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DBS microelectrode

A R Sitnikov, Yu A Grigoryan, L P Mishnyakova
Background: The use of the anterior nucleus of thalamus (ANT) as a target for treatment of pharmacoresistant epilepsy is based on its crucial role in seizure propagation. We describe results of chronic bilateral ANT stimulation and bilateral ANT lesions in 31 patients with refractory epilepsy. Methods: ANT DBS was performed in 12 patients (group I) and bilateral stereotactic radiofrequency lesions of ANT were performed in 19 patients (group II). Targeting was based on stereotactic atlas information with correction of the final coordinates according to the location of anatomical landmarks and intraoperative microelectrode recording data...
2018: Surgical Neurology International
Martin Jakobs, Erenik Krasniqi, Manja Kloß, Jan-Oliver Neumann, Benito Campos, Andreas W Unterberg, Karl L Kiening
OBJECTIVES: Implantation of deep brain stimulation (DBS) electrodes requires stereotactic imaging. Stereotactic magnetic resonance imaging (MRI) for DBS surgery has become more popular and intraoperative MRI scanners have become more available. We report on our cohort of movement disorder patients who underwent intraoperative stereotactic MRI-only DBS electrode implantation. METHODS: A review of our DBS database for eligible patients over a study period of 8 years was performed...
August 7, 2018: World Neurosurgery
Christopher S Lozano, Manish Ranjan, Alexandre Boutet, David S Xu, Walter Kucharczyk, Alfonso Fasano, Andres M Lozano
OBJECTIVE The clinical results of deep brain stimulation (DBS) of the subthalamic nucleus (STN) are highly dependent on accurate targeting and target implantation. Several targeting tactics are in current use, including image-only and/or electrophysiologically guided approaches using microelectrode recordings (MERs). The purpose of the present study was to make an appraisal of imaging only-based versus imaging with the addition of intraoperative MER-guided STN electrode targeting. METHODS The authors evaluated 100 consecutive patients undergoing STN DBS...
August 3, 2018: Journal of Neurosurgery
G Du, P Zhuang, M Hallett, Y-Q Zhang, J-Y Li, Y-J Li
Background: The cardinal features of Parkinson's disease (PD) are bradykinesia, rigidity and rest tremor. Abnormal activity in the basal ganglia is predicted to underlie the mechanism of motor symptoms. This study aims to characterize properties of oscillatory activity in the basal ganglia and motor thalamus in patients with PD. Methods: Twenty-nine patients with PD who underwent bilateral or unilateral electrode implantation for subthalamic nucleus (STN) DBS ( n  = 11), unilateral pallidotomy ( n  = 9) and unilateral thalamotomy (n = 9) were studied...
2018: Translational Neurodegeneration
Terence D Sanger, Mark Liker, Enrique Arguelles, Ruta Deshpande, Arash Maskooki, Diana Ferman, Aprille Tongol, Aaron Robison
Deep brain stimulation (DBS) for secondary (acquired, combined) dystonia does not reach the high degree of efficacy achieved in primary (genetic, isolated) dystonia. We hypothesize that this may be due to variability in the underlying injury, so that different children may require placement of electrodes in different regions of basal ganglia and thalamus. We describe a new targeting procedure in which temporary depth electrodes are placed at multiple possible targets in basal ganglia and thalamus, and probing for efficacy is performed using test stimulation and recording while children remain for one week in an inpatient Neuromodulation Monitoring Unit (NMU)...
July 17, 2018: Brain Sciences
Silje Bjerknes, Mathias Toft, Ane E Konglund, Uyen Pham, Trine Rygvold Waage, Lena Pedersen, Mona Skjelland, Ira Haraldsen, Stein Andersson, Espen Dietrichs, Inger Marie Skogseid
Background: Subthalamic nucleus deep brain stimulation improves motor symptoms and fluctuations in advanced Parkinson's disease, but the degree of clinical improvement depends on accurate anatomical electrode placement. Methods used to localize the sensory-motor part of the nucleus vary substantially. Using microelectrode recordings, at least three inserted microelectrodes are needed to obtain a three-dimensional map. Therefore, multiple simultaneously inserted microelectrodes should provide better guidance than single sequential microelectrodes...
May 2018: Movement Disorders Clinical Practice
Barbara Carl, Miriam Bopp, Marko Gjorgjevski, Christopher Nimsky
OBJECTIVE: To investigate how frameless navigational techniques can be implemented to support standard frame-based stereotactic procedures. METHODS: In 25 patients (18 deep brain stimulation procedures, 3 stereotactic biopsies, and 4 stereoencephalography procedures), 57 trajectories were planned. A navigation reference array was attached to the stereotactic frame for automatic registration applying intraoperative computed tomography. RESULTS: User-independent automatic registration resulted in a low navigation registration error (0...
