1
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Barbosa RP, Moreau C, Rolland AS, Rascol O, Brefel-Courbon C, Ory-Magne F, Bastos P, de Barros A, Hainque E, Rouaud T, Marques A, Eusebio A, Benatru I, Drapier S, Guehl D, Maltete D, Tranchant C, Wirth T, Giordana C, Tir M, Thobois S, Hopes L, Hubsch C, Jarraya B, Corvol JC, Bereau M, Devos D, Fabbri M. The impact of subthalamic deep-brain stimulation in restoring motor symmetry in Parkinson's disease patients: a prospective study. J Neurol 2024; 271:2582-2595. [PMID: 38334813 DOI: 10.1007/s00415-023-12162-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 12/15/2023] [Accepted: 12/16/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND AND OBJECTIVES The impact of subthalamic deep-brain stimulation (STN-DBS) on motor asymmetry and its influence on both motor and non-motor outcomes remain unclear. The present study aims at assessing the role of STN-DBS on motor asymmetry and how its modulation translates into benefits in motor function, activities of daily living (ADLs) and quality of life (QoL). METHODS Postoperative motor asymmetry has been assessed on the multicentric, prospective Predictive Factors and Subthalamic Stimulation in Parkinson's Disease cohort. Asymmetry was evaluated at both baseline (pre-DBS) and 1 year after STN-DBS. A patient was considered asymmetric when the right-to-left MDS-UPDRS part III difference was ≥ 5. In parallel, analyses have been carried out using the absolute right-to-left difference. The proportion of asymmetric patients at baseline was compared to that in the post-surgery evaluation across different medication/stimulation conditions. RESULTS 537 PD patients have been included. The proportion of asymmetric patients was significantly reduced after both STN-DBS and medication administration (asymmetric patients: 50% in pre-DBS MedOFF, 35% in MedOFF/StimON, 26% in MedON/StimOFF, and 12% in MedON/StimON state). Older patients at surgery and with higher baseline UPDRS II scores were significantly less likely to benefit from STN-DBS at the level of motor asymmetry. No significant correlation between motor asymmetry and ADLs (UPDRS II) or overall QoL (PDQ-39) score was observed. Asymmetric patients had significantly higher mobility, communication, and daily living PDQ-39 sub-scores. CONCLUSIONS Both STN-DBS and levodopa lead to a reduction in motor asymmetry. Motor symmetry is associated with improvements in certain QoL sub-scores.
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Affiliation(s)
- Raquel Pinheiro Barbosa
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Caroline Moreau
- Department of Medical Pharmacology, Neurology, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
- Movement Disorders Department, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
| | - Anne Sophie Rolland
- Department of Medical Pharmacology, Neurology, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
- Movement Disorders Department, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Christine Brefel-Courbon
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Fabienne Ory-Magne
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Paulo Bastos
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Amaury de Barros
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France
| | - Elodie Hainque
- Department of Neurology, NS-PARK/FCRIN Network, France, Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Tiphaine Rouaud
- Department of Neurology, NS-PARK/FCRIN Network, Nantes University Hospital, 44093, Nantes Cedex, France
| | - Ana Marques
- Neurology Department, NS-PARK/FCRIN Network, Université Clermont Auvergne, EA7280, Clermont-Ferrand University Hospital, 63000, Clermont-Ferrand, France
| | - Alexandre Eusebio
- Aix Marseille Université, AP-HM, Hôpital de La Timone, Service de Neurologie et Pathologie du Mouvement, and UMR CNRS, Marseille et Versailles, France
| | - Isabelle Benatru
- Service de Neurologie, Centre Expert Parkinson, NS-PARK/FCRIN Network, CIC-INSERM 1402, CHU Poitiers, 86000, Poitiers, France
| | - Sophie Drapier
- Department of Neurology, NS-PARK/FCRIN Network, Rennes University Hospital, CIC-INSERM 1414, 35033, Rennes Cedex, France
| | - Dominique Guehl
- CHU de Bordeaux, Centre Expert Parkinson, Institut des Maladies Neuro-Dégénératives, 33000, Bordeaux, France
| | - David Maltete
- Department of Neurology, Rouen University Hospital and University of Rouen, Rouen, France
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, NS-PARK/FCRIN Network, INSERM U1239, Mont-Saint-Aignan, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut de Génétique Et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
- NS-PARK/FCRIN Network, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Thomas Wirth
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- Institut de Génétique Et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
- NS-PARK/FCRIN Network, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Caroline Giordana
- Neurology Department, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Melissa Tir
- Department of Neurology, Expert Centre for Parkinson's Disease, NS-PARK/FCRIN Network, Amiens University Hospital, EA 4559 Laboratoire de Neurosciences Fonctionnelles et Pathologie (LNFP) Université de Picardie Jules Verne, University of Picardy Jules Verne (UPJV), Amiens, France
- Department of Neurosurgery, Expert Centre for Parkinson's Disease, NS-PARK/FCRIN Network, Amiens University Hospital, EA 4559 Laboratoire de Neurosciences Fonctionnelles Et Pathologie (LNFP) Université de Picardie Jules Verne, University of Picardy Jules Verne (UPJV), Versailles, France
| | - Stephane Thobois
- Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux; CNRS, Institut Des Sciences Cognitives, UMR 5229, Bron, France
- NS-PARK/FCRIN Network, Centre Expert Parkinson, Hôpital Neurologique "Pierre Wertheimer", Hospices Civils de Lyon, Lyon, France
| | - Lucie Hopes
- Neurology Department, Nancy University Hospital, 54000, Nancy, France
| | - Cecile Hubsch
- NS-PARK/FCRIN Network, Hôpital Fondation Ophtalmologique A de Rothschild, Unité James Parkinson, 75019, Paris, France
| | - Bechir Jarraya
- Pôle Neurosciences, Foch Hospital, Suresnes, France
- Université de Versailles Paris-Saclay, INSERM U992, CEA Neurospin, Marseille et Versailles, France
| | - Jean Christophe Corvol
- Department of Neurology, NS-PARK/FCRIN Network, France, Sorbonne Université, Paris Brain Institute-ICM, Inserm, CNRS, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Matthieu Bereau
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030, Besançon Cedex, France
- Université de Franche-Comté, UR LINC 481, F-2500, Besançon, France
| | - David Devos
- Department of Medical Pharmacology, Neurology, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
- Movement Disorders Department, Referent Center of Parkinson's Disease, CHU of Lille, Univ. Lille Neuroscience & Cognition, Inserm, UMR-S1172, Licend, NS-PARK/FCRIN Network, 59000, Lille, France
| | - Margherita Fabbri
- Department of Clinical Pharmacology and Neurosciences, Parkinson Expert Center, Centre d'Investigation Clinique CIC1436, NeuroToul COEN Center, Toulouse, NS-PARK/FCRIN Network, University Hospital of Toulouse, Toulouse, France.
