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Vogel D, Nordin T, Feiler S, Wårdell K, Coste J, Lemaire JJ, Hemm S. Probabilistic stimulation mapping from intra-operative thalamic deep brain stimulation data in essential tremor. J Neural Eng 2024; 21:036017. [PMID: 38701768 DOI: 10.1088/1741-2552/ad4742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/03/2024] [Indexed: 05/05/2024]
Abstract
Deep brain stimulation (DBS) is a therapy for Parkinson's disease (PD) and essential tremor (ET). The mechanism of action of DBS is still incompletely understood. Retrospective group analysis of intra-operative data recorded from ET patients implanted in the ventral intermediate nucleus of the thalamus (Vim) is rare. Intra-operative stimulation tests generate rich data and their use in group analysis has not yet been explored.Objective.To implement, evaluate, and apply a group analysis workflow to generate probabilistic stimulation maps (PSMs) using intra-operative stimulation data from ET patients implanted in Vim.Approach.A group-specific anatomical template was constructed based on the magnetic resonance imaging scans of 6 ET patients and 13 PD patients. Intra-operative test data (total:n= 1821) from the 6 ET patients was analyzed: patient-specific electric field simulations together with tremor assessments obtained by a wrist-based acceleration sensor were transferred to this template. Occurrence and weighted mean maps were generated. Voxels associated with symptomatic response were identified through a linear mixed model approach to form a PSM. Improvements predicted by the PSM were compared to those clinically assessed. Finally, the PSM clusters were compared to those obtained in a multicenter study using data from chronic stimulation effects in ET.Main results.Regions responsible for improvement identified on the PSM were in the posterior sub-thalamic area (PSA) and at the border between the Vim and ventro-oral nucleus of the thalamus (VO). The comparison with literature revealed a center-to-center distance of less than 5 mm and an overlap score (Dice) of 0.4 between the significant clusters. Our workflow and intra-operative test data from 6 ET-Vim patients identified effective stimulation areas in PSA and around Vim and VO, affirming existing medical literature.Significance.This study supports the potential of probabilistic analysis of intra-operative stimulation test data to reveal DBS's action mechanisms and to assist surgical planning.
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Affiliation(s)
- Dorian Vogel
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, Muttenz, Switzerland
| | - Teresa Nordin
- Department of Biomedical Engineering, Linköping University, Campus US, Linköping, Sweden
| | - Stefanie Feiler
- Dynamics and statistics of complex systems, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, Muttenz, Switzerland
| | - Karin Wårdell
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, Muttenz, Switzerland
- Department of Biomedical Engineering, Linköping University, Campus US, Linköping, Sweden
| | - Jérôme Coste
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
- Service de Neurochirurgie, Hôpital Gabriel-Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand, France
| | - Jean-Jacques Lemaire
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
- Service de Neurochirurgie, Hôpital Gabriel-Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, Clermont-Ferrand, France
| | - Simone Hemm
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, Muttenz, Switzerland
- Department of Biomedical Engineering, Linköping University, Campus US, Linköping, Sweden
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2
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Cavallieri F, Mulroy E, Moro E. The history of deep brain stimulation. Parkinsonism Relat Disord 2024; 121:105980. [PMID: 38161106 DOI: 10.1016/j.parkreldis.2023.105980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
Deep brain stimulation (DBS) surgery is an established and effective treatment for several movement disorders (tremor, Parkinson's disease, and dystonia), and is under investigation in numerous other neurological and psychiatric disorders. However, the origins and development of this neurofunctional technique are not always well understood and recognized. In this mini-review, we review the history of DBS, highlighting important milestones and the most remarkable protagonists (neurosurgeons, neurologists, and neurophysiologists) who pioneered and fostered this therapy throughout the 20th and early 21st century. Alongside DBS historical markers, we also briefly discuss newer developments in the field, and the future challenges which accompany such progress.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Eoin Mulroy
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, Centre Hospitalier Universitaire de Grenoble, Grenoble Institute of Neuroscience, INSERM U1216, Grenoble, France.
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3
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Moslehi S, Rowland C, Smith JH, Watterson WJ, Griffiths W, Montgomery RD, Philliber S, Marlow CA, Perez MT, Taylor RP. Fractal Electronics for Stimulating and Sensing Neural Networks: Enhanced Electrical, Optical, and Cell Interaction Properties. ADVANCES IN NEUROBIOLOGY 2024; 36:849-875. [PMID: 38468067 DOI: 10.1007/978-3-031-47606-8_43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Imagine a world in which damaged parts of the body - an arm, an eye, and ultimately a region of the brain - can be replaced by artificial implants capable of restoring or even enhancing human performance. The associated improvements in the quality of human life would revolutionize the medical world and produce sweeping changes across society. In this chapter, we discuss several approaches to the fabrication of fractal electronics designed to interface with neural networks. We consider two fundamental functions - stimulating electrical signals in the neural networks and sensing the location of the signals as they pass through the network. Using experiments and simulations, we discuss the favorable electrical performances that arise from adopting fractal rather than traditional Euclidean architectures. We also demonstrate how the fractal architecture induces favorable physical interactions with the cells they interact with, including the ability to direct the growth of neurons and glia to specific regions of the neural-electronic interface.
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Affiliation(s)
- S Moslehi
- Physics Department, University of Oregon, Eugene, OR, USA
| | - C Rowland
- Physics Department, University of Oregon, Eugene, OR, USA
| | - J H Smith
- Physics Department, University of Oregon, Eugene, OR, USA
| | - W J Watterson
- Physics Department, University of Oregon, Eugene, OR, USA
| | - W Griffiths
- Physics Department, University of Oregon, Eugene, OR, USA
| | - R D Montgomery
- Physics Department, University of Oregon, Eugene, OR, USA
| | - S Philliber
- Physics Department, University of Oregon, Eugene, OR, USA
| | - C A Marlow
- Physics Department, California Polytechnic State University, San Luis Obispo, CA, USA
| | - M-T Perez
- Department of Clinical Sciences Lund, Division of Ophthalmology, Lund University, Lund, Sweden
| | - R P Taylor
- Physics Department, University of Oregon, Eugene, OR, USA.
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Chen P, Cheng C, Yang X, Sha TT, Zou X, Zhang F, Jiang W, Xu Y, Cao X, You YM, Luo Z. Wireless Deep Brain Stimulation by Ultrasound-Responsive Molecular Piezoelectric Nanogenerators. ACS NANO 2023; 17:25625-25637. [PMID: 38096441 DOI: 10.1021/acsnano.3c10227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
Implantable neural stimulation devices are becoming prevalent in bioelectronic medicine for the precise treatment of various clinical diseases. Nevertheless, the limited lifespan and buckling size of the implanted devices remain significant obstacles for chronic clinical application. In this study, we developed an ultrasound-driven battery-free neurostimulator based on a high-performance mini-sized nanogenerator and demonstrated its successful application for the deep-brain-stimulation (DBS) therapy of Parkinson's disease in a rat model. This soft piezoelectric-triboelectric hybrid nanogenerators (PTNG) are made of porous thin-films of molecular piezoelectric materials, which have great advantages of facile, scalable, low-temperature, and flexible processing. Without any bucky accessory control circuits, the subcutaneously implanted soft PTNG can function as a wirelessly powered neurostimulator, allowing for the adjustment of stimulation parameters through external programmable ultrasound pulses. This DBS electroceutical application of energy-harvesting thin-film devices based on molecular piezoelectric materials provides valuable insight into the development of a soft high-performance bioelectronic device.
