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Sui Y, Yu H, Zhang C, Chen Y, Jiang C, Li L. Deep brain-machine interfaces: sensing and modulating the human deep brain. Natl Sci Rev 2022; 9:nwac212. [PMID: 36644311 PMCID: PMC9834907 DOI: 10.1093/nsr/nwac212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/02/2022] [Accepted: 10/04/2022] [Indexed: 01/18/2023] Open
Abstract
Different from conventional brain-machine interfaces that focus more on decoding the cerebral cortex, deep brain-machine interfaces enable interactions between external machines and deep brain structures. They sense and modulate deep brain neural activities, aiming at function restoration, device control and therapeutic improvements. In this article, we provide an overview of multiple deep brain recording and stimulation techniques that can serve as deep brain-machine interfaces. We highlight two widely used interface technologies, namely deep brain stimulation and stereotactic electroencephalography, for technical trends, clinical applications and brain connectivity research. We discuss the potential to develop closed-loop deep brain-machine interfaces and achieve more effective and applicable systems for the treatment of neurological and psychiatric disorders.
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Affiliation(s)
- Yanan Sui
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Huiling Yu
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Chen Zhang
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Yue Chen
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
| | - Changqing Jiang
- National Engineering Research Center of Neuromodulation, Tsinghua University, Beijing 100084, China
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Radjenovic S, Dörl G, Gaal M, Beisteiner R. Safety of Clinical Ultrasound Neuromodulation. Brain Sci 2022; 12:brainsci12101277. [PMID: 36291211 PMCID: PMC9599299 DOI: 10.3390/brainsci12101277] [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: 08/29/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/23/2022] Open
Abstract
Transcranial ultrasound holds much potential as a safe, non-invasive modality for navigated neuromodulation, with low-intensity focused ultrasound (FUS) and transcranial pulse stimulation (TPS) representing the two main modalities. While neuroscientific and preclinical applications have received much interest, clinical applications are still relatively scarce. For safety considerations, the current literature is largely based on guidelines for ultrasound imaging that uses various physical parameters to describe the ultrasound pulse form and expected bioeffects. However, the safety situation for neuromodulation is inherently different. This article provides an overview of relevant ultrasound parameters with a focus on bioeffects relevant for safe clinical applications. Further, a retrospective analysis of safety data for clinical TPS applications in patients is presented.
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Abou Khzam R, El Jalbout ND, Seif R, Sadaka A. An unusual presentation of convergence insufficiency in a patient with Parkinson's disease stimulated by deep brain stimulation. Am J Ophthalmol Case Rep 2022; 26:101531. [PMID: 35509285 PMCID: PMC9058585 DOI: 10.1016/j.ajoc.2022.101531] [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: 10/25/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To report convergence insufficiency in a patient with Parkinson's’ disease stimulated by turning on the deep brain stimulator. Observations 72-year-old male with Parkinson's disease and hypertension presenting for the evaluation of blurry vision at near and mid distance that started after activation of an implanted Deep brain stimulator. Baseline ophthalmologic evaluation prior to deep brain stimulator implantation surgery and with the deep brain stimulator turned off demonstrated a full motility, centered eyes for distance and near and a best corrected visual acuity of 20/20, normal pupil exam, confrontational visual fields and dilated fundus exam. Following this examination, the Deep brain stimulator was turned on and re-evaluation few minutes later demonstrated the same findings except for a 6-prism diopter exotropia at near consistent with convergence insufficiency. Following our evaluation a set of +3 diopters base-in prisms were added to near glasses with total relief of symptoms. The patient did not require surgical adjustment of the deep brain stimulator leads. Conclusions and importance Given the therapeutic effects of deep brain stimulation on convergence insufficiency reported in several studies, in addition to the influence of deep brain stimulation as Parkinson's Disease treatment in areas possibly associated with vergence control, convergence insufficiency secondary to deep brain stimulation does not seem very unlikely, although not often reported. Further studies are needed to optimize deep brain stimulation surgery to maximize benefits and limit adverse events, as well as being aware of convergence insufficiency as a possible cause for visual disturbance.
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Affiliation(s)
- Rayan Abou Khzam
- Lebanese American University Gillbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
- Department of Ophthalmology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Nahia Dib El Jalbout
- Lebanese American University Gillbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
- Department of Ophthalmology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Roland Seif
- Lebanese American University Gillbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
- Department of Ophthalmology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
| | - Ama Sadaka
- Lebanese American University Gillbert and Rose-Marie Chagoury School of Medicine, Byblos, Lebanon
- Department of Ophthalmology, Lebanese American University Medical Center, Rizk Hospital, Beirut, Lebanon
- Corresponding author. Department of Ophthalmology, LAU Medical Center, Rizk Hospital, P.O. Box 11-3288, Beirut, Lebanon.
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Gharooni AA, Kwon BK, Fehlings MG, Boerger TF, Rodrigues-Pinto R, Koljonen PA, Kurpad SN, Harrop JS, Aarabi B, Rahimi-Movaghar V, Wilson JR, Davies BM, Kotter MRN, Guest JD. Developing Novel Therapies for Degenerative Cervical Myelopathy [AO Spine RECODE-DCM Research Priority Number 7]: Opportunities From Restorative Neurobiology. Global Spine J 2022; 12:109S-121S. [PMID: 35174725 PMCID: PMC8859698 DOI: 10.1177/21925682211052920] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
STUDY DESIGN Narrative review. OBJECTIVES To provide an overview of contemporary therapies for the James Lind Alliance priority setting partnership for degenerative cervical myelopathy (DCM) question: 'Can novel therapies, including stem-cell, gene, pharmacological and neuroprotective therapies, be identified to improve the health and wellbeing of people living with DCM and slow down disease progression?' METHODS A review of the literature was conducted to outline the pathophysiology of DCM and present contemporary therapies that may hold therapeutic value in 3 broad categories of neuroprotection, neuroregeneration, and neuromodulation. RESULTS Chronic spinal cord compression leads to ischaemia, neuroinflammation, demyelination, and neuronal loss. Surgical intervention may halt progression and improve symptoms, though the majority do not make a full recovery leading to lifelong disability. Neuroprotective agents disrupt deleterious secondary injury pathways, and one agent, Riluzole, has undergone Phase-III investigation in DCM. Although it did not show efficacy on the primary outcome modified Japanese Orthopaedic Association scale, it showed promising results in pain reduction. Regenerative approaches are in the early stage, with one agent, Ibudilast, currently in a phase-III investigation. Neuromodulation approaches aim to therapeutically alter the state of spinal cord excitation by electrical stimulation with a variety of approaches. Case studies using electrical neuromuscular and spinal cord stimulation have shown positive therapeutic utility. CONCLUSION There is limited research into interventions in the 3 broad areas of neuroprotection, neuroregeneration, and neuromodulation for DCM. Contemporary and novel therapies for DCM are now a top 10 priority, and whilst research in these areas is limited in DCM, it is hoped that this review will encourage research into this priority.
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Affiliation(s)
- Aref-Ali Gharooni
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopedics, The University of British Columbia, Vancouver, BC, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Timothy F. Boerger
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - Ricardo Rodrigues-Pinto
- Spinal Unit (UVM), Department of Orthopaedics, Centro Hospitalar Universitário do Porto - Hospital de Santo António, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Paul Aarne Koljonen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Shekar N. Kurpad
- Department of Neurosurgery, Medical College of Wisconsin, Wauwatosa, WI, USA
| | - James S. Harrop
- Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Bizhan Aarabi
- Department of Neurosurgery, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jefferson R. Wilson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Benjamin M. Davies
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - Mark R. N. Kotter
- Neurosurgery Unit, Department of Clinical Neuroscience, University of Cambridge, UK
| | - James D. Guest
- Department of Neurosurgery and The Miami Project to Cure Paralysis, The Miller School of Medicine, University of Miami, Miami, FL, USA
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Abreu V, Vaz R, Chamadoira C, Rebelo V, Reis C, Costa F, Martins J, Gillies MJ, Aziz TZ, Pereira EAC. Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: Efficacy at five years' follow-up and effective volume of activated brain tissue. Neurochirurgie 2021; 68:52-60. [PMID: 34166646 DOI: 10.1016/j.neuchi.2021.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 04/24/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
Chronic neuropathic pain affects 7%-10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years' post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patient-reported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p=0.0001), on UW-NPS of 35.2% (p=0.3582), on BPI of 65.1% (p=0.0505) and on SF-36 of 5% (p=0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p=0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p=0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts.