July 7, 2018: World Neurosurgery
Witold H Polanski, K Daniel Martin, Swen Günther, Gabriele Schackert, Lisa Klingelhoefer, Mareike Fauser, Alexander Storch, Stephan B Sobottka
Background: For quality analysis, we applied the Six Sigma concept to define quality indicators and their boundaries as well as to compare treatment-dependent outcome data of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson's disease (PD). Methods: The Unified Parkinson Disease Rating Scale (UPDRS) III with on medication and on stimulation, the reduction of daily levodopa equivalence doses (LED), and the stimulation amplitude 1 year after surgery were registered...
June 18, 2018: International Journal for Quality in Health Care
Gabriella Panuccio, Ilaria Colombi, Michela Chiappalone
Temporal lobe epilepsy (TLE) is the most common partial complex epileptic syndrome and the least responsive to medications. Deep brain stimulation (DBS) is a promising approach when pharmacological treatment fails or neurosurgery is not recommended. Acute brain slices coupled to microelectrode arrays (MEAs) represent a valuable tool to study neuronal network interactions and their modulation by electrical stimulation. As compared to conventional extracellular recording techniques, they provide the added advantages of a greater number of observation points and a known inter-electrode distance, which allow studying the propagation path and speed of electrophysiological signals...
May 15, 2018: Journal of Visualized Experiments: JoVE
Andrew L Ko, Philippe Magown, Alp Ozpinar, Vural Hamzaoglu, Kim J Burchiel
BACKGROUND: Asleep deep brain stimulation (aDBS) implantation replaces microelectrode recording for image-guided implantation, shortening the operative time and reducing cerebrospinal fluid egress. This may decrease pneumocephalus, thus decreasing brain shift during implantation. OBJECTIVE: To compare the incidence and volume of pneumocephalus during awake (wkDBS) and aDBS procedures. METHODS: A retrospective review of bilateral DBS cases performed at Oregon Health & Science University from 2009 to 2017 was undertaken...
2018: Stereotactic and Functional Neurosurgery
Reuben R Shamir, Yuval Duchin, Jinyoung Kim, Remi Patriat, Odeya Marmor, Hagai Bergman, Jerrold L Vitek, Guillermo Sapiro, Atira Bick, Ruth Eliahou, Renana Eitan, Zvi Israel, Noam Harel
BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a proven and effective therapy for the management of the motor symptoms of Parkinson's disease (PD). While accurate positioning of the stimulating electrode is critical for success of this therapy, precise identification of the STN based on imaging can be challenging. We developed a method to accurately visualize the STN on a standard clinical magnetic resonance imaging (MRI). The method incorporates a database of 7-Tesla (T) MRIs of PD patients together with machine-learning methods (hereafter 7 T-ML)...
May 24, 2018: Neurosurgery
John A Thompson, Salam Oukal, Hagai Bergman, Steven Ojemann, Adam O Hebb, Sara Hanrahan, Zvi Israel, Aviva Abosch
OBJECTIVE Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become standard care for the surgical treatment of Parkinson's disease (PD). Reliable interpretation of microelectrode recording (MER) data, used to guide DBS implantation surgery, requires expert electrophysiological evaluation. Recent efforts have endeavored to use electrophysiological signals for automatic detection of relevant brain structures and optimal implant target location. The authors conducted an observational case-control study to evaluate a software package implemented on an electrophysiological recording system to provide online objective estimates for entry into and exit from the STN...
May 18, 2018: Journal of Neurosurgery
Frédéric L W V J Schaper, Yan Zhao, Marcus L F Janssen, G Louis Wagner, Albert J Colon, Danny M W Hilkman, Erik Gommer, Mariëlle C G Vlooswijk, Govert Hoogland, Linda Ackermans, Lo J Bour, Richard J A Van Wezel, Paul Boon, Yasin Temel, Tjitske Heida, Vivianne H J M Van Kranen-Mastenbroek, Rob P W Rouhl
Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a promising treatment for patients with refractory epilepsy. However, therapy response varies and precise positioning of the DBS lead is potentially essential for maximizing therapeutic efficacy. We investigate if single-cell recordings acquired by microelectrode recordings can aid targeting of the ANT during surgery and hypothesize that the neuronal firing properties of the target region relate to clinical outcome. We prospectively included 10 refractory epilepsy patients and performed microelectrode recordings under general anesthesia to identify the change in neuronal signals when approaching and transecting the ANT...
