Stereotactic and Functional Neurosurgery最新文献

{"title":"Spinal Cord Stimulation Effects on Restless Legs Syndrome: A Single-Center Experience.","authors":"Elijah Li Wang, Garrett W Thrash, Riyaz Razi, Yifei Sun, Keith McGregor, Prasad Shirvalkar, Harrison C Walker, Christopher J Earley, Marshall T Holland","doi":"10.1159/000553453","DOIUrl":"10.1159/000553453","url":null,"abstract":"<p><strong>Introduction: </strong>Restless legs syndrome (RLS) is a lifelong disorder characterized by recurrent, uncomfortable sensations and irresistible urges to move the legs that peak in the evening. Spinal cord stimulation (SCS) is a longstanding neuromodulation treatment for chronic neuropathic pain with emerging evidence of potential effectiveness toward RLS through a potential shared pathophysiology of central sensitization.</p><p><strong>Methods: </strong>A retrospective review of our institution's electronic health record system was performed to identify patients who received SCS for chronic pain with a concomitant RLS diagnosis. Patients who had a diagnosis of RLS in their chart were secondarily confirmed to have RLS using the Cambridge-Hopkins RLS Questionnaire via telephone. The International Restless Leg Syndrome (IRLSS) Study Group Rating Scale and multiple Patient-Recorded Outcomes Measurements System (NIH PROMIS) of sleep data were obtained via telephone with patients recalling their symptoms pre- and post-SCS implantation.</p><p><strong>Results: </strong>A group of 11 patients with an existing SCS system implanted for chronic pain and comorbid RLS confirmed on the Cambridge-Hopkins questionnaire were identified. The IRLS summed score showed a statistically significant (p = 0.0343) improvement with a large effect size (r = 0.64) indicating that overall symptom severity measured by the IRLS scale decreased significantly with SCS. There was also a significant (p = 0.0223) reduction with a large effect size (r = 0.69) in the summed NIH PROMIS sleep-related impairment scores, suggesting that SCS had a substantial positive impact on sleep-related impairments. Contrary to this, insignificant (p = 0.778) changes were observed in the summed NIH PROMIS sleep disturbance scores with a small effect size (r = 0.09).</p><p><strong>Conclusion: </strong>SCS has been shown to be an effective, novel treatment for chronic pain but also has positive effects on medication refractory RLS. While this small, retrospective study is limited by recall bias, it provides further evidence of SCS serendipitously improving RLS symptoms. Future prospective research evaluating the effects of SCS on RLS symptoms, pathophysiology, and sleep is needed to further evaluate this phenomenon.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2026-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148689865","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":"Challenging the Traditional Paradigm: Clinical and Functional Outcomes of Early versus Very-Early Subthalamic Deep Brain Stimulation in Parkinson's Disease.","authors":"Buse Cagla Ari, Ozgun Koksal, Nesrin Helvaci Yilmaz, Mihrimah Sultan Cakmak, Yasemin Ekmis, Eylul Adiguzel, Yavuz Samanci, Erdem Kurt, Gulay Kenangil, Andres M Lozano, T Ali Zirh","doi":"10.1159/000553293","DOIUrl":"10.1159/000553293","url":null,"abstract":"<p><strong>Introduction: </strong>Subthalamic nucleus deep brain stimulation (STN-DBS) is an established treatment for advanced Parkinson's disease (PD). While traditionally reserved for later stages, growing evidence suggests earlier intervention may offer benefits. This study compares outcomes of early versus very-early DBS in a single-center cohort.</p><p><strong>Methods: </strong>This retrospective study included 65 PD patients undergoing STN-DBS (2015-2025), grouped as very-early (<5 years disease duration, n = 32) or early (≥5 years, n = 33). Groups were comparable in age, sex, and disease severity. Results included Hoehn and Yahr (H&Y), UPDRS-III, MMSE, and levodopa equivalent daily dose (LEDD) assessed preoperatively, early postoperatively, and at 3 years.