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1.
Nat Commun ; 10(1): 4798, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31641118

RESUMO

Inhibitory control is fundamental to children's self-regulation and cognitive development. Here we investigate cortical-basal ganglia pathways underlying inhibitory control in children and their adult-like maturity. We first conduct a comprehensive meta-analysis of extant neurodevelopmental studies of inhibitory control and highlight important gaps in the literature. Second, we examine cortical-basal ganglia activation during inhibitory control in children ages 9-12 and demonstrate the formation of an adult-like inhibitory control network by late childhood. Third, we develop a neural maturation index (NMI), which assesses the similarity of brain activation patterns between children and adults, and demonstrate that higher NMI in children predicts better inhibitory control. Fourth, we show that activity in the subthalamic nucleus and its effective connectivity with the right anterior insula predicts children's inhibitory control. Fifth, we replicate our findings across multiple cohorts. Our findings provide insights into cortical-basal ganglia circuits and global brain organization underlying the development of inhibitory control.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiologia , Adolescente , Adulto , Gânglios da Base/fisiologia , Córtex Cerebral/fisiologia , Criança , Bases de Dados Factuais , Humanos , Imagem por Ressonância Magnética , Tempo de Reação/fisiologia , Núcleo Subtalâmico/fisiologia , Adulto Jovem
2.
Artigo em Russo | MEDLINE | ID: mdl-31626229

RESUMO

An effect of deep brain stimulation on postural instability and gait disorders in Parkinson's disease S.G. Sultanova, N.V. Fedorova, E.V. Bril, A.A. Gamaleya, A.A. Tomskiy During the last time, surgical treatment of patients with Parkinson's disease has firmly taken its place in the general algorithm for managing patients with this pathology. Deep brain electrostimulation is the most advanced and promising method, which allows the reduction in the severity of main clinical manifestations of the disease, including axial symptoms. It is noted that certain temporal aspects of parkinsonian gait disorder remain therapeutically resistant. Subthalamic nucleus stimulation was also reported to improve levodopa-responsive freezing of gait. In this review, the authors summarize the effects of deep brain stimulation on gait and postural symptoms.


Assuntos
Estimulação Encefálica Profunda , Transtornos Neurológicos da Marcha , Doença de Parkinson , Marcha , Transtornos Neurológicos da Marcha/complicações , Transtornos Neurológicos da Marcha/terapia , Humanos , Doença de Parkinson/complicações , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiologia
3.
Stereotact Funct Neurosurg ; 97(3): 183-188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31600751

RESUMO

Three right-handed patients diagnosed with Holmes tremor (HT), who suffered from pharmacotherapy-refractory tremor, were eligible for unilateral posterior subthalamic area deep brain stimulation (PSA-DBS). All patients were evaluated with the Fahn-Tolosa-Marin Tremor Rating Scale (FTMTRS) and Clinical Global Impression scale (CGI) before DBS, 6, and 12 months after the PSA-DBS as well as at the last follow-up. In all patients, we observed a significant improvement of tremor control as demonstrated by changes in the FTMTRS and the CGI scales. Mean improvement of tremor in all patients was 56% for the FTMRTS with a corresponding change in the CGI scale. Our study demonstrates that PSA-DBS is efficacious in the treatment of HT. Indeed, PSA is a promising target for DBS for intractable proximal and distal tremor, even in cases of previous, suboptimal functional neurosurgery. The beneficial effect lasts over a long-term follow-up. PSA-DBS may be considered as an alternative target of DBS in tremor treatment.


