Stimulation For Movement Disorders Research Articles

ID: 336362 Feasibility of Quantitative Susceptibility Mapping to identify targets for Deep Brain Stimulation in Movement Disorders

ID: 336362 Feasibility of Quantitative Susceptibility Mapping to identify targets for Deep Brain Stimulation in Movement Disorders

Functional imaging of deep brain stimulation in dystonia: a review

Much remains to be learned about the mechanism of benefit of deep brain stimulation in movement disorders in general and dystonia specifically. A full accounting of the pathophysiology of dystonia additionally remains unclear. Given its ability to evaluate whole-brain network changes, functional neuroimaging is an important tool to advance understanding of the effects of deep brain stimulation, which in turn could offer insight into the pathophysiology of dystonia and suggest novel deep brain stimulation targets for the disorder. This review surveys the published literature of functional neuroimaging studies evaluating deep brain stimulation effects in dystonia, including PET, SPECT, and functional MRI studies. To date, study cohorts have been relatively small, though several general patterns emerge when studies are viewed collectively, including reduced functional activation patterns with stimulation turned on during motor tasks, particularly in frontal cortical regions. During rest with stimulation on, several studies showed areas of relatively decreased perfusion only in those participants who experienced clinical benefit from deep brain stimulation. Future research may benefit from larger cohorts with more homogeneous forms of dystonia, potentially enabled by multi-center initiatives. Additional benefits may result from more detailed longitudinal assessments and greater use of functional MRI, with study designs that take into account the technical limitations of this modality in the context of movement disorders and deep brain stimulation.

A structural magnetic resonance imaging review of clinical motor outcomes from deep brain stimulation in movement disorders.

Patients with movement disorders treated by deep brain stimulation do not always achieve successful therapeutic alleviation of motor symptoms, even in cases where surgery is without complications. Magnetic resonance imaging (MRI) offers methods to investigate structural brain-related factors that may be predictive of clinical motor outcomes. This review aimed to identify features which have been associated with variability in clinical post-operative motor outcomes in patients with Parkinson's disease, dystonia, and essential tremor from structural MRI modalities. We performed a literature search for articles published between 1 January 2000 and 1 April 2022 and identified 5197 articles. Following screening through our inclusion criteria, we identified 60 total studies (39 = Parkinson's disease, 11 = dystonia syndromes and 10 = essential tremor). The review captured a range of structural MRI methods and analysis techniques used to identify factors related to clinical post-operative motor outcomes from deep brain stimulation. Morphometric markers, including volume and cortical thickness were commonly identified in studies focused on patients with Parkinson's disease and dystonia syndromes. Reduced metrics in basal ganglia, sensorimotor and frontal regions showed frequent associations with reduced motor outcomes. Increased structural connectivity to subcortical nuclei, sensorimotor and frontal regions was also associated with greater motor outcomes. In patients with tremor, increased structural connectivity to the cerebellum and cortical motor regions showed high prevalence across studies for greater clinical motor outcomes. In addition, we highlight conceptual issues for studies assessing clinical response with structural MRI and discuss future approaches towards optimizing individualized therapeutic benefits. Although quantitative MRI markers are in their infancy for clinical purposes in movement disorder treatments, structural features obtained from MRI offer the powerful potential to identify candidates who are more likely to benefit from deep brain stimulation and provide insight into the complexity of disorder pathophysiology.

Magnetothermal Neurostimulation: A Minimally Invasive and "Wireless" Alternative for Deep Brain Stimulation in Movement Disorders?

