Bilateral subthalamic nucleus stimulation (STN-DBS) is used to improve parkinsonian symptoms and attenuate levodopa-induced motor complications. In some patients, such clinical improvement allows antiparkinsonian medication (ApMed) withdrawal. We show the clinical outcome at the long-term follow-up of patients with advanced Parkinsons disease (PD) in which STN-DBS was used in monotherapy, and compare the clinical results of patients without medication with those obtained in parkinsonian patients in which ApMed were reduced but could not be totally displaced after surgery. We analyzed clinical outcome of ten patients with PD in which all ApMed was withdrawn after bilateral subthalamic stimulation and 16 parkinsonian patients still taking antiparkinsonian medication after surgery. After 1.5 years, STN-DBS monotherapy produced UPDRS motor scores similar to those observed in the on-drug condition before surgery without the inconvenience of motor fluctuations and dyskinesias. No significant ...
Subthalamic nucleus deep brain stimulation (STN DBS) protects dopaminergic neurons of the substantia nigra pars compacta (SNpc) against 6-OHDA and MPTP. We evaluated STN DBS in a parkinsonian model that displays α-synuclein pathology using unilateral, intranigral injections of recombinant adeno-associated virus pseudotype 2/5 to overexpress wildtype human α-synuclein (rAAV2/5 α-syn). A low titer of rAAV2/5 α-syn results in progressive forelimb asymmetry, loss of striatal dopaminergic terminal density and modest loss of SNpc dopamine neurons after eight weeks, corresponding to robust human-Snca expression and no effect on rat-Snca, Th, Bdnf or Trk2 ...
All information about the latest scientific publications of the Clínica Universidad de Navarra. Movement-related changes in oscillatory activity in the human subthalamic nucleus: ipsilateral vs. contralateral movements.
Our study shows that STN stimulation, in combination with L-Dopa treatment, reduces postural instability by increasing motor abilities and specific postural related mechanisms, leading to a reduction in falls. Balance precision is improved, even in more difficult situations, both during the EC condition and in sensory challenged conditions. The patients sensorimotor strategies were of better quality and they displayed more appropriate strategies, using better proprioception in relation to the other sensors. In situations of sensorial conflict, the patients were able to adapt their balance more accurately, especially in proprioceptive management situations, suggesting an improvement in central information processing.. In the traditional view of postural control, balance during quiet stance and its adaptation to the environment is based on background postural tone and on postural reflexes, which are generated by the vestibular, visual, and somatosensory systems,44 and involve higher levels of ...
TY - GEN. T1 - Evidence for the existence of homolateral and contralateral projections from the substantia nigra to the subthalamic nucleus in the rat. AU - Lakke, E.A.J.F.. AU - Heida, Tjitske. AU - Usunoff, K.G.. AU - Marani, Enrico. PY - 2005/5/14. Y1 - 2005/5/14. N2 - Hemichorea/ballism is a rare neurological disorder but the crucial involvement of the subthalamic nucleus (STN) in its pathophysiology is appreciated since decades. The idiopathic Parkinsons disease is a common neurodegenerative disorder but the key role of the STN in the pathophysiological origin of the parkinsonian state became only recently evident. The STN was believed to exert an inhibitory, probably - GABA-mediated, effect on its projection nuclei, and this belief is one of the major reasons to overlook the involvement of the STN in the parkinsonian pathophysiology. It is now firmly established that the STN projection neurons are glutamatergic, excitatory, and heavily innervate by widely branching axons of the substantia ...
The purpose of this study is to determine the safety and efficacy of AAV-GAD gene transfer into the subthalamic nucleus (STN) region of the brain. This study involves the treatment of subjects with medically refractory Parkinsons disease (PD). The gene transfer product, a disabled virus with a gene called GAD, will be infused into the STN bilaterally using stereotactic surgical techniques. The overall goal of this approach is to normalize the activity of the STN and reduce the motor symptoms of PD.. Because the change in UPDRS demonstrated a positive outcome, the sham surgery subjects from the blinded portion of the study will be invited to crossover into the Open-label Arm portion of the study. The Open-label Arm will further evaluate the safety and efficacy of AAV-GAD gene transfer into the subthalamic nucleus (STN) region of the brain. ...