</p><p><strong>Results: </strong>Mean age was 62.45 ± 8.79 years; 69.2% were male. Both groups showed significant postoperative improvement in H&Y (p < 0.001), with partial decline at 3 years, though still better than baseline. No significant group-time interaction was observed for H&Y or UPDRS-III, indicating similar long-term motor outcomes. The group-by-time interaction for LEDD was significant (p = 0.002), reflecting different medication trajectories: both groups converged to similar postoperative LEDD levels despite the early DBS group starting from a substantially higher baseline (1,010 ± 514 vs 676 ± 394 mg/day; p = 0.005). Multivariable regression showed that baseline preoperative LEDD was the dominant predictor of postoperative medication reduction; after adjustment, surgical timing was no longer significantly associated with LEDD reduction (p = 0.622). Very-early DBS patients had lower early postoperative H&Y scores (p = 0.022). Six patients were reclassified as PD plus during follow-up; sensitivity analyses yielded consistent results.</p><p><strong>Conclusion: </strong>Both very-early and early STN-DBS provide significant short-term motor benefits, though some decline occurs over time. Very-early DBS was associated with greater postoperative medication reduction and more favorable early functional outcomes, while long-term motor outcomes remained comparable between groups. However, differences in baseline medication burden may have contributed to the observed LEDD reduction patterns.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2026-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13600690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148685462","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":"Dopamine Transporter Imaging Predicts Mortality in a Long-Term Follow-Up after Subthalamic Deep Brain Stimulation in Parkinson's Disease.","authors":"Birgitte Liang Chen Thomsen, Steen Rusborg Jensen, Anders Lundetoft Clausen, Sine Fjeldhøj, Bo Jespersen, Merete Karlsborg, Markus Nowak Lonsdale, Annemette Løkkegaard","doi":"10.1159/sfn/aeuag002","DOIUrl":"10.1159/sfn/aeuag002","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an efficient treatment for advanced Parkinson's disease (PD), when oral medication no longer provides satisfactory symptom control or causes disabling side effects. However, long-term outcomes vary considerably, and reliable preoperative biomarkers remain lacking. Dopamine transporter single-photon emission computed tomography (DAT SPECT) provides an indirect in vivo measure of presynaptic striatal dopaminergic degeneration in the basal ganglia. In patients evaluated for STN-DBS, DAT SPECT with [123I]FP-CIT supported the clinical diagnosis. This study aimed to examine whether preoperative DAT SPECT predicts the long-term outcome after STN-DBS surgery.</p><p><strong>Methods: </strong>Fifty-five patients with PD underwent DAT SPECT before STN-DBS surgery. Motor symptoms were assessed in ON and OFF medication states before surgery, and at long-term follow-up, 8-14 years after surgery. Cognition was assessed before surgery and at the long-term follow-up, and clinical data were curated retrospectively from medical records.</p><p><strong>Results: </strong>Lower DAT striatal specific binding ratio (SBR) significantly correlated with longer disease duration, indicating greater dopaminergic loss. Reduced striatal SBR predicted increased mortality during the long-term follow-up. Regional analyses revealed that this association was driven by the caudate nucleus. Furthermore, greater caudate compared to putaminal involvement, reflected by a higher putaminal/caudate uptake ratio, was related to longer disease duration and increased mortality. Preoperative DAT SPECT measures were not associated with DBS effect, cognitive function, or depression.</p><p><strong>Conclusion: </strong>Dopamine transporter imaging provides valuable insight into the pathophysiology and disease progression of PD. Although DAT SPECT did not predict the therapeutic effect of STN-DBS, this study demonstrates that DAT SPECT captures aspects of disease progression and survival in PD. These results highlight the value of assessing the dopaminergic system before advanced treatment, as DAT SPECT may provide prognostic indicators that could complement the preoperative evaluation.