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Koivu M, Sihvonen AJ, Eerola-Rautio J, Pauls KAM, Resendiz-Nieves J, Vartiainen N, Kivisaari R, Scheperjans F, Pekkonen E. Clinical and Brain Morphometry Predictors of Deep Brain Stimulation Outcome in Parkinson's Disease. Brain Topogr 2024:10.1007/s10548-024-01054-2. [PMID: 38662300 DOI: 10.1007/s10548-024-01054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Subthalamic deep brain stimulation (STN-DBS) is known to improve motor function in advanced Parkinson's disease (PD) and to enable a reduction of anti-parkinsonian medication. While the levodopa challenge test and disease duration are considered good predictors of STN-DBS outcome, other clinical and neuroanatomical predictors are less established. This study aimed to evaluate, in addition to clinical predictors, the effect of patients' individual brain topography on DBS outcome. The medical records of 35 PD patients were used to analyze DBS outcomes measured with the following scales: Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) off medication at baseline, and at 6-months during medication off and stimulation on, use of anti-parkinsonian medication (LED), Abnormal Involuntary Movement Scale (AIMS) and Non-Motor Symptoms Questionnaire (NMS-Quest). Furthermore, preoperative brain MRI images were utilized to analyze the brain morphology in relation to STN-DBS outcome. With STN-DBS, a 44% reduction in the UPDRS-III score and a 43% decrease in the LED were observed (p<0.001). Dyskinesia and non-motor symptoms decreased significantly [median reductions of 78,6% (IQR 45,5%) and 18,4% (IQR 32,2%) respectively, p=0.001 - 0.047]. Along with the levodopa challenge test, patients' age correlated with the observed DBS outcome measured as UPDRS-III improvement (ρ= -0.466 - -0.521, p<0.005). Patients with greater LED decline had lower grey matter volumes in left superior medial frontal gyrus, in supplementary motor area and cingulum bilaterally. Additionally, patients with greater UPDRS-III score improvement had lower grey matter volume in similar grey matter areas. These findings remained significant when adjusted for sex, age, baseline LED and UPDRS scores respectively and for total intracranial volume (p=0.0041- 0.001). However, only the LED decrease finding remained significant when the analyses were further controlled for stimulation amplitude. It appears that along with the clinical predictors of STN-DBS outcome, individual patient topographic differences may influence DBS outcome. Clinical Trial Registration Number: NCT06095245, registration date October 23, 2023, retrospectively registered.
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Affiliation(s)
- Maija Koivu
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland.
| | - Aleksi J Sihvonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Eerola-Rautio
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
| | - K Amande M Pauls
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
| | | | - Nuutti Vartiainen
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
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Viljaharju V, Mertsalmi T, Pauls KAM, Koivu M, Eerola‐Rautio J, Udd M, Pekkonen E. Levodopa-Entacapone-Carbidopa Intestinal Gel Treatment in Advanced Parkinson's Disease: A Single-Center Study of 30 Patients. Mov Disord Clin Pract 2024; 11:159-165. [PMID: 38386490 PMCID: PMC10883392 DOI: 10.1002/mdc3.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Levodopa-entacapone-carbidopa intestinal gel (LECIG) is a novel device assisted treatment option for advanced Parkinson's disease (PD). It has been available in Finland since 2020. There is paucity of scientific studies considering LECIG treatment in clinical practice. OBJECTIVES Objectives of this study were to evaluate the changes in medication, adverse events and early discontinuations of LECIG treatment in real life clinical practice. METHODS The records of 30 consecutive patients, who received LECIG between years 2020 and 2022 in Helsinki University Hospital, were retrospectively analyzed. Data considering changes in medication, discontinuations, and adverse events during the first six months of LECIG treatment was collected. RESULTS Mean levodopa equivalent daily dose (LEDD) rose significantly between baseline before LECIG and six months with treatment (1230 mg vs. 1570 mg, P = 0.001). Three patients were discarded during nasojejunal tube test phase and seven discontinued the treatment during six-month follow-up. Most common reasons for discontinuation were difficulty in finding suitable infusion rate and neuropsychiatric problems. Safety issues encountered were similar to those reported with levodopa-carbidopa intestinal gel (LCIG) treatment. One case of rhabdomyolysis due to severe dyskinesia during LECIG treatment was observed. Patients were satisfied with the small size of the pump system. CONCLUSIONS LEDD seems to increase during the first months of LECIG treatment. When compared to studies on LCIG, safety profile of LECIG appears similar, but early discontinuation rate is higher than expected. However, long-term studies are lacking. Only clear advantage to LCIG appears to be the smaller LECIG pump size.
