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1.
Dev Med Child Neurol ; 62(1): 28-33, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31211420

RESUMO

Cerebral palsy (CP) is a complex disorder and children frequently have multiple impairments. Dystonia is a particularly frustrating impairment that interferes with rehabilitation and function and is difficult to treat. Of the available treatments, deep brain stimulation (DBS) has emerged as an option with the potential for large effect size in a subgroup of children. While brain stimulation has been used in CP for more than 40 years, modern devices and targeting methods are improving both the safety and efficacy of the procedure. Successful use of DBS depends on appropriate selection of patients, identification of effective neuroanatomical targets in each patient, careful neurosurgical procedure, and detailed follow-up evaluation and programming. The use of functional neurosurgery for neuromodulation in CP remains a technology in its infancy, but improving experience and knowledge are likely to make this one of the safest and most effective interventions for children with moderate-to-severe motor disorders. This review summarizes the current procedures for patient and target selection, and surgical implantation of DBS electrodes for CP. The history of DBS and future directions when used in secondary dystonia are also examined. WHAT THIS PAPER ADDS: Selection of candidates for deep brain stimulation (DBS) requires understanding of dystonia in cerebral palsy . DBS could become a first-line treatment option in some children.


Assuntos
Paralisia Cerebral/terapia , Estimulação Encefálica Profunda , Distonia/terapia , Paralisia Cerebral/complicações , Paralisia Cerebral/cirurgia , Criança , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/normas , Estimulação Encefálica Profunda/tendências , Distonia/etiologia , Distonia/cirurgia , Humanos
2.
J Neurosurg ; 131(2): 333-342, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370011

RESUMO

Deep brain stimulation (DBS) has evolved considerably over the past 4 decades. Although it has primarily been used to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia, recently it has been approved to treat obsessive-compulsive disorder and epilepsy. Novel potential indications in both neurological and psychiatric disorders are undergoing active study. There have been significant advances in DBS technology, including preoperative and intraoperative imaging, surgical approaches and techniques, and device improvements. In addition to providing significant clinical benefits and improving quality of life, DBS has also increased the understanding of human electrophysiology and network interactions. Despite the value of DBS, future developments should be aimed at developing less invasive techniques and attaining not just symptom improvement but curative disease modification.


Assuntos
Estimulação Encefálica Profunda/tendências , Transtornos Mentais/cirurgia , Doenças do Sistema Nervoso/cirurgia , Estimulação Encefálica Profunda/métodos , Previsões , Humanos , Transtornos Mentais/diagnóstico por imagem , Doenças do Sistema Nervoso/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos
3.
Stereotact Funct Neurosurg ; 97(3): 141-152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31412334

RESUMO

The last two decades have seen a re-emergence of surgery for intractable psychiatric disease, in large part due to increased use of deep brain stimulation. The development of more precise, image-guided, less invasive interventions has improved the safety of these procedures, even though the relative merits of modulation at various targets remain under investigation. With an increase in the number and type of interventions for modulating mood/anxiety circuits, the need for biomarkers to guide surgeries and predict treatment response is as critical as ever. Electroencephalography (EEG) has a long history in clinical neurology, cognitive neuroscience, and functional neurosurgery, but has limited prior usage in psychiatric surgery. MEDLINE, Embase, and Psyc-INFO searches on the use of EEG in guiding psychiatric surgery yielded 611 articles, which were screened for relevance and quality. We synthesized three important themes. First, considerable evidence supports EEG as a biomarker for response to various surgical and non-surgical therapies, but large-scale investigations are lacking. Second, intraoperative EEG is likely more valuable than surface EEG for guiding target selection, but comes at the cost of greater invasiveness. Finally, EEG may be a promising tool for objective functional feedback in developing "closed-loop" psychosurgeries, but more systematic investigations are required.


