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Esplin N, Kusyk D, Jeong SW, Elhamdani S, Abdel Aziz K, Webb A, Angle C, Whiting D, Tomycz ND. Movement disorder Deep brain stimulation Hybridization: Patient and caregiver outcomes. Clin Park Relat Disord 2024; 10:100234. [PMID: 38292816 PMCID: PMC10827541 DOI: 10.1016/j.prdoa.2024.100234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 11/11/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Background and Objectives Deep brain stimulation (DBS) is a well-established surgical treatment for certain movement disorders and involves the implantation of brain electrodes connected to implantable pulse generators (IPGs). As more device manufacturers have entered the market, some IPG technology has been designed to be compatible with brain electrodes from other manufacturers, which has facilitated the hybridization of implant technology. The aim of this study was to assess the benefits of hybridization of non-rechargeable, constant voltage IPGs to rechargeable, constant current IPGs. Methods A list of DBS movement disorder patients who had their non-rechargeable, constant voltage IPGs replaced with rechargeable, constant current IPGs from a different manufacturer was compiled. Structured surveys of these patients, and their caregivers when applicable, were undertaken to determine both patient and caregiver satisfaction in this DBS hybridization strategy. Results Eighteen patients met inclusion criteria and twelve patients or their caregivers completed the structured survey (67% response rate). Nine patients had Parkinson's disease (75%), three had essential tremor (25%). Nine (75%) were converted from bilateral single-channel IPGs, and three (25%) were converted from a unilateral dual-channel IPGs. Overall, 92% of patients and caregivers surveyed reported improvement or no change in their symptoms, 92% reported a decrease or no change in their medication requirements, and 92% report they are satisfied or very satisfied with their IPG hybridization and would recommend the surgery to similar patients. There were no immediate surgical complications. Conclusion In this series of movement disorder DBS patients, surgery was safe and patient and caregiver satisfaction were high with a hybridization of non-rechargeable, constant voltage IPGs to rechargeable, constant current IPGs.
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Affiliation(s)
- Nathan Esplin
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Dorian Kusyk
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Seung W Jeong
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Shahed Elhamdani
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Khaled Abdel Aziz
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Amanda Webb
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Cindy Angle
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Donald Whiting
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
| | - Nestor D. Tomycz
- Department of Neurosurgery, Allegheny Health Network, 320 East North Ave, Pittsburgh PA 15212, United States
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Gamé X, Ruffion A, Cornu JN, Phé V, Peyronnet B, Perrouin-Verbe MA, Aublant C, Adé A, Chartier-Kastler E. Sacral neuromodulation: Rechargeable versus non-rechargeable device. What would the patient preferences be in France? Prog Urol 2022; 32:672-680. [PMID: 35752523 DOI: 10.1016/j.purol.2022.04.011] [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: 12/10/2021] [Revised: 04/03/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
AIMS Sacral neuromodulation (SNM) is a minimally invasive technique that provides effective treatment for the management of refractory overactive bladder (OAB), non-obstructive urinary retention (NOUR), and fecal incontinence (FI). This study assessed patient preferences between the currently available non-rechargeable SNM device and a new, full-body magnetic resonance imaging (MRI)-safe, smaller, rechargeable device. METHODS An online cross-sectional survey was conducted among French OAB, NOUR, FI patients, recruited via a market research vendor. To assess their preferences, patients were asked to indicate their level of agreement with 10 statements regarding the size of the device, its rechargeability, and the role of MRI using a 6-item Likert scale. A descriptive statistical analysis was performed. RESULTS In all, 95 patients (68% women), mean age 50 years, were included in the study: 51% were treated for OAB; 44% received an oral treatment and 28% had SNM. Overall, 71% of the 95 patients indicated a preference for the new device; 75% considered that recharging the device would not impact their lifestyle; 74% believed that the smaller size of the rechargeable device would facilitate their choice to be treated with SNM; 80% found full-body MRI compatibility important. CONCLUSIONS Most patients may prefer the new rechargeable SNM device over the current "standard". Compatibility with full-body MRI and the smaller device size seemed the key features of the newer device that would influence their choice of being treated with SNM. Future national and international recommendations should consider a shared decision-making process between the physician and the patient. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- X Gamé
- Département d'urologie, transplantation rénale et andrologie, CHU Rangueil, TSA50032, 31059 Toulouse, France.
