1
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Giordano F, Caporalini C, Peraio S, Mongardi L, Buccoliero AM, Cavallo MA, Genitori L, Lenge M, Mura R, Melani F, L'Erario M, Lelli L, Pennica M. Post-mortem histopathology of a pediatric brain after bilateral DBS of GPI for status dystonicus: case report and review of the literature. Childs Nerv Syst 2020; 36:1845-1851. [PMID: 32613424 DOI: 10.1007/s00381-020-04761-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/22/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate the effects of deep brain stimulation (DBS) electrodes on the brain of a dystonic pediatric patient submitted to bilateral DBS of the globus pallidus internus (GPI). METHODS An 8-year-old male patient underwent bilateral DBS of GPI for status dystonicus. He died 2 months later due to multiorgan failure triggered by bacterial pneumonia. A post-mortem pathological study of the brain was done. RESULTS At visual inspection, no grossly apparent softening, hemorrhage, or necrosis of the brain adjacent to the DBS lead tracts was detected. High-power microscopic examination of the tissue surrounding the electrode trajectories showed lymphocyte infiltration, astrocytic gliosis, microglia, macrophages, and clusters of multinucleate giant cells. Significant astrocytosis was confirmed by GFAP staining in the electrode site. The T cell lymphocyte activity was overexpressed with activated macrophages detected with CD3, CD20, CD45, and CD68 stains respectively. There was no gliosis or leukocyte infiltration away from the surgical tracks of the electrodes. CONCLUSION This is the first post-mortem examination of a child's brain after bilateral DBS of GPI. The comparison with adult post-mortem reports showed no significant differences and confirms the safety of DBS implantation in the pediatric population too.
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Affiliation(s)
- Flavio Giordano
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy. .,Functional and Epilepsy Neurosurgery Unit, Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Viale Pieraccini 24, 50139, Florence, Italy.
| | - Chiara Caporalini
- Division of Pathology, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Simone Peraio
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Lorenzo Mongardi
- Department of Neurosurgery, Sant'Anna Hospital University of Ferrara, Ferrara, Italy
| | - Anna Maria Buccoliero
- Division of Pathology, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | | | - Lorenzo Genitori
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Matteo Lenge
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy.,Child Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Regina Mura
- Department of Neurosurgery, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Federico Melani
- Child Neurology Unit and Laboratories, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Manuela L'Erario
- Pediatric Anesthesiology and Intensive Care Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Leonardo Lelli
- Diagnostic Imaging Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
| | - Michele Pennica
- Pediatric Anesthesiology and Intensive Care Unit, Children's Hospital A. Meyer-University of Florence, Florence, Italy
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2
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Low-frequency Stimulation at the Subiculum is Anti-convulsant and Anti-drug-resistant in a Mouse Model of Lamotrigine-resistant Temporal Lobe Epilepsy. Neurosci Bull 2020; 36:654-658. [PMID: 32157502 DOI: 10.1007/s12264-020-00482-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/10/2019] [Indexed: 10/24/2022] Open
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3
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Ghasemi Z, Naderi N, Shojaei A, Raoufy MR, Ahmadirad N, Mirnajafi-Zadeh J. Effect of Low-Frequency Electrical Stimulation on the High-K+-Induced Neuronal Hyperexcitability in Rat Hippocampal Slices. Neuroscience 2018; 369:87-96. [DOI: 10.1016/j.neuroscience.2017.11.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/04/2017] [Accepted: 11/06/2017] [Indexed: 12/23/2022]
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4
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Jung R, Abbas JJ, Kuntaegowdanahalli S, Thota AK. Bionic intrafascicular interfaces for recording and stimulating peripheral nerve fibers. ACTA ACUST UNITED AC 2017; 1:55-69. [PMID: 29480906 DOI: 10.2217/bem-2017-0009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022]
Abstract
The network of peripheral nerves presents extraordinary potential for modulating and/or monitoring the functioning of internal organs or the brain. The degree to which these pathways can be used to influence or observe neural activity patterns will depend greatly on the quality and specificity of the bionic interface. The anatomical organization, which consists of multiple nerve fibers clustered into fascicles within a nerve bundle, presents opportunities and challenges that may necessitate insertion of electrodes into individual fascicles to achieve the specificity that may be required for many clinical applications. This manuscript reviews the current state-of-the-art in bionic intrafascicular interfaces, presents specific concerns for stimulation and recording, describes key implementation considerations and discusses challenges for future designs of bionic intrafascicular interfaces.
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Affiliation(s)
- Ranu Jung
- Department of Biomedical Engineering, Florida International University, EC2602, 10555 W Flagler Street, Miami, FL 33134, USA.,Department of Biomedical Engineering, Florida International University, EC2602, 10555 W Flagler Street, Miami, FL 33134, USA
| | - James J Abbas
- Center for Adaptive Neural Systems, School of Biological & Health Systems Engineering, PO Box 879709 Arizona State University, Tempe, AZ 85287-9709, USA.,Center for Adaptive Neural Systems, School of Biological & Health Systems Engineering, PO Box 879709 Arizona State University, Tempe, AZ 85287-9709, USA
| | - Sathyakumar Kuntaegowdanahalli
- Department of Biomedical Engineering, Florida International University, EC2602, 10555 W Flagler Street, Miami, FL 33134, USA.,Department of Biomedical Engineering, Florida International University, EC2602, 10555 W Flagler Street, Miami, FL 33134, USA
| | - Anil K Thota
- Department of Biomedical Engineering, Florida International University, EC2602, 10555 W Flagler Street, Miami, FL 33134, USA.,Department of Biomedical Engineering, Florida International University, EC2602, 10555 W Flagler Street, Miami, FL 33134, USA
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5
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Study of the anti-seizure effects of low-frequency stimulation following kindling (a review of the cellular mechanism related to the anti-seizure effects of low-frequency electrical stimulation). Neurol Sci 2016; 38:19-26. [DOI: 10.1007/s10072-016-2694-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 08/17/2016] [Indexed: 02/04/2023]
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6
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di Biase L, Munhoz RP. Deep brain stimulation for the treatment of hyperkinetic movement disorders. Expert Rev Neurother 2016; 16:1067-78. [DOI: 10.1080/14737175.2016.1196139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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7
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Pycroft L, Boccard SG, Owen SLF, Stein JF, Fitzgerald JJ, Green AL, Aziz TZ. Brainjacking: Implant Security Issues in Invasive Neuromodulation. World Neurosurg 2016; 92:454-462. [PMID: 27184896 DOI: 10.1016/j.wneu.2016.05.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 05/04/2016] [Accepted: 05/05/2016] [Indexed: 01/06/2023]
Abstract
The security of medical devices is critical to good patient care, especially when the devices are implanted. In light of recent developments in information security, there is reason to be concerned that medical implants are vulnerable to attack. The ability of attackers to exert malicious control over brain implants ("brainjacking") has unique challenges that we address in this review, with particular focus on deep brain stimulation implants. To illustrate the potential severity of this risk, we identify several mechanisms through which attackers could manipulate patients if unauthorized access to an implant can be achieved. These include blind attacks in which the attacker requires no patient-specific knowledge and targeted attacks that require patient-specific information. Blind attacks include cessation of stimulation, draining implant batteries, inducing tissue damage, and information theft. Targeted attacks include impairment of motor function, alteration of impulse control, modification of emotions or affect, induction of pain, and modulation of the reward system. We also discuss the limitations inherent in designing implants and the trade-offs that must be made to balance device security with battery life and practicality. We conclude that researchers, clinicians, manufacturers, and regulatory bodies should cooperate to minimize the risk posed by brainjacking.
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Affiliation(s)
- Laurie Pycroft
- Oxford Functional Neurosurgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom.
| | - Sandra G Boccard
- Oxford Functional Neurosurgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Sarah L F Owen
- Department of Applied Health and Professional Development, Oxford Brookes University, Headington Campus, Oxford, United Kingdom
| | - John F Stein
- Department of Physiology, Anatomy, and Genetics, Sherrington Road, Oxford, United Kingdom
| | - James J Fitzgerald
- Oxford Functional Neurosurgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Alexander L Green
- Oxford Functional Neurosurgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
| | - Tipu Z Aziz
- Oxford Functional Neurosurgery, University of Oxford, John Radcliffe Hospital, Headington, Oxford, United Kingdom
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8
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Thapa L, Bhattarai S, Shrestha MP, Panth R, Gongal DN, Devkota UP. Chorea-acanthocytosis: a case report. Int Med Case Rep J 2016; 9:39-42. [PMID: 26955294 PMCID: PMC4772938 DOI: 10.2147/imcrj.s95882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Neuroacanthocytosis is a group of rare disorders. We report a 36-year-old right-handed female who presented with gradually progressive abnormal facial movements, generalized weakness, and lower-lip biting starting 4 years ago. On examination, she had lower-lip ulcer, orofacial dyskinesias, and peripheral neuropathy. Her peripheral blood smears showed acanthocytosis and magnetic resonance imaging revealed atrophied head of caudate nuclei and putaminal hyperintensities on T2-weighted and fluid attenuated inversion recovery images. Work-up for autoimmune and metabolic causes was negative. She was diagnosed with chorea-acanthocytosis, an entity under neuroacanthocytosis syndrome and the patient was offered symptomatic treatment.