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Affiliation(s)
- V Abreu
- Department of Neuroradiology. Centro Hospitalar Universitário do Porto, Porto, Portugal; Faculdade de Medicina da Universidade do Porto, Portugal.
| | - R Vaz
- Faculdade de Medicina da Universidade do Porto, Portugal; Department of Neurosurgery. Centro Hospitalar Universitário São João, Porto, Portugal; Neurociences Unity Hospital Cuf, Porto, Portugal
| | - C Chamadoira
- Department of Neurosurgery. Centro Hospitalar Universitário São João, Porto, Portugal
| | - V Rebelo
- Pain Unit. Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Reis
- Department of Neuroradiology. Centro Hospitalar Universitário São João, Porto, Portugal
| | - F Costa
- Department of Neuroradiology. Centro Hospitalar Universitário São João, Porto, Portugal
| | | | - M J Gillies
- Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
| | - T Z Aziz
- Faculdade de Medicina da Universidade do Porto, Portugal; Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom
| | - E A C Pereira
- Faculdade de Medicina da Universidade do Porto, Portugal; Neurosciences Research Centre, Institute of Molecular and Clinical Neurosciences, St. George's, University of London, London, United Kingdom
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Bijanki KR, Metzger BA, Steger CM. Leveraging Intracranial Neural Data to Accelerate Progress Toward Novel Therapies for Psychiatric Symptoms and Disorders. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:506-507. [PMID: 33965166 DOI: 10.1016/j.bpsc.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Kelly R Bijanki
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas.
| | - Brian A Metzger
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Camille M Steger
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, Massachusetts
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Green AL, Paterson DJ. Using Deep Brain Stimulation to Unravel the Mysteries of Cardiorespiratory Control. Compr Physiol 2020; 10:1085-1104. [PMID: 32941690 DOI: 10.1002/cphy.c190039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article charts the history of deep brain stimulation (DBS) as applied to alleviate a number of neurological disorders, while in parallel mapping the electrophysiological circuits involved in generating and integrating neural signals driving the cardiorespiratory system during exercise. With the advent of improved neuroimaging techniques, neurosurgeons can place small electrodes into deep brain structures with a high degree accuracy to treat a number of neurological disorders, such as movement impairment associated with Parkinson's disease and neuropathic pain. As well as stimulating discrete nuclei and monitoring autonomic outflow, local field potentials can also assess how the neurocircuitry responds to exercise. This technique has provided an opportunity to validate in humans putative circuits previously identified in animal models. The central autonomic network consists of multiple sites from the spinal cord to the cortex involved in autonomic control. Important areas exist at multiple evolutionary levels, which include the anterior cingulate cortex (telencephalon), hypothalamus (diencephalon), periaqueductal grey (midbrain), parabrachial nucleus and nucleus of the tractus solitaries (brainstem), and the intermediolateral column of the spinal cord. These areas receive afferent input from all over the body and provide a site for integration, resulting in a coordinated efferent autonomic (sympathetic and parasympathetic) response. In particular, emerging evidence from DBS studies have identified the basal ganglia as a major sub-cortical cognitive integrator of both higher center and peripheral afferent feedback. These circuits in the basal ganglia appear to be central in coupling movement to the cardiorespiratory motor program. © 2020 American Physiological Society. Compr Physiol 10:1085-1104, 2020.
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Affiliation(s)
- Alexander L Green
- Division of Medical Sciences, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David J Paterson
- Department of Physiology Anatomy and Genetics, University of Oxford, Oxford, UK
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Li D, Cui Z, Xu S, Xu T, Wu S, Bouakaz A, Wan M, Zhang S. Low-Intensity Focused Ultrasound Stimulation Treatment Decreases Blood Pressure in Spontaneously Hypertensive Rats. IEEE Trans Biomed Eng 2020; 67:3048-3056. [PMID: 32086192 DOI: 10.1109/tbme.2020.2975279] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We applied low-intensity focused ultrasound (LIFU) stimulation of the ventrolateral periaqueductal gray (vlPAG) in spontaneously hypertensive rats (SHRs) model to demonstrate the feasibility of LIFU stimulation to decrease blood pressure (BP). METHODS The rats were treated with LIFU stimulation for 20 min every day for one week. The change of BP and heart rate (HR) were recorded to evaluate the antihypertensive effect. Then the plasma levels of epinephrine (EPI), norepinephrine (NE), and angiotensin II (ANGII) were measured to evaluate the activity of the sympathetic nervous system (SNS) and the renin-angiotensin system (RAS). The c-fos immunofluorescence assay was performed to investigate the antihypertensive nerve pathway. Moreover, the biological safety of ultrasound sonication was examined. RESULTS The LIFU stimulation induced a significant reduction of BP in 8 SHRs. The mean systolic blood pressure (SBP) was reduced from 170 ± 4 mmHg to 128 ± 4.5 mmHg after a one-week treatment, p < 0.01. The activity of SNS and RAS were also inhibited. The results of the c-fos immunofluorescence assay showed that US stimulation of the vlPAG significantly enhanced the neuronal activity both in vlPAG and caudal ventrolateral medulla (CVLM) regions. And the US stimulation used in this study did not cause significant tissue damage, hemorrhage and cell apoptosis in the sonication region. CONCLUSION The results support that LIFU stimulation of the vlPAG could relieve hypertension in SHRs. SIGNIFICANCE The LIFU stimulation of the vlPAG could potentially be a new alternative non-invasive device therapy for hypertension.
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Zhou X, Liu S, Wang Y, Yin T, Yang Z, Liu Z. High-Resolution Transcranial Electrical Simulation for Living Mice Based on Magneto-Acoustic Effect. Front Neurosci 2019; 13:1342. [PMID: 31920507 PMCID: PMC6923685 DOI: 10.3389/fnins.2019.01342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 11/28/2019] [Indexed: 01/13/2023] Open
Abstract
Transcranial electrical stimulation is an important neuromodulation tool, which has been widely applied in the cognitive sciences and in the treatment of neurological and psychiatric diseases. In this work, a novel non-invasive method of transcranial electrical stimulation with high-resolution transcranial magneto-acoustic stimulation (TMAS) method has been tested experimentally in living mice for the first time. It can achieve spatial resolution of 2 mm in the cortex and even in the deep brain regions. The induced electrical field of TMAS was simulated and measured using a test sample. Then, an animal experimental system was built, and the healthy as well as Parkinson’s disease (PD) mice were simulated by TMAS in vivo. To investigate the effect of transcranial ultrasound stimulation (TUS) at the same time as TMAS, a TUS group was added in the experiments and its results compared with those of the TMAS group. The results not only demonstrate the high-resolution ability and safety of TMAS, but also show that both TMAS and TUS improved the synaptic plasticity of the PD mice and might improve the spatial learning and memory ability of the healthy mice and the PD mice, although the improvement performance of the TMAS group was superior to that of the TUS-group. Based on the in vivo TMAS studies, we propose that TMAS functions as a dual-mode stimulation combining the electric field of the magneto-acoustic effect and the mechanical force of TUS. Our results also provide an explanation of the mechanism of TMAS. This research suggests that future use of US stimulation in magnetic resonance imaging (MRI)-guided studies should involve careful consideration of the induced magneto-acoustic electrical field caused by the static magnetic field of MRI.
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Affiliation(s)
- Xiaoqing Zhou
- Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Biomedical Engineering, Tianjin, China
| | - Shikun Liu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Biomedical Engineering, Tianjin, China
| | - Yuexiang Wang
- College of Medicine, State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, China
| | - Tao Yin
- Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Biomedical Engineering, Tianjin, China
| | - Zhuo Yang
- College of Medicine, State Key Laboratory of Medicinal Chemical Biology, Nankai University, Tianjin, China
| | - Zhipeng Liu
- Chinese Academy of Medical Sciences & Peking Union Medical College, Institute of Biomedical Engineering, Tianjin, China
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Gilbert F, Brown, Dasgupta, Martens, Klein, Goering. An Instrument to Capture the Phenomenology of Implantable Brain Device Use. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Caldwell DJ, Ojemann JG, Rao RPN. Direct Electrical Stimulation in Electrocorticographic Brain-Computer Interfaces: Enabling Technologies for Input to Cortex. Front Neurosci 2019; 13:804. [PMID: 31440127 PMCID: PMC6692891 DOI: 10.3389/fnins.2019.00804] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Electrocorticographic brain computer interfaces (ECoG-BCIs) offer tremendous opportunities for restoring function in individuals suffering from neurological damage and for advancing basic neuroscience knowledge. ECoG electrodes are already commonly used clinically for monitoring epilepsy and have greater spatial specificity in recording neuronal activity than techniques such as electroencephalography (EEG). Much work to date in the field has focused on using ECoG signals recorded from cortex as control outputs for driving end effectors. An equally important but less explored application of an ECoG-BCI is directing input into cortex using ECoG electrodes for direct electrical stimulation (DES). Combining DES with ECoG recording enables a truly bidirectional BCI, where information is both read from and written to the brain. We discuss the advantages and opportunities, as well as the barriers and challenges presented by using DES in an ECoG-BCI. In this article, we review ECoG electrodes, the physics and physiology of DES, and the use of electrical stimulation of the brain for the clinical treatment of disorders such as epilepsy and Parkinson’s disease. We briefly discuss some of the translational, regulatory, financial, and ethical concerns regarding ECoG-BCIs. Next, we describe the use of ECoG-based DES for providing sensory feedback and for probing and modifying cortical connectivity. We explore future directions, which may draw on invasive animal studies with penetrating and surface electrodes as well as non-invasive stimulation methods such as transcranial magnetic stimulation (TMS). We conclude by describing enabling technologies, such as smaller ECoG electrodes for more precise targeting of cortical areas, signal processing strategies for simultaneous stimulation and recording, and computational modeling and algorithms for tailoring stimulation to each individual brain.