| | - A Ruffion
- Équipe 2, service d'urologie, Centre d'innovation en cancérologie de Lyon (EA 3738 CICLY), faculté de médecine Lyon Sud, hospices civils de Lyon, université Lyon 1, centre hospitalier Lyon Sud, Pierre Bénite, France
| | - J-N Cornu
- Service d'urologie, centre hospitalier universitaire de Rouen, Rouen, France
| | - V Phé
- Academic Hospital Tenon, Sorbonne université, Assistance publique-Hôpitaux de Paris, Paris, France
| | - B Peyronnet
- Service d'urologie, centre hospitalier universitaire de Rennes, Rennes, France
| | - M-A Perrouin-Verbe
- Service d'urologie, centre hospitalier universitaire de Nantes, Nantes, France
| | - C Aublant
- Neuromodulation, neurovascular & pelvic healths, Medtronic France, Paris, France
| | - A Adé
- Health economics & reimbursement, Medtronic France, Paris, France
| | - E Chartier-Kastler
- Academic hospital, Sorbonne université, Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
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Frey J, Cagle J, Johnson KA, Wong JK, Hilliard JD, Butson CR, Okun MS, de Hemptinne C. Past, Present, and Future of Deep Brain Stimulation: Hardware, Software, Imaging, Physiology and Novel Approaches. Front Neurol 2022; 13:825178. [PMID: 35356461 PMCID: PMC8959612 DOI: 10.3389/fneur.2022.825178] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 02/04/2022] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) has advanced treatment options for a variety of neurologic and neuropsychiatric conditions. As the technology for DBS continues to progress, treatment efficacy will continue to improve and disease indications will expand. Hardware advances such as longer-lasting batteries will reduce the frequency of battery replacement and segmented leads will facilitate improvements in the effectiveness of stimulation and have the potential to minimize stimulation side effects. Targeting advances such as specialized imaging sequences and “connectomics” will facilitate improved accuracy for lead positioning and trajectory planning. Software advances such as closed-loop stimulation and remote programming will enable DBS to be a more personalized and accessible technology. The future of DBS continues to be promising and holds the potential to further improve quality of life. In this review we will address the past, present and future of DBS.
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Affiliation(s)
- Jessica Frey
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Jackson Cagle
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Kara A. Johnson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Joshua K. Wong
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Justin D. Hilliard
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Christopher R. Butson
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Coralie de Hemptinne
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, United States
- *Correspondence: Coralie de Hemptinne
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Shlobin NA, Rosenow JM. Ethical Considerations in the Implantation of Neuromodulatory Devices. Neuromodulation 2022; 25:222-231. [PMID: 35125141 DOI: 10.1111/ner.13357] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Neuromodulatory devices are increasingly used by neurosurgeons to manage a variety of chronic conditions. Given their potential benefits, it is imperative to create clear ethical guidelines for the use of these devices. We present a tiered ethical framework for neurosurgeon recommendations for the use of neuromodulatory devices. MATERIALS AND METHODS We conducted a literature review to identify factors neurosurgeons should consider when choosing to offer a neuromodulatory device to a patient. RESULTS Neurosurgeons must weigh reductions in debilitating symptoms, improved functionality, and preserved quality of life against risks for intraoperative complications and adverse events due to stimulation or the device itself. Neurosurgeons must also evaluate whether patients and families will maintain responsibility for the management of neuromodulatory devices. Consideration of these factors should occur on an axis of resource allocation, ranging from provision of neuromodulatory devices to those with greatest potential benefit in resource-limited settings to provision of neuromodulatory devices to all patients with indications in contexts without resource limitations. Neurosurgeons must also take action to promote device effectiveness throughout the duration of care. CONCLUSIONS Weighing risks and benefits of providing neuromodulatory devices and assessing ability to remain responsible for the devices on the level of the individual patient indicate which patients are most likely to achieve benefit from these devices. Consideration of these factors on an axis of resource allocation will allow for optimal provision of neuromodulatory devices to patients in settings of varied resources. Neurosurgeons play a primary role in promoting the effectiveness of these devices.