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Liu L, Wang D, Luo Y, Liu Y, Guo Y, Yang GZ, Qiu G. Intraoperative assessment of microimplantation-induced acute brain inflammation with titanium oxynitride-based plasmonic biosensor. Biosens Bioelectron 2024; 264:116664. [PMID: 39159588 DOI: 10.1016/j.bios.2024.116664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 07/11/2024] [Accepted: 08/10/2024] [Indexed: 08/21/2024]
Abstract
Implantable devices for brain-machine interfaces and managing neurological disorders have experienced rapid growth in recent years. Although functional implants offer significant benefits, issues related to transient trauma and long-term biocompatibility and safety are of significant concern. Acute inflammatory reaction in the brain tissue caused by microimplants is known to be an issue but remains poorly studied. This study presents the use of titanium oxynitride (TiNO) nanofilm with defined surface plasmon resonance (SPR) properties for point-of-care characterizing of acute inflammatory responses during robot-controlled micro-neuro-implantation. By leveraging surface-enriched oxynitride, TiNO nanofilms can be biomolecular-functionalized through silanization. This label-free TiNO-SPR biosensor exhibits a high sensitivity toward the inflammatory cytokine interleukin-6 with a detection limit down to 6.3 fg ml-1 and a short assay time of 25 min. Additionally, intraoperative monitoring of acute inflammatory responses during microelectrode implantation in the mice brain has been accomplished using the TiNO-SPR biosensors. Through intraoperative cerebrospinal fluid sampling and point-of-care plasmonic biosensing, the rhythm of acute inflammatory responses induced by the robot-controlled brain microelectrodes implantation has been successfully depicted, offering insights into intraoperative safety assessment of invasive brain-machine interfaces.
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Affiliation(s)
- Linlin Liu
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, 200240, PR China
| | - Danhua Wang
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, 200240, PR China
| | - Yating Luo
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, 200240, PR China
| | - Yuxuan Liu
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, 200240, PR China
| | - Yao Guo
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, 200240, PR China
| | - Guang-Zhong Yang
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, 200240, PR China.
| | - Guangyu Qiu
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, 800 Dong Chuan Road, Shanghai, 200240, PR China.
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2
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Stawiski M, Bucciarelli V, Vogel D, Hemm S. Optimizing neuroscience data management by combining REDCap, BIDS and SQLite: a case study in Deep Brain Stimulation. Front Neuroinform 2024; 18:1435971. [PMID: 39301120 PMCID: PMC11410584 DOI: 10.3389/fninf.2024.1435971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/19/2024] [Indexed: 09/22/2024] Open
Abstract
Neuroscience studies entail the generation of massive collections of heterogeneous data (e.g. demographics, clinical records, medical images). Integration and analysis of such data in research centers is pivotal for elucidating disease mechanisms and improving clinical outcomes. However, data collection in clinics often relies on non-standardized methods, such as paper-based documentation. Moreover, diverse data types are collected in different departments hindering efficient data organization, secure sharing and compliance to the FAIR (Findable, Accessible, Interoperable, Reusable) principles. Henceforth, in this manuscript we present a specialized data management system designed to enhance research workflows in Deep Brain Stimulation (DBS), a state-of-the-art neurosurgical procedure employed to treat symptoms of movement and psychiatric disorders. The system leverages REDCap to promote accurate data capture in hospital settings and secure sharing with research institutes, Brain Imaging Data Structure (BIDS) as image storing standard and a DBS-specific SQLite database as comprehensive data store and unified interface to all data types. A self-developed Python tool automates the data flow between these three components, ensuring their full interoperability. The proposed framework has already been successfully employed for capturing and analyzing data of 107 patients from 2 medical institutions. It effectively addresses the challenges of managing, sharing and retrieving diverse data types, fostering advancements in data quality, organization, analysis, and collaboration among medical and research institutions.
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Affiliation(s)
- Marc Stawiski
- Neuroengineering Group, Institute for Medical Engineering and Medical Informatics, School of Life Sciences, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Vittoria Bucciarelli
- Neuroengineering Group, Institute for Medical Engineering and Medical Informatics, School of Life Sciences, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Dorian Vogel
- Neuroengineering Group, Institute for Medical Engineering and Medical Informatics, School of Life Sciences, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Simone Hemm
- Neuroengineering Group, Institute for Medical Engineering and Medical Informatics, School of Life Sciences, FHNW University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
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Mayer R, Desai K, Aguiar RSDT, McClure JJ, Kato N, Kalman C, Pilitsis JG. Evolution of Deep Brain Stimulation Techniques for Complication Mitigation. Oper Neurosurg (Hagerstown) 2024; 27:148-157. [PMID: 38315020 DOI: 10.1227/ons.0000000000001071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024] Open
Abstract
Complication mitigation in deep brain stimulation has been a topic matter of much discussion in the literature. In this article, we examine how neurosurgeons as individuals and as a field generated and adapted techniques to prevent infection, lead fracture/lead migration, and suboptimal outcomes in both the acute period and longitudinally. The authors performed a MEDLINE search inclusive of articles from 1987 to June 2023 including human studies written in English. Using the Rayyan platform, two reviewers (J.P. and R.M.) performed a title screen. Of the 776 articles, 252 were selected by title screen and 172 from abstract review for full-text evaluation. Ultimately, 124 publications were evaluated. We describe the initial complications and inefficiencies at the advent of deep brain stimulation and detail changes instituted by surgeons that reduced them. Furthermore, we discuss the trend in both undesired short-term and long-term outcomes with emphasis on how surgeons recognized and modified their practice to provide safer and better procedures. This scoping review adds to the literature as a guide to both new neurosurgeons and seasoned neurosurgeons alike to understand better what innovations have been trialed over time as we embark on novel targets and neuromodulatory technologies.
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Affiliation(s)
- Ryan Mayer
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton , Florida , USA
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4
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Oberholzer J, Fayolle D, Vandenbulcke A, Gaudet JG. Cardiac arrest during deep brain stimulation: A case report. Clin Case Rep 2024; 12:e9147. [PMID: 39005577 PMCID: PMC11239760 DOI: 10.1002/ccr3.9147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/05/2024] [Accepted: 06/18/2024] [Indexed: 07/16/2024] Open
Abstract
We present the case of a 54-year-old male with severe Parkinson's disease and chronic, non-reversible pulmonary artery hypertension who had seizures and a cardiorespiratory arrest during surgery for deep brain stimulation, a minimally invasive procedure usually associated with a low risk of complications. This case illustrates how perioperative changes in antiparkinsonian therapy in patient with multiple comorbidities may significantly affect the risk profile.
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Affiliation(s)
- Julian Oberholzer
- Department of AnesthesiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - Damien Fayolle
- Department of NeurologyHôpitaux Universitaires GenèveGenevaSwitzerland
| | - Alberto Vandenbulcke
- Department of NeurosurgeryCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
| | - John G. Gaudet
- Department of AnesthesiologyCentre Hospitalier Universitaire VaudoisLausanneSwitzerland
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5
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Chao-Chia Lu D, Boulay C, Chan ADC, Sachs AJ. A Systematic Review of Neurophysiology-Based Localization Techniques Used in Deep Brain Stimulation Surgery of the Subthalamic Nucleus. Neuromodulation 2024; 27:409-421. [PMID: 37462595 DOI: 10.1016/j.neurom.2023.02.081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 01/13/2023] [Accepted: 02/09/2023] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This systematic review is conducted to identify, compare, and analyze neurophysiological feature selection, extraction, and classification to provide a comprehensive reference on neurophysiology-based subthalamic nucleus (STN) localization. MATERIALS AND METHODS The review was carried out using the methods and guidelines of the Kitchenham systematic review and provides an in-depth analysis on methods proposed on STN localization discussed in the literature between 2000 and 2021. Three research questions were formulated, and 115 publications were identified to answer the questions. RESULTS The three research questions formulated are answered using the literature found on the respective topics. This review discussed the technologies used in past research, and the performance of the state-of-the-art techniques is also reviewed. CONCLUSION This systematic review provides a comprehensive reference on neurophysiology-based STN localization by reviewing the research questions other new researchers may also have.
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Affiliation(s)
| | | | | | - Adam J Sachs
- The Ottawa Hospital Research Institute, Ottawa, ON, Canada
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Stapińska-Syniec A, Sobstyl M, Paskal W. Skin-related complications following deep brain stimulation surgery: A single-center retrospective analysis of 525 patients who underwent DBS surgery. Clin Neurol Neurosurg 2023; 225:107571. [PMID: 36608467 DOI: 10.1016/j.clineuro.2022.107571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/24/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Although Deep Brain Stimulation (DBS) is a safe and proven treatment modality for patients suffering from debilitating movement and neuropsychiatric disorders, it is not free from complications. Management of skin erosion and infection following DBS surgery constitutes a challenge in everyday clinical practice. OBJECTIVES Skin-related complications were evaluated in patients who underwent DBS surgery due to Parkinson's disease (PD), dystonia, essential tremor (ET), and other indications including Tourette syndrome (TS), Obsessive-Compulsive Disorder (OCD), and epilepsy. METHODS A retrospective analysis of clinical data was performed on patients who underwent DBS surgery between November 2008 and September 2021 at the Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw. RESULTS 525 patients who underwent 927 DBS leads implantations were included in the analysis. There were 398 patients with PD, 80 with dystonia, 26 with ET, 7 with drug-resistant epilepsy, 5 with Multiple Sclerosis, 4 with Holme's or cerebellar tremor, 3 with TS, and 2 with OCD. 42 patients (8,0%) had 78 skin infection episodes. The overall level of skin erosion was 3,8% (20/525 patients). The risk of developing infection episode was connected with younger age at diagnosis (p = 0.017) and at surgery (p = 0.023), whereas the development of skin erosion was connected with the dystonia diagnosis (p = 0.012). Patients with dystonia showed the highest rate of infections and erosions (11/70 and 7/70 patients retrospectively). DISCUSSION Postoperative skin complications are a serious side effect of DBS surgery. CONCLUSION Our study suggests that dystonic patients are at higher risk of developing skin-related complications after DBS surgery.
