Thalamic Deep Brain Stimulation for Post-Traumatic Neuropathic Limb Pain: Efficacy at Five Years’ Follow-Up and Effective Volume of Activated Brain Tissue

Abstract BACKGROUND: Deep brain stimulation (DBS) at the internal globus pallidus (GPi) has replaced ablative procedures for the treatment of primary generalized dystonia (PGD) because it is adjustable, reversible, and yields robust clinical improvement that appears to be long lasting. OBJECTIVE: To describe the long-term responses to pallidal DBS of a consecutive series of 22 pediatric patients with PGD. METHODS: Retrospective chart review of 22 consecutive PGD patients, ≤21 years of age treated by one DBS team over an 8-year period. The Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) was used to evaluate symptom severity and functional disability, pre- and post-operatively. Adverse events and medication changes were also noted. RESULTS: The median follow-up was 2 years (range, 1-8 years). All 22 patients reached 1-year follow-up; 14 reached 2 years, and 11 reached 3 years. The BFMDRS motor subscores were improved 84%, 93%, and 94% (median) at these time points. These motor responses were matched by equivalent improvements in function, and the response to DBS resulted in significant reductions in oral and intrathecal medication requirements after 12 and 24 months of stimulation. There were no hemorrhages or neurological complications related to surgery and no adverse effects from stimulation. Significant hardware-related complications were noted, in particular, infection (14%), which delayed clinical improvement. CONCLUSION: Pallidal DBS is a safe and effective treatment for PGD in patients <21 years of age. The improvement appears durable. Improvement in device design should reduce hardware-related complications over time.

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A prospective, double-blinded randomized controlled trial evaluating deep brain stimulation using multiple-source, constant-current rechargeable system for Parkinson's Disease: 3-year follow-up

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2020.06.162 ◽

2020 ◽

Vol 79 ◽

pp. e39-e40

Author(s):

J. Vitek ◽

R. Jain ◽

P. Starr

Keyword(s):

Randomized Controlled Trial ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Controlled Trial ◽

Multiple Source ◽

Constant Current ◽

Randomized Controlled ◽

Double Blinded ◽

Deep Brain

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A Meta-Analysis of the Effect of Subthalamic Nucleus-Deep Brain Stimulation in Parkinson's Disease-Related Pain

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.688818 ◽

2021 ◽

Vol 15 ◽

Author(s):

Yu Diao ◽

Yutong Bai ◽

Tianqi Hu ◽

Zixiao Yin ◽

Huangguang Liu ◽

...

Keyword(s):

Parkinson’S Disease ◽

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Meta Analysis ◽

Motor Symptom ◽

Stn Dbs ◽

Deep Brain

Pain from Parkinson's disease (PD) is a non-motor symptom affecting the quality of life and has prevalence of 20–80%. However, it is unclear whether subthalamic nucleus deep brain stimulation (STN–DBS), a well-established treatment for PD, is effective forPD-related pain. Thus, the objective of this meta-analysis was to investigate the efficacy of STN-DBS on PD-related pain and explore how its duration affects the efficacy of STN-DBS. A systematic search was performed using PubMed, Embase, and the Cochrane Library. Nine studies included numerical rating scale (NRS), visual analog scale (VAS), or non-motor symptom scale (NMSS) scores at baseline and at the last follow-up visit and therefore met the inclusion criteria of the authors. These studies exhibited moderate- to high-quality evidence. Two reviewers conducted assessments for study eligibility, risk of bias, data extraction, and quality of evidence rating. Random effect meta-analysis revealed a significant change in PD-related pain as assessed by NMSS, NRS, and VAS (P <0.01). Analysis of the short and long follow-up subgroups indicated delayed improvement in PD-related pain. These findings (a) show the efficacy of STN-DBS on PD-related pain and provide higher-level evidence, and (b) implicate delayed improvement in PD-related pain, which may help programming doctors with supplement selecting target and programming.Systematic Review Registration: This study is registered in Open Science Framework (DOI: 10.17605/OSF.IO/DNM6K).

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The Experiences of Patients with Deep Brain Stimulation in Parkinson’s Disease: Challenges, Expectations, and Accomplishments

Acta Medica Academica ◽

10.5644/ama2006-124.281 ◽

2020 ◽

Vol 49 (1) ◽

pp. 36

Author(s):

