1
|
Huntoon K, Look A, Young NA, Deogaonkar M. Effect of Dexmedetomidine on Perception of Paresthesia during Subthalamic Nucleus Deep Brain Stimulation Surgery for Parkinson's Disease. Neurol India 2023; 71:304-307. [PMID: 37148057 DOI: 10.4103/0028-3886.375375] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Background Deep brain stimulation (DBS) has become a well-established treatment for the management of Parkinson's disease (PD). The most common method of lead targeting utilizes microelectrode recording (MER) and intraoperative macrostimulation to confirm accurate placement of the lead. This has been significantly aided by the use of dexmedetomidine (DEX) sedation during the procedure. Despite the frequent use of DEX, it has been theorized that DEX may have some effects on the MER during intraoperative testing. The effect on the perception of sensory thresholds during macrostimulation in the form of paresthesia is still unreported. Objectives To investigate the effect of the sedative DEX on sensory perception thresholds observed in the intraoperative versus postoperative settings for patients undergoing subthalamic nucleus (STN) DBS surgery for PD. Materials and Methods Adult patients (n = 8) with a diagnosis of PD underwent placement of DBS leads (n = 14) in the STN. Patients were subjected to intraoperative macrostimulation for capsular and sensory thresholds prior to placement of each DBS lead. These were compared to sensory thresholds observed in the postoperative setting during outpatient programming at three depths on each lead (n = 42). Results In most contacts (22/42) (P = 0.19), sensory thresholds for paresthesia perception were either perceived at a higher voltage or absent during intraoperative testing in comparison to those observed in the postoperative setting. Conclusions DEX appears to have measurable (though not statistically significant) effect on the perception of paresthesia observed during intraoperative testing.
Collapse
Affiliation(s)
- Kristin Huntoon
- Department of Neurological, Surgery the Ohio State University Wexner Medical Center Columbus, Ohio, US
| | - Andrew Look
- Department of Neurological, Surgery the Ohio State University Wexner Medical Center Columbus, Ohio, US
| | - Nicole A Young
- Deep Brain Stimulation Program, SpecialtyCare Inc. Nashville, TN, US
| | - Milind Deogaonkar
- Department of Neurosurgery, West Virginia University Morgantown, West Virginia, US
| |
Collapse
|
2
|
Damante MA, Ganguly R, Huntoon KM, Kraut EH, Deogaonkar M. A Case Report of Siblings with Dystonia: A Potential Link Between DYT11 Mutation and Platelet Dysfunction. Neurol India 2022; 70:402-404. [PMID: 35263928 DOI: 10.4103/0028-3886.338650] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Myoclonus-dystonia syndrome (MDS) is an autosomal dominant disorder due to a mutated epsilon-sarcoglycan gene (SGCE) at the dystonia 11 (DYT11) locus on chromosome 7q21-31. ε-sarcoglycan has been identified in vascular smooth muscle and has been suggested to stabilize the capillary system. This report describes two siblings with MDS treated with bilateral globus pallidus interna deep brain stimulation. One patient had a history of bleeding following dental procedures, menorrhagia, and DBS placement complicated by intraoperative bleeding during cannula insertion. The other sibling endorsed frequent epistaxis. Subsequent procedures were typically treated perioperatively with platelet or tranexamic acid transfusion. Hematologic workup showed chronic borderline thrombocytopenia but did not elucidate a cause-specific platelet dysfunction or underlying coagulopathy. The bleeding history and thrombocytopenia observed suggest a potential link between MDS and platelet dysfunction. Mutated ε-sarcoglycan may destabilize the capillary system, thus impairing vasoconstriction and leading to suboptimal platelet aggregation.
Collapse
Affiliation(s)
- Mark A Damante
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Ranjit Ganguly
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Kristin M Huntoon
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Eric H Kraut
- Division of Hematology and Oncology, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
3
|
Abstract
Epidemiological studies show a steady rise in the prevalence of obstructive sleep apnea (OSA). Untreated OSA is responsible for numerous chronic health conditions, motor vehicle, and workplace-related accidents leading to substantial economic burden both to the individual and society. Multiple causes for OSA and a wide range of consequences has made its diagnosis and treatment difficult. Obstructive sleep apnea may be caused by anatomical variation, increased collapsibility of the upper airway, low sleep arousal threshold, and exaggerated response to desaturation. Lifestyle changes, anatomical corrective surgeries, and oral appliances have been used but patient compliance is poor as it interferes in the daily routine. Neuromodulation is a promising functional modifying option that addresses the cause of obstructive sleep apnea at multiple levels.
Collapse
Affiliation(s)
- Vikas Naik
- Department of Neurosurgery, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
| | - Ninad Khandekar
- Department of Medicine, Government Medical College, Nagpur, Maharashtra, India
| | - Milind Deogaonkar
- Department of Functional Neurosurgery, West Virginia University Health Sciences, WV, USA
| |
Collapse
|
4
|
Abstract
Deep brain stimulation (DBS) and Motor Cortex stimulation (MCS) have been used for control of chronic pain. Chronic pain of any origin is complex and difficult to treat. Stimulation of various areas in brain-like sensory thalamus, medial nuclei of thalamus including centro-lateral nucleus of thalamus (CL), periaqueductal gray, periventricular gray, nucleus accumbence and motor cortex provides partial relief in properly selected patients. This article reviews the pain pathways, theories of pain, targets for DBS and rationale of DBS and MCS. It also discusses the patient selection, technical details of each target.
Collapse
Affiliation(s)
- Patrick Senatus
- Department of Neurosurgery, Ayer Neuroscience Institute, Hartford HealthCare, Hartford, CT, USA
| | - Sarah Zurek
- Department of Neurosurgery, Ayer Neuroscience Institute, Hartford HealthCare, Hartford, CT, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| |
Collapse
|
5
|
Abstract
Background Depression, Obsessive-compulsive Disorder (OCD), and addiction are the leading disabling psychiatric conditions with huge health care and psychosocial burden besides increased morbidity and mortality. Deep brain stimulation (DBS) for depression, OCD, and addiction is increasingly explored and is quite challenging. We present a brief review of the pertinent literature of DBS for depression, OCD, and addiction and present the status and challenges. Objective The aim of this study was to review the current status and challenges with the DBS for Depression, Obsessive-compulsive Disorder (OCD), and addiction. Method The pertinent brief literature was reviewed in reference to the DBS for Depression, Obsessive-compulsive Disorder (OCD), and addiction. Results To date, OCD is the only psychiatric condition approved for DBS therapy (under humanitarian device exemption). Although the initial encouraging results of DBS in depression were encouraging but the two larger multicenter clinical trials failed to meet the primary objective. Further evaluation and studies are ongoing. Similarly, the initial results of DBS for addiction are encouraging; however, the experience is limited. Conclusion DBS for depression, OCD, and addiction seem challenging but promising. Further refinement of the target and evaluation in a larger and controlled setting is needed, specifically for depression and addiction.
