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Bonanno M, Calabrò RS. Bridging the Gap between Basic Research and Clinical Practice: The Growing Role of Translational Neurorehabilitation. MEDICINES (BASEL, SWITZERLAND) 2023; 10:45. [PMID: 37623809 PMCID: PMC10456256 DOI: 10.3390/medicines10080045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/25/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
Translational neuroscience is intended as a holistic approach in the field of brain disorders, starting from the basic research of cerebral morphology and with the function of implementing it into clinical practice. This concept can be applied to the rehabilitation field to promote promising results that positively influence the patient's quality of life. The last decades have seen great scientific and technological improvements in the field of neurorehabilitation. In this paper, we discuss the main issues related to translational neurorehabilitation, from basic research to current clinical practice, and we also suggest possible future scenarios.
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Affiliation(s)
| | - Rocco Salvatore Calabrò
- IRCCS Centro Neurolesi “Bonino-Pulejox”, Via Palermo, SS 113, C. da Casazza, 98124 Messina, Italy;
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Lee DA, Lee J, Lee HJ, Park KM. Alterations of limbic structure volumes and limbic covariance network in patients with cluster headache. J Clin Neurosci 2022; 103:72-77. [PMID: 35843183 DOI: 10.1016/j.jocn.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 06/27/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
The aim of this study was to compare the limbic structures and covariance network in patients with cluster headache to those of healthy controls. We enrolled 23 patients with newly diagnosed cluster headache and 31 healthy controls. They underwent three-dimensional T1-weighted imaging utilizing a 3.0 Tesla MRI scanner. Volumetric analysis of the subcortical limbic structures, including the hippocampus, amygdala, thalamus, mammillary body, hypothalamus, basal forebrain, septal nuclei, fornix, and nucleus accumbens, was performed. We examined the limbic covariance network using a graph theory. The volumes of the limbic structures between patients with cluster headache and healthy controls were significantly different. The volume of the left hippocampus in patients with cluster headache was significantly lower than that in healthy controls (0.256 vs 0.291 %, p = 0.002). Patients with cluster headache showed significant alterations of the limbic covariance network. The average strength, global efficiency, local efficiency, mean clustering coefficient, and transitivity were lower (5.238 vs 10.322, p = 0.030; 0.355 vs 0.608, p = 0.020; 0.547 vs 1.553, p = 0.020; 0.424 vs 0.895, p = 0.016; respectively), whereas the characteristic path length was higher (3.314 vs 1.752, p = 0.040) in patients with cluster headache than in healthy controls. We detected alterations of limbic structure volumes in patients with cluster headache compared to healthy controls, especially in the hippocampus. We also found significant alterations in the limbic covariance network in patients with cluster headache who showed decreased segregation and integration. These abnormalities could be related to the pathophysiology of cluster headache.
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Affiliation(s)
- Dong Ah Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Joonwon Lee
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ho-Joon Lee
- Department of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
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Shin JH, Yu R, Kang MK, Lee CY, Woo KA, Chang HJ, Kim HJ, Lee J, Jeon B. High preoperative gait variability is a prognostic predictor of gait and balance in Parkinson disease patients with deep brain stimulation. Parkinsonism Relat Disord 2022; 100:1-5. [PMID: 35640414 DOI: 10.1016/j.parkreldis.2022.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/06/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The objective biomarker for prediction of gait and balance in the long-term follow-up of Parkinson's disease(PD) patients with subthalamic nucleus deep brain stimulation(STN-DBS) has not yet been elucidated. We investigated the value of pre-operative quantitative gait parameters for the prediction of long-term prognosis of gait in PD patients with DBS. METHODS We retrospectively collected gait videos(both medication ON/OFF states) of PD patients recorded as preoperative evaluation before STN DBS. We enrolled patients who were followed-up for more than 5 years after the surgery from 2006 to 2014. We derived objective gait parameters from video-based gait analysis algorithm. We defined the clinical milestones of frequent falling, impaired walking, and loss of autonomy based on the Unified Parkinson's disease rating scale and Hoehn and Yahr stage, which were regularly followed up to 156 months after surgery. We calculated hazard ratios(HRs) of baseline gait parameters for predicting the clinical milestones. RESULTS A total of 96 gait videos from 63 PD patients were analyzed. The mean follow-up duration(standard deviation) was 88.0(34.2) months after surgery. Relatively high (>mean + 1 standard deviation) variability for step length, step time and stride time (HR = 2.92[1.02-8.33], 3.91[1.38-11.11] and 7.16[2.09-24.52],respectively) in medication-ON state significantly predicted reaching any of the three clinical milestones of frequent falling, impaired walking and loss of autonomy. Gait parameters from the medication-OFF state did not predict any clinical milestone. CONCLUSIONS High preoperative gait variability from the medication-ON state predicts long-term outcomes for gait and balance in PD patients with STN DBS.
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Affiliation(s)
- Jung Hwan Shin
- Department of Neurology, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Ri Yu
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Kyung Kang
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Gyeonggi-do, South Korea
| | - Chan Young Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Kyung Ah Woo
- Department of Neurology, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Hee Jin Chang
- Department of Neurology, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Jehee Lee
- Department of Computer Science and Engineering, Seoul National University, Seoul, South Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University, Seoul, South Korea.
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Abstract
SignificanceAnxiety disorders are among the most prevalent mental illnesses worldwide. Despite significant advances in their treatment, many patients remain treatment resistant. Thus, new treatment modalities and targets are much needed. Therefore, we developed a deep brain stimulation therapy that targets a recently identified anxiety center in the lateral hypothalamus. We show that this therapy rapidly silences anxiety-implicated neurons and immediately relieves diverse anxiety symptoms in a variety of stressful situations. This therapeutic effect occurs without acute or chronic side effects that are typical of many existing treatments, such as physical sedation or memory deficits. These findings identify a clinically applicable new therapeutic strategy for helping patients to manage treatment-resistant anxiety.
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Zheng L, Feng Z, Xu Y, Yuan Y, Hu Y. An Anodic Phase Can Facilitate Rather Than Weaken a Cathodic Phase to Activate Neurons in Biphasic-Pulse Axonal Stimulations. Front Neurosci 2022; 16:823423. [PMID: 35368280 PMCID: PMC8968170 DOI: 10.3389/fnins.2022.823423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Electrical pulses have been promisingly utilized in neural stimulations to treat various diseases. Usually, charge-balanced biphasic pulses are applied in the clinic to eliminate the possible side effects caused by charge accumulations. Because of its reversal action to the preceding cathodic phase, the subsequent anodic phase has been commonly considered to lower the activation efficiency of biphasic pulses. However, an anodic pulse itself can also activate axons with its “virtual cathode” effect. Therefore, we hypothesized that the anodic phase of a biphasic pulse could facilitate neuronal activation in some circumstances. To verify the hypothesis, we compared the activation efficiencies of cathodic pulse, biphasic pulse, and anodic pulse applied in both monopolar and bipolar modes in the axonal stimulation of alveus in rat hippocampal CA1 region in vivo. The antidromically evoked population spikes (APS) were recorded and used to evaluate the amount of integrated firing of pyramidal neurons induced by pulse stimulations. We also used a computational model to investigate the pulse effects on axons at various distances from the stimulation electrode. The experimental results showed that, with a small pulse intensity, a cathodic pulse recruited more neurons to fire than a biphasic pulse. However, the situation was reversed with an increased pulse intensity. In addition, setting an inter-phase gap of 100 μs was able to increase the activation efficiency of a biphasic pulse to exceed a cathodic pulse even with a relatively small pulse intensity. Furthermore, the latency of APS evoked by a cathodic pulse was always longer than that of APS evoked by a biphasic pulse, indicating different initial sites of the neuronal firing evoked by the different types of pulses. The computational results of axon modeling showed that the subsequent anodic phase was able to relieve the hyperpolarization block in the flanking regions generated by the preceding cathodic phase, thereby increasing rather than decreasing the activation efficiency of a biphasic pulse with a relatively great intensity. These results of both rat experiments and computational modeling firstly reveal a facilitation rather than an attenuation effect of the anodic phase on biphasic-pulse stimulations, which provides important information for designing electrical stimulations for neural therapies.