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Affiliation(s)
- Lekhjung Thapa
- Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Suman Bhattarai
- Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Milan P Shrestha
- Department of Neurology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Rajesh Panth
- Department of Pathology, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Dinesh Nath Gongal
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
| | - Upendra Prasad Devkota
- Department of Neurosurgery, National Institute of Neurological and Allied Sciences, Kathmandu, Nepal
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9
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Song S, Kong X, Sava V, Cao C, Acosta S, Borlongan C, Sanchez-Ramos J. Transient Microneedle Insertion into Hippocampus Triggers Neurogenesis and Decreases Amyloid Burden in a Mouse Model of Alzheimer's Disease. Cell Transplant 2016; 25:1853-1861. [PMID: 26892497 DOI: 10.3727/096368916x691114] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Targeted microlesions of the hippocampus have been reported to enhance neurogenesis in the subgranular zone (SGZ). The potential therapeutic impact of transient insertion of a microneedle was investigated in a mouse model of Alzheimer's disease (AD). We tested the hypothesis that transient microinjury to the brain elicits cellular responses that mediate beneficial regenerative processes. Brief stereotaxic insertion and removal of a microneedle into the right hippocampus of 14-month-old APP/PS1 mouse brains resulted in (a) stimulation of hippocampal neurogenesis and (b) reduction of amyloid-β plaque number in the CA-1 region. This treatment also resulted in a trend toward improved performance in the radial arm water maze (RAWM). Further studies of fundamental cellular mechanisms of the brain's response to microinjury will be useful for investigation of potential neuroprotective and deleterious effects of targeted microlesions and deep brain stimulation in AD.
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Affiliation(s)
- Shijie Song
- James Haley VA Medical Center, Tampa, FL, USA.,Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA.,Department of Neurosurgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Xiaoyung Kong
- James Haley VA Medical Center, Tampa, FL, USA.,Department of Neurosurgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Vasyl Sava
- Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Chuanhai Cao
- Byrd Alzheimer's Institute, University of South Florida, Tampa, FL, USA
| | - Sandra Acosta
- Department of Neurosurgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Cesar Borlongan
- Department of Neurosurgery, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Juan Sanchez-Ramos
- James Haley VA Medical Center, Tampa, FL, USA.,Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
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10
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Cogan SF, Ludwig KA, Welle CG, Takmakov P. Tissue damage thresholds during therapeutic electrical stimulation. J Neural Eng 2016; 13:021001. [PMID: 26792176 DOI: 10.1088/1741-2560/13/2/021001] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recent initiatives in bioelectronic modulation of the nervous system by the NIH (SPARC), DARPA (ElectRx, SUBNETS) and the GlaxoSmithKline Bioelectronic Medicines effort are ushering in a new era of therapeutic electrical stimulation. These novel therapies are prompting a re-evaluation of established electrical thresholds for stimulation-induced tissue damage. APPROACH In this review, we explore what is known and unknown in published literature regarding tissue damage from electrical stimulation. MAIN RESULTS For macroelectrodes, the potential for tissue damage is often assessed by comparing the intensity of stimulation, characterized by the charge density and charge per phase of a stimulus pulse, with a damage threshold identified through histological evidence from in vivo experiments as described by the Shannon equation. While the Shannon equation has proved useful in assessing the likely occurrence of tissue damage, the analysis is limited by the experimental parameters of the original studies. Tissue damage is influenced by factors not explicitly incorporated into the Shannon equation, including pulse frequency, duty cycle, current density, and electrode size. Microelectrodes in particular do not follow the charge per phase and charge density co-dependence reflected in the Shannon equation. The relevance of these factors to tissue damage is framed in the context of available reports from modeling and in vivo studies. SIGNIFICANCE It is apparent that emerging applications, especially with microelectrodes, will require clinical charge densities that exceed traditional damage thresholds. Experimental data show that stimulation at higher charge densities can be achieved without causing tissue damage, suggesting that safety parameters for microelectrodes might be distinct from those defined for macroelectrodes. However, these increased charge densities may need to be justified by bench, non-clinical or clinical testing to provide evidence of device safety.
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Affiliation(s)
- Stuart F Cogan
- The Department of Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
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11
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Jagid J, Madhavan K, Bregy A, Desai M, Ruiz A, Quencer R, Landy HJ. Deep brain stimulation complicated by bilateral large cystic cavitation around the leads in a patient with Parkinson's disease. BMJ Case Rep 2015; 2015:bcr-2015-211470. [PMID: 26475878 DOI: 10.1136/bcr-2015-211470] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Deep brain stimulation (DBS) is an approved and effective therapy for patients suffering from advanced Parkinson's disease (PD). Several clinical trials have indicated significant motor function improvement in patients undergoing subthalamic nucleus stimulation. This therapy is, rarely, associated with complications, mostly related to infections, seizures or stimulation-induced side effects. We report a case of a 71-year-old man with a 10-year history of PD who underwent bilateral placement of subthalamic nucleus DBS. As a complication, the patient showed subjective postoperative cognitive decline, and subsequent MRI showed peri-lead oedema, which progressed to large cystic cavitation around the leads without indication of infection. The patient received steroid therapy and the cavitations regressed without surgical intervention.
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Affiliation(s)
- Jonathan Jagid
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Karthik Madhavan
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Amade Bregy
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Mehul Desai
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Armando Ruiz
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Robert Quencer
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Howard J Landy
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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12
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Li M, Zhang W. Oscillations in pedunculopontine nucleus in Parkinson's disease and its relationship with deep brain stimulation. Front Neural Circuits 2015; 9:47. [PMID: 26388741 PMCID: PMC4556974 DOI: 10.3389/fncir.2015.00047] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 08/21/2015] [Indexed: 11/22/2022] Open
Abstract
The recent development of deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) for the treatment of parkinsonian patients, particularly those in advanced stages with axial symptoms, has ignited interest into the study of this brain nucleus. In contrast to the extensively studied alterations of neural activity that occur in the basal ganglia in Parkinson’s disease (PD), our understanding of the activity of the PPN remains insufficient. In recent years, however, a series of studies recording oscillatory activity in the PPN of parkinsonian patients have made important findings. Here, we briefly review recent studies that explore the different kinds of oscillations observed in the PPN of parkinsonian patients, and how they underlie the pathophysiology of PD and the efficacy of PPN-DBS in these disorders.
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Affiliation(s)
- Min Li
- The National Key Clinic Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Engineering Technology Research Center of Education Ministry of China, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University Guangzhou, China
| | - Wangming Zhang
- The National Key Clinic Specialty, Guangdong Provincial Key Laboratory on Brain Function Repair and Regeneration, The Engineering Technology Research Center of Education Ministry of China, Department of Neurosurgery, Zhujiang Hospital, Southern Medical University Guangzhou, China
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13
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Nakano N, Miyauchi M, Nakanishi K, Saigoh K, Mitsui Y, Kato A. Successful Combination of Pallidal and Thalamic Stimulation for Intractable Involuntary Movements in Patients with Neuroacanthocytosis. World Neurosurg 2015; 84:1177.e1-7. [PMID: 26165146 DOI: 10.1016/j.wneu.2015.06.052] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 06/22/2015] [Accepted: 06/23/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Neuroacanthocytosis (NA) is a rare neurodegenerative disease that involves severe involuntary movements including chorea, dystonia, and trunk spasms. Current treatments are not effective for these involuntary movements. Although there are a few reports on the use of deep brain stimulation to treat patients with NA, the optimal stimulation target is not yet definitive. Some authors have reported successful improvement of NA symptoms with stimulation of the globus pallidum interna, and others have reported a reduction in trunk spasm with stimulation of the ventralis oralis complex of the thalamus. We investigated whether the optimal target is well defined for NA. METHODS We describe the effect of combination stimulation of the globus pallidum interna and the ventralis oralis complex of the thalamus in 2 patients with NA who presented with severe intractable involuntary movements. RESULTS Gpi stimulation alone was an insufficient effect for trunk spasm and/or chorea. Vo complex stimulation given without Gpi stimulation resulted in improvement of trunk spasm after 2 weeks and might also have had an incomplete effect on involuntary movement including a chorea. The combination of Gpi and Vo complex stimulation reduced the trunk spasms and chorea. This improvement was maintained at 3 months after surgery. The Unified Huntington's Disease Rating Scale score at 1 year after surgery was lower than that before surgery. CONCLUSIONS Gpi stimulation appears to be insufficient to control violent involuntary movements; therefore, combined GPi and Vo complex stimulation provided some moderate advantage over Gpi stimulation alone.
