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At least 19 recordsLinked to original sources
PubMed2026

Choice of Anesthesia in Microelectrode Recording-guided Deep Brain Stimulation Surgery for Parkinson's Disease (CHAMPION): A Noninferiority Randomized Controlled Trial.

BACKGROUND: Deep brain stimulation for Parkinson's disease is often performed under conscious sedation or general anesthesia. However, anesthetic agents may influence intraoperative microelectrode recording, and the optimal anesthesia method for microelectrode recording remains unclear. This study compared general anesthesia and conscious sedation in preserving microelectrode recording signal intensity during deep brain stimulation. METHODS: In this prospective, noninferiority randomized controlled trial, patients with Parkinson's disease (United Kingdom Brain Bank criteria) undergoing elective bilateral surgery were randomized 1:1 to the conscious sedation or the general anesthesia group. During surgery, a desflurane anesthetic titrated against the quality of the electrophysiologic signal was applied in the general anesthesia group, whereas patients in the conscious sedation group received dexmedetomidine anesthesia. The primary outcome was the proportion of patients with high-quality microelectrode recording (normalized root mean square greater than 2.0), assessed postoperatively off-line. Secondary outcomes included operation and recording duration, 6-month clinical efficacy, and complication rates. RESULTS: Of 188 randomized patients (94 general anesthesia, 93 conscious sedation), desflurane anesthesia was noninferior for high normalized root mean square proportion (89.4% vs . 90.3%; difference, -0.96%; 95% CI, -9.62 to 7.70). The general anesthesia group had shorter operative time (difference, -9.07&#x2009;min; 95% CI, -13.99 to -4.14; P < 0.001). At 6 months, changes in Unified Parkinson's Disease Rating Scale score (difference, -2.50; 95% CI, -7.20 to 2.20; P = 0.297), levodopa equivalent daily dose (difference, -58.4&#x2009;mg; 95% CI, -133.56 to 16.75; P = 0.128), and complication rates (general anesthesia: 10.9% vs . conscious sedation: 8.9%; P = 0.655) were comparable between the groups. CONCLUSIONS: General anesthesia is noninferior to conscious sedation for microelectrode-guided subthalamic nucleus deep brain stimulation, providing equivalent signal intensity and clinical outcomes while improving procedural efficiency, supporting its use as a valid clinical option.

Humans↗
PubMed2026

Deep brain stimulation for Tourette syndrome: a systematic review and meta-analysis.

Deep brain stimulation (DBS) has emerged as a promising neuromodulatory therapy for patients with refractory Tourette syndrome (TS). Various brain targets-including the globus pallidus internus (GPi) and several thalamic nuclei-have been explored, yet the comparative efficacy of DBS in different targets remain unclear. This meta-analysis aims to evaluate the clinical efficacy of DBS in TS and assess symptom improvements across different stimulation targets. A systematic search of PubMed, Embase, and Web of Science identified studies published between October 2014 and September 2025. Study quality was assessed using the French and Gronseth classification system. Outcomes of interest included pre- and postoperative scores on the Yale Global Tic Severity Scale (YGTSS) and Yale-Brown Obsessive Compulsive Scale (YBOCS). A total of 22 studies involving 358 patients were included in this meta-analysis. Mean YGTSS scores decreased from 69.19&#x2009;&#xb1;&#x2009;18.04 preoperatively to 35.88&#x2009;&#xb1;&#x2009;17.23 postoperatively. There was an average 48% reduction in YGTSS scores. DBS led to a substantial reduction in tic severity (YGTSS: GPi, SMD&#x2009;=&#x2009;2.29, P&#x2009;<&#x2009;0.00001; thalamus, SMD&#x2009;=&#x2009;2.33, P&#x2009;<&#x2009;0.0001). Within the GPi subgroup, stimulation of the anteromedial GPi (amGPi) resulted in significantly better benefits (SMD&#x2009;=&#x2009;3.01, P&#x2009;<&#x2009;0.00001) compared to the posterior-ventrolateral GPi (pvlGPi), which did not reach statistical significance (SMD&#x2009;=&#x2009;1.23, P&#x2009;=&#x2009;0.05). YBOCS scores decreased from a mean of 17.38&#x2009;&#xb1;&#x2009;6.15 preoperatively to 9.16&#x2009;&#xb1;&#x2009;4.12 postoperatively. The average reduction in YBOCS scores was 47%. Obsessive-compulsive disorder (OCD) symptoms also showed significant improvement following DBS (overall YBOCS, SMD&#x2009;=&#x2009;0.94, P&#x2009;<&#x2009;0.00001; amGPi, SMD&#x2009;=&#x2009;1.49, P&#x2009;=&#x2009;0.004; pvlGPi, SMD&#x2009;=&#x2009;0.72; P&#x2009;=&#x2009;0.006). DBS is an effective and target-sensitive intervention for TS, alleviating both motor tics and obsessive-compulsive symptoms. Compared to therapies such as pvlGPi and thalamic-DBS, amGPi-DBS may demonstrate greater therapeutic potential compared with pvlGPi-DBS, suggesting its potential advantage in modulating the associated circuits involved in the pathophysiology of TS.

