1
|
Sultana OF, Bandaru M, Islam MA, Reddy PH. Unraveling the complexity of human brain: Structure, function in healthy and disease states. Ageing Res Rev 2024; 100:102414. [PMID: 39002647 DOI: 10.1016/j.arr.2024.102414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/29/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
The human brain stands as an intricate organ, embodying a nexus of structure, function, development, and diversity. This review delves into the multifaceted landscape of the brain, spanning its anatomical intricacies, diverse functional capacities, dynamic developmental trajectories, and inherent variability across individuals. The dynamic process of brain development, from early embryonic stages to adulthood, highlights the nuanced changes that occur throughout the lifespan. The brain, a remarkably complex organ, is composed of various anatomical regions, each contributing uniquely to its overall functionality. Through an exploration of neuroanatomy, neurophysiology, and electrophysiology, this review elucidates how different brain structures interact to support a wide array of cognitive processes, sensory perception, motor control, and emotional regulation. Moreover, it addresses the impact of age, sex, and ethnic background on brain structure and function, and gender differences profoundly influence the onset, progression, and manifestation of brain disorders shaped by genetic, hormonal, environmental, and social factors. Delving into the complexities of the human brain, it investigates how variations in anatomical configuration correspond to diverse functional capacities across individuals. Furthermore, it examines the impact of neurodegenerative diseases on the structural and functional integrity of the brain. Specifically, our article explores the pathological processes underlying neurodegenerative diseases, such as Alzheimer's, Parkinson's, and Huntington's diseases, shedding light on the structural alterations and functional impairments that accompany these conditions. We will also explore the current research trends in neurodegenerative diseases and identify the existing gaps in the literature. Overall, this article deepens our understanding of the fundamental principles governing brain structure and function and paves the way for a deeper understanding of individual differences and tailored approaches in neuroscience and clinical practice-additionally, a comprehensive understanding of structural and functional changes that manifest in neurodegenerative diseases.
Collapse
Affiliation(s)
- Omme Fatema Sultana
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Madhuri Bandaru
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - Md Ariful Islam
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA
| | - P Hemachandra Reddy
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Nutritional Sciences Department, College of Human Sciences, Texas Tech University, Lubbock, TX 79409, USA; Department of Pharmacology and Neuroscience, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA 5. Department of Public Health, Graduate School of Biomedical Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA; Department of Speech, Language, and Hearing Sciences, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA.
| |
Collapse
|
2
|
Loughlin H, Jackson J, Looman C, Starll A, Goldman J, Shan Z, Yu C. Aerobic exercise improves depressive symptoms in the unilateral 6-OHDA-lesioned rat model of Parkinson's disease. IBRO Neurosci Rep 2024; 16:468-475. [PMID: 38560366 PMCID: PMC10981038 DOI: 10.1016/j.ibneur.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
Aerobic exercise has been shown to have established benefits on motor function in Parkinson's disease (PD). However, the impact of exercise on depressive symptoms in PD remains unclear. This study aimed to investigate the effects of regular exercise, specifically using a forced running wheel, on both motor performance and the prevalence of depression in a unilateral 6-OHDA-lesioned rat model of PD. The behavioral outcomes of exercise were assessed through the rotarod test (RT), forelimb adjusting step test (FAST), sucrose consumption test (SCT), and novelty sucrose splash test (NSST). Our data revealed evident depressive symptoms in the PD animals, characterized by reduced sucrose consumption in the SCT and diminished exploratory activity in the NSST compared to the naïve control group. Specifically, after 11 weeks of exercise, the PD exercise group demonstrated the most significant improvements in sucrose consumption in the SCT. Additionally, this group exhibited reduced immobility and increased exploratory behavior compared to the PD control group in the NSST. Furthermore, the PD exercise group displayed the greatest improvement in correcting forelimb stepping bias. Our results suggested that a regimen of running wheel exercise enhances motor abilities and mitigates the occurrence of depressive behaviors caused by 6-OHDA dopamine depletion in the PD rat model.
Collapse
Affiliation(s)
- Hannah Loughlin
- Department of Biomedical Engineering, Michigan Technological University, United States
| | - Jacob Jackson
- Department of Biomedical Engineering, Michigan Technological University, United States
| | - Chloe Looman
- Department of Biomedical Engineering, Michigan Technological University, United States
| | - Alayna Starll
- Department of Biomedical Engineering, Michigan Technological University, United States
| | - Jeremy Goldman
- Department of Biomedical Engineering, Michigan Technological University, United States
| | - Zhiying Shan
- Department of Kinesiology and Integrative Physiology, United States
| | - Chunxiu Yu
- Department of Biomedical Engineering, Michigan Technological University, United States
| |
Collapse
|
3
|
Siddique MAB, Zhang Y, An H. Monitoring time domain characteristics of Parkinson's disease using 3D memristive neuromorphic system. Front Comput Neurosci 2023; 17:1274575. [PMID: 38162516 PMCID: PMC10754992 DOI: 10.3389/fncom.2023.1274575] [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: 08/08/2023] [Accepted: 11/06/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Parkinson's disease (PD) is a neurodegenerative disorder affecting millions of patients. Closed-Loop Deep Brain Stimulation (CL-DBS) is a therapy that can alleviate the symptoms of PD. The CL-DBS system consists of an electrode sending electrical stimulation signals to a specific region of the brain and a battery-powered stimulator implanted in the chest. The electrical stimuli in CL-DBS systems need to be adjusted in real-time in accordance with the state of PD symptoms. Therefore, fast and precise monitoring of PD symptoms is a critical function for CL-DBS systems. However, the current CL-DBS techniques suffer from high computational demands for real-time PD symptom monitoring, which are not feasible for implanted and wearable medical devices. Methods In this paper, we present an energy-efficient neuromorphic PD symptom detector using memristive three-dimensional integrated circuits (3D-ICs). The excessive oscillation at beta frequencies (13-35 Hz) at the subthalamic nucleus (STN) is used as a biomarker of PD symptoms. Results Simulation results demonstrate that our neuromorphic PD detector, implemented with an 8-layer spiking Long Short-Term Memory (S-LSTM), excels in recognizing PD symptoms, achieving a training accuracy of 99.74% and a validation accuracy of 99.52% for a 75%-25% data split. Furthermore, we evaluated the improvement of our neuromorphic CL-DBS detector using NeuroSIM. The chip area, latency, energy, and power consumption of our CL-DBS detector were reduced by 47.4%, 66.63%, 65.6%, and 67.5%, respectively, for monolithic 3D-ICs. Similarly, for heterogeneous 3D-ICs, employing memristive synapses to replace traditional Static Random Access Memory (SRAM) resulted in reductions of 44.8%, 64.75%, 65.28%, and 67.7% in chip area, latency, and power usage. Discussion This study introduces a novel approach for PD symptom evaluation by directly utilizing spiking signals from neural activities in the time domain. This method significantly reduces the time and energy required for signal conversion compared to traditional frequency domain approaches. The study pioneers the use of neuromorphic computing and memristors in designing CL-DBS systems, surpassing SRAM-based designs in chip design area, latency, and energy efficiency. Lastly, the proposed neuromorphic PD detector demonstrates high resilience to timing variations in brain neural signals, as confirmed by robustness analysis.
Collapse
Affiliation(s)
- Md Abu Bakr Siddique
- Department of Electrical and Computer Engineering, Michigan Technological University, Houghton, MI, United States
| | - Yan Zhang
- Department of Biological Sciences, Michigan Technological University, Houghton, MI, United States
| | - Hongyu An
- Department of Electrical and Computer Engineering, Michigan Technological University, Houghton, MI, United States
| |
Collapse
|
4
|
Gülke E, Horn MA, Caffier J, Pinnschmidt H, Hamel W, Moll CKE, Gulberti A, Pötter-Nerger M. Comparison of subthalamic unilateral and bilateral theta burst deep brain stimulation in Parkinson's disease. Front Hum Neurosci 2023; 17:1233565. [PMID: 37868697 PMCID: PMC10585145 DOI: 10.3389/fnhum.2023.1233565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
High-frequency, conventional deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) is usually applied bilaterally under the assumption of additive effects due to interhemispheric crosstalk. Theta burst stimulation (TBS-DBS) represents a new patterned stimulation mode with 5 Hz interburst and 200 Hz intraburst frequency, whose stimulation effects in a bilateral mode compared to unilateral are unknown. This single-center study evaluated acute motor effects of the most affected, contralateral body side in 17 PD patients with unilateral subthalamic TBS-DBS and 11 PD patients with bilateral TBS-DBS. Compared to therapy absence, both unilateral and bilateral TBS-DBS significantly improved (p < 0.05) lateralized Movement Disorder Society-Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS III) scores. Bilateral TBS-DBS revealed only slight, but not significant additional effects in comparison to unilateral TBS-DBS on total lateralized motor scores, but on the subitem lower limb rigidity. These results indicate that bilateral TBS-DBS has limited additive beneficial effects compared to unilateral TBS-DBS in the short term.
Collapse
Affiliation(s)
- Eileen Gülke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin A. Horn
- Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julian Caffier
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Pinnschmidt
- Institute of Medical Biometry and Epidemiology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K. E. Moll
- Institute of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
5
|
Ghosh S, Sinha JK, Ghosh S, Sharma H, Bhaskar R, Narayanan KB. A Comprehensive Review of Emerging Trends and Innovative Therapies in Epilepsy Management. Brain Sci 2023; 13:1305. [PMID: 37759906 PMCID: PMC10527076 DOI: 10.3390/brainsci13091305] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/10/2023] [Indexed: 09/29/2023] Open
Abstract
Epilepsy is a complex neurological disorder affecting millions worldwide, with a substantial number of patients facing drug-resistant epilepsy. This comprehensive review explores innovative therapies for epilepsy management, focusing on their principles, clinical evidence, and potential applications. Traditional antiseizure medications (ASMs) form the cornerstone of epilepsy treatment, but their limitations necessitate alternative approaches. The review delves into cutting-edge therapies such as responsive neurostimulation (RNS), vagus nerve stimulation (VNS), and deep brain stimulation (DBS), highlighting their mechanisms of action and promising clinical outcomes. Additionally, the potential of gene therapies and optogenetics in epilepsy research is discussed, revealing groundbreaking findings that shed light on seizure mechanisms. Insights into cannabidiol (CBD) and the ketogenic diet as adjunctive therapies further broaden the spectrum of epilepsy management. Challenges in achieving seizure control with traditional therapies, including treatment resistance and individual variability, are addressed. The importance of staying updated with emerging trends in epilepsy management is emphasized, along with the hope for improved therapeutic options. Future research directions, such as combining therapies, AI applications, and non-invasive optogenetics, hold promise for personalized and effective epilepsy treatment. As the field advances, collaboration among researchers of natural and synthetic biochemistry, clinicians from different streams and various forms of medicine, and patients will drive progress toward better seizure control and a higher quality of life for individuals living with epilepsy.