Movement Disorders Clinical PracticeVolume 9, Issue 4 p. 454-455 IN FOCUS Magnetothermal Neurostimulation: A Minimally Invasive and “Wireless” Alternative for Deep Brain Stimulation in Movement Disorders? Sergio A. Castillo-Torres MD, Corresponding Author Sergio A. Castillo-Torres MD [email protected] orcid.org/0000-0002-4727-2535 Edmond J. Safra Fellowship in Movement Disorders at Servicio de Movimientos Anormales, Departamento de Neurología, Fleni, Buenos Aires, Argentina Correspondence to: Dr. Sergio Andrés Castillo Torres, Edmond J. Safra Fellowship in Movement Disorders, Servicio de Movimientos Anormales, Departamento de Neurología, Fleni, Montañeses 2325, CABA, C1428AQK, Buenos Aires, Argentina; E-mail: [email protected]Search for more papers by this authorMauricio J. Páez-Maggio MD, Mauricio J. Páez-Maggio MD Servicio de Movimientos Anormales, Departamento de Neurología, Fleni, Buenos Aires, ArgentinaSearch for more papers by this author Sergio A. Castillo-Torres MD, Corresponding Author Sergio A. Castillo-Torres MD [email protected] orcid.org/0000-0002-4727-2535 Edmond J. Safra Fellowship in Movement Disorders at Servicio de Movimientos Anormales, Departamento de Neurología, Fleni, Buenos Aires, Argentina Correspondence to: Dr. Sergio Andrés Castillo Torres, Edmond J. Safra Fellowship in Movement Disorders, Servicio de Movimientos Anormales, Departamento de Neurología, Fleni, Montañeses 2325, CABA, C1428AQK, Buenos Aires, Argentina; E-mail: [email protected]Search for more papers by this authorMauricio J. Páez-Maggio MD, Mauricio J. Páez-Maggio MD Servicio de Movimientos Anormales, Departamento de Neurología, Fleni, Buenos Aires, ArgentinaSearch for more papers by this author First published: 09 February 2022 https://doi.org/10.1002/mdc3.13420Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume9, Issue4May 2022Pages 454-455 RelatedInformation

Deep brain stimulation in movement disorders: 15 year experience of King Faisal Specialist Hospital & Research Center

Deep brain stimulation is a revolutionary intervention that treats specific movement disorders through targeting particular areas in the brain. DBS offers hope for patients that do not reach sufficient benefit from medical management. King Faisal Specialist Hospital and Research Center has been providing DBS treatments since 2003 and has since provided the full spectrum of care surrounding the surgical and medical elements of implanting a DBS Device and monitoring the results through follow ups, programming and medical management support. The existence of this vast experience will serve as a reliable and detailed reference to navigate the decision, choice, management and follow ups for the use of DBS in movement disorders patients.

Neurophysiological biomarkers to optimize deep brain stimulation in movement disorders.

Intraoperative neurophysiological information could increase accuracy of surgical deep brain stimulation (DBS) lead placement. Subsequently, DBS therapy could be optimized by specifically targeting pathological activity. In Parkinson’s disease, local field potentials (LFPs) excessively synchronized in the beta band (13–35 Hz) correlate with akinetic-rigid symptoms and their response to DBS therapy, particularly low beta band suppression (13–20 Hz) and high frequency gamma facilitation (35–250 Hz). In dystonia, LFPs abnormally synchronize in the theta/alpha (4–13 Hz), beta and gamma (60–90 Hz) bands. Phasic dystonic symptoms and their response to DBS correlate with changes in theta/alpha synchronization. In essential tremor, LFPs excessively synchronize in the theta/alpha and beta bands. Adaptive DBS systems will individualize pathological characteristics of neurophysiological signals to automatically deliver therapeutic DBS pulses of specific spatial and temporal parameters.

Use of non-invasive stimulation in movement disorders: a critical review.

Noninvasive stimulation has been widely used in the past 30 years to study and treat a large number of neurological diseases, including movement disorders. In this critical review, we illustrate the rationale for use of these techniques in movement disorders and summarize the best medical evidence based on the main clinical trials performed to date. A nationally representative group of experts performed a comprehensive review of the literature in order to analyze the key clinical decision-making factors driving transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) in movement disorders. Classes of evidence and recommendations were described for each disease. Despite unavoidable heterogeneities and low effect size, TMS is likely to be effective for treating motor symptoms and depression in Parkinson's disease (PD). The efficacy in other movement disorders is unclear. TMS is possibly effective for focal hand dystonia, essential tremor and cerebellar ataxia. Additionally, it is likely to be ineffective in reducing tics in Tourette syndrome. Lastly, tDCS is likely to be effective in improving gait in PD. There is encouraging evidence for the use of noninvasive stimulation on a subset of symptoms in selected movement disorders, although the means to optimize protocols for improving positive outcomes in routine clinical practice remain undetermined. Similarly, the best stimulation paradigms and responder profile need to be investigated in large clinical trials with established therapeutic and assessment paradigms that could also allow genuine long-term benefits to be determined.

