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At least 1,135 records · Page 63Linked to original sources
PubMed1999

Thalamic stimulation in patients with multiple sclerosis.

OBJECTIVE: To assess tremor control and side effects in patients with multiple sclerosis (MS) treated with chronic thalamic stimulation for relief of upper extremity tremor. METHODS: Five patients were studied before and after thalamic placement of a deep brain stimulation (DBS) system. Preoperative and postoperative evaluation included magnetic resonance imaging, Extended Disability Status Scale (EDSS), the Bain-Finchley visual analog scale for tremor, video recording and neuropsychological testing. Stereotactic targeting of the Vim nucleus was done using computed tomography; intraoperative testing was done under local anesthesia before permanent implantation. RESULTS: Functionally useful tremor suppression was obtained in 3/5 patients. Neuropsychological deficits of higher cortical function, memory and visuospatial coordination were observed in all patients before surgery; in 1 patient with improved postoperative visuospatial coordination, worsened memory was found. New brainstem plaque formation was seen several weeks after surgery in 1 patient who had an acute worsening of MS which improved after high-dose intravenous steroids. CONCLUSIONS: Chronic thalamic stimulation may help selected patients with MS-induced tremor. Given the complexity of their underlying illness, patients must be selected carefully, and long-term follow-up is vital to evaluate the true utility of DBS.

Adult↗
PubMed2002

Effects of bilateral stimulation of the subthalamic nucleus in patients with severe Parkinson's disease and motor fluctuations.

We present the efficacy and side effects of bilateral deep brain stimulation (DBS) of the subthalamic nuclei (STN) performed with a more simplified surgical procedure than described by the Grenoble group. A consecutive series of 26 patients with advanced and levodopa-responsive Parkinson's disease and motor complications was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) part I-VI, timed tests, and a patient diary for 2 days concerning on-off phenomenon and dyskinesias. At 3 months, evaluation of stimulation by the UPDRS motor score was performed in a double-blind manner and a significant improvement of 57% was found. The results 12 months after surgery off medication showed significant improvement in both UPDRS motor score and activities of daily living of 64% and, on medication, a significant reduction of 86% in duration of dyskinesias and 83% in duration of off-periods. Reduction in medication was less than for other groups, probably because we used smaller doses of levodopa before the operation. No serious side effects were encountered. When the patients are carefully selected and followed up, bilateral DBS of STN is a significant progress in treatment of advanced idiopathic Parkinson's disease with levodopa-induced motor complications.

Activities of Daily Living↗
PubMed2006

Subthalamic nucleus stimulation in Parkinson's disease : anatomical and electrophysiological localization of active contacts.

OBJECTIVES: 1 - To assess the anatomical localization of the active contacts of deep brain stimulation targeted to the subthalamic nucleus (STN) in Parkinson's disease patients. 2 - To analyze the stereotactic spatial distribution of the active contacts in relation to the dorsal and the ventral electrophysiologically-defined borders of the STN and the stereotactic theoretical target. METHODS: Twenty-eight patients underwent bilateral high-frequency stimulation of the STN (HFS-STN). An indirect anatomical method based on ventriculography coupled to electrophysiological techniques were used to localize the STN. Clinical improvement was evaluated by Unified Parkinson's Disease Rating Scale motor score (UPDRS III). The normalized stereotactic coordinates of the active contact centres, dorsal and ventral electrophysiologically-defined borders of the STN were obtained from intraoperative X-rays images. These coordinates were represented in a three-dimensional stereotactic space and in the digitalized atlas of the human basal ganglia. RESULTS: HFS-STN resulted in significant improvement of motor function (62.8%) in off-medication state and levodopa-equivalent dose reduction of 68.7% (p < 0.05). Most of the active contacts (78.6%) were situated close to (+/- 1.6 mm) the dorsal border of the STN (STN-DB), while 16% were dorsal and 5.4% were ventral to it. Similar distribution was observed in the atlas. The euclidean distance between the STN-DB distribution center and the active contacts distribution center was 0.31 mm, while the distance between the active contacts distribution center and the stereotactic theoretical target was 2.15 mm. Most of the space defined by the active contacts distribution (53%) was inside that defined by the STN-DB distribution. CONCLUSION: In our series, most of the active electrodes were situated near the STN-DB. This suggests that HFS-STN could influence not only STN but also the dorsal adjacent structures (zona incerta and/or Fields of Forel).