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Affiliation(s)
- Vili Viljaharju
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Tuomas Mertsalmi
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - K. Amande M. Pauls
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Maija Koivu
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Johanna Eerola‐Rautio
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
| | - Marianne Udd
- Department of Gastroenterological SurgeryHelsinki University HospitalHelsinkiFinland
| | - Eero Pekkonen
- Department of NeurologyHelsinki University HospitalHelsinkiFinland
- Department of Clinical Neurosciences (Neurology)University of HelsinkiHelsinkiFinland
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Pauls KAM, Salmela E, Korsun O, Kujala J, Salmelin R, Renvall H. Human Sensorimotor Beta Event Characteristics and Aperiodic Signal Are Highly Heritable. J Neurosci 2024; 44:e0265232023. [PMID: 37973377 PMCID: PMC10860623 DOI: 10.1523/jneurosci.0265-23.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 10/24/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
Individuals' phenotypes, including the brain's structure and function, are largely determined by genes and their interplay. The resting brain generates salient rhythmic patterns that can be characterized noninvasively using functional neuroimaging such as magnetoencephalography (MEG). One of these rhythms, the somatomotor (rolandic) beta rhythm, shows intermittent high amplitude "events" that predict behavior across tasks and species. Beta rhythm is altered in neurological disease. The aperiodic (1/f) signal present in electrophysiological recordings is also modulated by some neurological conditions and aging. Both sensorimotor beta and aperiodic signal could thus serve as biomarkers of sensorimotor function. Knowledge about the extent to which these brain functional measures are heritable could shed light on the mechanisms underlying their generation. We investigated the heritability and variability of human spontaneous sensorimotor beta rhythm events and aperiodic activity in 210 healthy male and female adult siblings' spontaneous MEG activity. The most heritable trait was the aperiodic 1/f signal, with a heritability of 0.87 in the right hemisphere. Time-resolved beta event amplitude parameters were also highly heritable, whereas the heritabilities for overall beta power, peak frequency, and measures of event duration remained nonsignificant. Human sensorimotor neural activity can thus be dissected into different components with variable heritability. We postulate that these differences partially reflect different underlying signal-generating mechanisms. The 1/f signal and beta event amplitude measures may depend more on fixed, anatomical parameters, whereas beta event duration and its modulation reflect dynamic characteristics, guiding their use as potential disease biomarkers.
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Affiliation(s)
- K Amande M Pauls
- Department of Neurology, Helsinki University Hospital, and Department of Clinical Neurosciences, University of Helsinki, 00029 Helsinki, Finland
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, 00290 Helsinki, Finland
| | - Elina Salmela
- Organismal and Evolutionary Biology Research Programme, Faculty of Biological and Environmental Sciences, University of Helsinki, 00014 Helsinki, Finland
- Department of Biology, University of Turku, 20014 Turku, Finland
| | - Olesia Korsun
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, 02150 Espoo, Finland
| | - Jan Kujala
- Department of Psychology, University of Jyväskylä, 40014 Jyväskylä, Finland
| | - Riitta Salmelin
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, 02150 Espoo, Finland
| | - Hanna Renvall
- BioMag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, 00290 Helsinki, Finland
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, 02150 Espoo, Finland
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Viljaharju V, Mertsalmi T, Pauls KAM, Koivu M, Eerola-Rautio J, Udd M, Pekkonen E. Single-Center Study of 103 Consecutive Parkinson's Disease Patients with Levodopa-Carbidopa Intestinal Gel. Mov Disord Clin Pract 2022; 9:60-68. [PMID: 35005066 DOI: 10.1002/mdc3.13361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 09/13/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022] Open
Abstract
Background Levodopa-carbidopa intestinal gel (LCIG) effectively reduces off time and dyskinesia and increases on time in advanced Parkinson's disease (PD). However, patients with LCIG-infusion experience frequent complications and some discontinue treatment early on. Objectives The objectives of this study were to find predictive factors for early dropout from the LCIG infusion, analyze the treatment burden on the tertiary health care system, and explore changes in medication during the LCIG treatment. Methods LCIG-infusion was administrated to 103 patients between July 2006 and May 2020 at the Helsinki University Hospital, accumulating 350 years of follow-up data. We evaluated, retrospectively, changes in medication during treatment, discontinuation of the infusion, and adverse events from the patient records. Results Living alone was a predictive factor for early dropout (OR = 3.88; 95% CI = 1.03-14.66; P = 0.045). The treatment burden on the tertiary health care system increased after the initiation of LCIG infusion mostly because of common complications related to the infusion system (median change of in- and out-patient visits +1, P = 0.03). Mean levodopa equivalent daily dose (LEDD) rose from baseline to 6 months (1246.7 vs. 1684.9, P = 0.001) and stabilized thereafter. Patients commonly switched from "polypharmacy" to "LCIG-only" or "LCIG + oral levodopa" medication-groups during long-term treatment. Conclusions Recurrent complications related to the infusion system increase the treatment burden on tertiary healthcare system after the initiation of LCIG-infusion. Most patients continue long-term with the infusion. Few patients discontinue infusion during the first year after initiation and living alone appears to be a risk factor for this outcome.
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Affiliation(s)
- Vili Viljaharju
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Tuomas Mertsalmi
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - K Amande M Pauls
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Maija Koivu
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Johanna Eerola-Rautio
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
| | - Marianne Udd
- Department of Gastroenterological Surgery Helsinki University Hospital Helsinki Finland
| | - Eero Pekkonen
- Department of Neurology Helsinki University Hospital Helsinki Finland.,Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
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Pauls KAM, Toppila J, Koivu M, Eerola-Rautio J, Udd M, Pekkonen E. Polyneuropathy monitoring in Parkinson's disease patients treated with levodopa/carbidopa intestinal gel. Brain Behav 2021; 11:e2408. [PMID: 34758207 PMCID: PMC8671764 DOI: 10.1002/brb3.2408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/06/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Levodopa-carbidopa-intestinal-gel (LCIG) infusion is an effective treatment for advanced PD with motor fluctuations. Polyneuropathy occurs as a complication in 10-15% of patients. We wanted to assess the frequency of polyneuropathy in Finnish advanced Parkinson's disease (PD) patients with continuous LCIG infusion, and the value of different clinical monitoring parameters during follow-up. MATERIALS AND METHODS Patient records of PD patients started on LCIG infusion at Helsinki University Hospital who received nerve conduction studies at baseline and 6 months after treatment initiation were reviewed for epidemiological information, mini mental state examination, baseline and 6 months' UPRDS-III, weight, body mass index, levodopa dose (LD), plasma homocysteine levels, folate, vitamin B6 and B12. RESULTS Out of 19 patients (n = 6 on B-vitamin substitution), two (10.5%) developed new-onset polyneuropathy after initiation of LCIG therapy (n = 0 with vitamin substitution). Neuropathy was associated with significant weight loss (BMI reduction > 1.5), but not with other monitoring parameters. Homocysteine rose significantly in patients not substituted with B-vitamin complex, but not in patients with B-vitamin substitution. Homocysteine changes correlated with LD changes in the absence of vitamin B substitution. After oral B-vitamin substitution, both patients' polyneuropathy remained electrophysiologically and clinically stable. CONCLUSIONS Rates of polyneuropathy in Finnish PD patients with LCIG treatment are comparable to previous studies. Patients' weight should be included in regular follow up monitoring and can be used for patient self-monitoring. Vitamin B substitution appears to reduce coupling between levodopa dose and homocysteine and may be useful to prevent polyneuropathy related to LCIG.
