Neuromodulation最新文献

{"title":"Meta-analysis of Randomized Controlled Trials on the Efficacy of Sacral Neuromodulation in Chronic Constipation","authors":"Sameh Hany Emile MBBCh, MSc, MD ,&nbsp;Justin Dourado MD ,&nbsp;Anjelli Wignakumar MBBS, BSc (Hons) ,&nbsp;Nir Horesh MD ,&nbsp;Zoe Garoufalia MD ,&nbsp;Rachel Gefen MD ,&nbsp;Marylise Boutros MD ,&nbsp;Steven D. Wexner MD","doi":"10.1016/j.neurom.2025.03.001","DOIUrl":"10.1016/j.neurom.2025.03.001","url":null,"abstract":"<div><h3>Objectives</h3><div>The present systematic review aimed to assess the outcome of sacral neuromodulation (SNM) in adult patients with chronic constipation.</div></div><div><h3>Materials and Methods</h3><div>A systematic review of randomized controlled trials (RCTs) that assessed the efficacy of SNM in chronic constipation was conducted and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guideline. PubMed, Scopus, and Web of Science were screened from their inception through March 2024. The primary outcome was improvement in constipation and quality of life (QoL), and the secondary outcome was adverse events after treatment. The risk of bias and certainty of evidence were assessed by the risk of bias 2 tool and Grading of Recommendations Assessment, Development, and Evaluation approach.</div></div><div><h3>Results</h3><div>Five RCTs incorporating 187 patients (93.6% female) with a median age of 42.5 years were included; 154 patients underwent SNM whereas 86 patients were crossed over to sham stimulation, and 33 received conservative treatment, amounting to a control group of 119 patients. The odds of relief of constipation after SNM were similar to those in the control group in the random-effect model (odds ratio [OR]: 1.92, 95% CI: 0.68–5.42, <em>p</em> = 0.217). The median percentage of reduction in the Cleveland Clinic Florida/Wexner Constipation Score was 27.9% in the SNM group vs 18.4% in the control group. No significant differences were observed in QoL. Both groups had similar odds of adverse events (OR: 2.22, 95% CI: 0.19–25.53, <em>p</em> = 0.521).</div></div><div><h3>Conclusion</h3><div>Although a relatively safe treatment, SNM was not associated with any tangible improvements in either constipation or QoL.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 5","pages":"Pages 737-745"},"PeriodicalIF":3.2,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Noninvasive Brain Stimulation Techniques Combined With Motor Interventions in Adult Patients After Stroke: An Overview of Systematic Reviews.","authors":"Sofia Straudi, Ishtiaq Ahmed, Elisa Vallin, Silvia Borsato, Michela Bozzolan, Marco Da Roit, Stefano G Lazzarini, Chiara Arienti","doi":"10.1016/j.neurom.2025.05.004","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.05.004","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to provide an overview of systematic reviews (SRs) about the effectiveness of combining noninvasive brain stimulation (NIBS) techniques with rehabilitation in adult patients with stroke.</p><p><strong>Materials and methods: </strong>The overview protocol has been prospectively registered on the International Prospective Register of Systematic Reviews (CRD42021241226). Eight electronic databases were searched from inception to December 2023. SRs investigating the effectiveness of NIBS techniques in addition to motor interventions compared with sham stimulation and the same motor interventions in adults with stroke were included. The methodologic quality of the included SRs was assessed using A MeaSurement Tool to Assess systematic Reviews-2. The certainty of the evidence was evaluated through the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>This overview included 13 SRs (85 primary studies, 2768 participants): Nine focused on arm and six on gait rehabilitation. The quality of the included SRs was low or critically low. The included SRs reported a high clinical heterogeneity for NIBS techniques and protocols or motor rehabilitation. Of the 42 outcomes assessed, two (4.7%) were judged as high-certainty evidence and referred to the lack of superiority of combining NIBS, especially transcranial direct current stimulation, with arm robotics for improving arm function. Moreover, 21 outcomes (50%) were judged as low-certainty evidence; they highlighted the way NIBS combined with rehabilitation can positively affect several functional domains.</p><p><strong>Conclusions: </strong>Even if no firm conclusions can be derived from the available literature owing to the quality of the included SRs and the heterogeneity of NIBS techniques and additional motor rehabilitation, some clinical indications have been provided.