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Olson MC, Shill H, Ponce F, Aslam S. Deep brain stimulation in PD: risk of complications, morbidity, and hospitalizations: a systematic review. Front Aging Neurosci 2023; 15:1258190. [PMID: 38046469 PMCID: PMC10690827 DOI: 10.3389/fnagi.2023.1258190] [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: 07/13/2023] [Accepted: 10/30/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a progressive and debilitating neurological disorder. While dopaminergic medication improves PD symptoms, continued management is complicated by continued symptom progression, increasing medication fluctuations, and medication-related dyskinesia. Deep brain stimulation (DBS) surgery is a well-accepted and widespread treatment often utilized to address these symptoms in advanced PD. However, DBS may also lead to complications requiring hospitalization. In addition, patients with PD and DBS may have specialized care needs during hospitalization. Methods This systematic review seeks to characterize the complications and risk of hospitalization following DBS surgery. Patient risk factors and modifications to DBS surgical techniques that may affect surgical risk are also discussed. Results It is found that, when candidates are carefully screened, DBS is a relatively low-risk procedure, but rate of hospitalization is somewhat increased for DBS patients. Discussion More research is needed to determine the relative influence of more advanced disease vs. DBS itself in increased rate of hospitalization, but education about DBS and PD is important to insure effective patient care within the hospital.
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Affiliation(s)
- Markey C. Olson
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
- Department of Neurosurgery, Barrow Brain and Spine, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Holly Shill
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Francisco Ponce
- Department of Neurosurgery, Barrow Brain and Spine, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
| | - Sana Aslam
- Department of Neurology, Muhammad Ali Movement Disorders Clinic, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ, United States
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Luo M, Narasimhan S, Larson PS, Martin AJ, Konrad PE, Miga MI. Impact of brain shift on neural pathways in deep brain stimulation: a preliminary analysis via multi-physics finite element models. J Neural Eng 2021; 18. [PMID: 33740780 DOI: 10.1088/1741-2552/abf066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/19/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The effectiveness of deep brain stimulation (DBS) depends on electrode placement accuracy, which can be compromised by brain shift during surgery. While there have been efforts in assessing the impact of electrode misplacement due to brain shift using preop- and postop- imaging data, such analysis using preop- and intraop- imaging data via biophysical modeling has not been conducted. This work presents a preliminary study that applies a multi-physics analysis framework using finite element biomechanical and bioelectric models to examine the impact of realistic intraoperative shift on neural pathways determined by tractography. APPROACH The study examined six patients who had undergone interventional magnetic resonance (iMR)-guided DBS surgery. The modeling framework utilized a biomechanical approach to update preoperative MR to reflect shift-induced anatomical changes. Using this anatomically deformed image and its undeformed counterpart, bioelectric effects from shifting electrode leads could be simulated and neural activation differences were approximated. Specifically, for each configuration, volume of tissue activation (VTA) was computed and subsequently used for tractography estimation. Total tract volume and overlapping volume with motor regions as well as connectivity profile were compared. In addition, volumetric overlap between different fiber bundles among configurations was computed and correlated to estimated shift. MAIN RESULT The study found deformation-induced differences in tract volume, motor region overlap, and connectivity behavior, suggesting the impact of shift. There is a strong correlation (R=-0.83) between shift from intended target and intended neural pathway recruitment, where at threshold of ~2.94 mm, intended recruitment completely degrades. The determined threshold is consistent with and provides quantitative support to prior observations and literature that deviations of 2-3 mm are detrimental. SIGNIFICANCE The findings support and advance prior studies and understanding to illustrate the need to account for shift in DBS and the potentiality of computational modeling for estimating influence of shift on neural activation.
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Affiliation(s)
- Ma Luo
- Biomedical Engineering, Vanderbilt University, 5824 Stevenson Center, Nashville, Tennessee, 37232, UNITED STATES
| | - Saramati Narasimhan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Nashville, Tennessee, 37212, UNITED STATES
| | - Paul S Larson
- Department of Neurological Surgery, University of California San Francisco, Box 0112, 505 Parnassus Ave, Room M779, San Francisco, California, 94143, UNITED STATES
| | - Alastiar J Martin
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California, 94143, UNITED STATES
| | - Peter E Konrad
- Department of Neurosurgery, West Virginia University, PO Box 9183, Morgantown, West Virginia, 26506, UNITED STATES
| | - Michael I Miga
- Department of Biomedical Engineering, Vanderbilt University, 5901 Stevenson Center, Nashville, Tennessee, 37235, UNITED STATES
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Yang PF, Phipps MA, Jonathan S, Newton AT, Byun N, Gore JC, Grissom WA, Caskey CF, Chen LM. Bidirectional and state-dependent modulation of brain activity by transcranial focused ultrasound in non-human primates. Brain Stimul 2021; 14:261-272. [PMID: 33460838 PMCID: PMC7988301 DOI: 10.1016/j.brs.2021.01.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/19/2020] [Accepted: 01/08/2021] [Indexed: 01/10/2023] Open
Abstract
Transcranial focused ultrasound (FUS) stimulation under MRI guidance, coupled with functional MRI (fMRI) monitoring of effects, offers a precise, noninvasive technology to dissect functional brain circuits and to modulate altered brain functional networks in neurological and psychiatric disorders. Here we show that ultrasound at moderate intensities modulated neural activity bi-directionally. Concurrent sonication of somatosensory areas 3a/3b with 250 kHz FUS suppressed the fMRI signals produced there by peripheral tactile stimulation, while at the same time eliciting fMRI activation at inter-connected, off-target brain regions. Direct FUS stimulation of the cortex resulted in different degrees of BOLD signal changes across all five off-target regions, indicating that its modulatory effects on active and resting neurons differed. This is the first demonstration of the dual suppressive and excitative modulations of FUS on a specific functional circuit and of ability of concurrent FUS and MRI to evaluate causal interactions between functional circuits with neuron-class selectivity.
