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Marín-Castañeda LA, Armas-Salazar A, González-Salido J, Cid-Rodriguez FX, Lee Á, Carrillo-Ruiz JD. The 100 Most Cited Articles on Functional Neurosurgery in Latin America: A Scientometric Analysis. World Neurosurg 2024; 184:303-309.e8. [PMID: 38280629 DOI: 10.1016/j.wneu.2024.01.106] [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: 11/19/2023] [Revised: 01/18/2024] [Accepted: 01/19/2024] [Indexed: 01/29/2024]
Abstract
Significant progress has been made in Stereotactic and Functional Neurosurgery (SFN) within Latin America (LATAM), which can be attributed to the rapid advancements in technology and a growing pool of expertise. However, despite the growing importance of this field, a comprehensive scientometric analysis of LATAM contributions is still lacking. The aim of this study is to shed light on the top-cited articles in the field authored by LATAM researchers. A search of the Scopus database was performed using specific keywords in the field of SFN to retrieve the top 100 most cited articles. Only those with LATAM affiliation for the first or corresponding position were included. The 100 top-cited articles were published between 1978 and 2019 across 47 different journals. On average, these articles had a citation count of 97.2 citations. A total of 635 LATAM authors were identified, including 145 women. Notably, the 5 most productive and impactful authors were Velasco F., Velasco M., Velasco A.L., Cukiert A., and Jiménez F. Within the field of SFN, epilepsy accounted for 47% of the documents, while the remaining 53% encompassed research on psychiatric diseases, movement disorders, translational research, pain, and electrical mapping. Epilepsia emerged as the journal with the highest number of articles. Mexico and Brazil contributed the most articles, with the University of São Paulo and the Hospital General de Mexico being the most productive institutions. This scientometric analysis highlights the impactful research contributions from the region, identifies influential authors and institutions, and emphasizes the necessity for additional collaboration and exploration.
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Affiliation(s)
- Luis A Marín-Castañeda
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; La Salle University School of Medicine, Mexico City, Mexico
| | - Armando Armas-Salazar
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City, Mexico
| | | | - Fátima X Cid-Rodriguez
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City, Mexico
| | - Ángel Lee
- Stroke Unit, Angeles del Pedregal Hospital, Mexico City, Mexico
| | - José D Carrillo-Ruiz
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico; Neuroscience Coordination, Psychology Faculty, Anahuac University, Mexico City, Mexico; Research Direction, General Hospital of Mexico, Mexico City, Mexico.
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Stenmark Persson R, Fytagoridis A, Ryzhkov M, Hariz M, Blomstedt P. Long-Term Follow-Up of Unilateral Deep Brain Stimulation Targeting the Caudal Zona Incerta in 13 Patients with Parkinsonian Tremor. Stereotact Funct Neurosurg 2023; 101:369-379. [PMID: 37879313 DOI: 10.1159/000533793] [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: 06/15/2023] [Accepted: 08/22/2023] [Indexed: 10/27/2023]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an established treatment for Parkinson's disease (PD) and other movement disorders. The ventral intermediate nucleus of the thalamus is considered as the target of choice for tremor disorders, including tremor-dominant PD not suitable for DBS in the subthalamic nucleus (STN). In the last decade, several studies have shown promising results on tremor from DBS in the posterior subthalamic area (PSA), including the caudal zona incerta (cZi) located posteromedial to the STN. The aim of this study was to evaluate the long-term effect of unilateral cZi/PSA-DBS in patients with tremor-dominant PD. METHODS Thirteen patients with PD with medically refractory tremor were included. The patients were evaluated using the motor part of the Unified Parkinson Disease Rating Scale (UPDRS) off/on medication before surgery and off/on medication and stimulation 1-2 years (short-term) after surgery and at a minimum of 3 years after surgery (long-term). RESULTS At short-term follow-up, DBS improved contralateral tremor by 88% in the off-medication state. This improvement persisted after a mean of 62 months. Contralateral bradykinesia was improved by 40% at short-term and 20% at long-term follow-up, and the total UPDRS-III by 33% at short-term and by 22% at long-term follow-up with stimulation alone. CONCLUSIONS Unilateral cZi/PSA-DBS seems to remain an effective treatment for patients with severe Parkinsonian tremor several years after surgery. There was also a modest improvement on bradykinesia.
