Academic literature on the topic 'Subthalamic Deep Brain Stimulation (STN-DBS)'
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Journal articles on the topic "Subthalamic Deep Brain Stimulation (STN-DBS)"
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Walker, Harrison C., Ray L. Watts, Christian J. Schrandt, He Huang, Stephanie L. Guthrie, Barton L. Guthrie, and Erwin B. Montgomery. "Activation of subthalamic neurons by contralateral subthalamic deep brain stimulation in Parkinson disease." Journal of Neurophysiology 105, no. 3 (March 2011): 1112–21. http://dx.doi.org/10.1152/jn.00266.2010.
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Multiple studies have shown bilateral improvement in motor symptoms in Parkinson disease (PD) following unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) and internal segment of the globus pallidus, yet the mechanism(s) underlying this phenomenon are poorly understood. We hypothesized that STN neuronal activity is altered by contralateral STN DBS. This hypothesis was tested intraoperatively in humans with advanced PD using microelectrode recordings of the STN during contralateral STN DBS. We demonstrate alterations in the discharge pattern of STN neurons in response to contralateral STN DBS including short latency, temporally precise, stimulation frequency-independent responses consistent with antidromic activation. Furthermore, the total discharge frequency during contralateral high frequency stimulation (160 Hz) was greater than during low frequency stimulation (30 Hz) and the resting state. These findings demonstrate complex responses to DBS and imply that output activation throughout the basal ganglia-thalamic-cortical network rather than local inhibition is a therapeutic mechanism of DBS.
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Honey, Christopher R., Clement Hamani, Suneil K. Kalia, Tejas Sankar, Marina Picillo, Renato P. Munhoz, Alfonso Fasano, and Michel Panisset. "Deep Brain Stimulation Target Selection for Parkinson’s Disease." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 44, no. 1 (March 15, 2016): 3–8. http://dx.doi.org/10.1017/cjn.2016.22.
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AbstractDuring the “DBS Canada Day” symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to discuss three main questions on target selection for deep brain stimulation (DBS) of patients with Parkinson’s disease (PD). First, is the subthalamic nucleus (STN) or the globus pallidus internus (GPi) the ideal target? In summary, both targets are equally effective in improving the motor symptoms of PD. STN allows a greater medications reduction, while GPi exerts a direct antidyskinetic effect. Second, are there further potential targets? Ventral intermediate nucleus DBS has significant long-term benefit for tremor control but insufficiently addresses other motor features of PD. DBS in the posterior subthalamic area also reduces tremor. The pedunculopontine nucleus remains an investigational target. Third, should DBS for PD be performed unilaterally, bilaterally or staged? Unilateral STN DBS can be proposed to asymmetric patients. There is no evidence that a staged bilateral approach reduces the incidence of DBS-related adverse events.
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Tambirajoo, Kantharuby, Luciano Furlanetti, Michael Samuel, and Keyoumars Ashkan. "Subthalamic Nucleus Deep Brain Stimulation in Post-Infarct Dystonia." Stereotactic and Functional Neurosurgery 98, no. 6 (2020): 386–98. http://dx.doi.org/10.1159/000509317.
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Dystonia secondary to cerebral infarcts presents months to years after the initial insult, is usually unilateral and causes significant morbidity. Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is established as the most frequent target in the management of the dystonic symptoms. We report our experience with subthalamic nucleus (STN) DBS in 3 patients with post-infarct dystonia, in whom GPi DBS was not confidently possible due to the presence of striatal infarcts. Two patients had unilateral STN DBS implantation, whereas the third patient had bilateral STN DBS implantation for bilateral dystonic symptoms. Prospectively collected preoperative and postoperative functional assessment data including imaging, medication and neuropsychology evaluations were analyzed with regard to symptom improvement. Median follow-up period was 38.3 months (range 26–43 months). All patients had clinically valuable improvements in dystonic symptoms and pain control despite variable improvements in the Burke-Fahn-Marsden dystonia rating scores. In our series, we have demonstrated that STN DBS could be an alternative in the management of post-infarct dystonia in patients with abnormal striatal anatomy which precludes GPi DBS. A multidisciplinary team-based approach is essential for patient selection and management.
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Nakano, Naoki, Mamoru Taneda, Akira Watanabe, and Amami Kato. "Computed Three-Dimensional Atlas of Subthalamic Nucleus and Its Adjacent Structures for Deep Brain Stimulation in Parkinson's Disease." ISRN Neurology 2012 (January 12, 2012): 1–13. http://dx.doi.org/10.5402/2012/592678.
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Background. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is one of the standard surgical treatments for advanced Parkinson's disease. However, it has been difficult to accurately localize the stimulated contact area of the electrode in the subthalamic nucleus and its adjacent structures using a two-dimensional atlas. The goal of this study is to verify the real and detailed localization of stimulated contact of the DBS electrode therapeutically inserted into the STN and its adjacent structures using a novel computed three-dimensional atlas built by a personal computer. Method. A three-dimensional atlas of the STN and its adjacent structures (3D-Subthalamus atlas) was elaborated on the basis of sagittal slices from the Schaltenbrand and Wahren stereotactic atlas on a personal computer utilizing a commercial software. The electrode inserted into the STN and its adjacent structures was superimposed on our 3D-Subthalamus atlas based on intraoperative third ventriculography in 11 cases. Findings. Accurate localization of the DBS electrode was identified using the 3D-Subthalamus atlas, and its clinical efficacy of the electrode stimulation was investigated in all 11 cases. Conclusion. This study demonstrates that the 3D-Subthalamus atlas is a useful tool for understanding the morphology of deep brain structures and for the precise anatomical position findings of the stimulated contact of a DBS electrode. The clinical analysis using the 3D atlas supports the contention that the stimulation of structures adjacent to the STN, particularly the zona incerta or the field of Forel H, is as effective as the stimulation of the STN itself for the treatment of advanced Parkinson's disease.
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Amirnovin, Ramin, Ziv M. Williams, G. Rees Cosgrove, and Emad N. Eskandar. "Experience with Microelectrode Guided Subthalamic Nucleus Deep Brain Stimulation." Operative Neurosurgery 58, suppl_1 (February 1, 2006): ONS—96—ONS—102. http://dx.doi.org/10.1227/01.neu.0000192690.45680.c2.
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Abstract OBJECTIVE: Subthalamic deep brain stimulation (DBS) has rapidly become the standard surgical therapy for medically refractory Parkinson disease. However, in spite of its wide acceptance, there is considerable variability in the technical approach. This study details our technique and experience in performing microelectrode recording (MER) guided subthalamic nucleus (STN) DBS in the treatment of Parkinson disease. METHODS: Forty patients underwent surgery for the implantation of 70 STN DBS electrodes. Stereotactic localization was performed using a combination of magnetic resonance and computed tomographic imaging. We used an array of three microelectrodes, separated by 2 mm, for physiological localization of the STN. The final location was selected based on MER and macrostimulation through the DBS electrode. RESULTS: The trajectory selected for the DBS electrode had an average pass through the STN of 5.6 ± 0.4 mm on the left and 5.7 ± 0.4 mm on the right. The predicted location was used in 42% of the cases but was modified by MER in the remaining 58%. Patients were typically discharged on the second postoperative day. Eighty-five percent of patients were sent home, 13% required short-term rehabilitation, and one patient required long-term nursing services. Seven complications occurred over 4 years. Four patients suffered small hemorrhages, one patient experienced a lead migration, one developed an infection of the pulse generator, and one patient suffered from a superficial cranial infection. CONCLUSION: Simultaneous bilateral MER-guided subthalamic DBS is a relatively safe and well-tolerated procedure. MER plays an important role in optimal localization of the DBS electrodes.
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Zeiler, F. A., M. Wilkinson, and J. P. Krcek. "Subthalamic Nucleus Deep Brain Stimulation: An Invaluable Role for MER." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 40, no. 4 (July 2013): 572–75. http://dx.doi.org/10.1017/s0317167100014682.
