PubMed Health⌕ Search

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 289 records · Page 16Linked to original sources
PubMed2004

Management of hardware infections following deep brain stimulation.

OBJECTIVE: To report our experience on hardware-related infections following deep brain stimulation (DBS). METHODS: The present article presents the retrospective clinical notes review of gained in a two-centre, single-surgeon study experience of 108 consecutive DBS cases between 1996 and 2002. In all patients the minimum follow-up was six months. One hundred and eight patients received an intracerebral electrode implantation and 106 underwent internalization. RESULTS: In total 178 electrodes were implanted with a mean follow-up of 42.6 months and a cumulative follow-up of 367.7 patient-years. Four patients (3.8%) developed an infection related to the DBS-hardware and all were initially treated with antibiotics. Two patients eventually required additional surgical treatment. CONCLUSION: Infections due to DBS-hardware can result in considerable levels of morbidity. In certain cases antibiotic therapy may be adequate. In others, surgical intervention to externalise the electrodes may be necessary. In our experience, there was never a need to remove the electrodes.

Adult↗
PubMed2002

Movement-related modulation of neural activity in human basal ganglia and its L-DOPA dependency: recordings from deep brain stimulation electrodes in patients with Parkinson's disease.

Through electrodes implanted for deep brain stimulation in three patients (5 sides) with Parkinson's disease, we recorded the electrical activity from the human basal ganglia before, during and after voluntary contralateral finger movements, before and after L-DOPA. We analysed the movement-related spectral changes in the electroencephalographic signal from the subthalamic nucleus (STN) and from the internal globus pallidus (GPi). Before, during and after voluntary movements, signals arising from the human basal ganglia contained two main frequencies: a high beta (around 26 Hz), and a low beta (around 18 Hz). The high beta (around 26 Hz) power decreased in the STN and GPi, whereas the low beta (around 18 Hz) power decrease was consistently found only in the GPi. Both frequencies changed their power with a specific temporal modulation related to the different movement phases. L-DOPA specifically and selectively influenced the spectral power changes in these two signal bands.

Antiparkinson Agents↗
PubMed1998

Deep brain stimulation is preferable to thalamotomy for tremor suppression.

BACKGROUND: The use of deep brain stimulation (DBS) at a site identical to that of thalamotomy is becoming increasingly popular for the control of tremor. It therefore seemed reasonable to compare the two operations. METHODS: A retrospective comparison was made of 19 DBS implants--16 for Parkinson's disease (PD), 3 for essential tremor (ET)--and 26 thalamotomies--23 for PD and 3 for ET--performed by the author with similar techniques between November 1, 1990 and July 1, 1996 and followed for at least 3 months. RESULTS: Complete tremor abolition occurred in 42% of both groups, near abolition in 79% and 69% respectively, recurrence in 5% and 15%, respectively. To achieve these results, 15% of thalamotomies, but no DBS implant, had to be repeated. Thus tremor recurrence after DBS can be controlled by stimulation parameter adjustment rather than by re-operation. A "microthalamotomy" effect from merely implanting an electrode, seen in 53% of cases and persisting for more than 1 year in five cases, prognosticated a good result and underlined the need for precision in target site selection. Ataxia, dysarthria, and gait disturbance were more common after thalamotomy (42%) than DBS (26%), but when they occurred after DBS they could nearly always be controlled by adjusting stimulation parameters. CONCLUSIONS: Thus, the flexibility of DBS for tremor control and complication avoidance makes it superior to thalamotomy for tremor control at the expense of equipment cost and continual management.

Ataxia↗
PubMed2000

Mechanisms of deep brain stimulation and future technical developments.

Possible mechanisms underlying the therapeutic effect of deep brain stimulation (DBS) are reviewed, particularly the notion that DBS is inhibitory. Computer simulations are described that model the effect of different frequencies and regularity of neuronal activity (target neuron), either spontaneous or stimulated, on information transfer between two other neurons. Most simulations resulted in a loss of information. These were the least with high frequency and regular activity or stimulation of the target neuron with regularity having the least deleterious effect on information transfer. The simulations suggest that irregular activity in neurons converging with other neurons can result in a loss of information transfer. This may explain why increased irregularity in globus pallidus activity associated with Parkinson's disease, dystonia and hemiballismus may result in symptoms. Further, the therapeutic effect of DBS may be due to driving neurons at higher and perhaps more importantly, regular frequencies. There were simulations in which information transfer was augmented suggesting the presence of stochastic resonance. This most often occurred with low frequency activity in the target neuron. It is hypothesized that low frequency activity, either spontaneous or stimulated, could account for involuntary movements, including tremor. Future directions and challenges to DBS are also discussed.

