SEARCH · PubMed Health

Results for “Deep Brain Stimulation”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 235 records · Page 13Linked to original sources

PubMed2004

Deep brain stimulation and its effect on sleep in Parkinson's disease.

Deep Brain Stimulation (DBS) is an effective treatment for patients with advanced Parkinson's disease (PD) and motor complications whose condition can no longer be improved by adjustment of medical therapy. PD patients often report increased daily somnolence and night sleep abnormalities partially related to dopaminergic treatment. In a survey of 386 consecutive non-demented non-depressed PD patients seen in our clinic over a period of 3 months we found increased daily somnolence to be relatively uncommon in non-demented PD patients, although it may be associated with stable treatment with high dose dopamine agonists. Disease related factors seemed responsible for night sleep abnormalities. Because DBS of the subthalamic nucleus (STN) reduces motor disability, as well as total medication intake, one would expect a similar benefit on sleep abnormalities. Indeed, recent evidence suggests that chronic STN-DBS may improve sleep quality through increased nocturnal mobility and reduction of sleep fragmentation.

Brain↗

PubMedDate not supplied

How does deep brain stimulation work? Present understanding and future questions.

High-frequency deep brain stimulation (DBS) of the thalamus or basal ganglia represents an effective clinical technique for the treatment of several medically refractory movement disorders (e.g., Parkinson's disease, essential tremor, and dystonia). In addition, new clinical applications of DBS for other neurologic and psychiatric disorders (e.g., epilepsy and obsessive-compulsive disorder) have been vaulted forward. Although DBS has been effective in the treatment of movement disorders and is rapidly being explored for the treatment of other neurologic disorders, the scientific understanding of its mechanisms of action remains unclear and continues to be debated in the scientific community. Optimization of DBS technology for present and future therapeutic applications will depend on identification of the therapeutic mechanism(s) of action. The goal of this review is to address the present knowledge of the effects of high frequency stimulation within the central nervous system and comment on the functional implications of this knowledge for uncovering the mechanism(s) of DBS. Four general hypotheses have been developed to explain the mechanism(s) of DBS: depolarization blockade, synaptic inhibition, synaptic depression, and stimulation-induced modulation of pathologic network activity. Using the results from microdialysis, neural recording, functional imaging, and neural modeling experiments, the authors address the main hypotheses and attempt to reconcile what have been considered conflicting results from different research modalities.

Basal Ganglia↗

PubMed1999

Placement of deep brain stimulators into the subthalamic nucleus.

We present our technique for deep brain stimulation (DBS) of the subthalamic nucleus (STN) and include information which may be helpful in general DBS. With the patient in a stereotactic head frame, the anterior and posterior commissures are identified on SPGR-sequence magnetic resonance imaging (MRI). STN coordinates are based on a stereotactic brain atlas at 12 mm lateral, 2 mm posterior and 5 mm caudal to the midcommissural point. Surgical navigation software allows for planning of the trajectory. Electromyography is used to quantitatively measure tremor responses to macrostimulation. Permanent lead placement is confirmed with intraoperative fluoroscopy and postoperative MRI.

Brain Mapping↗

PubMed2004

The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients.

OBJECT: Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is beneficial for generalized dystonia and has been proposed as a treatment for cervical dystonia. The Canadian Stereotactic/Functional and Movement Disorders Groups designed a pilot project to investigate the following hypothesis: that bilateral DBS of the GPi will reduce the severity of cervical dystonia at 1 year of follow up, as scored in a blinded fashion by two neurologists using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcome measures included pain and disability subscores of the TWSTRS, Short Form-36 quality of life index, and the Beck Depression Inventory. METHODS: Three patients have undergone surgery in Calgary with a follow-up duration of 7.4 +/- 5.9 months (mean +/- standard deviation). One patient underwent inadvertent ineffective stimulation for the first 3 months and did not experience a benefit until DBS programming was corrected. All three patients had rapid response to stimulation, with the muscles relaxing immediately and abnormal movements improving within days. Total TWSTRS scores improved by 79%, and severity subscores improved significantly, from 15.7 +/- 2.1 to 7.7 +/- 2.9 (paired t-test, p = 0.02). Pain and disability subscores improved from 25.5 +/- 4.1 to 3.3 +/- 3.1 (paired t-test, p = 0.002) and from 13.3 +/- 4.9 to 3.3 +/- 4.2 (paired t-test, p = 0.06), respectively. CONCLUSIONS: Although it is too early to reach broad conclusions, this report of preliminary results confirms the efficacy of DBS of the GPi for cervical dystonia.