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Affiliation(s)
| | - Anders Fytagoridis
- Department of Clinical Neuroscience, Neurosurgery, Karolinska Institute, Stockholm, Sweden
| | - Maxim Ryzhkov
- Cranial and Spinal Technologies, Medtronic, Lafayette, Colorado, USA
| | - Marwan Hariz
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
- UCL Queen Square Institute of Neurology, London, UK
| | - Patric Blomstedt
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
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Velasco-Campos F, Esqueda-Liquidano M, Roldan-Valadez E, Carrillo-Ruiz JD, Navarro-Olvera JL, Aguado-Carrillo G. Prelemniscal Radiations as a Target for the Treatment of Parkinson Disease - Individual Variations in the Stereotactic Location of Fiber Components: A Probabilistic Tractography Study. World Neurosurg 2022; 166:e345-e352. [PMID: 35817353 DOI: 10.1016/j.wneu.2022.07.008] [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: 05/11/2022] [Revised: 07/02/2022] [Accepted: 07/04/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Prelemniscal radiation (Raprl) lesions and deep brain stimulation effectively control motor symptoms of Parkinson disease, but individual variations in the stereotactic location of its fiber components constitute a significant concern. The objective of this study was to determine individual variations in the stereotactic location of fiber tracts composing Raprl. METHODS Raprl fiber composition was determined in a group of 10 Parkinson patients and 10 matched controls using 3T magnetic resonance imaging, brain imaging processed for diffusion-weighted images, tract density imaging, and constrained spherical deconvolution. The stereotactic position of the point of maximal proximity (PMP), which is the point where the most significant number of fibers is concentrated in the smallest volume in the tractography, was evaluated in the right and left hemispheres of the same person, between individuals and between patients and controls for each tract in coordinates "x," "y," and "z." The stereotactic coordinates at which PMP of all tracts meet were statistically determined, representing the recommended aim for this target. RESULTS Stereotactic coordinates of the 3 fiber tracts composing Raprl, cerebellar-thalamic-cortical, globus pallidus-peduncle-pontine nucleus, and mesencephalic-orbital frontal cortex, did not vary between right and left hemispheres in the same person and between patients and controls. In contrast, PMP variability between individuals was significant, mainly for the mesencephalic-orbitofrontal tract. Therefore, probabilistic tractography can better determine individual variations to plan electrode trajectories. CONCLUSIONS Individual PMP variations for fiber tracts in Raprl, identified by probabilistic tractography, provide a platform for planning the stereotactic approach to conform volumes for deep brain stimulation and lesions.
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Affiliation(s)
- Francisco Velasco-Campos
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | | | | | | | | | - Gustavo Aguado-Carrillo
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico.
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Carrillo-Ruiz JD, Armas-Salazar A, Navarro-Olvera JL, Beltrán JQ, Bowles B, González-Garibay G, Lee Á. Bibliometric Analysis of Mexican Publications on Stereotactic and Functional Neurosurgery From 1949 to 2021. Front Surg 2022; 9:886391. [PMID: 35615655 PMCID: PMC9124808 DOI: 10.3389/fsurg.2022.886391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 03/31/2022] [Indexed: 11/20/2022] Open
Abstract
Background Stereotactic and functional neurosurgery (SFN) is a rapidly evolving field and some emerging countries, especially Mexico, have made significant contributions to this discipline. A bibliometric analysis has never been performed in Latin America, and this would be particularly important to show the areas that remain poorly studied, and design research strategies for the future. Methods Scopus was queried using keywords pertaining to functional neurosurgery, restricting the affiliation country to Mexico, and considering documents published after 1949. Added to the initial search, a complementary literature exploration by author, considering the publications of the most productive neurosurgeons, was performed. A descriptive statistical analysis was carried out. Results From 5,109 articles, only 371 were eligible. Scientific production has gradually increased with time. Epilepsy (31%) and movement disorders (27.4%) were the most studied neurological conditions, whereas the other 41.6% corresponded to pain, behavior disorders, spinal cord injuries, neuromodulation, stereotactic biopsies, and SFN history. Level of evidence was predominantly level V (59.1%). Publication output is highly skewed to Mexico City, which represents 78.4% of national production. Relative to factors associated with impact of research, publications in English had more citations (28.5 mean citations per paper), and journals with an impact factor greater than one had more than 10 mean citations per paper. Conclusions Mexico has experienced an increase in the productivity of SFN literature, addressing the most prevalent issues in the country (epilepsy and motor disorders). However, it is necessary to report studies with a higher level of evidence, as well as to decentralize the research collaborating with national institutions outside Mexico City. On the other hand, it is imperative to promote scientific production in English and in high-impact indexed journals to increase the visibility of our production. We would like to call upon our colleagues in other countries to reproduce our methodology, in order to determine the factors associated with the impact and productivity on SFN research.