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Lin Y, Xu D, Gao F, Zheng X. Ulinastatin inhibits NLRP3-induced apoptosis in a PD cell model. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:924. [PMID: 34350239 PMCID: PMC8263882 DOI: 10.21037/atm-21-1882] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 05/13/2021] [Indexed: 12/26/2022]
Abstract
Background Emerging evidence suggests that inflammation induced by the inflammasome plays a crucial role in the course of Parkinson’s disease (PD). Ulinastatin (UTI) has shown significant anti-inflammatory effects. However, few studies have examined whether UTI protects neurons through its anti-inflammatory effects in PD. The purpose of this study is to determine whether UTI exerts neuroprotection in a PD cell model and to explore the mechanisms. Methods SH-SY5Y cells and nerve growth factor (NGF)-treated PC12 cells were used to establish MPP+ induced PD cell models. Cells were pre-treated with UTI, then cell viabilities were detected using the MTT assay. Lactate dehydrogenase (LDH) release was detected using the LDH release assay kit. Inflammatory factors such as IL-1β, IL-6, and TNF-α were detected using ELISA. The expression levels of TH, NLRP3, caspase-1, ASC, IL-1β, and IL-18 were measured using western blotting, and DA release was detected using HPLC. A NLRP3 activator Nigericin was used to verify the effect of NLRP3 in the neuroprotective mechanism of UTI. Results We observed decreased cell viability, increased apoptosis, and increased inflammatory factors such as IL-1β, IL-6, and TNF-α in the MPP+ induced PD model. We also found decreased DA secretion and TH expression, as well as increased NLRP3, caspase-1, ASC, IL-1α, and IL-18 expression in the MPP+ induced PD model. These changes were significantly attenuated by UTI pre-treatment in a dose dependent manner. NLRP3 activator Nigericin markedly increased LDH release, accelerated apoptosis, increased inflammation levels and decreased DA secretion and TH expression, suggesting that Nigericin eliminated the neuroprotective effect of UTI on MPP+ treated cells. Conclusions Our data demonstrated that UTI pre-treatment performed a neuroprotective role in the MPP+ induced PD cell models by inhibiting the NLRP3 pathway.
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Affiliation(s)
- Yicheng Lin
- Cheeloo College of Medicine, Shandong University, Shandong Qianfoshan Hospital, Jinan, China
| | - Dongsheng Xu
- Department of Kidney Transplantation, The Second Hospital, Shandong University, Jinan, China
| | - Feng Gao
- Key Laboratory for Experimental Teratology of the Ministry of Education and Biomedical Isotope Research Center, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xiaolei Zheng
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Casquero-Veiga M, Bueno-Fernandez C, Romero-Miguel D, Lamanna-Rama N, Nacher J, Desco M, Soto-Montenegro ML. Exploratory study of the long-term footprint of deep brain stimulation on brain metabolism and neuroplasticity in an animal model of obesity. Sci Rep 2021; 11:5580. [PMID: 33692388 PMCID: PMC7946931 DOI: 10.1038/s41598-021-82987-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) is a powerful neurostimulation therapy proposed for the treatment of several neuropsychiatric disorders. However, DBS mechanism of action remains unclear, being its effects on brain dynamics of particular interest. Specifically, DBS reversibility is a major point of debate. Preclinical studies in obesity showed that the stimulation of the lateral hypothalamus (LH) and nucleus accumbens (NAcc), brain centers involved in satiety and reward circuits, are able to modulate the activity of brain structures impaired in this pathology. Nevertheless, the long-term persistence of this modulation after DBS withdrawal was unexplored. Here we examine the in vivo presence of such changes 1 month after LH- and NAcc-DBS, along with differences in synaptic plasticity, following an exploratory approach. Thus, both stimulated and non-stimulated animals with electrodes in the NAcc showed a common pattern of brain metabolism modulation, presumably derived from the electrodes' presence. In contrast, animals stimulated in the LH showed a relative metabolic invariance, and a reduction of neuroplasticity molecules, evidencing long-lasting neural changes. Our findings suggest that the reversibility or persistence of DBS modulation in the long-term depends on the selected DBS target. Therefore, the DBS footprint would be influenced by the stability achieved in the neural network involved during the stimulation.
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Affiliation(s)
- Marta Casquero-Veiga
- Laboratorio de Imagen Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
| | - Clara Bueno-Fernandez
- Neurobiology Unit, Cell Biology Department, Interdisciplinary Research Structure for Biotechnology and Biomedicine (BIOTECMED), Universitat de València, Madrid, Spain
| | - Diego Romero-Miguel
- Laboratorio de Imagen Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Nicolás Lamanna-Rama
- Laboratorio de Imagen Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan Nacher
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.,Neurobiology Unit, Cell Biology Department, Interdisciplinary Research Structure for Biotechnology and Biomedicine (BIOTECMED), Universitat de València, Madrid, Spain.,Fundación Investigación Hospital Clínico de Valencia, INCLIVA, Madrid, Spain
| | - Manuel Desco
- Laboratorio de Imagen Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain. .,Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Madrid, Spain. .,Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | - María Luisa Soto-Montenegro
- Laboratorio de Imagen Médica, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
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Goonasekera C, Jones H, Lawrence R, Hanrahan J, Iyer P, Nijhawan A. Exploring the utility of neuro-monitoring in neurosurgery: The users' perspective in a single center. Saudi J Anaesth 2021; 15:7-13. [PMID: 33824636 PMCID: PMC8016046 DOI: 10.4103/sja.sja_862_20] [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: 08/12/2020] [Revised: 09/01/2020] [Accepted: 09/13/2020] [Indexed: 11/05/2022] Open
Abstract
Background: The purpose of intraoperative neuro-monitoring (IONM) is to minimize injury to eloquent neural structures and optimize tumor resection. Method: We explored the utility of IONM using a qualitative approach in a single center. Eight experienced users of its use in spinal and cranial surgery in adults and children were the informants. Using a constant comparative method, the findings were collated by thematic analysis. Results: The user perspective is that of caution to minimize adverse effects whilst empowering the need for formal training to enhance its efficacy. The process of IONM needs standardization as practices vary amongst users. Most users expressed limited trust on its current capabilities but hoped for its advancement to achieve higher sensitivity and specificity. None were however prepared to abandon its use. Conclusion: IONM needs optimization. Its utility depends on user vigilance, multi-disciplinary validation, and individual expertise. This study draws out key issues from the user perspective that need to be addressed in order to enhance the utility of IONM.
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Affiliation(s)
- Chulananda Goonasekera
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - Holly Jones
- King's College London Faculty of Life Sciences and Medicine, School of Medicine, London, UK
| | - Rebekah Lawrence
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - John Hanrahan
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - Priyanka Iyer
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
| | - Aditi Nijhawan
- Department of Anesthetics, King's College Hospital NHS Trust, Denmark Hill, London SE59RS, UK
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Furlanetti L, Hasegawa H, Oviedova A, Raslan A, Samuel M, Selway R, Ashkan K. O-Arm Stereotactic Imaging in Deep Brain Stimulation Surgery Workflow: A Utility and Cost-Effectiveness Analysis. Stereotact Funct Neurosurg 2020; 99:93-106. [PMID: 33260175 DOI: 10.1159/000510344] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Deep brain stimulation (DBS) surgery is an established treatment for movement disorders. Advances in neuroimaging techniques have resulted in improved targeting accuracy that may improve clinical outcomes. This study aimed to evaluate the safety and feasibility of using the Medtronic O-arm device for the acquisition of intraoperative stereotactic imaging, targeting, and localization of DBS electrodes compared with standard stereotactic MRI or computed tomography (CT). METHODS Patients were recruited prospectively into the study. Routine frame-based stereotactic DBS surgery was performed. Intraoperative imaging was used to facilitate and verify the accurate placement of the intracranial electrodes. The acquisition of coordinates and verification of the position of the electrodes using the O-arm were evaluated and compared with conventional stereotactic MRI or CT. Additionally, a systematic review of the literature on the use of intraoperative imaging in DBS surgery was performed. RESULTS Eighty patients were included. The indications for DBS surgery were dystonia, Parkinson's disease, essential tremor, and epilepsy. The globus pallidus internus was the most commonly targeted region (43.7%), followed by the subthalamic nucleus (35%). Stereotactic O-arm imaging reduced the overall surgical time by 68 min, reduced the length of time of acquisition of stereotactic images by 77%, reduced patient exposure to ionizing radiation by 24.2%, significantly reduced operating room (OR) costs per procedure by 31%, and increased the OR and neuroradiology suite availability. CONCLUSIONS The use of the O-arm in DBS surgery workflow significantly reduced the duration of image acquisition, the exposure to ionizing radiation, and costs when compared with standard stereotactic MRI or CT, without reducing accuracy.
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Affiliation(s)
- Luciano Furlanetti
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom,
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Anna Oviedova
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Ahmed Raslan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Samuel
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, United Kingdom
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Siegenthaler JR, Gushiken BC, Hill DF, Cowen SL, Heien ML. Moving Fast-Scan Cyclic Voltammetry toward FDA Compliance with Capacitive Decoupling Patient Protection. ACS Sens 2020; 5:1890-1899. [PMID: 32580544 DOI: 10.1021/acssensors.9b02249] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Carbon-fiber microelectrodes allow for high spatial and temporal measurements of electroactive neurotransmitter measurements in vivo using fast-scan cyclic voltammetry (FSCV). However, common instrumentation for such measurements systems lack patient safety precautions. To add safety precautions as well as to overcome chemical and electrical noise, a two-electrode FSCV headstage was modified to introduce an active bandpass filter on the electrode side of the measurement amplifier. This modification reduced the measured noise and ac-coupled the voltammetric measurement and moved it from a classical direct current response measurement. ac-coupling not only reduces the measured noise, but also moves FSCV toward compliance with IEC-60601-1, enabling future human trials. Here, we develop a novel ac-coupled voltammetric measurement method of electroactive neurotransmitters. Our method allows for the modeling of a system to then calculate a waveform to compensate for added impedance and capacitance for the system. We describe how first by measuring the frequency response of the system and modeling the analogue response as a digital filter we can then calculate a predicted waveform. The predicted waveform, when applied to the bandpass filter, is modulated to create a desired voltage sweep at the electrode interface. Further, we describe how this modified FSCV waveform is stable, allowing for the measurement of electroactive neurotransmitters. We later describe a 32.7% sensitivity enhancement for dopamine with this new measurement as well as maintaining a calibration curve for dopamine, 3,4-dihydroxyphenylacetic acid, ascorbic acid, and serotonin in vitro. We then validate dopamine in vivo with stimulated release. Our developed measurement method overcame the added capacitance that would traditionally make a voltammetric measurement impossible, and it has wider applications in electrode sensor development, allowing for measurement with capacitive systems, which previously would not have been possible.