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Affiliation(s)
- K Amande M Pauls
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jussi Toppila
- Department of Clinical Neurophysiology, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki, Finland
| | - Maija Koivu
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Johanna Eerola-Rautio
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
| | - Marianne Udd
- Department of Gastrointestinal Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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Pelzer EA, Pauls KAM, Braun N, Tittgemeyer M, Timmermann L. Probabilistic tractography in the ventrolateral thalamic nucleus: cerebellar and pallidal connections. Brain Struct Funct 2020; 225:1685-1689. [PMID: 32363531 PMCID: PMC7286851 DOI: 10.1007/s00429-020-02076-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 04/18/2020] [Indexed: 12/26/2022]
Abstract
The ventrolateral thalamic nucleus (VL), as part of the 'motor thalamus', is main relay station of cerebellar and pallidal projections. It comprises anterior (VLa) and posterior (VLpd and VLpv) subnuclei. Though the fibre architecture of cerebellar and pallidal projections to of the VL nucleus has already been focus in a numerous amount of in vitro studies mainly in animals, probabilistic tractography now offers the possibility of an in vivo comparison in healthy humans. In this study we performed a (a) qualitative and (b) quantitative examination of VL-cerebellar and VL-pallidal pathways and compared the probability distributions between both projection fields in the VL after an (I) atlas-based and (II) manual-based segmentation procedure. Both procedures led to high congruent results of cerebellar and pallidal connectivity distributions: the maximum of pallidal projections was located in anterior and medial parts of the VL nucleus, whereas cerebellar connectivity was more located in lateral and posterior parts. The median connectivity for cerebellar connections in both approaches (manual and atlas-based segmentation) was VLa > VLpv > VLpd, whereas the pallidal median connectivity was VLa ~ VLpv > VLpd in the atlas-based approach and VLpv > VLa > VLpd in the manual approach.
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Affiliation(s)
- Esther A Pelzer
- Department of Neurology, University Hospital Cologne, Cologne, Germany. .,Max-Planck Institute for Metabolism Research, Gleulerstr. 50, 50931, Cologne, Germany.
| | - K Amande M Pauls
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland.,Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland.,BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Nina Braun
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Marc Tittgemeyer
- Max-Planck Institute for Metabolism Research, Gleulerstr. 50, 50931, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany.,Department of Neurology, University Hospital Marburg, Marburg, Germany
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Greuel A, Pauls KAM, Koy A, Südmeyer M, Schnitzler A, Timmermann L, Fink GR, Eggers C. Pallidal Deep Brain Stimulation Reduces Sensorimotor Cortex Activation in Focal/Segmental Dystonia. Mov Disord 2020; 35:629-639. [DOI: 10.1002/mds.27970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/02/2019] [Accepted: 12/08/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Andrea Greuel
- Department of Neurology University Hospital of Giessen and Marburg Marburg Germany
| | - K. Amande M. Pauls
- Department of Neurology Helsinki University Central Hospital Helsinki Finland
- Department of Clinical Neurosciences (Neurology) University of Helsinki Helsinki Finland
- BioMag Laboratory, Helsinki University Hospital Medical Imaging Center University of Helsinki and Helsinki University Hospital Helsinki Finland
| | - Anne Koy
- Department of Pediatrics Faculty of Medicine and University Hospital Cologne, University of Cologne Cologne Germany
| | - Martin Südmeyer
- Department of Neurology Ernst‐von‐Bergmann Klinikum Potsdam Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Department of Neurology, Medical Faculty Heinrich‐Heine‐University Düsseldorf Düsseldorf Germany
| | - Lars Timmermann
- Department of Neurology University Hospital of Giessen and Marburg Marburg Germany
- Center for Mind, Brain and Behavior Universities Marburg and Giessen Marburg Germany
| | - Gereon R. Fink
- Department of Neurology Faculty of Medicine and University Hospital Cologne, University of Cologne Cologne Germany
- Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM‐3) Research Center Jülich Jülich Germany
| | - Carsten Eggers
- Department of Neurology University Hospital of Giessen and Marburg Marburg Germany
- Center for Mind, Brain and Behavior Universities Marburg and Giessen Marburg Germany
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Pauls KAM, Bröckelmann PJ, Hammesfahr S, Becker J, Hellerbach A, Visser-Vandewalle V, Dembek TA, Meister IG, Timmermann L. Dysarthria in pallidal Deep Brain Stimulation in dystonia depends on the posterior location of active electrode contacts: a pilot study. Parkinsonism Relat Disord 2017; 47:71-75. [PMID: 29137852 DOI: 10.1016/j.parkreldis.2017.11.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 09/17/2017] [Accepted: 11/06/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Pallidal Deep Brain Stimulation (GPi-DBS) is an efficient treatment for primary dystonia. We investigated stimulation-induced dysarthria, which is the most frequent side-effect of GPi-DBS. METHODS Speech was recorded while reading a standard text, and performing rapid syllable repetitions ON and OFF DBS in ten dystonia patients (6 men; 3 cervical, 4 segmental, 3 generalized, unselected for DBS-related speech impairments). Speech and articulation rate, pauses, and syllable repetition rates were extracted via acoustic analysis. Locations of active stimulation contacts and volumes of tissue activated (VTA) were calculated. RESULTS The number of pauses increased significantly ON vs. OFF stimulation (Wilcoxon test, p < 0.05). More posteriorly localized active contacts were associated with slower syllable repetition (Pearson correlation, p < 0.05). VTA size did not correlate with any measure of dysarthria. CONCLUSION Using quantitative acoustic signal analysis, this study demonstrates that GPi-DBS alters motor aspects of speech. Both inadvertent stimulation of parts of the internal capsule, or interference with GPi function and outflow are possible causes. Understanding causes of GPi-DBS-induced speech changes can improve DBS programming.
