Deep Brain Stimulation

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Followup of bilateral subthalamic deep brain stimulation for Parkinsons disease

To demonstrate the effects of bilateral subthalamic deep brain stimulation (STN-DBS) in the treatment of Parkinson's disease (PD) after 4-45 months' follow-up. Keywords Deep brain stimulation subthalamic nucleus follow-up. In the past few years, deep brain stimulation (DBS) has become an accepted treatment modality for Parkinson's disease (PD) patients who experience disabling motor fluctuations and dyskinesia as a result of dopaminergic therapy, and some follow-up data have been published, including short-term follow-up for 3-6 months and

Deep brain stimulation as a functional scalpel

The reported series of patients extends the use of deep brain stimulation beyond the field of Parkinson's disease to new fields such as cluster headache, disruptive behaviour, SUNCt, epilepsy and tardive dystonia. Keywords Deep brain stimulation movement disorder chronic pain dystonia Parkinson's disease. At the beginning of the century stereotactic neurosurgery was used on animals for experimental purpose with the aim of mapping the brain's electrical activity and functional responses. The mapping process was followed by the development of surgery that was capable of changing function of brain, through small lesions in a key area. In the nineties, deep brain stimulation (DBS), after its optimization by Benabid 2-5 , for the control of parkinsonian tremor gained worldwide the role of a promising therapeutical tool. The administration of high frequency and low amplitude electric stimulation, allows the modulation of neuronal activity in a reversible way the parameter of stimulation can...

Detection of boundaries of subthalamic nucleus by multiplecell spike density analysis in deep brain stimulation for

Keywords Parkinson's disease deep brain stimulation subthalamic nucleus substantia nigra, microelectrode semimicroelectrode. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) affords great benefits to the daily activities in patients with advanced Parkinson's disease (PD) 4, 5, 7 . Most of recent reports have placed emphasis on microelectrode recording of single cell activity for refining the anatomical targeting of the STN during surgery 1, 2, 8-10 . The ventral boundary of the STN is, however, sometimes unclear 9 . Because a microelectrode detects only electrical events arising from a small area, multiple sampling of single cell activity is needed by changing the location of the electrode tip to determine whether the electrode has passed through the ventral

Rapid subthalamic nucleus deep brain stimulation lead placement utilising CTMRI fusion microelectrode recording and

Mri Normal Aging

Subthalamic nucleus (STN) deep brain stimulation (DBS) has become an established treatment strategy for patients with medically refractory Parkinson's disease (PD). There are however numerous strategies employed for STN lead placement. Variations include method of STN localisation, use of microelectrode recording, number of microelectrode recording passes and time taken for the procedure. We describe a relatively simple and rapid technique of STN lead placement utilising CT MRI image fusion, microelectrode recording and test stimulation. Keywords Deep brain stimulation movement disorder Parkinson's disease subthalamic nucleus. Subthalamic nucleus (STN) deep brain stimulation (DBS) has become an established treatment strategy for patients with medically refractory Parkinson's disease (PD). There are however numerous strategies employed for STN lead placement. Variations include method of STN localisation, use of microelectrode recording, number of microelectrode recording passes and...

Pallidal highfrequency deep brain stimulation for camptocormia an experience of three cases

The term ''camptocormia'' describes a forward-flexed posture. It is a condition characterized by severe frontal flexion of the trunk. Recently, camptocormia has been regarded as a form of abdominal segmental dystonia. Deep brain stimulation (DBS) is a promising therapeutic approach to various types of movement disorders. The authors report the neurological effects of DBS to the bilateral globus pallidum (GPi) in three cases of disabling camptocormia. Deep brain stimulation (DBS) has been regarded as a promising therapeutic approach for various types of movement disorders. The authors report the neurological effects of deep brain stimulation to the bilateral globus pallidum (GPi-DBS) in three cases of disabling camptocormia.

The Value of Animal Models

Normal motor behavior is the final product of massive neural computation performed by tissues with precise three-dimensional organizations and connectivity patterns. Similar to an electronics technician searching for a defective transistor on a circuit board, clinicians and scientists engaged in movement disorders research identify neuronal populations causally associated with specific forms of abnormal motor behavior. Studies of this type are a critical first step in defining targets for stereotactic neurosurgical procedures. Animal models have been crucial for identifying the subthalamic nucleus (STN), globus pallidus pars interna, and ventral intermediate nucleus of the thalamus as appropriate targets for deep brain stimulation in patients with Parkinson disease, dystonia, and essential tremor, respectively. In vivo studies have also been critical for characterizing the neuro-physiological underpinnings of spasticity and task-specific dystonias and, as a consequence, rehabilitation...

