Application Of Deep Brain Stimulation Research Articles

Animal studies in clinical MRI scanners: A custom setup for combined fMRI and deep-brain stimulation in awake rats

BackgroundIn humans, functional magnetic resonance imaging (fMRI) cannot be used to its full potential to study the effects of deep-brain stimulation (DBS) on the brain due to safety reasons. Application of DBS in small animals is an alternative, but was hampered by technical limitations thus far. New MethodWe present a novel setup that extends the range of available applications by studying animals in a clinical scanner. We used a 3 T-MRI scanner with a custom-designed receiver coil and a restrainer to measure brain activity in awake rats. DBS electrodes made of silver were used to minimize electromagnetic artifacts. Before scanning, rats were habituated to the restrainer. ResultsUsing our novel setup, we observed minor DBS-electrode artifacts, which did not interfere with brain-activity measurements significantly. Movement artifacts were also minimal and were not further reduced by restrainer habituation. Bilateral DBS in the dorsal part of the ventral striatum (dVS) resulted in detectable increases in brain activity around the electrodes tips. Comparison with Existing MethodsThis novel setup offers a low-cost alternative to dedicated small-animal scanners. Moreover, it can be implemented in widely available clinical 3 T scanners. Although spatial and temporal resolution was lower than what is achieved in anesthetized rats in high-field small-animal scanners, we obtained scans in awake animals, thus, testing the effects of bilateral DBS of the dVS in a more physiological state. ConclusionsWith this new technical setup, the neurobiological mechanism of action of DBS can be explored in awake, restrained rats in a clinical 3 T-MRI scanner.

Deep Brain Stimulation for PTSD

Deep brain stimulation (DBS) has shown promising results for a number of psychiatric indications. Preclinical models have good validity for studying the effects and mechanisms of DBS in psychiatry. We conducted preclinical work that led to the translational application of DBS in post-traumatic stress disorder (PTSD).

Computational investigation of the impact of deep brain stimulation contact size and shape on neural selectivity

Background. Understanding neural selectivity is essential for optimizing medical applications of deep brain stimulation (DBS). We previously showed that modulation of the DBS waveform can induce changes in orientation-based selectivity, and that lengthening of DBS pulses or directional segmentation can reduce preferential selectivity for large axons. In this work, we sought to investigate a simple, but important question from a generalized perspective: how do the size and shape of the contact influence neural selectivity? Methods. We created multicompartment neuron models for several axon diameters and used finite element modeling with standard-sized cylindrical leads to determine the effects on changing contact size and shape on axon activation profiles and volumes of tissue activated. Contacts ranged in size from 0.04 to 16 mm2, compared with a standard size of 6 mm2. Results. We found that changes in contact size are predicted to induce substantial changes in orientation-based selectivity in the context of a cylindrical lead, and changes in contact width or height can alter this selectivity. Smaller contact sizes were more effective in constraining neural activation to small, nearby axons. However, micro-scale contacts enable only limited spread of neural activation before exceeding standard charge density limitations; further, energetic efficiency is optimized by somewhat larger contacts. Interpretations. Small-scale contacts may be optimal for constraining stimulation in nearby grey matter and avoiding orientation-selective activation. However, given charge density limitations and energy inefficiency of micro-scale contacts, we predict that contacts sized similarly to or slightly smaller than segmented clinical leads may optimize energy efficiency while avoiding charge density limitations.

Deep Brain Stimulation for Alzheimer's Disease: Stimulation Parameters and Potential Mechanisms of Action

Deep brain stimulation (DBS) is a neurosurgical technique that regulates neuron activity by using internal pulse generators to electrodes in specific target areas of the brain. As a blind treatment, DBS is widely used in the field of mental and neurological diseases, although its mechanism of action is still unclear. In the past 10 years, DBS has shown a certain positive effect in animal models and patients with Alzheimer's disease (AD), but there are also different results that may be related to the stimulation parameters of DBS. Based on this, determining the optimal stimulation parameters for DBS in AD and understanding its mechanism of action are essential to promote the clinical application of DBS in AD. This review aims to explore the therapeutic effect of DBS in AD, and to analyze its stimulation parameters and potential mechanism of action. The keywords “Deep brain stimulation” and “Alzheimer's Disease” were used for systematic searches in the literature databases of Web of Science and PubMed (from 1900 to September 29, 2020). All human clinical studies and animal studies were reported in English, including individual case studies and long-term follow-up studies, were included. These studies described the therapeutic effects of DBS in AD. The results included 16 human clinical studies and 14 animal studies, of which 28 studies clearly demonstrated the positive effect of DBS in AD. We analyzed the current stimulation parameters of DBS in AD from stimulation target, stimulation frequency, stimulation start time, stimulation duration, unilateral/bilateral treatment and current intensity, etc., and we also discussed its potential mechanism of action from multiple aspects, including regulating related neural networks, promoting nerve oscillation, reducing β-amyloid and tau levels, reducing neuroinflammation, regulating the cholinergic system, inducing the synthesis of nerve growth factor.

