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Manes JL, Bullock L, Meier AM, Turner RS, Richardson RM, Guenther FH. A neurocomputational view of the effects of Parkinson's disease on speech production. Front Hum Neurosci 2024; 18:1383714. [PMID: 38812472 PMCID: PMC11133703 DOI: 10.3389/fnhum.2024.1383714] [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: 02/07/2024] [Accepted: 04/23/2024] [Indexed: 05/31/2024] Open
Abstract
The purpose of this article is to review the scientific literature concerning speech in Parkinson's disease (PD) with reference to the DIVA/GODIVA neurocomputational modeling framework. Within this theoretical view, the basal ganglia (BG) contribute to several different aspects of speech motor learning and execution. First, the BG are posited to play a role in the initiation and scaling of speech movements. Within the DIVA/GODIVA framework, initiation and scaling are carried out by initiation map nodes in the supplementary motor area acting in concert with the BG. Reduced support of the initiation map from the BG in PD would result in reduced movement intensity as well as susceptibility to early termination of movement. A second proposed role concerns the learning of common speech sequences, such as phoneme sequences comprising words; this view receives support from the animal literature as well as studies identifying speech sequence learning deficits in PD. Third, the BG may play a role in the temporary buffering and sequencing of longer speech utterances such as phrases during conversational speech. Although the literature does not support a critical role for the BG in representing sequence order (since incorrectly ordered speech is not characteristic of PD), the BG are posited to contribute to the scaling of individual movements in the sequence, including increasing movement intensity for emphatic stress on key words. Therapeutic interventions for PD have inconsistent effects on speech. In contrast to dopaminergic treatments, which typically either leave speech unchanged or lead to minor improvements, deep brain stimulation (DBS) can degrade speech in some cases and improve it in others. However, cases of degradation may be due to unintended stimulation of efferent motor projections to the speech articulators. Findings of spared speech after bilateral pallidotomy appear to indicate that any role played by the BG in adult speech must be supplementary rather than mandatory, with the sequential order of well-learned sequences apparently represented elsewhere (e.g., in cortico-cortical projections).
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Affiliation(s)
- Jordan L. Manes
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Communicative Disorders and Sciences, University at Buffalo, Buffalo, NY, United States
| | - Latané Bullock
- Program in Speech and Hearing Bioscience and Technology, Division of Medical Sciences, Harvard Medical School, Boston, MA, United States
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Andrew M. Meier
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
| | - Robert S. Turner
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Aligning Science Across Parkinson’s (ASAP) Collaborative Research Network, Chevy Chase, MD, United States
| | - R. Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Frank H. Guenther
- Department of Speech, Language, and Hearing Sciences, Boston University, Boston, MA, United States
- Department of Biomedical Engineering, Boston University, Boston, MA, United States
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA, United States
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Somma T, Fellico F, De Rosa A, Bocchino A, Corvino S, Milone A, Cappabianca P, Esposito F. Impact of deep brain stimulation therapy on the vertebral sagittal balance in Parkinson's disease patients. Neurosurg Rev 2023; 47:7. [PMID: 38063935 DOI: 10.1007/s10143-023-02243-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 11/20/2023] [Accepted: 12/04/2023] [Indexed: 12/18/2023]
Abstract
Parkinson's disease (PD) is characterized by cardinal motor signs: 4-6 Hz resting tremor, rigidity, and bradykinesia. In addition, 3-18% of PD patients have camptocormia, an abnormal forward flexion of the thoracolumbar spine, which may have a negative impact on patients' quality of life. Different possible treatments have been suggested for such a condition, but no one is resolutive. This study aims to define the possible impact of DBS, with selective targeting on the dorsal-lateral region of the STN, on the sagittal balance of patients affected by PD. Among all patients that have undergone DBS procedures in our institution, we selected eight subjects, four females and four males, with selective targeting on the dorsal-lateral region of the subthalamic nucleus (STN) because of camptocormia and other severe postural changes. Radiological assessments of spinal balance parameters before surgery and at 6 and 12 months postoperatively were carried out. Comparison of preoperative and postoperative spine X-ray data showed a statistically significant improvement in dorsal kyphosis angle (D-Cobb) 12 months after the operation. Deep brain stimulation with selective targeting of the dorsal lateral part of the STN may induce changes of the posture in patients with Parkinson's disease 12 months after the operation, which appears to improve in this small sample size, but larger observational and controlled trials would be required to confirm this observation.
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Affiliation(s)
- Teresa Somma
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Fabrizio Fellico
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea De Rosa
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Andrea Bocchino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Sergio Corvino
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Antonio Milone
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Paolo Cappabianca
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy
| | - Felice Esposito
- Department of Neuroscience and Reproductive and Dental Sciences, Division of Neurosurgery, Università Degli Studi Di Napoli Federico II, Naples, Italy.
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Chernov MM, Swan CB, Leiter JC. In Search of a Feedback Signal for Closed-Loop Deep Brain Stimulation: Stimulation of the Subthalamic Nucleus Reveals Altered Glutamate Dynamics in the Globus Pallidus in Anesthetized, 6-Hydroxydopamine-Treated Rats. BIOSENSORS 2023; 13:bios13040480. [PMID: 37185555 PMCID: PMC10137023 DOI: 10.3390/bios13040480] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023]
Abstract
Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) is a surgical procedure for alleviating motor symptoms of Parkinson's Disease (PD). The pattern of DBS (e.g., the electrode pairs used and the intensity of stimulation) is usually optimized by trial and error based on a subjective evaluation of motor function. We tested the hypotheses that DBS releases glutamate in selected basal ganglia nuclei and that the creation of 6-hydroxydopamine (6-OHDA)-induced nigrostriatal lesions alters glutamate release during DBS in those basal ganglia nuclei. We studied the relationship between a pseudo-random binary sequence of DBS and glutamate levels in the STN itself or in the globus pallidus (GP) in anesthetized, control, and 6-OHDA-treated rats. We characterized the stimulus-response relationships between DBS and glutamate levels using a transfer function estimated using System Identification. Stimulation of the STN elevated glutamate levels in the GP and in the STN. Although the 6-OHDA treatment did not affect glutamate dynamics in the STN during DBS in the STN, the transfer function between DBS in the STN and glutamate levels in the GP was significantly altered by the presence or absence of 6-OHDA-induced lesions. Thus, glutamate responses in the GP in the 6-OHDA-treated animals (but not in the STN) depended on dopaminergic inputs. For this reason, measuring glutamate levels in the GP may provide a useful feedback target in a closed-loop DBS device in patients with PD since the dynamics of glutamate release in the GP during DBS seem to reflect the loss of dopaminergic neurons in the SNc.
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Affiliation(s)
- Mykyta M Chernov
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth Medical School, Hanover, NH 03755, USA
| | - Christina B Swan
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth Medical School, Hanover, NH 03755, USA
| | - James C Leiter
- Department of Molecular and Systems Biology, Geisel School of Medicine at Dartmouth Medical School, Hanover, NH 03755, USA
- The White River Junction VA Medical Center, 215 N Main St, White River Junction, VT 05009, USA
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Magnusson JL, Leventhal DK. Revisiting the "Paradox of Stereotaxic Surgery": Insights Into Basal Ganglia-Thalamic Interactions. Front Syst Neurosci 2021; 15:725876. [PMID: 34512279 PMCID: PMC8429495 DOI: 10.3389/fnsys.2021.725876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Basal ganglia dysfunction is implicated in movement disorders including Parkinson Disease, dystonia, and choreiform disorders. Contradicting standard "rate models" of basal ganglia-thalamic interactions, internal pallidotomy improves both hypo- and hyper-kinetic movement disorders. This "paradox of stereotaxic surgery" was recognized shortly after rate models were developed, and is underscored by the outcomes of deep brain stimulation (DBS) for movement disorders. Despite strong evidence that DBS activates local axons, the clinical effects of lesions and DBS are nearly identical. These observations argue against standard models in which GABAergic basal ganglia output gates thalamic activity, and raise the question of how lesions and stimulation can have similar effects. These paradoxes may be resolved by considering thalamocortical loops as primary drivers of motor output. Rather than suppressing or releasing cortex via motor thalamus, the basal ganglia may modulate the timing of thalamic perturbations to cortical activity. Motor cortex exhibits rotational dynamics during movement, allowing the same thalamocortical perturbation to affect motor output differently depending on its timing with respect to the rotational cycle. We review classic and recent studies of basal ganglia, thalamic, and cortical physiology to propose a revised model of basal ganglia-thalamocortical function with implications for basic physiology and neuromodulation.