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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5
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Shlobin NA, Campbell JM, Rosenow JM, Rolston JD. Ethical considerations in the surgical and neuromodulatory treatment of epilepsy. Epilepsy Behav 2022; 127:108524. [PMID: 34998267 PMCID: PMC10184316 DOI: 10.1016/j.yebeh.2021.108524] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/19/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
Surgical resection and neuromodulation are well-established treatments for those with medically refractory epilepsy. These treatments entail important ethical considerations beyond those which extend to the treatment of epilepsy generally. In this paper, the authors explore these unique considerations through a framework that relates foundational principles of bioethics to features of resective epilepsy surgery and neuromodulation. The authors conducted a literature review to identify ethical considerations for a variety of epilepsy surgery procedures and to examine how foundational principles in bioethics may inform treatment decisions. Healthcare providers should be cognizant of how an increased prevalence of somatic and psychiatric comorbidities, the dynamic nature of symptom burden over time, the individual and systemic barriers to treatment, and variable sociocultural contexts constitute important ethical considerations regarding the use of surgery or neuromodulation for the treatment of epilepsy. Moreover, careful attention should be paid to how resective epilepsy surgery and neuromodulation relate to notions of patient autonomy, safety and privacy, and the shared responsibility for device management and maintenance. A three-tiered approach-(1) gathering information and assessing the risks and benefits of different treatment options, (2) clear communication with patient or proxy with awareness of patient values and barriers to treatment, and (3) long-term decision maintenance through continued identification of gaps in understanding and provision of information-allows for optimal treatment of the individual person with epilepsy while minimizing disparities in epilepsy care.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Justin M Campbell
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Neuroscience, University of Utah, Salt Lake City, UT, USA
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
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Runge J, Nagel JM, Schrader C, Saryyeva A, Krauss JK. Rechargeable Pacemaker Technology in Deep Brain Stimulation: A Step Forward, But Not for Everyone. Mov Disord Clin Pract 2021; 8:1112-1115. [PMID: 34631947 PMCID: PMC8485590 DOI: 10.1002/mdc3.13306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/12/2021] [Accepted: 06/27/2021] [Indexed: 11/11/2022] Open
Abstract
Background Rechargeable implantable pulse generator (IPG) technology has several advantages over non‐rechargeable systems and is routinely used now in deep brain stimulation (DBS). Little is known about the occasional need and the circumstances for switching back to non‐rechargeable technology. Cases Out of a cohort of 640 patients, 102 patients received a rechargeable IPG at first implantation or at the time of replacement surgery. Out of these, 3 patients underwent preemptive replacement with non‐rechargeable devices for the following reasons: dissatisfaction with handling and recharge frequency (pallidal DBS in advanced Parkinson's disease/dystonia), severe DBS OFF status subsequent to missed recharging (subthalamic DBS in Parkinson's disease) and twiddler's syndrome (nucleus accumbens DBS in alcohol dependency). Conclusions Although rechargeable IPG technology has been received well and is used widely, there are unexpected scenarios that require replacement surgery with non‐rechargeable IPGs.