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Affiliation(s)
- James R. Siegenthaler
- Department of Chemistry & Biochemistry, University of Arizona, Tucson, Arizona, United States
| | - Breanna C. Gushiken
- Department of Chemistry & Biochemistry, University of Arizona, Tucson, Arizona, United States
| | - Daniel F. Hill
- Department of Physiology, University of Arizona, Tucson, Arizona, United States
| | - Stephen L. Cowen
- Department of Psychology, University of Arizona, Tucson, Arizona, United States
- Evelyn F. McKnight Brain Institute, University of Arizona, Tucson, Arizona, United States
| | - Michael L. Heien
- Department of Chemistry & Biochemistry, University of Arizona, Tucson, Arizona, United States
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Kim R, Yoo D, Choi JH, Shin JH, Park S, Kim HJ, Paek SH, Jeon B. Sex differences in the short-term and long-term effects of subthalamic nucleus stimulation in Parkinson's disease. Parkinsonism Relat Disord 2019; 68:73-78. [DOI: 10.1016/j.parkreldis.2019.09.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 09/19/2019] [Accepted: 09/25/2019] [Indexed: 10/25/2022]
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Kim R, Yoo D, Jung YJ, Lee WW, Ehm G, Yun JY, Kim HJ, Lee JY, Kim JY, Kim HJ, Paek SH, Jeon B. Determinants of Functional Independence or Its Loss following Subthalamic Nucleus Stimulation in Parkinson's Disease. Stereotact Funct Neurosurg 2019; 97:106-112. [PMID: 31266044 DOI: 10.1159/000500277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/10/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE This study aimed to describe the change in functional status following bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) and to identify predictors of postoperative functional dependence. METHODS We included PD patients with bilateral STN-DBS who had complete Schwab & England Activities of Daily Living (S&E ADL) Scale data at baseline and 6 months after surgery from our prospective registry. Functional dependence was defined as an S&E ADL score of less than 80%. All data were collected from the on-medication state and on-stimulation state (after surgery). Logistic regression analyses were performed to determine the factors predictive of functional dependence after surgery. RESULTS A total of 196 patients were included. At baseline, 41 patients were functionally dependent and the other 155 were functionally independent. Among the patients with preoperative dependence, 32 (78%) became functionally independent after surgery, and this conversion was associated with a lower baseline axial score (p = 0.012). Among the patients with preoperative independence, 21 (14%) developed postoperative dependence, and this conversion was associated with a higher baseline axial score (p = 0.013) and its smaller improvement (p < 0.001). Female sex (odds ratio [OR] 3.214; 95% confidence interval [CI] 1.210-8.542; p = 0.019) and a higher baseline axial score (OR 1.184; 95% CI 1.056-1.327; p = 0.004) significantly predicted the risk of postoperative functional dependence. CONCLUSIONS We found that functional status following bilateral STN-DBS is closely related to preoperative axial symptoms. When loss of independence is a potential target for STN-DBS, clinicians should take into consideration the severity of axial impairment before surgery.
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Affiliation(s)
- Ryul Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dallah Yoo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yu Jin Jung
- Department of Neurology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Woong-Woo Lee
- Department of Neurology, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Gwanhee Ehm
- Department of Neurology, National Medical Center, Seoul, Republic of Korea
| | - Ji Young Yun
- Department of Neurology, Ewha Womans University Seoul Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Hee Jin Kim
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jee-Young Lee
- Department of Neurology, Seoul National University - Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji-Young Kim
- Department of Neurology, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Han-Joon Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Ha Paek
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Beomseok Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea,
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Reyes-Garcés N, Diwan M, Boyacı E, Gómez-Ríos GA, Bojko B, Nobrega JN, Bambico FR, Hamani C, Pawliszyn J. In Vivo Brain Sampling Using a Microextraction Probe Reveals Metabolic Changes in Rodents after Deep Brain Stimulation. Anal Chem 2019; 91:9875-9884. [DOI: 10.1021/acs.analchem.9b01540] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Nathaly Reyes-Garcés
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - Mustansir Diwan
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Ezel Boyacı
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - German A. Gómez-Ríos
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - Barbara Bojko
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
| | - José N. Nobrega
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Francis R. Bambico
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Clement Hamani
- Research Imaging Centre, Centre for Addiction and Mental Health, Toronto, Ontario Canada
| | - Janusz Pawliszyn
- Department of Chemistry, University of Waterloo, Waterloo, Ontario, Canada N2L 3G1
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14
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Kim R, Kim HJ, Shin C, Park H, Kim A, Paek SH, Jeon B. Long-term effect of subthalamic nucleus deep brain stimulation on freezing of gait in Parkinson's disease. J Neurosurg 2019; 131:1797-1804. [PMID: 30641837 DOI: 10.3171/2018.8.jns18350] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson's disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD. METHODS Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson's Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation). RESULTS During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition. CONCLUSIONS Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.
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Affiliation(s)
- Ryul Kim
- Departments of1Neurology and
- 2Department of Neurology, Aerospace Medical Center, Republic of Korea Air Force, Cheongju, Chungcheongbuk-do, Korea
| | | | - Chaewon Shin
- 3Department of Neurology, Kyung Hee University Hospital, Seoul; and
| | | | | | - Sun Ha Paek
- 4Neurosurgery, Seoul National University Hospital, College of Medicine
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On the Use of t-Distributed Stochastic Neighbor Embedding for Data Visualization and Classification of Individuals with Parkinson's Disease. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2018; 2018:8019232. [PMID: 30532798 PMCID: PMC6247646 DOI: 10.1155/2018/8019232] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 09/16/2018] [Accepted: 10/02/2018] [Indexed: 12/23/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder that remains incurable. The available treatments for the disorder include pharmacologic therapies and deep brain stimulation (DBS). These approaches may cause distinct side effects and motor responses. This work presents the application of t-distributed stochastic neighbor embedding (t-SNE), which is a machine learning algorithm for nonlinear dimensionality reduction and data visualization, for the problem of discriminating neurologically healthy individuals from those suffering from PD (treated with levodopa and DBS). Furthermore, the assessment of classification methods is presented. Inertial and electromyographic data were collected while the subjects executed a sequence of four motor tasks. The results were focused on the comparison of the classification performance of a support vector machine (SVM) while discriminating two-dimensional feature sets estimated from Principal Component Analysis (PCA), Sammon's mapping, and t-SNE. The results showed visual and statistical differences for all three investigated groups. Classification accuracy for PCA, Sammon's mapping, and t-SNE was, respectively, 73.5%, 78.6%, and 96.9% for the training set and 67.8%, 74.1%, and 76.6% for the test set. The possibility of discriminating healthy individuals from those with PD treated with levodopa and DBS highlights the fact that each treatment method produces distinct motor behavior. The scatter plots resulting from t-SNE could be used in the clinical practice as an objective tool for measuring the discrepancy between normal and abnormal motor behaviors, being thus useful for the adjustment of treatments and the follow-up of the disorder.
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Casquero-Veiga M, García-García D, Desco M, Soto-Montenegro ML. Understanding Deep Brain Stimulation: In Vivo Metabolic Consequences of the Electrode Insertional Effect. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8560232. [PMID: 30417016 PMCID: PMC6207900 DOI: 10.1155/2018/8560232] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 09/10/2018] [Accepted: 10/01/2018] [Indexed: 12/16/2022]
Abstract
Deep brain stimulation (DBS) is a neurosurgery technique widely used in movement disorders, although its mechanism of action remains unclear. In fact, apart from the stimulation itself, the mechanical insertion of the electrode may play a crucial role. Here we aimed to distinguish between the insertional and the DBS effects on brain glucose metabolism. To this end, electrodes were implanted targeting the medial prefrontal cortex in five adult male Wistar rats. Positron Emission Tomography (PET) studies were performed before surgery (D0) and seven (D7) and nine days (D9) after that. DBS was applied during the 18FDG uptake of the D9 study. PET data were analysed with statistical parametric mapping. We found an electrode insertional effect in cortical areas, while DBS resulted in a more widespread metabolic pattern. The consequences of simultaneous electrode and DBS factors revealed a combination of both effects. Therefore, the insertion metabolic effects differed from the stimulation ones, which should be considered when assessing DBS protocols.
