Neuromodulation最新文献

{"title":"Neuromodulation and Disorders of Consciousness: Systematic Review and Pathophysiology","authors":"Rajeev R. Dutta BS ,&nbsp;Sheila Abdolmanafi AS ,&nbsp;Alex Rabizadeh BS ,&nbsp;Rounak Baghbaninogourani BS ,&nbsp;Shirin Mansooridara MD ,&nbsp;Alexander Lopez MD, MS ,&nbsp;Yama Akbari MD, PhD ,&nbsp;Michelle Paff MD","doi":"10.1016/j.neurom.2024.09.003","DOIUrl":"10.1016/j.neurom.2024.09.003","url":null,"abstract":"<div><h3>Introduction</h3><div>Disorders of consciousness (DoC) represent a range of clinical states, affect hundreds of thousands of people in the United States, and have relatively poor outcomes. With few effective pharmacotherapies, neuromodulation has been investigated as an alternative for treating DoC. To summarize the available evidence, a systematic review of studies using various forms of neuromodulation to treat DoC was conducted.</div></div><div><h3>Materials and Methods</h3><div>Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for systematic literature review, the PubMed, Scopus, and Web of Science databases were queried to identify articles published between 1990 and 2023 in which neuromodulation was used, usually in conjunction with pharmacologic intervention, to treat or reverse DoC in humans and animals. Records were excluded if DoC (eg, unresponsive wakefulness syndrome, minimally conscious state, etc) were not the primary clinical target.</div></div><div><h3>Results</h3><div>A total of 69 studies (58 human, 11 animal) met the inclusion criteria for the systematic review, resulting in over 1000 patients and 150 animals studied in total. Most human studies investigated deep brain stimulation (<em>n</em> = 15), usually of the central thalamus, and transcranial magnetic stimulation (<em>n</em> = 18). Transcranial direct-current stimulation (<em>n</em> = 15) and spinal cord stimulation (<em>n</em> = 6) of the dorsal column also were represented. A few studies investigated low-intensity focused ultrasound (<em>n</em> = 2) and median nerve stimulation (<em>n</em> = 2). Animal studies included primate and murine models, with nine studies involving deep brain stimulation, one using ultrasound, and one using transcranial magnetic stimulation.</div></div><div><h3>Discussion</h3><div>While clinical outcomes were mixed and possibly confounded by natural recovery or pharmacologic interventions, deep brain stimulation appeared to facilitate greater improvements in DoC than other modalities. However, repetitive transcranial magnetic stimulation also demonstrated clinical potential with much lower invasiveness.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 380-400"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Personalized Theta Transcranial Alternating Current Stimulation and Gamma Transcranial Alternating Current Stimulation Bring Differential Neuromodulatory Effects on the Resting Electroencephalogram: Characterizing the Temporal, Spatial, and Spectral Dimensions of Transcranial Alternating Current Stimulation","authors":"Rahul Venugopal ME, MPhil, PhD ,&nbsp;Arun Sasidharan MBBS, PhD ,&nbsp;Kankana Bhowmick BS, MS ,&nbsp;Nithin Nagaraj MS, PhD ,&nbsp;Kaviraja Udupa MBBS, MD, PhD ,&nbsp;John P. John MBBS, MD ,&nbsp;Bindu M. Kutty MSc, MPhil, PhD","doi":"10.1016/j.neurom.2024.08.008","DOIUrl":"10.1016/j.neurom.2024.08.008","url":null,"abstract":"<div><h3>Objectives</h3><div>The neuromodulatory effects of transcranial alternating current stimulation (tACS) on electroencephalogram (EEG) dynamics are quite heterogenous. The primary objective of the study is to comprehensively characterize the effects of two tACS protocols on resting-state EEG.