Theta Burst Deep Brain Stimulation in Movement Disorders.

Theta Burst Deep Brain Stimulation in Movement Disorders.

Prefrontal - subthalamic pathway supports action selection in a spatial working memory task

Subthalamic nucleus (STN) is the main source of feed-forward excitation in the basal ganglia and a main target of therapeutic deep brain stimulation in movement disorders. Alleviation of motor symptoms during STN stimulation can be accompanied by deterioration of abilities to quickly choose between conflicting alternatives. Cortical afferents to the subthalamic region (ST), comprising STN and zona incerta (ZI), include projections from the medial prefrontal cortex (mPFC), yet little is known about prefrontal-subthalamic coordination and its relevance for decision-making. Here we combined electrophysiological recordings with optogenetic manipulations of projections from mPFC to ST in mice as they performed a spatial working memory task (T-maze) or explored an elevated plus maze (anxiety test). We found that gamma oscillations (30–70 Hz) are coordinated between mPFC and ST at theta (5–10 Hz) and, less efficiently, at sub-theta (2–5 Hz) frequencies. An optogenetic detuning of the theta/gamma cross-frequency coupling between the regions into sub-theta range impaired performance in the T-maze, yet did not affect anxiety-related behaviors in the elevated plus maze. Both detuning and inhibition of the mPFC-ST pathway led to repeated incorrect choices in the T-maze. These effects were not associated with changes of anxiety and motor activity measures. Our findings suggest that action selection in a cognitively demanding task crucially involves theta rhythmic coordination of gamma oscillatory signaling in the prefrontal-subthalamic pathway.

Non-invasive Transcranial Electrical Stimulation in Movement Disorders.

Dysfunction within large-scale brain networks as the basis for movement disorders is an accepted hypothesis. The treatment options for restoring network function are limited. Non-invasive brain stimulation techniques such as repetitive transcranial magnetic stimulation are now being studied to modify the network. Transcranial electrical stimulation (tES) is also a portable, cost-effective, and non-invasive way of network modulation. Transcranial direct current stimulation and transcranial alternating current stimulation have been studied in Parkinson’s disease, dystonia, tremor, and ataxia. Transcranial pulsed current stimulation and transcranial random noise stimulation are not yet studied enough. The literature in the use of these techniques is intriguing, yet many unanswered questions remain. In this review, we highlight the studies using these four potential tES techniques and their electrophysiological basis and consider the therapeutic implication in the field of movement disorders. The objectives are to consolidate the current literature, demonstrate that these methods are feasible, and encourage the application of such techniques in the near future.

A Population Model of Deep Brain Stimulation in Movement Disorders From Circuits to Cells.

For more than 30 years, deep brain stimulation (DBS) has been used to target the symptoms of a number of neurological disorders and in particular movement disorders such as Parkinson’s disease (PD) and essential tremor (ET). It is known that the loss of dopaminergic neurons in the substantia nigra leads to PD, while the exact impact of this on the brain dynamics is not fully understood, the presence of beta-band oscillatory activity is thought to be pathological. The cause of ET, however, remains uncertain, however pathological oscillations in the thalamocortical-cerebellar network have been linked to tremor. Both of these movement disorders are treated with DBS, which entails the surgical implantation of electrodes into a patient’s brain. While DBS leads to an improvement in symptoms for many patients, the mechanisms underlying this improvement is not clearly understood, and computational modeling has been used extensively to improve this. Many of the models used to study DBS and its effect on the human brain have mainly utilized single neuron and single axon biophysical models. We have previously shown in separate models however, that the use of population models can shed much light on the mechanisms of the underlying pathological neural activity in PD and ET in turn, and on the mechanisms underlying DBS. Together, this work suggested that the dynamics of the cerebellar-basal ganglia thalamocortical network support oscillations at frequency range relevant to movement disorders. Here, we propose a new combined model of this network and present new results that demonstrate that both Parkinsonian oscillations in the beta band and oscillations in the tremor frequency range arise from the dynamics of such a network. We find regions in the parameter space demonstrating the different dynamics and go on to examine the transition from one oscillatory regime to another as well as the impact of DBS on these different types of pathological activity. This work will allow us to better understand the changes in brain activity induced by DBS, and allow us to optimize this clinical therapy, particularly in terms of target selection and parameter setting.