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Abstract:Introduction:Subthalamic nucleus (STN) deep brain stimulation (DBS) is currently the main surgical procedure for medically refractory Parkinson's disease. The benefit of intra-operative microelectrode recording (MER) for the purpose of neurophysiological localization and mapping of the STN continues to be debated.Methods:A retrospective review of the charts and operative reports of all patients receiving STN DBS implantation for Parkinson's disease at our institution from January 2004 to March 2011 was done.Results:Data from 43 of 44 patients with Parkinson's disease treated with STN DBS were reviewed. The average number of tracts on the left was 2.4, versus 2.3 on the right. The average dorsal and ventral anatomical boundaries of the STN based on Schaltenbrand's Stereotactic Atlas were estimated to be at -5.0 mm above and +1.4 mm below target respectively. The average dorsal and ventral boundaries of the STN using MER were -2.6 mm above and +2.0 mm below target respectively. The average dorsal-ventral distance of the STN as predicted by Stereotactic Atlas was 6.4 mm, compared to 4.6 mm as determined by MER. MER demonstrated the average dorsal and ventral boundaries on the left side were -2.6 mm and +2.2 mm from target respectively, while the average dorsal and ventral boundaries on the right side were -2.5 mm and +1.8 mm from target respectively with MER.Conclusions:MER in STN DBS surgery demonstrated measurable difference between stereotactic atlas/MRI STN target and neurophysiologic STN localization.
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Ostrem, Jill L., Marta San Luciano, Kristen A. Dodenhoff, Nathan Ziman, Leslie C. Markun, Caroline A. Racine, Coralie de Hemptinne, Monica M. Volz, Susan L. Heath, and Philip A. Starr. "Subthalamic nucleus deep brain stimulation in isolated dystonia." Neurology 88, no. 1 (November 30, 2016): 25–35. http://dx.doi.org/10.1212/wnl.0000000000003451.
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Objective:To report long-term safety and efficacy outcomes of a large cohort of patients with medically refractory isolated dystonia treated with subthalamic nucleus (STN) deep brain stimulation (DBS).Methods:Twenty patients (12 male, 8 female; mean age 49 ± 16.3 years) with medically refractory isolated dystonia were studied (14 were followed for 36 months). The primary endpoints were change in Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) motor score and Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) total score at 36 months compared to preoperative baseline. Multiple secondary outcomes were also assessed (ClinicalTrials.govNCT00773604).Results:Eighteen of 20 patients showed improvement 12 months after STN DBS with sustained benefit persisting for 3 years (n = 14). At 36 months, BFMDRS motor scores improved 70.4% from a mean 17.9 ± 8.5 to 5.3 ± 5.6 (p = 0.0002) and total TWSTRS scores improved 66.6% from a mean 41.0 ± 18.9 to 13.7 ± 17.9 (p = 0.0002). Improvement at 36 months was equivalent to that seen at 6 months. Disability and quality of life measures were also improved. Three hardware-related and 24 stimulation-related nonserious adverse events occurred between years 1 and 3 (including 4 patients with dyskinesia).Conclusions:This study offers support for long-term tolerability and sustained effectiveness of STN DBS in the treatment of severe forms of isolated dystonia.Classification of evidence:This study provides Class IV evidence that STN DBS decreases long-term dystonia severity in patients with medically refractory isolated dystonia.
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Mosley, Philip E., Saee Paliwal, Katherine Robinson, Terry Coyne, Peter Silburn, Marc Tittgemeyer, Klaas E. Stephan, Alistair Perry, and Michael Breakspear. "The structural connectivity of subthalamic deep brain stimulation correlates with impulsivity in Parkinson’s disease." Brain 143, no. 7 (June 22, 2020): 2235–54. http://dx.doi.org/10.1093/brain/awaa148.
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Abstract Subthalamic deep brain stimulation (STN-DBS) for Parkinson’s disease treats motor symptoms and improves quality of life, but can be complicated by adverse neuropsychiatric side-effects, including impulsivity. Several clinically important questions remain unclear: can ‘at-risk’ patients be identified prior to DBS; do neuropsychiatric symptoms relate to the distribution of the stimulation field; and which brain networks are responsible for the evolution of these symptoms? Using a comprehensive neuropsychiatric battery and a virtual casino to assess impulsive behaviour in a naturalistic fashion, 55 patients with Parkinson’s disease (19 females, mean age 62, mean Hoehn and Yahr stage 2.6) were assessed prior to STN-DBS and 3 months postoperatively. Reward evaluation and response inhibition networks were reconstructed with probabilistic tractography using the participant-specific subthalamic volume of activated tissue as a seed. We found that greater connectivity of the stimulation site with these frontostriatal networks was related to greater postoperative impulsiveness and disinhibition as assessed by the neuropsychiatric instruments. Larger bet sizes in the virtual casino postoperatively were associated with greater connectivity of the stimulation site with right and left orbitofrontal cortex, right ventromedial prefrontal cortex and left ventral striatum. For all assessments, the baseline connectivity of reward evaluation and response inhibition networks prior to STN-DBS was not associated with postoperative impulsivity; rather, these relationships were only observed when the stimulation field was incorporated. This suggests that the site and distribution of stimulation is a more important determinant of postoperative neuropsychiatric outcomes than preoperative brain structure and that stimulation acts to mediate impulsivity through differential recruitment of frontostriatal networks. Notably, a distinction could be made amongst participants with clinically-significant, harmful changes in mood and behaviour attributable to DBS, based upon an analysis of connectivity and its relationship with gambling behaviour. Additional analyses suggested that this distinction may be mediated by the differential involvement of fibres connecting ventromedial subthalamic nucleus and orbitofrontal cortex. These findings identify a mechanistic substrate of neuropsychiatric impairment after STN-DBS and suggest that tractography could be used to predict the incidence of adverse neuropsychiatric effects. Clinically, these results highlight the importance of accurate electrode placement and careful stimulation titration in the prevention of neuropsychiatric side-effects after STN-DBS.
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Pham, Uyen, Anne-Kristin Solbakk, Inger-Marie Skogseid, Mathias Toft, Are Hugo Pripp, Ane Eidahl Konglund, Stein Andersson, et al. "Personality Changes after Deep Brain Stimulation in Parkinson’s Disease." Parkinson's Disease 2015 (2015): 1–7. http://dx.doi.org/10.1155/2015/490507.
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Objectives. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a recognized therapy that improves motor symptoms in advanced Parkinson’s disease (PD). However, little is known about its impact on personality. To address this topic, we have assessed personality traits before and after STN-DBS in PD patients.Methods. Forty patients with advanced PD were assessed with the Temperament and Character Inventory (TCI): the Urgency, Premeditation, Perseverance, Sensation Seeking impulsive behaviour scale (UPPS), and the Neuroticism and Lie subscales of the Eysenck Personality Questionnaire (EPQ-N, EPQ-L) before surgery and after three months of STN-DBS. Collateral information obtained from the UPPS was also reported.Results. Despite improvement in motor function and reduction in dopaminergic dosage patients reported lower score on the TCI Persistence and Self-Transcendence scales, after three months of STN-DBS, compared to baseline (P=0.006;P=0.024). Relatives reported significantly increased scores on the UPPS Lack of Premeditation scale at follow-up (P=0.027).Conclusion. STN-DBS in PD patients is associated with personality changes in the direction of increased impulsivity.
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Miocinovic, Svjetlana, Martin Parent, Christopher R. Butson, Philip J. Hahn, Gary S. Russo, Jerrold L. Vitek, and Cameron C. McIntyre. "Computational Analysis of Subthalamic Nucleus and Lenticular Fasciculus Activation During Therapeutic Deep Brain Stimulation." Journal of Neurophysiology 96, no. 3 (September 2006): 1569–80. http://dx.doi.org/10.1152/jn.00305.2006.