Action Potentials↗
PubMed2004

Subthalamic nucleus stimulation restores glucose metabolism in associative and limbic cortices and in cerebellum: evidence from a FDG-PET study in advanced Parkinson's disease.

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a highly effective surgical treatment in patients with advanced Parkinson's disease (PD). Because the STN has been shown to represent an important relay station not only in motor basal ganglia circuits, the modification of brain areas also involved in non-motor functioning can be expected by this intervention. To determine the impact of STN-DBS upon the regional cerebral metabolic rate of glucose (rCMRGlc), we performed positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) in eight patients with advanced PD before surgery as well as in the DBS on- and off-conditions 4 months after electrode implantation and in ten age-matched healthy controls. Before surgery, PD patients showed widespread bilateral reductions of cortical rCMRGlc versus controls but a hypermetabolic state in the left rostral cerebellum. In the STN-DBS on-condition, clusters of significantly increased rCMRGlc were found in both lower thalami reaching down to the midbrain area and remote from the stimulation site in the right frontal cortex, temporal cortex, and parietal cortex, whereas rCMRGlc significantly decreased in the left rostral cerebellum. Therefore, STN-DBS was found to suppress cerebellar hypermetabolism and to partly restore physiologic glucose consumption in limbic and associative projection territories of the basal ganglia. These data suggest an activating effect of DBS upon its target structures and confirm a central role of the STN in motor as well as associative, limbic, and cerebellar basal ganglia circuits.

Aged↗
PubMed2006

Auditory cortical responses to electrical stimulation of the inferior colliculus: implications for an auditory midbrain implant.

The success and limitations of cochlear implants (CIs) along with recent advances in deep brain stimulation and neural engineering have motivated the development of a central auditory prosthesis. In this study, we investigated the effects of electrical stimulation of the inferior colliculus central nucleus (ICC) on primary auditory cortex (A1) activity to determine the potential benefits of an auditory midbrain implant (AMI). We recorded multiunit activity in A1 of ketamine-anesthetized guinea pigs in response to single-pulse (200 micros/phase) monopolar stimulation of the ICC using multisite silicon-substrate probes. We then compared measures of threshold, dynamic range, and tonotopic spread of activation for ICC stimulation with that of published data for CI stimulation. Our results showed that compared with cochlear stimulation, ICC stimulation achieved: 1) thresholds about 8 dB lower; 2) dynamic ranges > or = 4 dB greater; and 3) more localized, frequency-specific activation, even though frequency specificity was partially lost at higher stimulus levels for low-frequency ICC regions. Our results also showed that stimulation of rostral ICC regions elicited lower thresholds but with greater activation spread along the tonotopic gradient of A1 than did stimulation of more caudal regions. These results suggest that an AMI may improve frequency and level coding with lower energy requirements compared with CIs. However, a trade-off between lower perceptual thresholds and better frequency discrimination may exist that depends on location of stimulation along the caudorostral dimension of the ICC. Overall, this study provides the foundation for future AMI research and development.

Acoustic Stimulation↗
PubMed2003

Dual-floor burr hole adjusted to burr-hole ring and cap for implantation of stimulation electrodes. Technical note.

Using a new perforator, the authors have developed a new dual-floor burr-hole method for use in deep brain stimulation therapy. The modification is called "dual-floor" because the usual 15-mm-diameter burr hole, which is located centrally and reaches the dura mater, is surrounded by a 4-mm-wide rim that is also planed downward by the new perforator to a depth of 4 mm. This dual-floor burr hole is adjusted to fit the burr-hole ring and cap that are are supplied by the electrode manufacturer. Such a method eliminates bulging of the scalp just over the burr-hole ring and cap. In addition, it is helpful for securing a tight fixation between the burr-hole ring and the skull.

