Deep Brain Stimulation Targeting the Globus Pallidus Interna for Dystonic Tremor in the Setting of Generalized Dystonia

2020 ◽  
pp. 205-208
Author(s):  
Qiang Zhang ◽  
Teri R. Thomsen
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
High Frequency ◽  
Pulse Width ◽  
Low Frequency ◽  
Good Control ◽  
Dystonic Tremor ◽  
Generalized Dystonia ◽  
Deep Brain

Intractable generalized dystonia can be treated by deep brain stimulation (DBS) targeting the globus pallidus interna (GPi). The GPi DBS parameters used for generalized dystonia are frequently different from those used for Parkinson disease, with low-frequency, high–pulse width stimulation being common. This chapter presents a patient with generalized dystonia and debilitating dystonic tremor involving the bilateral hands. He could not tolerate higher pulse width than 60 µsec, but high-frequency (130-Hz) stimulation achieved good control of the dystonic tremor as well as of the generalized dystonia. DBS therapy improved his qualify of life. For generalized dystonia and coexisting dystonic tremor, the tremor may in some cases respond to high-frequency GPi DBS.

Choosing a Target for Deep Brain Stimulation in Dystonia-Associated Tremor

2020 ◽  
pp. 195-200
Author(s):  
Mustafa S. Siddiqui ◽  
Stephen B. Tatter
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Systematic Approach ◽  
Favorable Outcome ◽  
Dystonic Tremor ◽  
Generalized Dystonia ◽  
Deep Brain

This chapter presents a case of medication-refractory primary generalized dystonia presenting with disabling symptoms of cervical dystonia and dystonic bilateral arm tremors. This case posed a challenge in the choice of the appropriate target for deep brain stimulation (DBS) because the targeting of the globus pallidus interna improves dystonia symptoms but may have a less predictable response to tremor. DBS targeting the ventral intermedius may not in many cases improve dystonia symptoms but can effectively control tremor. The authors describe a case in which they employed a systematic approach including implanting multiple leads in different DBS targets. This approach resulted in a favorable outcome for this patient in dystonia and in dystonic tremor.

scholarly journals Deep Brain Stimulation of the Globus Pallidus Internus in the Parkinsonian Primate: Local Entrainment and Suppression of Low-Frequency Oscillations

2009 ◽  
Vol 101 (4) ◽  
pp. 1941-1960 ◽  
Author(s):  
Kevin W. McCairn ◽  
Robert S. Turner
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
High Frequency ◽  
Low Frequency ◽  
Therapeutic Effects ◽  
Spontaneous Movement ◽  
Internal Globus Pallidus ◽  
Low Frequency Oscillations ◽  
Deep Brain

Competing theories seek to account for the therapeutic effects of high-frequency deep brain stimulation (DBS) of the internal globus pallidus (GPi) for medically intractable Parkinson's disease. To investigate this question, we studied the spontaneous activity of 102 pallidal neurons during GPiDBS in two macaques rendered parkinsonian by administration of MPTP. Stimulation through macroelectrodes in the GPi (≥200 μA at 150 Hz for 30 s) reduced rigidity in one animal and increased spontaneous movement in both. Novel artifact subtraction methods allowed uninterrupted single-unit recording during stimulation. GPiDBS induced phasic (78% of cells) or sustained (22%) peristimulus changes in firing in both pallidal segments. A subset of cells responded at short latency (<2 ms) in a manner consistent with antidromic driving. Later phasic increases clustered at 3- to 5-ms latency. Stimulation-induced decreases were either phasic, clustered at 1–3 ms, or sustained, showing no peristimulus modulation. Response latency and magnitude often evolved over 30 s of stimulation, but responses were relatively stable by the end of that time. GPiDBS reduced mean firing rates modestly and only in GPi (−6.9 spikes/s). Surprisingly, GPiDBS had no net effect on the prevalence or structure of burst firing. GPiDBS did reduce the prevalence of synchronized low-frequency oscillations. Some cell pairs became synchronized instead at the frequency of stimulation. Suppression of low-frequency oscillations did not require high-frequency synchronization, however, or even the presence of a significant peristimulus response. In summary, the therapeutic effects of GPiDBS may be mediated by an abolition of low-frequency synchronized oscillations as a result of phasic driving.

