The effect of posterior hypothalamus region deep brain stimulation on sleep

Cephalalgia ◽  
2013 ◽  
Vol 34 (3) ◽  
pp. 219-223 ◽  
Author(s):  
Stjepana Kovac ◽  
Mary-Anne Wright ◽  
Sofia H Eriksson ◽  
Ludvic Zrinzo ◽  
Manjit Matharu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Sleep Disorders ◽  
Brain Stimulation ◽  
Case Reports ◽  
Posterior Part ◽  
Sleep Patterns ◽  
Before And After ◽  
Promising Treatment ◽  
Cluster Headaches ◽  
Deep Brain

Background Early observations by von Economo showed that the posterior part of the hypothalamus (PH) plays a prominent role in sleep-wake regulation. The PH is a candidate area involved in cluster headaches and other trigeminal autonomic cephalalgias (TACs) and is targeted for deep brain stimulation (DBS). Case reports Sleep studies in two men, 69- and 39-years-old, with pre-existing sleep disorders, before and after PH-DBS for pharamacoresistant cluster headache and SUNCT syndrome showed that PH-DBS led to a dramatic alteration of the patients’ sleep patterns. This coincided with an improvement of the predominantly diurnal TACs, suggesting a PH-DBS-induced change in sleep patterns. Hypnograms after DBS demonstrated disrupted sleep and a prolonged period of wakefulness after midnight in both patients, which was reproduced the second night. Conclusions PH-DBS, a promising treatment for severe refractory TACs, affects sleep quality and pre-existing sleep disorders. This needs to be considered when treating patients with PH-DBS.

Visual Effects of Deep Brain Stimulation in a Patient with Parkinson’s Disease

2019 ◽  
pp. 158-173
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Visual System ◽  
Brain Stimulation ◽  
Neurodegenerative Disorder ◽  
Initial Examination ◽  
Before And After ◽  
Deep Brain ◽  
Cover Test

Background: Parkinson’s disease (PD) is a progressive neurodegenerative disorder caused by a dopamine deficiency that presents with motor symptoms. Visual disorders can occur concomitantly but are frequently overlooked. Deep brain stimulation (DBS) has been an effective treatment to improve tremors, stiffness and overall mobility, but little is known about its effects on the visual system. Case Report: A 75-year-old Caucasian male with PD presented with longstanding binocular diplopia. On baseline examination, the best-corrected visual acuity was 20/25 in each eye. On observation, he had noticeable tremors with an unsteady gait. Distance alternating cover test showed exophoria with a right hyperphoria. Near alternating cover test revealed a significantly larger exophoria accompanied by a reduced near point of convergence. Additional testing with a 24-2 Humphrey visual field and optical coherence tomography (OCT) of the nerve and macula were unremarkable. The patient underwent DBS implantation five weeks after initial examination, and the device was activated four weeks thereafter. At follow up, the patient still complained of intermittent diplopia. There was no significant change in the manifest refraction or prism correction. On observation, the patient had remarkably improved tremors with a steady gait. All parameters measured were unchanged. The patient was evaluated again seven months after device activation. Although vergence ranges at all distances were improved, the patient was still symptomatic for intermittent diplopia. OCT scans of the optic nerve showed borderline but symmetric thinning in each eye. All other parameters measured were unchanged. Conclusion: The case found no significant changes on ophthalmic examination after DBS implantation and activation in a patient with PD. To the best of the authors’ knowledge, there are no other cases in the literature that investigated the effects of DBS on the visual system pathway in a patient with PD before and after DBS implantation and activation.