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High Cervical Intrathecal Targeted Drug Delivery for Refractory Neuropathic Craniofacial Pain.","authors":"Shyam A Desai, Harold W Burke, Adejuyigbe O Adaralegbe, Jennifer A Sweet, Salim M Hayek, Michael D Staudt","doi":"10.1016/j.neurom.2025.05.007","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.05.007","url":null,"abstract":"<p><strong>Objectives: </strong>Neuropathic craniofacial pain syndromes are heterogeneous with regards to clinical presentation and etiology. As such, they pose a diagnostic and management challenge, and are often refractory to medical and interventional management. High cervical intrathecal drug delivery has been reported in the management of refractory cancer-related craniofacial pain, although the literature regarding its use in neuropathic craniofacial pain remains limited. This study aims to describe the successful management of a series of patients with refractory neuropathic craniofacial pain who underwent implantation of a high cervical intrathecal drug delivery system (IDDS).</p><p><strong>Materials and methods: </strong>A single-center retrospective chart review was conducted in patients with refractory non-cancer neuropathic craniofacial pain who underwent implantation of an IDDS with the intrathecal catheter tip placed at a high cervical level. A variety of medical, interventional, and neuromodulation modalities had failed in these patients. Data collection spanned 2016 through March 2025. Medical charts were reviewed for demographic data, operative details, pain severity outcomes, intrathecal medication dosing, and the incidence of complications.</p><p><strong>Results: </strong>Overall, 12 patients (ten women, two men) underwent a high cervical intrathecal catheter trial. Nine patients had successful trials with reported improvement in pain >50%, with no significant reported side effects to a combination of fentanyl/bupivacaine. All patients suffered from neuropathic pain in the trigeminal distribution, with three patients experiencing corneal neuropathy. Patients were observed for a mean of 64.8 ± 48.1 months. Pain severity was significantly lower at last follow-up than at baseline (numeric rating scale of 9.5 ± 0.9 vs 4.3 ± 2.3) (p < 0.01). Three patients required catheter revision owing to migration. No patients were explanted for loss of efficacy.</p><p><strong>Conclusions: </strong>High cervical intrathecal drug delivery can be an effective treatment option for patients with refractory neuropathic craniofacial pain, even in patients presenting with heterogeneous pain of differing etiologies and failure with other treatments.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144529026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcutaneous Cervical Vagus Nerve Stimulation Modulates Prefrontal Cortex Activity During Opioid Withdrawal in Individuals With Opioid Use Disorder.","authors":"Farhan N Rahman, Afra Nawar, Jonathon A Nye, Jaiyoun Choi, Tamara P Lambert, Madeline Robinson, Asim H Gazi, Vikram Abbaraju, Nikolina Tomic, Anna B Harrison, Nora Jaquemet, Kellen Mermin-Bunnell, Hewitt Mesfin, Trinity A Gray, Justine W Welsh, Kelly E Dunn, Marom Bikson, Viola Vaccarino, Amit J Shah, Omer T Inan, James Douglas Bremner","doi":"10.1016/j.neurom.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.04.012","url":null,"abstract":"<p><strong>Background: </strong>Opioid use disorder (OUD) is associated with considerable morbidity and mortality with limited treatment approaches. Understanding brain mechanisms in response to treatment could be useful in guiding future developments in treatment approaches.</p><p><strong>Objective: </strong>The purpose of this study was to assess the effects of transcutaneous cervical vagus nerve stimulation (tcVNS) on brain response to opioid use cues in patients with OUD in opioid withdrawal.</p><p><strong>Materials and methods: </strong>Patients with OUD who were in the early stage of recovery and/or on medication underwent brain imaging with positron emission tomography and radiolabeled water in conjunction with stimulation with active tcVNS or sham devices and exposure to opioid-use-related cues.</p><p><strong>Results: </strong>tcVNS caused a relative increase in function in the anterior cingulate, dorsal anterior cingulate, and left inferior frontal gyrus during exposure to opioid cues. There also was a pattern of increased activation in the ventral striatum and orbitofrontal cortex.</p><p><strong>Conclusion: </strong>tcVNS modulates brain areas implicated in opioid addiction, suggesting a useful role as an adjunctive therapy for OUD.</p><p><strong>Clinical trial registration: </strong>The Clinicaltrials.gov registration number for the study is NCT04556552.