scholarly journals Anticonvulsant vs. Proconvulsant Effect of in situ Deep Brain Stimulation at the Epileptogenic Focus

2021 ◽  
Vol 15 ◽  
Author(s):  
Ping Chou ◽  
Chung-Chin Kuo
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Rational Design ◽  
The Other ◽  
Anticonvulsant Effect ◽  
Epileptogenic Focus ◽  
Kindling Effect ◽  
Wide Range ◽  
Deep Brain

Since deep brain stimulation (DBS) at the epileptogenic focus (in situ) denotes long-term repetitive stimulation of the potentially epileptogenic structures, such as the amygdala, the hippocampus, and the cerebral cortex, a kindling effect and aggravation of seizures may happen and complicate the clinical condition. It is, thus, highly desirable to work out a protocol with an evident quenching (anticonvulsant) effect but free of concomitant proconvulsant side effects. We found that in the basolateral amygdala (BLA), an extremely wide range of pulsatile stimulation protocols eventually leads to the kindling effect. Only protocols with a pulse frequency of ≤1 Hz or a direct current (DC), with all of the other parameters unchanged, could never kindle the animal. On the other hand, the aforementioned DC stimulation (DCS), even a pulse as short as 10 s given 5 min before the kindling stimuli or a pulse given even to the contralateral BLA, is very effective against epileptogenicity and ictogenicity. Behavioral, electrophysiological, and histological findings consistently demonstrate success in seizure quenching or suppression as well as in the safety of the specific DBS protocol (e.g., no apparent brain damage by repeated sessions of stimulation applied to the BLA for 1 month). We conclude that in situ DCS, with a novel and rational design of the stimulation protocol composed of a very low (∼3% or 10 s/5 min) duty cycle and assuredly devoid of the potential of kindling, may make a successful antiepileptic therapy with adequate safety in terms of little epileptogenic adverse events and tissue damage.

Development of in situ Imaging Probe for Surgical Operation of Deep Brain Stimulation

2011 ◽  
Vol 131 (12) ◽  
pp. 427-428
Author(s):  
Toshihiko Noda ◽  
Pan Yi-Li ◽  
Ayato Tagawa ◽  
Takuma Kobayashi ◽  
Kiyotaka Sasagawa ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Surgical Operation ◽  
Imaging Probe ◽  
Deep Brain ◽  
In Situ Imaging

scholarly journals Pattern theory of self and situating moral aspects: the need to include authenticity, autonomy and responsibility in understanding the effects of deep brain stimulation

2020 ◽  
Author(s):  
Przemysław Zawadzki
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Full Range ◽  
The Self ◽  
The Other ◽  
Pattern Theory ◽  
Complex Relation ◽  
Induced Changes ◽  
Deep Brain

AbstractThe aims of this paper are to: (1) identify the best framework for comprehending multidimensional impact of deep brain stimulation (DBS) on the self; (2) identify weaknesses of this framework; (3) propose refinements to it; (4) in pursuing (3), show why and how this framework should be extended with additional moral aspects and demonstrate their interrelations; (5) define how moral aspects relate to the framework; (6) show the potential consequences of including moral aspects on evaluating DBS’s impact on patients’ selves. Regarding (1), I argue that the pattern theory of self (PTS) can be regarded as such a framework. In realizing (2) and (3), I indicate that most relevant issues concerning PTS that require resolutions are ontological issues, including the persistence question, the “specificity problem”, and finding lacking relevant aspects of the self. In realizing (4), I identify aspects of the self not included in PTS which are desperately needed to investigate the full range of potentially relevant DBS-induced changes—authenticity, autonomy, and responsibility, and conclude that how we define authenticity will have implications for our concept of autonomy, which in turn will determine how we think about responsibility. Concerning (5), I discuss a complex relation between moral aspects and PTS—on one hand, they serve as the lens through which a particular self-pattern can be evaluated; on the other, they are, themselves, products of dynamical interactions of various self-aspects. Finally, I discuss (6), demonstrating novel way of understanding the effects of DBS on patients’ selves.