Assuntos
Ataxia/diagnóstico por imagem , Ataxia/terapia , Estimulação Encefálica Profunda/métodos , Núcleo Subtalâmico/diagnóstico por imagem , Núcleo Subtalâmico/fisiologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Resultado do Tratamento
4.
Stereotact Funct Neurosurg ; 97(3): 207-211, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31600763

RESUMO

The authors describe how severe coughing and breathing issues were caused by a deep brain stimulation (DBS) system due to current induction in the adjacent vagus nerve. A 57-year-old man with Parkinson's disease (PD) who received bilateral subthalamic nucleus DBS presented with coughing and breathing difficulty when his DBS system was activated. The intensity of coughing was directly related to the amount of stimulation. When the DBS system was turned off, his cough resolved immediately. A system check revealed no radiographic abnormalities and all electrode impedances were within the normal range. We hypothesize that the coughing was caused by an induced electromagnetic stimulation of the vagus nerve from the extensions, which were running in close proximity to the nerve in the neck. Since the patient could not tolerate the coughing at stimulation settings required to ameliorate his PD symptoms, we ultimately exchanged the extensions and moved them further away from the vagus nerve. This resulted in immediate, complete, and continuous relief of the patient's symptoms.


Assuntos
Tosse/etiologia , Estimulação Encefálica Profunda/efeitos adversos , Doença de Parkinson/terapia , Estimulação do Nervo Vago/efeitos adversos , Tosse/diagnóstico , Estimulação Encefálica Profunda/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/diagnóstico , Núcleo Subtalâmico/fisiologia , Nervo Vago/fisiologia
5.
J Clin Neurosci ; 70: 85-91, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31481291

RESUMO

To compare outcome between young [<65 yrs] and old [>65 yrs] patients of Parkinson's disease who underwent bilateral STN DBS a non-randomized retrospective study was done. 20 young (Young group) and 20 elderly (Old group) patients with matched baseline UPDRS were selected and followed up for 2 years after deep brain stimulation (DBS) surgery. The total and motor UPDRS, before, one year and two years after surgery was compared. PDQ39 a quality of life questionnaire and MMSE were also recorded. Zarit care burden interview (ZCBI) was used to analyse caregiver burden. Analysis of data was done using Mann-Whitney Test as the data was ordinal. The difference was not statistically significant at 1st and 2nd year of follow up in total and motor UPDRS. A significant reduction in Levodopa equivalent daily dose was seen in young and old group from preoperative period to 1st & then 2nd year of follow up. The difference was not statistically significant (P = 0.946) at 1st (P = 0.946) and at 2nd year (P = 0.989). Both the groups showed improvement in their PDQ39. The difference was not statistically significant at 1st (P = 0.636) and at 2nd year of follow up (P = 0.417). Caregiver burden (ZCBI) improved in both the groups and the difference was not statistically significant at 1st (P = 0.105) and at 2nd year of follow up (P = 0.078).In this study STN DBS didn't lead to any cognitive decline (MMSE) whatever is the age of patient during follow up. Bilateral STN DBS for Parkinson's disease is equally effective in young and elderly patients.


Assuntos
Fatores Etários , Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Resultado do Tratamento , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Núcleo Subtalâmico/fisiologia
6.
J Clin Neurosci ; 69: 104-108, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31416732

RESUMO

This retrospective study aims to explore the clinical utility of microelectrode recording (MER) during subthalamic deep brain stimulation (DBS) surgery in patients with Parkinson's disease (PD). We analyzed the data from 103 PD patients, who consecutively received bilateral subthalamic nucleus (STN) DBS at an experienced academic medical center. We collected demographic, clinical, and DBS related data, including intraoperative microelectrode recording data, electrode positioning, and clinical effects provided by intraoperative microstimulation. The 2 brain sides were independently analyzed and are described as first and second side (to be operated on); the first side is contralateral to motor symptoms onset. Patients were mostly men (64.1%). In both sides of the brain, percentage of agreement with the electrode final position was higher with clinical results than with intraoperative microelectrode recordings (98% vs 57% on the first implantation side, and 97% vs 58% on the second implantation side, respectively). Regarding electrode final implantation depth, 86% of electrodes were implanted between 0 mm and +2 mm in relation to anatomical target, and 95% of electrodes were implanted from -2 mm to +2 mm. Our study suggests that MER might not be necessary to achieve good clinical outcomes in PD patients undergoing STN DBS. These results support and inform the design of future prospective controlled research studies.