Collapse
Affiliation(s)
- Shampa Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
- ICMR—National Institute of Nutrition, Tarnaka, Hyderabad 500007, India
| | | | - Soumya Ghosh
- GloNeuro, Sector 107, Vishwakarma Road, Noida 201301, India
| | | | - Rakesh Bhaskar
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| | - Kannan Badri Narayanan
- School of Chemical Engineering, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
- Research Institute of Cell Culture, Yeungnam University, 280 Daehak-Ro, Gyeongsan, Gyeongbuk 38541, Republic of Korea
| |
Collapse
|
6
|
Bosley KM, Luo Z, Amoozegar S, Acedillo K, Nakajima K, Johnson LA, Vitek JL, Wang J. Effect of subthalamic coordinated reset deep brain stimulation on Parkinsonian gait. Front Neuroinform 2023; 17:1185723. [PMID: 37692361 PMCID: PMC10483836 DOI: 10.3389/fninf.2023.1185723] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Coordinated Reset Deep Brain Stimulation (CR DBS) is a novel DBS approach for treating Parkinson's disease (PD) that uses lower levels of burst stimulation through multiple contacts of the DBS lead. Though CR DBS has been demonstrated to have sustained therapeutic effects on rigidity, tremor, bradykinesia, and akinesia following cessation of stimulation, i.e., carryover effect, its effect on Parkinsonian gait has not been well studied. Impaired gait is a disabling symptom of PD, often associated with a higher risk of falling and a reduced quality of life. The goal of this study was to explore the carryover effect of subthalamic CR DBS on Parkinsonian gait. Methods Three non-human primates (NHPs) were rendered Parkinsonian and implanted with a DBS lead in the subthalamic nucleus (STN). For each animal, STN CR DBS was delivered for several hours per day across five consecutive days. A clinical rating scale modified for NHP use (mUPDRS) was administered every morning to monitor the carryover effect of CR DBS on rigidity, tremor, akinesia, and bradykinesia. Gait was assessed quantitatively before and after STN CR DBS. The stride length and swing speed were calculated and compared to the baseline, pre-stimulation condition. Results In all three animals, carryover improvements in rigidity, bradykinesia, and akinesia were observed after CR DBS. Increased swing speed was observed in all the animals; however, improvement in stride length was only observed in NHP B2. In addition, STN CR DBS using two different burst frequencies was evaluated in NHP B2, and differential effects on the mUPDRS score and gait were observed. Discussion Although preliminary, our results indicate that STN CR DBS can improve Parkinsonian gait together with other motor signs when stimulation parameters are properly selected. This study further supports the continued development of CR DBS as a novel therapy for PD and highlights the importance of parameter selection in its clinical application.
Collapse
Affiliation(s)
- Kai M. Bosley
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Ziling Luo
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Sana Amoozegar
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Kit Acedillo
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Kanon Nakajima
- Neuroscience Program, Macalester College, Saint Paul, MN, United States
| | - Luke A. Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
7
|
Onder H, Bahtiyarca ZT, Comoglu S. Subjective Assessments of Voice in Parkinson's Disease Subjects with and without STN-DBS Therapy. Ann Indian Acad Neurol 2023; 26:491-495. [PMID: 37970309 PMCID: PMC10645232 DOI: 10.4103/aian.aian_1_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 02/19/2023] [Accepted: 03/10/2023] [Indexed: 11/17/2023] Open
Abstract
Introduction The causal relation between STN-DBS and speech problems and the associated clinical features are in the incipient stages of being investigated. Methods All the Parkinson's disease (PD) subjects with and without STN-DBS who applied to our movement disorders outpatient clinics between January 2022 and June 2022 and agreed to participate in the study were enrolled. The demographic data and clinical features were noted. Besides, the MDS-UPDRS was administered during the medication off-state in all subjects. All the participants completed the voice handicap index (VHI). Besides, the Freezing of Gait Questionnaire (FOGQ) and the quality of life (QoL) scales including the Parkinson's Disease Questionnaire (PDQ-39) and the Schwab and England Activities of Daily Living (ADL) scale were also administered to all the individuals. Results We have included 66 patients with PD (F/M = 23/43). Thirty-five patients were those with DBS therapy whereas 31 patients were without. The results of the comparative analyses between the patients with and without DBS therapy revealed that the DBS group had a higher disease duration (P = 0.006) and FOGQ scores (P = 0.008). The VHI scores did not differ between groups (P = 0.577), and the correlation analyses did not reveal an association between the VHI scores and the duration of DBS therapy. However, the VHI scores correlated with the disease duration as well as the FOG scores. Conclusion We did not find convincing evidence supporting the increased risk of speech disturbance with STN-DBS therapy. We suggest that the frequent existence of speech disturbance in this patient subgroup with STN-DBS is associated with the classical nature of PD.
Collapse
Affiliation(s)
- Halil Onder
- Deparment of Neurology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Zeynep Tuba Bahtiyarca
- Deparment of Physical Therapy and Rehabilitation, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Selcuk Comoglu
- Deparment of Neurology, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
8
|
Ma R, Yin Z, Chen Y, Yuan T, An Q, Gan Y, Xu Y, Jiang Y, Du T, Yang A, Meng F, Zhu G, Zhang J. Sleep outcomes and related factors in Parkinson's disease after subthalamic deep brain electrode implantation: a retrospective cohort study. Ther Adv Neurol Disord 2023; 16:17562864231161163. [PMID: 37200769 PMCID: PMC10185976 DOI: 10.1177/17562864231161163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/15/2023] [Indexed: 05/20/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) improves sleep qualities in Parkinson's disease (PD) patients; however, it remains elusive whether STN-DBS improves sleep by directly influencing the sleep circuit or alleviates other cardinal symptoms such as motor functions, other confounding factors including stimulation intensity may also involve. Studying the effect of microlesion effect (MLE) on sleep after STN-DBS electrode implantation may address this issue. Objective To examine the influence of MLE on sleep quality and related factors in PD, as well as the effects of regional and lateral specific correlations with sleep outcomes after STN-DBS electrode implantation. Study Design Case-control study; Level of evidence, 3. Data Sources and Methods In 78 PD patients who underwent bilateral STN-DBS surgery in our center, we compared the sleep qualities, motor performances, anti-Parkinsonian drug dosage, and emotional conditions at preoperative baseline and postoperative 1-month follow-up. We determined the related factors of sleep outcomes and visualized the electrodes position, simulated the MLE-engendered volume of tissue lesioned (VTL), and investigated sleep-related sweet/sour spots and laterality in STN. Results MLE improves sleep quality with Pittsburgh Sleep Quality Index (PSQI) by 13.36% and Parkinson's Disease Sleep Scale-2 (PDSS-2) by 17.95%. Motor (P = 0.014) and emotional (P = 0.001) improvements were both positively correlated with sleep improvements. However, MLE in STN associative subregions, as an independent factor, may cause sleep deterioration (r = 0.348, P = 0.002), and only the left STN showed significance (r = 0.327, P = 0.004). Sweet spot analysis also indicated part of the left STN associative subregion is the sour spot indicative of sleep deterioration. Conclusion The MLE of STN-DBS can overall improve sleep quality in PD patients, with a positive correlation between motor and emotional improvements. However, independent of all other factors, the MLE in the STN associative subregion, particularly the left side, may cause sleep deterioration.
Collapse
Affiliation(s)
- Ruoyu Ma
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yingchuan Chen
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tingting Du
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan
Hospital, Capital Medical University, No. 119 South 4th Ring West Road,
Fengtai District, Beijing 100070, China
- Department of Functional Neurosurgery, Beijing
Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation,
Beijing, China
| |
Collapse
|
9
|
Tawfik HA, Dutton JJ. Debunking the Puzzle of Eyelid Apraxia: The Muscle of Riolan Hypothesis. Ophthalmic Plast Reconstr Surg 2023; 39:211-220. [PMID: 36136731 DOI: 10.1097/iop.0000000000002291] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Apraxia of eyelid opening (AEO) has been defined by the presence of an intermittent nonparalytic bilateral loss of the volitional ability to open the eyes or to maintain the eyelids in a sustained elevated position. It is not known whether the condition represents an apraxia, a dystonia, or a freezing phenomenon, and several different nomenclatorial terms have been suggested for this condition including the so-called AEO (scAEO), blepahrocolysis, focal eyelid dystonia, and so on. The primary goal of this review is to attempt to clarify the pathogenetic mechanisms underlying scAEO as a clinical phenomenon. This review also addresses the issue of whether scAEO is part of the spectrum of blepharospasm (BSP) which includes BSP, dystonic blinks and other dystonic eyelid conditions, or whether it is a separate phenomenologically heterogeneous disease with clinical features that merely overlap with BSP. METHODS A literature review was conducted in PubMed, MEDLINE, PubMed Central (PMC), NCBI Bookshelf, and Embase for several related keywords including the terms "apraxia of eyelid opening," "pretarsal blepharospasm," "blepharocolysis," "eyelid freezing," "eyelid akinesia," "levator inhibition," "blepharospasm-plus," as well as "blepharospasm." The clinical findings in patients with scAEO who fulfilled the classic diagnostic criteria of the disease that were originally set by Lepore and Duvoisin were included, while patients with isolated blepharospasm or dystonic blinks (DB) were excluded. In addition, electromyographic (EMG) studies in patients with scAEO were reviewed in detail with special emphasis on studies that performed synchronous EMG recordings both from the levator muscle (LPS) and the pretarsal orbicularis oculi muscle (OO). RESULTS The apraxia designation is clearly a misnomer. Although scAEO behaves clinically as a hypotonic freezing phenomenon, it also shares several cardinal features with focal dystonias. The authors broadly categorized the EMG data into 3 different patterns. The first pattern (n = 26/94 [27.6%]) was predominantly associated with involuntary discharges in the OO muscle and has been termed pretarsal blepharospasm (ptBSP). The commonest pattern was pattern no. 2 (n = 53/94 [56.38%]), which was characterized by involuntary discharges in the OO muscle, together with a disturbed reciprocal innervation of the antagonist levator muscle and is dubbed disturbed reciprocal innervation (DRI). This EMG pattern is difficult to discern from the first pattern. Pattern no. 3 (n = 15/94 [15.9%]) is characterized by an isolated levator palpebrae inhibition (ILPI). This levator silence was observed alone without EMG evidence of contractions in the pretarsal orbicularis or a disturbed reciprocal relation of both muscles. CONCLUSION EMG evidence shows that the great majority (84%) of patients show a dystonic pattern, whereas ILPI (16%) does not fit the dystonic spectrum. The authors propose that a spasmodic contraction of the muscle of Riolan may be the etiological basis for levator inhibition in patients with ILPI. If this is true, all the 3 EMG patterns observed in scAEO patients (ptBSP, DRI, and ILPI) would represent an atypical form of BSP. The authors suggest coining the terms Riolan muscle BSP ( rmBSP ) for ILPI, and the term atypical focal eyelid dystonia ( AFED ) instead of the term scAEO, as both terms holistically encompass both the clinical and EMG data and concur with the authors' theorem.