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Affiliation(s)
- Pai-Feng Yang
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - M Anthony Phipps
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Sumeeth Jonathan
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Allen T Newton
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nellie Byun
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - John C Gore
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - William A Grissom
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Charles F Caskey
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Li Min Chen
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
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Malaga KA, Costello JT, Chou KL, Patil PG. Atlas-independent, N-of-1 tissue activation modeling to map optimal regions of subthalamic deep brain stimulation for Parkinson disease. NEUROIMAGE-CLINICAL 2020; 29:102518. [PMID: 33333464 PMCID: PMC7736726 DOI: 10.1016/j.nicl.2020.102518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/25/2020] [Accepted: 11/27/2020] [Indexed: 01/13/2023]
Abstract
Neuroanatomical variations among patients are obscured in atlas-based VTA modeling. N-of-1 neuroanatomical and VTA modeling enables patient-level precision. Mean optimal stimulation is dorsomedial to the STN, near its posterior half. Individual VTAs deviate from optimal stimulation sites to varying degrees. Optimal stimulation sites for rigidity, bradykinesia, and tremor partially overlap.
Background Motor outcomes after subthalamic deep brain stimulation (STN DBS) for Parkinson disease (PD) vary considerably among patients and strongly depend on stimulation location. The objective of this retrospective study was to map the regions of optimal STN DBS for PD using an atlas-independent, fully individualized (N-of-1) tissue activation modeling approach and to assess the relationship between patient-level therapeutic volumes of tissue activation (VTAs) and motor improvement. Methods The stimulation-induced electric field for 40 PD patients treated with bilateral STN DBS was modeled using finite element analysis. Neurostimulation models were generated for each patient, incorporating their individual STN anatomy, DBS lead position and orientation, anisotropic tissue conductivity, and clinical stimulation settings. A voxel-based analysis of the VTAs was then used to map the optimal location of stimulation. The amount of stimulation in specific regions relative to the STN was measured and compared between STNs with more and less optimal stimulation, as determined by their motor improvement scores and VTA. The relationship between VTA location and motor outcome was then assessed using correlation analysis. Patient variability in terms of STN anatomy, active contact position, and VTA location were also evaluated. Results from the N-of-1 model were compared to those from a simplified VTA model. Results Tissue activation modeling mapped the optimal location of stimulation to regions medial, posterior, and dorsal to the STN centroid. These regions extended beyond the STN boundary towards the caudal zona incerta (cZI). The location of the VTA and active contact position differed significantly between STNs with more and less optimal stimulation in the dorsal-ventral and anterior-posterior directions. Therapeutic stimulation spread noticeably more in the dorsal and posterior directions, providing additional evidence for cZI as an important DBS target. There were significant linear relationships between the amount of dorsal and posterior stimulation, as measured by the VTA, and motor improvement. These relationships were more robust than those between active contact position and motor improvement. There was high variability in STN anatomy, active contact position, and VTA location among patients. Spherical VTA modeling was unable to reproduce these results and tended to overestimate the size of the VTA. Conclusion Accurate characterization of the spread of stimulation is needed to optimize STN DBS for PD. High variability in neuroanatomy, stimulation location, and motor improvement among patients highlights the need for individualized modeling techniques. The atlas-independent, N-of-1 tissue activation modeling approach presented in this study can be used to develop and evaluate stimulation strategies to improve clinical outcomes on an individual basis.
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Affiliation(s)
- Karlo A Malaga
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Joseph T Costello
- Department of Electrical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Kelvin L Chou
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
| | - Parag G Patil
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA; Department of Neurology, University of Michigan, Ann Arbor, MI, USA; Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA.
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Effects of Subthalamic Nucleus Deep Brain Stimulation on Facial Emotion Recognition in Parkinson's Disease: A Critical Literature Review. Behav Neurol 2020; 2020:4329297. [PMID: 32724481 PMCID: PMC7382738 DOI: 10.1155/2020/4329297] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/12/2020] [Indexed: 01/04/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective therapy for Parkinson's disease (PD). Nevertheless, DBS has been associated with certain nonmotor, neuropsychiatric effects such as worsening of emotion recognition from facial expressions. In order to investigate facial emotion recognition (FER) after STN DBS, we conducted a literature search of the electronic databases MEDLINE and Web of science. In this review, we analyze studies assessing FER after STN DBS in PD patients and summarize the current knowledge of the effects of STN DBS on FER. The majority of studies, which had clinical and methodological heterogeneity, showed that FER is worsening after STN DBS in PD patients, particularly for negative emotions (sadness, fear, anger, and tendency for disgust). FER worsening after STN DBS can be attributed to the functional role of the STN in limbic circuits and the interference of STN stimulation with neural networks involved in FER, including the connections of the STN with the limbic part of the basal ganglia and pre- and frontal areas. These outcomes improve our understanding of the role of the STN in the integration of motor, cognitive, and emotional aspects of behaviour in the growing field of affective neuroscience. Further studies using standardized neuropsychological measures of FER assessment and including larger cohorts are needed, in order to draw definite conclusions about the effect of STN DBS on emotional recognition and its impact on patients' quality of life.