Deep Brain Stimulation Initiative: Toward Innovative Technology, New Disease Indications, and Approaches to Current and Future Clinical Challenges in Neuromodulation Therapy.

Deep brain stimulation (DBS) is one of the most important clinical therapies for neurological disorders. DBS also has great potential to become a great tool for clinical neuroscience research. Recently, the National Engineering Laboratory for Neuromodulation at Tsinghua University held an international Deep Brain Stimulation Initiative workshop to discuss the cutting-edge technological achievements and clinical applications of DBS. We specifically addressed new clinical approaches and challenges in DBS for movement disorders (Parkinson's disease and dystonia), clinical application toward neurorehabilitation for stroke, and the progress and challenges toward DBS for neuropsychiatric disorders. This review highlighted key developments in (1) neuroimaging, with advancements in 3-Tesla magnetic resonance imaging DBS compatibility for exploration of brain network mechanisms; (2) novel DBS recording capabilities for uncovering disease pathophysiology; and (3) overcoming global healthcare burdens with online-based DBS programming technology for connecting patient communities. The successful event marks a milestone for global collaborative opportunities in clinical development of neuromodulation to treat major neurological disorders.

Suppressing synchronous firing of epileptiform activity by high-frequency stimulation of afferent fibers in rat hippocampus.

AimsDeep brain stimulation (DBS) is a promising technology for treating epilepsy. However, the efficacy and underlying mechanisms of the high‐frequency stimulation (HFS) utilized by DBS to suppress epilepsy remain uncertain. Previous studies have shown that HFS can desynchronize the firing of neurons. In this study, we investigated whether the desynchronization effects of HFS can suppress epileptiform events.MethodsHFS trains with seconds of duration (short) and a minute of duration (long) were applied at the afferent fibers (ie, Schaffer collaterals) of the hippocampal CA1 region in anesthetized rats in vivo. The amplitude and the rate of population spikes (PS) appeared in the downstream of stimulation were calculated to evaluate the intensity of synchronized firing of neuronal populations between short and long HFS groups. A test of paired‐pulse depression (PPD) was used to assess the alteration of inhibitory neuronal circuits.ResultsThe sustained stimulation of a 60‐s long HFS suppressed the afterdischarges that were induced by a 5‐s short HFS to impair the local inhibitions. During the sustained HFS, the mean PS amplitude reduced significantly and the burst firing decreased, while the amount of neuronal firing did not change significantly. The paired‐pulse tests showed that with a similar baseline level of small PS2/PS1 ratio indicating a strong PPD, the 5‐s HFS increased the PS2/PS1 ratio to a value that was significantly greater than the corresponding ratio during sustained HFS, indicating that the PPD impaired by a short HFS may be restored by a sustained HFS.ConclusionsThe sustained HFS can desynchronize the population firing of epileptiform activity and accelerate a recovery of inhibitions to create a balance between the excitation and the inhibition of local neuronal circuits. The study provides new clues for further understanding the mechanism of DBS and for advancing the clinical application of DBS in treating epilepsy.

Machine Learning's Application in Deep Brain Stimulation for Parkinson's Disease: A Review.

Deep brain stimulation (DBS) is a surgical treatment for advanced Parkinson’s disease (PD) that has undergone technological evolution that parallels an expansion in clinical phenotyping, neurophysiology, and neuroimaging of the disease state. Machine learning (ML) has been successfully used in a wide range of healthcare problems, including DBS. As computational power increases and more data become available, the application of ML in DBS is expected to grow. We review the literature of ML in DBS and discuss future opportunities for such applications. Specifically, we perform a comprehensive review of the literature from PubMed, the Institute for Scientific Information’s Web of Science, Cochrane Database of Systematic Reviews, and Institute of Electrical and Electronics Engineers’ (IEEE) Xplore Digital Library for ML applications in DBS. These studies are broadly placed in the following categories: (1) DBS candidate selection; (2) programming optimization; (3) surgical targeting; and (4) insights into DBS mechanisms. For each category, we provide and contextualize the current body of research and discuss potential future directions for the application of ML in DBS.