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Affiliation(s)
- Naoki Nakano
- Department of Neurosurgery, Kinki University, School of Medicine, Osaka, Japan.
| | - Masaharu Miyauchi
- Department of Neurosurgery, Kinki University, School of Medicine, Osaka, Japan
| | - Kinya Nakanishi
- Department of Neurosurgery, Kinki University, School of Medicine, Osaka, Japan
| | - Kazumasa Saigoh
- Department of Neurology, Kinki University, School of Medicine, Osaka, Japan
| | - Yoshiyuki Mitsui
- Department of Neurology, Kinki University, School of Medicine, Osaka, Japan
| | - Amami Kato
- Department of Neurosurgery, Kinki University, School of Medicine, Osaka, Japan
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14
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Kronenbuerger M, Nolte KW, Coenen VA, Burgunder JM, Krauss JK, Weis J. Brain alterations with deep brain stimulation: New insight from a neuropathological case series. Mov Disord 2015; 30:1125-30. [PMID: 26011773 DOI: 10.1002/mds.26247] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 03/20/2015] [Accepted: 03/26/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Previous studies on human brain tissue alterations caused by deep brain stimulation described glial and reactive inflammatory changes. In the current pathoanatomical study, we extended the analysis to signs of axonal changes and the influence of concomitant disease. METHODS Brains of 10 patients with Parkinson's disease or essential tremor and a total of 18 electrodes were systematically examined up to 7.5 y after surgery. RESULTS In general, tissue that had long-term contact with the electrode material exhibited astrogliosis in all, T-lymphocytes in 93%, and multinucleated giant cells in 68% of patients. Immunohistochemistry showed an increase in amyloid precursor protein immunoreactive axonal swellings in the brain at the electrically active parts of the electrodes. Patients who died of septicemia showed a more severe astrogliosis and giant cell reaction than patients who died of cardiovascular events. Parkinson's disease or essential tremor did not differentially produce histopathological changes around the electrodes. CONCLUSION Long-term electrical stimulation by deep brain stimulation causes minor axonal changes. The cause of death, but not the underlying neurological disease, affects the histopathological changes around the electrode. The findings need to be reproduced by examining larger patient subgroups.
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Affiliation(s)
- Martin Kronenbuerger
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Neurology, RWTH Aachen University Hospital, Aachen, Germany
| | - Kay Wilhelm Nolte
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Volker Arnd Coenen
- Department of Stereotactic and Functional Neurosurgery, Freiburg University Medical Center, Freiburg, Germany
| | - Jean-Marc Burgunder
- Department of Neurology, University of Berne, Inselspital, Berne, Switzerland
| | - Joachim K Krauss
- Department of Neurosurgery, Medical School Hannover (MHH), Hannover, Germany
| | - Joachim Weis
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
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15
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Nagy A, Noyce A, Velayos-Baeza A, Lees AJ, Warner TT, Ling H. Late Emergence of Parkinsonian Phenotype and Abnormal Dopamine Transporter Scan in Chorea-Acanthocytosis. Mov Disord Clin Pract 2015; 2:182-186. [PMID: 30713892 DOI: 10.1002/mdc3.12138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 11/14/2014] [Accepted: 11/21/2014] [Indexed: 11/05/2022] Open
Abstract
Chorea-acanthocytosis (ChAc) is a neurodegenerative condition predominantly manifesting with chorea and often acanthocytes on peripheral blood film. Abnormal appearances with 123I-FP-CIT single-photon emission computed tomography (SPECT) have not previously been reported in ChAc. We describe 2 cases with typical presentations of ChAc and late development of parkinsonism with asymmetric reduction in presynaptic striatal uptake on 123I-FP-CIT SPECT. Case 1, a 50-year-old male, developed micrographia and limb bradykinesia 14 years after initial presentation at the age of 30. Case 2, a 42-year-old female presenting with vocal tics and generalized dystonia at the age of 25, developed tremor, bradykinesia, and rigidity 11 years into the disease course. These cases represent the best description to date of the natural history of ChAc, in which the early hyperkinetic clinical syndromes give way to a parkinsonian phenotype. This is consistent with a gradual deterioration of presynaptic nigrostriatal projections, reflected in the clinical parkinsonism and abnormal 123I FP-CIT SPECT.
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Affiliation(s)
- Anna Nagy
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Barts and the London School of Medicine and Dentistry London United Kingdom
| | - Alastair Noyce
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
| | | | - Andrew J Lees
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
| | - Thomas T Warner
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
| | - Helen Ling
- Reta Lila Weston Institute of Neurological Studies UCL Institute of Neurology London United Kingdom.,Queen Square Brain Bank Department of Molecular Neuroscience UCL Institute of Neurology United Kingdom
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16
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Smith KM, Spindler MA. Uncommon applications of deep brain stimulation in hyperkinetic movement disorders. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2015; 5:278. [PMID: 25713746 PMCID: PMC4314611 DOI: 10.7916/d84x56hp] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/20/2014] [Indexed: 12/12/2022]
Abstract
Background In addition to the established indications of tremor and dystonia, deep brain stimulation (DBS) has been utilized less commonly for several hyperkinetic movement disorders, including medication-refractory myoclonus, ballism, chorea, and Gilles de la Tourette (GTS) and tardive syndromes. Given the lack of adequate controlled trials, it is difficult to translate published reports into clinical use. We summarize the literature, draw conclusions regarding efficacy when possible, and highlight concerns and areas for future study. Methods A Pubmed search was performed for English-language articles between January 1980 and June 2014. Studies were selected if they focused primarily on DBS to treat the conditions of focus. Results We identified 49 cases of DBS for myoclonus-dystonia, 21 for Huntington's disease, 15 for choreacanthocytosis, 129 for GTS, and 73 for tardive syndromes. Bilateral globus pallidus interna (GPi) DBS was the most frequently utilized procedure for all conditions except GTS, in which medial thalamic DBS was more common. While the majority of cases demonstrate some improvement, there are also reports of no improvement or even worsening of symptoms in each condition. The few studies including functional or quality of life outcomes suggest benefit. A limited number of studies included blinded on/off testing. There have been two double-blind controlled trials performed in GTS and a single prospective double-blind, uncontrolled trial in tardive syndromes. Patient characteristics, surgical target, stimulation parameters, and duration of follow-up varied among studies. Discussion Despite these extensive limitations, the literature overall supports the efficacy of DBS in these conditions, in particular GTS and tardive syndromes. For other conditions, the preliminary evidence from small studies is promising and encourages further study.
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Affiliation(s)
- Kara M Smith
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Meredith A Spindler
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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DiLorenzo DJ, Jankovic J, Simpson RK, Takei H, Powell SZ. Neurohistopathological Findings at the Electrode-Tissue Interface in Long-Term Deep Brain Stimulation: Systematic Literature Review, Case Report, and Assessment of Stimulation Threshold Safety. Neuromodulation 2014; 17:405-18; discussion 418. [DOI: 10.1111/ner.12192] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/25/2014] [Accepted: 03/25/2014] [Indexed: 11/29/2022]
Affiliation(s)
| | - Joseph Jankovic
- Department of Neurology; Baylor College of Medicine; Houston TX USA
| | | | - Hidehiro Takei
- Department of Pathology; The Methodist Hospital; Houston TX USA
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18
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Abstract
Deep brain stimulation has emerged rapidly as an effective therapy for movement disorders. Deep brain stimulation includes an implanted brain electrode and a pacemaker-like implanted pulse generator. The clinical application of deep brain stimulation proceeded in the absence of clear understandings of its mechanisms of action or extensive preclinical studies of safety and efficacy. Post mortem studies suggest that there is a loss of neurons in proximity to the active electrode, but the resulting lesions are not sufficient to treat the disorder and efficacy requires continued stimulation. Overall complication rates can exceed 25%, and permanent neurologic sequelae result in 4-6% of cases. As the application of deep brain stimulation expands, it is critical to understand the origin of adverse events and the delivery of nondamaging stimulation.