Assuntos
Eletroencefalografia/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Transtornos Mentais/cirurgia , Psicocirurgia/métodos , Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/tendências , Eletroencefalografia/tendências , Previsões , Humanos , Monitorização Neurofisiológica Intraoperatória/tendências , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/tendências , Psicocirurgia/tendências
4.
J Clin Neurosci ; 68: 13-19, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31375306

RESUMO

Implantable neurostimulation devices provide a direct therapeutic link to the nervous system and can be considered brain-computer interfaces (BCI). Under this definition, BCI are not simply science fiction, they are part of existing neurosurgical practice. Clinical BCI are standard of care for historically difficult to treat neurological disorders. These systems target the central and peripheral nervous system and include Vagus Nerve Stimulation, Responsive Neurostimulation, and Deep Brain Stimulation. Recent advances in clinical BCI have focused on creating "closed-loop" systems. These systems rely on biomarker feedback and promise individualized therapy with optimal stimulation delivery and minimal side effects. Success of clinical BCI has paralleled research efforts to create BCI that restore upper extremity motor and sensory function to patients. Efforts to develop closed loop motor/sensory BCI is linked to the successes of today's clinical BCI.


Assuntos
Interfaces Cérebro-Computador/tendências , Estimulação Encefálica Profunda/tendências , Doenças do Sistema Nervoso/terapia , Estimulação do Nervo Vago/tendências , Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/métodos , Humanos , Estimulação do Nervo Vago/instrumentação , Estimulação do Nervo Vago/métodos
5.
Stereotact Funct Neurosurg ; 97(2): 106-112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31266044

RESUMO

OBJECTIVE: This study aimed to describe the change in functional status following bilateral subthalamic nucleus stimulation (STN-DBS) in Parkinson's disease (PD) and to identify predictors of postoperative functional dependence. METHODS: We included PD patients with bilateral STN-DBS who had complete Schwab & England Activities of Daily Living (S&E ADL) Scale data at baseline and 6 months after surgery from our prospective registry. Functional dependence was defined as an S&E ADL score of less than 80%. All data were collected from the on-medication state and on-stimulation state (after surgery). Logistic regression analyses were performed to determine the factors predictive of functional dependence after surgery. RESULTS: A total of 196 patients were included. At baseline, 41 patients were functionally dependent and the other 155 were functionally independent. Among the patients with preoperative dependence, 32 (78%) became functionally independent after surgery, and this conversion was associated with a lower baseline axial score (p = 0.012). Among the patients with preoperative independence, 21 (14%) developed postoperative dependence, and this conversion was associated with a higher baseline axial score (p = 0.013) and its smaller improvement (p < 0.001). Female sex (odds ratio [OR] 3.214; 95% confidence interval [CI] 1.210-8.542; p = 0.019) and a higher baseline axial score (OR 1.184; 95% CI 1.056-1.327; p = 0.004) significantly predicted the risk of postoperative functional dependence. CONCLUSIONS: We found that functional status following bilateral STN-DBS is closely related to preoperative axial symptoms. When loss of independence is a potential target for STN-DBS, clinicians should take into consideration the severity of axial impairment before surgery.


Assuntos
Atividades Cotidianas , Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Recuperação de Função Fisiológica/fisiologia , Núcleo Subtalâmico/fisiologia , Atividades Cotidianas/psicologia , Adulto , Idoso , Estimulação Encefálica Profunda/tendências , Inglaterra/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/epidemiologia , Doença de Parkinson/psicologia , Estudos Prospectivos , Resultado do Tratamento
6.
Rev. Hosp. Ital. B. Aires (2004) ; 39(2): 64-66, jun. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1048015

RESUMO

El trastorno obsesivo-compulsivo (TOC) afecta al 2% de la población general, llegando en ocasiones a causar un deterioro funcional severo y de la calidad de vida de las personas afectadas. Entre el 10 y el 30% de los pacientes con este trastorno no responde a los tratamientos recomendados: farmacológicos y terapia cognitivo-conductual. La Food and Drug Administration de los Estados Unidos (FDA) aprobó en el año 2008 la Estimulación cerebral profunda (ECP) para pacientes con TOC resistente a tratamiento. La ECP, utilizada frecuentemente para el tratamiento de la enfermedad de Parkinson refractaria, es una opción viable para los pacientes con TOC resistente, con efectos adversos poco frecuentes y transitorios. (AU)


Obsessive-compulsive disorder (OCD) affects 2% of the general population, sometimes resulting in severe impairment of functional capacity and quality of life of affected people. Between 10 and 30% of these patients do not respond to recommended treatments: pharmacological and cognitive behavioral therapy. In 2008, the FDA approved Deep Brain Stimulation (DBS) for patients with OCD resistant to treatment. DBS, frequently used for the treatment of refractory Parkinson's disease, is a viable option for the treatment of patients with resistant OCD, with infrequent and transient adverse effects. (AU)