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Affiliation(s)
- David J Caldwell
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Medical Scientist Training Program, University of Washington, Seattle, WA, United States.,Center for Neurotechnology, University of Washington, Seattle, WA, United States
| | - Jeffrey G Ojemann
- Center for Neurotechnology, University of Washington, Seattle, WA, United States.,Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Rajesh P N Rao
- Department of Bioengineering, University of Washington, Seattle, WA, United States.,Center for Neurotechnology, University of Washington, Seattle, WA, United States.,Paul G. Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
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12
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Elliott M, Momin S, Fiddes B, Farooqi F, Sohaib SA. Pacemaker and Defibrillator Implantation and Programming in Patients with Deep Brain Stimulation. Arrhythm Electrophysiol Rev 2019; 8:138-142. [PMID: 31114689 PMCID: PMC6528032 DOI: 10.15420/aer.2018.63.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The need for cardiac device implantation in patients receiving deep brain stimulation (DBS) is increasing. Despite the theoretical risk of the two systems interacting, there are no clear guidelines for cardiologists carrying out cardiac device implantation in this population. We performed a review of the literature and describe 13 case reports in which patients have both DBS and a cardiac pacemaker or ICD implanted. Except for one early study, in which an ICD shock reset the deep brain stimulator, no significant interactions have been reported. We discuss the potential interactions between DBS and cardiac devices, and provide practical advice for implanting cardiologists. We conclude that, provided that specific precautions are taken, cardiac device implantation is likely to be safe in patients with DBS.
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Affiliation(s)
- Mark Elliott
- Department of Cardiology, King George Hospital Ilford, UK
| | - Sheikh Momin
- Department of Cardiology, King George Hospital Ilford, UK
| | - Barnaby Fiddes
- Barking, Havering and Redbridge University Hospitals NHS Trust Romford, UK
| | - Fahad Farooqi
- Department of Cardiology, King George Hospital Ilford, UK
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13
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Huang C, Chu H, Ma Y, Zhou Z, Dai C, Huang X, Fang L, Ao Q, Huang D. The neuroprotective effect of deep brain stimulation at nucleus basalis of Meynert in transgenic mice with Alzheimer's disease. Brain Stimul 2018; 12:161-174. [PMID: 30181106 DOI: 10.1016/j.brs.2018.08.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/19/2018] [Accepted: 08/22/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Alzheimer's disease (AD) is the most common type of dementia and mainly treated by drugs, while the therapeutic outcomes are very limited. This study aimed to determine the optimized parameters of deep brain stimulation (DBS) which was applied to the treatment of AD and propose the involved mechanisms. METHODS Amyloid-β precursor protein/Presenilin1 (APP/PS1) transgenic mice were used and received DBS at nucleus basalis of Meynert (NBM). The optimized parameters of DBS were determined by using different stimulation frequencies, durations and ages of mice under Morris water maze test. The involved mechanisms and the possible signal pathways were also investigated. RESULTS The optimized parameters for DBS were high frequency (100 Hz) for 21 days starting from early age (4 months old). Under the above parameters, the soluble Aβ40 and Aβ42 in the hippocampus and cortex were down-regulated significantly. DBS increased survival neurons and reduced apoptotic cells in the hippocampus and cortex. Meanwhile, the apoptosis-related proteins caspase-3, caspase-8 and Bid were down-regulated. Moreover, DBS caused a significant increase of superoxide dismutase, glutathione peroxidase and choline acetyltransferase activity as well as a decrease of methane dicarboxylic aldehyde content and acetylcholine esterase activity. Phosphorylation of Akt (p-Akt)/total Akt (t-Akt) was up-regulated while p-extracellular signal-regulated kinase 1/2 (ERK1/2)/t-ERK1/2 was down-regulated. The neuroprotective effect of DBS was attenuated by their inhibitors. CONCLUSIONS NBM-DBS starting from 4 months of age for 21 days at a high frequency (100 Hz) has therapeutic effects on AD through activating phosphatidylinositol 3'-kinase (PI3K)/Akt pathway and inhibiting ERK1/2 pathway.
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Affiliation(s)
- Chuyi Huang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai 200120, China
| | - Heling Chu
- Department of Neurology, Huashan Hospital, Fudan University, No.12 Mid. Wulumuqi Road, Shanghai 200040, China
| | - Yu Ma
- Department of Neurosurgery, Tsinghua University Yuquan Hospital, No. 5 Shijingshan Road, Shijingshan District, Beijing 100049, China
| | - Zaiying Zhou
- Center for Statistical Science of Tsinghua University, Beijing 100084, China
| | - Chuanfu Dai
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
| | - Xiaowen Huang
- Department of Orthopedics, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Liang Fang
- Department of Mathematical Sciences, Tsinghua University, Beijing 100084, China
| | - Qiang Ao
- Department of Tissue Engineering, China Medical University, No. 77 Puhe Road, Shenyang Liaoning, 110122, China.
| | - Dongya Huang
- Department of Neurology, Shanghai East Hospital, Tongji University School of Medicine, No. 150 Jimo Road, Shanghai 200120, China.
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Sinclair NC, McDermott HJ, Bulluss KJ, Fallon JB, Perera T, Xu SS, Brown P, Thevathasan W. Subthalamic nucleus deep brain stimulation evokes resonant neural activity. Ann Neurol 2018; 83:1027-1031. [PMID: 29727475 PMCID: PMC6025792 DOI: 10.1002/ana.25234] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/10/2018] [Accepted: 04/12/2018] [Indexed: 11/27/2022]
Abstract
Deep brain stimulation (DBS) is a rapidly expanding treatment for neurological and psychiatric conditions; however, a target-specific biomarker is required to optimize therapy. Here, we show that DBS evokes a large-amplitude resonant neural response focally in the subthalamic nucleus. This response is greatest in the dorsal region (the clinically optimal stimulation target for Parkinson disease), coincides with improved clinical performance, is chronically recordable, and is present under general anesthesia. These features make it a readily utilizable electrophysiological signal that could potentially be used for guiding electrode implantation surgery and tailoring DBS therapy to improve patient outcomes.
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Affiliation(s)
- Nicholas C Sinclair
- Bionics Institute, East Melbourne, Victoria, Australia.,Department of Medical Bionics, University of Melbourne, East Melbourne, Victoria, Australia
| | - Hugh J McDermott
- Bionics Institute, East Melbourne, Victoria, Australia.,Department of Medical Bionics, University of Melbourne, East Melbourne, Victoria, Australia
| | - Kristian J Bulluss
- Bionics Institute, East Melbourne, Victoria, Australia.,Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.,Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria, Australia
| | - James B Fallon
- Bionics Institute, East Melbourne, Victoria, Australia.,Department of Medical Bionics, University of Melbourne, East Melbourne, Victoria, Australia
| | - Thushara Perera
- Bionics Institute, East Melbourne, Victoria, Australia.,Department of Medical Bionics, University of Melbourne, East Melbourne, Victoria, Australia
| | - San San Xu
- Bionics Institute, East Melbourne, Victoria, Australia.,Department of Medical Bionics, University of Melbourne, East Melbourne, Victoria, Australia.,Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit and Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Wesley Thevathasan
- Bionics Institute, East Melbourne, Victoria, Australia.,Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia.,Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, Australia
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15
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Lucke-Wold B, Nolan R, Nwafor D, Nguyen L, Cheyuo C, Turner R, Rosen C, Marsh R. Post-Traumatic Stress Disorder Delineating the Progression and Underlying Mechanisms Following Blast Traumatic Brain Injury. JOURNAL OF NEUROSCIENCE AND NEUROPHARMACOLOGY 2018; 4:118. [PMID: 29888766 PMCID: PMC5993449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Posttraumatic Stress Disorder (PTSD) is a devastating condition that can develop after blast Traumatic Brain Injury (TBI). Ongoing work has been performed to understand how PTSD develops after injury. In this review, we highlight how PTSD affects individuals, discuss what is known about the physiologic changes to the hypothalamic pituitary axis and neurotransmitter pathways, and present an overview of genetic components that may predispose individuals to developing PTSD. We then provide an overview of current treatment strategies to treat PTSD in veterans and present new strategies that may be useful going forward. The need for further clinical and pre-clinical studies is imperative to improve diagnosis, treatment, and management for patients that develop PTSD following blast TBI.