Multimodal neurosurgical strategies for the management of dystonias

Dystonia have many subtypes, and is classified as focal, segmental and generalized. As for focal dystonia, spasmodic torticollis (cervical dystonia) and writer's cramp are most common. Cervical dystonia is mainly treated effectively with selective peripheral denervation, and task specific focal dystonia of the hand (writer's cramp) is effectively alleviated by stereotactic ventro-oral thalamotomy. Generalized dystonia is dramatically improved with deep brain stimulation of the globus pallidus interna. Because the majority of dystonia is medically refractory and surgical treatment results in marked improvement, the authors strongly believe that dystonia should be regarded as a definite neurosurgical indication. Based on personal experience of nearly 200 cases of dystonia surgery, the authors describe a multimodal approach to various types of dystonias. Also we discuss possible relation between dystonias and psychiatric conditions, and future new indication of dystonia surgery. Keywords...

Clinical Features And Classification Of The Human Dystonias

Under the clinically oriented classification, two main eti-ologic categories appear primary torsion dystonia (PTD), defined as a syndrome in which dystonia is the predominant phenotypic manifestation and there is no evidence of neuronal degeneration or an acquired cause, and secondary (nonprimary) dystonia, which may be further divided into those with inherited, complex, and acquired etiologies (Bressman 2003 Bressman 2004). No consistent pathological changes have been demonstrated to date for primary dystonia. In contrast, many secondary forms of dystonia are often associated with degenerative processes, such as striatal necrosis in glutaric aciduria (Strauss et al. 2003). Although dystonia may improve with oral medications, bot-ulinum toxin injections, and deep brain stimulation surgery, investigators have not identified a specific single treatment for primary dystonia (Jankovic 2004). Treatment of secondary dystonia is often directed at treating the underlying condition, such as...

Research Applications

Or the lateral area of the sensorimotor subthalamic nucleus ameliorated parkinsonian motor behaviors in behaving animals, suggesting that these areas might be good targets for ablative or deep brain stimulation (Baron et al. 2002). The MPTP primate model also has provided an opportunity to investigate surgical interventions. For example, lesioning the STN in MPTP-treated monkeys demonstrated reduction of parkinsonism (Bergman et al. 1990). This strategy was tested due to the earlier observation that spontaneous activity in STN neurons was increased in MPTP monkeys compared to normal animals. Further, others found that direct lesions of the subthalamic nucleus alleviated parkinsonism in MPTP monkeys (Aziz et al. 1992). Similarly, lesions of the pars reticulata of the substantia nigra may reduce contralateral bradykinesia and akinesia in MPTP monkeys (Wichmann et al. 2001). A recent study investigated the effects of high frequency stimulation of the STN and found that it increased...

Subject Index Vol 130

Benign extramedullary tumours, 1988, Vol. 16 Frameless stereotactic surgery neuronavigation, 2003, Vol. 29 surgical wands, 1998, Vol. 24 Functional neurosurgery, 1983, Vol. 10 chronic deep brain stimulation, Advances Treatment of Diseases of the Central Nervous System Using Encapsulated Cells (A. F. Hottinger, P. Aebischer) Intracranial Endoscopy (G. Fries, A. Perneczky) Chronic Deep Brain Stimulation for Movement Disorders (D. Caparros-Lefebvre, S. Blond, J. P. N'Guyen, P. Pollak, A. L. Benabid) Technical Standards Recent Advances in the Treatment of Central Nervous System Germ Cell Tumors (Y. Sawamura, H. Shirato, N. de Tribolet) Hypothalamic Gliomas (V. V. Dolenc) Surgical Approaches of the Anterior Fossa and Preservation of Olfaction (J. G. Passagia, J. P. Chirossel, J. J. Favre)

Steep situation 4 How long is too long

How long does it take you to get to sleep If you lie restless in bed for more than 30 minutes or so, we recommend that you get up. What Get up when you want to sleep Getting up may sound counterproductive, but it's important for your brain to associate your bed with sleep. So if you lie in bed too long without actually sleeping, your brain will only get more mixed up. Furthermore, when you get up and do something boring such as pay bills, your brain will associate unpleasantness with getting up. Just don't do something stimulating. And if you do pay your bills in the middle of the night, please check your addition in the morning.

