1
|
Bohlhalter S, Benninger D, Brogle D, Hatz F, Kaelin-Lang A, Möller JC, Kägi G, Schuepbach M. Commentary to the controversy: Should asleep deep brain stimulation in Parkinson's disease be preferred over the awake approach? Swiss Med Wkly 2024; 154:3856. [PMID: 39137440 DOI: 10.57187/s.3856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
No abstract available.
Collapse
Affiliation(s)
- Stephan Bohlhalter
- Neurocenter, Lucerne Cantonal Hospital, Lucerne, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - David Benninger
- Department of Neurology, CHUV, Lausanne, and Neurology, Reha Rheinfelden, Rheinfelden, Switzerland
| | - Deborah Brogle
- Departement of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Florian Hatz
- Departement of Neurology, University Hospital Basel, Basel, Switzerland
| | - Alain Kaelin-Lang
- Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Jens Carsten Möller
- Parkinson Center, Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Georg Kägi
- Departement of Neurology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | |
Collapse
|
2
|
Hvingelby VS, Pavese N. Surgical Advances in Parkinson's Disease. Curr Neuropharmacol 2024; 22:1033-1046. [PMID: 36411569 PMCID: PMC10964101 DOI: 10.2174/1570159x21666221121094343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/24/2022] [Accepted: 10/29/2022] [Indexed: 11/23/2022] Open
Abstract
While symptomatic pharmacological therapy remains the main therapeutic strategy for Parkinson's disease (PD), over the last two decades, surgical approaches have become more commonly used to control levodopa-induced motor complications and dopamine-resistant and non-motor symptoms of PD. In this paper, we discuss old and new surgical treatments for PD and the many technological innovations in this field. We have initially reviewed the relevant surgical anatomy as well as the pathological signaling considered to be the underlying cause of specific symptoms of PD. Subsequently, early attempts at surgical symptom control will be briefly reviewed. As the most well-known surgical intervention for PD is deep brain stimulation, this subject is discussed at length. As deciding on whether a patient stands to benefit from DBS can be quite difficult, the different proposed paradigms for precisely this are covered. Following this, the evidence regarding different targets, especially the subthalamic nucleus and internal globus pallidus, is reviewed as well as the evidence for newer proposed targets for specific symptoms. Due to the rapidly expanding nature of knowledge and technological capabilities, some of these new and potential future capabilities are given consideration in terms of their current and future use. Following this, we have reviewed newer treatment modalities, especially magnetic resonance-guided focused ultrasound and other potential surgical therapies, such as spinal cord stimulation for gait symptoms and others. As mentioned, the field of surgical alleviation of symptoms of PD is undergoing a rapid expansion, and this review provides a general overview of the current status and future directions in the field.
Collapse
Affiliation(s)
- Victor S. Hvingelby
- Department of Clinical Medicine, Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
| | - Nicola Pavese
- Department of Clinical Medicine, Nuclear Medicine and PET Center, Aarhus University, Aarhus, Denmark
- Clinical Ageing Research Unit, Newcastle Upon Tyne, Newcastle University, United Kingdom
| |
Collapse
|
3
|
Slavin KV. Commentary: Targeting Accuracy and Clinical Outcomes of Awake versus Asleep Interventional Magnetic Resonance Imaging-Guided Deep Brain Stimulation for Parkinson's Disease: The University of California, San Francisco Experience. Neurosurgery 2023; 92:e87-e88. [PMID: 36727768 DOI: 10.1227/neu.0000000000002378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/04/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA
| |
Collapse
|
4
|
Slavin KV. Commentary: Complications Related to Deep Brain Stimulation Lead Implantation: A Single-Surgeon Case Series. Oper Neurosurg (Hagerstown) 2023; 24:e308-e309. [PMID: 36745978 DOI: 10.1227/ons.0000000000000643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 02/08/2023] Open
Affiliation(s)
- Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois, USA.,Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois, USA
| |
Collapse
|
5
|
Rao AT, Chou KL, Patil PG. Localization of deep brain stimulation trajectories via automatic mapping of microelectrode recordings to MRI. J Neural Eng 2023; 20. [PMID: 36763997 DOI: 10.1088/1741-2552/acbb2b] [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: 07/09/2022] [Accepted: 02/10/2023] [Indexed: 02/12/2023]
Abstract
Objective. Suboptimal electrode placement during subthalamic nucleus deep brain stimulation (STN DBS) surgery may arise from several sources, including frame-based targeting errors and intraoperative brain shift. We present a computer algorithm that can accurately localize intraoperative microelectrode recording (MER) tracks on preoperative magnetic resonance imaging (MRI) in real-time, thereby predicting deviation between the surgical plan and the MER trajectories.Approach. Random forest (RF) modeling was used to derive a statistical relationship between electrophysiological features on intraoperative MER and voxel intensity on preoperative T2-weighted MR imaging. This model was integrated into a larger algorithm that can automatically localize intraoperative MER recording tracks on preoperative MRI in real-time. To verify accuracy, targeting error of both the planned intraoperative trajectory ('planned') and the algorithm-derived trajectory ('calculated') was estimated by measuring deviation from the final DBS lead location on postoperative high-resolution computed tomography ('actual').Main results. MR imaging and MERs were obtained from 24 STN DBS implant trajectories. The cross-validated RF model could accurately distinguish between gray and white matter regions along MER trajectories (AUC 0.84). When applying this model within the localization algorithm, thecalculatedMER trajectory estimate was found to be significantly closer to theactualDBS lead when compared to theplannedtrajectory recorded during surgery (1.04 mm vs 1.52 mm deviation,p< 0.002), with improvement shown in 19/24 cases (79%). When applying the algorithm to simulated DBS trajectory plans with randomized targeting error, up to 4 mm of error could be resolved to <2 mm on average (p< 0.0001).Significance. This work presents an automated system for intraoperative localization of electrodes during STN DBS surgery. This neuroengineering solution may enhance the accuracy of electrode position estimation, particularly in cases where high-resolution intraoperative imaging is not available.