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Affiliation(s)
- Joachim Runge
- Department of Neurosurgery Hannover Medical School Hannover Germany
| | - Johanna M Nagel
- Department of Neurosurgery Hannover Medical School Hannover Germany
| | | | - Assel Saryyeva
- Department of Neurosurgery Hannover Medical School Hannover Germany
| | - Joachim K Krauss
- Department of Neurosurgery Hannover Medical School Hannover Germany
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Qiu X, Peng T, Lin Z, Zhu K, Wang Y, Sun B, Ashkan K, Zhang C, Li D. Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: Preference and Satisfaction in Chinese Patients With Parkinson's Disease. Front Neurol 2021; 12:668322. [PMID: 34211431 PMCID: PMC8239223 DOI: 10.3389/fneur.2021.668322] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction: DBS is a widely used therapy for PD. There is now a choice between fixed-life implantable pulse generators (IPGs) and rechargeable IPGs, each having advantages and disadvantages. This study aimed to evaluate the preference and satisfaction of Chinese patients with Parkinson's disease (PD) who were treated with deep brain stimulation (DBS). Materials and Methods: Two hundred and twenty PD patients were treated with DBS and completed a self-reported questionnaire to assess their long-term satisfaction and experience with the type of battery they had chosen and the key factors affecting these choices. The survey was performed online and double-checked for completeness and accuracy. Results: The median value of the postoperative duration was 18 months. The most popular way for patients to learn about DBS surgery was through media (79/220, 35.9%) including the Internet and television programs. In total, 87.3% of the DBS used rechargeable IPGs (r-IPG). The choice between rechargeable and non-rechargeable IPGs was significantly associated with affordability ( χ ( 1 ) 2 = 19.13, p < 0.001). Interestingly, the feature of remote programming significantly affected patients' choices between domestic and imported brands ( χ ( 1 ) 2 = 16.81, p < 0.001). 87.7% of the patients were satisfied with the stimulating effects as well as the implanted device itself. 40.6% of the patients with r-IPGs felt confident handling devices within 1 week after discharge. More than half of the patients checked their batteries every week. The mean interval for battery recharge was 4.3 days. 57.8% of the patients spent around 1 h recharging, and 71.4% of them recharged the battery independently. Conclusions: Most patients were satisfied with their choice of IPGs. The patients' economic status and the remote programming function of the device were the two most critical factors in their decision. The skill of recharging the IPG was easy to master for most patients.
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Affiliation(s)
- Xian Qiu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Peng
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyu Lin
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kaiwen Zhu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhan Wang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Chencheng Zhang
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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8
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Qiu X, Wang Y, Lin Z, Wu Y, Xu W, Wu Y, Sun B, Ashkan K, Zhang C, Li D. Fixed-Life or Rechargeable Batteries for Deep Brain Stimulation: Preference and Satisfaction Among Patients With Hyperkinetic Movement Disorders. Front Neurol 2021; 12:662383. [PMID: 34122307 PMCID: PMC8193684 DOI: 10.3389/fneur.2021.662383] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/26/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Deep brain stimulation (DBS) is an established treatment for hyperkinetic movement disorders. Patients undergoing DBS can choose between the use of a rechargeable or non-rechargeable battery for implanted pulse generators (IPG). Objectives: In this study, we aimed to evaluate patient preferences and satisfaction with rechargeable and non-rechargeable batteries for IPGs after undergoing DBS. Methods: Overall, 100 patients with hyperkinetic movement disorders (dystonia: 79, Tourette syndrome: 21) who had undergone DBS took a self-designed questionnaire to assess their satisfaction and experience with the type of battery they had chosen and the factors influencing their choice. Results: Of the participants, 87% were satisfied with the stimulating effects of the treatment as well as the implanted device; 76% had chosen rechargeable devices (r-IPGs), 71.4% of whom recharged the battery themselves. Economic factors were the main reason for choosing both r-IPG and non-rechargeable IPG (nr-IPG). The questionnaire revealed that 66% of the patients checked their r-IPG battery every week. The mean interval for battery recharge was 4.3 days. Conclusions: The majority of the patients were satisfied with their in-service-IPG, regardless of whether it was a r-IPG or nr-IPG. Affordability was the main factor influencing the choice of IPG. The majority of the patients were confident in recharging the battery of their r-IPG themselves; only 11% of patients experienced difficulties. Understanding the recharge process remains difficult for some patients and increasing the number of training sessions for the device may be helpful.
