Technical aspects and considerations of deep brain stimulation surgery for movement disorders

Sakas, Damianos E.; Kouyialis, Andreas T.; Boviatsis, Efstathios; Panourias, I. G.; Stathis, Pantelis; Tagaris, G.

doi:10.1007/978-3-211-33081-4_18

Cited by 25 publications

(22 citation statements)

References 18 publications

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“…Consider, for example, point B in Fig. 1 and a stimulation lead downward displaced by X mm, 0 < X ≤ 1.5 [9]. The new distance B = d 2 -(d 1 + X) < d 2 -d 1 .…”

Section: Discussionmentioning

confidence: 99%

“…On the third day after surgery, the patient underwent postoperative MRI for further verification of the lead position [32]. This procedure secured that only downward displacement of the stimulation lead could be present that could not exceed 1.5 mm [9], [33].…”

Section: A Mers and Dbs Implantationmentioning

confidence: 99%

“…The microelectrode trajectory that is selected for stimulation is the one exhibiting movement-related activity or the largest amount of STN-specific discharge pattern. Once the trajectory is selected, a "trial-and-error" macrostimulation determines the therapeutic window for the selected STN area by identifying the best clinical response without intraoperative side effects [9].…”

mentioning

confidence: 99%

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Beta-Band Frequency Peaks Inside the Subthalamic Nucleus as a Biomarker for Motor Improvement After Deep Brain Stimulation in Parkinson's Disease

Michmizos

Frangou

Stathis

et al. 2015

IEEE J. Biomed. Health Inform.

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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) remains an empirical, yet highly effective, surgical treatment for advanced Parkinson's disease (PD). DBS outcome depends on accurate stimulation of the STN sensorimotor area which is a trial-and-error procedure taking place during and after surgery. Pathologically enhanced beta-band (13-35 Hz) oscillatory activity across the cortico-basal ganglia pathways is a prominent neurophysiological phenomenon associated with PD. We hypothesized that weighing together beta-band frequency peaks from simultaneous microelectrode recordings in "off-state" PD patients could map the individual neuroanatomical variability and serve as a biomarker for the location of the STN sensorimotor neurons. We validated our hypothesis with 9 and 11 patients that, respectively, responded well and poorly to bilateral DBS, after at least two years of follow up. We categorized "good" and "poor" DBS responders based on their clinical assessment alongside a > 40% and <30% change, respectively, in "off" unified PD rating scale motor scores. Good (poor) DBS responders had, in average, 1 mm (3.5 mm) vertical distance between the maximum beta-peak weighted across the parallel microelectrodes and the center of the stimulation area. The distances were statistically different in the two groups ( p = 0.0025 ). Our biomarker could provide personalized intra- and postoperative support in stimulating the STN sensorimotor area associated with optimal long-term clinical benefits.

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“…Consider, for example, point B in Fig. 1 and a stimulation lead downward displaced by X mm, 0 < X ≤ 1.5 [9]. The new distance B = d 2 -(d 1 + X) < d 2 -d 1 .…”

Section: Discussionmentioning

confidence: 99%

Section: A Mers and Dbs Implantationmentioning

confidence: 99%

mentioning

confidence: 99%

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Beta-Band Frequency Peaks Inside the Subthalamic Nucleus as a Biomarker for Motor Improvement After Deep Brain Stimulation in Parkinson's Disease

Michmizos

Frangou

Stathis

et al. 2015

IEEE J. Biomed. Health Inform.

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“…Esta última recibe el nombre de estimulación cerebral profunda (ECP o DBS, por sus iniciales en inglés). Los criterios de inclusión y los parámetros de estimulación para pacientes parkinsonianos que reciben ECP varían ampliamente de acuerdo a cada valoración neurológica en particular, pero se ha utilizado exitosamente para cuadros de trastorno obsesivo compulsivo (Benabid & Torres, 2012;Kopell & Greenberg, 2008;Rezai, 2009), epilepsia (Jaseja, Gupta, Jain, & Gupta, 2014;Van et al, 2015;Mottonen et al, 2016), depresión (Cusin & Dougherty, 2013;Okun et al, 2014;Berlim, McGirr, Van den Eynde, Fleck, & Giacobbe, 2014;Quraan et al, 2014;Lilleeng, Gjerstad, Baardsen, Dalen, & Larsen, 2015;Williams et al, 2016) & Beuls, 2004;Sakas et al, 2007;Larson, 2008;Marks, Honeycutt, Acosta, & Reed, 2009).…”

