Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson’s disease

Oertel, Markus Florian; Schüpbach, W. M. Michael; Ghika, Joseph-André; Stieglitz, Lennart; Fiechter, Michael; Kaelin‐Lang, Alain; Raabe, Andreas; Pollo, Claudio

doi:10.1007/s00701-016-3044-5

Cited by 18 publications

(7 citation statements)

References 22 publications

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“…DBS is hypothesized to alleviate the symptoms of neurological disorders by inhibiting an overactive or dysrhythmic focus. , DBS also provides a special method with which to understand the inherent mechanisms of the basal ganglia loop. The effective DBS targets include the subthalamic nucleus (STN), , the globus pallidus internus (GPi), , and the thalamic ventral intermedius nucleus (Vim). , Electrical stimulation in these basal ganglia nuclei has been reported as a clinical treatment, particularly STN-DBS treatment . GPi-DBS had been confirmed to represent an acceptable target, but little research has been performed in this structure, largely because of a lack of suitable technology.…”

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confidence: 99%

Microelectrode Arrays Modified with Nanocomposites for Monitoring Dopamine and Spike Firings under Deep Brain Stimulation in Rat Models of Parkinson’s Disease

et al. 2019

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Little is known about the efficacy of deep brain stimulation (DBS) as an effective treatment for Parkinson’s Disease (PD) because of the lack of multichannel neural electrical and chemical detection techniques at the cellular level. In this study, a 7-mm-long and 250-μm-wide microelectrode array (MEA) was fabricated to provide real-time monitoring of dopamine (DA) concentration and neural spike firings in the caudate putamen (CPU) of rats with PD. Platinumn nanoparticles and reduced graphene oxide nanocomposites (Pt/rGO) were modified onto the sensitive microelectrode sites. The detection limit (50 nM) and sensitivity (8.251 pA/μM) met the specific requirements for DA detection in vivo. A single neural spike was isolated due to the high signal-to-noise ratio of the MEA. DBS was applied in the affected side of the globus pallidus internal (GPi) in PD rats. After DBS, the concentration of DA in the bilateral CPU increased markedly. The mean increment of the ipsilateral DA was 7.33 μM (increasing from 0.54 μM to 7.87 μM), which was 2.2-fold higher than the increment in the contralateral side. The mean amplitude of neural spikes in the bilateral CPU decreased more than 10%, and was more obvious in the ipsilateral side where the spike amplitude changed from 169 μV to 134 μV. Spike firing rate decreased by 65% (ipsilateral side) and 51% (contralateral side). The power of the local field potential decreased to 940 μW (ipsilateral side) and 530 μW (contralateral side) in 0–30 Hz. Collectively, our data show that the GPi-DBS plays a significant regulatory role in the bilateral CPU in terms of DA concentration, spike firing, and power; furthermore, the ipsilateral variations of the dual mode signals were more significant than those in the contralateral side. These results provide new detection and stimulation technology for understanding the mechanisms underlying Parkinson’s disease and should, therefore, represent a useful resource for the design of future treatments.

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confidence: 99%

Microelectrode Arrays Modified with Nanocomposites for Monitoring Dopamine and Spike Firings under Deep Brain Stimulation in Rat Models of Parkinson’s Disease

et al. 2019

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“…Several experimental studies have suggested that simultaneous stimulation of multiple nuclei may be more therapeutically effective than stimulating a single nucleus (Mazzone et al, 2005; Oertel et al, 2017). To test this in the present model, the connection structures for the individual cases of STN-DBS and GPi-DBS, described in section 2.10, are combined.…”

Section: Resultsmentioning

confidence: 99%

Suppression of Parkinsonian Beta Oscillations by Deep Brain Stimulation: Determination of Effective Protocols

Müller

Robinson

2018

Front. Comput. Neurosci.

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A neural field model of the corticothalamic-basal ganglia system is developed that describes enhanced beta activity within subthalamic and pallidal circuits in Parkinson's disease (PD) via system resonances. A model of deep brain stimulation (DBS) of typical clinical targets, the subthalamic nucleus (STN) and globus pallidus internus (GPi), is added and studied for several distinct stimulation protocols that are used for treatment of the motor symptoms of PD and that reduce pathological beta band activity (13–30 Hz) in the corticothalamic-basal ganglia network. The resulting impact of DBS on enhanced beta activity in the STN and GPi, as well as cortico-subthalamic and cortico-pallidal coherence, are studied. Both STN-DBS and GPi-DBS are found to be effective for suppressing peak STN and GPi power in the beta band, with GPi-DBS being slightly more effective in both the STN and the GPi for all stimulus protocols tested. The largest decrease in cortico-STN coherence is observed during STN-DBS, whereas GPi-DBS is most effective for reducing cortico-GPi coherence. A reduction of the pathologically large STN connection strengths that define the parkinsonian state results in enhanced 6 Hz activity and could thus represent a compensatory mechanism that has the side effect of driving parkinsonian tremor-like oscillations. This model provides a method for systematically testing effective DBS protocols that agrees with experimental and clinical findings. Furthermore, the model suggests GPi-DBS and STN-DBS have distinct impacts on elevated synchronization between the basal ganglia and motor cortex in PD.

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“…However, staged dual stimulation, a more conservative approach, has also been successful in HT, 20 dystonic tremor, 14 and idiopathic Parkinson's disease. 17 Weighing the risk and benefits of a multitarget approach for each patient is an important and delicate exercise. Such an approach can be undertaken with a reasonable safety profile, but it relies on the requisite capacity and expertise to optimize DBS management.…”

Section: Discussionmentioning

confidence: 99%

Multitarget deep brain stimulation for clinically complex movement disorders

Parker¹,

Raghu²,

FitzGerald³

et al. 2021

Journal of Neurosurgery

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Deep brain stimulation (DBS) of single-target nuclei has produced remarkable functional outcomes in a number of movement disorders such as Parkinson’s disease, essential tremor, and dystonia. While these benefits are well established, DBS efficacy and strategy for unusual, unclassified movement disorder syndromes is less clear. A strategy of dual pallidal and thalamic electrode placement is a rational approach in such cases where there is profound, medically refractory functional impairment. The authors report a series of such cases: midbrain cavernoma hemorrhage with olivary hypertrophy, spinocerebellar ataxia-like disorder of probable genetic origin, Holmes tremor secondary to brainstem stroke, and hemiballismus due to traumatic thalamic hemorrhage, all treated by dual pallidal and thalamic DBS. All patients demonstrated robust benefit from DBS, maintained in long-term follow-up. This series demonstrates the flexibility and efficacy, but also the limitations, of dual thalamo-pallidal stimulation for managing axial and limb symptoms of tremors, dystonia, chorea, and hemiballismus in patients with complex movement disorders.

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Combined thalamic and subthalamic deep brain stimulation for tremor-dominant Parkinson’s disease

Cited by 18 publications

References 22 publications

Microelectrode Arrays Modified with Nanocomposites for Monitoring Dopamine and Spike Firings under Deep Brain Stimulation in Rat Models of Parkinson’s Disease

Microelectrode Arrays Modified with Nanocomposites for Monitoring Dopamine and Spike Firings under Deep Brain Stimulation in Rat Models of Parkinson’s Disease

Suppression of Parkinsonian Beta Oscillations by Deep Brain Stimulation: Determination of Effective Protocols

Multitarget deep brain stimulation for clinically complex movement disorders

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