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Affiliation(s)
| | - David García-García
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid 28007, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid 28029, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés 28911, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid 28007, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid 28029, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés 28911, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid 28029, Spain
| | - María Luisa Soto-Montenegro
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid 28007, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid 28029, Spain
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17
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Casquero-Veiga M, García-García D, Pascau J, Desco M, Soto-Montenegro ML. Stimulating the nucleus accumbens in obesity: A positron emission tomography study after deep brain stimulation in a rodent model. PLoS One 2018; 13:e0204740. [PMID: 30261068 PMCID: PMC6160153 DOI: 10.1371/journal.pone.0204740] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 09/13/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE The nucleus accumbens (NAcc) has been suggested as a possible target for deep brain stimulation (DBS) in the treatment of obesity. Our hypothesis was that NAcc-DBS would modulate brain regions related to reward and food intake regulation, consequently reducing the food intake and, finally, the weight gain. Therefore, we examined changes in brain glucose metabolism, weight gain and food intake after NAcc-DBS in a rat model of obesity. PROCEDURES Electrodes were bilaterally implanted in 2 groups of obese Zucker rats targeting the NAcc. One group received stimulation one hour daily during 15 days, while the other remained as control. Weight and daily consumption of food and water were everyday registered the days of stimulation, and twice per week during the following month. Positron emission tomography (PET) studies with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) were performed 1 day after the end of DBS. PET data was assessed by statistical parametric mapping (SPM12) software and region of interest (ROI) analyses. RESULTS NAcc-DBS lead to increased metabolism in the cingulate-retrosplenial-parietal association cortices, and decreased metabolism in the NAcc, thalamic and pretectal nuclei. Furthermore, ROIs analyses confirmed these results by showing a significant striatal and thalamic hypometabolism, and a cortical hypermetabolic region. However, NAcc-DBS did not induce a decrease in either weight gain or food intake. CONCLUSIONS NAcc-DBS led to changes in the metabolism of regions associated with cognitive and reward systems, whose impairment has been described in obesity.
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Affiliation(s)
| | | | - Javier Pascau
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Spain
| | - Manuel Desco
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
- Departamento de Bioingeniería e Ingeniería Aeroespacial, Universidad Carlos III de Madrid, Leganés, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - María Luisa Soto-Montenegro
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- CIBER de Salud Mental (CIBERSAM), Madrid, Spain
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Edwards CA, Kouzani A, Lee KH, Ross EK. Neurostimulation Devices for the Treatment of Neurologic Disorders. Mayo Clin Proc 2017; 92:1427-1444. [PMID: 28870357 DOI: 10.1016/j.mayocp.2017.05.005] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 04/16/2017] [Accepted: 05/01/2017] [Indexed: 12/01/2022]
Abstract
Rapid advancements in neurostimulation technologies are providing relief to an unprecedented number of patients affected by debilitating neurologic and psychiatric disorders. Neurostimulation therapies include invasive and noninvasive approaches that involve the application of electrical stimulation to drive neural function within a circuit. This review focuses on established invasive electrical stimulation systems used clinically to induce therapeutic neuromodulation of dysfunctional neural circuitry. These implantable neurostimulation systems target specific deep subcortical, cortical, spinal, cranial, and peripheral nerve structures to modulate neuronal activity, providing therapeutic effects for a myriad of neuropsychiatric disorders. Recent advances in neurotechnologies and neuroimaging, along with an increased understanding of neurocircuitry, are factors contributing to the rapid rise in the use of neurostimulation therapies to treat an increasingly wide range of neurologic and psychiatric disorders. Electrical stimulation technologies are evolving after remaining fairly stagnant for the past 30 years, moving toward potential closed-loop therapeutic control systems with the ability to deliver stimulation with higher spatial resolution to provide continuous customized neuromodulation for optimal clinical outcomes. Even so, there is still much to be learned about disease pathogenesis of these neurodegenerative and psychiatric disorders and the latent mechanisms of neurostimulation that provide therapeutic relief. This review provides an overview of the increasingly common stimulation systems, their clinical indications, and enabling technologies.
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Affiliation(s)
- Christine A Edwards
- School of Engineering, Deakin University, Geelong, Victoria, Australia; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
| | - Abbas Kouzani
- School of Engineering, Deakin University, Geelong, Victoria, Australia
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN
| | - Erika K Ross
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN; Department of Surgery, Mayo Clinic, Rochester, MN.
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Parastarfeizabadi M, Kouzani AZ. Advances in closed-loop deep brain stimulation devices. J Neuroeng Rehabil 2017; 14:79. [PMID: 28800738 PMCID: PMC5553781 DOI: 10.1186/s12984-017-0295-1] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/04/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Millions of patients around the world are affected by neurological and psychiatric disorders. Deep brain stimulation (DBS) is a device-based therapy that could have fewer side-effects and higher efficiencies in drug-resistant patients compared to other therapeutic options such as pharmacological approaches. Thus far, several efforts have been made to incorporate a feedback loop into DBS devices to make them operate in a closed-loop manner. METHODS This paper presents a comprehensive investigation into the existing research-based and commercial closed-loop DBS devices. It describes a brief history of closed-loop DBS techniques, biomarkers and algorithms used for closing the feedback loop, components of the current research-based and commercial closed-loop DBS devices, and advancements and challenges in this field of research. This review also includes a comparison of the closed-loop DBS devices and provides the future directions of this area of research. RESULTS Although we are in the early stages of the closed-loop DBS approach, there have been fruitful efforts in design and development of closed-loop DBS devices. To date, only one commercial closed-loop DBS device has been manufactured. However, this system does not have an intelligent and patient dependent control algorithm. A closed-loop DBS device requires a control algorithm to learn and optimize the stimulation parameters according to the brain clinical state. CONCLUSIONS The promising clinical effects of open-loop DBS have been demonstrated, indicating DBS as a pioneer technology and treatment option to serve neurological patients. However, like other commercial devices, DBS needs to be automated and modernized.
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Affiliation(s)
| | - Abbas Z. Kouzani
- School of Engineering, Deakin University, Waurn Ponds, VIC 3216 Australia
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20
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Spagnolo PA, Goldman D. Neuromodulation interventions for addictive disorders: challenges, promise, and roadmap for future research. Brain 2017; 140:1183-1203. [PMID: 28082299 PMCID: PMC6059187 DOI: 10.1093/brain/aww284] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/24/2016] [Accepted: 09/12/2016] [Indexed: 01/27/2023] Open
Abstract
Addictive disorders are a major public health concern, associated with high relapse rates, significant disability and substantial mortality. Unfortunately, current interventions are only modestly effective. Preclinical studies as well as human neuroimaging studies have provided strong evidence that the observable behaviours that characterize the addiction phenotype, such as compulsive drug consumption, impaired self-control, and behavioural inflexibility, reflect underlying dysregulation and malfunction in specific neural circuits. These developments have been accompanied by advances in neuromodulation interventions, both invasive as deep brain stimulation, and non-invasive such as repetitive transcranial magnetic stimulation and transcranial direct current stimulation. These interventions appear particularly promising as they may not only allow us to probe affected brain circuits in addictive disorders, but also seem to have unique therapeutic applications to directly target and remodel impaired circuits. However, the available literature is still relatively small and sparse, and the long-term safety and efficacy of these interventions need to be confirmed. Here we review the literature on the use of neuromodulation in addictive disorders to highlight progress limitations with the aim to suggest future directions for this field.
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Affiliation(s)
- Primavera A Spagnolo
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
| | - David Goldman
- Office of the Clinical Director, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
- Laboratory of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland, USA
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Lee KH, Lujan JL, Trevathan JK, Ross EK, Bartoletta JJ, Park HO, Paek SB, Nicolai EN, Lee JH, Min HK, Kimble CJ, Blaha CD, Bennet KE. WINCS Harmoni: Closed-loop dynamic neurochemical control of therapeutic interventions. Sci Rep 2017; 7:46675. [PMID: 28452348 PMCID: PMC5408229 DOI: 10.1038/srep46675] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 03/24/2017] [Indexed: 01/24/2023] Open
Abstract
There has been significant progress in understanding the role of neurotransmitters in normal and pathologic brain function. However, preclinical trials aimed at improving therapeutic interventions do not take advantage of real-time in vivo neurochemical changes in dynamic brain processes such as disease progression and response to pharmacologic, cognitive, behavioral, and neuromodulation therapies. This is due in part to a lack of flexible research tools that allow in vivo measurement of the dynamic changes in brain chemistry. Here, we present a research platform, WINCS Harmoni, which can measure in vivo neurochemical activity simultaneously across multiple anatomical targets to study normal and pathologic brain function. In addition, WINCS Harmoni can provide real-time neurochemical feedback for closed-loop control of neurochemical levels via its synchronized stimulation and neurochemical sensing capabilities. We demonstrate these and other key features of this platform in non-human primate, swine, and rodent models of deep brain stimulation (DBS). Ultimately, systems like the one described here will improve our understanding of the dynamics of brain physiology in the context of neurologic disease and therapeutic interventions, which may lead to the development of precision medicine and personalized therapies for optimal therapeutic efficacy.