scholarly journals Psychiatric neurosurgery in the 21st century: overview and the growth of deep brain stimulation

2017 ◽  
Vol 41 (5) ◽  
pp. 281-286 ◽  
Author(s):  
Kenneth Barrett
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Obsessive Compulsive ◽  
Major Depressive ◽  
Future Directions ◽  
Compulsive Disorder ◽  
Wide Range ◽  
Psychiatric Conditions ◽  
Ablative Procedures ◽  
Deep Brain

SummaryAmbulatory deep brain stimulation (DBS) became possible in the late 1980s and was initially used to treat people with movement disorders. Trials of DBS in people with treatment-resistant psychiatric disorder began in the late 1990s, initially focusing on obsessive-compulsive disorder, major depressive disorder and Tourette syndrome. Despite methodological issues, including small participant numbers and lack of consensus over brain targets, DBS is now being trialled in a wide range of psychiatric conditions. There has also been more modest increase in ablative procedures. This paper reviews these developments in the light of contemporary brain science, considers future directions and discusses why the approach has not been adopted more widely within psychiatry.

Deep Brain Stimulation Generator Failure due to External Defibrillation in a Patient with Essential Tremor

2020 ◽  
pp. 1-2
Author(s):  
Gregory Davis ◽  
Zachary Levine
Keyword(s):  
Cardiac Arrest ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Case Reports ◽  
The Other ◽  
Deep Brain Stimulator ◽  
Rf Transmission ◽  
Deep Brain

There exist only two case reports to date of open cardiac defibrillation with deep brain stimulator system (DBS) implantation. We report a 64-year-old male with DBS system in place for essential tremor who underwent cardiac defibrillation after cardiac arrest. Afterwards, his device impedances were all high and his tremor symptoms returned. Both problems resolved with implantation of a new generator and required no changes to the intracranial leads or extension cables. This is significantly different from the two previous reports. One included a significantly different DBS system relying on transcutaneous RF transmission and reported a lesioning effect after cardioversion. The other utilized a modern DBS system but reported damage to the generator and intracranial leads. We report that only the generator sustained damage, and that there were no intracranial changes that occurred.

Deep brain stimulation for prolonged disorders of consciousness

2016 ◽  
Vol 11 (4) ◽  
pp. 105-111
Author(s):  
Gilberto KK Leung
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Functional Neuroimaging ◽  
Vegetative State ◽  
Persistent Vegetative State ◽  
Conscious State ◽  
Disorders Of Consciousness ◽  
Minimal Conscious State ◽  
Wide Range ◽  
Deep Brain

Deep brain stimulation has emerged as a “last resort” therapy for patients with prolonged disorders of consciousness. The latter encompasses a range of conditions including minimal conscious state and persistent vegetative state. Functional neuroimaging studies have shown that minimal conscious state and persistent vegetative state have different patterns of residual brain function and may therefore respond differently to deep brain stimulation. The failure to distinguish between the two conditions in this context can give rise to false expectation, misunderstanding and ill-guided treatment. As a halfway technology for prolonged disorders of consciousness, deep brain stimulation could also produce improvement in awareness that is in fact harm, and its impact may involve a wide range of public interests. This paper will discuss related ethical and legal issues with an emphasis on the distinction between minimal conscious state and persistent vegetative state in the application of deep brain stimulation.

scholarly journals Methods for Lowering the Power Consumption of OS-Based Adaptive Deep Brain Stimulation Controllers

Sensors ◽  
2021 ◽  
Vol 21 (7) ◽  
pp. 2349
Author(s):  
Roberto Rodriguez-Zurrunero ◽  
Alvaro Araujo ◽  
Madeleine M. Lowery
Keyword(s):  
Deep Brain Stimulation ◽  
Power Consumption ◽  
Brain Stimulation ◽  
Energy Efficient ◽  
Sampling Rate ◽  
Implantable Devices ◽  
Duty Cycling ◽  
Wide Range ◽  
Dynamic Sampling ◽  
Deep Brain