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Affiliation(s)
- Ping Chen
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Chi Cheng
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xiaomei Yang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tai-Ting Sha
- Ordered Matter Science Research Center, Southeast University, Nanjing, Jiangsu 211189, China
| | - Xianghui Zou
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Fuchi Zhang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Wei Jiang
- Department of Neurosurgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yan Xu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xuebing Cao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Yu-Meng You
- Ordered Matter Science Research Center, Southeast University, Nanjing, Jiangsu 211189, China
| | - Zhiqiang Luo
- National Engineering Research Center for Nanomedicine, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
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Grembecka B, Majkutewicz I, Harackiewicz O, Wrona D. Deep-Brain Subthalamic Nucleus Stimulation Enhances Food-Related Motivation by Influencing Neuroinflammation and Anxiety Levels in a Rat Model of Early-Stage Parkinson's Disease. Int J Mol Sci 2023; 24:16916. [PMID: 38069238 PMCID: PMC10706602 DOI: 10.3390/ijms242316916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
Deep-brain subthalamic nucleus stimulation (DBS-STN) has become a well-established therapeutic option for advanced Parkinson's disease (PD). While the motor benefits of DBS-STN are widely acknowledged, the neuropsychiatric effects are still being investigated. Beyond its immediate effects on neuronal circuits, emerging research suggests that DBS-STN might also modulate the peripheral inflammation and neuroinflammation. In this work, we assessed the effects of DBS-STN on food-related motivation, food intake pattern, and the level of anxiety and compared them with markers of cellular and immune activation in nigrostriatal and mesolimbic areas in rats with the 6-OHDA model of early PD. To evaluate the potential mechanism of observed effects, we also measured corticosterone concentration in plasma and leukocyte distribution in peripheral blood. We found that DBS-STN applied during neurodegeneration has beneficial effects on food intake pattern and motivation and reduces anxiety. These behavioral effects occur with reduced percentages of IL-6-labeled cells in the ventral tegmental area and substantia nigra pars compacta in the stimulated brain hemisphere. At the same brain structures, the cFos cell activations were confirmed. Simultaneously, the corticosterone plasma concentration was elevated, and the peripheral blood lymphocytes were reduced after DBS-STN. We believe that comprehending the relationship between the effects of DBS-STN on inflammation and its therapeutic results is essential for optimizing DBS therapy in PD.
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Affiliation(s)
- Beata Grembecka
- Department of Animal and Human Physiology, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, 80-308 Gdańsk, Poland; (I.M.); (O.H.); (D.W.)
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6
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Hariz M, Blomstedt Y, Blomstedt P, Hariz G. Anthropology of Deep Brain Stimulation; the 30th Anniversary of STN DBS in 2023. Mov Disord Clin Pract 2023; 10:1285-1292. [PMID: 37772285 PMCID: PMC10525058 DOI: 10.1002/mdc3.13858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 09/30/2023] Open
Abstract
Background The year 2023 marks the 30th anniversary of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD). This procedure prompted a universal interest in DBS for various brain disorders and resulted in a unique expansion of clinical and scientific collaboration between many disciplines, with impact on many aspects of society. Objective To study the anthropology of DBS, that is, its ethno-geographic origins, its evolution, its impact on clinicians and scientists, and its influence on society at large. Material and Methods The authors scrutinized the geo-ethnic origins of the pioneers of modern DBS, and they evaluated, based on the literature and on a long-term praxis, the development of DBS and its impact on clinicians, on healthcare, and on society. Results Scientists and clinicians from various geo-ethnic origins pioneered modern DBS, leading to worldwide spread of this procedure and to the establishment of large multidisciplinary teams in many centers. Neurologists became actively involved in surgery and took on new laborious tasks of programming ever more complicated DBS systems. Publications sky-rocketed and the global spread of DBS impacted positively on several aspects of society, including healthcare, awareness of neurological diseases, interdisciplinary relations, conferences, patient organizations, unemployment, industry, etc. Conclusions STN DBS has boosted the field of deep brain electrotherapy for many neurological and psychiatric illnesses, and DBS has generated a global benefit on many aspects of society, well beyond its clinical benefits on symptoms of diseases. With the ever-increasing indications for DBS, more positive global impact is expected.
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Affiliation(s)
- Marwan Hariz
- Department of Clinical NeuroscienceUmeå UniversityUmeåSweden
- UCL Institute of Neurology, Queen SquareLondonUnited Kingdom
| | | | | | - Gun‐Marie Hariz
- Department of Clinical NeuroscienceUmeå UniversityUmeåSweden
- Department of Community Medicine and RehabilitationUmeå UniversityUmeåSweden
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7
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Loh A, Boutet A, Germann J, Al-Fatly B, Elias GJB, Neudorfer C, Krotz J, Wong EHY, Parmar R, Gramer R, Paff M, Horn A, Chen JJ, Azevedo P, Fasano A, Munhoz RP, Hodaie M, Kalia SK, Kucharczyk W, Lozano AM. A Functional Connectome of Parkinson's Disease Patients Prior to Deep Brain Stimulation: A Tool for Disease-Specific Connectivity Analyses. Front Neurosci 2022; 16:804125. [PMID: 35812235 PMCID: PMC9263841 DOI: 10.3389/fnins.2022.804125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/26/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Aaron Loh
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Alexandre Boutet
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Jürgen Germann
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Bassam Al-Fatly
- Movement Disorders and Neuromodulation Unit, Department of Neurology With Experimental Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gavin J. B. Elias
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Clemens Neudorfer
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Jillian Krotz
- Baycrest Health Sciences, Rotman Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Emily H. Y. Wong
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Roohie Parmar
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Robert Gramer
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Michelle Paff
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology With Experimental Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - J. Jean Chen
- Baycrest Health Sciences, Rotman Research Institute, Toronto, ON, Canada
- Department of Medical Biophysics, University of Toronto, Toronto, ON, Canada
| | - Paula Azevedo
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Alfonso Fasano
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
- Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Renato P. Munhoz
- Division of Neurology, Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, University Health Network, Toronto, ON, Canada
| | - Mojgan Hodaie
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Suneil K. Kalia
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Walter Kucharczyk
- Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Andres M. Lozano
- Krembil Neuroscience Center, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
- *Correspondence: Andres M. Lozano
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8
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Loh A, Gwun D, Chow CT, Boutet A, Tasserie J, Germann J, Santyr B, Elias G, Yamamoto K, Sarica C, Vetkas A, Zemmar A, Madhavan R, Fasano A, Lozano AM. Probing responses to deep brain stimulation with functional magnetic resonance imaging. Brain Stimul 2022; 15:683-694. [PMID: 35447378 DOI: 10.1016/j.brs.2022.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an established treatment for certain movement disorders and has additionally shown promise for various psychiatric, cognitive, and seizure disorders. However, the mechanisms through which stimulation exerts therapeutic effects are incompletely understood. A technique that may help to address this knowledge gap is functional magnetic resonance imaging (fMRI). This is a non-invasive imaging tool which permits the observation of DBS effects in vivo. OBJECTIVE The objective of this review was to provide a comprehensive overview of studies in which fMRI during active DBS was performed, including studied disorders, stimulated brain regions, experimental designs, and the insights gleaned from stimulation-evoked fMRI responses. METHODS We conducted a systematic review of published human studies in which fMRI was performed during active stimulation in DBS patients. The search was conducted using PubMED and MEDLINE. RESULTS The rate of fMRI DBS studies is increasing over time, with 37 studies identified overall. The median number of DBS patients per study was 10 (range = 1-67, interquartile range = 11). Studies examined fMRI responses in various disease cohorts, including Parkinson's disease (24 studies), essential tremor (3 studies), epilepsy (3 studies), obsessive-compulsive disorder (2 studies), pain (2 studies), Tourette syndrome (1 study), major depressive disorder, anorexia, and bipolar disorder (1 study), and dementia with Lewy bodies (1 study). The most commonly stimulated brain region was the subthalamic nucleus (24 studies). Studies showed that DBS modulates large-scale brain networks, and that stimulation-evoked fMRI responses are related to the site of stimulation, stimulation parameters, patient characteristics, and therapeutic outcomes. Finally, a number of studies proposed fMRI-based biomarkers for DBS treatment, highlighting ways in which fMRI could be used to confirm circuit engagement and refine DBS therapy. CONCLUSION A review of the literature reflects an exciting and expanding field, showing that the combination of DBS and fMRI represents a uniquely powerful tool for simultaneously manipulating and observing neural circuitry. Future work should focus on relatively understudied disease cohorts and stimulated regions, while focusing on the prospective validation of putative fMRI-based biomarkers.