</div></div><div><h3>Materials and Methods</h3><div>A total of 36 healthy participants were recruited and were randomized into three groups. Two groups received either personalized theta (4–8 Hz) or gamma (40 Hz) stimulation bilaterally in the frontal regions for 20 minutes (4 minutes ON, 1 minute OFF, four cycles). The third group performed relaxed breath watching for 20 minutes. Artifact-free, 1-minute EEG segments from the baseline, during tACS, and after stimulation resting EEG were characterized to see the effects of tACS. Threshold-free cluster enhanced permutation tests (for spectral measures) and two-way mixed analysis of variance (for aperiodic slope) were used for statistical inferences.</div></div><div><h3>Results</h3><div>Current modeling simulation using ROAST with preset parameters (800 μA, AF3 AF4 locations) showed that induced electric fields can activate frontal cortical regions. During the stimulation period, personalized theta tACS entrained theta band power in the centro-parietal areas. There was a compensatory power decrease in the beta and gamma bands after theta tACS. No entrainment effects were observed for gamma tACS during stimulation, but a significant entrainment was observed in the theta and beta bands in the parieto-occipital regions after stimulation. The delta band power decreased in the central regions. No spectral modulations were seen after breath watching. The spectral slope, which measures aperiodic activity, was not affected by either breath watching or tACS.</div></div><div><h3>Conclusions</h3><div>Characterizing the effects of multiple tACS protocols is critical to effectively target specific neural oscillatory patterns and to personalize the protocols. The study can be extended to target specific oscillatory patterns associated with cognitive deficits in neuro-psychiatric conditions.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 425-433"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142470916","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":"Field H1 of Forel vs Subthalamic Nucleus Electrical Stimulation in Parkinson’s Disease: Long-term Effects on Motor Symptoms and Quality of Life","authors":"Juliana Passinho Azevedo Rodrigues MD ,&nbsp;Maria Sheila Guimarães Rocha MD, PhD ,&nbsp;Kaito Alves Carvalho Laube MD ,&nbsp;Ricardo Iglesio MD, PhD ,&nbsp;Paulo Roberto Terzian Filho MD ,&nbsp;Julian Letícia de Freitas MD ,&nbsp;Eberval Gadelha Figueiredo MD, PhD ,&nbsp;Carlos Gilberto Carlotti Jr MD, PhD ,&nbsp;Diogo Coutinho Soriano PhD ,&nbsp;Fábio Godinho MD, PhD","doi":"10.1016/j.neurom.2024.09.473","DOIUrl":"10.1016/j.neurom.2024.09.473","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Deep brain stimulation (DBS) of the subthalamic nucleus (STN) relieves motor symptoms, including levodopa-responsive gait disorders in Parkinson’s disease (PD). Traditionally, STN-DBS is not indicated to treat severe, clinically resistant axial symptoms. In this scenario, field H1 of Forel (FF) stimulation (FF-DBS) is likely a feasible option, given it improves motor symptoms, including freezing of gait (FOG), as shown by a short-term study. However, no data are available about the long-term effects of this therapy. Finally, no study has compared the long-term effects of FF and STN-DBS.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;We report the long-term outcome (&gt;five years) of bilateral FF-DBS in patients with PD. We also compare the effects of FF-DBS and STN-DBS on motor symptoms, cognition, and quality of life.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Materials and Methods&lt;/h3&gt;&lt;div&gt;We studied 22 patients (ten with FF-DBS and 12 with STN-DBS). Motor symptoms, cognition, quality of life, and gait symptoms were assessed using the motor part of the Movement Disorders Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS III), the Mattis Dementia Rating Scale, the 39-item PD quality of life (PDQ-39), and the FOG questionnaire (FOG score) respectively. The levodopa equivalent daily dose was recorded. Comparisons of the FF and STN-DBS results were conducted.