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Affiliation(s)
- K A M Pauls
- Department of Neurology, University Hospital of Cologne, Cologne, Germany.
| | - P J Bröckelmann
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - S Hammesfahr
- Department of Neurology, University Hospital of Cologne, Cologne, Germany; Department for Diagnostic und Interventional Radiology, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - J Becker
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - A Hellerbach
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - V Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital of Cologne, Cologne, Germany
| | - T A Dembek
- Department of Neurology, University Hospital of Cologne, Cologne, Germany
| | - I G Meister
- Department of Neurology, University Hospital of Cologne, Cologne, Germany; Department of Neurology, Evangelisches Krankenhaus Lippstadt, Lippstadt, Germany
| | - L Timmermann
- Department of Neurology, University Hospital of Cologne, Cologne, Germany; Department of Neurology, University Hospital of Marburg, Marburg, Germany
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Pauls KAM, Krauss JK, Kühn AA, Moro E, Fink GR, Volkmann J, Timmermann L. Pallidal DBS for dystonia in the age of personalized medicine. Parkinsonism Relat Disord 2017; 45:101-102. [PMID: 28964627 DOI: 10.1016/j.parkreldis.2017.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 11/19/2022]
Abstract
In response to the correspondence by Albanese and co-workers, we discuss etiology as a factor predicting outcome of pallidal DBS in dystonia, reanalysing our dataset on causes of non-response to pallidal DBS in isolated dystonia by looking only at patients with a diagnosis of idiopathic dystonia at time of surgery.
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Affiliation(s)
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Andrea A Kühn
- Department of Neurology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Elena Moro
- Division of Neurology, University Hospital Center of Grenoble, Grenoble, France
| | - Gereon R Fink
- Department of Neurology, Uniklinik Köln, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Jens Volkmann
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Lars Timmermann
- Department of Neurology, University of Marburg, Marburg, Germany
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Pauls KAM, Krauss JK, Kämpfer CE, Kühn AA, Schrader C, Südmeyer M, Allert N, Benecke R, Blahak C, Boller JK, Fink GR, Fogel W, Liebig T, El Majdoub F, Mahlknecht P, Kessler J, Mueller J, Voges J, Wittstock M, Wolters A, Maarouf M, Moro E, Volkmann J, Bhatia KP, Timmermann L. Causes of failure of pallidal deep brain stimulation in cases with pre-operative diagnosis of isolated dystonia. Parkinsonism Relat Disord 2017; 43:38-48. [PMID: 28690015 DOI: 10.1016/j.parkreldis.2017.06.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/22/2017] [Accepted: 06/27/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Pallidal deep brain stimulation (GPi-DBS) is an effective therapy for isolated dystonia, but 10-20% of patients show improvement below 25-30%. We here investigated causes of insufficient response to GPi-DBS in isolated dystonia in a cross-sectional study. METHODS Patients with isolated dystonia at time of surgery, and <30% improvement on the Burke-Fahn-Marsden dystonia-rating-scale (BFMDRS) after ≥6 months of continuous GPi-DBS were videotaped ON and OFF stimulation, and history, preoperative videos, brain MRI, medical records, stimulation settings, stimulation system integrity, lead location, and genetic information were obtained and reviewed by an expert panel. RESULTS 22 patients from 11 centres were included (8 men, 14 women; 9 generalized, 9 segmental, 3 focal, 1 bibrachial dystonia; mean (range): age 48.7 (25-72) years, disease duration 22.0 (2-40) years, DBS duration 45.5 (6-131) months). Mean BFMDRS-score was 31.7 (4-93) preoperatively and 32.3 (5-101) postoperatively. Half of the patients (n = 11) had poor lead positioning alone or in combination with other problems (combined with: other disease n = 6, functional dystonia n = 1, other problems n = 2). Other problems were disease other than isolated inherited or idiopathic dystonia (n = 5), fixed deformities (n = 2), functional dystonia (n = 3), and other causes (n = 1). Excluding patients with poor lead location from further analysis, non-isolated dystonia accounted for 45.5%, functional dystonia for 27.3%, and fixed deformities for 18.2%. In patients with true isolated dystonia, lead location was the most frequent problem. CONCLUSION After exclusion of lead placement and stimulation programming issues, non-isolated dystonia, functional dystonia and fixed deformities account for the majority of GPi-DBS failures in dystonia.