Amitriptyline↗

PubMed2003

Deep brain stimulation in treatment refractory obsessive compulsive disorder.

Obsessive-compulsive disorder is a worldwide psychiatric disorder with a lifetime prevalence of 2% and mainly characterized by obsessional ideas and compulsive behaviors and rituals. Many patients show improvement under cognitive behavioral and/or pharmacological treatment. A minority of patients is refractory to all available therapy and may benefit from capsulotomy. This study aims to investigate deep brain stimulation (DBS) as a last resort treatment alternative to capsulotomy in treatment refractory obsessive-compulsive disorder. Eight patients have been implanted bilaterally in the anterior limbs of the internal capsules with a quadripolar electrode. This paper presents the results of the first 4 operated patients. Acute deep brain stimulation displays an immediate improvement of the speech, mood, eye contact and motor function. Chronic deep brain stimulation improves significantly the obsessional and compulsive symptomatology in three out of the four patients. This study definitely needs replication, but the results are promising. Reversible deep brain stimulation may improve the symptomatology of treatment refractory OCD patients, without significant side effects.

Adult↗

PubMed2002

Methods for programming and patient management with deep brain stimulation of the globus pallidus for the treatment of advanced Parkinson's disease and dystonia.

Globus pallidus (GPi) deep brain stimulation can markedly improve severe medication-refractory Parkinson's disease (PD) and dystonia. Appropriate perioperative patient management can assist with electrode implantation. Optimizing stimulation settings and simultaneously adjusting medications (when appropriate) can substantially improve patient outcomes. Although there are a large number of possible stimulation settings, in clinical practice, a relatively narrow range of settings has been shown to be most efficacious. A systematic approach to determining those settings that maximally improve parkinsonism and suppress drug-induced dyskinesias is outlined following a clear algorithm that uses the observation that stimulation of the dorsal and ventral pallidum has been shown to have opposite motor effects in PD. Based on the available literature, recommendations are also made for the use of GPi deep brain stimulation in dystonia.

Dystonia↗

PubMed2006

Bipolar deep brain stimulation permits routine EKG, EEG, and polysomnography.

As the population of patients treated with deep brain stimulation (DBS) grows and the patients age, more will require routine or emergent electrophysiologic tests. DBS artifact may render these uninterpretable, whereas stopping DBS may release symptoms that confound evaluation. The authors find that monopolar, but not bipolar, stimulation produces significant artifact during EKG, EEG, and polysomnography.

Aged↗

PubMed1990

Deep brain stimulation for control of intractable pain in humans, present and future: a ten-year follow-up.

Deep brain stimulation with chronically implanted electrodes has provided satisfactory control of pain in patients with intractable chronic pain syndromes, which have been refractory to medication and other conventional modalities of management. In this series the authors present their experience with 48 patients who have been followed for periods ranging from 6 months to 10 years. Long-term pain control was achieved in 30 patients (63%). Both the periventricular gray and specific sensory thalamic nuclei have been used as targets. Our results indicate that there is an initial 2-year fall-off of pain control caused by idiopathic tolerance, with stable results thereafter, regardless of site of the implant. This is suggestive of some biochemical modification of tissues around the electrode. Patients with failed-back syndrome secondary to multiple disc operations fared well; those with pain secondary to progressive neurological disorders or cancer had only short-term pain relief, and those with thalamic pain, cauda equina injury, or phantom limb pain usually had a poor result. Deep brain stimulation, in selected patients, appears to provide long-term pain control safely with few side effects or complications.