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2
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Hamani C, Davidson B, Lipsman N, Abrahao A, Nestor SM, Rabin JS, Giacobbe P, Pagano RL, Campos ACP. Insertional effect following electrode implantation: an underreported but important phenomenon. Brain Commun 2024; 6:fcae093. [PMID: 38707711 PMCID: PMC11069120 DOI: 10.1093/braincomms/fcae093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/08/2023] [Accepted: 03/26/2024] [Indexed: 05/07/2024] Open
Abstract
Deep brain stimulation has revolutionized the treatment of movement disorders and is gaining momentum in the treatment of several other neuropsychiatric disorders. In almost all applications of this therapy, the insertion of electrodes into the target has been shown to induce some degree of clinical improvement prior to stimulation onset. Disregarding this phenomenon, commonly referred to as 'insertional effect', can lead to biased results in clinical trials, as patients receiving sham stimulation may still experience some degree of symptom amelioration. Similar to the clinical scenario, an improvement in behavioural performance following electrode implantation has also been reported in preclinical models. From a neurohistopathologic perspective, the insertion of electrodes into the brain causes an initial trauma and inflammatory response, the activation of astrocytes, a focal release of gliotransmitters, the hyperexcitability of neurons in the vicinity of the implants, as well as neuroplastic and circuitry changes at a distance from the target. Taken together, it would appear that electrode insertion is not an inert process, but rather triggers a cascade of biological processes, and, as such, should be considered alongside the active delivery of stimulation as an active part of the deep brain stimulation therapy.
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Affiliation(s)
- Clement Hamani
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Benjamin Davidson
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Nir Lipsman
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurosurgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Agessandro Abrahao
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Sean M Nestor
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Jennifer S Rabin
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Division of Neurology, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto M5G 1V7, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Rosana L Pagano
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP CEP 01308-060, Brazil
| | - Ana Carolina P Campos
- Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
- Laboratory of Neuroscience, Hospital Sírio-Libanês, São Paulo, SP CEP 01308-060, Brazil
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3
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Busch JL, Kaplan J, Bahners BH, Roediger J, Faust K, Schneider GH, Florin E, Schnitzler A, Krause P, Kühn AA. Local Field Potentials Predict Motor Performance in Deep Brain Stimulation for Parkinson's Disease. Mov Disord 2023; 38:2185-2196. [PMID: 37823518 DOI: 10.1002/mds.29626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective treatment option for patients with Parkinson's disease (PD). However, clinical programming remains challenging with segmented electrodes. OBJECTIVE Using novel sensing-enabled neurostimulators, we investigated local field potentials (LFPs) and their modulation by DBS to assess whether electrophysiological biomarkers may facilitate clinical programming in chronically implanted patients. METHODS Sixteen patients (31 hemispheres) with PD implanted with segmented electrodes in the subthalamic nucleus and a sensing-enabled neurostimulator were included in this study. Recordings were conducted 3 months after DBS surgery following overnight withdrawal of dopaminergic medication. LFPs were acquired while stimulation was turned OFF and during a monopolar review of both directional and ring contacts. Directional beta power and stimulation-induced beta power suppression were computed. Motor performance, as assessed by a pronation-supination task, clinical programming and electrode placement were correlated to directional beta power and stimulation-induced beta power suppression. RESULTS Better motor performance was associated with stronger beta power suppression at higher stimulation amplitudes. Across directional contacts, differences in directional beta power and the extent of stimulation-induced beta power suppression predicted motor performance. However, within individual hemispheres, beta power suppression was superior to directional beta power in selecting the contact with the best motor performance. Contacts clinically activated for chronic stimulation were associated with stronger beta power suppression than non-activated contacts. CONCLUSIONS Our results suggest that stimulation-induced β power suppression is superior to directional β power in selecting the clinically most effective contact. In sum, electrophysiological biomarkers may guide programming of directional DBS systems in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Johannes L Busch
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Berlin, Germany
| | - Jonathan Kaplan
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jan Roediger
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Patricia Krause
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
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4
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Ramesh V, Stratmann N, Schaufler V, Angelov SD, Nordhorn ID, Heissler HE, Martínez-Hincapié R, Čolić V, Rehbock C, Schwabe K, Karst U, Krauss JK, Barcikowski S. Mechanical Stability of Nano-Coatings on Clinically Applicable Electrodes, Generated by Electrophoretic Deposition. Adv Healthc Mater 2022; 11:e2102637. [PMID: 36148583 DOI: 10.1002/adhm.202102637] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 09/08/2022] [Indexed: 01/28/2023]
Abstract
The mechanical stability of implant coatings is crucial for medical approval and transfer to clinical applications. Here, electrophoretic deposition (EPD) is a versatile coating technique, previously shown to cause significant post-surgery impedance reduction of brain stimulation platinum electrodes. However, the mechanical stability of the resulting coating has been rarely systematically investigated. In this work, pulsed-DC EPD of laser-generated platinum nanoparticles (PtNPs) on Pt-based, 3D neural electrodes is performed and the in vitro mechanical stability is examined using agarose gel, adhesive tape, and ultrasonication-based stress tests. EPD-generated coatings are highly stable inside simulated brain environments represented by agarose gel tests as well as after in vivo stimulation experiments. Electrochemical stability of the NP-modified surfaces is tested via cyclic voltammetry and that multiple scans may improve coating stability could be verified, indicated by higher signal stability following highly invasive adhesive tape stress tests. The brain sections post neural stimulation in rats are analyzed via laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS). Measurements reveal higher levels of Pt near the region stimulated with coated electrodes, in comparison to uncoated controls. Even though local concentrations in the vicinity of the implanted electrode are elevated, the total Pt mass found is below systemic toxicologically relevant concentrations.