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Caregivers' Perspectives and Decision-Making on Deep Brain Stimulation in GNAO1-Related Disorders.","authors":"Jana Domínguez-Carral, Carola Reinhard, Jane Yoo, Luca Soliani, Laura Cif, Juan Darío Ortigoza-Escobar","doi":"10.1016/j.neurom.2025.05.005","DOIUrl":"10.1016/j.neurom.2025.05.005","url":null,"abstract":"<p><strong>Objectives: </strong>Deep brain stimulation (DBS) is an advanced treatment for individuals with GNAO1-related disorders (GNAO1-RD), which are characterized by severe movement abnormalities such as status dystonicus and dyskinetic crises. Decision-making surrounding DBS is complex and influenced by medical, emotional, and logistical factors. This study aimed to explore caregiver perspectives on the decision-making process, including influencing factors and family experiences.</p><p><strong>Materials and methods: </strong>A European Union survey was administered to caregivers of individuals with genetically confirmed GNAO1-RD who had undergone DBS. The survey collected data on demographics, clinical features, decision-making factors, and postoperative experiences. Quantitative data were descriptively analyzed whereas qualitative data were thematically analyzed.</p><p><strong>Results: </strong>Twelve caregivers from ten countries participated, with individuals who underwent DBS at a median age of 10.69 years and follow-up durations ranging from <1 to 8.9 years. The primary indication was the management of status dystonicus and dyskinetic crises (9/12). The decision was categorized as urgent in nine of 12 cases. Factors influencing the decision included long-term quality of life, DBS effectiveness, prevention of hospitalizations, and surgeon expertise. Postoperatively, eight of 12 families reported significant reductions in status dystonicus and dyskinetic crises, with improvements observed within days to months. Challenges included inadequate preoperative information, rushed decisions due to medical urgency, and emotional tolls.</p><p><strong>Conclusions: </strong>DBS is perceived by caregivers as a life-saving intervention for GNAO1-RD, effectively reducing dyskinetic crises and status dystonicus while improving quality of life. DBS decision-making is highly complex and emotionally taxing. Enhanced communication, evidence-based guidance, and caregiver support are critical to empowering families during this process.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Two Methods of Deep Brain Stimulation Lead Reconstruction and Their Prediction Capacities.","authors":"Renata Montes Garcia Barbosa, Joyce Yuri Silvestre Yamamoto, Miriam Carvalho Soares, Isabela Bruzzi Bezerra Paraguay, Sara Carvalho Barbosa Casagrande, Jorge Dornellys da Silva Lapa, Marcos Eugênio Ramalho Bezerra, Guilherme Sperling Torezani, Vanessa Milanese Holanda, Gabriel de Castro Micheli, Egberto Reis Barbosa, Rubens Gisbert Cury","doi":"10.1016/j.neurom.2025.04.013","DOIUrl":"10.1016/j.neurom.2025.04.013","url":null,"abstract":"<p><strong>Objectives: </strong>Deep brain stimulation (DBS) technology has become increasingly advanced, and tools capable of optimizing programming are necessary. Three-dimensional (3D) electrode imaging reconstruction has the potential to assist clinicians in selecting the most effective DBS contacts. In this study, we evaluated the predictive capacity of two different methods (Matlab software [Mathworks, Inc., Natick, MA] and Brainlab software [Brainlab, Munich, Germany]) in identifying effective DBS contacts, compared with clinical examination (the standard of care). The study also analyzes whether one method is superior.</p><p><strong>Materials and methods: </strong>Overall, 29 patients were included: 27 with Parkinson's disease (PD) and two with dystonia (DT). Therefore, images of the 58 brain hemispheres were obtained. Of these, 56 had directional leads, and two had leads with eight-ring contacts. Electrode reconstruction was performed using Matlab software and Brainlab software. The anatomic relationship between the electrodes and the targets (subthalamic nucleus or globus pallidus internus) was analyzed. Contacts within the sweet spot of the target were chosen through 3D reconstruction visualization. In addition, if the best contact levels were directional, the best located directional contacts were chosen (this was possible in 40 leads). The best contact was defined as that with the highest motor symptoms improvement rate based on clinical examination (standard of care).</p><p><strong>Results: </strong>The mean age of the patients was 56 years; 24 patients underwent surgery within ≤one year from the surgery, and the maximum time from surgery was three years. The difference in contact-level suggestion was only one hemisphere, with Matlab software correctly suggesting the best clinical contact in 83% (48/58) and Brainlab software in 84% (49/58). The suggestion capacity of the directional contacts was 80% for both methods. Furthermore, there was a 94.8% concordance rate between the two methods (55/58) on choosing the best contacts on the basis of image reconstruction.</p><p><strong>Conclusion: </strong>Matlab software and Brainlab software are effective image reconstruction methods for accurately suggesting the best contact on the basis of clinical examination.