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The subthalamic nucleus (STN) is the most common target for the treatment of Parkinson’s disease (PD) with deep brain stimulation (DBS). DBS of the globus pallidus internus (GPi) is also effective in the treatment of PD. The output fibers of the GPi that form the lenticular fasciculus pass in close proximity to STN DBS electrodes. In turn, both STN projection neurons and GPi fibers of passage represent possible therapeutic targets of DBS in the STN region. We built a comprehensive computational model of STN DBS in parkinsonian macaques to study the effects of stimulation in a controlled environment. The model consisted of three fundamental components: 1) a three-dimensional (3D) anatomical model of the macaque basal ganglia, 2) a finite element model of the DBS electrode and electric field transmitted to the tissue medium, and 3) multicompartment biophysical models of STN projection neurons, GPi fibers of passage, and internal capsule fibers of passage. Populations of neurons were positioned within the 3D anatomical model. Neurons were stimulated with electrode positions and stimulation parameters defined as clinically effective in two parkinsonian monkeys. The model predicted axonal activation of STN neurons and GPi fibers during STN DBS. Model predictions regarding the degree of GPi fiber activation matched well with experimental recordings in both monkeys. Only axonal activation of the STN neurons showed a statistically significant increase in both monkeys when comparing clinically effective and ineffective stimulation. Nonetheless, both neural targets may play important roles in the therapeutic mechanisms of STN DBS.
Dissertations / Theses on the topic "Subthalamic Deep Brain Stimulation (STN-DBS)"
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Werner, Lucas. "Sex-differences in reported adverse side-effects caused by Deep Brain Stimulation therapy in the subthalamic nucleus." Thesis, Uppsala universitet, Institutionen för biologisk grundutbildning, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-445646.
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Parkinson’s disease is a common neurological disease which will progressively damagedopaminergic neurons in the brain. Later stages of the disease will result in death of theneurons. The diagnosis is often made with respect to the motor symptoms, which includetremors, bradykinesia, and rigidity. In addition to motor symptoms, non-motor symptomsappear in many patients, such as cognitive changes and mood disorders. One method used totreat Parkinson’s disease is deep brain stimulation, where electric pulses are emitted to aspecific brain area. A common target is the subthalamic nucleus, which is part of the basalganglia. By using deep brain stimulation, the dose of other medications for Parkinson’sdisease can be lowered. However, the mechanisms of deep brain stimulation are not yetentirely known, and there have been many reports of adverse side-effects caused by thismethod, including depression and other types of mood changes. Even so, information of apossible sex distribution of these side-effects is still limited. Here, a qualitative essay wasmade where 16 articles describing reported side-effects in men and women were compared. Inaddition, unpublished data from optogenetic studies on male and female mice were analysedin order to examine putative sex-differences upon experimental brain stimulation strategies.The results from the optogenetics results did not show any statistically significant sexdifferences.In contrast, by comparing the selected articles in which results of deep brainstimulation treatment in patients were reported, some differences were found. First, it seemsthat women report more depressive-like symptoms than men. Second, while men also reportdepressions, they also report more aggressive behaviour upon the treatment. A preliminaryconclusion of this essay is therefore that certain sex-differences can be observed among theadverse side-effects reported upon deep brain stimulation in Parkinson´s disease. However,since the studied material was limited, more research is required to make firmer conclusions.
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Lundgren, Fanny, and Johanna Qvist. "Deep brain stimulation of subthalamic nucleus and caudal zona incerta in patients with Parkinson’s disease: A perceptual study of effects on articulatory precision." Thesis, Umeå universitet, Logopedi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-71179.
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Abstract Background Deep brain stimulation (DBS) is a viable surgical treatment method for Parkinson’s disease (PD). It has positive effects on the classical motor symptoms, but effects on speech and voice are not equally beneficial. The speech disorder related to PD is hypokinetic dysarthria, with impaired articulatory precision as a prominent symptom. Studies have shown effects on different aspects of speech due to DBS of the subthalamic nucleus (STN) but the effects of stimulation of the caudal zona incerta (cZi) are less explored. Aims The aim of the current study was to investigate the effect of STN-DBS and cZi-DBS on perceptually measured articulatory precision in PD patients. Method Read speech productions were collected from 19 DBS-treated PD patients, ten STN and nine cZi. The recordings were made before surgery and 12 months postoperatively with stimulator on and off. Levodopa medication was always on. From the reading passage, three-syllable words were selected and isolated. Articulatory precision of the words was rated in two different assessments; an overall rating of articulatory precision and an identification of occurring misarticulations. Results The results from the perceptual assessment showed a decrease in articulatory precision after surgery for both groups. The decrease was significant for the cZi group, but not for the STN group. There was no significant difference between the groups. The frequency of observed misarticulations increased as an effect of DBS for both patient groups, with significant increase for the STN group but not for the cZi group. There was no significant difference between the groups. The most commonly observed misarticulation categories were stop-plosive reduced in quality, fricative realized as other fricative and stop-plosive realized as fricative . Conclusions The results obtained in the current study show that STN-DBS and cZi-DBS may have adverse effects on articulatory precision in PD patients. Keywords Articulatory precision, Parkinson’s disease, DBS, STN, cZi
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Kumbhare, Deepak. "3D FUNCTIONAL MODELING OF DBS EFFICACY AND DEVELOPMENT OF ANALYTICAL TOOLS TO EXPLORE FUNCTIONAL STN." VCU Scholars Compass, 2011. http://scholarscompass.vcu.edu/etd/2531.
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Introduction: Exploring the brain for optimal locations for deep brain stimulation (DBS) therapy is a challenging task, which can be facilitated by analysis of DBS efficacy in a large number of patients with Parkinson’s disease (PD). The Unified Parkinson's Disease Rating Scale (UPDRS) scores indicate the DBS efficacy of the corresponding stimulation location in a particular patient. The spatial distribution of these clinical scores can be used to construct a functional model which closely models the expected efficacy of stimulation in the region. Designs and Methods: In this study, different interpolation techniques were investigated that can appropriately model the DBS efficacy for Parkinson’s disease patients. These techniques are linear triangulation based interpolation, ‘roving window’ interpolation and ‘Monopolar inverse weighted distance’ (MIDW) interpolation. The MIDW interpolation technique is developed on the basis of electric field geometry of the monopolar DBS stimulation electrodes, based on the DBS model of monopolar cathodic stimulation of brain tissues. Each of these models was evaluated for their predictability, interpolation accuracy, as well as other benefits and limitations. The bootstrapping based optimization method was proposed to minimize the observational and patient variability in the collected database. A simulation study was performed to validate that the statistically optimized interpolated models were capable to produce reliable efficacy contour plots and reduced false effect due to outliers. Some additional visualization and analysis tools including a graphic user interface (GUI) were also developed for better understanding of the scenario. Results: The interpolation performance of the MIDW interpolation, the linear triangulation method and Roving window method was evaluated as interpolation error as 0.0903, 0.1219 and0.3006 respectively. Degree of prediction for the above methods was found to be 0.0822, 0.2986 and 0.0367 respectively. The simulation study demonstrate that the mean improvement in outlier handling and increased reliability after bootstrapping based optimization (performed on Linear triangulation interpolation method) is 6.192% and 12.8775% respectively. The different interpolation techniques used to model monopolar and bipolar stimulation data is found to be useful to study the corresponding efficacy distribution. A user friendly GUI (PDRP_GUI) and other utility tools are developed. Conclusion: Our investigation demonstrated that the MIDW and linear triangulation methods provided better degree of prediction, whereas the MIDW interpolation with appropriate configuration provided better interpolation accuracy. The simulation study suggests that the bootstrapping-based optimization can be used as an efficient tool to reduce outlier effects and increase interpolated reliability of the functional model of DBS efficacy. Additionally, the differential interpolation techniques used for monopolar and bipolar stimulation modeling facilitate study of overall DBS efficacy using the entire dataset.