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Affiliation(s)
- Xian Qiu
- Department of Nursing, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuhan Wang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhengyu Lin
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yunhao Wu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenying Xu
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwen Wu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Chencheng Zhang
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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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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Liu H, Temel Y, Boonstra J, Hescham S. The effect of fornix deep brain stimulation in brain diseases. Cell Mol Life Sci 2020; 77:3279-3291. [PMID: 31974655 PMCID: PMC7426306 DOI: 10.1007/s00018-020-03456-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/17/2019] [Accepted: 01/08/2020] [Indexed: 01/02/2023]
Abstract
Deep brain stimulation is used to alleviate symptoms of neurological and psychiatric disorders including Parkinson's disease, epilepsy, and obsessive-compulsive-disorder. Electrically stimulating limbic structures has been of great interest, and in particular, the region of the fornix. We conducted a systematic search for studies that reported clinical and preclinical outcomes of deep brain stimulation within the fornix up to July 2019. We identified 13 studies (7 clinical, 6 preclinical) that examined the effects of fornix stimulation in Alzheimer's disease (n = 9), traumatic brain injury (n = 2), Rett syndrome (n = 1), and temporal lobe epilepsy (n = 1). Overall, fornix stimulation can lead to decreased rates of cognitive decline (in humans), enhanced memory (in humans and animals), visuo-spatial memorization (in humans and animals), and improving verbal recollection (in humans). While the exact mechanisms of action are not completely understood, studies suggest fornix DBS to be involved with increased functional connectivity and neurotransmitter levels, as well as enhanced neuroplasticity.
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Affiliation(s)
- Huajie Liu
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, The Netherlands
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, The Netherlands
| | - Jackson Boonstra
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, The Netherlands
| | - Sarah Hescham
- Department of Neurosurgery, Maastricht University Medical Center, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- European Graduate School of Neuroscience (EURON), Maastricht University, Maastricht, The Netherlands.
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Furlanetti L, Raslan A, Khaleeq T, Hasegawa H, Tambirajoo R, Samuel M, Ashkan K. Fixed-Life or Rechargeable Battery for Deep Brain Stimulation: A Prospective Long-Term Study of Patient's Preferences. Stereotact Funct Neurosurg 2020; 98:43-47. [PMID: 32069466 DOI: 10.1159/000505700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/30/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) is an established treatment for movement disorders. We have previously shown that in our practice, the majority of adult patients prefer fixed-life implantable pulse generators (IPGs), although rechargeable batteries are increasingly used. The aim of this study was to evaluate patients' long-term satisfaction with their choice of battery and factors that influence their decision. METHODS Thirty patients with DBS were given a questionnaire to assess long-term satisfaction and experience with the type of battery they had chosen. RESULTS Twenty-six patients completed the survey. The mean age was 67.7 ± 7.3 years, and mean follow-up was 18.0 ± 7.2 months. The indications for DBS were Parkinson's disease (76.9%), tremor (11.5%) and dystonia (11.5%). Eleven patients (42.5%) had chosen the rechargeable battery. All patients were still happy with their choices and would not change the type of battery if they had the chance to do so. However, in patients who chose the fixed-life battery, concern about the size of battery rose from 6.7% pre-operatively to 60% on long-term post-operative follow-up. In patients who chose the rechargeable battery, concern about the need to recharge the battery did not change, remaining low postoperatively. Interestingly, even though the main reason cited for choosing the fixed-life battery was the convenience and concern about forgetting to recharge the battery, patients who had chosen a rechargeable IPG did not experience this problem. CONCLUSION Patients and caregivers should be involved in the choice of battery, as each type of IPG has its own advantages and disadvantages. Long-term evaluation of patient's experience and satisfaction with battery of choice revealed that size of the IPG, need for further replacement surgeries and need for recharging remain matters of major concern. Although preoperatively often underestimated, the size of the battery seems to be an important factor in long-term satisfaction.