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Affiliation(s)
- Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, United States of America
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, United States of America
| | - J. Luis Lujan
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, United States of America
| | - James K. Trevathan
- Mayo Graduate School, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Erika K. Ross
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - John J. Bartoletta
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Hyung Ook Park
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Seungleal Brian Paek
- Mayo Graduate School, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Evan N. Nicolai
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Jannifer H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN 55905, United States of America
| | | | - Charles D. Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Kevin E. Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN 55905, United States of America
- Division of Engineering, Mayo Clinic, Rochester, MN 55905, United States of America
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22
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De Vloo P, Raymaekers S, van Kuyck K, Luyten L, Gabriëls L, Nuttin B. Rechargeable Stimulators in Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Prospective Interventional Cohort Study. Neuromodulation 2017; 21:203-210. [PMID: 28256778 DOI: 10.1111/ner.12577] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND From 1999 onwards, deep brain stimulation (DBS) has been proposed as an alternative to capsulotomy in refractory cases of obsessive-compulsive disorder (OCD). Although rechargeable implantable pulse generators (rIPGs) have been used extensively in DBS for movement disorders, there are no reports on rIPGs in patients with a psychiatric DBS indication, and even possible objections to their use. OBJECTIVE We aim to evaluate rIPGs in OCD in terms of effectiveness, applicability, safety, and need for IPG replacement. METHODS In this prospective before-after study recruiting from 2007 until 2012, OCD patients requiring at least one IPG replacement per 18 months were proposed to have a rIPG implanted at the next IPG depletion. OCD severity was the primary outcome. Ten patients were analyzed. RESULTS Psychiatric symptoms and global functioning remained stable in the two years after as compared to the two years before rIPG implantation. Over the same period, the prescribed OCD medication doses did not increase and the DBS stimulation parameters were largely unaltered. Until the end of the follow-up (mean 4¾ years; maximum seven years), the DBS-related surgery frequency decreased and there were no rIPG replacements. During the first few weeks after implantation, two patients obsessively checked the rIPG, but afterwards there were no signs of compulsively checking or recharging the rIPG. Two patients experienced rIPG overdischarges (five occurrences in total). CONCLUSIONS This is the first report on rIPGs in DBS for OCD patients. The use of rIPGs in this population appears to be effective, applicable, and safe and diminishes the need for IPG replacements.
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Affiliation(s)
- Philippe De Vloo
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.,Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
| | - Simon Raymaekers
- Department of Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - Kris van Kuyck
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
| | - Laura Luyten
- Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium.,Research Group Psychology of Learning and Experimental Psychopathology, KU Leuven, Leuven, Belgium
| | | | - Bart Nuttin
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.,Research Group Experimental Neurosurgery and Neuroanatomy, KU Leuven, Leuven, Belgium
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23
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Machado ARP, Zaidan HC, Paixão APS, Cavalheiro GL, Oliveira FHM, Júnior JAFB, Naves K, Pereira AA, Pereira JM, Pouratian N, Zhuo X, O'Keeffe A, Sharim J, Bordelon Y, Yang L, Vieira MF, Andrade AO. Feature visualization and classification for the discrimination between individuals with Parkinson's disease under levodopa and DBS treatments. Biomed Eng Online 2016; 15:169. [PMID: 28038673 PMCID: PMC5203727 DOI: 10.1186/s12938-016-0290-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/26/2016] [Indexed: 12/15/2022] Open
Abstract
Background Over the years, a number of distinct treatments have been adopted for the management of the motor symptoms of Parkinson’s disease (PD), including pharmacologic therapies and deep brain stimulation (DBS). Efficacy is most often evaluated by subjective assessments, which are prone to error and dependent on the experience of the examiner. Our goal was to identify an objective means of assessing response to therapy. Methods In this study, we employed objective analyses in order to visualize and identify differences between three groups: healthy control (N = 10), subjects with PD treated with DBS (N = 12), and subjects with PD treated with levodopa (N = 16). Subjects were assessed during execution of three dynamic tasks (finger taps, finger to nose, supination and pronation) and a static task (extended arm with no active movement). Measurements were acquired with two pairs of inertial and electromyographic sensors. Feature extraction was applied to estimate the relevant information from the data after which the high-dimensional feature space was reduced to a two-dimensional space using the nonlinear Sammon’s map. Non-parametric analysis of variance was employed for the verification of relevant statistical differences among the groups (p < 0.05). In addition, K-fold cross-validation for discriminant analysis based on Gaussian Finite Mixture Modeling was employed for data classification. Results The results showed visual and statistical differences for all groups and conditions (i.e., static and dynamic tasks). The employed methods were successful for the discrimination of the groups. Classification accuracy was 81 ± 6% (mean ± standard deviation) and 71 ± 8%, for training and test groups respectively. Conclusions This research showed the discrimination between healthy and diseased groups conditions. The methods were also able to discriminate individuals with PD treated with DBS and levodopa. These methods enable objective characterization and visualization of features extracted from inertial and electromyographic sensors for different groups.
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Affiliation(s)
- Alessandro R P Machado
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil.
| | - Hudson Capanema Zaidan
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
| | - Ana Paula Souza Paixão
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
| | - Guilherme Lopes Cavalheiro
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
| | - Fábio Henrique Monteiro Oliveira
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
| | - João Areis Ferreira Barbosa Júnior
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
| | - Kheline Naves
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
| | - Adriano Alves Pereira
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
| | | | - Nader Pouratian
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Xiaoyi Zhuo
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Andrew O'Keeffe
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Justin Sharim
- Department of Neurosurgery, University of California, Los Angeles, USA
| | - Yvette Bordelon
- Department of Neurology, University of California, Los Angeles, USA
| | - Laurice Yang
- Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Marcus Fraga Vieira
- Bioengineering and Biomechanics Laboratory, Federal University of Goiás, Goiânia, Brazil
| | - Adriano O Andrade
- Postgraduate Program in Electrical and Biomedical Engineering, Faculty of Electrical Engineering, Centre for Innovation and Technology Assessment in Health (NIATS), Federal University of Uberlândia, Uberlândia, Brazil
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24
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Abstract
Functional neurosurgery has undergone rapid growth over the last few years fueled by advances in imaging technology and novel treatment modalities. These advances have led to new surgical treatments using minimally invasive and precise techniques for conditions such as Parkinson's disease, essential tremor, epilepsy, and psychiatric disorders. Understanding the goals and technological issues of these procedures is imperative for the anesthesiologist to ensure safe management of patients presenting for functional neurosurgical procedures. In this review, we discuss the advances in neurosurgical techniques for deep brain stimulation, focused ultrasound and minimally invasive laser-based treatment of refractory epilepsy and provide a guideline for anesthesiologists caring for patients undergoing these procedures.
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Yeoh TY, Manninen P, Kalia SK, Venkatraghavan L. Anesthesia considerations for patients with an implanted deep brain stimulator undergoing surgery: a review and update. Can J Anaesth 2016; 64:308-319. [DOI: 10.1007/s12630-016-0794-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 10/06/2016] [Accepted: 12/08/2016] [Indexed: 11/25/2022] Open
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Da Cunha C, Boschen SL, Gómez-A A, Ross EK, Gibson WSJ, Min HK, Lee KH, Blaha CD. Toward sophisticated basal ganglia neuromodulation: Review on basal ganglia deep brain stimulation. Neurosci Biobehav Rev 2015; 58:186-210. [PMID: 25684727 DOI: 10.1016/j.neubiorev.2015.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 12/11/2022]
Abstract
This review presents state-of-the-art knowledge about the roles of the basal ganglia (BG) in action-selection, cognition, and motivation, and how this knowledge has been used to improve deep brain stimulation (DBS) treatment of neurological and psychiatric disorders. Such pathological conditions include Parkinson's disease, Huntington's disease, Tourette syndrome, depression, and obsessive-compulsive disorder. The first section presents evidence supporting current hypotheses of how the cortico-BG circuitry works to select motor and emotional actions, and how defects in this circuitry can cause symptoms of the BG diseases. Emphasis is given to the role of striatal dopamine on motor performance, motivated behaviors and learning of procedural memories. Next, the use of cutting-edge electrochemical techniques in animal and human studies of BG functioning under normal and disease conditions is discussed. Finally, functional neuroimaging studies are reviewed; these works have shown the relationship between cortico-BG structures activated during DBS and improvement of disease symptoms.