Animals↗
PubMed2003

Effects of deep brain stimulation and medication on bradykinesia and muscle activation in Parkinson's disease.

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and antiparkinsonian medication (Meds) have proved to be effective therapies for treating bradykinesia in Parkinson's disease. However, it is not currently known how or to what extent STN stimulation alters the control signals to agonist and antagonist muscles to change movement speed. Our objective was to investigate movement speed along with the amplitude and temporal features of EMG activity to determine how and to what extent these parameters are changed by DBS and medication. Nine patients with Parkinson's disease were studied following neurosurgery that implanted high-frequency stimulating electrodes in the STN. The experiments for the patients were performed in each of four treatment conditions: (i) OFF treatment; (ii) STN DBS; (iii) Meds; and (iv) Meds plus STN DBS. Also, a group of age- and gender-matched control subjects were examined. Medication and DBS had similar effects in that both treatments increased movement speed, increased the amplitude of the first agonist burst, increased burst duration, reduced the number of agonist bursts, reduced cocontraction, increased the size of the antagonist EMG, and reduced the centroid time of the antagonist EMG. When DBS and medication were combined, only temporal measures of burst duration and the number of agonist bursts were different from the medication alone condition. There was a positive association between the level of bradykinesia OFF treatment and the level of bradykinesia following DBS and medication. The movement speed of neurologically normal control subjects' was over 40% higher during both flexion and extension movements when compared with the patients during Meds plus STN DBS. The changes in the muscle activation patterns provide a mechanism of action for the pharmacological and surgical interventions used to treat bradykinesia in Parkinson's disease. However, despite the success of medication and DBS at improving bradykinesia in patients with Parkinson's disease, patients' movement speed was not restored to normal due to limitations in the amplitude and temporal scaling of the agonist and antagonist bursting pattern. These findings suggest a link between basal ganglia function in scaling both the amplitude and temporal parameters of the input to the motor neuron pool.

Adolescent↗
PubMed2004

Thalamic deep brain stimulation for essential tremor: relation of lead location to outcome.

OBJECTIVE: Thalamic deep brain stimulation (DBS) is commonly used to treat essential tremor, but the optimal lead location within the thalamus has not been systematically evaluated. We examined the relation of lead location to clinical outcome in a series of essential tremor patients treated by thalamic DBS. METHODS: Fifty-seven leads in 37 patients were studied. Lead locations were measured by postoperative magnetic resonance imaging. Contralateral arm tremor was assessed in the DBS-on and DBS-off states using the Fahn-Tolosa-Marin tremor rating scale, with a mean follow-up of 26 months. Lead locations were statistically correlated, using analysis of variance, with percent improvement in tremor resulting from DBS activation. RESULTS: Improvement in tremor score was significantly correlated with lead location in both the anteroposterior and lateral dimensions. In the plane of the commissures, the optimal electrode location was determined statistically to be 6.3 mm anterior to the posterior commissure and 12.3 mm lateral to the midline, or 10.0 mm lateral to the third ventricle. CONCLUSION: Optimal electrode location for thalamic DBS in essential tremor corresponds to the anterior margin of the ventralis intermedius nucleus. Leads located greater than 2 mm (in the plane of the commissures) from the optimal coordinates are more likely to be associated with poor tremor control than leads within 2 mm of the optimal location. The incidence of true physiological tolerance to the antitremor effect of thalamic DBS (defined as poor tremor control in spite of lead location within 2 mm of the optimal site) was found to be 9%.

Adult↗
PubMed2001

Revision of deep brain stimulator for tremor. Technical note.