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Wikström, Matilda, and Julia Andersson. "Precision och stabilitet vid klusilexplosionen hos patienter med Parkinsons sjukdom : En jämförelse mellan effekten av Deep Brain Stimulation i kaudala zona incerta (cZi) respektive nucleus subthalamicus (STN)." Thesis, Umeå universitet, Logopedi, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-64015.
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Bakgrund: Deep Brain Stimulation (DBS) i nucleus subthalamicus (STN) och i kaudala zona incerta (cZi) har visat positiva effekter på motoriska symtom (rörelseförmåga och balans) vid Parkinsons sjukdom. Efter DBS har dock negativa taleffekter noterats, inklusive nedsatt artikulatorisk precision och stabilitet. Nedsatt artikulatorisk precisionoch stabilitet påverkar klusilproduktionen mest vilket kan resultera i att klusilexplosionen uteblir eller att multipla explosioner uppstår. Mål: Att undersöka artikulatorisk precision och stabilitet vid klusilexplosionen efter DBS i STN respektive cZi. Metod: I studien deltog 19 patienter varav 9 deltagare stimulerats i STN och 10 deltagare i cZi. Talinspelningar gjordes innan operation och ett år efter operation med DBSstimulering på och av. Klusilerna i talmaterialet delades in i tre kategorier, de med en klusilexplosion, de med två eller flera klusilexplosioner samt de utan klusilexplosion. Hypotesprövning gjordes gällande fördelningen av klusiler med multipla explosioner samt klusiler utan explosion mellan och inom patientgrupperna samt inom respektive klusil. Resultat: Multipla explosioner ökade hos cZi-patienterna och minskade hos STNpatienterna. Klusiler som saknade explosion ökade hos STN-patienterna medan de minskade hos cZi-patienterna. För båda patientgrupperna ökade multipla explosioner och klusiler utan explosion då stimuleringen var på jämfört med av. Skillnaderna mellan och inom grupperna var inte signifikanta. Slutsats: Artikulatorisk precision och stabilitet påverkades efter DBS i form av bristande stabilitet, för kort slutningsrörelse och felaktig koordination av slutningsrörelsen. Detta resulterade i multipla explosioner och uteblivna explosioner med olika effekter för elektrodlokalisationerna.Background: Deep Brain Stimulation (DBS) in Subthalamicus Nucleus (STN) and Caudala zona incerta (cZi) have shown positive effects on motor symptoms in Parkinson‘s disease. Negative effects on speech after DBS has been noted including reduced articulatory precision. Reduced articulatory precision and stability affects the production of stop consonants and as a result, loss of burst or multiple burst can occur. Aim: To investigate articulatory precision and stability regarding the burst in stop consonants after DBS of STN or cZi. Method: The study included 19 patients with 9 patients stimulated in STN and 10 patientsin cZi. Speech recordings were made before surgery and one year after with stimulation ON and OFF. The stop consonants were divided into three categories, those with one burst, those with two or more bursts (multiple burst) and those with loss of burst. Hypothesis testing was done on the categorization of the stop consonants in and between the groups and between the stop consonants types. Results: Multiple burst increased in the cZi group and decreased in the STN group. Stop consonants with loss of burst increased in the STN group but decreased in the cZi group. For both groups multiple burst and stop consonants with loss of burst increased with stimulation on. The differences between and within the groups were not significant. Conclusion: Articulatory precision and stability were affected by DBS with decreased stability, shortened occlusion and incorrect coordination. As a result multiple burst and loss of burst occurred in both groups.
Speech, voice and swallowing outcomes after deep brain stimulation of the zona incerta and the pedunculopontine nucleus in Parkinson’s disease: Comparsion with stimulation of the subthalamic nucleus
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Johansson, Johannes, and Karin Wårdell. "Intracerebral quantitative chromophore estimation from reflectance spectra captured during deep brain stimulation implantation." Linköpings universitet, Biomedicinsk instrumentteknik, 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-81381.
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Quantification of blood fraction (fblood), blood oxygenation (S
), melanin, lipofuscin and oxidised and reduced Cytochrome aa 3 and c was done from diffuse reflectance spectra captured in cortex, white matter, globus pallidus internus (GPi) and subthalamus during stereotactic implantations of 29 deep brain stimulation (DBS) electrodes with the aim of investigating whether the chromophores can give physiological information about the targets for DBS. Double-sided Mann-Whitney U -tests showed more lipofuscin in GPi compared to white matter and subthalamus (p < 0.05). Compared to the other structures, fbloodwas significantly higher in cortex (p < 0.05) and S
lower in GPi (p < 0.05). Median values and range for fblood were 1.0 [0.2–6.0]% in the cortex, 0.3 [0.1–8.2]% in white matter, 0.2 [0.1–0.8]% in the GPi and 0.2 [0.1–11.7]% in the subthalamus. Corresponding values for S
was 20 [0–81]% in the cortex, 29 [0–78]% in white matter, 0 [0–0]% in the GPi and 0 [0–92]% in the subthalamus. In conclusion, the measurements indicate very low oxygenation and blood volume for DBS patients, especially in the GPi. It would be of great interest to investigate whether this is due to the disease, the normal situation or an artefact of doing invasive measurements.
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Schweizer, Nadine. "Across Borders : A Histological and Physiological Study of the Subthalamic Nucleus in Reward and Movement." Doctoral thesis, Uppsala universitet, Institutionen för neurovetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-275165.
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The basal ganglia are the key circuitry controlling movement and reward behavior. Both locomotion and reward-related behavior are also modified by dopaminergic input from the substantia nigra and the ventral tegmental area (VTA). If the basal ganglia are severed by lesion or in disease, such as in Parkinson’s disease, the affected individuals suffer from severe motor impairments and often of affective and reward-related symptoms. The subthalamic nucleus (STN) is a glutamatergic key area of the basal ganglia and a common target for deep brain stimulation in Parkinson’s disease to alleviate motor symptoms. The STN serves not only motoric, but also limbic and cognitive functions, which is often attributed to a tripartite anatomical subdivision. However, the functional output of both VTA and STN may rely more on intermingled subpopulations than on a strictly anatomical subdivision. In this doctoral thesis, the role of subpopulations within and associated with the basal ganglia is addressed from both a genetic and a behavioral angle. The identification of a genetically defined subpopulation within the STN, co-expressing Paired-like homeodomain transcription factor 2 (Pitx2) and Vesicular glutamate transport 2 (Vglut2), made it possible to conditionally reduce glutamatergic transmission from this subgroup of neurons and to investigate its influence on locomotion and motivational behavior, giving interesting insights into the mechanisms possibly underlying deep brain stimulation therapy and its side-effects. We address the strong influence of the Pitx2-Vglut2 subpopulation on movement, as well as the more subtle changes in reward-related behavior and the impact of the alterations on the reward-related dopaminergic circuitry. We also further elucidate the genetic composition of the STN by finding new markers for putative STN subpopulations, thereby opening up new possibilities to target those cells genetically and optogenetically. This will help in future to examine both STN development, function in the adult central nervous system and defects caused by specific deletion. Eventually identifying and characterizing subpopulations of the STN can contribute to the optimization of deep brain stimulation and help to reduce its side-effects, or even open up possibilities for genetic or optogenetic therapy approaches.
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Tiran-Cappello, Alix. "Rôle du noyau subthalamique et de ses afférences hyperdirectes provenant du cortex préfrontal dans le codage et la recherche de récompense chez le rat." Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0448/document.