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Liddle J, Sundraraj A, Ireland D, Bennett S, Stillerova T, Silburn P. Impact of deep brain stimulation on people with Parkinson's disease: A mixed methods feasibility study exploring lifespace and community outcomes. Hong Kong J Occup Ther 2019; 32:97-107. [PMID: 32009861 PMCID: PMC6967222 DOI: 10.1177/1569186119865736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 06/25/2019] [Indexed: 01/07/2023] Open
Abstract
Background Deep brain stimulation is a surgical treatment for Parkinson’s
disease. Its impacts on motor symptoms are widely reported;
however, little is known about the broader impact of deep brain
stimulation on the community lives of people with Parkinson’s
disease. Lifespace is a measure of lived community mobility,
providing an indication of community access and
participation. Aims This pilot study explored the feasibility of remotely monitoring
the qualitative and quantitative community outcomes related to
deep brain stimulation. Methods A longitudinal mixed methods study with a convergent design was
undertaken exploring the lifespace, quality of life, life
satisfaction and lived experiences of people with Parkinson’s
disease before and after deep brain stimulation. Data were
collected through questionnaires, semi-structured interviews and
a smartphone-based application which collected geolocation
data. Results Quantitative and qualitative data from eight participants living
with Parkinson’s disease were analysed and integrated. At
baseline, participants had a median age of 68 years and a median
Hoehn and Yahr score of 2. Measuring a range of community-based
outcomes indicated different change trajectories for individuals
across outcomes. Key content areas were developed from the
qualitative data: participation in occupations and travel and
home. This study indicates the potential value of including
geolocation data-based lifespace collection in metropolitan and
regional areas. Conclusions Monitoring lifespace in conjunction with subjective measures
provides insights into the complex and individually varied
experiences. Further research could explore the impacts of deep
brain stimulation on occupations and community participation to
gain a deeper understanding of the related needs and support
clinical approaches.
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Affiliation(s)
- Jacki Liddle
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Australia.,School of Information Technology and Electrical Engineering, The University of Queensland, Australia
| | - Amreetaa Sundraraj
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - David Ireland
- CSIRO, Australian ehealth Research Centre, Australia
| | - Sally Bennett
- School of Health and Rehabilitation Sciences, The University of Queensland, Australia
| | - Tereza Stillerova
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Australia
| | - Peter Silburn
- Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Australia
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Conrad E, Mossner J, Chou K, Patil P. Atlas-Independent, Electrophysiological Mapping of the Optimal Locus of Subthalamic Deep Brain Stimulation for the Motor Symptoms of Parkinson Disease. Stereotact Funct Neurosurg 2018; 96:91-99. [DOI: 10.1159/000486643] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 01/08/2018] [Indexed: 11/19/2022]
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Yang PF, Phipps MA, Newton AT, Chaplin V, Gore JC, Caskey CF, Chen LM. Neuromodulation of sensory networks in monkey brain by focused ultrasound with MRI guidance and detection. Sci Rep 2018; 8:7993. [PMID: 29789605 PMCID: PMC5964220 DOI: 10.1038/s41598-018-26287-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 05/08/2018] [Indexed: 01/16/2023] Open
Abstract
Focused ultrasound (FUS) has gained recognition as a technique for non-invasive neuromodulation with high spatial precision and the ability to both excite and inhibit neural activity. Here we demonstrate that MRI-guided FUS is capable of exciting precise targets within areas 3a/3b in the monkey brain, causing downstream activations in off-target somatosensory and associated brain regions which are simultaneously detected by functional MRI. The similarity between natural tactile stimulation-and FUS- evoked fMRI activation patterns suggests that FUS likely can excite populations of neurons and produce associated spiking activities that may be subsequently transmitted to other functionally related touch regions. The across-region differences in fMRI signal changes relative to area 3a/3b between tactile and FUS conditions also indicate that FUS modulated the tactile network differently. The significantly faster rising (>1 sec) fMRI signals elicited by direct FUS stimulation at the targeted cortical region suggest that a different neural hemodynamic coupling mechanism may be involved in generating fMRI signals. This is the first demonstration of imaging neural excitation effects of FUS with BOLD fMRI on a specific functional circuit in non-human primates.
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Affiliation(s)
- Pai-Feng Yang
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA
| | - M Anthony Phipps
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA
| | - Allen T Newton
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA
| | - Vandiver Chaplin
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA
| | - John C Gore
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA
| | - Charles F Caskey
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA.
| | - Li Min Chen
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt University Institute of Imaging Science, Nashville, TN, USA.
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Gulick DW, Li T, Kleim JA, Towe BC. Comparison of Electrical and Ultrasound Neurostimulation in Rat Motor Cortex. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:2824-2833. [PMID: 28964613 DOI: 10.1016/j.ultrasmedbio.2017.08.937] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 08/16/2017] [Accepted: 08/17/2017] [Indexed: 06/07/2023]
Abstract
Ultrasound (US) is known to non-invasively stimulate and modulate brain function; however, the mechanism of action is poorly understood. This study tested US stimulation of rat motor cortex (100 W/cm2, 200 kHz) in combination with epidural cortical stimulation. US directly evoked hindlimb movement. This response occurred even with short US bursts (3 ms) and had short latency (10 ms) and long refractory (3 s) periods. Unexpectedly, the epidural cortical stimulation hindlimb response was not altered during the 3-s refractory period of the US hindlimb response. This finding suggests that the US refractory period is not a general suppression of motor cortex, but rather the recovery time of a US-specific mechanism.
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Affiliation(s)
- Daniel W Gulick
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA.
| | - Tao Li
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jeffrey A Kleim
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
| | - Bruce C Towe
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, Arizona, USA
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Gordon CR, Santiago GF, Huang J, Bergey GK, Liu S, Armand M, Brem H, Anderson WS. First In-Human Experience With Complete Integration of Neuromodulation Device Within a Customized Cranial Implant. Oper Neurosurg (Hagerstown) 2017; 15:39-45. [DOI: 10.1093/ons/opx210] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 09/01/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Neuromodulation devices have the potential to transform modern day treatments for patients with medicine-resistant neurological disease. For instance, the NeuroPace System (NeuroPace Inc, Mountain View, California) is a Food and Drug Administration (FDA)-approved device developed for closed-loop direct brain neurostimulation in the setting of drug-resistant focal epilepsy. However, current methods require placement either above or below the skull in nonanatomic locations. This type of positioning has several drawbacks including visible deformities and scalp pressure from underneath leading to eventual wound healing difficulties, micromotion of hardware with infection, and extrusion leading to premature explantation.