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Affiliation(s)
- José Damián Carrillo-Ruiz
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
- Faculty of Health Sciences Direction of Anahuac University Mexico, Mexico City, Mexico
| | - Armando Armas-Salazar
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
- Postgraduate Department, School of Higher Education in Medicine, National Polytechnic Institute, Mexico City, Mexico
| | - José Luis Navarro-Olvera
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
| | - Jesús Q. Beltrán
- Unit for Stereotactic and Functional Neurosurgery, and Research Direction, General Hospital of Mexico, Mexico City, Mexico
| | - Brigham Bowles
- Instituto Nacional de Neurología y Neurocirugía, Neuroendovascular Therapy, Mexico City, Mexico
| | | | - Ángel Lee
- Instituto Nacional de Neurología y Neurocirugía, Neuroendovascular Therapy, Mexico City, Mexico
- Comisión Coordinadora de Institutos Nacionales de Salud y Hospitales de Alta Especialidad, Mexico City, Mexico
- *Correspondence: Ángel Lee
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Stenmark Persson R, Nordin T, Hariz GM, Wårdell K, Forsgren L, Hariz M, Blomstedt P. Deep Brain Stimulation of Caudal Zona Incerta for Parkinson's Disease: One-Year Follow-Up and Electric Field Simulations. Neuromodulation 2021; 25:935-944. [PMID: 34313376 DOI: 10.1111/ner.13500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/04/2021] [Accepted: 06/29/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effects of bilateral caudal zona incerta (cZi) deep brain stimulation (DBS) for Parkinson's disease (PD) one year after surgery and to create anatomical improvement maps based on patient-specific simulation of the electric field. MATERIALS AND METHODS We report the one-year results of bilateral cZi-DBS in 15 patients with PD. Patients were evaluated on/off medication and stimulation using the Unified Parkinson's Disease Rating Scale (UPDRS). Main outcomes were changes in motor symptoms (UPDRS-III) and quality of life according to Parkinson's Disease Questionnaire-39 (PDQ-39). Secondary outcomes included efficacy profile according to sub-items of UPDRS-III, and simulation of the electric field distribution around the DBS lead using the finite element method. Simulations from all patients were transformed to one common magnetic resonance imaging template space for creation of improvement maps and anatomical evaluation. RESULTS Median UPDRS-III score off medication improved from 40 at baseline to 21 on stimulation at one-year follow-up (48%, p < 0.0005). PDQ-39 summary index did not change but the subdomains activities of daily living (ADL) and stigma improved (25%, p < 0.03 and 75%, p < 0.01), whereas communication worsened (p < 0.03). For UPDRS-III sub-items, stimulation alone reduced median tremor score by 9 points, akinesia by 3, and rigidity by 2 points at one-year follow-up in comparison to baseline (90%, 25%, and 29% respectively, p < 0.01). Visual analysis of the anatomical improvement maps based on simulated electrical fields showed no evident relation with the degree of symptom improvement and neither did statistical analysis show any significant correlation. CONCLUSIONS Bilateral cZi-DBS alleviates motor symptoms, especially tremor, and improves ADL and stigma in PD patients one year after surgery. Improvement maps may be a useful tool for visualizing the spread of the electric field. However, there was no clear-cut relation between anatomical location of the electric field and the degree of symptom relief.