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Affiliation(s)
| | - Daniel K Leventhal
- Department of Neurology, University of Michigan, Ann Arbor, MI, United States.,Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, United States.,Parkinson Disease Foundation Research Center of Excellence, University of Michigan, Ann Arbor, MI, United States.,Department of Neurology, VA Ann Arbor Health System, Ann Arbor, MI, United States
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Zavala B, Mirzadeh Z, Chen T, Lambert M, Chapple KM, Dhall R, Ponce FA. Electrophysiologic Mapping for Target Acquisition in Deep Brain Stimulation May Become Unnecessary in the Era of Intraoperative Imaging. World Neurosurg 2021; 152:e51-e61. [PMID: 33905908 DOI: 10.1016/j.wneu.2021.04.069] [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: 02/01/2021] [Revised: 04/15/2021] [Accepted: 04/16/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Electrophysiologic mapping (EM) has been instrumental in advancing neuroscience and ensuring accurate lead placement for deep brain stimulation. However, EM is associated with increased operative time, expense, and potential risk. Intraoperative imaging to verify lead placement provides an opportunity to reassess the clinical role of EM. We investigated whether EM 1) provides new information that corrects suboptimal preoperative target selection by the physician or 2) simply corrects intraoperative stereotactic error, which can instead be quickly corrected with intraoperative imaging. METHODS Deep brain stimulation lead location errors were evaluated by measuring whether repositioning leads based on EM directed the final lead placement 1) away from or 2) toward the original target. We retrospectively identified 50 patients with 61 leads that required repositioning directed by EM. The stereotactic coordinates of each lead were determined with intraoperative computed tomography. RESULTS In 45 of 61 leads (74%), the electrophysiologically directed repositioning moved the lead toward the initial target. The mean radial errors between the preoperative plan and targeted contact coordinates before and after repositioning were 2.2 and 1.5 mm, respectively (P < 0.001). Microelectrode recording was more likely than test stimulation to direct leads toward the initial target (88% vs. 63%; P = 0.03). The nucleus targeted was associated with the likelihood of moving toward the initial target. CONCLUSIONS Electrophysiologic mapping corrected primarily for errors in lead placement rather than providing new information regarding errors in target selection. Thus, intraoperative imaging and improvements in stereotactic techniques may reduce or even eliminate dependence on EM.
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Affiliation(s)
- Baltazar Zavala
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Zaman Mirzadeh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Tsinsue Chen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Margaret Lambert
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Kristina M Chapple
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Rohit Dhall
- Department of Neurology, University of Arkansas, Little Rock, Arkansas, USA
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
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6
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Abdul-Latif R, Stupans I, Allahham A, Adhikari B, Thrimawithana T. Natural antioxidants in the management of Parkinson's disease: Review of evidence from cell line and animal models. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2021; 19:300-310. [PMID: 33863692 DOI: 10.1016/j.joim.2021.03.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/21/2021] [Indexed: 12/21/2022]
Abstract
Parkinson's disease (PD) is a chronic progressive neurodegenerative disease. It results from the death of dopaminergic neurons. The pathophysiological mechanisms in idiopathic PD include the production of α-synuclein and mitochondrial respiratory function-affecting complex I, caused by reactive oxygen species. Therefore, the use of natural antioxidants in PD may provide an alternative therapy that prevents oxidative stress and reduces disease progression. In this review, the effects of hydroxytyrosol, Ginkgo biloba, Withania somnifera, curcumin, green tea, and Hypericum perforatum in PD animal and cell line models are compared and discussed. The reviewed antioxidants show evidence of protecting neural cells from oxidative stress in animal and cell models of PD. However, the clinical efficacy of these phytochemicals needs to be optimised and further investigated.
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Affiliation(s)
- Reem Abdul-Latif
- Discipline of Pharmacy, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, VIC 3084, Australia
| | - Ieva Stupans
- Discipline of Pharmacy, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, VIC 3084, Australia
| | - Ayman Allahham
- Discipline of Pharmacy, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, VIC 3084, Australia
| | - Benu Adhikari
- Biosciences and Food Technology, School of Science, Royal Melbourne Institute of Technology University, Bundoora, VIC 3084, Australia
| | - Thilini Thrimawithana
- Discipline of Pharmacy, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University, Bundoora, VIC 3084, Australia.
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7
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Tafreshi AR, Peng T, Yu C, Kramer DR, Gogia AS, Lee MB, Barbaro MF, Sebastian R, Del Campo-Vera RM, Chen KH, Kellis SS, Lee B. A Phantom Study of the Spatial Precision and Accuracy of Stereotactic Localization Using Computed Tomography Imaging with the Leksell Stereotactic System. World Neurosurg 2020; 139:e297-e307. [DOI: 10.1016/j.wneu.2020.03.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/17/2022]
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Treu S, Strange B, Oxenford S, Neumann WJ, Kühn A, Li N, Horn A. Deep brain stimulation: Imaging on a group level. Neuroimage 2020; 219:117018. [PMID: 32505698 DOI: 10.1016/j.neuroimage.2020.117018] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/07/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
Deep Brain Stimulation (DBS) is an established treatment option for movement disorders and is under investigation for treatment in a growing number of other brain diseases. It has been shown that exact electrode placement crucially affects the efficacy of DBS and this should be considered when investigating novel indications or DBS targets. To measure clinical improvement as a function of electrode placement, neuroscientific methodology and specialized software tools are needed. Such tools should have the goal to make electrode placement comparable across patients and DBS centers, and include statistical analysis options to validate and define optimal targets. Moreover, to allow for comparability across different centers, these need to be performed within an algorithmically and anatomically standardized and openly available group space. With the publication of Lead-DBS software in 2014, an open-source tool was introduced that allowed for precise electrode reconstructions based on pre- and postoperative neuroimaging data. Here, we introduce Lead Group, implemented within the Lead-DBS environment and specifically designed to meet aforementioned demands. In the present article, we showcase the various processing streams of Lead Group in a retrospective cohort of 51 patients suffering from Parkinson's disease, who were implanted with DBS electrodes to the subthalamic nucleus (STN). Specifically, we demonstrate various ways to visualize placement of all electrodes in the group and map clinical improvement values to subcortical space. We do so by using active coordinates and volumes of tissue activated, showing converging evidence of an optimal DBS target in the dorsolateral STN. Second, we relate DBS outcome to the impact of each electrode on local structures by measuring overlap of stimulation volumes with the STN. Finally, we explore the software functions for connectomic mapping, which may be used to relate DBS outcomes to connectivity estimates with remote brain areas. The manuscript is accompanied by a walkthrough tutorial which allows users to reproduce all main results presented here. All data and code needed to reproduce results are openly available.
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Affiliation(s)
- Svenja Treu
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, Spain; Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany.
| | - Bryan Strange
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, Spain
| | - Simon Oxenford
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Wolf-Julian Neumann
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Andrea Kühn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Exzellenzcluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ningfei Li
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
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9
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Niederer J, Patriat R, Rosenberg O, Palnitkar T, Darrow D, Park MC, Schrock L, Eberly LE, Harel N. Factors Influencing Electrode Position and Bending of the Proximal Lead in Deep Brain Stimulation for Movement Disorders. Stereotact Funct Neurosurg 2020; 98:300-312. [PMID: 32485728 DOI: 10.1159/000507029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The introduction of intracranial air (ICA) during deep brain stimulation (DBS) surgery is thought to have a negative influence on targeting and clinical outcomes. OBJECTIVE To investigate ICA volumes following surgery and other patient-specific factors as potential variables influencing translocation of the DBS electrode and proximal lead bowing. METHODS High-resolution postoperative computed tomography scans (≤1.0 mm resolution in all directions) within 24 h following DBS surgery and 4-6 weeks of follow-up were acquired. A total of 50 DBS leads in 33 patients were available for analysis. DBS leads included Abbott/St. Jude Medical InfinityTM, Boston Scientific VerciseTM, and Medtronic 3389TM. RESULTS Both ICA volume and anatomical target were significantly associated with measures of DBS electrode translocation. ICA volume and DBS lead model were found to be significant predictors of proximal lead bowing. Measures of proximal lead bowing and translocation along the electrode trajectory for the Medtronic 3389TM DBS lead were significantly larger than measures for the Abbott/St. Jude Medical InfinityTM and Boston Scientific VerciseTM DBS leads. CONCLUSION The association between ICA volume and translocation of the DBS electrode is small in magnitude and not clinically relevant for DBS cases within a normal range of postoperative subdural air volumes. Differences in proximal lead bowing observed between DBS leads may reflect hardware engineering subtleties in the construction of DBS lead models.
