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At least 667 records · Page 37Linked to original sources
PubMed2002

Deep brain stimulation of the subthalamic nucleus versus levodopa challenge in Parkinson's disease: measuring the on- and off-conditions with FDG-PET.

In order to compare the effects of high-frequency stimulation of the subthalamic nucleus (STN-DBS) and a levodopa-challenge on cerebral metabolic activity, we conducted PET scans with [(18)F]2-fluoro-2-deoxyglucose (FDG) in the drug- and stimulation- on- and off-condition in a single patient suffering from advanced PD. Our data revealed evidence for improved thalamocortical processing released from inhibition by overactive basal ganglia output nuclei in both on-conditions. While levodopa also led to a reduction of lentiform hyperactivity, effective STN stimulation seemed to interfere with distinct cerebellar and limbic circuits.

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PubMed1982

A correlative anatomical and clinical study of pain suppression by deep brain stimulation.

The clinical results of electrical stimulation in medial thalamic regions for cancer pain have been correlated with the exact location of the stimulation sites. Five brains were examined by post-mortem histology. Chronic implantation of enamel coated platinum-iridium electrodes for up to 17 months caused relatively mild glial and neuronal reactions and no significant haemorrhage or infarction. The anatomical verifications showed that the electrodes were close to, but not exactly in, the regions defined by the stereotactic coordinates. From the clinico-anatomical correlations it appears that good pain relief can be obtained by electrical stimulation in the periventricular gray region of the posterior thalamus.

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PubMed2006

Microelectrode recording can be a good adjunct in magnetic resonance image-directed subthalamic nucleus deep brain stimulation for parkinsonism.

BACKGROUND: The contribution of MER to improving bilateral STN-DBS is debatable. To resolve the controversy and elucidate the role of MER in DBS, we compared the outcome of bilateral STN-DBS surgery with and without MER in parkinsonian patients. METHODS: From February 2002 to November 2002, the first 7 of 13 consecutive parkinsonian patients received STN-DBS without MER (group A), and the last 6 received STN-DBS with MER (group B). Pre- and postoperative assessments included scoring of UPDRS with video taping, and MR images. RESULTS: The mean Hoehn and Yahr stage was 3.6 in group A and 4.0 in group B. The mean follow-up was 7.4 months for group A and 5.3 months for group B. The mean coordinates of the tip of the permanent electrode relative to the mid-commissural point were x = 8.1 mm, y = 4.3 mm, and z = 5.9 mm for group A and x = 10.6 mm, y = 4.1 mm, and z = 6.9 mm for group B. When levodopa was withdrawn from group A for 12 hours at follow-up, the postoperative UPDRS total score improved by 27.6% (P = .01) and the motor score by 25.4% (P = .02); their LEDD decreased by 17.5% (P = .03). In group B, the postoperative UPDRS total score improved by 49.3% (P = .00002) and the motor score by 45.2% (P = .0004); LEDD decreased by 48.5% (P = .01). CONCLUSIONS: Although STN-DBS is a promising surgical modality for advanced parkinsonian patients, there is an inevitable learning curve associated with adopting this new procedure. Intraoperative MER is an effective way to ensure correct electrode placement in the STN. With the assistance of intraoperative MER, the outcome of STN-DBS can be improved significantly.

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PubMed1980

Suppression of intention tremor by contingent deep-brain stimulation.

Severe intention tremor of the upper limb was suppressed in three patients with multiple sclerosis by stimulation in the contralateral midbrain and basal ganglia with stereotactically placed bipolar electrodes. Permanent electrodes were implanted in two patients. The therapeutic effects of stimulation have in part been maintained, without any change in electrical threshold, throughout the period of observation (six months).

Adult↗
PubMed2002

Thalamic field potentials during deep brain stimulation of periventricular gray in chronic pain.

Stimulation of the central gray matter areas has been used for the treatment of chronic pain for decades. To better understand the mechanism of action of such treatment we studied the effects of stimulation of the periventricular gray (PVG) on the sensory thalamus in two patients with chronic central pain. In each case, two electrodes were implanted in the PVG (Medtronic 3389) and the ventroposterolateral thalamic nucleus (Medtronic 3387), respectively, under guidance of CT/MRI image fusion. The PVG was stimulated in the frequency range of 2-100 Hz in alert patients while pain was assessed using the McGill-Melzack visual analogue scale. In addition, local field potentials (FPs) were recorded from the sensory thalamus during PVG stimulation. Maximum pain relief was obtained with 5-25 Hz stimulation while 50-100 Hz made the pain worse. This suggests that pain suppression was frequency dependent. Interestingly, we detected low frequency FPs at 0.2-0.4 Hz closely associated with the pain. During 5-25 Hz PVG stimulation the amplitude of this potential was significantly reduced and this was associated with marked pain relief. At the higher frequencies (50-100 Hz) however, there was no reduction in the FPs and no pain suppression. We have found an interesting correlation between thalamic activity and chronic pain. This curious low frequency potential may provide an objective index for quantifying chronic pain, and may hold further clues to the mechanism of action of PVG stimulation.

