Reduction of Side Effects by Segmented Electrodes in Case of Subthalamic Nucleus Deep Brain Stimulation in Parkinson Disease: A Case Report.

Patients suffering treatment resistant Parkinson´s disease (PD) are potential candidates for deep brain stimulation (DBS). Commonly most implanted electrodes have a cylindrical shape with quadripolar electrode contacts and generate a symmetrical stimulation field around the lead. To reduce side effects through activation of neighboring fibers a new electrode design with segmented contacts was developed and enables a better adaption of the field of stimulation as well as a multi-target stimulation to improve therapeutic benefits. We report about a 51-year-old male patient with a 15-year history of treatment-refractory PD, who was implanted with bilateral segmented electrodes in the subthalamic nucleus (STN) with St. Jude Medical Infinity™ DBS System (Abbott/St. Jude Medical, Saint Paul, Minnesota, USA). Despite a clear mood-enhancing effect, stimulation with ring electrodes caused motor side effects including rigor and speech disorder. With segmented electrodes an effective and gentle stimulation was achieved. The stimulation of the anterior segments in the central position of the electrode in the STN showed no side-effects and allowed a reduction of initial symptoms in an low stimulation amplitude. Despite precise preoperatively planning and intraoperative trial stimulation, side effects of STN stimulation are very common. The application of segmented electrodes permits more options to reduce side effects rather than using ring electrodes. Studies with larger samples sizes are needed to establish the optional DBS electrode.

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

Aktuelle Neurologie ◽

10.1055/s-0029-1238842 ◽

2009 ◽

Vol 36 (S 02) ◽

Cited By ~ 1

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

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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 ◽

10.1093/neuros/nyaa201 ◽

2020 ◽

Cited By ~ 2

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.

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Improved Outcome on Interleaved Deep Brain Stimulation Settings

Deep Brain Stimulation ◽

10.1093/med/9780190647209.003.0032 ◽

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.

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Latency of subthalamic nucleus deep brain stimulation-evoked cortical activity as a potential biomarker for postoperative motor side effects

Clinical Neurophysiology ◽

10.1016/j.clinph.2020.02.021 ◽

2020 ◽

Vol 131 (6) ◽

pp. 1221-1229

Author(s):

Zachary T. Irwin ◽

Mohammad Z. Awad ◽

Christopher L. Gonzalez ◽

Arie Nakhmani ◽

J.Nicole Bentley ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Side Effects ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Cortical Activity ◽

Potential Biomarker ◽

Deep Brain

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Choreatic Side Effects of Deep Brain Stimulation of the Anteromedial Subthalamic Nucleus for Treatment-Resistant Obsessive-Compulsive disorder

World Neurosurgery ◽

10.1016/j.wneu.2017.05.067 ◽

2017 ◽

Vol 104 ◽

pp. 1048.e9-1048.e13 ◽

Cited By ~ 5

Author(s):

Anne E.P. Mulders ◽

Albert F.G. Leentjens ◽

Koen Schruers ◽

Annelien Duits ◽

Linda Ackermans ◽

...

Keyword(s):

Deep Brain Stimulation ◽

Side Effects ◽

Obsessive Compulsive Disorder ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Treatment Resistant ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Deep Brain ◽

Stimulation Of

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Stimulation-induced side effects after deep brain stimulation – a systematic review

Acta Neuropsychiatrica ◽

10.1017/neu.2019.35 ◽

2019 ◽

Vol 32 (2) ◽

pp. 57-64

Author(s):

Marcin Zygmunt Zarzycki ◽

Izabela Domitrz

Keyword(s):

Deep Brain Stimulation ◽

Side Effects ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Cochrane Library ◽

Scientific Database ◽

Compulsive Disorder ◽

Segmental Dystonia ◽

Medical Histories ◽

Deep Brain

AbstractObjective:Deep brain stimulation (DBS) was approved by Food and Drug Administration for Parkinson’s disease, essential tremor, primary generalised or segmental dystonia and obsessive-compulsive disorder (OCD) treatment. The exact mechanism of DBS remains unclear which causes side effects. The aim of this review was to assess variables causing stimulation-induced chronic psychiatric/personality-changing side effects.Methods:The analysis of scientific database (PubMed, Cochrane Library, EMBASE) was conducted. The included articles had to be research study or case report and DBS to be conducted in therapeutic purposes. The researches with mental disorders in patients’ medical histories were excluded.Results:Seventeen articles were used in the review. In the group of movement disorders the characteristic of side effects was strongly related to the placement of the electrode implantation. Tiredness/fatigue was correlated with DBS in thalamus. Implantations in subthalamic nucleus were mostly followed by affective side effects such as depression or suicide. The higher voltage of electrode was connected with more severe depression after implantation. The analysis of affective disorder contained only three articles – two about OCD and one about depression. Forgetfulness and word-finding problems as activities connected with cognition may be an inevitable side effect if obsessive thoughts are to be inhibited.Conclusion:DBS of subthalamic nucleus should be seen as the most hazardous place of implantation. As a result there is a strong need of ‘gold standards’ based on the connectivity research and closer cooperation of scientists and clinicians.