Assuntos
Humanos , Estimulação Encefálica Profunda/métodos , Transtorno Obsessivo-Compulsivo/terapia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Qualidade de Vida , Sinais e Sintomas , Estimulação Encefálica Profunda/efeitos adversos , Estimulação Encefálica Profunda/tendências , Transtornos Mentais/cirurgia , Transtorno Obsessivo-Compulsivo/complicações , Transtorno Obsessivo-Compulsivo/etiologia , Transtorno Obsessivo-Compulsivo/tratamento farmacológico
8.
Int J Neurosci ; 129(10): 1013-1023, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31092102

RESUMO

The effective treatment of many diseases requires the use of multiple treatment strategies among which neuromodulation is playing an increasingly important role. Neuromodulation devices that act to normalize or modulate nerve activity through the targeted delivery of electrical stimuli will be the focus of this review. These devices encompass deep brain stimulators, vagus nerve stimulators, spinal cord simulators and sacral nerve stimulators. Already neuromodulation has proven successful in the treatment of a broad range of conditions from Parkinson's disease to chronic pain and urinary incontinence. Many of these approaches seek to exploit the activities of the autonomic nervous system, which influences organ function through the release of neurotransmitters and associated signalling cascades. This review will outline existing and emerging applications for each of these neuromodulation devices, proposed mechanisms of action and clinical studies evaluating both their safety and therapeutic efficacy.


Assuntos
Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/tendências , Estimulação Elétrica Nervosa Transcutânea/métodos , Estimulação Elétrica Nervosa Transcutânea/tendências , Ensaios Clínicos como Assunto/métodos , Estimulação Encefálica Profunda/métodos , Estimulação Encefálica Profunda/tendências , Epilepsia/fisiopatologia , Epilepsia/terapia , Humanos , Doença de Parkinson/fisiopatologia , Doença de Parkinson/terapia , Estimulação da Medula Espinal/métodos , Estimulação da Medula Espinal/tendências , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Resultado do Tratamento , Estimulação do Nervo Vago/métodos , Estimulação do Nervo Vago/tendências
9.
Neuromodulation ; 22(4): 484-488, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31120180

RESUMO

OBJECTIVES: This study sought to determine whether there is a gender disparity in patients undergoing deep brain stimulation (DBS) surgery for Parkinson's disease (PD) at a single health system, and better understand the reasons for this discrepancy. MATERIALS AND METHODS: We analyzed data from the University of Miami DBS Database, which included 3251 PD patients, using chi-square, repeated measures ANOVA, and t tests to examine gender differences in the number of patients referred for surgery, reasons for referral, number receiving/not receiving surgery, reasons for not receiving surgery, and postsurgical outcomes. RESULTS: During the study period, 207 PD patients were referred for DBS (75.8% male), and 100 underwent surgery (77.0% male). Of those who did not receive surgery, the most common reasons were need for further medical optimization (26.2%), suboptimal performance on neuropsychological evaluation (22.4%), other reason (20.6%), lost to follow-up (18.7%), or patient preference (12.2%). However, in women one of the most common reasons was patient preference (28.0%), and this was significant compared to men (p < 0.001). Men were more likely to be lost to follow-up (p = 0.046). There was no statistically significant difference in postsurgical outcomes. CONCLUSIONS: Despite similar postsurgical improvements, women were less likely to undergo DBS surgery due to their own preference, while men were more likely to be lost to follow-up. These data underscore the need for increased education and awareness of DBS so that all patients with PD who qualify for surgery can benefit from this procedure.


Assuntos
Estimulação Encefálica Profunda/psicologia , Disparidades em Assistência à Saúde , Doença de Parkinson/psicologia , Doença de Parkinson/cirurgia , Preferência do Paciente/psicologia , Caracteres Sexuais , Idoso , Estimulação Encefálica Profunda/tendências , Feminino , Seguimentos , Disparidades em Assistência à Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico
10.
Neuromodulation ; 22(4): 451-455, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30951239

