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Paff M, Loh A, Sarica C, Lozano AM, Fasano A. Update on Current Technologies for Deep Brain Stimulation in Parkinson's Disease. J Mov Disord 2020; 13:185-198. [PMID: 32854482 PMCID: PMC7502302 DOI: 10.14802/jmd.20052] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/22/2020] [Accepted: 07/05/2020] [Indexed: 01/19/2023] Open
Abstract
Deep brain stimulation (DBS) is becoming increasingly central in the treatment of patients with Parkinson's disease and other movement disorders. Recent developments in DBS lead and implantable pulse generator design provide increased flexibility for programming, potentially improving the therapeutic benefit of stimulation. Directional DBS leads may increase the therapeutic window of stimulation by providing a means of avoiding current spread to structures that might give rise to stimulation-related side effects. Similarly, control of current to individual contacts on a DBS lead allows for shaping of the electric field produced between multiple active contacts. The following review aims to describe the recent developments in DBS system technology and the features of each commercially available DBS system. The advantages of each system are reviewed, and general considerations for choosing the most appropriate system are discussed.
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Affiliation(s)
- Michelle Paff
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Can Sarica
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Andres M. Lozano
- Division of Neurosurgery, University Health Network, University of Toronto, Toronto, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson’s Disease, Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Canada
- Krembil Brain Institute, Toronto, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Canada
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Harmsen IE, Elias GJ, Beyn ME, Boutet A, Pancholi A, Germann J, Mansouri A, Lozano CS, Lozano AM. Clinical trials for deep brain stimulation: Current state of affairs. Brain Stimul 2020; 13:378-385. [DOI: 10.1016/j.brs.2019.11.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/07/2019] [Accepted: 11/17/2019] [Indexed: 12/20/2022] Open
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Li D, Zhang C, Gault J, Wang W, Liu J, Shao M, Zhao Y, Zeljic K, Gao G, Sun B. Remotely Programmed Deep Brain Stimulation of the Bilateral Subthalamic Nucleus for the Treatment of Primary Parkinson Disease: A Randomized Controlled Trial Investigating the Safety and Efficacy of a Novel Deep Brain Stimulation System. Stereotact Funct Neurosurg 2017; 95:174-182. [DOI: 10.1159/000475765] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 04/05/2017] [Indexed: 11/19/2022]
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Liu Z, Liu Y, Yang Y, Wang L, Dou W, Guo J, Wang Y, Guo Y, Wan X, Ma W, Wang R. Subthalamic Nuclei Stimulation in Patients With Pantothenate Kinase-Associated Neurodegeneration (PKAN). Neuromodulation 2017; 20:484-491. [DOI: 10.1111/ner.12549] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/12/2016] [Accepted: 10/12/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Ziyuan Liu
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Yang Liu
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Yingmai Yang
- Department of Neurology; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Lin Wang
- Department of Neurology; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Wanchen Dou
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Jinzhu Guo
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Yu Wang
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Yi Guo
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Xinhua Wan
- Department of Neurology; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Wenbin Ma
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
| | - Renzhi Wang
- Department of Neurosurgery; Peking Union Medical College Hospital, Chinese Academy of Medical Sciences; P. R. China
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Wang K, Chai Q, Qiao H, Zhang J, Liu T, Meng F. Vagus nerve stimulation balanced disrupted default-mode network and salience network in a postsurgical epileptic patient. Neuropsychiatr Dis Treat 2016; 12:2561-2571. [PMID: 27785033 PMCID: PMC5067064 DOI: 10.2147/ndt.s116906] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION In recent years, treatment of intractable epilepsy has become more challenging, due to an increase in resistance to antiepileptic drugs, as well as diminished success following resection surgery. Here, we present the case of a 19-year old epileptic patient who received vagus nerve stimulation (VNS) following unsuccessful left parietal-occipital lesion-resection surgery, with results indicating an approximate 50% reduction in seizure frequency and a much longer seizure-free interictal phase. MATERIALS AND METHODS Using resting-state functional magnetic resonance imaging, we measured the changes in resting-state brain networks between pre-VNS treatment and 6 months post-VNS, from the perspective of regional and global variations, using regional homogeneity and large-scale functional connectives (seeding posterior cingulate cortex and anterior cingulate cortex), respectively. RESULTS After 6 months of VNS therapy, the resting-state brain networks were slightly reorganized in regional homogeneity, mainly in large-scale functional connectivity, where excessive activation of the salience network was suppressed, while at the same time the suppressed default-mode network was activated. CONCLUSION With regard to resting-state brain networks, we propose a hypothesis based on this single case study that VNS acts on intractable epilepsy by modulating the balance between salience and default-mode networks through the integral hub of the anterior cingulate cortex.
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Affiliation(s)
- Kailiang Wang
- Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation
| | - Qi Chai
- Beijing Neurosurgical Institute, Capital Medical University
| | - Hui Qiao
- Beijing Neurosurgical Institute, Capital Medical University
| | - Jianguo Zhang
- Beijing Key Laboratory of Neurostimulation; Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Tinghong Liu
- Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation
| | - Fangang Meng
- Beijing Neurosurgical Institute, Capital Medical University; Beijing Key Laboratory of Neurostimulation
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Jia F, Guo Y, Wan S, Chen H, Hao H, Zhang J, Li L. Variable frequency stimulation of subthalamic nucleus for freezing of gait in Parkinson's disease. Parkinsonism Relat Disord 2015; 21:1471-2. [PMID: 26467485 DOI: 10.1016/j.parkreldis.2015.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/25/2015] [Accepted: 10/02/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Fumin Jia
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Yi Guo
- Department of Neurosurgery, Peking Union Medical College Hospital, Beijing, China
| | - Sen Wan
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Hao Chen
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Hongwei Hao
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China
| | - Jianguo Zhang
- Department of Functional Neurosurgery, Beijing Tiantan Hospital, Beijing, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, Tsinghua University, Beijing, China; Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China.
