Stereotactic and Functional Neurosurgery最新文献

{"title":"Comparative Study Evaluating a New Dose Optimization Software for Gamma Knife Treatment Planning: Comparison of 80 Challenging Treatment Plans.","authors":"Lucie Hamáčková, Josef Novotný, Markéta Farníková, Roman Liščák, Gabriela Šimonová, Dušan Urgošík, Michal Schmitt","doi":"10.1159/000546214","DOIUrl":"10.1159/000546214","url":null,"abstract":"<p><strong>Introduction: </strong>In 2020, Elekta Instrument AB, Stockholm, released a new dose optimizer for Leksell GammaPlan, which includes the possibility of inverse planning. This study aimed to compare the new software with the previous manual version of treatment planning for stereotactic radiosurgery and evaluate its performance.</p><p><strong>Materials and methods: </strong>Four types of diagnoses - vestibular schwannomas, pituitary adenomas, meningiomas, and single brain metastasis - along with 80 clinically approved challenging cases, were selected for testing the new software. Key parameters, including coverage, selectivity, target volume, and doses to critical structures, were collected and statistically analysed using a t test. These parameters were compared based on the Leksell Gamma Knife (LGK) Society standardization document for stereotactic radiosurgery, both for each diagnosis and for the entire dataset.</p><p><strong>Results: </strong>The new software showed a clear advantage, particularly in sparing critical structures while maintaining or improving treatment plan conformity. Doses to critical structures such as the optic nerve, brainstem, cochlea, and pituitary gland decreased by an average of 13% (0.76 Gy), 7% (0.52 Gy), 7% (0.2 Gy), and 14% (1.04 Gy), respectively, reducing toxicity. Other plan parameters also showed significant improvements, except for the gradient index. Selectivity improved by 11% (0.03), the Shaw Conformity Index improved by 10% (0.1), and coverage improved by 0.01. Additionally, treatment time was reduced by 10% enhancing patient comfort.</p><p><strong>Conclusion: </strong>Overall, LGK Lightning is faster and produces treatment plans with superior parameters compared to manual planning.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144175039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Battery Longevity in Deep Brain Stimulation for Parkinson's Disease.","authors":"Forough Yazdanian, Alejandro Enriquez-Marulanda, Nima Dehmamy, Ali Mortezaei, Taimur Hassan, Jay L Shils, Ron L Alterman","doi":"10.1159/000544714","DOIUrl":"10.1159/000544714","url":null,"abstract":"<p><strong>Introduction: </strong>In patients receiving deep brain stimulation (DBS) therapy, the longevity of the implanted pulse generator (IPG) is influenced by multiple factors, including patient diagnosis, therapeutic target, neurostimulator type, number of implanted leads, and stimulation settings. Recent advancements in DBS technology include longer-lived batteries, both standard and rechargeable. This study assessed the estimated IPG longevity of Medtronic, Inc., Percept™ PC neurostimulator in Parkinson's disease (PD) and explores factors associated with IPG lifespan.</p><p><strong>Methods: </strong>Retrospective analysis of Percept™ devices in 31 PD patients who underwent bilateral DBS targeting either the internal globus pallidus or the subthalamic nucleus (STN). The analysis included demographics, clinical information, stimulation settings, lead locations, and total effective energy delivered (TEED).</p><p><strong>Results: </strong>The median IPG longevity was 75.9 months (51.6-92.3). Among stimulation parameters, frequency demonstrated the strongest inverse correlation with longevity (r = -0.49, p < 0.01), followed by pulse width (r = -0.39, p < 0.01), TEED (r = -0.35, p < 0.01), current amplitude (r = -0.33, p < 0.01), and voltage (r = -0.25, p = 0.04), regardless of laterality. In STN-targeted patients, a significant association was observed between the Z-coordinate of the right lead and the presence of side effects (p = 0.04). Monopolar stimulation on the dominant side showed significantly longer IPG longevity compared to bipolar stimulation (80.6 vs. 49.6 months, p = 0.01).</p><p><strong>Conclusion: </strong>Significant negative correlations were observed between longevity and various stimulation parameters regardless of laterality. Monopolar stimulation on the dominant side was associated with increased longevity.