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La stimulation cérébrale profonde (SCP) est actuellement un traitement efficace pour la maladie de parkinson. Cette approche est maintenant fortement envisagée pour le traitement des addictions. Elle consiste à délivrer des impulsions électriques au sein d’une structure cérébrale : le noyau subthalamique. Nous avons montré dans le noyau subthalamique l’existence de signatures associée à la transition vers l’addiction et la prise compulsive de drogue, ainsi que le potentiel thérapeutique de la SCP pour réduire la consommation pathologique et compulsive de cocaïne chez des rats. Nous avons également montré le contrôle spécifique du noyau subthalamique sur la motivation pour la nourriture sucrée et les drogues d’abus. Dans l’ensemble, cette thèse devrait permettre une meilleure compréhension des mécanismes de la SCP, de son potentiel thérapeutique pour les addictions et de ses éventuels effets secondairesDeep brain stimulation (DBS) is currently one form of effective treatment for Parkinson’s disease. This approach is currently considered for the treatment of addiction. It consists in the delivery of small electric impulses inside a brain structure: the subthalamic nucleus. We have shown in the subthalamic nucleus the existence of signature associated with the transition to addiction and compulsive drug abuse, as well as the therapeutic potential of DBS to reduce pathological intake and compulsive cocaine abuse in rats. We also established the specific control exerted by the subthalamic nucleus on the motivation for sweet food and drug of abuse. Overall this thesis could allow a better understanding of the mechanisms of DBS, its therapeutic potential in addiction and possible side effects
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Santos, Fabiane Caillava dos. "Fatores de risco para alterações cognitivas no pós-operatório de implante DBS-STN na doença de Parkinson : análise de neuroimagem e variaveis clínicas." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2017. http://hdl.handle.net/10183/179715.
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Atualmente se tem bem estabelecido o tratamento para Doença de Parkinson, dentre eles o DBS (Deep Brain Stimulation). Embora haja controvérsias, muitos estudos têm demonstrado os efeitos adversos do DBS sobre a cognição, humor e comportamento. Assim, este estudo buscou investigar a associação entre os prejuízos cognitivos no pós-operatório e a volumetria cerebral em pacientes parkinsonianos submetidos a DBS, verificando se a correlação entre ambos pode ser considerada fator de risco para os prejuízos encontrados no pós-operatório. Fizeram parte da população estudada 25 indivíduos, 80% do sexo masculino, que foram submetidos ao procedimento cirúrgico de estimulação cerebral profunda (DBS) no Hospital de Clínicas de Porto Alegre (HCPA), em Porto Alegre entre 2012 e 2015. Estes sujeitos foram submetidos a uma bateria de testes cognitivos, bem como a testes clínicos e a ressonância magnética computadorizada nos períodos pré e pós-operatório em 6 meses. Os dados foram analisados através de estatísticas descritivas, coeficiente de correlação de Pearson e Teste t. Os resultados serão considerados significativos a um nível de significância máximo de 5% (p≤ 0,05) e o software estatístico utilizado para a análise será o SPSS versão 20.0. Quanto aos aspectos cognitivos avaliados, somente a fluência verbal fonêmica mostrou redução significativa entre os períodos pré e pós-operatório (p=0,003). A transfixação dos ventrículos foi associada à perda na fluência verbal semântica (p=0,009) e na memória (p=0,016) no pós-operatório. A presença de lesão na substância branca foi associada ao maior prejuízo na função executiva (p=0,017), fluência verbal semântica (p=0,039) e memória (p=0,050). Conclusão: Os prejuízos na fluência verbal semântica e memória no pós-operatório foram associados à presença de lesão na substância branca e a transfixação dos ventrículos pelo cabo com 6 eletrodos. A perda na função executiva foi associada a presença de lesão na substância branca. Os danos na fluência verbal fonêmica no pós-operatório, embora difiram estatisticamente, não foram associados a quaisquer achados da RM.Currently, the treatment for Parkinson's Disease has been well established, among them DBS (Deep Brain Stimulation). Although controversial, many studies have demonstrated the adverse effects of DBS on cognition, mood, and behavior. Thus, this study sought to investigate the association between cognitive impairment in the postoperative period and cerebral volume in patients with Parkinson's disease who underwent DBS, and whether the correlation between the two can be considered as a risk factor for the possible postoperative losses. Twenty-five subjects, 80% male, who underwent deep brain stimulation (DBS) at the Hospital de Clínicas in Porto Alegre, Porto Alegre, between 2012 and 2015, were submitted to a cognitive battery, as well as clinical trials and computerized magnetic resonance imaging in the preoperative and postoperative periods at 6 months. Data were analyzed through descriptive statistics, Pearson's correlation coefficient and t-test. The results will be considered significant at a maximum significance level of 5% (p≤0.05) and the statistical software used for analysis will be SPSS version 20.0. Concerning the cognitive aspects evaluated, only phonemic verbal fluency showed a significant reduction between the pre and postoperative periods (p = 0.003). The transfixation of the ventricles was associated with loss of semantic verbal fluency (p = 0.009) and memory (p = 0.016) in the postoperative period. The presence of lesion in the white matter was associated with greater impairment in executive function (p = 0.017), semantic verbal fluency (p = 0.039) and memory (p = 0.050). Conclusion: The losses in the semantic verbal fluency and memory in the postoperative period were associated with the presence of white matter lesion and the transfixation of the ventricles by the cable with electrodes. The loss of executive function was associated with the presence of injury in the white matter. Damage to phonemic verbal fluency in 8 the postoperative period, although statistically different, was not associated with any MRI findings.
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Unger, Elin, and Sofia Wahlgren. "Artikulatorisk hastighet och precision i stavelseupprepning för patienter med Parkinsons sjukdom: : En postoperativ jämförelse mellan patienter som genomgått Deep Brain Stimulation i Caudal Zona Incerta (cZi) respektive Nucleus Subthalamicus (STN)." Thesis, Umeå universitet, Logopedi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-146254.
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Bakgrund: En förbättring av kroppslig motorik efter Deep Brain Stimulation (DBS) har noterats hos Parkinsonpatienter efter Deep Brain Stimulation (DBS) i Nucleus Subthalamicus (STN) och Caudal Zona Incerta (cZi). Postoperativa effekter för talmotorik och övrig kroppsmotorik skiljer sig dock ofta åt. Försämring av flera talaspekter har rapporterats, inklusive nedsatt artikulatorisk precision. Minskad artikulatorisk precision hos Parkinsonpatienter påverkar produktionen av tonlösa klusiler, såväl som talhastigheten. Detta kan mätas via akustisk analys av diadochokinetiska uppgifter (DDK) i form av stavelseupprepning, genom kontroll av andel stavelser med mätbar Voice Onset Time (VOT) samt antal stavelser per sekund. Mål: Att jämföra effekten av DBS-stimulering i STN respektive cZi vid stavelseupprepning genom andelen mätbara VOT-resultat samt antalet stavelser per sekund. Ett andra mål var att beskriva hur relationen mellan artikulatorisk hastighet och andel mätbara VOT-värden påverkas av stimulering för de båda lokalisationsgrupperna. Metod: Det fanns 7 patienter i varje lokalisationsgrupp. Talinspelningar skedde före operation, samt 12 månader efter operation med stimulatorn av respektive på. Andelen mätbara VOT-resultat för de tonlösa klusilerna mättes i varje uppgift, liksom antalet stavelser per sekund. Hypotesprövning genomfördes mellan grupperna såväl som mellan de båda postoperativa tillfällena (stimulator av respektive på). Regressionskoefficienten beräknades för förhållandet mellan andelen mätbara VOT-värden och talhastighet för respektive lokalisationsgrupp. Resultat: Andelen mätbara VOT-resultat minskade då stimulatorn var på för båda lokalisationsgrupperna. Minskningen var signifikant för STN men inte för cZi. Resultatet för cZi närmade sig dock signifikans. Antalet stavelser per sekund ökade för AMRuppgiften samt förblev oförändrat för SMR-uppgiften hos STN-gruppen med påslagen stimulator. För cZi sågs då en konstant nedåtgående trend. Regressionskoefficienten för förhållandet mellan andelen mätbara VOT-värden och antalet stavelser per sekund förändrades inte på ett enhetligt sätt när stimulatorn var av respektive på mellan de båda grupperna. Slutsats: Talet påverkas av DBS-stimulering genom en oprecis artikulation av tonlösa klusiler. Lokalisationsgrupperna STN och cZi uppvisade samma förändringsmönster för andelen mätbara VOT-värden, men skiljde sig åt vid antalet stavelser per sekund. Detta tycks vara en indikation på att operation i dessa lokalisationer har olika effekt på taltempo. Teorin om articulatory undershoot tycks kunna appliceras på båda grupperna, dock uppvisar cZi en samtidig hastighetsminskning gällande antal stavelser per sekund, där STN istället uppvisar en hastighetsökning vid stimulering. Nyckelord: Parkinsons sjukdom, DBS, STN, cZi, stavelseupprepning, andel mätbara VOTvärden, antal stavelser per sekund, artikulatorisk precision, artikulatorisk hastighet.