Lifting Mood Through Exercise

Hy devote a whole chapter to exercise in a book that deals with anxiety and depression Well, because getting up and moving increases the naturally occurring feel-good endorphins in the human body. When endorphins, substances occurring naturally in the brain that are chemically similar to morphine, spread through your brain, you get a sense of well-being and pleasure. And it's hard to be depressed or anxious when you feel good inside.

Sleep situation 3 The sleep setting

The environment you sleep in plays a major part in determining the quality of your sleep. For most people, sleep comes more easily when it's dark. But what if your work shift requires that you sleep in the daytime Consider getting blackout curtains or wearing a sleep mask because darkness tells your brain it's time to sleep.

Making the Medication Decision

Today, we know more about the brain and its relationship to emotional problems than ever before we understand that chemical imbalances in the brain accompany both anxiety and depression. Because of this growing knowledge, some television commercials would lead you to believe that making some simple corrections to your brain chemistry with the advertised drug will cure your problem. Voila

Abnormal Motor Signs

FIGURE 1 Effects of selective lesions on motor signs in the dystonic rat. The number of abnormal motor signs on P20 was counted over a five-minute observation period. All lesions had significant effects (P< 0.01) on the total number of motor signs. EAA, excitatory amino acid lesion dLV, dorsal half of the lateral vestibular nucleus MCN, medial cerebellar nucleus INT, interpositus cerebellar nucleus LCN, lateral cerebellar nucleus CTRL, control. (Reprinted from Brain Research, vol. 697, LeDoux et al. 1995 with permission from Elsevier.)

Visuospatial Disorders In Parkinson Disease

Since degeneration of dopaminergic neurons constitutes the main biochemical abnormality found in PD, dopamine depletion has been considered to account for most of the symptoms, including behavioral abnormalities and cognitive deficits (89). If striatal dopamine deficiency plays a role in PD patients' cognitive deficit, specialized hemispheric functions contralateral to the motor symptoms should be altered in patients with hemiparkinsonism, providing a unique opportunity to study the effect of asymmetrical subcortical degeneration on cognitive functions (108). Yet, the results of these studies have been controversial. A number of studies were not able to demonstrate a specific pattern of difference between patients with predominantly left and right symptoms (9,109-111). However, a number of more recent studies (43,44) did find a specific directional bias related to the side of the predominant symptoms. On the other hand, Pillon et al. (112) demonstrated that cognitive impairment is...

Prospects for the Future

Bradley Hyman

Ultimately, investment in brain research is the only cost-effective means to avoid the pending public health catastrophe facing countries with aging populations. Now it is essential to reevaluate priorities in all developed countries with resources with the goal of significantly expanding the world commitment to support research on disorders of the aging brain. The ultimate aim of such an international initiative should be the reduction of the duration of illness, numbers at risk or affected by AD and, cost of care. Fortunately, the necessary scientific leads and the technical information are at hand to launch a bold initiative. A delay in the onset of disabling symptoms will allow patients to continue functioning independently for longer periods. An initiative aimed at mobilizing the necessary resource to delay the onset of the disease by five years for all age groups over 65 would reduce nearly half the total number of individuals with the disease. But, we need to act quickly. In 20...

Unique MAP2 Species in Human Neuroblastoma Cells

Other studies by Joachim Kirsch in collaboration with Heinrich Betz at the Max-Planck-Institute for Brain Research, Frankfurt, have demonstrated that a 93-kDa glycine receptor-associated protein binds to tubulin. This 92 -kDa protein (termed Gephyrin) appears to anchor the glycine receptor at postsynaptic sites via binding to subsynaptic tubulin and thus serves an important role in the topological organization of the postsynaptic membrane 112 .

