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Advances in Invasive and Non-invasive Brain Stimulation in Movement Disorders

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Systems Neuroscience".

Deadline for manuscript submissions: 7 June 2024 | Viewed by 34709

Special Issue Editors


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Guest Editor
Department of functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Interests: Parkinson disease; dystonia; Tourette syndrome and deep brain stimulation (DBS)
Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville, FL 32611, USA
Interests: Parkinson's disease; dystonia; Tourette syndrome; neuromodulation techniques, such as deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS)

E-Mail Website
Guest Editor
Department of functional Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
Interests: deep brain stimulation; Parkinson disease; dystonia

Special Issue Information

Dear Colleagues,

Movement disorders including Parkinson’s disease (PD), essential tremor (ET), and dystonia are chronic neurodegenerative diseases that are increasingly prevalent, affecting many individuals around the world. Invasive and non-Invasive Brain Stimulation, including deep brain stimulation (DBS) and transcranial magnetic stimulations, are effective treatments for common movement disorders and have been used to modulate neural activity through the delivery of electrical stimulation to key brain structures. The long-term efficacy of stimulation in treating disorders such as Parkinson’s disease and essential tremor has encouraged its application to a wide range of neurological and psychiatric conditions.

Dr. Jianguo Zhang
Dr. Wei Hu
Dr. Fangang Meng
Guest Editors

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Keywords

  • movement disorders
  • Parkinson disease
  • essential tremor
  • dystonia
  • brain stimulation

Published Papers (18 papers)

