High-fidelity transmission of high-frequency burst stimuli from peripheral nerve to thalamic nuclei in children with dystonia

AbstractHigh-frequency peripheral nerve stimulation has emerged as a noninvasive alternative to thalamic deep brain stimulation for some patients with essential tremor. It is not known whether such techniques might be effective for movement disorders in children, nor is the mechanism and transmission of the peripheral stimuli to central brain structures understood. This study was designed to investigate the fidelity of transmission from peripheral nerves to thalamic nuclei in children with dystonia undergoing deep brain stimulation surgery. The ventralis intermediate (VIM) thalamus nuclei showed a robust evoked response to peripheral high-frequency burst stimulation, with a greatest response magnitude to intra-burst frequencies between 50 and 100 Hz, and reliable but smaller responses up to 170 Hz. The earliest response occurred at 12–15 ms following stimulation onset, suggesting rapid high-fidelity transmission between peripheral nerve and thalamic nuclei. A high-bandwidth, low-latency transmission path from peripheral nerve to VIM thalamus is consistent with the importance of rapid and accurate sensory information for the control of coordination and movement via the cerebello-thalamo-cortical pathway. Our results suggest the possibility of non-invasive modulation of thalamic activity in children with dystonia, and therefore the possibility that a subset of children could have beneficial clinical response without the need for invasive deep brain stimulation.

Download Full-text

Gait and Balance Changes with Investigational Peripheral Nerve Cell Therapy during Deep Brain Stimulation in People with Parkinson’s Disease

Brain Sciences ◽

10.3390/brainsci11040500 ◽

2021 ◽

Vol 11 (4) ◽

pp. 500

Author(s):

Geetanjali Gera ◽

Zain Guduru ◽

Tritia Yamasaki ◽

Julie A. Gurwell ◽

Monica J. Chau ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Peripheral Nerve ◽

Brain Stimulation ◽

Step Length ◽

Gait Velocity ◽

Balance Performance ◽

Improved Performance ◽

Deep Brain

Background: The efficacy of deep brain stimulation (DBS) and dopaminergic therapy is known to decrease over time. Hence, a new investigational approach combines implanting autologous injury-activated peripheral nerve grafts (APNG) at the time of bilateral DBS surgery to the globus pallidus interna. Objectives: In a study where APNG was unilaterally implanted into the substantia nigra, we explored the effects on clinical gait and balance assessments over two years in 14 individuals with Parkinson’s disease. Methods: Computerized gait and balance evaluations were performed without medication, and stimulation was in the off state for at least 12 h to best assess the role of APNG implantation alone. We hypothesized that APNG might improve gait and balance deficits associated with PD. Results: While people with a degenerative movement disorder typically worsen with time, none of the gait parameters significantly changed across visits in this 24 month study. The postural stability item in the UPDRS did not worsen from baseline to the 24-month follow-up. However, we measured gait and balance improvements in the two most affected individuals, who had moderate PD. In these two individuals, we observed an increase in gait velocity and step length that persisted over 6 and 24 months. Conclusions: Participants did not show worsening of gait and balance performance in the off therapy state two years after surgery, while the two most severely affected participants showed improved performance. Further studies may better address the long-term maintanenace of these results.

Download Full-text

Deep Brain Stimulation of the Posterior Insula in Chronic Pain: A Theoretical Framework

Brain Sciences ◽

10.3390/brainsci11050639 ◽

2021 ◽

Vol 11 (5) ◽

pp. 639

Author(s):

David Bergeron ◽

Sami Obaid ◽

Marie-Pierre Fournier-Gosselin ◽

Alain Bouthillier ◽

Dang Khoa Nguyen

Keyword(s):

Chronic Pain ◽

Electrical Stimulation ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

High Frequency ◽

Brain Lesion ◽

Low Frequency ◽

Posterior Insula ◽

Deep Brain ◽

Stimulation Of

Introduction: To date, clinical trials of deep brain stimulation (DBS) for refractory chronic pain have yielded unsatisfying results. Recent evidence suggests that the posterior insula may represent a promising DBS target for this indication. Methods: We present a narrative review highlighting the theoretical basis of posterior insula DBS in patients with chronic pain. Results: Neuroanatomical studies identified the posterior insula as an important cortical relay center for pain and interoception. Intracranial neuronal recordings showed that the earliest response to painful laser stimulation occurs in the posterior insula. The posterior insula is one of the only regions in the brain whose low-frequency electrical stimulation can elicit painful sensations. Most chronic pain syndromes, such as fibromyalgia, had abnormal functional connectivity of the posterior insula on functional imaging. Finally, preliminary results indicated that high-frequency electrical stimulation of the posterior insula can acutely increase pain thresholds. Conclusion: In light of the converging evidence from neuroanatomical, brain lesion, neuroimaging, and intracranial recording and stimulation as well as non-invasive stimulation studies, it appears that the insula is a critical hub for central integration and processing of painful stimuli, whose high-frequency electrical stimulation has the potential to relieve patients from the sensory and affective burden of chronic pain.