Özlem İbrahimoğlu ◽

Sevinc Mersin ◽

Eda Akyol

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

Healthcare Professionals ◽

Focus Group Interviews ◽

The Mean ◽

Group Interviews ◽

Deep Brain

Objectives. Deep brain stimulation (DBS) is a safe and effective alternative treatment of some movement disorders such as Parkinson's disease. Although DBS is an effective treatment for Parkinson's disease, because of the necessity of surgical intervention, follow-up and the effects on symptoms, this study was carried out to determine the challenges, expectations and accomplishments of patients with DBS in Parkinson’s disease.Materials and Methods. This qualitative study was carried out at the Neurosurgery Department of a research hospital in Turkey with seven patients who underwent DBS between 2008 and 2018. In the study, the challenges, expectations, and accomplishments of patients were investigated by using three focus group interviews in October 2018.Results. Among the participants, six patients were male, and one patient was female. The mean age of the patients was 56.85}16.48. Three main themes were revealed in the study. These were (1) Reborn; decrease in dependence, sense of accomplishment, enjoyment of life, (2) Prejudice; perceived as severely ill by others and (3) Fear; not being accustomed to the device, loss of device function.Conclusion. The results obtained from this study can be used in the process of adaptation to this process by discussing and evaluating the challenges, expectations and accomplishments of the Parkinson's patient in DBS with healthcare professionals and other patients.

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The medial forebrain bundle as a target for deep brain stimulation for obsessive-compulsive disorder

CNS Spectrums ◽

10.1017/s1092852916000286 ◽

2016 ◽

Vol 22 (3) ◽

pp. 282-289 ◽

Cited By ~ 30

Author(s):

Volker A. Coenen ◽

Thomas E. Schlaepfer ◽

Peter Goll ◽

Peter C. Reinacher ◽

Ulrich Voderholzer ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Major Depression ◽

Brain Stimulation ◽

Medial Forebrain Bundle ◽

Reward System ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Deep Brain

Deep brain stimulation (DBS) is a promising putative modality for the treatment of refractory psychiatric disorders such as major depression and obsessive-compulsive disorder (OCD). Several targets have been posited; however, a clear consensus on differential efficacy and possible modes of action remain unclear. DBS to the supero-lateral branch of the medial forebrain bundle (slMFB) has recently been introduced for major depression (MD). Due to our experience with slMFB stimulation for MD, and because OCD might be related to similar dysfunctions of the reward system, treatment with slMFB DBS seams meaningful. Here we describe our first 2 cases together with a hypothetical mode of action.We describe diffusion tensor imaging (DTI) fiber tractographically (FT)-assisted implantation of the bilateral DBS systems in 2 male patients. In a selected literature overview, we discuss the possible mode of action. Both patients were successfully implanted and stimulated. The follow-up time was 12 months. One patient showed a significant response (Yale–Brown Obsessive-Compulsive Scale [YBOCS] reduction by 35%); the other patient reached remission criteria 3 months after surgery (YBOCS<14) and showed mild OCD just above the remission criterion at 12 months follow-up.While the hypermetabolism theory for OCD involves the cortico–striato–thalamo–cortical (CSTC) network, we think that there is clinical evidence that the reward system plays a crucial role. Our findings suggest an important role of this network in mechanisms of disease development and recovery. In this uncontrolled case series, continuous bilateral DBS to the slMFB led to clinically significant improvements of ratings of OCD severity. Ongoing research focuses on the role of the reward system in OCD, and its yet-underestimated role in this underlying neurobiology of the disease.

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Treating post-traumatic tremor with deep brain stimulation: Report of five cases

Parkinsonism & Related Disorders ◽

10.1016/j.parkreldis.2013.07.022 ◽

2013 ◽

Vol 19 (12) ◽

pp. 1100-1105 ◽

Cited By ~ 16

Author(s):

Neil M. Issar ◽

Peter Hedera ◽

Fenna T. Phibbs ◽

Peter E. Konrad ◽

Joseph S. Neimat

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Post Traumatic ◽

Deep Brain

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Long-term follow-up of Huntington disease treated by bilateral deep brain stimulation of the internal globus pallidus

Journal of Neurosurgery ◽

10.3171/jns/2008/109/7/0130 ◽

2008 ◽

Vol 109 (1) ◽

pp. 130-132 ◽

Cited By ~ 45

Author(s):

Brigitte Biolsi ◽

Laura Cif ◽

Hassan El Fertit ◽

Santiago Gil Robles ◽

Philippe Coubes

Keyword(s):

Deep Brain Stimulation ◽

Globus Pallidus ◽

Brain Stimulation ◽

Movement Disorders ◽

Huntington Disease ◽

Internal Globus Pallidus ◽

Efficient Treatment ◽

Deep Brain ◽

Stimulation Of

Deep brain stimulation is now accepted as a safe and efficient treatment for movement disorders including selected types of dystonia and dyskinesia. Very little, however, is known about its effect on other movement disorders, particularly for “choreic” movements. Huntington disease is a fatal autosomal-dominant neurodegenerative disorder characterized by movement disorders, progressive cognitive impairment, and psychiatric symptoms. Bilateral chronic stimulation of the internal globus pallidus was performed to control choreic movements in a 60-year-old man with a 10-year history of Huntington disease. Chronic deep brain stimulation resulted in remarkable improvement of choreic movements. Postoperative improvement was sustained after 4 years of follow-up with a marked improvement in daily quality of life.

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