Collapse
Affiliation(s)
- Hatem A Tawfik
- Department of Ophthalmology, Ain Shams University, Cairo, Egypt
| | - Jonathan J Dutton
- Department of Ophthalmology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| |
Collapse
|
10
|
Nawaz A, Hasan O, Jabeen S. Formal Verification of Deep Brain Stimulation Controllers for Parkinson's Disease Treatment. Neural Comput 2023; 35:671-698. [PMID: 36827600 DOI: 10.1162/neco_a_01569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/01/2022] [Indexed: 02/26/2023]
Abstract
Deep brain stimulation (DBS) is a widely accepted treatment for the Parkinson's disease (PD). Traditionally, it is done in an open-loop manner, where stimulation is always ON, irrespective of the patient needs. As a consequence, patients can feel some side effects due to the continuous high-frequency stimulation. Closed-loop DBS can address this problem as it allows adjusting stimulation according to the patient need. The selection of open- or closed-loop DBS and an optimal algorithm for closed-loop DBS are some of the main challenges in DBS controller design, and typically the decision is made through sampling based simulations. In this letter, we used model checking, a formal verification technique used to exhaustively explore the complete state space of a system, for analyzing DBS controllers. We analyze the timed automata of the open-loop and closed-loop DBS controllers in response to the basal ganglia (BG) model. Furthermore, we present a formal verification approach for the closed-loop DBS controllers using timed computation tree logic (TCTL) properties, that is, safety, liveness (the property that under certain conditions, some event will eventually occur), and deadlock freeness. We show that the closed-loop DBS significantly outperforms existing open-loop DBS controllers in terms of energy efficiency. Moreover, we formally analyze the closed-loop DBS for energy efficiency and time behavior with two algorithms, the constant update algorithm and the error prediction update algorithm. Our results demonstrate that the closed-loop DBS running the error prediction update algorithm is efficient in terms of time and energy as compared to the constant update algorithm.
Collapse
Affiliation(s)
- Arooj Nawaz
- School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad 44000, Pakistan
| | - Osman Hasan
- School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad 44000, Pakistan
| | - Shaista Jabeen
- Electrical and Computer Engineering Department, COMSATS University, Islamabad 45550, Pakistan
| |
Collapse
|
11
|
Efficacy of short pulse and conventional deep brain stimulation in Parkinson's disease: a systematic review and meta-analysis. Neurol Sci 2023; 44:815-825. [PMID: 36383263 DOI: 10.1007/s10072-022-06484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/28/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) is a common treatment for Parkinson's disease. However, the clinical efficacy of short pulse width DBS (spDBS) compared with conventional DBS (cDBS) is still unknown. OBJECTIVE This meta-analysis investigated the effectiveness of spDBS versus cDBS in patients with PD. METHODS Four databases (PubMed, Cochrane, Web of Science, and Embase) were independently searched until October 2021 by two reviewers. We utilized the following scales and items: therapeutic windows (TW), efficacy threshold, side effect threshold, Movement Disorder Society-Sponsored Revision Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III off-medication score, Speech Intelligence Test (SIT), and Freezing of Gait Questionnaire (FOG-Q). RESULTS The analysis included seven studies with a total of 87 patients. The results indicated that spDBS significantly widened the therapeutic windows (0.99, 95% CI = 0.61 to 1.38) while increasing the threshold amplitudes of side effects (2.25, 95% CI = 1.69 to 2.81) and threshold amplitudes of effects (1.60, 95% CI = 0.84 to 2.36). There was no statistically significant difference in UPDRS part III, SIT, and FOG-Q scores between spDBS and cDBS groups, suggesting that treatment with both cDBS and spDBS may result in similar effects of improved dysarthria and gait disorders. CONCLUSIONS Compared with cDBS, spDBS is effective in expanding TW. Both types of deep brain stimulation resulted in improved gait disorders and speech intelligibility.
Collapse
|
12
|
Tripoliti E, Ramig L. Elektrische Stimulation tiefer Hirnstrukturen: Auswirkungen auf das Sprechen. SPRACHE · STIMME · GEHÖR 2022. [DOI: 10.1055/a-1941-3588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
|
13
|
Liu J, Ding H, Xu K, Wang D, Ouyang J, Liu Z, Liu R. Micro lesion effect of pallidal deep‑brain stimulation for meige syndrome. Sci Rep 2022; 12:19980. [PMID: 36411289 PMCID: PMC9678874 DOI: 10.1038/s41598-022-23156-2] [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: 04/22/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022] Open
Abstract
To analyse the microlesion effect (MLE) in the globus pallidus interna (GPi) of deep brain stimulation (DBS) in patients with Meige syndrome. Thirty-two patients with primary Meige syndrome who underwent GPi-DBS in this study. Burke-Fahn-Marsden Dystonia Rating Scale scores (BFMDRS-M) were obtained for the evaluation of clinical symptoms at 3 days before DBS (baseline), 24 h after DBS surgery, once weekly for 1 month until electrical stimulation, 6 months postoperatively and 12 months after surgery. Twenty-seven patients had MLE after GPi-DBS. The mean time of BFMDRS-M scores maximal improvement from MLE was 35.9 h postoperatively (range, 24-48 h), and the mean scores improved by 49.35 ± 18.16%. At 12 months after surgery, the mean BFMDRS-M scores improved by 50.28 ± 29.70%. There was a positive correlation between the magnitude of MLE and the motor score at 12 months after GPi-DBS (R2 = 0.335, p < 0.05). However, there was no correlation between the duration of MLE and DBS improvement. Most Meige syndrome patients who underwent GPi-DBS and had MLE benefited from MLE. For Meige syndrome, MLE might be a predictive factor for patient clinical symptom improvement from DBS.
Collapse
Affiliation(s)
- Jiayu Liu
- grid.411634.50000 0004 0632 4559Department of Neurosurgery, Peking University People’s Hospital, 11Th Xizhimen South St., Beijing, 100044 China
| | - Hu Ding
- grid.411634.50000 0004 0632 4559Department of Neurosurgery, Peking University People’s Hospital, 11Th Xizhimen South St., Beijing, 100044 China
| | - Ke Xu
- grid.411634.50000 0004 0632 4559Department of Neurosurgery, Peking University People’s Hospital, 11Th Xizhimen South St., Beijing, 100044 China
| | - Dongliang Wang
- grid.411634.50000 0004 0632 4559Department of Neurosurgery, Peking University People’s Hospital, 11Th Xizhimen South St., Beijing, 100044 China
| | - Jia Ouyang
- grid.411634.50000 0004 0632 4559Department of Neurosurgery, Peking University People’s Hospital, 11Th Xizhimen South St., Beijing, 100044 China
| | - Zhi Liu
- grid.411634.50000 0004 0632 4559Department of Neurosurgery, Peking University People’s Hospital, 11Th Xizhimen South St., Beijing, 100044 China
| | - Ruen Liu
- grid.411634.50000 0004 0632 4559Department of Neurosurgery, Peking University People’s Hospital, 11Th Xizhimen South St., Beijing, 100044 China
| |
Collapse
|
14
|
MRI-guided DBS of STN under general anesthesia for Parkinson's disease: results and microlesion effect analysis. Acta Neurochir (Wien) 2022; 164:2279-2286. [PMID: 35841433 DOI: 10.1007/s00701-022-05302-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The efficacy of the subthalamic nucleus (STN) stimulation for Parkinson's disease has been widely established. The microlesion effect (MLE) due to deep brain stimulation (DBS) electrode implantation has been reputed to be a good predictor for long-term efficacy of the procedure but its analysis in asleep implantation is still unclear. We thus analyzed MLE rate in our strategy of targeting the STN on MRI under general anesthesia and its correlation with our long-term results. METHOD We retrospectively analyzed 32 consecutive parkinsonian patients implanted with a DBS targeting the STN bilaterally under general anesthesia between October 2013 and December 2020. Targeting was performed after head frame and localizer placement using a stereotactic peroperative robotic 3D fluoroscopy (Artis Zeego, Siemens) fused with preoperative CT and MRI data. We collected intraoperative data, postoperative occurrence of MLE, modification of Unified Parkinson Disease Rating Scale item III (UPDRS III) postoperatively and at subsequent visit, as well as reduction of medication. RESULTS The mean operative time was 223 min. No permanent complication occurred. MLE was observed in 90.7%. The mean follow-up time was 17 months. The UPDRS III for the off medication/on stimulation condition improved by 64.8% from baseline. The mean dose reduction of Prolopa after the surgical procedure was 31.3%. CONCLUSIONS Direct targeting of STN under general anesthesia based on preoperative CT and MRI data fused with a preoperative 3D fluoroscopy is safe. It allows for a high rate of postoperative MLE (90.7%) and results in prolonged clinical improvement.
Collapse
|
15
|
Ruiz MCM, Guimarães RP, Mortari MR. Parkinson’s Disease Rodent Models: are they suitable for DBS research? J Neurosci Methods 2022; 380:109687. [DOI: 10.1016/j.jneumeth.2022.109687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 07/20/2022] [Accepted: 08/02/2022] [Indexed: 11/20/2022]
|
16
|
Rispoli V, Díaz Crescitelli ME, Cavallieri F, Antonelli F, Meletti S, Ghirotto L, Valzania F. Needs and Perceptions of Patients With Dystonia During the COVID-19 Pandemic: A Qualitative Framework Analysis of Survey Responses From Italy. Front Neurol 2022; 13:808433. [PMID: 35785354 PMCID: PMC9243746 DOI: 10.3389/fneur.2022.808433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction:The COVID-19 pandemic and its countermeasures have created changes in both life and healthcare. With the prioritization of COVID-19-related management, the risks and experiences of patients suffering from rare conditions, such as dystonia, during the pandemic remain understudied.Materials and MethodsUsing a framework analysis of a nationwide qualitative online survey, we sought to explore the perspectives of patients with dystonia on their clinical assistance and possible unmet needs during the first pandemic wave. An online survey consisting of 37 items (such as demographic characteristics, dystonia-related features, neurological service provision, therapeutic relationship with the neurologist, perceptions related to virus infection, perceptions about healthcare-related needs, work-related questions, requesting information, and seeking support during the pandemic) was carried out using both close and open-ended questions.ResultsResponses from 62 participants were collected, with most of them from the red zones in Italy, where they were confined indoors. Social isolation was a relevant stressor. Motor and non-motor symptoms increased with detrimental consequences for patients' job and daily functionality. Outpatient clinics and rehabilitation sessions were temporarily shut down, and even telephone/mail support was sparse. Despite efforts, patients felt alone in dealing with dystonia.ConclusionThe first wave of the pandemic and its related restrictions had detrimental consequences for people living with dystonia, and their relevant needs remained unmet. These findings may contribute to implementing remedial healthcare provisions in this pandemic or in future pandemics.