Adult↗

PubMed2005

Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up.

Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6-12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n = 49) or globus pallidus internus (GPi, n = 20) included in a multicentre study. Patients were assessed preoperatively and at 1 year and 3-4 years after surgery. The primary outcome measure was the change in the 'off' medication score of the Unified Parkinson's Disease Rating Scale motor part (UPDRS-III) at 3-4 years. Stimulation of the STN or GPi induced a significant improvement (50 and 39%; P < 0.0001) of the 'off' medication UPDRS-III score at 3-4 years with respect to baseline. Stimulation improved cardinal features and activities of daily living (ADL) (P < 0.0001 and P < 0.02 for STN and GPi, respectively) and prolonged the 'on' time spent with good mobility without dyskinesias (P < 0.00001). Daily dosage of levodopa was significantly reduced (35%) in the STN-treated group only (P < 0.001). Comparison of the improvement induced by stimulation at 1 year with 3-4 years showed a significant worsening in the 'on' medication motor states of the UPDRS-III, ADL and gait in both STN and GPi groups, and speech and postural stability in the STN-treated group. Adverse events (AEs) included cognitive decline, speech difficulty, instability, gait disorders and depression. These were more common in patients treated with DBS of the STN. No patient abandoned treatment as a result of these side effects. This experience, which represents the first multicentre study assessing the long-term efficacy of either STN or GPi stimulation, shows a significant and substantial clinically important therapeutic benefit for at least 3-4 years in a large cohort of patients with severe Parkinson's disease.

Activities of Daily Living↗

PubMed2006

MEP latency shift after implantation of deep brain stimulation systems in the subthalamic nucleus in patients with advanced Parkinson's disease.

Deep brain stimulation (DBS) into the subthalamic nucleus (STN) is a highly effective treatment for advanced Parkinson's disease (PD). The consequences of STN stimulation on intracortical and corticospinal excitability have been addressed in a few studies using transcranial magnetic stimulation (TMS). Although excitability measurements were compared between the STN stimulation OFF and ON condition, in these experiments, there are no longitudinal studies examining the impact of electrode implantation per se on motor excitability. Here, we explored the effects of STN electrode implantation on resting motor thresholds (RMT), motor evoked potential (MEP) recruitment curves, and MEP onset latencies on 2 consecutive days before and shortly after STN surgery with the stimulator switched off, thus avoiding the effects of chronic DBS on the motor system, in 8 PD patients not taking any dopaminergic medication. After surgery, RMT and MEP recruitment curves were unchanged. In contrast, MEP onset latencies were significantly shorter when examined in relaxed muscles but were unchanged under preactivation. We hypothesize that postoperatively TMS pulses induced small currents in scalp leads underneath the TMS coil connecting the external stimulator with STN electrodes leading to inadvertent stimulation of fast-conducting descending neural elements in the vicinity of the STN, thereby producing submotor threshold descending volleys. These "conditioning" volleys probably preactivated spinal motor neurons leading to earlier suprathreshold activation by the multiple corticospinal volleys produced by TMS of the motor cortex. These TMS effects need to be considered when interpreting results of excitability measurements in PD patients after implantation of STN electrodes.

Aged↗

PubMed2001

Deep brain stimulation of the subthalamic nucleus: clinical effectiveness and safety.

The authors report the data relative to the clinical effectiveness of bilateral deep brain stimulation of the subthalamic nucleus in 16 patients with PD 3 months after the surgery. The comparison of the Unified PD Rating Scale scores in the different conditions of medication and stimulation, and the lack of significant surgical complications, confirm the effectiveness and the safety of the subthalamic nucleus deep brain stimulation for the treatment of advanced PD.

Aged↗

PubMed2005

Deep brain stimulation in a patient on immunosuppressive therapy after renal transplant.