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Affiliation(s)
- Jacob Niederer
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Rémi Patriat
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Oren Rosenberg
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tara Palnitkar
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael C Park
- Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lauren Schrock
- Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lynn E Eberly
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Noam Harel
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA, .,Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA,
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10
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Essential Tremor: Lesions. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Tekriwal A, Afshar NM, Santiago-Moreno J, Kuijper FM, Kern DS, Halpern CH, Felsen G, Thompson JA. Neural Circuit and Clinical Insights from Intraoperative Recordings During Deep Brain Stimulation Surgery. Brain Sci 2019; 9:brainsci9070173. [PMID: 31330813 PMCID: PMC6681002 DOI: 10.3390/brainsci9070173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022] Open
Abstract
Observations using invasive neural recordings from patient populations undergoing neurosurgical interventions have led to critical breakthroughs in our understanding of human neural circuit function and malfunction. The opportunity to interact with patients during neurophysiological mapping allowed for early insights in functional localization to improve surgical outcomes, but has since expanded into exploring fundamental aspects of human cognition including reward processing, language, the storage and retrieval of memory, decision-making, as well as sensory and motor processing. The increasing use of chronic neuromodulation, via deep brain stimulation, for a spectrum of neurological and psychiatric conditions has in tandem led to increased opportunity for linking theories of cognitive processing and neural circuit function. Our purpose here is to motivate the neuroscience and neurosurgical community to capitalize on the opportunities that this next decade will bring. To this end, we will highlight recent studies that have successfully leveraged invasive recordings during deep brain stimulation surgery to advance our understanding of human cognition with an emphasis on reward processing, improving clinical outcomes, and informing advances in neuromodulatory interventions.
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Affiliation(s)
- Anand Tekriwal
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80203, USA
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80203, USA
- Medical Scientist Training Program, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Neema Moin Afshar
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Juan Santiago-Moreno
- Medical Scientist Training Program, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Fiene Marie Kuijper
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80203, USA
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Gidon Felsen
- Department of Physiology and Biophysics, University of Colorado School of Medicine, Aurora, CO 80203, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, CO 80203, USA.
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO 80203, USA.
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Xing F, Li L, Liu M, Duan X, Long Y, Xiang Z. [Perioperative treatment progress of Parkinson's disease with hip fracture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1032-1037. [PMID: 30238731 DOI: 10.7507/1002-1892.201801133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To review the progress of perioperative treatments for patients of Parkinson's disease and hip fractures. Methods The related literature of treatments for patients of Parkinson's disease and hip fractures were reviewed and analyzed from the aspects such as the perioperative management, selection of operation ways, and prognosis. Results The patients of Parkinson's disease are more likely to sustain hip fractures because of postural instability and osteoporosis. The perioperative treatments for patients of Parkinson's disease and hip fractures should be determined by orthopedists, neurologist, anesthesiologist, and physical therapist. There is still controversy about the selection of operation and surgical approach. And the prognosis of patients of Parkinson's disease and hip fractures are associated with the severity of Parkinson's disease. Conclusion There are few clinical studies about the patients of Parkinson's disease and hip fractures. The mid-term and long-term functional outcomes of patients of Parkinson's disease and hip fractures are unsufficient. And the best treatments of patients of Parkinson's disease and hip fractures need to be further explored.
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Affiliation(s)
- Fei Xing
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Lang Li
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ming Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xin Duan
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Ye Long
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Zhou Xiang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Schwabe K, Krauss JK. What rodent models of deep brain stimulation can teach us about the neural circuit regulation of prepulse inhibition in neuropsychiatric disorders. Schizophr Res 2018; 198:45-51. [PMID: 28663025 DOI: 10.1016/j.schres.2017.06.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 06/16/2017] [Accepted: 06/19/2017] [Indexed: 11/29/2022]
Abstract
Deep brain stimulation (DBS) is routinely used for treatment of movement disorders and it is also under investigation for neuropsychiatric disorders with deficient sensorimotor gating, such as schizophrenia, Tourette's syndrome and obsessive compulsive disorder. Electrical stimulation induces excitation and inhibition both at the stimulation site and at projection sites, thus modulating synchrony and oscillatory behavior of neuronal networks. We first provide background information on DBS in neuropsychiatric disorders accompanied by deficient sensorimotor gating. We then introduce prepulse inhibition (PPI) as a measure for sensorimotor gating in these disorders. Thereafter, we report on the use of DBS in rat models with deficient PPI induced by pharmacologic, genetic and neurodevelopmental manipulation. These models offer the opportunity to define the neuronal circuit regulation that is of relevance to PPI and its deficits in neuropsychiatric disorders with disturbed sensorimotor gating. Finally, we report on the use of the PPI paradigm in human patients operated for DBS on/off stimulation, which may further elucidate the neuronal network involved in regulation of PPI.
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Affiliation(s)
- Kerstin Schwabe
- Department of Neurosurgery, Medical University Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - Joachim K Krauss
- Department of Neurosurgery, Medical University Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
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Mogilner AY, Machado AG, Rezai AR. Deep Brain Stimulation. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00036-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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15
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Delbeke J, Hoffman L, Mols K, Braeken D, Prodanov D. And Then There Was Light: Perspectives of Optogenetics for Deep Brain Stimulation and Neuromodulation. Front Neurosci 2017; 11:663. [PMID: 29311765 PMCID: PMC5732983 DOI: 10.3389/fnins.2017.00663] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022] Open
Abstract
Deep Brain Stimulation (DBS) has evolved into a well-accepted add-on treatment for patients with severe Parkinsons disease as well as for other chronic neurological conditions. The focal action of electrical stimulation can yield better responses and it exposes the patient to fewer side effects compared to pharmaceuticals distributed throughout the body toward the brain. On the other hand, the current practice of DBS is hampered by the relatively coarse level of neuromodulation achieved. Optogenetics, in contrast, offers the perspective of much more selective actions on the various physiological structures, provided that the stimulated cells are rendered sensitive to the action of light. Optogenetics has experienced tremendous progress since its first in vivo applications about 10 years ago. Recent advancements of viral vector technology for gene transfer substantially reduce vector-associated cytotoxicity and immune responses. This brings about the possibility to transfer this technology into the clinic as a possible alternative to DBS and neuromodulation. New paths could be opened toward a rich panel of clinical applications. Some technical issues still limit the long term use in humans but realistic perspectives quickly emerge. Despite a rapid accumulation of observations about patho-physiological mechanisms, it is still mostly serendipity and empiric adjustments that dictate clinical practice while more efficient logically designed interventions remain rather exceptional. Interestingly, it is also very much the neuro technology developed around optogenetics that offers the most promising tools to fill in the existing knowledge gaps about brain function in health and disease. The present review examines Parkinson's disease and refractory epilepsy as use cases for possible optogenetic stimulation therapies.
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Affiliation(s)
- Jean Delbeke
- LCEN3, Department of Neurology, Institute of Neuroscience, Ghent University, Ghent, Belgium
| | | | - Katrien Mols
- Neuroscience Research Flanders, Leuven, Belgium.,Life Science and Imaging, Imec, Leuven, Belgium
| | | | - Dimiter Prodanov
- Neuroscience Research Flanders, Leuven, Belgium.,Environment, Health and Safety, Imec, Leuven, Belgium
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Raju SS, Niranjan A, Monaco III EA, Flickinger JC, Lunsford LD. Stereotactic Radiosurgery for Intractable Tremor-Dominant Parkinson Disease: A Retrospective Analysis. Stereotact Funct Neurosurg 2017; 95:291-297. [DOI: 10.1159/000479236] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/06/2017] [Indexed: 11/19/2022]
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Themistocleous MS, Sakas DE, Boviatsis E, Tagaris G, Kouyialis A, Psachoulia C, Stathis P. The Insertion of Electrodes in the Brain for Electrophysiological Recording or Chronic Stimulation Is Not Associated With Any Biochemically Detectable Neuronal Injury. Neuromodulation 2017; 20:424-428. [PMID: 28393415 DOI: 10.1111/ner.12598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 01/29/2017] [Accepted: 02/15/2017] [Indexed: 01/29/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the degree of brain tissue injury that could be potentially induced by the introduction of a) microrecording electrodes, b) macrostimulation electrodes, or c) chronic stimulation electrodes. We aimed to evaluate whether the use of five simultaneous microrecording tracks is associated with any brain injury not detectable by conventional imaging such as CT or MRI. MATERIALS AND METHODS The study included 61 patients who underwent surgery for implantation of 121 DBS leads. In all cases, five simultaneous tracts were utilized for microelectrode recordings. All patients underwent measurements of serum S-100b at specific time points as follows: a) prior to the operation, and b) intraoperatively at specific stages of the procedure: 1) after opening the burr hole, 2) after the insertion of microrecording electrodes, 3) during macrostimulation, 4) at the end of the operation, and 5) on the first postoperative day. RESULTS The levels of serum S-100B protein remained within the normal range during the entire period of investigation in all patients with the exception of two cases. In both patients, the procedure was complicated by intraparenchymal hemorrhage visible in neuro-imaging. The first patient developed a small intraparenchymal hemorrhage, visible on the postoperative MRI, with no neurological deficit. The second patient experienced a focal epileptic seizure after the insertion of the right DBS chronic lead and the postoperative CT scan revealed a right frontal lobe hemorrhage. CONCLUSION These results strongly indicate that the insertion of either multiple recording electrodes or the implantation of chronic electrodes in DBS does not increase the risk of brain hemorrhage or of other intracranial complications, and furthermore it does not cause any biochemically detectable brain tissue damage.