Deep brain stimulation in the management of paediatric neuropsychiatric conditions: Current evidence and future directions.

Neurosurgery has provided an alternative option for patients with refractory psychiatric indications. Lesion procedures were the initial techniques used, but deep brain stimulation (DBS) has the advantage of relative reversibility and adjustability. This review sets out to delineate the current evidence for DBS use in psychiatric conditions, with an emphasis on the paediatric population, highlighting pitfalls and opportunities. A systematic review of the literature was conducted on studies reporting the use of DBS in the management of psychiatric disorders. The PRISMA guidelines were employed to structure the review of the literature. Data was discussed focusing on the indications for DBS management of psychiatric conditions in the paediatric age group. A total of seventy-three full-text papers reported the use of DBS surgery for the management of psychiatric conditions matching the inclusion criteria. The main indications were Tourette Syndrome (GTS) (15 studies), Obsessive Compulsive Disorder (OCD) (20), Treatment Resistant Depression (TRD) (27), Eating Disorders (ED) (7) and Aggressive Behaviour and self-harm (AB) (4). Out of these, only 11 studies included patients in the paediatric age group (≤18 years-old). Among the paediatric patients, the indications for surgery included GTS, AB and ED. The application of deep brain stimulation for psychiatric indications has progressed at a steady pace in the adult population and at a much slower pace in the paediatric population. Future studies in children should be done in a trial setting with strict and robust criteria. A move towards personalising DBS therapy with new stimulation paradigms will provide new frontiers and possibilities in this growing field.

Neuromodulation in Psychiatric disorders: Experimental and Clinical evidence for reward and motivation network Deep Brain Stimulation: Focus on the medial forebrain bundle.

Deep brain stimulation (DBS) in psychiatric illnesses has been clinically tested over the past 20years. The clinical application of DBS to the superolateral branch of the medial forebrain bundle in treatment-resistant depressed patients-one of several targets under investigation-has shown to be promising in a number of uncontrolled open label trials. However, there are remain numerous questions that need to be investigated to understand and optimize the clinical use of DBS in depression, including, for example, the relationship between the symptoms, the biological substrates/projections and the stimulation itself. In the context of precision and customized medicine, the current paper focuses on clinical and experimental research of medial forebrain bundle DBS in depression or in animal models of depression, demonstrating how clinical and scientific progress can work in tandem to test the therapeutic value and investigate the mechanisms of this experimental treatment. As one of the hypotheses is that depression engenders changes in the reward and motivational networks, the review looks at how stimulation of the medial forebrain bundle impacts the dopaminergic system.

Deep Brain Stimulation for Major Depression and Obsessive-Compulsive Disorder—Discontinuation of Ongoing Stimulation

Deep brain stimulation (DBS) is currently under research for the treatment of psychiatric disorders, e.g., obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Since the application of DBS in psychiatry has been in use for about 20 years, it is necessary to evaluate its long-term use now. A main issue in the long-term treatment of DBS concerns the effects of a discontinuation of stimulation due to intended as well as unintended reasons. In this contribution, the literature describing discontinuation effects following DBS in OCD and TRD is reviewed. Furthermore, a patient is reported in depth who experienced an unintended discontinuation of supero-lateral medial forebrain bundle (slMFB) DBS for TRD. In this case, the battery was fully depleted without the patient noticing. DBS had led to a sustained response for seven years before discontinuation of stimulation for just several weeks caused a progressive worsening of depression. Altogether, the rapid occurrence of symptom worsening, the absence of a notification about the stimulation status and the difficulties to recapture antidepressant response represent important safety aspects. For a further understanding of the described effects, time courses until worsening of depression as well as biological mechanisms need to be investigated in double-blind controlled trials.

Clinical applications of neurochemical and electrophysiological measurements for closed-loop neurostimulation.