OBJECTIVE
To introduce complete integration of a neuromodulation device within a customized cranial implant for biocompatibility optimization and prevention of visible deformity.
METHODS
We report a patient with drug-resistant focal epilepsy despite previous seizure surgery and maximized medical therapy. Preoperative imaging demonstrated severe resorption of previous bone flap causing deformity and risk for injury. She underwent successful responsive neurostimulation device implantation via complete integration within a clear customized cranial implant.
RESULTS
The patient has recovered well without complication and has been followed closely for 180 d. Device interrogation with electrocorticographic data transmission has been successfully performed through the clear implant material for the first time with no evidence of any wireless transmission interference.
CONCLUSION
Cranial contour irregularities, implant site infection, and bone flap resorption/osteomyelitis are adverse events associated with implantable neurotechnology. This method represents a novel strategy to incorporate all future neuromodulation devices within the confines of a low-profile, computer-designed cranial implant and the newfound potential to eliminate contour irregularities, improve outcomes, and optimize patient satisfaction.
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Affiliation(s)
- Chad R Gordon
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore Maryland
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gabriel F Santiago
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore Maryland
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Judy Huang
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Gregory K Bergey
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shuya Liu
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Mehran Armand
- Department of Mechanical Engineering, Johns Hopkins University, Baltimore, Maryland
- Johns Hopkins University Applied Physics Laboratory, Laurel, Maryland
| | - Henry Brem
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William S Anderson
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Deep Brain Stimulation of Hemiparkinsonian Rats with Unipolar and Bipolar Electrodes for up to 6 Weeks: Behavioral Testing of Freely Moving Animals. PARKINSONS DISEASE 2017; 2017:5693589. [PMID: 28758044 PMCID: PMC5512044 DOI: 10.1155/2017/5693589] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/24/2017] [Accepted: 04/11/2017] [Indexed: 12/15/2022]
Abstract
Although the clinical use of deep brain stimulation (DBS) is increasing, its basic mechanisms of action are still poorly understood. Platinum/iridium electrodes were inserted into the subthalamic nucleus of rats with unilateral 6-OHDA-induced lesions of the medial forebrain bundle. Six behavioral parameters were compared with respect to their potential to detect DBS effects. Locomotor function was quantified by (i) apomorphine-induced rotation, (ii) initiation time, (iii) the number of adjusting steps in the stepping test, and (iv) the total migration distance in the open field test. Sensorimotor neglect and anxiety were quantified by (v) the retrieval bias in the corridor test and (vi) the ratio of migration distance in the center versus in the periphery in the open field test, respectively. In our setup, unipolar stimulation was found to be more efficient than bipolar stimulation for achieving beneficial long-term DBS effects. Performance in the apomorphine-induced rotation test showed no improvement after 6 weeks. DBS reduced the initiation time of the contralateral paw in the stepping test after 3 weeks of DBS followed by 3 weeks without DBS. Similarly, sensorimotor neglect was improved. The latter two parameters were found to be most appropriate for judging therapeutic DBS effects.
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Patel SH, Halpern CH, Shepherd TM, Timpone VM. Electrical stimulation and monitoring devices of the CNS: An imaging review. J Neuroradiol 2017; 44:175-184. [DOI: 10.1016/j.neurad.2016.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 10/12/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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Haahr A, Brincks J, Sørensen D. Coping with Parkinson's disease in everyday life: a systematic review protocol. ACTA ACUST UNITED AC 2017; 15:1288-1297. [DOI: 10.11124/jbisrir-2016-002989] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Villalobos J, Fallon JB, McNeill PM, Allison RK, Bibari O, Williams CE, McDermott HJ. Preclinical evaluation of a miniaturized Deep Brain Stimulation electrode lead. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:6908-11. [PMID: 26737881 DOI: 10.1109/embc.2015.7319981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The effect of miniaturizing the electrode lead for Deep Brain Stimulation (DBS) therapy was investigated in this work. A direct comparison was made between a miniature lead (0.65 mm diameter) and a lead of standard size (1.3 mm). Acute in vivo implantation in two cat brains was performed to evaluate surgical trauma and confirm capacity to target thalamic nuclei. Insertion into a homogeneous gel model of neural tissue was used to compare insertion forces while visualizing the process. The standard size cannula, used first to guide lead insertion, required substantially higher insertion force compared with the miniature version and produced a significantly larger region of tissue disruption. The characteristic hemorrhage and edema extended 119-352 μm from the implanted track surface of the miniature lead and cannula, while these extended 311-571 μm for the standard size lead and cannula. A miniature DBS implant can reduce the extent of trauma and could potentially help improve neural function preservation after functional neurosurgery.
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Kölbl F, N'Kaoua G, Naudet F, Berthier F, Faggiani E, Renaud S, Benazzouz A, Lewis N. An Embedded Deep Brain Stimulator for Biphasic Chronic Experiments in Freely Moving Rodents. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2016; 10:72-84. [PMID: 25546861 DOI: 10.1109/tbcas.2014.2368788] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper describes a Deep Brain Stimulation device, portable, for chronic experiments on rodents in the context of Parkinson's disease. Our goal is to equip the animal with a device that mimics the human therapeutic conditions. It implies to respect a set of properties such as bilateral current-mode and charge-balanced stimulation, as well as programmability, low power consumption and re-usability to finally reach a suitable weight for long-term experiments. After the analysis of the solutions found in the literature, the full design of the device is explained. First, the stimulation front-end circuit driven by a processor unit, then the choice of supply sources which is a critical point for the weight and life-time of our system. Our low cost system has been realized using commercial discrete components and the overall power consumption was minimized. We achieved 6 days of maximal current stimulation with the chosen battery for a weight of 13.8 g . Finally, the device was carried out in vivo on rats during a 3 weeks experiment as the used implantation technique allows battery changing. This experiment also permits to emphasize the mechanical aspects including the packaging and electrodes holding.
