Deep Brain Stimulation最新文献

{"title":"Directional deep brain stimulation for cervical dystonia: Outcomes, challenges and future directions","authors":"Luke Andrews ,&nbsp;Ahmad M.S. Ali ,&nbsp;Mohammed Elmolla ,&nbsp;Simon S. Keller ,&nbsp;Maneesh Bhojak ,&nbsp;Jibril Osman-Farah ,&nbsp;Antonella Macerollo","doi":"10.1016/j.jdbs.2024.11.002","DOIUrl":"10.1016/j.jdbs.2024.11.002","url":null,"abstract":"<div><h3>Background</h3><div>Cervical dystonia is a movement disorder marked by involuntary head and neck muscle contractions. Deep brain stimulation (DBS) targeting the globus pallidus internus (GPi) is a recognised treatment, with directional DBS—enabling current steering—gaining traction in movement disorder management.</div></div><div><h3>Objective</h3><div>This study assessed clinical outcomes in cervical dystonia patients treated with directional DBS at our centre, compared to a matched group receiving conventional DBS, and examined challenges and research directions in directional DBS for dystonia.</div></div><div><h3>Methods</h3><div>Eleven patients with adult-onset isolated cervical dystonia received bilateral GPi stimulation with directional DBS systems, compared to a demographically matched cohort with conventional systems. Clinical outcomes and stimulation parameters were recorded at the latest follow-up, and electrode positioning was analysed using patient-specific volumes of tissue activated (VTA).</div></div><div><h3>Results</h3><div>Directional DBS significantly improved dystonia severity, pain, disability, and quality of life (p &lt; 0.001), with no significant differences versus conventional DBS. Five patients utilised at least one directional electrode; six were set to bilateral “ring-mode” stimulation. Group VTA for directional DBS was positioned more medial and anterior than ring-mode or conventional DBS. Side effects were less frequent in directional DBS (20 %) than in ring-mode (83 %) or conventional DBS (36 %).</div></div><div><h3>Conclusion</h3><div>Directional DBS showed efficacy comparable to conventional DBS in managing cervical dystonia, with fewer side effects. Despite these benefits, its application in dystonia remains limited compared to other movement disorders, such as Parkinson’s disease and essential tremor, though advances in image-guided programming and biomarker discovery could support wider use in dystonia management.</div></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"7 ","pages":"Pages 7-13"},"PeriodicalIF":0.0,"publicationDate":"2024-11-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Read my lips: Clear versus standard masks during awake deep brain stimulation surgery – A randomized clinical trial","authors":"Chesney S. Oravec ,&nbsp;Rebecca L. Calafiore ,&nbsp;Sidish Venkataraman ,&nbsp;Robert K. Townsend ,&nbsp;Jacob Brendle ,&nbsp;Muneera Kapadia ,&nbsp;Carol A. Kittel ,&nbsp;Mustafa S. Siddiqui ,&nbsp;Adrian W. Laxton ,&nbsp;Stephen B. Tatter ,&nbsp;Amber Kimball-Hsu ,&nbsp;Wesley Hsu","doi":"10.1016/j.jdbs.2024.11.001","DOIUrl":"10.1016/j.jdbs.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>We sought to determine if using clear masks in the operating room improves communication for patients undergoing awake deep brain stimulation (DBS) surgery.</div></div><div><h3>Methods</h3><div>This randomized, controlled study involved patients undergoing awake DBS receiving communication from the neurologist wearing a covered or clear mask for the intraoperative assessment, using a block randomization schedule. Adult patients (&gt;18) undergoing DBS surgery between November 2021 and July 2023 were evaluated for inclusion. The primary outcome was a dichotomized response to the first question of a 10-question survey: “Did this provider explain things in a way that was easy to understand?”, answered using a Likert scale of 1–4. Secondary outcomes included differences in the responses to the remaining questions.</div></div><div><h3>Results</h3><div>104 patients were assessed for eligibility, 72 were enrolled, and 65 completed all questionnaires. More males than females (72.3 % versus 27.7 %) were enrolled, and most patients (64 %) underwent DBS for treatment of Parkinson’s disease. The primary outcome analysis showed 93.5 % positive response in the clear mask group compared to 85.3 % in the covered mask group (p = 0.502). There were no infections within 30 days or study-related adverse events in either population.