Electric Stimulation Therapy↗
PubMed1999

[The effect of thalamic stimulation on levodopa induced dyskinesias--evaluation of a new target: the center parafascicular median].

After 10 years of clinical practice (1987-1997), chronic thalamic deep brain stimulation (DBS) is considered to be effective in the treatment of drug-resistant parkinsonian tremor. DBS has produced few side-effects, which are usually reversible. More recently, DBS has been applied to other movement disorders (akinesia and rigidity, dyskinesias, dystonia), using new targets: internal pallidum, subthalamic nucleus. These targets have been selected on the basis of neurophysiological or anatomo-clinical data suggesting they could be effective. Control of L-Dopa peak-dose dyskinesias by thalamic ventralis intermedius nucleus (V.im.) stimulation has been reported by the Lille team, but not by the Grenoble team. We therefore re-examined all teleradioanatomical data of both teams, and compared them with the therapeutic effects. Location of 99 monopolar electrodes of thalamic stimulation, applied to treat parkinsonian tremor, has been retrospectively measured. The Lille team included 21 patients (22 electrodes); the Grenoble team included 52 patients (74 electrodes). L-Dopa dyskinesias were suppressed in all 9 patients in Lille, and improved clearly in only 8 out of 32 patients in Grenoble. The mean center of electrodes was significantly different between both teams, being deeper, more posterior and medial in Lille. This did not correspond to the coordinates of the V.im., but seems to be closer to those of the centromedian and parafascicular complex (CM-Pf), according to stereotactic atlases. Considering only the dyskinetic patients, the therapeutic effects on L-Dopa dyskinesias were related to the differences observed in the electrode position, but not to the team membership. Improvement of L-Dopa dyskinesias was significantly associated with deeper and more medial placement of electrodes. Retrospective analysis of ventriculographic data confirmed that the electrode position and therapeutic effects of DBS are strongly related. Our study suggested that CM-Pf stimulation could control both tremor and L-Dopa dyskinesias. This hypothesis is consistent with neuro-anatomical data showing that CM-Pf is connected to internal pallidum, the stimulation of which controls specifically L-Dopa dyskinesias.

Aged↗
PubMed2003

Deep brain and motor cortex stimulation for post-stroke movement disorders and post-stroke pain.

Our experience of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in patients with post-stroke movement disorders and post-stroke pain is reviewed. DBS of the thalamic nuclei ventralis oralis posterior et intermedius proved to be useful in more than 70% of patients with post-stroke involuntary movements (hemiballismus, hemichoreo-athetosis, distal resting and/or action tremor, and proximal postural tremor). The effect of DBS of the thalamic nucleus ventralis caudalis or internal capsule on post-stroke pain was usually disappointing. Excellent pain control can be achieved by MCS in approximately 50% of patients with post-stroke pain. In the course of clinical trials on MCS for the control of post-stroke pain, it was found that co-existent post-stroke involuntary movements (hemichoreo-athetosis and resting tremor) could also be controlled by MCS. Post-stroke involuntary movements, especially those in thalamic syndrome, are sometimes associated with post-stroke pain. In such disorders, involuntary movements are attenuated, but the pain in the same patients is often exacerbated by DBS of the thalamic nuclei ventralis oralis posterior et intermedius. MCS could be the therapy of choice under such circumstances. Subjective improvement of voluntary motor performance, which had been impaired in association with mild or moderate hemiparesis, was reported during MCS by approximately 20% of patients with post-stroke pain. Such an effect on voluntary motor performance appears to be caused by an inhibition of their rigidity. The reversibility of DBS and MCS makes them an important option for the control of post-stroke movement disorders and post-stroke pain.

Electrodes, Implanted↗
PubMed1999

A positron emission tomographic study of subthalamic nucleus stimulation in Parkinson disease: enhanced movement-related activity of motor-association cortex and decreased motor cortex resting activity.