Gamma activity in the subthalamic nucleus (STN) is widely viewed as a pro-kinetic rhythm. Here we test the hypothesis that rather than being specifically linked to movement execution, gamma activity reflects dynamic processing in this nucleus. We investigated the role of gamma during fast stopping and recorded scalp electroencephalogram and local field potentials from deep brain stimulation electrodes in 9 Parkinsons disease patients. Patients interrupted finger tapping (paced by a metronome) in response to a stop-signal sound, which was timed such that successful stopping would occur only in ~50% of all trials. STN gamma (60-90 Hz) increased most strongly when the tap was successfully stopped, whereas phase-based connectivity between the contralateral STN and motor cortex decreased. Beta or theta power seemed less directly related to stopping. In summary, STN gamma activity may support flexible motor control as it did not only increase during movement execution but also during rapid action-stopping.
Objective: To study the pyramidal tract side effects (PTSEs) induced by the spread of current from the subthalamic nucleus (STN) to the pyramidal tract (PT), in parkinsonian patients undergoing STN stimulation. Methods: We assessed 14 patients bilaterally implanted with tetrapolar electrodes. For each side separately, we detected the threshold of adverse effects induced by monopolar stimulation delivered by the chronically used contact. The voltage was progressively increased until the patient experienced discomfort. We videotaped all the PTSEs induced at 130 Hz - high-frequency stimulation (HFS) - and at 2 or 3 Hz - low-frequency stimulation (LFS). Superimposing the pre- and postoperative MRIs, we measured the distance (R) from the centre of the used contact (cC) to the medial border of the PT. Results: The progressive increase in voltage at HFS induced tonic motor contractions, mainly located in the face, in 27/28 electrodes. LFS induced synchronous rhythmic myoclonus in the same territory. ...
A Leksell Stereotactic frame was mounted on the patients head. An O-arm® was used to perform a stereotactic volumetric computed tomography (CT) scan of the head. These CT images were then merged with a Stealth navigation system protocol MRI of the brain. A three-dimensional reconstruction of the images was performed to identify the locations of the anterior commissure (AC) and posterior commissure (PC). The coordinates chosen were 12 mm to the left and right of the AC-PC midpoint, 3 mm behind the AC-PC midpoint, and 4 mm below the AC-PC midpoint. The AC-PC distance was measured to be 26.87 mm. After a bifrontal incision, bilateral burr holes overlying the coronal suture were created approximately 4 cm from the midline at each side. Next, a microelectrode drive for the right side was mounted to the Leksell frame. Microelectrode recordings (MERs) were not optimal for the right side, so an O-arm CT scan was performed which showed that the electrodes were lateral and anterior to the desired ...
The first intracellular electrical recordings of subthalamic neurons were performed using sharp electrodes in a rat slice preparation.[citation needed] In these recordings three key observations were made, all three of which have dominated subsequent reports of subthalamic firing properties. The first observation was that, in the absence of current injection or synaptic stimulation, the majority of cells were spontaneously firing. The second observation is that these cells are capable of transiently firing at very high frequencies. The third observation concerns non-linear behaviors when cells are transiently depolarized after being hyperpolarized below -65mV. They are then able to engage voltage-gated calcium and sodium currents to fire bursts of action potentials. Several recent studies have focused on the autonomous pacemaking ability of subthalamic neurons. These cells are often referred to as "fast-spiking pacemakers",[11] since they can generate spontaneous action potentials at rates of 80 ...
