Medial forebrain bundle stimulation elicits psychotropic side effects in Subthalamic Nucleus Deep Brain Stimulation for PD – new insights through Diffusion Tensor Imaging

2009 ◽  
Vol 36 (S 02) ◽  
Author(s):  
VA Coenen ◽  
T Hurwitz ◽  
J Panksepp ◽  
B Mädler ◽  
CR Honey
Keyword(s):  
Diffusion Tensor Imaging ◽  
Deep Brain Stimulation ◽  
Side Effects ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Medial Forebrain Bundle ◽  
Diffusion Tensor ◽  
Through Diffusion ◽  
Deep Brain

MEDIAL FOREBRAIN BUNDLE STIMULATION AS A PATHOPHYSIOLOGICAL MECHANISM FOR HYPOMANIA IN SUBTHALAMIC NUCLEUS DEEP BRAIN STIMULATION FOR PARKINSON'S DISEASE

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. 1106-1115 ◽  
Author(s):  
Volker A. Coenen ◽  
Christopher R. Honey ◽  
Trevor Hurwitz ◽  
Ahmed A. Rahman ◽  
Jacqueline McMaster ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Diffusion Tensor Imaging ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Medial Forebrain Bundle ◽  
Diffusion Tensor ◽  
Stn Dbs ◽  
Deep Brain

Abstract OBJECTIVE Hypomania accounts for approximately 4% to 13% of psychotropic adverse events during subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease. Diffusion of current into the inferior and medial “limbic” STN is often reported to be the cause. We suggest a different explanation, in which the coactivation of the medial forebrain bundle (MFB), outside the STN, leads to hypomania during STN DBS. METHODS Six patients with advanced Parkinson's disease (age, 54 ± 11 years) underwent bilateral STN DBS surgery. Preoperative diffusion tensor imaging scans for fiber tracking of the MFB were conducted on a 3T magnetic resonance imaging scanner. After implantation, the electrode positions were determined with computed tomography and integrated in a diffusion tensor imaging software environment. RESULTS The medial STN was shown to send tributaries to the MFB using it as a pathway to connect to the reward circuitry. One patient, who had a transient, stimulation-induced acute hypomanic episode, showed a direct contact between 1 active electrode contact and these putative limbic STN tributaries to the MFB unilaterally on the left. In 5 asymptomatic patients, the active contacts were between 2.9 and 7.5 mm distant from the MFB or its limbic STN tributaries. CONCLUSION We hypothesize that STN DBS-induced reversible acute hypomania might be elicited by inadvertent and unilateral coactivation of putative limbic STN tributaries to the MFB. These findings may provide insight into the neural pathways of hypomania and may facilitate future investigations of the pathophysiology of mood disorders.

scholarly journals Combined Unilateral Subthalamic Nucleus and Contralateral Globus Pallidus Interna Deep Brain Stimulation for Treatment of Parkinson Disease: A Pilot Study of Symptom-Tailored Stimulation

Neurosurgery ◽  
2020 ◽  
Author(s):  
Chencheng Zhang ◽  
Linbin Wang ◽  
Wei Hu ◽  
Tao Wang ◽  
Yijie Zhao ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Parkinson Disease ◽  
Globus Pallidus ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Bilateral Stimulation ◽  
Adverse Side Effects ◽  
Deep Brain

Abstract BACKGROUND Subthalamic nucleus (STN) and globus pallidus interna (GPi) are the most effective targets in deep brain stimulation (DBS) treatment for Parkinson disease (PD). However, the individualized selection of targets remains a clinical challenge. OBJECTIVE To combine unilateral STN and contralateral GPi stimulation (STN DBS in one brain hemisphere and GPi DBS in the other) to maximize the clinical advantages of each target while inducing fewer adverse side effects in selected patients with PD because each target has its own clinical effects and risk profiles. METHODS We reviewed the clinical outcomes of 8 patients with idiopathic PD treated with combined unilateral STN and contralateral GPi DBS. Clinical outcome assessments, focusing on motor and nonmotor symptoms, were performed at baseline and 6-mo and 12-mo follow-up. We performed the assessments under the following conditions: medication on and off (bilateral stimulation on and off and unilateral STN stimulation on). RESULTS Patients showed a significant improvement in motor symptoms, as assessed by the Unified Parkinson Disease Rating Scale III (UPDRS-III) and Timed Up-and-Go Test (TUG), in the off-medication/on-stimulation state at 6-mo and 12-mo follow-up. Also, patients reported a better quality of life, and their intake of levodopa was reduced at 12-mo follow-up. In the on-medication condition, bilateral stimulation was associated with an improvement in axial symptoms, with a 64% improvement in measures of gait and falls at 12-mo follow-up. No irreversible adverse side effects were observed. CONCLUSION Our findings suggest that combined unilateral STN and contralateral GPi DBS could offer an effective and well-tolerated DBS treatment for certain PD patients.

Post-Traumatic Tremor and Thalamic Deep Brain Stimulation: Evidence for Use of Diffusion Tensor Imaging

2016 ◽  
Vol 96 ◽  
pp. 607.e7-607.e11 ◽  
Author(s):  
Sandra G.J. Boccard ◽  
Pedro Rebelo ◽  
Binith Cheeran ◽  
Alexander Green ◽  
James J. FitzGerald ◽  
...  
Keyword(s):  
Diffusion Tensor Imaging ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Diffusion Tensor ◽  
Post Traumatic ◽  
Deep Brain

Improved Outcome on Interleaved Deep Brain Stimulation Settings

2020 ◽  
pp. 155-160
Author(s):  
Svjetlana Miocinovic ◽  
Pravin Khemani ◽  
Rebecca Whiddon ◽  
Shilpa Chitnis
Keyword(s):  
Deep Brain Stimulation ◽  
Side Effects ◽  
Parkinson Disease ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Programming Method ◽  
Additional Advantage ◽  
Stimulation Parameters ◽  
Improved Outcome ◽  
Deep Brain

Interleaving is a DBS programming method whereby two sets of stimulation parameters are applied interchangeably (on a millisecond level). This chapter describes a patient with Parkinson disease who was implanted with subthalamic nucleus deep brain stimulation but achieved suboptimal tremor control with conventional programming (monopolar, double monopolar, or bipolar settings). Interleaving allowed the dorsal contact to be set to a higher setting, while the contact below was set to a tolerable lower setting. Together, the two contacts provided complete tremor resolution without side effects. It is unknown whether interleaving provides any additional advantage over simply allowing use of different amplitudes at different contacts, but potential mechanisms are discussed.

Sign in / Sign up

Export Citation Format

Share Document