Humans↗
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↗
PubMed2026

Epilepsy: Bridging Epidemiological Landscapes, Molecular Mechanisms, and Emerging Precision Therapeutics.

Epilepsy ranks among the most prevalent neurological disorders worldwide, and recent years have witnessed significant advancements in understanding its epidemiological features, pathophysiological mechanisms, diagnostic methodologies, and therapeutic approaches. This review systematically examines the epidemiology of epilepsy, highlighting pronounced regional and population-based disparities, particularly the substantial treatment gap observed in low-income countries. Regarding pathogenesis, epilepsy development involves aberrant ion channel function, neuroinflammatory processes, dysregulation of the mTOR signaling pathway, and genetic predispositions. Diagnostic innovations, including ultra-high field magnetic resonance imaging, artificial intelligence-enhanced electroencephalogram analysis, and liquid biopsy techniques, have markedly enhanced the precision of epileptogenic focus localization and etiological identification. Genetic investigations have uncovered numerous epilepsy-associated genes, thereby underpinning the advancement of targeted therapies. Therapeutically, novel antiepileptic drugs, neuromodulation modalities such as vagus nerve stimulation and deep brain stimulation, alongside gene therapy, have expanded treatment options for refractory epilepsy. Nonetheless, global epilepsy management continues to confront challenges including limited drug accessibility, social stigma, and pharmacoresistance. The future trajectory emphasizes individualized and precision medicine approaches, integrating genomics, biomarker discovery, and intelligent monitoring technologies to foster comprehensive improvements in epilepsy diagnosis and treatment.

epidemiology↗
PubMed2026

Assessment of Surgical Salvage Outcomes for Exposed Cranial Neuromodulating Devices.

OBJECTIVES: Implanted neuromodulating devices (NMDs) such as cochlear implants (CIs) and deep brain stimulators (DBSs) are commonly used in modern medicine. Rarely, complications arise post-operatively, including hardware exposure. Traditional teaching suggests that these devices require removal if exposed; however, surgical salvage is a high risk, high reward alternative. We review our single institution experience managing NMD exposure with surgical salvage. METHODS: Retrospective chart review was performed on individuals who had a NMD implanted and underwent an attempt at surgical salvage for exposure during the study period (January 01, 2021 through December 31, 2023). Study outcome success was defined as maintaining a functional NMD 1&#x2009;year after salvage was attempted. Surgical techniques associated with successful salvage were compared. RESULTS: Nine of 729 patients (1.2%) implanted with NMDs experienced hardware exposure during this 2-year study period. Nine subjects were referred for NMD salvage; however, only 6 of 9 subjects (66.7%, CI&#x2009;=&#x2009;3; DBS&#x2009;=&#x2009;3) underwent NMD salvage attempts. Four of the subjects had successful salvage demonstrated successful salvage with a functioning NMD and without wound healing concerns 1&#x2009;year after their salvage procedure. CONCLUSIONS: Classic teaching states that exposed NMDs require explantation. However, this approach necessarily imposes time without benefit from the NMD between explantation and reimplantation. Our experience demonstrates that surgical salvage can be a successful alternative for the majority (66.7%) of individuals.

Humans↗
PubMed2026

A systematic review of macaque brain stimulation: Trends and future directions.