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The first 1000 consecutive spike times of each recording were used for all analyses of spike-cortex synchronization. To provide a sensitive measure of spike-LFP interactions and to calculate latencies between the timing of spikes and peaks in cortical oscillatory activity, we analyzed the spike-timed average (STA) of the M1 LFP. The STA was computed in a 1 s window centered on the time of occurrence of STN spikes. We used the STA to calculate an STN spike-M1 LFP oscillation modulation index MIO as follows (see Fig. 3B-D). (1) The peak frequency of the STA was determined from the maximum of its power spectrum (512-point FFT, MATLAB function pwelch, 1.96 Hz resolution) (see Fig. 3B, inset). (2) We bandpass filtered the STA with a frequency band of width 4 Hz, centered on the peak frequency [100 tap FIR filter implemented using MATLAB function filtfilt for bidirectional filtering to avoid filter-induced phase shifts (Moran et al., 2008)]. (3) We calculated the amplitude envelope of the ...
The objective of the present study was to determine whether lesion of the subthalamic nucleus (STN) promoted by N-methyl- D-aspartate (NMDA) would rescue nigrostriatal dopaminergic neurons after unilateral 6-hydroxydopamine (6-OHDA) injection into the medial forebrain bundle (MFB). Initially, 16 μg 6-OHDA (6-OHDA group) or vehicle (artificial cerebrospinal fluid - aCSF; Sham group) was infused into the right MFB of adult male Wistar rats. Fifteen days after surgery, the 6-OHDA and Sham groups were randomly subdivided and received ipsilateral injection of either 60 mM NMDA or aCSF in the right STN. Additionally, a control group was not submitted to stereotaxic surgery. Five groups of rats were studied: 6-OHDA/NMDA, 6-OHDA/Sham, Sham/ NMDA, Sham/Sham, and control. Fourteen days after injection of 6-OHDA, rats were submitted to the rotational test induced by apomorphine (0.1 mg/kg, ip) and to the open-field test. The same tests were performed again 14 days after NMDA-induced lesion of the STN. The ...
TY - JOUR. T1 - Correspondence of microelectrode mapping with magnetic resonance imaging for subthalamic nucleus procedures. T2 - Commentary. AU - Burchiel, Kim. AU - Winfree, Christopher J.. PY - 2005/3. Y1 - 2005/3. UR - http://www.scopus.com/inward/record.url?scp=14044272643&partnerID=8YFLogxK. UR - http://www.scopus.com/inward/citedby.url?scp=14044272643&partnerID=8YFLogxK. U2 - 10.1016/j.surneu.2004.08.014. DO - 10.1016/j.surneu.2004.08.014. M3 - Article. AN - SCOPUS:14044272643. VL - 63. SP - 253. JO - World Neurosurgery. JF - World Neurosurgery. SN - 1878-8750. IS - 3. ER - ...
High frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) suppresses parkinsonian motor symptoms and modulates cortical activity. ... Cortical evoked potentials (cEP) generated by STN DBS reflect the response of cortex to subcortical stimulation, and the goal was to determine the neural origin of cEP using a two-step approach. First, we recorded cEP over ipsilateral primary motor cortex during different frequencies of STN DBS in awake healthy and unilateral 6-OHDA lesioned parkinsonian rats. Second, we used a biophysically-based model of the thalamocortical network to deconstruct the neural origin of the cEP. The in vivo cEP included short (R1), intermediate (R2) and long-latency (R3) responses. Model-based cortical responses to simulated STN DBS matched remarkably well the in vivo responses. R1 was generated by antidromic activation of layer 5 pyramidal neurons, while recurrent activation of layer 5 pyramidal neurons via excitatory axon collaterals reproduced R2. R3 was ...
High frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) suppresses parkinsonian motor symptoms and modulates cortical activity. ... Cortical evoked potentials (cEP) generated by STN DBS reflect the response of cortex to subcortical stimulation, and the goal was to determine the neural origin of cEP using a two-step approach. First, we recorded cEP over ipsilateral primary motor cortex during different frequencies of STN DBS in awake healthy and unilateral 6-OHDA lesioned parkinsonian rats. Second, we used a biophysically-based model of the thalamocortical network to deconstruct the neural origin of the cEP. The in vivo cEP included short (R1), intermediate (R2) and long-latency (R3) responses. Model-based cortical responses to simulated STN DBS matched remarkably well the in vivo responses. R1 was generated by antidromic activation of layer 5 pyramidal neurons, while recurrent activation of layer 5 pyramidal neurons via excitatory axon collaterals reproduced R2. R3 was ...