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Affiliation(s)
- Warren M Grill
- Duke University, Department of Biomedical Engineering, Durham, NC 27708-0281, USA.
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19
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Hippocampal neurogenesis and the brain repair response to brief stereotaxic insertion of a microneedle. Stem Cells Int 2013; 2013:205878. [PMID: 23554817 PMCID: PMC3608357 DOI: 10.1155/2013/205878] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 11/23/2012] [Accepted: 01/14/2013] [Indexed: 12/13/2022] Open
Abstract
We tested the hypothesis that transient microinjury to the brain elicits cellular and humoral responses that stimulate hippocampal neurogenesis. Brief stereotaxic insertion and removal of a microneedle into the right hippocampus resulted in (a) significantly increased expression of granulocyte-colony stimulating factor (G-CSF), the chemokine MIP-1a, and the proinflammatory cytokine IL12p40; (b) pronounced activation of microglia and astrocytes; and (c) increase in hippocampal neurogenesis. This study describes immediate and early humoral and cellular mechanisms of the brain's response to microinjury that will be useful for the investigation of potential neuroprotective and deleterious effects of deep brain stimulation in various neuropsychiatric disorders.
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Abstract
Deep brain stimulation is a remarkable therapy that has mainstreamed electrical stimulation of the brain for the treatment of neurological dysfunction. To appreciate the mechanisms of deep brain stimulation, we need to understand the excitability of neural tissue. Here, we survey the pertinent principles of electrical excitation in the brain. The amount of current delivered and the tissue conductivity together determine the strength and extent of potentials generated by stimulation. The electrode-tissue interface is an important junction where electrical charge carriers in the stimulation hardware are converted to ionic charge carriers in the tissue. Cathodic stimulation tends to depolarize neural elements more easily than anodic stimulation. The current-distance relationship describes how the amount of current needed to excite an axon increases as a function of its distance from the electrode. This relationship also depends on the axon's diameter because large-diameter axons are excited more easily than small-diameter axons. For a given axon, the strength-duration relationship describes the inverse relationship between threshold current amplitude and pulse duration. Specific stimulation parameters must be considered to avoid stimulation-induced tissue damage. A strong foundation in these principles facilitates understanding of the complex effects of electrical stimulation in the brain.
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Affiliation(s)
- David T Brocker
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
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21
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Daly J, Liu J, Aghagolzadeh M, Oweiss K. Optimal space-time precoding of artificial sensory feedback through mutichannel microstimulation in bi-directional brain-machine interfaces. J Neural Eng 2012; 9:065004. [PMID: 23187009 PMCID: PMC5988221 DOI: 10.1088/1741-2560/9/6/065004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Brain-machine interfaces (BMIs) aim to restore lost sensorimotor and cognitive function in subjects with severe neurological deficits. In particular, lost somatosensory function may be restored by artificially evoking patterns of neural activity through microstimulation to induce perception of tactile and proprioceptive feedback to the brain about the state of the limb. Despite an early proof of concept that subjects could learn to discriminate a limited vocabulary of intracortical microstimulation (ICMS) patterns that instruct the subject about the state of the limb, the dynamics of a moving limb are unlikely to be perceived by an arbitrarily-selected, discrete set of static microstimulation patterns, raising questions about the generalization and the scalability of this approach. In this work, we propose a microstimulation protocol intended to activate optimally the ascending somatosensory pathway. The optimization is achieved through a space-time precoder that maximizes the mutual information between the sensory feedback indicating the limb state and the cortical neural response evoked by thalamic microstimulation. Using a simplified multi-input multi-output model of the thalamocortical pathway, we show that this optimal precoder can deliver information more efficiently in the presence of noise compared to suboptimal precoders that do not account for the afferent pathway structure and/or cortical states. These results are expected to enhance the way microstimulation is used to induce somatosensory perception during sensorimotor control of artificial devices or paralyzed limbs.
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Affiliation(s)
- John Daly
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48823, U.S.A
| | - Jianbo Liu
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48823, U.S.A
| | - Mehdi Aghagolzadeh
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48823, U.S.A
| | - Karim Oweiss
- Department of Electrical and Computer Engineering, Michigan State University, East Lansing, MI 48823, U.S.A
- Neuroscience Program, Michigan State University, East Lansing, MI 48823, U.S.A
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22
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van Kuyck K, Welkenhuysen M, Arckens L, Sciot R, Nuttin B. Histological alterations induced by electrode implantation and electrical stimulation in the human brain: a review. Neuromodulation 2012; 10:244-61. [PMID: 22150838 DOI: 10.1111/j.1525-1403.2007.00114.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objectives. Electrical brain stimulation is used as a treatment for patients with intractable chronic pain and movement disorders. However, the implantation of electrodes and electrical stimulation may induce histological changes around the electrode tip. We aimed to review the histological changes in humans that were electrically stimulated in the brain. Methods. We traced 26 autopsy studies of which 19 patients received cerebellar stimulation and 37 patients deep brain stimulation. Results. Electrode implantation and electrical stimulation induced in part of the cases formation of a fibrous sheath around the electrode, loss of fairly large neurons, and limited gliosis. Macroscopic lesions were present in only some cases, mostly due to pulling at the extension cable in the postoperative evaluation period preceding definite implantation of the electrode wire and stimulator. Conclusions. Electrical brain stimulation induces histological changes in some patients. According to electrical brain stimulation studies in animals, these changes can be related to the charge and charge density per phase (and their interaction).
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Affiliation(s)
- Kris van Kuyck
- Laboratory of Experimental Functional Neurosurgery, Department of Neuroscience, K.U.Leuven, Leuven, Belgium; Laboratory Neuroplasticity and Neuroproteomics, Department of Biology, K.U.Leuven, Leuven, Belgium; and Morphology and Molecular Pathology Section, Department of Morphology and Medical Imaging, K.U.Leuven, Leuven, Belgium
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Wide therapeutic time-window of low-frequency stimulation at the subiculum for temporal lobe epilepsy treatment in rats. Neurobiol Dis 2012; 48:20-6. [PMID: 22659307 DOI: 10.1016/j.nbd.2012.05.011] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 05/07/2012] [Accepted: 05/24/2012] [Indexed: 11/22/2022] Open
Abstract
Low-frequency stimulation (LFS) has been considered as an option for the treatment of intractable epilepsy. However, previous data showed that LFS of certain brain regions only exerts its effect within a very narrow therapeutic time window, which lasts from seconds to tens of seconds, thus restricting its clinical application. The present study was designed to determine whether there exists a target with a wider therapeutic window for LFS treatment. Therefore, evoked seizures in the rat were induced by amygdala kindling and spontaneous seizures were induced by pilocarpine. The effects of different modes of LFS at the subiculum on the progression and severity of evoked seizures and the frequency of spontaneous seizure were evaluated. We found that (i) LFS at 1Hz delivered to the subiculum before and immediately after the kindling stimulations, or after the cessation of afterdischarge (afterdischarge duration, ADD) decreased the seizure stages and shortened the ADD both in seizure acquisition and expression in amygdaloid-kindled seizures. In addition, even LFS delivered after duration of double the ADD prolonged the kindling progression. (ii) LFS delivered at 1Hz, but not 0.5, 3 or 130Hz, immediately after the cessation of kindling stimulations retarded the progression of kindling seizures. (iii) Pilocarpine-induced spontaneous seizures were completely inhibited by 1Hz LFS. Thus, these results demonstrated that LFS of the subiculum has a wide therapeutic time-window for temporal lobe epilepsy treatment in rats, suggesting that the subiculum may be a promising and suitable target for clinical application.