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Affiliation(s)
- Aaron Loh
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - David Gwun
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Jordy Tasserie
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Brendan Santyr
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Gavin Elias
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Kazuaki Yamamoto
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Can Sarica
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Artur Vetkas
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Department of Neurosurgery, Tartu University Hospital, University of Tartu, Tartu, Estonia
| | - Ajmal Zemmar
- Department of Neurosurgery, Henan University School of Medicine, Zhengzhou, China; Department of Neurosurgery, University of Louisville, Louisville, KY, United States
| | | | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital and Division of Neurology, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Research Institute, Toronto, Ontario, Canada.
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Wårdell K, Nordin T, Vogel D, Zsigmond P, Westin CF, Hariz M, Hemm S. Deep Brain Stimulation: Emerging Tools for Simulation, Data Analysis, and Visualization. Front Neurosci 2022; 16:834026. [PMID: 35478842 PMCID: PMC9036439 DOI: 10.3389/fnins.2022.834026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/01/2022] [Indexed: 01/10/2023] Open
Abstract
Deep brain stimulation (DBS) is a well-established neurosurgical procedure for movement disorders that is also being explored for treatment-resistant psychiatric conditions. This review highlights important consideration for DBS simulation and data analysis. The literature on DBS has expanded considerably in recent years, and this article aims to identify important trends in the field. During DBS planning, surgery, and follow up sessions, several large data sets are created for each patient, and it becomes clear that any group analysis of such data is a big data analysis problem and has to be handled with care. The aim of this review is to provide an update and overview from a neuroengineering perspective of the current DBS techniques, technical aids, and emerging tools with the focus on patient-specific electric field (EF) simulations, group analysis, and visualization in the DBS domain. Examples are given from the state-of-the-art literature including our own research. This work reviews different analysis methods for EF simulations, tractography, deep brain anatomical templates, and group analysis. Our analysis highlights that group analysis in DBS is a complex multi-level problem and selected parameters will highly influence the result. DBS analysis can only provide clinically relevant information if the EF simulations, tractography results, and derived brain atlases are based on as much patient-specific data as possible. A trend in DBS research is creation of more advanced and intuitive visualization of the complex analysis results suitable for the clinical environment.
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Affiliation(s)
- Karin Wårdell
- Neuroengineering Lab, Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Teresa Nordin
- Neuroengineering Lab, Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Dorian Vogel
- Neuroengineering Lab, Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
| | - Peter Zsigmond
- Department of Neurosurgery and Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Carl-Fredrik Westin
- Neuroengineering Lab, Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Marwan Hariz
- Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, London, United Kingdom
- Department of Clinical Sciences, Neuroscience, Ume University, Umeå, Sweden
| | - Simone Hemm
- Neuroengineering Lab, Department of Biomedical Engineering, Linköping University, Linköping, Sweden
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Muttenz, Switzerland
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10
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Moslehi S, Rowland C, Smith JH, Watterson WJ, Miller D, Niell CM, Alemán BJ, Perez MT, Taylor RP. Controlled assembly of retinal cells on fractal and Euclidean electrodes. PLoS One 2022; 17:e0265685. [PMID: 35385490 PMCID: PMC8985931 DOI: 10.1371/journal.pone.0265685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
Controlled assembly of retinal cells on artificial surfaces is important for fundamental cell research and medical applications. We investigate fractal electrodes with branches of vertically-aligned carbon nanotubes and silicon dioxide gaps between the branches that form repeating patterns spanning from micro- to milli-meters, along with single-scaled Euclidean electrodes. Fluorescence and electron microscopy show neurons adhere in large numbers to branches while glial cells cover the gaps. This ensures neurons will be close to the electrodes’ stimulating electric fields in applications. Furthermore, glia won’t hinder neuron-branch interactions but will be sufficiently close for neurons to benefit from the glia’s life-supporting functions. This cell ‘herding’ is adjusted using the fractal electrode’s dimension and number of repeating levels. We explain how this tuning facilitates substantial glial coverage in the gaps which fuels neural networks with small-world structural characteristics. The large branch-gap interface then allows these networks to connect to the neuron-rich branches.
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Affiliation(s)
- Saba Moslehi
- Physics Department, University of Oregon, Eugene, Oregon, United States of America
- Materials Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - Conor Rowland
- Physics Department, University of Oregon, Eugene, Oregon, United States of America
- Materials Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - Julian H. Smith
- Physics Department, University of Oregon, Eugene, Oregon, United States of America
- Materials Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - William J. Watterson
- Physics Department, University of Oregon, Eugene, Oregon, United States of America
- Materials Science Institute, University of Oregon, Eugene, Oregon, United States of America
| | - David Miller
- Physics Department, University of Oregon, Eugene, Oregon, United States of America
- Materials Science Institute, University of Oregon, Eugene, Oregon, United States of America
- Oregon Center for Optical, Molecular and Quantum Science, University of Oregon, Eugene, Oregon, United States of America
| | - Cristopher M. Niell
- Institute of Neuroscience, University of Oregon, Eugene, Oregon, United States of America
- Department of Biology, University of Oregon, Eugene, Oregon, United States of America
| | - Benjamín J. Alemán
- Physics Department, University of Oregon, Eugene, Oregon, United States of America
- Materials Science Institute, University of Oregon, Eugene, Oregon, United States of America
- Oregon Center for Optical, Molecular and Quantum Science, University of Oregon, Eugene, Oregon, United States of America
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, Oregon, United States of America
| | - Maria-Thereza Perez
- Division of Ophthalmology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- NanoLund, Lund University, Lund, Sweden
- * E-mail: (RPT); (MTP)
| | - Richard P. Taylor
- Physics Department, University of Oregon, Eugene, Oregon, United States of America
- Materials Science Institute, University of Oregon, Eugene, Oregon, United States of America
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of Oregon, Eugene, Oregon, United States of America
- * E-mail: (RPT); (MTP)
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11
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Baig F, Pereira EAC. Letter to the Editor. DBS in elderly patients: neurological challenges versus neurosurgical complications. J Neurosurg 2021; 135:1582-1583. [PMID: 34144519 DOI: 10.3171/2021.2.jns21484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Outram S, Muñoz KA, Kostick-Quenet K, Sanchez CE, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Koenig BA, Starr PA, Gunduz A, Foote KD, Okun MS, Goodman WK, McGuire AL, Zuk P, Lázaro-Muñoz G. Patient, Caregiver, and Decliner Perspectives on Whether to Enroll in Adaptive Deep Brain Stimulation Research. Front Neurosci 2021; 15:734182. [PMID: 34690676 PMCID: PMC8529029 DOI: 10.3389/fnins.2021.734182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
This research study provides patient and caregiver perspectives as to whether or not to undergo adaptive deep brain stimulation (aDBS) research. A total of 51 interviews were conducted in a multi-site study including patients undergoing aDBS and their respective caregivers along with persons declining aDBS. Reasons highlighted for undergoing aDBS included hopes for symptom alleviation, declining quality of life, desirability of being in research, and altruism. The primary reasons for not undergoing aDBS issues were practical rather than specific to aDBS technology, although some persons highlighted a desire to not be the first to trial the new technology. These themes are discussed in the context of "push" factors wherein any form of surgical intervention is preferable to none and "pull" factors wherein opportunities to contribute to science combine with hopes and/or expectations for the alleviation of symptoms. We highlight the significance of study design in decision making. aDBS is an innovative technology and not a completely new technology. Many participants expressed value in being part of research as an important consideration. We suggest that there are important implications when comparing patient perspectives vs. theoretical perspectives on the choice for or against aDBS. Additionally, it will be important how we communicate with patients especially in reference to the complexity of study design. Ultimately, this study reveals that there are benefits and potential risks when choosing a research study that involves implantation of a medical device.