Collapse
Affiliation(s)
- Manish Ranjan
- Department of Neurosurgery, Rockefeller Neuroscience Institute, USA
| | - Nutan Ranjan
- Department of Behavioral Medicine and Psychiatry, West Virginia University, West Virginia, USA
| | | | - Ali Rezai
- Department of Neurosurgery, Rockefeller Neuroscience Institute, USA
| |
Collapse
|
6
|
Bhagwat AA, Deogaonkar M, Deopujari CE. Microsurgery and Neuromodulation for Facial Spasms. Neurol India 2021; 68:S196-S201. [PMID: 33318350 DOI: 10.4103/0028-3886.302455] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Facial spasms are of various types. Hemifacial spasm (HFS) is characterized by unilateral tonic-clonic contractions of facial muscles, following a specific pattern of disease progression. It has well-delineated clinical, radiological and electrophysiological features. We have conducted an extensive review of existing literature on the subject, as regards etiopathogenesis, clinical features, investigations and management options for facial spasms. Primary Hemifacial spasm (HFS) may be treated using pharmacotherapy, botulinum toxin injections or microvascular decompression surgery. Microvascular decompression has the potential to reverse the pathological changes of the disease and has proved to be the most successful of all treatment options. Other facial spasms are exceedingly difficult to treat and may need neuromodulation as an option. The following article attempts to review the clinical features and therapeutic approaches to managing patients with facial spasms.
Collapse
Affiliation(s)
- Aniruddha A Bhagwat
- Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Milind Deogaonkar
- Department of Neurosurgery, University of West Virginia, Medical Centre Drive, Morgantown WV, USA
| | | |
Collapse
|
7
|
Tripathi R, Deogaonkar M. Fundamentals of Neuromodulation and Pathophysiology of Neural Networks in Health and Disease. Neurol India 2021; 68:S163-S169. [PMID: 33318346 DOI: 10.4103/0028-3886.302463] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuromodulation involves altering neuronal circuitry and subsequent physiological changes with the aim to ameliorate neurological symptoms. Over the years several techniques have been used to obtain neuromodulatory effects for treatment of conditions including Parkinson disease, essential tremor, dystonia or seizures. We provide brief description of the various therapeutics that have been used and mechanisms involved in pathophysiology of these disorders as well as the therapeutic mechanisms of the treatment modalities.
Collapse
Affiliation(s)
- Richa Tripathi
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, 33 Medical Center Drive, Morgantown, WV, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, 33 Medical Center Drive, Morgantown, WV, USA
| |
Collapse
|
8
|
Rajan R, Skorvanek M, Magocova V, Siddiqui J, AlSinaidi OA, Shinawi HM, AlSubaie F, AlOmar N, Deogaonkar M, Bajwa JA. Neuromodulation Options and Patient Selection for Parkinson's Disease. Neurol India 2021; 68:S170-S178. [PMID: 33318347 DOI: 10.4103/0028-3886.302473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neuromodulation therapies, including deep brain stimulation (DBS) and pump therapies, are currently the standard of care for PD patients with advanced disease and motor complications that are difficult to control with medical management alone. The quest for alternate lesser invasive approaches led to the development of several novel therapies like intrajejunal levodopa infusions (IJLI), continuous subcutaneous apomorphine infusions (CSAI) and Magnetic Resonance guided Focused Ultrasound (MRgFUS) in recent years. To achieve good outcomes with any of these therapeutic modalities, careful patient selection, multidisciplinary evaluation and technical expertise are equally important. In this review, we will provide an overview of the neuromodulation strategies currently available for PD, emphasizing on patient selection and choosing among the various strategies.
Collapse
Affiliation(s)
- Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Matej Skorvanek
- Department of Neurology, P. J. Safarik University; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia, USA
| | - Veronika Magocova
- Department of Neurology, P. J. Safarik University; Department of Neurology, University Hospital of L. Pasteur, Kosice, Slovakia, USA
| | - Junaid Siddiqui
- Department of Neurology, University of Missouri-School of Medicine, Columbia, MO, USA
| | - Omar A AlSinaidi
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Heba M Shinawi
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Fahd AlSubaie
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Najeeb AlOmar
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Milind Deogaonkar
- Department of Neurological Surgery, West Virginia University, Morgantown, WV, USA
| | - Jawad A Bajwa
- Department of Neurology, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| |
Collapse
|
9
|
Solcà M, Krishna V, Young N, Deogaonkar M, Herbelin B, Orepic P, Mange R, Rognini G, Serino A, Rezai A, Blanke O. Enhancing analgesic spinal cord stimulation for chronic pain with personalized immersive virtual reality. Pain 2021; 162:1641-1649. [PMID: 33259460 DOI: 10.1097/j.pain.0000000000002160] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/28/2020] [Accepted: 11/02/2020] [Indexed: 01/24/2023]
Abstract
ABSTRACT Spinal cord stimulation (SCS) is an approved treatment for truncal and limb neuropathic pain. However, pain relief is often suboptimal and SCS efficacy may reduce over time, requiring sometimes the addition of other pain therapies, stimulator revision, or even explantation. We designed and tested a new procedure by combining SCS with immersive virtual reality (VR) to enable analgesia in patients with chronic leg pain. We coupled SCS and VR by linking SCS-induced paresthesia with personalized visual bodily feedback that was provided by VR and matched to the spatiotemporal patterns of SCS-induced paresthesia. In this cross-sectional prospective interventional study, 15 patients with severe chronic pain and an SCS implant underwent congruent SCS-VR (personalized visual feedback of the perceived SCS-induced paresthesia displayed on the patient's virtual body) and 2 control conditions (incongruent SCS-VR and VR alone). We demonstrate the efficacy of neuromodulation-enhanced VR for the treatment of chronic pain by showing that congruent SCS-VR reduced pain ratings on average by 44%. Spinal cord stimulation-VR analgesia was stronger than that in both control conditions (enabling stronger analgesic effects than incongruent SCS-VR analgesia or VR alone) and kept increasing over successive stimulations, revealing the selectivity and consistency of the observed effects. We also show that analgesia persists after congruent SCS-VR had stopped, indicating carry over effects and underlining its therapeutic potential. Linking latest VR technology with recent insights from the neuroscience of body perception and SCS neuromodulation, our personalized new SCS-VR platform highlights the impact of immersive digiceutical therapies for chronic pain.Registration: clinicaltrials.gov, Identifier: NCT02970006.