Assuntos
Estimulação Encefálica Profunda/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Doença de Parkinson/terapia , Eletrodos Implantados , Feminino , Humanos , Masculino , Microeletrodos , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Núcleo Subtalâmico/fisiologia
7.
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
8.
Handb Clin Neurol ; 160: 345-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31277859

RESUMO

Electrophysiologic mapping remains an integral component of deep brain stimulation (DBS) surgical procedures, particularly in movement disorder cases where functional maps are used to guide DBS lead placement in patients with Parkinson's disease, dystonia, or tremor. Overall, the goal of the surgical procedure is to implant the distal end of a chronic, multicontact depth electrode into a specific brain region for the purpose of delivering therapeutic electrical stimulation. Regions that are currently targeted for patients with movement disorders include the subthalamic nucleus, the ventral intermediate nucleus of the thalamus, and the globus pallidus. Multiple imaging modalities are used initially to derive a stereotactic plan and guide the initial microelectrode trajectory. Changes in neuronal firing rate and pattern, both spontaneous and in response to somatosensory stimulation, are used to establish the location of the tip of the microelectrode(s), while acute stimulation can be used to estimate the proximity of neighboring brain regions. In this chapter, we will provide an overview of the microelectrode recording process as it is commonly applied to refine image-based targeting of lead placement for DBS surgery.


Assuntos
Mapeamento Encefálico/métodos , Estimulação Encefálica Profunda/métodos , Transtornos dos Movimentos/fisiopatologia , Transtornos dos Movimentos/terapia , Mapeamento Encefálico/instrumentação , Estimulação Encefálica Profunda/instrumentação , Globo Pálido/fisiologia , Humanos , Microeletrodos , Transtornos dos Movimentos/diagnóstico , Núcleo Subtalâmico/fisiologia
9.
Brain Stimul ; 12(5): 1127-1134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31130498

RESUMO

BACKGROUND: Directional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is needed to improve therapy and help guide postoperative programming. OBJECTIVE: To determine whether clinical effects of dDBS can be predicted in individual patients based on lead location and volume of tissue activated (VTA) modelling. METHODS: We analysed a prospective series of 28 PD patients. Imaging analysis and systematic clinical testing performed 4-6 months postoperatively yielded location, clinical efficacy and corresponding therapeutic windows for 272 directional contacts. We calculated the corresponding VTAs to build a probabilistic stimulation map using voxel-wise statistical analysis. RESULTS: We found a positive and statistically significant correlation between the overlap ratio of a patient's individual stimulation volume and the probabilistic map's sweet spot -defined as the 10% voxels with the highest clinical efficacy values (average Spearman's rho = 0.43, average p ≤ 0.036). Patients who had a larger therapeutic window with directional compared to omnidirectional stimulation had a larger distance between the electrode and the sweet spot centroid (average distances 2.3 vs. 1.5 mm, p = 0.0019). CONCLUSION: Our analysis provides new insights into how the definition of a probabilistic sweet spot based on directional stimulation data and individual VTA modelling can be applied to predict clinically effective directional stimulation and help guide clinicians with the intricate postoperative DBS programming.


Assuntos
Mapeamento Encefálico/métodos , Estimulação Encefálica Profunda/métodos , Doença de Parkinson/terapia , Estudo de Prova de Conceito , Núcleo Subtalâmico/fisiologia , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Resultado do Tratamento
10.
Elife ; 82019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31063130

RESUMO

To effectively interact with their environment, humans must often select actions from multiple incompatible options. Existing theories propose that during motoric response-conflict, inappropriate motor activity is actively (and perhaps non-selectively) suppressed by an inhibitory fronto-basal ganglia mechanism. We here tested this theory across three experiments. First, using scalp-EEG, we found that both outright action-stopping and response-conflict during action-selection invoke low-frequency activity of a common fronto-central source, whose activity relates to trial-by-trial behavioral indices of inhibition in both tasks. Second, using simultaneous intracranial recordings from the basal ganglia and motor cortex, we found that response-conflict increases the influence of the subthalamic nucleus on M1-representations of incorrect response-tendencies. Finally, using transcranial magnetic stimulation, we found that during the same time period when conflict-related STN-to-M1 communication is increased, cortico-spinal excitability is broadly suppressed. Together, these findings demonstrate that fronto-basal ganglia networks buttress action-selection under response-conflict by rapidly and non-selectively net-inhibiting inappropriate motor tendencies.