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Affiliation(s)
- Luciano Furlanetti
- Department of Neurosurgery, King's College Hospital, London, United Kingdom,
| | - Ahmed Raslan
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Tahir Khaleeq
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Ruby Tambirajoo
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Michael Samuel
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
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12
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Holland MT, Trapp NT, McCormick LM, Jareczek FJ, Zanaty M, Close LN, Beeghly J, Greenlee JDW. Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Long Term Naturalistic Follow Up Study in a Single Institution. Front Psychiatry 2020; 11:55. [PMID: 32184741 PMCID: PMC7058594 DOI: 10.3389/fpsyt.2020.00055] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/22/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) is a proven, effective tool in the treatment of movement disorders. Expansion of indications for DBS into the realm of neuropsychiatric disorders, especially obsessive-compulsive disorder (OCD), has gained fervent interest, although data on appropriate clinical utilization remains limited. METHODS A retrospective, naturalistic study followed nine severely affected OCD patients (average YBOCs score before implantation 34.2 ± 2.5) treated with DBS of ventral capsule/ventral striatum, with average follow up of 54.8 months. RESULTS With chronic stimulation (years), a majority of the patients achieved significant benefits in obsessive-compulsive and depressive symptoms. Six patients experienced periods of OCD remission following implantation. Four of the six responders required more than 12 months to achieve response. Relief of major depressive symptoms occurred in four out of six patients with documented co-morbid depression. Settings required to achieve efficacy were higher than those typically utilized for movement disorders, necessitating increased impulse generator (IPG) battery demand. We found patients benefited from conversion to a rechargeable IPG to prevent serial operations for IPG replacement. For patients with rechargeable IPGs, the repetitive habit of recharging did not appear to aggravate or trigger new obsessive-compulsive behaviors or anxiety symptoms. CONCLUSIONS Our study supports and builds upon other research suggesting that DBS for OCD in a real-world setting can be implemented successfully and provide long-term benefit for severely affected OCD patients. Optimal patient selection and DBS programming criteria are discussed. The use of rechargeable IPGs appears to be both cost effective and well-tolerated in this population.
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Affiliation(s)
- Marshall T Holland
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Nicholas T Trapp
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Laurie M McCormick
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States.,Rein Center: Emotional Health and Well-Being, Iowa City, IA, United States
| | | | - Mario Zanaty
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - Liesl N Close
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
| | - James Beeghly
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Jeremy D W Greenlee
- Department of Neurosurgery, University of Iowa, Iowa City, IA, United States
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13
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Jakobs M, Helmers AK, Synowitz M, Slotty PJ, Anthofer JM, Schlaier JR, Kloss M, Unterberg AW, Kiening KL. A multicenter, open-label, controlled trial on acceptance, convenience, and complications of rechargeable internal pulse generators for deep brain stimulation: the Multi Recharge Trial. J Neurosurg 2019; 133:821-829. [PMID: 31419794 DOI: 10.3171/2019.5.jns19360] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/07/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Rechargeable neurostimulators for deep brain stimulation have been available since 2008, promising longer battery life and fewer replacement surgeries compared to non-rechargeable systems. Long-term data on how recharging affects movement disorder patients are sparse. This is the first multicenter, patient-focused, industry-independent study on rechargeable neurostimulators. METHODS Four neurosurgical centers sent a questionnaire to all adult movement disorder patients with a rechargeable neurostimulator implanted at the time of the trial. The primary endpoint was the convenience of the recharging process rated on an ordinal scale from "very hard" (1) to "very easy" (5). Secondary endpoints were charge burden (time spent per week on recharging), user confidence, and complication rates. Endpoints were compared for several subgroups. RESULTS Datasets of 195 movement disorder patients (66.1% of sent questionnaires) with Parkinson's disease (PD), tremor, or dystonia were returned and included in the analysis. Patients had a mean age of 61.3 years and the device was implanted for a mean of 40.3 months. The overall convenience of recharging was rated as "easy" (4). The mean charge burden was 122 min/wk and showed a positive correlation with duration of therapy; 93.8% of users felt confident recharging the device. The rate of surgical revisions was 4.1%, and the infection rate was 2.1%. Failed recharges occurred in 8.7% of patients, and 3.6% of patients experienced an interruption of therapy because of a failed recharge. Convenience ratings by PD patients were significantly worse than ratings by dystonia patients. Caregivers recharged the device for the patient in 12.3% of cases. Patients who switched from a non-rechargeable to a rechargeable neurostimulator found recharging to be significantly less convenient at a higher charge burden than did patients whose primary implant was rechargeable. Age did not have a significant impact on any endpoint. CONCLUSIONS Overall, patients with movement disorders rated recharging as easy, with low complication rates and acceptable charge burden.