RESUMO

OBJECTIVES: To compare the therapeutic window (TW) of cathodic monopolar, bipolar, anodic monopolar, and a novel "semi-bipolar" stimulation in ten Parkinson's disease patients who underwent deep brain stimulation of the subthalamic nucleus. MATERIALS AND METHODS: Patients were assessed in the "OFF" L-dopa condition. Each upper limb was tested separately for therapeutic threshold, TW and side-effect threshold (SET). Battery consumption index (BCI) also was documented. RESULTS: Compared to cathodic stimulation, therapeutic threshold was significantly higher for anodic, bipolar, and semi-bipolar stimulation (3.8 ± 1.6 vs. 4.9 ± 2.1, 5.0 ± 1.9, and 5.2 ± 1.9 mA, p = 0.0006, 0.0002, and 0.008, respectively). SET was significantly higher for bipolar stimulation (10.9 ± 2.5 mA) vs. cathodic (6.8 ± 2.2 mA, p < 0.0001) and anodic stimulation (9.2 ± 2.6 mA, p = 0.005). The SET of anodic and semi-bipolar stimulation was significantly higher vs. cathodic stimulation (p < 0.0001). TW of cathodic stimulation (2.5 ± 1.5 mA) was significantly narrower vs. bipolar (5.4 ± 2.0 mA, p < 0.0001), semi-bipolar (4.6 ± 2.6 mA, p = 0.001) and anodic stimulation (4.3 ± 2.3 mA, p < 0.0001). Bipolar (p = 0.005) and semi-bipolar (p = 0.0005) stimulation had a significantly wider TW vs. anodic stimulation. BCI of cathodic stimulation (5.9 ± 1.3) was significantly lower compared to bipolar (13.7 ± 6.8, p < 0.0001), semi-bipolar (11.0 ± 4.3, p = 0.0005), and anodic stimulation (8.1 ± 3.0, p < 0.0001). Anodic BCI was significantly lower than bipolar (p = 0.005) and semi-bipolar (p = 0.0002) stimulation while semi-bipolar BCI was lower than bipolar stimulation (p = 0.0005). CONCLUSIONS: While awaiting further studies, our findings suggest that cathodic stimulation should be preferred in light of its reduced battery consumption, possibly followed by semi-bipolar in case of stimulation-induced side-effects.


Assuntos
Estimulação Encefálica Profunda/tendências , Eletrodos Implantados/tendências , Doença de Parkinson/terapia , Idoso , Estimulação Encefálica Profunda/instrumentação , Estimulação Encefálica Profunda/normas , Eletrodos/normas , Eletrodos/tendências , Eletrodos Implantados/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico
11.
Brain Stimul ; 12(4): 851-857, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30842036

RESUMO

BACKGROUND: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established treatment for motor complications in Parkinson disease (PD). Since 2012, the nonrechargeable dual-channel neurostimulator available in France seems to have shorter battery longevity compared to the same manufacturer's previous model. OBJECTIVE: The aim of this study was to evaluate the battery longevity of older and more recent neurostimulators from the same manufacturer and to explore factors associated with battery life variations. MATERIALS AND METHODS: We retrospectively studied our cohort of PD patients who underwent STN DBS between 1987 and 2017. We collected data concerning neurostimulator replacements and parameters. We compared the survival of the first device available, Kinetra® and the current one, Activa-PC® (Medtronic Inc.) and estimated the factors that had an impact on battery longevity through a Cox logistic regression. RESULTS: Three hundred sixty-four PD patients received a total of 654 DBS STN neurostimulators: 317 Kinetra® and 337 Activa-PC®. The survival analysis, using the Kaplan-Meier estimator, showed a difference between the curves of the two devices (log-rank test; p < 0.001). The median survival of an Activa-PC® neurostimulator was 1666 days, while it was 2379 days for a Kinetra®. After adjustment, according to the multivariate analysis, the main factors associated with battery lifetime were: the neurostimulator type; the number of subsequent neurostimulator implantations; the total electrical energy delivered (TEED); and sex. CONCLUSION: The Kinetra® neurostimulator lifetime is 2.5 years longer than the Activa-PC®. The type of the device, the high TEED and the number of subsequent neurostimulator implantations influence battery longevity most. These results have medical-economic implications since the survival of PD patients with DBS increases over years.