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Result&lt;/h3&gt;&lt;div&gt;The mean follow-up was 6.18 years (95% CI: 5.57–6.78). Compared with the preoperative period, patients with FF had an average reduction of 32.2% in the MDS-UPDRS III scores (&lt;em&gt;p&lt;/em&gt; &lt; 0.01), a decrease of 35.3% in the FOG scores (&lt;em&gt;p&lt;/em&gt; &lt; 0.01), and an improvement of 25.9% in the PDQ-39 (&lt;em&gt;p&lt;/em&gt; &lt; 0.01). There was a 7.5% decrease in cognition (&lt;em&gt;p&lt;/em&gt; &lt; 0.01). Levodopa equivalent dose (LED) was reduced by 26.3% (&lt;em&gt;p&lt;/em&gt; &lt; 0.01). The STN group had an average reduction of 39.4% in the MDS-UPDRS III scores (&lt;em&gt;p&lt;/em&gt; &lt; 0.01), a decrease of 23.7% in the FOG scores (&lt;em&gt;p&lt;/em&gt; &lt; 0.01), and an improvement of 33.2% in the PDQ-39 scores (&lt;em&gt;p&lt;/em&gt; &lt; 0.01). Cognition decreased by 1.6% (&lt;em&gt;p&lt;/em&gt; &lt; 0.01) and LED by 15.06% (&lt;em&gt;p&lt;/em&gt; = 0.02). Patients with FF-DBS were older than those with STN-DBS at the time of surgery: 61.2 years and 55.7 years, respectively (&lt;em&gt;p&lt;/em&gt; = 0.02), and had longer duration of disease (&lt;em&gt;p&lt;/em&gt; = 0.02). Patients with FF-DBS had a greater reduction in FOG (&lt;em&gt;p&lt;/em&gt; = 0.02) than did the STN group and presented with a greater decrease in cognition (&lt;em&gt;p&lt;/em&gt; &lt; 0.01) after five years. STN-DBS had a greater effect on quality of life.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;Both FF-DBS and STN-DBS relieved motor symptoms and improved quality of life over a long-term period. Patients with FF-DBS had a higher reduction in both FOG and in LED than did those with STN-DBS. These data support our hypothesis that FF-DBS is a safe and efficient option for treating motor symptoms in PD, in","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 492-500"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142624301","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":"Response to Letter to the Editor Regarding: The Neurostimulation Appropriateness Consensus Committee (NACC)©: Recommendations for the Mitigation of Complications of Neurostimulation","authors":"Timothy Deer MD ,&nbsp;Dawood Sayed MD","doi":"10.1016/j.neurom.2025.01.002","DOIUrl":"10.1016/j.neurom.2025.01.002","url":null,"abstract":"","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 547-548"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747762","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":"Information for Readers","authors":"","doi":"10.1016/S1094-7159(25)00045-5","DOIUrl":"10.1016/S1094-7159(25)00045-5","url":null,"abstract":"","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Page A5"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143748095","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":"Anesthetic Effect on the Subthalamic Nucleus in Microelectrode Recording and Local Field Potential of Parkinson’s Disease","authors":"Pin-Han Huang ,&nbsp;Yu-Shen Pan ,&nbsp;Shin-Yuan Chen MD ,&nbsp;Sheng-Huang Lin MD, PhD","doi":"10.1016/j.neurom.2024.04.002","DOIUrl":"10.1016/j.neurom.2024.04.002","url":null,"abstract":"<div><h3>Objectives</h3><div><span>Anesthetic agents used during deep brain stimulation<span> (DBS) surgery might interfere with microelectrode recording (MER) and local field potential (LFP) and thus affect the accuracy of surgical target localization. This review aimed to identify the effects of different anesthetic agents on </span></span>neuronal activity<span> of the subthalamic nucleus (STN) during the MER procedure.</span></div></div><div><h3>Materials and Methods</h3><div>We used Medical Subject Heading terms to search the PubMed, EMBASE, EBSCO, and ScienceDirect data bases. MER characteristics were sorted into quantitative and qualitative data types. Quantitative data included the burst index, pause index, firing rate (FR), and interspike interval. Qualitative data included background activity, burst discharge (BD), and anesthetic agent effect. We also categorized the reviewed manuscripts into those describing local anesthesia with sedation (LAWS) and those describing general anesthesia (GA) and compiled the effects of anesthetic agents on MER and LFP characteristics.