The treatment of essential tremor with thalamic deep brain stimulation (DBS) is considered to be more effective and to cause less morbidity than treatment with thalamotomy. Nonetheless, implantation of an indwelling electrode, connectors, and a generator is associated with specific types of morbidity. The authors describe three patients who required revision of their DBS systems due to lead breakage. The connector between the DBS electrode and the extension wire, which connects to the subclavicular pulse generator, was originally placed subcutaneously in the cervical region to decrease the risk of erosion through the scalp and to improve cosmesis. Three patients presented with fractured DBS electrodes that were located in the cervical region near the connector, necessitating reoperation with stereotactic retargeting and placement of a new intracranial electrode. At reoperation, the connectors were placed subgaleally over the parietal region. Management of these cases has led to modifications in the operative procedure designed to improve the durability of DBS systems. The authors recommend that surgeons avoid placing the connection between the DBS electrode and the extension wire in the cervical region because patient movement can cause microfractures in the electrode. Such microfractures require intracranial revision, which may be associated with a higher risk of morbidity than the initial operation. The authors also recommend considering prophylactic relocation of the connectors from the cervical area to the subgaleal parietal region to decrease the risk of future DBS electrode fracture, which would necessitate a more lengthy procedure to revise the intracranial electrode.

Aged↗
PubMed2006

Deep brain stimulation of the substantia nigra pars reticulata exerts long lasting suppression of amygdala-kindled seizures.

Deep brain stimulation (DBS) has been used to treat a variety of neurological disorders including epilepsy. However, we have limited knowledge about effective target areas, optimal stimulation parameters, and long-term effect of DBS on epileptic seizures. Here we examined the effects of DBS of the substantia nigra pars reticulata (SNr) on amygdala-kindled seizures. Microwire electrodes were implanted into the SNr and amygdala of adult male rats. When stage 5-kindled seizures were achieved by daily amygdala kindling, high frequency stimulation was delivered to the SNr bilaterally 1 s after cessation of kindling. Our DBS protocol completely blocked kindled seizures in 10 out of 23 (43.5%) rats studied. Furthermore, when the same amygdala kindling procedure was performed 24 h later without DBS, the kindling failed to elicit any seizure signs in 6 of these 10 rats. Some of the post-DBS period of seizure suppression lasted for up to 4 days. In other 3 rats, only mild stage 1 to 2 seizures appeared following amygdala kindling. Only 1 of the 10 rats for which DBS had blocked kindled seizures exhibited full-scale 5 stage-kindled seizures 24 h after DBS. These results suggest that highly plastic neural networks are involved in amygdala-kindled seizures and that DBS, if well timed with the onset of amygdala kindling, may exert long lasting effects on the networks that may prevent the recurrence of kindled seizures.

Amygdala↗
PubMed2007

Neuropsychological effects of bilateral deep brain stimulation of the subthalamic nucleus in Parkinson's disease.

OBJECTIVE: Although a relatively new technique, bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) for the treatment of advanced cases of Parkinson's disease (PD) shows considerable promise. While the benefits of the STN stimulation for the treatment of motor symptoms of PD are well established, some studies have reported negative neuropsychological outcomes, especially in elderly patients. The objective of the present study was to investigate the neuropsychological effects of bilateral STN-DBS in a small sample of elderly patients with PD. METHODS: Six patients with PD (mean age 73.0 +/- 10.45 years) were assessed both before and approximately 6 months after DBS surgery in six neuropsychological domains. These domains included orientation, estimated IQ, attention/working memory, language, memory, and visual-spatial functioning. Additionally, depressive symptoms were assessed using the Geriatric Depression Scale. Daily doses of antiparkinsonian medications, in levodopa equivalents, were also compared pre- and postoperatively. RESULTS: Antiparkinsonian medications were reduced postoperatively by a mean of 65%, from a mean levodopa equivalent dosage of 987 mg/day to 346 mg/day. Category fluency, a word generation task within the language domain, was the only test in which participants demonstrated a statistically significant decline in performance. Participants demonstrated a mean score decrease of 41% (p < 0.05) in category fluency. CONCLUSIONS: The pathophysiology of the observed deficit remains ill defined. However, despite a small sample size, the study provides further evidence that bilateral STN-DBS in PD patients can be associated with negative neuropsychological outcome in word fluency, especially in elderly patients. Implications regarding patient selection for bilateral STN-DBS and recommendations for future research are further discussed.

Aged↗
PubMed2003

Transient dystonia following magnetic resonance imaging in a patient with deep brain stimulation electrodes for the treatment of Parkinson disease. Case report.

Data from previous studies have shown that magnetic resonance (MR) imaging of the head can be performed safely in patients with deep brain stimulators. The authors report on a 73-year-old patient with bilaterally implanted deep brain electrodes for the treatment of Parkinson disease, who exhibited dystonic and partially ballistic movements of the left leg immediately after an MR imaging session. Such dystonic or ballistic movements had not been previously observed in this patient. In the following months, this focal movement disorder resolved completely. This case demonstrates the possible risks of MR imaging in patients with deep brain stimulators.