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The anterograde transport of Phaseolus vulgaris-leucoagglutinin (PHA-L) was combined with postembedding immunocytochemistry for gamma-aminobutyric acid (GABA) to study the topography, the synaptic organization and the neurotransmitter content of the pallidosubthalamic projection in the rat. After injections of PHA-L in different parts of the globus pallidus a rich plexus of anterogradely labelled fibres and terminals was found in the ipsilateral subthalamic nucleus. The immunoreactive elements were distributed according to a mediolateral and rostrocaudal topography. Injections of PHA-L restricted to the lateral two-thirds of the globus pallidus gave rise to a massive anterograde labelling confined to the lateral half of the subthalamic nucleus. On the other hand, injections of PHA-L strictly confined to the medial part of the globus pallidus resulted in anterograde labelling that occupied the ventromedial pole of the subthalamic nucleus. In some cases a few retrogradely labelled cells were found ...
Whats been mysterious is we dont know how those stimulation treatments really work," says Karl Deisseroth, a bioengineer and psychiatrist at Stanford University and senior researcher on a new project that sheds light-literally-on how DBS affects the Parkinsonian brain.. Deisseroth and his colleagues engineered cells in the subthalamic nucleus of mice with Parkinsons to express proteins derived from light-sensing bacteria. One protein triggers cells to fire in response to blue light, while another quiets cells electrical activity in response to yellow light. The researchers systematically marched through the circuit targeted by DBS, piping in light through a fiber-optic cable to probe each cell type in turn.. "What we found was quite surprising," says Deisseroth. None of the cell types in the subthalamic nucleus, when stimulated or calmed by light, had any effect on the mices symptoms. But when light was used to activate the wire-like axons projecting to the subthalamic nucleus from other ...
BACKGROUND: Deep brain stimulation (DBS) of subcortical brain areas such as the periaqueductal grey and subthalamic nucleus has been shown to alter cardiovascular autonomic performance. The supramedullary circuitry controlling respiratory airways is not well defined and has not been tested in humans. OBJECTIVE: To use direct electric stimulation via DBS macroelectrodes to test whether airway resistance could be manipulated by these areas in awake humans. METHODS: Thirty-seven patients with in-dwelling deep brain electrodes for movement disorders or chronic pain underwent spirometry according to the European Respiratory Society guidelines. Testing was performed randomly 3 times on stimulation and 3 times off stimulation; patients were blinded to the test. Thoracic diameter changes were measured by a circumferential pressure-sensitive thoracic band. Ten periaqueductal grey and 10 subthalamic nucleus patients were tested. To control for confounding pain and movement disorder relief, the sensory thalamus in
Background: The birth of stereotactic functional neurosurgery in 1947 was to a great extent dependent on the development of ventriculography. The last decades have witnessed a renaissance of functional stereotactic neurosurgery in the treatment of patients with movement disorders. Initially, these procedures were largely based on the same imaging technique that had been used since the birth of this technique, and that is still used in some centers. The introduction of new imaging modalities such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) provided new potentials, but also new challenges for accurate identification and visualisation of the targets in the basal ganglia and the thalamus with an urge to thoroughly evaluate and optimize the stereotactic targeting technique, as well as evaluate accurately in stereotactic space the location and extent of stereotactic Radiofrequency (RF) lesions and the position of deep brain stimulation (DBS) electrodes.. Aims: To study the ...