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12 pages, 3005 KiB  
Article
β Oscillations of Dorsal STN as a Potential Biomarker in Parkinson’s Disease Motor Subtypes: An Exploratory Study
by Yongjie Li, Yuqi Zeng, Mangui Lin, Yingqing Wang, Qinyong Ye, Fangang Meng, Guofa Cai and Guoen Cai
Brain Sci. 2023, 13(5), 737; https://doi.org/10.3390/brainsci13050737 - 28 Apr 2023
Cited by 2 | Viewed by 1207
Abstract
Parkinson’s disease (PD) can be divided into postural instability and difficult gait (PIGD) and tremor dominance (TD) subtypes. However, potential neural markers located in the dorsal ventral side of the subthalamic nucleus (STN) for delineating the two subtypes of PIGD and TD have [...] Read more.
Parkinson’s disease (PD) can be divided into postural instability and difficult gait (PIGD) and tremor dominance (TD) subtypes. However, potential neural markers located in the dorsal ventral side of the subthalamic nucleus (STN) for delineating the two subtypes of PIGD and TD have not been demonstrated. Therefore, this study aimed to investigate the spectral characteristics of PD on the dorsal ventral side. The differences in the β oscillation spectrum of the spike signal on the dorsal and ventral sides of the STN during deep brain stimulation (DBS) were investigated in 23 patients with PD, and coherence analysis was performed for both subtypes. Finally, each feature was associated with the Unified Parkinson’s Disease Rating Scale (UPDRS). The β power spectral density (PSD) in the dorsal STN was found to be the best predictor of the PD subtype, with 82.6% accuracy. The PSD of dorsal STN β oscillations was greater in the PIGD group than in the TD group (22.17% vs. 18.22%; p < 0.001). Compared with the PIGD group, the TD group showed greater consistency in the β and γ bands. In conclusion, dorsal STN β oscillations could be used as a biomarker to classify PIGD and TD subtypes, guide STN-DBS treatment, and relate to some motor symptoms. Full article
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<p>Inclusion and exclusion of patients with PD. MERs, microelectrode recordings; DBS, deep brain stimulation; GPI, globus pallidus internus; PIGD, postural instability and gait difficulty; TD, tremor dominant.</p>
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<p>Comparative analysis of two subtypes of power spectral density (PSD) in the subthalamic nucleus (STN). Variation in the PSD plot shows that the PIGD group oscillated at higher energy values in the β band. (<b>A</b>) The PIGD subtype microelectrode records data from the dorsal and ventral STN. (<b>B</b>) The TD subtype microelectrode records data from the dorsal and ventral STN. A two-tailed Wilcoxon rank-sum test was used to compare each band between the PIGD and TD groups (with 250 MERs in the PIGD group and 129 MERs in the TD group), and divided into the upper and lower sides of the STN nuclei. Significant differences were found between the PIGD and TD groups in the dorsal part of the STN. (<b>C</b>) Comparison of Spectral Sizes between Two Subtypes in Four Frequency Bands. (<b>D</b>) Comparison of spectral sizes of two subtypes of STN on the dorsal and ventral sides in four frequency bands. ** Indicates <span class="html-italic">p</span> &lt; 0.001 in the PIGD and TD groups.</p>
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<p>Comparative analysis of two subtypes of power spectral density (PSD) in the subthalamic nucleus (STN). Variation in the PSD plot shows that the PIGD group oscillated at higher energy values in the β band. (<b>A</b>) The PIGD subtype microelectrode records data from the dorsal and ventral STN. (<b>B</b>) The TD subtype microelectrode records data from the dorsal and ventral STN. A two-tailed Wilcoxon rank-sum test was used to compare each band between the PIGD and TD groups (with 250 MERs in the PIGD group and 129 MERs in the TD group), and divided into the upper and lower sides of the STN nuclei. Significant differences were found between the PIGD and TD groups in the dorsal part of the STN. (<b>C</b>) Comparison of Spectral Sizes between Two Subtypes in Four Frequency Bands. (<b>D</b>) Comparison of spectral sizes of two subtypes of STN on the dorsal and ventral sides in four frequency bands. ** Indicates <span class="html-italic">p</span> &lt; 0.001 in the PIGD and TD groups.</p>
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<p>Comparison of correlations between the PIGD and TD groups for each power band. (<b>A</b>) Coherence is quantified as a significant correlation between spike and background activity, with dashed lines indicating significant coherence at 95% confidence intervals. (<b>B</b>) Comparison chart of significant coherence percentage of two subtypes in β and γ.</p>
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<p>Comparison of correlations between the PIGD and TD groups for each power band. (<b>A</b>) Coherence is quantified as a significant correlation between spike and background activity, with dashed lines indicating significant coherence at 95% confidence intervals. (<b>B</b>) Comparison chart of significant coherence percentage of two subtypes in β and γ.</p>
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<p>ROC curves for PIGD and TD differentiated using the power spectral density (PSD) in the β band: PSD in the β band (blue) and PSD in the dorsal beta band (red).</p>
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13 pages, 8311 KiB  
Article
Technical Issues of Vim–PSA Double-Target DBS for Essential Tremor
by Xusheng Hou, Yixiang Mo, Zhiyuan Zhu, Huan Zhang, Xinzi Liu, Zhihao Zou, Xiaozheng He, Shan Xue, Jiangtao Li, Mengqian Li and Shizhong Zhang
Brain Sci. 2023, 13(4), 566; https://doi.org/10.3390/brainsci13040566 - 28 Mar 2023
Cited by 1 | Viewed by 2380
Abstract
Background: Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA) as the most common targets. The stimulation efficacy of ET with Vim–PSA double-target DBS has been reported. Herein, [...] Read more.