Database of MNI stereotactic coordinates for deep brain stimulation targets in neuropsychiatric disorders

2011 ◽  
Vol 26 (S2) ◽  
pp. 1149-1149
Author(s):  
U. Moser ◽  
M. Savli ◽  
R. Lanzenberger ◽  
S. Kasper
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Functional Neuroimaging ◽  
Case Reports ◽  
Three Dimensional ◽  
Compulsive Disorder ◽  
Neuroimaging Data ◽  
Specific Disorders ◽  
Image Position ◽  
Deep Brain

IntroductionDeep brain stimulation (DBS) is a promising therapy option for otherwise treatment-resistant neuropsychiatrie disorders, especially in obsessive-compulsive disorder (OCD), major depression (TRD) and Tourette's Syndrome (TS).ObjectiveThe brain coordinates of the DBS targets are mainly reported using measurements in original, unnormalized brains. In the neuroimaging community stereotactic data are mainly indicated in the standardized Montreal Neurological Institute (MNI) space, i.e. a three-dimensional proportional grid system.AimsImproved comparability between targets in DBS studies and molecular and functional neuroimaging data from PET, SPECT, MRI, fMRI, mostly published with stereotactic data.MethodsA comprehensive and systematic literature search for published DBS case reports or studies in TRD, OCD and TS was performed. We extracted the tip positions of electrode leads as provided in the publications or by the authors, and transferred individual coordinates to the standard brain in the MNI space.Results46 publications fulfilled the inclusion criteria. The main targets for the specific disorders and one or two examples of their calculated MNI coordinates are indicated in the table:[MNI coordinates of the main DBS targets]ConclusionsWe provide DBS data of neuropsychiatrie disorders in the MNI space, improving the comparability to molecular, functional and structural neuroimaging data.

Gait worsening and the microlesion effect following deep brain stimulation for essential tremor

2019 ◽  
Vol 90 (8) ◽  
pp. 913-919 ◽  
Author(s):  
Ryan Roemmich ◽  
Jaimie A Roper ◽  
Robert S Eisinger ◽  
Jackson N Cagle ◽  
Lauren Maine ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Repeated Measures ◽  
Walking Speed ◽  
Stimulation Parameters ◽  
Gait Parameters ◽  
Before And After ◽  
Walking Speeds ◽  
Deep Brain

ObjectiveTo investigate the effects of unilateral thalamic deep brain stimulation (DBS) on walking in persons with medication-refractory essential tremor (ET).MethodsWe performed laboratory-based gait analyses on 24 persons with medication-refractory ET before and after unilateral thalamic DBS implantation. Normal and tandem walking parameters were analysed across sessions (PRE-DBS/DBS OFF/DBS ON) by repeated measures analyses of variance. Pearson’s correlations assessed whether changes in walking after DBS were global (ie, related across gait parameters). Baseline characteristics, lead locations and stimulation parameters were analysed as possible contributors to gait effects.ResultsDBS minimally affected gait at the cohort level. However, 25% of participants experienced clinically meaningful gait worsening. Walking speed decreased by >30% in two participants and by >10% in four others. Decreased walking speed correlated with increased gait variability, indicating global gait worsening in affected participants. The worsening persisted even after the stimulation was turned off. Participants with worse baseline tandem walking performance may be more likely to experience post-DBS gait worsening; the percentage of tandem missteps at baseline was nearly three times higher and tandem walking speeds were approximately 30% slower in participants who experienced gait worsening. However, these differences in tandem walking in persons with gait worsening as compared with those without worsening were not statistically significant. Lead locations and stimulation parameters were similar in participants with and without gait worsening.ConclusionGlobal gait worsening occurred in 25% of participants with unilateral DBS for medication-refractory ET. The effect was present on and off stimulation, likely indicating a microlesion effect.

scholarly journals Impulse Control Disorders Following Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson's Disease: Clinical Aspects

2011 ◽  
Vol 2011 ◽  
pp. 1-9 ◽  
Author(s):  
Polyvios Demetriades ◽  
Hugh Rickards ◽  
Andrea Eugenio Cavanna
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Impulse Control ◽  
Case Reports ◽  
Impulse Control Disorders ◽  
Clinical Aspects ◽  
Dopaminergic Medication ◽  
Deep Brain