Assuntos
Córtex Motor/fisiologia , Desempenho Psicomotor , Tratos Piramidais/fisiologia , Núcleo Subtalâmico/fisiologia , Adulto , Excitabilidade Cortical , Eletroencefalografia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Estimulação Magnética Transcraniana , Adulto Jovem
11.
Turk Neurosurg ; 29(3): 355-361, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30984985

RESUMO

AIM: To compare the effects of subthalamic nucleus (STN) and globus pallidus interna (GPi) deep brain stimulation (DBS) on the motor outcome, gait and balance function, fall risk (FR), and non-motor symptoms in patients with advanced Parkinson's disease (PD). MATERIAL AND METHODS: We randomized patients with advanced PD with the indication of DBS to undergo either STN or GPi DBS and followed them for 2 years. We collected data at baseline and postoperative 6, 12, and 24 months. We compared changes in the Unified Parkinson's Disease Rating Scale (UPDRS) score, timed gait tests, posturography, non-motor symptom questionnaire (NMSQuest), hospital anxiety and depression (HAD) scale, and levodopa equivalent dose (LED). RESULTS: We enrolled and randomized 12 patients to receive either STN (n = 6) or GPi (n = 6) DBS. Postoperative motor outcomes were significantly improved in both groups (p < 0.05). In both groups, timed gait tests exhibited better performance in mobility; however, patients receiving GPi DBS performed better than those receiving STN DBS in the timed gait tests (p < 0.05). Furthermore, the posturographic evaluation demonstrated a significant elevation in the FR in the STN group (p < 0.05). CONCLUSION: Both STN and GPi DBS are equally effective in alleviating disabling motor complications. However, seemingly, STN DBS could cause more gait and balance problems; hence, a tailored approach seems to be more appropriate in the target selection.


Assuntos
Estimulação Encefálica Profunda/métodos , Marcha/fisiologia , Globo Pálido/fisiologia , Doença de Parkinson/cirurgia , Equilíbrio Postural/fisiologia , Núcleo Subtalâmico/fisiologia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/fisiopatologia , Distribuição Aleatória , Fatores de Tempo , Resultado do Tratamento
12.
Neurosci Lett ; 705: 99-105, 2019 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-31028845

RESUMO

OBJECTIVE: To assess the role of onset age in the results of bilateral subthalamic nucleus deep brain stimulation (STN-DBS), we carried out a retrospective study of two groups of patients regarding age at disease onset. METHODS: We compared, up to 3 years after surgery, the clinical effects, quality of life and the levodopa equivalent daily dose (LEDD) in patients with young-onset Parkinson's disease (onset age <50 years, YOPD) vs patients with older-onset Parkinson's disease (onset age ≥50 years, OOPD). RESULTS: A dramatic improvement in motor symptoms was equally observed in both groups of patients after DBS. The improvements of the Unified Parkinson's Disease Rating Scale part III motor scale (UPDRS-III) score, axial sub-score and non-axial sub-score from baseline gradually decreased over time. The benefit of STN-DBS for the axial symptoms decreased most rapidly, which directly resulted in a progressive decline in stimulation efficacy in both groups. Nevertheless, the improvement in non-axial symptoms after DBS was remarkable and long-lasting. The quality of life in both groups were also improved after DBS but were slightly decreased in the following years. The reduced LEDD were equivalent in both groups. CONCLUSIONS: STN-DBS alleviates motor symptoms and improves quality of life equally in both YOPD and OOPD patients with similar LEDD. The initial therapeutic benefit of STN-DBS for PD gradually decreases over time, mainly due to the progression of PD and the rapid withdrawal of the benefit for axial symptoms.