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13685724/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148680093","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":"Assessment of Pain Relief and Sensory Dysfunction Outcomes after CyberKnife Radiosurgery for Trigeminal Neuralgia using Detailed Radiobiological Dose Modeling: Results from a Retrospective Study on Large International Patient Cohort.","authors":"Evaggelos Pantelis, Argyris Moutsatsos, Anastasia Stergioula, Pantelis Karaiskos, David J Park, Ahed H Kattaa, Cynthia Chuang, Steven D Chang, Livia Corinna Bianchi, Irene Redaelli, Anna Stefania Martinotti, Giancarlo Beltramo, Güliz Acker, Diana Sladek, Carolin Senger, Antonio Pontoriero, Eleonora Trifiletti, Alfredo Conti, Pantaleo Romanelli","doi":"10.1159/000553331","DOIUrl":"10.1159/000553331","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study was to evaluate clinical outcomes and identify patient- and treatment-related predictors of pain relief onset, long-term pain control, and sensory dysfunction in patients with medically refractory trigeminal neuralgia (TN) treated with CyberKnife radiosurgery (CKRS), incorporating radiobiological modeling of delivered doses.</p><p><strong>Methods: </strong>A retrospective study was performed across 5 international institutions, analyzing 560 TN patients treated with CKRS between 2009 and 2024. Demographic, clinical, and dosimetric data were collected. Pain and sensory dysfunction outcomes were evaluated using the modified Barrow Neurological Institute Pain Intensity Scale (mBNI-PIS) and Facial Numbness Scale (BNI-FNS), respectively. Logistic regression and Cox proportional hazards models were used to identify predictors of pain relief, latency, long-term pain control, and facial numbness risk. Biological effective dose (BED) distributions were calculated accounting for sublethal DNA damage repair and treatment delivery timelines; retreatments were excluded.</p><p><strong>Results: </strong>In this study, pain relief (defined as BNI-PIS I-IIIa) was achieved in 92% of patients with a median latency of 12 weeks (range: 0-76 weeks). The median follow-up was 50 months (range: 6-175 months). Actuarial freedom-from-pain rates were 85%, 78%, 68%, and 58% at 12, 24, 60, and 120 months, respectively. Bothersome and severely bothersome facial numbness occurred in 5% and 1% of patients, respectively, while an additional 21% experienced non-bothersome numbness. Multivariate analysis identified older age, higher target maximum dose, and BED (>1,607 Gy_2.47) values and shorter beam-on and treatment times as predictors of early pain relief (<30 days), whereas neurovascular conflict (NVC) predicted delayed response. Older age and NVC were also associated with pain control maintenance. Multiple sclerosis predicted both reduced treatment response and increased pain recurrence risk. Maximum target dose of 77 Gy and integral BED of 59 mJ_2.47 (corresponding to a target volume of 47 mm3) were independently associated with a 10% hypoesthesia risk.</p><p><strong>Conclusion: </strong>CKRS provides high pain relief onset (92%) and durable pain control (68% at 60 months) in TN patients, with low bothersome (5%) and severely bothersome (1%) facial numbness rates. The identified dosimetric thresholds offer practical guidance for optimizing treatment planning while balancing hypoesthesia risk.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-13"},"PeriodicalIF":2.1,"publicationDate":"2026-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148702029","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":"Management Patterns in Deep Brain Stimulator Hardware Infection: Is Hardware Sparing Feasible?","authors":"Subeikshanan Venkatesan, Rasheedat T Zakare-Fagbamila, Sai Sriram, Ramya Reddy, Kelly Foote, Justin D Hilliard","doi":"10.1159/sfn/aeuag001","DOIUrl":"https://doi.org/10.1159/sfn/aeuag001","url":null,"abstract":"<p><strong>Introduction: </strong>Deep brain stimulation (DBS) hardware infection is a serious complication with heterogeneous presentations and no standardized management guidelines. Management ranges from hardware-sparing (HS) washout to partial (PE) or complete explantation (CE). This study aimed to evaluate outcomes of initial management strategies and identify factors associated with treatment failure and escalation.</p><p><strong>Methods: </strong>We conducted a single-center retrospective review of adult DBS patients (2002-2020) who required surgery for first-time and recurrent hardware infection or wound erosion. Treatment success was defined as infection clearance without further surgical intervention. Treatment failure was defined as escalation or conversion to a more extensive procedure among those who did not clear the infection.Outcomes were characterized using two complementary definitions - infection clearance success rate defined as absence of recurrent DBS-related infection or wound erosion after index management and non-escalation success rate, defined as avoidance to progression of a more advanced surgical strategy after index procedure. Recurrence freedom was evaluated using Kaplan-Meier analysis, and predictors of recurrence were assessed using multivariable Cox proportional hazards regression.