Neurostimulation techniques can powerfully modulate neural circuit activity and provide causal insights into the relationship between brain function and behavior. Macaque monkeys have long been a key animal model for brain stimulation studies. While stimulating the macaque brain with one or a few electrodes has already taught us much about brain function and dysfunction, recent technological advances promise a future with more precise stimulation using many more electrodes. However, such possibilities also increase the number of choices an experimenter has when designing their study. We can learn from a rich past, but a comprehensive overview of which brain regions have been studied and with what stimulation parameters is lacking. Here, we present a PRISMA-compliant systematic review of 734 macaque brain stimulation studies using electrical and/or optogenetic stimulation. We find a striking bias in which brain areas have traditionally been stimulated: a mere 10 brain regions account for half of all studies, with the remainder of studies investigating approximately 150 other areas. Across studies, stimulation frequency robustly predicted direct behavioral effects independent of brain region, while amplitude did not. Future studies could more systematically explore less studied regions through lower stimulation frequencies (e.g., 20-50&#x202f;Hz) alongside established ranges (&#x223c;200&#x202f;Hz). Tools such as fMRI or optical imaging can capture neural circuit engagement evoked by these frequencies, even when behavioral effects are absent or remain subtle. Our synthesis offers a guide towards the next steps in high-channel-count, high-precision stimulation approaches.

Animals↗
PubMed2026

Transcranial Magnetic Stimulation for Patients with Exposure Therapy Resistant Obsessive-Compulsive Disorder (TETRO): Study Protocol for a Multicenter Randomized Controlled Trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a disabling mental disorder, characterized by obsessions, compulsions, and substantial morbidity. Approximately 50% of adults with OCD fail to achieve satisfactory outcomes from first-line treatments, such as exposure therapy with response prevention (ERP), with or without medication. This leads to chronic social, educational, and occupational impairment. While invasive procedures such as deep brain stimulation are available for severe, treatment-refractory cases, a need remains for less invasive alternatives. Repetitive transcranial magnetic stimulation (rTMS), a noninvasive intervention, shows promise in reducing OCD symptoms. Unlike in depression, rTMS is not yet reimbursed for OCD in the Dutch healthcare system. OBJECTIVE: This study examines the efficacy and cost-effectiveness of low-frequency (1Hz) rTMS targeting the presupplementary motor area (pre-SMA) compared to sham rTMS as an adjuvant treatment to ERP in adults with OCD with inadequate response to first-line treatment. METHODS: A total of 250 adults with OCD will be enrolled in this multicenter randomized controlled trial. Participants will be randomly assigned to ERP combined with either active or sham 1Hz rTMS over the pre-SMA. Treatment is administered 4 times weekly for at least 5 weeks (20 rTMS-ERP sessions), with optional extension of 1 to 2 weeks, up to 28 rTMS-ERP sessions. Clinical assessments occur at baseline, weekly during treatment, posttreatment, and at 3, 6, and 12 months follow-up. Participants undergo pre- and posttreatment (functional) (MRI) scans, including a symptom provocation task. Blood sampling takes place pre- and posttreatment and at 3-month follow-up. The primary outcome is OCD severity at posttreatment, as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Secondary outcomes include functional improvement, quality of life, and societal costs. Pretreatment symptom profiles, genotype, and brain network topology will be analyzed as predictors of response and relapse risk. Pre-to-post treatment change in blood-based and magnetic resonance (MR)-based neuroplasticity markers will help explore differential mechanisms between ERP alone and combined rTMS-ERP. We expect that the verum rTMS protocol will be cost-effective compared to sham-rTMS. RESULTS: Recruitment started in April 2022, and as of February 2026, 201 participants have been enrolled. Posttreatment assessments are projected to be completed in December 2026, with final one-year follow-up evaluations anticipated by the end of 2027. CONCLUSIONS: To our knowledge, this study is the first adequately powered randomized controlled trial examining efficacy, cost-effectiveness, and mechanism of action of rTMS for OCD as adjuvant therapy to ERP. In case of efficacy and/or cost-effectiveness, it will pave the way for rTMS as insured health care for adults with OCD in the Netherlands, and possibly other European countries. Furthermore, this trial will provide insight into the mechanisms of treatment response to intensive ERP, with and without adjunctive rTMS, as well as potential side effects, individual variability, and long-term outcomes in adults with OCD.