</div></div><div><h3>Discussion</h3><div>This randomized controlled trial demonstrates that the use of clear masks in the setting of awake brain surgery has no difference on patient perception of communication compared to covered masks. There were no infections or mask-related adverse events. This suggests that clear masks are a safe and effective alternative to traditional masks in the operating room.</div></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"7 ","pages":"Pages 1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The correlation between motor improvement and disability in activities of daily living after DBS in Parkinson’s disease, tremor and dystonia","authors":"Yarit Wiggerts ,&nbsp;Annabel van der Weide ,&nbsp;Evan Markidis ,&nbsp;Joke M. Dijk ,&nbsp;Vincent J.J. Odekerken ,&nbsp;Maarten Bot ,&nbsp;Pepijn van den Munckhof ,&nbsp;P. Rick Schuurman ,&nbsp;Rob M.A. de Bie ,&nbsp;Martijn Beudel","doi":"10.1016/j.jdbs.2024.10.002","DOIUrl":"10.1016/j.jdbs.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Deep brain stimulation (DBS) for Parkinson’s disease (PD), essential tremor (ET), and dystonia is a well-established treatment option. The correlation between motor symptom improvement and effect on disability is inconclusive.</div></div><div><h3>Objectives</h3><div>To assess the correlation between DBS-induced improvements of motor symptoms and disability for PD, ET and dystonia.</div></div><div><h3>Methods</h3><div>Disability and motor scores were obtained before and six to twelve months after surgery for 324 PD, 35 ET and 40 dystonia patients.</div></div><div><h3>Results</h3><div>There was a modest and significant correlation for PD (Rho=0.284, <em>p</em> &lt; 0.001), a substantial and significant correlation for ET (Rho=0.542, <em>p</em> &lt; 0.001) and no correlation for dystonia (Rho=0.238, <em>p</em> = 0.138) between motor score and disability improvement.</div></div><div><h3>Conclusions</h3><div>The effect of DBS on motor symptoms and disability is not uniformly for dystonia. Possible reasons for this are that the scales used might not be responsive or other symptoms than motor symptoms might have a greater impact on disability.</div></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"6 ","pages":"Pages 29-33"},"PeriodicalIF":0.0,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142528231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep brain stimulation in a patient with dystonic tremor with a novel familial VPS16 gene mutation","authors":"Chiara van der Kuy ,&nbsp;Pieter L. Kubben ,&nbsp;Linda Ackermans ,&nbsp;Mayke Oosterloo ,&nbsp;Mark L. Kuijf ,&nbsp;Marcus L.F. Janssen","doi":"10.1016/j.jdbs.2024.10.001","DOIUrl":"10.1016/j.jdbs.2024.10.001","url":null,"abstract":"<div><div>Dystonia is a neurological disorder characterized by intermittent muscle contractions or abnormal movements. The pathophysiology and pathogenetic variations are increasingly better understood, but their translation into appropriate treatment is still largely lacking. We present a case of a woman suffering from a dystonic tremor of the upper limbs and head. Both the patient treated with DBS and her sister carry a novel mutation in the VPS16 gene. Treatment proved to be successful through deep brain stimulation targeting the ventral intermediate nucleus of the thalamus.</div></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"6 ","pages":"Pages 20-22"},"PeriodicalIF":0.0,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical dystonia patients with psychiatric classification: Despite dystonia improvement less improvement in other domains after DBS surgery","authors":"Annabel van der Weide ,&nbsp;Anjum Aarifa Khanom ,&nbsp;Yarit Wiggerts ,&nbsp;Yasmin Namavar ,&nbsp;Joke Dijk ,&nbsp;Maarten Bot ,&nbsp;Pepijn van den Munckhof ,&nbsp;Rick Schuurman ,&nbsp;Rob M.A. de Bie ,&nbsp;Jibril Osman Farah ,&nbsp;Antonella Macerollo ,&nbsp;Martijn Beudel","doi":"10.1016/j.jdbs.2024.09.001","DOIUrl":"10.1016/j.jdbs.2024.09.001","url":null,"abstract":"<div><h3>Background</h3><div>Patient satisfaction of deep brain stimulation (DBS) for cervical dystonia (CD) is heterogeneous. A high prevalence of psychiatric disorders in patients with CD is well-established. The presence of psychiatric classification in CD may affect the outcomes of DBS treatment.