</p><p><strong>Results: </strong>Ninety-eight patients were included. Initial management consisted of HS in 39 patients, PE in 37, and CE in 22. Using the infection-clearance definition, success was observed in 38% of HS cases, 62% of PE cases, and 59% of CE cases. When success was defined by avoidance of escalation, HS achieved non-escalation success in 49% of cases and PE in 78%. Recurrence freedom differed significantly by management strategy, with PE and CE demonstrating greater durability than HS (log-rank χ² = 23.98, p < 0.001). In multivariable Cox regression, PE and CE were associated with significantly lower recurrence hazard compared with HS, while erosion at presentation independently predicted recurrence. Disease category was associated with conversion/escalation, with Parkinson's disease patients less likely to undergo escalation, but PD status did not predict recurrence freedom. Despite lower infection-control durability, HS preserved stimulation for a clinically meaningful interval in selected patients.</p><p><strong>Conclusion: </strong>DBS infection outcomes reflect the interaction between infection phenotype, management aggressiveness, and patient-centered goals of therapy. PE and CE provide greater recurrence freedom than HS, particularly when infection control is the primary objective. However, HS remains clinically relevant in selected patients because it may preserve therapeutic stimulation and delay or avoid escalation, even when definitive infection clearance is not achieved.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1"},"PeriodicalIF":2.1,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148670636","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":"Theoretical Evaluation of a Parietal Trajectory for Subthalamic Deep Brain Stimulation.","authors":"Cameron C McIntyre, Anneke M Frankemolle-Gilbert, Angela M Noecker","doi":"10.1159/000553640","DOIUrl":"10.1159/000553640","url":null,"abstract":"<p><strong>Introduction: </strong>The subthalamic region consists of a complex intersection of many different axonal pathways. Emerging hypotheses in deep brain stimulation (DBS) for Parkinson's disease (PD) suggest that direct stimulation of specific axonal pathways may be linked to the control of specific motor symptoms (e.g., cerebellothalamic (CT) - tremor; motor hyperdirect (mHD) - bradykinesia; pallidothalamic (PT) - rigidity). However, the typical frontal DBS lead trajectory limits opportunities to co-activate all of these pathways.</p><p><strong>Methods: </strong>We used advanced biophysical DBS models to evaluate the theoretical utility of a parietal lead trajectory into the subthalamic region that could facilitate activation of the PT, mHD, and CT pathways. We compared a typical frontal DBS lead trajectory with a traditional 8-contact directional DBS lead to the parietal alternative with a 16-contact directional DBS lead. The analyses were performed within the context of the CIT168 human atlas brain populated with the Petersen axonal pathway models.</p><p><strong>Results: </strong>PT, mHD, and CT fibers are distributed in an anterior-to-posterior fashion within the subthalamic white matter. Given this anatomical feature, traditional frontal trajectories limit opportunities for multi-pathway DBS because the electrode contacts are primarily aligned dorsal-ventrally. Alternatively, the span of DBS contacts along a parietal trajectory can provide better opportunities to activate all of the pathways of interest, while also avoiding unwanted activation of the internal capsule.</p><p><strong>Conclusion: </strong>Parietal DBS trajectories warrant consideration in PD therapy as the research concepts of pathway-targeted stimulation begin migrating into clinical practice.