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Effect of low-frequency electrical stimulation parameters on its anticonvulsant action during rapid perforant path kindling in rat. Epilepsy Res 2012; 99:69-77. [DOI: 10.1016/j.eplepsyres.2011.10.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 10/13/2011] [Accepted: 10/15/2011] [Indexed: 11/20/2022]
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Vedam-Mai V, Yachnis A, Ullman M, Javedan SP, Okun MS. Postmortem observation of collagenous lead tip region fibrosis as a rare complication of DBS. Mov Disord 2012; 27:565-9. [PMID: 22314706 DOI: 10.1002/mds.24916] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 12/20/2011] [Accepted: 01/01/2012] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Despite the widespread effective use of deep brain stimulation (DBS) for various movement and psychiatric disorders, little is known about its safety and tissue responses. METHODS The University of Florida Deep Brain Stimulation Brain Tissue Network (DBS-BTN) conducted postmortem brain examinations on 26 cases to identify and characterize (using histological techniques) pathologic tissue changes associated with the placement of DBS devices. RESULTS We report the unusual finding of prominent collagenous fibrosis around the lead tip in a 74-year-old man with idiopathic Parkinson's disease who had bilateral STN-DBS. Histological study confirmed the diagnosis of idiopathic Parkinson's disease, and there was striking, dense collagenous fibrosis at the distal end of the right DBS lead associated with focal hemosiderin deposition, chronic inflammation, and mild gliosis. We have in our brain bank 25 other DBS cases that on examination showed only mild to moderate gliosis and no dramatic tissue response to DBS lead placement. CONCLUSIONS We are not aware of any prior reports of such a dramatic reaction to DBS placement to date.
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Affiliation(s)
- Vinata Vedam-Mai
- Department of Neurosurgery, UF Center for Movement Disorders & Neurorestoration, Gainesville, Florida 32607, USA
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26
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Kupsch A, Tagliati M, Vidailhet M, Aziz T, Krack P, Moro E, Krauss JK. Early postoperative management of DBS in dystonia: programming, response to stimulation, adverse events, medication changes, evaluations, and troubleshooting. Mov Disord 2011; 26 Suppl 1:S37-53. [PMID: 21692111 DOI: 10.1002/mds.23624] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Early postoperative management in deep brain stimulation-treated patients with dystonia differs from that of patients with essential tremor and Parkinson's disease, mainly due to the usually delayed effects of deep brain stimulation and the heterogenous clinical manifestation and etiologies of dystonia. The present chapter summarizes the available data about and concentrates on practical clinical aspects of early postoperative management in deep brain stimulation-treated patients with dystonia.
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Affiliation(s)
- Andreas Kupsch
- Division of Neurology, Charité, Campus Virchow, Berlin, Germany.
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27
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Jung HH, Danek A, Walker RH. Neuroacanthocytosis syndromes. Orphanet J Rare Dis 2011; 6:68. [PMID: 22027213 PMCID: PMC3212896 DOI: 10.1186/1750-1172-6-68] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 10/25/2011] [Indexed: 11/10/2022] Open
Abstract
Neuroacanthocytosis (NA) syndromes are a group of genetically defined diseases characterized by the association of red blood cell acanthocytosis and progressive degeneration of the basal ganglia. NA syndromes are exceptionally rare with an estimated prevalence of less than 1 to 5 per 1'000'000 inhabitants for each disorder. The core NA syndromes include autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome which have a Huntington´s disease-like phenotype consisting of a choreatic movement disorder, psychiatric manifestations and cognitive decline, and additional multi-system features including myopathy and axonal neuropathy. In addition, cardiomyopathy may occur in McLeod syndrome. Acanthocytes are also found in a proportion of patients with autosomal dominant Huntington's disease-like 2, autosomal recessive pantothenate kinase-associated neurodegeneration and several inherited disorders of lipoprotein metabolism, namely abetalipoproteinemia (Bassen-Kornzweig syndrome) and hypobetalipoproteinemia leading to vitamin E malabsorption. The latter disorders are characterized by a peripheral neuropathy and sensory ataxia due to dorsal column degeneration, but movement disorders and cognitive impairment are not present. NA syndromes are caused by disease-specific genetic mutations. The mechanism by which these mutations cause neurodegeneration is not known. The association of the acanthocytic membrane abnormality with selective degeneration of the basal ganglia, however, suggests a common pathogenetic pathway. Laboratory tests include blood smears to detect acanthocytosis and determination of serum creatine kinase. Cerebral magnetic resonance imaging may demonstrate striatal atrophy. Kell and Kx blood group antigens are reduced or absent in McLeod syndrome. Western blot for chorein demonstrates absence of this protein in red blood cells of chorea-acanthocytosis patients. Specific genetic testing is possible in all NA syndromes. Differential diagnoses include Huntington disease and other causes of progressive hyperkinetic movement disorders. There are no curative therapies for NA syndromes. Regular cardiologic studies and avoidance of transfusion complications are mandatory in McLeod syndrome. The hyperkinetic movement disorder may be treated as in Huntington disease. Other symptoms including psychiatric manifestations should be managed in a symptom-oriented manner. NA syndromes have a relentlessly progressive course usually over two to three decades.
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Affiliation(s)
- Hans H Jung
- Department of Neurology, University Hospital Zürich, Zürich, Switzerland.
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28
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Edwards TC, Zrinzo L, Limousin P, Foltynie T. Deep brain stimulation in the treatment of chorea. Mov Disord 2011; 27:357-63. [PMID: 21997283 DOI: 10.1002/mds.23967] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Deep brain stimulation has been used as a means of reducing dyskinesias in various conditions, including Parkinson's disease and dystonia for many years. Recently, owing to the clinical similarities between L-dopa induced dyskinesia and chorea, deep brain stimulation has now been implemented as a novel treatment method in both Huntington's disease and neuroacanthocytosis, and a paucity of case studies exist reporting its efficacy. This review will summarize the case studies of deep brain stimulation in both Huntington's disease and neuroacanthocytosis, and discuss the possible implications and limitations associated with these reports. As both these disorders are often refractory to medication and difficult to treat, deep brain stimulation may be a useful treatment option in the future.
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Affiliation(s)
- Thomas C Edwards
- Sobell Department of Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, WC1N 3BG, UK
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29
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The neuropsychiatry of neuroacanthocytosis syndromes. Neurosci Biobehav Rev 2011; 35:1275-83. [DOI: 10.1016/j.neubiorev.2011.01.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 12/28/2010] [Accepted: 01/05/2011] [Indexed: 11/18/2022]
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Abstract
The term "neuroacanthocytosis" describes a heterogeneous group of molecularly-defined disorders which result in progressive neurodegeneration, predominantly of the basal ganglia, and erythrocyte acanthocytosis. The clinical presentation of neuroacanthocytosis syndromes typically involves chorea and dystonia, but a range of other movement disorders may be seen. Psychiatric and cognitive symptoms may be prominent. There can be considerable phenotypic overlap; however, features of inheritance, age of onset, neuroimaging and laboratory findings, in addition to the spectrum of central and peripheral neurological abnormalities and extraneuronal involvement, can help to distinguish the specific syndromes. The two core neuroacanthocytosis syndromes, in which acanthocytosis is a typical, although not invariable finding, are autosomal recessive chorea-acanthocytosis and X-linked McLeod syndrome. Acanthocytes are found in a smaller proportion of patients with Huntington's disease-like 2 and pantothenate kinase-associated neurodegeneration. Additionally, acanthocytosis has been reported in a few patients with other neurological disorders. The causative genes do not appear to be linked by a specific function or pathway, although abnormalities of membrane processing may be implicated. The connection between the erythrocyte membrane abnormality, which results in the characteristic "thorny" protrusions, the vulnerability of the basal ganglia, and the respective genetic mutations, is obscure.
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Affiliation(s)
- Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx and Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA
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Skousen JL, Merriam SME, Srivannavit O, Perlin G, Wise KD, Tresco PA. Reducing surface area while maintaining implant penetrating profile lowers the brain foreign body response to chronically implanted planar silicon microelectrode arrays. PROGRESS IN BRAIN RESEARCH 2011; 194:167-80. [PMID: 21867802 DOI: 10.1016/b978-0-444-53815-4.00009-1] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A consistent feature of the foreign body response (FBR), irrespective of the type of implant, is persistent inflammation at the biotic-abiotic interface signaled by biomarkers of macrophage/microglial activation. Since macrophage-secreted factors shape the foreign body reaction, implant designs that reduce macrophage activation should improve biocompatibility and, with regard to recording devices, should improve reliability and longevity. At present, it is unclear whether the goal of seamless integration is possible or whether electrode developers can modulate specific aspects of the FBR by intentionally manipulating the constitutive properties of the implant. To explore this area, we studied the chronic brain FBR to planar solid silicon microelectrode arrays and planar lattice arrays with identical penetrating profiles but with reduced surface area in rats after an 8-week indwelling period. Using quantitative immunohistochemistry, we found that presenting less surface area after equivalent iatrogenic injury is accompanied by significantly less persistent macrophage activation, decreased blood brain barrier leakiness, and reduced neuronal cell loss. Our findings show that it is possible for implant developers to modulate specific aspects of the FBR by intentionally manipulating the constitutive properties of the implant. Our results also support the theory that the FBR to implanted electrode arrays, and likely other implants, can be explained by the presence of macrophages at the biotic-abiotic interface, which act as a sustained delivery source of bioactive agents that diffuse into the adjacent tissue and shape various features of the brain FBR. Further, our findings suggest that one method to improve the recording consistency and lifetime of implanted microelectrode arrays is to design implants that reduce the amount of macrophage activation at the biotic-abiotic interface and/or enhance the clearance or impact of their released factors.