Assuntos
Estimulação Encefálica Profunda/tendências , Fontes de Energia Elétrica/tendências , Neuroestimuladores Implantáveis/tendências , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiologia , Adulto , Idoso , Estudos de Coortes , Estimulação Encefálica Profunda/instrumentação , Eletrodos Implantados/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Estudos Retrospectivos
12.
Neuromodulation ; 22(4): 373-379, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30865342

RESUMO

OBJECTIVES: Minimally conscious state (MCS) is a disorder of consciousness in which minimal but definite behavioral evidence of self-awareness or environmental awareness is demonstrated. Deep brain stimulation (DBS) of various targets has been used to promote recovery in patients with disorders of consciousness with varying results. The aim of this systematic review was to assess the effects of DBS in MCS following traumatic brain injury (TBI). MATERIALS AND METHODS: A systematic literature review was carried out using a number of electronic bibliographic data bases to identify relevant studies. We included all studies describing applications of DBS on patients in MCS following TBI. RESULTS: Eight studies were identified, including a total of ten patients, aged 15-58 years. The time from injury to stimulation ranged from 3 to 252 months, with the duration of follow-up post-DBS ranging from 10 to 120 months. Seven patients improved their postsurgical outcome score measures (three patients with the coma recovery scale, one with the near coma scale, and three with the Glasgow outcome score). A descriptive favorable outcome was reported in one patient. Two patients were reported not to have shown any improvements following the intervention. CONCLUSIONS: Current evidence is based on a small population of heterogeneous patients. The time from injury to stimulation was significantly variable and problematic, as spontaneous recovery can occur within the first year of injury. Although seven patients showed promising results in validated outcome measures, evidence supporting the use of DBS in MCS patients following TBI is lacking. There is need for controlled and randomized studies.


Assuntos
Lesões Encefálicas Traumáticas/terapia , Estado de Consciência/fisiologia , Estimulação Encefálica Profunda/métodos , Estado Vegetativo Persistente/terapia , Recuperação de Função Fisiológica/fisiologia , Adolescente , Adulto , Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/epidemiologia , Estimulação Encefálica Profunda/tendências , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estado Vegetativo Persistente/diagnóstico , Estado Vegetativo Persistente/epidemiologia , Adulto Jovem
13.
Neuromodulation ; 22(4): 456-464, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30844131

RESUMO

OBJECTIVE: Although deep brain stimulation (DBS) is an effective treatment for movement disorders, improvement varies substantially in individuals, across clinical trials, and over time. Noninvasive biomarkers that predict the individual response to DBS could be used to optimize outcomes and drive technological innovation in neuromodulation. We sought to evaluate whether noninvasive event related potentials elicited by subthalamic DBS during surgical targeting predict the tolerability of a given stimulation site in patients with advanced Parkinson's disease. METHODS: Using electroencephalography, we measured event related potentials elicited by 20 Hz DBS over a range of stimulus intensities across the spatial extent of the implanted electrode array in 11 patients. We correlated event related potential timing and morphology with the stimulus amplitude thresholds for motor side effects during postoperative programming at ≥130 Hz. RESULTS: During surgical targeting, DBS at 20 Hz elicits large amplitude, high frequency activity (evoked HFA) with mean onset latency of 9.0 ± 0.3 msec and a mean frequency of 175.8 ± 7.8 Hz. The lowest DBS amplitude that elicits the HFA predicts thresholds for motor side effects during postoperative stimulation at ≥130 Hz (p < 0.001, ANOVA). CONCLUSION: Event related potentials elicited by DBS can predict clinically relevant corticospinal activation by stimulation after surgery. Noninvasive scalp physiology requires no patient interaction and could serve as a biomarker to guide targeting, postoperative programming, and emerging technologies such as directional and closed-loop stimulation.


Assuntos
Estimulação Encefálica Profunda/efeitos adversos , Potencial Evocado Motor/fisiologia , Córtex Motor/fisiologia , Doença de Parkinson/cirurgia , Complicações Pós-Operatórias/diagnóstico , Núcleo Subtalâmico/fisiologia , Idoso , Estimulação Encefálica Profunda/tendências , Eletrodos Implantados/efeitos adversos , Eletrodos Implantados/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Complicações Pós-Operatórias/fisiopatologia , Valor Preditivo dos Testes
14.
Brain Stimul ; 12(4): 893-900, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30876883