Section: Estimulación Cerebral Profunda (Ecp)unclassified

La Enfermedad de Parkinson: Etiología, Tratamientos y Factores Preventivos

Hurtado

Cárdenas

et al. 2017

Univ Psychol

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RESUMENLa enfermedad de Parkinson (EP) es la patología neurodegenerativa motora con mayor incidencia a nivel mundial, cuyas causas aún no son claras. Actualmente no existe cura, pero es posible contar con diferentes tratamientos que permiten aliviar algunos de sus síntomas y enlentecer su curso. Debido a la gran cantidad de informaciones, en ocasiones contradictorias sobre los llamados "factores de riesgo" (entendidos éstos como situaciones que pueden exacerbar la posibilidad de aparición de la enfermedad, incluyendo desde la predisposición familiar hasta la exposición prolongada a substancias exógenas), en esta revisión se pretende ofrecer una panorámica actual sobre factores asociados a la aparición de EP. Se revisan también algunos tratamientos que buscan contrarrestar la pérdida de la función dopaminérgica de la substancia nigra (SN) y algunas de las aproximaciones terapéuticas tanto farmacológicas, como por estimulación cerebral profunda (ECP) o por implante celular. Se revisan también investigaciones sobre el potencial terapéutico de compuestos con alta especificidad a receptores colinérgicos (nAChRs) y antagonistas de receptores de adenosina, específicamente del subtipo A2A. Posiblemente durante las próximas décadas, nuestro conocimiento en epigenética pueda arrojar nuevas luces sobre esta interacción, así como sobre las relaciones entre ciertas líneas de microbios intestinales y aparición de EP. En este momento, la alternativa terapéutica que ofrece mayor eficacia es la ECP, sin embargo, a futuro se espera que el desarrollo de nuevas estrategias de implante cerebral pueda ofrecer una cura real de la EP. Palabras claveEnfermedad de Parkinson (EP); estimulación cerebral profunda (ECP); sustancia nigra (SN); núcleo subtálamico (NST); globo pálido interno (GPi). ABSTRACTParkinson's disease (PD) is the most prevalent neurodegenerative motor pathology worldwide, the causes of which are still unclear. Currently there is no cure, but it is possible to have different treatments that allow to alleviate some of its symptoms and slow its course. Due to the large amount of information, sometimes contradictory, about the

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“…The procedure involves the image-guided selection of a deep brain target, which is then stereotactically implanted with electrodes, in an effort to disrupt the activity of the target structure and its dysfunctional circuit 11 12…”

Section: Challenge 3: Dbs Is Inherently Risky Neurosurgery With Unknomentioning

confidence: 99%

Informed consent for clinical trials of deep brain stimulation in psychiatric disease: challenges and implications for trial design: Table 1

et al. 2011

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Advances in neuromodulation and an improved understanding of the anatomy and circuitry of psychopathology have led to a resurgence of interest in surgery for psychiatric disease. Clinical trials exploring deep brain stimulation (DBS), a focally targeted, adjustable and reversible form of neurosurgery, are being developed to address the use of this technology in highly selected patient populations. Psychiatric patients deemed eligible for surgical intervention, such as DBS, typically meet stringent inclusion criteria, including demonstrated severity, chronicity and a failure of conventional therapy. Although a humanitarian device exemption by the US Food and Drug Administration exists for its use in obsessive-compulsive disorder, DBS remains a largely experimental treatment in the psychiatric context, with its use currently limited to clinical trials and investigative studies. The combination of a patient population at the limits of conventional therapy and a novel technology in a new indication poses interesting challenges to the informed consent process as it relates to clinical trial enrollment. These challenges can be divided into those that relate to the patient, their disease and the technology, with each illustrating how traditional conceptualisations of research consent may be inadequate in the surgical psychiatry context. With specific reference to risk analysis, patient autonomy, voluntariness and the duty of the clinician-researcher, this paper will discuss the unique challenges that clinical trials of surgery for refractory psychiatric disease present to the consent process. Recommendations are also made for an ethical approach to clinical trial consent acquisition in this unique patient population.

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Technical aspects and considerations of deep brain stimulation surgery for movement disorders

Cited by 25 publications

References 18 publications

Beta-Band Frequency Peaks Inside the Subthalamic Nucleus as a Biomarker for Motor Improvement After Deep Brain Stimulation in Parkinson's Disease

Beta-Band Frequency Peaks Inside the Subthalamic Nucleus as a Biomarker for Motor Improvement After Deep Brain Stimulation in Parkinson's Disease

La Enfermedad de Parkinson: Etiología, Tratamientos y Factores Preventivos

Informed consent for clinical trials of deep brain stimulation in psychiatric disease: challenges and implications for trial design: Table 1

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