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13482787/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621460","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":"Six-Year Single Centre Experience with Frameless, Fiducial-Less Deep Brain Stimulation in Parkinsons Disease: Accuracy, Outcomes, and Clinical Feasibility.","authors":"Filip Blazek, David Krahulik, Martin Nevrly, Pavel Otruba, Klara Balazova, Ahmed Naser Mohamed Afifi, Lumir Hrabalek, Petr Kanovsky","doi":"10.1159/000552756","DOIUrl":"https://doi.org/10.1159/000552756","url":null,"abstract":"<p><strong>Background: </strong>Frameless and fiducial-less deep brain stimulation (DBS) guided by intraoperative cone-beam CT has emerged as a less invasive alternative to frame-based stereotaxy, yet comprehensive long-term data remain limited. This study summarizes six years of institutional experience with O-arm-navigated, frameless, fiducial-less subthalamic nucleus (STN) DBS for Parkinson's disease.</p><p><strong>Methods: </strong>Forty-two consecutive patients with idiopathic Parkinson's disease underwent bilateral STN-DBS using O-arm-based registration and NexFrame targeting between 2018 and 2024. Preoperative planning incorporated structural MRI and diffusion tractography-derived connectivity-based STN parcellation. Accuracy was assessed by postoperative CT-MRI fusion, and clinical outcomes were evaluated at 12 months using UPDRS III and levodopa equivalent daily dose (LEDD). Postoperative lead reconstruction and volume-of-tissue-activation modelling were performed in SureTune 3.</p><p><strong>Results: </strong>All 84 electrodes were successfully implanted with a mean target registration error of 0.47 ± 0.09 mm and a mean vector error of 1.19 ± 0.48 mm. No lead revisions were required. At 12 months, UPDRS III improved from 33.4 ± 7.2 to 14.6 ± 4.9 (-56.3%; p < 0.001), and LEDD decreased by 49.9% (p < 0.001). Complications were minor and included one transient peri-lead edema and one connector-related issue. In most patients, active contacts were located within the dorsolateral (motor) STN, consistent with robust clinical benefit.</p><p><strong>Conclusions: </strong>In this single-centre retrospective series, O-arm-navigated frameless and fiducial-less STN-DBS was associated with favourable implantation accuracy, good motor outcomes, and a low complication rate. In the absence of a contemporaneous control cohort, these findings should be interpreted as supporting the technical feasibility and clinical utility of this workflow rather than demonstrating superiority or non-inferiority versus frame-based DBS.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-18"},"PeriodicalIF":2.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621401","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":"Location of Neurostimulation Affects Short-Term Emotional Wellbeing Outcomes in Parkinson's Disease Patients.","authors":"Muhammad Faran, Hailey Chae, Danielle A Pietramala, Sabrina Nadeem, Franziska A Schmidt, Evan Wilson, Nancy E Polyhronopoulos, Mandeep K Sandhu, Jessica Dong, Natasha Sarai, Fidel Vila-Rodriguez, Christopher R Honey, Stefan Lang","doi":"10.1159/000553012","DOIUrl":"10.1159/000553012","url":null,"abstract":"<p><strong>Introduction: </strong>Emotional wellbeing is a major determinant of quality of life (QoL) in Parkinson's disease (PD) patients. Previous studies have found mixed results regarding the effect of subthalamic nucleus (STN) deep brain stimulation (DBS) on depression and anxiety, major contributors to emotional wellbeing. There is evidence that the location of neurostimulation of the STN may explain this variability. However, studies investigating this matter have also yielded inconsistent findings. Therefore, the objective of this study was to determine the effect of STN DBS on emotional wellbeing at 6 months and 1 year and to examine whether the location of neurostimulation influences outcomes.</p><p><strong>Methods: </strong>This is a retrospective cohort study of 94 patients who received bilateral STN DBS between 2008 and 2023 in Vancouver, Canada. Emotional wellbeing was assessed using the emotional wellbeing index (EWI) of the Parkinson's disease questionnaire-39 (PDQ-39). We divided the EWI into sub-domains assessing anxiety (EWI-A) and depression (EWI-D). We analyzed clinical outcomes using linear mixed-effect models, controlling for confounding variables. We separated the group into responders and non-responders for further analysis. For subjects with appropriate imaging (n = 18), volume of tissue activated was calculated and related to clinical outcomes, to assess for a location that led to a significant improvement in EWI, EWI-A, and EWI-D.