RESUMO

BACKGROUND: Deep brain stimulation (DBS) is a well-established surgical therapy for Parkinson's disease (PD). Intraoperative imaging (IMG), intraoperative physiology (PHY) and their combination (COMB) are the three mainstream DBS guidance methods. OBJECTIVE: To comprehensively compare the use of IMG-DBS, PHY-DBS and COMB-DBS in treating PD. METHODS: PubMed, Embase, the Cochrane Library and OpenGrey were searched to identify PD-DBS studies reporting guidance techniques published between January 1, 2010, and May 1, 2018. We quantitatively compared the therapeutic effects, surgical time, target error and complication risk and qualitatively compared the patient experience, cost and technical prospects. A meta-regression analysis was also performed. This study is registered with PROSPERO, number CRD42018105995. RESULTS: Fifty-nine cohorts were included in the main analysis. The three groups were equivalent in therapeutic effects and infection risks. IMG-DBS (p < 0.001) and COMB-DBS (p < 0.001) had a smaller target error than PHY-DBS. IMG-DBS had a shorter surgical time (p < 0.001 and p = 0.008, respectively) and a lower intracerebral hemorrhage (ICH) risk (p = 0.013 and p = 0.004, respectively) than PHY- and COMB-DBS. The use of intraoperative imaging and microelectrode recording correlated with a higher surgical accuracy (p = 0.018) and a higher risk of ICH (p = 0.049). CONCLUSIONS: The comparison of COMB-DBS and PHY-DBS showed intraoperative imaging's superiority (higher surgical accuracy), while the comparison of COMB-DBS and IMG-DBS showed physiological confirmation's inferiority (longer surgical time and higher ICH risk). Combined with previous evidence, the use of intraoperative neuroimaging techniques should become a future trend.


Assuntos
Estimulação Encefálica Profunda/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Doença de Parkinson/diagnóstico por imagem , Doença de Parkinson/terapia , Vigília/fisiologia , Estimulação Encefálica Profunda/tendências , Feminino , Humanos , Monitorização Neurofisiológica Intraoperatória/tendências , Microeletrodos , Estudos Observacionais como Assunto/métodos , Doença de Parkinson/fisiopatologia , Resultado do Tratamento
15.
Brain Stimul ; 12(4): 845-850, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30876884

RESUMO

BACKGROUND: People with Parkinson's disease (PD) treated with deep brain stimulation (DBS) with non-rechargeable implantable pulse generators (IPGs) require elective IPG replacement operations involving surgical and anesthesiologic risk. Life expectancy and the number of replacements per patient with DBS are increasing. OBJECTIVE: To determine whether IPG longevity is influenced by stimulation parameters alone or whether there is an independent effect of the number of battery replacements and IPG model. METHODS: PD patients treated with bilateral subthalamic DBS were included if there was at least one IPG replacement due to battery end of life. Fifty-five patients had one or two IPG replacements and seven had three or four replacements, (80 Kinetra® and 23 Activa-PC®). We calculated longevity corrected for total electrical energy delivered (TEED) and tested for the effect of IPG model and number of previous battery replacements on this measure. RESULTS: TEED-corrected IPG longevity for the 1st implanted IPG was 51.3 months for Kinetra® and 35.6 months for Activa-PC®, which dropped by 5.9 months and 2.8 months, respectively with each subsequent IPG replacement (p < 10-6 for IPG model and p < 10-3 for IPG number). CONCLUSIONS: Activa-PC® has shorter battery longevity than the older Kinetra®, battery longevity reduces with repeated IPG replacements and these findings are independent of TEED. Battery longevity should be considered both in clinical decisions and in the design of new DBS systems. Clinicians need accessible, reliable and user-friendly tools to provide online estimated battery consumption and end of life. Furthermore, this study supports the consideration of using rechargeable IPGs in PD.


Assuntos
Tomada de Decisão Clínica/métodos , Estimulação Encefálica Profunda/tendências , Fontes de Energia Elétrica/tendências , Eletrodos Implantados/tendências , Doença de Parkinson/terapia , Idoso , Estimulação Encefálica Profunda/instrumentação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Estudos Retrospectivos , Fatores de Tempo
16.
Neuromodulation ; 22(4): 478-483, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30908813