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Affiliation(s)
- John L Skousen
- Department of Bioengineering, University of Utah, Salt Lake City, UT, USA
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32
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A comparison of the tissue response to chronically implanted Parylene-C-coated and uncoated planar silicon microelectrode arrays in rat cortex. Biomaterials 2010; 31:9163-72. [DOI: 10.1016/j.biomaterials.2010.05.050] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 05/20/2010] [Indexed: 11/21/2022]
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33
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Winslow BD, Tresco PA. Quantitative analysis of the tissue response to chronically implanted microwire electrodes in rat cortex. Biomaterials 2010; 31:1558-67. [DOI: 10.1016/j.biomaterials.2009.11.049] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 11/17/2009] [Indexed: 10/20/2022]
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34
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Intracranial electrode implantation produces regional neuroinflammation and memory deficits in rats. Exp Neurol 2009; 222:42-50. [PMID: 20026042 DOI: 10.1016/j.expneurol.2009.12.006] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 08/28/2009] [Accepted: 12/05/2009] [Indexed: 11/21/2022]
Abstract
Deep brain stimulation (DBS) is an established treatment for advanced Parkinson's disease (PD). The procedure entails intracranial implantation of an electrode in a specific brain structure followed by chronic stimulation. Although the beneficial effects of DBS on motor symptoms in PD are well known, it is often accompanied by cognitive impairments, the origin of which is not fully understood. To explore the possible contribution of the surgical procedure itself, we studied the effect of electrode implantation in the subthalamic nucleus (STN) on regional neuroinflammation and memory function in rats implanted bilaterally with stainless steel electrodes. Age-matched sham and intact rats were used as controls. Brains were removed 1 or 8 weeks post-implantation and processed for in vitro autoradiography with [(3)H]PK11195, an established marker of microglial activation. Memory function was assessed by the novel object recognition test (ORT) before surgery and 2 and 8 weeks after surgery. Electrode implantation produced region-dependent changes in ligand binding density in the implanted brains at 1 as well as 8 weeks post-implantation. Cortical regions showed more intense and widespread neuroinflammation than striatal or thalamic structures. Furthermore, implanted animals showed deficits in ORT performance 2 and 8 weeks post-implantation. Thus, electrode implantation resulted in a widespread and persistent neuroinflammation and sustained memory impairment. These results suggest that the insertion and continued presence of electrodes in the brain, even without stimulation, may lead to inflammation-mediated cognitive deficits in susceptible individuals, as observed in patients treated with DBS.
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35
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Groiss SJ, Wojtecki L, Südmeyer M, Schnitzler A. Deep brain stimulation in Parkinson's disease. Ther Adv Neurol Disord 2009; 2:20-8. [PMID: 21180627 PMCID: PMC3002606 DOI: 10.1177/1756285609339382] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
During the last 15 years deep brain stimulation (DBS) has been established as a highly-effective therapy for advanced Parkinson's disease (PD). Patient selection, stereotactic implantation, postoperative stimulator programming and patient care requires a multi-disciplinary team including movement disorders specialists in neurology and functional neurosurgery. To treat medically refractory levodopa-induced motor complications or resistant tremor the preferred target for high-frequency DBS is the subthalamic nucleus (STN). STN-DBS results in significant reduction of dyskinesias and dopaminergic medication, improvement of all cardinal motor symptoms with sustained long-term benefits, and significant improvement of quality of life when compared with best medical treatment. These benefits have to be weighed against potential surgery-related adverse events, device-related complications, and stimulus-induced side effects. The mean disease duration before initiating DBS in PD is currently about 13 years. It is presently investigated whether the optimal timing for implantation may be at an earlier disease-stage to prevent psychosocial decline and to maintain quality of life for a longer period of time.
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Affiliation(s)
- S. J. Groiss
- Department of Neurology, Center for Movement Disorders and Neuromodulation,
Heinrich-Heine-University of Düsseldorf, Germany, Institute of
Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University of
Düsseldorf, Germany
| | - L. Wojtecki
- Department of Neurology, Center for Movement Disorders and Neuromodulation,
Heinrich-Heine-University of Düsseldorf, Germany, Institute of
Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University of
Düsseldorf, Germany
| | - M. Südmeyer
- Department of Neurology, Center for Movement Disorders and Neuromodulation,
Heinrich-Heine-University of Düsseldorf, Germany, Institute of
Clinical Neuroscience and Medical Psychology, Heinrich-Heine-University of
Düsseldorf, Germany
| | - A. Schnitzler
- Professor in Neurology, Director of the Institute of Clinical Neuroscience
and Medical Psychology, Heinrich-Heine-University Düsseldorf,
Germany, Department of Neurology, Center for Movement Disorders and
Neuromodulation, Heinrich-Heine-University Düsseldorf, Germany
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36
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Garcia Ruiz PJ, Ayerbe J, Bader B, Danek A, Sainz MJ, Cabo I, Frech FA. Deep brain stimulation in chorea acanthocytosis. Mov Disord 2009; 24:1546-7. [DOI: 10.1002/mds.22592] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Ishida C, Makifuchi T, Saiki S, Hirose G, Yamada M. A neuropathological study of autosomal-dominant chorea-acanthocytosis with a mutation of VPS13A. Acta Neuropathol 2009; 117:85-94. [PMID: 18584183 DOI: 10.1007/s00401-008-0403-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2008] [Revised: 06/07/2008] [Accepted: 06/08/2008] [Indexed: 10/21/2022]
Abstract
We report the first autopsy case of genetically confirmed, autosomal-dominant chorea-acanthocytosis (AD-ChAc), showing a heterozygous mutation (G-A) at nucleotide position 8,295 in exon 57 of VPS13A. The patient was a 36-year-old Japanese man and the duration of his illness was 11 years. Neuropathologically, the patient showed marked atrophy and neuronal loss, particularly small and medium-sized neurons, with astrocytic gliosis in the caudate nucleus, putamen and globus pallidus. These findings were similar to previous autopsy reports of autosomal-recessive ChAc (AR-ChAc) with mutations of VPS13A. The broad distribution of atrophic neurons and astrocytosis throughout the whole brain was unique in our AD-ChAc patient and has not been described in AR-ChAc. The neuronal density of the dorsal caudate nucleus was lower than that of the ventral side in this patient as well as in three Huntington's disease (HD) patients. The neuronal densities in both the rostral and caudal sides were lower than that in the middle region at the anterior commissure level, while in the three HD patients, the neuronal densities of the caudate nucleus were more decreased in the caudal side. This ChAc patient showed faint immunoreactivity in the caudate nucleus and globus pallidus with antibodies against the striatal neurotransmitters, methionine-enkephalin, leucine-enkephalin and substance P. The difference in patterns of neuronal vulnerability could reflect those in the mechanisms of neurodegeneration between ChAc and HD.
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HajjHassan M, Chodavarapu V, Musallam S. NeuroMEMS: Neural Probe Microtechnologies. SENSORS 2008; 8:6704-6726. [PMID: 27873894 PMCID: PMC3707475 DOI: 10.3390/s8106704] [Citation(s) in RCA: 130] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Revised: 09/27/2008] [Accepted: 10/21/2008] [Indexed: 11/25/2022]
Abstract
Neural probe technologies have already had a significant positive effect on our understanding of the brain by revealing the functioning of networks of biological neurons. Probes are implanted in different areas of the brain to record and/or stimulate specific sites in the brain. Neural probes are currently used in many clinical settings for diagnosis of brain diseases such as seizers, epilepsy, migraine, Alzheimer's, and dementia. We find these devices assisting paralyzed patients by allowing them to operate computers or robots using their neural activity. In recent years, probe technologies were assisted by rapid advancements in microfabrication and microelectronic technologies and thus are enabling highly functional and robust neural probes which are opening new and exciting avenues in neural sciences and brain machine interfaces. With a wide variety of probes that have been designed, fabricated, and tested to date, this review aims to provide an overview of the advances and recent progress in the microfabrication techniques of neural probes. In addition, we aim to highlight the challenges faced in developing and implementing ultra-long multi-site recording probes that are needed to monitor neural activity from deeper regions in the brain. Finally, we review techniques that can improve the biocompatibility of the neural probes to minimize the immune response and encourage neural growth around the electrodes for long term implantation studies.