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Affiliation(s)
- Vaijayanthi Ramesh
- Institute of Technical Chemistry I, University of Duisburg-Essen and Center for NanoIntegration Duisburg-Essen (CENIDE), 45141, Essen, Germany
| | - Nadine Stratmann
- Institute of Technical Chemistry I, University of Duisburg-Essen and Center for NanoIntegration Duisburg-Essen (CENIDE), 45141, Essen, Germany
| | - Viktor Schaufler
- Institute of Technical Chemistry I, University of Duisburg-Essen and Center for NanoIntegration Duisburg-Essen (CENIDE), 45141, Essen, Germany
| | - Svilen D Angelov
- Department of Neurosurgery, Hannover Medical School, 30625, Hannover, Germany
| | - Ilona D Nordhorn
- Institute of Inorganic and Analytical Chemistry, University of Münster, 48149, Münster, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, 30625, Hannover, Germany
| | - Ricardo Martínez-Hincapié
- Electrochemistry for Energy Conversion, Max-Planck-Institute for Chemical Energy Conversion, 45470, Mulheim an der Ruhr, Germany
| | - Viktor Čolić
- Electrochemistry for Energy Conversion, Max-Planck-Institute for Chemical Energy Conversion, 45470, Mulheim an der Ruhr, Germany
| | - Christoph Rehbock
- Institute of Technical Chemistry I, University of Duisburg-Essen and Center for NanoIntegration Duisburg-Essen (CENIDE), 45141, Essen, Germany
| | - Kerstin Schwabe
- Department of Neurosurgery, Hannover Medical School, 30625, Hannover, Germany
| | - Uwe Karst
- Institute of Inorganic and Analytical Chemistry, University of Münster, 48149, Münster, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, 30625, Hannover, Germany
| | - Stephan Barcikowski
- Institute of Technical Chemistry I, University of Duisburg-Essen and Center for NanoIntegration Duisburg-Essen (CENIDE), 45141, Essen, Germany
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5
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Visanji NP, Ghani M, Yu E, Kakhki EG, Sato C, Moreno D, Naranian T, Poon YY, Abdollahi M, Naghibzadeh M, Rajalingam R, Lozano AM, Kalia SK, Hodaie M, Cohn M, Statucka M, Boutet A, Elias GJB, Germann J, Munhoz R, Lang AE, Gan-Or Z, Rogaeva E, Fasano A. Axial Impairment Following Deep Brain Stimulation in Parkinson's Disease: A Surgicogenomic Approach. JOURNAL OF PARKINSONS DISEASE 2021; 12:117-128. [PMID: 34602499 PMCID: PMC8842751 DOI: 10.3233/jpd-212730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Postoperative outcome following deep brain stimulation (DBS) of the subthalamic nucleus is variable, particularly with respect to axial motor improvement. We hypothesized a genetic underpinning to the response to surgical intervention, termed “surgicogenomics”. Objective: We aimed to identify genetic variants associated with clinical heterogeneity in DBS outcome of Parkinson’s disease (PD) patients that could then be applied clinically to target selection leading to improved surgical outcome. Methods: Retrospective clinical data was extracted from 150 patient’s charts. Each individual was genotyped using the genome-wide NeuroX array tailored to study neurologic diseases. Genetic data were clustered based on surgical outcome assessed by comparing pre- and post-operative scores of levodopa equivalent daily dose and axial impairment at one and five years post-surgery. Allele frequencies were compared between patients with excellent vs. moderate/poor outcomes grouped using a priori defined cut-offs. We analyzed common variants, burden of rare coding variants, and PD polygenic risk score. Results: NeuroX identified 2,917 polymorphic markers at 113 genes mapped to known PD loci. The gene-burden analyses of 202 rare nonsynonymous variants suggested a nominal association of axial impairment with 14 genes (most consistent with CRHR1, IP6K2, and PRSS3). The strongest association with surgical outcome was detected between a reduction in levodopa equivalent daily dose and common variations tagging two linkage disequilibrium blocks with SH3GL2. Conclusion: Once validated in independent populations, our findings may be implemented to improve patient selection for DBS in PD.