Chapter 12 - Smart neuromodulation in movement disorders

Deep brain stimulation (DBS) is a technique for invasive subcortical neuromodulation using a totally implantable permanent device. DBS is an effective therapy for movement disorders and is under investigation for the treatment of many other conditions including Tourette syndrome, epilepsy, and depression. Traditional DBS is limited by labor-intensive manual programming, high current requirements, and lack of responsiveness to fluctuations in the patient's signs and symptoms. The field is moving toward adaptive closed loop systems with stimulation modulated by peripheral or intracranial sensors, a technique often described as "smart neuromodulation." Advances in the understanding of brain rhythms associated with specific neurologic symptoms and the introduction of novel bidirectional neural interfaces are facilitating investigative studies of closed loop stimulation in movement disorders. These studies suggest the potential for greater efficacy with fewer adverse effects. It may be possible to generalize the hardware platforms and control strategies developed to other brain disorders.

Anatomical brain structures normalization for deep brain stimulation in movement disorders.

Deep brain stimulation (DBS) therapy requires extensive patient-specific planning prior to implantation to achieve optimal clinical outcomes. Collective analysis of patient's brain images is promising in order to provide more systematic planning assistance. In this paper the design of a normalization pipeline using a group specific multi-modality iterative template creation process is presented. The focus was to compare the performance of a selection of freely available registration tools and select the best combination. The workflow was applied on 19 DBS patients with T1 and WAIR modality images available. Non-linear registrations were computed with ANTS, FNIRT and DRAMMS, using several settings from the literature. Registration accuracy was measured using single-expert labels of thalamic and subthalamic structures and their agreement across the group. The best performance was provided by ANTS using the High Variance settings published elsewhere. Neither FNIRT nor DRAMMS reached the level of performance of ANTS. The resulting normalized definition of anatomical structures were used to propose an atlas of the diencephalon region defining 58 structures using data from 19 patients.

Deep Brain Stimulation in Movement Disorders: From Experimental Surgery to Evidence-Based Therapy.

Deep brain stimulation (DBS) of 3 different targets is the most important therapeutic innovation of the past 30 years for patients with fluctuating Parkinson's disease (PD), disabling dystonia, tremors, and refractory Gilles de la Tourette syndrome. When compared with medical treatment alone, controlled studies have shown better motor, nonmotor, and particularly quality-of-life outcomes with large effect sizes for advanced complicated PD that cannot be improved with medication, and also for PD patients with only early fluctuations. Class 1 studies have also shown superiority over medical treatment for generalized, segmental, and botulinum-toxin refractory focal cervical dystonia. Long-term efficacy is established for all indications with open studies. For tremors, open studies have shown that DBS is remarkably effective on PD and essential tremor, but efficacy on severe essential tremor and cerebellar tremors is limited by a tendency for tolerance/habituation, including concerns about long-term efficacy. Open studies of disabling Gilles de la Tourette syndrome show an improvement in tics. New developments hold a promise for further improvement. New hardware with directional stimulation and new stimulation paradigms are further areas of research. The targets of DBS are refined with new imaging processing that will help to diversify the surgical targets. New indications are being explored. Closed-loop DBS using brain or peripheral sensor signals have shown favorable clinical short-term results. Long-term data are lacking, and it is hoped that similar approaches for other movement or behavioral disorders may be developed. Exciting new developments carry the hope for a more pathophysiology-based approach for DBS for various brain circuit disorders. © 2019 International Parkinson and Movement Disorder Society.

The use of transcranial magnetic stimulation as a treatment for movement disorders: A critical review.