The development of closed-loop deep brain stimulation (DBS) systems represents a significant opportunity for innovation in the clinical application of neurostimulation therapies. Despite the highly dynamic nature of neurological diseases, open-loop DBS applications are incapable of modifying parameters in real time to react to fluctuations in disease states. Thus, current practice for the designation of stimulation parameters, such as duration, amplitude, and pulse frequency, is an algorithmic process. Ideal stimulation parameters are highly individualized and must reflect both the specific disease presentation and the unique pathophysiology presented by the individual. Stimulation parameters currently require a lengthy trial-and-error process to achieve the maximal therapeutic effect and can only be modified during clinical visits. The major impediment to the development of automated, adaptive closed-loop systems involves the selection of highly specific disease-related biomarkers to provide feedback for the stimulation platform. This review explores the disease relevance of neurochemical and electrophysiological biomarkers for the development of closed-loop neurostimulation technologies. Electrophysiological biomarkers, such as local field potentials, have been used to monitor disease states. Real-time measurement of neurochemical substances may be similarly useful for disease characterization. Thus, the introduction of measurable neurochemical analytes has significantly expanded biomarker options for feedback-sensitive neuromodulation systems. The potential use of biomarker monitoring to advance neurostimulation approaches for treatment of Parkinson's disease, essential tremor, epilepsy, Tourette syndrome, obsessive-compulsive disorder, chronic pain, and depression is examined. Further, challenges and advances in the development of closed-loop neurostimulation technology are reviewed, as well as opportunities for next-generation closed-loop platforms.

Pre-dopa Deep Brain Stimulation: Is Early Deep Brain Stimulation Able to Modify the Natural Course of Parkinson's Disease?

Deep brain stimulation (DBS) is an established therapy for the management of Parkinson’s disease (PD). However, DBS is indicated as the disease progresses and motor complications derived from pharmacological therapy arise. Here, we evaluate the potential of DBS prior to levodopa (L-Dopa) in improving quality of life (QoL), challenging the state of the art for DBS therapy. We present data on clinical manifestation, decision finding during early indication to DBS, and trajectories after DBS. We further discuss current paradigms for DBS and hypothesize on possible mechanisms. Six patients, between 50 and 67 years old, presenting at least 5 years of PD symptoms, and without L-Dopa therapy initiation, received subthalamic nucleus (STN) DBS implantation. In the six PD cases, indication for DBS was not driven by motor complications, as supported by current guidelines, but by relevant QoL impairment and patient’s reluctance to initiate L-Dopa treatment. All patients treated with STN-DBS prior to L-Dopa presented improvement in motor and non-motor symptoms and significant QoL improvement. All patients reduced the intake of dopamine agonists, and five are currently free from L-Dopa medication, with no reported adverse events. We introduce a multicenter observational study to investigate whether early DBS treatment may affect the natural course of PD. Early application of DBS instead of L-Dopa administration could have a pathophysiological basis and be prompted by a significant incline on QoL through disease progression; however, the clinical value of this proposed paradigm shift should be addressed in clinical trials aimed at modulating the natural course of PD.

Optimal open-loop desynchronization of neural oscillator populations.

Deep brain stimulation (DBS) is an increasingly used medical treatment for various neurological disorders. While its mechanisms are not fully understood, experimental evidence suggests that through application of periodic electrical stimulation DBS may act to desynchronize pathologically synchronized populations of neurons resulting desirable changes to a larger brain circuit. However, the underlying mathematical mechanisms by which periodic stimulation can engender desynchronization in a coupled population of neurons is not well understood. In this work, a reduced phase-amplitude reduction framework is used to characterize the desynchronizing influence of periodic stimulation on a population of coupled oscillators. Subsequently, optimal control theory allows for the design of periodic, open-loop stimuli with the capacity to destabilize completely synchronized solutions while simultaneously stabilizing rotating block solutions. This framework exploits system nonlinearities in order to strategically modify unstable Floquet exponents. In the limit of weak neural coupling, it is shown that this method only requires information about the phase response curves of the individual neurons. The effects of noise and heterogeneity are also considered and numerical results are presented. This framework could ultimately be used to inform the design of more efficient deep brain stimulation waveforms for the treatment of neurological disease.