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Affiliation(s)
- Claudio Da Cunha
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Suelen L Boschen
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Alexander Gómez-A
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Erika K Ross
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Charles D Blaha
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
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Ballester González J, Dvorkin-Gheva A, Silva C, Foster JA, Szechtman H. Nucleus accumbens core and pathogenesis of compulsive checking. Behav Pharmacol 2015; 26:200-16. [PMID: 25426580 PMCID: PMC5398318 DOI: 10.1097/fbp.0000000000000112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Accepted: 10/16/2014] [Indexed: 11/26/2022]
Abstract
To investigate the role of the nucleus accumbens core (NAc) in the development of quinpirole-induced compulsive checking, rats received an excitotoxic lesion of NAc or sham lesion and were injected with quinpirole (0.5 mg/kg) or saline; development of checking behavior was monitored for 10 biweekly tests. The results showed that even after the NAc lesion, quinpirole still induced compulsive checking, suggesting that the pathogenic effects produced by quinpirole lie outside the NAc. Although the NAc lesion did not prevent the induction of compulsive checking, it altered how quickly it develops, suggesting that the NAc normally contributes toward the induction of compulsive checking. Saline-treated rats with an NAc lesion were hyperactive, but did not develop compulsive checking, indicating that hyperactivity by itself is not sufficient for the pathogenesis of compulsive checking. It is proposed that compulsive checking is the exaggerated output of a security motivation system and that the NAc serves as a neural hub for coordinating the orderly activity of neural modules of this motivational system. Evidence is considered suggesting that the neurobiological condition for the pathogenesis of compulsive checking is two-fold: activation of dopamine D2/D3 receptors without concurrent stimulation of D1-like receptors and long-term plastic changes related to quinpirole-induced sensitization.
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Affiliation(s)
| | - Anna Dvorkin-Gheva
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Charmaine Silva
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Jane A. Foster
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Henry Szechtman
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Wang Y, Liu T. Quantitative susceptibility mapping (QSM): Decoding MRI data for a tissue magnetic biomarker. Magn Reson Med 2015; 73:82-101. [PMID: 25044035 PMCID: PMC4297605 DOI: 10.1002/mrm.25358] [Citation(s) in RCA: 563] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 06/13/2014] [Accepted: 06/18/2014] [Indexed: 01/03/2023]
Abstract
In MRI, the main magnetic field polarizes the electron cloud of a molecule, generating a chemical shift for observer protons within the molecule and a magnetic susceptibility inhomogeneity field for observer protons outside the molecule. The number of water protons surrounding a molecule for detecting its magnetic susceptibility is vastly greater than the number of protons within the molecule for detecting its chemical shift. However, the study of tissue magnetic susceptibility has been hindered by poor molecular specificities of hitherto used methods based on MRI signal phase and T2* contrast, which depend convolutedly on surrounding susceptibility sources. Deconvolution of the MRI signal phase can determine tissue susceptibility but is challenged by the lack of MRI signal in the background and by the zeroes in the dipole kernel. Recently, physically meaningful regularizations, including the Bayesian approach, have been developed to enable accurate quantitative susceptibility mapping (QSM) for studying iron distribution, metabolic oxygen consumption, blood degradation, calcification, demyelination, and other pathophysiological susceptibility changes, as well as contrast agent biodistribution in MRI. This paper attempts to summarize the basic physical concepts and essential algorithmic steps in QSM, to describe clinical and technical issues under active development, and to provide references, codes, and testing data for readers interested in QSM.
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Affiliation(s)
- Yi Wang
- Radiology, Weill Medical College of Cornell UniversityNew York, New York, USA
- Biomedical Engineering, Cornell UniversityIthaca, New York, USA
- Biomedical Engineering, Kyung Hee UniversitySeoul, South Korea
| | - Tian Liu
- MedImageMetric, LLCNew York, New York, USA
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Ineichen C, Glannon W, Temel Y, Baumann CR, Sürücü O. A critical reflection on the technological development of deep brain stimulation (DBS). Front Hum Neurosci 2014; 8:730. [PMID: 25278864 PMCID: PMC4166315 DOI: 10.3389/fnhum.2014.00730] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/30/2014] [Indexed: 12/03/2022] Open
Abstract
Since the translational research findings of Benabid and colleagues which partly led to their seminal paper regarding the treatment of mainly tremor-dominant Parkinson patients through thalamic high-frequency-stimulation (HFS) in 1987, we still struggle with identifying a satisfactory mechanistic explanation of the underlying principles of deep brain stimulation (DBS). Furthermore, the technological advance of DBS devices (electrodes and implantable pulse generators, IPG’s) has shown a distinct lack of dynamic progression. In light of this we argue that it is time to leave the paleolithic age and enter hellenistic times: the device-manufacturing industry and the medical community together should put more emphasis on advancing the technology rather than resting on their laurels.
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Affiliation(s)
- Christian Ineichen
- Institute of Biomedical Ethics, University of Zurich Zurich, Switzerland
| | - Walter Glannon
- Department of Philosophy, University of Calgary Calgary, CGY, Canada
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | | | - Oguzkan Sürücü
- Division of Neurosurgery, University Hospital Zurich Zurich, Switzerland
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Iravani B, Towhidkhah F, Roghani M. A new feature extraction method and classification of early stage Parkinsonian rats with and without DBS treatment. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2014; 37:655-64. [PMID: 25173488 DOI: 10.1007/s13246-014-0296-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
Parkinson Disease (PD) is one of the most common neural disorders worldwide. Different treatments such as medication and deep brain stimulation (DBS) have been proposed to minimize and control Parkinson's symptoms. DBS has been recognized as an effective approach to decrease most movement disorders of PD. In this study, a new method is proposed for feature extraction and separation of treated and untreated Parkinsonan rats. For this purpose, unilateral intrastriatal 6-hydroxydopamine (6-OHDA, 12.5 μg/5 μl of saline-ascorbate)-lesioned rats were treated with DBS. We performed a behavioral experiment and video tracked traveled trajectories of rats. Then, we investigated the effect of deep brain stimulation of subthalamus nucleus on their behavioral movements. Time, frequency and chaotic features of traveled trajectories were extracted. These features provide the ability to quantify the behavioral movements of Parkinsonian rats. The results showed that the traveled trajectories of untreated were more convoluted with the different time/frequency response. Compared to the traditional features used before to quantify the animals' behavior, the new features improved classification accuracy up to 80 % for untreated and treated rats.
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Affiliation(s)
- B Iravani
- Department of Biomedical, Amirkabir University of Technology, Hafez Street, Tehran, Iran
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Chen L, Li N, Gao L, Yang C, Fang W, Wang XL, Gao GD. Improved stereotactic procedure enhances the accuracy of deep brain stimulation electrode implantation in non-human primates. Int J Neurosci 2014; 125:380-9. [DOI: 10.3109/00207454.2014.940524] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Zibly Z, Graves CA, Harnof S, Hadani M, Cohen ZR. Sonoablation and application of MRI guided focused ultrasound in a preclinical model. J Clin Neurosci 2014; 21:1808-14. [PMID: 25012486 DOI: 10.1016/j.jocn.2014.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 04/05/2014] [Indexed: 01/16/2023]
Abstract
Stereotaxic sonoablative surgery by MRI guided high intensity focused ultrasound (FUS) holds great potential in disorders of the central nervous system (CNS). We previously described the ExAblate 2000 system (InSightec, Tirat Carmel, Israel), currently in use for various pathologies including uterine, liver, and, breast tumors, and referred to as the "body" system. Using a porcine model we have previously demonstrated, using the body system, the ablative capacity and thermal transfer in the cortex; developed a reproducible and translational model of craniectomy and post-operative recovery in FUS; and determined a grouping strategy based on thermal ablation and pathologic incremental changes in the cortex. Here we describe a novel ExAblate 4000 system that is designed specifically to treat CNS disorders ("head" system). Twenty-two swine underwent an improved wide craniectomy for positioning of the ExAblate 4000 containing 1024 elements arrayed with MRI guidance. Further neurologic and pathological analysis was performed 1 week post-operatively. Subjects underwent a wide craniectomy followed by high intensity MR guided focused ultrasound (MRgHIFU) sonoablation. Thermal ultrasonic ablative lesions were achieved in all subjects (n=22) ranging from 52-65°C following ∼70 consecutive sonications at 80 watts. These subjects were grouped based on thermal ablative lesions and post-operative staging (MRI, gross and microscopic pathology). Our results indicate the reproducibility of a porcine model for cerebral ablation, achieved across a dynamic temperature range, and well tolerated in this cohort. The ExAblate 4000 system is efficient through a wide craniectomy as well as a closed skull and demonstrates a high safety margin. Incremental hemorrhage and necrosis were minimal and energy dependent, indicating MRgHIFU can be used for the treatment of various cerebral pathologies and movement disorders.