Assuntos
Estimulação Encefálica Profunda , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiologia , Adulto , Idade de Início , Idoso , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Levodopa/uso terapêutico , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/tratamento farmacológico , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do Tratamento
13.
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
14.
Neuromodulation ; 22(4): 493-502, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30889314

RESUMO

OBJECTIVES: Despite its efficacy in tremor-suppression, the ventral intermediate thalamic (VIM) nucleus has largely been neglected in deep brain stimulation (DBS) for tremor-dominant Parkinson's disease (tdPD). The employment of a parietal approach, however, allows stimulation of VIM and subthalamic nucleus (STN) using one trajectory only and thus constitutes a promising alternative to existing strategies. In the present study, we investigate safety and efficacy of combined lead implantation and stimulation of STN and VIM using a parietal approach. MATERIALS AND METHODS: Retrospective analysis of five patients with tdPD was performed who underwent DBS using a parietal approach. Changes in symptom severity, disease-specific health-related quality of life and l-dopa equivalent doses (LED) were evaluated over a total time course of 12 months. RESULTS: DBS within both targets yielded significant improvement of parkinsonian symptoms (median: 40.0%, p = 0.04) in the first 6 months of continuous stimulation and remained stable thereafter (median improvement at 12 months: 43.2%, p = 0.07). Sustained improvement of tremor (median at 6 months: 100.0%, p = 0.04; median at 12 months 83.3%, p = 0.04) and quality of life scores (median at 6 months: 29.8%, p = 0.04; median at 12 months: 32.6%, p = 0.04) was noted throughout the follow-up period. No significant change of LEDs was observed by the end of follow-up (median decrease: 2.2%, p = 0.89). CONCLUSIONS: Simultaneous DBS of VIM and STN using one trajectory is safe, yielding good control of parkinsonian tremors. Further studies, however, are necessary to determine whether a parietal trajectory affords better control over tremor symptoms than established strategies and hence justifies the potential risks associated with the alternative approach.


Assuntos
Estimulação Encefálica Profunda/métodos , Lobo Parietal/diagnóstico por imagem , Doença de Parkinson/diagnóstico por imagem , Núcleo Subtalâmico/diagnóstico por imagem , Tremor/diagnóstico por imagem , Núcleos Ventrais do Tálamo/diagnóstico por imagem , Idoso , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Lobo Parietal/fisiologia , Doença de Parkinson/terapia , Estudos Retrospectivos , Núcleo Subtalâmico/fisiologia , Tremor/fisiopatologia , Tremor/terapia , Núcleos Ventrais do Tálamo/fisiologia
15.
Brain Stimul ; 12(4): 868-876, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30833216

RESUMO

BACKGROUND: Closed loop deep brain stimulation (clDBS) in Parkinson's disease (PD) using subthalamic (STN) neural feedback has been shown to be efficacious only in the acute post-operative setting, using externalized leads and stimulators. OBJECTIVE: To determine feasibility of neural (N)clDBS using the clinical implanted neurostimulator (Activa™ PC + S, FDA IDE approved) and a novel beta dual threshold algorithm in tremor and bradykinesia dominant PD patients on chronic DBS. METHODS: 13 PD subjects (20 STNs), on open loop (ol)DBS for 22 ±â€¯7.8 months, consented to NclDBS driven by beta (13-30 Hz) power using a dual threshold algorithm, based on patient specific therapeutic voltage windows. Tremor was assessed continuously, and bradykinesia was evaluated after 20 min of NclDBS using a repetitive wrist flexion-extension task (rWFE). Total electrical energy delivered (TEED) on NclDBS was compared to olDBS using the same active electrode. RESULTS: NclDBS was tolerated for 21.67 [21.10-26.15] minutes; no subject stopped early. Resting beta band power was measurable and similar between tremor and bradykinesia dominant patients. NclDBS improved bradykinesia and tremor while delivering only 56.86% of the TEED of olDBS; rWFE velocity (p = 0.003) and frequency (p < 0.001) increased; tremor was below 0.15 rad/sec for 95.4% of the trial and averaged 0.26 rad/sec when present. CONCLUSION: This is the first study to demonstrate that STN NclDBS is feasible, efficacious and more efficient than olDBS in tremor and bradykinesia dominant PD patients, on long-term DBS, using an implanted clinical neurostimulator and driven by beta power with a novel dual threshold algorithm, based on customized therapeutic voltage windows.