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Affiliation(s)
| | - Michał Sobstyl
- Department of Neurosurgery, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Wiktor Paskal
- Department of Methodology, Laboratory of Center for Preclinical Research, Medical University of Warsaw, Warsaw, Poland
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Salahi S, Mousavi MA, Azizi G, Hossein-Khannazer N, Vosough M. Stem Cell-based and Advanced Therapeutic Modalities for Parkinson's Disease: A Risk-effectiveness Patient-centered Analysis. Curr Neuropharmacol 2022; 20:2320-2345. [PMID: 35105291 PMCID: PMC9890289 DOI: 10.2174/1570159x20666220201100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/29/2022] Open
Abstract
Treatment of Parkinson's disease (PD), the second most prevalent neurodegenerative disorder, is currently considered a challenging issue since it causes substantial disability, poor quality of life, and mortality. Despite remarkable progress in advanced conventional therapeutic interventions, the global burden of the disease has nearly doubled, prompting us to assess the riskeffectiveness of different treatment modalities. Each protocol could be considered as the best alternative treatment depending on the patient's situation. Prescription of levodopa, the most effective available medicine for this disorder, has been associated with many complications, i.e., multiple episodes of "off-time" and treatment resistance. Other medications, which are typically used in combination with levodopa, may have several adverse effects as well. As a result, the therapies that are more in line with human physiology and make the least interference with other pathways are worth investigating. On the other hand, remaining and persistent symptoms after therapy and the lack of effective response to the conventional approaches have raised expectations towards innovative alternative approaches, such as stem cell-based therapy. It is critical to not overlook the unexplored side effects of innovative approaches due to the limited number of research. In this review, we aimed to compare the efficacy and risk of advanced therapies with innovative cell-based and stemcell- based modalities in PD patients. This paper recapitulated the underlying factors/conditions, which could lead us to more practical and established therapeutic outcomes with more advantages and few complications. It could be an initial step to reconsider the therapeutic blueprint for patients with Parkinson's disease.
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Affiliation(s)
- Sarvenaz Salahi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Maryam Alsadat Mousavi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Gholamreza Azizi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nikoo Hossein-Khannazer
- Gastroenterology and Liver Diseases Research Center, Research, Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Experimental Cancer Medicine, Institution for Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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8
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Hamani C. Commentary: Awake Deep Brain Stimulation Surgery Without Intraoperative Imaging Is Accurate and Effective: A Case Series. Oper Neurosurg (Hagerstown) 2022; 23:e201-e202. [PMID: 35972116 DOI: 10.1227/ons.0000000000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Affiliation(s)
- Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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9
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Amlong C, Rusy D, Sanders RD, Lake W, Raz A. Dexmedetomidine depresses neuronal activity in the subthalamic nucleus during deep brain stimulation electrode implantation surgery. BJA OPEN 2022; 3:100088. [PMID: 37588575 PMCID: PMC10430856 DOI: 10.1016/j.bjao.2022.100088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 08/03/2022] [Indexed: 08/18/2023]
Abstract
Background Micro-electrode recordings are often necessary during electrode implantation for deep brain stimulation of the subthalamic nucleus. Dexmedetomidine may be a useful sedative for these procedures, but there is limited information regarding its effect on neural activity in the subthalamic nucleus and on micro-electrode recording quality. Methods We recorded neural activity in five patients undergoing deep brain stimulation implantation to the subthalamic nucleus. Activity was recorded after subthalamic nucleus identification while patients received dexmedetomidine sedation (loading - 1 μg kg-1 over 10-15 min, maintenance - 0.7 μg kg-1 h-1). We compared the root-mean square (RMS) and beta band (13-30 Hz) oscillation power of multi-unit activity recorded by microelectrode before, during and after recovery from dexmedetomidine sedation. RMS was normalised to values recorded in the white matter. Results Multi-unit activity decreased during sedation in all five patients. Mean normalised RMS decreased from 2.8 (1.5) to 1.6 (1.1) during sedation (43% drop, p = 0.056). Beta band power dropped by 48.4%, but this was not significant (p = 0.15). Normalised RMS values failed to return to baseline levels during the time allocated for the study (30 min). Conclusions In this small sample, we demonstrate that dexmedetomidine decreases neuronal firing in the subthalamic nucleus as expressed in the RMS of the multi-unit activity. As multi-unit activity is a factor in determining the subthalamic nucleus borders during micro-electrode recordings, dexmedetomidine should be used with caution for sedation during these procedures. Clinical trial number NCT01721460.
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Affiliation(s)
- Corey Amlong
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Deborah Rusy
- Department of Anesthesiology, University of Wisconsin, Madison, WI, USA
| | - Robert D. Sanders
- University of Sydney, Sydney, Australia
- Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Wendell Lake
- Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
| | - Aeyal Raz
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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10
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Masuda H, Shirozu H, Ito Y, Fukuda M, Fujii Y. Surgical Strategy for Directional Deep Brain Stimulation. Neurol Med Chir (Tokyo) 2021; 62:1-12. [PMID: 34719582 PMCID: PMC8754682 DOI: 10.2176/nmc.ra.2021-0214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Deep brain stimulation (DBS) is a well-established treatment for drug-resistant involuntary movements. However, the conventional quadripole cylindrical lead creates electrical fields in all directions, and the resulting spread to adjacent eloquent structures may induce unintended effects. Novel directional leads have therefore been designed to allow directional stimulation (DS). Directional leads have the advantage of widening the therapeutic window (TW), compensating for slight misplacement of the lead and requiring less electrical power to provide the same effect as a cylindrical lead. Conversely, the increase in the number of contacts from four to eight and the addition of directional elements has made stimulation programming more complex. For these reasons, new treatment strategies are required to allow effective directional DBS. During lead implantation, the directional segment should be placed in a "sweet spot," and the orientation of the directional segment is important for programming. Trial-and-error testing of a large number of contacts is unnecessary, and efficient and systematic execution of the programmed procedure is desirable. Recent improvements in imaging technologies have enabled image-guided programming. In the future, optimal stimulations are expected to be programmed by directional recording of local field potentials.
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Affiliation(s)
- Hiroshi Masuda
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Hiroshi Shirozu
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Yosuke Ito
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Masafumi Fukuda
- Division of Functional Neurosurgery, Nishiniigata National Hospital
| | - Yukihiko Fujii
- Department of Neurosurgery, Brain Research Institute, Niigata University
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Coenen VA, Reisert M. DTI for brain targeting: Diffusion weighted imaging fiber tractography-Assisted deep brain stimulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:47-67. [PMID: 34446250 DOI: 10.1016/bs.irn.2021.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fiber tractography assisted Deep Brain Stimulation (DBS) has been performed by different groups for more than 10 years to now. Groups around the world have adapted initial approaches to currently embrace the fiber tractography technology mainly for treating tremor (DBS and lesions), psychiatric indications (OCD and major depression) and pain (DBS). Despite the advantages of directly visualizing the target structure, the technology is demanding and is vulnerable to inaccuracies especially since it is performed on individual level. In this contribution, we will focus on tremor and psychiatric indications, and will show future applications of sophisticated tractography applications for subthalamic nucleus (STN) DBS surgery and stimulation steering as an example.
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Affiliation(s)
- Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany; Center for Deep Brain Stimulation, Medical Center of Freiburg University, Freiburg, Germany.
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University, Freiburg, Germany; Medical Faculty of Freiburg University, Freiburg, Germany; Department of Radiology-Medical Physics, Freiburg University, Freiburg, Germany
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12
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Brinda AK, Doyle AM, Blumenfeld M, Krieg J, Alisch JSR, Spencer C, Lecy E, Wilmerding LK, DeNicola A, Johnson LA, Vitek JL, Johnson MD. Longitudinal analysis of local field potentials recorded from directional deep brain stimulation lead implants in the subthalamic nucleus. J Neural Eng 2021; 18:10.1088/1741-2552/abfc1c. [PMID: 33906174 PMCID: PMC8504120 DOI: 10.1088/1741-2552/abfc1c] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/27/2021] [Indexed: 11/12/2022]
Abstract
Objective.The electrode-tissue interface surrounding a deep brain stimulation (DBS) lead is known to be highly dynamic following implantation, which may have implications on the interpretation of intraoperatively recorded local field potentials (LFPs). We characterized beta-band LFP dynamics following implantation of a directional DBS lead in the sensorimotor subthalamic nucleus (STN), which is a primary target for treating Parkinson's disease.Approach.Directional STN-DBS leads were implanted in four healthy, non-human primates. LFPs were recorded over two weeks and again 1-4 months after implantation. Impedance was measured for two weeks post-implant without stimulation to compare the reactive tissue response to changes in LFP oscillations. Beta-band (12-30 Hz) peak power was calculated from the LFP power spectra using both common average referencing (CAR) and intra-row bipolar referencing (IRBR).Results.Resting-state LFPs in two of four subjects revealed a steady increase of beta power over the initial two weeks post-implant whereas the other two subjects showed variable changes over time. Beta power variance across days was significantly larger in the first two weeks compared to 1-4 months post-implant in all three long-term subjects. Further, spatial maps of beta power several hours after implantation did not correlate with those measured two weeks or 1-4 months post-implant. CAR and IRBR beta power correlated across short- and long-term time points. However, depending on the time period, subjects showed a significant bias towards larger beta power using one referencing scheme over the other. Lastly, electrode-tissue impedance increased over the two weeks post-implant but showed no significant correlation to beta power.Significance.These results suggest that beta power in the STN may undergo significant changes following DBS lead implantation. DBS lead diameter and electrode recording configurations can affect the post-implant interpretation of oscillatory features. Such insights will be important for extrapolating results from intraoperative and externalized LFP recordings.