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Affiliation(s)
- Simon Outram
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, United States
| | - Katrina A. Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Kristin Kostick-Quenet
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Clarissa E. Sanchez
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Lavina Kalwani
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | | | - Laura Torgerson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Demetrio Sierra-Mercado
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
- Department of Anatomy and Neurobiology, School of Medicine, University of Puerto Rico, San Juan, Puerto Rico
| | - Jill O. Robinson
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Stacey Pereira
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Barbara A. Koenig
- Program in Bioethics, University of California, San Francisco, San Francisco, CA, United States
| | - Philip A. Starr
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, United States
| | - Aysegul Gunduz
- Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Kelly D. Foote
- Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Michael S. Okun
- Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Amy L. McGuire
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Peter Zuk
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Gabriel Lázaro-Muñoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
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13
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Xu SS, Malpas CB, Bulluss KJ, McDermott HJ, Kalincik T, Thevathasan W. Lesser-Known Aspects of Deep Brain Stimulation for Parkinson's Disease: Programming Sessions, Hardware Surgeries, Residential Care Admissions, and Deaths. Neuromodulation 2021; 25:836-845. [PMID: 34114293 DOI: 10.1111/ner.13466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The long-term treatment burden, duration of community living, and survival of patients with Parkinson's disease (PD) after deep brain stimulation (DBS) implantation are unclear. This study aims to determine the frequency of programming, repeat hardware surgeries (of the intracranial electrode, implantable pulse generator [IPG], and extension-cable), and the timings of residential care and death in patients with PD treated with DBS. MATERIALS AND METHODS In this cross-sectional, population-based study, individual-level data were collected from the Australian government covering a 15-year period (2002-2016) on 1849 patients with PD followed from DBS implantation. RESULTS The mean DBS implantation age was 62.6 years and mean follow-up 5.0 years. Mean annual programming rates were 6.9 in the first year and 2.8 in subsequent years. 51.4% of patients required repeat hardware surgery. 11.3% of patients had repeat intracranial electrode surgery (including an overall 1.1% of patients who were completely explanted). 47.6% of patients had repeat IPG/extension-cable surgery including for presumed battery depletion. 6.2% of patients had early repeat IPG/extension-cable surgery (within one year of any previous such surgery). Thirty-day postoperative mortality was 0.3% after initial DBS implantation and 0.6% after any repeat hardware surgery. 25.3% of patients were admitted into residential care and 17.4% died. The median interval to residential care and death was 10.2 years and 11.4 years, respectively. Age more than 65 years was associated with fewer repeat hardware surgeries for presumed complications (any repeat surgery of electrodes, extension-cables, and early IPG surgery) and greater rates of residential care admission and death. CONCLUSIONS Data from a large cohort of patients with PD treated with DBS found that the median life span after surgery is ten years. Repeat hardware surgery, including of the intracranial electrodes, is common. These findings support development of technologies to reduce therapy burden such as enhanced surgical navigation, hardware miniaturization, and improved battery efficiency.
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Affiliation(s)
- San San Xu
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Medical Bionics, The University of Melbourne, East Melbourne, VIC, Australia.,Department of Neurology, Austin Hospital, Heidelberg, VIC, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.,MS Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristian J Bulluss
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, and Department of Neurosurgery, Austin Hospital, Heidelberg, VIC, Australia
| | - Hugh J McDermott
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Medical Bionics, The University of Melbourne, East Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,MS Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wesley Thevathasan
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Neurology, Austin Hospital, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
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14
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Mathur S, Stamford J. Bringing Advanced Therapies for Parkinson's Disease to the Clinic: The Patient's Perspective. JOURNAL OF PARKINSONS DISEASE 2021; 11:S141-S145. [PMID: 33967058 PMCID: PMC8543244 DOI: 10.3233/jpd-212650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is an urgent unmet need in the Parkinson’s disease community—advanced therapies to modify the inevitable decline that occurs in those affected by this progressive neurodegenerative disease for which there is no cure. This will require collaboration from all stakeholders and central to those partnerships are patients themselves. But participation in clinical trials and clinical use of advanced therapies have their own risk profile above and beyond standard therapeutics as evidenced by past invasive procedures. Therefore, it is of utmost importance that clear, evidence-based information about these potential treatments be clearly communicated by those exploring their use to ensure safe and informed participation from the patient community. Likewise, patients must weigh the benefits of these treatments their limitations and risks in order to truly give informed consent to participate in bringing these treatments to the clinic. Here we explore these issues from the patient perspective.
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Affiliation(s)
| | - Jon Stamford
- Gentleman Neuroscientist and Independent Parkinson's Advocate
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15
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Treatment Options for Motor and Non-Motor Symptoms of Parkinson's Disease. Biomolecules 2021; 11:biom11040612. [PMID: 33924103 PMCID: PMC8074325 DOI: 10.3390/biom11040612] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) usually presents in older adults and typically has both motor and non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss in the mid-brain substantia nigra pars compacta region. Outlined here is an integrative medicine and health strategy that highlights five treatment options for people with Parkinson’s (PwP): rehabilitate, therapy, restorative, maintenance, and surgery. Rehabilitating begins following the diagnosis and throughout any additional treatment processes, especially vis-à-vis consulting with physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either the dopamine precursor levodopa (with carbidopa) or a dopamine agonist, compounds that preserve residual dopamine, and other specific motor/non-motor-related compounds. Restorative uses strenuous aerobic exercise programs that can be neuroprotective. Maintenance uses complementary and alternative medicine substances that potentially support and protect the brain microenvironment. Finally, surgery, including deep brain stimulation, is pursued when PwP fail to respond positively to other treatment options. There is currently no cure for PD. In conclusion, the best strategy for treating PD is to hope to slow disorder progression and strive to achieve stability with neuroprotection. The ultimate goal of any management program is to improve the quality-of-life for a person with Parkinson’s disease.
