mm) was observed along the planned implantation trajectory of the second electrode. In 1 patient, the implantation trajectory of the second electrode went through a sulcus after cortical brain shift. In 9 patients, intracranial air volume between 0.1 and 38.5 ml was observed with MRI after implantation of the first electrode. Significant X-ray absorption changes were induced by an intracranial air volume of greater than 8 ml. CONCLUSION In bilateral DBS implantation, brain shift effects can cause misallocation of the second electrode with the risk of adverse or no stimulation effects as well as unnecessary cortical damage. A lack of X-ray signal changes caused by intracranial air invasion during DBS lead implantation indicates a lack of clinically relevant brain shift.
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Freund HJ, Kuhn J, Lenartz D, Mai JK, Schnell T, Klosterkoetter J, Sturm V. Cognitive functions in a patient with Parkinson-dementia syndrome undergoing deep brain stimulation. ACTA ACUST UNITED AC 2009; 66:781-5. [PMID: 19506141 DOI: 10.1001/archneurol.2009.102] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Dementia represents one of the most challenging health problems. Despite intense research, available therapies have thus far only achieved modest results. Deep brain stimulation (DBS) is an effective treatment option for some movement disorders and is under study for psychiatric applications. Recently, diencephalic DBS revealed selective effects on memory functions, another facet of subcortical DBS. OBJECTIVE To report a new DBS strategy for the modification of cognitive functions in a patient with severe Parkinson-dementia syndrome. DESIGN Prospective study with double-blinded sham stimulation period. SETTING Departments of Stereotaxy and Functional Neurosurgery and Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany. PATIENT A 71-year-old man with slowly progressive Parkinson-dementia syndrome. Intervention We inserted 2 electrodes into the nucleus basalis of Meynert in addition to electrodes in the subthalamic nucleus. Main Outcome Measure Improvement of cognitive functions. RESULTS Turning on the subthalamic nucleus electrodes improved motor symptoms but left cognitive performance almost unchanged. Turning on electrical stimulation of the nucleus basalis of Meynert resulted in markedly improved cognitive functions. The improvement in attention, concentration, alertness, drive, and spontaneity resulted in the patient's renewed enjoyment of former interests and enhanced social communication. CONCLUSIONS Such a broad effect on cognition is consistent with ample experimental evidence revealing that the nucleus basalis of Meynert provides cholinergic innervation to the cortical mantle, complemented by glutaminergic and gamma-aminobutyric acid-transmitting projections from the basal forebrain. These projections provide background tuning facilitating cortical operations. Furthermore, nucleus basalis of Meynert stimulation paired with sensory stimuli can accomplish persistent reorganization of specific processing modules. The improvements in cognitive and behavioral performance in our patient are likely to be related to the effects of stimulating residual cholinergic projections and cell bodies in the nucleus basalis of Meynert.
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Reck C, Florin E, Wojtecki L, Groiss S, Voges J, Sturm V, Schnitzler A, Timmermann L. Differential distribution of coherence between beta-band subthalamic oscillations and forearm muscles in Parkinson’s disease during isometric contraction. Clin Neurophysiol 2009; 120:1601-9. [DOI: 10.1016/j.clinph.2009.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/24/2009] [Accepted: 05/20/2009] [Indexed: 11/24/2022]
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Cohen MX, Axmacher N, Lenartz D, Elger CE, Sturm V, Schlaepfer TE. Good vibrations: cross-frequency coupling in the human nucleus accumbens during reward processing. J Cogn Neurosci 2009; 21:875-89. [PMID: 18702577 DOI: 10.1162/jocn.2009.21062] [Citation(s) in RCA: 157] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The nucleus accumbens is critical for reward-guided learning and decision-making. It is thought to "gate" the flow of a diverse range of information (e.g., rewarding, aversive, and novel events) from limbic afferents to basal ganglia outputs. Gating and information encoding may be achieved via cross-frequency coupling, in which bursts of high-frequency activity occur preferentially during specific phases of slower oscillations. We examined whether the human nucleus accumbens engages such a mechanism by recording electrophysiological activity directly from the accumbens of human patients undergoing deep brain stimulation surgery. Oscillatory activity in the gamma (40-80 Hz) frequency range was synchronized with the phase of simultaneous alpha (8-12 Hz) waves. Further, losing and winning small amounts of money elicited relatively increased gamma oscillation power prior to and following alpha troughs, respectively. Gamma-alpha synchronization may reflect an electrophysiological gating mechanism in the human nucleus accumbens, and the phase differences in gamma-alpha coupling may reflect a reward information coding scheme similar to phase coding.
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Cohen MX, Axmacher N, Lenartz D, Elger CE, Sturm V, Schlaepfer TE. Neuroelectric signatures of reward learning and decision-making in the human nucleus accumbens. Neuropsychopharmacology 2009; 34:1649-58. [PMID: 19092783 DOI: 10.1038/npp.2008.222] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Learning that certain actions lead to risky rewards is critical for biological, social, and economic survival, but the precise neural mechanisms of such reward-guided learning remain unclear. Here, we show that the human nucleus accumbens plays a key role in learning about risks by representing reward value. We recorded electrophysiological activity directly from the nucleus accumbens of five patients undergoing deep brain stimulation for treatment of refractory major depression. Patients engaged in a simple reward-learning task in which they first learned stimulus-outcome associations (learning task), and then were able to choose from among the learned stimuli (choosing task). During the learning task, nucleus accumbens activity reflected potential and received reward values both during the cue stimulus and during the feedback. During the choosing task, there was no nucleus accumbens activity during the cue stimulus, but feedback-related activity was pronounced and similar to that during the learning task. This pattern of results is inconsistent with a prediction error response. Finally, analyses of cross-correlations between the accumbens and simultaneous recordings of medial frontal cortex suggest a dynamic interaction between these structures. The high spatial and temporal resolution of these recordings provides novel insights into the timing of activity in the human nucleus accumbens, its functions during reward-guided learning and decision-making, and its interactions with medial frontal cortex.
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