</div></div><div><h3>Results</h3><div><span>In total, 26 studies on MER were identified, of which 12 used LAWS and 14 used GA. Three studies on LFP also were identified. We found that the FR was preserved under LAWS but tended to be lower under GA, and BD was reduced in both groups. Individually, propofol<span> enhanced BD but was better used for sedation, or the dosage should be minimized in GA. Similarly, low-dose dexmedetomidine sedation did not disturb MER. Opioids could be used as adjunctive anesthetic agents. Volatile anesthesia had the least </span></span>adverse effect on MER under GA, with minimal alveolar concentration at 0.5. Dexmedetomidine anesthesia did not affect LFP, whereas propofol interfered with the power of LFP.</div></div><div><h3>Conclusions</h3><div>The effects of the tested anesthetics on the STN in MER and LFP of Parkinson’s disease varied; however, identifying the STN and achieving a good clinical outcome are possible under controlled anesthetic conditions. For patient comfort, anesthesia should be considered in STN-DBS.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 414-424"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141293589","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":"Impact of Preoperative Cognition on Motor Improvement in Bilateral Subthalamic Nucleus-Deep Brain Stimulation for Parkinson's Disease","authors":"Vibuthi Sisodia MD ,&nbsp;Rosalie Ursinus MSc ,&nbsp;Gert J. Geurtsen PhD ,&nbsp;Yarit Wiggerts MSc ,&nbsp;Peter Richard Schuurman MD, PhD ,&nbsp;Martijn Beudel MD, PhD ,&nbsp;Rob M.A. de Bie MD, PhD ,&nbsp;Bart E.K.S. Swinnen MD, PhD","doi":"10.1016/j.neurom.2024.07.011","DOIUrl":"10.1016/j.neurom.2024.07.011","url":null,"abstract":"<div><h3>Objective</h3><div>This study aimed to assess the influence of preoperative cognition on postoperative motor and nonmotor outcomes in patients with Parkinson disease (PD) after deep brain stimulation (DBS).</div></div><div><h3>Materials and Methods</h3><div>A retrospective study was performed in subjects with PD with bilateral subthalamic DBS. Preoperative cognition was indexed by Parkinson’s Disease-Cognitive Rating Scale (PD-CRS) and global neuropsychological evaluation (NPE) scores. The primary outcome was change from baseline to postoperative off-drug Movement Disorders Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) part 3 score. Secondary outcomes included change from baseline to postoperative MDS-UPDRS part 1 subscores.</div></div><div><h3>Results</h3><div>The study included 226 subjects; 176 patients (77.9%) had normal cognition (PD-NC); 48 (21.2%) had mild cognitive impairment (MCI), and two (0.9%) had PD dementia. Proportional change (−41.4% vs −52.2%, <em>p</em> = 0.013) in off-drug MDS-UPDRS part 3 score was smaller in PD-MCI than in PD-NC. PD-CRS (Pearson’s <em>r</em> = 0.236, <em>p</em> &lt; 0.001) and NPE (Pearson’s <em>r</em> = 0.219, <em>p</em> &lt; 0.001) scores displayed a positive correlation with proportional change in off-drug MDS-UPDRS part 3 score. Worse PD-CRS scores were related to larger improvements in MDS-UPDRS part 1.2 (hallucinations) (Pearson’s <em>r</em> = 0.135, <em>p</em> = 0.045).</div></div><div><h3>Conclusions</h3><div>DBS induces a clinically meaningful motor improvement in patients with cognitive impairment and PD, but the improvement may be smaller than in patients who are not cognitively affected. Further research into the risk-benefit balance of DBS in people with PD and cognitive dysfunction is warranted.