Collapse
Affiliation(s)
- Marco Solcà
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Department of Psychiatry, Geneva University Hospital, Geneva, Switzerland
| | - Vibhor Krishna
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, United States
| | - Nicole Young
- Department of Neurological Surgery, The Ohio State University, Columbus, OH, United States
| | - Milind Deogaonkar
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Bruno Herbelin
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Pavo Orepic
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Robin Mange
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Giulio Rognini
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
| | - Andrea Serino
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- MySpace, Department of Clinical Neurosciences, University Hospital of Lausanne, Lausanne, Switzerland
| | - Ali Rezai
- Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States
| | - Olaf Blanke
- Laboratory of Cognitive Neuroscience, Center for Neuroprosthetics and Brain Mind Institute, School of Life Sciences, Swiss Federal Institute of Technology (EPFL), Lausanne, Switzerland
- Department of Neurology, Geneva University Hospital, Geneva, Switzerland
| |
Collapse
|
10
|
Abstract
BACKGROUND Chronic, focal, neuropathic pain is difficult to treat. Local nerve blocks are either ineffective or do not last. Regular neuromodulation modalities like spinal cord stimulation (SCS) or pain pump are invasive and affect a larger area. OBJECTIVES To discuss the indications, technique, nuances, programming, and outcomes of peripheral neuromodulation. METHODS The article reviews published literature and the author's own experience of over 500 cases of peripheral neuromodulation. RESULTS AND CONCLUSION Peripheral neuromodulation using peripheral nerve field stimulation (PNFS) is an effective, minimally invasive, targeted method of treatment. It is a relatively new modality in the field of neuromodulation but is used more often.
Collapse
Affiliation(s)
- Milind Deogaonkar
- Department of Neurosurgery, West Virginia University Health Sciences Center, Morgantown, WV, USA
| |
Collapse
|
11
|
Huntoon KM, Young NA, Look AC, Deogaonkar M. Direct Comparison of Posterior Subthalamic Area Stimulation versus Subthalamic Nucleus Deep Brain Stimulation in Parkinson's Disease. Neurol India 2020; 68:165-167. [PMID: 32129269 DOI: 10.4103/0028-3886.279694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In this case report, we describe successful tremor capture via stimulation of the posterior subthalamic area (PSA) for a patient with tremor-predominant Parkinson's disease. In this scenario, the patient had a deep brain stimulation (DBS) lead placed in the PSA of the right hemisphere and a DBS lead placed in the subthalmic nucleus (STN) of the left hemisphere. Therefore, we were able to directly compare tremor capture in the same patient receiving stimulation in two different brain areas. We show that both placements are equally efficacious for tremor suppression, though the DBS lead placed in the PSA required slightly higher current intensity. This comparison in the same patient confirms that stimulation of the PSA can successfully suppress tremor in Parkinson's disease.
Collapse
Affiliation(s)
- Kristin M Huntoon
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Nicole A Young
- Department of Neuroscience, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Andrew C Look
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| | - Milind Deogaonkar
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States
| |
Collapse
|
12
|
Deogaonkar M, Chandra PS. Foreword. Neurol India 2020; 68:S161. [DOI: 10.4103/0028-3886.302479] [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: 11/04/2022]
|
13
|
Young NA, Brown MP, Peng J, Kline D, Reider C, Deogaonkar M. Predicting extended hospital stay after deep brain stimulation surgery in Parkinson's patients. J Clin Neurosci 2019; 69:241-244. [PMID: 31431404 DOI: 10.1016/j.jocn.2019.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 05/03/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The goal of deep brain stimulation (DBS) is to achieve maximal benefit for the patient while minimizing the likelihood of adverse effects. Currently, no standardized criteria exist that predicts extended hospital stay in DBS patients, although careful patient selection is recognized as a very important step for successful DBS therapy. OBJECTIVES AND METHODS The objective of this study was to identify eight key factors that predicted extended post-operative hospital stay following DBS lead implantation, in an effort to better identify patients that would require minimal hospital stay, resulting in reduced cost and reduced exposure to hospital- related problems. Univariate logistic regression models were used to examine associations between each factor and patients' post-surgical outcomes. RESULTS Using data collected from 183 patients, we found that 53 patients required a hospital stay longer than two days within one month post-procedure. Those who were 70 years or older and those who had frequent falls were significantly more likely to require extended post-surgical care. Patients that scored three points or higher on our eight-factor assessment scale had a greater likelihood of experiencing an event that would require an extended hospital stay following DBS lead placement, regardless of what three factors were present. CONCLUSIONS Any PD patient who is 70 years or older, incurring frequent falls, or with more than three points on our scale, should be carefully screened and cautioned about likely prolonged recovery and extended post-operative hospital stay.
Collapse
Affiliation(s)
- Nicole A Young
- Department of Neuroscience, Center for Neuromodulation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Matthew P Brown
- Department of Neurological Surgery, Center for Neuromodulation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Juan Peng
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - David Kline
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carson Reider
- Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Milind Deogaonkar
- Department of Neurological Surgery, Center for Neuromodulation, The Ohio State University Wexner Medical Center, Columbus, OH, USA; Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
14
|
Krishna V, Sammartino F, Rabbani Q, Changizi B, Agrawal P, Deogaonkar M, Knopp M, Young N, Rezai A. Connectivity-based selection of optimal deep brain stimulation contacts: A feasibility study. Ann Clin Transl Neurol 2019; 6:1142-1150. [PMID: 31353863 PMCID: PMC6649384 DOI: 10.1002/acn3.784] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/19/2019] [Accepted: 03/26/2019] [Indexed: 01/25/2023] Open
Abstract
Background The selection of optimal deep brain stimulation (DBS) parameters is time‐consuming, experience‐dependent, and best suited when acute effects of stimulation can be observed (e.g., tremor reduction). Objectives To test the hypothesis that optimal stimulation location can be estimated based on the cortical connections of DBS contacts. Methods We analyzed a cohort of 38 patients with Parkinson's disease (24 training, and 14 test cohort). Using whole‐brain probabilistic tractography, we first mapped the cortical regions associated with stimulation‐induced efficacy (rigidity, bradykinesia, and tremor improvement) and side effects (paresthesia, motor contractions, and visual disturbances). We then trained a support vector machine classifier to categorize DBS contacts into efficacious, defined by a therapeutic window ≥2 V (threshold for side effect minus threshold for efficacy), based on their connections with cortical regions associated with efficacy versus side effects. The connectivity‐based classifications were then compared with actual stimulation contacts using receiver‐operating characteristics (ROC) curves. Results Unique cortical clusters were associated with stimulation‐induced efficacy and side effects. In the training dataset, 42 of the 47 stimulation contacts were accurately classified as efficacious, with a therapeutic window of ≥3 V in 31 (66%) and between 2 and 2.9 V in 11 (24%) electrodes. This connectivity‐based estimation was successfully replicated in the test cohort with similar accuracy (area under ROC = 0.83). Conclusions Cortical connections can predict the efficacy of DBS contacts and potentially facilitate DBS programming. The clinical utility of this paradigm in optimizing DBS outcomes should be prospectively tested, especially for directional electrodes.