The identification of a new generation of adaptive strategies for deep brain stimulation (DBS) will require the development of mixed hardware–software systems for testing and implementing such controllers clinically. Towards this aim, introducing an operating system (OS) that provides high-level features (multitasking, hardware abstraction, and dynamic operation) as the core element of adaptive deep brain stimulation (aDBS) controllers could expand the capabilities and development speed of new control strategies. However, such software frameworks also introduce substantial power consumption overhead that could render this solution unfeasible for implantable devices. To address this, in this work four techniques to reduce this overhead are proposed and evaluated: a tick-less idle operation mode, reduced and dynamic sampling, buffered read mode, and duty cycling. A dual threshold adaptive deep brain stimulation algorithm for suppressing pathological oscillatory neural activity was implemented along with the proposed energy saving techniques on an energy-efficient OS, YetiOS, running on a STM32L476RE microcontroller. The system was then tested using an emulation environment coupled to a mean field model of the parkinsonian basal ganglia to simulate local field potential (LFPs) which acted as a biomarker for the controller. The OS-based controller alone introduced a power consumption overhead of 10.03 mW for a sampling rate of 1 kHz. This was reduced to 12 μW by applying the proposed tick-less idle mode, dynamic sampling, buffered read and duty cycling techniques. The OS-based controller using the proposed methods can facilitate rapid and flexible testing and implementation of new control methods. Furthermore, the approach has the potential to become a central element in future implantable devices to enable energy-efficient implementation of a wide range of control algorithms across different neurological conditions and hardware platforms.

Speech Rate Mediated Vowel and Stop Voicing Distinctiveness in Parkinson's Disease

2021 ◽  
pp. 1-28
Author(s):  
Thea Knowles ◽  
Scott G. Adams ◽  
Mandar Jog
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Voice Onset Time ◽  
Speech Rate ◽  
Onset Time ◽  
Speaking Rate ◽  
Wide Range ◽  
Deep Brain

Purpose The purpose of this study was to quantify changes in acoustic distinctiveness in two groups of talkers with Parkinson's disease as they modify across a wide range of speaking rates. Method People with Parkinson's disease with and without deep brain stimulation and older healthy controls read 24 carrier phrases at different speech rates. Target nonsense words in the carrier phrases were designed to elicit stop consonants and corner vowels. Participants spoke at seven self-selected speech rates from very slow to very fast, elicited via magnitude production. Speech rate was measured in absolute words per minute and as a proportion of each talker's habitual rate. Measures of segmental distinctiveness included a temporal consonant measure, namely, voice onset time, and a spectral vowel measure, namely, vowel articulation index. Results All talkers successfully modified their rate of speech from slow to fast. Talkers with Parkinson's disease and deep brain stimulation demonstrated greater baseline speech impairment and produced smaller proportional changes at the fast end of the continuum. Increasingly slower speaking rates were associated with increased temporal contrasts (voice onset time) but not spectral contrasts (vowel articulation). Faster speech was associated with decreased contrasts in both domains. Talkers with deep brain stimulation demonstrated more aberrant productions across all speaking rates. Conclusions Findings suggest that temporal and spectral segmental distinctiveness are asymmetrically affected by speaking rate modifications in Parkinson's disease. Talkers with deep brain stimulation warrant further investigation with regard to speech changes they make as they adjust their speaking rate.