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Wei Z, Gordon CR, Bergey GK, Sacks JM, Anderson WS. Implant Site Infection and Bone Flap Osteomyelitis Associated with the NeuroPace Responsive Neurostimulation System. World Neurosurg 2015; 88:687.e1-687.e6. [PMID: 26743382 DOI: 10.1016/j.wneu.2015.11.106] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Revised: 11/08/2015] [Accepted: 11/12/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND The NeuroPace RNS System is a method recently approved by the U.S. Food and Drug Administration for closed-loop direct brain stimulation in selected patients with drug-resistant partial seizures. The long-term risks of implant site infection and accompanying bone flap osteomyelitis associated with responsive neurostimulation (RNS) devices have not been fully appreciated. CASE DESCRIPTION We report 3 cases of refractory partial epilepsy that were treated with RNS therapy in conjunction with antiepileptic drugs. Patients underwent invasive epilepsy monitoring and resection of seizure foci. All patients continued to have debilitating partial seizures and underwent implantation of the RNS device, which resulted in various degrees of symptomatic relief. On average, the battery of the implantable pulse generator was replaced every 2 years. All 3 patients developed implant site infection and bone flap osteomyelitis with multiple implantable pulse generator replacements, and the RNS devices were removed. Bone flaps were removed in 2 patients because of significant osteomyelitis and were reconstructed in a delayed fashion with customized cranial implants. No patient had evidence of meningitis or cerebritis. The patients were treated via a multidisciplinary approach, and all patients recovered well with satisfactory wound healing and seizure control. CONCLUSIONS Implant site infection and bone flap osteomyelitis are significant adverse events associated with the RNS device. The incidence of infection in this series (10%) is comparable to the incidence reported in the long-term trial. The infection risk is mainly associated with reoperations and increases with multiple implantable pulse generator replacements. The RNS device may benefit from reducing technical risk factors that are associated with postoperative bone and soft tissue infections.
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Affiliation(s)
- Zhikui Wei
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
| | - Chad R Gordon
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA; Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gregory K Bergey
- Department of Neurology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Justin M Sacks
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - William S Anderson
- Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
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Seemann M, Zech N, Lange M, Hansen J, Hansen E. [Anesthesiological aspects of deep brain stimulation : special features of implementation and dealing with brain pacemaker carriers]. Anaesthesist 2014; 62:549-56. [PMID: 23817843 DOI: 10.1007/s00101-013-2201-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deep brain stimulation (DBS) provides a very effective treatment for a number of neurological diseases including Parkinson's disease, movement disorders and epilepsy. In DBS microelectrodes are positioned in defined cerebral target areas and connected to a pacemaker. It is most often performed as an awake craniotomy with intraoperative testing. Various anesthesiological regimes are used to protect the patient from surgical stress on the one hand and to achieve ideal test conditions on the other. They include local anesthesia or scalp blocks, intermittent general anesthesia or analgosedation with or without airway protection; however, anesthetic agents interfere with hemodynamic stability and ventilation, with vigilance and cooperation and in addition with the symptoms and microelectrode recording. Guidance and communication have a pivotal impact on patient needs for pharmacological interventions. With increasing numbers of DBS procedures, anesthesiologists are more often faced with patients carrying brain pacemakers. For anesthesia the characteristics of the disease as well as the respective long-term medication have to be considered. In addition, the rules for handling patients with pacemakers need to be followed to avoid both dysfunction of the generator and tissue damage due to overheating of the electrodes.
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Affiliation(s)
- M Seemann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland
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Sonia Angeline M, Sarkar A, Anand K, Ambasta R, Kumar P. Sesamol and naringenin reverse the effect of rotenone-induced PD rat model. Neuroscience 2013; 254:379-94. [DOI: 10.1016/j.neuroscience.2013.09.029] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/12/2013] [Accepted: 09/15/2013] [Indexed: 01/05/2023]
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19
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Cheng CY, Hsing MT, Chen YH, Wu SL, Sy HN, Chen CM, Yang YJ, Lee MC. Deep brain stimulation for Parkinson's disease using frameless technology. Br J Neurosurg 2013; 28:383-6. [DOI: 10.3109/02688697.2013.848838] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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20
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Gelabert-González M, Relova Quinteiro JL, Castro-García A. [Deep brain stimulation. Twenty-five years later]. Med Clin (Barc) 2013; 141:29-32. [PMID: 23540386 DOI: 10.1016/j.medcli.2013.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Miguel Gelabert-González
- Departamento de Cirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
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21
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Gallego JÁ, Rocon E, Belda-Lois JM, Pons JL. A neuroprosthesis for tremor management through the control of muscle co-contraction. J Neuroeng Rehabil 2013; 10:36. [PMID: 23587119 PMCID: PMC3661364 DOI: 10.1186/1743-0003-10-36] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 03/25/2013] [Indexed: 11/16/2022] Open
Abstract
Background Pathological tremor is the most prevalent movement disorder. Current treatments do not attain a significant tremor reduction in a large proportion of patients, which makes tremor a major cause of loss of quality of life. For instance, according to some estimates, 65% of those suffering from upper limb tremor report serious difficulties during daily living. Therefore, novel forms for tremor management are required. Since muscles intrinsically behave as a low pass filter, and tremor frequency is above that of volitional movements, the authors envisioned the exploitation of these properties as a means of developing a novel treatment alternative. This treatment would rely on muscle co-contraction for tremor management, similarly to the strategy employed by the intact central nervous system to stabilize a limb during certain tasks. Methods We implemented a neuroprosthesis that regulated the level of muscle co-contraction by injecting current at a pair of antagonists through transcutaneous neurostimulation. Co-contraction was adapted to the instantaneous parameters of tremor, which were estimated from the raw recordings of a pair of solid state gyroscopes with a purposely designed adaptive algorithm. For the experimental validation, we enrolled six patients suffering from parkinsonian or essential tremor of different severity, and evaluated the effect of the neuroprosthesis during standard tasks employed for neurological examination. Results The neuroprosthesis attained significant attenuation of tremor (p<0.001), and reduced its amplitude up to a 52.33±25.48%. Furthermore, it alleviated both essential and parkinsonian tremor in spite of their different etiology and symptomatology. Tremor severity was not a limiting factor on the performance of the neuroprosthesis, although there was a subtle trend towards larger attenuation of more severe tremors. Tremor frequency was not altered during neurostimulation, as expected from the central origin of Parkinson’s disease and essential tremor. All patients showed a good tolerance to neurostimulation in terms of comfort and absence of pain, and some spontaneously reported that they felt that tremor was reduced when the neuroprosthesis was activated. Conclusions The results presented herein demonstrate that the neuroprosthesis provides systematic attenuation of the two major types of tremor, irrespectively from their severity. This study sets the basis for the validation of the neuroprosthesis as an alternative, non-invasive means for tremor management.