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lack of Therapeutic Benefit of Ventral Intermediate Nucleus Thalamotomy for Tremor-Like Myoclonus in Two Cases of Benign Adult Familial Myoclonus Epilepsy.","authors":"Taku Nonaka, Takashi Asahi, Shiro Horisawa, Ichiro Takumi, Kiyonobu Ikeda, Akikazu Nakamura, Kenko Azuma, Hiroyuki Akagawa, Jiro Yamamoto, Nobutaka Yamamoto, Takaomi Taira","doi":"10.1159/000546301","DOIUrl":"10.1159/000546301","url":null,"abstract":"<p><strong>Introduction: </strong>Benign adult familial myoclonus epilepsy (BAFME) is an autosomal dominant disorder characterized by adult-onset cortical tremor and infrequent generalized seizures. Treatment options for managing involuntary movements in BAFME remain limited.</p><p><strong>Case presentation: </strong>Here, we present 2 cases involving individuals with BAFME who underwent Vim thalamotomy for tremor-like myoclonus. Despite the intervention, neither patient experienced any improvement in their symptoms.</p><p><strong>Conclusion: </strong>These findings suggest that the Vim may not contribute to the pathophysiology of tremor-like myoclonus in BAFME, despite the established efficacy of Vim thalamotomy in the treatment of essential tremor.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-5"},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Feasibility and Complication Analyses of Extraoperative (Bedside) Removal of Stereo-Electroencephalography Electrodes.","authors":"Jiahao J Chen, Thandar Aung, Theodora Constantine, Jorge Alvaro Gonzalez-Martinez","doi":"10.1159/000545984","DOIUrl":"10.1159/000545984","url":null,"abstract":"<p><strong>Introduction: </strong>Stereotactic electroencephalography (SEEG) involves the implantation of intracortical electrodes for the precise localization of the epileptogenic zone and is well-established in terms of its safety and efficacy during implantation; however, there is a notable lack of research comparing different electrode removal techniques, specifically regarding complications and feasibility of these approaches. This study evaluates the feasibility and clinical utility of intraoperative versus extraoperative (bedside) removal of stereotactic electroencephalography (SEEG) electrodes.</p><p><strong>Methods: </strong>The early feasibility study retrospectively reviewed 117 consecutive SEEG patients at our institution, comparing 101 intraoperative cases with 16 extraoperative cases. A total of 1,624 SEEG electrodes were evaluated. Results related to demographics, feasibility of bedside removal, and occurrence of complications were analyzed and statistically compared between groups.</p><p><strong>Results: </strong>Our findings reveal comparable patient demographics across both groups and demonstrate low complication rates of 1.98% for intraoperative and 0.00% for extraoperative removals, with a combined rate of 1.71%. Importantly, zero cases of infection were observed in both settings. In addition to the low rates of complication in both the intraoperative and extraoperative explant groups, the study indicates a statistically significantly reduced use of sedation in the extraoperative group, which may enhance patient comfort and eliminate the need for additional sedatives during their ongoing treatment. The extraoperative bedside approach also offers practical benefits, such as removing the need for operating room (OR) resources and staffing, which can prevent OR delays and contribute to shorter hospital stays.</p><p><strong>Conclusion: </strong>With the appropriate indications, the extraoperative removal of SEEG electrodes appears to be a feasible and safe alternative to the intraoperative method. It presents potential advantages in optimizing patient flow within epilepsy monitoring units, improving operational efficiency, and potentially reducing healthcare costs while promoting patient comfort. Future research is essential to validate these findings further and refine the bedside technique for broader clinical application.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995503","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Robots in Epilepsy Surgery.","authors":"Matthias Tomschik, Sarina Noelle Somer, Christian Dorfer","doi":"10.1159/000545985","DOIUrl":"10.1159/000545985","url":null,"abstract":"<p><strong>Background: </strong>Epilepsy is a prevalent chronic neurological disease affecting millions. Many patients respond to medical therapies, but a third of patients does not and potentially requires neurosurgical procedures. These can be used to localize the onset of seizures and subsequently treat patients. Robotic technologies have emerged over the last decades to increase the efficacy and safety of epilepsy surgery. We therefore wanted to describe the role that robotics in epilepsy surgery have taken since their introduction more than 30 years ago.