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Deep Brain Stimulation

Fraser Henderson, Istvan Takacs
BACKGROUND: Troubleshooting of deep brain stimulators (Activa SC/PC/RC Medtronic PLC) sometimes results in a decision to replace a tunneled stretch-coil extension cable. We present a simple technique to accomplish this atraumatically without a tunneling tool. OBJECTIVES: In the treatment of patients with deep brain stimulators, complication avoidance and efficiency of operative time are paramount. We sought to find the most safe, effective, and rapid method for performing the conceptually-simple yet technically-nuanced act of replacing lead extension cables...
October 18, 2016: World Neurosurgery
David Feifel, Katherine Pappas
Repetitive transcranial magnetic stimulation (rTMS) is an emerging non-pharmacological approach to treating many brain-based disorders. rTMS uses electromagnetic coils to stimulate areas of the brain non-invasively. Deep transcranial magnetic stimulation (dTMS) with the Brainsway H1-coil system specifically is a type of rTMS indicated for treating patients with major depressive disorder (MDD) who are resistant to medication. The unique H1-coil design of this device is able to stimulate neuronal pathways that lie deeper in the targeted brain areas than those reached by conventional rTMS coils...
October 4, 2016: Journal of Visualized Experiments: JoVE
C Schlenstedt, A Shalash, M Muthuraman, D Falk, K Witt, G Deuschl
The aim of this meta-analysis was to summarize the short- and long-term effects of bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) on gait and freezing of gait (FOG) in Parkinson's disease and to detect predictors of post-stimulation outcome. A comprehensive review of the literature was conducted up to October 2015 using Medline Ovid databases for studies analyzing the effect of bilateral STN-DBS on FOG and/or gait. Sixteen studies with available data for the gait item (no. 29) of the Unified Parkinson's Disease Rating Scale (UPDRS) and six studies with the FOG item (no...
October 20, 2016: European Journal of Neurology: the Official Journal of the European Federation of Neurological Societies
Aristide Merola, Alberto Romagnolo, Laura Rizzi, Mario Giorgio Rizzone, Maurizio Zibetti, Michele Lanotte, George Mandybur, Andrew P Duker, Alberto J Espay, Leonardo Lopiano
To determine the clinical and demographic correlates of persistent, remitting, and new-onset impulse control behaviors (ICBs) before and after subthalamic deep brain stimulation (STN-DBS) in Parkinson's disease (PD). We compared the pre- and post-surgical prevalence of ICBs, classified as impulse control disorders (ICD), dopamine dysregulation syndrome (DDS), and punding in 150 consecutive PD STN-DBS-treated patients and determined the association with motor, cognitive, neuropsychological, and neuropsychiatric endpoints...
October 19, 2016: Journal of Neurology
Xin Wang, Jing Wang, Haikang Zhao, Nan Li, Shunnan Ge, Lei Chen, Jiaming Li, Jiangpeng Jing, Mingming Su, Zhaohui Zheng, Jinan Zhang, Guodong Gao, Xuelian Wang
BACKGROUND: Symptomatic intracranial hemorrhage (ICH) may lead to permanent neurological disability of patients and has impeded the extensive clinical application of deep brain stimulation (DBS). The present study was conducted to discuss the incidence, prevention, and treatment of symptomatic ICH after DBS surgery. METHODS: From January 2009 to December 2014, 396 patients underwent DBS with a total of 691 implanted leads. In all, 10 patients had symptomatic ICH...
October 20, 2016: British Journal of Neurosurgery
David S Xu, Francisco Ponce
High-frequency deep brain stimulation (DBS) is a neurosurgical procedure that was introduced in the late 1980s for the treatment of movement disorders. It is a reversible, adjustable, and non-ablative therapy that has been used in over 100,000 people worldwide. The surgical procedure used to implant the DBS system, as well as the effects of chronic electrical stimulation, have been shown to be safe and effective through many clinical trials. The ability to therapeutically modulate the motor circuits of the brain in this manner has resulted in consideration of use of this surgical strategy for other neurodegenerative and neuropsychiatric disorders involving non-motor circuits, including appetite, mood, and cognition...
October 14, 2016: Current Alzheimer Research
Michitaka Funayama, Motoichiro Kato, Masaru Mimura
BACKGROUND: Although post-stroke depression is a well-characterized disorder, there is less understanding of how pre-existence of depression is affected by a stroke. CASE PRESENTATION: We describe a patient with treatment-resistant major depression, which had been ongoing for 14 years but disappeared shortly after onset of a subarachnoid hemorrhage. Her cognitive function and functional status were mostly unaffected by the stroke. However, she no longer excessively regretted past events...