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Affiliation(s)
- Juan Álvaro Gallego
- Bioengineering Group, Consejo Superior de Investigaciones Científicas (CSIC), Ctra Campo Real km 0.2-La Poveda, 28500 Arganda del Rey, Spain.
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García-Gomar MG, Concha L, Alcauter S, Abraham JS, Carrillo-Ruiz JD, Farfan GC, Campos FV. Probabilistic tractography of the posterior subthalamic area in Parkinson’s disease patients. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/jbise.2013.63a048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Huang YZ, Lu CS, Rothwell JC, Lo CC, Chuang WL, Weng YH, Lai SC, Chen RS. Modulation of the disturbed motor network in dystonia by multisession suppression of premotor cortex. PLoS One 2012; 7:e47574. [PMID: 23071824 PMCID: PMC3468590 DOI: 10.1371/journal.pone.0047574] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 09/17/2012] [Indexed: 11/26/2022] Open
Abstract
Daily sessions of therapeutic transcranial brain stimulation are thought to prolong or amplify the effect of a single intervention. Here we show in patients with focal hand dystonia that additional, new effects build up progressively over time, making it difficult to predict the effect of long term interventions from shorter treatment sessions. In a sham-controlled study, real or sham continuous theta burst stimulation (cTBS) was given once daily for five consecutive days to dorsolateral premotor cortex (PMd). Five days of real, but not sham, premotor cTBS improved intracortical inhibition in primary motor cortex (M1) to a similar extent on day 1 and day 5. However 5 days of cTBS were required to restore the abnormal PMd-M1 interactions observed on day 1. Similarly, excessive M1 plasticity seen at baseline was also significantly reduced by five days of real premotor cTBS. There was only a marginal benefit on writing. The results show that additional, new effects, at sites distant from the point of stimulation, build up progressively over time, making it difficult to predict the effect of long term interventions from shorter treatment sessions. The results indicate that it may take many days of therapeutic intervention to rebalance activity in a complex network.
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Affiliation(s)
- Ying-Zu Huang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
| | - Chin-Song Lu
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
| | - John C. Rothwell
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, University College London, Queen Square, London, United Kingdom
| | - Chung-Chuan Lo
- Institute of Systems Neuroscience, National Tsing Hua University, Hsinchu, Taiwan
| | - Wen-Li Chuang
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
| | - Yi-Hsin Weng
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
| | - Szu-Chia Lai
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
| | - Rou-Shayn Chen
- Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
- * E-mail:
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Rodriguez-Romaguera J, Do Monte FHM, Quirk GJ. Deep brain stimulation of the ventral striatum enhances extinction of conditioned fear. Proc Natl Acad Sci U S A 2012; 109:8764-9. [PMID: 22586125 PMCID: PMC3365168 DOI: 10.1073/pnas.1200782109] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) reduces symptoms of intractable obsessive-compulsive disorder (OCD), but the mechanism of action is unknown. OCD is characterized by avoidance behaviors that fail to extinguish, and DBS could act, in part, by facilitating extinction of fear. We investigated this possibility by using auditory fear conditioning in rats, for which the circuits of fear extinction are well characterized. We found that DBS of the VS (the VC/VS homolog in rats) during extinction training reduced fear expression and strengthened extinction memory. Facilitation of extinction was observed for a specific zone of dorsomedial VS, just above the anterior commissure; stimulation of more ventrolateral sites in VS impaired extinction. DBS effects could not be obtained with pharmacological inactivation of either dorsomedial VS or ventrolateral VS, suggesting an extrastriatal mechanism. Accordingly, DBS of dorsomedial VS (but not ventrolateral VS) increased expression of a plasticity marker in the prelimbic and infralimbic prefrontal cortices, the orbitofrontal cortex, the amygdala central nucleus (lateral division), and intercalated cells, areas known to learn and express extinction. Facilitation of fear extinction suggests that, in accord with clinical observations, DBS could augment the effectiveness of cognitive behavioral therapies for OCD.