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Affiliation(s)
| | - Teresa Nordin
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Gun-Marie Hariz
- Department of Clinical Science, Neuroscience, Umeå University, Umeå, Sweden
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Lars Forsgren
- Department of Clinical Science, Neuroscience, Umeå University, Umeå, Sweden
| | - Marwan Hariz
- Department of Clinical Science, Neuroscience, Umeå University, Umeå, Sweden.,Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, UK
| | - Patric Blomstedt
- Department of Clinical Science, Neuroscience, Umeå University, Umeå, Sweden
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Sasagawa A, Enatsu R, Kitagawa M, Mikami T, Nakayama-Kamada C, Kuribara T, Hirano T, Arihara M, Mikuni N. Target Selection of Directional Lead in Patients with Parkinson's Disease. Neurol Med Chir (Tokyo) 2020; 60:622-628. [PMID: 33162470 PMCID: PMC7803701 DOI: 10.2176/nmc.tn.2020-0210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Several structures including subthalamic nucleus (STN), the caudal zona incerta (cZI), the prelemniscal radiation (Raprl), and the thalamic ventral intermediate nucleus (Vim) have been reported to be useful for improving symptoms of Parkinson’s disease (PD). However, the effect of each target is still unclear. Therefore, we investigated each structure’s effects and adverse effects using a directional lead implanted in the posterior STN adjacent to the cZI and Raprl in two patients with tremor-dominant PD. In Case 1, maximal reduction of tremor was obtained by stimulation toward the Vim, and stimulation toward the thalamic reticular nucleus (TRN) reduced verbal fluency, but did not induce dysarthria. In Case 2, maximal reduction of tremor was obtained by stimulation toward the dorsal STN and Raprl. Maximal reduction of rigidity was achieved by stimulation toward the dorsal STN, Raprl, and cZI. Bradykiensia was improved by stimulation in all directions, but dyskinesia and dysarthria were evoked by stimulation toward the dorsal STN and cZI. The directional lead may elucidate the stimulation effect of each structure and broaden target selection depending on patients’ symptoms and adverse effects.
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Affiliation(s)
- Ayaka Sasagawa
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | | | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | | | - Tomoyoshi Kuribara
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Tsukasa Hirano
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Masayasu Arihara
- Department of Neurosurgery, Sapporo Medical University School of Medicine
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine
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García-Gomar MG, Concha L, Soto-Abraham J, Tournier JD, Aguado-Carrillo G, Velasco-Campos F. Long-Term Improvement of Parkinson Disease Motor Symptoms Derived From Lesions of Prelemniscal Fiber Tract Components. Oper Neurosurg (Hagerstown) 2020; 19:539-550. [PMID: 32629480 DOI: 10.1093/ons/opaa186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 04/15/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Prelemniscal radiations (Raprl) are composed of different fiber tracts, connecting the brain stem and cerebellum with basal ganglia and cerebral cortex. In Parkinson disease (PD), lesions in Raprl induce improvement of tremor, rigidity, and bradykinesia in some patients, while others show improvement of only 1 or 2 symptoms, suggesting different fiber tracts mediate different symptoms. OBJECTIVE To search for correlations between improvements of specific symptoms with surgical lesions of specific fiber tract components of Raprl in patients with PD. METHODS A total of 10 patients were treated with unilateral radiofrequency lesions directed to Raprl. The improvement for tremor, rigidity, bradykinesia, posture, and gait was evaluated at 24 to 33 mo after operation through the Unified Parkinson's Disease Rating Scale (UPDRS) score, and the precise location and extension of lesions through structural magnetic resonance imaging and probabilistic tractography at 6 to 8 mo postsurgery. Correlation between percentage of fiber tract involvement and percentage of UPDRS-III score improvement was evaluated through Spearman's correlation coefficient. RESULTS Group average improvement was 86% for tremor, 62% for rigidity, 56% for bradykinesia, and 45% for gait and posture. Improvement in global UPDRS score correlated with extent of lesions in fibers connecting with contralateral cerebellar cortex and improvement of posture and gait with fibers connecting with contralateral deep cerebellar nuclei. Lesion of fibers connecting the globus pallidum with pedunculopontine nucleus induced improvement of gait and posture over other symptoms. CONCLUSION Partial lesion of Raprl fibers resulted in symptom improvement at 2-yr follow-up. Lesions of selective fiber components may result in selective improvement of specific symptoms.