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Affiliation(s)
- AnneMarie K Brinda
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Alex M Doyle
- Department of Neuroscience, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Madeline Blumenfeld
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Jordan Krieg
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Joseph S R Alisch
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Chelsea Spencer
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Emily Lecy
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Lucius K Wilmerding
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
| | - Adele DeNicola
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Luke A Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, 7-105 Nils Hasselmo Hall, 312 Church Street SE, Minneapolis, MN 55455, United States of America
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13
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Islam MS, Azim F, Saju H, Zargaran A, Shirzad M, Kamal M, Fatema K, Rehman S, Azad MAM, Ebrahimi-Barough S. Pesticides and Parkinson's disease: Current and future perspective. J Chem Neuroanat 2021; 115:101966. [PMID: 33991619 DOI: 10.1016/j.jchemneu.2021.101966] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
Inappropriate use of pesticides has globally exposed mankind to a number of health hazards. Still their production is rising at the rate of 11 % annually and, has already exceeded more than 5 million tons in 2000 (FAO 2017). Plenty of available data reveals that pesticides exposures through agricultural use and food-preservative residue consumption may lead to neurodegenerative disorders like Parkinson's and Alzheimer's diseases. Parkinson's disease (PD) is a progressive motor impairment and a neurodegenerative disorder, considered as the leading source of motor disability. Pesticides strongly inhibit mitochondrial Complex-I, causing mitochondrial dysfunction and death of dopaminergic neurons in the substantia nigra (SN), thus leading to pathophysiologic implications of PD. Current medical treatment strategies, including pharmacotherapeutics and supportive therapies can only provide symptomatic relief. While complementary and alternative medicines including traditional medicine or acupuncture are considered as beneficial ways of treatment with significant clinical effect. Medically non-responding cases can be treated by surgical means, 'Deep Brain Stimulation'. Cell therapy is also an emerging and promising technology for disease modeling and drug development in PD. Their main aim is to replace and/or support the lost and dying dopaminergic neurons in the SN. Recently I/II clinical phase trial (Japan) have used dopaminergic progenitors generated from induced pluripotent stem (iPS) cells which can unveil a successful cell therapy to treat PD symptoms efficiently. This review focuses on PD caused by pesticides use, current treatment modalities, and ongoing research updates. Since PD is not a cell-autonomous disease rather caused by multiple factors, a combinatorial therapeutic approach may address not only the motor-related symptoms but also non-motor cognitive-behavioral issues.
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Affiliation(s)
- Md Shahidul Islam
- Dept. of Tissue Engineering and Applied Cell Sciences, Tehran University of Medical Sciences, Iran.
| | - Fazli Azim
- Dept. of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Iran; IHITC: Isolation Hospital & Infection Treatment Centre, Islamabad, Pakistan.
| | - Hedaeytullah Saju
- School of Persian Medicine (Traditional Medicine), Tehran University of Medical Science, Tehran, Iran.
| | - Arman Zargaran
- School of Persian Medicine (Traditional Medicine), Tehran University of Medical Science, Tehran, Iran.
| | - Meysam Shirzad
- School of Persian Medicine (Traditional Medicine), Tehran University of Medical Science, Tehran, Iran.
| | - Mostofa Kamal
- Shaheed Suhrawardi Medical College & Hospital, Dhaka, Bangladesh.
| | - Kaniz Fatema
- National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh.
| | - Sumbul Rehman
- Faculty of Unani Medicine, Department of Ilmul Advia (Unani Pharmacology), Aligarh Muslim University, India.
| | - M A Momith Azad
- Dept of Research & Product Development (Natural Medicine), The IBN SINA Pharma Ltd, Bangladesh.
| | - Somayeh Ebrahimi-Barough
- Dept. of Tissue Engineering and Applied Cell Sciences, Tehran University of Medical Sciences, Iran.
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14
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Jones JD, Orozco T, Bowers D, Hu W, Jabarkheel Z, Chiu S, Ramirez-Zamora A, Foote K, Okun MS, Wagle Shukla A. Cognitive Outcomes for Essential Tremor Patients Selected for Thalamic Deep Brain Stimulation Surgery Through Interdisciplinary Evaluations. Front Hum Neurosci 2020; 14:578348. [PMID: 33362489 PMCID: PMC7759538 DOI: 10.3389/fnhum.2020.578348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/10/2020] [Indexed: 11/20/2022] Open
Abstract
Objective: Deep brain stimulation (DBS) targeted to the ventral intermediate (VIM) nucleus of the thalamus is effective for motor symptoms in essential tremor (ET), but there is limited data on cognitive outcomes. We examined cognitive outcomes in a large cohort of ET DBS patients (pre-DBS and 1+ year after DBS). Methods: In a retrospective analysis, we used repeated-measures ANOVA testing to examine whether the age of tremor onset, age at DBS surgery, hemisphere side implanted with lead, unilateral vs. bilateral implantations, and presence of surgical complications influenced the cognitive outcomes. Neuropsychological outcomes of interest were verbal memory, executive functioning, working memory, language functioning, visuospatial functioning, and general cognitive function. Results: We identified 50 ET DBS patients; 29 (58%) males; the mean age of tremor onset was 35.84 (±21.50) years with a median age of 38 years. The mean age at DBS was 68.18 (±10.07) years. There were 37 unilateral 30 left, seven right, and 13 bilateral brain implantations. In the subgroup analysis, there was a significant interaction between assessment (pre vs. post) and age of tremor onset (<38 vs. >38 years); F(1,30) = 4.47; p = 0.043 for working memory. The post hoc testing found improvements for younger onset ET. Similarly, there was a significant interaction between assessment (pre vs. post) and complications vs. no complications subgroups; F(1,45) = 4.34; p = 0.043 for verbal memory with worsening scores seen for ET patients with complications. The remaining tests were not significant. Conclusion: In this large cohort of ET patients with (>30% improvements), DBS was not accompanied by a significant decline in many cognitive domains. These outcomes were possibly related to the selection of patients with normal cognitive functioning before surgery, unilateral DBS implantations for the majority, and selection of patients with optimal response to DBS.
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Affiliation(s)
- Jacob D Jones
- Department of Psychology, California State University, San Bernardino, CA, United States
| | - Tatiana Orozco
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Dawn Bowers
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Wei Hu
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Zakia Jabarkheel
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Shannon Chiu
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kelly Foote
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Department of Neurology, Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
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15
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Coelli S, Levi V, Del Vecchio Del Vecchio J, Mailland E, Rinaldo S, Eleopra R, Bianchi AM. An intra-operative feature-based classification of microelectrode recordings to support the subthalamic nucleus functional identification during deep brain stimulation surgery. J Neural Eng 2020; 18. [PMID: 33202390 DOI: 10.1088/1741-2552/abcb15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/17/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Subthalamic Nucleus (STN) is the most selected target for the placement of the Deep Brain Stimulation (DBS) electrode to treat Parkinson's disease. Its identification is a delicate and challenging task which is based on the interpretation of the STN functional activity acquired through microelectrode recordings (MER). Aim of this work is to explore the potentiality of a set of twenty-five features to build a classification model for the discrimination of MER signals belonging to the STN. APPROACH We explored the use of different sets of spike-dependent and spike-independent features in combination with an Ensemble Trees classification (ET) algorithm on a dataset composed of thirteen patients receiving bilateral DBS. We compared results from six subsets of features and two dataset conditions (with and without standardization) using performance metrics on a leave-one-patient-out validation schema. MAIN RESULTS We obtained statistically better results (i.e., higher accuracy p-value = 0.003) on the raw dataset than on the standardized one, where the selection of seven features using a minimum redundancy maximum relevance (MRMR) algorithm provided a mean accuracy of 94.1%, comparable with the use of the full set of features. In the same conditions, the spike-dependent features provided the lowest accuracy (86.8%), while a power density-based index was shown to be a good indicator of STN activity (92.3%). SIGNIFICANCE Results suggest that a small and simple set of features can be used for an efficient classification of microelectrode recordings to implement an intraoperative support for clinical decision during deep brain stimulation surgery.