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Yang, Hsuan-Ju, and 楊絢如. "Deep brain stimulation of subthalamic nucleus (STN-DBS) in Parkinson’s disease impairs inhibitory function of automaticity." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/82392299040182405455.
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碩士中國醫藥大學
神經科學與認知科學研究所碩士班
100
Abstract Deep brain stimulation of subthalamic nucleus (STN-DBS) is a new treatment to Parkinson’s disease (PD). However, it may impair patients’ cognitive function, particularly in the inhibitory control. Thus, the goal of this study is to investigate whether STN-DBS impairs PD’s inhibitory control in different domains. Moreover, the underlying mechanism affected will be explored. In this study, we selected three cognitive tasks to evaluate PD patient’s inhibitory function in different domains, that is, the flanker task to measure the ability of suppressing flanker distracting information, Stroop task to measure the ability of suppressing automatic response, and the stop-signal task to measure the ability of suppressing motor/behavioral response. Fourteen PD patients with STN-DBS were recruited in this study. They performed these three tasks when their DBS were on and off, respectively. The results showed a significantly larger Stroop effect when the DBS was turning on than off, suggesting that STN-DBS increased difficulty on suppressing automatic responses. Meanwhile, no significant performance changes were found in the flanker task and the stop-signal task comparing DBS on and off. There was no correlation between patient’s motor improvements and their cognitive impairments after DBS on. Our result showed that STN-DBS improves PD’s motor function but causes cognitive side effect on inhibitory function. Our distributional analysis showed that STN-DBS may induce difficulty in selective suppression with the caveat of increasing irrelevant response activation cannot be excluded.
Books on the topic "Subthalamic Deep Brain Stimulation (STN-DBS)"
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Chitnis, Shilpa, Pravin Khemani, and Michael S. Okun, eds. Deep Brain Stimulation. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.001.0001.
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The fundamental principles of deep brain stimulation treatment are derived from decades of empirical and experiential observations. Through a case-based approach, this book is an effort to distill the expertise of clinical teams who are at the frontlines of managing patients with deep brain stimulation. The vast majority of patients with tremors, Parkinson disease, dystonia and other hyperkinetic disorders treated with DBS obtain significant relief of their neurological symptoms with conventional programming techniques that are outlined at the beginning of each section in this book. However, perioperative complications, stimulation induced side-effects and unexpected clinical symptoms such as freezing of gait after globus pallidus implantation for dystonia (Case 20), persistent dyskinesia after subthalamic stimulation (Case 17), and erosion of device hardware (Case 24) warrant unconventional and creative troubleshooting techniques to improve surgical outcomes while being constantly cognizant of their impact on the patient. Each case in the book is illustrative of the iterative process of managing deep brain stimulation patients who have entrusted their health to specialists who are not only determined to improve their quality of life regardless of the complexity of the clinical scenario but also share their invaluable observations with readers who may someday face a similar challenge when treating their patients.
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Mason, Peggy. Basal Ganglia. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190237493.003.0025.
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The core function of the basal ganglia is action selection, the process of choosing between mutually exclusive actions. Under baseline or default conditions, the basal ganglia suppress movement and prevent more than one movement from occurring simultaneously. The importance of chunking and operational learning is explored through exemplary typing tasks. Pathways through the basal ganglia employ the same input and output ports. Inputs far outnumber outputs from the basal ganglia. Subcortical loops through the basal ganglia are more effective than are cortical loops. The functions of the hyperdirect, direct and indirect pathways to motor control in the skeletomotor loop are detailed. Hemiballismus, Parkinson’s disease, and Huntington’s disease are key basal ganglia disorders. The use of deep brain stimulation (DBS) of the subthalamic nucleus as a treatment for Parkinson’s disease is discussed. Finally, additional basal ganglia loops such as the oculomotor loop are introduced.
Book chapters on the topic "Subthalamic Deep Brain Stimulation (STN-DBS)"
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Sasaki, Fuyuko, Yasushi Shimo, and Nobutaka Hattori. "Target Selection for Parkinson Disease With Medication-Refractory Unilateral Resting Tremor." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 55–58. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0010.
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A 67-year-old, right-handed man had a 7-year history of right-dominant, severe medication-refractory resting and action-postural tremor, rigidity, bradykinesia, and impairment of postural reflexes, with his symptoms poorly responsive to oral antiparkinsonian medication. His parkinsonian symptoms with the exception of tremor responded to levodopa infusion. His most bothersome symptom was tremor, and implantation of a left subthalamic nucleus (STN) deep brain stimulation (DBS) lead was pursued with possible posterior subthalamic area (PSA) DBS if the tremor suppression by STN was not intraoperatively sufficient. Ultimately, the STN DBS lead provided reasonable tremor suppression during the operation, and there was no need for PSA DBS. After the surgery, his tremor and other parkinsonian symptoms were well-controlled. This case highlights that unilateral STN DBS is a reasonable indication for medication-refractory parkinsonian tremor with significant laterality of bothersome symptoms, although other options may also be considered.
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Sharma, Vibhash D., Kelly E. Lyons, and Rajesh Pahwa. "Management of Stimulation-Induced Dyskinesia in Parkinson Disease With Interleaving Programming Settings." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 97–100. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0019.
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Deep brain stimulation (DBS) of subthalamic nucleus (STN) can effectively control motor complications in Parkinson disease (PD). The outcome of DBS therapy depends on lead placement in the dorsolateral aspect of STN, as well as post-DBS programming. Effective DBS programming requires knowledge of side effects/complications related to stimulation. One of the infrequent complications of STN DBS is stimulation-induced dyskinesia, which can present similar to levodopa-induced dyskinesia with choreiform, ballistic, or dystonic movements. Stimulation-induced dyskinesia can be bothersome and can interfere with effective control of motor symptoms because typically the contact causing dyskinesia is the most effective in improving motor symptoms. This chapter discusses clinical presentation and management strategies in a patient with tremor-predominant PD who developed stimulation-induced dyskinesia. After trying multiple programming parameters, patient tremor and dyskinesia were effectively controlled on interleaved programming settings. The authors conclude that interleaving DBS programming can be a potential option for management of stimulation-induced dyskinesia.
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Mitchell, Kyle T., Kristen A. Dodenhoff, Philip A. Starr, and Jill L. Ostrem. "Stimulation-Induced Dyskinesia, Interleaving Settings, and Management of Subthalamic Nucleus Deep Brain Stimulation in DYT1 Dystonia." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Rasheda El-Nazer, Richard B. Dewey, Padraig O’Suilleabhain, and Shilpa Chitnis, 201–4. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0038.