RESUMO

BACKGROUND: Ano-rectal motility impairment is often observed during Parkinson's disease (PD), generating symptoms as constipation and/or incontinence with impaired quality of life. Subthalamic nuclei (STN) deep brain stimulation (DBS) improves motor symptoms of PD, but its effects on anorectal motility are unknown. This study aimed to assess the effects of STN-DBS on the anorectal motility in PD patients, in a randomized cross-over study. METHODS: Sixteen PD patients with bilateral STN-DBS for at least 6 months were included. The anal resting pressure, duration and maximal amplitude of squeeze effort, recto-anal inhibitory reflex, maximal tolerable rectal volume, and anal pressure during defecation effort were measured and compared after STN-DBS was switched OFF and then ON for 2 hours, or vice-versa, in a randomized order. KEY RESULTS: STN-DBS increased maximal amplitude of anal squeezing pressure (OFF: 85.7 ± 14.5 vs ON: 108.4 ± 21.0 cmH2 O; P = 0.02), with no significant difference in the duration (P = 0.10). No other significant difference was found between stimulation conditions (OFF vs ON) for anal resting pressure (OFF: 72.5 ± 8.6 cmH2 O vs ON: 71.7 ± 9.0 cmH2 O; P = 0.24), recto-anal inhibitory reflex, maximal tolerable rectal volume (OFF: 231 ± 24 mL vs ON: 241 ± 26 mL; P = 0.68), or anal pressure during defecation effort with a similar rate of ano-rectal dyssynergia (7/16 and 8/16 with and without STN-DBS, respectively). No order effect (ON-OFF vs OFF-ON) was observed. CONCLUSION AND INFERENCES: STN-DBS increased anal squeezing pressure, but did not modify anorectal dyssynergia in PD patients, This study demonstrated the involvement of STN in the voluntary control of anorectal motility in PD patients.


Assuntos
Canal Anal/fisiologia , Estimulação Encefálica Profunda/métodos , Motilidade Gastrointestinal/fisiologia , Doença de Parkinson/terapia , Reto/fisiologia , Núcleo Subtalâmico/fisiologia , Adulto , Idoso , Estudos Cross-Over , Estimulação Encefálica Profunda/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Estudo de Prova de Conceito
17.
Neuromodulation ; 22(4): 403-415, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30775834

RESUMO

OBJECTIVE: Detailed biophysical modeling of deep brain stimulation (DBS) provides a theoretical approach to quantify the cellular response to the applied electric field. However, the most accurate models for performing such analyses, patient-specific field-cable (FC) pathway-activation models (PAMs), are so technically demanding to implement that their use in clinical research is greatly limited. Predictive algorithms can simplify PAM calculations, but they generally fail to reproduce the output of FC models when evaluated over a wide range of clinically relevant stimulation parameters. Therefore, we set out to develop a novel driving-force (DF) predictive algorithm (DF-Howell), customized to the study of DBS, which can better match FC results. METHODS: We developed the DF-Howell algorithm and compared its predictions to FC PAM results, as well as to the DF-Peterson algorithm, which is currently the most accurate and generalizable DF-based method. Comparison of the various methods was quantified within the context of subthalamic DBS using activation thresholds of axons representing the internal capsule, hyperdirect pathway, and cerebellothalamic tract for various combinations of fiber diameters, stimulus pulse widths, and electrode configurations. RESULTS: The DF-Howell predictor estimated activation of the three axonal pathways with less than a 6.2% mean error with respect to the FC PAM for all 21 cases tested. In 15 of the 21 cases, DF-Howell outperformed DF-Peterson in estimating pathway activation, reducing mean-errors up to 22.5%. CONCLUSIONS: DF-Howell represents an accurate predictor for estimating axonal pathway activation in patient-specific DBS models, but errors still exist relative to FC PAM calculations. Nonetheless, the tractability of DF algorithms helps to reduce the technical barriers for performing accurate biophysical modeling in clinical DBS research studies.


Assuntos
Algoritmos , Estimulação Encefálica Profunda/tendências , Cápsula Interna/diagnóstico por imagem , Modelos Neurológicos , Núcleo Subtalâmico/diagnóstico por imagem , Axônios/fisiologia , Estimulação Encefálica Profunda/métodos , Previsões , Humanos , Cápsula Interna/fisiologia , Núcleo Subtalâmico/fisiologia
19.
J Neurosurg ; 131(6): 1797-1804, 2019 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-30641837