We performed thalamic deep brain stimulation (DBS) surgery to treat severe essential tremor in a 36 year-old woman who had undergone cadaveric renal transplant four years earlier. She was receiving chronic immunosuppressive therapy. Post-operative healing was normal and there have been no infections of the DBS hardware. There were no peri-operative complications and no rejection of the transplanted kidney. She remains on the same systemic immunosuppressive agents as pre-operatively: prednisone, cyclosporine, and mycophenolate mofetil (CellCept). DBS surgery may be safely performed in carefully selected patients on systemic immunosuppression after renal transplant.

Adult↗

PubMed2004

Psychiatric complications of deep brain stimulation for Parkinson's disease.

BACKGROUND: The purpose of this article is to review the current literature regarding deep brain stimulation (DBS) of the subthalamic nucleus as a treatment for Parkinson's disease and to bring to the attention of the psychiatric community the possible psychiatric complications of this treatment. METHOD: A MEDLINE search of English-language publications was conducted using PubMed in July 2003. The search term used was deep brain stimulation. In addition, pertinent references were obtained from the retrieved articles. Reports and studies of psychiatric complications of DBS patients were reviewed and are discussed. A case report is presented of a man who developed hypomanic symptoms shortly after beginning DBS treatment for Parkinson's disease. RESULTS: There have been an increasing number of reports of postprocedure psychiatric complications, including depression, mania, aggression, and deficits in language. Improvement in symptoms of severe obsessive-compulsive disorder and depression has also been reported. CONCLUSION: As information continues to emerge, psychiatrists will play vital roles in the assessment and continuing care of patients who receive DBS. These findings may also provide the framework to determine which patients are at psychiatric risk from DBS. Symptoms of refractory obsessive-compulsive disorder have been noted to improve with DBS, which has led researchers to begin studying its effectiveness for this condition.

Bipolar Disorder↗

PubMed2005

Computer-aided placement of deep brain stimulators: from planning to intraoperative guidance.

In current practice, optimal placement of deep-brain stimulators (DBSs) used to treat movement disorders in patients with Parkinson's disease and essential tremor is an iterative procedure. A target is chosen preoperatively based on anatomical landmarks identified on magnetic resonance images. This point is used as an initial position that is refined intraoperatively using both microelectrode recordings and macrostimulation. In this paper, we report on our current progress toward developing a system for the computer-assisted preoperative selection of target points and for the intraoperative adjustment of these points. The system consists of a deformable atlas of optimal target points that can be used to select automatically the preoperative target, of an electrophysiological atlas, and of an intraoperative interface. Results we have obtained show that automatic prediction of target points is an achievable goal. Our results also indicate that electrophysiological information could be used to resolve structures not visible in anatomic images, thus improving both preoperative and intraoperative guidance. Our intraoperative system has reached the stage of a working prototype and we compare targeting accuracy as well as the number of paths needed to reach the targets with our system and with the method in current clinical use.

Algorithms↗

PubMed1985

Deep brain stimulation for alleviating chronic intractable pain.

The authors present their 4-year experience with 18 patients who had deep brain stimulation. Most were referred because of chronic pain of varied etiology. All conventional modalities of management had failed. Both the paraventricular gray matter and the sensory thalamus were target sites. The 18 patients underwent a total of 21 implants. Follow-up ranged from 6 months to 4 years with moderate relief of prestimulation pain in 14 patients (77%). Patients with failed back syndrome secondary to multiple disc operations fared well. Patients with pain secondary to progressive neurologic disorders or cancer had only short-lived benefits, while those with pain from cauda equina injury or vascular disease had a poor result. Deep brain stimulation appears to be an effective means of controlling chronic pain in selected cases.

Adult↗

PubMed2006

Electrophysiological mapping for the implantation of deep brain stimulators for Parkinson's disease and tremor.