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16
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Almahariq F, Sedmak G, Vuletić V, Dlaka D, Orešković D, Marčinković P, Raguž M, Chudy D. The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease. J Neurol Surg A Cent Eur Neurosurg 2021; 82:518-525. [PMID: 33618414 DOI: 10.1055/s-0040-1715826] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In 33 consecutive patients with Parkinson's disease (PD) undergoing awake deep brain stimulation (DBS) without microelectrode recording (MER), we assessed and validated the precision and accuracy of direct targeting of the subthalamic nucleus (STN) using preoperative magnetic resonance imaging (MRI) and stereotactic computed tomography (CT) image fusion combined with immediate postoperative stereotactic CT and postoperative MRI, and we report on the side effects and clinical results up to 6 months' follow-up. MATERIALS AND METHODS Preoperative nonstereotactic MRI and stereotactic CT images were merged and used for planning the trajectory and final lead position. Immediate postoperative stereotactic CT and postoperative nonstereotactic MRI provided the validation of the final electrode position. Changes in the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores and the levodopa equivalent daily doses (LEDD) and appearance of adverse side effects were assessed. RESULTS The mean Euclidian distance (ED) error between the planned position and the final position of the lead in the left STN was 1.69 ± 0.82 mm and that in the right STN was 2.12 ± 1.00. The individual differences between planned and final position in each of the three coordinates were less than 2 mm. The UPDRS III scores improved by 75% and LEDD decreased by 45%. Few patients experienced complications, such as postoperative infection (n = 1), or unwanted side effects, such as emotional instability (n = 1). CONCLUSION Our results confirm that direct targeting of an STN on stereotactic CT merged with MRI could be a valid method for placement the DBS electrode. The magnitude of our targeting error is comparable with the reported errors when using MER and other direct targeting approaches.
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Affiliation(s)
- Fadi Almahariq
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia.,Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Goran Sedmak
- Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Croatian Institute for Brain Research, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Vladimira Vuletić
- Department of Neurology, School of Medicine, University of Rijeka, University Hospital Rijeka, Rijeka, Croatia
| | - Domagoj Dlaka
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Darko Orešković
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Petar Marčinković
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Marina Raguž
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Darko Chudy
- Department of Neurosurgery, Clinical Hospital Dubrava, Zagreb, Croatia.,Center of Excellence in Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Department of Surgery, School of Medicine, University of Zagreb, Zagreb, Croatia
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17
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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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18
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Boutet A, Chow CT, Narang K, Elias GJB, Neudorfer C, Germann J, Ranjan M, Loh A, Martin AJ, Kucharczyk W, Steele CJ, Hancu I, Rezai AR, Lozano AM. Improving Safety of MRI in Patients with Deep Brain Stimulation Devices. Radiology 2020; 296:250-262. [PMID: 32573388 DOI: 10.1148/radiol.2020192291] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
MRI is a valuable clinical and research tool for patients undergoing deep brain stimulation (DBS). However, risks associated with imaging DBS devices have led to stringent regulations, limiting the clinical and research utility of MRI in these patients. The main risks in patients with DBS devices undergoing MRI are heating at the electrode tips, induced currents, implantable pulse generator dysfunction, and mechanical forces. Phantom model studies indicate that electrode tip heating remains the most serious risk for modern DBS devices. The absence of adverse events in patients imaged under DBS vendor guidelines for MRI demonstrates the general safety of MRI for patients with DBS devices. Moreover, recent work indicates that-given adequate safety data-patients may be imaged outside these guidelines. At present, investigators are primarily focused on improving DBS device and MRI safety through the development of tools, including safety simulation models. Existing guidelines provide a standardized framework for performing safe MRI in patients with DBS devices. It also highlights the possibility of expanding MRI as a tool for research and clinical care in these patients going forward.
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Affiliation(s)
- Alexandre Boutet
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clement T Chow
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Keshav Narang
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Gavin J B Elias
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Clemens Neudorfer
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Jürgen Germann
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Manish Ranjan
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Aaron Loh
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Alastair J Martin
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Walter Kucharczyk
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Christopher J Steele
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ileana Hancu
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Ali R Rezai
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
| | - Andres M Lozano
- From the University Health Network, Toronto, Canada (A.B., C.T.C., K.N., G.J.B.E., C.N., J.G., A.L., W.K., A.M.L.); Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., W.K.); Department of Neurosurgery, West Virginia University, Morgantown, WVa (M.R., A.R.R.); Department of Neurosurgery, Rockefeller Neuroscience Institute, Morgantown, WVa (M.R., A.R.R.); Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, Calif (A.J.M.); Department of Psychology, Concordia University, Montreal, Canada (C.J.S.); Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany (C.J.S.); Center for Scientific Review, National Institutes of Health, Bethesda, Md (I.H.); and Division of Neurosurgery, Department of Surgery, Toronto Western Hospital and University of Toronto, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.M.L.)
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Boutet A, Elias GJB, Gramer R, Neudorfer C, Germann J, Naheed A, Bennett N, Li B, Gwun D, Chow CT, Maciel R, Valencia A, Fasano A, Munhoz RP, Foltz W, Mikulis D, Hancu I, Kalia SK, Hodaie M, Kucharczyk W, Lozano AM. Safety assessment of spine MRI in deep brain stimulation patients. J Neurosurg Spine 2020; 32:973-983. [PMID: 32059193 DOI: 10.3171/2019.12.spine191241] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/06/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Many centers are hesitant to perform clinically indicated MRI in patients who have undergone deep brain stimulation (DBS). Highly restrictive guidelines prohibit the use of most routine clinical MRI protocols in these patients. The authors' goals were to assess the safety of spine MRI in patients with implanted DBS devices, first through phantom model testing and subsequently through validation in a DBS patient cohort. METHODS A phantom was used to assess DBS device heating during 1.5-T spine MRI. To establish a safe spine protocol, routinely used clinical sequences deemed unsafe (a rise in temperature > 2°C) were modified to decrease the rise in temperature. This safe phantom-based protocol was then used to prospectively run 67 spine MRI sequences in 9 DBS participants requiring clinical imaging. The primary outcome was acute adverse effects; secondary outcomes included long-term adverse clinical effects, acute findings on brain MRI, and device impedance stability. RESULTS The increases in temperature were highest when scanning the cervical spine and lowest when scanning the lumbar spine. A temperature rise < 2°C was achieved when 3D sequences were modified to 2D and when the number of slices was decreased by the minimum amount compared to routine spine MRI protocols (but there were still more slices than allowed by vendor guidelines). Following spine MRI, no acute or long-term adverse effects or acute findings on brain MR images were detected. Device impedances remained stable. CONCLUSIONS Patients with DBS devices may safely undergo spine MRI with a fewer number of slices compared to those used in routine clinical protocols. Safety data acquisition may allow protocols outside vendor guidelines with a maximized number of slices, reducing the need for radiologist supervision.Clinical trial registration no.: NCT03753945 (ClinicalTrials.gov).