Feedforward control of poststroke movement disorders by ondemand type stimulation of the thalamus and motor cortex

Deep brain stimulation (DBS) of the thalamus (Vo Vim) has become popular as a means of controlling involuntary movements, including post-stroke movement disorders. We have also found that post-stroke movement disorders and motor weakness can sometimes be controlled by motor cortex stimulation (MCS). In some forms of movement disorders, motor dysfunction becomes evident only when patients intend to move their body. We have developed an on-demand type stimulation system which triggers stimulation by detecting intrinsic signals of intention to move. Such a system represents feed-forward control (FFC) of involuntary movements. We report here our experience of DBS and MCS for controlling post-stroke movement disorders, and discuss the value of FFC. Excellent control of post-stroke movement disorders was achieved by conventional DBS and or MCS in 20 of 28 patients with hemichoreoathetosis, hemiballism tremor, and motor weakness. FFC was tested in 6 patients who demonstrated excellent...

Relationship To Human Dystonia

Autocorrelation Spike Train

FIGURE 6 Purkinje cell spike trains from normal (A) and dystonic (B) rats. Complex spikes are identified with arrows. (Reprinted from Experimental Brain Research, vol. 145, LeDoux and Lorden 2002 with permission from Springer-Verlag.) FIGURE 6 Purkinje cell spike trains from normal (A) and dystonic (B) rats. Complex spikes are identified with arrows. (Reprinted from Experimental Brain Research, vol. 145, LeDoux and Lorden 2002 with permission from Springer-Verlag.) FIGURE 7 Spike train characteristics of a hemispheric Purkinje cell from a P15 normal rat. (A) Simple-spike interspike-interval histogram. (B) Simple-spike autocorrelation. (C) Complex-spike interspike interval histogram. (D) Complex-spike autocorrelation. (E) Cross-correlation between simple and complex spikes. (Reprinted from Experimental Brain Research, vol. 145, LeDoux and Lorden 2002 with permission from SpringerVerlag.) FIGURE 8 Spike train characteristics of a vermal Purkinje cell from a P16 dystonic rat. (A) Simple...

Author Biography

Having chosen the brain as his lifelong field of study and work, the next decision involved the choice of either clinical neurology or brain research Dr. Hendelman chose the latter, with the help of Dr. Francis McNaughton, a senior neurologist at the MNI. Postgraduate studies continued for 4 years in the United States, in the emerging field of developmental neuroscience, using the new techniques of nerve tissue culture and electron microscopy. Dr. Richard Bunge was his research mentor at Columbia University Medical Center in New York City, while his neuroanatomy mentor was Dr. Malcolm Carpenter, author of the well-known textbook Human Neuroanatomy.

Video Legends

SEGMENT 3 A 56-year-old man with a long history of PD with mild bradykinesia and moderate to severe resting and action tremor of the right hand. Because he had incomplete tremor response to medications, he underwent implantation of a left thalamic deep brain stimulator. Note his abrupt benefit when he activates the stimulator with a small magnet.

Blepharospasm

Symptom-based animal models of blepharospasm have utilized brain stimulation, drug administration, and two factor approaches to produce spasms of involuntary lid closure. Although all of the animal models exhibit closure of the lid, the experimental procedures that cause involuntary closure appear only rarely to resemble processes that are likely to occur in benign essential blepharospasm.

Series Preface

The Frontiers in Neuroscience series presents the insights of experts on emerging experimental techniques and theoretical concepts that are or will be at the vanguard of neuroscience. Books in the series cover topics ranging from methods to investigate apoptosis to modern techniques for neural ensemble recordings in behaving animals. The series also covers new and exciting multidisciplinary areas of brain research, such as computational neuroscience and neuroengineering, and describes breakthroughs in fields like insect sensory neuroscience, primate audition, and biomedical engineering. The goal is for this series to be the reference that every neuroscientist uses in order to get acquainted with new methodologies in brain research. These books can be given to graduate students and postdoctoral fellows when they are looking for guidance to start a new line of research. We hope that, as the volumes become available, the effort put in by us, the publisher, the book editors, and the...

Dedications

Eva obtained her PhD in Biology from the Georg August University, Gottingen, Germany, in 1967, and her postdoctoral training at the Vogt Institute for Brain Research, University of D sseldorf, Germany, in 19671971. In 1971, she moved to the Christian Albrecht University of Kiel, Germany, where she and Heiko started their pioneering studies on the cytoarchitecture of the human brain. In 1979, Eva followed Heiko to the J.W.

Brain Blaster

Brain Blaster

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