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Affiliation(s)
- Mohamad HajjHassan
- Department of Electrical and Computer Engineering, McGill University, 3480 University Street, Montreal, Canada H3A 2A7.
| | - Vamsy Chodavarapu
- Department of Electrical and Computer Engineering, McGill University, 3480 University Street, Montreal, Canada H3A 2A7.
| | - Sam Musallam
- Department of Electrical and Computer Engineering, McGill University, 3480 University Street, Montreal, Canada H3A 2A7.
- Department of Physiology, McGill University, 3655 Promenade Osler, Montreal, Canada H3G 1Y6.
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Akinesia, motor oscillations and the pedunculopontine nucleus in rats and men. Exp Neurol 2008; 215:1-4. [PMID: 18977223 DOI: 10.1016/j.expneurol.2008.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 09/18/2008] [Indexed: 01/10/2023]
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Wu DC, Xu ZH, Wang S, Fang Q, Hu DQ, Li Q, Sun HL, Zhang SH, Chen Z. Time-dependent effect of low-frequency stimulation on amygdaloid-kindling seizures in rats. Neurobiol Dis 2008; 31:74-9. [DOI: 10.1016/j.nbd.2008.03.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Revised: 03/21/2008] [Accepted: 03/24/2008] [Indexed: 10/22/2022] Open
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Aziz TZ, Stein JF. Editorial commentary: Oscillatory activity and deep brain stimulation in the pedunculopontine nucleus. Exp Neurol 2008; 212:247-50. [PMID: 18555218 DOI: 10.1016/j.expneurol.2008.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 04/21/2008] [Accepted: 04/23/2008] [Indexed: 10/22/2022]
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Pilitsis JG, Chu Y, Kordower J, Bergen DC, Cochran EJ, Bakay RA. POSTMORTEM STUDY OF DEEP BRAIN STIMULATION OF THE ANTERIOR THALAMUS. Neurosurgery 2008; 62:E530-2; discussion E532. [DOI: 10.1227/01.neu.0000316024.81786.78] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE
As new clinical applications for deep brain stimulation (DBS) emerge and the number of patients with DBS systems continues to grow, lead technology will also advance. To direct improvement of these leads, improved understanding of the effects of the DBS electrodes and stimulation parameters on the surrounding brain parenchyma is necessary. We present a postmortem evaluation of a patient who had previously undergone bilateral DBS of the anterior thalamic nucleus.
CLINICAL PRESENTATION
A 21-year-old, right-handed man with a 2-year history of epilepsy secondary to encephalitis underwent bilateral DBS of the anterior nucleus of the thalamus. He died 8 months after surgery, and his death was classified as a sudden, unexpected, unexplained death as a result of epilepsy.
INTERVENTION
Microscopic examination and immunohistochemical analysis using glial fibrillary acidic protein, CD11b, CD45, and CD 68 were performed. The thalami of this patient were then compared with brain tissue obtained from a 45-year-old patient who died as a result of a myocardial infarction and had no history of neurological disease and no surgical intervention. There were no differences in the microscopic and histochemical evaluation of the thalami between patients, other than immediately around the electrode tract. Minimal tissue damage, mild astrocytosis, and mild inflammation surrounding the electrode termination site were observed.
CONCLUSION
We report the first postmortem examination after bilateral DBS of the anterior nucleus of the thalamus for epilepsy. A comparison with control tissue showed no significant difference other than mild inflammation along the lead track.
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Affiliation(s)
- Julie G. Pilitsis
- Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois
| | - Yaping Chu
- Department of Neuroscience, Rush University Medical Center, Chicago, Illinois
| | - Jeffrey Kordower
- Department of Neuroscience, Rush University Medical Center, Chicago, Illinois
| | - Donna C. Bergen
- Department of Neuroscience, Rush University Medical Center, Chicago, Illinois
| | | | - Roy A.E. Bakay
- Departments of Neurosurgery and Neuroscience, Rush University Medical Center, Chicago, Illinois
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Carmichael DW, Pinto S, Limousin-Dowsey P, Thobois S, Allen PJ, Lemieux L, Yousry T, Thornton JS. Functional MRI with active, fully implanted, deep brain stimulation systems: safety and experimental confounds. Neuroimage 2007; 37:508-17. [PMID: 17590355 DOI: 10.1016/j.neuroimage.2007.04.058] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 03/21/2007] [Accepted: 04/30/2007] [Indexed: 01/11/2023] Open
Abstract
We investigated safety issues and potential experimental confounds when performing functional magnetic resonance imaging (fMRI) investigations in human subjects with fully implanted, active, deep brain stimulation (DBS) systems. Measurements of temperature and induced voltage were performed in an in vitro arrangement simulating bilateral DBS during magnetic resonance imaging (MRI) using head transmit coils in both 1.5 and 3.0 T MRI systems. For MRI sequences typical of an fMRI study with coil-averaged specific absorption rates (SARs) less than 0.4 W/kg, no MRI-induced temperature change greater than the measurement sensitivity (0.1 degrees C) was detected at 1.5 T, and at 3 T temperature elevations were less than 0.5 degrees C, i.e. within safe limits. For the purposes of demonstration, MRI pulse sequences with SARs of 1.45 W/kg and 2.34 W/kg (at 1.5 T and 3 T, respectively) were prescribed and elicited temperature increases (>1 degrees C) greater than those considered safe for human subjects. Temperature increases were independent of the presence or absence of active stimulator pulsing. At both field strengths during echo planar MRI, the perturbations of DBS equipment performance were sufficiently slight, and temperature increases sufficiently low to suggest that thermal or electromagnetically mediated experimental confounds to fMRI with DBS are unlikely. We conclude that fMRI studies performed in subjects with subcutaneously implanted DBS units can be both safe and free from DBS-specific experimental confounds. Furthermore, fMRI in subjects with fully implanted rather than externalized DBS stimulator units may offer a significant safety advantage. Further studies are required to determine the safety of MRI with DBS for other MRI systems, transmit coil configurations and DBS arrangements.
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Affiliation(s)
- David W Carmichael
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
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Nielsen MS, Bjarkam CR, Sørensen JC, Bojsen-Møller M, Sunde NA, Østergaard K. Chronic subthalamic high-frequency deep brain stimulation in Parkinson's disease ? a histopathological study. Eur J Neurol 2007; 14:132-8. [PMID: 17250719 DOI: 10.1111/j.1468-1331.2006.01569.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study describes the pathological findings in the brain of a patient with Parkinson's disease (PD) treated with bilateral subthalamic high-frequency deep brain stimulation (STN DBS) for 29 months prior to death. After routine neuropathological examination, tissue blocks containing the electrode tracts, the subthalamic nucleus (STN), the substantia nigra and the pre-frontal cortex were paraffin embedded and cut into 5-microm-thick serial sections and stained with several conventional staining methods and immunohistochemistry. Bilateral nigral depigmentation, cell loss and Lewy body formation confirmed the diagnosis of PD. Microscopic evaluation furthermore confirmed the location of the electrodes in the STN. The electrode tracts were surrounded by a 150-microm-wide glial fibrillary acidic protein (GFAP)-positive capsule consisting of a thin collagen layer lining the lumen of the tract, whilst an area with few cells and axons constituted the capsule wall towards the surrounding normal brain tissue. The brain tissue appeared normal outside the capsule boundaries with no difference in areas of stimulation compared with areas of no stimulation. Our results correspond with previous studies performed after fewer months of STN DBS and indicate mild histopathological changes in the vicinity of the electrode tract, appearing to result from the electrode placement and not from the electrical stimulation.
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Affiliation(s)
- M S Nielsen
- Department of Neurobiology, Institute of Anatomy, University of Aarhus, Aarhus, Denmark.
