Postmortem studies of deep brain stimulation for Parkinson's disease: a systematic review of the literature.

Deep brain stimulation (DBS), arguably the greatest therapeutic advancement in the treatment of Parkinson's disease since dopamine replacement therapy, is now routinely used. While the exact mechanisms by which DBS works still remain unknown, over the past three decades since it was first described, we have gained significant insight into several of the processes involved. Though often overlooked in this regard, increasing numbers of postmortem and autopsy studies are contributing significantly to our understanding. In this manuscript, we review the literature involving the pathological findings from autopsies in patients who have undergone deep brain stimulation surgeries for Parkinson's disease. The major results show that multiple stereotactic targeting methods can be accurate at placing leads in the desired nuclei that help with clinically effective results, that perioperative complications and inaccurate diagnosis as determined by autopsy can lead to suboptimal stimulation effect and that the normal long-term effects of chronic stimulation include fibrosis around the electrodes and a mild immune response. In addition, recent results suggest mechanisms by which DBS might be effective in Parkinson's disease i.e., through rescuing pathological changes in microvasculature and by promoting the proliferation of neural progenitor cells.

Random-Access Multiphoton Microscopy for Fast Three-Dimensional Imaging.

Studies in several important areas of neuroscience, including analysis of single neurons as well as neural networks, continue to be limited by currently available experimental tools. By combining molecular probes of cellular function, such as voltage-sensitive or calcium-sensitive dyes, with advanced microscopy techniques such as multiphoton microscopy, experimental neurophysiologists have been able to partially reduce this limitation. These approaches usually provide the needed spatial resolution along with convenient optical sectioning capabilities for isolating regions of interest. However, they often fall short in providing the necessary temporal resolution, primarily due to their restrained laser scanning mechanisms. In this regard, we review a method of laser scanning for multiphoton microscopy that overcomes the temporal limitations of pervious approaches and allows for what is known as 3D Random Access Multiphoton (3D RAMP) microscopy, an imaging technique that supports full three dimensional recording of many sites of interest on physiologically relevant time scales.

Anatomic Targeting of the Optimal Location for Thalamic Deep Brain Stimulation in Patients with Essential Tremor.

BACKGROUND: Thalamic deep brain stimulation (DBS) is an effective strategy for treatment of essential tremor (ET). With limitations of imaging modalities, targeting largely relies on indirect methods. This study was designed to determine the optimal target for DBS in ET and construct a targeting method based on probabilistic maps. METHODS: Patients with ET who had sustained tremor reduction at 1 year and optimal microelectrode recordings were selected. Stimulation volume was individually modeled in standard space, and a final optimal region was derived for the whole population. A fornix (FX) targeting method was developed to determine the location of the optimal stimulation site relative to the FX and posterior commissure (PC) in the anteroposterior plane, the border between the thalamus and internal capsule in the mediolateral plane, and the anterior commissure (AC)-PC (AC-PC) plane in the dorsoventral axis. Following comparative analyses with other standard indirect methods (25% of AC-PC and PC + 6 mm), the FX method was studied in relation to diffusion tensor imaging. RESULTS: Using the FX method, the optimal stimulation site was at the intersection of two thirds and one third of the PC-FX distance (mean of 28% ± 1.5 AC-PC length) and 4 mm medial to the lateral border of the thalamus. Compared with previously used methods, there was a significant reduction in variability of the optimal stimulation site with the FX method. The target defined using this strategy was found to be within the boundaries of the dentatorubrothalamic tract. CONCLUSIONS: The FX method may be an additional targeting strategy in patients undergoing thalamic DBS surgery.

Management of Skull Base Tumor-Associated Facial Pain.

Cancer-associated facial pain can be caused by a variety of pathologic conditions. Here the authors describe the symptoms and incidence of facial pain secondary to three separate anatomic subcategories of cancer. The authors subsequently discuss the effectiveness and drawbacks of the most common methods of treatment.

Fast three-dimensional laser scanning scheme using acousto-optic deflectors.

A scheme for fast 3-D laser scanning using acousto-optic deflectors is proposed and demonstrated. By employing counterpropagating acoustic waves that are both chirped and offset in their frequencies, we show that it is possible to simultaneously scan both axially and laterally with frame rates on the order of tens of kilohertz. This scheme was specifically designed for application with multiphoton imaging, particularly of neurons, where it will enable the concurrent monitoring of physiological signals at multiple locations within a microscopic 3-D volume (350 x 350 x 200 microm). When used for this purpose, we demonstrate how this scheme would also inherently compensate for spatial dispersion when ultrafast laser pulses are used in acousto-optic multiphoton microscopy.

Trigeminal and glossopharyngeal neuralgia.

Trigeminal neuralgia and glossopharyngeal neuralgia are two causes of paroxysmal craniofacial pain. Either can be debilitating in affected individuals. This article reviews the epidemiology, pathogenesis, diagnosis, and treatment options for these disorders.

High-speed two-photon imaging.

The small size of neuronal dendrites and spines combined with the high speed of neurophysiological signals, such as transients in membrane potential or ion concentration, necessitates that any functional study of these structures uses recording methods with both high spatial and high temporal resolutions. In this regard, conventional two-photon microscopy, in combination with fluorescent indicators sensitive to physiological parameters, has proved to be only a partial solution by providing near-diffraction-limited spatial resolution even when imaging structures deep inside light-scattering tissue. This is because the relatively slow beam-scanning methods used in most conventional two-photon microscopes severely limit the extent to which functional data can be recorded. Here, we detail developments to create high-speed two-photon imaging systems that overcome this limitation and discuss important considerations that must be taken into account when attempting to construct such systems.