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Affiliation(s)
- Zion Zibly
- Department of Neurological Surgery, The Charles Clore Hospitalization Tower, West Wing Sheba Medical Center, Ramat Gan, Israel.
| | - Christian A Graves
- Department of Pathology, Microbiology, and Immunology, 6439 Garners Ferry Rd., Building 1, Room C27, Columbia, SC 29209, USA
| | - Sagi Harnof
- Department of Neurological Surgery, The Charles Clore Hospitalization Tower, West Wing Sheba Medical Center, Ramat Gan, Israel
| | - Moshe Hadani
- Department of Neurological Surgery, The Charles Clore Hospitalization Tower, West Wing Sheba Medical Center, Ramat Gan, Israel
| | - Zvi R Cohen
- Department of Neurological Surgery, The Charles Clore Hospitalization Tower, West Wing Sheba Medical Center, Ramat Gan, Israel
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Grahn PJ, Mallory GW, Khurram OU, Berry BM, Hachmann JT, Bieber AJ, Bennet KE, Min HK, Chang SY, Lee KH, Lujan JL. A neurochemical closed-loop controller for deep brain stimulation: toward individualized smart neuromodulation therapies. Front Neurosci 2014; 8:169. [PMID: 25009455 PMCID: PMC4070176 DOI: 10.3389/fnins.2014.00169] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 06/02/2014] [Indexed: 01/13/2023] Open
Abstract
Current strategies for optimizing deep brain stimulation (DBS) therapy involve multiple postoperative visits. During each visit, stimulation parameters are adjusted until desired therapeutic effects are achieved and adverse effects are minimized. However, the efficacy of these therapeutic parameters may decline with time due at least in part to disease progression, interactions between the host environment and the electrode, and lead migration. As such, development of closed-loop control systems that can respond to changing neurochemical environments, tailoring DBS therapy to individual patients, is paramount for improving the therapeutic efficacy of DBS. Evidence obtained using electrophysiology and imaging techniques in both animals and humans suggests that DBS works by modulating neural network activity. Recently, animal studies have shown that stimulation-evoked changes in neurotransmitter release that mirror normal physiology are associated with the therapeutic benefits of DBS. Therefore, to fully understand the neurophysiology of DBS and optimize its efficacy, it may be necessary to look beyond conventional electrophysiological analyses and characterize the neurochemical effects of therapeutic and non-therapeutic stimulation. By combining electrochemical monitoring and mathematical modeling techniques, we can potentially replace the trial-and-error process used in clinical programming with deterministic approaches that help attain optimal and stable neurochemical profiles. In this manuscript, we summarize the current understanding of electrophysiological and electrochemical processing for control of neuromodulation therapies. Additionally, we describe a proof-of-principle closed-loop controller that characterizes DBS-evoked dopamine changes to adjust stimulation parameters in a rodent model of DBS. The work described herein represents the initial steps toward achieving a “smart” neuroprosthetic system for treatment of neurologic and psychiatric disorders.
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Affiliation(s)
- Peter J Grahn
- Mayo Clinic College of Medicine, Mayo Clinic Rochester, MN, USA
| | - Grant W Mallory
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | - Obaid U Khurram
- Mayo Clinic College of Medicine, Mayo Clinic Rochester, MN, USA
| | - B Michael Berry
- Mayo Clinic College of Medicine, Mayo Clinic Rochester, MN, USA
| | - Jan T Hachmann
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | - Allan J Bieber
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA ; Department of Neurology, Mayo Clinic Rochester, MN, USA
| | - Kevin E Bennet
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA ; Division of Engineering, Mayo Clinic Rochester, MN, USA
| | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA ; Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, MN, USA
| | - Su-Youne Chang
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA ; Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, MN, USA
| | - J L Lujan
- Department of Neurologic Surgery, Mayo Clinic Rochester, MN, USA ; Department of Physiology and Biomedical Engineering, Mayo Clinic Rochester, MN, USA
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Hybrid scaffold composed of hydrogel/3D-framework and its application as a dopamine delivery system. J Control Release 2014; 175:10-6. [DOI: 10.1016/j.jconrel.2013.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 10/08/2013] [Accepted: 12/03/2013] [Indexed: 01/07/2023]
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Weihberger O, Okujeni S, Mikkonen JE, Egert U. Quantitative examination of stimulus-response relations in cortical networks in vitro. J Neurophysiol 2013; 109:1764-74. [DOI: 10.1152/jn.00481.2012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Variable responses of neuronal networks to repeated sensory or electrical stimuli reflect the interaction of the stimulus' response with ongoing activity in the brain and its modulation by adaptive mechanisms, such as cognitive context, network state, or cellular excitability and synaptic transmission capability. Here, we focus on reliability, length, delays, and variability of evoked responses with respect to their spatial distribution, interaction with spontaneous activity in the networks, and the contribution of GABAergic inhibition. We identified network-intrinsic principles that underlie the formation and modulation of spontaneous activity and stimulus-response relations with the use of state-dependent stimulation in generic neuronal networks in vitro. The duration of spontaneously recurring network-wide bursts of spikes was best predicted by the length of the preceding interval. Length, delay, and structure of responses to identical stimuli systematically depended on stimulus timing and distance to the stimulation site, which were described by a set of simple functions of spontaneous activity. Response length at proximal recording sites increased with the duration of prestimulus inactivity and was best described by a saturation function y( t) = A( 1 − e−α t). Concomitantly, the delays of polysynaptic late responses at distant sites followed an exponential decay y( t) = Be−β t + C. In addition, the speed of propagation was determined by the overall state of the network at the moment of stimulation. Disinhibition increased the number of spikes/network burst and interburst interval length at unchanged gross firing rate, whereas the response modulation by the duration of prestimulus inactivity was preserved. Our data suggest a process of network depression during bursts and subsequent recovery that limit evoked responses following distinct rules. We discuss short-term synaptic depression due to depletion of neurotransmitter vesicles as an underlying mechanism. The seemingly unreliable patterns of spontaneous activity and stimulus-response relations thus follow a predictable structure determined by the interdependencies of network structures and activity states.
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Affiliation(s)
- Oliver Weihberger
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
- Neurobiology and Biophysics, Faculty of Biology, University of Freiburg, Freiburg, Germany; and
- Department of Microsystems Engineering–IMTEK, University of Freiburg, Freiburg, Germany
| | - Samora Okujeni
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
- Neurobiology and Biophysics, Faculty of Biology, University of Freiburg, Freiburg, Germany; and
- Department of Microsystems Engineering–IMTEK, University of Freiburg, Freiburg, Germany
| | - Jarno E. Mikkonen
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Ulrich Egert
- Bernstein Center Freiburg, University of Freiburg, Freiburg, Germany
- Department of Microsystems Engineering–IMTEK, University of Freiburg, Freiburg, Germany
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Fakhar K, Hastings E, Butson CR, Foote KD, Zeilman P, Okun MS. Management of deep brain stimulator battery failure: battery estimators, charge density, and importance of clinical symptoms. PLoS One 2013; 8:e58665. [PMID: 23536810 PMCID: PMC3594176 DOI: 10.1371/journal.pone.0058665] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Accepted: 02/05/2013] [Indexed: 11/19/2022] Open
Abstract
Objective We aimed in this investigation to study deep brain stimulation (DBS) battery drain with special attention directed toward patient symptoms prior to and following battery replacement. Background Previously our group developed web-based calculators and smart phone applications to estimate DBS battery life (http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator). Methods A cohort of 320 patients undergoing DBS battery replacement from 2002–2012 were included in an IRB approved study. Statistical analysis was performed using SPSS 20.0 (IBM, Armonk, NY). Results The mean charge density for treatment of Parkinson’s disease was 7.2 µC/cm2/phase (SD = 3.82), for dystonia was 17.5 µC/cm2/phase (SD = 8.53), for essential tremor was 8.3 µC/cm2/phase (SD = 4.85), and for OCD was 18.0 µC/cm2/phase (SD = 4.35). There was a significant relationship between charge density and battery life (r = −.59, p<.001), as well as total power and battery life (r = −.64, p<.001). The UF estimator (r = .67, p<.001) and the Medtronic helpline (r = .74, p<.001) predictions of battery life were significantly positively associated with actual battery life. Battery status indicators on Soletra and Kinetra were poor predictors of battery life. In 38 cases, the symptoms improved following a battery change, suggesting that the neurostimulator was likely responsible for symptom worsening. For these cases, both the UF estimator and the Medtronic helpline were significantly correlated with battery life (r = .65 and r = .70, respectively, both p<.001). Conclusions Battery estimations, charge density, total power and clinical symptoms were important factors. The observation of clinical worsening that was rescued following neurostimulator replacement reinforces the notion that changes in clinical symptoms can be associated with battery drain.
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Affiliation(s)
- Kaihan Fakhar
- Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Erin Hastings
- Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Christopher R. Butson
- Departments of Neurology & Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America
| | - Kelly D. Foote
- Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Pam Zeilman
- Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
| | - Michael S. Okun
- Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America
- * E-mail:
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Dournes C, Beeské S, Belzung C, Griebel G. Deep brain stimulation in treatment-resistant depression in mice: comparison with the CRF1 antagonist, SSR125543. Prog Neuropsychopharmacol Biol Psychiatry 2013; 40:213-20. [PMID: 23367508 DOI: 10.1016/j.pnpbp.2012.07.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Deep brain stimulation (DBS) has been demonstrated to represent a targeted therapeutic alternative for treatment-resistant depression. In this study, we used the unpredictable chronic mild stress (UCMS) test to validate high-frequency electrical stimulation of the cingulate cortex (CC) as a possible treatment to improve behavioral symptoms associated with a depressive-like state in treatment-resistant mice. The effects of DBS were compared with those of the CRF(1) antagonist, SSR125543. Mice were subjected to UCMS, which consisted of the sequential and unpredictable application of mild stressors for a total of 8 weeks. From week 4 until the end of week 6, mice received either a saline injection or were treated with the antidepressant, fluoxetine (10 mg/kg, i.p.). At the end of week 6, fluoxetine-treated mice were subdivided into two populations, that is one responding to fluoxetine, and one not responding, based on their fur coat state, an index of depressive-like state in this test. Non-responders were subsequently subjected to bilateral DBS (at 80 or 120 Hz, 1-h/day) or were treated with SSR125543 (20 mg/kg, i.p.) for two weeks. Stimulation of the CC at 120 Hz in treatment-resistant mice resulted in a normalization of motivated-like responses, anxiety-related behaviors, hyperactivity and aggressiveness. SSR125543 improved motivated-like and aggressive behaviors. These findings demonstrate that bilateral DBS of the CC and, to a lesser extent, pharmacological blockade of the CRF(1) receptor in treatment-resistant mice can attenuate several aspects of depressive-like behaviors, suggesting further that these approaches may represent valid alternatives for the treatment of drug-resistant depressed and/or anxious patients.
