Deep Brain Stimulation in Children with Dystonia: Experience from a Tertiary Care Center (S28.006)

Objective: The aim of the study was to retrospectively evaluate the effect of directional deep brain stimulation (DBS) on ataxia in an essential tremor patient population. Materials and Methods: A retrospective chart review of documented Scale for Assessment and Rating of Ataxia (SARA) scores were analyzed using a case-control design. All subjects we evaluated were treated at a single, tertiary care academic center. We reviewed 14 patients who underwent bilateral ventral intermediate nucleus of the thalamus (VIM) implantation with microelectrode recording, with electrodeposition and segmented contact orientation confirmed via postoperative computed tomography. The main outcome was to determine change in ataxia scores between directional versus monopolar circumferential stimulation. Results: Fourteen patients (9 males, median age at implantation 69 [range 63–82]) underwent surgery between October 2017 and July 2020 at the UNC Movement Disorders Center. SARA scores between directional stimulation and monopolar circumferential stimulation demonstrated a significant reduction in total scores with best possible segmented stimulation (n = 13, p < 0.0001, 95% confidence interval [CI] −3.496 to −6.789). This difference remained statistically significant even after removing the SARA tremor subscore (n = 13, p < 0.0001, 95% CI −3.155 to −6.274). In line with prior reports, SARA score changes from the preoperative state were generally worsened when applying monopolar circumferential stimulation bilaterally (n = 13, p = 0.655; 95% CI −2.836 to 4.359), but improved with directional stimulation (n = 13, p = 0.010; 95% CI −1.216 to −7.547). Conclusion: This retrospective analysis appears to show evidence for improved outcomes through directional stimulation in bilateral VIM DBS implantation with reduction of ataxic side effects that have traditionally plagued postoperative results, all while providing optimized tremor reduction via stimulation.

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Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.36.7.2870 ◽

2020 ◽

Vol 36 (7) ◽

Author(s):

Usama Ahmed ◽

Faraz Shafiq ◽

Dileep Kumar ◽

Khalid Ahsan ◽

Waleed Bin Ghaffar ◽

...

Keyword(s):

Retrospective Review ◽

Care Center ◽

Tertiary Care ◽

Total Duration ◽

Anaesthetic Management ◽

University Hospital ◽

Neurophysiological Monitoring ◽

Tertiary Care Center ◽

Brain Simulation ◽

Deep Brain

Objectives: To review anaesthesia related outcome, perioperative complications and overall length of stay (LOS) in hospital for patients who had deep brain stimulation (DBS). Methods: The study was retrospective review of patients medical records diagnosed with Parkinson disease (PD) and underwent DBS at The Aga Khan University Hospital, Karachi from 2017-2019. Data was reviewed from file notes and patient chart and recorded on predesigned Performa. Frequency and percentages were used to present the data. Results: All patients were anaesthetized using Sleep-Awake-Sleep technique (SAS). Dexmedetomidine was mainly used for conscious sedation. Bispectral index monitor (BIS) was used to monitor the depth of sedation, and kept between 70-85 during sedative phase. All patients had successful intraoperative neurological monitoring, stimulation, and placement of electrodes. Total duration of anesthesia varied significantly in between the patients. Maximum duration was 600 minutes. None of our patient had any intraoperative event related to anaesthetic management. Overall five patients had some adverse events during ward stay. Mean LOS in hospital was four days. Conclusion: Anaesthetic management of DBS is well-tolerated. It requires dedicated team. The SAS technique is excellent for intraoperative neurophysiological monitoring. Careful selection of sedative agents and monitoring depth of anaesthesia using BIS would be beneficial in terms of improving related outcomes. doi: https://doi.org/10.12669/pjms.36.7.2870 How to cite this:Ahmed U, Shafiq F, Kumar D, Ahsan K, Ghaffar W, Bari E. Anaesthetic management of patients undergoing deep brain simulation: A retrospective review of 8 cases from a tertiary care center of Pakistan. Pak J Med Sci. 2020;36(7):---------. doi: https://doi.org/10.12669/pjms.36.7.2870 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Subcallosal Cingulate Deep Brain Stimulation for Treatment-Resistant Unipolar and Bipolar Depression

Yearbook of Neurology and Neurosurgery ◽

10.1016/j.yneu.2012.05.058 ◽

2012 ◽

Vol 2012 ◽

pp. 241-243

Author(s):

P. House

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Bipolar Depression ◽

Treatment Resistant ◽

Deep Brain

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Deep Brain Stimulation Aids Resistant Depression

Internal Medicine News ◽

10.1016/s1097-8690(08)71087-4 ◽

2008 ◽

Vol 41 (19) ◽

pp. 20

Author(s):

MICHELE G. SULLIVAN

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Resistant Depression ◽

Deep Brain

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Nicht-medikamentöse Optionen zur Behandlung pharmakoresistenter Epilepsien

Therapeutische Umschau ◽

10.1024/0040-5930/a001023 ◽

2018 ◽

Vol 75 (7) ◽

pp. 448-454

Author(s):

Thomas Grunwald ◽

Judith Kröll

Keyword(s):

Deep Brain Stimulation ◽

Brain Stimulation ◽

Tiefe Hirnstimulation ◽

Ketogene Diät ◽

Deep Brain

Zusammenfassung. Wenn mit den ersten beiden anfallspräventiven Medikamenten keine Anfallsfreiheit erzielt werden konnte, so ist die Wahrscheinlichkeit, dies mit anderen Medikamenten zu erreichen, nur noch ca. 10 %. Es sollte dann geprüft werden, warum eine Pharmakoresistenz besteht und ob ein epilepsiechirurgischer Eingriff zur Anfallsfreiheit führen kann. Ist eine solche Operation nicht möglich, so können palliative Verfahren wie die Vagus-Nerv-Stimulation (VNS) und die tiefe Hirnstimulation (Deep Brain Stimulation) in eine bessere Anfallskontrolle ermöglichen. Insbesondere bei schweren kindlichen Epilepsien stellt auch die ketogene Diät eine zu erwägende Option dar.

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