The hypothalamic nucleus is a small, oval part of the hypothalamus in the brain, made of gray matter. Functionally, this is part of the system of basic windings.. As the name suggests ("sub"), located on the bottom side of the hill, which lies close to the center of the brain. Hypothalamic nucleus affects motor control, and can also play a role in psychological processes.. People with damage to hypothalamic nuclei show increased impulsivity and behavioral problems. Studies indicate that hypothalamic nucleus may be associated with problems such as attention deficit hyperactivity disorder or addictive behavior.. In the formation of the nucleus of the hypothalamus may actually help treat the symptoms of Parkinsons disease. Especially in the case of motor function. Less conclusive results were obtained on mood disorders associated with Parkinsons disease.. ...
The brain and the spinal cord were obtained by autopsy. The right hemisphere and samples from brainstem and cerebellum were deep frozen for biochemical analysis. The left hemisphere, the spinal cord and most of the brainstem and the cerebellum were fixed in 10% buffered formalin. Gross examination showed mild atrophy of the temporal lobe (Figure 1) and the subthalamic nucleus, as well as loss of pigment in the substantia nigra (Figure 2). Microscopic examination showed moderate spongiosis and neuronal loss in the substantia nigra (Figure 3) and locus coeruleus, but no Lewy bodies were seen. Rare plaques were observed in the temporal and occipital cortex. Tau immunohistochemistry (using AD2, a monoclonal antibody raised against the phosphorylated serine residues 396-404 of tau) revealed sparse neurofibrillary tangles in the locus coeruleus (Figure 4) and the substantia nigra. The same lesions were more numerous and associated with threads in the subthalamic nucleus (Figure 5), the zona incerta, ...
Electrical stimulation using extradural electrodes-placed underneath the skull but not implanted in the brain, is a safe approach with meaningful benefits for patients with Parkinsons disease according to new research.... Read More... ...
There has been a renaissance in the surgical treatment of Parkinsons disease (PD) over the last 15-20 years as a result of the long-term complications of L-DOPA use. The current cornerstone of surgical treatment for PD is high-frequency deep-brain stimulation (DBS) of the subthalamic nucleus (STN) using implantable electrodes and an implantable pulse generator/battery. Among well-selected patients, that is, patients with idiopathic PD, L-DOPA-responsive symptoms and no significant psychiatric comorbidities or cognitive decline, STN DBS can provide improvements in motor symptoms and quality of life, with low risks of adverse effects. In this article, we briefly describe the evolution of surgical treatments for PD, and the rationale for current DBS procedures. We also provide details of our practice, including patient selection, surgical technique and postoperative stimulation programming and medication adjustment. Current and possible future alternatives to DBS of the STN are also ...
The primary objective is to optimize the current DBS-treatment of advanced PD. For the primary objective the following research question will be answered: by performing subthalamic nucleus (STN) DBS under general anesthesia, will there be a significant reduction in cognitive, mood and behavioral adverse effects when compared to STN DBS under local anesthesia ...
Searching for sequences which incorporate uncommon amino acids or nucleotides can be a challenge for even the most experienced searchers. Oftentimes the only way to capture these uncommon sequences is to use the value-added features of the sequence databases on STN. This e-Seminar will explain how to search sequences with uncommon amino acid residues, sequences that have been modified, and sequences that use variables for amino acid or nucleotide residues. While this e-Seminar is geared towards the intermediate-to-advanced sequence searcher, any STN searcher with basic sequence searching skills should find this session beneficial.. Download the presentation here.. ...
Klempir, O.; Krupicka, R.; Mehnert, J.; Cejka, V.; Polakova, K.; Brozova, H.; Szabo, Z.; Ruzicka, E.; Jech, R.: Reshaping cortical activity with subthalamic stimulation in Parkinsons disease during finger tapping and gait mapped by near infrared spectroscopy. Journal of Applied Biomedicine 17, S. 157 - 166 (2019 ...
STN DBS is effective for the older patients with PD.•STN DBS is relatively safe for the older patients with PD.•STN DBS can be a good treatment option both in ...
Patients with Parkinson disease who experienced pain before undergoing subthalamic nucleus deep brain stimulation (STN DBS) had that pain improved or eliminated at eight years after surgery...