Collapse
Affiliation(s)
- Vibhor Krishna
- Center for NeuromodulationThe Ohio State UniversityColumbusOhio
| | | | - Qinwan Rabbani
- Center for NeuromodulationThe Ohio State UniversityColumbusOhio
| | | | - Punit Agrawal
- Center for NeuromodulationThe Ohio State UniversityColumbusOhio
| | | | - Michael Knopp
- Wright Center of Innovation in Biomedical ImagingThe Ohio State UniversityColumbusOhio
| | - Nicole Young
- Center for NeuromodulationThe Ohio State UniversityColumbusOhio
| | - Ali Rezai
- Center for NeuromodulationThe Ohio State UniversityColumbusOhio
| |
Collapse
|
15
|
Deogaonkar M. Can cognitive decline be the nemesis of motor improvement secondary to deep brain stimulation? Neurol India 2019; 67:393-394. [PMID: 31085843 DOI: 10.4103/0028-3886.258016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Milind Deogaonkar
- Department of Neurological Surgery, Center for Neuromodulation, Neuroscience Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
16
|
Sammartino F, Krishna V, Rabbani Q, Changizi B, Agrawal P, Deogaonkar M, Young NA, Rezai A. Abstract #121: Automated prediction of optimal stimulation settings in STN DBS for PD. Brain Stimul 2019. [DOI: 10.1016/j.brs.2018.12.128] [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: 10/27/2022] Open
|
17
|
Krishna V, Sammartino F, Rabbani Q, Changizi BK, Agrawal P, Deogaonkar M, Knopp MV, Young N, Rezai AR. 348 An Integrated Solution to Predict the Stimulation Parameters After STN DBS for PD. Neurosurgery 2018. [DOI: 10.1093/neuros/nyy303.348] [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: 11/12/2022] Open
|
18
|
|
19
|
Sharma M, Reeves K, Deogaonkar M, Rezai AR. Deep Brain Stimulation for Obsessive–Compulsive Disorder. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00085-1] [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: 11/17/2022]
|
20
|
Adnan AK, Alexopoulos A, Alo KM, Alterman RL, Amar A, Andrade P, Arulkumar S, Awad AJ, Baltuch G, Barolat G, Barthélemy EJ, Barua NU, Bennett ME, Bentley N, Bezchlibnyk YB, Bijanki KR, Bingaman W, Boggs JW, Boon P, Brouwer BA, Campos LW, Caparso A, Capozzo A, Chae J, Chang JW, Cheng J, Copenhaver D, Deer TR, Deogaonkar M, Dhar D, Dohmeier K, Dougherty DD, Durand DM, Foote K, Gilligan J, Gill SS, Gonzalez-Martinez J, Greenberg BD, Gross RE, H. Pourfar M, Hamani C, Hayek SM, Holtzheimer PE, Ilfeld BM, Jin H, Joosten B, Jung NY, Kim CH, Kim YG, Klehr M, Koch P, Kohl S, Kopell BH, Kramer D, Krames ES, Krishnan B, Krishna V, Kuhn J, Kyung-soo Hong J, Leonardo K, Leong MS, Li D, Linninger AA, Lipsman N, Liu C, Lozano AM, Mackow M, Malinowski MN, Mayberg HS, Mazzone P, Mehta AI, Mehta V, Mills-Joseph R, Nair D, North RB, Okun M, Patel NK, Patil PG, Pope JE, Poree LR, Prager JP, Raedt R, Rasouli JJ, Rasskazoff S, Rauck R, Reeves K, Rezai AR, Russin J, Sabersky A, Saulino M, Scarnati E, Schu S, Sharma M, Shipley J, Shirvalkar P, Slavin KV, Stanton-Hicks M, Stone S, Stuart WA, Sun B, Tangen K, Tepper SJ, van Kleef M, Vancamp T, Verrills P, Viselli F, Visser-Vandewalle V, Vitale F, Vonck K, Wang T, Wang X, Weiner RL, Widge AS, Wongsarnpigoon A, Y. Mogilner A, Yaeger KA, Yaksh TL, Yin D, Zeljic K, Zhang C, Zhan S. List of Contributors of Volume 2. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.01005-6] [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: 10/17/2022]
|
21
|
Deogaonkar M. Neuromodulation in Tourette's syndrome. Neurol India 2017; 65:103-104. [DOI: 10.4103/0028-3886.198271] [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: 11/04/2022]
|
22
|
Nada EM, Rajan S, Grandhe R, Deogaonkar M, Zimmerman NM, Ebrahim Z, Avitsian R. Intraoperative Hypotension During Second Stage of Deep Brain Stimulator Placement: Same Day versus Different Day Procedures. World Neurosurg 2016; 95:40-45. [DOI: 10.1016/j.wneu.2016.07.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 07/12/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022]
|
23
|
Shaw A, Sharma M, Zibly Z, Ikeda D, Deogaonkar M. Sandwich technique, peripheral nerve stimulation, peripheral field stimulation and hybrid stimulation for inguinal region and genital pain. Br J Neurosurg 2016; 30:631-636. [PMID: 27347767 DOI: 10.1080/02688697.2016.1199777] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Ilioinguinal neuralgia (IG) and genitofemoral (GF) neuralgia following inguinal hernia repair is a chronic and debilitating neuropathic condition. Recently, peripheral nerve stimulation has become an effective and minimally invasive option for the treatment of refractory pain. Here we present a retrospective case series of six patients who underwent placement of peripheral nerve stimulation electrodes using various techniques for treatment of refractory post-intervention inguinal region pain. METHODS Six patients with post-intervention inguinal, femoral or GF neuropathic pain were evaluated for surgery. Either octopolar percutaneous electrodes or combination of paddle and percutaneous electrodes were implanted in the area of their pain. Pain visual analog scores (VAS), surgical complication rate, preoperative symptom duration, degree of pain relief, preoperative and postoperative work status, postoperative changes in medication usage, and overall degree of satisfaction with this therapy was assessed. RESULTS All six patients had an average improvement of 62% in the immediate post-operative follow-up. Four patients underwent stimulation for IG, one for femoral neuralgia, and another for GF neuralgia. Peripheral nerve stimulation provided at least 50% pain relief in all the six patients with post-intervention inguinal region pain. 85% of patients indicated they were completely satisfied with the therapy overall. There was one treatment failure with an acceptable complication rate. CONCLUSION Peripheral nerve or field stimulation for post-intervention inguinal region pain is a safe and effective treatment for this refractory and complex problem for patients who have exhausted other management options.