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Affiliation(s)
- Martin Jakobs
- 1Department of Neurosurgery, Division of Stereotactic Neurosurgery, and
- Departments of2Neurosurgery and
| | - Ann-Kristin Helmers
- 4Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel, Kiel
| | - Michael Synowitz
- 4Department of Neurosurgery, University Medical Center Schleswig-Holstein, Campus Kiel, Christian-Albrechts-University Kiel, Kiel
| | - Philipp J Slotty
- 5Department of Stereotactic and Functional Neurosurgery, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf; and
| | - Judith M Anthofer
- 6Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Jürgen R Schlaier
- 6Department of Neurosurgery, University Hospital Regensburg, Regensburg, Germany
| | - Manja Kloss
- 3Neurology, University Hospital Heidelberg, Heidelberg
| | | | - Karl L Kiening
- 1Department of Neurosurgery, Division of Stereotactic Neurosurgery, and
- Departments of2Neurosurgery and
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14
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Niemann M, Schneider GH, Kühn A, Vajkoczy P, Faust K. Clinical Efficacy of Bilateral Deep Brain Stimulation Does Not Change After Implantable Pulse Generator Replacement but the Impedances Do: A Prospective Study. Neuromodulation 2019; 23:530-536. [PMID: 31323173 DOI: 10.1111/ner.13022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 05/13/2019] [Accepted: 06/12/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an approved therapy option for movement disorders such as Parkinson's disease (PD), essential Tremor (ET), and dystonia. While current research focuses on rechargeable implantable pulse generators (IPGs), little is known about changes of the motor functions after IPG replacement and the consequences of additionally implanted hardware. OBJECTIVE To assess changes of the motor functions, the therapy impedances, and the total electric energy delivered (TEED) after elective IPG replacement. METHODS We prospectively acquired the data of 47 patients with PD, ET, and dystonia treated with bilateral DBS. Motor functions were rated prior to and after surgery using the revised Unified Parkinson's Disease Rating Scale part III (MDS-UPDRS-III), the Fahn-Tolosa-Marin Tremor-Rating-Scale (FTM-TRS), and the Unified Dystonia Rating Scale (UDRS). Furthermore, the therapy impedances and TEED were assessed at the aforementioned times. RESULTS While preoperative motor scores were 48.32 ± 17.16 in PD, 39.71 ± 12.28 in ET, and 18.48 ± 16.30 in dystonia patients, postoperative scores were 47.84 ± 24.33, 32.86 ± 15.82, and 15.02 ± 15.17, respectively. Only in dystonia patients, motor scores significantly differed. Perioperative therapy impedance changes were 142.66 ± 105.35 Ω (Kinetra® to Activa® PC), -68.75 ± 43.05 Ω (Activa® PC to Activa® PC), and - 51.38 ± 38.75 Ω (Activa® PC to Activa® RC). Perioperative TEED changes were - 37.15 ± 38.87 μJ, 2.03 ± 35.91 μJ, and 12.39 ± 6.31 μJ in that first, second, and third group, respectively. Both the therapy impedances and TEED significantly differed between groups. CONCLUSION Although there were no statistically significant changes in the motor functions of all patients after elective IPG replacement, the therapy impedances were significantly higher and TEED was significantly lower after IPG replacement with concurrent Pocket Adapter implantation.
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Affiliation(s)
- Marcel Niemann
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | | | - Andrea Kühn
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité University Medicine Berlin, Berlin, Germany
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15
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Mitchell KT, Volz M, Lee A, San Luciano M, Wang S, Starr PA, Larson P, Galifianakis NB, Ostrem JL. Patient Experience with Rechargeable Implantable Pulse Generator Deep Brain Stimulation for Movement Disorders. Stereotact Funct Neurosurg 2019; 97:113-119. [PMID: 31288242 DOI: 10.1159/000500993] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 05/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Nonrechargeable deep brain stimulation implantable pulse generators (IPGs) for movement disorders require surgical replacement every few years due to battery depletion. Rechargeable IPGs reduce frequency of replacement surgeries and inherent risks of complications but require frequent recharging. Here, we evaluate patient experience with rechargeable IPGs and define predictive characteristics for higher satisfaction. METHODS We contacted all patients implanted with rechargeable IPGs at a single center in a survey-based study. We analyzed patient satisfaction with respect to age, diagnosis, target, charging duration, and body mass index. We tabulated hardware-related adverse events. RESULTS Dystonia patients had significantly higher satisfaction than Parkinson's disease patients in recharging, display, programmer, and training domains. Common positive responses were "fewer surgeries" and "small size." Common negative responses were "difficulty finding the right position to recharge" and "need to recharge every day." Hardware-related adverse events occurred in 21 of 59 participants. CONCLUSION Patient experience with rechargeable IPGs was largely positive; however, frustrations with recharging and adverse events were common. Dystonia diagnosis was most predictive of high satisfaction across multiple categories, potentially related to expected long disease duration with need for numerous IPG replacements.