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 484-491"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142350815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How Long Does Deep Brain Stimulation Give Patients Benefit?","authors":"Esin Bulut MS ,&nbsp;P. Mitchell Johansen MD ,&nbsp;Alya Elbualy BS ,&nbsp;Cheyenne Kalman BS ,&nbsp;Ryan Mayer ,&nbsp;Nicholas Kato BS ,&nbsp;Rodrigo Salmeron de Toledo Aguiar MD ,&nbsp;Julie G. Pilitsis MD, PhD, MBA","doi":"10.1016/j.neurom.2024.05.007","DOIUrl":"10.1016/j.neurom.2024.05.007","url":null,"abstract":"<div><h3>Introduction</h3><div>One of the most common questions patients ask when they are contemplating deep brain stimulation (DBS) is how long it will last. To guide physicians in answering this query, we performed a scoping review to assess the current state of the literature and to identify the gaps that need to be addressed.</div></div><div><h3>Materials and Methods</h3><div>The authors performed a MEDLINE search inclusive of articles from January 1987 (advent of DBS literature) to June 2023 including human and modeling studies written in English. For longevity of therapy data, only studies with a mean follow-up of ≥three years were included. Using the Rayyan platform, two reviewers (JP and RM) performed a title screen. Of the 734 articles, 205 were selected by title screen and 109 from abstract review. Ultimately, a total of 122 articles were reviewed. The research questions we explored were 1) how long can the different components of the DBS system maintain functionality? and 2) how long can DBS remain efficacious in treating Parkinson’s disease (PD), essential tremor (ET), dystonia, and other disorders?</div></div><div><h3>Results</h3><div>We showed that patients with PD, ET, and dystonia maintain a considerable long-term benefit in motor scores seven to ten years after implant, although the percentage improvement decreases over time. Stimulation off scores in PD and ET show worsening, consistent with disease progression. Battery life varies by the disease treated and the programming settings used. There remains a paucity of literature after ten years, and the impact of new device technology has not been classified to date.</div></div><div><h3>Conclusion</h3><div>We reviewed existing data on DBS longevity. Overall, outcomes data after ten years of therapy are substantially limited in the current literature. We recommend that physicians who have data for patients with DBS exceeding this duration publish their results.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 472-483"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141603957","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":"Rectangular Repetitive Transcranial Magnetic Monophasic vs Biphasic Stimulation for Major Depressive Disorder: A Randomized Controlled Pilot Trial","authors":"Michelle S. Goodman PhD ,&nbsp;Daniel M. Blumberger MD, MSc ,&nbsp;Mehran Talebinejad PhD ,&nbsp;Adrian D.C. Chan PhD ,&nbsp;Robert Chen MBBChir, MSc ,&nbsp;Tony T. Yang MD, PhD","doi":"10.1016/j.neurom.2024.11.010","DOIUrl":"10.1016/j.neurom.2024.11.010","url":null,"abstract":"<div><h3>Objectives</h3><div>Biphasic sinusoidal repetitive transcranial magnetic stimulation (rTMS) is a noninvasive brain stimulation treatment that has been approved by the US Food and Drug Administration for treatment-resistant depression (TRD). Recent advances suggest that standard rTMS may be improved by altering the pulse shape; however, there is a paucity of research investigating pulse shape, owing primarily to the technologic limitations of currently available devices. This pilot study examined the feasibility, tolerability, and preliminary efficacy of biphasic and monophasic rectangular rTMS for TRD.</div></div><div><h3>Material and Methods</h3><div>Twenty adult participants with TRD received randomized biphasic and monophasic rectangular rTMS; 30 rectangular rTMS sessions (3000 pulses per session) were delivered as daily sessions over six weeks at 120% resting motor threshold. Neuropsychologic testing was conducted before and after the six-week treatment course, and at one, four, and 12 weeks after treatment.</div></div><div><h3>Results</h3><div>Two participants withdrew, leaving a final sample size of 18. Both monophasic and biphasic rTMS protocols significantly reduced depressive symptoms in patients with TRD without any significant side effects. In contrast to our hypothesis, there were no differences between the two treatment groups in terms of change in depressive scores, response rates, or remission rates.