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Affiliation(s)
- Brandon Lucke-Wold
- Department of Neurosurgery, West Virginia University School of
Medicine, Morgantown, WV, USA
- Center for Neuroscience, West Virginia University Health Science
Center, Morgantown, WV, USA
| | - Richard Nolan
- Department of Neurosurgery, West Virginia University School of
Medicine, Morgantown, WV, USA
- Center for Neuroscience, West Virginia University Health Science
Center, Morgantown, WV, USA
| | - Divine Nwafor
- Department of Neurosurgery, West Virginia University School of
Medicine, Morgantown, WV, USA
- Center for Neuroscience, West Virginia University Health Science
Center, Morgantown, WV, USA
| | - Linda Nguyen
- Department of Pediatric Neurology, University of California San
Diego, San Diego, CA, USA
| | - Cletus Cheyuo
- Department of Neurosurgery, West Virginia University School of
Medicine, Morgantown, WV, USA
| | - Ryan Turner
- Department of Neurosurgery, West Virginia University School of
Medicine, Morgantown, WV, USA
| | - Charles Rosen
- Department of Neurosurgery, West Virginia University School of
Medicine, Morgantown, WV, USA
| | - Robert Marsh
- Department of Neurosurgery, West Virginia University School of
Medicine, Morgantown, WV, USA
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16
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Mole JA, Prangnell SJ. Role of clinical neuropsychology in deep brain stimulation: Review of the literature and considerations for clinicians. APPLIED NEUROPSYCHOLOGY-ADULT 2017; 26:283-296. [PMID: 29236528 DOI: 10.1080/23279095.2017.1407765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Deep Brain Stimulation (DBS) is an effective surgical therapy for several neurological movement disorders. The clinical neuropsychologist has a well-established role in the neuropsychological evaluation and selection of surgical candidates. In this article, we argue that the clinical neuropsychologist's role is much broader, when considered in relation to applied psychologists' core competencies. We consider the role of the clinical neuropsychologist in DBS in relation to: assessment, formulation, evaluation and research, intervention or implementation, and communication. For each competence the relevant evidence-base was reviewed. Clinical neuropsychology has a vital role in presurgical assessment of cognitive functioning and psychological, and emotional and behavioral difficulties. Formulation is central to the selection of surgical candidates and crucial to intervention planning. Clinical neuropsychology has a well-established role in postsurgical assessment of cognitive functioning and psychological, emotional, and behavioral outcomes, which is fundamental to evaluation on an individual and service level. The unique contribution clinical neuropsychology makes to pre- and postsurgical interventions is also highlighted. Finally, we discuss how clinical neuropsychology can promote clear and effective communication with patients and between professionals.
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Affiliation(s)
- Joseph A Mole
- a Russell Cairns Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust , Oxford , UK
| | - Simon J Prangnell
- a Russell Cairns Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust , Oxford , UK
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17
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Abreu V, Vaz R, Rebelo V, Rosas MJ, Chamadoira C, Gillies MJ, Aziz TZ, Pereira EAC. Thalamic Deep Brain Stimulation for Neuropathic Pain: Efficacy at Three Years' Follow-Up. Neuromodulation 2017. [PMID: 28631870 DOI: 10.1111/ner.12620] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECT Chronic neuropathic pain is estimated to affect 3-4.5% of the worldwide population, posing a serious burden to society. Deep Brain Stimulation (DBS) is already established for movement disorders and also used to treat some "off-label" conditions. However, DBS for the treatment of chronic, drug refractory, neuropathic pain, has shown variable outcomes with few studies performed in the last decade. Thus, this procedure has consensus approval in parts of Europe but not the USA. This study prospectively evaluated the efficacy at three years of DBS for neuropathic pain. METHODS Sixteen consecutive patients received 36 months post-surgical follow-up in a single-center. Six had phantom limb pain after amputation and ten deafferentation pain after brachial plexus injury, all due to traumas. To evaluate the efficacy of DBS, patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, University of Washington Neuropathic Pain Score (UWNPS), Brief Pain Inventory (BPI), and 36-Item Short-Form Health Survey (SF-36). RESULTS Contralateral, ventroposterolateral sensory thalamic DBS was performed in sixteen patients with chronic neuropathic pain over 29 months. A postoperative trial of externalized DBS failed in one patient with brachial plexus injury. Fifteen patients proceeded to implantation but one patient with phantom limb pain after amputation was lost for follow-up after 12 months. No surgical complications or stimulation side effects were noted. After 36 months, mean pain relief was sustained, and the median (and interquartile range) of the improvement of VAS score was 52.8% (45.4%) (p = 0.00021), UWNPS was 30.7% (49.2%) (p = 0.0590), BPI was 55.0% (32.0%) (p = 0.00737), and SF-36 was 16.3% (30.3%) (p = 0.4754). CONCLUSIONS DBS demonstrated efficacy at three years for chronic neuropathic pain after traumatic amputation and brachial plexus injury, with benefits sustained across all pain outcomes measures and slightly greater improvement in phantom limb pain.
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Affiliation(s)
- Vasco Abreu
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Rui Vaz
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Departmento de Neurocirugia, Hospital de São João, Porto, Portugal.,Center for Neurosciences CUF Porto, Porto, Portugal
| | - Virgínia Rebelo
- Departamento de Psicologia, Hospital São João, Porto, Portugal
| | - Maria José Rosas
- Center for Neurosciences CUF Porto, Porto, Portugal.,Departamento de Neurologia, Hospital São João, Porto, Portugal
| | - Clara Chamadoira
- Faculdade de Medicina, Universidade do Porto, Porto, Portugal.,Departmento de Neurocirugia, Hospital de São João, Porto, Portugal
| | - Martin J Gillies
- Department of Neurosurgery and Nuffield Department of Surgery, Oxford University Hospitals, Oxford, United Kingdom
| | - Tipu Z Aziz
- Departmento de Neurocirugia, Hospital de São João, Porto, Portugal.,Department of Neurosurgery and Nuffield Department of Surgery, Oxford University Hospitals, Oxford, United Kingdom
| | - Erlick A C Pereira
- Departmento de Neurocirugia, Hospital de São João, Porto, Portugal.,Academic Neurosurgery Unit, St. George's, University of London, London, United Kingdom
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18
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Griffiths J, Teddy P. Neuromodulation and obstetric anaesthesia. Int J Obstet Anesth 2017; 30:1-4. [DOI: 10.1016/j.ijoa.2017.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 02/25/2017] [Accepted: 02/28/2017] [Indexed: 10/20/2022]
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19
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Surgical Neurostimulation for Spinal Cord Injury. Brain Sci 2017; 7:brainsci7020018. [PMID: 28208601 PMCID: PMC5332961 DOI: 10.3390/brainsci7020018] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 01/07/2023] Open
Abstract
Traumatic spinal cord injury (SCI) is a devastating neurological condition characterized by a constellation of symptoms including paralysis, paraesthesia, pain, cardiovascular, bladder, bowel and sexual dysfunction. Current treatment for SCI involves acute resuscitation, aggressive rehabilitation and symptomatic treatment for complications. Despite the progress in scientific understanding, regenerative therapies are lacking. In this review, we outline the current state and future potential of invasive and non-invasive neuromodulation strategies including deep brain stimulation (DBS), spinal cord stimulation (SCS), motor cortex stimulation (MCS), transcutaneous direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS) in the context of SCI. We consider the ability of these therapies to address pain, sensorimotor symptoms and autonomic dysregulation associated with SCI. In addition to the potential to make important contributions to SCI treatment, neuromodulation has the added ability to contribute to our understanding of spinal cord neurobiology and the pathophysiology of SCI.