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Affiliation(s)
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | | | - Andrea A Kühn
- Department of Neurology, Charite Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Schrader
- Department of Neurology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Martin Südmeyer
- Department of Neurology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Niels Allert
- Neurological Rehabilitation Center Godeshöhe, Bonn, Germany
| | - Rainer Benecke
- Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany
| | - Christian Blahak
- Department of Neurology, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Jana K Boller
- Department of Neurology, Uniklinik Köln, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Uniklinik Köln, Cologne, Germany; Institute of Neuroscience and Medicine (INM-3), Forschungszentrum Jülich, Jülich, Germany
| | - Wolfgang Fogel
- Department of Neurology, Deutsche Klinik für Diagnostik, Wiesbaden, Germany
| | - Thomas Liebig
- Department of Neuroradiology, Uniklinik Köln, Cologne, Germany
| | - Faycal El Majdoub
- Department of Stereotaxic and Functional Neurosurgery, Uniklinik Köln, Cologne, Germany
| | - Philipp Mahlknecht
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Kessler
- Department of Neurology, Uniklinik Köln, Cologne, Germany
| | - Joerg Mueller
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria; Department of Neurology, Vivantes Klinikum Spandau, Berlin, Germany
| | - Juergen Voges
- Department for Stereotactic Neurosurgery, Universitätsklinikum Magdeburg, Magdeburg, Germany; Leibniz Institute of Neurobiology, Magdeburg, Germany
| | | | - Alexander Wolters
- Department of Neurology, Universitätsmedizin Rostock, Rostock, Germany
| | - Mohammad Maarouf
- Department of Stereotaxic and Functional Neurosurgery, Uniklinik Köln, Cologne, Germany
| | - Elena Moro
- Division of Neurology, University Hospital Center of Grenoble, Grenoble, France
| | - Jens Volkmann
- Department of Neurology, Universitätsklinikum Würzburg, Würzburg, Germany
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Koy A, Weinsheimer M, Pauls KAM, Kühn AA, Krause P, Huebl J, Schneider GH, Deuschl G, Erasmi R, Falk D, Krauss JK, Lütjens G, Schnitzler A, Wojtecki L, Vesper J, Korinthenberg R, Coenen VA, Visser-Vandewalle V, Hellmich M, Timmermann L. German registry of paediatric deep brain stimulation in patients with childhood-onset dystonia (GEPESTIM). Eur J Paediatr Neurol 2017; 21:136-146. [PMID: 27424797 DOI: 10.1016/j.ejpn.2016.05.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 05/22/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Data on paediatric deep brain stimulation (DBS) is limited, especially for long-term outcomes, because of small numbers in single center series and lack of systematic multi-center trials. OBJECTIVES We seek to systematically evaluate the clinical outcome of paediatric patients undergoing DBS. METHODS A German registry on paediatric DBS (GEPESTIM) was created to collect data of patients with dystonia undergoing DBS up to the age of 18 years. Patients were divided into three groups according to etiology (group 1 inherited, group 2 acquired, and group 3 idiopathic dystonia). RESULTS Data of 44 patients with a mean age of 12.8 years at time of operation provided by 6 German centers could be documented in the registry so far (group 1 n = 18, group 2 n = 16, group 3 n = 10). Average absolute improvement after implantation was 15.5 ± 18.0 for 27 patients with pre- and postoperative Burke-Fahn-Marsden Dystonia Rating scale movement scores available (p < 0.001) (group 1: 19.6 ± 19.7, n = 12; group 2: 7.0 ± 8.9, n = 8; group 3: 19.2 ± 20.7, n = 7). Infection was the main reason for hardware removal (n = 6). 20 IPG replacements due to battery expiry were necessary in 15 patients at 3.7 ± 1.8 years after last implantation. DISCUSSION Pre- and postoperative data on paediatric DBS are very heterogeneous and incomplete but corroborate the positive effects of DBS on inherited and acquired dystonia. Adverse events including relatively frequent IPG replacements due to battery expiry seem to be a prominent feature of children with dystonia undergoing DBS. The registry enables collaborative research on DBS treatment in the paediatric population and to create standardized management algorithms in the future.
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Affiliation(s)
- A Koy
- Department of Neurology, University Hospital of Cologne, Germany; Department of Paediatrics, University Hospital of Cologne, Germany.
| | - M Weinsheimer
- Department of Neurology, University Hospital of Cologne, Germany
| | - K A M Pauls
- Department of Neurology, University Hospital of Cologne, Germany
| | - A A Kühn
- Department of Neurology, Charité University Medicine Berlin, Germany
| | - P Krause
- Department of Neurology, Charité University Medicine Berlin, Germany
| | - J Huebl
- Department of Neurology, Charité University Medicine Berlin, Germany
| | - G-H Schneider
- Department of Neurosurgery, Charité University Medicine Berlin, Germany
| | - G Deuschl
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - R Erasmi
- Department of Neurology, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - D Falk
- Department of Neurosurgery, University Hospital of Schleswig-Holstein, Campus Kiel, Germany
| | - J K Krauss
- Department of Neurosurgery, Medical School, MHH, Hannover, Germany
| | - G Lütjens
- Department of Neurosurgery, Medical School, MHH, Hannover, Germany
| | - A Schnitzler
- Department of Neurology, University Hospital of Düsseldorf, Germany
| | - L Wojtecki
- Department of Neurology, University Hospital of Düsseldorf, Germany
| | - J Vesper
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Düsseldorf, Germany
| | - R Korinthenberg
- Department of Paediatrics, Freiburg University Medical Centre, Germany
| | - V A Coenen
- Department Stereotactic and Functional Neurosurgery, Freiburg University Medical Centre, Germany
| | - V Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital of Cologne, Germany
| | - M Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - L Timmermann
- Department of Neurology, University Hospital of Cologne, Germany.