</div></div><div><h3>Conclusions</h3><div>Findings from this pilot study revealed that both biphasic and monophasic rectangular rTMS are safe and well-tolerated. Larger, double-blind sham-controlled trials are needed to confirm the response and remission rates observed in this study.</div></div><div><h3>Clinical Trial Registration</h3><div>The <span><span>Clinicaltrials.gov</span><svg><path></path></svg></span> registration number for the study is NCT02667041.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 511-519"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143747919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Efficacy of Bilateral Globus Pallidus Stimulation in the Treatment of Meige Syndrome","authors":"Shiyu Fu MM,&nbsp;Zhiquan Yang MD,&nbsp;Xinghui He MD,&nbsp;Dingyang Liu MD,&nbsp;Zhuanyi Yang MD,&nbsp;Junmei Zhang MM,&nbsp;Liangchao Du BMed","doi":"10.1016/j.neurom.2024.02.002","DOIUrl":"10.1016/j.neurom.2024.02.002","url":null,"abstract":"<div><h3>Objective</h3><div><span><span>This study aimed to investigate the long-term efficacy and prognosis of bilateral globus pallidus internus (GPi) </span>deep brain stimulation (DBS) in patients with </span>benign essential blepharospasm<span> (BEB) and complete Meige syndrome, and to search for the best therapeutic subregion within the GPi.</span></div></div><div><h3>Materials and Methods</h3><div>Data were collected for 36 patients with Meige syndrome<span> who underwent bilateral GPi-DBS surgery at our hospital between March 2014 and February 2022. Using the Burk-Fahn-Marsden Dystonia Rating Scale (BFMDRS)-Movement (BFMDRS-M) and BFMDRS-Disability (BFMDRS-D), the severity of the symptoms of patients with complete Meige syndrome was evaluated before surgery and at specific time points after surgery. Patients with BEB were clinically evaluated for the severity of blepharospasm using BFMDRS-M, the Blepharospasm Disability Index (BDI), and Jankovic Rating Scale (JRS). Three-dimensional reconstruction of the GPi-electrode was performed in some patients using the lead-DBS software, and the correlation between GPi subregion volume of tissue activated (VTA) and symptom improvement was analyzed in patients six months after surgery. The follow-up duration ranged from six to 99 months.</span></div></div><div><h3>Results</h3><div>Compared with preoperative scores, the results of all patients at six months after surgery and final follow-up showed a significant decrease (<em>p</em> &lt; 0.05) in the mean BFMDRS-M score. Among them, the average BFMDRS-M improvement rates in patients with BEB at six months after surgery and final follow-up were 60.3% and 69.7%, respectively, whereas those in patients with complete Meige syndrome were 54.5% and 58.3%, respectively. The average JRS and BDI scores of patients with BEB also decreased significantly (<em>p</em><span> &lt; 0.05) at six months after surgery and at the final follow-up (JRS improvement: 38.6% and 49.1%, respectively; BDI improvement: 42.6% and 57.4%, respectively). We were unable to identify significantly correlated prognostic factors. There was a significant correlation between GPi occipital VTA and symptom improvement in patients at six months after surgery (</span><em>r</em> = 0.34, <em>p</em> = 0.025).</div></div><div><h3>Conclusions</h3><div>Our study suggests that bilateral GPi-DBS is an effective treatment for Meige syndrome, with no serious postoperative complications. The VTA in the GPi subregion may be related to the movement score improvement. In addition, further research is needed to predict patients with poor surgical outcomes.</div></div>","PeriodicalId":19152,"journal":{"name":"Neuromodulation","volume":"28 3","pages":"Pages 532-544"},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140850767","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}