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20
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Dhar M, Sreevastava DK, Gupta N, Mishra S. Choice of sedative for deep brain stimulation in Parkinson’s disease: Our experience and comparison of two cases. EGYPTIAN JOURNAL OF ANAESTHESIA 2017. [DOI: 10.1016/j.egja.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Mridul Dhar
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
| | - Deepak Kumar Sreevastava
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
| | - Nitish Gupta
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
| | - Somya Mishra
- Department of Anaesthesiology and Critical Care, Army Hospital (Research & Referral), New Delhi, India
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21
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Wan Hassan WMN, Yeap BT, Ab Mukmin L, Ghani ARI, Mohd Zaini RH. An unusual case of repeated venous air embolism during awake bilateral deep brain stimulation surgery. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2016. [DOI: 10.1080/22201181.2016.1223925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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22
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Martín N, Valero R, Hurtado P, Gracia I, Fernández C, Rumià J, Valldeoriola F, Carrero EJ, Tercero FJ, de Riva N, Fàbregas N. Experience with “Fast track” postoperative care after deep brain stimulation surgery. Neurocirugia (Astur) 2016; 27:263-268. [DOI: 10.1016/j.neucir.2016.02.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/15/2016] [Accepted: 02/16/2016] [Indexed: 12/11/2022]
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23
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24
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Sharma M, Deogaonkar M. Accuracy and safety of targeting using intraoperative “O-arm” during placement of deep brain stimulation electrodes without electrophysiological recordings. J Clin Neurosci 2016; 27:80-6. [DOI: 10.1016/j.jocn.2015.06.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/16/2015] [Accepted: 06/20/2015] [Indexed: 10/22/2022]
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25
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Standing Up for Learning: A Pilot Investigation on the Neurocognitive Benefits of Stand-Biased School Desks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010059. [PMID: 26703700 PMCID: PMC4730450 DOI: 10.3390/ijerph13010059] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 11/24/2015] [Accepted: 12/17/2015] [Indexed: 11/17/2022]
Abstract
Standing desks have proven to be effective and viable solutions to combat sedentary behavior among children during the school day in studies around the world. However, little is known regarding the potential of such interventions on cognitive outcomes in children over time. The purpose of this pilot study was to determine the neurocognitive benefits, i.e., improvements in executive functioning and working memory, of stand-biased desks and explore any associated changes in frontal brain function. 34 freshman high school students were recruited for neurocognitive testing at two time points during the school year: (1) in the fall semester and (2) in the spring semester (after 27.57 (1.63) weeks of continued exposure). Executive function and working memory was evaluated using a computerized neurocognitive test battery, and brain activation patterns of the prefrontal cortex were obtained using functional near infrared spectroscopy. Continued utilization of the stand-biased desks was associated with significant improvements in executive function and working memory capabilities. Changes in corresponding brain activation patterns were also observed. These findings provide the first preliminary evidence on the neurocognitive benefits of standing desks, which to date have focused largely on energy expenditure. Findings obtained here can drive future research with larger samples and multiple schools, with comparison groups that may in turn implicate the importance of stand-biased desks, as simple environmental changes in classrooms, on enhancing children’s cognitive functioning that drive their cognitive development and impact educational outcomes.
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26
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Pessoa BL, Escudeiro G, Nascimento OJM. Emerging Treatments for Neuropathic Pain. Curr Pain Headache Rep 2015; 19:56. [DOI: 10.1007/s11916-015-0530-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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27
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Boccard SGJ, Pereira EAC, Aziz TZ. Deep brain stimulation for chronic pain. J Clin Neurosci 2015; 22:1537-43. [PMID: 26122383 DOI: 10.1016/j.jocn.2015.04.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/11/2015] [Indexed: 11/29/2022]
Abstract
Deep brain stimulation (DBS) is a neurosurgical intervention popularised in movement disorders such as Parkinson's disease, and also reported to improve symptoms of epilepsy, Tourette's syndrome, obsessive compulsive disorders and cluster headache. Since the 1950s, DBS has been used as a treatment to relieve intractable pain of several aetiologies including post stroke pain, phantom limb pain, facial pain and brachial plexus avulsion. Several patient series have shown benefits in stimulating various brain areas, including the sensory thalamus (ventral posterior lateral and medial), the periaqueductal and periventricular grey, or, more recently, the anterior cingulate cortex. However, this technique remains "off label" in the USA as it does not have Federal Drug Administration approval. Consequently, only a small number of surgeons report DBS for pain using current technology and techniques and few regions approve it. Randomised, blinded and controlled clinical trials that may use novel trial methodologies are desirable to evaluate the efficacy of DBS in patients who are refractory to other therapies. New imaging techniques, including tractography, may help optimise electrode placement and clinical outcome.
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Affiliation(s)
- Sandra G J Boccard
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.
| | - Erlick A C Pereira
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
| | - Tipu Z Aziz
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, Level 6, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK
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28
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O'Callaghan EL, McBryde FD, Burchell AE, Ratcliffe LEK, Nicolae L, Gillbe I, Carr D, Hart EC, Nightingale AK, Patel NK, Paton JFR. Deep brain stimulation for the treatment of resistant hypertension. Curr Hypertens Rep 2015; 16:493. [PMID: 25236853 DOI: 10.1007/s11906-014-0493-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Hypertension is a leading risk factor for the development of several cardiovascular diseases. As the global prevalence of hypertension increases, so too has the recognition of resistant hypertension. Whilst figures vary, the proportion of hypertensive patients that are resistant to multiple drug therapies have been reported to be as high as 16.4 %. Resistant hypertension is typically associated with elevated sympathetic activity and abnormal homeostatic reflex control and is termed neurogenic hypertension because of its presumed central autonomic nervous system origin. This resistance to conventional pharmacological treatment has stimulated a plethora of medical devices to be investigated for use in hypertension, with varying degrees of success. In this review, we discuss a new therapy for drug-resistant hypertension, deep brain stimulation. The utility of deep brain stimulation in resistant hypertension was first discovered in patients with concurrent neuropathic pain, where it lowered blood pressure and improved baroreflex sensitivity. The most promising central target for stimulation is the ventrolateral periaqueductal gray, which has been well characterised in animal studies as a control centre for autonomic outflow. In this review, we will discuss the promise and potential mechanisms of deep brain stimulation in the treatment of severe, resistant hypertension.
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Affiliation(s)
- Erin L O'Callaghan
- School of Physiology & Pharmacology, University of Bristol, Bristol, BS8 1TD, UK
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29
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Kalakoti P, Ahmed O, Bollam P, Missios S, Wilden J, Nanda A. Predictors of unfavorable outcomes following deep brain stimulation for movement disorders and the effect of hospital case volume on outcomes: an analysis of 33, 642 patients across 234 US hospitals using the National (Nationwide) Inpatient Sample from 2002 to 2011. Neurosurg Focus 2015; 38:E4. [DOI: 10.3171/2015.3.focus1547] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT
With limited data available on association of risk factors and effect of hospital case volume on outcomes following deep brain stimulation (DBS), the authors attempted to identify these associations using a large population-based database.
METHODS
The authors performed a retrospective cohort study involving patients who underwent DBS for 3 primary movement disorders: Parkinson’s disease, essential tremor, and dystonia from 2002 to 2011 using the National (Nationwide) Inpatient Sample (NIS) database. Using national estimates, the authors identified associations of patient demographics, clinical characteristics, and hospital characteristics on short-term postoperative outcomes following DBS. Additionally, effect of hospital volume on unfavorable outcomes was investigated.
RESULTS
Overall, 33, 642 patients underwent DBS for 3 primary movement disorders across 234 hospitals in the US. The mean age of the cohort was 63.42 ± 11.31 years and 36% of patients were female. The inpatients’ postoperative risks were 5.9% for unfavorable discharge, 10.2% for prolonged length of stay, 14.6% for high-end hospital charges, 0.5% for wound complications, 0.4% for cardiac complications, 1.8% for venous thromboembolism, and 5.5% for neurological complications, including those arising from an implanted nervous system device. Compared with low-volume centers, odds of having an unfavorable discharge, prolonged LOS, high-end hospital charges, wound, and cardiac complications were significantly lower in the high-volume and medium-volume centers.
CONCLUSIONS
The authors’ study provides individualized estimates of the risks of postoperative complications based on patient demographics and comorbidities and hospital characteristics, which could potentially be used as an adjunct for risk stratification for patients undergoing DBS.
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30
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Sharma M, Deogaonkar M, Rezai A. Assessment of potential targets for deep brain stimulation in patients with Alzheimer's disease. J Clin Med Res 2015; 7:501-5. [PMID: 26015813 PMCID: PMC4432890 DOI: 10.14740/jocmr2127w] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/18/2022] Open
Abstract
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder affecting 36 million people worldwide and 5.2 million in the United States. The pathogenesis of AD is still elusive. Accumulations of abnormal proteins (beta amyloid and tau protein), inflammatory cascades, abnormal responses to oxidative stress and alteration in oxidative metabolism have been implicated in AD. There are few effective therapeutic options available for this disorder at present. Neuromodulation offers a novel treatment modality for patients with AD. The databases of Medline and PubMed were searched for various studies in English literature describing the deep brain stimulation (DBS) in patients with AD. Various animal and human clinical studies have shown promising initial results with bilateral DBS targeting various anatomical nodes. In this review, we attempt to highlight the pathophysiology, neural circuitry and potential neuromodulation options in patients with AD. In appropriately selected patients, DBS can potentially delay the cognitive decline, enhance memory functions and can improve the overall quality of life. However, further randomized controlled trials are required to validate the efficacy of neuromodulation and to determine the most optimal target for AD.