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Affiliation(s)
- Marios S Themistocleous
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Damianos E Sakas
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Efstathios Boviatsis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - George Tagaris
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
| | - Andreas Kouyialis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece
| | | | - Pantelis Stathis
- Department of Neurosurgery, University of Athens Medical School, "Evangelismos" Hospital, Athens, Greece.,P. Kokkalis Hellenic Center for Neurosurgical Research, Athens, Greece
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McElcheran CE, Yang B, Anderson KJ, Golestanirad L, Graham SJ. Parallel radiofrequency transmission at 3 tesla to improve safety in bilateral implanted wires in a heterogeneous model. Magn Reson Med 2017; 78:2406-2415. [DOI: 10.1002/mrm.26622] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 01/05/2017] [Accepted: 01/06/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Clare E. McElcheran
- Physical Sciences Platform, Sunnybrook Health Sciences Institute; Toronto Canada
- Department of Medical Biophysics; University of Toronto; Toronto Canada
| | - Benson Yang
- Physical Sciences Platform, Sunnybrook Health Sciences Institute; Toronto Canada
| | - Kevan J.T. Anderson
- Physical Sciences Platform, Sunnybrook Health Sciences Institute; Toronto Canada
| | - Laleh Golestanirad
- Massachusetts General Hospital, Harvard Medical School; Charlestown Massachusetts USA
| | - Simon J. Graham
- Physical Sciences Platform, Sunnybrook Health Sciences Institute; Toronto Canada
- Department of Medical Biophysics; University of Toronto; Toronto Canada
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Bentley JN, Guan Z, Cummings KS, Chou KL, Patil PG. Influence of Intracranial Air on Electrode Position and Clinical Outcomes following Deep Brain Stimulation for Parkinson's Disease. Stereotact Funct Neurosurg 2017; 95:6-12. [DOI: 10.1159/000452843] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 10/18/2016] [Indexed: 11/19/2022]
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Abulseoud OA, Kasasbeh A, Min HK, Fields JA, Tye SJ, Goerss S, Knight EJ, Sampson SM, Klassen BT, Matsumoto JY, Stoppel C, Lee KH, Frye MA. Stimulation-Induced Transient Nonmotor Psychiatric Symptoms following Subthalamic Deep Brain Stimulation in Patients with Parkinson's Disease: Association with Clinical Outcomes and Neuroanatomical Correlates. Stereotact Funct Neurosurg 2016; 94:93-101. [PMID: 27093641 DOI: 10.1159/000445076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 02/29/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND The clinical and neurobiological underpinnings of transient nonmotor (TNM) psychiatric symptoms during the optimization of stimulation parameters in the course of subthalamic nucleus deep brain stimulation (STN-DBS) remain under intense investigation. METHODS Forty-nine patients with refractory Parkinson's disease underwent bilateral STN-DBS implants and were enrolled in a 24-week prospective, naturalistic follow-up study. Patients who exhibited TNM psychiatric manifestations during DBS parameter optimization were evaluated for potential associations with clinical outcome measures. RESULTS Twenty-nine TNM+ episodes were reported by 15 patients. No differences between TNM+ and TNM- groups were found in motor outcome. However, unlike the TNM- group, TNM+ patients did not report improvement in subsyndromal depression or quality of life. TNM+ episodes were more likely to emerge during bilateral monopolar stimulation of the medial STN. CONCLUSIONS The occurrence of TNM psychiatric symptoms during optimization of stimulation parameters was associated with the persistence of subsyndromal depression and with lower quality of life ratings at 6 months. The neurobiological underpinnings of TNM symptoms are investigated yet remain difficult to explain.
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Affiliation(s)
- Osama A Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn., USA
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Cui Z, Pan L, Song H, Xu X, Xu B, Yu X, Ling Z. Intraoperative MRI for optimizing electrode placement for deep brain stimulation of the subthalamic nucleus in Parkinson disease. J Neurosurg 2016; 124:62-9. [DOI: 10.3171/2015.1.jns141534] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
The degree of clinical improvement achieved by deep brain stimulation (DBS) is largely dependent on the accuracy of lead placement. This study reports on the evaluation of intraoperative MRI (iMRI) for adjusting deviated electrodes to the accurate anatomical position during DBS surgery and acute intracranial changes.
METHODS
Two hundred and six DBS electrodes were implanted in the subthalamic nucleus (STN) in 110 patients with Parkinson disease. All patients underwent iMRI after implantation to define the accuracy of lead placement. Fifty-six DBS electrode positions in 35 patients deviated from the center of the STN, according to the result of the initial postplacement iMRI scans. Thus, we adjusted the electrode positions for placement in the center of the STN and verified this by means of second or third iMRI scans. Recording was performed in adjusted parameters in the x-, y-, and z-axes.
RESULTS
Fifty-six (27%) of 206 DBS electrodes were adjusted as guided by iMRI. Electrode position was adjusted on the basis of iMRI 62 times. The sum of target coordinate adjustment was −0.5 mm in the x-axis, −4 mm in the y-axis, and 15.5 mm in the z-axis; the total of distance adjustment was 74.5 mm in the x-axis, 88 mm in the y-axis, and 42.5 mm in the z-axis. After adjustment with the help of iMRI, all electrodes were located in the center of the STN. Intraoperative MRI revealed 2 intraparenchymal hemorrhages in 2 patients, brain shift in all patients, and leads penetrating the lateral ventricle in 3 patients.
CONCLUSIONS
The iMRI technique can guide surgeons as they adjust deviated electrodes to improve the accuracy of implanting the electrodes into the correct anatomical position. The iMRI technique can also immediately demonstrate acute changes such as hemorrhage and brain shift during DBS surgery.
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Affiliation(s)
- Zhiqiang Cui
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Longsheng Pan
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Huifang Song
- 2Department of Neurology, Hebei Province Luan County People’s Hospital, Luan County, Hebei Province, China
| | - Xin Xu
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Bainan Xu
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Xinguang Yu
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
| | - Zhipei Ling
- 1Department of Neurosurgery, PLA General Hospital, PLA Postgraduate Medical School, Beijing; and
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McCairn KW, Iriki A, Isoda M. Common therapeutic mechanisms of pallidal deep brain stimulation for hypo- and hyperkinetic movement disorders. J Neurophysiol 2015; 114:2090-104. [PMID: 26180116 PMCID: PMC4595610 DOI: 10.1152/jn.00223.2015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 07/06/2015] [Indexed: 12/31/2022] Open
Abstract
Abnormalities in cortico-basal ganglia (CBG) networks can cause a variety of movement disorders ranging from hypokinetic disorders, such as Parkinson's disease (PD), to hyperkinetic conditions, such as Tourette syndrome (TS). Each condition is characterized by distinct patterns of abnormal neural discharge (dysrhythmia) at both the local single-neuron level and the global network level. Despite divergent etiologies, behavioral phenotypes, and neurophysiological profiles, high-frequency deep brain stimulation (HF-DBS) in the basal ganglia has been shown to be effective for both hypo- and hyperkinetic disorders. The aim of this review is to compare and contrast the electrophysiological hallmarks of PD and TS phenotypes in nonhuman primates and discuss why the same treatment (HF-DBS targeted to the globus pallidus internus, GPi-DBS) is capable of ameliorating both symptom profiles. Recent studies have shown that therapeutic GPi-DBS entrains the spiking of neurons located in the vicinity of the stimulating electrode, resulting in strong stimulus-locked modulations in firing probability with minimal changes in the population-scale firing rate. This stimulus effect normalizes/suppresses the pathological firing patterns and dysrhythmia that underlie specific phenotypes in both the PD and TS models. We propose that the elimination of pathological states via stimulus-driven entrainment and suppression, while maintaining thalamocortical network excitability within a normal physiological range, provides a common therapeutic mechanism through which HF-DBS permits information transfer for purposive motor behavior through the CBG while ameliorating conditions with widely different symptom profiles.