October 19, 2016: BMC Neurology
Michael J Murray, Heidi DeBlock, Brian Erstad, Anthony Gray, Judi Jacobi, Che Jordan, William McGee, Claire McManus, Maureen Meade, Sean Nix, Andrew Patterson, M Karen Sands, Richard Pino, Ann Tescher, Richard Arbour, Bram Rochwerg, Catherine Friederich Murray, Sangeeta Mehta
OBJECTIVE: To update the 2002 version of "Clinical practice guidelines for sustained neuromuscular blockade in the adult critically ill patient." DESIGN: A Task Force comprising 17 members of the Society of Critical Medicine with particular expertise in the use of neuromuscular-blocking agents; a Grading of Recommendations Assessment, Development, and Evaluation expert; and a medical writer met via teleconference and three face-to-face meetings and communicated via e-mail to examine the evidence and develop these practice guidelines...
November 2016: Critical Care Medicine
Yuan Liu, Benoit M Dawant
Deep brain stimulation, as a primary surgical treatment for various neurological disorders, involves implanting electrodes to stimulate target nuclei within millimeter accuracy. Accurate pre-operative target selection is challenging due to the poor contrast in its surrounding region in MR images. In this paper, we present a learning-based method to automatically and rapidly localize the target using multi-modal images. A learning-based technique is applied first to spatially normalize the images in a common coordinate space...
February 2016: ... IEEE-EMBS International Conference on Biomedical and Health Informatics. IEEE-EMBS International Conference on Biomedical and Health Informatics
A Kibleur, G Gras-Combe, D Benis, J Bastin, T Bougerol, S Chabardès, M Polosan, O David
High-frequency deep brain stimulation of the subthalamic nucleus can be used to treat severe obsessive-compulsive disorders that are refractory to conventional treatments. The mechanisms of action of this approach possibly rely on the modulation of associative-limbic subcortical-cortical loops, but remain to be fully elucidated. Here in 12 patients, we report the effects of high-frequency stimulation of the subthalamic nucleus on behavior, and on electroencephalographic responses and inferred effective connectivity during motor inhibition processes involved in the stop signal task...
October 18, 2016: Translational Psychiatry
Alexander I Tröster, Joseph Jankovic, Michele Tagliati, DeLea Peichel, Michael S Okun
OBJECTIVE: The aim of this study was to evaluate the neurobehavioral safety of constant-current subthalamic deep brain stimulation and to compare the neuropsychological effects of stimulation versus electrode placement alone. METHODS: A total of 136 patients with Parkinson's disease underwent bilateral subthalamic device implantation in this randomized trial. Patients received stimulation either immediately after device implantation (n = 101; active stimulation) or beginning 3 months after surgery (n = 35; delayed activation control)...
October 18, 2016: Movement Disorders: Official Journal of the Movement Disorder Society
Julien Bonenfant, Sophie Drapier, Jean François Houvenaghel, Florian Naudet, Claire Haegelen, Paul Sauleau, Marc Vérin
INTRODUCTION: Over a 3-year period, we monitored the efficacy and safety of deep-brain stimulation of the globus pallidus pars interna in patients with advanced Parkinson's disease whose cognitive, psychiatric impairment and/or dopa-resistant axial motor signs made them ineligible for surgery targeting the subthalamic nucleus. METHODS: A total of 25 patients were assessed before surgery, 1 year and 3 years after surgery, on the UPDRS and a neuropsychological battery...
October 11, 2016: Parkinsonism & related Disorders
Andreas Hartmann
In patients with severe, treatment-refractory Gilles de la Tourette syndrome (GTS), deep brain stimulation (DBS) of various targets has been increasingly explored over the past 15 years. The multiplicity of surgical targets is intriguing and may be partly due to the complexity of GTS, specifically the various and frequent associated psychiatric comorbidities in this disorder. Thus, the target choice may not only be aimed at reducing tics but also comorbidities. While this approach is laudable, it also carries the risk to increase confounding factors in DBS trials and patient evaluation...
2016: F1000Research
Felix Neumaier, Mario Paterno, Serdar Alpdogan, Etienne E Tevoufouet, Toni Schneider, Jürgen Hescheler, Walid Albanna
Brain surgery to promote behavioural or affective changes in men remains one of the most controversial topics at the interface of medicine, psychiatry, neuroscience and bioethics. Rapid expansion of neuropsychiatric deep brain stimulation has recently revived the field and warrants a careful appraisal of its two sides, namely the promise to help severely devastated patients on the one hand and the dangers of premature application without appropriate justification on the other. Here, we reconstruct the vivid history of the field and examine its present status to delineate the progression from crude free-hand operations into a multi-disciplinary treatment of last resort...