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Mendez I, Song M, Chiasson P, Bustamante L. Point-of-Care Programming for Neuromodulation. Neurosurgery 2013; 72:99-108; discussion 108. [DOI: 10.1227/neu.0b013e318276b5b2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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40
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Daye PM, Monosov IE, Hikosaka O, Leopold DA, Optican LM. pyElectrode: an open-source tool using structural MRI for electrode positioning and neuron mapping. J Neurosci Methods 2012; 213:123-31. [PMID: 23261658 DOI: 10.1016/j.jneumeth.2012.12.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/10/2012] [Accepted: 12/12/2012] [Indexed: 11/18/2022]
Abstract
Neurophysiologists want to place the tip of an electrode in a specific area of the brain. The coordinates of this area can be obtained from standard stereotaxic atlases. However, individual brains may not align with the atlas exactly. Additionally, for chronic recordings, electrodes are placed through a chamber attached to the animal's skull. Thus, the user wants to know where the area of interest is in chamber coordinates, not stereotaxic coordinates. After the chamber has been attached an MRI is often made. This assists in electrode placement, as the location of a target relative to the chamber can be determined based on the atlas. However, doing this in practice requires rough estimation or cumbersome calculations. pyElectrode provides a graphical display and performs calculations necessary to convert between stereotaxic and chamber coordinates, thus facilitating MR-based targeting from an implanted chamber. It also allows the experimenter to visualize recording or stimulation sites during experiments. Finally, it can display and output those sites on an MRI slice background in a format suitable for publication.
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Affiliation(s)
- Pierre M Daye
- Laboratory of Sensorimotor Research, National Eye Institute, National Institutes of Health, Bethesda, MD, USA.
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Falowski S, Ghods AJ, Bakay RAE. Displacement of a deep brain stimulator lead during placement of an additional ipsilateral lead. Neuromodulation 2012; 16:41-4; discussion 44-5. [PMID: 22947046 DOI: 10.1111/j.1525-1403.2012.00500.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The use of Deep Brain Stimulation (DBS) has been increasing. It follows the premise of neuromodulation in that it is reversible, as compared to previous lesioning procedures. MATERIALS AND METHODS Complications with DBS are inherently low and range from short-term complications during surgery such as hemorrhage to long-term complications that include lead fractures and infection. Over time, the authors have experienced indications for additional lead placements or change in position of the lead on the ipsilateral side. There is the inherent possibility of direct contact between leads or the microelectrode. This can lead to malpositioning, displacement of a lead placed previously, and malfunctioning. RESULT We report a case in which a lead placed previously becomes displaced during microelectrode recording on the ipsilateral side. CONCLUSION This scenario was corrected and had no clinical or functional complication. Placement of an additional ipsilateral DBS lead can be a safe and effective treatment option.
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Affiliation(s)
- Steven Falowski
- Department of Neurosurgery, Rush University Medical College, Chicago, IL 60612, USA.
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Wu C, Sharan AD. Neurostimulation for the Treatment of Epilepsy: A Review of Current Surgical Interventions. Neuromodulation 2012; 16:10-24; discussion 24. [DOI: 10.1111/j.1525-1403.2012.00501.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Montuno MA, Kohner AB, Foote KD, Okun MS. An algorithm for management of deep brain stimulation battery replacements: devising a web-based battery estimator and clinical symptom approach. Neuromodulation 2012; 16:147-53. [PMID: 22646907 DOI: 10.1111/j.1525-1403.2012.00457.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective technique that has been utilized to treat advanced and medication-refractory movement and psychiatric disorders. In order to avoid implanted pulse generator (IPG) failure and consequent adverse symptoms, a better understanding of IPG battery longevity and management is necessary. BACKGROUND Existing methods for battery estimation lack the specificity required for clinical incorporation. Technical challenges prevent higher accuracy longevity estimations, and a better approach to managing end of DBS battery life is needed. METHODS The literature was reviewed and DBS battery estimators were constructed by the authors and made available on the web at http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator. A clinical algorithm for management of DBS battery life was constructed. The algorithm takes into account battery estimations and clinical symptoms. RESULTS Existing methods of DBS battery life estimation utilize an interpolation of averaged current drains to calculate how long a battery will last. Unfortunately, this technique can only provide general approximations. There are inherent errors in this technique, and these errors compound with each iteration of the battery estimation. Some of these errors cannot be accounted for in the estimation process, and some of the errors stem from device variation, battery voltage dependence, battery usage, battery chemistry, impedance fluctuations, interpolation error, usage patterns, and self-discharge. We present web-based battery estimators along with an algorithm for clinical management. We discuss the perils of using a battery estimator without taking into account the clinical picture. CONCLUSION Future work will be needed to provide more reliable management of implanted device batteries; however, implementation of a clinical algorithm that accounts for both estimated battery life and for patient symptoms should improve the care of DBS patients.
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Affiliation(s)
- Michael A Montuno
- Department of Neurology, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, FL 32607, USA
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Chang SY, Jay T, Muñoz J, Kim I, Lee KH. Wireless fast-scan cyclic voltammetry measurement of histamine using WINCS--a proof-of-principle study. Analyst 2012; 137:2158-65. [PMID: 22416270 DOI: 10.1039/c2an16038b] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Histamine is among the most poorly understood biogenic amines, yet the histaminergic system spreads throughout the brain and has been implicated in functions as diverse as homeostasis and synaptic plasticity. Not surprisingly then, it has been linked to a number of conditions including minimally conscious state, persistent vegetative state, epilepsy, addiction, cluster headache, essential tremor, and Parkinson's disease. We have previously reported that the Wireless Instantaneous Neurotransmitter Concentration Sensing (WINCS) system can monitor dopamine, serotonin, and adenosine using fast-scan cyclic voltammetry (FSCV). Here, we demonstrate the expanded capability of the WINCS system to measure histamine. The optimal FSCV waveform was determined to be a triangle wave scanned between -0.4 and +1.4 V at a rate of 400 V s(-1) applied at 10 Hz. Using this optimized FSCV parameter, we found histamine release was induced by high frequency electrical stimulation at the tuberomammillary nucleus in rat brain slices. Our results suggest that the WINCS system can provide reliable, high fidelity measurements of histamine, consistently showing oxidative currents at +1.3 V, a finding that may have important clinical implications.
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Affiliation(s)
- Su-Youne Chang
- Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Pizzolato G, Mandat T. Deep brain stimulation for movement disorders. Front Integr Neurosci 2012; 6:2. [PMID: 22291623 PMCID: PMC3265746 DOI: 10.3389/fnint.2012.00002] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Accepted: 01/09/2012] [Indexed: 11/13/2022] Open
Abstract
Stereotactic technique and the introduction of deep brain stimulation (DBS) can be considered two milestones in the field of surgical neuromodulation. At present the role of DBS in the treatment of clinically and epidemiologically relevant movement disorders is widely accepted and DBS procedures are performed in many clinical centers worldwide. Here we review the current state of the art of DBS treatment for the most common movement disorders: Parkinson’s disease, essential tremor, and dystonia. In this review, we give a brief description of the candidate patient selection criteria, the different anatomical targets for each of these condition, and the expected outcomes as well as possible side effects.
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Affiliation(s)
- Gilberto Pizzolato
- Neurology Clinic, Department of Medical Sciences, University of Trieste Trieste, Italy
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Kanagaratnam L, Lee A, Whalley D, Figtree GA. Overcoming artifacts and fears: electrophysiology study and radiofrequency ablation in a Parkinsonian patient with supraventricular tachycardia and a brain neurostimulator. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 36:e1-3. [PMID: 21883310 DOI: 10.1111/j.1540-8159.2011.03204.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 04/15/2011] [Accepted: 05/23/2011] [Indexed: 11/29/2022]
Abstract
With the ageing of the population and expanding use of deep brain stimulation in the treatment of various neurological and neuropsychiatric conditions, there will be an increasing number of patients with these devices who present with cardiac conditions necessitating electrophysiology studies (EPS). However, neurostimulator devices have been shown to cause significant artifacts on electrocardiography recordings. We present the case of a 53-year-old Parkinsonian woman with a brain neurostimulator device who underwent a successful EPS with radiofrequency ablation.
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Affiliation(s)
- Logan Kanagaratnam
- Department of Cardiology, Royal North Shore Hospital, Sydney, Australia.
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