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Affiliation(s)
- Kevin W McCairn
- Systems Neuroscience and Movement Disorders Laboratory, Korea Brain Research Institute, Daegu, Republic of Korea;
| | - Atsushi Iriki
- Laboratory for Symbolic Cognitive Development, RIKEN Brain Science Institute, Wako, Saitama, Japan; and
| | - Masaki Isoda
- Department of Physiology, Kansai Medical University School of Medicine, Hirakata, Osaka, Japan
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Cho KR, Kim HR, Im YS, Youn J, Cho JW, Lee JI. Outcome of gamma knife thalamotomy in patients with an intractable tremor. J Korean Neurosurg Soc 2015; 57:192-6. [PMID: 25810859 PMCID: PMC4373048 DOI: 10.3340/jkns.2015.57.3.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 10/02/2014] [Accepted: 10/15/2014] [Indexed: 11/27/2022] Open
Abstract
Objective Tremor is a common movement disorder that interferes with daily living. Since the medication for tremor has some limitations, surgical intervention is needed in many patients. In certain patients who cannot undergo aggressive surgical intervention, Gamma Knife thalamotomy (GKT) is a safe and effective alternative. Methods From June 2012 to August 2013, 7 patients with an intractable tremor underwent GKT. Four of these 7 patients had medical comorbidities, and 3 patients refused to undergo traditional surgery. Each patient was evaluated with the modified Fahn-Tolosa-Marin tremor rating scale (TRS) along with analysis of handwriting samples. All of the patients underwent GKT with a maximal dose of 130 Gy to the left ventralis intermedius (VIM) nucleus of the thalamus. Follow-up brain MRI was performed after 3 to 8 months of GKT, and evaluation with the TRS was also performed. Results Six patients showed objective improvement in the TRS score. Excluding one patient who demonstrated tremor progression, there was 28.9% improvement in the TRS score. However, five patients showed subjective improvement in their symptoms. On comparing the TRS scores between follow-up periods of more and less than 4 months, the follow-up TRS score at more than 4 months of GKT was significantly improved compared to that at less than 4 months of GKT. Follow-up MRI showed radiosurgical changes in 5 patients. Conclusion GKT with a maximal dose of 130 Gy to the VIM is a safe procedure that can replace other surgical procedures.
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Affiliation(s)
- Kyung Rae Cho
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Rye Kim
- Department of Neurosurgery, Konyang University Hospital, College of Medicine, Konyang University, Daejeon, Korea
| | - Yong Seok Im
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Youn
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jin Whan Cho
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung-Il Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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McCairn KW, Turner RS. Pallidal stimulation suppresses pathological dysrhythmia in the parkinsonian motor cortex. J Neurophysiol 2015; 113:2537-48. [PMID: 25652922 DOI: 10.1152/jn.00701.2014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/03/2015] [Indexed: 02/06/2023] Open
Abstract
Although there is general consensus that deep brain stimulation (DBS) yields substantial clinical benefit in patients with Parkinson's disease (PD), the therapeutic mechanism of DBS remains a matter of debate. Recent studies demonstrate that DBS targeting the globus pallidus internus (GPi-DBS) suppresses pathological oscillations in firing rate and between-cell spike synchrony in the vicinity of the electrode but has negligible effects on population-level firing rate or the prevalence of burst firing. The present investigation examines the downstream consequences of GPi-DBS at the level of the primary motor cortex (M1). Multielectrode, single cell recordings were conducted in the M1 of two parkinsonian nonhuman primates (Macaca fasicularis). GPi-DBS that induced significant reductions in muscular rigidity also reduced the prevalence of both beta (12-30 Hz) oscillations in single unit firing rates and of coherent spiking between pairs of M1 neurons. In individual neurons, GPi-DBS-induced increases in mean firing rate were three times more common than decreases; however, averaged across the population of M1 neurons, GPi-DBS induced no net change in mean firing rate. The population-level prevalence of burst firing was also not affected by GPi-DBS. The results are consistent with the hypothesis that suppression of both pathological, beta oscillations and synchronous activity throughout the cortico-basal ganglia network is a major therapeutic mechanism of GPi-DBS.
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Affiliation(s)
- Kevin W McCairn
- Department of Neurological Surgery, University of California, San Francisco, California; Department of Biological Sciences, Milton Keynes, The Open University, Buckinghamshire, United Kingdom; and
| | - Robert S Turner
- Department of Neurological Surgery, University of California, San Francisco, California; Department of Neurobiology and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania
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Slade AB, Aguilar G. Monte Carlo method for photon heating using temperature-dependent optical properties. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 118:234-241. [PMID: 25488656 DOI: 10.1016/j.cmpb.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 11/20/2014] [Accepted: 11/21/2014] [Indexed: 06/04/2023]
Abstract
The Monte Carlo method for photon transport is often used to predict the volumetric heating that an optical source will induce inside a tissue or material. This method relies on constant (with respect to temperature) optical properties, specifically the coefficients of scattering and absorption. In reality, optical coefficients are typically temperature-dependent, leading to error in simulation results. The purpose of this study is to develop a method that can incorporate variable properties and accurately simulate systems where the temperature will greatly vary, such as in the case of laser-thawing of frozen tissues. A numerical simulation was developed that utilizes the Monte Carlo method for photon transport to simulate the thermal response of a system that allows temperature-dependent optical and thermal properties. This was done by combining traditional Monte Carlo photon transport with a heat transfer simulation to provide a feedback loop that selects local properties based on current temperatures, for each moment in time. Additionally, photon steps are segmented to accurately obtain path lengths within a homogenous (but not isothermal) material. Validation of the simulation was done using comparisons to established Monte Carlo simulations using constant properties, and a comparison to the Beer-Lambert law for temperature-variable properties. The simulation is able to accurately predict the thermal response of a system whose properties can vary with temperature. The difference in results between variable-property and constant property methods for the representative system of laser-heated silicon can become larger than 100K. This simulation will return more accurate results of optical irradiation absorption in a material which undergoes a large change in temperature. This increased accuracy in simulated results leads to better thermal predictions in living tissues and can provide enhanced planning and improved experimental and procedural outcomes.
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Affiliation(s)
| | - Guillermo Aguilar
- Bourns Hall A345, University of California, Riverside, Riverside, CA 92521, USA.
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27
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Sui L, Huang S, Peng B, Ren J, Tian F, Wang Y. Deep brain stimulation of the amygdala alleviates fear conditioning-induced alterations in synaptic plasticity in the cortical–amygdala pathway and fear memory. J Neural Transm (Vienna) 2014; 121:773-82. [DOI: 10.1007/s00702-014-1183-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/21/2014] [Indexed: 11/28/2022]
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Adult hemiparkinsonian rats do not benefit from tactile stimulation. Behav Brain Res 2014; 261:97-105. [DOI: 10.1016/j.bbr.2013.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/03/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
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Kasasbeh A, Abulseoud OA, Matsumoto JY, Stead SM, Goerss SJ, Klassen BT, Huston J, Min HK, Lee KH, Frye MA. Lack of differential motor outcome with subthalamic nucleus region stimulation in Parkinson's disease. J Clin Neurosci 2013; 20:1520-6. [PMID: 23906524 DOI: 10.1016/j.jocn.2013.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 02/09/2013] [Indexed: 11/16/2022]
Abstract
Deep brain stimulation (DBS) has emerged as a viable therapy for Parkinson's disease (PD). The impact of subthalamic nucleus (STN) lead placement (lateral versus medial) on motor outcome, however, has not been systematically evaluated. Forty-eight patients with PD underwent STN-DBS surgery and were evaluated postoperatively for 48 weeks for motor improvement as measured by the Unified Parkinson's Disease Rating Scale (UPDRS) part III (standardized motor examination) and levodopa equivalent daily dose (LEDD). Postoperative MRI was used to identify the location of the active stimulating contact and motor outcome was analyzed. STN-DBS was associated with significant improvement in motor outcome as determined by a reduction in the UPDRS part III subscore from 34.44 ± 1.29 at baseline to 18.76 ± 1.06 at end visit (p<0.0001) and a reduction in LEDD from 1721 ± 152 mg/day at baseline to 1134 ± 119 mg/day at end visit (p=0.0024). Patients with stimulating contacts in the medial STN compared to the lateral STN did not demonstrate any significant differences in motor outcome (UPDRS, p=0.5811; LEDD, p=0.7341). No significant differences were found in motor outcome between patients with STN stimulation compared to stimulation of surrounding fiber tracts (p=0.80). No significant difference in stimulation voltage was noted with respect to lead location. Our study did not find a significant effect for the location of active contact and motor outcome neither within the subregions of the STN nor between the STN and surrounding fibers. Further research is needed to better understand the neurophysiological basis for these results.
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Affiliation(s)
- Aimen Kasasbeh
- Department of Neurosurgery, Mayo Clinic, Rochester MN, USA
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Kooshkabadi A, Lunsford LD, Tonetti D, Flickinger JC, Kondziolka D. Gamma Knife thalamotomy for tremor in the magnetic resonance imaging era. J Neurosurg 2013; 118:713-8. [DOI: 10.3171/2013.1.jns121111] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The surgical management of disabling tremor has gained renewed vigor with the availability of deep brain stimulation. However, in the face of an aging population of patients with increasing surgical comorbidities, noninvasive approaches for tremor management are needed. The authors' purpose was to study the technique and results of stereotactic radiosurgery performed in the era of MRI targeting.