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

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.

Freezing of Gait After Bilateral Globus Pallidus Interna Deep Brain Stimulation in Generalized Dystonia

2020 ◽  
pp. 105-108
Author(s):  
Mariana Moscovich
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Freezing Of Gait ◽  
Left Handed ◽  
Old Left ◽  
Generalized Dystonia ◽  
Walking Difficulty ◽  
Deep Brain

Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is a safe and long-term effective treatment for medication-refractory dystonia. However, complications and side effects may occur. Freezing of gait (FOG) is a rare phenomenon in patients with dystonia, although very frequently this complication is observed in patients with Parkinson disease (PD). FOG can be disabling and may severely impair quality of life, even when episodic. This chapter reports on a case of a 49-year-old left-handed man presenting with FOG, impairment in balance, and walking difficulty. These issues emerged 3 years after successful bilateral GPi DBS for primary generalized dystonia.

Serial 1H-MRS of thalamus during deep brain stimulation of bilateral globus pallidus internus for primary generalized dystonia

2008 ◽  
Vol 50 (12) ◽  
pp. 1055-1059 ◽  
Author(s):  
Mikhail F. Chernov ◽  
Taku Ochiai ◽  
Takaomi Taira ◽  
Yuko Ono ◽  
Ryoichi Nakamura ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Globus Pallidus Internus ◽  
1H Mrs ◽  
Generalized Dystonia ◽  
Deep Brain ◽  
Stimulation Of

Globus pallidus deep brain stimulation for generalized dystonia: Clinical and PET investigation

Neurology ◽  
1999 ◽  
Vol 53 (4) ◽  
pp. 871-871 ◽  
Author(s):  
R. Kumar ◽  
A. Dagher ◽  
W. D. Hutchison ◽  
A. E. Lang ◽  
A. M. Lozano
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
Generalized Dystonia ◽  
Deep Brain

High Frequency Bilateral Globus Pallidus Interna Deep Brain Stimulation Can Improve Both Chorea and Dysarthria in Chorea-acanthocytosis

2019 ◽  
Vol 62 ◽  
pp. 248-250 ◽  
Author(s):  
Kai-Liang Wang ◽  
Christopher W. Hess ◽  
Dan Xu ◽  
Jian-Guo Zhang ◽  
Wei Hu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Globus Pallidus ◽  
Brain Stimulation ◽  
High Frequency ◽  
Deep Brain

scholarly journals Deep Brain Stimulation Frequency of the Subthalamic Nucleus Affects Phonemic and Action Fluency in Parkinson’s Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Valéria de Carvalho Fagundes ◽  
Carlos R. M. Rieder ◽  
Aline Nunes da Cruz ◽  
Bárbara Costa Beber ◽  
Mirna Wetters Portuguez
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
High Frequency ◽  
Verbal Fluency ◽  
Low Frequency ◽  
Stn Dbs ◽  
Deep Brain

Introduction.Deep brain stimulation of the subthalamic nucleus (STN-DBS) in Parkinson’s disease (PD) has been linked to a decline in verbal fluency. The decline can be attributed to surgical effects, but the relative contributions of the stimulation parameters are not well understood. This study aimed to investigate the impact of the frequency of STN-DBS on the performance of verbal fluency tasks in patients with PD.Methods.Twenty individuals with PD who received bilateral STN-DBS were evaluated. Their performances of verbal fluency tasks (semantic, phonemic, action, and unconstrained fluencies) upon receiving low-frequency (60 Hz) and high-frequency (130 Hz) STN-DBS were assessed.Results.The performances of phonemic and action fluencies were significantly different between low- and high-frequency STN-DBS. Patients showed a decrease in these verbal fluencies for high-frequency STN-DBS.Conclusion.Low-frequency STN-DBS may be less harmful to the verbal fluency of PD patients.

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