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Affiliation(s)
| | | | - Gregory J. Quirk
- Departments of Psychiatry and Anatomy and Neurobiology, University of Puerto Rico School of Medicine, San Juan, PR 00936-5067
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25
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Haahr A, Kirkevold M, Hall EO, Østergaard K. ‘Being in it together’: living with a partner receiving deep brain stimulation for advanced Parkinson’s disease - a hermeneutic phenomenological study. J Adv Nurs 2012; 69:338-47. [DOI: 10.1111/j.1365-2648.2012.06012.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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26
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Muniz AMS, Nadal J, Lyons KE, Pahwa R, Liu W. Long-term evaluation of gait initiation in six Parkinson's disease patients with bilateral subthalamic stimulation. Gait Posture 2012; 35:452-7. [PMID: 22154114 DOI: 10.1016/j.gaitpost.2011.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 09/09/2011] [Accepted: 11/03/2011] [Indexed: 02/02/2023]
Abstract
Defined as the transient state between standing and walking, gait initiation is negatively affected in Parkinson's disease (PD), which often results in significant disability. Although deep brain stimulation (DBS) is the most common surgical procedure for PD, the long-term effects of DBS on gait initiation are not well studied. The present study evaluated the long-term effects of subthalamic nucleus (STN) DBS on the preparation phase of gait initiation using principal component (PC) analysis. Six patients with PD who had undergone STN DBS and 24 healthy control subjects were evaluated. PD subjects were assessed 11.3±10.3 (P1) and 78.9±10.6 (P2) months after surgery. PD subjects were tested with STN DBS in two conditions: without medication and with medication. PC analysis was applied separately for the vertical, anterior-posterior and medial-lateral components of ground reaction force (GRF) recorded during gait initiation. Three PC scores were chosen by the scree test for each GRF component and all these PC scores were used for calculating a standard distance between healthy controls and PD subjects. The Friedman test showed a significant difference in standard distance among conditions (P=0.004), with the post-hoc test recognizing differences among P1 conditions and P2 medication-on condition. The eigenvector loading factors pointed to major differences between PD conditions surrounding the maximum amplitude of vertical and anterior-posterior GRF. For the studied sample, all distances increased in the follow-up evaluation (P2) with and without medications, indicating a worsening in gait initiation after seven years.
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Affiliation(s)
- A M S Muniz
- Department of Post-graduation, Physical Education Collage of Brazilian Army, Rio de Janeiro, RJ, Brazil.
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Arfin SK, Sarpeshkar R. An energy-efficient, adiabatic electrode stimulator with inductive energy recycling and feedback current regulation. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2012; 6:1-14. [PMID: 23852740 DOI: 10.1109/tbcas.2011.2166072] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In this paper, we present a novel energy-efficient electrode stimulator. Our stimulator uses inductive storage and recycling of energy in a dynamic power supply. This supply drives an electrode in an adiabatic fashion such that energy consumption is minimized. It also utilizes a shunt current-sensor to monitor and regulate the current through the electrode via feedback, thus enabling flexible and safe stimulation. Since there are no explicit current sources or current limiters, wasteful energy dissipation across such elements is naturally avoided. The dynamic power supply allows efficient transfer of energy both to and from the electrode and is based on a DC-DC converter topology that we use in a bidirectional fashion in forward-buck or reverse-boost modes. In an exemplary electrode implementation intended for neural stimulation, we show how the stimulator combines the efficiency of voltage control and the safety and accuracy of current control in a single low-power integrated-circuit built in a standard .35 μm CMOS process. This stimulator achieves a 2x-3x reduction in energy consumption as compared to a conventional current-source-based stimulator operating from a fixed power supply. We perform a theoretical analysis of the energy efficiency that is in accord with experimental measurements. This theoretical analysis reveals that further improvements in energy efficiency may be achievable with better implementations in the future. Our electrode stimulator could be widely useful for neural, cardiac, retinal, cochlear, muscular and other biomedical implants where low power operation is important.
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Affiliation(s)
- Scott K Arfin
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
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Pizzolato G, Mandat T. Deep brain stimulation for movement disorders. Front Integr Neurosci 2012; 6:2. [PMID: 22291623 PMCID: PMC3265746 DOI: 10.3389/fnint.2012.00002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 01/09/2012] [Indexed: 11/13/2022] Open
Abstract
Stereotactic technique and the introduction of deep brain stimulation (DBS) can be considered two milestones in the field of surgical neuromodulation. At present the role of DBS in the treatment of clinically and epidemiologically relevant movement disorders is widely accepted and DBS procedures are performed in many clinical centers worldwide. Here we review the current state of the art of DBS treatment for the most common movement disorders: Parkinson’s disease, essential tremor, and dystonia. In this review, we give a brief description of the candidate patient selection criteria, the different anatomical targets for each of these condition, and the expected outcomes as well as possible side effects.
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Affiliation(s)
- Gilberto Pizzolato
- Neurology Clinic, Department of Medical Sciences, University of Trieste Trieste, Italy
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Thompson A, Morishita T, Okun MS. DBS and electrical neuro-network modulation to treat neurological disorders. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2012. [PMID: 23206686 DOI: 10.1016/b978-0-12-404706-8.00014-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The use of neuromodulatory techniques in the treatment of neurological disorders is expanding and now includes devices targeting the motor cortex, basal ganglia, spinal cord, peripheral nervous system, and autonomic nervous system. In this chapter, we review and discuss the current and past literature as well as review indications for each of these devices in the ongoing management of many common neurological diseases including chronic pain, Parkinson's disease, tremor, dystonia, and epilepsy. We also discuss and update mechanisms of deep brain stimulation and electrical neuro-network modulation.