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144333594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Abdominal Vagus Nerve Stimulation Increases Firing in the Rat Locus Coeruleus.","authors":"Tomoko Hyakumura, Sophie C Payne, Jerico V Matarazzo, Wendy K Adams, James B Fallon","doi":"10.1016/j.neurom.2025.05.003","DOIUrl":"10.1016/j.neurom.2025.05.003","url":null,"abstract":"<p><strong>Background: </strong>Cervical vagus nerve stimulation (VNS) is a clinically available treatment for refractory epilepsy and depression. Animal studies show that electrical activation of the noradrenergic brain region, locus coeruleus (LC), is essential for the therapeutic effects of cervical VNS for the treatment of these conditions. Cervical VNS often causes side effects such as coughing, headache, and apnea-hypopnea. Such side effects can be mitigated by reducing stimulation intensity; however, evidence suggests this reduces efficacy of treatment. Abdominal VNS, targeting the vagus nerve below the nerve branches that cause these side effects, is an alternative strategy to deliver VNS.</p><p><strong>Objective: </strong>This study aimed to assess whether abdominal VNS increases spike activity in the LC without causing any off-target effects.</p><p><strong>Materials and methods: </strong>Cervical and abdominal vagi of anesthetized male Sprague-Dawley rats were implanted with cuff electrode arrays, and a tungsten electrode was used to record neural activity in the LC. Changes in the firing rate of LC neurons and changes to the heart and breathing rate were recorded during cervical and abdominal VNS.</p><p><strong>Results: </strong>Cervical VNS significantly reduced heart and/or breathing rate (two-way repeated measures analysis of variance, p < 0.05; n = 6) when stimulation was 0.82 ± 0.09 mA or higher. This stimulation level was termed the \"off-target effect threshold.\" Abdominal VNS did not produce any changes in heart and breathing rate at any stimulus level tested. Cervical and abdominal VNS, delivered at 2 mA (maximum tested) significantly increased spike activity predominantly in the anteromedial LC, compared with prestimulation baseline (paired t-test, p < 0.001, n = 6). However, when \"safe levels,\" that is, below the off-target effect threshold, of VNS were applied, only abdominal VNS increased spike activity in the LC.</p><p><strong>Conclusion: </strong>Abdominal VNS activated the LC without causing changes to vitals and could be used as an alternative approach to providing VNS therapy for brain disorders such as drug-resistant epilepsy and depression.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144340284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Greater Occipital Nerve Block Modulate Brainstem Excitability? Insights From a Randomized Controlled Study in Migraine.","authors":"Ahmet Başarı, İlker Arslan, Çağrı Cansu, Güngör Enver Özgencil, Levent Özbek, Bülent Cengiz","doi":"10.1016/j.neurom.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.04.010","url":null,"abstract":"<p><strong>Objectives: </strong>Greater occipital nerve block (GONb) is widely used in the treatment of migraine; however, its effects on brainstem excitability remain unclear. This study aimed to assess whether GONb alters brainstem excitability in patients with migraine by evaluating blink reflex (BR) and masseter inhibitory reflex (MIR) parameters.</p><p><strong>Materials and methods: </strong>This randomized, placebo-controlled, double-blind study included 34 patients with migraine who received either GONb (n = 17) or placebo (n = 17). BR and MIR responses were recorded before and after treatment. The primary outcome was the change in BR R2 response latency, whereas secondary outcomes included BR inhibition, MIR parameters, and pain reduction (visual analog scale [VAS] scores).</p><p><strong>Results: </strong>GONb significantly reduced BR R2 response latency (p = 0.002), indicating altered brainstem excitability. However, no significant changes were observed in BR inhibition (p > 0.05) or MIR parameters (p > 0.05). GONb led to a significant reduction in migraine frequency (-84.6%, p < 0.0001) and pain severity (VAS: 7.2 ± 1.1 to 2.3 ± 1.6, p < 0.0001), but these improvements did not correlate with neurophysiologic findings.</p><p><strong>Conclusions: </strong>This study reveals that GONb modifies brainstem excitability by affecting BR R2 latency but does not significantly affect BR inhibition or MIR responses. The findings suggest that GONb selectively influences trigeminal nociceptive pathways rather than global brainstem inhibitory circuits. Further studies with larger cohorts and longer follow-up are needed to elucidate the broader neurophysiologic effects of GONb in migraine.