Deep Brain Stimulation

2021 ◽  
Author(s):  
Tipu Aziz ◽  
Holly Roy
Keyword(s):  
Alzheimer’S Disease ◽  
Parkinson’S Disease ◽  
Alzheimer's Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Brain Regions ◽  
Clinical Aspects ◽  
Wide Range ◽  
Deep Brain

Deep brain stimulation (DBS) is a neurosurgical technology that allows the manipulation of activity within specific brain regions through delivery of electrical stimulation via implanted electrodes. The growth of DBS has led to research around the development of novel interventions for a wide range of neurological and neuropsychiatric conditions, including Parkinson’s disease, dystonia, chronic pain, Tourette’s syndrome, treatment-resistant depression, anorexia nervosa, and Alzheimer’s disease. Some of these treatment approaches have a high level of efficacy as well as an established place in the clinical armamentarium for the diseases in question, such as DBS for movement disorders, including Parkinson’s disease. Other interventions are at a more developmental stage, such as DBS for depression and Alzheimer’s disease. Success both in clinical aspects of DBS and new innovations depends on a close-knit multidisciplinary team incorporating experts in the underlying condition (often neurologists and psychiatrists); neurosurgeons; nurse specialists, who may be involved in device programming and other aspects of patient care; and researchers including neuroscientists, imaging specialists, engineers, and signal analysts. Directly linked to the growth of DBS as a specialty is allied research around neural signals analysis and device development, which feed directly back into further clinical progress. The close links between clinical DBS and basic and translational research make it an exciting and fast-moving area of neuroscience.

Multitarget, dual-electrode deep brain stimulation of the thalamus and subthalamic area for treatment of Holmes' tremor

2014 ◽  
Vol 120 (5) ◽  
pp. 1025-1032 ◽  
Author(s):  
Kazutaka Kobayashi ◽  
Yoichi Katayama ◽  
Hideki Oshima ◽  
Mitsuru Watanabe ◽  
Koichiro Sumi ◽  
...  
Keyword(s):  
Neural Network ◽  
Deep Brain Stimulation ◽  
Essential Tremor ◽  
Brain Stimulation ◽  
Rating Scale ◽  
The Other ◽  
Parkinsonian Tremor ◽  
Holmes Tremor ◽  
Dual Lead ◽  
Deep Brain

Object Holmes' tremor (HT) is generally considered to be a symptomatic tremor associated with lesions of the cerebellum, midbrain, or thalamus. Deep brain stimulation (DBS) therapy for essential tremor and parkinsonian tremor has proved quite successful. In contrast, surgical treatment outcomes for HT have often been disappointing. The use of 2 ipsilateral DBS electrodes implanted in parallel within the thalamus for severe essential tremor has been reported. Since dual-lead stimulation within a single target can cover a wider area than single-lead stimulation, it produces greater effects. On the other hand, DBS of the subthalamic area (SA) was recently reported to be effective for refractory tremor. Methods The authors implanted 2 DBS electrodes (one at the nucleus ventralis oralis/nucleus ventralis intermedius and the other at the SA) in 4 patients with HT. For more than 2 years after implantation, each patient's tremor was evaluated using a tremor rating scale under the following 4 conditions of stimulation: “on” for both thalamus and SA DBS; “off” for both thalamus and SA DBS; “on” for thalamus and “off” for SA DBS; and “on” for SA and “off” for thalamus DBS. Results The tremor in all patients was improved for more than 2 years (mean 25.8 ± 3.5 months). Stimulation with 2 electrodes exerted greater effect on the tremor than did 1-electrode stimulation. Interestingly, in all patients progressive effects were observed, and in one patient treated with DBS for 1 year, tremor did not appear even while stimulation was temporarily switched off, suggesting irreversible improvement effects. The presence of both resting and intentional/action tremor implies combined destruction of the pallidothalamic and cerebellothalamic pathways in HT. A larger stimulation area may thus be required for HT patients. Multitarget, dual-lead stimulation permits coverage of the wide area needed to suppress the tremor without adverse effects of stimulation. Some reorganization of the neural network may be involved in the development of HT because the tremor appears several months after the primary insult. The mechanism underlying the absence of tremor while stimulation was temporarily off remains unclear, but the DBS may have normalized the abnormal neural network. Conclusions The authors successfully treated patients with severe HT by using dual-electrode DBS over a long period. Such DBS may offer an effective and safe treatment modality for intractable HT.

Sign in / Sign up

Export Citation Format

Share Document