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Affiliation(s)
- Naomi P Visanji
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric Yu
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada.,The Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Erfan Ghani Kakhki
- DisorDATA Analytics, Ottawa, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Taline Naranian
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Yu-Yan Poon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Maryam Abdollahi
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Maryam Naghibzadeh
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Mojgan Hodaie
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Melanie Cohn
- Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jürgen Germann
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Renato Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada.,The Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,The Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, 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, UHN, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
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6
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Malinova V, Jaskólski DJ, Wójcik R, Mielke D, Rohde V. Frameless x-ray-based lead re-implantation after partial hardware removal of deep brain stimulation system with preservation of intracerebral trajectories. Acta Neurochir (Wien) 2021; 163:1873-1878. [PMID: 33754181 PMCID: PMC8195963 DOI: 10.1007/s00701-021-04807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/10/2021] [Indexed: 11/26/2022]
Abstract
Background Deep brain stimulation (DBS) is an established treatment for patients with medical refractory movement disorders with continuously increasing use also in other neurological and psychiatric diseases. Early and late complications can lead to revision surgeries with partial or complete DBS-system removal. In this study, we aimed to report on our experience with a frameless x-ray-based lead re-implantation technique after partial hardware removal or dysfunction of DBS-system, allowing the preservation of intracerebral trajectories. Methods We describe a surgical procedure with complete implant removal due to infection except for the intracranial part of the electrode and with non-stereotactic electrode re-implantation. A retrospective analysis of a patient series treated using this technique was performed and the surgical outcome was evaluated including radiological and clinical parameters. Results A total of 8 DBS-patients with lead re-implantation using the frameless x-ray-based method were enrolled in the study. A revision of 14 leads was performed, whereof a successful lead re-implantation could be achieved without any problems in 10 leads (71%). In two patients (one patient with dystonia and one patient with tremor), the procedure was not successful, so we placed both leads frame-based stereotactically. Conclusions The described x-ray-based technique allows a reliable frameless electrode re-implantation after infection and electrode dysfunction and might represent an efficient alternative to frame-based procedures for lead revision making the preservation of intracerebral trajectories possible.
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Affiliation(s)
- Vesna Malinova
- Department of Neurosurgery, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
| | - Dariusz J Jaskólski
- Department of Neurosurgery and Neurooncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Rafal Wójcik
- Department of Neurosurgery and Neurooncology, Barlicki University Hospital, Medical University of Lodz, Lodz, Poland
| | - Dorothee Mielke
- Department of Neurosurgery, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Veit Rohde
- Department of Neurosurgery, Georg-August-University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
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7
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Costanza A, Radomska M, Bondolfi G, Zenga F, Amerio A, Aguglia A, Serafini G, Amore M, Berardelli I, Pompili M, Nguyen KD. Suicidality Associated With Deep Brain Stimulation in Extrapyramidal Diseases: A Critical Review and Hypotheses on Neuroanatomical and Neuroimmune Mechanisms. Front Integr Neurosci 2021; 15:632249. [PMID: 33897384 PMCID: PMC8060445 DOI: 10.3389/fnint.2021.632249] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation (DBS) is a very well-established and effective treatment for patients with extrapyramidal diseases. Despite its generally favorable clinical efficacy, some undesirable outcomes associated with DBS have been reported. Among such complications are incidences of suicidal ideation (SI) and behavior (SB) in patients undergoing this neurosurgical procedure. However, causal associations between DBS and increased suicide risk are not demonstrated and they constitute a debated issue. In light of these observations, the main objective of this work is to provide a comprehensive and unbiased overview of the literature on suicide risk in patients who received subthalamic nucleus (STN) and internal part of globus pallidum (GPi) DBS treatment. Additionally, putative mechanisms that might be involved in the development of SI and SB in these patients as well as caveats associated with these hypotheses are introduced. Finally, we briefly propose some clinical implications, including therapeutic strategies addressing these potential disease mechanisms. While a mechanistic connection between DBS and suicidality remains a controversial topic that requires further investigation, it is of critical importance to consider suicide risk as an integral component of candidate selection and post-operative care in DBS.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, ASO Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Michalina Radomska
- Faculty of Psychology, University of Geneva (UNIGE), Geneva, Switzerland
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention (SPLIC), Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Francesco Zenga
- Department of Neurosurgery, University and City of Health and Science Hospital, Turin, Italy
| | - Andrea Amerio
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Mood Disorders Program, Tufts Medical Center, Boston, MA, United States
| | - Andrea Aguglia
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Gianluca Serafini
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genova, Genova, Italy.,Department of Psychiatry, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Khoa D Nguyen
- Department of Microbiology and Immunology, Stanford University, Palo Alto, CA, United States.,Tranquis Therapeutics, Palo Alto, CA, United States.,Hong Kong University of Science and Technology, Hong Kong, China
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8
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Evers J, Lowery M. The Active Electrode in the Living Brain: The Response of the Brain Parenchyma to Chronically Implanted Deep Brain Stimulation Electrodes. Oper Neurosurg (Hagerstown) 2021; 20:131-140. [PMID: 33074305 DOI: 10.1093/ons/opaa326] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/10/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Deep brain stimulation is an established symptomatic surgical therapy for Parkinson disease, essential tremor, and a number of other movement and neuropsychiatric disorders. The well-established foreign body response around implanted electrodes is marked by gliosis, neuroinflammation, and neurodegeneration. However, how this response changes with the application of chronic stimulation is less well-understood. OBJECTIVE To integrate the most recent evidence from basic science, patient, and postmortem studies on the effect of such an "active" electrode on the parenchyma of the living brain. METHODS A thorough and in-part systematic literature review identified 49 papers. RESULTS Increased electrode-tissue impedance is consistently observed in the weeks following electrode implantation, stabilizing at approximately 3 to 6 mo. Lower impedance values are observed around stimulated implanted electrodes when compared with unstimulated electrodes. A temporary reduction in impedance has also been observed in response to stimulation in nonhuman primates. Postmortem studies from patients confirm the presence of a fibrous sheath, astrocytosis, neuronal loss, and neuroinflammation in the immediate vicinity of the electrode. When comparing stimulated and unstimulated electrodes directly, there is some evidence across animal and patient studies of altered neurodegeneration and neuroinflammation around stimulated electrodes. CONCLUSION Establishing how stimulation influences the electrical and histological properties of the surrounding tissue is critical in understanding how these factors contribute to DBS efficacy, and in controlling symptoms and side effects. Understanding these complex issues will aid in the development of future neuromodulation systems that are optimized for the tissue environment and required stimulation protocols.