Transcranial magnetic stimulation is a safe and painless non-invasive brain stimulation technique that has been largely used in the past 30 years to explore cortical function in healthy participants and, inter alia, the pathophysiology of movement disorders. During the years, its use has evolved from primarily research purposes to treatment of a large variety of neurological and psychiatric diseases. In this article, we illustrate the basic principles on which the therapeutic use of transcranial magnetic stimulation is based and review the clinical trials that have been performed in patients with movement disorders. A search of the PubMed database for research and review articles was performed on therapeutic applications of transcranial magnetic stimulation in movement disorders. The search included the following conditions: Parkinson's disease, dystonia, Tourette syndrome and other chronic tic disorders, Huntington's disease and choreas, and essential tremor. The results of the studies and possible mechanistic explanations for the relatively minor effects of transcranial magnetic stimulation are discussed. Possible ways to improve the methodology and achieve greater therapeutic efficacy are discussed. Despite the promising and robust rationales for the use of transcranial magnetic stimulations as a treatment tool in movement disorders, the results taken as a whole are not as successful as were initially expected. There is encouraging evidence that transcranial magnetic stimulation may improve motor symptoms and depression in Parkinson's disease, but the efficacy in other movement disorders is unclear. Possible improvements in methodology are on the horizon but have yet to be implemented in large clinical studies. © 2019 International Parkinson and Movement Disorder Society © 2019 International Parkinson and Movement Disorder Society.

Deep brain stimulation in movement disorders: evidence and therapy standards

The deep brain stimulation (DBS) in movement disorders is well established and in many aspects evidence-based procedure. The treatment indications are very heterogeneous and very specific in their course and therapy. The deep brain stimulation plays very important, but usually not the central role in this conditions. The success in the application of DBS is essentially associated with the correct, appropriate and timely indication of the therapy in the course of these diseases. Thanks to the good standardization of the DBS procedure and sufficient published data, the recommendations for indication, diagnosis and operative procedures can be generated. The following article attempts to summarize the most important decision-making criteria and current therapy standards in this fairly comprehensive subject and to present them in close proximity to practice.

Transcranial direct current stimulation can enhance working memory in Huntington's disease

Transcranial direct current stimulation (tDCS) combined with a cognitive task can enhance targeted aspects of cognitive functioning in clinical populations. The movement disorder Huntington's disease (HD) is associated with progressive cognitive impairment. Deficits in working memory (WM) can be apparent early in the disease and impact functional capacity. We investigated whether tDCS combined with cognitive training could improve WM in patients with HD, and if baseline clinical or cognitive measures may predict efficacy. Twenty participants with HD completed this crossover trial, undergoing 1.5mA anodal tDCS over left dorsolateral prefrontal cortex and sham stimulation on separate visits. Participants and assessor were blinded to condition order, which was randomised across participants. All participants completed baseline clinical and cognitive assessments. Pre- and post-stimulation tasks included digit reordering, computerised n-back tests and a Stroop task. During 15min of tDCS/sham stimulation, participants practiced 1- and 2-back WM tasks. Participants exhibited an increase in WM span on the digit re-ordering span task from pre- to post-stimulation after tDCS, but not after sham stimulation. Gains in WM were positively related to motor symptom ratings and negatively associated with verbal fluency scores. Patients with more severe motor symptoms showed greatest improvement, suggesting that motor symptom ratings may help identify patients who are most likely to benefit from tDCS. Conclusions: Dorsolateral prefrontal tDCS appears well tolerated in HD and enhances WM span compared to sham stimulation. Our findings strongly encourage further investigation of the extent to which tDCS combined with cognitive training could enhance everyday function in HD.ClinicalTrials.gov; NCT02216474 Brain stimulation in Movement Disorders; https://clinicaltrials.gov/ct2/show/NCT02216474