RESUMO

OBJECTIVE: Subthalamic nucleus deep brain stimulation (STN DBS) is effective against freezing of gait (FOG) in Parkinson's disease (PD); however, whether this effect persists over the long term is debated. The aim of the current study was to investigate the long-term effect of STN DBS on FOG in patients with PD. METHODS: Data on 52 cases in which PD patients received bilateral STN DBS were obtained from a prospective registry. The authors blindly analyzed FOG incidence and its severity from the videotapes of a 5-m walking task at the baseline and at the 1-, 2-, and 5- or 7-year follow-up visits. They also compared the axial score from the Unified Parkinson's Disease Rating Scale (UPDRS) part III, UPDRS part II (UPDRS-II) item 14, and the FOG questionnaire (FOG-Q). Postoperatively, video-based FOG analysis and the axial score were evaluated under 4 conditions (off-medication/off-stimulation, off-medication/on-stimulation, on-medication/off-stimulation, and on-medication/on-stimulation), and UPDRS-II item 14 and the FOG-Q score were evaluated under 2 conditions (off-medication/on-stimulation and on-medication/on-stimulation). RESULTS: During the off-medication state, the on-stimulation condition improved FOG outcomes, except for video-based FOG severity, up to the last follow-up compared with the baseline. Video-based FOG outcomes and the axial score during the off-medication state were improved with the on-stimulation condition up to the last follow-up compared with the off-stimulation condition. During the on-medication state, the on-stimulation condition did not improve any FOG outcome compared with the baseline; however, it improved video-based FOG outcomes up to the 2-year follow-up and the axial score up to the last follow-up compared with the off-stimulation condition. CONCLUSIONS: Our findings suggest that STN DBS has a long-term effect on FOG in the off-medication state. However, STN DBS did not show a long-term effect on FOG in the on-medication state, although it had a short-term effect until the 2-year follow-up.


Assuntos
Estimulação Encefálica Profunda/tendências , Transtornos Neurológicos da Marcha/terapia , Doença de Parkinson/terapia , Núcleo Subtalâmico , Idoso , Estimulação Encefálica Profunda/métodos , Feminino , Seguimentos , Transtornos Neurológicos da Marcha/diagnóstico por imagem , Transtornos Neurológicos da Marcha/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/complicações , Doença de Parkinson/diagnóstico por imagem , Núcleo Subtalâmico/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento
20.
Brain Stimul ; 12(1): 175-183, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30245163

RESUMO

BACKGROUND: Deep brain stimulation (DBS) is currently used to treat addiction, with the nucleus accumbens (NAc) as one promising target. The anterior limb of the internal capsule (ALIC) is also a potential target, as it carries fiber tracts connecting the mesocorticolimbic circuits that are crucially involved in several psychiatric disorders, including addiction. Stimulating the NAc and ALIC simultaneously may have a synergistic effect against addiction. METHODS: Eight patients with a long history of heroin use and multiple relapses, despite optimal conventional treatments, were enrolled. Customized electrodes were implanted through the ALIC into the NAc, and deep brain stimulation (DBS) treatment began two weeks after surgery. The patients were followed for at least 24 months. The duration of drug-free time, severity of drug cravings, psychometric evaluations, and PET studies of glucose metabolism before and after DBS were conducted. All adverse events were recorded. RESULTS: With DBS, five patients were abstinent for more than three years, two relapsed after abstaining for six months, and one was lost of follow-up at three months. The degree of cravings for drug use after DBS was reduced if the patients remained abstinent (p < 0.001). Simultaneous DBS of the NAc and ALIC also improved the quality of life, alleviated psychiatric symptoms, and increased glucose metabolism in addiction-related brain regions. Moreover, stimulation-related adverse events were few and reversible. CONCLUSIONS: Simultaneous DBS of the NAc and ALIC appears to be safe, with few side effects, and may prevent long-term heroin relapse after detoxification in certain patients. (This trial was registered at ClinicalTrials.gov, NCT01274988).


Assuntos
Estimulação Encefálica Profunda/tendências , Dependência de Heroína/diagnóstico por imagem , Dependência de Heroína/terapia , Cápsula Interna/diagnóstico por imagem , Núcleo Accumbens/diagnóstico por imagem , Adulto , Estimulação Encefálica Profunda/métodos , Feminino , Seguimentos , Dependência de Heroína/psicologia , Humanos , Cápsula Interna/fisiologia , Masculino , Pessoa de Meia-Idade , Núcleo Accumbens/fisiologia , Projetos Piloto , Qualidade de Vida , Recidiva , Fatores de Tempo , Adulto Jovem
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