Steel, David Anthony and Basu, Surajit (2017) Does trajectory matter? A study looking into the relationship of trajectory with target engagement and error accommodation in subthalamic nucleus deep brain stimulation. Acta Neurochirurgica . ISSN 0942-0940 Fletcher, Kimberley J. and das Nair, Roshan and Macniven, Jamie A. and Basu, Surajit and Byrne, Paul (2012) An interpretative phenomenological analysis of the patient experience of awake craniotomy: brain tumour diagnosis to discharge. British Journal of Health Psychology, 17 (4). pp. 828-842. ISSN 2044-8287 ...
The study, whose co-authors included George Mandybur, MD, an associate professor of neurosurgery at the University of Cincinnati (UC) College of Medicine and Mayfield Clinic neurosurgeon, and Fredy Revilla, MD, an associate professor of neurology and UC Health neurologist, was published Jan. 11, 2012, in the online edition of Lancet Neurology. Mandybur and Revilla are members of the James J. and Joan A. Gardner Center for Parkinsons Disease and Movement Disorders at the UC Neuroscience Institute, a specialty center within UC Health. Principal investigator of the study was Michael Okun, MD, a neurologist and co-director of the Center for Movement Disorders and Neurorestoration at the University of Florida College of Medicine. Deep brain stimulation (DBS) devices stimulate the subthalamic nucleus deep within the brain. Deep brain stimulation surgery has been shown to reduce symptoms of Parkinsons and to improve quality of life. The Lancet Neurology study examined the new Libra and LibraXP ...
Recently, the subthalamic nucleus (STN) has been shown to be critically involved in decision-making, action selection, and motor control. Here we investigate the effect of deep brain stimulation (DBS) of the STN on reward-based decision-learning in patients diagnosed with Parkinsons disease (PD). We determined computational measures of outcome evaluation and reward prediction from PD patients who performed a probabilistic reward-based decision-learning task. In previous work, these measures covaried with activation in the nucleus caudatus (outcome evaluation during the early phases of learning) and the putamen (reward prediction during later phases of learning). We observed that stimulation of the STN motor regions in PD patients served to improve reward-based decision-learning, probably through its effect on activity in frontostriatal motor loops (prominently involving the putamen and, hence, reward prediction). In a subset of relatively younger patients with relatively shorter disease duration, the
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a clinically effective neurosurgical treatment for Parkinson disease. Tissue reaction to chronic DBS therapy and the definitive location of active stimulation contacts are best studied on a postmortem basis in patients who have undergone DBS. The authors report the postmortem analysis of STN DBS following 5 years and 11 months of effective chronic stimulation including the histologically verified location of the active contacts associated with bilateral implants. They also describe tissue response to intraoperative test passes with recording microelectrodes and stimulating semimacroelectrodes. The results indicated that 1) the neural tissue surrounding active and nonactive contacts responds similarly, with a thin glial capsule and foreign-body giant cell reaction surrounding the leads as well as piloid gliosis, hemosiderin-laden macrophages, scattered lymphocytes, and Rosenthal fibers; 2) there was evidence of separate tracts in ...