BACKGROUND: Long-term high-frequency stimulation of the subthalamic nucleus (STN) improves akinesia in Parkinson disease. The neural correlates of STN stimulation are not well understood. Positron emission tomography can be applied to the in vivo study of the mechanisms of deep brain stimulation. OBJECTIVE: To study changes in regional cerebral blood flow as an index of synaptic activity in patients with Parkinson disease with effective STN stimulation on and off during rest and movement. METHODS: Eight patients with Parkinson disease who had electrodes implanted in the STN underwent 12 measurements of regional cerebral blood flow with water O 15 positron emission tomography at rest and during performance of paced freely selected joystick movements, both with and without STN stimulation (3 scans per experimental condition). Motor performance and reaction and movement times were monitored. Statistical parametric mapping was used to compare changes in regional cerebral blood flow between conditions and differences in activation. RESULTS: All patients showed improvement in reaction and movement times during scans with the stimulator on. As predicted, increases in activation of rostral supplementary motor area and premotor cortex ipsilateral to stimulation were observed when stimulation was on during contralateral movement (P<.001). Unpredicted observations included decreases in regional cerebral blood flow in primary motor cortex at rest induced by STN stimulation. CONCLUSION: Stimulation of the STN reduces the movement-related impairment of frontal motor association areas and the inappropriate motor cortex resting activity in Parkinson disease.

Adult↗
PubMed2002

Chronic high-frequency globus pallidus internus stimulation in different types of dystonia: a clinical, video, and MRI report of six patients presenting with segmental, cervical, and generalized dystonia.

The results of deep brain stimulation (DBS) of the globus pallidus internus (Gpi) in six patients with generalized, focal, and segmental dystonia are presented. Pre- and postoperative assessments are given for one patient with generalized inherited dystonia and for five patients with idiopathic segmental or cervical dystonia. Clinical symptoms were evaluated before and 3-12 months after surgery using the Burke-Fahn-Marsden (BFM) dystonia rating scale for primary torsion dystonia and the Tsui scale for cervical dystonia. The Short-Form Health Survey (SF-36) was completed by each patient to document preoperative and postoperative health status. Also, neurological status was documented by video before and during chronic stimulation. Magnetic resonance imaging studies were performed to show the anatomical localization of the electrode leads. Five patients showed a progressive improvement within 7 days. One patient with cervical dystonia and Meige's syndrome showed no improvement for 3 months, but beneficial effects were observed after 12 months. On average, the BFM movement scale scores decreased by 72.5% and Tsui scale scores by 63%. SF-36 showed an improvement in health status by an average of 36% according to eight different health categories. We conclude that chronic high-frequency Gpi stimulation in different types of dystonia is a very effective and safe treatment.

Adult↗
PubMed2004

Electrical stimulation of the globus pallidus internus in patients with primary generalized dystonia: long-term results.

OBJECT: Primary generalized dystonia (PGD) is a medically refractory disease of the brain causing twisting or spasmodic movements and abnormal postures. In more than 30% of cases it is associated with the autosomal DYT1 mutation. Continuous electrical stimulation of the globus pallidus internus (GPi) has been used successfully in the treatment of PGD. The aim of this study was to examine the long-term efficacy and safety of deep brain stimulation (DBS) in the treatment of PGD in children and adults with and without the DYT1 mutation. METHODS: Thirty-one patients with PGD were selected for surgery. Electrodes were bilaterally implanted under stereotactic guidance and connected to neurostimulators that were inserted subcutaneously. Efficacy was evaluated by comparing scores on the clinical and functional Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) before and after implantation. The efficacy of stimulation improved with time. After 2 years, compared with preoperative values, the mean (+/- standard deviation) clinical and functional BFMDRS scores had improved by 79 +/- 19% and 65 +/- 33%, respectively. At the 2-year follow-up examination the improvement was comparable in patients with and without the DYT1 mutation in both the functional (p = 0.12) and clinical (p = 0.33) scores. Children displayed greater improvements in the clinical score than adult patients (p = 0.04) at 2 years of follow up. In contrast, there was no significant difference in functional scores between children and adults (p = 0.95). CONCLUSIONS: Electrical stimulation of the GPi is an effective, reversible, and adaptable treatment for PGD and should be considered for conditions refractory to pharmaceutical therapies.