Aged↗
PubMedDate not supplied

Deep brain stimulation for dystonia.

Within the past few years, there has been a renaissance of functional neurosurgery for the treatment of dystonic movement disorders. In particular, deep brain stimulation (DBS) has widened the spectrum of therapeutical options for patients with otherwise intractable dystonia. It has been introduced only with a delay after DBS became an accepted treatment for advanced Parkinson' disease (PD). In this overview, the authors summarize the current status of its clinical application in dystonia. Deep brain stimulation for dystonia has been developed from radiofrequency lesioning, but it has replaced the latter largely in most centers. The main target used for primary dystonia is the posteroventral globus pallidus internus (GPi), and its efficacy has been shown in generalized dystonia, segmental dystonia, and complex cervical dystonia. The optimal target for secondary dystonias is still unclear, but some patients appear to benefit more from thalamic stimulation. The improvement of dystonia with chronic DBS frequently is delayed, in particular concerning tonic dystonic postures. Because more energy is needed for stimulation than in other movement disorders such as PD, more frequent battery replacements are necessary, which results in relatively higher costs for chronic DBS. The study of intraoperative microelectrode recordings and of local field potentials by the implanted DBS electrodes has yielded new insights in the pathophysiology of dystonia. Larger studies are underway presently to validate the observations being made.

Brain Mapping↗
PubMedDate not supplied

[Applied neurophysiology in the deep brain stimulation treatment of multiple sclerosis tremor].

INTRODUCTION: Many patients with multiple sclerosis (MS) develop tremors that may involve one or both lower and/or upper extremities, head and/or voice. In the last few years, chronic high frequency deep brain stimulation of the ventral intermedious (Vim) thalamic nucleus (Vim-DBS, deep brain stimulation) seems to be gradually replacing Vim-thalamotomy in surgical treatment of tremor. The thalamotomy is a destructive procedure of the whole neural components, whereas Vim-DBS has shown to be a selective neurophysiological procedure to block a specific group of neural components, in particular large, fast and low threshold ones. MS is a disease of uncertain etiology characterized by demyelinating plaques in central nervous system. The neurophysiological intraoperative targeting applied to this pathology identifies demyelinated plaques and the functional state of Vim, reduces pitfalls and increases accuracy. Methods included spontaneous and induced multiunit activity recording, semimicroelectrode and tetraelectrode thalamic evoked potentials recording and micro/macro stimulation techniques.

Adult↗
PubMed2004

Unilateral battery depletion in Parkinson's disease patients treated with bilateral subthalamic nucleus deep brain stimulation may require urgent surgical replacement.

We describe 2 patients with advanced Parkinson's disease (PD) treated with bilateral deep brain stimulation of the subthalamic nucleus in whom unilateral stimulator battery depletion resulted in the rapid appearance of disabling PD symptoms (severe rigidity, bradykinesia and gait difficulty). Both patients did not respond to high doses of dopaminergic medications and were restored to their previous level of function only with battery replacement. One patient developed a deep vein thrombosis and pulmonary emboli as a result of prolonged immobility. Although extreme worsening of PD secondary to battery depletion may be rare, such patients should have their stimulators replaced promptly.

Aged↗
PubMed2006

The silent period of the thenar muscles to contralateral and ipsilateral deep brain stimulation.

OBJECTIVE: We aimed at characterizing the silent period induced in hand muscles by subcortical stimulation through electrodes implanted on the subthalamic nucleus for deep brain stimulation (STN-DBS). METHODS: In 10 patients with Parkinson's disease, we analyzed the inhibitory effects induced in the contralateral and ipsilateral thenar muscles by STN-DBS of varying stimulus intensity and strength of muscle contraction. RESULTS: Both, the contralateral silent period (CSP) and the ipsilateral silent period (ISP) were induced by stimuli at an intensity subthreshold for eliciting a contralateral motor evoked potential (MEP) and were composed of two phases. With a stimulus intensity of 120% of active threshold and a strength of 20%, the first CSP had a mean onset latency of 38.0 +/- 2.9 ms and a mean duration of 37.7 ms +/- 2.8 ms, and the second CSP had a mean onset latency of 90.6 +/- 18.5 ms and a mean duration of 53.4 +/- 6.3 ms. The first ISP had a mean onset latency of 34.9 +/- 4.3 ms and a mean duration of 12.5 +/- 3.4 ms, and the second ISP had a mean onset latency of 76.3 +/- 10.1 ms and a mean duration of 23.1 +/- 9.0 ms. The duration of both phases of the CSP increased with increasing the stimulus intensity and the burst separating the two phases of the CSP increased in size with increasing the strength of muscle contraction or the stimulus intensity. No ipsilateral MEP was observed in any patient at any strength or stimulus intensity. CONCLUSION: Our results indicate that the silent period induced by STN-DBS has specific physiological mechanisms that differ from those of the silent period induced by cortical transcranial magnetic stimulation. SIGNIFICANCE: The induction of ISP by stimulation of the motor tract at a point caudal to the corpus callosum indicates that non-callosal pathways are capable of generating ISP.