Collapse
Affiliation(s)
- Vittorio Rispoli
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | | | - Francesco Cavallieri
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Antonelli
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Stefano Meletti
- Neurology, Neuroscience Head Neck Department, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
- Neurology Unit, Department of Biomedical, Metabolic and Neural Science, University of Modena and Reggio Emilia, Modena, Italy
| | - Luca Ghirotto
- Qualitative Research Unit - Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- *Correspondence: Luca Ghirotto
| | - Franco Valzania
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
17
|
Chandra V, Hilliard JD, Foote KD. Deep brain stimulation for the treatment of tremor. J Neurol Sci 2022; 435:120190. [DOI: 10.1016/j.jns.2022.120190] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/07/2022] [Accepted: 02/17/2022] [Indexed: 01/15/2023]
|
18
|
Wang J, Fergus SP, Johnson LA, Nebeck SD, Zhang J, Kulkarni S, Bokil H, Molnar GF, Vitek JL. Shuffling Improves the Acute and Carryover Effect of Subthalamic Coordinated Reset Deep Brain Stimulation. Front Neurol 2022; 13:716046. [PMID: 35250798 PMCID: PMC8894645 DOI: 10.3389/fneur.2022.716046] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 01/18/2022] [Indexed: 02/05/2023] Open
Abstract
Coordinated reset deep brain stimulation (CR DBS) in the subthalamic nucleus (STN) has been demonstrated effective for the treatment of the motor signs associated with Parkinson's disease (PD). A critical CR parameter is an order in which stimulation is delivered across contacts. The relative effect of alternating vs. not alternating this order, i.e., shuffling vs. non-shuffling, however, has not been evaluated in vivo. The objective of this study is to compare the effect of shuffled vs. non-shuffled STN CR DBS on Parkinsonian motor signs. Two Parkinsonian non-human primates were implanted with a DBS lead in the STN. The effects of STN CR DBS with and without shuffling were compared with the traditional isochronal DBS (tDBS) using a within-subject design. For each stimulation setting, DBS was delivered for 2 or 4 h/day for 5 consecutive days. The severity of PD was assessed using a modified clinical rating scale immediately before, during, and 1 h after DBS, as well as on days following the discontinuation of the 5 days of daily stimulation, i.e., carryover effect. Shuffled STN CR DBS produced greater acute and carryover improvements on Parkinsonian motor signs compared with non-shuffled CR. Moreover, this difference was more pronounced when more effective stimulation intensity and burst frequency settings were used. tDBS showed limited carryover effects. Given the significant effect of shuffling on the effectiveness of CR DBS, it will be critical for future studies to further define the relative role of different CR parameters for the clinical implementation of this novel stimulation paradigm.
Collapse
Affiliation(s)
- Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Sinta P. Fergus
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Luke A. Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Shane D. Nebeck
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Jianyu Zhang
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | | | - Hemant Bokil
- Boston Scientific Neuromodulation, Valencia, CA, United States
| | - Gregory F. Molnar
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| |
Collapse
|
19
|
Oswal A, Cao C, Yeh CH, Neumann WJ, Gratwicke J, Akram H, Horn A, Li D, Zhan S, Zhang C, Wang Q, Zrinzo L, Foltynie T, Limousin P, Bogacz R, Sun B, Husain M, Brown P, Litvak V. Neural signatures of hyperdirect pathway activity in Parkinson's disease. Nat Commun 2021; 12:5185. [PMID: 34465771 PMCID: PMC8408177 DOI: 10.1038/s41467-021-25366-0] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/02/2021] [Indexed: 11/25/2022] Open
Abstract
Parkinson's disease (PD) is characterised by the emergence of beta frequency oscillatory synchronisation across the cortico-basal-ganglia circuit. The relationship between the anatomy of this circuit and oscillatory synchronisation within it remains unclear. We address this by combining recordings from human subthalamic nucleus (STN) and internal globus pallidus (GPi) with magnetoencephalography, tractography and computational modelling. Coherence between supplementary motor area and STN within the high (21-30 Hz) but not low (13-21 Hz) beta frequency range correlated with 'hyperdirect pathway' fibre densities between these structures. Furthermore, supplementary motor area activity drove STN activity selectively at high beta frequencies suggesting that high beta frequencies propagate from the cortex to the basal ganglia via the hyperdirect pathway. Computational modelling revealed that exaggerated high beta hyperdirect pathway activity can provoke the generation of widespread pathological synchrony at lower beta frequencies. These findings suggest a spectral signature and a pathophysiological role for the hyperdirect pathway in PD.
Collapse
Affiliation(s)
- Ashwini Oswal
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
- The Wellcome Centre for Human Neuroimaging, University College London, London, UK.
| | - Chunyan Cao
- Department of Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Chien-Hung Yeh
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- School of Information and Electronics Engineering, Beijing Institute of Technology, Beijing, China
| | | | - James Gratwicke
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Harith Akram
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Andreas Horn
- Department of Neurology, Charité University, Berlin, Germany
| | - Dianyou Li
- Department of Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Shikun Zhan
- Department of Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Chao Zhang
- Department of Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Qiang Wang
- Department of Neurology, Charité University, Berlin, Germany
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Rafal Bogacz
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Bomin Sun
- Department of Neurosurgery, Affiliated Ruijin Hospital, School of Medicine, Shanghai JiaoTong University, Shanghai, China
| | - Masud Husain
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Peter Brown
- MRC Brain Network Dynamics Unit, University of Oxford, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| | - Vladimir Litvak
- The Wellcome Centre for Human Neuroimaging, University College London, London, UK.
| |
Collapse
|
20
|
Strotzer QD, Kohl Z, Anthofer JM, Faltermeier R, Schmidt NO, Torka E, Greenlee MW, Fellner C, Schlaier JR, Beer AL. Structural Connectivity Patterns of Side Effects Induced by Subthalamic Deep Brain Stimulation for Parkinson's Disease. Brain Connect 2021; 12:374-384. [PMID: 34210163 DOI: 10.1089/brain.2021.0051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Tractography based on diffusion-weighted magnetic resonance imaging (DWI) models the structural connectivity of the human brain. Deep brain stimulation (DBS) targeting the subthalamic nucleus is an effective treatment for advanced Parkinson's disease, but may induce adverse effects. This study investigated the relationship between structural connectivity patterns of DBS electrodes and stimulation-induced side effects. Materials and Methods: Twenty-one patients with Parkinson's disease treated with bilateral subthalamic DBS were examined. Overall, 168 electrode contacts were categorized as inducing or noninducing depending on their capability for inducing side effects such as motor effects, paresthesia, dysarthria, oculomotor effects, hyperkinesia, and other complications as assessed during the initial programming session. Furthermore, the connectivity of each contact with target regions was evaluated by probabilistic tractography based on DWI. Finally, stimulation sites and structural connectivity patterns of inducing and noninducing contacts were compared. Results: Inducing contacts differed across the various side effects and from those mitigating Parkinson's symptoms. Although contacts showed a largely overlapping spatial distribution within the subthalamic region, they could be distinguished by their connectivity patterns. In particular, inducing contacts were more likely connected with supplementary motor areas (hyperkinesia, dysarthria), frontal cortex (oculomotor), fibers of the internal capsule (paresthesia), and the basal ganglia-thalamo-cortical circuitry (dysarthria). Discussion: Side effects induced by DBS seem to be associated with distinct connectivity patterns. Cerebellar connections are hardly associated with side effects, although they seem relevant for mitigating motor symptoms in Parkinson's disease. A symptom-specific, connectivity-based approach for target planning in DBS may enhance treatment outcomes and reduce adverse effects.
Collapse
Affiliation(s)
- Quirin D Strotzer
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany.,Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany.,Institute of Radiology, and University of Regensburg Medical Center, Regensburg, Germany
| | - Zacharias Kohl
- Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany.,Department of Neurology, University of Regensburg Medical Center, Regensburg, Germany.,Department of Molecular Neurology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Judith M Anthofer
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany.,Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany
| | - Rupert Faltermeier
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany
| | - Nils O Schmidt
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany
| | - Elisabeth Torka
- Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany.,Department of Neurology, University of Regensburg Medical Center, Regensburg, Germany
| | - Mark W Greenlee
- Institute of Psychology, University of Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Institute of Radiology, and University of Regensburg Medical Center, Regensburg, Germany
| | - Juergen R Schlaier
- Department of Neurosurgery, University of Regensburg Medical Center, Regensburg, Germany.,Center for Deep Brain Stimulation, University of Regensburg Medical Center, Regensburg, Germany
| | - Anton L Beer
- Institute of Psychology, University of Regensburg, Regensburg, Germany
| |
Collapse
|
21
|
Wilt JA, Merner AR, Zeigler J, Montpetite M, Kubu CS. Does Personality Change Follow Deep Brain Stimulation in Parkinson's Disease Patients? Front Psychol 2021; 12:643277. [PMID: 34393883 PMCID: PMC8361492 DOI: 10.3389/fpsyg.2021.643277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Deep Brain Stimulation (DBS) has emerged as a safe, effective, and appealing treatment for Parkinson's Disease (PD), particularly for improving motor symptoms (e. g., tremor, bradykinesia, and rigidity). However, concerns have been raised about whether DBS causes psychological changes, including changes to personality: characteristic and relatively stable patterns of affect, behavior, cognition, and desire. In this article, after first presenting some background information about PD and DBS, we examined evidence obtained from various empirical research methods (quantitative, qualitative, and mixed methods for evaluating patient valued characteristics) pertaining to whether DBS causes personality change. General limitations across research methods include a lack of randomized clinical trials and small sample sizes. We organized our review of findings according to different layers of personality variables: dispositional traits (including personality pathology), characteristic adaptations, and narrative identity. Though most work has been done on dispositional traits, there is not much evidence that dispositional traits change following DBS. Little work has been done on characteristic adaptations, but there is somewhat consistent evidence for positive perceived progress toward goals across a number of domains: routine activities, work, social/relational, and leisure. Nascent work on narrative identity holds promise for revealing issues around self-image that may be common following DBS. We listed a number of strategies for advancing research, highlighting opportunities related to personality conceptualization, personality assessment, and interdisciplinary scholarship. Finally, we offer practical applications of our findings for the informed consent process and for ongoing treatment.
Collapse
Affiliation(s)
- Joshua A Wilt
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States.,Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Jaclyn Zeigler
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | | | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| |
Collapse
|
22
|
Vos SH, Kessels RPC, Vinke RS, Esselink RAJ, Piai V. The Effect of Deep Brain Stimulation of the Subthalamic Nucleus on Language Function in Parkinson's Disease: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2794-2810. [PMID: 34157249 DOI: 10.1044/2021_jslhr-20-00515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose This systematic review focuses on the effect of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on language function in Parkinson's disease (PD). It fills an important gap in recent reviews by considering other language tasks in addition to verbal fluency. Method We critically and systematically reviewed the literature on studies that investigated the effect of bilateral STN-DBS on language function in PD. All studies included a matched PD control group who were on best medical treatment, with language testing at similar baseline and follow-up intervals as the DBS PD group. Results Thirteen identified studies included a form of a verbal fluency task, seven studies included picture naming, and only two studies included more language-oriented tasks. We found that verbal fluency was negatively affected after DBS, whereas picture naming was unaffected. Studies investigating individual change patterns using reliable change indices showed that individual variability is larger for picture naming than for verbal fluency. Conclusions Verbal fluency is the most frequently investigated aspect of language function. Our analysis showed a pattern of decline in verbal fluency across multiple studies after STN-DBS, whereas picture naming was unaffected. Data on more language-oriented tests in a large DBS sample and best medical treatment control group are sparse. The investigation of language function in PD after DBS requires sensitive language tests (with and without time pressure) and experimental designs as used in the studies reviewed here. Reliable change index statistics are a promising tool for investigating individual differences in performance after DBS. Supplemental Material https://doi.org/10.23641/asha.14794458.