Collapse
Affiliation(s)
- Andrew Shaw
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Mayur Sharma
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Zion Zibly
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Daniel Ikeda
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| | - Milind Deogaonkar
- a Department of Neurosurgery , Center of Neuromodulation, Wexner Medical Center, The Ohio State University , Columbus , OH , USA
| |
Collapse
|
24
|
Sharma M, Naik V, Deogaonkar M. Emerging applications of deep brain stimulation. J Neurosurg Sci 2016; 60:242-255. [PMID: 26788743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Deep brain stimulation (DBS) implantation surgery is an established treatment modality for a variety of medical refractory movement disorders such as Parkinson's disease, essential tremors and dystonia. Following the success of DBS in these movement disorders with a high rate of safety and efficacy, there is a resurgence of interest in the utility of this modality in other medical refractory disorders. Consequently, neuromodulation has been explored for a variety of refractory conditions such as neuropsychiatric disorders (major depressive disorders, obsessive-compulsive disorders, addictions), eating disorders including obesity, traumatic brain injury, post-traumatic stress disorders (PTSD), dementias and chronic pain. This review provides an overview of the emerging applications of DBS in these disorders, including summary of the published literature. We have highlighted the pathophysiology and likely aberrant neural circuits involved in these refractory disorders. Current and possible surgical targets for neurosurgical intervention related to these disorders have also been discussed. Furthermore, recent advances such as closed loop systems; responsive neurostimulation systems and optogenetics techniques have been addressed.
Collapse
Affiliation(s)
- Mayur Sharma
- Neurosurgical Oncology, Cleveland Clinic, Cleveland, OH, USA -
| | | | | |
Collapse
|
25
|
Sharma M, Young J, Grecula J, McGregor J, Deogaonkar M. Gamma knife ventral capsulotomy for posttraumatic brain injury obsessive-compulsive disorder. Neurol India 2016; 64:552-4. [PMID: 27147168 DOI: 10.4103/0028-3886.181549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio 43210, USA
| |
Collapse
|
26
|
Sharma M, Deogaonkar M. Accuracy and safety of targeting using intraoperative “O-arm” during placement of deep brain stimulation electrodes without electrophysiological recordings. J Clin Neurosci 2016; 27:80-6. [DOI: 10.1016/j.jocn.2015.06.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 06/16/2015] [Accepted: 06/20/2015] [Indexed: 10/22/2022]
|
27
|
Bouton CE, Shaikhouni A, Annetta NV, Bockbrader MA, Friedenberg DA, Nielson DM, Sharma G, Sederberg PB, Glenn BC, Mysiw WJ, Morgan AG, Deogaonkar M, Rezai AR. Restoring cortical control of functional movement in a human with quadriplegia. Nature 2016; 533:247-50. [PMID: 27074513 DOI: 10.1038/nature17435] [Citation(s) in RCA: 461] [Impact Index Per Article: 57.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 02/15/2016] [Indexed: 12/30/2022]
Abstract
Millions of people worldwide suffer from diseases that lead to paralysis through disruption of signal pathways between the brain and the muscles. Neuroprosthetic devices are designed to restore lost function and could be used to form an electronic 'neural bypass' to circumvent disconnected pathways in the nervous system. It has previously been shown that intracortically recorded signals can be decoded to extract information related to motion, allowing non-human primates and paralysed humans to control computers and robotic arms through imagined movements. In non-human primates, these types of signal have also been used to drive activation of chemically paralysed arm muscles. Here we show that intracortically recorded signals can be linked in real-time to muscle activation to restore movement in a paralysed human. We used a chronically implanted intracortical microelectrode array to record multiunit activity from the motor cortex in a study participant with quadriplegia from cervical spinal cord injury. We applied machine-learning algorithms to decode the neuronal activity and control activation of the participant's forearm muscles through a custom-built high-resolution neuromuscular electrical stimulation system. The system provided isolated finger movements and the participant achieved continuous cortical control of six different wrist and hand motions. Furthermore, he was able to use the system to complete functional tasks relevant to daily living. Clinical assessment showed that, when using the system, his motor impairment improved from the fifth to the sixth cervical (C5-C6) to the seventh cervical to first thoracic (C7-T1) level unilaterally, conferring on him the critical abilities to grasp, manipulate, and release objects. This is the first demonstration to our knowledge of successful control of muscle activation using intracortically recorded signals in a paralysed human. These results have significant implications in advancing neuroprosthetic technology for people worldwide living with the effects of paralysis.
Collapse
Affiliation(s)
- Chad E Bouton
- Medical Devices and Neuromodulation, Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Ammar Shaikhouni
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio 43210, USA.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio 43210, USA
| | - Nicholas V Annetta
- Medical Devices and Neuromodulation, Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Marcia A Bockbrader
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio 43210, USA.,Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio 43210, USA
| | - David A Friedenberg
- Advanced Analytics and Health Research, Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Dylan M Nielson
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio 43210, USA.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio 43210, USA
| | - Gaurav Sharma
- Medical Devices and Neuromodulation, Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Per B Sederberg
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio 43210, USA.,Department of Psychology, The Ohio State University, Columbus, Ohio 43210, USA
| | - Bradley C Glenn
- Energy Systems, Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - W Jerry Mysiw
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio 43210, USA.,Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, Ohio 43210, USA
| | - Austin G Morgan
- Medical Devices and Neuromodulation, Battelle Memorial Institute, 505 King Avenue, Columbus, Ohio 43201, USA
| | - Milind Deogaonkar
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio 43210, USA.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio 43210, USA
| | - Ali R Rezai
- Center for Neuromodulation, The Ohio State University, Columbus, Ohio 43210, USA.,Department of Neurological Surgery, The Ohio State University, Columbus, Ohio 43210, USA
| |
Collapse
|
28
|
Deogaonkar M, Sharma M, Oluigbo C, Nielson DM, Yang X, Vera-Portocarrero L, Molnar GF, Abduljalil A, Sederberg PB, Knopp M, Rezai AR. Spinal Cord Stimulation (SCS) and Functional Magnetic Resonance Imaging (fMRI): Modulation of Cortical Connectivity With Therapeutic SCS. Neuromodulation 2015; 19:142-53. [PMID: 26373920 DOI: 10.1111/ner.12346] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 06/24/2015] [Revised: 08/03/2015] [Accepted: 08/05/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The neurophysiological basis of pain relief due to spinal cord stimulation (SCS) and the related cortical processing of sensory information are not completely understood. The aim of this study was to use resting state functional magnetic resonance imaging (rs-fMRI) to detect changes in cortical networks and cortical processing related to the stimulator-induced pain relief. METHODS Ten patients with complex regional pain syndrome (CRPS) or neuropathic leg pain underwent thoracic epidural spinal cord stimulator implantation. Stimulation parameters associated with "optimal" pain reduction were evaluated prior to imaging studies. Rs-fMRI was obtained on a 3 Tesla, Philips Achieva MRI. Rs-fMRI was performed with stimulator off (300TRs) and stimulator at optimum (Opt, 300 TRs) pain relief settings. Seed-based analysis of the resting state functional connectivity was conducted using seeds in regions established as participating in pain networks or in the default mode network (DMN) in addition to the network analysis. NCUT (normalized cut) parcellation was used to generate 98 cortical and subcortical regions of interest in order to expand our analysis of changes in functional connections to the entire brain. We corrected for multiple comparisons by limiting the false discovery rate to 5%. RESULTS Significant differences in resting state connectivity between SCS off and optimal state were seen between several regions related to pain perception, including the left frontal insula, right primary and secondary somatosensory cortices, as well as in regions involved in the DMN, such as the precuneus. In examining changes in connectivity across the entire brain, we found decreased connection strength between somatosensory and limbic areas and increased connection strength between somatosensory and DMN with optimal SCS resulting in pain relief. This suggests that pain relief from SCS may be reducing negative emotional processing associated with pain, allowing somatosensory areas to become more integrated into default mode activity. CONCLUSION SCS reduces the affective component of pain resulting in optimal pain relief. Study shows a decreased connectivity between somatosensory and limbic areas associated with optimal pain relief due to SCS.