Chronic Disease↗
PubMed2002

Vocal tremor reduction with deep brain stimulation: a preliminary report.

Vocal tremor has been a challenging problem for patients and their physicians. In some cases, it has been possible to lesson the symptom's tremor through medications and/or voice therapy. However, in most cases no good treatment has been available. Chronic stimulation of the thalamus has been successful in controlling tremors of the upper limb and other portions of the body. Our preliminary experience suggests that it may also be helpful in controlling vocal tremor.

Aged↗
PubMed1990

Deep brain stimulation in the treatment of chronic pain in man: where and why?

In current clinical practice, two brain structures are stimulated for the relief of chronic pain, namely the somatosensory thalamic nuclei (VPL-VPM) and the periventricular and periaqueductal gray matter (PVG-PAG). Whereas stimulation of the VPL-VPM is almost exclusively used for the treatment of deafferentation pain, stimulation of the PVG-PAG is mostly used in cases of nociceptive pain. We present our results of VPL-VPM stimulation in 36 patients with deafferentation pain. Initial pain relief was obtained in 61% of patients. To-day, after a mean follow-up of more than 4 years, 30% are still pain free. This success rate was found to be lower than the mean reported success rate of 57%, based on a survey of the world literature. Upon reviewing the literature, it was apparent that the reported success rates vary considerably between different authors. Some tentative explanations are given for this large discrepancy in success rate. The mechanisms by which electrical stimulation of the VPL-VPM suppresses deafferentation pain remain to be elucidated. Recent clinical and experimental findings suggest that a dopaminergic mechanism might be involved.

Brain↗
PubMed2002

EEG and evoked potential recording from the subthalamic nucleus for deep brain stimulation of intractable epilepsy.

OBJECTIVES: The substantia nigra in the animal model has been implicated in the control of epilepsy. The substantia nigra pars reticulata (SNpr) receives afferents from the subthalamic nucleus (STN), which thus may have an effect on the control of epilepsy. There is evidence in the animal model of a direct connection from the cortex to the STN. High-frequency STN stimulation is being used in experimental trial for the management of intractable epilepsy. Our primary objective in this study was to determine if there was epileptiform activity recorded from the STN in association with scalp recorded epileptiform activity to support the presence of a pathway from the cortex to the STN in humans as described in animals that may be important for the management of epilepsy. This article describes the interictal and ictal electroencephalographic (EEG) findings as well as evoked potential recordings from the STN in these patients with intractable epilepsy. METHODS: Four patients (3 males) ranging from 19 to 45 years with intractable focal epilepsy refractory to anti-epileptic drugs were studied. Two patients failed vagal nerve stimulation and one patient had previous epilepsy surgery. Depth electrodes were implanted stereotactically in the STN bilaterally. A comparative analysis of the interictal and ictal activities recorded from the scalp and STN electrodes was performed. Median nerve somatosensory evoked potentials (SEPs) and auditory evoked potentials (AEPs) were also recorded. RESULTS: Interictal sharp waves recorded in the scalp EEG were always negative in polarity. These sharp waves were always associated with sharp waves recorded at the ipsilateral STN electrode contacts that were always positive in polarity. In addition repetitive spikes were recorded independently at the left or right STN electrode contacts, with no reflection at the scalp. These spikes were extremely stereotyped, of high amplitude and short duration, and were positive or negative in polarity. Focal scalp EEG seizures were also recorded at the ipsilateral STN electrodes. In 3 patients SEPs were recorded from the contralateral STN electrodes corresponding to the P14/N18 far-field complex. In two patients AEPs were recorded, and wave V (near-field) and wave VII (far-field) from the contralateral STN electrodes. CONCLUSIONS: This study demonstrates that scalp recorded epileptiform activity is reflected at the ipsilateral STN either following or preceding the scalp sharp waves. The STN sharp waves are most probably an expression of the direct cortico-STN glutamatergic pathways that have been demonstrated previously in animals. This pathway in man may be important with regard to a possible mechanism for the treatment of epilepsy with STN stimulation.

Action Potentials↗