</p><p><strong>Summary: </strong>Robotic assistance in epilepsy surgery has evolved for more than 30 years. Its earliest use in stereotactic EEG (SEEG) implantations has now also become its most widely used application. Multiple studies have demonstrated that robotic guidance increases the accuracy while also making the implantation of electrodes faster. Beyond diagnostics, robotics have also gained widespread acceptance in ablative neurosurgical procedures where robotic systems improve the placement and can even aid in the fine-tuning of laser fibers for laser interstitial thermotherapy. Additionally, robotics has been employed in the placement of electrodes for intracranial neuromodulation therapies in epilepsy such as deep brain stimulation and responsive neurostimulation. Ongoing innovations are further expanding the uses of robotic technologies in epilepsy surgery from aiding in endoscopic procedures to automated craniotomies.</p><p><strong>Key messages: </strong>Robotics in epilepsy surgery has come a long way and has already taken a central role in procedure intended for diagnostic and therapeutic purposes. This narrative review details its many benefits and provides an outlook for future developments.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-7"},"PeriodicalIF":1.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12148316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gamma Knife Radiosurgery for Glossopharyngeal Neuralgia: A Retrospective Study.","authors":"Andrea Franzini, Piero Picozzi, Zefferino Rossini, Maria Pia Tropeano, Beatrice Claudia Bono, Ali Baram, Pierina Navarria, Federico Pessina","doi":"10.1159/000545986","DOIUrl":"10.1159/000545986","url":null,"abstract":"<p><strong>Introduction: </strong>The treatment of patients with glossopharyngeal neuralgia (GN) refractory to medical therapies is challenging. Gamma knife radiosurgery (GKRS) has emerged as an incisionless treatment option with outcomes reported in a limited number of studies. The aim of this study was to report on the outcomes of GKRS in patients with GN treated at our center.</p><p><strong>Methods: </strong>We retrospectively reviewed all patients with GN who underwent GKRS at our center since 2017. Pain intensity was evaluated using the Barrow Neurological Institute (BNI) pain score modified for GN. Adverse events were recorded.</p><p><strong>Results: </strong>Six patients underwent GKRS for GN at our center between 2017 and 2024. The maximum dose delivered was 85 Gy for 1 patient and 90 Gy for the others. After a median period of 2 weeks from GKRS, all patients experienced pain reduction (BNI I-IIIa). Pain recurred during follow-up in 2 patients after 9 and 3 months, respectively. Both underwent repeat GKRS, which relieved pain in one. No adverse event or neurological deficit occurred.</p><p><strong>Conclusions: </strong>GKRS is an effective, well-tolerated treatment for patients with GN. Pain may recur over time, but more durable pain relief can be achieved with repeat GKRS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2025-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automatic Detection of Directional Lead Orientation in Deep Brain Stimulation using Photon-Counting Detector Computed Tomography: A Phantom Study.","authors":"Stefan Hunsche, Alexandra Hellerbach, Markus Eichner, Christoph Panknin, Sebastian Faby, Jochen Wirths, Veerle Visser-Vandewalle, Harald Treuer, Dieter Fedders","doi":"10.1159/000541151","DOIUrl":"10.1159/000541151","url":null,"abstract":"<p><strong>Introduction: </strong>Photon-counting detector computed tomography (PCD-CT) represents the next generation of CT technology, offering enhanced capabilities for detecting the orientation of directional leads in deep brain stimulation (DBS). This study aims to refine PCD-CT-based lead orientation determination using an automated method applicable to devices from various manufacturers, addressing current methodological limitations and improving neurosurgical precision.