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Affiliation(s)
- Stefania Coelli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Lombardia, ITALY
| | - Vincenzo Levi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Lombardia, ITALY
| | | | - Enrico Mailland
- Neurology Unit, Dipartimento di Area Medica Internistica, ASST Santi Paolo e Carlo, Milano, Lombardia, ITALY
| | - Sara Rinaldo
- Movement Disorder Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Lombardia, ITALY
| | - Roberto Eleopra
- Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Lombardia, ITALY
| | - Anna Maria Bianchi
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milano, Lombardia, ITALY
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16
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Malinova V, Pinter A, Dragaescu C, Rohde V, Trenkwalder C, Sixel-Döring F, von Eckardstein KL. The role of intraoperative microelectrode recording and stimulation in subthalamic lead placement for Parkinson's disease. PLoS One 2020; 15:e0241752. [PMID: 33156830 PMCID: PMC7647091 DOI: 10.1371/journal.pone.0241752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/20/2020] [Indexed: 12/29/2022] Open
Abstract
Objective Intraoperative microelectrode recording (MER) and test-stimulation are regarded as the gold standard for proper placement of subthalamic (STN) deep brain stimulation (DBS) electrodes in Parkinson’s disease (PD), requiring the patient to be awake during the procedure. In accordance with good clinical practice, most attending neurologists will request the clinically most efficacious trajectory for definite lead placement. However, the necessity of microelectrode-test-stimulation is disputed, as it may limit the access to DBS therapy, excluding those not willing or incapable of undergoing awake surgery. Methods We retrospectively analyzed the MERs and microelectrode-test-stimulation results with regard to the decision on definite lead placement and clinical outcome in a cohort of 67 PD-patients with STN-DBS. All patients received bilateral quadripolar ring electrodes. To ascertain overall procedural efficacy, we calculated the surgical index (SI) by comparing preoperative motor improvement induced by levodopa to that induced by stimulation 7 to 18 months after surgery, measured as the relative difference between ON and OFF-states on the Unified Parkinson’s Disease Rating Scale motor part (UPDRS-3). Additionally, a side-specific surgical index (SSSI) was calculated using the unilateral assessable items of the UPDRS-3. The SSSI where microelectrode-test-stimulation overruled MER were compared to those where the result of microelectrode-test-stimulation was congruent to MER results. Results A total of 134 electrodes were analyzed. For final lead placement, the central trajectory was chosen in 54% of patient hemispheres. The mean SI was 0.99 (± 0.24). SSSI averaged 1.04 (± 0.45). In 37 lead placements, microelectrode-test-stimulation overruled MER in the final trajectory selection, in 27 of these lead placements adverse effects during microelectrode-test-stimulation were decisive. Neither the number of test electrodes used nor the STN-signal length had an impact on the SSSI. The SSSI did not differ between lead placements with MER/microelectrode-test-stimulation congruency and those where the results of microelectrode-test-stimulation initiated lead placement in a trajectory with shorter STN signal. Conclusion Intraoperative testing is mandatory to ensure an optimal motor outcome of STN DBS in PD-patients when using quadripolar ring electrodes. However, we also demonstrated that neither the length of the STN-signal on MER nor the number of test electrodes influenced the motor outcome.
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Affiliation(s)
- Vesna Malinova
- Department of Neurosurgery, Göttingen University Medical Center, Göttingen, Germany
- * E-mail:
| | - Anabel Pinter
- Department of Neurology, Göttingen University Medical Center, Göttingen, Germany
| | | | - Veit Rohde
- Department of Neurosurgery, Göttingen University Medical Center, Göttingen, Germany
| | - Claudia Trenkwalder
- Department of Neurosurgery, Göttingen University Medical Center, Göttingen, Germany
- Paracelsus Elena Clinic, Kassel, Germany
| | | | - Kajetan L. von Eckardstein
- Department of Neurosurgery, Göttingen University Medical Center, Göttingen, Germany
- Department of Neurosurgery, Westpfalz-Klinikum Kaiserslautern, Kaiserslautern, Germany
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17
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Park HR, Lim YH, Song EJ, Lee JM, Park K, Park KH, Lee WW, Kim HJ, Jeon B, Paek SH. Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience. J Clin Med 2020; 9:jcm9093044. [PMID: 32967337 PMCID: PMC7564882 DOI: 10.3390/jcm9093044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/13/2020] [Accepted: 09/17/2020] [Indexed: 02/07/2023] Open
Abstract
Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson's disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the long operation time under LA without medication. In addition, it cannot be even be performed on PD patients with poor physical and neurological condition. Recently, it has been reported that STN DBS under general anesthesia (GA) can be successfully performed due to the feasible MER under GA, as well as the technical advancement in direct targeting and intraoperative imaging. The authors reviewed the previously published literature on STN DBS under GA using intraoperative imaging and MER, focused on discussing the technique, clinical outcome, and the complication, as well as introducing our single-center experience. Based on the reports of previously published studies and ours, GA did not interfere with the MER signal from STN. STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Long-term follow-up with a large number of the patients would be necessary to validate the safety and efficacy of STN DBS under GA.
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Affiliation(s)
- Hye Ran Park
- Department of Neurosurgery, Soonchunhyang University Seoul Hospital, Seoul 04401, Korea;
| | - Yong Hoon Lim
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Eun Jin Song
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
| | - Jae Meen Lee
- Department of Neurosurgery, Pusan National University Hospital, Busan 49241, Korea;
| | - Kawngwoo Park
- Department of Neurosurgery, Gachon University Gil Medical Center, Incheon 21565, Korea;
| | - Kwang Hyon Park
- Department of Neurosurgery, Chuungnam National University Sejong Hospital, Sejong 30099, Korea;
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea;
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea; (H.-J.K.); (B.J.)
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul 03080, Korea; (Y.H.L.); (E.J.S.)
- Correspondence: ; Tel.: +82-22-072-2876
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18
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Kim M, Jung NY, Chang JW. Image analysis of the intracranial lead bending phenomenon during deep brain stimulation. PLoS One 2020; 15:e0237537. [PMID: 32785286 PMCID: PMC7423130 DOI: 10.1371/journal.pone.0237537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background An accurate and precise surgical procedure is crucial for patient safety and treatment efficacy of deep brain stimulation (DBS). Objectives To investigate the characteristics of intracranial lead bending phenomenon after DBS, and to suggest the methods to avoid bending-related complications. Methods A retrospective review of brain computed tomography scans after DBS was performed. Using 3-dimensional reconstruction, the maximal distance between the planned trajectory and actual lead location was measured. When the distance exceeded the lead body diameter, the lead was considered bent. The distance between the bending point and planned trajectory, and the relative direction between the bending point and lead securing site were analyzed. Changes over time in the range of lead bending and depth were analyzed when possible. Results A total of 190 implanted leads in 102 patients were analyzed; 104 leads (54.7%) were bent. The average deviation of bent leads was 2.3 mm (range, 1.3–7.1 mm). Thirty-five (18.4%) and seven leads (3.7%) had deviations exceeding twice and three times the lead body diameter, respectively. Angles between the deviation point and securing site at the skull ranged from 135–180° in 83 leads (53.2%), 45–135° in 58 (37.2%), and 0–45° in 15 (9.6%). Among 17 leads that were initially bent, 16 had less deviation compared to baseline. The lead depth increased in 35 (92.1%) of 38 leads by 1.2 mm (range, 0.1–4.7 mm). Conclusion The extent of lead bending should be considered during the planning and procedural phases of intracranial lead implantation for DBS.
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Affiliation(s)
- Minsoo Kim
- Department of Neurosurgery, Samsung Medical Center, Seoul, Korea
- Department of Medicine, Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan, College of Medicine, Ulsan, Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
- * E-mail:
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19
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Principles of Safe Stereotactic Trajectories. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Wang J, Ponce FA, Tao J, Yu HM, Liu JY, Wang YJ, Luan GM, Ou SW. Comparison of Awake and Asleep Deep Brain Stimulation for Parkinson's Disease: A Detailed Analysis Through Literature Review. Neuromodulation 2019; 23:444-450. [PMID: 31830772 DOI: 10.1111/ner.13061] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 08/22/2019] [Accepted: 09/11/2019] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) for Parkinson's disease (PD) has been applied to clinic for approximately 30 years. The goal of this review is to explore the similarities and differences between "awake" and "asleep" DBS techniques. METHODS A comprehensive literature review was carried out to identify relevant studies and review articles describing applications of "awake" or "asleep" DBS for Parkinson's disease. The surgical procedures, clinical outcomes, costs and complications of each technique were compared in detail through literature review. RESULTS The surgical procedures of awake and asleep DBS surgeries rely upon different methods for verification of intended target acquisition. The existing research results demonstrated that the stereotactic targeting accuracy of lead placement obtained by either method is reliable. There were no significant differences in clinical outcomes, costs, or complications between the two techniques. CONCLUSION The surgical and clinical outcomes of asleep DBS for PD are comparable to those of awake DBS.
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Affiliation(s)
- Jun Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Jun Tao
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Hong-Mei Yu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Ji-Yuan Liu
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Yun-Jie Wang
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
| | - Guo-Ming Luan
- Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, P. R., China
| | - Shao-Wu Ou
- Department of Neurosurgery, The First Hospital of China Medical University, Shenyang, P. R., China
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21
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Jo Y, Oh C, Lee HJ. Microelectromechanical Systems-Based Neurotools for Non-Invasive Ultrasound Brain Stimulation. ACTA ACUST UNITED AC 2019. [DOI: 10.33069/cim.2019.0009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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22
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Deep brain stimulation for Parkinson's disease - Does measuring quality matter? Parkinsonism Relat Disord 2019; 60:1-2. [PMID: 30796008 DOI: 10.1016/j.parkreldis.2019.02.018] [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: 11/24/2022]
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23
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Tastevin M, Spatola G, Régis J, Lançon C, Richieri R. Deep brain stimulation in the treatment of obsessive-compulsive disorder: current perspectives. Neuropsychiatr Dis Treat 2019; 15:1259-1272. [PMID: 31190832 PMCID: PMC6526924 DOI: 10.2147/ndt.s178207] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 04/23/2019] [Indexed: 12/18/2022] Open
Abstract
Deep brain stimulation (DBS) is a neuro-psychosurgical technique widely accepted in movement disorders, such as Parkinson's disease. Since 1999, DBS has been explored for severe, chronic and treatment-refractory psychiatric diseases. Our review focuses on DBS in obsessive-compulsive disorder (OCD), considered as a last treatment resort by most of learned societies in psychiatry. Two main stimulation areas have been studied: the striatal region and the subthalamic nucleus. But, most of the trials are open-labeled, and the rare controlled ones have failed to highlight the most efficient target. The recent perspectives are otherwise encouraging. Indeed, clinicians are currently considering other promising targets. A case series of 2 patients reported a decrease in OCD symptoms after DBS in the medial forebrain bundle and an open-label study is exploring bilateral habenula stimulation. New response criteria are also investigating such as quality of life, or subjective and lived-experience. Moreover, first papers about cost-effectiveness which is an important criterion in decision making, have been published. The effectiveness of tractography-assisted DBS or micro-assisted DBS is studying with the aim to improve targeting precision. In addition, a trial involving rechargeable pacemakers is undergoing because this mechanism could be efficient and have a positive impact on cost-effectiveness. A recent trial has discussed the possibility of using combined cognitive behavioral therapy (CBT) and DBS as an augmentation strategy. Finally, based on RDoc Research, the latest hypotheses about the understanding of cortico-striato-thalamo-cortical circuits could offer new directions including clinical predictors and biomarkers to perform adaptive closed-loop systems in the next future.