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Affiliation(s)
- Mayur Sharma
- Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Milind Deogaonkar
- Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Ali Rezai
- Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
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31
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Minks DP, Pereira EAC, Young VEL, Hogarth KM, Quaghebeur G. Role of radiology in central nervous system stimulation. Br J Radiol 2015; 88:20140507. [PMID: 25715044 PMCID: PMC4651263 DOI: 10.1259/bjr.20140507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 02/10/2015] [Accepted: 02/23/2015] [Indexed: 11/05/2022] Open
Abstract
Central nervous system (CNS) stimulation is becoming increasingly prevalent. Deep brain stimulation (DBS) has been proven to be an invaluable treatment for movement disorders and is also useful in many other neurological conditions refractory to medical treatment, such as chronic pain and epilepsy. Neuroimaging plays an important role in operative planning, target localization and post-operative follow-up. The use of imaging in determining the underlying mechanisms of DBS is increasing, and the dependence on imaging is likely to expand as deep brain targeting becomes more refined. This article will address the expanding role of radiology and highlight issues, including MRI safety concerns, that radiologists may encounter when confronted with a patient with CNS stimulation equipment in situ.
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Affiliation(s)
- D P Minks
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - E A C Pereira
- Department of Neurosurgery, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - V E L Young
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - K M Hogarth
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - G Quaghebeur
- Department of Neuroradiology, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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32
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Hyam JA, Pereira EAC, McCulloch P, Javed S, Plaha P, Mooney L, Forrow BA, Joint C, Whone A, Gill S, Glasziou P, Aziz TZ, Green AL. Implementing novel trial methods to evaluate surgery for essential tremor. Br J Neurosurg 2015; 29:334-9. [DOI: 10.3109/02688697.2014.997670] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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33
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Chakrabarti R, Ghazanwy M, Tewari A. Anesthetic challenges for deep brain stimulation: a systematic approach. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:359-69. [PMID: 25210668 PMCID: PMC4158643 DOI: 10.4103/1947-2714.139281] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ablative intracranial surgery for Parkinson's disease has advanced to embedding electrodes into precise areas of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred in view of its reversibility, adjustability, and capability to be safely performed bilaterally. DBS is been increasingly used for other movement disorders, intractable tremors epilepsy, and sometimes chronic pain. Anesthesiologists need to amalgamate the knowledge of neuroanatomical structures and surgical techniques involved in placement of microelectrodes in defined cerebral target areas. Perioperative verbal communication with the patient during the procedure is quintessential and may attenuate the need for pharmacological agents. This review will endeavor to assimilate the present knowledge regarding the patient selection, available/practiced anesthesia regimens, and perioperative complications after our thorough search for literature published between 1991 and 2013.
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Affiliation(s)
| | - Mahmood Ghazanwy
- Department of Neuroanaesthesia, Cleveland Clinic Foundation, Ohio, USA
| | - Anurag Tewari
- Department of Neuroanaesthesia, Cleveland Clinic Foundation, Ohio, USA
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Feng X, Liu C, Guo Q, Bai Y, Ren Y, Ren B, Bai J, Chen L. Research progress in rehabilitation treatment of stroke patients: A bibliometric analysis. Neural Regen Res 2014; 8:1423-30. [PMID: 25206438 PMCID: PMC4107764 DOI: 10.3969/j.issn.1673-5374.2013.15.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 04/20/2013] [Indexed: 12/17/2022] Open
Abstract
Background: Stroke presents as a transient or chronic brain dysfunction and is associated with high morbidity and high mortality. The doctors and scientists would like to argue how to enhance the validity of the rehabilitation treatment and how to further improve the level of treatment on stroke. Objective: The aim of this study was to quantitatively analyze the current worldwide progress in research on stroke rehabilitation treatment based on Web of Science database and ClinicalTrial.gov in the past 10 years. Methods: We conducted a quantitative analysis of clinical trial articles regarding stroke rehabilitation published in English from 2003 to 2013 and indexed in the National Institutes of Health Clinical Trials registry and Web of Science databases. Data were downloaded on March 15, 2013. Results: (1) From 2003 to 2013, 2 654 clinical trials investigating stroke were indexed in ClinicalTrials.gov. There were only 58 clinical trials registered in 2003, and there was a marked increase from 2005. A total of 605 clinical trials on the rehabilitation of stroke were conducted in the past 10 years. (2) The analysis showed that most of the trials in the field were registered by North American institutions. With respect to the Asian countries, China and Taiwan area of China also published a reasonable proportion of the trials, but comparatively speaking, the number of trials is really rare. Most of the interventions were drugs, followed by the devices, and behavioral interventions were ranked third. (3) In the past 10 years, there were 4 052 studies on stroke indexed by Web of Science database. Conclusion: From perspective of research progress, we found that the number of clinical trials and papers on stroke rehabilitation has increased significantly in the past 10 years, between them a remarkable positive correlation exists.
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Affiliation(s)
- Xiaodong Feng
- Rehabilitation Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450004, Henan Province, China
| | - Chengmei Liu
- Rehabilitation Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450004, Henan Province, China
| | - Qingchuan Guo
- Rehabilitation Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450004, Henan Province, China
| | - Yanjie Bai
- Rehabilitation Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450004, Henan Province, China
| | - Yafeng Ren
- Rehabilitation Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450004, Henan Province, China
| | - Binbin Ren
- Rehabilitation Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450004, Henan Province, China
| | - Junmin Bai
- Rehabilitation Center, the First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Zhengzhou 450004, Henan Province, China
| | - Lidian Chen
- Fujian University of Traditional Chinese Medicine, Fuzhou 350122, Fujian Province, China
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Angotzi GN, Boi F, Zordan S, Bonfanti A, Vato A. A programmable closed-loop recording and stimulating wireless system for behaving small laboratory animals. Sci Rep 2014; 4:5963. [PMID: 25096831 PMCID: PMC4123143 DOI: 10.1038/srep05963] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 07/10/2014] [Indexed: 11/08/2022] Open
Abstract
A portable 16-channels microcontroller-based wireless system for a bi-directional interaction with the central nervous system is presented in this work. The device is designed to be used with freely behaving small laboratory animals and allows recording of spontaneous and evoked neural activity wirelessly transmitted and stored on a personal computer. Biphasic current stimuli with programmable duration, frequency and amplitude may be triggered in real-time on the basis of the recorded neural activity as well as by the animal behavior within a specifically designed experimental setup. An intuitive graphical user interface was developed to configure and to monitor the whole system. The system was successfully tested through bench tests and in vivo measurements on behaving rats chronically implanted with multi-channels microwire arrays.
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Affiliation(s)
- Gian Nicola Angotzi
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia, Genova, Italy
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Fabio Boi
- Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Stefano Zordan
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
| | - Andrea Bonfanti
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Italy
| | - Alessandro Vato
- Center for Neuroscience and Cognitive Systems @UniTn, Istituto Italiano di Tecnologia, Rovereto, Italy
- Department of Robotics, Brain and Cognitive Sciences, Istituto Italiano di Tecnologia, Genova, Italy
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Abstract
Deep brain stimulation (DBS) is a neurosurgical intervention the efficacy, safety, and utility of which are established in the treatment of Parkinson's disease. For the treatment of chronic, neuropathic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated with current standards of neuroimaging and stimulator technology over the last decade . We summarize the history, science, selection, assessment, surgery, programming, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and latterly rostral anterior cingulate cortex (Cg24) in 113 patients treated at 2 centers (John Radcliffe, Oxford, UK, and Hospital de São João, Porto, Portugal) over 13 years. Several experienced centers continue DBS for chronic pain, with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS under general anesthesia considered for whole or hemibody pain, or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.