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Affiliation(s)
- Alexandre Boutet
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
| | | | | | | | | | - Asma Naheed
- 1Joint Department of Medical Imaging, University of Toronto
| | - Nicole Bennett
- 1Joint Department of Medical Imaging, University of Toronto
| | - Bryan Li
- 2University Health Network, Toronto
| | | | | | - Ricardo Maciel
- 2University Health Network, Toronto
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
| | | | - Alfonso Fasano
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 4Krembil Brain Institute, Toronto
| | - Renato P Munhoz
- 3Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Division of Neurology, University of Toronto
- 4Krembil Brain Institute, Toronto
| | - Warren Foltz
- 5Department of Radiation Oncology, STTARR Innovation Centre, University Health Network, Toronto, Ontario, Canada; and
| | - David Mikulis
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
- 4Krembil Brain Institute, Toronto
| | - Ileana Hancu
- 6National Institutes of Health, Center for Scientific Review, Bethesda, Maryland
| | | | | | - Walter Kucharczyk
- 1Joint Department of Medical Imaging, University of Toronto
- 2University Health Network, Toronto
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20
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Vogel D, Shah A, Coste J, Lemaire JJ, Wårdell K, Hemm S. Anatomical brain structures normalization for deep brain stimulation in movement disorders. NEUROIMAGE-CLINICAL 2020; 27:102271. [PMID: 32446242 PMCID: PMC7240191 DOI: 10.1016/j.nicl.2020.102271] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/09/2020] [Accepted: 04/20/2020] [Indexed: 11/25/2022]
Abstract
Non-linear iterative structural normalization method focused on the deep brain. Multi-modality image data from deep brain stimulation patients. Comparison of ANTS, FNIRT and DRAMMS for the non-linear registrations using different settings for each. Evaluation of the registration tools based on the analysis of 58 structures of the deep brain segmented manually by a single expert. ANTS was identified as the best performing non-linear registration tool.
Deep brain stimulation (DBS) therapy requires extensive patient-specific planning prior to implantation to achieve optimal clinical outcomes. Collective analysis of patient’s brain images is promising in order to provide more systematic planning assistance. In this paper the design of a normalization pipeline using a group specific multi-modality iterative template creation process is presented. The focus was to compare the performance of a selection of freely available registration tools and select the best combination. The workflow was applied on 19 DBS patients with T1 and WAIR modality images available. Non-linear registrations were computed with ANTS, FNIRT and DRAMMS, using several settings from the literature. Registration accuracy was measured using single-expert labels of thalamic and subthalamic structures and their agreement across the group. The best performance was provided by ANTS using the High Variance settings published elsewhere. Neither FNIRT nor DRAMMS reached the level of performance of ANTS. The resulting normalized definition of anatomical structures were used to propose an atlas of the diencephalon region defining 58 structures using data from 19 patients.
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Affiliation(s)
- Dorian Vogel
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, 4132 Muttenz, Switzerland; Department of Biomedical Engineering, Linköping University, SE-581 85 Linköping, Sweden.
| | - Ashesh Shah
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, 4132 Muttenz, Switzerland.
| | - Jérôme Coste
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France; Service de Neurochirurgie, Hôpital Gabriel-Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, F-63003 Clermont-Ferrand Cedex 1, France.
| | - Jean-Jacques Lemaire
- Université Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, F-63000 Clermont-Ferrand, France; Service de Neurochirurgie, Hôpital Gabriel-Montpied, Centre Hospitalier Universitaire de Clermont-Ferrand, 58 rue Montalembert, F-63003 Clermont-Ferrand Cedex 1, France.
| | - Karin Wårdell
- Department of Biomedical Engineering, Linköping University, SE-581 85 Linköping, Sweden.
| | - Simone Hemm
- Institute for Medical Engineering and Medical Informatics, School of Life Sciences, University of Applied Sciences and Arts Northwestern Switzerland, Hofackerstrasse 30, 4132 Muttenz, Switzerland; Department of Biomedical Engineering, Linköping University, SE-581 85 Linköping, Sweden.
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21
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Boutet A, Hancu I, Saha U, Crawley A, Xu DS, Ranjan M, Hlasny E, Chen R, Foltz W, Sammartino F, Coblentz A, Kucharczyk W, Lozano AM. 3-Tesla MRI of deep brain stimulation patients: safety assessment of coils and pulse sequences. J Neurosurg 2020; 132:586-594. [PMID: 30797197 DOI: 10.3171/2018.11.jns181338] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 11/05/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Physicians are more frequently encountering patients who are treated with deep brain stimulation (DBS), yet many MRI centers do not routinely perform MRI in this population. This warrants a safety assessment to improve DBS patients' accessibility to MRI, thereby improving their care while simultaneously providing a new tool for neuromodulation research. METHODS A phantom simulating a patient with a DBS neuromodulation device (DBS lead model 3387 and IPG Activa PC model 37601) was constructed and used. Temperature changes at the most ventral DBS electrode contacts, implantable pulse generator (IPG) voltages, specific absorption rate (SAR), and B1+rms were recorded during 3-T MRI scanning. Safety data were acquired with a transmit body multi-array receive and quadrature transmit-receive head coil during various pulse sequences, using numerous DBS configurations from "the worst" to "the most common."In addition, 3-T MRI scanning (T1 and fMRI) was performed on 41 patients with fully internalized and active DBS using a quadrature transmit-receive head coil. MR images, neurological examination findings, and stability of the IPG impedances were assessed. RESULTS In the phantom study, temperature rises at the DBS electrodes were less than 2°C for both coils during 3D SPGR, EPI, DTI, and SWI. Sequences with intense radiofrequency pulses such as T2-weighted sequences may cause higher heating (due to their higher SAR). The IPG did not power off and kept a constant firing rate, and its average voltage output was unchanged. The 41 DBS patients underwent 3-T MRI with no adverse event. CONCLUSIONS Under the experimental conditions used in this study, 3-T MRI scanning of DBS patients with selected pulse sequences appears to be safe. Generally, T2-weighted sequences (using routine protocols) should be avoided in DBS patients. Complementary 3-T MRI phantom safety data suggest that imaging conditions that are less restrictive than those used in the patients in this study, such as using transmit body multi-array receive coils, may also be safe. Given the interplay between the implanted DBS neuromodulation device and the MRI system, these findings are specific to the experimental conditions in this study.
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Affiliation(s)
- Alexandre Boutet
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | - Ileana Hancu
- 3GE Global Research Center, Niskayuna, New York; and
| | - Utpal Saha
- 4Krembil Research Institute, Toronto, Ontario, Canada
| | - Adrian Crawley
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | | | | | | | - Robert Chen
- 2University Health Network; and
- 5Division of Neurology, Department of Medicine, University of Toronto
| | - Warren Foltz
- 6STTARR Innovation Centre, Department of Radiation Oncology
| | | | - Ailish Coblentz
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
| | - Walter Kucharczyk
- 1Joint Department of Medical Imaging, and
- 2University Health Network; and
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22
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van Poppelen D, Sisodia V, de Haan RJ, Dijkgraaf MGW, Schuurman PR, Geurtsen GJ, Berk AEM, de Bie RMA, Dijk JM. Protocol of a randomized open label multicentre trial comparing continuous intrajejunal levodopa infusion with deep brain stimulation in Parkinson's disease - the INfusion VErsus STimulation (INVEST) study. BMC Neurol 2020; 20:40. [PMID: 32005175 PMCID: PMC6995127 DOI: 10.1186/s12883-020-1621-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 01/20/2020] [Indexed: 01/03/2023] Open
Abstract
Background Both Deep Brain Stimulation (DBS) and Continuous intrajejunal Levodopa Infusion (CLI) are effective therapies for the treatment of Parkinson’s disease (PD). To our knowledge, no direct head-to-head comparison of DBS and CLI has been performed, whilst the costs probably differ significantly. In the INfusion VErsus STimulation (INVEST) study, costs and effectiveness of DBS and CLI are compared in a randomized controlled trial (RCT) in patients with PD, to study whether higher costs of one of the therapies are justified by superiority of that treatment. Methods A prospective open label multicentre RCT is being performed, with ancillary patient preference observational arms. Patients with PD who, despite optimal pharmacological treatment, have severe response fluctuations, bradykinesia, dyskinesias, or painful dystonia are eligible for inclusion. A total of 66 patients will be randomized. There is no minimal inclusion in the patient preference arms. The primary health economic outcomes are costs per unit on the Parkinson’s Disease Questionnaire-39 (PDQ-39) and costs per unit Quality-Adjusted Life Year (QALY) at 12 months. The main clinical outcome is patient-reported quality of life measured with the PDQ-39 at 12 months. Patients will additionally be followed during 36 months after initiation of the study treatment. Discussion The INVEST trial directly compares the costs and effectiveness of the advanced therapies DBS and CLI. Trial registration Dutch Trial Register identifier 4753, registered November 3rd, 2014; EudraCT number 2014–001501-32, Clinicaltrials.gov: NCT02480803.