Collapse
Affiliation(s)
- Sandra H Vos
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - R Saman Vinke
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rianne A J Esselink
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vitória Piai
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| |
Collapse
|
23
|
Wei X, Zhang H, Gong B, Chang S, Lu M, Yi G, Zhang Z, Deng B, Wang J. An Embedded Multi-Core Real-Time Simulation Platform of Basal Ganglia for Deep Brain Stimulation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1328-1340. [PMID: 34232884 DOI: 10.1109/tnsre.2021.3095316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Closed-loop deep brain stimulation (DBS) paradigm is gaining tremendous favor due to its potential capability of further and more efficient improvements in neurological diseases. Preclinical validation of closed-loop controller is quite necessary in order to minimize injury risks of clinical trials to patients, which can greatly benefit from real-time computational models and thus potentially reduce research and development costs and time. Here we developed an embedded multi-core real-time simulation platform (EMC-RTP) for a biological-faithful computational network model of basal ganglia (BG). The single neuron model is implemented in a highly real-time manner using a reasonable simplification. A modular mapping architecture with hierarchical routing organization was constructed to mimic the pathological neural activities of BG observed in parkinsonian conditions. A closed-loop simulation testbed for DBS validation was then set up using a host computer as the DBS controller. The availability of EMC-RTP and the testbed system was validated by comparing the performance of open-loop and proportional-integral (PI) controllers. Our experimental results showed that the proposed EMC-RTP reproduces abnormal beta bursts of BG in parkinsonian conditions while meets requirements of both real-time and computational accuracy as well. Closed-loop DBS experiments using the EMC-RTP suggested that the platform could perform reasonable output under different kinds of DBS strategies, indicating the usability of the platform.
Collapse
|
24
|
Weiss D, Volkmann J, Fasano A, Kühn A, Krack P, Deuschl G. Changing Gears - DBS For Dopaminergic Desensitization in Parkinson's Disease? Ann Neurol 2021; 90:699-710. [PMID: 34235776 DOI: 10.1002/ana.26164] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/06/2021] [Accepted: 07/06/2021] [Indexed: 12/19/2022]
Abstract
In Parkinson's disease, both motor and neuropsychiatric complications unfold as a consequence of both incremental striatal dopaminergic denervation and intensifying long-term dopaminergic treatment. Together, this leads to 'dopaminergic sensitization' steadily increasing motor and behavioral responses to dopaminergic medication that result in the detrimental sequalae of long-term dopaminergic treatment. We review the clinical presentations of 'dopaminergic sensitization', including rebound off and dyskinesia in the motor domain, and neuropsychiatric fluctuations and behavioral addictions with impulse control disorders and dopamine dysregulation syndrome in the neuropsychiatric domain. We summarize state-of-the-art deep brain stimulation, and show that STN-DBS allows dopaminergic medication to be tapered, thus supporting dopaminergic desensitization. In this framework, we develop our integrated debatable viewpoint of "changing gears", that is we suggest rethinking earlier use of subthalamic nucleus deep brain stimulation, when the first clinical signs of dopaminergic motor or neuropsychiatric complications emerge over the steadily progressive disease course. In this sense, subthalamic deep brain stimulation may help reduce longitudinal motor and neuropsychiatric symptom expression - importantly, not by neuroprotection but by supporting dopaminergic desensitization through postoperative medication reduction. Therefore, we suggest considering STN-DBS early enough before patients encounter potentially irreversible psychosocial consequences of dopaminergic complications, but importantly not before a patient shows first clinical signs of dopaminergic complications. We propose to consider neuropsychiatric dopaminergic complications as a new inclusion criterion in addition to established motor criteria, but this concept will require validation in future clinical trials. ANN NEUROL 2021.
Collapse
Affiliation(s)
- Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilian-University, Würzburg, Germany
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, ON, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Andrea Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig Holstein (UKSH), Christian-Albrechts-University Kiel, Kiel, Germany
| |
Collapse
|
25
|
Kim MJ, Chang KW, Park SH, Chang WS, Jung HH, Chang JW. Stimulation-Induced Side Effects of Deep Brain Stimulation in the Ventralis Intermedius and Posterior Subthalamic Area for Essential Tremor. Front Neurol 2021; 12:678592. [PMID: 34177784 PMCID: PMC8220085 DOI: 10.3389/fneur.2021.678592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) targeting the ventralis intermedius (VIM) nucleus of the thalamus and the posterior subthalamic area (PSA) has been shown to be an effective treatment for essential tremor (ET). The aim of this study was to compare the stimulation-induced side effects of DBS targeting the VIM and PSA using a single electrode. Patients with medication-refractory ET who underwent DBS electrode implantation between July 2011 and October 2020 using a surgical technique that simultaneously targets the VIM and PSA with a single electrode were enrolled in this study. A total of 93 patients with ET who had 115 implanted DBS electrodes (71 unilateral and 22 bilateral) were enrolled. The Clinical Rating Scale for Tremor (CRST) subscores improved from 20.0 preoperatively to 4.3 (78.5% reduction) at 6 months, 6.3 (68.5% reduction) at 1 year, and 6.5 (67.5% reduction) at 2 years postoperation. The best clinical effect was achieved in the PSA at significantly lower stimulation amplitudes. Gait disturbance and clumsiness in the leg was found in 13 patients (14.0%) upon stimulation of the PSA and in significantly few patients upon stimulation of the VIM (p = 0.0002). Fourteen patients (15.1%) experienced dysarthria when the VIM was stimulated; this number was significantly more than that with PSA stimulation (p = 0.0233). Transient paresthesia occurred in 13 patients (14.0%) after PSA stimulation and in six patients (6.5%) after VIM stimulation. Gait disturbance and dysarthria were significantly more prevalent in patients undergoing bilateral DBS than in those undergoing unilateral DBS (p = 0.00112 and p = 0.0011, respectively). Paresthesia resolved either after reducing the amplitude or switching to bipolar stimulation. However, to control gait disturbance and dysarthria, some loss of optimal tremor control was necessary at that particular electrode contact. In the present study, the most common stimulation-induced side effect associated with VIM DBS was dysarthria, while that associated with PSA DBS was gait disturbance. Significantly, more side effects were associated with bilateral DBS than with unilateral DBS. Therefore, changing active DBS contacts to simultaneous targeting of the VIM and PSA may be especially helpful for ameliorating stimulation-induced side effects.
Collapse
Affiliation(s)
- Myung Ji Kim
- Department of Neurosurgery, Korea University Medical Center, Korea University College of Medicine, Ansan Hospital, Ansan-si, South Korea
| | - Kyung Won Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - So Hee Park
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Won Seok Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| | - Jin Woo Chang
- Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
26
|
Ali HAM, Abdullah SS, Faraj MK. High impedance analysis in recordings of deep brain stimulation surgery. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
27
|
Merner AR, Frazier T, Ford PJ, Cooper SE, Machado A, Lapin B, Vitek J, Kubu CS. Changes in Patients' Desired Control of Their Deep Brain Stimulation and Subjective Global Control Over the Course of Deep Brain Stimulation. Front Hum Neurosci 2021; 15:642195. [PMID: 33732125 PMCID: PMC7959799 DOI: 10.3389/fnhum.2021.642195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/27/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: To examine changes in patients’ desired control of the deep brain stimulator (DBS) and perception of global life control throughout DBS. Methods: A consecutive cohort of 52 patients with Parkinson’s disease (PD) was recruited to participate in a prospective longitudinal study over three assessment points (pre-surgery, post-surgery months 3 and 6). Semi-structured interviews assessing participants’ desire for stimulation control and perception of global control were conducted at all three points. Qualitative data were coded using content analysis. Visual analog scales were embedded in the interviews to quantify participants’ perceptions of control over time. Results: Participants reported significant increases in their perception of global control over time and significant declines in their desired control of the stimulation. These changes were unrelated to improvements in motor symptoms. Improvements in global control were negatively correlated with a decline in desired stimulation control. Qualitative data indicate that participants have changed, nuanced levels of desired control over their stimulators. Increased global life control following DBS may be attributed to increased control over PD symptoms, increased ability to engage in valued activities, and increased overall self-regulation, while other domains related to global control remained unaffected by DBS. Conclusions: There are few empirical data documenting patients’ desire for stimulation control throughout neuromodulation and how stimulation control is related to other aspects of control despite the growing application of neuromodulation devices to treat a variety of disorders. Our data highlight distinctions in different types of control and have implications for the development of patient-controlled neurostimulation devices.
Collapse
Affiliation(s)
- Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States.,Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Thomas Frazier
- Department of Psychology, John Carroll University, University Heights, OH, United States
| | - Paul J Ford
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States.,Neuroethics Program, Cleveland Clinic, Cleveland, OH, United States
| | - Scott E Cooper
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Andre Machado
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
| | - Brittany Lapin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States.,Center for Outcomes Research and Evaluation, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States
| | - Jerrold Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States.,Neuroethics Program, Cleveland Clinic, Cleveland, OH, United States
| |
Collapse
|
28
|
Piano C, Bove F, Tufo T, Imbimbo I, Genovese D, Stefani A, Marano M, Peppe A, Brusa L, Cerroni R, Motolese F, Di Stasio E, Mazza M, Daniele A, Olivi A, Calabresi P, Bentivoglio AR. Effects of COVID-19 Lockdown on Movement Disorders Patients With Deep Brain Stimulation: A Multicenter Survey. Front Neurol 2020; 11:616550. [PMID: 33391174 PMCID: PMC7772207 DOI: 10.3389/fneur.2020.616550] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/16/2020] [Indexed: 12/14/2022] Open
Abstract
Background: The containment measures taken by Italian government authorities during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic caused the interruption of neurological activities of outpatient clinics. Vulnerable patients, as Parkinson's disease (PD) and dystonic patients with deep brain stimulation (DBS), may have an increased risk of chronic stress related to social restriction measures and may show a potential worsening of motor and psychiatric symptoms. Methods: This cross-sectional multicenter study was carried out during the SARS-CoV-2 pandemic and was based on a structured survey administered during a telephone call. The questionnaire was designed to gather motor and/or psychiatric effects of the lockdown and coronavirus disease 2019 (COVID-19) epidemiologic information in PD and dystonic patients with a functioning DBS implant. Results: One hundred four patients were included in the study, 90 affected by PD and 14 by dystonia. Forty-nine patients reported a subjective perception of worsening of global neurological symptoms (motor and/or psychiatric) related to the containment measures. In the multivariate analysis, having problems with the DBS device was the only independent predictor of motor worsening [odds ratio (OR) = 3.10 (1.22–7.91), p = 0.018]. Independent predictors of psychiatric worsening were instrumental activities of daily living (IADL) score [OR = 0.78 (0.64–0.95), p = 0.012] and problems with DBS [OR = 5.69 (1.95–16.62), p = 0.001]. Only one patient underwent nasopharyngeal swabs, both negative, and no patient received a diagnosis of COVID-19. Conclusions: Lockdown restriction measures were associated with subjective worsening of motor and psychiatric symptoms in PD and dystonic patients treated with DBS, and they may have exacerbated the burden of neurological disease and increased the chronic stress related to the DBS management.