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Affiliation(s)
| | - Luis Concha
- Institute of Neurobiology, Universidad Nacional Autónoma de México, Campus Juriquilla, Juriquilla, Mexico
| | - Julian Soto-Abraham
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Ciudad de México, Mexico
| | - Jacques D Tournier
- Department of Biomedical Engineering, School of Bioengineering and Imaging Sciences, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom.,Centre for the Developing Brain, School of Bioengineering and Imaging Sciences, King's College London, King's Health Partners, St. Thomas' Hospital, London, United Kingdom
| | - Gustavo Aguado-Carrillo
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Ciudad de México, Mexico
| | - Francisco Velasco-Campos
- Unit for Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Ciudad de México, Mexico
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Navarro-Olvera JL, Diaz-Martinez JA, Covaleda-Rodriguez JC, Carrillo-Ruiz JD, Soto-Abraham JE, Aguado-Carrillo G, Velasco-Campos F. Radiofrequency Ablation of Prelemniscal Radiations for the Treatment of Non-Parkinsonian Tremor. Stereotact Funct Neurosurg 2020; 98:160-166. [PMID: 32340019 DOI: 10.1159/000505699] [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: 10/02/2019] [Accepted: 12/31/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Previous reports proposed prelemniscal radiations (Raprl) as a target to treat motor symptoms of Parkinson's disease, and this was found particularly effective to control rest and postural tremor. However, tremor of other etiologies has been seldom treated with deep brain stimulation or ablation in this target. We present a series of such cases successfully treated by Raprl radiofrequency (RF) lesions. MATERIAL AND METHODS Six patients with predominant unilateral tremor on the right arm: 4 intention, 1 cerebellar and 1 rubral tremor, incapacitating in spite of at least 2 regimes of medical treatment at maximal tolerated doses, were operated under local anesthesia. RF lesions were performed in Raprl contralateral to most prominent symptoms. Patients had monthly evaluation of tremor severity through the Fahn-Tolosa-Marin Tremor Rating Scale and disability through the Tremor Disability Scale along a 1-year follow-up. RESULTS In 4/6 patients tremor was stopped by the simple insertion of an RF electrode in Raprl; in the other 2 cases, stimulation through the RF electrode at 100 Hz, with 100 µs and 1.0-1.5 V, stopped the tremor without side effects. Tremor disappeared in all cases immediately after surgery and partially reappeared in 2 cases with an amplitude about 20% of the preoperative condition. RF lesions in postoperative MRI ranked from 1.8 to 2.6 mm in diameter. CONCLUSIONS RF lesioning in Raprl is a simple, highly effective, inexpensive way to treat tremor of different etiologies.