Assuntos
Estimulação Encefálica Profunda/métodos , Neuroestimuladores Implantáveis/tendências , Doença de Parkinson/terapia , Núcleo Subtalâmico/fisiologia , Idoso , Estimulação Encefálica Profunda/instrumentação , Feminino , Humanos , Hipocinesia/epidemiologia , Hipocinesia/fisiopatologia , Hipocinesia/terapia , Masculino , Pessoa de Meia-Idade , Doença de Parkinson/epidemiologia , Doença de Parkinson/fisiopatologia , Tremor/epidemiologia , Tremor/fisiopatologia , Tremor/terapia
16.
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
17.
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
18.
Int J Neurosci ; 129(9): 933-935, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30795708

RESUMO

Hemophilia B is an X linked recessive deficiency of factor IX that presents with a range of clinical severity that co-relates with factor levels. Although guidelines exist to guide perioperative hemostasis in such patients, there is scarce data on elective high-risk neurosurgeries, resulting in a reluctance to offer these patients elective neurosurgeries. These patients thus rarely if ever undergo such procedures. We report a unique case of undiagnosed mild hemophilia B in a gentleman that was found incidentally at age 64 during pre-operative workup. This gentleman had intractable Parkinson's disease for which subthalmic deep brain stimulation was indicated. He was found to have a prolonged APTT on initial lab testing. After subsequent workup, and having excluded the presence of inhibitors, he was diagnosed with Hemophilia B. With the use of Factor IX concentrates (AlphaNine®) and close clinical, laboratory, and radiological monitoring a plan was made for this patient to undergo this procedure. Our patient successfully underwent subthalmic deep brain stimulation with microelectrode recordings and intraoperative test stimulation in a two-step procedure, followed by single channel implantable neurostimulator and extension wire implantations 2 weeks later. The successful peri-operative course of this patient using this novel approach is described, and the need for future data in this regard is emphasized.


Assuntos
Estimulação Encefálica Profunda/métodos , Hemofilia B/diagnóstico , Hemofilia B/terapia , Núcleo Subtalâmico/fisiologia , Hemofilia B/genética , Humanos , Masculino , Microeletrodos , Pessoa de Meia-Idade
19.
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
20.
Turk Neurosurg ; 29(5): 677-682, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30806475

RESUMO

AIM: To investigate the effect of using microelectrode recording (MER) on the length of time required to carry out a deep brain stimulation (DBS) procedure of the subthalamic nucleus in patients with Parkinson's disease (PD). MATERIAL AND METHODS: The time required to include MER in the DBS operation was calculated for the first and second sides in 24 patients with PD. The number of microelectrodes used on each trajectory for the first and second sides, and the percentage of permanent electrodes implanted on each trajectory for the first and second sides, were quantified. RESULTS: The average times taken to use MER were 23.4 ± 6.2 minutes, 17.4 ± 6.5 minutes, and 41.2 ± 6.3 minutes for the first side, second side and total procedure, respectively. In 75% of patients, the permanent electrode was implanted at the planned target site for the first side, and in 61% of patients for the second side. CONCLUSION: MER extends the time required to carry out the DBS procedure. However, during surgery, it provides real-time information on the electrodes' neurophysiological locations and helps the surgical team choose an alternative target if the planned target does not produce satisfying results.


Assuntos
Estimulação Encefálica Profunda/métodos , Monitorização Neurofisiológica Intraoperatória/métodos , Doença de Parkinson/cirurgia , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Microeletrodos , Pessoa de Meia-Idade , Estudos Prospectivos , Núcleo Subtalâmico/fisiologia , Fatores de Tempo
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