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Walker RH, Danek A, Dobson-Stone C, Guerrini R, Jung HH, Lafontaine AL, Rampoldi L, Tison F, Andermann E. Developments in neuroacanthocytosis: Expanding the spectrum of choreatic syndromes. Mov Disord 2006; 21:1794-805. [PMID: 16958034 DOI: 10.1002/mds.21108] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
As with other neurodegenerative disorders, research into the group of diseases known under the umbrella term of "neuroacanthocytosis" has greatly benefited from the identification of causative genes. The distinct and unifying aspect of these disorders is the presence of thorny deformations of circulating erythrocytes. This may be due to abnormal properties of red cell membranes, which could lead to insights into mechanisms of neurodegeneration. Research approaches in this field, in addition to examining functions and protein interactions of the affected proteins with particular respect to neurons, have also drawn upon the expertise of hematologists and red cell membrane biologists. In this article, recent developments in the field are presented.
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Affiliation(s)
- Ruth H Walker
- Department of Neurology, Veterans Affairs Medical Center, Bronx, and Mount Sinai School of Medicine, New York, NY 10468, USA.
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Al-Asmi A, Jansen AC, Badhwar A, Dubeau F, Tampieri D, Shustik C, Mercho S, Savard G, Dobson-Stone C, Monaco AP, Andermann F, Andermann E. Familial temporal lobe epilepsy as a presenting feature of choreoacanthocytosis. Epilepsia 2005; 46:1256-63. [PMID: 16060937 DOI: 10.1111/j.1528-1167.2005.65804.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE Choreoacanthocytosis (ChAc) is an autosomal recessive disorder caused by mutations in VPS13A on chromosome 9q21 and characterized by neurodegeneration and red cell acanthocytosis. Seizures are not uncommon in ChAc but have not been well characterized in the literature. We report two ChAc families in which patients presented with temporal lobe epilepsy. METHODS Detailed medical and family histories were obtained. EEG, video-telemetry, brain magnetic resonance imaging (MRI) with volumetric studies of amygdala and hippocampus, as well as neuropsychological testing were performed. Blood smears were examined for acanthocytosis. Mutation analysis of VPS13A was carried out in five patients. RESULTS Six patients in three sibships were initially seen with seizures. Age at seizure onset ranged from 22 to 38 years. Seizures preceded other clinical manifestations of ChAc by < or = 15 years. The epileptic aura consisted of a sensation of déjà-vu, fear, hallucinations, palpitations, or vertigo. EEG with video-telemetry showed epileptiform discharges originating either from one or both temporal lobes. Epilepsy was generally well controlled, but some patients had periods of increased seizure frequency requiring treatment with multiple antiepileptic drugs (AEDs). Both families shared a deletion of exons 70-73 of VPS13A, extending to exons 6-7 of GNA14. CONCLUSIONS Temporal lobe epilepsy may be the presenting feature of ChAc and may delay its diagnosis. Epilepsy in ChAc patients represents a challenge, because seizures may at times be difficult to control, and some AEDs may worsen the involuntary movements. Mutations in VPS13A or GNA14 or both may be associated with clinical features of temporal lobe epilepsy.
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Affiliation(s)
- Abdullah Al-Asmi
- Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
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Danek A, Jung HH, Melone MAB, Rampoldi L, Broccoli V, Walker RH. Neuroacanthocytosis: new developments in a neglected group of dementing disorders. J Neurol Sci 2005; 229-230:171-86. [PMID: 15760637 DOI: 10.1016/j.jns.2004.11.024] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neurological abnormalities associated with spiculated, "acanthocytic" red cells in blood have been summarized as neuroacanthocytosis. This is a heterogeneous group of conditions that can now be clearly subdivided on the basis of genetic discoveries. The core neuroacanthocytosis syndromes are autosomal recessive chorea-acanthocytosis (ChAc) and the X-linked McLeod syndrome (MLS). Huntington's disease-like 2 (HLD2) and pantothenate kinase associated neurodegeneration (PKAN) can now also be included. All of these share dyskinesias, cognitive deterioration and progressive neurodegeneration mainly of the basal ganglia, but they are sufficiently distinct to permit a specific working diagnosis on the basis of clinical, laboratory and imaging findings. In addition, the VPS13A (formerly called CHAC), XK, JPH3 and PANK2 genes, respectively, may be examined for mutations. Unfortunately, little is yet known about the normal and abnormal physiology of the protein products of these genes, but they appear to be involved in membrane function and intracellular protein sorting. Since no cures are yet available, development and study of disease models in experimental animals (mouse, C. elegans) is a priority for current research. From a clinical point of view, the common occurrence of cardiomyopathy in MLS, the transfusion hazards due to the McLeod Kell phenotype and the possibility of improving the violent trunk spasms and orofacial dyskinesias typical for ChAc (with subsequent lip or tongue mutilations and feeding dystonia) by deep brain surgery or stimulation should be considered in patient management.
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Affiliation(s)
- Adrian Danek
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität Marchioninistr. 15 D-81366 Munich, Germany.
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Simon SL, Douglas P, Baltuch GH, Jaggi JL. Error Analysis of MRI and Leksell Stereotactic Frame Target Localization in Deep Brain Stimulation Surgery. Stereotact Funct Neurosurg 2005; 83:1-5. [PMID: 15695925 DOI: 10.1159/000083861] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Stereotactic deep brain stimulation (DBS) is the surgical treatment of choice for medication-refractory patients with Parkinson's disease and essential tremor. The subthalamic nucleus and ventral intermediate nucleus of the thalamus appear to be effective targets for electrode placement. Because these targets are small and encased in fiber tracts, their localization can be exceedingly difficult. However, the precision of electrode placement is crucial for obtaining successful results. Currently, surgeons rely on preoperative MRI or CT images to derive stereotactic coordinates for targeting sites such as the subthalamic nucleus and ventral intermediate nucleus of the thalamus coupled with microelectrode recordings during surgery for proper electrode placement. However, it has been argued that the stereotactic head frame produces detrimental artifacts during MRI. We examined MRI images taken from 11 patients undergoing repeat DBS surgery, and determined the coordinates of the previously placed electrode. We then set the Leksell G stereotactic frame to these coordinates and obtained fluoroscope-localizing images. Using MATLAB image analysis tools, we were able to quantify the 3-dimensional error in target localization by measuring the distance from the electrode tip to the targeted coordinate. The mean errors were 0.09 +/- 0.34 mm perpendicular, lateral to medial, 0.01 +/- 0.32 perpendicular, posterior to anterior, and -0.08 +/- 0.33 mm parallel to the electrode, superior to inferior. According to statistical analysis, the error was random and did not seem to move in any predictable fashion. Therefore, we conclude that preoperative MRI images can be safely used in DBS surgery, and they do not negatively affect its accuracy.
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Affiliation(s)
- Scott L Simon
- Parkinson's Disease and Movement Disorders Center at Pennsylvania Hospital, Department of Neurosurgery, University of Pennsylvania, Philadelphia, PA 19107, USA
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Kuncel AM, Grill WM. Selection of stimulus parameters for deep brain stimulation. Clin Neurophysiol 2004; 115:2431-41. [PMID: 15465430 DOI: 10.1016/j.clinph.2004.05.031] [Citation(s) in RCA: 271] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2004] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To provide an analysis of stimulation parameters for deep brain stimulation (DBS). METHODS Synthesis of theoretical and empirical findings is used to provide guidance for the selection of stimulus parameters. Finite element modeling is used to investigate the effects of contact location and electrode geometry on the electric field, and to estimate the effects of current density distribution on the limit for non-damaging stimulation. RESULTS Anatomical targeting of DBS electrodes is complicated by the uncertainty of which neural elements are targeted and differences in the electric field distribution in fiber tracts and nuclei. Electrical targeting by selection of electrode geometry and stimulus waveform can alter the distribution of the electric field and control neural activation. The recommended charge density limit for DBS represents a liberal estimate for non-damaging stimulation. Short duration stimulus pulses reduce charge injection and increase the therapeutic window between therapeutic effects and side effects. CONCLUSIONS There are several challenges to developing rational methods of selecting stimulus parameters including a large number of degrees of freedom, the unknown effects of stimulation, and the complexity of the responses. SIGNIFICANCE Understanding the fundamentals of electrical stimulation of the nervous system enables rational selection of stimulus parameters.
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Affiliation(s)
- Alexis M Kuncel
- Department of Biomedical Engineering, Duke University, Box 90281, Durham, NC 27708-0281, USA
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