</div></div><div><h3>Methods</h3><div>A cohort of 49 patients with CD and GPi-DBS was retrospectively studied in two centers. Psychiatric history was obtained from patient records. Pre- and post-operative Toronto Western Spasmodic Torticollis Rating Scores (TWSTRS, range 0–85) were compared between patients with and those without psychiatric classification. The TWSTRS disability and pain sub-scores were combined to evaluate non-motor improvement. The severity sub-score was used to assess motor improvement.</div></div><div><h3>Results</h3><div>Twenty (40.8 %) patients had a psychiatric classification, predominantly major depressive disorder and anxiety disorders. Following DBS treatment, the overall mean (± SD) improvement on the TWSTRS was 38.0 ± 29.2 %. Significantly, patients with a psychiatric classification experienced less improvement in the non-motor domain than the patients without a psychiatric classification (29.1 ± SD 38.2 % [range −41.7 to 96.6 %] vs. 51.9 ± 33.6 % [range −8.6 to 100.0 %]; <em>p</em> = 0.02).</div></div><div><h3>Conclusion</h3><div>Our findings indicate that CD patients with psychiatric classifications experience less non-motor improvement following DBS. Psychiatric comorbidities could influence the lacking experience of successful DBS treatment despite good motor outcome. Therefore, it is important to establish these comorbidities in CD patients undergoing DBS with respect to expectation management and treatment if necessary.</div></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"6 ","pages":"Pages 23-28"},"PeriodicalIF":0.0,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142421272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to Leentjens and Coenen","authors":"Walter Glannon","doi":"10.1016/j.jdbs.2024.08.001","DOIUrl":"10.1016/j.jdbs.2024.08.001","url":null,"abstract":"","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"6 ","pages":"Page 19"},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949669124000101/pdfft?md5=85197f44d71d3fcaeec05fe655185a44&pid=1-s2.0-S2949669124000101-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020829","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the cognitive implications of traditional and novel subthalamic nucleus deep brain stimulation paradigms in Parkinson’s disease","authors":"Anouk Wolters ,&nbsp;Yasin Temel ,&nbsp;Hans Clusmann ,&nbsp;Sarah-Anna Hescham","doi":"10.1016/j.jdbs.2024.07.003","DOIUrl":"10.1016/j.jdbs.2024.07.003","url":null,"abstract":"<div><p>Parkinson's disease (PD) is a prevalent neurodegenerative disorder primarily affecting the motor system. However, it is also accompanied by significant non-motor symptoms such as sleep disturbances, cognitive impairment, and mood disorders. While dopaminergic deficits in the substantia nigra pars compacta are linked to motor symptoms, cognitive decline and non-motor symptoms may involve other neurotransmitter systems, including cholinergic pathways. This review investigates the cognitive implications of traditional and novel subthalamic nucleus (STN) deep brain stimulation (DBS) paradigms in PD. Recognising the growing significance of cognitive function in the management of PD, our study aims to analyse comprehensively how different DBS approaches impact cognitive outcomes. By reviewing existing literature, we examine the cognitive domains of PD patients undergoing traditional STN DBS and explore the effects of novel stimulation paradigms. The findings from these studies may enhance our understanding of the cognitive consequences associated with STN DBS and inform therapeutic strategies to optimize patient outcomes in PD management.