Local field potential (LFP) recordings from patients with deep brain stimulation electrodes in the basal ganglia have suggested that frequency-specific activities correlate with force or effort, but previous studies have not been able to disambiguate the two. Here, we dissociated effort from actual force generated by contrasting the force generation of different fingers while recording LFP activity from the subthalamic nucleus (STN) in patients with Parkinsons disease who had undergone functional surgery. Patients were studied while on their normal dopaminergic medication. We investigated the relationship between frequency-specific oscillatory activity in the STN and voluntary flexion of either the index or little finger at different effort levels. At each tested effort level (10%, 25%, and 40% of the maximal voluntary contraction force of each individual finger), the index finger generated larger force than the little finger. Movement-related suppression of beta-band power in the STN LFP was
Nilsson MH, Rehncrona S, Jarnlo G-B. Fear of falling and falls in people with Parkinsons disease treated with deep brain stimulation in the subthalamic nuclei. Acta Neurol Scand: 2011: 123: 424-429. © 2010 John Wiley & Sons A/S. Background - N
As part of the basal ganglia circuitry, these anatomic locations play a critical role in the control of movement. The effects of stimulating these brain regions are indicated in the Table. Thalamic (Vim) stimulation is only effective for tremor, not for the other symptoms of Parkinsons disease. Stimulation of the globus pallidus or subthalamic nucleus, in contrast, may benefit not only tremor but also other parkinsonian symptoms such as rigidity, bradykinesia, dyskinesias, and gait problems. For most patients with Parkinsons disease, DBS of the globus pallidus or subthalamic nucleus are more appropriate choices than thalamic DBS because stimulation at these targets affects a broader range of symptoms. A recent studycompared the outcomes of 300 patients who were randomized to deep brain stimulation of either the globus pallidus interna or subthalamic nucleus (Follett et al 2010). Two years after surgery, there was no clear advantage to either location. Patients undergoing subthalamic ...
Subjects receive bilateral subthalamic nucleus (B-STN) DBS and continue to take optimal drug therapy as prescribed by their treating neurologist.. B-STN DBS: Deep brain stimulation (DBS) of both the right and left sub-thalamic nucleus (STN) is an FDA approved treatment for mid- and advanced PD. DBS is not approved for early stage PD. In mid- and advanced stage Parkinsons disease, using DBS in this area of the brain lessens symptoms and allows patients to take less drug to control the disease. Dosage and frequency are not applicable to the DBS. Once the DBS is placed, unless deemed necessary, it will not be removed.. Optimal drug therapy: The drugs used on this study are not investigational. They are drugs for Parkinsons disease that are standard of care. The drug form, dosage, frequency and duration will vary. ...
|b||i|Background:|/i||/b| In this reported case, 7 years after the start of deep brain stimulation (DBS) of the bilateral subthalamic nucleus (STN), glioblastoma multiforme (GB
The findings are reported in the June 3, 2010 issue of the New England Journal of Medicine.. When patients receive DBS for Parkinsons, a neurosurgeon precisely guides a very fine wire into one of two regions deep in the brain, the subthalamic nucleus (STN) or the globus pallidus interna (GPi). It had been thought that STN DBS is more effective at controlling motor symptoms but more likely to aggravate non-motor symptoms. The new study - the largest most comprehensive study ever done of patients receiving bilateral STN DBS or GPi DBS - challenges that idea. Researchers concluded that motor outcomes between the two groups were not significantly different and there were very modest differences in mood and cognitive function between the two groups.. The multicenter team of researchers included Penn Medicines Matthew Stern, MD, director of Penns Parkinsons Disease and Movement Disorder clinic, professor of Neurology and one of the studys lead investigators, Gordon Baltuch, professor of ...
During development the subthalamus is continuous with the hypothalamus, but is separated by white matter fibres mainly from the internal capsule. Caudally, the subthalamus or prethalamus is separated from the thalamus by the zona limitans intrathalamica.[citation needed] Postnatally, the subthalamus lies beneath the thalamus, hence sub (meaning below) thalamus. It also lies dorsolateral to the hypothalamus. ...
Follett KA, Weaver FM, Stern M, Hur K, Harris CL, Luo P, Marks WJ Jr, Rothlind J, Sagher O, Moy C, Pahwa R, Burchiel K, Hogarth P, Lai EC, Duda JE, Holloway K, Samii A, Horn S, Bronstein JM, Stoner G, Starr PA, Simpson R, Baltuch G, De Salles A, Huang GD, Reda DJ; CSP 468 Study Group. Pallidal versus subthalamic deep-brain stimulation for Parkinsons disease. N Engl J Med. 2010 Jun 3;362(22):2077-91. Bhansali: The goal of this study was to compare alterations in motor function in patients with advanced Parkinsons disease with placement of DBS electrodes in the subthalamic nucleus (STN) versus the globus pallidus (GPi) over the course of 24 months following surgery. This double-blind, randomized trial with intention-to-treat analyses assigned 299 Veterans Affairs hospital patients to receive either STN or pallidal stimulation. Motor function was assessed over the course of 24 months at 3 month intervals using the Unified Parkinsons Disease Rating Scale, part III (UPDRS-III); at each session, ...
