Pallidal deep brain stimulation for dystonia: a long term study

Meoni, Sara; Fraix, Valérie; Castrioto, Anna; Benabid, Alim Louis; Seigneuret, Éric; Vercueil, Laurent; Pollak, Pierre; Krack, Paul; Chevrier, Eric; Chabardès, Stéphan; Moro, Elena

doi:10.1136/jnnp-2016-315504

Cited by 50 publications

(31 citation statements)

References 31 publications

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“…After screening titles and abstracts, 479 potentially relevant articles were identified, and the full text was assessed against the inclusion criteria. Finally, 240 articles were chosen to be included in this meta‐analysis …”

Section: Resultsmentioning

confidence: 99%

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

Bullard

Hutchison

Lee

et al. 2020

Neuromodulation: Technology at the Neural Interface

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Objective A new age of neuromodulation is emerging: one of restorative neuroengineering and neuroprosthetics. As novel device systems move toward regulatory evaluation and clinical trials, a critical need arises for evidence‐based identification of potential sources of hardware‐related complications to assist in clinical trial design and mitigation of potential risk. Materials and Methods The objective of this systematic review is to provide a detailed safety analysis for future intracranial, fully implanted, modular neuroprosthetic systems. To achieve this aim, we conducted an evidence‐based analysis of hardware complications for the most established clinical intracranial modular system, deep brain stimulation (DBS), as well as the most widely used intracranial human experimental system, the silicon‐based (Utah) array. Results Of 2328 publications identified, 240 articles met the inclusion criteria and were reviewed for DBS hardware complications. The most reported adverse events were infection (4.57%), internal pulse generator malfunction (3.25%), hemorrhage (2.86%), lead migration (2.58%), lead fracture (2.56%), skin erosion (2.22%), and extension cable malfunction (1.63%). Of 433 publications identified, 76 articles met the inclusion criteria and were reviewed for Utah array complications. Of 48 human subjects implanted with the Utah array, 18 have chronic implants. Few specific complications are described in the literature; hence, implant duration served as a lower bound for complication‐free operation. The longest reported duration of a person with a Utah array implant is 1975 days (~5.4 years). Conclusions Through systematic review of the clinical and human‐trial literature, our study provides the most comprehensive safety review to date of DBS hardware and human neuroprosthetic research using the Utah array. The evidence‐based analysis serves as an important reference for investigators seeking to identify hardware‐related safety data, a necessity to meet regulatory requirements and to design clinical trials for future intracranial, fully implanted, modular neuroprosthetic systems.

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Section: Resultsmentioning

confidence: 99%

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

Bullard

Hutchison

Lee

et al. 2020

Neuromodulation: Technology at the Neural Interface

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“…Deep brain stimulation (DBS) is clinically used to treat various neurological and neuropsychiatric conditions [1,2], yet despite its widespread use, its mechanisms of action are not fully understood [3e5]. The effects of DBS in humans are often studied using noninvasive functional imaging [6,7]: H 2 O 15 positron emission tomography (PET) [8,9] and functional magnetic resonance imaging (fMRI) [10e13].…”

Section: Introductionmentioning

confidence: 99%

Neurovascular coupling during deep brain stimulation

Noor

Murari

et al. 2020

Brain Stimulation

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a b s t r a c tBackground: Deep brain stimulation (DBS) is an effective treatment for movement disorders, yet its mechanisms of action remain unclear. One method used to study its circuit-wide neuromodulatory effects is functional magnetic resonance imaging (fMRI) which measures hemodynamics as a proxy of neural activity. To interpret functional imaging data, we must understand the relationship between neural and vascular responses, which has never been studied with the high frequencies used for DBS. Objective: To measure neurovascular coupling in the rat motor cortex during thalamic DBS. Method: Simultaneous intrinsic optical imaging and extracellular electrophysiology was performed in the motor cortex of urethane-anesthetized rats during thalamic DBS at 7 different frequencies. We related Maximum Change in Reflectance (MCR) from the imaging data to Integrated Evoked Potential (IEP) and change in broadband power of multi-unit (MU) activity, computing Spearman's correlation to determine the strength of these relationships. To determine the source of these effects, we studied the contributions of antidromic versus orthodromic activation in motor cortex perfusion using synaptic blockers. Results: MCR, IEP and change in MU power increased linearly to 60 Hz and saturated at higher frequencies of stimulation. Blocking orthodromic transmission only reduced the DBS-induced change in optical signal by~25%, suggesting that activation of corticofugal fibers have a major contribution in thalamic-induced cortical activation. Conclusion: DBS-evoked vascular response is related to both evoked field potentials as well as multi-unit activity.

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“…The HD patients recruited in this study had less severe dystonic symptoms compared to the dystonia patients, so the elevated low frequency band power may reflect the dystonic syndrome rather than the disease itself. The second question is whether idiopathic dystonia responds well to GPi-DBS ( 32 – 34 ), as the dystonic syndrome in HD does not ( 35 ). Based on this study, we conclude that the dystonic syndrome in HD is not that prominent compared to dystonia and DBS may most strongly suppress the prominent frequency band.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Globus Pallidus Internus Local Field Potentials in Hyperkinetic Disease

et al. 2018

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Background: Dystonia and Huntington's disease (HD) are both hyperkinetic movement disorders but exhibit distinct clinical characteristics. Aberrant output from the globus pallidus internus (GPi) is involved in the pathophysiology of both HD and dystonia, and deep brain stimulation (DBS) of the GPi shows good clinical efficacy in both disorders. The electrode externalized period provides an opportunity to record local field potentials (LFPs) from the GPi to examine if activity patterns differ between hyperkinetic disorders and are associated with specific clinical characteristics.Methods: LFPs were recorded from 7 chorea-dominant HD and nine cervical dystonia patients. Differences in oscillatory activities were compared by power spectrum and Lempel-Ziv complexity (LZC). The discrepancy band power ratio was used to control for the influence of absolute power differences between groups. We further identified discrepant frequency bands and frequency band ratios for each subject and examined the correlations with clinical scores.Results: Dystonia patients exhibited greater low frequency power (6–14 Hz) while HD patients demonstrated greater high-beta and low-gamma power (26–43 Hz) (p < 0.0298, corrected). United Huntington Disease Rating Scale chorea sub-score was positively correlated with 26–43 Hz frequency band power and negatively correlated with the 6–14 Hz/26–43 Hz band power ratio.Conclusion: Dystonia and HD are characterized by distinct oscillatory activity patterns, which may relate to distinct clinical characteristics. Specifically, chorea may be related to elevated high-beta and low-gamma band power, while dystonia may be related to elevated low frequency band power. These LFPs may be useful biomarkers for adaptive DBS to treat hyperkinetic diseases.

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Pallidal deep brain stimulation for dystonia: a long term study

Abstract: GPi DBS is an effective and safe treatment in most patients with dystonia.

Cited by 50 publications

References 31 publications

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

Estimating Risk for Future Intracranial, Fully Implanted, Modular Neuroprosthetic Systems: A Systematic Review of Hardware Complications in Clinical Deep Brain Stimulation and Experimental Human Intracortical Arrays

Neurovascular coupling during deep brain stimulation

Characteristics of Globus Pallidus Internus Local Field Potentials in Hyperkinetic Disease

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