Novel targets in deep brain stimulation for movement disorders

Baumgartner, Alexander J.; Thompson, John A.; Kern, Drew S.; Ojemann, Steven G.

doi:10.1007/s10143-022-01770-y

Cited by 20 publications

(17 citation statements)

References 164 publications

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“…Forming a structural pathway between the cerebellum, subcortical regions, and areas of the cortex, the DRTT poses as a novel therapeutic target for movement disorder DBS. (67) To the best of our knowledge, the DRTT in cervical dystonia has been explored in one previous study, showing altered markers of microstructure relative to healthy controls. (33) Namely, reduced fractional anisotropy of the left DRTT and reduced axial and mean diffusivity of the right DRTT were observed.…”

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

Andrews

Keller

Osman-Farah

et al. 2023

Preprint

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Background: Cervical dystonia is a movement disorder, characterised by involuntary head and neck muscle contractions. Although deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective treatment option, motor outcomes can vary even when sufficient targeting accuracy is achieved. Increasing evidence supports a role of brainstem and cerebellum dysfunction in cervical dystonia pathogenesis. Objective: To determine whether morphometry of brainstem and dentate nuclei, and DBS stimulatory overlap with cerebello-thalamic tracts modelled from normative connectivity, were related to DBS clinical motor outcomes. Methods: 27 patients with idiopathic cervical dystonia underwent bilateral targeting of the GPi. and were separated into suboptimal and optimal motor outcome groups. Dentate nuclei and brainstem volumes were quantified in association with clinical outcomes. A brainstem shape analysis was conducted and used as a seed to assess connectivity from a normative structural connectome. Patient-specific electrodes were modelled to quantify stimulatory overlap with the GPi and proximity to cerebellothalamic tracts. Results: GPi implantation accuracy did not significantly differ between groups. Significantly reduced dentate nuclei and brainstem volumes were observed in patients with poorer clinical outcomes. Regional surface shape change of the brainstem was also observed in patients with poorer responses. Fibre tracking from this area intersected cerebellar, pallidal and cortical motor regions. Electrode field intersection with the non-decussating dentatorubrothalamic tract in the right, and in both hemispheres were also positively associated with clinical outcome. Conclusions: Variability in cerebellar and brainstem morphometry, and stimulation of non-decussating cerebello-thalamic pathways may contribute to the mediation of DBS motor outcomes.

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Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

Andrews

Keller

Osman-Farah

et al. 2023

Preprint

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“…After three decades of DBS, this procedure remains the most used and most efficient surgical treatment for some cardinal symptoms of PD. Investigations of the new brain targets mentioned above, and maybe of other brain areas, will continue aiming to further improving outcome [110]. This will be facilitated by improved imaging of the brain, including functional MRI [118] and connectivity imaging [119,120].…”

Section: Future Prospects Of Dbs In Pdmentioning

confidence: 99%

“…There are ongoing attempts to investigate DBS in other brain targets, either to provide more efficient therapy to some symptoms, or to address some motor symptoms otherwise resistant to DBS in conventional brain targets, or aiming to alleviate nonmotor symptoms of PD such as dementia [110]. The posterior subthalamic area (PSA) is an area below the thalamus that is crowded with sensory and motor tracts.…”

Section: Other Investigated Brain Targets For Dbs In Pdmentioning

confidence: 99%

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Deep brain stimulation for Parkinson's disease

Hariz

Blomstedt

2022

J Intern Med

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Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) is an established safe neurosurgical symptomatic therapy for eligible patients with advanced disease in whom medical treatment fails to provide adequate symptom control and good quality of life, or in whom dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored to the patient's symptoms and targeted to various nodes along the basal ganglia–thalamus circuitry, which mediates the various symptoms of the illness; DBS in the thalamus is most efficient for tremors, and DBS in the pallidum most efficient for rigidity and dyskinesias, whereas DBS in the subthalamic nucleus (STN) can treat both tremors, akinesia, rigidity and dyskinesias, and allows for decrease in doses of medications even in patients with advanced stages of the disease, which makes it the preferred target for DBS. However, DBS in the STN assumes that the patient is not too old, with no cognitive decline or relevant depression, and does not exhibit severe and medically resistant axial symptoms such as balance and gait disturbances, and falls. Dysarthria is the most common side effect of DBS, regardless of the brain target. DBS has a long‐lasting effect on appendicular symptoms, but with progression of disease, nondopaminergic axial features become less responsive to DBS. DBS for PD is highly specialised; to enable adequate selection and follow‐up of patients, DBS requires dedicated multidisciplinary teams of movement disorder neurologists, functional neurosurgeons, specialised DBS nurses and neuropsychologists.

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“…Previous studies of STN-DBS in movement disorders show that stimulating the STN and its adjacent areas may induce different effects, 33,34 which may have implications for the treatment of epilepsy. The volume of tissue activated (VTA) around the stimulated electrode directly affects the stimulation outcomes.…”

Section: Target Selectionmentioning

confidence: 99%

Deep brain stimulation of the subthalamic nucleus for epilepsy

Yan

Ren

2022

Acta Neuro Scandinavica

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Deep brain stimulation of the subthalamic nucleus (STN‐DBS) is a promising palliative option for patients with refractory epilepsy. However, crucial questions remain unanswered: Which patients are the optimal candidates? How, where, and when to stimulate the STN? And what is the mechanism of STN‐DBS action on epilepsy? Thus, we reviewed the clinical evidence on the antiepileptic effects of STN‐DBS and its possible mechanisms on drug‐resistant epilepsy, its safety, and the factors influencing stimulation outcomes. This information may guide clinical decision‐making. In addition, based on the current knowledge on the effect of STN‐DBS on epilepsy, we suggest research that needs to be carried out in the future.

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Novel targets in deep brain stimulation for movement disorders

Cited by 20 publications

References 164 publications

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

WITHDRAWN: Infratentorial Morphometry and Deep Brain Stimulation Outcome in Cervical Dystonia

Deep brain stimulation for Parkinson's disease

Deep brain stimulation of the subthalamic nucleus for epilepsy

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