Neuroimaging of Deep Brain Stimulation
This article discusses how imaging improves surgical techniques and outcomes and widens possibilities in translational neuroscience in Parkinson disease, essential tremor, generalized dystonia, and epilepsy. In movement disorders diffusion tensor imaging allows anatomic segment of cortical areas and different functional subregions within deep-seated targets to understand the side effects of stimulation and gain more data to describe the therapeutic mechanism of action. The introduction of visualization of white matter tracks increases the safety of neurosurgical techniques in functional neurosurgery and neuro-oncology.
Abstract Deep brain stimulation (DBS) has evolved considerably over the past 4 decades. Although it has primarily been used to treat movement disorders such as Parkinson's disease, essential tremor, and dystonia, recently it has been approved to treat obsessive-compulsive disorder and epilepsy. Novel potential indications in both neurological and psychiatric disorders are undergoing active study. There have been significant advances in DBS technology, including preoperative and intraoperative imaging, surgical approaches and techniques, and device improvements. In addition to providing significant clinical benefit...
Medtronic continues to develop products for deep brain stimulation (DBS) for the treatment of movement disorders including Parkinson ’s disease (PD), essential tremor (ET), dystonia, and other neurological disorders such as epilepsy and obsessive-compulsive disorder (OCD). As part of the development process, the effectiveness and safety of new products must be evaluated before initiation of clinical trials. While some evaluatio ns can be performed with bench testing and simulation, regulatory agencies often require in vivo testing in preclinical animal models.
CONCLUSIONS: RC-IPGs can provide DBS patients with long-term therapeutic benefit while minimizing the need for battery replacement surgery. The authors have implanted rechargeable stimulators in 206 patients undergoing DBS surgery, and here they demonstrate the cost-effectiveness and high patient satisfaction associated with this procedure. PMID: 30265199 [PubMed - as supplied by publisher]
CONCLUSIONS Closed-loop DBS seeks to employ biomarkers, derived from sensors such as electromyography, electrocorticography, and local field potentials, to provide real-time, patient-responsive therapy for movement disorders. Most studies appear to focus on the treatment of Parkinson's disease. Several approaches hold promise, but additional studies are required to determine which approaches are feasible, efficacious, and efficient. PMID: 30064321 [PubMed - in process]
ConclusionThe results suggest that the subthalamic nucleus, internal globus pallidus and maybe also the thalamus are involved firstly in the subconscious cognitive process 100–250 ms after the stimuli, then in the conscious cognitive processes at the level of the afferent information processing network at 250–400 ms and finally they affect conscious cognitive activity at a time of large brain neuronal network 500–1500 ms after stimuli.
ConclusionsAs DBS-MEG research continues to develop, we can expect to gain a better understanding of diverse pathophysiological networks and their response to DBS. This knowledge will improve treatment efficacy, reduce side-effects, reveal optimal surgical targets, and advance the development of closed-loop neuromodulation.
Deep brain stimulation (DBS) is an established therapy to treat several neurological disorders (e.g. essential tremor, Parkinson ’s disease, dystonia, obsessive-compulsive disorder) (Benabid et al., 1991; Greenberg et al., 2010; Obeso et al., 2001; Vidailhet et al., 2005) and its efficacy is being explored for a range of additional indications (e.g. epilepsy, treatment-resistant depression, neuropathic pain, Tourette syndro me) (Fisher et al., 2010; Holtzheimer, 2012; Lempka et al., 2017; Malone et al., 2009; Morrell and RNS System in Epilepsy Study Group, 2011; Schrock et al., 2015).
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Conclusions As DBS-MEG research continues to develop, we can expect to gain a better understanding of diverse pathophysiological networks and their response to DBS. This knowledge will improve treatment efficacy, reduce side-effects, reveal optimal surgical targets, and advance the development of closed-loop neuromodulation.
Nexeon Medsytems is a medical device company focused on providing innovative neurostimulation products for patients suffering from debilitating neurological diseases, including Parkinson’s and essential tremor. It was founded in 2005 with ...