Methods
The authors evaluated outcomes in 86 patients (mean age 71 years; number of procedures 88) who underwent a unilateral Gamma Knife thalamotomy (GKT) for tremor during a 15-year period that spanned the era of MRI-based target selection (1996–2011). Symptoms were related to essential tremor in 48 patients (19 age ≥ 80 years and 3 age ≥ 90 years), Parkinson disease in 27 patients (11 age ≥ 80 years [1 patient underwent bilateral procedures]), and multiple sclerosis in 11 patients (1 patient underwent bilateral procedures). A single 4-mm isocenter was used to deliver a maximum dose of 140 Gy to the posterior-inferior region of the nucleus ventralis intermedius. The Fahn-Tolosa-Marin clinical tremor rating scale was used to grade tremor, handwriting, and ability to drink. The median follow-up was 23 months.
Results
The mean tremor score was 3.28 ± 0.79 before and 1.81 ± 1.15 after (p < 0.0001) GKT; the mean handwriting score was 2.78 ± 0.82 and 1.62 ± 1.04, respectively (p < 0.0001); and the mean drinking score was 3.14 ± 0.78 and 1.80 ± 1.15, respectively (p < 0.0001). After GKT, 57 patients (66%) showed improvement in all 3 scores, 11 patients (13%) in 2 scores, and 2 patients (2%) in just 1 score. In 16 patients (19%) there was a failure to improve in any score. Two patients developed a temporary contralateral hemiparesis, 1 patient noted dysphagia, and 1 sustained facial sensory loss.
Conclusions
Gamma Knife thalamotomy in the MRI era was a safe and effective noninvasive surgical strategy for medically refractory tremor in the elderly or those with contraindications to deep brain stimulation or stereotactic radiofrequency (thermal) thalamotomy.
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Affiliation(s)
| | | | | | - John C. Flickinger
- 1Departments of Neurological Surgery and
- 2Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Douglas Kondziolka
- 1Departments of Neurological Surgery and
- 2Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Marshall DF, Strutt AM, Williams AE, Simpson RK, Jankovic J, York MK. Alternating verbal fluency performance following bilateral subthalamic nucleus deep brain stimulation for Parkinson's disease. Eur J Neurol 2012; 19:1525-31. [DOI: 10.1111/j.1468-1331.2012.03759.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
Affiliation(s)
- D. F. Marshall
- Department of Neurology; Parkinson's Disease and Movement Disorders Center; Baylor College of Medicine; Houston TX USA
| | - A. M. Strutt
- Department of Neurology; Parkinson's Disease and Movement Disorders Center; Baylor College of Medicine; Houston TX USA
| | - A. E. Williams
- Department of Neurology; Parkinson's Disease and Movement Disorders Center; Baylor College of Medicine; Houston TX USA
| | - R. K. Simpson
- Department of Neurosurgery; The Methodist Hospital Neurological Institute; Houston TX USA
| | - J. Jankovic
- Department of Neurology; Parkinson's Disease and Movement Disorders Center; Baylor College of Medicine; Houston TX USA
| | - M. K. York
- Department of Neurology; Parkinson's Disease and Movement Disorders Center; Baylor College of Medicine; Houston TX USA
- Michael E. DeBakey Veteran Affairs Medical Center; Parkinson's Disease Research Education and Clinical Center; Houston TX USA
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Frighetto L, Bizzi J, Annes RD, Silva RDS, Oppitz P. Stereotactic radiosurgery for movement disorders. Surg Neurol Int 2012; 3:S10-6. [PMID: 22826805 PMCID: PMC3400484 DOI: 10.4103/2152-7806.91605] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 12/21/2011] [Indexed: 11/18/2022] Open
Abstract
Initially designed for the treatment of functional brain targets, stereotactic radiosurgery (SRS) has achieved an important role in the management of a wide range of neurosurgical pathologies. The interest in the application of the technique for the treatment of pain, and psychiatric and movement disorders has returned in the beginning of the 1990s, stimulated by the advances in neuroimaging, computerized dosimetry, treatment planning software systems, and the outstanding results of radiosurgery in other brain diseases. Since SRS is a neuroimaging-guided procedure, without the possibility of neurophysiological confirmation of the target, deep brain stimulation (DBS) and radiofrequency procedures are considered the best treatment options for movement-related disorders. Therefore, SRS is an option for patients who are not suitable for an open neurosurgical procedure. SRS thalamotomy provided results in tremor control, comparable to radiofrequency and DBS. The occurrence of unpredictable larger lesions than expected with permanent neurological deficits is a limitation of the procedure. Improvements in SRS technique with dose reduction, use of a single isocenter, and smaller collimators were made to reduce the incidence of this serious complication. Pallidotomies performed with radiosurgery did not achieve the same good results. Even though the development of DBS has supplanted lesioning as the first alternative in movement disorder surgery; SRS might still be the only treatment option for selected patients.
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Affiliation(s)
- Leonardo Frighetto
- Neurosurgeon of the Neurology and Neurosurgery Service, Stereotactic Radiosurgery Section, Moinhos de Vento Hospital, Porto Alegre, São Vicente de Paulo University Hospital, Passo Fundo, RS, Brazil
- Neurosurgeon, São Vicente de Paulo University Hospital, Passo Fundo, RS, Brazil
| | - Jorge Bizzi
- Neurosurgeon of the Neurology and Neurosurgery Service, Stereotactic Radiosurgery Section, Moinhos de Vento Hospital, Porto Alegre, São Vicente de Paulo University Hospital, Passo Fundo, RS, Brazil
| | | | | | - Paulo Oppitz
- Neurosurgeon of the Neurology and Neurosurgery Service, Stereotactic Radiosurgery Section, Moinhos de Vento Hospital, Porto Alegre, São Vicente de Paulo University Hospital, Passo Fundo, RS, Brazil
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Brusa L, Ceravolo R, Kiferle L, Monteleone F, Iani C, Schillaci O, Stanzione P, Koch G. Metabolic changes induced by theta burst stimulation of the cerebellum in dyskinetic Parkinson’s disease patients. Parkinsonism Relat Disord 2012; 18:59-62. [DOI: 10.1016/j.parkreldis.2011.08.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 08/22/2011] [Accepted: 08/23/2011] [Indexed: 12/19/2022]
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Ben-Haim S, Gologorsky Y, Monahan A, Weisz D, Alterman RL. Fiducial registration with spoiled gradient-echo magnetic resonance imaging enhances the accuracy of subthalamic nucleus targeting. Neurosurgery 2011; 69:870-5; discussion 875. [PMID: 21552170 DOI: 10.1227/neu.0b013e318222ae33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND A variety of imaging strategies may be used to derive reliable stereotactic coordinates when performing deep brain stimulation lead implants. No single technique has yet proved optimal. OBJECTIVE To compare the relative accuracy of stereotactic coordinates for the subthalamic nucleus (STN) derived either from fast spin echo/inversion recovery (FSE/IR) magnetic resonance imaging MRI alone (group 1) or FSE/IR in conjunction with T1-weighted spoiled gradient-echo MRI (group 2). METHODS A retrospective analysis of 145 consecutive STN deep brain stimulation lead placements (group 1, n = 72; group 2, n = 73) was performed in 81 Parkinson disease patients by 1 surgical team. From the operative reports, we recorded the number of microelectrode recording trajectories required to localize the desired STN target and the span of STN traversed along the implantation trajectory. In addition, we calculated the 3-dimensional vector difference between the initial MRI-derived coordinates and the final physiologically refined coordinates. RESULTS The proportion of implants completed with just 1 microelectrode recording trajectory was greater (81% vs 58%; P < .001) and the 3-dimensional vector difference between the anatomically selected target and the microelectrode recording-refined target was smaller (0.6 ± 1.2 vs 0.9 ± 1.3; P = .04) in group 2 than in group 1. At the same time, the mean expanse of STN recorded along the implantation trajectory was 8% greater in group 2 (4.8 ± 0.6 vs 5.2 ± 0.6 mm; P < .001). CONCLUSION A combination of stereotactic FSE/IR and spoiled gradient-echo MRI yields more accurate coordinates for the STN than FSE/IR MRI alone.
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Affiliation(s)
- Sharona Ben-Haim
- Department of Neurosurgery, Mount Sinai School of Medicine, New York, NY, USA
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Sankar T, Lozano AM. Surgical approach to l-dopa-induced dyskinesias. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2011; 98:151-71. [PMID: 21907086 DOI: 10.1016/b978-0-12-381328-2.00006-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Many patients treated chronically with l-dopa for Parkinson disease (PD) become functionally disabled by l-dopa-induced dyskinesias (LID). Evolved from early empirical procedures, modern stereotactic surgical lesioning techniques and deep brain stimulation (DBS) can effectively treat LID while simultaneously improving the cardinal motor symptoms of PD. Here we review the common surgical targets used to treat LID, and compare their relative efficacy. We explain the anti-dyskinetic action of surgery at each of these targets based on evolving models of basal ganglia function. Finally, we discuss the appropriate selection of patients with LID for surgery and address relevant technical and management issues in these patients.