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"6 ","pages":"Pages 9-18"},"PeriodicalIF":0.0,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949669124000095/pdfft?md5=7f8ea55dc32157755f3cf14ac43f3099&pid=1-s2.0-S2949669124000095-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141850901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuropsychological and social predictors of participation in a deep brain stimulation study of Parkinson’s disease and dystonia","authors":"Amelia Hahn ,&nbsp;Ann A. Lazar ,&nbsp;Stephanie Cernera ,&nbsp;Simon Little ,&nbsp;Sarah S. Wang ,&nbsp;Philip A. Starr ,&nbsp;Caroline A. Racine","doi":"10.1016/j.jdbs.2024.07.002","DOIUrl":"10.1016/j.jdbs.2024.07.002","url":null,"abstract":"<div><h3>Objectives</h3><p>Participation is essential to DBS research, yet circumstances that affect diverse participation remain unclear. Here we evaluate factors impacting participation in an adaptive DBS study of Parkinson’s disease (PD) and dystonia.</p></div><div><h3>Methods</h3><p>Twenty participants were implanted with a sensing-enabled DBS device (Medtronic Summit RC+S) that allows neural data streaming in naturalistic settings and encouraged to stream as much as possible for the first five months after surgery. Using standardized baseline data obtained through neuropsychological evaluation, we compared neuropsychological and social variables to streaming hours.</p></div><div><h3>Results</h3><p>Marital status and irritability significantly impacted streaming hours (estimate=136.7, bootstrapped (^<em>b</em>) <em>CI</em>^<em>b</em>=45.0 to 249.0, <em>p</em>^<em>b</em>=0.016, and estimate=−95.1, <em>CI</em>^<em>b</em>=−159.9 to −49.2, <em>p</em>^<em>b</em>=0.027, respectively). These variables remained significant after multivariable analysis. Composite scores on verbal memory evaluations predicted the number of hours of data streamed (<em>R</em>^<em>2</em>=0.284, estimate=67.7, <em>CI</em>^<em>b</em>=20.1 to 119.9, <em>p</em>^<em>b</em>=0.019).</p></div><div><h3>Discussion</h3><p>Verbal memory impairment, irritability, and lack of a caregiver may be associated with decreased participation. Further study of factors that impact research participation is critical to the sustained inclusion of diverse participants.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"6 ","pages":"Pages 1-6"},"PeriodicalIF":0.0,"publicationDate":"2024-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949669124000083/pdfft?md5=73140f5ac8529d60f93fa7fbf69eed21&pid=1-s2.0-S2949669124000083-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141952851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep brain stimulation for major depressive disorder: continued access or abandonment? Comment to Glannon [1]","authors":"Albert F.G. Leentjens ,&nbsp;Volker A. Coenen","doi":"10.1016/j.jdbs.2024.07.001","DOIUrl":"10.1016/j.jdbs.2024.07.001","url":null,"abstract":"","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"6 ","pages":"Pages 7-8"},"PeriodicalIF":0.0,"publicationDate":"2024-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2949669124000071/pdfft?md5=827cea7a58bd7ff794b838513e2a8af6&pid=1-s2.0-S2949669124000071-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141707204","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deep brain stimulation for major depressive disorder: Continued access or abandonment?","authors":"Walter Glannon","doi":"10.1016/j.jdbs.2024.05.001","DOIUrl":"10.1016/j.jdbs.2024.05.001","url":null,"abstract":"<div><p>Participants in DBS clinical trials for major depressive and other psychiatric disorders may not have access to post-trial neuromodulation. Some commentators have claimed that this would be unfair to trial participants and effectively abandon them. Continued access to these devices could be justified only if there were a statistically significant difference in outcomes between active and sham stimulation and participants responded positively to active DBS. Clinicians and investigators have post-trial obligations to provide appropriate care and psychosocial support to patients and trial participants. Depending on trial outcomes and patient responses, lack of access to continued DBS may not be unfair to them or a form of abandonment.</p></div>","PeriodicalId":100359,"journal":{"name":"Deep Brain Stimulation","volume":"5 ","pages":"Pages 30-32"},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S294966912400006X/pdfft?md5=d8164a13fc48a5d2d63f1bd7417ed526&pid=1-s2.0-S294966912400006X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141033971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}