Utilization of the Intraoperative Mobile AIRO® CT Scanner in Stereotactic Surgery: Workflow and Effectiveness

Background: In frame-based stereotactic surgery, intraoperative imaging is crucial. It generally follows a workflow including preoperative MRI and intraoperative frame-based CT. The intraoperative transport of the anesthetized and intubated patient to and from the CT unit can be time-consuming and cumbersome. Here, we report the first 50 patients who underwent stereotactic biopsies using the mobile AIRO® intraoperative CT (iCT) scanner. Methods: A conventional stereotactic frame was mounted to the AIRO® carbon table via carbon adapter. 0°gantry thin-slice iCT was performed. The imaging data were transferred to a conventional stereotaxy working unit. After fusion of the preoperative MRI and AIRO® iCT, the stereotactic system was built based on the iCT, and trajectories were calculated accordingly. Results: The frame-based stereotactic iCT was easy to implement and successfully accomplished in all patients. The MRI/iCT image fusion was feasible in all of the studies. A conclusive histological result was obtained in 46 of the 50 cases included. There was no bleeding complication. Net surgery time was reduced by 38 min, on average. Conclusion: We conclude that the AIRO® system is a safe, easy-to-use, and sufficiently accurate iCT for CT frame-based stereotactic biopsy planning that results in a considerable reduction of surgery time. In the future, it remains to be evaluated if the accuracy rates and intraoperative workflow will permit its application in deep brain stimulation and other functional procedures as well.

Pedunculopontine Nucleus Deep Brain Stimulation Improves Gait Disorder in Parkinson's Disease: A Systematic Review and Meta-analysis.

Deep brain stimulation (DBS) of the pedunculopontine nucleus (PPN) has been proposed as a treatment strategy for gait disorder in patients with Parkinson's disease (PD). We thus performed a systematic review and meta-analysis of randomized and nonrandomized controlled trials to assess the effect of this treatment on gait disorder in patients with PD. We systematically searched PubMed, Cochrane, Web of Knowledge, Wan Fang and WIP for randomized and nonrandomized controlled trials (published before July 29, 2014; no language restrictions) comparing PPN-DBS with other treatments. We assessed pooled data using a random effects model and a fixed effects model. Of 130 identified studies, 14 were eligible and were included in our analysis (N = 82 participants). Compared to those presurgery, the Unified Parkinson Disease Rating Scale (UPDRS) 27-30 scores for patients were lowered by PPN-DBS [3.94 (95% confidence interval, CI = 1.23 to 6.65)]. The UPDRS 13 and 14 scores did not improve with levodopa treatment [0.43 (- 0.35 to 1.20); 0.35 (- 0.50 to 1.19)], whereas the UPDRS 27-30 scores could be improved by the therapy [1.42 (95% CI 0.34 to 2.51)]. The Gait and Falls Questionnaire and UPDRS 13 and 14 scores showed significant improvements after PPN-DBS under the medication-off (MED-OFF) status [15.44 (95% CI = 8.44 to 22.45); 1.57 (95% CI = 0.84 to 2.30); 1.34 (95% CI = 0.84 to 1.84)]. PPN-DBS is a potential therapeutic target that could improve gait and fall disorders in patients with PD. Our findings will help improve the clinical application of DBS in PD patients with gait disorder.

Application of Deep Brain Stimulation for Treatment-resistant Obsessive Compulsive Disorder: Current Status and Future Perspectives in Japan.

As in many Western countries, deep brain stimulation (DBS) is already being used daily in Japan to clinically treat neurological diseases such as Parkinson’s disease, essential tremor, and dystonia. Additionally, in both Europe and the United States, numerous case reports as well as multicenter randomized controlled trials have examined its use for treatment-refractory mental illnesses such as obsessive compulsive disorder (OCD) and major depressive disorder. Based on a number of the reports, the European Union (EU) and the USA Food and Drug Administration (FDA) granted limited approval of DBS for treatment-resistant OCD in 2009. Furthermore, a systematic review and meta-analysis in 2015 showed that DBS therapy for patients with treatment-resistant OCD had efficacy and was safe. Unlike the EU and the USA, DBS is not used to treat OCD or other psychiatric disorders in Japan, even though people with treatment-resistant OCD and their physicians and families urgently need additional treatments. This situation results from the “Resolution of total denial for psychosurgery,” which the Japanese Society of Psychiatry and Neurology adopted in 1975. We believe that the appropriateness of using DBS for treating psychiatric disorders including OCD should be considered after thorough discussion and consideration based on accurate and objective understanding. Currently, the field of psychiatry in Japan seems to lack scientific consideration as well as scientific understanding in this area. Under these circumstances, we hope that this review article will help psychiatrists and other relevant parties in Japan to gain an accurate and scientific understanding of DBS.