Parkinson's disease (PD) has been associated with the development of impulse control disorders (ICDs), possibly due to overstimulation of the mesolimbic system by dopaminergic medication. Preliminary reports have suggested that deep brain stimulation (DBS), a neurosurgical procedure offered to patients with treatment-resistant PD, affects ICD in a twofold way. Firstly, DBS allows a decrease in dopaminergic medication and hence causes an improvement in ICDs. Secondly, some studies have proposed that specific ICDs may develop after DBS. This paper addresses the effects of DBS on ICDs in patients with PD. A literature search identified four original studies examining a total of 182 patients for ICDs and nine case reports of 39 patients that underwent DBS and developed ICDs at some point. Data analysis from the original studies did not identify a significant difference in ICDs between patients receiving dopaminergic medication and patients on DBS, whilst the case reports showed that 56% of patients undergoing DBS had poor outcome with regards to ICDs. We discuss these ambivalent findings in the light of proposed pathogenetic mechanisms. Longitudinal, prospective studies with larger number of patients are required in order to fully understand the role of DBS on ICDs in patients with PD.

scholarly journals Neuropsychiatric Outcome of an Adolescent Who Received Deep Brain Stimulation for Tourette's Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
S. J. Pullen ◽  
C. A. Wall ◽  
K. H. Lee ◽  
S. M. Stead ◽  
B. T. Klassen ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Adaptive Functioning ◽  
Case Reports ◽  
Tourette's Syndrome ◽  
Adolescent Male ◽  
Tourette’S Syndrome ◽  
Patient Reported ◽  
Deep Brain ◽  
Neuropsychiatric Outcome

This case study followed one adolescent patient who underwent bilateral deep brain stimulation of the centromedian parafascicular complex (CM-Pf) for debilitating, treatment refractory Tourette's syndrome for a period of 1.5 years. Neurocognitive testing showed no significant changes between baseline and follow-up assessments. Psychiatric assessment revealed positive outcomes in overall adaptive functioning and reduction in psychotropic medication load in this patient. Furthermore, despite significant baseline psychiatric comorbidity, this patient reported no suicidal ideation following electrode implantation. Deep brain stimulation is increasingly being used in children and adolescents. This case reports on the positive neurologic and neuropsychiatric outcome of an adolescent male with bilateral CM-Pf stimulation.

scholarly journals Personality Changes after Deep Brain Stimulation in Parkinson’s Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Uyen Pham ◽  
Anne-Kristin Solbakk ◽  
Inger-Marie Skogseid ◽  
Mathias Toft ◽  
Are Hugo Pripp ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Sensation Seeking ◽  
Eysenck Personality Questionnaire ◽  
Personality Changes ◽  
Before And After ◽  
Stn Dbs ◽  
Deep Brain

Objectives. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a recognized therapy that improves motor symptoms in advanced Parkinson’s disease (PD). However, little is known about its impact on personality. To address this topic, we have assessed personality traits before and after STN-DBS in PD patients.Methods. Forty patients with advanced PD were assessed with the Temperament and Character Inventory (TCI): the Urgency, Premeditation, Perseverance, Sensation Seeking impulsive behaviour scale (UPPS), and the Neuroticism and Lie subscales of the Eysenck Personality Questionnaire (EPQ-N, EPQ-L) before surgery and after three months of STN-DBS. Collateral information obtained from the UPPS was also reported.Results. Despite improvement in motor function and reduction in dopaminergic dosage patients reported lower score on the TCI Persistence and Self-Transcendence scales, after three months of STN-DBS, compared to baseline (P=0.006;P=0.024). Relatives reported significantly increased scores on the UPPS Lack of Premeditation scale at follow-up (P=0.027).Conclusion. STN-DBS in PD patients is associated with personality changes in the direction of increased impulsivity.