Collapse
Affiliation(s)
- Carla Piano
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Tommaso Tufo
- Neurosurgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Isabella Imbimbo
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Fondazione Don Carlo Gnocchi Onlus, Milan, Italy
| | - Danilo Genovese
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Stefani
- Department of System Medicine, Unità Operativa Semplice Dipartimentale (UOSD) Parkinson, University of Rome Tor Vergata, Rome, Italy
| | - Massimo Marano
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | - Livia Brusa
- Neurology Unit, S. Eugenio Hospital, Rome, Italy
| | - Rocco Cerroni
- Department of System Medicine, Unità Operativa Semplice Dipartimentale (UOSD) Parkinson, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Motolese
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Enrico Di Stasio
- Unit of Chemistry, Biochemistry and Clinical Molecular Biology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Institute of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marianna Mazza
- Department of Geriatrics, Neuroscience and Orthopedics, Institute of Psychiatry and Psychology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Daniele
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy.,Neurosurgery Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Calabresi
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anna Rita Bentivoglio
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Department of Neurosciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | | |
Collapse
|
29
|
Aubignat M, Lefranc M, Tir M, Krystkowiak P. Deep brain stimulation programming in Parkinson's disease: Introduction of current issues and perspectives. Rev Neurol (Paris) 2020; 176:770-779. [DOI: 10.1016/j.neurol.2020.02.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 01/28/2020] [Accepted: 02/12/2020] [Indexed: 12/11/2022]
|
30
|
Palleis C, Gehmeyr M, Mehrkens JH, Bötzel K, Koeglsperger T. Establishment of a Visual Analog Scale for DBS Programming (VISUAL-STIM Trial). Front Neurol 2020; 11:561323. [PMID: 33192994 PMCID: PMC7661931 DOI: 10.3389/fneur.2020.561323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022] Open
Abstract
Background: Deep brain stimulation (DBS) has become a standard treatment for advanced stages of Parkinson's disease, essential tremor, and dystonia. In addition to the correct surgical device implantation, effective programming is regarded to be the most important factor for clinical outcome. Despite established strategies for adjusting neurostimulation, DBS programming remains time- and resource-consuming. Although kinematic and neuronal biosignals have recently been examined as potential feedback for closed-loop DBS (CL-DBS), there is an ongoing need for programming strategies to adapt the stimulation parameters and electrode configurations accurately and effectively. Methods: Here, we tested the usefulness of a patient-rated visual analog scale (VAS) for real-time adjustment of DBS parameters. The stimulation parameters (contact and amplitude) in Parkinson's patients with STN-DBS (n = 17) were optimized based on the patient's subjective VAS rating. A Minkowski distance (Md) was calculated to compare the individual combination of contact selection and amplitude to the stimulation parameters that resulted from classical programming based on clinical signs and symptoms. Results: We found no statistically significant difference between VAS-based and classical programming in regard to the specific contact or amplitude used or in regard to the clinical disease severity (UPDRS). Conclusions: Our data suggest that VAS-based and classical programming strategies both lead to similar short-term results. Although further research will be required to assess the validity of VAS-based DBS programming, our results support the investigation of the patient's subjective rating as an additional and valid feedback signal for individualized DBS adjustment.
Collapse
Affiliation(s)
- Carla Palleis
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Mona Gehmeyr
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilian University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilian University, Munich, Germany
| | - Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilian University, Munich, Germany.,Department of Translational Brain Research, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| |
Collapse
|
31
|
Picillo M, Phokaewvarangkul O, Poon YY, McIntyre CC, Beylergil SB, Munhoz RP, Kalia SK, Hodaie M, Lozano AM, Fasano A. Levodopa Versus Dopamine Agonist after Subthalamic Stimulation in Parkinson's Disease. Mov Disord 2020; 36:672-680. [PMID: 33165964 PMCID: PMC8048876 DOI: 10.1002/mds.28382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 01/23/2023] Open
Abstract
Background No clinical trials have been specifically designed to compare medical treatments after surgery in Parkinson's disease (PD). Objective Study's objective was to compare the efficacy and safety of levodopa versus dopamine agonist monotherapy after deep brain stimulation (DBS) in PD. Methods Thirty‐five surgical candidates were randomly assigned to receive postoperative monotherapy with either levodopa or dopamine agonist in a randomized, single‐blind study. All patients were reevaluated in short‐ (3 months), mid‐ (6 months), and long‐term (2.5 years) follow‐up after surgery. The primary outcome measure was the change in the Non‐Motor Symptoms Scale (NMSS) 3 months after surgery. Secondary outcome measures were the percentage of patients maintaining monotherapy, change in motor symptoms, and specific non‐motor symptoms (NMS). Analysis was performed primarily in the intention‐to‐treat population. Results Randomization did not significantly affect the primary outcome (difference in NMSS between treatment groups was 4.88 [95% confidence interval: −11.78–21.53, P = 0.566]). In short‐ and mid‐term follow‐up, monotherapy was safe and feasible in more than half of patients (60% in short‐ and 51.5% in mid‐term follow‐up), but it was more often possible for patients on levodopa. The ability to maintain dopamine agonist monotherapy was related to optimal contact location. In the long term, levodopa monotherapy was feasible only in a minority of patients (34.2%), whereas dopamine agonist monotherapy was not tolerated due to worsening of motor conditions or occurrence of impulse control disorders. Conclusions This trial provides evidence for simplifying pharmacological treatment after functional neurosurgery for PD. The reduction in dopamine receptor agonists should be attempted while monitoring for occurrence of NMSs, such as apathy and sleep disturbances. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Collapse
Affiliation(s)
- Marina Picillo
- Department of Medicine, Surgery and Dentistry, Neuroscience Section, Centre for Neurodegenerative Diseases (CEMAND), University of Salerno, Salerno, Italy
| | - Onanong Phokaewvarangkul
- Department of Medicine, Faculty of Medicine, Chulalongkorn Centre of Excellence for Parkinson's Disease & Related Disorders, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Yu-Yan Poon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Sinem Balta Beylergil
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, Ohio, USA
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Krembil Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Krembil Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Krembil Research Institute, Toronto, Ontario, Canada.,Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| |
Collapse
|
32
|
Zhang C, Zhu K, Lin Z, Huang P, Pan Y, Sun B, Li D. Utility of Deep Brain Stimulation Telemedicine for Patients With Movement Disorders During the COVID-19 Outbreak in China. Neuromodulation 2020; 24:337-342. [PMID: 33006811 PMCID: PMC7646652 DOI: 10.1111/ner.13274] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To explore the utility of deep brain stimulation (DBS) telemedicine in the management of patients with movement disorders from January 2019 to March 2020, covering the main period of the COVID-19 outbreak in China. MATERIALS AND METHODS We obtained data from 40 hospitals around China that employed DBS tele-programming for their outpatients with Parkinson's disease or dystonia from January 2019 to March 2020. Data were obtained on the number and nature of patients' DBS health care service requests, reasons for their requests, the number of DBS telemedicine sessions subsequently completed, safety issues, and the patients' satisfaction with the DBS tele-programing parameter adjustments made. RESULTS There were 909 DBS tele-programming health service requests (from 196 patients) completed during the study period. The results showed: 1) the number of DBS telemedicine sessions requested and the number of patients examined increased during the COVID-19 outbreak in February and March 2020 when compared with the monthly numbers in 2019; 2) the most common reason for the patients' health service requests was poor symptom control; 3) the most common DBS tele-programming adjustment made was voltage change; 4) overall, most (89%) DBS tele-programming adjustment sessions were experienced by the patients as satisfactory; and 5) significant adverse events and unexpected treatment interruptions caused by connection failure or other hardware- or software-related problems did not occur. CONCLUSIONS DBS telemedicine could have a unique role to play in maintaining the delivery of DBS treatment and medical care to outpatients with movement disorders during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Kaiwen Zhu
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| |
Collapse
|
33
|
Dayal V, De Roquemaurel A, Grover T, Ferreira F, Salazar M, Milabo C, Candelario‐McKeown J, Zrinzo L, Akram H, Limousin P, Foltynie T. Novel Programming Features Help Alleviate Subthalamic Nucleus Stimulation‐Induced Side Effects. Mov Disord 2020; 35:2261-2269. [DOI: 10.1002/mds.28252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Viswas Dayal
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Alexis De Roquemaurel
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Timothy Grover
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Francisca Ferreira
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
| | - Maricel Salazar
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Catherine Milabo
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Joseph Candelario‐McKeown
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Harith Akram
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement Neurosciences University College London Institute of Neurology London United Kingdom
- Unit of Functional Neurosurgery National Hospital for Neurology and Neurosurgery London United Kingdom
| |
Collapse
|
34
|
Finger ME, Siddiqui MS, Morris AK, Ruckart KW, Wright SC, Haq IU, Madden LL. Auditory-Perceptual Evaluation of Deep Brain Stimulation on Voice and Speech in Patients With Dystonia. J Voice 2020; 34:636-644. [PMID: 30879706 PMCID: PMC6745002 DOI: 10.1016/j.jvoice.2019.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 02/15/2019] [Accepted: 02/19/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effects of globus pallidus interna (GPi) deep brain stimulation (DBS) on speech and voice quality of patients with primary, medically refractory dystonia. METHODS Voices of 14 patients aged ≥18 years (males = 7 and females = 7) with primary dystonia (DYT1 gene mutation dystonia = 4, cervical dystonia = 6, and generalized dystonia = 4) with bilateral GPi DBS were assessed. Five blinded raters (two fellowship-trained laryngologists and three speech/language pathologists) evaluated audio recordings of each patient pre- and post-DBS. Perceptual voice quality was rated using the Grade, Roughness, Breathiness, Asthenia, and Strain scale and changes in speech intelligibility were assessed with the Clinical Global Impression scale of Severity instrument. Inter-rater and intrarater reliability rates for perceptual voice ratings were assessed using the kappa coefficient. RESULTS Voice quality parameters showed mean improvements in Grade (P < 0.0001), Roughness (P = 0.0043), and Strain (P < 0.0001) 12 months post-DBS. Asthenia increased from baseline to 6 months (P = 0.0022) and declined significantly from 6 to 12 months (P = 0.0170). Breathiness did not change significantly over time. Speech intelligibility also improved from 6 to 12 months (P = 0.0202) and from pre-DBS to 12 months post-DBS (P = 0.0022). Grade and Strain ratings had nearly perfect and substantial inter-rater agreement (0.84 and 0.71, respectively). CONCLUSIONS Voice and speech intelligibility improved after bilateral GPi DBS for dystonia. GPi DBS may emerge as a potential treatment option for patients with medically refractory laryngeal dystonia.