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Koy A, Pauls KAM, Flossdorf P, Becker J, Schönau E, Maarouf M, Liebig T, Fricke O, Fink GR, Timmermann L. Young Adults with Dyskinetic Cerebral Palsy Improve Subjectively on Pallidal Stimulation, but not in Formal Dystonia, Gait, Speech and Swallowing Testing. Eur Neurol 2014; 72:340-8. [DOI: 10.1159/000360984] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2013] [Accepted: 02/26/2014] [Indexed: 11/19/2022]
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Pauls KAM, Hammesfahr S, Moro E, Moore AP, Binder E, El Majdoub F, Fink GR, Sturm V, Krauss JK, Maarouf M, Timmermann L. Deep brain stimulation in the ventrolateral thalamus/subthalamic area in dystonia with head tremor. Mov Disord 2014; 29:953-9. [DOI: 10.1002/mds.25884] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 01/28/2014] [Accepted: 03/06/2014] [Indexed: 11/05/2022] Open
Affiliation(s)
- K. Amande M. Pauls
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
| | - Sven Hammesfahr
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
| | - Elena Moro
- Division of Neurology; Toronto Western Hospital, University of Toronto; Toronto Canada
| | - A. Peter Moore
- The Walton Centre NHS Foundation Trust; Liverpool United Kingdom
| | - Ellen Binder
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
- Cognitive Neuroscience; Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Jülich Germany
| | - Faycal El Majdoub
- Department of Stereotaxy and Functional Neurosurgery; Uniklinik Köln, University of Cologne; Cologne Germany
| | - Gereon R. Fink
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
- Cognitive Neuroscience; Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich; Jülich Germany
| | - Volker Sturm
- Department of Stereotaxy and Functional Neurosurgery; Uniklinik Köln, University of Cologne; Cologne Germany
| | - Joachim K. Krauss
- Department of Neurosurgery; Medical School Hannover; Hannover Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery; Uniklinik Köln, University of Cologne; Cologne Germany
| | - Lars Timmermann
- Department of Neurology; University Hospital Cologne, University of Cologne; Cologne Germany
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Pedrosa DJ, Auth M, Pauls KAM, Runge M, Maarouf M, Fink GR, Timmermann L. Verbal fluency in essential tremor patients: the effects of deep brain stimulation. Brain Stimul 2014; 7:359-64. [PMID: 24661791 DOI: 10.1016/j.brs.2014.02.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/16/2014] [Accepted: 02/22/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To assess the effects of different frequencies of thalamic Deep-Brain-Stimulation (DBS) on cognitive performance of patients suffering from Essential Tremor (ET). METHODS In 17 ET-patients with thalamic-DBS, Tremor-Rating-Scale (TRS), standardized phonemic and semantic verbal fluency (VF), Stroop-Color-Word-Test and Digit-span-test were investigated in three randomized stimulation-settings: i) high-frequency stimulation (HFS), ii) low-frequency stimulation (LFS) and iii) OFF-stimulation (DBS-OFF). Paired-samples t-test for TRS and one-way repeated measures analysis of variance for cognitive performance were calculated. RESULTS Tremor was reduced during HFS (MeanTRS-HFS = 12.9 ± 9.6) compared to DBS-OFF (MeanTRS-OFF = 44.4 ± 19.8, P < .001) and to LFS (MeanTRS-10 Hz = 50.0 ± 24.2; P < .001). While performance of Stroop-task and digit-span remained unaffected by stimulation-settings (P > .05), phonemic and semantic VF differed significantly between the three conditions (FPvf = 5.28, FSvf = 3.41, both P < .05). Post-hoc comparisons revealed significant differences for both phonemic and semantic VF between LFS (MeanPvf-10 Hz = 54.6 ± 9.2, MeanSvf-10 Hz = 56.4 ± 7.9) and HFS (MeanPvf-ON = 48.3 ± 11.4, MeanSvf-ON = 51.1 ± 11.0, both P < .05), while DBS-OFF (MeanPvf-OFF = 51.2 ± 9.3, MeanSvf-OFF = 53.6 ± 12.9) and HFS and DBS-OFF and LFS did not differ significantly (P > .05). CONCLUSIONS HFS compared to LFS or DBS-OFF significantly reduced tremor but simultaneously worsened VF while working memory and cognitive inhibition remained unaffected. In contrast, LFS enhanced VF but did not ameliorate tremor. The data emphasize the relevance of thalamocortical loops for verbal fluency but also suggest that more sophisticated DBS-regimes in ET may improve both motor and cognitive performance.
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Affiliation(s)
- David J Pedrosa
- Department of Neurology, University Hospital Cologne, Cologne, Germany.
| | - Michelle Auth
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - K Amande M Pauls
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Matthias Runge
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Mohammad Maarouf
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany
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15
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Boller JK, Barbe MT, Pauls KAM, Reck C, Brand M, Maier F, Fink GR, Timmermann L, Kalbe E. Decision-making under risk is improved by both dopaminergic medication and subthalamic stimulation in Parkinson's disease. Exp Neurol 2014; 254:70-7. [PMID: 24444545 DOI: 10.1016/j.expneurol.2014.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
Inconsistent findings regarding the effects of dopaminergic medication (MED) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) on decision making processes and impulsivity in Parkinson's disease (PD) patients have been reported. This study investigated the influence of MED and STN-DBS on decision-making under risk. Eighteen non-demented PD patients, treated with both MED and STN-DBS (64.3±10.2years, UPDRS III MED off, DBS off 45.5±17.1) were tested with the Game of Dice Task (GDT) which probes decision-making under risk during four conditions: MED on/DBS on, MED on/DBS off, MED off/DBS on, and MED off/DBS off. Task performance across conditions was compared analyzing two GDT-parameters: (i) the "net score" indicating advantageous decisions, and (ii) the patient's ability to use negative feedback. Significantly higher GDT net scores were observed in Med on in contrast to Med off conditions as well as in DBS on versus DBS off conditions. However, no effect of therapy for the patient's ability to make use of negative feedback could be detected. The data suggest a positive influence of both MED and STN-DBS on making decisions under risk in PD patients, an effect which seems to be mediated by mechanisms other than the use of negative feedback.