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Affiliation(s)
- Tejas Sankar
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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Kim YH, Kim HJ, Kim C, Kim DG, Jeon BS, Paek SH. Comparison of electrode location between immediate postoperative day and 6 months after bilateral subthalamic nucleus deep brain stimulation. Acta Neurochir (Wien) 2010; 152:2037-45. [PMID: 20721590 DOI: 10.1007/s00701-010-0771-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 08/09/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVE We compared the electrode positions of subthalamic nucleus (STN) deep brain stimulation (DBS) estimated at the immediate postoperative period with those estimated 6 months after surgery. METHODS Brain CT scans were taken immediately and 6 months after bilateral STN DBS in 53 patients with Parkinson's disease. The two images were fused using the mutual information technique. The discrepancies of electrode positions in three coordinates were measured in the fused images, and the relationship with the pneumocephalus was evaluated. RESULTS The average discrepancy of x- and y-coordinates of electrode positions at the level of STN (3.5 mm below the anterior commissure-posterior commissure line) were 0.6 ± 0.5 mm (range, 0~2.1 mm) and 1.0 ± 0.8 mm (range, 0~5.2 mm), respectively. The average discrepancy of z-coordinates of the electrode tips of the fused images was 1.0 ± 0.8 mm (range, 0.1~4.0 mm). The volume of pneumocephalus (range, 0~76 ml) was correlated with the y-coordinate discrepancies (p < 0.005). CONCLUSION The electrode positions in the immediate postoperative CT might have significant discrepancies with those in the CT taken at a stable period after STN DBS especially when there is a large amount of pneumocephalus.
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Affiliation(s)
- Yong Hwy Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, South Korea
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37
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Lee JY, Kim JW, Lee JY, Lim YH, Kim C, Kim DG, Jeon BS, Paek SH. Is MRI a reliable tool to locate the electrode after deep brain stimulation surgery? Comparison study of CT and MRI for the localization of electrodes after DBS. Acta Neurochir (Wien) 2010; 152:2029-36. [PMID: 20882302 DOI: 10.1007/s00701-010-0779-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 08/13/2010] [Indexed: 11/30/2022]
Abstract
PURPOSE MRI has been utilized to localize the electrode after deep brain stimulation, but its accuracy has been questioned due to image distortion. Under the hypothesis that MRI is not adequate for evaluation of electrode position after deep brain stimulation, this study is aimed at validating the accuracy of MRI in electrode localization in comparison with CT scan. METHODS Sixty one patients who had undergone STN DBS were enrolled for the analysis. Using mutual information technique, CT and MRI taken at 6 months after the operation were fused. The x and y coordinates of the centers of electrodes shown of CT and MRI were compared in the fused images to calculate average difference at five different levels. The difference of the tips of the electrodes, designated as the z coordinate, was also calculated. RESULTS The average of the distance between the centers of the electrodes in the five levels estimated in the fused image of brain CT and MRI taken at least 6 months after STN DBS was 1.33 mm (0.1-5.8 mm). The average discrepancy of x coordinates for all five levels between MRI and CT was 0.56 ± 0.54 mm (0-5.7 mm), the discrepancy of y coordinates was 1.06 ± 0.59 mm (0-3.5 mm), and for the z coordinate, it was 0.98 ± 0.52 mm (0-3.1 mm) (all p values < 0.001). Notably, the average discrepancy of x coordinates at 3.5 mm below AC-PC level, i.e., at the STN level between MRI and CT, was 0.59 ± 0.42 mm (0-2.4 mm); the discrepancy of y coordinates was 0.81 ± 0.47 mm (0-2.9 mm) (p values < 0.001). CONCLUSIONS The results suggest that there was significant discrepancy between the centers of electrodes estimated by CT and MRI after STN DBS surgery.
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Affiliation(s)
- Ji Yeoun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Jongno-gu, Seoul, South Korea
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Bronstein JM, Tagliati M, Alterman RL, Lozano AM, Volkmann J, Stefani A, Horak FB, Okun MS, Foote KD, Krack P, Pahwa R, Henderson JM, Hariz MI, Bakay RA, Rezai A, Marks WJ, Moro E, Vitek JL, Weaver FM, Gross RE, DeLong MR. Deep brain stimulation for Parkinson disease: an expert consensus and review of key issues. ACTA ACUST UNITED AC 2010; 68:165. [PMID: 20937936 DOI: 10.1001/archneurol.2010.260] [Citation(s) in RCA: 580] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To provide recommendations to patients, physicians, and other health care providers on several issues involving deep brain stimulation (DBS) for Parkinson disease (PD). DATA SOURCES AND STUDY SELECTION An international consortium of experts organized, reviewed the literature, and attended the workshop. Topics were introduced at the workshop, followed by group discussion. DATA EXTRACTION AND SYNTHESIS A draft of a consensus statement was presented and further edited after plenary debate. The final statements were agreed on by all members. CONCLUSIONS (1) Patients with PD without significant active cognitive or psychiatric problems who have medically intractable motor fluctuations, intractable tremor, or intolerance of medication adverse effects are good candidates for DBS. (2) Deep brain stimulation surgery is best performed by an experienced neurosurgeon with expertise in stereotactic neurosurgery who is working as part of a interprofessional team. (3) Surgical complication rates are extremely variable, with infection being the most commonly reported complication of DBS. (4) Deep brain stimulation programming is best accomplished by a highly trained clinician and can take 3 to 6 months to obtain optimal results. (5) Deep brain stimulation improves levodopa-responsive symptoms, dyskinesia, and tremor; benefits seem to be long-lasting in many motor domains. (6) Subthalamic nuclei DBS may be complicated by increased depression, apathy, impulsivity, worsened verbal fluency, and executive dysfunction in a subset of patients. (7) Both globus pallidus pars interna and subthalamic nuclei DBS have been shown to be effective in addressing the motor symptoms of PD. (8) Ablative therapy is still an effective alternative and should be considered in a select group of appropriate patients.
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Affiliation(s)
- Jeff M Bronstein
- University of California, Los Angeles, School of Medicine, Department of Neurology, 710 Westwood Plaza, Los Angeles, CA 90095, USA.
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Murdoch BE. Surgical approaches to treatment of Parkinson's disease: Implications for speech function. INTERNATIONAL JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2010; 12:375-384. [PMID: 20602579 DOI: 10.3109/17549507.2010.495785] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Although neurosurgical procedures have been reported to be successful in relieving many of the motor symptoms of Parkinson's disease (PD) (e.g., tremor, rigidity, bradykinesia) in the limb musculature, their effect on speech is much less consistent. This paper will review and evaluate reports in the literature on the effects of various surgical interventions for PD, including thalamotomy, pallidotomy, and DBS, on speech. In particular the paper will focus on the implications of these findings for one's understanding of the neurological control of the speech mechanism. As a foundation, contemporary models of the neuropathophysiology of PD and hypokinetic dysarthria will be outlined and explained. The various neurosurgical treatments for PD will be described and their theoretical underpinning discussed with regard to their proposed effects on subcortical and cortical motor control systems. Evidence suggestive of the need to reconsider contemporary thinking in relation to the neurology of speech and the need to differentiate it from limb neurology will be highlighted.
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Cho ZH, Min HK, Oh SH, Han JY, Park CW, Chi JG, Kim YB, Paek SH, Lozano AM, Lee KH. Direct visualization of deep brain stimulation targets in Parkinson disease with the use of 7-tesla magnetic resonance imaging. J Neurosurg 2010; 113:639-47. [PMID: 20380532 PMCID: PMC3160785 DOI: 10.3171/2010.3.jns091385] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECT A challenge associated with deep brain stimulation (DBS) in treating advanced Parkinson disease (PD) is the direct visualization of brain nuclei, which often involves indirect approximations of stereotactic targets. In the present study, the authors compared T2*-weighted images obtained using 7-T MR imaging with those obtained using 1.5- and 3-T MR imaging to ascertain whether 7-T imaging enables better visualization of targets for DBS in PD. METHODS The authors compared 1.5-, 3-, and 7-T MR images obtained in 11 healthy volunteers and 1 patient with PD. RESULTS With 7-T imaging, distinct images of the brain were obtained, including the subthalamic nucleus (STN) and internal globus pallidus (GPi). Compared with the 1.5- and 3-T MR images of the STN and GPi, the 7-T MR images showed marked improvements in spatial resolution, tissue contrast, and signal-to-noise ratio. CONCLUSIONS Data in this study reveal the superiority of 7-T MR imaging for visualizing structures targeted for DBS in the management of PD. This finding suggests that by enabling the direct visualization of neural structures of interest, 7-T MR imaging could be a valuable aid in neurosurgical procedures.