Collapse
Affiliation(s)
- Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Mayur Sharma
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Chima Oluigbo
- Department of Neurosurgery, Children's National Medical Center, Washington, DC, USA
| | - Dylan M Nielson
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Xiangyu Yang
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | | | | | - Amir Abduljalil
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Per B Sederberg
- Department of Psychology, The Ohio State University, Columbus, OH, USA
| | - Michael Knopp
- Department of Radiology, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Ali R Rezai
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| |
Collapse
|
29
|
Scharpf DT, Sharma M, Deogaonkar M, Rezai A, Bergese SD. Practical considerations and nuances in anesthesia for patients undergoing deep brain stimulation implantation surgery. Korean J Anesthesiol 2015; 68:332-9. [PMID: 26257844 PMCID: PMC4524930 DOI: 10.4097/kjae.2015.68.4.332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 12/02/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 12/02/2022] Open
Abstract
The field of functional neurosurgery has expanded in last decade to include newer indications, new devices, and new methods. This advancement has challenged anesthesia providers to adapt to these new requirements. This review aims to discuss the nuances and practical issues that are faced while administering anesthesia for deep brain stimulation surgery.
Collapse
Affiliation(s)
- Danielle Teresa Scharpf
- Department of Neuroanestheisa, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Mayur Sharma
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Ali Rezai
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| | - Sergio D Bergese
- Department of Neuroanestheisa, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, OH, USA
| |
Collapse
|
30
|
Sharma M, Deogaonkar M, Rezai A. Assessment of potential targets for deep brain stimulation in patients with Alzheimer's disease. J Clin Med Res 2015; 7:501-5. [PMID: 26015813 PMCID: PMC4432890 DOI: 10.14740/jocmr2127w] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 12/18/2022] Open
Abstract
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder affecting 36 million people worldwide and 5.2 million in the United States. The pathogenesis of AD is still elusive. Accumulations of abnormal proteins (beta amyloid and tau protein), inflammatory cascades, abnormal responses to oxidative stress and alteration in oxidative metabolism have been implicated in AD. There are few effective therapeutic options available for this disorder at present. Neuromodulation offers a novel treatment modality for patients with AD. The databases of Medline and PubMed were searched for various studies in English literature describing the deep brain stimulation (DBS) in patients with AD. Various animal and human clinical studies have shown promising initial results with bilateral DBS targeting various anatomical nodes. In this review, we attempt to highlight the pathophysiology, neural circuitry and potential neuromodulation options in patients with AD. In appropriately selected patients, DBS can potentially delay the cognitive decline, enhance memory functions and can improve the overall quality of life. However, further randomized controlled trials are required to validate the efficacy of neuromodulation and to determine the most optimal target for AD.
Collapse
Affiliation(s)
- Mayur Sharma
- Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Milind Deogaonkar
- Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| | - Ali Rezai
- Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
| |
Collapse
|
31
|
Sharma M, Rhiew R, Deogaonkar M, Rezai A, Boulis N. Accuracy and precision of targeting using frameless stereotactic system in deep brain stimulator implantation surgery. Neurol India 2015; 62:503-9. [PMID: 25387619 DOI: 10.4103/0028-3886.144442] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the accuracy of targeting using NexFrame frameless targeting system during deep brain stimulation (DBS) surgery. MATERIALS AND METHODS Fifty DBS leads were implanted in 33 patients using the NexFrame (Medtronic, Minneapolis, MN) targeting system. Postoperative thin cut CT scans were used for lead localization. X, Y, Z coordinates of the tip of the lead were calculated and compared with the intended target coordinates to assess the targeting error. Comparative frame-based data set was obtained from randomly selected 33 patients during the same period that underwent 65 lead placements using Leksell stereotactic frame. Euclidean vector was calculated for directional error. Multivariate analysis of variance was used to compare the accuracy between two systems. RESULTS The mean error of targeting using frameless system in medio-lateral plane was 1.4 mm (SD ± 1.3), in antero-posterior plane was 0.9 mm (SD ± 1.0) and in supero-inferior plane Z was 1.0 mm (SD ± 0.9). The mean error of targeting using frame-based system in medio-lateral plane was 1.0 mm (SD ± 0.7), in antero-posterior plane was 0.9 mm (SD ± 0.5) and in supero-inferior plane Z was 0.7 mm (SD ± 0.6). The error in targeting was significantly more (P = 0.03) in the medio-lateral plane using the frameless system as compared to the frame-based system. Mean targeting error in the Euclidean directional vector using frameless system was 2.2 (SD ± 1.6) and using frame-based system was 1.7 (SD ± 0.6) (P = 0.07). There was significantly more error in the first 25 leads placed using the frameless system than the second 25 leads (P = 0.0015). CONCLUSION The targeting accuracy of the frameless system was lower as compared to frame-based system in the medio-lateral direction. Standard deviations (SDs) were higher using frameless system as compared to the frame-based system indicating lower accuracy of this system. Error in targeting should be considered while using frameless stereotactic system for DBS implantation surgery.