Background: Deep brain stimulation (DBS) is an effective surgical treatment for essential tremor (ET), with the ventral intermediate nucleus (Vim) and posterior subthalamic area (PSA) as the most common targets. The stimulation efficacy of ET with Vim–PSA double-target DBS has been reported. Herein, we aim to propose surgical techniques for Vim–PSA double-target DBS surgery. Methods: This study enrolled six patients with ET who underwent Vim–PSA double-target electrode implantation from October 2019 to May 2022. The targets were located and adjusted using coordinates and multimodality MRI images. A burr hole was accurately drilled in line with the electrode trajectory under the guidance of a stereotactic frame. Novel approaches were adopted during the electrode implantation process for pneumocephalus reduction, including “arachnoid piamater welding” and “water sealing”. Electrophysiological recording was used to identify the implantation sites of the electrodes. A 3D reconstruction model of electrodes and nuclei was established to facilitate programming. Results: The combination of coordinates and multimodality MRI images for target location and adjustment enabled the alignment of Vim and PSA. Postoperative CT scanning showed that the electrode was precisely implanted. Stereotactic guidance facilitated accurate burr hole drilling. “Arachnoid piamater welding” and “water sealing” were efficient in reducing pneumocephalus. Intraoperative electrophysiological verified the efficacy of Vim–PSA double-target DBS surgery. Conclusions: The methods for target location and adjustment, accurate drilling of the burr hole, reduction in pneumocephalus, and intraoperative electrophysiological verification are key issues in DBS surgery targeting both the Vim and PSA. This study may provide technical support for Vim–PSA DBS, especially for surgeons with less experience in functional neurosurgery. Full article
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<p>A demonstration of target planning for the Vim and PSA. Targets are located through the atlas-defined stereotactic coordinates, DTI images, and FGATIR images. (<b>A</b>) The DRTT is delineated using DTI tractography on the axial anterior commissure–posterior commissure (AC-PC) plane. The Vim target is located on the DTI images, indicated with a green “+”. The DRTT is delineated by the DTI images on the sagittal (<b>B</b>) and coronal planes (<b>C</b>). (<b>D</b>) Unannotated axial FGATIR images, 1 mm below the AC-PC plane. (<b>E</b>) The Vim nucleus region is delineated with a green circle on the axial FGATIR images. (<b>F</b>) The green “+” represents the planned Vim target. (<b>G</b>,<b>H</b>) The cZi lies laterally to the DRTT on the most prominent RN layer. The green “+” represents the planned cZi target, which is usually located on the axial T2WI images.</p>
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<p>The cZi is selected as the preferred PSA region for alignment of the Vim and PSA. (<b>A</b>) The default coronal and sagittal angles of trajectory are usually preset on the axial plane. The coronal and sagittal angles are adjusted to ensure that the trajectory traverses the target of Vim on the coronal (<b>B</b>) and sagittal planes (<b>C</b>). (<b>D</b>) The cZi target is marked with a green “+” on the axial T2WI images. (<b>E</b>) The common stimulated area of Raprl for ET is marked with a yellow “+” on the T2WI images. (<b>F</b>) The Raprl target lies medial and anterior to the cZi on the same plane of the axial T2WI images. To illustrate the selection of the stimulation region in the PSA, the planned Vim–cZi and Vim–Raprl trajectories are compared on the axial (<b>G</b>), coronal (<b>H</b>), and sagittal (<b>I</b>) planes, respectively. In this case, the Vim stereotactic coordinates are 13.7 mm lateral, 5.6 mm posterior, and 1.0 mm inferior relative to the MCP. The cZi stereotactic coordinates are 12.5 mm lateral, 6.9 mm posterior, and 4.0 mm inferior relative to the MCP. As for the Raprl, the stereotactic coordinates are 10.6 mm lateral, 6.1 mm posterior, and 4.0 mm inferior relative to the MCP. Correspondingly, the coronal and sagittal angles of the Vim–cZi trajectory are, respectively, 18.1 degrees and 68.9 degrees (∠1 and ∠3 in <a href="#brainsci-13-00566-f002" class="html-fig">Figure 2</a>H,I). The coronal and sagittal angles of the Vim–Raprl trajectory are, respectively, 42.1 degrees and 80.4 degrees (∠2 and ∠4 in <a href="#brainsci-13-00566-f002" class="html-fig">Figure 2</a>H,I). Both the coronal and sagittal angles of the Vim–Raprl trajectory are significantly larger than those of the Vim–cZi trajectory. Meanwhile, the Vim–Raprl trajectory traverses the internal capsule and insular cortex.</p>
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<p>The comparison of three methods to reduce pneumocephalus and CSF loss. Representative intraoperative CT images of three patients who underwent bilateral electrode implantation, each with one of three burr hole-sealing approaches, are presented. (<b>A</b>) A 58-year-old male patient with Parkinson’s disease (PD) underwent bilateral STN-DBS electrode implantation in 2013. During the operation, bone wax was used to seal the burr hole. The air volume of the intraoperative CT images was 20.81 cm<sup>3</sup>. (<b>B</b>) A 65-year-old female patient with ET underwent bilateral Vim-DBS electrode implantation in 2021. The burr hole was filled with fibrin glue during the surgery. The air volume of the intraoperative CT images was 2.51 cm<sup>3</sup>. (<b>C</b>) A 60-year-old female patient with ET underwent bilateral Vim–PSA DBS electrode implantation in 2022. We adopted the “water sealing” method for this patient. The air volume of the intraoperative CT images was 4.18 cm<sup>3</sup>.</p>