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Affiliation(s)
- Erlick A C Pereira
- Oxford Functional Neurosurgery and Experimental Neurology Group, Department of Neurological Surgery and Nuffield Department of Surgical Sciences, Oxford University, John Radcliffe Hospital, Oxford, OX3 9DU, UK,
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Pereira EAC, Boccard SG, Linhares P, Chamadoira C, Rosas MJ, Abreu P, Rebelo V, Vaz R, Aziz TZ. Thalamic deep brain stimulation for neuropathic pain after amputation or brachial plexus avulsion. Neurosurg Focus 2014; 35:E7. [PMID: 23991820 DOI: 10.3171/2013.7.focus1346] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Fifteen hundred patients have received deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy over the last half-century, but few during the last decade. Deep brain stimulation for neuropathic pain has shown variable outcomes and gained consensus approval in Europe but not the US. This study prospectively evaluated the efficacy at 1 year of DBS for phantom limb pain after amputation, and deafferentation pain after brachial plexus avulsion (BPA), in a single-center case series. METHODS Patient-reported outcome measures were collated before and after surgery, using a visual analog scale (VAS) score, 36-Item Short-Form Health Survey (SF-36), Brief Pain Inventory (BPI), and University of Washington Neuropathic Pain Score (UWNPS). RESULTS Twelve patients were treated over 29 months, receiving contralateral, ventroposterolateral sensory thalamic DBS. Five patients were amputees and 7 had BPAs, all from traumas. A postoperative trial of externalized DBS failed in 1 patient with BPA. Eleven patients proceeded to implantation and gained improvement in pain scores at 12 months. No surgical complications or stimulation side effects were noted. In the amputation group, after 12 months the mean VAS score improved by 90.0% ± 10.0% (p = 0.001), SF-36 by 57.5% ± 97.9% (p = 0.127), UWNPS by 80.4% ± 12.7% (p < 0.001), and BPI by 79.9% ± 14.7% (p < 0.001). In the BPA group, after 12 months the mean VAS score improved by 52.7% ± 30.2% (p < 0.001), SF-36 by 15.6% ± 30.5% (p = 1.000), UWNPS by 26.2% ± 40.8% (p = 0.399), and BPI by 38.4% ± 41.7% (p = 0.018). Mean DBS parameters were 2.5 V, 213 microseconds, and 25 Hz. CONCLUSIONS Deep brain stimulation demonstrated efficacy at 1 year for chronic neuropathic pain after traumatic amputation and BPA. Clinical trials that retain patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.
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Affiliation(s)
- Erlick A C Pereira
- Department of Neurosurgery and Nuffield Department of Surgery, Oxford University Hospitals, Oxford, United Kingdom.
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Abstract
Deep brain stimulation (DBS) is a commonly used neurosurgical form of therapeutic brain stimulation that has been demonstrated to be safe, well tolerated, and effective for the treatment of essential tremor, Parkinson's disease, and primary dystonia. These particular uses have been approved by the U.S. Food and Drug Administration (FDA). Investigational studies using DBS have been conducted for refractory epilepsy, obesity, chronic pain, tardive dyskinesia, Tourette syndrome, and other movement disorders, but none of these studies has led to FDA approval for these indications. Although the use of DBS has been approved by the FDA under a Humanitarian Device Exemption for the treatment of treatment-resistant obsessive-compulsive disorder, studies systematically investigating the potential use of DBS for various severe chronic psychiatric disorders are in their earliest stages, and further studies are warranted.
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Seemann M, Zech N, Lange M, Hansen J, Hansen E. [Anesthesiological aspects of deep brain stimulation : special features of implementation and dealing with brain pacemaker carriers]. Anaesthesist 2014; 62:549-56. [PMID: 23817843 DOI: 10.1007/s00101-013-2201-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Deep brain stimulation (DBS) provides a very effective treatment for a number of neurological diseases including Parkinson's disease, movement disorders and epilepsy. In DBS microelectrodes are positioned in defined cerebral target areas and connected to a pacemaker. It is most often performed as an awake craniotomy with intraoperative testing. Various anesthesiological regimes are used to protect the patient from surgical stress on the one hand and to achieve ideal test conditions on the other. They include local anesthesia or scalp blocks, intermittent general anesthesia or analgosedation with or without airway protection; however, anesthetic agents interfere with hemodynamic stability and ventilation, with vigilance and cooperation and in addition with the symptoms and microelectrode recording. Guidance and communication have a pivotal impact on patient needs for pharmacological interventions. With increasing numbers of DBS procedures, anesthesiologists are more often faced with patients carrying brain pacemakers. For anesthesia the characteristics of the disease as well as the respective long-term medication have to be considered. In addition, the rules for handling patients with pacemakers need to be followed to avoid both dysfunction of the generator and tissue damage due to overheating of the electrodes.
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Affiliation(s)
- M Seemann
- Klinik für Anästhesiologie, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland
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Hyam JA, Aziz TZ, Green AL. Control of the lungs via the human brain using neurosurgery. PROGRESS IN BRAIN RESEARCH 2014; 209:341-66. [PMID: 24746057 DOI: 10.1016/b978-0-444-63274-6.00018-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Neurosurgery can alter cardiorespiratory performance via central networks and includes deep brain stimulation (DBS), a routinely employed therapy for movement disorders and chronic pain syndromes. We review the established cardiovascular effects of DBS and the presumed mechanism by which they are produced via the central autonomic network. We then review the respiratory effects of DBS, including modulation of respiratory rate and lung function indices, and the mechanisms via which these may occur. We conclude by highlighting the potential future therapeutic applications of DBS for intractable airway diseases.
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Affiliation(s)
- Jonathan A Hyam
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
| | - Tipu Z Aziz
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alexander L Green
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK; Department of Physiology, Anatomy & Genetics, University of Oxford, Oxford, UK; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Heman-Ackah SM, Hallegger M, Rao MS, Wood MJA. RISC in PD: the impact of microRNAs in Parkinson's disease cellular and molecular pathogenesis. Front Mol Neurosci 2013; 6:40. [PMID: 24312000 PMCID: PMC3834244 DOI: 10.3389/fnmol.2013.00040] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/31/2013] [Indexed: 12/19/2022] Open
Abstract
Parkinson's disease (PD) is a debilitating neurodegenerative disease characterized primarily by the selective death of dopaminergic (DA) neurons in the substantia nigra pars compacta of the midbrain. Although several genetic forms of PD have been identified, the precise molecular mechanisms underlying DA neuron loss in PD remain elusive. In recent years, microRNAs (miRNAs) have been recognized as potent post-transcriptional regulators of gene expression with fundamental roles in numerous biological processes. Although their role in PD pathogenesis is still a very active area of investigation, several seminal studies have contributed significantly to our understanding of the roles these small non-coding RNAs play in the disease process. Among these are studies which have demonstrated specific miRNAs that target and down-regulate the expression of PD-related genes as well as those demonstrating a reciprocal relationship in which PD-related genes act to regulate miRNA processing machinery. Concurrently, a wealth of knowledge has become available regarding the molecular mechanisms that unify the underlying etiology of genetic and sporadic PD pathogenesis, including dysregulated protein quality control by the ubiquitin-proteasome system and autophagy pathway, activation of programmed cell death, mitochondrial damage and aberrant DA neurodevelopment and maintenance. Following a discussion of the interactions between PD-related genes and miRNAs, this review highlights those studies which have elucidated the roles of these pathways in PD pathogenesis. We highlight the potential of miRNAs to serve a critical regulatory role in the implicated disease pathways, given their capacity to modulate the expression of entire families of related genes. Although few studies have directly linked miRNA regulation of these pathways to PD, a strong foundation for investigation has been laid and this area holds promise to reveal novel therapeutic targets for PD.
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Affiliation(s)
- Sabrina M Heman-Ackah
- Department of Physiology, Anatomy and Genetics, University of Oxford Oxford, UK ; Center for Regenerative Medicine, US National Institutes of Health Bethesda, MD, USA
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Stidd DA, Vogelsang K, Krahl SE, Langevin JP, Fellous JM. Amygdala Deep Brain Stimulation Is Superior to Paroxetine Treatment in a Rat Model of Posttraumatic Stress Disorder. Brain Stimul 2013; 6:837-44. [DOI: 10.1016/j.brs.2013.05.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2012] [Revised: 05/21/2013] [Accepted: 05/30/2013] [Indexed: 11/16/2022] Open
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Sharma M, Ambekar S, Guthikonda B, Wilden J, Nanda A. Regional trends and the impact of various patient and hospital factors on outcomes and costs of hospitalization between academic and nonacademic centers after deep brain stimulation surgery for Parkinson's disease: a United States Nationwide Inpatient Sample analysis from 2006 to 2010. Neurosurg Focus 2013; 35:E2. [DOI: 10.3171/2013.8.focus13295] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The aim of this study was to analyze the incidence of adverse outcomes, complications, inpatient mortality, length of hospital stay, and the factors affecting them between academic and nonacademic centers after deep brain stimulation (DBS) surgery for Parkinson's disease (PD). The authors also analyzed the impact of various factors on the total hospitalization charges after this procedure.
Methods
This is a retrospective cohort study using the Nationwide Inpatient Sample (NIS) from 2006 to 2010. Various patient and hospital variables were analyzed from the database. The adverse discharge disposition and the higher cost of hospitalization were taken as the dependent variables.