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Deer TR, Krames E, Mekhail N, Pope J, Leong M, Stanton-Hicks M, Golovac S, Kapural L, Alo K, Anderson J, Foreman RD, Caraway D, Narouze S, Linderoth B, Buvanendran A, Feler C, Poree L, Lynch P, McJunkin T, Swing T, Staats P, Liem L, Williams K. The Appropriate Use of Neurostimulation: New and Evolving Neurostimulation Therapies and Applicable Treatment for Chronic Pain and Selected Disease States. Neuromodulation 2014; 17:599-615; discussion 615. [DOI: 10.1111/ner.12204] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 01/14/2014] [Accepted: 02/07/2014] [Indexed: 12/20/2022]
Affiliation(s)
| | | | - Nagy Mekhail
- University of Kentucky-Lexington; Lexington KY USA
| | - Jason Pope
- Center for Pain Relief; Charleston WV USA
| | | | | | | | - Leo Kapural
- Carolinas Pain Institute at Brookstown; Wake Forest Baptist Health; Winston-Salem NC USA
| | - Ken Alo
- The Methodist Hospital Research Institute; Houston TX USA
- Monterey Technical Institute; Monterey Mexico
| | | | - Robert D. Foreman
- University of Oklahoma Health Sciences Center, College of Medicine; Oklahoma City OK USA
| | - David Caraway
- Center for Pain Relief, Tri-State, LLC; Huntington WV USA
| | - Samer Narouze
- Anesthesiology and Pain Medicine, Neurological Surgery; Summa Western Reserve Hospital; Cuyahoga Falls OH USA
| | - Bengt Linderoth
- Functional Neurosurgery and Applied Neuroscience Research Unit, Karolinska Institute; Karolinska University Hospital; Stockholm Sweden
| | | | - Claudio Feler
- University of Tennessee; Memphis TN USA
- Valley View Hospital; Glenwood Springs CO USA
| | - Lawrence Poree
- University of California at San Francisco; San Francisco CA USA
- Pain Clinic of Monterey Bay; Aptos CA
| | - Paul Lynch
- Arizona Pain Specialists; Scottsdale AZ USA
| | | | - Ted Swing
- Arizona Pain Specialists; Scottsdale AZ USA
| | - Peter Staats
- Premier Pain Management Centers; Shrewsbury NJ USA
- Johns Hopkins University; Baltimore MD USA
| | - Liong Liem
- St. Antonius Hospital; Nieuwegein The Netherlands
| | - Kayode Williams
- Johns Hopkins School of Medicine and Carey Business School; Baltimore MD USA
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Shi L, Yang AC, Meng DW, Li SW, Liu HG, Li JJ, Wang X, Zhang X, Zhang JG. Pathological alterations and stress responses near DBS electrodes after MRI scans at 7.0T, 3.0T and 1.5T: an in vivo comparative study. PLoS One 2014; 9:e101624. [PMID: 24988329 PMCID: PMC4079335 DOI: 10.1371/journal.pone.0101624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 06/09/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to investigate the pathological alterations and the stress responses around deep brain stimulation (DBS) electrodes after magnetic resonance imaging (MRI) scans at 7.0T, 3.0T and 1.5T. MATERIALS AND METHODS DBS devices were stereotactically implanted into the brains of New Zealand rabbits, targeting the left nucleus ventralis posterior thalami, while on the right side, a puncture passage pointing to the same target was made. MRI scans at 7.0T, 3.0T and 1.5T were performed using transmit/receive head coils. The pathological alterations of the surrounding tissue were evaluated by hematoxylin and eosin staining (H&E staining) and transmission electron microscopy (TEM). The levels of the 70 kDa heat shock protein (HSP-70), Neuronal Nuclei (NeuN) and Caspase-3 were determined by western-blotting and quantitative polymerase chain reaction (QPCR) to assess the stress responses near the DBS electrodes. RESULTS H&E staining and TEM showed that the injury around the DBS electrodes was featured by a central puncture passage with gradually weakened injurious alterations. Comparisons of the injury across the groups manifested similar pathological alterations near the DBS electrodes in each group. Moreover, western-blotting and QPCR assay showed that the level of HSP-70 was not elevated by MRI scans (p>0.05), and the levels of NeuN and Caspase-3 were equal in each group, regardless of the field strengths applied (p>0.05). CONCLUSIONS Based on these findings, it is reasonable to conclude that in this study the MRI scans at multiple levels failed to induce additional tissue injury around the DBS electrodes. These preliminary data furthered our understanding of MRI-related DBS heating and encouraged revisions of the current MRI guidelines for patients with DBS devices.
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Affiliation(s)
- Lin Shi
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - An-Chao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Da-Wei Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shao-Wu Li
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Huan-Guang Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jun-Ju Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, People's Hospital of Hainan Province, Haikou, Hainan Province, China
| | - Xiu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jian-Guo Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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