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Affiliation(s)
- Judith Evers
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland.,CÚRAM SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Madeleine Lowery
- School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland.,CÚRAM SFI Research Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
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9
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Cheng GX, Yin SB, Yang YH, Hu YH, Huang CY, Yao QM, Ting WJ. Effects of bilateral subthalamic nucleus deep brain stimulation on motor symptoms in Parkinson's disease: a retrospective cohort study. Neural Regen Res 2021; 16:905-909. [PMID: 33229727 PMCID: PMC8178796 DOI: 10.4103/1673-5374.297089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Deep brain stimulation of the bilateral subthalamic nucleus (STN) is a therapeutic option for patients with Parkinson's disease (PD) in whom medical therapies have been ineffective. This retrospective cohort study analyzed the motor function of 27 patients with advanced PD, from the First Affiliated Hospital of Guangzhou Medical University, China, who received deep brain stimulation of the bilateral subthalamic nucleus and evaluated its therapeutic effects. The 10-year follow-up data of patients was analyzed in Qingyuan People's Hospital, Sixth Affiliated Hospital of Guangzhou Medical University, China. The follow-up data were divided into two categories based on patients during levodopa treatment (on-medication) and without levodopa treatment (off-medication). Compared with baseline, the motor function of on-medication PD patients improved after deep brain stimulation of the bilateral subthalamic nucleus. Even 2 years later, the motor function of off-medication PD patients had improved. On-medication PD patients exhibited better therapeutic effects over the 5 years than off-medication PD patients. On-medication patients' akinesia, speech, postural stability, gait, and cognitive function worsened only after 5 years. These results suggest that the motor function of patients with advanced PD benefitted from treatment with deep brain stimulation of the bilateral subthalamic nucleus over a period up to 5 years. The overall therapeutic effects were more pronounced when levodopa treatment was combined with deep brain stimulation of the bilateral subthalamic nucleus. This study was approved by Institutional Review Board of Qingyuan People's Hospital, The Sixth Affiliated Hospital of Guangzhou Medical University, China (approval No. QPH-IRB-A0140) on January 11, 2018.
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Affiliation(s)
- Guo-Xiong Cheng
- Deparment of Neurosurgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Shu-Bin Yin
- Deparment of Neurosurgery, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong Province, China
| | - Ying-Hao Yang
- Deparment of Neurosurgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yuan-Hu Hu
- Deparment of Neurosurgery, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong Province, China
| | - Chih-Yang Huang
- Graduate Institute of Basic Medical Science, China Medical University; Department of Health and Nutrition Biotechnology, Asia University, Taichung; College of Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, Hualien; Medical Research Center for Exosome and Mitochondria Related Diseases, China Medical University and Hospital, Taichung, Taiwan, China
| | - Qian-Ming Yao
- Deparment of Neurosurgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou; Deparment of Neurosurgery, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong Province, China
| | - Wei-Jen Ting
- Deparment of Neurosurgery, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan, Guangdong Province, China
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10
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Krauss JK, Lipsman N, Aziz T, Boutet A, Brown P, Chang JW, Davidson B, Grill WM, Hariz MI, Horn A, Schulder M, Mammis A, Tass PA, Volkmann J, Lozano AM. Technology of deep brain stimulation: current status and future directions. Nat Rev Neurol 2020; 17:75-87. [PMID: 33244188 DOI: 10.1038/s41582-020-00426-z] [Citation(s) in RCA: 271] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2020] [Indexed: 01/20/2023]
Abstract
Deep brain stimulation (DBS) is a neurosurgical procedure that allows targeted circuit-based neuromodulation. DBS is a standard of care in Parkinson disease, essential tremor and dystonia, and is also under active investigation for other conditions linked to pathological circuitry, including major depressive disorder and Alzheimer disease. Modern DBS systems, borrowed from the cardiac field, consist of an intracranial electrode, an extension wire and a pulse generator, and have evolved slowly over the past two decades. Advances in engineering and imaging along with an improved understanding of brain disorders are poised to reshape how DBS is viewed and delivered to patients. Breakthroughs in electrode and battery designs, stimulation paradigms, closed-loop and on-demand stimulation, and sensing technologies are expected to enhance the efficacy and tolerability of DBS. In this Review, we provide a comprehensive overview of the technical development of DBS, from its origins to its future. Understanding the evolution of DBS technology helps put the currently available systems in perspective and allows us to predict the next major technological advances and hurdles in the field.
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Affiliation(s)
- Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Nir Lipsman
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Tipu Aziz
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Benjamin Davidson
- Department of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - Marwan I Hariz
- Department of Clinical Neuroscience, University of Umea, Umea, Sweden
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Michael Schulder
- Department of Neurosurgery, Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA
| | - Antonios Mammis
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter A Tass
- Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Jens Volkmann
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany.,Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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11
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Kern DS, Uy D, Rhoades R, Ojemann S, Abosch A, Thompson JA. Discrete changes in brain volume after deep brain stimulation in patients with Parkinson's disease. J Neurol Neurosurg Psychiatry 2020; 91:928-937. [PMID: 32651244 DOI: 10.1136/jnnp-2019-322688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 04/06/2020] [Accepted: 06/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Deep brain stimulation (DBS), targeting the subthalamic nucleus (STN) and globus pallidus interna, is a surgical therapy with class 1 evidence for Parkinson's disease (PD). Bilateral DBS electrodes may be implanted within a single operation or in separate staged surgeries with an interval of time that varies patient by patient. In this study, we used the variation in the timing of implantation from the first to the second implantation allowing for examination of potential volumetric changes of the basal ganglia in patients with PD who underwent staged STN DBS. METHODS Thirty-two patients with a mean time interval between implantations of 141.8 (±209.1; range: 7-700) days and mean duration of unilateral stimulation of 244.7 (±227.7; range: 20-672) days were included in this study. Using volumetric analysis of whole hemisphere and subcortical structures, we observed whether implantation or stimulation affected structural volume. RESULTS We observed that DBS implantation, but not the duration of stimulation, induced a significant reduction of volume in the caudate, pallidum, putamen and thalamus ipsilateral to the implanted hemisphere. These findings were not dependent on the trajectory of the implanted electrode nor on first surgery pneumocephalus (0.07%: %Δ for intracranial volume between first and second surgery). In addition, unique regional atrophy differences were evident in each of the structures. CONCLUSION Our results demonstrate that DBS implantation surgery may affect hemisphere volume at the level of subcortical structures connected to the surgical target.