EP 41. Deep brain stimulation for movement disorders in Kazakhstan

Introduction Movement disorders are very complicated diseases to treat. Sometimes medical treatment is not successful or results in unpleasant complications. There is a neurosurgical treatment for movement disorders, which is advanced and very effective in well selected cases. The DBS surgery program in Kazakhstan started in 2013. Materials and methods 130 patients with movement disorders were operated on in the National center for neurosurgery (Kazakhstan) in the period 2013–2015 including 117 PD patients, 10 dystonia cases, 1 Tourette syndrome, 1 essential tremor and 1 neuropathic pain. There were 58 male and 72 female. The average age of the patients was 51 y.o. STN was a target in 116 cases, GPi in 12, VIM – 1 and ventroposterolateral nucleus of the sensory thalamus in 1 case. Follow up of the 73 patients was more then 1 year. We used international selection criteria for DBS for PD. Their clinical assessment was established by using UPDRS. The average duration of disease was 10 years. Severe fluctuations and dyskinesia were present in 75% of cases. Focal dystonia (torticollis) was a major indication for GPi DBS. For implantation, we used the multipurpose stereotactic frame by Electa (Sweden) and SurgiPlan software by Elekta (Sweden). We implanted the DBS therapy Activa PC system from Medtronic (USA, Minneapolis), which consisted of two leads, extension cables and an IPG. Most of the cases (90%) were implanted using microelectroderecording using the LeadPoint® Micro Electrode Recording (MER) system. Results Excellent improvement of motor functions (more than 50% by UPDRS) in PD patients increased from 65% in 2013 and 71% in 2014 to 92% in 2015. Postural instability, gait problems and autonomic symptoms were less regressed. We decreased the dosage of dopaminergic drugs for 30–50% and thereafter the drug induced dyskinesia regressed in all cases. Moreover in 6 cases we postponed medication completely. DBS for dystonia was dramatically effective in cases with cervical dystonia and less successful in secondary dystonia cases. The Tourette patient became significantly better by the Yale Global Tic Severity Scale but after cancelling the drugs there was a sudden deterioration. We are continuing to follow up him. The essential tremor case became better but not completely. We had complications in 12 cases: 1 symptomatic bleeding with hemiparesis, 2 asymptomatic bleeding with successful reimplantations, 7 infection and 2 tromboembolism (1 fatal). The patient who bled was implanted again after intensive care and rehabilitation. Two infected cases were reimplanted in 6 months. Getting more experience using special protocols and standards based on evidence medicine the rate of complications decreased year after year. Conclusion Deep brain stimulation is an effective treatment of PD and can decrease main symptoms of the disease: rigidity, tremor and bradykinesia and sometimes postural instability and gait problems. Dystonia and essential tremor are the real indication for DBS. More indications should be investigated using stereotactic neurosurgery. The right patient selection is the key for good results in this procedure. There is a DBS program in Kazakhstan in the National Center for neurosurgery.

Pedunculopontine Nucleus Stimulation in Intractable Epilepsy: A Recent Patent on Deep Brain Stimulation Therapy

The pathogenesis and management of intractable epilepsy (IE) remain challenging to neuroscientists even today. Electrical stimulation therapies like vagal nerve and deep brain stimulation (DBS) are gaining popularity as effective adjunctive treatments with a continued search for newer DBS targets. The strong antiepileptic influence of rapid eye movement sleep (REMS) controlled by acetylcholine neurons (AChN) in the pedunculpontine nucleus (PPN) in humans is well documented, the stimulation of which has been found to induce and enhance REMS. Furthermore, a specific reduction of AChN in the PPN has been observed in autopsy examination of patients with West syndrome (a severe form of epilepsy). Therefore, in view of the strong antiepileptic influence of REMS and its control by AChN in PPN, it is postulated that the PPN may be electrically stimulated as per pre-configurable programming and requirement for enhancing the genesis of REMS during the night sleep time to provide protection against epileptogenesis and seizureoccurrence. The PPN is also responsible for initiation of locomotion and control of gait based on which patents on PPN stimulation in movement disorders like Parkinson’s disease and as therapy for sleep disorders are already available. This brief article presents a recent patent on PPN stimulation in IE. Keywords: Acetylcholine neurons, biomarker of intractability, deep brain stimulation, EEG-desynchronization, EEGsynchronization, electrical stimulation therapy, pedunculopontine nucleus, polysomnography, REM sleep.

Neurosurgery: Directional electrodes widen the therapeutic window for deep brain stimulation in movement disorders.

Neurosurgery: Directional electrodes widen the therapeutic window for deep brain stimulation in movement disorders