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Affiliation(s)
- Jana K Boller
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Institute of Neurosciences and Medicine (INM-3), Cognitive Neurology Section, Research Centre Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany.
| | - K Amande M Pauls
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Christiane Reck
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Matthias Brand
- General Psychology: Cognition, Faculty of Engineering, University of Duisburg-Essen, Campus Duisburg, Forsthausweg 2, 47048 Duisburg, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, Ahrendahls Wiese 199, 45141 Essen, Germany.
| | - Franziska Maier
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Institute of Neurosciences and Medicine (INM-3), Cognitive Neurology Section, Research Centre Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany.
| | - Lars Timmermann
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Elke Kalbe
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Institute of Gerontology & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Vechta, Driverstrasse 22, 49377 Vechta, Germany.
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Woopen C, Pauls KAM, Koy A, Moro E, Timmermann L. Early application of deep brain stimulation: Clinical and ethical aspects. Prog Neurobiol 2013; 110:74-88. [DOI: 10.1016/j.pneurobio.2013.04.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 04/10/2013] [Accepted: 04/16/2013] [Indexed: 11/25/2022]
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Florin E, Dafsari HS, Reck C, Barbe MT, Pauls KAM, Maarouf M, Sturm V, Fink GR, Timmermann L. Modulation of local field potential power of the subthalamic nucleus during isometric force generation in patients with Parkinson's disease. Neuroscience 2013; 240:106-16. [PMID: 23454540 DOI: 10.1016/j.neuroscience.2013.02.043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 02/15/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022]
Abstract
Investigations of local field potentials of the subthalamic nucleus of patients with Parkinson's disease have provided evidence for pathologically exaggerated oscillatory beta-band activity (13-30 Hz) which is amenable to physiological modulation by, e.g., voluntary movement. Previous functional magnetic resonance imaging studies in healthy controls have provided evidence for an increase of subthalamic nucleus blood-oxygenation-level-dependant signal in incremental force generation tasks. However, the modulation of neuronal activity by force generation and its relationship to peripheral feedback remain to be elucidated. We hypothesised that beta-band activity in the subthalamic nucleus is modulated by incremental force generation. Subthalamic nucleus local field potentials were recorded intraoperatively in 13 patients with Parkinson's disease (37 recording sites) during rest and five incremental isometric force generation conditions of the arm with applied loads of 0-400 g (in 100-g increments). Repeated measures analysis of variance (ANOVA) revealed a modulation of local field potential (LFP) power in the upper beta-band (in 24-30 Hz; F(₃.₀₄₂)=4.693, p=0.036) and the gamma-band (in 70-76 Hz; F(₄)=4.116, p=0.036). Granger-causality was computed with the squared partial directed coherence and showed no significant modulation during incremental isometric force generation. Our findings indicate that the upper beta- and gamma-band power of subthalamic nucleus local field potentials are modulated by the physiological task of force generation in patients with Parkinson's disease. This modulation seems to be not an effect of a modulation of peripheral feedback.
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Affiliation(s)
- E Florin
- Department of Neurology, University Hospital Cologne, Cologne, Germany.
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Koy A, Hellmich M, Pauls KAM, Marks W, Lin JP, Fricke O, Timmermann L. Effects of deep brain stimulation in dyskinetic cerebral palsy: A meta-analysis. Mov Disord 2013; 28:647-54. [DOI: 10.1002/mds.25339] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Revised: 11/27/2012] [Accepted: 12/03/2012] [Indexed: 01/26/2023] Open
Affiliation(s)
| | - Martin Hellmich
- Institute of Medical Statistics, Informatics and Epidemiology; University of Cologne; Germany
| | | | - Warren Marks
- Department of Pediatric Neurology; Cook Children's Medical Center; Fort Worth; Texas; United States of America
| | - Jean-Pierre Lin
- Complex Motor Disorders Service, Pediatric Neuroscience; Guy's & St Thomas' Hospitals Foundation Trust & King's College Hospital Foundation Trust, King's Health Partners; London; United Kingdom
| | - Oliver Fricke
- Department of Pediatric Neurology; University Hospital; Cologne; Germany
| | - Lars Timmermann
- Department of Neurology; University Hospital Cologne; Germany
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Pedrosa DJ, Reck C, Florin E, Pauls KAM, Maarouf M, Wojtecki L, Dafsari HS, Sturm V, Schnitzler A, Fink GR, Timmermann L. Essential tremor and tremor in Parkinson's disease are associated with distinct 'tremor clusters' in the ventral thalamus. Exp Neurol 2012; 237:435-43. [PMID: 22809566 DOI: 10.1016/j.expneurol.2012.07.002] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/29/2012] [Accepted: 07/08/2012] [Indexed: 11/17/2022]
Abstract
Different tremor entities such as Essential Tremor (ET) or tremor in Parkinson's disease (PD) can be ameliorated by the implantation of electrodes in the ventral thalamus for Deep Brain Stimulation (DBS). The exact neural mechanisms underlying this treatment, as well as the specific pathophysiology of the tremor in both diseases to date remain elusive. Since tremor-related local field potentials (LFP) have been shown to cluster with a somatotopic representation in the subthalamic nucleus, we here investigated the neurophysiological correlates of tremor in the ventral thalamus in ET and PD using power and coherence analysis. Local field potentials (LFPs) at different recording depths and surface electromyographic signals (EMGs) from the extensor and flexor muscles of the contralateral forearm were recorded simultaneously in twelve ET and five PD patients. Data analysis revealed individual electrophysiological patterns of LFP-EMG coherence at single and double tremor frequency for each patient. Patterns observed varied in their spatial distribution within the Ventral lateral posterior nucleus of the thalamus (VLp), revealing a specific topography of 'tremor clusters' for PD and ET. The data strongly suggest that within VLp individual tremor-related electrophysiological signatures exist in ET and PD tremor.