Download Full-text

Very high frequency versus low & high frequency Subthalamic Deep Brain Stimulation on gait in Parkinson’s disease: A preliminary study

Gait & Posture ◽

10.1016/j.gaitpost.2020.08.099 ◽

2020 ◽

Vol 81 ◽

pp. 400

Author(s):

M. Yanardag ◽

E.G. Yiğit Tekkanat ◽

N. Durmaz Çelik ◽

S. Özkan ◽

M. Vural ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

High Frequency ◽

Very High Frequency ◽

Preliminary Study ◽

Very High ◽

Deep Brain

Download Full-text

Letter to the Editor Regarding “Deep Brain Stimulation in Intractable Epilepsy: Pedunculopontine Nucleus versus Thalamic Nuclei: A Perspective”

World Neurosurgery ◽

10.1016/j.wneu.2020.04.104 ◽

2020 ◽

Vol 139 ◽

pp. 703

Author(s):

Harinder Jaseja

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Intractable Epilepsy ◽

Pedunculopontine Nucleus ◽

Thalamic Nuclei ◽

Letter To The Editor ◽

Deep Brain

Download Full-text

High-frequency measurement of depressive severity in a patient treated for severe treatment-resistant depression with deep-brain stimulation

Translational Psychiatry ◽

10.1038/tp.2017.145 ◽

2017 ◽

Vol 7 (8) ◽

pp. e1207-e1207 ◽

Cited By ~ 3

Author(s):

S Sani ◽

J Busnello ◽

R Kochanski ◽

Y Cohen ◽

R D Gibbons

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

High Frequency ◽

Frequency Measurement ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Resistant Depression ◽

Deep Brain

Download Full-text

Intraoperative Characterization of Subthalamic Nucleus-to-Cortex Evoked Potentials in Parkinson’s Disease Deep Brain Stimulation

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2021.590251 ◽

2021 ◽

Vol 15 ◽

Author(s):

Lila H. Levinson ◽

David J. Caldwell ◽

Jeneva A. Cronin ◽

Brady Houston ◽

Steve I. Perlmutter ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Evoked Potentials ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

High Frequency ◽

Therapeutic Effects ◽

Stn Dbs ◽

Deep Brain

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a clinically effective tool for treating medically refractory Parkinson’s disease (PD), but its neural mechanisms remain debated. Previous work has demonstrated that STN DBS results in evoked potentials (EPs) in the primary motor cortex (M1), suggesting that modulation of cortical physiology may be involved in its therapeutic effects. Due to technical challenges presented by high-amplitude DBS artifacts, these EPs are often measured in response to low-frequency stimulation, which is generally ineffective at PD symptom management. This study aims to characterize STN-to-cortex EPs seen during clinically relevant high-frequency STN DBS for PD. Intraoperatively, we applied STN DBS to 6 PD patients while recording electrocorticography (ECoG) from an electrode strip over the ipsilateral central sulcus. Using recently published techniques, we removed large stimulation artifacts to enable quantification of STN-to-cortex EPs. Two cortical EPs were observed – one synchronized with DBS onset and persisting during ongoing stimulation, and one immediately following DBS offset, here termed the “start” and the “end” EPs respectively. The start EP is, to our knowledge, the first long-latency cortical EP reported during ongoing high-frequency DBS. The start and end EPs differ in magnitude (p < 0.05) and latency (p < 0.001), and the end, but not the start, EP magnitude has a significant relationship (p < 0.001, adjusted for random effects of subject) to ongoing high gamma (80–150 Hz) power during the EP. These contrasts may suggest mechanistic or circuit differences in EP production during the two time periods. This represents a potential framework for relating DBS clinical efficacy to the effects of a variety of stimulation parameters on EPs.

Download Full-text

High-frequency deep brain stimulation of the putamen improves bradykinesia in Parkinson's disease

Movement Disorders ◽

10.1002/mds.23998 ◽

2011 ◽

Vol 27 (1) ◽

pp. 168-169

Author(s):

Erwin B. Montgomery ◽

He Huang ◽

Harrison C. Walker ◽

Barton L. Guthrie ◽

Ray L. Watts

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Brain Stimulation ◽

High Frequency ◽

Deep Brain ◽

Stimulation Of

Download Full-text

Evaluation of Automatic Segmentation of Thalamic Nuclei through Clinical Effects Using Directional Deep Brain Stimulation Leads: A Technical Note

Brain Sciences ◽

10.3390/brainsci10090642 ◽

2020 ◽

Vol 10 (9) ◽

pp. 642

Author(s):

Marie T. Krüger ◽

Rebecca Kurtev-Rittstieg ◽

Georg Kägi ◽

Yashar Naseri ◽

Stefan Hägele-Link ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Side Effects ◽

Brain Stimulation ◽

Technical Note ◽

Patient Specific ◽

Brain Anatomy ◽

Clinical Effects ◽

Thalamic Nuclei ◽

Lead Placement ◽

Deep Brain

Automatic anatomical segmentation of patients’ anatomical structures and modeling of the volume of tissue activated (VTA) can potentially facilitate trajectory planning and post-operative programming in deep brain stimulation (DBS). We demonstrate an approach to evaluate the accuracy of such software for the ventral intermediate nucleus (VIM) using directional leads. In an essential tremor patient with asymmetrical brain anatomy, lead placement was adjusted according to the suggested segmentation made by the software (Brainlab). Postoperatively, we used directionality to assess lead placement using side effect testing (internal capsule and sensory thalamus). Clinical effects were then compared to the patient-specific visualization and VTA simulation in the GUIDE™ XT software (Boston Scientific). The patient’s asymmetrical anatomy was correctly recognized by the software and matched the clinical results. VTA models matched best for dysarthria (6 out of 6 cases) and sensory hand side effects (5/6), but least for facial side effects (1/6). Best concordance was observed for the modeled current anterior and back spread of the VTA, worst for the current side spread. Automatic anatomical segmentation and VTA models can be valuable tools for DBS planning and programming. Directional DBS leads allow detailed postoperative assessment of the concordance of such image-based simulation and visualization with clinical effects.

Download Full-text