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Affiliation(s)
- Maud Tastevin
- Department of Psychiatry, Addictions and Psychiatry for Children, Public Assistance Marseille Hospitals, 13005 Marseille, France
| | - Giorgio Spatola
- Department of Functional and Stereotactic Neurosurgery, Public Assistance Marseille Hospitals, 13005 Marseille, France.,Institut de Neurosciences des Systèmes, Aix Marseille University, Inserm UMR1106, France
| | - Jean Régis
- Department of Functional and Stereotactic Neurosurgery, Public Assistance Marseille Hospitals, 13005 Marseille, France.,Institut de Neurosciences des Systèmes, Aix Marseille University, Inserm UMR1106, France
| | - Christophe Lançon
- Department of Psychiatry, Addictions and Psychiatry for Children, Public Assistance Marseille Hospitals, 13005 Marseille, France
| | - Raphaëlle Richieri
- Department of Psychiatry, Addictions and Psychiatry for Children, Public Assistance Marseille Hospitals, 13005 Marseille, France.,Faculté des Sciences de Saint Jérôme, Aix Marseille University, Institut Fresnel - UMR 7249, Marseille, France
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24
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Bjerknes S, Toft M, Konglund AE, Pham U, Waage TR, Pedersen L, Skjelland M, Haraldsen I, Andersson S, Dietrichs E, Skogseid IM. Multiple Microelectrode Recordings in STN-DBS Surgery for Parkinson's Disease: A Randomized Study. Mov Disord Clin Pract 2018; 5:296-305. [PMID: 30009214 PMCID: PMC6033169 DOI: 10.1002/mdc3.12621] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022] Open
Abstract
Background Subthalamic nucleus deep brain stimulation improves motor symptoms and fluctuations in advanced Parkinson's disease, but the degree of clinical improvement depends on accurate anatomical electrode placement. Methods used to localize the sensory‐motor part of the nucleus vary substantially. Using microelectrode recordings, at least three inserted microelectrodes are needed to obtain a three‐dimensional map. Therefore, multiple simultaneously inserted microelectrodes should provide better guidance than single sequential microelectrodes. We aimed to compare the use of multiple simultaneous versus single sequential microelectrode recordings on efficacy and safety of subthalamic nucleus stimulation. Methods Sixty patients were included in this double‐blind, randomized study, 30 in each group. Primary outcome measures were the difference from baseline to 12 months in the MDS‐UPDRS motor score (part III) in the off‐medication state and quality of life using the Parkinson's Disease Questionnaire‐39 (PDQ‐39) scores. Results The mean reduction of the MDS‐UPDRS III off score was 35 (SD 12) in the group investigated with multiple simultaneous microelectrodes compared to 26 (SD 10) in the single sequential microelectrode group (p = 0.004). The PDQ‐39 Summary Index did not differ between the groups, but the domain scores activities of daily living and bodily discomfort improved significantly more in the multiple microelectrodes group. The frequency of serious adverse events did not differ significantly. Conclusions After 12 months of subthalamic nucleus stimulation, the multiple microelectrodes group had a significantly greater improvement both in MDS‐UPDRS III off score and in two PDQ‐39 domains. Our results may support the use of multiple simultaneous microelectrode recordings. Trial registration http://ClinicalTrials.gov Identifier: NCT00855621 (first received March 3, 2009).
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Affiliation(s)
- Silje Bjerknes
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Mathias Toft
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Ane E Konglund
- Department of Neurosurgery Oslo University Hospital Oslo Norway
| | - Uyen Pham
- Department of Neuropsychiatry and Psychosomatic Medicine Oslo University Hospital Oslo Norway
| | | | - Lena Pedersen
- Department of Neurology Oslo University Hospital Oslo Norway
| | - Mona Skjelland
- Department of Neurology Oslo University Hospital Oslo Norway
| | - Ira Haraldsen
- Department of Neuropsychiatry and Psychosomatic Medicine Oslo University Hospital Oslo Norway
| | | | - Espen Dietrichs
- Department of Neurology Oslo University Hospital Oslo Norway.,Institute of Clinical Medicine University of Oslo Oslo Norway
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25
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Rossi M, Bruno V, Arena J, Cammarota Á, Merello M. Challenges in PD Patient Management After DBS: A Pragmatic Review. Mov Disord Clin Pract 2018; 5:246-254. [PMID: 30363375 PMCID: PMC6174419 DOI: 10.1002/mdc3.12592] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 01/01/2018] [Accepted: 01/15/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) or internal globus pallidus (GPi) represents an effective and universally applied therapy for Parkinson's disease (PD) motor complications. However, certain procedure-related problems and unrealistic patient expectations may detract specialists from indicating DBS more widely despite significant clinical effects. METHODS This review provides a pragmatic educational summary of the most conflicting postoperative management issues in patients undergoing DBS for PD. RESULTS DBS in PD has been associated with certain complications and post-procedural management issues, which can complicate surgical outcome interpretation. Many PD patients consider DBS outcomes negative due to unfulfilled expectations, even when significant motor symptom improvement is achieved. Speech, gait, postural stability, and cognition may worsen after DBS and body weight may increase. Although DBS may induce impulse control disorders in some cases, in others, it may actually improve them when dopamine agonist dosage is reduced after surgery. However, apathy may also arise, especially when dopaminergic medication tapering is rapid. Gradual loss of response with time suggests disease progression, rather than the wearing off of DBS effects. Furthermore, implantable pulse generator expiration is considered a movement disorder emergency, as it may worsen parkinsonian symptoms or cause life-threatening akinetic crises due to malignant DBS withdrawal syndrome. CONCLUSION Major unsolved issues occurring after DBS therapy preclude complete patient satisfaction. Multidisciplinary management at experienced centers, as well as careful and comprehensive delivery of information to patients, should contribute to make DBS outcome expectations more realistic and allow post procedural complications to be better accepted.
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Affiliation(s)
- Malco Rossi
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Verónica Bruno
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)Buenos AiresArgentina
| | - Julieta Arena
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Ángel Cammarota
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
| | - Marcelo Merello
- Movement Disorders Section, Neuroscience DepartmentRaul Carrea Institute for Neurological Research (FLENI)Buenos AiresArgentina
- Argentine National Scientific and Technological Research Council (CONICET)Buenos AiresArgentina
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Kil D, De Vloo P, Fierens G, Ceyssens F, Hunyadi B, Bertrand A, Nuttin B, Puers R. A foldable electrode array for 3D recording of deep-seated abnormal brain cavities. J Neural Eng 2018; 15:036029. [PMID: 29569571 DOI: 10.1088/1741-2552/aab915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study describes the design and microfabrication of a foldable thin-film neural implant and investigates its suitability for electrical recording of deep-lying brain cavity walls. APPROACH A new type of foldable neural electrode array is presented, which can be inserted through a cannula. The microfabricated electrode is specifically designed for electrical recording of the cavity wall of thalamic lesions resulting from stroke. The proof-of-concept is demonstrated by measurements in rat brain cavities. On implantation, the electrode array unfolds in the brain cavity, contacting the cavity walls and allowing recording at multiple anatomical locations. A three-layer microfabrication process based on UV-lithography and Reactive Ion Etching is described. Electrochemical characterization of the electrode is performed in addition to an in vivo experiment in which the implantation procedure and the unfolding of the electrode are tested and visualized. MAIN RESULTS Electrochemical characterization validated the suitability of the electrode for in vivo use. CT imaging confirmed the unfolding of the electrode in the brain cavity and analysis of recorded local field potentials showed the ability to record neural signals of biological origin. SIGNIFICANCE The conducted research confirms that it is possible to record neural activity from the inside wall of brain cavities at various anatomical locations after a single implantation procedure. This opens up possibilities towards research of abnormal brain cavities and the clinical conditions associated with them, such as central post-stroke pain.
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Affiliation(s)
- Dries Kil
- Department of ESAT-MICAS, KU Leuven, Leuven, Belgium
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Mogilner AY, Machado AG, Rezai AR. Deep Brain Stimulation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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D’Haese PF, Konrad PE, Dawant BM. Big Data and Deep Brain Stimulation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00013-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The Effects of Intraoperative Sedation on Surgical Outcomes of Deep Brain Stimulation Surgery. Can J Neurol Sci 2017; 45:168-175. [PMID: 29237514 DOI: 10.1017/cjn.2017.269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Intraoperative sedation is often used to facilitate deep brain stimulation (DBS) surgery; however, these sedative agents also suppress microelectrode recordings (MER). To date, there have been no studies that have examined the effects of differing sedatives on surgical outcomes and the success of DBS surgery. METHODS We performed a retrospective study to evaluate the effect of differing sedative agents on postoperative surgical outcomes at 6 months in parkinsonian adult patients who underwent DBS surgery, from January 2004 through December 2014, at one academic center. Surgical outcomes of DBS were evaluated using a simplified Unified Parkinson Diseases Rating Score-III and levodopa dose equivalent reduction at baseline and 6 months postoperatively. RESULTS We analyzed data from 121 of 124 consecutive parkinsonian patients. Propofol, dexmedetomidine, remifentanil, and midazolam were used individually or in combination. All sedatives were routinely discontinued 20 to 30 minutes before MER, in accordance with our institutional protocol. We found no statistically significant association between the use of individual agent or combination of sedative agents and surgical outcomes at 6 months, the success of DBS, duration of MER, duration of stage 1 procedure, and perioperative complications. CONCLUSIONS Our study showed that the choice of sedative agent was not associated with poor surgical outcomes after DBS surgery using MER and macrostimulation techniques in parkinsonian patients.