</p><p><strong>Results: </strong>We found no significant difference in EWI at 6 months and 1 year after STN DBS at the group level. There was a significant improvement in EWI-A at 6 months (p < 0.001) and 1 year (p = 0.045). No significant difference in EWI-D was observed at either time point. 37.1% of patients in our cohort were EWI responders, while 62.9% were non-responders. Similarly at 1 year, 35.7% of patients were responders and 64.3% were non-responders. Stimulation of the dorsal STN was associated with improved EWI outcomes at 6 months, but not at 1-year (p < 0.05 FWE corrected).</p><p><strong>Conclusion: </strong>There is significant variability in EWI outcomes following STN DBS. In the imaging analysis subgroup, stimulation of the dorsal region of the STN explained some of this variability in the short-term. Improvement in motor symptoms due to DBS may be a mediating variable between location of neurostimulation in the dorsal STN and improvements in emotional wellbeing.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148621404","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":"Dentato-Rubro-Thalamic Tract-Targeted Cerebellar Deep Brain Stimulation for Post-Stroke Spasticity and Dystonia: Preliminary Experience.","authors":"Paweł Sokal, Magdalena Jabłońska, Maciej Broda, Milena Świtońska","doi":"10.1159/000553581","DOIUrl":"10.1159/000553581","url":null,"abstract":"<p><strong>Introduction: </strong>Post-stroke motor impairment with spastic hemiparesis remains a significant therapeutic challenge, as conventional rehabilitation and pharmacological strategies often fail to achieve sustained functional recovery. Neuromodulation targeting cerebellar pathways, particularly the dentato-rubro-thalamic tract (DRTT), may provide an alternative therapeutic approach.</p><p><strong>Methods: </strong>The study reports the first 3 cases of chronic post-ischemic stroke-related spastic hemiparesis and dystonic features treated with deep brain stimulation (DBS) targeting the DRTT at the level of the dentate nucleus after unsuccessful botulinum toxin therapy and intensive rehabilitation. Directional DBS systems were implanted using tractography-guided targeting. Clinical outcomes were assessed preoperatively and during sequential stimulation at 130 Hz, 70 Hz, and 30 Hz (each for 6 weeks), followed by a 3-week stimulation-off phase. Outcome measures included the Modified Ashworth Scale (MAS), Fugl-Meyer Assessment of the Upper Limb (FMA-UL), Chedoke Arm and Hand Activity Inventory (CAHAI), Unified Dystonia Rating Scale (UDRS), and modified Rankin Scale (mRS).</p><p><strong>Results: </strong>FMA-UL scores progressively improved as stimulation frequency decreased, with mean improvements of 12.3% at 130 Hz, 14.7% at 70 Hz, and 18.4% at 30 Hz. A partial decline was observed during the stimulation-off phase (12.2%). Functional performance (CAHAI) showed the greatest improvement at 30 Hz (11.9%) and decreased to 6.6% during the stimulation-off period. Proximal spasticity was modestly reduced in the shoulder and elbow by approximately one MAS point during stimulation but returned to baseline stimulation-off. Distal spasticity remained largely unchanged. Dystonic features demonstrated frequency-dependent improvement, most pronounced at 30 Hz (43.9%), with partial persistence after stimulation discontinuation (27.5%). Global disability (mRS) remained stable or showed mild improvement.</p><p><strong>Conclusions: </strong>Preliminary findings suggest that DRTT-targeted cerebellar DBS, particularly at lower frequencies, may offer a promising adjunctive treatment for post-stroke spasticity and motor impairment refractory to conventional therapies. These initial observations from an ongoing clinical trial require confirmation in larger cohorts with extended follow-up.</p>","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-12"},"PeriodicalIF":2.1,"publicationDate":"2026-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148592978","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":"Reply to \"Metric Choice and Programming-Output Concordance in DBS Lead Reconstruction Robustness\".","authors":"Sabry L Barlatey, Andreas Nowacki","doi":"10.1159/000553410","DOIUrl":"10.1159/000553410","url":null,"abstract":"","PeriodicalId":22078,"journal":{"name":"Stereotactic and Functional Neurosurgery","volume":" ","pages":"1-2"},"PeriodicalIF":2.1,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148438003","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}