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Affiliation(s)
- D van Poppelen
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - V Sisodia
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - R J de Haan
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - M G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - G J Geurtsen
- Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - A E M Berk
- Dutch Parkinson's disease association (Parkinson Vereniging), Kosterijland 12, Bunnik, the Netherlands
| | - R M A de Bie
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - J M Dijk
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
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23
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Sedrak M, Sabelman E, Pezeshkian P, Duncan J, Bernstein I, Bruce D, Tse V, Khandhar S, Call E, Heit G, Alaminos-Bouza A. Biplanar X-Ray Methods for Stereotactic Intraoperative Localization in Deep Brain Stimulation Surgery. Oper Neurosurg (Hagerstown) 2019; 19:302-312. [PMID: 31858143 DOI: 10.1093/ons/opz397] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/28/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Efficacy in deep brain stimulation (DBS) is dependent on precise positioning of electrodes within the brain. Intraoperative fluoroscopy, computed tomography (CT), or magnetic resonance imaging are used for stereotactic intraoperative localization (StIL), but the utility of biplanar X-ray has not been evaluated in detail.
OBJECTIVE
To determine if analysis of orthogonal biplanar X-rays using graphical analysis (GA), ray tracing (RT), and/or perspective projection (PP) can be utilized for StIL.
METHODS
A review of electrode tip positions comparing postoperative CT to X-ray methods was performed for DBS operations containing orthogonal biplanar X-ray with referential spheres and pins.
RESULTS
Euclidean (Re) errors for final DBS electrode position on intraoperative X-rays vs postoperative CT using GA, RT, and PP methods averaged 1.58 mm (±0.75), 0.74 mm (±0.45), and 1.07 mm (±0.64), respectively (n = 56). GA was more accurate with a ventriculogram. RT and PP predicted positions that correlated with third ventricular structures on ventriculogram cases. RT was the most stable but required knowledge of the geometric setup. PP was more flexible than RT but required well-distributed reference points. A single case using the O-arm demonstrated Re errors of 0.43 mm and 0.28 mm for RT and PP, respectively. In addition, these techniques could also be used to calculate directional electrode rotation.
CONCLUSION
GA, RT, and PP can be employed for precise StIL during DBS using orthogonal biplanar X-ray. These methods may be generalized to other stereotactic procedures or instances of biplanar imaging such as angiograms, radiosurgery, or injection therapeutics.
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Affiliation(s)
- Mark Sedrak
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
- Stanford University, Stanford, California
| | - Eric Sabelman
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
| | | | - John Duncan
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
| | - Ivan Bernstein
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
| | - Diana Bruce
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
| | - Victor Tse
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
| | - Suketu Khandhar
- Kaiser Permanente Sacramento Medical Center and Medical Offices, Sacramento, California
| | - Elena Call
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
| | - Gary Heit
- Department of Neurosurgery, Kaiser Permanente, Redwood City, California
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24
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Brundin P, Bloem BR. The Times They Are a-Changin': Parkinson's Disease 20 Years from Now. JOURNAL OF PARKINSONS DISEASE 2019; 8:S1-S2. [PMID: 30584172 PMCID: PMC6311357 DOI: 10.3233/jpd-189002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Patrik Brundin
- Center for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, MI, USA
| | - Bastiaan R Bloem
- Parkinson Center Nijmegen, Radboud University Medical Center, Nijmegen, The Netherlands
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25
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Boutet A, Rashid T, Hancu I, Elias GJB, Gramer RM, Germann J, Dimarzio M, Li B, Paramanandam V, Prasad S, Ranjan M, Coblentz A, Gwun D, Chow CT, Maciel R, Soh D, Fiveland E, Hodaie M, Kalia SK, Fasano A, Kucharczyk W, Pilitsis J, Lozano AM. Functional MRI Safety and Artifacts during Deep Brain Stimulation: Experience in 102 Patients. Radiology 2019; 293:174-183. [PMID: 31385756 DOI: 10.1148/radiol.2019190546] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BackgroundWith growing numbers of patients receiving deep brain stimulation (DBS), radiologists are encountering these neuromodulation devices at an increasing rate. Current MRI safety guidelines, however, limit MRI access in these patients.PurposeTo describe an MRI (1.5 T and 3 T) experience and safety profile in a large cohort of participants with active DBS systems and characterize the hardware-related artifacts on images from functional MRI.Materials and MethodsIn this prospective study, study participants receiving active DBS underwent 1.5- or 3-T MRI (T1-weighted imaging and gradient-recalled echo [GRE]-echo-planar imaging [EPI]) between June 2017 and October 2018. Short- and long-term adverse events were tracked. The authors quantified DBS hardware-related artifacts on images from GRE-EPI (functional MRI) at the cranial coil wire and electrode contacts. Segmented artifacts were then transformed into standard space to define the brain areas affected by signal loss. Two-sample t tests were used to assess the difference in artifact size between 1.5- and 3-T MRI.ResultsA total of 102 participants (mean age ± standard deviation, 60 years ± 11; 65 men) were evaluated. No MRI-related short- and long-term adverse events or acute changes were observed. DBS artifacts were most prominent near the electrode contacts and over the frontoparietal cortical area where the redundancy of the extension wire is placed subcutaneously. The mean electrode contact artifact diameter was 9.3 mm ± 1.6, and 1.9% ± 0.8 of the brain was obscured by the coil artifact. The coil artifacts were larger at 3 T than at 1.5 T, obscuring 2.1% ± 0.7 and 1.4% ± 0.7 of intracranial volume, respectively (P < .001). The superficial frontoparietal cortex and deep structures neighboring the electrode contacts were most commonly obscured.ConclusionWith a priori local safety testing, patients receiving deep brain stimulation may safely undergo 1.5- and 3-T MRI. Deep brain stimulation hardware-related artifacts only affect a small proportion of the brain.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Martin in this issue.
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Affiliation(s)
- Alexandre Boutet
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Tanweer Rashid
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Ileana Hancu
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Gavin J B Elias
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Robert M Gramer
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Jürgen Germann
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Marisa Dimarzio
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Bryan Li
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Vijayashankar Paramanandam
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Sreeram Prasad
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Manish Ranjan
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Ailish Coblentz
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Dave Gwun
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Clement T Chow
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Ricardo Maciel
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Derrick Soh
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Eric Fiveland
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Mojgan Hodaie
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Suneil K Kalia
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Alfonso Fasano
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Walter Kucharczyk
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Julie Pilitsis
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
| | - Andres M Lozano
- From the Joint Department of Medical Imaging, University of Toronto, Toronto, Canada (A.B., A.C., W.K.); Division of Neurosurgery, Toronto Western Hospital, University Health Network, 399 Bathurst St, WW 4-437, Toronto, ON, Canada M5T 2S8 (A.B., G.J.B.E., R.M.G., J.G., B.L., V.P., S.P., M.R., A.C., D.G., C.T.C., R.M., D.S., M.H., S.K.K., A.F., W.K., A.M.L.); Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY (T.R., M.D., J.P.); Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Division of Neurology, University of Toronto, Toronto, Ontario, Canada (I.H., V.P., S.P., R.M., D.S., A.F.); GE Global Research Center, Niskayuna, NY (E.F.); Krembil Brain Institute, Toronto, Canada (A.F.); and Department of Neurosurgery, Albany Medical Center, Albany, NY (J.P.)