Adult↗
PubMed1999

Direct stereotactic MRI location in the globus pallidus for chronic stimulation in Parkinson's disease.

We evaluated the direct location in the globus pallidus (GP) under stereotactic MRI (sMRI) guidance in five parkinsonians treated with chronic deep brain stimulation (four bilaterally). The sMRI consisted of three orthogonal (horizontal, frontal, sagittal) sets of images obtained with a stereotactic frame and its localiser. The sMRI was coupled with ventriculography to compare the location with the classic indirect method based on commissural landmarks. The target was defined on T2-weighted slices in the anterior part of the medial GP, at the vertex of the nucleus. It was reached via one track with a semi-micro-electrode and step by step high frequency stimulation, then replaced by a quadripolar electrode once we located the site enabling the optimal clinical improvement. Stereotactic x-rays localised the final position of the electrode. A company software matched sMRI, ventriculography, and peroperative (perop) x-rays, with reference to the stereotactic location boxes. We analysed the effects of acute (perop) and chronic (six-month follow-up) stimulation of active plots (acplots), i.e. leading to optimal clinical improvement. Three distances with reference to the acplots were measured both on sMRI and ventriculography: the laterality from the median sagittal plane of the third ventricle; the anterior position from the midpoint of the intercommissural line (Icl), and the vertical position with regard to the Icl. We then compared the differences in measurements (n = 64) with the Bland and Altman method. The mean difference was 0.09 mm with 95% of the values between +/- 1 mm, but only the laterality had a statistically significant agreement (all the differences included between +/- two times the standard deviation of the mean). The acplots distances from the dorsal, ventral, and medial boundaries of GP (defined by manual surrounding on frontal and horizontal planes) were measured on sMRI. With one exception, the acplots were all included in the nucleus. The six-month acplots were located dorsally with reference to the perop ones. Clinical benefit at six-months follow-up showed results comparable to the literature. Direct location of GP target based on sMRI seems a simple and reliable method.

Cerebral Ventriculography↗
PubMed2004

Sensitivity of temporal excitation properties to the neuronal element activated by extracellular stimulation.

Measurements of the chronaxies and refractory periods with extracellular stimuli have been used to conclude that large diameter axons are responsible for the effects of deep brain stimulation (DBS). We hypothesized that because action potential initiation by extracellular stimulation occurs in the axons of central nervous system (CNS) neurons, the chronaxies and refractory periods determined using extracellular stimulation would be similar for cells and axons. Computer simulation was used to determine the sensitivity of chronaxie and refractory period to the neural element stimulated. The results demonstrate that chronaxies and refractory periods were dependent on the polarity of the extracellular stimulus and the electrode-to-neuron distance, and indicate that there is little systematic difference in either chronaxies or refractory periods between local cells or axons of passage with extracellular stimulation. This finding points out the difficulty in drawing conclusions regarding which neuronal elements are activated based on extracellular measurements of temporal excitation properties.

Action Potentials↗
PubMed2003

Short-term effect of bilateral subthalamic stimulation for advanced Parkinson's disease.

BACKGROUND: Subthalamic nucleus (STN) hyperactivity is a pathophysiological phenomenon of Parkinson's disease (PD). Inhibition of this hyperactivity by chronic deep brain stimulation (DBS) can possibly reset the aberrant function of the cortico-striato-thalamal circuit and improve the parkinsonian symptoms. DBS was introduced as a safe and alternative way of performing functional stereotaxic surgery for treating PD. METHODS: Seven advanced PD patients with complicated motor fluctuations and dyskinesia were enrolled in the study. A quadripolar electrode was bilaterally installed in the STN. Patients were evaluated before and 6 months after implantation using a battery of clinical assessments, including the motor score of the unified Parkinson's disease rating scale (UPDRS), modified Hoehn and Yahr (HY) staging, and the Schwab and England activities of daily living scale (SEADL). Preoperative baseline evaluations included both "off-medication" periods and "on-medication" periods, while postoperative evaluations included a cross-over of the above 2 periods with and without DBS. RESULTS: The motor disability, HY staging, and SEADL all significantly improved in both the off- and on-medication periods 6 months after STN DBS. Compared to the baseline off-medication score, a significant improvement was found in the UPDRS motor and other subscores including tremors, rigidity, and bradykinesia. The SEADL score showed a great improvement of 205.6%. Ballism/chorea, mood changes, and blepharospasm may have been induced by DBS. Neither serious nor permanent side effects appeared. CONCLUSIONS: Bilateral STN DBS improved the motor symptoms in advanced PD patients in both the off- and on-medication periods. They showed improvements not only in motor disabilities of tremors, rigidity, bradykinesia, and postural and gait instability, but also in levodopa-related dyskinesia and psychosis.