Humans↗
PubMed1976

[Role of interoceptive signalization in modulating emotional-behavioral responses].

Chronic experiments were conducted on rabbits; electrodes were implanted into the deep structures of the brain. Stimulation of gastric receptors led to modulation of the emotional-behavioristic reactions induced by electric stimulation of the hypothalamus, the amygdala and the hypocampus. The effect depended on the intensity of interoceptive stimulation and peculiarities of the emotional reaction with own cerebral control systems.

Aggression↗
PubMed1976

[Methods of pain modulation by electrical stimulation (author's transl)].

Different methods of modulating pain by electrical stimulation are described: (1) Nondestructive transcutaneous nerve stimulation is recommended for neurogenic pain syndromes prior to other procedures (success rate about 30%); (2) The implantation of electrodes on the dorsal columns yields good effects in 65% after careful selection; (3) First results with implantations in deep brain structures are discussed.

Analgesia↗
PubMed1978

Release of dopamine in both caudate nuclei and both substantia nigrae in response to unilateral stimulation of cerebellar nuclei in the cat.

The effects of unilateral focal electrical stimulation of the deep cerebellar nuclei on the activity of the nigrostriatal dopaminergic neurons on both sides of the brain were examined in halothane anaesthetized cats. For this purpose, push-pull cannulae were inserted into both caudate nuclei and both substantia nigrae, and the release of [3H] dopamine ([3H]DA) continuously formed from [3,5-3H]L-tyrosine was estimated in superfusates. The unilateral electrical stimulation of the right cerebellar dentate nucleus induced a long-lasting increase in the release of [3H]DA in the left caudate nucleus and a simultaneous decrease in the release of [3H]transmitter in the right caudate nucleus. These changes were associated with opposite fluctuations in the release of [3H]DA from the corresponding substantia nigrae. Thus, the electrical stimulation of the right dentate nucleus induced a pronounced decrease in the release of the [3H]-amine in the [3H]transmitter in the corresponding substantia nigra, whereas the activity of the contralateral substantia nigra, whereas the release in the ipsilateral substantia nigra was simultaneously increased. In contrast, the unilateral electrical stimulation of the right cerebellar fastigial nucleus resulted only in an increased release of [3H]DA in the ipsilateral (right) caudate nucleus, associated with a decreased release of the [3H]transmitter in the corresponding substantia nigra, whereas the activity of the contralateral (left) dopaminergic system was not significantly affected. These results support a direct functional interaction between the cerebellum and the basal ganglia. They also suggest that the release of DA from dopaminergic axonal terminals is inversely correlated to the extent of the transmitter release from dendrites.

Adrenergic Fibers↗
PubMed1979

Influence of diffuse brain stimulation (DBS) on human sleep. I. Sleep pattern changes.

A 20 min period of diffuse brain stimulation (DBS), administered just before sleep onset in 16 human subjects, appeared to alter significantly the first sleep cycle of the succeeding sleep. The length of the first sleep cycle and the amount of REM sleep increased, whereas a shift from deep to more superficial NREM sleep occurred. This effect of DBS on sleep is discussed with respect to data from the literature on the effect of narcotic DBS and on that of local brain stimulation in animals.

Adult↗
PubMed1977

Respiratory and circulatory effects of saxitoxin in the cerebrospinal fluid.