Pharmacological action of dexmedetomidine and its application in deep brain stimulation surgery

Dexmedetomidine (Dex), a new sedative agent that is not mediated by γ-aminobutyric acid (GABA) receptor, provides a new option for patients who need sedation in clinical practice, and has been widely used in clinical anesthesia of different types of surgeries. This review analyzes the recent progresses in the application of Dex in deep brain stimulation (DBS), summarizes the pharmacological effects of Dex on the peripheral nervous system, respiratory system and circulatory system, and introduces its advantageous and recommended doses in DBS surgery. Currently, the application of Dex in DBS is still being explored. Dex does not intervene microelectrode recording and Dex-treated patients are easy to be awakened, so this agent has good prospect for application in DBS. In the future, conscious sedation with Dex as the main sedative agent may become the first choice for DBS surgery. Key words: Dexmedetomidine; Deep brain stimulation; Microelectrode recording

Deep Brain Stimulation for Epilepsy: Biomarkers for Optimization.

Two large-scale controlled clinical trials have provided Class I evidence for the benefit of deep brain stimulation (DBS) as a therapy for refractory epilepsy. However, the efficacy has been variable, with some patients not achieving any improvement in their seizure control. This disparity could be the result of suboptimal stimulation parameters/electrodes or alternatively a difference in the type of seizures being treated. This review presents the most recent clinical results with a focus on two major targets for DBS, the anterior nucleus of the thalamus (ANT) and the hippocampus. We detail the etiologies where DBS might work best, and provide evidence for the use of recorded neural responses for the optimization of stimulation parameters and closed-loop control of devices. Stimulation of the hippocampus may work well for both focal and generalized seizures, whereas ANT stimulation may be best for focal seizures only. Studies have demonstrated that changes in stimulation-evoked response shape can be used as a biomarker for stimulation efficacy. Furthermore, new biomarkers have been identified that could be used for closed-loop stimulation. Improvements in patient screening and stimulation optimization are needed for patients to achieve optimal seizure control. Furthermore, therapy should be adjusted to suit individual patient needs. Recording evoked responses during the application of DBS could be used to measure the effectiveness of DBS and titrate stimulation as needed.

A superoxide scavenging coating for improving tissue response to neural implants

The advancement of neural prostheses requires implantable neural electrodes capable of electrically stimulating or recording signals from neurons chronically. Unfortunately, the implantation injury and presence of foreign bodies lead to chronic inflammation, resulting in neuronal death in the vicinity of electrodes. A key mediator of inflammation and neuronal loss are reactive oxygen and nitrogen species (RONS). To mitigate the effect of RONS, a superoxide dismutase mimic compound, manganese(III) meso-tetrakis-(N-(2-aminoethyl)pyridinium-2-yl) porphyrin (iSODm), was synthesized to covalently attach to the neural probe surfaces. This new compound showed high catalytic superoxide scavenging activity. In microglia cell line cultures, the iSODm coating effectively reduced superoxide production and altered expression of iNOS, NADPH oxidase, and arginase. After 1 week of implantation, iSODm coated electrodes showed significantly lower expression of markers for oxidative stress immediately adjacent to the electrode surface, as well as significantly less neurons undergoing apoptosis. Statement of SignificanceOne critical challenge in the translation of neural electrode technology to clinically viable devices for brain computer interface or deep brain stimulation applications is the chronic degradation of the device performance due to neuronal degeneration around the implants. One of the key mediators of inflammation and neuronal degeneration is reactive oxygen and nitrogen species released by injured neurons and inflammatory microglia. This research takes a biomimetic approach to synthesize a compound having similar reactivity as superoxide dismutase, which can catalytically scavenge reactive oxygen and nitrogen species, thereby reducing oxidative stress and decreasing neuronal degeneration. By immobilizing the compound covalently on the surface of neural implants, we show that the neuronal degeneration and oxidative stress around the implants is significantly reduced.

Deep brain stimulation: practical insights and common queries

The number of patients with deep brain stimulation (DBS) devices implanted is increasing. Although practices vary between centres, patients are typically given training and information from their DBS nurse or...