Collapse
Affiliation(s)
- Mary E Finger
- Departments of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina; Departments of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Mustafa S Siddiqui
- Departments of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Amy K Morris
- Departments of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn W Ruckart
- Departments of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - S Carter Wright
- Departments of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ihtsham U Haq
- Departments of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lyndsay L Madden
- Departments of Otolaryngology-Head and Neck Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
| |
Collapse
|
35
|
Grover T, Georgiev D, Kalliola R, Mahlknecht P, Zacharia A, Candelario J, Hyam J, Zrinzo L, Hariz M, Foltynie T, Limousin P, Jahanshahi M, Tripoliti E. Effect of Low versus High Frequency Subthalamic Deep Brain Stimulation on Speech Intelligibility and Verbal Fluency in Parkinson's Disease: A Double-Blind Study. JOURNAL OF PARKINSONS DISEASE 2020; 9:141-151. [PMID: 30594934 DOI: 10.3233/jpd-181368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Subthalamic deep brain stimulation (STN-DBS) is an established treatment for late stage Parkinson's disease (PD). Speech intelligibility (SI) and verbal fluency (VF) have been shown to deteriorate following chronic STN-DBS. It has been suggested that speech might respond favourably to low frequency stimulation (LFS). OBJECTIVE We examined how SI, perceptual speech characteristics, phonemic and semantic VF and processes underlying it (clustering and switching) respond to LFS of 60 and 80 Hz in comparison to high frequency stimulation (HFS) (110, 130 and 200 Hz). METHODS In this double-blind study, 15 STN-DBS PD patients (mean age 65, SD = 5.8, 14 right handed, three females), were assessed at five stimulation frequencies: 60 Hz, 80 Hz, 110 Hz, 130 Hz and 200 Hz. In addition to the clinical neurological assessment of speech, VF and SI were assessed. RESULTS SI and in particular articulation, respiration, phonation and prosody improved with LFS (all p < 0.05). Phonemic VF switching improved with LFS (p = 0.005) but this did not translate to an improved phonemic VF score. A trend for improved semantic VF was found. A negative correlation was found between perceptual characteristics of speech and duration of chronic stimulation (all p < 0.05). CONCLUSIONS These findings highlight the need for meticulous programming of frequency to maximise SI in chronic STN-DBS. The findings further implicate stimulation frequency in changes to specific processes underlying VF, namely phonemic switching and demonstrate the potential to address such deficits through advanced adjustment of stimulation parameters.
Collapse
Affiliation(s)
- Timothy Grover
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Dejan Georgiev
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.,Department of Neurology, University Medical Centre Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Slovenia.,Faculty of Computer and Information Sciences, University of Ljubljana, Slovenia
| | - Rania Kalliola
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Philipp Mahlknecht
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK.,Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - André Zacharia
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Joseph Candelario
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Jonathan Hyam
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Thomas Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| | - Elina Tripoliti
- Sobell Department of Motor Neuroscience and Movement Disorders, Unit of Functional Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square, London, UK
| |
Collapse
|
36
|
Horn MA, Gulberti A, Gülke E, Buhmann C, Gerloff C, Moll CK, Hamel W, Volkmann J, Pötter‐Nerger M. A New Stimulation Mode for Deep Brain Stimulation in Parkinson's Disease: Theta Burst Stimulation. Mov Disord 2020; 35:1471-1475. [DOI: 10.1002/mds.28083] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 04/02/2020] [Accepted: 04/09/2020] [Indexed: 11/07/2022] Open
Affiliation(s)
- Martin A. Horn
- University Medical Center Hamburg‐Eppendorf Department of Neurology Hamburg Germany
| | - Alessandro Gulberti
- University Medical Center Hamburg‐Eppendorf Department of Neurology Hamburg Germany
- University Medical Center Hamburg‐Eppendorf Department of Neurophysiology and Pathophysiology Hamburg Germany
| | - Eileen Gülke
- University Medical Center Hamburg‐Eppendorf Department of Neurology Hamburg Germany
| | - Carsten Buhmann
- University Medical Center Hamburg‐Eppendorf Department of Neurology Hamburg Germany
| | - Christian Gerloff
- University Medical Center Hamburg‐Eppendorf Department of Neurology Hamburg Germany
| | - Christian K.E. Moll
- University Medical Center Hamburg‐Eppendorf Department of Neurophysiology and Pathophysiology Hamburg Germany
| | - Wolfgang Hamel
- University Medical Center Hamburg‐Eppendorf Department of Neurosurgery Hamburg Germany
| | - Jens Volkmann
- University Hospital Würzburg Department of Neurology Würzburg Germany
| | - Monika Pötter‐Nerger
- University Medical Center Hamburg‐Eppendorf Department of Neurology Hamburg Germany
| |
Collapse
|
37
|
LFP-Net: A deep learning framework to recognize human behavioral activities using brain STN-LFP signals. J Neurosci Methods 2020; 335:108621. [DOI: 10.1016/j.jneumeth.2020.108621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 01/21/2020] [Accepted: 01/31/2020] [Indexed: 11/21/2022]
|
38
|
Treatment of severe refractory dystonic tremor associated with cervical dystonia by bilateral deep brain stimulation: A case series report. Clin Neurol Neurosurg 2020; 190:105644. [DOI: 10.1016/j.clineuro.2019.105644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Revised: 11/08/2019] [Accepted: 12/16/2019] [Indexed: 11/21/2022]
|
39
|
Steinhardt J, Münte TF, Schmid SM, Wilms B, Brüggemann N. A systematic review of body mass gain after deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease. Obes Rev 2020; 21:e12955. [PMID: 31823457 DOI: 10.1111/obr.12955] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
This systematic review investigated the effects of deep brain stimulation of the subthalamic nucleus on extent and time course of body mass changes in patients with Parkinson's disease. A computerized search identified relevant articles using a priori defined inclusion and exclusion criteria. A descriptive analysis was calculated for the main outcome parameters body mass and BMI. Thirty-eight out of 206 studies fulfilled the inclusion criteria (979 patients aged 59.0±7.5 years). Considering the longest follow-up time for each study, body mass and BMI showed a mean increase across studies of +5.71kg (p < .0001; d = 0.64) and +1.8kg/m2 (p < .0001; d = 1.61). The time course of body mass gain revealed a continuous increase ranging from +3.25kg (d = 0.69) at 3 months, +3.88kg (d = 0.21) at 6 months, +6.35kg (d = 0.72) at 12 months, and +6.11kg (d = 1.02) greater than 12 months. Changes in BMI were associated with changes in disease severity (r = 0.502, p = .010) and pharmacological treatment (r = 0.440, p = .0231). Data suggest that body mass gain is one of the most common side effects of deep brain stimulation going beyond normalization of preoperative weight loss. Considering the negative health implications of overweight, we recommend the development of tailored therapies to prevent overweight and associated metabolic disorders following this treatment.
Collapse
Affiliation(s)
- Julia Steinhardt
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Department of Internal Medicine, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - Sebastian M Schmid
- Institute of Psychology II, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Britta Wilms
- Institute of Psychology II, University of Lübeck, Lübeck, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Lübeck, Germany.,Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| |
Collapse
|
40
|
Bouthour W, Béreau M, Kibleur A, Zacharia A, Tomkova Chaoui E, Fleury V, Benis D, Momjian S, Bally J, Lüscher C, Krack P, Burkhard PR. Dyskinesia‐inducing lead contacts optimize outcome of subthalamic stimulation in Parkinson's disease. Mov Disord 2019; 34:1728-1734. [DOI: 10.1002/mds.27853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/25/2019] [Accepted: 08/14/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Walid Bouthour
- Department of Neurology Geneva University Hospital Geneva Switzerland
- Department of Basic Neuroscience University of Geneva Geneva Switzerland
| | - Matthieu Béreau
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Astrid Kibleur
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - André Zacharia
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | | | - Vanessa Fleury
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Damien Benis
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Shahan Momjian
- Department of Neurosurgery Geneva University Hospital Geneva Switzerland
| | - Julien Bally
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Christian Lüscher
- Department of Neurology Geneva University Hospital Geneva Switzerland
- Department of Basic Neuroscience University of Geneva Geneva Switzerland
| | - Paul Krack
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | | |
Collapse
|
41
|
Castano-Candamil S, Piroth T, Reinacher P, Sajonz B, Coenen VA, Tangermann M. An Easy-to-Use and Fast Assessment of Patient-Specific DBS-Induced Changes in Hand Motor Control in Parkinson's Disease. IEEE Trans Neural Syst Rehabil Eng 2019; 27:2155-2163. [PMID: 31536010 DOI: 10.1109/tnsre.2019.2941453] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
For Parkinson's disease (PD), efficient and fast monitoring of fine motor function is fundamental for capturing transient phenomena induced by deep brain stimulation (DBS), thus, enabling a fast and accurate tuning of stimulation parameters. Tuning of DBS parameters is important for obtaining a patient-specific optimal clinical effect and to regularly compensate for disease progress. We propose a fine motor function assessment framework for capturing transient DBS-induced changes. The main goals are to obtain a fast, repeatable, objective, robust, and DBS-sensitive motor-score, in addition to a high-dimensional characterization of motor components by means of an interpretable data-driven model. To achieve this, we combine a hand motor-task, termed the copy-draw test, with a linear model for analyzing features extracted from the proposed task. The approach was tested with four patients totaling eight sessions analyzed. Our approach delivers a motor-score that is sensitive to DBS-induced changes in motor function. It can be applied repeatedly within seconds. The interpretability of the underlying machine learning model provides a direct overview of the feature relevance. This analysis allows to detect and characterize single movement components that are sensitive to DBS. The proposed assessment framework is an useful tool to push forward the data-driven identification of PD-relevant neural markers. Consequent to this end, the source code of the paradigm is made publicly available.
Collapse
|
42
|
Su F, Kumaravelu K, Wang J, Grill WM. Model-Based Evaluation of Closed-Loop Deep Brain Stimulation Controller to Adapt to Dynamic Changes in Reference Signal. Front Neurosci 2019; 13:956. [PMID: 31551704 PMCID: PMC6746932 DOI: 10.3389/fnins.2019.00956] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 08/26/2019] [Indexed: 12/19/2022] Open
Abstract
High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective in suppressing the motor symptoms of Parkinson's disease (PD). Current clinically-deployed DBS technology operates in an open-loop fashion, i.e., fixed parameter high-frequency stimulation is delivered continuously, invariant to the needs or status of the patient. This poses two major challenges: (1) depletion of the stimulator battery due to the energy demands of continuous high-frequency stimulation, (2) high-frequency stimulation-induced side-effects. Closed-loop deep brain stimulation (CL DBS) may be effective in suppressing parkinsonian symptoms with stimulation parameters that require less energy and evoke fewer side effects than open loop DBS. However, the design of CL DBS comes with several challenges including the selection of an appropriate biomarker reflecting the symptoms of PD, setting a suitable reference signal, and implementing a controller to adapt to dynamic changes in the reference signal. Dynamic changes in beta oscillatory activity occur during the course of voluntary movement, and thus there may be a performance advantage to tracking such dynamic activity. We addressed these challenges by studying the performance of a closed-loop controller using a biophysically-based network model of the basal ganglia. The model-based evaluation consisted of two parts: (1) we implemented a Proportional-Integral (PI) controller to compute optimal DBS frequencies based on the magnitude of a dynamic reference signal, the oscillatory power in the beta band (13-35 Hz) recorded from model globus pallidus internus (GPi) neurons. (2) We coupled a linear auto-regressive model based mapping function with the Routh-Hurwitz stability analysis method to compute the parameters of the PI controller to track dynamic changes in the reference signal. The simulation results demonstrated successful tracking of both constant and dynamic beta oscillatory activity by the PI controller, and the PI controller followed dynamic changes in the reference signal, something that cannot be accomplished by constant open-loop DBS.