The vast majority of centers use electrophysiological mapping techniques to finalize target selection during the implantation of deep brain stimulation (DBS) leads for the treatment of Parkinson's disease and tremor. This review discusses the techniques used for physiological mapping and addresses the questions of how various mapping strategies modify target selection and outcome following subthalamic nucleus (STN), globus pallidus internus (GPi), and ventralis intermedius (Vim) deep brain stimulation. Mapping strategies vary greatly across centers, but can be broadly categorized into those that use microelectrode or semimicroelectrode techniques to optimize position prior to implantation and macrostimulation through a macroelectrode or the DBS lead, and those that rely solely on macrostimulation and its threshold for clinical effects (benefits and side effects). Microelectrode criteria for implantation into the STN or GPi include length of the nucleus recorded, presence of movement-responsive neurons, and/or distance from the borders with adjacent structures. However, the threshold for the production of clinical benefits relative to side effects is, in most centers, the final, and sometimes only, determinant of DBS electrode position. Macrostimulation techniques for mapping, the utility of microelectrode mapping is reflected in its modification of electrode position in 17% to 87% of patients undergoing STN DBS, with average target adjustments of 1 to 4 mm. Nevertheless, with the absence of class I data, and in consideration of the large number of variables that impact clinical outcome, it is not possible to conclude that one technique is superior to the other in so far as motor Unified Parkinson's Disease Rating Scale outcome is concerned. Moreover, mapping technique is only one out of many variables that determine the outcome. The increase in surgical risk of intracranial hemorrhage correlated to the number of microelectrode trajectories must be considered against the risk of suboptimal benefits related to omission of this technique.

Brain↗

PubMed1979

The influence of chronic deep brain stimulation on excitability and morphology of the stimulated tissue.

Bipolar electrical stimulations of the rostal hippocampus and of the amygdala were performed at irregular intervals in wakeful unrestrained cats via chronically implanted glass-insulated stainless steel electrodes. The excitability of the stimulated tissue remained unchanged during the whole investigation period of six months up to one and a half years, as was revealed by regularly performed comparisons of shape, latency, and amplitude of evoked potentials elicited by electrical stimulation of the rostral hippocampus and recorded within the ipsilateral mammillary body. The histological examination of the stimulated tissue revealed a fibrillary gliosis due to the trauma caused by the insertion of the electrodes, but no signs of additional tissue damage due to electrical stimulation or chronic mechanical irritation. The results indicate that it is possible to perform therapeutic stimulations of deep brain structures for long periods without inducing relevant changes in morphology or electrical responsiveness of the stimulated tissue. No kindling phenomena are to be expected, if the stimulations are performed at irregular intervals.

Amygdala↗

PubMed2004

Implantation of bilateral deep brain stimulators in patients with Parkinson disease and preexisting cardiac pacemakers. Report of two cases.

Deep brain stimulation (DBS) has become an important modality in the treatment of refractory Parkinson disease (PD). In patients with comorbid arrhythmias requiring cardiac pacemakers, DBS therapy is complicated by concerns over a possible electrical interaction between the devices (or with device programming) and the inability to use magnetic resonance imaging guidance for implantation. The authors report two cases of PD in which patients with preexisting cardiac pacemakers underwent successful implantation of bilateral DBS electrodes in the subthalamic nucleus (STN). Each patient underwent computerized tomography-guided stereotactic frame-based placement of DBS electrodes with microelectrode recording. Both extension wires were passed from the right side of the head and neck (contralateral to the pacemaker) to place the cranial pulse generators subcutaneously in the left and right abdomen. The cranial pulse generators were placed farther than 6 in from the cardiac pacemaker and from each other to decrease the chance of interference between the devices during telemetry reprogramming. Postoperative management involved brain stimulator programming sessions with simultaneous cardiological monitoring of pacemaker function and cardiac rhythm. No interference was noted at any time, and proper pacemaker function was maintained throughout the follow-up period. With bilateral STN stimulation, both patients experienced a dramatic improvement in their PD symptoms, including elimination of dyskinesias, reduction of "off" severity, and increase of "on" duration. With some modifications of implantation strategy, two patients with cardiac pacemakers were successfully treated with bilateral DBS STN therapy for refractory PD. To our knowledge, this is the first report on patients with cardiac pacemakers undergoing brain stimulator implantation.

Aged↗