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Hartmann CJ, Fliegen S, Groiss SJ, Wojtecki L, Schnitzler A. An update on best practice of deep brain stimulation in Parkinson's disease. Ther Adv Neurol Disord 2019; 12:1756286419838096. [PMID: 30944587 PMCID: PMC6440024 DOI: 10.1177/1756286419838096] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/01/2019] [Indexed: 11/16/2022] Open
Abstract
During the last 30 years, deep brain stimulation (DBS) has evolved into the clinical standard of care as a highly effective treatment for advanced Parkinson’s disease. Careful patient selection, an individualized anatomical target localization and meticulous evaluation of stimulation parameters for chronic DBS are crucial requirements to achieve optimal results. Current hardware-related advances allow for a more focused, individualized stimulation and hence may help to achieve optimal clinical results. However, current advances also increase the degrees of freedom for DBS programming and therefore challenge the skills of healthcare providers. This review gives an overview of the clinical effects of DBS, the criteria for patient, target, and device selection, and finally, offers strategies for a structured programming approach.
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Affiliation(s)
- Christian J Hartmann
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Sabine Fliegen
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan J Groiss
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Lars Wojtecki
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Abstract
The identification of MPTP, a relatively simple compound which causes selective degeneration of the substantia nigra after systemic administration, has had an a significant impact on the understanding and treatment of Parkinson’s disease (PD) over the last 30 years. This article is prefaced by the intriguing “medical detective story” that lead to the discovery of the biological effects of MPTP in humans. The steps that lead to the unraveling its mechanism of action and their impact on research into pathways underlying nigrostriatal degeneration are reviewed. The impact of the animal models that have been developed utilizing MPTP is also described with a focus on the translational implications of MPTP-related research. These include use of MAO-B inhibitors aimed at neuroprotection in PD and the importance of a stable primate model for PD which was utilized to better understand the circuitry of the basal ganglia, and the identification of the subthalamic nucleus as a target for deep brain stimulation. Finally, the results of a broad range of epidemiologic studies aimed as assessing the impact of environmental factors in PD that have been inspired by MPTP are summarized, including the discovery of other neurotoxicants (rotenone and paraquat) with parkinsonogenic effects. Overall, this article attempts to describe how the discovery of this nigral neurotoxicant began, where it is currently, and what the future may hold.
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Affiliation(s)
- J. William Langston
- Correspondence to: J. William Langston, Parkinson’s Institute, Sunnyvale, CA, USA. E-mail:
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Ineichen C, Shepherd NR, Sürücü O. Understanding the Effects and Adverse Reactions of Deep Brain Stimulation: Is It Time for a Paradigm Shift Toward a Focus on Heterogenous Biophysical Tissue Properties Instead of Electrode Design Only? Front Hum Neurosci 2018; 12:468. [PMID: 30538625 PMCID: PMC6277493 DOI: 10.3389/fnhum.2018.00468] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/06/2018] [Indexed: 02/02/2023] Open
Abstract
Deep brain stimulation (DBS) has been proven to be an effective treatment modality for various late-stage neurological and psychiatric disorders. However, knowledge on the electrical field distribution in the brain tissue is still scarce. Most recent attempts to understand electric field spread were primarily focused on the effect of different electrodes on rather simple tissue models. The influence of microanatomic, biophysical tissue properties in particular has not been investigated in depth. Ethical concerns restrict thorough research on field distribution in human in vivo brain tissue. By means of a simplified model, we investigated the electric field distribution in a broader area of the subthalamic nucleus (STN). Pivotal biophysical parameters including conductivity, permittivity and permeability of brain tissue were incorporated in the model. A brain tissue model was created with the finite element method (FEM). Stimulation was mimicked with parameters used for monopolar stimulation of patients suffering from Parkinson's disease. Our results were visualized with omnidirectional and segmented electrodes. The stimulated electric field was visualized with superimpositions on a stereotactic atlas (Morel). Owing to the effects of regional tissue properties near the stimulating electrode, marked field distortions occur. Such effects include, for example, isolating effects of heavily myelinated neighboring structures, e.g., the internal capsule. In particular, this may be illustrated through the analysis of a larger coronal area. While omnidirectional stimulation has been associated with vast current leakage, higher targeting precision was obtained with segmented electrodes. Finally, targeting was improved when the influence of microanatomic structures on the electric spread was considered. Our results confirm that lead design is not the sole influence on current spread. An omnidirectional lead configuration does not automatically result in an omnidirectional spread of current. In turn, segmented electrodes do not automatically imply an improved steering of current. Our findings may provide an explanation for side-effects secondary to current leakage. Furthermore, a possible explanation for divergent results in the comparison of the intraoperative awake patient and the postoperative setting is given. Due to the major influence of biophysical tissue properties on electric field shape, the local microanatomy should be considered for precise surgical targeting and optimal hardware implantation.
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Affiliation(s)
- Christian Ineichen
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, Zurich, Switzerland.,Institute of Biomedical Ethics and History of Medicine, University of Zurich, Zurich, Switzerland
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Dashtipour K, Tafreshi A, Lee J, Crawley B. Speech disorders in Parkinson's disease: pathophysiology, medical management and surgical approaches. Neurodegener Dis Manag 2018; 8:337-348. [DOI: 10.2217/nmt-2018-0021] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The prevalence of speech disorders among individuals with Parkinson's disease (PD) has been reported to be as high as 89%. Speech impairment in PD results from a combination of motor and nonmotor deficits. The production of speech depends upon the coordination of various motor activities: respiration, phonation, articulation, resonance and prosody. A speech disorder is defined as impairment in any of its inter-related components. Despite the high prevalence of speech disorders in PD, only 3–4% receive speech treatment. Treatment modalities include pharmacological intervention, speech therapy, surgery, deep brain stimulation and vocal fold augmentation. Although management of Parkinsonian dysarthria is clinically challenging, speech treatment in PD should be part of a multidisciplinary approach to patient care in this disease.
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Affiliation(s)
- Khashayar Dashtipour
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Ali Tafreshi
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jessica Lee
- Department of Neurology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Brianna Crawley
- Department of Otolaryngology, Loma Linda University School of Medicine, Loma Linda, CA, USA
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Cabrera LY, Goudreau J, Sidiropoulos C. Critical appraisal of the recent US FDA approval for earlier DBS intervention. Neurology 2018; 91:133-136. [DOI: 10.1212/wnl.0000000000005829] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 03/29/2018] [Indexed: 11/15/2022] Open
Abstract
In November 2015, Medtronic announced the US Food and Drug Administration (FDA) approval for the use of deep brain stimulation (DBS) therapy in people with Parkinson disease (PD) “of at least 4 years duration and with recent onset motor complications, or motor complications of longer-standing duration that are not adequately controlled with medication.” The approval was based on data from the EARLYSTIM clinical trial, a randomized, prospective, multicenter, parallel-group clinical trial in Germany and France involving 251 patients with PD. While others have reviewed the application of DBS earlier in the disease course and the results from EARLYSTIM, we focus on the conceptual, scientific, clinical, ethical, and policy issues that arise regarding the recent FDA approval.
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