Collapse
Affiliation(s)
- Fei Su
- Department of Biomedical Engineering, Duke University, Durham, NC, United States.,School of Mechanical and Electrical Engineering, Shandong Agricultural University, Tai'an, China.,School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Karthik Kumaravelu
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| | - Jiang Wang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, United States
| |
Collapse
|
43
|
Elkouzi A, Tsuboi T, Burns MR, Eisinger RS, Patel A, Deeb W. Dorsal GPi/GPe Stimulation Induced Dyskinesia in a Patient with Parkinson's Disease. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-685. [PMID: 31565536 PMCID: PMC6744811 DOI: 10.7916/tohm.v0.685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/05/2019] [Indexed: 01/16/2023]
Abstract
Clinical vignette A 68-year-old man with Parkinson’s disease (PD) had bilateral GPi DBS placed for management of his motor fluctuations. He developed stimulation-induced dyskinesia (SID) with left dorsal GPi stimulation. Clinical dilemma What do we know about SID in PD patients with GPi DBS? What are the potential strategies used to maximize the DBS therapeutic benefit and minimize the side effects of stimulation? Clinical solution Avoiding the contact implicated in SID and programming more ventral contacts, using lower voltage, frequency and pulse width and programming in bipolar configuration all appear to help minimize the SID and provide appropriate symptomatic motor control. Gap in knowledge Little is known about SID in patients with PD who had GPi DBS therapy. More studies using volume of tissue activated and diffusion tensor imaging MRI are needed to localize specific tracts in or around the GPi that may be implicated in SID.
Collapse
Affiliation(s)
- Ahmad Elkouzi
- Department of Neurology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Takashi Tsuboi
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | - Matthew R Burns
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| | | | - Amar Patel
- Department of Neurology, Yale school of Medicine, Yale University, New Haven, CT, USA
| | - Wissam Deeb
- Fixel Institute for Neurological Diseases, Gainesville, FL, USA
| |
Collapse
|
44
|
Eleopra R, Rinaldo S, Devigili G, Lettieri C, Mondani M, D'Auria S, Piacentino M, Pilleri M. Brain impedance variation of directional leads implanted in subthalamic nuclei of Parkinsonian patients. Clin Neurophysiol 2019; 130:1562-1569. [PMID: 31301634 DOI: 10.1016/j.clinph.2019.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 06/13/2019] [Accepted: 06/14/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Conventional deep brain stimulation (DBS) systems with ring-shaped leads generate spherical electrical fields. In contrast, novel directional leads use segmented electrodes. Aim of this study was to quantify the impedance variations over time in subjects with the directional Cartesia-Boston® system. METHODS Impedance records, programming settings, and clinical data of 11 consecutive Parkinsonian patients implanted with DBS directional leads in two Italian centers (Udine and Vicenza) were retrospectively evaluated. Data were collected before starting stimulation (in the operating room and at days 5 and 40) and after switching stimulation on at the successive follow-up visits (1, 6 and 12 months). RESULTS Directional leads have significantly higher impedance than ring leads. Stimulated contacts had always lower impedance compared to non-stimulated contacts. Before DBS-on, all contacts had higher impedance in the operating room, with an initial decrease five days post-surgery and a subsequent increase at day 40, more evident for directional contacts. The impedance of directional leads increased post-implantation at 1 and 6 months with a plateau at 12 months. CONCLUSIONS There was a significant difference between the directional and ring leads at baseline (before activation of DBS) and during follow-up (chronic DBS). SIGNIFICANCE Our study reveals new information about the impedance of segmented electrodes that is useful for patient management during the initial test period, as well as during long-term DBS follow-up.
Collapse
Affiliation(s)
- Roberto Eleopra
- Neurological Unit I, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy.
| | - Sara Rinaldo
- Neurological Unit I, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Grazia Devigili
- Neurological Unit I, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Christian Lettieri
- Neurological Unit, S. Maria della Misericordia Universital Hospital, Udine, Italy
| | - Massimo Mondani
- Neurosurgical Unit, S. Maria della Misericordia Universital Hospital, Udine, Italy
| | - Stanislao D'Auria
- Neurosurgical Unit, S. Maria della Misericordia Universital Hospital, Udine, Italy
| | | | - Manuela Pilleri
- Neurological Unit, Villa Margherita Hospital, Arcugnano, Vicenza, Italy
| |
Collapse
|
45
|
Seritan AL, Heiry M, Iosif AM, Dodge M, Ostrem JL. Telepsychiatry for patients with movement disorders: a feasibility and patient satisfaction study. JOURNAL OF CLINICAL MOVEMENT DISORDERS 2019; 6:1. [PMID: 31183157 PMCID: PMC6555013 DOI: 10.1186/s40734-019-0077-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/27/2019] [Indexed: 01/01/2023]
Abstract
Background Telemedicine is a convenient health service delivery modality for patients with movement disorders, including Parkinson's disease (PD), but is currently underutilized in the management of associated psychiatric symptoms. This study explored the feasibility of and patient satisfaction with telepsychiatry services at an academic movement disorders center. Methods All patients seen by telepsychiatry between January and December 2017 at the UCSF Movement Disorders and Neuromodulation Center were invited to participate. Participation was voluntary. Patients received an initial survey after the first telepsychiatry visit and satisfaction surveys after each visit. Survey responses were collected online via Research Electronic Data Capture (REDCap). Frequencies were calculated for categorical variables, and means and standard deviations were generated for continuous variables. Results Thirty-three patients (79% with PD; 72% Medicare recipients; 64% men; mean age, 61.1 ± 10.5 years; mean distance to clinic, 79.9 ± 81.3 miles) completed a total of 119 telepsychiatry and 62 in-person visits. Twenty-two initial surveys and 50 satisfaction surveys (from 21 patients) were collected. Patients were very satisfied with the care (95%), convenience (100%), comfort (95%), and overall visit (95%). Technical quality was somewhat lower rated, with 76% patients reporting they were very satisfied, while 19% were satisfied. All patients would recommend telemedicine to friends or family members. Conclusions Telepsychiatry is a feasible option for patients with movement disorders, leading to high patient satisfaction and improved access to care. Technical aspects still need optimization. Whenever available, telepsychiatry can be considered in addition to in-person visits. Future studies with larger samples should explore its impact on patient care outcomes and caregiver burden.
Collapse
Affiliation(s)
- Andreea L Seritan
- 1Department of Psychiatry, University of California, 401 Parnassus Ave, Box 0984-APC, San Francisco, CA 94143 USA.,2University of California, San Francisco Weill Institute for Neurosciences, San Francisco, USA
| | - Melissa Heiry
- 2University of California, San Francisco Weill Institute for Neurosciences, San Francisco, USA.,3Department of Neurology, University of California, San Francisco, San Francisco, California USA
| | - Ana-Maria Iosif
- 4Department of Public Health Sciences, University of California, Davis, Davis, California USA
| | - Michael Dodge
- 5University of California, San Francisco, School of Medicine, San Francisco, USA
| | - Jill L Ostrem
- 2University of California, San Francisco Weill Institute for Neurosciences, San Francisco, USA.,3Department of Neurology, University of California, San Francisco, San Francisco, California USA
| |
Collapse
|
46
|
Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K. Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies. Front Neurol 2019; 10:410. [PMID: 31231293 PMCID: PMC6558426 DOI: 10.3389/fneur.2019.00410] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).
Collapse
Affiliation(s)
- Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| |
Collapse
|
47
|
Continuous subcutaneous apomorphine infusion in Parkinson's disease: causes of discontinuation and subsequent treatment strategies. Neurol Sci 2019; 40:1917-1923. [PMID: 31111272 DOI: 10.1007/s10072-019-03920-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 05/02/2019] [Indexed: 11/27/2022]
Abstract
Continuous subcutaneous apomorphine infusion (CSAI) is a well-recognized therapeutic option for the management of motor fluctuations in Parkinson's disease (PD), although clinical experience suggests that most patients discontinue CSAI after a variable amount of time due to several causes and circumstances. The objective of the present study was to evaluate the reasons of CSAI discontinuation and to investigate which treatment was adopted afterwards. Two independent raters retrospectively reviewed the electronic medical record of 114 patients treated with CSAI for at least 6 months. The records were reviewed regarding efficacy, safety, and evolution of CSAI treatment. Most of PD patients on CSAI had a significant improvement in their clinical condition. Lack of improvement of dyskinesia was the most frequent causes of treatment discontinuation. The second reason for CSAI discontinuation was cognitive deterioration. At CSAI discontinuation, younger patients were more likely to undergo deep brain stimulation (DBS), while older patients and patients with cognitive impairment were more likely switched to oral therapy alone (OTA). CSAI is an effective treatment that unfortunately must be discontinued in a great number of patients with advanced PD. As older age is the main limiting factor for accessing second-level therapies at CSAI discontinuation, CSAI treatment should not be postponed to older age. CSAI might be considered a good first-line and fast strategy in patients undergoing rapid deterioration of their quality of life while waiting for DBS or levodopa/carbidopa intestinal gel therapy.
Collapse
|
48
|
Wülfing JM, Kumar SS, Boedecker J, Riedmiller M, Egert U. Adaptive long-term control of biological neural networks with Deep Reinforcement Learning. Neurocomputing 2019. [DOI: 10.1016/j.neucom.2018.10.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
49
|
Hartmann CJ, Fliegen S, Groiss SJ, Wojtecki L, Schnitzler A. An update on best practice of deep brain stimulation in Parkinson's disease. Ther Adv Neurol Disord 2019; 12:1756286419838096. [PMID: 30944587 PMCID: PMC6440024 DOI: 10.1177/1756286419838096] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/01/2019] [Indexed: 11/16/2022] Open
Abstract
During the last 30 years, deep brain stimulation (DBS) has evolved into the clinical standard of care as a highly effective treatment for advanced Parkinson’s disease. Careful patient selection, an individualized anatomical target localization and meticulous evaluation of stimulation parameters for chronic DBS are crucial requirements to achieve optimal results. Current hardware-related advances allow for a more focused, individualized stimulation and hence may help to achieve optimal clinical results. However, current advances also increase the degrees of freedom for DBS programming and therefore challenge the skills of healthcare providers. This review gives an overview of the clinical effects of DBS, the criteria for patient, target, and device selection, and finally, offers strategies for a structured programming approach.
Collapse
Affiliation(s)
- Christian J Hartmann
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Sabine Fliegen
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan J Groiss
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Lars Wojtecki
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
50
|
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]
|