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Affiliation(s)
- Kyle T Mitchell
- Department of Neurology, University of California San Francisco, San Francisco, California, USA,
| | - Monica Volz
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Aaron Lee
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Marta San Luciano
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Sarah Wang
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Philip A Starr
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Paul Larson
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Nicholas B Galifianakis
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
| | - Jill L Ostrem
- Department of Neurology, University of California San Francisco, San Francisco, California, USA
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16
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Roet M, Hescham SA, Jahanshahi A, Rutten BPF, Anikeeva PO, Temel Y. Progress in neuromodulation of the brain: A role for magnetic nanoparticles? Prog Neurobiol 2019; 177:1-14. [PMID: 30878723 DOI: 10.1016/j.pneurobio.2019.03.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 12/19/2022]
Abstract
The field of neuromodulation is developing rapidly. Current techniques, however, are still limited as they i) either depend on permanent implants, ii) require invasive procedures, iii) are not cell-type specific, iv) involve slow pharmacokinetics or v) have a restricted penetration depth making it difficult to stimulate regions deep within the brain. Refinements into the different fields of neuromodulation are thus needed. In this review, we will provide background information on the different techniques of neuromodulation discussing their latest refinements and future potentials including the implementation of nanoparticles (NPs). In particular we will highlight the usage of magnetic nanoparticles (MNPs) as transducers in advanced neuromodulation. When exposed to an alternating magnetic field (AMF), certain MNPs can generate heat through hysteresis. This MNP heating has been promising in the field of cancer therapy and has recently been introduced as a method for remote and wireless neuromodulation. This indicates that MNPs may aid in the exploration of brain functions via neuromodulation and may eventually be applied for treatment of neuropsychiatric disorders. We will address the materials chemistry of MNPs, their biomedical applications, their delivery into the brain, their mechanisms of stimulation with emphasis on MNP heating and their remote control in living tissue. The final section compares and discusses the parameters used for MNP heating in brain cancer treatment and neuromodulation. Concluding, using MNPs for nanomaterial-mediated neuromodulation seem promising in a variety of techniques and could be applied for different neuropsychiatric disorders when more extensively investigated.
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Affiliation(s)
- Milaine Roet
- School for Mental Health and Neuroscience, Department of Neurosurgery, Maastricht University, Maastricht, 6200, MD, The Netherlands; European Graduate School of Neuroscience (EURON), The Netherlands
| | - Sarah-Anna Hescham
- School for Mental Health and Neuroscience, Department of Neurosurgery, Maastricht University, Maastricht, 6200, MD, The Netherlands; European Graduate School of Neuroscience (EURON), The Netherlands
| | - Ali Jahanshahi
- School for Mental Health and Neuroscience, Department of Neurosurgery, Maastricht University, Maastricht, 6200, MD, The Netherlands; European Graduate School of Neuroscience (EURON), The Netherlands
| | - Bart P F Rutten
- School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, 6200, MD, The Netherlands; European Graduate School of Neuroscience (EURON), The Netherlands
| | - Polina O Anikeeva
- Department of Materials Science and Engineering, Department of Brain and Cognitive Sciences, Research Laboratory of Electronics, McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, 02139, MA, United States of America
| | - Yasin Temel
- School for Mental Health and Neuroscience, Department of Neurosurgery, Maastricht University, Maastricht, 6200, MD, The Netherlands; European Graduate School of Neuroscience (EURON), The Netherlands; Department of Neurosurgery, Maastricht University Medical Center, Maastricht, 6202, AZ, The Netherlands.
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