</p><p><strong>Methods: </strong>An automated method was developed to ascertain the orientation of directional DBS leads using PCD-CT data and grayscale model fitting for devices from Boston Scientific, Medtronic, and Abbott. A phantom study was conducted to evaluate the precision and accuracy of this method, comparing it with the stripe artifact method across different lead alignments relative to the CT gantry axis.</p><p><strong>Results: </strong>Except for the Medtronic Sensight™ lead, where detection was occasionally unfeasible if aligned normal to the z-axis of the CT gantry, a clinically very unlikely alignment, the lead orientation could be automatically determined regardless of its position. The accuracy and precision of this automated method was comparable to those of the stripe artifact method.</p><p><strong>Conclusion: </strong>PCD-CT enables the automatic determination of lead orientation from leading manufacturers with an accuracy comparable to the stripe artifact method, and it offers the added benefit of being independent of the clinically occurring orientation of the head and, consequently, the lead relative to the CT gantry axis.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"55-62"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142354211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Focused Ultrasound in the Treatment of Epilepsy: Current Applications and Future Directions.","authors":"Benjamin Sterling Succop, Andreas Seas, Joshua Woo, Kevin Jesus Bode Padron, Alyssa M Bartlett, Bhavya Shah, Shruti Agashe, Stephen Harward Ii","doi":"10.1159/000545716","DOIUrl":"10.1159/000545716","url":null,"abstract":"<p><strong>Introduction: </strong>Epilepsy is the fourth most common neurological disorder, affecting nearly 1% of the global population. Despite recent advancements in medical therapies, approximately one-third of patients remain refractory to treatment, necessitating consideration of surgical intervention. Historically, epilepsy surgery has been invasive and maximalist in nature, involving extensive brain resections with significant risk for morbidity. However, emerging approaches offer promising, less-invasive alternatives. One such technique is focused ultrasound (FUS), a rapidly evolving, incisionless, image-guided therapy that allows physicians to precisely target specific brain regions with ultrasonic energy to achieve a range of therapeutic effects.</p><p><strong>Methods: </strong>Systematic methods were implemented to define the scope of preclinical and clinical applications of FUS to treat epilepsy. Inclusion criteria included preclinical experiment, case study, case series, cohort studies, and clinical trials involving therapeutic application of FUS for treatment of epilepsy of any etiology. The primary exclusion criterion was FUS for indications other than treatment of epilepsy.</p><p><strong>Results: </strong>Forty-six published articles and 9 ongoing clinical trials were included for a total of 55 studies. For ablative therapies, 10 studies were identified, of which 2 were preclinical studies, 1 was a clinical proof-of-concept study, 3 were clinical case reports, 1 was a completed clinical pilot study, and 3 were ongoing Phase I-Phase II clinical trials. For neuromodulatory FUS, 30 studies were identified, of which 19 were preclinical studies, 1 was a clinical case report, 4 were clinical pilot studies, and 6 were ongoing Phase I-Phase II clinical trials. Lastly, with respect to FUS-mediated blood-brain barrier (BBB) opening studies, 15 were identified, all of which were preclinical studies.</p><p><strong>Discussion: </strong>Currently, FUS has been clinically applied for targeted brain ablation (high intensity [HIFU]) and neuromodulation (low intensity [LIFU]), with recent basic science applications of sonogenetics and targeted drug delivery through the BBB (Precise Intracerebral Noninvasive Guided, or PING, Surgery) offering new opportunities for clinical translation. This review summarizes preclinical and clinical applications of FUS for epilepsy treatment, addresses challenges to implementation, and explores key areas for future research.