scholarly journals A Systematic Review of the Biological Processes Involved in Deep-Brain Stimulation for Parkinson's disease: A Focus on the Potential Disease-Modifying Effects

2021 ◽  
Vol 05 (02) ◽  
pp. 1-1
Author(s):  
Francesco Sciancalepore ◽  
◽  
Giulia Remoli ◽  
Leonardo Tariciotti ◽  
Giulia Sarti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Early Stage ◽  
Case Reports ◽  
Biological Processes ◽  
Inclusion Criteria ◽  
Disease Modifying ◽  
Deep Brain

Deep-Brain Stimulation (DBS) is an important treatment option for the management of Parkinson’s disease (PD) and is a common symptomatic treatment. However, an increasing number of studies have examined the biological processes to assess if DBS can also modify the natural history of PD by acting on its pathophysiological mechanisms. Relevant literature published up to November 2020 was systematically searched on databases such as PubMed, ISI Web of Knowledge, Academic Search Index, and Science Citation Index. The following predefined inclusion criteria were applied to the full-text versions of the selected articles: i) recruiting and monitoring of PD subjects that were previously treated with DBS and ii) investigating the electrophysiological, biochemical, epigenetic, or neuroimaging effects of DBS. Studies focusing exclusively on motor and clinical changes were excluded. Reviews, case reports, studies on animal models, and computational studies were also not considered. Out of 2,960 records screened, 43 studies met the inclusion criteria. Only three studies described a potential disease-modifying effect of DBS. However, a wide heterogeneity was observed in the investigated biomarkers, and the design and methodological issues of several studies limited their ability to find potential disease-modifying features. Specifically, 60.4% of the trials followed-up subjects for no more than 1 year from the surgical intervention, and 67.4% observed patients with PD only once after DBS. Moreover, 64.2% of the studies enrolled late-stage PD patients. Most of the studies (88.4%) reported that DBS only had a symptomatic effect, with several of them showing some limitations in the study design and recruitment of patients. Further studies using shared biomarkers are encouraged to assess if and how DBS might affect the progression of PD. Based on the existing preclinical literature, prospective clinical trials examining the course of PD in early-stage patients are needed.

scholarly journals Effect of DBS on decreasing pain intensity in individuals with PD: a systematic review

2021 ◽  
Author(s):  
Gabriela Albertino Vieira ◽  
Raquel Medeiros de Souza ◽  
Érica Rocha Assunção ◽  
Laís Soares Figueiredo ◽  
Natália Rafael Perdigão ◽  
...  
Keyword(s):  
Systematic Review ◽  
Deep Brain Stimulation ◽  
Pain Intensity ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Motor Symptom ◽  
Background Pain ◽  
Before And After ◽  
Deep Brain

Background: Pain is a common non-motor symptom in Parkinson’s disease (PD), causing impairment in the functionality and quality of life. Objectives: To summarize the effects of deep brain stimulation (DBS) on pain intensity in PD. Design: Systematic review. Methods: A search was conducted using the Pubmed, Scielo, Embase, Lilacs, and Cochrane databases. Keywords were: “Parkinson* AND (“DBS” OR “deep brain stimulation”) AND “pain”. Complete available articles that measured pain intensity before and after DBS were selected. Results: Of the 251 studies, 17 met the criteria. The sample included from 14 to 79 patients (n = 532). The time of surgery was 3 to 96 months. The subthalamic nucleus was the main surgical target. Seventeen and 389 individuals were submitted to unilateral and bilateral implantation, respectively. Globus pallidus was used as a surgical target in three studies. The unilateral implant was performed in 12 patients and the bilateral in 37. Different instruments were used to measure the pain intensity. It declined after surgery in all studies. Conclusion: The results show that pain intensity decreased after DBS, and most studies performed bilateral stimulation in the subthalamic nucleus. This information is important in guiding the therapeutic approach in PD patients with pain. However, the different surgical parameters and instruments used to assess pain limit the summarization of results.

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