Aged↗
PubMed2004

[Manipulation of mental competence: an ethical problem in case of electrical stimulation of the subthalamic nucleus for severe Parkinson's disease].

Three years after the implantation of electrodes in the subthalamic nucleus (STN) and the start of deep brain stimulation (DBS) for advanced Parkinson's disease, a 62-year-old man was admitted because of a stimulation-related manic state that did not respond to treatment with a mood stabiliser and that led to chaotic behaviour, megalomania, serious financial debts and mental incompetence. Although adjustment of the stimulation parameters resulted in a normophoric state with a return of insight and capacity to judge, this was only at the cost of a serious exacerbation of his motor symptoms that left the patient bedridden. There was no therapeutic margin between the two states. Ultimately, there seemed to be only two alternatives: to admit the patient to a nursing home because of serious invalidity, but mentally in good condition, or to admit the patient to a chronic psychiatric ward because of a manic state, but with acceptable motor capacity and ADL functions. Thorough ethical evaluation followed. When not being stimulated, the patient was considered competent to decide about his own treatment; in this condition the patient chose for the second option. In accordance with his own wishes he was therefore legally committed to a chronic ward in the regional psychiatric hospital. The current ethical views on mental competence do not consider the potential influence of modern methods of treatment such as STN-DBS on this capacity.

Bipolar Disorder↗
PubMed1993

[Deep cerebral stimulation in patients with post-traumatic vegetative state. 25 cases].

In 25 cases of post traumatic vegetative state persisting 3 months after the initial injury, deep brain stimulation (DBS) has been used with the aim to activate the cortex and the hope to produce some degree of functional recovery. Electrodes were stereotaxically implanted in the centrum medianum-parafascicularis complex. Bipolar stimulation was provided daily from 8 a.m. to 8 p.m. In 12 cases no changes occurred in the clinical features and overall behaviour. DBS was given up after 2 months. All these patients with a follow-up of 1 to 10 years, remained in a permanent vegetative state, 4 of them eventually deceased. In 13 cases, following 1 to 3 weeks of DBS a definite improvement was obtained with recovery of some degree of consciousness and interpersonal relationship. However all these patients, with 1 to 12 years follow-up remained severely disabled. 2 of them deceased from intercurrent causes. The practical meaning of these clinical results are questioned. We consider that the absence of response to DBS is an important argument to predict the irreversibility of post traumatic vegetative state. It is not certain that DBS is directly responsible for positive changes observed, some degree of long-term spontaneous recovery being already documented in such patients. However it seems likely that DBS accelerates recovery and possibly improves the final level of performances.

Brain Injuries↗
PubMed2001

Thalamic stimulation in neuropathic pain: 27 years later.

An overview is given of CNS mechanisms which are behind the beneficial effects of VPL-VPM thalamic stimulation in the treatment of neuropathic pain. Further research in this field is urgently needed and the recent possibility to combine Deep Brain Stimulation with positron emission tomography (PET) will certainly help to unravel the brain circuitry implicated in stimulation-produced analgesia. Brain stimulation is an artificial way to activate nervous tissue that is reversible and, when correctly applied, has few complications. The clinical results warrant a continued dissemination of brain stimulation as a treatment in well selected cases of neuropathic pain.

Electric Stimulation Therapy↗