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Affiliation(s)
- Jose Luis Navarro-Olvera
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico,
| | | | | | | | | | - Gustavo Aguado-Carrillo
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
| | - Francisco Velasco-Campos
- Unit of Stereotactic and Functional Neurosurgery, General Hospital of Mexico, Mexico City, Mexico
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Vassal F, Dilly D, Boutet C, Bertholon F, Charier D, Pommier B. White matter tracts involved by deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a connectivity study based on preoperative diffusion tensor imaging tractography. Br J Neurosurg 2019; 34:187-195. [PMID: 31833430 DOI: 10.1080/02688697.2019.1701630] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To depict the specific brain networks that are modulated by deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD), using diffusion tensor imaging-based fibre tractography (DTI-FT).Materials and methods: Nine patients who received bilateral STN-DBS for PD were included. Electrodes were localized by co-registering preoperative magnetic resonance imaging and postoperative computed tomography. The volume of tissue activated (VTA) was estimated as an isotropic, spherical electric field distribution centred at each effective electrode contact's centroid coordinates, taking into account individual stimulation parameters (i.e. voltage, impedance). Brain connectivity analysis was undertaken using a deterministic DTI-FT method, seeded from a single region of interest corresponding to the VTA. The labelling of the reconstructed white matter fibre tracts relied on their path and (sub)cortical termination territories.Results: Six months after surgery, we observed a statistically significant reduction in both the Unified Parkinson Disease Rating Scale part III and L-dopa equivalent daily dose. Areas consistently connected to the VTA included the brainstem (100%), cerebellum (94%), dorsal (i.e. supplementary motor area) and lateral premotor cortex (94%), and primary motor cortex (72%). An involvement of the hyperdirect pathway (HDP) connecting the STN and the (pre)motor cortex was demonstrated.Conclusions: The connectivity patterns observed in this study suggest that the therapeutic effects of STN-DBS are mediated through the modulation of distributed, large-scale motor networks. Specifically, the depiction of projection neurons connecting the stimulated area/STN to the (pre)motor cortex, reinforce the growing evidence that the HDP might be a potential therapeutic target in PD. If further replicated, these findings could raise the possibility that DTI-FT reconstruction of the HDP may critically improve DBS targeting and stimulation parameters selection, through the development of programming tools that incorporate VTA modelling and patient-specific DTI-FT data.
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Affiliation(s)
- François Vassal
- Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Domitille Dilly
- Department of Neurology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Claire Boutet
- Department of Neuroradiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Frédérique Bertholon
- Department of Clinical Neurophysiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - David Charier
- Department of Anesthesiology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Benjamin Pommier
- Department of Neurosurgery, University Hospital of Saint-Etienne, Saint-Etienne, France
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Enatsu R, Kitagawa M, Mikami T, Kanno A, Komura S, Mikuni N. A Case Report of Multitrack Recording of Posterior Subthalamic Nucleus, Caudal Zona Incerta, and Prelemniscal Radiation: Which Is Most Effective for Bradykinesia? NMC Case Rep J 2019; 6:91-93. [PMID: 31417839 PMCID: PMC6692598 DOI: 10.2176/nmccrj.cr.2018-0277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/22/2019] [Indexed: 12/30/2022] Open
Abstract
Deep brain stimulation (DBS) of the posterior subthalamic nucleus (pSTN), caudal zona incerta (cZI), and prelemniscal radiation (Raprl) has been shown to improve Parkinsonian motor symptoms. We herein report neurophysiological and functional differences among the cZI, Raprl, and pSTN in a 68-year-old male patient with Parkinson's disease (PD). The stereotactic implantation of DBS electrodes in the right STN was performed. Thereafter, a transfrontal trajectory for the left cZI was planned for left side implantation, with the expectation that the electrode entered the pSTN in the case of a posterior brain shift. In the implantation of the DBS lead in the cZI, three microelectrodes were simultaneously placed in an array with the central, medial, and anterior positions placed 2 mm apart to delineate the cZI, Raprl, and pSTN, respectively. A maximal reduction in bradykinesia was obtained from the stimulation of the pSTN at the lowest voltage thresholds, and the voltage threshold for abolishing tremors was lower in the Raprl and cZI than in the pSTN. The left DBS lead was implanted in the pSTN because right-sided bradykinesia was more severe than tremor. The multitrack recording of cZI, Raprl, and pSTN might broaden target selection depending on patients' symptoms.