Aged↗
PubMed2005

Retrospective cross-evaluation of an histological and deformable 3D atlas of the basal ganglia on series of Parkinsonian patients treated by deep brain stimulation.

In functional neurosurgery, there is a growing need for accurate localization of the functional targets. Since deep brain stimulation (DBS) of the Vim thalamic nucleus has been proposed for the treatment of Parkinson's disease, the target has evolved toward the globus pallidus and subthalamic nucleus (STN) and the therapeutic indications have enlarged to include psychiatric disorders such as Tourette syndrome or obsessive compulsive disorders. In these pathologies, the target has been restrained to smaller functional subterritories of the basal ganglia, requiring more refined techniques to localize smaller and smallerbrain regions, often invisible in routine clinical MRI. Different strategies have been developed to identify such deep brain targets. Direct methods can identify structures in the MRI itself, but only the larger ones. Indirect methods are based on the use of anatomical atlases. The present strategy comprised a 3D histological atlas and the MRI of the same brain specimen, and deformation methodology developped to fit the atlas toward the brain of any given patient. In this paper, this method is evaluated in the aim of being applied to further studies of anatomo-clinical correlation. The accuracy of the method is first discussed, followed by the study of short series of Parkinsonian patients treated by DBS, allowing to compare the deformed atlas with various per- and post-operative data.

Basal Ganglia↗
PubMed2003

A novel quality of life instrument for deep brain stimulation in movement disorders.

OBJECTIVE: To develop a short instrument to examine quality of life (QoL) which specifically addresses patients with movement disorders treated by deep brain stimulation (DBS). DESIGN: The instrument was developed within an existing concept of a modular questionnaire (questions on life satisfaction: "general life satisfaction" QLS(M)-A, and "satisfaction with health" QLS(M)-G), in which each item is weighted according to its relative importance to the individual. METHODS: Items were generated by interviews with 20 DBS patients, followed by item reduction and scale generation, factor analysis to determine relevant and final questionnaire items, estimation of reliability, and validation based on the medical outcome study 36 item short form health survey (SF-36) and the EuroQol (EQ-5D) (data from 152 patients with Parkinson's disease, essential tremor, or idiopathic torsion dystonia, including 75 patients with DBS). RESULTS: Initial questionnaires were reduced to 12 items for a "movement disorder module" (QLS(M)-MD), and five items for a "deep brain stimulation module" (QLS(M)-DBS). Psychometric analysis revealed Cronbach's alpha values of of 0.87 and 0.73, and satisfactory correlation coefficients for convergent validity with SF-36 and EQ-5D. CONCLUSIONS: QLS(M)-MD and QLS(M)-DBS can evaluate quality of life aspects of DBS in movement disorders. Psychometric evaluation showed the questionnaires to be reliable, valid, and well accepted by the patients.

Activities of Daily Living↗
PubMed2006

Mesial temporal inhibition in a patient with deep brain stimulation of the anterior thalamus for epilepsy.

We investigated the electrophysiological effects of high-frequency anterior thalamic deep brain stimulation using intracerebral mesial and lateral temporal depth electrodes in a patient with intractable focal epilepsy. Monopolar and bipolar stimulation delivered to the thalamic anterior nucleus using the programmable ITREL II stimulation device led to a significant decrease of cross power spectral density and a nonsignificant decrease of coherence in ipsilateral hippocampal structures. No such effect was found in lateral temporal or contralateral sites. The hippocampal inhibition was clearly related to the voltage (> or =7 V) and frequency (> or =70 Hz) of the thalamic stimulus and occurred with a delay of approximately 60 s after stimulus onset.

Adult↗