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Affiliation(s)
- Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Daniel Uy
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Modern Human Anatomy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Remy Rhoades
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, CO, USA .,Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,Modern Human Anatomy Program, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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12
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Serranová T, Sieger T, Růžička F, Bakštein E, Dušek P, Vostatek P, Novák D, Růžička E, Urgošík D, Jech R. Topography of emotional valence and arousal within the motor part of the subthalamic nucleus in Parkinson's disease. Sci Rep 2019; 9:19924. [PMID: 31882633 PMCID: PMC6934686 DOI: 10.1038/s41598-019-56260-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 12/02/2019] [Indexed: 01/24/2023] Open
Abstract
Clinical motor and non-motor effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) seem to depend on the stimulation site within the STN. We analysed the effects of the position of the stimulation electrode within the motor STN on subjective emotional experience, expressed as emotional valence and arousal ratings to pictures representing primary rewards and aversive fearful stimuli in 20 PD patients. Patients' ratings from both aversive and erotic stimuli matched the mean ratings from a group of 20 control subjects at similar position within the STN. Patients with electrodes located more posteriorly reported both valence and arousal ratings from both the rewarding and aversive pictures as more extreme. Moreover, posterior electrode positions were associated with a higher occurrence of depression at a long-term follow-up. This brain-behavior relationship suggests a complex emotion topography in the motor part of the STN. Both valence and arousal representations overlapped and were uniformly arranged anterior-posteriorly in a gradient-like manner, suggesting a specific spatial organization needed for the coding of the motivational salience of the stimuli. This finding is relevant for our understanding of neuropsychiatric side effects in STN DBS and potentially for optimal electrode placement.
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Affiliation(s)
- Tereza Serranová
- Department of Neurology and Center of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital, Kateřinská 30, 128 08, Prague, Czech Republic.
| | - Tomáš Sieger
- Department of Neurology and Center of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital, Kateřinská 30, 128 08, Prague, Czech Republic.,Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 166 27, Prague, Czech Republic
| | - Filip Růžička
- Department of Neurology and Center of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital, Kateřinská 30, 128 08, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, 150 30, Prague, Czech Republic
| | - Eduard Bakštein
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 166 27, Prague, Czech Republic.,National Institute of Mental Health, Klecany, Topolová 748, 250 67, Czech Republic
| | - Petr Dušek
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 166 27, Prague, Czech Republic
| | - Pavel Vostatek
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 166 27, Prague, Czech Republic
| | - Daniel Novák
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Technická 2, 166 27, Prague, Czech Republic
| | - Evžen Růžička
- Department of Neurology and Center of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital, Kateřinská 30, 128 08, Prague, Czech Republic
| | - Dušan Urgošík
- Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, 150 30, Prague, Czech Republic
| | - Robert Jech
- Department of Neurology and Center of Clinical Neuroscience, Charles University, 1st Faculty of Medicine and General University Hospital, Kateřinská 30, 128 08, Prague, Czech Republic.,Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Roentgenova 2, 150 30, Prague, Czech Republic
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13
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Mugge L, Krafcik B, Pontasch G, Alnemari A, Neimat J, Gaudin D. A Review of Biomarkers Use in Parkinson with Deep Brain Stimulation: A Successful Past Promising a Bright Future. World Neurosurg 2019; 123:197-207. [DOI: 10.1016/j.wneu.2018.11.247] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/29/2018] [Accepted: 11/30/2018] [Indexed: 12/18/2022]
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14
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Astrocytic Response to Acutely- and Chronically-Implanted Microelectrode Arrays in the Marmoset ( Callithrix jacchus) Brain. Brain Sci 2019; 9:brainsci9020019. [PMID: 30678038 PMCID: PMC6406890 DOI: 10.3390/brainsci9020019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/09/2019] [Accepted: 01/22/2019] [Indexed: 11/27/2022] Open
Abstract
Microelectrode implants are an important tool in neuroscience research and in developing brain–machine interfaces. Data from rodents have consistently shown that astrocytes are recruited to the area surrounding implants, forming a glial scar that increases electrode impedance and reduces chronic utility. However, studies in non-human primates are scarce, with none to date in marmosets. We used glial fibrillary acidic protein (GFAP) immunostaining to characterize the acute and chronic response of the marmoset brain to microelectrodes. By using densitometry, we showed that marmoset astrocytes surround brain implants and that a glial scar is formed over time, with significant increase in the chronic condition relative to the acute condition animal.