October 13, 2016: World Neurosurgery
Damien Benis, Olivier David, Brigitte Piallat, Astrid Kibleur, Laurent Goetz, Manik Bhattacharjee, Valérie Fraix, Eric Seigneuret, Paul Krack, Stéphan Chabardès, Julien Bastin
The subthalamic nucleus (STN) plays a critical role during action inhibition, perhaps by acting like a fast brake on the motor system when inappropriate responses have to be rapidly suppressed. However, the mechanisms involving the STN during motor inhibition are still unclear, particularly because of a relative lack of single-cell responses reported in this structure in humans. In this study, we used extracellular microelectrode recordings during deep brain stimulation surgery in patients with Parkinson's disease (PD) to study STN neurophysiological correlates of inhibitory control during a stop signal task...
September 21, 2016: Cortex; a Journal Devoted to the Study of the Nervous System and Behavior
Sapana R Patel, Hanga Galfavy, Marcia B Kimeldorf, Lisa B Dixon, Helen Blair Simpson
OBJECTIVE: This study examined preferences for and acceptability of treatments for obsessive-compulsive disorder (OCD). METHODS: Through an online survey, adults who self-reported OCD chose their preferred evidence-based treatments, rated acceptability of novel treatments, and answered open-ended questions about their preferences. Analyses examined associations between demographic, clinical, and treatment variables and first-line and augmentation treatment preferences...
October 17, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
Yi Wang, HongBin Liu, Peng Li, Wei Wang
A 40-year-old male who had a severe tremor, bradykinesia, and rigidity for 6 years underwent bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) at our hospital. The patient did not have any prior ischemia events or any risk factors in his medical history. Six and 9 months post-operation, this patient was admitted to the hospital twice for lower left limb involuntary twitching. Two magnetic resonance imaging (MRI) scans showed cerebral ischemia surrounding the implanted electrode. To our knowledge, this is the first case of recurrent cerebral ischemia associated with DBS...
October 15, 2016: Acta Neurochirurgica
Astrid Kibleur, Mircea Polosan, Pauline Favre, David Rudrauf, Thierry Bougerol, Stéphan Chabardès, Olivier David
Deep brain stimulation (DBS) of the subgenual cingulate gyrus (area CG25) is beneficial in treatment resistant depression. Though the mechanisms of action of Cg25 DBS remain largely unknown, it is commonly believed that Cg25 DBS modulates limbic activity of large networks to achieve thymic regulation of patients. To investigate how emotional attention is influenced by Cg25 DBS, we assessed behavioral and electroencephalographic (EEG) responses to an emotional Stroop task in 5 patients during ON and OFF stimulation conditions...
October 12, 2016: NeuroImage
Isabelle Beaulieu-Boire, Camila C Aquino, Alfonso Fasano, Yu-Yan Poon, Melanie Fallis, Antony E Lang, Mojgan Hodaie, Suneil K Kalia, Andres Lozano, Elena Moro
BACKGROUND: Rare causes of inherited movement disorders often present with a debilitating phenotype of dystonia, sometimes combined with parkinsonism and other neurological signs. Since these disorders are often resistant to medications, DBS may be considered as a possible treatment. METHODS: Patients with identified genetic diseases (ataxia-telangiectasia, chorea-achantocytosis, dopa-responsive dystonia, congenital nemaline myopathy, methylmalonic aciduria, neuronal ceroid lipofuscinosis, spinocerebellar ataxia types 2 and 3, Wilson's disease, Woodhouse-Sakati syndrome, methylmalonic aciduria, and X trisomy) and disabling dystonia underwent bilateral GPi DBS (bilateral thalamic Vim nucleus in 1 case)...
October 4, 2016: Brain Stimulation
Adam M Nagy, Christopher M Tolleson
Deep brain stimulation (DBS) is a unique, functional neurosurgical therapy indicated for medication refractory movement disorders as well as some psychiatric diseases. Multicontact electrodes are placed in "deep" structures within the brain with targets varying depending on the surgical indication. An implanted programmable pulse generator supplies the electrodes with a chronic, high frequency electrical current that clinically mimics the effects of ablative lesioning techniques. DBS's efficacy has been well established for its movement disorder indications (Parkinson's disease, essential tremor, and dystonia)...
October 8, 2016: Brain Sciences
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