Collapse
Affiliation(s)
- Akshay T Rao
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States of America.,Department of Neurology, University of Michigan, Ann Arbor, MI, United States of America.,Department of Neurosurgery, University of Michigan, Ann Arbor, MI, United States of America
| |
Collapse
|
6
|
Zhao GR, Cheng YF, Feng KK, Wang M, Wang YG, Wu YZ, Yin SY. Clinical Study of Intraoperative Microelectrode Recordings during Awake and Asleep Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease: A Retrospective Cohort Study. Brain Sci 2022; 12:brainsci12111469. [PMID: 36358395 PMCID: PMC9688350 DOI: 10.3390/brainsci12111469] [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: 09/26/2022] [Revised: 10/16/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Our objective is to analyze the difference of microelectrode recording (MER) during awake and asleep subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson’s disease (PD) and the necessity of MER during “Asleep DBS” under general anesthesia (GA). The differences in MER, target accuracy, and prognosis under different anesthesia methods were analyzed. Additionally, the MER length was compared with the postoperative electrode length by electrode reconstruction and measurement. The MER length of two groups was 5.48 ± 1.39 mm in the local anesthesia (LA) group and 4.38 ± 1.43 mm in the GA group, with a statistical significance between the two groups (p < 0.01). The MER length of the LA group was longer than its postoperative electrode length (p < 0.01), however, there was no significant difference between the MER length and postoperative electrode length in the GA group (p = 0.61). There were also no significant differences in the postoperative electrode length, target accuracy, and postoperative primary and secondary outcome scores between the two groups (p > 0.05). These results demonstrate that “Asleep DBS” under GA is comparable to “Awake DBS” under LA. GA has influences on MER during surgery, but typical STN discharges can still be recorded. MER is not an unnecessary surgical procedure.
Collapse
Affiliation(s)
- Guang-Rui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
- Department of Neurosurgery, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an 237000, China
| | - Yi-Feng Cheng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin 300350, China
| | - Ke-Ke Feng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin 300350, China
| | - Min Wang
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin 300350, China
| | - Yan-Gang Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
| | - Yu-Zhang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
| | - Shao-Ya Yin
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin 300350, China
- Correspondence:
| |
Collapse
|
7
|
Neumann WJ, Köhler RM, Kühn AA. A practical guide to invasive neurophysiology in patients with deep brain stimulation. Clin Neurophysiol 2022; 140:171-180. [PMID: 35659821 DOI: 10.1016/j.clinph.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
Deep brain stimulation (DBS) offers the unique opportunity to record human neural population activity as multiunit activity and local field potentials (LFP) directly from the target area in the depth of the brain. This has led to important discoveries through characterization of pathological activity patterns and identification of motor and cognitive correlates of basal ganglia function in patients with movement disorders. These findings have been covered extensively in a large body of literature, but the technical aspects of microelectrode and LFP recordings in DBS patients are rarely reported. This review summarizes the experience from invasive neurophysiology experiments in over 500 DBS cases in the last 20 years in a single centre. It introduces the basics of intraoperative microelectrode recordings, discusses the neurophysiological and technical aspects of LFP signals and gives and outlook on current and next-generation developments - from sensing enabled implantable devices to combined electrocorticography and LFP recordings during adaptive DBS.
Collapse
Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Richard M Köhler
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Chariteplatz 1, 10117 Berlin, Germany.
| |
Collapse
|