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15
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Erasmi R, Granert O, Zorenkov D, Falk D, Wodarg F, Deuschl G, Witt K. White Matter Changes Along the Electrode Lead in Patients Treated With Deep Brain Stimulation. Front Neurol 2018; 9:983. [PMID: 30519212 PMCID: PMC6259286 DOI: 10.3389/fneur.2018.00983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/31/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Deep brain stimulation (DBS) is an established treatment for various movement disorders. There is little data available about the potential damage to brain parenchyma through DBS treatment. The objective of this study was to investigate the occurrence of signal changes on magnetic resonance imaging (MRI) in patients treated with DBS. Methods: We retrospectively analyzed MRI scans of 30 DBS patients (21 patients with Parkinson's disease, 3 patients with dystonia and 6 patients with tremor) that had undergone additional MRI scans after DBS surgery (ranging from 2 months to 8 years). Axial T2 sequences were analyzed by two raters using a standardized lesion mapping procedure. Results: 26 out of 30 analyzed patients showed hyperintense white matter changes surrounding the DBS lead (mean volume = 2.43 ml). Lesions were prominent along the upper half of the electrode lead within the subcortical white matter, with no abnormalities along the lower lead. Their volume was significantly correlated to the time from surgery to MRI and to the number of microelectrodes used in surgery, but was independent from underlying disease (Parkinson's disease, dystonia, tremor), target structure (STN, GPi, VIM), demographical data, or cardiovascular risk factors. Discussion: White matter changes along the electrode leads in DBS patients are a frequent finding. These changes seem to evolve with certain latency after surgery and might be radiologically classified as a gliosis. Our findings identify the number of intraoperatively used microelectrodes as a risk factor in the formation of gliosis. Therefore, mechanical damage at the time of surgery and an individual tissue response might contribute to their evolution. Further studies are needed to define the exact mechanisms and their clinical impact.
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Affiliation(s)
- Richard Erasmi
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany.,Department of Neurology, University of Cologne, Cologne, Germany
| | - Oliver Granert
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Dmitry Zorenkov
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Daniela Falk
- Department of Neurosurgery, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Fritz Wodarg
- Department of Neuroradiology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Günther Deuschl
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Karsten Witt
- Department of Neurology, Christian-Albrechts University of Kiel, Kiel, Germany.,Department of Neurology and Research Center Neurosensory Science, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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16
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Guest JD, Moore SW, Aimetti AA, Kutikov AB, Santamaria AJ, Hofstetter CP, Ropper AE, Theodore N, Ulich TR, Layer RT. Internal decompression of the acutely contused spinal cord: Differential effects of irrigation only versus biodegradable scaffold implantation. Biomaterials 2018; 185:284-300. [DOI: 10.1016/j.biomaterials.2018.09.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 09/04/2018] [Accepted: 09/16/2018] [Indexed: 12/13/2022]
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17
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De Vloo P, Thal D, van Kuyck K, Nuttin B. Histopathology after microelectrode recording and twelve years of deep brain stimulation. Brain Stimul 2018; 11:1183-1186. [PMID: 29776858 DOI: 10.1016/j.brs.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 04/03/2018] [Accepted: 05/07/2018] [Indexed: 11/17/2022] Open
Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Laboratory for Experimental Neurosurgery and Neuroanatomy, KU Leuven, Herestraat 49, 3000, Leuven, Belgium; Department of Neurosurgery, Toronto Western Hospital - University of Toronto, 399 Bathurst Street, M5T 2S8, Toronto, Ontario, Canada.
| | - Dietmar Thal
- Department of Pathology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Laboratory for Neuropathology, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Kris van Kuyck
- Laboratory for Experimental Neurosurgery and Neuroanatomy, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Bart Nuttin
- Department of Neurosurgery, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium; Laboratory for Experimental Neurosurgery and Neuroanatomy, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
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Reddy GD, Lozano AM. Postmortem studies of deep brain stimulation for Parkinson's disease: a systematic review of the literature. Cell Tissue Res 2017; 373:287-295. [PMID: 28836072 DOI: 10.1007/s00441-017-2672-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/19/2017] [Indexed: 12/31/2022]
Abstract
Deep brain stimulation (DBS), arguably the greatest therapeutic advancement in the treatment of Parkinson's disease since dopamine replacement therapy, is now routinely used. While the exact mechanisms by which DBS works still remain unknown, over the past three decades since it was first described, we have gained significant insight into several of the processes involved. Though often overlooked in this regard, increasing numbers of postmortem and autopsy studies are contributing significantly to our understanding. In this manuscript, we review the literature involving the pathological findings from autopsies in patients who have undergone deep brain stimulation surgeries for Parkinson's disease. The major results show that multiple stereotactic targeting methods can be accurate at placing leads in the desired nuclei that help with clinically effective results, that perioperative complications and inaccurate diagnosis as determined by autopsy can lead to suboptimal stimulation effect and that the normal long-term effects of chronic stimulation include fibrosis around the electrodes and a mild immune response. In addition, recent results suggest mechanisms by which DBS might be effective in Parkinson's disease i.e., through rescuing pathological changes in microvasculature and by promoting the proliferation of neural progenitor cells.
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Affiliation(s)
- Gaddum Duemani Reddy
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, M5T2S8, Canada.
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, M5T2S8, Canada
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19
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Koenen S, Rehbock C, Heissler HE, Angelov SD, Schwabe K, Krauss JK, Barcikowski S. Optimizing in Vitro Impedance and Physico-Chemical Properties of Neural Electrodes by Electrophoretic Deposition of Pt Nanoparticles. Chemphyschem 2017; 18:1108-1117. [PMID: 28122149 DOI: 10.1002/cphc.201601180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Indexed: 11/12/2022]
Abstract
Neural electrodes suffer from an undesired incline in impedance when in permanent contact with human tissue. Nanostructures, induced by electrophoretic deposition (EPD) of ligand-free laser-generated nanoparticles (NPs) on the electrodes are known to stabilize impedance in vivo. Hence, Pt surfaces were systematically EPD-coated with Pt NPs and evaluated for impedance as well as surface coverage, contact angle, electrochemically active surface area (ECSA) and surface oxidation. The aim was to establish a systematic correlation between EPD process parameters and physical surface properties. The findings clearly reveal a linear decrease in impedance with increasing surface coverage, which goes along with a proportional reduction of the contact angle and an increase in ECSA and surface oxidation. EPD process parameters, prone to yield surface coatings with low impedance, are long deposition times (40-60 min), while high colloid concentrations (>250 μg mL-1 ) and electric field strengths (>25 V cm-1 ) should be avoided due to detrimental NP assemblage effects.