Collapse
Affiliation(s)
| | | | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, USA
| | | | | |
Collapse
|
32
|
Sharma M, Deogaonkar M. Deep brain stimulation in Huntington's disease: assessment of potential targets. J Clin Neurosci 2015; 22:812-7. [PMID: 25698541 DOI: 10.1016/j.jocn.2014.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [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: 09/04/2014] [Accepted: 11/02/2014] [Indexed: 01/17/2023]
Abstract
Huntington's disease (HD) is an autosomal-dominant neurodegenerative disorder that has very few effective therapeutic interventions. Since the disease has a defined neural circuitry abnormality, neuromodulation could be an option. Case reports, original research, and animal model studies were selected from the databases of Medline and PubMed. All related studies published up to July 2014 were included in this review. The following search terms were used: "Deep brain stimulation," "DBS," "thalamotomy," "pallidal stimulation," and "Huntington's Disease," "HD," "chorea," or "hyperkinetic movement disorders." This review examines potential nodes in the HD circuitry that could be modulated using deep brain stimulation (DBS) therapy. With rapid evolution of imaging and ability to reach difficult targets in the brain with refined DBS technology, some phenotypes of HD could potentially be treated with DBS in the near future. Further clinical studies are warranted to validate the efficacy of neuromodulation and to determine the most optimal target for HD.
Collapse
Affiliation(s)
- Mayur Sharma
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA.
| |
Collapse
|
33
|
Zibly Z, Sharma M, Shaw A, Yeremeyeva E, Deogaonkar M, Rezai A. Deep brain stimulation (DBS), lead migration, and the stimloc cap: complication avoidance. Neurol India 2015; 62:703-4. [PMID: 25591702 DOI: 10.4103/0028-3886.149441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | | | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| | | |
Collapse
|
34
|
Shaw AB, Sharma M, Shaikhouni A, Marlin ES, Ikeda DS, McGregor JM, Deogaonkar M. Neuromodulation as a last resort option in the treatment of chronic daily headaches in patients with idiopathic intracranial hypertension. Neurol India 2015; 63:707-11. [PMID: 26448229 DOI: 10.4103/0028-3886.166534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the feasibility and efficacy of occipital nerve stimulation (ONS) in patients with refractory headaches secondary to idiopathic intracranial hypertension (IIH). BACKGROUND IIH is a syndrome characterized by elevated intracranial pressures in the absence of a mass lesion. These patients typically present with chronic and intractable headaches. Cerebrospinal fluid (CSF) diversion fails in relieving the headache in a significant proportion of this population. ONS has been shown to be effective in medically refractory headaches and to our knowledge, has not been attempted as a therapeutic modality in this population. METHODS Four patients with occipital predominant chronic daily headaches and IIH who failed medical management underwent bilateral ONSs. Octopolar percutaneous electrodes were implanted in the defined area of pain. Visual Analog Scale (VAS) was used as an outcome measure. Patient demographics and surgical complications were also reviewed in this retrospective study. Following the trial period, all patients had >50% pain reduction resulting in permanent implantation. RESULTS All 4 patients had an average improvement of their VAS scores by 75%, with 85% spatial coverage and the remainder of the uncovered region being frontal. Sustained benefits were seen up to 3 years of follow-up. One patient had a lead erosion requiring removal followed by delayed re-implantation and another lost treatment efficacy at 2 years resulting in explantation. One patient required CSF diversion due to visual threat during the follow-up period but maintained sustained benefit from her ONS. CONCLUSIONS Bilateral ONS may be a useful treatment option in the management of selected patients with IIH, after standard surgical interventions have been attempted. Bilateral ONS may provide therapeutic option for management of residual headaches in these complicated patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
35
|
Sharma M, Shaikhouni A, Saleh E, Shaw A, Deogaonkar M. Peripheral nerve field stimulation for otalgia: A novel therapy for refractory deep ear pain. Interdisciplinary Neurosurgery 2014. [DOI: 10.1016/j.inat.2014.08.004] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
36
|
Henderson EY, Goble T, D'Haese PF, Pallavaram S, Oluigbo C, Agrawal P, Deogaonkar M, Rezai A. Successful subthalamic nucleus deep brain stimulation therapy after significant lead displacement from a subdural hematoma. J Clin Neurosci 2014; 22:387-90. [PMID: 25304438 DOI: 10.1016/j.jocn.2014.07.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 07/22/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022]
Abstract
A 57-year-old man with a 21 year history of Parkinson's disease underwent bilateral subthalamic nucleus deep brain stimulation (DBS) placement. One week postoperatively he developed an acute left subdural hematoma from a fall with significant displacement of the DBS leads. It was promptly evacuated, the patient slowly recovered neurologically, and the leads again moved near to the original position. Six months of stimulation therapy attained 50% reduction in symptoms. This case report demonstrates the movement of DBS leads due to brain shift and their ability to come back to previous location once the brain shift is corrected.
Collapse
Affiliation(s)
| | | | - Pierre-François D'Haese
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Srivatsan Pallavaram
- Department of Electrical Engineering & Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Chima Oluigbo
- Department of Neurological Surgery, Children's National Medical Center, Washington, DC, USA
| | - Punit Agrawal
- Department of Neurological Surgery, Center for Neuromodulation, Wexner Medical Center at the Ohio State University, Columbus, OH, USA
| | - Milind Deogaonkar
- Department of Neurology, Center for Neuromodulation, Wexner Medical Center at the Ohio State University, Columbus, OH, USA
| | - Ali Rezai
- Department of Neurology, Center for Neuromodulation, Wexner Medical Center at the Ohio State University, Columbus, OH, USA
| |
Collapse
|
37
|
|
38
|
Amit A, Sharma M, Deogaonkar M. Peripheral nerve stimulation by 'sandwich' paddle leads: technical note. Acta Neurochir (Wien) 2014; 156:1987-9. [PMID: 25160853 DOI: 10.1007/s00701-014-2208-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 08/15/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recently, there has been a burgeoning interest in the utility of peripheral nerve stimulation (PNS) for a variety of chronic focal neuropathic, musculoskeletal and visceral pain conditions. If the source of pain is directly related to a single peripheral nerve, surgical exposure and placing a paddle lead on the nerve are most effective. METHODS In this report, we describe a novel technique that optimizes the peripheral nerve stimulation by two paddle leads placed on either side of the nerve with their stimulating surfaces in contact with the nerve. After appropriate prepping and draping, the selected nerve is localized and circumferentially dissected free from the adjacent soft tissue. There should be enough length of nerve to accommodate two On-Point quadripolar leads (Medtronic, MN) along the length of the nerve in the same direction. RESULTS This 'sandwich' technique provides a wider interface of contacts with nerve fibers. It reduces the chance of migration and provides an opportunity for 'crosstalk.' CONCLUSION In selected cases where an open surgical PNS lead needs to be placed, the 'sandwich' technique can be used to augment the stimulation without additional morbidity. Although occasionally used in practice, this technique is still unreported.
Collapse
Affiliation(s)
- Amit Amit
- Department of Neurosurgery, Aberdeen Royal Infirmary, Aberdeen, UK,
| | | | | |
Collapse
|
39
|
Abstract
The field of pain management has experienced tremendous growth in implantable therapies secondary to the innovations of bioengineers, implanters, and industry. Every aspect of neuromodulation is amenable to innovation from implanting devices to anchors, electrodes, programming, and even patient programmers. Patients with previously refractory neuropathic pain syndromes have new and effective pain management strategies that are a direct result of innovations in implantable devices.