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"166-188"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Life after Deep Brain Stimulation: A Primary versus Secondary Dystonia Comparative Study.","authors":"Emily Sanrey, Marylou Grasso, Marie Brethome, Emilie Chan-Seng, Valérie Gil, Philippe Coubes, Gaëtan Poulen","doi":"10.1159/000545755","DOIUrl":"10.1159/000545755","url":null,"abstract":"<p><strong>Introduction: </strong>Generalized dystonia is a motor disorder causing major limitations in daily living activities. Deep brain stimulation (DBS) is an established therapy for primary disorders, but its efficacy in secondary ones remains variable. Although quality of life (QoL) assessment is crucial in disabling conditions to understand the comprehensive impact of surgical treatment on daily life, the available questionnaires are not well adapted.</p><p><strong>Methods: </strong>Herein, QoL after DBS was evaluated using a \"homemade\" scale. The DBS-QoL scale is a new questionnaire specifically designed for generalized dystonia patients.</p><p><strong>Results: </strong>Twenty-one DYT1 patients and 40 cerebral palsy patients underwent globus pallidus internus DBS during the inclusion period. Clinical improvement was measured using the BFMDRS and compared to QoL evolution using the DBS-QoL. We identified a significant positive impact of DBS on motor and functional aspects for both groups, with superior gains in DYT1 patients. In this group, we found significant improvement in functional aspects, whereas in perinatal hypoxic patients, the opposite trend was reported, with better satisfaction in terms of wellbeing. Across both etiologies, patients expressed satisfaction with the surgical outcomes (83%).</p><p><strong>Conclusion: </strong>QoL assessment, using a dedicated scale, was shown to complement BFMDRS, enhancing the detection of subtle symptom improvements in DBS-treated patients.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"206-211"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144048769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dorsal Column Spinal Cord Stimulation Attenuates Brain-Spine Connectivity through Locomotion- and Visuospatial-Specific Area Activation in Progressive Freezing of Gait.","authors":"Ajmal Zemmar, David H Aguirre-Padilla, Irene E Harmsen, Julianne Baarbé, Can Sarica, Kazuaki Yamamoto, Talyta Grippe, Ghazaleh Darmani, Amitabh Bhattacharya, Zhongcan Chen, Kelly E Gartner, Nelleke van Wouwe, Paula Azevedo, Artur Vetkas, Darcia Paul, Nardin Samuel, Gianluca Sorrento, Brendan Santyr, Nathan Rowland, Suneil Kalia, Robert Chen, Alfonso Fasano, Andres M Lozano","doi":"10.1159/000541986","DOIUrl":"10.1159/000541986","url":null,"abstract":"<p><strong>Introduction: </strong>Freezing of gait (FOG) is a clinical phenomenon with major life impairments and significant reduction in quality of life for affected patients. FOG is a feature of Parkinson's disease and a hallmark of primary progressive FOG, currently reclassified as Progressive Supranuclear Palsy-progressive gait freezing (PSP-PGF). The pathophysiology of FOG and particularly PGF, which is a rare degenerative disorder with a progressive natural history of gait decline, is poorly understood. Mechanistically, changes in oscillatory activity and synchronization in frontal cortical regions, the basal ganglia, and the midbrain locomotor region have been reported, indicating that dysrhythmic oscillations and coherence could play a causal role in the pathophysiology of FOG. Deep brain stimulation and spinal cord stimulation (SCS) have been tested as therapeutic neuromodulation avenues for FOG with mixed outcomes.</p><p><strong>Methods: </strong>We analyzed gait and balance in 3 patients with PSP-PGF who received percutaneous thoracic SCS and utilized magnetoencephalography (MEG), electroencephalography, and electromyography to evaluate functional connectivity between the brain and spine.</p><p><strong>Results: </strong>Gait and balance did not worsen over a 13-month period. This observation was accompanied by decreased beta-band spectral power in the whole brain and particularly in the basal ganglia. This was accompanied by increased functional connectivity in and between the sensorimotor cortices, basal ganglia, temporal cortex, and cerebellum, and a surge in corticomuscular coherence when SCS was paired with visual cues.</p><p><strong>Conclusion: </strong>Our results suggest synergistic activity between brain and spinal circuits upon SCS for FOG in PGF, which may have implications for future brain-spine interfaces and closed-loop neuromodulation for patients with FOG.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"90-101"},"PeriodicalIF":1.9,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142669245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}