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Affiliation(s)
- Sven Koenen
- Technical Chemistry I and, Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitätsstrasse 7, 45141, Essen, Germany
| | - Christoph Rehbock
- Technical Chemistry I and, Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitätsstrasse 7, 45141, Essen, Germany
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Svilen D Angelov
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Kerstin Schwabe
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Stephan Barcikowski
- Technical Chemistry I and, Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitätsstrasse 7, 45141, Essen, Germany
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20
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Sammartino F, Krishna V, Sankar T, Fisico J, Kalia SK, Hodaie M, Kucharczyk W, Mikulis DJ, Crawley A, Lozano AM. 3-Tesla MRI in patients with fully implanted deep brain stimulation devices: a preliminary study in 10 patients. J Neurosurg 2016; 127:892-898. [PMID: 28009238 DOI: 10.3171/2016.9.jns16908] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the safety of 3-T MRI in patients with implanted deep brain stimulation (DBS) systems. METHODS This study was performed in 2 phases. In an initial phantom study, a Lucite phantom filled with tissue-mimicking gel was assembled. The system was equipped with a single DBS electrode connected to an internal pulse generator. The tip of the electrode was coupled to a fiber optic thermometer with a temperature resolution of 0.1°C. Both anatomical (T1- and T2-weighted) and functional MRI sequences were tested. A temperature change within 2°C from baseline was considered safe. After findings from the phantom study suggested safety, 10 patients with implanted DBS systems targeting various brain areas provided informed consent and underwent 3-T MRI using the same imaging sequences. Detailed neurological evaluations and internal pulse generator interrogations were performed before and after imaging. RESULTS During phantom testing, the maximum temperature increase was registered using the T2-weighted sequence. The maximal temperature changes at the tip of the DBS electrode were < 1°C for all sequences tested. In all patients, adequate images were obtained with structural imaging, although a significant artifact from lead connectors interfered with functional imaging quality. No heating, warmth, or adverse neurological effects were observed. CONCLUSIONS To the authors' knowledge, this was the first study to assess the clinical safety of 3-T MRI in patients with a fully implanted DBS system (electrodes, extensions, and pulse generator). It provided preliminary data that will allow further examination and assessment of the safety of 3-T imaging studies in patients with implanted DBS systems. The authors cannot advocate widespread use of this type of imaging in patients with DBS implants until more safety data are obtained.
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Affiliation(s)
| | | | - Tejas Sankar
- Division of Neurosurgery, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Fisico
- Department of Medical Imaging, University of Toronto, Ontario; and
| | | | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, and
| | | | - David J Mikulis
- Department of Medical Imaging, University of Toronto, Ontario; and
| | - Adrian Crawley
- Department of Medical Imaging, University of Toronto, Ontario; and
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21
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Angelov SD, Koenen S, Jakobi J, Heissler HE, Alam M, Schwabe K, Barcikowski S, Krauss JK. Electrophoretic deposition of ligand-free platinum nanoparticles on neural electrodes affects their impedance in vitro and in vivo with no negative effect on reactive gliosis. J Nanobiotechnology 2016; 14:3. [PMID: 26753543 PMCID: PMC4710003 DOI: 10.1186/s12951-015-0154-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/22/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Electrodes for neural stimulation and recording are used for the treatment of neurological disorders. Their features critically depend on impedance and interaction with brain tissue. The effect of surface modification on electrode impedance was examined in vitro and in vivo after intracranial implantation in rats. Electrodes coated by electrophoretic deposition with platinum nanoparticles (NP; <10 and 50 nm) as well as uncoated references were implanted into the rat's subthalamic nucleus. After postoperative recovery, rats were electrostimulated for 3 weeks. Impedance was measured before implantation, after recovery and then weekly during stimulation. Finally, local field potential was recorded and tissue-to-implant reaction was immunohistochemically studied. RESULTS Coating with NP significantly increased electrode's impedance in vitro. Postoperatively, the impedance of all electrodes was temporarily further increased. This effect was lowest for the electrodes coated with particles <10 nm, which also showed the most stable impedance dynamics during stimulation for 3 weeks and the lowest total power of local field potential during neuronal activity recording. Histological analysis revealed that NP-coating did not affect glial reactions or neural cell-count. CONCLUSIONS Coating with NP <10 nm may improve electrode's impedance stability without affecting biocompatibility. Increased impedance after NP-coating may improve neural recording due to better signal-to-noise ratio.
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Affiliation(s)
- Svilen D Angelov
- Department of Neurosurgery, Hannover Medical School, Medical University Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Sven Koenen
- Technical Chemistry I and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitätsstrasse 7, 45141, Essen, Germany.
| | - Jurij Jakobi
- Technical Chemistry I and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitätsstrasse 7, 45141, Essen, Germany.
| | - Hans E Heissler
- Department of Neurosurgery, Hannover Medical School, Medical University Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Mesbah Alam
- Department of Neurosurgery, Hannover Medical School, Medical University Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Kerstin Schwabe
- Department of Neurosurgery, Hannover Medical School, Medical University Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Stephan Barcikowski
- Technical Chemistry I and Center for Nanointegration Duisburg-Essen (CENIDE), University of Duisburg-Essen, Universitätsstrasse 7, 45141, Essen, Germany.
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Medical University Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
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