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DYT1 dystonia is a primary dystonia with potential for significant symptomatic improvement after bilateral deep brain stimulation (DBS) of the globus pallidus interna (GPi). GPi is the historical target of choice for this disease. This chapter presents a case of an adolescent with disabling generalized DYT1 dystonia who underwent bilateral subthalamic nucleus (STN) DBS as part of a prospective clinical trial. While limb and cervical dystonia dramatically improved with DBS, programming was limited by stimulation-induced bilateral limb dyskinesia, including in the left arm, which was previously unaffected by dystonia. After years of evolving symptoms and complex programming, bilateral interleaved settings using both a contact in motor STN and the most dorsal DBS contact in the zona incerta resulted in sustained, near-complete resolution of dystonia without side effects. This case illustrates the use of the STN as an effective DBS target for primary dystonia, although complex programming was necessary to mitigate stimulation-induced dyskinesia.
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Afshari, Mitra, Jill L. Ostrem, Marta San Luciano, and Paul S. Larson. "Rescue Ventral Intermediate Thalamus Deep Brain Stimulation to Address Refractory Tremor Following Subthalamic Nucleus Deep Brain Stimulation With Brittle Dyskinesia." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 115–18. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0023.
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This chapter discusses a case in which a “rescue” deep brain stimulation (DBS) lead was implanted to address suboptimal tremor control. The patient was a 52-year-old woman with disabling bilateral postural and action hand tremor who also had mild parkinsonian signs. An essential tremor (ET)–Parkinson disease (PD) syndrome was suspected, and subthalamic nucleus (STN) DBS was pursued. Attempts at optimizing tremor control by reprogramming were limited by the induction of brittle dyskinesia even with small amounts of stimulation. Bilateral ventral intermediate thalamus DBS leads were then implanted, and the tremors improved significantly. Troubleshooting strategies for optimizing tremor control and reducing STN DBS–induced brittle dyskinesia are discussed. The chapter reviews important learning points on DBS target selection for ET, PD, and ET-PD spectrum syndromes.
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Chiu, Shannon Y., and Irene A. Malaty. "Tardive Dystonia and Dyskinesia Responsive to Deep Brain Stimulation." In Deep Brain Stimulation, edited by Shilpa Chitnis, Pravin Khemani, and Michael S. Okun, 233–38. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0044.
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Tardive disorders encompass phenomenologically diverse delayed-onset persistent involuntary motor symptoms associated with exposure to dopamine receptor blocking agents. Two common tardive disorders encountered in the clinical setting include tardive dyskinesia and tardive dystonia. This chapter presents a patient with severe refractory tardive dyskinesia and also tardive dystonia, manifesting as frequent and disabling retropulsion. He initially underwent bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) but was found to have lead migration secondary to his severe hyperkinetic movements. He had persistent symptoms despite lead revision and ultimately required bilateral subthalamic nucleus (STN) rescue DBS implantation. The rescue procedure was synergistic with the initial GPi DBS and markedly improved his symptoms. Severe tardive dyskinesia and dystonia may respond to bilateral GPi DBS, and if necessary, rescue STN DBS can be added.
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Siddiqui, Junaid, Raja Mehanna, and Jawad A. Bajwa. "Management of Brittle Dyskinesia and Dopamine Dysregulation Syndrome in Subthalamic Deep Brain Stimulation." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 101–4. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0020.
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Deep brain stimulation (DBS) is the most commonly performed interventional therapy for advanced Parkinson disease (PD). Subthalamic nucleus (STN) is the most common target for DBS implantation. It is established that STN microlesion effect can result in dyskinesia, usually indicating a good lead placement. At times, this dyskinesia may be severe and prolonged, and it may be exaggerated with DBS adjustments and with slight increase in dopaminergic therapy, which may require antidyskinetic medications temporarily to manage it. This is called brittle dyskinesia. It is important to be aware of this phenomenon for optimal management of this condition because this may result in significant morbidity despite proper lead placement and DBS programming. Also during DBS programming, high pulse width can adversely affect speech and gait. This chapter presents a case with brittle dyskinesia and speech impairment while discussing technical troubleshooting and clinical management.
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Ramirez-Zamora, Adolfo. "Acute Neuropsychiatric Symptoms and Impulse Control Disorders After Subthalamic Nucleus Deep Brain Stimulation." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 149–54. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0031.
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Neuropsychiatric symptoms, including impulse control disorders and mood changes, are common nonmotor features across all Parkinson disease (PD) stages. Subthalamic nucleus (STN) deep brain stimulation (DBS) is a safe and well-established treatment for the management of refractory motor fluctuations in PD; however, it has been associated with worsening neuropsychiatric symptoms in the short and long term. Recognizing the occurrence of stimulation-induced behavioral symptoms is critical to implement effective and timely treatment. Most reports indicate that stimulation of the ventral and medial region within the STN and surrounding structures, including the substantia nigra, might account for the occurrence of acute impulsive behaviors and hypomania, requiring adopting different programming strategies aimed at limiting behavioral side effects while reducing parkinsonism. Stimulation of the most dorsal and lateral contacts can mitigate behavioral side effects after STN DBS, but specific treatment needs to be applied based on the patient’s individual neuropsychiatric and motor presentations and specific imaging-based brain localization of DBS lead contacts.
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Mehanna, Raja. "Deep Brain Stimulation in Parkinson Disease." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 49–54. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0009.
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Deep brain stimulation (DBS) directed to the subthalamic nucleus (STN) or the globus pallidus interna (GPi) has been demonstrated to improve motor control as well as quality of life in patients with Parkinson disease (PD). While patient screening is key to ensure that only patients with the most advantageous risk-to-benefit ratio proceed to DBS, effective postoperative programming is key to improving cardinal motor symptoms of PD. Applying sound principles of DBS programming can maximize benefits and reduce side effects of DBS. This chapter suggests a systematic approach to DBS programming for PD as well as a few programming pearls.
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Kroth, Julia, Susanne Schneider, and Sergiu Groppa. "Deactivation of One Subthalamic Nucleus Deep Brain Stimulation Device to Address Brittle Ipsilateral Dyskinesia in a Patient With Tremor-Dominant Parkinson Disease." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 93–96. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0018.
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A 78-year-old right-handed woman with a 10-year history of tremor-dominant Parkinson disease (PD) was recommended for bilateral deep brain stimulation (DBS) in the subthalamic nucleus (STN). The patient was implanted with bilateral omnidirectional STN DBS electrodes after intraoperative microelectrode recordings and intraoperative test stimulation. Immediately after implantation, the motor symptoms improved considerably, but 3 to 4 weeks later, a debilitating left-sided resting tremor re-emerged. Personalized programming at the right STN ameliorated the tremor, while painful dyskinesia and hemiballism of the ipsilateral right side of the body developed subsequently over the next few days. Adapting the stimulation parameters and the dopaminergic medication improved these symptoms only marginally. After turning off the left STN electrode, the dyskinesia and hemiballism disappeared completely. In the following weeks, the amperage of the right STN electrode was increased gradually to control the left-sided resting tremor. This was possible without the development of ipsilateral hyperkinesia. During the off phases of stimulation, a considerable direct improvement of hyperkinesia was noted, and the decision to turn off the left STN electrode was ultimately made.
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Call, Elena, and Helen Bronte-Stewart. "Deep Brain Stimulation–Responsive Camptocormia in Parkinson Disease." In Deep Brain Stimulation, edited by Laura S. Surillo Dahdah, Padraig O’Suilleabhain, Hrishikesh Dadhich, Mazen Elkurd, Shilpa Chitnis, and Richard B. Dewey, 89–92. Oxford University Press, 2020. http://dx.doi.org/10.1093/med/9780190647209.003.0017.