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Affiliation(s)
- David J Pedrosa
- Department of Neurology, University Hospital Cologne, Cologne, Germany.
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20
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Barbe MT, Liebhart L, Runge M, Pauls KAM, Wojtecki L, Schnitzler A, Allert N, Fink GR, Sturm V, Maarouf M, Timmermann L. Deep brain stimulation in the nucleus ventralis intermedius in patients with essential tremor: habituation of tremor suppression. J Neurol 2010; 258:434-9. [PMID: 20927533 DOI: 10.1007/s00415-010-5773-3] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2010] [Revised: 09/21/2010] [Accepted: 09/22/2010] [Indexed: 11/27/2022]
Abstract
In patients with essential tremor (ET) already treated with chronic deep brain stimulation (DBS) of the nucleus ventralis intermedius (VIM) we investigated whether optimization of stimulation parameters could improve clinical tremor suppression, and whether this putative effect could be sustained over time. Twenty-three ET patients with VIM-DBS participated in the prospective study. All electrode contacts were tested systematically and stimulation parameters were optimized over the course of 2 days. Clinical tremor rating scale (TRS) was videotaped before, directly after the optimization and at a 10 weeks follow-up and evaluated blindly and independently by two clinicians. For stimulation effect optimization we increased the number of active contacts whereas the total charge applied to the tissue was kept constant. TRS hemi-body scores decreased significantly after optimization. At the 10 weeks follow-up, however, the improvement had faded and was no longer significant. The activities of daily living (ADL) remained significantly improved. Systematic optimization of VIM-DBS parameters in ET patients leads to a short term improvement which habituates over time. Our results provide further evidence for a tolerance effect in chronic VIM stimulation thereby suggesting that frequently alternating stimulation protocols should be tested in future studies of ET patients treated with VIM-DBS.
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Affiliation(s)
- Michael T Barbe
- Department of Neurology, University Hospital Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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Timmermann L, Pauls KAM, Wieland K, Jech R, Kurlemann G, Sharma N, Gill SS, Haenggeli CA, Hayflick SJ, Hogarth P, Leenders KL, Limousin P, Malanga CJ, Moro E, Ostrem JL, Revilla FJ, Santens P, Schnitzler A, Tisch S, Valldeoriola F, Vesper J, Volkmann J, Woitalla D, Peker S. Dystonia in neurodegeneration with brain iron accumulation: outcome of bilateral pallidal stimulation. ACTA ACUST UNITED AC 2010; 133:701-12. [PMID: 20207700 PMCID: PMC2842517 DOI: 10.1093/brain/awq022] [Citation(s) in RCA: 160] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Neurodegeneration with brain iron accumulation encompasses a heterogeneous group of rare neurodegenerative disorders that are characterized by iron accumulation in the brain. Severe generalized dystonia is frequently a prominent symptom and can be very disabling, causing gait impairment, difficulty with speech and swallowing, pain and respiratory distress. Several case reports and one case series have been published concerning therapeutic outcome of pallidal deep brain stimulation in dystonia caused by neurodegeneration with brain iron degeneration, reporting mostly favourable outcomes. However, with case studies, there may be a reporting bias towards favourable outcome. Thus, we undertook this multi-centre retrospective study to gather worldwide experiences with bilateral pallidal deep brain stimulation in patients with neurodegeneration with brain iron accumulation. A total of 16 centres contributed 23 patients with confirmed neurodegeneration with brain iron accumulation and bilateral pallidal deep brain stimulation. Patient details including gender, age at onset, age at operation, genetic status, magnetic resonance imaging status, history and clinical findings were requested. Data on severity of dystonia (Burke Fahn Marsden Dystonia Rating Scale-Motor Scale, Barry Albright Dystonia Scale), disability (Burke Fahn Marsden Dystonia Rating Scale-Disability Scale), quality of life (subjective global rating from 1 to 10 obtained retrospectively from patient and caregiver) as well as data on supportive therapy, concurrent pharmacotherapy, stimulation settings, adverse events and side effects were collected. Data were collected once preoperatively and at 2-6 and 9-15 months postoperatively. The primary outcome measure was change in severity of dystonia. The mean improvement in severity of dystonia was 28.5% at 2-6 months and 25.7% at 9-15 months. At 9-15 months postoperatively, 66.7% of patients showed an improvement of 20% or more in severity of dystonia, and 31.3% showed an improvement of 20% or more in disability. Global quality of life ratings showed a median improvement of 83.3% at 9-15 months. Severity of dystonia preoperatively and disease duration predicted improvement in severity of dystonia at 2-6 months; this failed to reach significance at 9-15 months. The study confirms that dystonia in neurodegeneration with brain iron accumulation improves with bilateral pallidal deep brain stimulation, although this improvement is not as great as the benefit reported in patients with primary generalized dystonias or some other secondary dystonias. The patients with more severe dystonia seem to benefit more. A well-controlled, multi-centre prospective study is necessary to enable evidence-based therapeutic decisions and better predict therapeutic outcomes.
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Affiliation(s)
- L Timmermann
- Klinik und Poliklinik für Neurologie, Uniklinik Köln, Kerpener Str. 62, 50924 Köln, Germany.
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Galldiks N, Pauls KAM, Fink GR, Haupt WF. Traction lesion of the brachial plexus during bodyflying. J Neurol 2010; 257:851-2. [PMID: 20143111 DOI: 10.1007/s00415-010-5461-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Revised: 12/14/2009] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
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Pauls KAM, Reck C, Barbe MT, Maarouf M, Sturm V, Fink GR, Timmermann L. Post-traumatic hyperkinesias in patients with Parkinson's disease with stimulation of the subthalamic nucleus. Akt Neurol 2009. [DOI: 10.1055/s-0029-1238856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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