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Deep Brain Stimulation of the Subthalamic Nucleus Modulates Reward-Related Behavior: A Systematic Review

Frontiers in Human Neuroscience ◽

10.3389/fnhum.2020.578564 ◽

2020 ◽

Vol 14 ◽

Author(s):

Yvan M. Vachez ◽

Meaghan C. Creed

Keyword(s):

Deep Brain Stimulation ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Systematic Analysis ◽

Reward Seeking ◽

Therapeutic Benefits ◽

Motivated Behavior ◽

Stn Dbs ◽

Deep Brain ◽

Stimulation Of

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for the motor symptoms of movement disorders including Parkinson's Disease (PD). Despite its therapeutic benefits, STN-DBS has been associated with adverse effects on mood and cognition. Specifically, apathy, which is defined as a loss of motivation, has been reported to emerge or to worsen following STN-DBS. However, it is often challenging to disentangle the effects of STN-DBS per se from concurrent reduction of dopamine replacement therapy, from underlying PD pathology or from disease progression. To this end, pre-clinical models allow for the dissociation of each of these factors, and to establish neural substrates underlying the emergence of motivational symptoms following STN-DBS. Here, we performed a systematic analysis of rodent studies assessing the effects of STN-DBS on reward seeking, reward motivation and reward consumption across a variety of behavioral paradigms. We find that STN-DBS decreases reward seeking in the majority of experiments, and we outline how design of the behavioral task and DBS parameters can influence experimental outcomes. While an early hypothesis posited that DBS acts as a “functional lesion,” an analysis of lesions and inhibition of the STN revealed no consistent pattern on reward-related behavior. Thus, we discuss alternative mechanisms that could contribute to the amotivational effects of STN-DBS. We also argue that optogenetic-assisted circuit dissection could yield important insight into the effects of the STN on motivated behavior in health and disease. Understanding the mechanisms underlying the effects of STN-DBS on motivated behavior-will be critical for optimizing the clinical application of STN-DBS.

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The Accuracy of Direct Targeting Using Fusion of MR and CT Imaging for Deep Brain Stimulation of the Subthalamic Nucleus in Patients with Parkinson's Disease

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1715826 ◽

2021 ◽

Author(s):

Fadi Almahariq ◽

Goran Sedmak ◽

Vladimira Vuletić ◽

Domagoj Dlaka ◽

Darko Orešković ◽

...

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Deep Brain Stimulation ◽

Side Effects ◽

Subthalamic Nucleus ◽

Brain Stimulation ◽

Final Position ◽

Emotional Instability ◽

Direct Targeting ◽

Deep Brain

Abstract Introduction In 33 consecutive patients with Parkinson's disease (PD) undergoing awake deep brain stimulation (DBS) without microelectrode recording (MER), we assessed and validated the precision and accuracy of direct targeting of the subthalamic nucleus (STN) using preoperative magnetic resonance imaging (MRI) and stereotactic computed tomography (CT) image fusion combined with immediate postoperative stereotactic CT and postoperative MRI, and we report on the side effects and clinical results up to 6 months' follow-up. Materials and Methods Preoperative nonstereotactic MRI and stereotactic CT images were merged and used for planning the trajectory and final lead position. Immediate postoperative stereotactic CT and postoperative nonstereotactic MRI provided the validation of the final electrode position. Changes in the Unified Parkinson's Disease Rating Scale III (UPDRS III) scores and the levodopa equivalent daily doses (LEDD) and appearance of adverse side effects were assessed. Results The mean Euclidian distance (ED) error between the planned position and the final position of the lead in the left STN was 1.69 ± 0.82 mm and that in the right STN was 2.12 ± 1.00. The individual differences between planned and final position in each of the three coordinates were less than 2 mm. The UPDRS III scores improved by 75% and LEDD decreased by 45%. Few patients experienced complications, such as postoperative infection (n = 1), or unwanted side effects, such as emotional instability (n = 1). Conclusion Our results confirm that direct targeting of an STN on stereotactic CT merged with MRI could be a valid method for placement the DBS electrode. The magnitude of our targeting error is comparable with the reported errors when using MER and other direct targeting approaches.

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