Collapse
Affiliation(s)
- Andrew Shaw
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Mayur Sharma
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Milind Deogaonkar
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA
| | - Ali Rezai
- Department of Neurological Surgery, Wexner Medical Center, Center for Neuromodulation, Ohio State University, 410 West 10th Avenue, Columbus, OH 43210, USA.
| |
Collapse
|
40
|
Zibly Z, Shaw A, Harnof S, Sharma M, Graves C, Deogaonkar M, Rezai A. Modulation of mind: therapeutic neuromodulation for cognitive disability. J Clin Neurosci 2014; 21:1473-7. [DOI: 10.1016/j.jocn.2013.11.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 11/07/2013] [Accepted: 11/13/2013] [Indexed: 12/20/2022]
|
41
|
Shaw A, Mohyeldin A, Zibly Z, Ikeda D, Deogaonkar M. Novel Tunneling System for Implantation of Percutaneous Nerve Field Stimulator Electrodes: A Technical Note. Neuromodulation 2014; 18:313-6; discussion 316. [DOI: 10.1111/ner.12224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/21/2014] [Accepted: 05/23/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Andrew Shaw
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Ahmed Mohyeldin
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Zion Zibly
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Daniel Ikeda
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| | - Milind Deogaonkar
- Center for Neuromodulation; Department of Neurological Surgery; Ohio State University Wexner Medical Center; Columbus OH USA
| |
Collapse
|
42
|
Abstract
Current data suggest that transcranial magnetic stimulation (TMS) has the potential to be an effective and complimentary treatment modality for patients with chronic neuropathic pain syndromes. The success of TMS for pain relief depends on the parameters of the stimulation delivered, the location of neural target, and duration of treatment. TMS can be used to excite or inhibit underlying neural tissue that depends on long-term potentiation and long-term depression, respectively. Long-term randomized controlled studies are warranted to establish the efficacy of repetitive TMS in patients with various chronic pain syndromes.
Collapse
Affiliation(s)
- Nicole A Young
- Department of Neuroscience, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA
| | - Mayur Sharma
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA
| | - Milind Deogaonkar
- Department of Neurosurgery, Center of Neuromodulation, Wexner Medical Center, The Ohio State University, 480 Medical Center Drive, Columbus, OH 43210, USA.
| |
Collapse
|
43
|
Deogaonkar M, Oluigbo C, Nielson D, Yang X, Sharma M, Vera-Portocarrero L, Molnar G, Abduljalil A, Sederberg P, Rezai AR. 186 Spinal Cord Stimulation and Functional Magnetic Resonance Imaging. Neurosurgery 2014. [DOI: 10.1227/01.neu.0000452460.11538.d1] [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: 11/19/2022] Open
|
44
|
|
45
|
|
46
|
Abstract
Deep brain stimulation (DBS) is used as a treatment for movement disorders. Unlike ablative procedures, DBS is reversible and adjustable. It is approved in the United States for treatment of Parkinson disease (PD), dystonia, and tremor. This surgical procedure is considered safe and effective for the management of the motor symptoms of these disorders, although it does not cure the underlying conditions. Potential complications of DBS surgery include intracranial hemorrhage, infections, and complications related to the hardware. There may also be complications related to stimulation or programming, although these are usually associated with dosages of dopaminergic medications and are reversible. DBS is usually performed under conscious sedation with awake evaluation during intraoperative physiologic testing. Typically, the procedure is performed with stereotactic image guidance, using computed tomography or magnetic resonance imaging (MRI) for targeting. Surgery can be accomplished with stereotactic frames or frameless systems. Recently, intraoperative MRI guidance has become available and is an alternative to the traditional surgical procedure, allowing for implantation of the DBS device under general anesthesia.
Collapse
Affiliation(s)
- Andre G Machado
- Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH 44195, USA.
| | | | | |
Collapse
|
47
|
Abstract
Deep brain stimulation has largely replaced ablative procedures for the treatment of advanced Parkinson disease, essential tremor, and dystonia. It is also approved for obsessive-compulsive disorder. Although not curative, it improves symptoms and quality of life.
Collapse
Affiliation(s)
- Andre Machado
- Center for Neurological Restoration, Cleveland, OH 44195, USA.
| | | | | |
Collapse
|
48
|
Ghosh P, Machado A, Deogaonkar M, Ghosh D. Deep Brain Stimulation in Children with Dystonia: Experience from a Tertiary Care Center (IN10-2.002). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.in10-2.002] [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: 11/15/2022] Open
|
49
|
Ghosh P, Machado A, Deogaonkar M, Ghosh D. Deep Brain Stimulation in Children with Dystonia: Experience from a Tertiary Care Center (S28.006). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.s28.006] [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: 11/15/2022] Open
|
50
|
Abstract
Object
Many previous studies have shown that placement of deep brain stimulation (DBS) electrodes carries a considerable risk of hemorrhage. To date, no studies have evaluated the incidence of intracranial hemorrhage after removal of DBS electrodes. The authors performed a retrospective chart review to identify the incidence and trends in hemorrhage after DBS electrode removal.
Methods
A retrospective chart review of all DBS electrodes removed at the Cleveland Clinic between October 2000 and May 2010 was performed. All patients underwent postoperative CT scanning. Each patient was evaluated for age, sex, side of placement, target, duration of lead placement, reason for removal, and medical comorbidities.
Results
A total of 78 lead removals were performed in the 10-year period (1300 leads were implanted during the same period). Of the 78 leads removed, 10 (12.8%) resulted in hemorrhages seen on postoperative CT scans. The hemorrhages were superficial cortical in 6 cases of lead removal (60%) and deep in 4 cases (40%). No statistically significant correlation to any of the factors evaluated was found. All hemorrhages were asymptomatic. The authors' retrospective study of 78 DBS lead removals revealed a high risk of intracranial hemorrhage (12.8% per lead). The risk of hemorrhage during removal is significantly greater than the risk of hemorrhage during implantation (2.0% per lead at the authors' center during the same period). There were more superficial hemorrhages, and all hemorrhages were asymptomatic.
Conclusions
Removal of DBS leads carries a significantly higher risk of postoperative hemorrhages that are seen on images but are not clinically symptomatic.
Collapse
Affiliation(s)
- James K. C. Liu
- 1Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and
| | - Hesham Soliman
- 1Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and
| | - Andre Machado
- 1Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and
| | - Milind Deogaonkar
- 1Center for Neurological Restoration, Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland; and
| | - Ali R. Rezai
- 2Department of Neurosurgery, The Ohio State University, Columbus, Ohio
| |
Collapse
|