Deep brain stimulation may have a beneficial effect on driving ability for people with Parkinsons disease, according to a new study published in the December 18, 2013, online issue of Neurology®, the medical journal of the American Academy of Neurology. Deep brain stimulation uses a surgical implant similar to a pacemaker to send electrical impulses to the brain.. "Up until now, we werent sure how deep brain stimulation would affect driving," said study author Carsten Buhmann, MD, of University Medical Center Hamburg-Eppendorf in Hamburg, Germany. "On the one hand, it might enhance driving ability by improving the motor problems which occur with Parkinsons disease, but on the other hand, it might hamper driving because it potentially causes a decline in executive cognitive skills.". The study involved 23 people who had deep brain stimulators, 21 people with Parkinsons disease who did not have stimulators and 21 people who did not have Parkinsons disease. All of the participants had been ...
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The goal of deep brain stimulation, which is generally referred to as DBS, is to improve function and quality of life. That is best achieved by being
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Subthalamic (STN) deep brain stimulation (DBS) alleviates common appendicular PD symptoms, such as: tremor, rigidity and bradykinesia. However, the effect STN-DBS has on modulating axial gait features has not been properly quantified objectively. The purpose of the present thesis was to investigate the role STN-DBS plays in modulating specific gait features such as pace, asymmetry, variability, rhythm and postural control. It is hypothesized that axial gait function is regulated predominantly by non-dopaminergic control systems. In the acute immediate post-operative phase a surgical effect, named the microlesion effect (MLE), is thought to produce a transient improvement of appendicular and axial symptoms. It was hypothesized the MLE is a surgical effect, having a non-specific influence on both appendicular and axial symptoms. Following surgical recovery and 6 months of clinically optimized STN-DBS, it was expected that the true STN-DBS effects would be presented. It was hypothesized that STN-DBS plays
Researchers have found that deep brain stimulation reduces binge eating in mice, suggesting that this surgery, which is approved for treatment of certain neurologic and psychiatric disorders, may also be an effective therapy for obesity.
By stimulating the brains of Parkinsons patients using electrodes, neurologists at Frances CHU Saint-Étienne University Hospital found that this surgical technique could improve motor performance by 70% and reduce medication-based treatment by 40 to 60%.. When medication is no longer sufficient to control tremors, deep brain stimulation is a new alternative available to patients suffering from Parkinsons disease.. Practiced since May 2015 at Frances CHU Saint-Étienne University Hospital, the technique appears to have proven results. Successfully operated patients saw motor performance improve by 70% and medication-based treatments reduce by 40 to 60%. The benefits of the operation were also found to remain for at least five years, with clear effects on patients quality of life.. The operation is carried out under general anesthetic. It involves inserting two temporary electrodes into a patients brain through a tiny opening in the cranium, targeting the subthalamic nucleus, which plays a ...
Deep brain stimulation (DBS) has been shown to be clinically effective for some forms of treatment-resistant chronic pain, but the precise mechanisms of action are not well understood. Here, we present an analysis of magnetoencephalography (MEG) data from a patient with whole-body chronic pain, in order to investigate changes in neural activity induced by DBS for pain relief over both short- and long-term. This patient is one of the few cases treated using DBS of the anterior cingulate cortex (ACC). We demonstrate that a novel method, null-beamforming, can be used to localise accurately brain activity despite the artefacts caused by the presence of DBS electrodes and stimulus pulses. The accuracy of our source localisation was verified by correlating the predicted DBS electrode positions with their actual positions. Using this beamforming method, we examined changes in whole-brain activity comparing pain relief achieved with deep brain stimulation (DBS ON) and compared with pain experienced with no