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systematic Review and Meta-Analysis of Bilateral Centromedian Nucleus Neuromodulation for Multifocal and Generalized Epilepsy.","authors":"Ahmad Alhourani, Ling-Ya Chao, Edward F Chang, Vikram R Rao","doi":"10.1016/j.neurom.2025.04.008","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.04.008","url":null,"abstract":"<p><strong>Objectives: </strong>Generalized and multifocal forms of drug-resistant epilepsy are highly prevalent but have limited treatment options. Centromedian nucleus (CMN) thalamic neuromodulation has emerged as an effective treatment for these epilepsies, but head-to-head neuromodulation modality trials do not exist, and optimal stimulation parameters are not established.</p><p><strong>Materials and methods: </strong>Using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, we conducted a systematic review by searching PubMed and Embase for peer-reviewed studies of bilateral CMN deep brain stimulation (DBS) or responsive neurostimulation (RNS) for generalized and/or multifocal epilepsy. From studies that met the inclusion criteria, we extracted individual patient data and used a mixed-effects model to compare seizure frequency reduction (SR) of modalities and for DBS, across different stimulation frequencies.</p><p><strong>Results: </strong>A total of 25 studies with 192 total patients were included. DBS and RNS yielded comparable SR (76.8% vs 66.7%, respectively, p = 0.1). Within the DBS cohort, high-frequency (>100 Hz) stimulation was more effective for SR by 20.16% (CI: 6.49-33.83) than low-frequency stimulation. Patients with Lennox-Gastaut Syndrome (LGS) had 13.37% lower SR (CI: -26.17 to -0.56) than did those without this diagnosis. Longer follow-up duration (≥18 months) was associated with 12.60% greater SR (CI: 2.53-22.68).</p><p><strong>Conclusions: </strong>For CMN thalamic neuromodulation in patients with multifocal or generalized epilepsy, modality type (RNS vs DBS) may matter less for SR than may underlying diagnosis (LGS vs not LGS), stimulation parameters (high- vs low-frequency), and treatment duration. These findings have implications for the therapeutic mechanism(s) of thalamic neuromodulation and motivate further study of optimal stimulation approaches.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimization Simulations of Transcranial Direct Current Stimulation Montages in Children With Perinatal Stroke.","authors":"Martin Bardhi, Ephrem Takele Zewdie, Adam Kirton, Helen L Carlson","doi":"10.1016/j.neurom.2025.05.002","DOIUrl":"https://doi.org/10.1016/j.neurom.2025.05.002","url":null,"abstract":"<p><strong>Background: </strong>Perinatal stroke (PS) is a vascular brain injury that causes most hemiparetic cerebral palsy. Transcranial direct current stimulation (tDCS) applies a weak electric field (EF) to the scalp, and targeting motor cortex (M1) paired with therapy may improve motor function. However, owing to developmental differences and idiosyncratic anatomy after early injury, optimal electrode placements are not known. We optimized electrode placements on the basis of individual anatomy and explored the resulting EF propagation patterns.</p><p><strong>Objective/hypothesis: </strong>We hypothesized that children with PS would have greater electrode displacement distances from standard montages and that optimizations could improve the strength and direction of EF at M1 targets.</p><p><strong>Materials and methods: </strong>Magnetic resonance images of participants with PS and of controls were preprocessed, segmented, and converted to three-dimensional meshes. SimNIBS (Thielscher, Copenhagen, Denmark) modeled EF for various tDCS electrode placements. Optimal placements were modeled to maximize EF strength or direction at the targeted M1. Electrode displacement distances and directions in addition to EF metrics were compared in groups and optimization strategies.</p><p><strong>Results: </strong>Optimal electrode displacement distance was greater in the arterial ischemic stroke group when EF strength in the lesioned M1 was optimized (W = 4.31, p < 0.01), located further posterior than controls. The opposite trend was observed when current direction was optimized (W = 3.68, p = 0.025). Displacement direction had higher variability in children with PS across all optimizations. Montage optimization improved EF metrics. Specifically, the anodal nondirectionally optimized protocol caused greater EF strength in simulations of participants with PS. Directionally optimized montages altered average current angle through the target M1, making it closer to perpendicular to the posterior bank of the precentral gyrus in all groups.</p><p><strong>Conclusions: </strong>Individualized electrode placements may optimize tDCS current propagation in children with PS, with tradeoffs between current direction and EF strength. tDCS current optimization may improve noninvasive neuromodulation therapies in children with disabilities.</p>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}