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Lin SH, Lai HY, Lo YC, Chou C, Chou YT, Yang SH, Sun I, Chen BW, Wang CF, Liu GT, Jaw FS, Chen SY, Chen YY. Decreased Power but Preserved Bursting Features of Subthalamic Neuronal Signals in Advanced Parkinson's Patients under Controlled Desflurane Inhalation Anesthesia. Front Neurosci 2017; 11:701. [PMID: 29311782 PMCID: PMC5733027 DOI: 10.3389/fnins.2017.00701] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/28/2017] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) surgery of the subthalamic nucleus (STN) under general anesthesia (GA) had been used in Parkinson's disease (PD) patients who are unable tolerate awake surgery. The effect of anesthetics on intraoperative microelectrode recording (MER) remains unclear. Understanding the effect of anesthetics on MER is important in performing STN DBS surgery with general anesthesia. In this study, we retrospectively performed qualitive and quantitative analysis of STN MER in PD patients received STN DBS with controlled desflurane anesthesia or LA and compared their clinical outcome. From January 2005 to March 2006, 19 consecutive PD patients received bilateral STN DBS surgery in Hualien Tzu-Chi hospital under either desflurane GA (n = 10) or LA (n = 9). We used spike analysis (frequency and modified burst index [MBI]) and the Hilbert transform to obtain signal power measurements for background and spikes, and compared the characterizations of intraoperative microelectrode signals between the two groups. Additionally, STN firing pattern characteristics were determined using a combined approach based on the autocorrelogram and power spectral analysis, which was employed to investigate differences in the oscillatory activities between the groups. Clinical outcomes were assessed using the Unified Parkinson's Disease Rating Scale (UPDRS) before and after surgery. The results revealed burst firing was observed in both groups. The firing frequencies were greater in the LA group and MBI was comparable in both groups. Both the background and spikes were of significantly greater power in the LA group. The power spectra of the autocorrelograms were significantly higher in the GA group between 4 and 8 Hz. Clinical outcomes based on the UPDRS were comparable in both groups before and after DBS surgery. Under controlled light desflurane GA, burst features of the neuronal firing patterns are preserved in the STN, but power is reduced. Enhanced low-frequency (4–8 Hz) oscillations in the MERs for the GA group could be a characteristic signature of desflurane's effect on neurons in the STN.
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Affiliation(s)
- Sheng-Huang Lin
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan.,Department of Neurology, Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - Hsin-Yi Lai
- Interdisciplinary Institute of Neuroscience and Technology, Qiushi Academy for Advanced Studies, Zhejiang University, Hangzhou, China
| | - Yu-Chun Lo
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Chin Chou
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Yi-Ting Chou
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Shih-Hung Yang
- Department of Mechanical and Computer Aided Engineering, Feng Chia University, Taichung, Taiwan
| | - I Sun
- Department of Life Sciences, Institute of Genome Sciences, National Yang Ming University, Taipei, China
| | - Bo-Wei Chen
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Ching-Fu Wang
- Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
| | - Guan-Tze Liu
- Department of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Fu-Shan Jaw
- Institute of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Shin-Yuan Chen
- Department of Neurosurgery, Tzu Chi General Hospital, Tzu Chi University, Hualien, Taiwan
| | - You-Yin Chen
- The Ph.D. Program for Neural Regenerative Medicine, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Biomedical Engineering, National Yang Ming University, Taipei, Taiwan
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Shi L, Zhang K, Meng FG, Zhu GY, Chen YC, Zhou JJ, Zhou ZH, Zhang JG. Delayed responses of subthalamic nucleus to deep brain stimulation in patients with Parkinson's disease. Parkinsonism Relat Disord 2017; 40:76-77. [PMID: 28416330 DOI: 10.1016/j.parkreldis.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 01/17/2017] [Accepted: 04/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, 100050, China
| | - Kai Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fan-Gang Meng
- Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Beijing, China
| | - Guan-Yu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ying-Chuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun-Jian Zhou
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | | | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Functional Neurosurgery Laboratory, Beijing Neurosurgical Institute, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, 100050, China.
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Shi L, Zhang CC, Li JJ, Zhu GY, Chen YC, Zhang JG. Could cough be an intraoperative indicator for venous air embolism in deep brain stimulation surgeries?: experiences from a large case series. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nada EM, Rajan S, Grandhe R, Deogaonkar M, Zimmerman NM, Ebrahim Z, Avitsian R. Intraoperative Hypotension During Second Stage of Deep Brain Stimulator Placement: Same Day versus Different Day Procedures. World Neurosurg 2016; 95:40-45. [DOI: 10.1016/j.wneu.2016.07.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022]
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Verhagen R, Schuurman PR, van den Munckhof P, Contarino MF, de Bie RMA, Bour LJ. Comparative study of microelectrode recording-based STN location and MRI-based STN location in low to ultra-high field (7.0 T) T2-weighted MRI images. J Neural Eng 2016; 13:066009. [DOI: 10.1088/1741-2560/13/6/066009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sweet JA, Pace J, Girgis F, Miller JP. Computational Modeling and Neuroimaging Techniques for Targeting during Deep Brain Stimulation. Front Neuroanat 2016; 10:71. [PMID: 27445709 PMCID: PMC4927621 DOI: 10.3389/fnana.2016.00071] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 06/09/2016] [Indexed: 12/15/2022] Open
Abstract
Accurate surgical localization of the varied targets for deep brain stimulation (DBS) is a process undergoing constant evolution, with increasingly sophisticated techniques to allow for highly precise targeting. However, despite the fastidious placement of electrodes into specific structures within the brain, there is increasing evidence to suggest that the clinical effects of DBS are likely due to the activation of widespread neuronal networks directly and indirectly influenced by the stimulation of a given target. Selective activation of these complex and inter-connected pathways may further improve the outcomes of currently treated diseases by targeting specific fiber tracts responsible for a particular symptom in a patient-specific manner. Moreover, the delivery of such focused stimulation may aid in the discovery of new targets for electrical stimulation to treat additional neurological, psychiatric, and even cognitive disorders. As such, advancements in surgical targeting, computational modeling, engineering designs, and neuroimaging techniques play a critical role in this process. This article reviews the progress of these applications, discussing the importance of target localization for DBS, and the role of computational modeling and novel neuroimaging in improving our understanding of the pathophysiology of diseases, and thus paving the way for improved selective target localization using DBS.
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Affiliation(s)
- Jennifer A Sweet
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan Pace
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Fady Girgis
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
| | - Jonathan P Miller
- Department of Neurosurgery, University Hospitals Case Medical Center, Case Western Reserve University Cleveland, OH, USA
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Teplitzky BA, Zitella LM, Xiao Y, Johnson MD. Model-Based Comparison of Deep Brain Stimulation Array Functionality with Varying Number of Radial Electrodes and Machine Learning Feature Sets. Front Comput Neurosci 2016; 10:58. [PMID: 27375470 PMCID: PMC4901081 DOI: 10.3389/fncom.2016.00058] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 05/27/2016] [Indexed: 12/29/2022] Open
Abstract
Deep brain stimulation (DBS) leads with radially distributed electrodes have potential to improve clinical outcomes through more selective targeting of pathways and networks within the brain. However, increasing the number of electrodes on clinical DBS leads by replacing conventional cylindrical shell electrodes with radially distributed electrodes raises practical design and stimulation programming challenges. We used computational modeling to investigate: (1) how the number of radial electrodes impact the ability to steer, shift, and sculpt a region of neural activation (RoA), and (2) which RoA features are best used in combination with machine learning classifiers to predict programming settings to target a particular area near the lead. Stimulation configurations were modeled using 27 lead designs with one to nine radially distributed electrodes. The computational modeling framework consisted of a three-dimensional finite element tissue conductance model in combination with a multi-compartment biophysical axon model. For each lead design, two-dimensional threshold-dependent RoAs were calculated from the computational modeling results. The models showed more radial electrodes enabled finer resolution RoA steering; however, stimulation amplitude, and therefore spatial extent of the RoA, was limited by charge injection and charge storage capacity constraints due to the small electrode surface area for leads with more than four radially distributed electrodes. RoA shifting resolution was improved by the addition of radial electrodes when using uniform multi-cathode stimulation, but non-uniform multi-cathode stimulation produced equivalent or better resolution shifting without increasing the number of radial electrodes. Robust machine learning classification of 15 monopolar stimulation configurations was achieved using as few as three geometric features describing a RoA. The results of this study indicate that, for a clinical-scale DBS lead, more than four radial electrodes minimally improved in the ability to steer, shift, and sculpt axonal activation around a DBS lead and a simple feature set consisting of the RoA center of mass and orientation enabled robust machine learning classification. These results provide important design constraints for future development of high-density DBS arrays.