1 In cats anaesthetized with pentobarbitone, saxitoxin and, on a few occasions, tetrodotoxin were injected into a lateral cerebral ventricle or into the subarachnoid space of the lower brain stem. Observations were made on frequency and tidal volume of breathing, on CO(2) responsiveness and on electrical responsiveness of the respiratory centre. Effects on the blood pressure were observed simultaneously.2 A single large dose of toxin, e.g., 250 ng, produced within minutes apneustic breathing and a rise in blood pressure which were converted rapidly to respiratory failure and hypotension. In contrast, repeated small doses, e.g., 25 ng, yielded only progressive slowing of the respiration together with circulatory hypotension. Bulbar depression was produced as effectively by subarachnoid injection as by intraventricular injection of the toxins. Onset of action was detectable within seconds.3 Slowing of the respiration occurred independently of change in tidal volume and whether or not the vagus nerves were cut. The reduction in breathing frequency is attributed to direct toxin-induced depression of the central respiratory oscillator.4 Steady-state measurements of tidal volume at controlled levels of alveolar CO(2) pressure in intermediate stages of respiratory depression showed that the toxins produced an increase in CO(2) stimulation threshold as well as a reduction in gain of CO(2) responsiveness, whether or not the vagus nerves were cut. Carotid arterial chemoreceptor reactivity to O(2) was demonstrable when central sensitivity to CO(2) was depressed. These effects are attributed to a direct influence of the toxins upon the brainstem CO(2)-tidal volume controller.5 Responsiveness of the medullary inspiratory centre to electrical stimulation persisted after the failure of spontaneous breathing was caused by the toxins. Conversely, restitution of electrical responsiveness preceded the reappearance of spontaneous respiratory activity in the recovery phase of toxic depression. Circulatory effects paralleled the changes in respiratory behaviour.6 On the basis of the relatively prompt and discrete alterations in the central respiratory and circulatory control mechanisms produced by saxitoxin and tetrodotoxin placed in the cerebrospinal fluid, it is concluded that the agents rapidly penetrated to deep target loci in the lower brain stem.

Animals↗
PubMed1976

Experimental bilateral deep temporal epilepsy. Effects of ablation of one focus and of different brain lesions.

In acute experiments in the rabbit, the amygdaloid nuclear complexes of the two sides were made epileptogenic through electrical stimulation or local injection of penicillin in gel. The effects on the epileptic pattern produced by surgical removal of one of the two epileptogenic amygdalae and the effects of sterotactic lesioning of the region of anterior commissure, head of caudate nucleus, and occipital cortex were analyzed. The occurrence of phenomena of both inhibitory and facilitatory interaction between the two epileptogenic amydalae was confirmed. In some experimental conditions, the restraining influence of an amygdaloid penicillin focus on the contralateral one was quite relevant, and its effect could persist even after surgical removal of the focus from which it originated. The mediation of the interamygdadoid epileptic interaction could not be ascribed to a single cerebral structure or anatomofunctionally homogenous group of structures. The phenomenon appears to involve several structures at different encephalic levels.

Amygdala↗
PubMed1977

Somatosensory properties of spinoreticular neurons in the cat.

(1) Spinal cord neurons projecting to the brain stem were studied in cats prepared by decerebration or anesthetized with barbiturate or nitrous oxide and halothane. Antidromic stimulation from the medial pontomedullary reticular formation (MDRF) and midbrain (MB) was used to identify the site of projection. (2) Receptive fields were mapped using adequate stimuli. A variety of noxious stimuli was employed to establish the capacity of these neurons to transmit nociceptive input. (3) Neurons were found to project bilaterally to the MPRF. Of 46 units tested for a more rostral projection, only 13 were activated from the MB electrode. (4) Neurons fall into three categories based on receptive fields: cutaneous, restricted (SR); deep, restricted (DR); and complex, extensive (CE). All 16 SR neurons were located in the dorsal horn and had low thresholds to mechanical stimulation of the skin. Seven discharged maximally to nociceptive inputs. The 34 DR neurons were widely distributed in the spinal gray and responded to pressure upon subcutaneous structures. Although 13 neurons increased their firing rate as the stimulus intensity was increased into the noxious range, nociceptive input could only be established with confidence in 4 neurons. The 38 CE neurons were located ventrally in the spinal gray and had highly convergent inputs from cutaneous and deep receptors. Ten responded maximally to noxious stimulation.

Afferent Pathways↗
PubMed1975

[Mixed and antidromal cortical responses evoked by electrical stimulation of the splenial portion of the corpus callosum].

In anesthetized cats, antidromic and orthodromic components were shown to be represented unequally in the mixed responses to the splenium stimulation recorded from various areas of the cortex. Orthodromic component makes about 50 per cent of the mixed response amplitude in the area 17, while in the area 18 and in middle part of the suprasylvian gyrus it makes about 70 per cent. In the regions beyond focus the mixed responses disappeared because of falling out of the orthodromic impulses. During antidromic recording of the responses, only deep layers got activated at weak stimuli, while both deep and superficial ones were involved at stronger stimulation.

Animals↗