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Affiliation(s)
- Zang-Hee Cho
- Neuroscience Research Institute, Gachon University of Medicine and Science, Incheon, Republic of Korea.
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Vergani F, Landi A, Pirillo D, Cilia R, Antonini A, Sganzerla EP. Surgical, Medical, and Hardware Adverse Events in a Series of 141 Patients Undergoing Subthalamic Deep Brain Stimulation for Parkinson Disease. World Neurosurg 2010; 73:338-44. [DOI: 10.1016/j.wneu.2010.01.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 01/14/2010] [Indexed: 11/24/2022]
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Guo T, Parrent AG, Peters TM. Surgical targeting accuracy analysis of six methods for subthalamic nucleus deep brain stimulation. ACTA ACUST UNITED AC 2010; 12:325-34. [PMID: 18066948 DOI: 10.3109/10929080701730987] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ting Guo
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada N6A 5K8.
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York MK, Wilde EA, Simpson R, Jankovic J. Relationship between neuropsychological outcome and DBS surgical trajectory and electrode location. J Neurol Sci 2009; 287:159-71. [PMID: 19767016 DOI: 10.1016/j.jns.2009.08.003] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Revised: 06/08/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND The outcome literature of subthalamic nuclei (STN) deep brain stimulation (DBS) suggests that cognitive declines are commonly reported following surgery. We hypothesized that differences in electrode position and surgical trajectory may lead to a differential neuropsychological outcome. METHODS We conducted a standardized evaluation of the location of the DBS electrode tip and the active electrodes, the surgical trajectory through which they were placed, and their relation to neuropsychological change scores (mental status, verbal memory, verbal fluency, and psychological measures) in 17 bilateral STN DBS patients using 6 months post-surgical magnetic resonance imaging data. RESULTS Declines in mental status scores were related to electrodes that were more posterior-laterally placed within the frontal quadrant in either hemisphere or those located superiorally in the left hemisphere. Electrodes that were closer to the approximated STN and more superiorally located in the left hemisphere were associated with verbal learning declines at 6 months following surgery. In the right hemisphere, the electrodes that were located more in the lateral direction were related to verbal short-term memory declines; while for verbal long-term memory declines were found for electrodes located more posterior-laterally in the left hemisphere. Declines in verbal fluency scores were more variable with associations found between change scores and electrodes in the lateral and superior directions in the left hemisphere and those electrodes closer to the approximated STN and more superiorally and posteriorally located in the right hemisphere. In contrast, semantic fluency declines were only related to right hemisphere electrodes located more superiorally. Declines in mood were related to those electrodes located further away from the approximated STN, particularly those located more inferiorally and laterally in the left hemisphere. Anxiety change scores were not associated with the location of the electrodes. CONCLUSIONS The results provide preliminary evidence that 6 months following bilateral STN DBS cognitive and emotional changes may be related to the surgical trajectory and electrode placement.
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Affiliation(s)
- Michele K York
- Department of Neurology, The Parkinson's Disease and Movement Disorders Clinic, Baylor College of Medicine, The Michael E Debakey Veterans Affairs Medical Center, Houston, Texas, United States.
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Kobayashi K, Katayama Y, Sumi K, Otaka T, Obuchi T, Kano T, Nagaoka T, Oshima H, Fukaya C, Yamamoto T, Atsumi H. Effects of Electrode Implantation Angle on Thalamic Stimulation for Treatment of Tremor. Neuromodulation 2009; 13:31-6. [DOI: 10.1111/j.1525-1403.2009.00235.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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McClelland S, Ford B, Senatus PB, Frucht SJ, Winfield LM, Yu Q, Du YE, Pullman SL, McKhann GM, Goodman RR. Typical variations of subthalamic electrode location do not predict limb motor function improvement in Parkinson's disease. J Clin Neurosci 2009; 16:771-8; discussion 779. [PMID: 19324551 DOI: 10.1016/j.jocn.2008.10.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Revised: 10/22/2008] [Accepted: 10/22/2008] [Indexed: 11/25/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for patients with medically refractory Parkinson's disease (PD). The degree to which the anatomic location of the DBS electrode tip determines the improvement of contralateral limb movement function has not been defined. This retrospective study was performed to address this issue. Forty-two DBS electrode tips in 21 bilaterally implanted patients were localized on postoperative MRI. The postoperative and preoperative planning MRIs were merged with the Stealth FrameLink 4.0 stereotactic planning workstation (Medtronic Inc., Minneapolis, MN, USA) to determine the DBS tip coordinates. Stimulation settings were postoperatively optimized for maximal clinical effect. Patients were videotaped 1 year postoperatively and assessed by a movement disorder neurologist blinded to electrode tip locations. The nine limb-related components of the Unified PD Rating Scale Part III were tabulated to obtain a limb score, and the electrode tip locations associated with the 15 least and 15 greatest limb scores were evaluated. Two-tailed t-tests revealed no significant difference in electrode tip location between the two groups in three-dimensional distance (p=0.759), lateral-medial (x) axis (p=0.983), anterior-posterior (y) axis (p=0.949) or superior-inferior (z) axis (p=0.894) from the intended anatomical target. The range of difference in tip location and limb scores was extensive. Our results suggest that anatomic targeting alone may provide the same clinical efficacy as is achieved by "fine-tuning" DBS placement with microelectrode recording to a specific target.
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Affiliation(s)
- Shearwood McClelland
- Department of Neurosurgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Sillay K, Starr P. Deep Brain Stimulation in Parkinson’s Disease. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Deep Brain Stimulation. Neuromodulation 2009. [DOI: 10.1016/b978-0-12-374248-3.00086-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Alberts JL, Voelcker-Rehage C, Hallahan K, Vitek M, Bamzai R, Vitek JL. Bilateral subthalamic stimulation impairs cognitive-motor performance in Parkinson's disease patients. Brain 2008; 131:3348-60. [PMID: 18842609 DOI: 10.1093/brain/awn238] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Deep brain stimulation (DBS) is a surgical procedure that has been shown effective in improving the cardinal motor signs of advanced Parkinson's disease, however, declines in cognitive function have been associated with bilateral subthalamic nucleus (STN) DBS. Despite the fact that most activities of daily living clearly have motor and cognitive components performed simultaneously, postoperative assessments of cognitive and motor function occur, in general, in isolation of one another. The primary aim of this study was to determine the effects of unilateral and bilateral STN DBS on upper extremity motor function and cognitive performance under single- and dual-task conditions in advanced Parkinson's disease patients. Data were collected from eight advanced Parkinson's disease patients between the ages of 48 and 70 years (mean 56.5) who had bilaterally placed STN stimulators. Stimulation parameters for DBS devices were optimized clinically and were stable for at least 6 months prior to study participation. Data were collected while patients were Off anti-parkinsonian medications under three stimulation conditions: Off stimulation, unilateral DBS and bilateral DBS. In each stimulation condition patients performed a cognitive (n-back task) and motor (force tracking) task under single- and dual-task conditions. During dual-task conditions, patients performed the n-back and force-maintenance task simultaneously. Under relatively simple dual-task conditions there were no differences in cognitive or motor performance under unilateral and bilateral stimulation. As dual-task complexity increased, cognitive and motor performance was significantly worse with bilateral compared with unilateral stimulation. In the most complex dual-task condition (i.e. 2-back + force tracking), bilateral stimulation resulted in a level of motor performance that was similar to the Off stimulation condition. Significant declines in cognitive and motor function under modest dual-task conditions with bilateral but not with unilateral STN DBS suggest that unilateral procedures may be an alternative to bilateral DBS for some patients, in particular, those with asymmetric symptomology. From a clinical perspective, these results underscore the need to assess cognitive and motor function simultaneously during DBS programming as these conditions may better reflect the context in which daily activities are performed.
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Affiliation(s)
- Jay L Alberts
- Department of Biomedical Engineering, Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH 44195, USA.
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Rezai AR, Machado AG, Deogaonkar M, Azmi H, Kubu C, Boulis NM. Surgery for movement disorders. Neurosurgery 2008; 62 Suppl 2:809-38; discussion 838-9. [PMID: 18596424 DOI: 10.1227/01.neu.0000316285.52865.53] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Movement disorders, such as Parkinson's disease, tremor, and dystonia, are among the most common neurological conditions and affect millions of patients. Although medications are the mainstay of therapy for movement disorders, neurosurgery has played an important role in their management for the past 50 years. Surgery is now a viable and safe option for patients with medically intractable Parkinson's disease, essential tremor, and dystonia. In this article, we provide a review of the history, neurocircuitry, indication, technical aspects, outcomes, complications, and emerging neurosurgical approaches for the treatment of movement disorders.
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Affiliation(s)
- Ali R Rezai
- Center for Neurological Restoration, and Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio 44122, USA.
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