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Affiliation(s)
| | - Laura M. Zitella
- Department of Biomedical Engineering, University of MinnesotaMinneapolis, MN, USA
| | - YiZi Xiao
- Department of Biomedical Engineering, University of MinnesotaMinneapolis, MN, USA
| | - Matthew D. Johnson
- Department of Biomedical Engineering, University of MinnesotaMinneapolis, MN, USA
- Institute for Translational Neuroscience, University of MinnesotaMinneapolis, MN, USA
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Telkes I, Jimenez-Shahed J, Viswanathan A, Abosch A, Ince NF. Prediction of STN-DBS Electrode Implantation Track in Parkinson's Disease by Using Local Field Potentials. Front Neurosci 2016; 10:198. [PMID: 27242404 PMCID: PMC4860394 DOI: 10.3389/fnins.2016.00198] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/21/2016] [Indexed: 12/24/2022] Open
Abstract
Optimal electrophysiological placement of the DBS electrode may lead to better long term clinical outcomes. Inter-subject anatomical variability and limitations in stereotaxic neuroimaging increase the complexity of physiological mapping performed in the operating room. Microelectrode single unit neuronal recording remains the most common intraoperative mapping technique, but requires significant expertise and is fraught by potential technical difficulties including robust measurement of the signal. In contrast, local field potentials (LFPs), owing to their oscillatory and robust nature and being more correlated with the disease symptoms, can overcome these technical issues. Therefore, we hypothesized that multiple spectral features extracted from microelectrode-recorded LFPs could be used to automate the identification of the optimal track and the STN localization. In this regard, we recorded LFPs from microelectrodes in three tracks from 22 patients during DBS electrode implantation surgery at different depths and aimed to predict the track selected by the neurosurgeon based on the interpretation of single unit recordings. A least mean square (LMS) algorithm was used to de-correlate LFPs in each track, in order to remove common activity between channels and increase their spatial specificity. Subband power in the beta band (11–32 Hz) and high frequency range (200–450 Hz) were extracted from the de-correlated LFP data and used as features. A linear discriminant analysis (LDA) method was applied both for the localization of the dorsal border of STN and the prediction of the optimal track. By fusing the information from these low and high frequency bands, the dorsal border of STN was localized with a root mean square (RMS) error of 1.22 mm. The prediction accuracy for the optimal track was 80%. Individual beta band (11–32 Hz) and the range of high frequency oscillations (200–450 Hz) provided prediction accuracies of 72 and 68% respectively. The best prediction result obtained with monopolar LFP data was 68%. These results establish the initial evidence that LFPs can be strategically fused with computational intelligence in the operating room for STN localization and the selection of the track for chronic DBS electrode implantation.
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Affiliation(s)
- Ilknur Telkes
- Clinical Neural Engineering Lab., Biomedical Engineering Department, University of Houston Houston, TX, USA
| | | | | | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Aurora, CO, USA
| | - Nuri F Ince
- Clinical Neural Engineering Lab., Biomedical Engineering Department, University of Houston Houston, TX, USA
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40
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Choi KS, Riva-Posse P, Gross RE, Mayberg HS. Mapping the "Depression Switch" During Intraoperative Testing of Subcallosal Cingulate Deep Brain Stimulation. JAMA Neurol 2015; 72:1252-60. [PMID: 26408865 PMCID: PMC4834289 DOI: 10.1001/jamaneurol.2015.2564] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE The clinical utility of monitoring behavioral changes during intraoperative testing of subcallosal cingulate deep brain stimulation is unknown. OBJECTIVE To characterize the structural connectivity correlates of deep brain stimulation-evoked behavioral effects using probabilistic tractography in depression. DESIGN, SETTING, AND PARTICIPANTS Categorization of acute behavioral effects was conducted in 9 adults undergoing deep brain stimulation implantation surgery for chronic treatment-resistant depression in a randomized and blinded testing session at Emory University. Patients were studied from September 1, 2011, through June 30, 2013. Post hoc analyses of the structural tractography patterns mediating distinct categories of evoked behavioral effects were defined, including the best response overall. Data analyses were performed from May 1 through July 1, 2015. MAIN OUTCOMES AND MEASURES Categorization of stimulation-induced transient behavioral effects and delineation of the shared white matter tracts mediating response subtypes. RESULTS Among the 9 patients, 72 active and 36 sham trials were recorded. The following stereotypical behavior patterns were identified: changes in interoceptive (noted changes in body state in 30 of 72 active and 4 of 36 sham trials) and in exteroceptive (shift in attention from patient to others in 9 of 72 active and 0 sham trials) awareness. The best response was a combination of exteroceptive and interoceptive changes at a single left contact for all 9 patients. Structural connectivity showed that the best response contacts had a pattern of connections to the bilateral ventromedial frontal cortex (via forceps minor and left uncinate fasciculus) and to the cingulate cortex (via left cingulum bundle), whereas behaviorally salient but nonbest contacts had only cingulate involvement. The involvement of the 3 white matter bundles during stimulation of the best contacts suggests a mechanism for the observed transient "depression switch." CONCLUSIONS AND RELEVANCE This analysis of transient behavior changes during intraoperative deep brain stimulation of the subcallosal cingulate and the subsequent identification of unique connectivity patterns may provide a biomarker of a rapid-onset depression switch to guide surgical implantation and to refine and optimize algorithms for the selection of contacts in long-term stimulation for treatment-resistant depression.
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Affiliation(s)
- Ki Sueng Choi
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Patricio Riva-Posse
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
| | - Robert E. Gross
- Departments of Neurosurgery, Emory University School of Medicine
| | - Helen S. Mayberg
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine
- Departments of Neurology, Emory University School of Medicine
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Sandström L, Hägglund P, Johansson L, Blomstedt P, Karlsson F. Speech intelligibility in Parkinson's disease patients with zona incerta deep brain stimulation. Brain Behav 2015; 5:e00394. [PMID: 26516614 PMCID: PMC4614054 DOI: 10.1002/brb3.394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/06/2015] [Accepted: 08/16/2015] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To investigate the effects of l-dopa (Levodopa) and cZi-DBS (deep brain stimulation in caudal zona incerta) on spontaneous speech intelligibility in patients with PD (Parkinson's disease). MATERIALS AND METHODS Spontaneous utterances were extracted from anechoic recordings from 11 patients with PD preoperatively (off and on l-dopa medication) and 6 and 12 months post bilateral cZi-DBS operation (off and on stimulation, with simultaneous l-dopa medication). Background noise with an amplitude corresponding to a clinical setting was added to the recordings. Intelligibility was assessed through a transcription task performed by 41 listeners in a randomized and blinded procedure. RESULTS A group-level worsening in spontaneous speech intelligibility was observed on cZi stimulation compared to off 6 months postoperatively (8 adverse, 1 positive, 2 no change). Twelve months postoperatively, adverse effects of cZi-DBS were not frequently observed (2 positive, 3 adverse, 6 no change). l-dopa administered preoperatively as part of the evaluation for DBS operation provided the overall best treatment outcome (1 adverse, 4 positive, 6 no change). CONCLUSIONS cZi-DBS was shown to have smaller negative effects when evaluated from spontaneous speech compared to speech effects reported previously. The previously reported reduction in word-level intelligibility 12 months postoperatively was not transferred to spontaneous speech for most patients. Reduced intelligibility due to cZi stimulation was much more prominent 6 months postoperatively than at 12 months.
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Affiliation(s)
- Linda Sandström
- Division of Speech and Language PathologyDepartment of Clinical SciencesUmeå UniversityUmeåSweden
| | - Patricia Hägglund
- Division of Speech and Language PathologyDepartment of Clinical SciencesUmeå UniversityUmeåSweden
| | - Louise Johansson
- Division of Speech and Language PathologyDepartment of Clinical SciencesUmeå UniversityUmeåSweden
| | - Patric Blomstedt
- Division of Clinical NeuroscienceDepartment of Pharmacology and Clinical NeuroscienceUmeå UniversityUmeåSweden
| | - Fredrik Karlsson
- Division of Speech and Language PathologyDepartment of Clinical SciencesUmeå UniversityUmeåSweden
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Scharpf DT, Sharma M, Deogaonkar M, Rezai A, Bergese SD. Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery. Korean J Anesthesiol 2015; 68:332-9. [PMID: 26257844 PMCID: PMC4524930 DOI: 10.4097/kjae.2015.68.4.332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/02/2022] Open
Abstract
The field of functional neurosurgery has expanded in last decade to include newer indications, new devices, and new methods. This advancement has challenged anesthesia providers to adapt to these new requirements. This review aims to discuss the nuances and practical issues that are faced while administering anesthesia for deep brain stimulation surgery.
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Affiliation(s)
- Danielle Teresa Scharpf
- Department of Neuroanestheisa, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Mayur Sharma
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Ali Rezai
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Sergio D Bergese
- Department of Neuroanestheisa, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
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Ho AL, Erickson-Direnzo E, Pendharkar AV, Sung CK, Halpern CH. Deep brain stimulation for vocal tremor: a comprehensive, multidisciplinary methodology. Neurosurg Focus 2015; 38:E6. [DOI: 10.3171/2015.3.focus1537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Tremulous voice is a characteristic feature of a multitude of movement disorders, but when it occurs in individuals diagnosed with essential tremor, it is referred to as essential vocal tremor (EVT). For individuals with EVT, their tremulous voice is associated with significant social embarrassment and in severe cases may result in the discontinuation of employment and hobbies. Management of EVT is extremely difficult, and current behavioral and medical interventions for vocal tremor result in suboptimal outcomes. Deep brain stimulation (DBS) has been proposed as a potential therapeutic avenue for EVT, but few studies can be identified that have systematically examined improvements in EVT following DBS. The authors describe a case of awake bilateral DBS targeting the ventral intermediate nucleus for a patient suffering from severe voice and arm tremor. They also present their comprehensive, multidisciplinary methodology for definitive treatment of EVT via DBS. To the authors’ knowledge, this is the first time comprehensive intraoperative voice evaluation has been used to guide microelectrode/stimulator placement, as well as the first time that standard pre- and post-DBS assessments have been conducted, demonstrating the efficacy of this tailored DBS approach.