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Camptocormia, involuntary flexion of the spine, is aggravated by action and improves when supine, if there is no skeletal deformity. Camptocormia in Parkinson disease (PD) is frequently refractory to dopaminergic medication. Deep brain stimulation (DBS) has been used to treat camptocormia with variable results. We present a PD patient with no camptocormia in the supine position but with progressive thoracic trunk flexion to about 90 degrees as he stood up. He had profound gait impairment and freezing of gait (FOG) off medication, but gait and FOG improved on medication. Camptocormia improved to about 30 degrees, but he had severe dyskinesias. Because he had no skeletal deformity, improved on medication, and had dyskinesias, he had bilateral 130 Hz subthalamic (STN) DBS. His Unified Parkinson’s Disease Rating Scale (UPDRS) Part III improved from 37 to 13 (off medication/on DBS), and after 14 months his camptocormia had resolved. Camptocormia that is responsive to dopaminergic medication, without a skeletal deformity, may respond to bilateral high-frequency STN DBS.
Conference papers on the topic "Subthalamic Deep Brain Stimulation (STN-DBS)"
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Vieira, Gabriela Albertino, Raquel Medeiros de Souza, Érica Rocha Assunção, Laís Soares Figueiredo, Natália Rafael Perdigão, and Paula Luciana Scalzo. "Effect of DBS on decreasing pain intensity in individuals with PD: a systematic review." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.230.
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Background: Pain is a common non-motor symptom in Parkinson’s disease (PD), causing impairment in the functionality and quality of life. Objectives: To summarize the effects of deep brain stimulation (DBS) on pain intensity in PD. Design: Systematic review. Methods: A search was conducted using the Pubmed, Scielo, Embase, Lilacs, and Cochrane databases. Keywords were: “Parkinson* AND (“DBS” OR “deep brain stimulation”) AND “pain”. Complete available articles that measured pain intensity before and after DBS were selected. Results: Of the 251 studies, 17 met the criteria. The sample included from 14 to 79 patients (n = 532). The time of surgery was 3 to 96 months. The subthalamic nucleus was the main surgical target. Seventeen and 389 individuals were submitted to unilateral and bilateral implantation, respectively. Globus pallidus was used as a surgical target in three studies. The unilateral implant was performed in 12 patients and the bilateral in 37. Different instruments were used to measure the pain intensity. It declined after surgery in all studies. Conclusion: The results show that pain intensity decreased after DBS, and most studies performed bilateral stimulation in the subthalamic nucleus. This information is important in guiding the therapeutic approach in PD patients with pain. However, the different surgical parameters and instruments used to assess pain limit the summarization of results.
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Pellegrin, Guilherme Rufino Marques, Arthur Neves Egídio, Alexandre Jahara Moreira Gomes Teixeira, Carolina Mendonça Cyranka, Diogo Abrantes de Oliveira, Enzo Tibiriçá de Rezende, Larissa Rodrigues Sotto Maior, Nathália Vieira Caires, Vanessa Teixeira Miquelito, and Leandro Souza Cruz. "The Efficacy of Deep Brain Stimulation in Parkinson’s Disease Treatment: A Systematic Review." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.128.
Full textAbstract:
Background: Deep brain stimulation (DBS) is a promising adjuvant therapy for Parkinson’s disease (PD) in intermediate and advanced states, improving motor symptoms and life quality. Objectives: To investigate the efficacy of DBS in PD treatment. Design and Setting: Systematic review performed on medical school in Brazil. Methods: A literature review in the MedLine database was conducted using the following descriptors: “Deep Brain Stimulation”, “Parkinson’s Disease” and its variations according to MeSH. Only randomized controlled trials conducted in humans and published in English in the last 10 years were included. The PRISMA statement was used to improve this systematic review’s findings. Results: Three clinical trials that evaluated the effects of DBS in PD’s management were analysed. The main result measurement tools used in the studies were the PDQ-39-SI and UPDRS-III scores. Hacked ML et al. (2018) concluded that drug therapy + DBS was significantly superior to isolated drug therapy (p <0.0002). Schuepbach WMM et al. (2019) found that the experimental group presented significantly better outcomes in comparison to the control group (p <0,05). Birchall EL et al. (2016) suggested that the DBS device implant in the subthalamic nucleus caused significant improvement in depressive symptoms, motor symptoms, quality of sleep (p <0.0001) and quality of life (p=0.0005) in comparison to the control group. Conclusions: DBS has shown to be an efficient therapy for PD, once it promoted better outcomes regarding motor symptoms, depression, quality of life and quality of sleep. However, it is necessary to be aware of eventual side effects in the post-operative period.
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Rodrigues, Amanda Gabriele Coelho, Ana Cassia Gonzalez dos Santos, Ligia Aurelio Vieira Pianta Tavares, and Beatriz Trajano Costa da Silva. "Complications after deep brain stimulator implantation in parkinson’s disease." In XIV Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2023. http://dx.doi.org/10.5327/1516-3180.141s1.384.
Full textAbstract:
Introduction: Parkinson’s disease (PD) is the second most common neurodegenerative disease, its prevalence increases exponentially with age, generating a series of physical, cognitive and emotional non-motor symptoms that disrupt functionality and interfere with quality of life. Surgical treatment with a deep brain stimulator (DBS) implant is an established method for treating these patients. Objectives: To describe the complications in DBS surgery for Parkinson’s. Methods: A literature review was performed using the SciELO, MEDLINE/ PubMed, Virtual Health Library and LILACS platforms, with the descriptors: “Parkinson”, “Deep brain stimulation”, “Subthalamic nucleus” and “surgery”. and “complicações” in Portuguese and English, in the last five years. In the end, 11 articles entered the review. Results: Motor impairment in activities of daily living has been described as post-surgical complications, even if it is minor compared to psychobehavioral manifestations. With regard to the most reported psychiatric symptoms, impulsivity, delirium, mania, depressive states, aggression, hallucinations and delusions, were the complications found after DBS implementation. Decline in verbal fluency and postoperative confusion were evidenced in several studies. Conclusion: Deep brain stimulation for Parkinson’s disease is an established advanced therapy that addresses motor symptoms and improves quality of life, however, it has been associated with numerous neuropsychiatric symptoms, these symptoms can be distressing, requiring intervention psychiatric. In short, the studies found in the selected articles indicate that it is necessary to direct and reprogram the devices to reduce the postoperative neuropsychiatric impairment, thus allowing the anticipation and prevention of these neuropsychiatric complications, improving the safety and tolerability of these patients.
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Oliveira Júnior, Rocymar Rebouças, Ana Carolina Soares de Lira, Nilson Batista Lemos, Lucas Sávio Fernandes Carvalho, Maria Júlia Plech Guimarães, Marialice Pinto Viana Correia, and Luciana Karla Viana Barroso. "The Non-motor Effects of Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Motor Disorders Caused by Parkinson’s Disease." In XIII Congresso Paulista de Neurologia. Zeppelini Editorial e Comunicação, 2021. http://dx.doi.org/10.5327/1516-3180.655.
Full textAbstract:
Introduction: Parkinson’s disease is a disease caused by the degeneration of dopaminergic neurons in the substantia nigra, and is characterized by a triad of symptoms: bradykinesia, muscle rigidity and rest tremors; which worsen progressively, leading the patient to resort to surgical treatment to ensure a better drug response. However, surgical intervention has proven to be efficient not only to alleviate Movement Disorders, but also to control the nonmotor symptoms of the disease. Objective: To evaluate the non-motor effects of Deep Brain Stimulation (DBS) in patients who do not respond adequately to drug treatment. Methods: This is a literature review conducted by searching the electronic databases Lilacs, Scielo, Medline and Pubmed from 2011 to 2021, using the descriptors “parkinsonism”, “deep brain stimulation”, “non-motor” and “depression”. Articles and specimens from the American and Brazilian literature on the topic were considered relevant. Results: The studies showed that patients who underwent the surgical procedure showed evolution of neurophysiological and psychosocial aspects, such as improved sleep quality, reduced risk of dementia, improved mood and minimized anxiety. In this sense, it is necessary to pay attention to the stage of Parkinson’s Disease evolution that the patient is in, in order to start the surgical treatment before it no longer has the expected expressive effects. Conclusion: It is expected, therefore, a significant improvement in the quality of life of patients undergoing PCT, which is not restricted to motor gains.