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Affiliation(s)
- Rei Enatsu
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Mayumi Kitagawa
- Department of Neurology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, Japan
| | - Takeshi Mikami
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Aya Kanno
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Shoichi Komura
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Nobuhiro Mikuni
- Department of Neurosurgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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Asahi T, Ikeda K, Yamamoto J, Tsubono H, Sato S. Pilot Study for Considering Subthalamic Nucleus Anatomy during Stimulation Using Directional Leads. J Mov Disord 2019; 12:97-102. [PMID: 30944286 PMCID: PMC6547037 DOI: 10.14802/jmd.18054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/06/2019] [Indexed: 12/22/2022] Open
Abstract
Objective Directional leads are used for deep brain stimulation (DBS). Two of the four contacts of the leads are divided into three parts, enabling controlled stimulation in a circumferential direction. The direction of adverse effects evoked by DBS in the subthalamic nucleus (STN) and stimulation strategies using directional leads were evaluated. Methods Directional leads were implanted into the bilateral STN of six parkinsonian patients (1 man, 5 women; mean age 66.2 years). The contact centers were located within the upper border of the STN, and the locations were identified electrically using microrecordings. Adverse effects were evaluated with electrical stimulation (30 μs, 130 Hz, limit 11 mA) using the directional part of each lead after surgery, and the final stimulation direction was investigated. Unified Parkinson’s disease rating scale (UPDRS) scores were evaluated before and after DBS. Results Fifty-six motor and four sensory symptoms were evoked by stimulation; no adverse effect was evoked in 14 contacts. Motor and sensory symptoms were evoked by stimulation in the anterolateral direction and medial to posterolateral direction, respectively. Stimulation in the posteromedial direction produced adverse effects less frequently. The most frequently used contacts were located above the STN (63%), followed by the upper part of the STN (32%). The mean UPDRS part III and dyskinesia scores decreased after DBS from 30.2 ± 11.7 to 7.2 ± 2.9 and 3.3 ± 2.4 to 0.5 ± 0.8, respectively. Conclusion The incidence of adverse effects was low for the posteromedial stimulation of the STN. Placing the directional part of the lead above the STN may facilitate the control of dyskinesia.
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Affiliation(s)
- Takashi Asahi
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan
| | - Kiyonobu Ikeda
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan
| | - Jiro Yamamoto
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan
| | - Hiroyuki Tsubono
- Department of Medical Engineering, Kanazawa Neurosurgical Hospital, Ishikawa, Japan
| | - Shuji Sato
- Department of Neurosurgery, Kanazawa Neurosurgical Hospital, Ishikawa, Japan
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Beltrán JQ, Carrillo-Ruiz JD. Neurological Functional Surgery in Mexico: From Pre-Columbian Cranial Surgery to Functional Neurosurgery in the 21st Century. World Neurosurg 2019; 122:549-558. [DOI: 10.1016/j.wneu.2018.11.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/16/2018] [Accepted: 11/18/2018] [Indexed: 01/28/2023]
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Martinez V, Hu SC, Foutz TJ, Ko A. Successful Treatment of Holmes Tremor With Deep Brain Stimulation of the Prelemniscal Radiations. Front Surg 2018; 5:21. [PMID: 29904635 PMCID: PMC5990850 DOI: 10.3389/fsurg.2018.00021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 02/27/2018] [Indexed: 12/20/2022] Open
Abstract
Holmes tremor (HT) is a rare movement disorder that is typically associated with cerebellar, thalamic or brainstem lesions following a delay. Treatment of HT with deep brain stimulation (DBS) has yielded positive results however; it is unclear which deep brain targets provide optimal therapeutic effects. Here we describe a case report in which a 34 year old man with HT treated successfully with DBS. The ventrointermediate nucleus (VIM) of the thalamus was considered as the initial target. Following electrode placement we determined that the ventral-most electrode contacts were located in the prelemniscal radiations (Raprl). When stimulating from the Raprl contacts, the patient demonstrated robust, stable therapeutic improvements using remarkably low voltages. Our case report corroborates prior evidence suggesting the Raprl as a viable therapeutic target for treating HT with DBS.
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Affiliation(s)
- Vicente Martinez
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Shu-Ching Hu
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Thomas J Foutz
- Department of Neurology, University of Washington, Seattle, WA, United States
| | - Andew Ko
- Department of Neurosurgery, University of Washington, Seattle, WA, United States
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Velasco F, Esqueda-Liquidano M, Velasco A, García-Gomar M. Prelemniscal Lesion for Selective Improvement of Parkinson Disease Tremor. Stereotact Funct Neurosurg 2018; 96:54-59. [DOI: 10.1159/000486318] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 12/05/2017] [Indexed: 12/19/2022]
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