April 2, 2018: International Journal of Neural Systems
Philip S Lee, Gregory M Weiner, Danielle Corson, Jessica Kappel, Yue-Fang Chang, Valerie R Suski, Sarah B Berman, Houman Homayoun, Amber D Van Laar, Donald J Crammond, R Mark Richardson
In deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD), there is debate concerning the use of neuroimaging alone to confirm correct anatomic placement of the DBS lead into the STN, versus the use of microelectrode recording (MER) to confirm functional placement. We performed a retrospective study of a contemporaneous cohort of 45 consecutive patients who underwent either interventional-MRI (iMRI) or MER-guided DBS lead implantation. We compared radial lead error, motor and sensory side effect, and clinical benefit programming thresholds, and pre- and post-operative unified PD rating scale scores, and levodopa equivalent dosages...
2018: Frontiers in Neurology
Andrea Bartoli, Rémi Tyrand, Maria I Vargas, Shahan Momjian, Colette Boëx
Deep brain stimulation (DBS) could become a palliative treatment for patients with drug-resistant epilepsy for which surgery cannot be proposed. The objective of this study was to perform microstimulation to measure the effects of DBS in epilepsy locally at the level of a few neurons, with microelectrode recordings, for the first time in patients with epilepsy. Microelectrode recordings were performed before, during and after microstimulation in nine patients with refractory epilepsy. Neuronal spikes were successfully extracted from multi-unit recordings with clustering in six out of seven patients during hippocampal and in one out of two patients during cortical dysplasia microstimulation (1 Hz, charge-balanced biphasic waveform, 60 μs/ph, 25 μA)...
2018: Frontiers in Neural Circuits
Erin L Schaeffer, Daniel Y Liu, Julie Guerin, Minkyu Ahn, Shane Lee, Wael F Asaad
BACKGROUND: During the deep brain stimulation (DBS) electrode implantation operation with microelectrode recordings (MER) in awake patients, somatotopic testing and test stimulation are performed to improve electrode placement and provide the most beneficial symptom reduction possible, while minimizing side effects. As this procedure is commonly used to alleviate abnormal movements associated with Parkinson's disease (PD) and Essential Tremor (ET), intraoperative assessment of a patient's movements is critical to optimizing surgical benefit...
June 1, 2018: Journal of Neuroscience Methods
Tsinsue Chen, Zaman Mirzadeh, Kristina M Chapple, Margaret Lambert, Holly A Shill, Guillermo Moguel-Cobos, Alexander I Tröster, Rohit Dhall, Francisco A Ponce
OBJECTIVE Recent studies have shown similar clinical outcomes between Parkinson disease (PD) patients treated with deep brain stimulation (DBS) under general anesthesia without microelectrode recording (MER), so-called "asleep" DBS, and historical cohorts undergoing "awake" DBS with MER guidance. However, few studies include internal controls. This study aims to compare clinical outcomes after globus pallidus internus (GPi) and subthalamic nucleus (STN) DBS using awake and asleep techniques at a single institution...
March 16, 2018: Journal of Neurosurgery
Rodger J Elble, Ludy Shih, Jeffrey W Cozzens
Essential tremor is the most common form of pathologic tremor. Surgical therapies disrupt tremorogenic oscillation in the cerebellothalamocortical pathway and are capable of abolishing severe tremor that is refractory to available pharmacotherapies. Surgical methods are raspidly improving and are the subject of this review. Areas covered: A PubMed search on 18 January 2018 using the query essential tremor AND surgery produced 839 abstracts. 379 papers were selected for review of the methods, efficacy, safety and expense of stereotactic deep brain stimulation (DBS), stereotactic radiosurgery (SRS), focused ultrasound (FUS) ablation, and radiofrequency ablation of the cerebellothalamocortical pathway...
April 2018: Expert Review of Neurotherapeutics
Fabiola Alonso, Dorian Vogel, Johannes Johansson, Karin Wårdell, Simone Hemm
The success of deep brain stimulation (DBS) relies primarily on the localization of the implanted electrode. Its final position can be chosen based on the results of intraoperative microelectrode recording (MER) and stimulation tests. The optimal position often differs from the final one selected for chronic stimulation with the DBS electrode. The aim of the study was to investigate, using finite element method (FEM) modeling and simulations, whether lead design, electrical setup, and operating modes induce differences in electric field (EF) distribution and in consequence, the clinical outcome...
February 6, 2018: Brain Sciences
Peter M Lauro, Shane Lee, Minkyu Ahn, Andrei Barborica, Wael F Asaad
BACKGROUND/OBJECTIVES: To create an open-source method for reconstructing microelectrode recording (MER) and deep brain stimulation (DBS) electrode coordinates along multiple parallel trajectories with patient-specific DBS implantation platforms to facilitate DBS research. METHODS: We combined the surgical geometry (extracted from WayPoint Planner), pre-/intra-/postoperative computed tomography (CT) and/or magnetic resonance (MR) images, and integrated them into the Analysis of Functional NeuroImages (AFNI) neuroimaging analysis environment using functions written in Python...
2018: Stereotactic and Functional Neurosurgery
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