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Affiliation(s)
| | | | | | - Chih-Kwang Sung
- 2Otolaryngology (Head and Neck Surgery), Stanford University School of Medicine, Stanford, California
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44
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Minks DP, Pereira EAC, Young VEL, Hogarth KM, Quaghebeur G. Role of radiology in central nervous system stimulation. Br J Radiol 2015; 88:20140507. [PMID: 25715044 PMCID: PMC4651263 DOI: 10.1259/bjr.20140507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/10/2015] [Accepted: 02/23/2015] [Indexed: 11/05/2022] Open
Abstract
Central nervous system (CNS) stimulation is becoming increasingly prevalent. Deep brain stimulation (DBS) has been proven to be an invaluable treatment for movement disorders and is also useful in many other neurological conditions refractory to medical treatment, such as chronic pain and epilepsy. Neuroimaging plays an important role in operative planning, target localization and post-operative follow-up. The use of imaging in determining the underlying mechanisms of DBS is increasing, and the dependence on imaging is likely to expand as deep brain targeting becomes more refined. This article will address the expanding role of radiology and highlight issues, including MRI safety concerns, that radiologists may encounter when confronted with a patient with CNS stimulation equipment in situ.
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Affiliation(s)
- D P Minks
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - E A C Pereira
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - V E L Young
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K M Hogarth
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - G Quaghebeur
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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van Horne CG, Vaughan SW, Massari C, Bennett M, Asfahani WSZ, Quintero JE, Gerhardt GA. Streamlining deep brain stimulation surgery by reversing the staging order. J Neurosurg 2015; 122:1042-7. [PMID: 25748305 DOI: 10.3171/2014.9.jns14619] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) is approved for several clinical indications; however, the sequencing of DBS surgery and the timeline for implementing stimulation therapy are not standardized. In over 140 cases so far, the authors have reversed the sequencing for staged implantation of DBS systems that was conducive to minimizing patient anxiety and discomfort while providing the opportunity to shorten the time between implantation and programming for therapeutic management of symptoms. Stage I was performed with the patient under general anesthesia and consisted of implantation of the pulse generator and lead extensions and placement of the bur holes. Stage II was completed 1-7 days later, using only local anesthesia, and included stereotactic frame-based microelectrode recordings, semi-microstimulation and macrostimulation, and testing and placement of the stimulating electrodes. Stage I lasted approximately 90 minutes, whereas Stage II lasted approximately 230 minutes. All patients tolerated the procedures and received a complete implanted system. Deep brain stimulation therapy was typically initiated on the same day as lead implantation. When sequencing was reversed and bur holes were placed during the first stage while a patient was under general anesthesia, the patient was able to tolerate the second awake stage and was able to begin stimulation therapy within 48 hours of the second stage.
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Affiliation(s)
- Craig G van Horne
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, Massachusetts; and
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Giller CA, Jenkins P. Some technical nuances for deep brain stimulator implantation. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2015. [DOI: 10.1016/j.inat.2014.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Eklund E, Qvist J, Sandström L, Viklund F, Van Doorn J, Karlsson F. Perceived articulatory precision in patients with Parkinson's disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta. CLINICAL LINGUISTICS & PHONETICS 2015; 29:150-166. [PMID: 25333411 DOI: 10.3109/02699206.2014.971192] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and caudal zona incerta (cZi) on speech articulation in patients with Parkinson's disease (PD) was investigated. Read speech samples were collected from nine patients with STN-DBS and 10 with cZi-DBS. The recordings were made pre-operatively and 12 months post-operatively with stimulator on and off (on medication). Blinded, randomised, repeated perceptual assessments were performed on words and isolated fricatives extracted from the recordings to assess (1) overall articulatory quality ratings, (2) frequency of occurrence of misarticulation patterns and (3) fricative production. Statistically significant worsening of articulatory measures on- compared with off-stimulation occurred in the cZi-DBS group, with deteriorated articulatory precision ratings, increased presence of misarticulations (predominately altered realisations of plosives and fricatives) and a reduced accuracy in fricative production. A similar, but not significant, trend was found for the STN-DBS group.
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Affiliation(s)
- Elisabeth Eklund
- Department of Clinical Sciences, Division of Speech and Language Pathology and
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Chakrabarti R, Ghazanwy M, Tewari A. Anesthetic challenges for deep brain stimulation: a systematic approach. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:359-69. [PMID: 25210668 PMCID: PMC4158643 DOI: 10.4103/1947-2714.139281] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ablative intracranial surgery for Parkinson's disease has advanced to embedding electrodes into precise areas of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred in view of its reversibility, adjustability, and capability to be safely performed bilaterally. DBS is been increasingly used for other movement disorders, intractable tremors epilepsy, and sometimes chronic pain. Anesthesiologists need to amalgamate the knowledge of neuroanatomical structures and surgical techniques involved in placement of microelectrodes in defined cerebral target areas. Perioperative verbal communication with the patient during the procedure is quintessential and may attenuate the need for pharmacological agents. This review will endeavor to assimilate the present knowledge regarding the patient selection, available/practiced anesthesia regimens, and perioperative complications after our thorough search for literature published between 1991 and 2013.
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Affiliation(s)
| | - Mahmood Ghazanwy
- Department of Neuroanaesthesia, Cleveland Clinic Foundation, Ohio, USA
| | - Anurag Tewari
- Department of Neuroanaesthesia, Cleveland Clinic Foundation, Ohio, USA
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Lee SW, Lee MK, Seo I, Kim HS, Kim JH, Kim YS. A groove technique for securing an electrode connector on the cranial bone: case analysis of efficacy. J Korean Neurosurg Soc 2014; 56:130-4. [PMID: 25328650 PMCID: PMC4200360 DOI: 10.3340/jkns.2014.56.2.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 05/05/2014] [Accepted: 08/16/2014] [Indexed: 12/01/2022] Open
Abstract
Objective A groove technique for securing an electrode connector was described as an alternative surgical technique in deep brain stimulation (DBS) surgery to avoid electrode connector-related complications, such as skin erosion, infection, and migration. Methods We retrospectively reviewed 109 patients undergoing one of two techniques; the standard technique (52 patients using 104 electrodes) and the groove technique (57 patients using 109 electrodes) for securing the electrode connector in DBS surgery, regardless of patient disease. In the standard percutaneous tunneling technique, the connector was placed on the vertex of the cranial surface. The other technique, so called the groove technique, created a groove (about 4 cm long, 8 mm wide) in the cranial bone at the posterior parietal area. Wound erosion and migration related to the connectors were compared between the two techniques. Results The mean follow-up period was 73 months for the standard method and 46 months for the groove technique. Connector-related complications were observed in three patients with the groove technique and in seven patients with the standard technique. Wound erosion at the connector sites per electrode was one (0.9%) with the groove technique and six (5.8%) with the standard technique. This difference was statistically significant. The electrode connector was migrated in two patients with the groove technique and in one patient with the standard technique. Conclusions The groove technique, which involves securing an electrode using a groove in the cranial bone at the posterior parietal area, offers an effective and safe method to avoid electrode connector-related complications during DBS surgery.
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Affiliation(s)
- Sung-Woo Lee
- Department of Neurosurgery, Maryknoll Hospital, Busan, Korea
| | - Myung-Ki Lee
- Department of Neurosurgery, Maryknoll Hospital, Busan, Korea
| | - Il Seo
- Department of Neurosurgery, Maryknoll Hospital, Busan, Korea
| | - Ho-Sang Kim
- Department of Neurosurgery, Maryknoll Hospital, Busan, Korea
| | - Jeong-Ho Kim
- Department of Neurosurgery, Maryknoll Hospital, Busan, Korea
| | - Yun-Suk Kim
- Department of Neurosurgery, Maryknoll Hospital, Busan, Korea
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Bériault S, Sadikot AF, Alsubaie F, Drouin S, Collins DL, Pike GB. Neuronavigation using susceptibility-weighted venography: application to deep brain stimulation and comparison with gadolinium contrast. J Neurosurg 2014; 121:131-41. [DOI: 10.3171/2014.3.jns131860] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Careful trajectory planning on preoperative vascular imaging is an essential step in deep brain stimulation (DBS) to minimize risks of hemorrhagic complications and postoperative neurological deficits. This paper compares 2 MRI methods for visualizing cerebral vasculature and planning DBS probe trajectories: a single data set T1-weighted scan with double-dose gadolinium contrast (T1w-Gd) and a multi–data set protocol consisting of a T1-weighted structural, susceptibility-weighted venography, and time-of-flight angiography (T1w-SWI-TOF). Two neurosurgeons who specialize in neuromodulation surgery planned bilateral STN DBS in 18 patients with Parkinson's disease (36 hemispheres) using each protocol separately. Planned trajectories were then evaluated across all vascular data sets (T1w-Gd, SWI, and TOF) to detect possible intersection with blood vessels along the entire path via an objective vesselness measure. The authors' results show that trajectories planned on T1w-SWI-TOF successfully avoided the cerebral vasculature imaged by conventional T1w-Gd and did not suffer from missing vascular information or imprecise data set registration. Furthermore, with appropriate planning and visualization software, trajectory corridors planned on T1w-SWI-TOF intersected significantly less fine vasculature that was not detected on the T1w-Gd (p < 0.01 within 2 mm and p < 0.001 within 4 mm of the track centerline). The proposed T1w-SWI-TOF protocol comes with minimal effects on the imaging and surgical workflow, improves vessel avoidance, and provides a safe cost-effective alternative to injection of gadolinium contrast.
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Affiliation(s)
| | - Abbas F. Sadikot
- 1McConnell Brain Imaging Centre and
- 2Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec; and
| | - Fahd Alsubaie
- 1McConnell Brain Imaging Centre and
- 2Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec; and
| | - Simon Drouin
- 1McConnell Brain Imaging Centre and
- 2Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, Montreal, Quebec; and
| | | | - G. Bruce Pike
- 3Department of Radiology, Hotchkiss Brain Institute, University of Calgary, Alberta, Canada
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