Results
A total of 2244 patients who underwent surgical treatment for PD were identified from the database. The mean age was 64.22 ± 9.8 years and 68.7% (n = 1523) of the patients were male. The majority of the patients was discharged to home or self-care (87.9%, n = 1972). The majority of the procedures was performed at high-volume centers (64.8%, n = 1453), at academic institutions (85.33%, n = 1915), in urban areas (n = 2158, 96.16%), and at hospitals with a large bedsize (86.6%, n = 1907) in the West or South. Adverse discharge disposition was more likely in elderly patients (OR > 1, p = 0.011) with high comorbidity index (OR 1.508 [95% CI 1.148–1.98], p = 0.004) and those with complications (OR 3.155 [95% CI 1.202–8.279], p = 0.033). A hospital with a larger annual caseload was an independent predictor of adverse discharge disposition (OR 3.543 [95% CI 1.781–7.048], p < 0.001), whereas patients treated by physicians with high case volumes had significantly better outcomes (p = 0.006). The median total cost of hospitalization had increased by 6% from 2006 through 2010. Hospitals with a smaller case volume (OR 0.093, p < 0.001), private hospitals (OR 11.027, p < 0.001), nonteaching hospitals (OR 3.139, p = 0.003), and hospitals in the West compared with hospitals in Northeast and the Midwest (OR 1.885 [p = 0.033] and OR 2.897 [p = 0.031], respectively) were independent predictors of higher hospital cost. The mean length of hospital stay decreased from 2.03 days in 2006 to 1.55 days in 2010. There was no difference in the discharge disposition among academic versus nonacademic centers and rural versus urban hospitals (p > 0.05).
Conclusions
Elderly female patients with nonprivate insurance and high comorbidity index who underwent surgery at low-volume centers performed by a surgeon with a low annual case volume and the occurrence of postoperative complications were correlated with an adverse discharge disposition. High-volume, government-owned academic centers in the Northeast were associated with a lower cost incurred to the hospitals. It can be recommended that the widespread availability of this procedure across small, academic centers in rural areas may not only provide easier access to the patients but also reduces the total cost of hospitalization.
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Boccard SGJ, Pereira EAC, Moir L, Aziz TZ, Green AL. Long-term outcomes of deep brain stimulation for neuropathic pain. Neurosurgery 2013; 72:221-30; discussion 231. [PMID: 23149975 DOI: 10.1227/neu.0b013e31827b97d6] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy has reported variable outcomes and has gained United Kingdom but not USA regulatory approval. OBJECTIVE To prospectively assess long-term efficacy of DBS for chronic neuropathic pain in a single-center case series. METHODS Patient reported outcome measures were collated before and after surgery, using a visual analog score, short-form 36-question quality-of-life survey, McGill pain questionnaire, and EuroQol-5D questionnaires (EQ-5D and health state). RESULTS One hundred ninety-seven patients were referred over 12 years, of whom 85 received DBS for various etiologies: 9 amputees, 7 brachial plexus injuries, 31 after stroke, 13 with spinal pathology, 15 with head and face pain, and 10 miscellaneous. Mean age at surgery was 52 years, and mean follow-up was 19.6 months. Contralateral DBS targeted the periventricular gray area (n = 33), the ventral posterior nuclei of the thalamus (n = 15), or both targets (n = 37). Almost 70% (69.4%) of patients retained implants 6 months after surgery. Thirty-nine of 59 (66%) of those implanted gained benefit and efficacy varied by etiology, improving outcomes in 89% after amputation and 70% after stroke. In this cohort, >30% improvements sustained in visual analog score, McGill pain questionnaire, short-form 36-question quality-of-life survey, and EuroQol-5D questionnaire were observed in 15 patients with >42 months of follow-up, with several outcome measures improving from those assessed at 1 year. CONCLUSION DBS for pain has long-term efficacy for select etiologies. Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.
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Affiliation(s)
- Sandra G J Boccard
- Department of Physiology, Anatomy and Genetics, University of Oxford, United Kingdom.
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Pereira EAC, Wang S, Owen SLF, Aziz TZ, Green AL. Human periventricular grey somatosensory evoked potentials suggest rostrocaudally inverted somatotopy. Stereotact Funct Neurosurg 2013; 91:290-7. [PMID: 23797328 DOI: 10.1159/000348324] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 01/20/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Somatosensory homunculi have been demonstrated in primary somatosensory cortex and ventral posterior thalamus but not periaqueductal and periventricular grey matter (PAVG), a therapeutic target for deep brain stimulation (DBS) in chronic pain. AIMS The study is an investigation of somatotopic representation in PAVG and assessment for a somatosensory homunculus. METHODS Five human subjects were investigated using electrical somatosensory stimulation and deep brain macroelectrode recording. DBS were implanted in the contralateral PAVG. Cutaneous arm, leg and face regions were stimulated while event-related potentials were recorded from deep brain electrodes. Electrode contact positions were mapped using MRI and brain atlas information. RESULTS Monopolar P1 somatosensory evoked potential amplitudes were highest and onset latencies shortest in contralateral caudal PAVG with facial stimulation and rostral with leg stimulation, in agreement with reported subjective sensation during intra-operative electrode advancement. CONCLUSIONS A rostrocaudally inverted somatosensory homunculus exists in the human PAVG region. Objective human evidence of PAVG somatotopy increases understanding of a brainstem region important to pain and autonomic control that is a clinical target for both pharmacological and neurosurgical therapies. Such knowledge may assist DBS target localisation for neuropathic pain syndromes related to particular body regions like brachial plexopathies, anaesthesia dolorosa and phantom limb pain.
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Affiliation(s)
- Erlick A C Pereira
- Oxford Functional Neurosurgery and Experimental Neurology Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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Abstract
Deep brain stimulation (DBS) is a neurosurgical intervention whose efficacy, safety, and utility have been shown in the treatment of movement disorders. For the treatment of chronic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated during the past decade using current standards of neuroimaging and stimulator technology. We summarize the history, science, selection, assessment, surgery, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and, latterly, the rostral anterior cingulate cortex (Cg24) in 100 patients treated now at two centers (John Radcliffe Hospital, Oxford, UK, and Hospital de São João, Porto, Portugal) over 12 years. Several experienced centers continue DBS for chronic pain with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS considered for whole-body pain or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials.
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Affiliation(s)
- Erlick A C Pereira
- Oxford Functional Neurosurgery and Experimental Neurology Group, Department of Neurological Surgery and Nuffield Department of Surgical Sciences, Oxford University, John Radcliffe Hospital, Oxford, UK
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Pereira EA, Wang S, Peachey T, Lu G, Shlugman D, Stein JF, Aziz TZ, Green AL. Elevated gamma band power in humans receiving naloxone suggests dorsal periaqueductal and periventricular gray deep brain stimulation produced analgesia is opioid mediated. Exp Neurol 2013; 239:248-55. [DOI: 10.1016/j.expneurol.2012.10.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 10/03/2012] [Accepted: 10/24/2012] [Indexed: 11/29/2022]
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Sutton AC, Yu W, Calos ME, Mueller LE, Berk M, Shim J, Molho ES, Brotchie JM, Carlen PL, Shin DS. Elevated potassium provides an ionic mechanism for deep brain stimulation in the hemiparkinsonian rat. Eur J Neurosci 2012; 37:231-41. [PMID: 23121286 DOI: 10.1111/ejn.12040] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 09/02/2012] [Accepted: 09/05/2012] [Indexed: 11/30/2022]
Abstract
The mechanism of high-frequency stimulation used in deep brain stimulation (DBS) for Parkinson's disease (PD) has not been completely elucidated. Previously, high-frequency stimulation of the rat entopeduncular nucleus, a basal ganglia output nucleus, elicited an increase in [K(+)](e) to 18 mm, in vitro. In this study, we assessed whether elevated K(+) can elicit DBS-like therapeutic effects in hemiparkinsonian rats by employing the limb-use asymmetry test and the self-adjusting stepping test. We then identified how these effects were meditated with in-vivo and in-vitro electrophysiology. Forelimb akinesia improved in hemiparkinsonian rats undergoing both tests after 20 mm KCl injection into the substantia nigra pars reticulata (SNr) or the subthalamic nucleus. In the SNr, neuronal spiking activity decreased from 38.2 ± 1.2 to 14.6 ± 1.6 Hz and attenuated SNr beta-frequency (12-30 Hz) oscillations after K(+) treatment. These oscillations are commonly associated with akinesia/bradykinesia in patients with PD and animal models of PD. Pressure ejection of 20 mm KCl onto SNr neurons in vitro caused a depolarisation block and sustained quiescence of SNr activity. In conclusion, our data showed that elevated K(+) injection into the hemiparkinsonian rat SNr improved forelimb akinesia, which coincided with a decrease in SNr neuronal spiking activity and desynchronised activity in SNr beta frequency, and subsequently an overall increase in ventral medial thalamic neuronal activity. Moreover, these findings also suggest that elevated K(+) may provide an ionic mechanism that can contribute to the therapeutic effects of DBS for the motor treatment of advanced PD.
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Affiliation(s)
- Alexander C Sutton
- Center for Neuropharmacology and Neuroscience, Albany Medical College, 47 New Scotland Avenue, Albany, NY 12208, USA
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