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Affiliation(s)
- Amanda Thompson
- Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Florida, USA
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Moro E, Albanese A, Krauss JK, Metman LV, Vidailhet M, Hariz MI. Guest Editors' introduction. Mov Disord 2011; 26 Suppl 1:S1-2. [DOI: 10.1002/mds.23560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Bystritsky A, Korb AS, Douglas PK, Cohen MS, Melega WP, Mulgaonkar AP, DeSalles A, Min BK, Yoo SS. A review of low-intensity focused ultrasound pulsation. Brain Stimul 2011; 4:125-36. [PMID: 21777872 DOI: 10.1016/j.brs.2011.03.007] [Citation(s) in RCA: 253] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 03/20/2011] [Accepted: 03/20/2011] [Indexed: 01/16/2023] Open
Abstract
With the recent approval by the Food and Drug Administration (FDA) of Deep Brain Stimulation (DBS) for Parkinson's Disease, dystonia and obsessive compulsive disorder (OCD), vagus nerve stimulation (VNS) for epilepsy and depression, and repetitive transcranial magnetic stimulation (rTMS) for the treatment of depression, neuromodulation has become increasingly relevant to clinical research. However, these techniques have significant drawbacks (eg, lack of special specificity and depth for the rTMS, and invasiveness and cumbersome maintenance for DBS). This article reviews the background, rationale, and pilot studies to date, using a new brain stimulation method-low-intensity focused ultrasound pulsation (LIFUP). The ability of ultrasound to be focused noninvasively through the skull anywhere within the brain, together with concurrent imaging (ie, functional magnetic resonance imaging [fMRI]) techniques, may create a role for research and clinical use of LIFUP. This technique is still in preclinical testing and needs to be assessed thoroughly before being advanced to clinical trials. In this study, we review over 50 years of research data on the use of focused ultrasound (FUS) in neuronal tissue and live brain, and propose novel applications of this noninvasive neuromodulation method.
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Affiliation(s)
- Alexander Bystritsky
- Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 90095, USA.
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Haahr A, Kirkevold M, Hall EOC, Ostergaard K. Living with advanced Parkinson's disease: a constant struggle with unpredictability. J Adv Nurs 2010; 67:408-17. [PMID: 20946567 DOI: 10.1111/j.1365-2648.2010.05459.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM This paper is a report of an exploration of patients' lifeworld and way of managing life with advanced Parkinson's disease prior to Deep Brain Stimulation and what they expect from life following this treatment. BACKGROUND Parkinson's disease is a progressive neurodegenerative disease, which is initially well-treated with L-dopa. Living with Parkinson's disease means living with the experience of continuous loss of independence and self-esteem and unpredictable ON/OFF phenomena. Thus, in the advanced stage of the disease, treatment with Deep Brain Stimulation may become relevant. METHOD Eleven patients eligible for Deep Brain Stimulation were interviewed prior to treatment. Data were collected in 2007 and analysed according to the hermeneutic phenomenological methodology of van Manen, using the four existentials as analytic tools. FINDINGS Living with advanced Parkinson's disease can be described as the experience of living with and managing unpredictability. The disease gradually took over, and participants had to struggle with unpredictability on a daily basis. Themes in relation to this were: The body - setting the agenda, Always a struggle to be on time, Living in dependence and compromise - being a burden, and Living with restrained space and changes in social life. CONCLUSION Parkinson's disease leads to profound bodily restrictions. Living with an unpredictable body affects all aspects of life, and nurses need to be aware of the impact the disease has on the entire lifeworld, and how this may affect the way treatment is perceived.
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Affiliation(s)
- Anita Haahr
- Department of Nursing Science, School of Public Health, Aarhus University, Denmark.
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Abstract
Clinical neurology and neurosurgery are two fields that face some of the most challenging and exciting problems remaining in medicine. Brain tumors, paralysis after trauma or stroke, and neurodegerative diseases are some of the many disorders for which effective therapies remain elusive. Nanotechnology seems poised to offer promising new solutions to some of these difficult problems. The latest advances in materials engineered at the nanoscale for applications relevant to the clinical neurosciences, such as medical imaging, nanotherapies for neurologic disease, nerve tissue engineering, and nanotechnological contributions to neuroelectrodes and brain-machine interface technology are reviewed. The primary classes of materials discussed include superparamagnetic iron oxide nanoparticles, gold nanoparticles, liposomes, carbon fullerenes, and carbon nanotubes. The potential of the field and the challenges that must be overcome for the current technology to become available clinically are highlighted.
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Affiliation(s)
- Kelly L. Collins
- University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0338
| | - Daniel A. Orringer
- University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0338
| | - Parag G. Patil
- University of Michigan Medical Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0338
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Kramer DR, Halpern CH, Buonacore DL, McGill KR, Hurtig HI, Jaggi JL, Baltuch GH. Best surgical practices: a stepwise approach to the University of Pennsylvania deep brain stimulation protocol. Neurosurg Focus 2010; 29:E3. [DOI: 10.3171/2010.4.focus10103] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) is the treatment of choice for otherwise healthy patients with advanced Parkinson disease who are suffering from disabling dyskinesias and motor fluctuations related to dopaminergic therapy. As DBS is an elective procedure, it is essential to minimize the risk of morbidity. Further, precision in targeting deep brain structures is critical to optimize efficacy in controlling motor features. The authors have already established an operational checklist in an effort to minimize errors made during DBS surgery. Here, they set out to standardize a strict, step-by-step approach to the DBS surgery used at their institution, including preoperative evaluation, the day of surgery, and the postoperative course. They provide careful instruction on Leksell frame assembly and placement as well as the determination of indirect coordinates derived from MR images used to target deep brain structures. Detailed descriptions of the operative procedure are provided, outlining placement of the stereotactic arc as well as determination of the appropriate bur hole location, lead placement using electrophysiology, and placement of the internal pulse generator. The authors also include their approach to preventing postoperative morbidity. They believe that a strategic, step-by-step approach to DBS surgery combined with a standardized checklist will help to minimize operating room mistakes that can compromise targeting and increase the risk of complication.
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