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<p>The canonical neuronal firing patterns of the Vim and PSA. The neuronal firing patterns from intraoperative MER are among the critical factors for selecting the electrode implantation site for the Vim–PSA double-target DBS surgery. Generally, the high background firing activity of neurons corresponding to tremors can be recorded in the Vim nucleus. On the other hand, the neuronal firing pattern of the PSA is characterized by low background noise and sparse neuronal firing.</p>
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<p>An illustration of the 3D reconstruction models for unilateral Vim–PSA double-target DBS. A single electrode was implanted into the Vim–PSA double target of the left hemisphere. The 3D reconstruction of the electrode, the Vim (green), the cZi (light blue), the STN (orange), the RN (red), and the DRTT (dark blue) are shown on the axial (<b>A</b>,<b>E</b>), coronal (<b>B</b>,<b>F</b>), and sagittal (<b>C</b>,<b>G</b>) sections. For a clearer illustration of the relative positions of the electrode implanted into the Vim and PSA, perspectives are displayed from the posterolateral (<b>D</b>) and anteromedial (<b>H</b>) directions.</p>
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11 pages, 4686 KiB  
Article
Altered Fractional Amplitude of Low-Frequency Fluctuation in Anxious Parkinson’s Disease
by Peiyao Zhang, Yunpeng Gao, Yingying Hu, Yuan Luo, Lu Wang, Kang Wang, Hong Tian and Miao Jin
Brain Sci. 2023, 13(1), 87; https://doi.org/10.3390/brainsci13010087 - 2 Jan 2023
Cited by 5 | Viewed by 1519
Abstract
Objective: Anxiety symptoms are persistent in Parkinson’s disease (PD), but the underlying neural substrates are still unclear. In the current study, we aimed to explore the underlying neural mechanisms in PD patients with anxiety symptoms. Methods: 42 PD-A patients, 41 PD patients without [...] Read more.
Objective: Anxiety symptoms are persistent in Parkinson’s disease (PD), but the underlying neural substrates are still unclear. In the current study, we aimed to explore the underlying neural mechanisms in PD patients with anxiety symptoms. Methods: 42 PD-A patients, 41 PD patients without anxiety symptoms (PD-NA), and 40 healthy controls (HCs) were recruited in the present study. All the subjects performed 3.0T fMRI scans. The fractional amplitude of low-frequency fluctuation (fALFF) analysis was used to investigate the alterations in neural activity among the three groups. A Pearson correlation analysis was performed between the altered fALFF value of the PD-A group and anxiety scores. Results: Compared with HCs, PD-A patients had higher fALFF values in the left cerebellum, cerebellum posterior lobe, bilateral temporal cortex, and brainstem and lower fALFF values in the bilateral inferior gyrus, bilateral basal ganglia areas, and left inferior parietal lobule. Moreover, between the two PD groups, PD-A patients showed higher fALFF values in the right precuneus and lower fALFF values in the bilateral inferior gyrus, bilateral basal ganglia areas, left inferior parietal lobule, and left occipital lobe. Furthermore, Pearson’s correlation analysis demonstrated that the right precuneus and left caudate were correlated with the Hamilton Anxiety Rating Scale scores. Conclusion: Our study found that anxiety symptoms in PD patients may be related to alterations of neurological activities in multiple brain regions. Furthermore, these may be critical radiological biomarkers for PD-A patients. Therefore, these findings can improve our understanding of the pathophysiological mechanisms underlying PD-A. Full article
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<p>Brain regions with significant differences in fALFF among the three groups (GRF multiple comparison correction, <span class="html-italic">p</span> &lt; 0.01 at the voxel level and <span class="html-italic">p</span> &lt; 0.05 at the cluster level).</p>
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<p>Brain regions showing differences in fALFF between groups. <span style="color:red">The red region</span> represents the brain region with significantly increased fALFF (PD-A &gt; HC, PD-A &gt; PD-NA, and PD-NA &gt; HC), and the blue region represents the brain region with significantly decreased DC (PD-A &lt; HC, PD-A &lt; PD-NA, and PD-NA &lt; HC).</p>
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<p>In PD-A patients, the fALFF value of the right precuneus showed a positive correlation with HAMA scores.</p>
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<p>In PD-A patients, the fALFF value of the left caudate showed a negative correlation with HAMA scores.</p>
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10 pages, 1053 KiB  
Article
Subthalamic Nucleus Deep Brain Stimulation Treats Parkinson’s Disease Patients with Cardiovascular Disease Comorbidity: A Retrospective Study of a Single Center Experience
by Changming Zhang, Jiakun Xu, Bin Wu, Yuting Ling, Qianqian Guo, Simin Wang, Lige Liu, Nan Jiang, Ling Chen and Jinlong Liu
Brain Sci. 2023, 13(1), 70; https://doi.org/10.3390/brainsci13010070 - 29 Dec 2022
Cited by 2 | Viewed by 1502
Abstract
Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective method for treating Parkinson’s disease (PD). However, safety of STN-DBS treating PD patients with cardiovascular disease (CVD) comorbidity is rarely focused and reported. The aim of this study is to investigate the [...] Read more.
Background: Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective method for treating Parkinson’s disease (PD). However, safety of STN-DBS treating PD patients with cardiovascular disease (CVD) comorbidity is rarely focused and reported. The aim of this study is to investigate the efficacy and safety of STN-DBS treating PD patients with CVD comorbidity. Methods: We retrospectively included PD patients with CVD comorbidity who underwent STN-DBS under general anesthesia in our center from January 2019 to January 2021. Patient’s PD symptoms and cardiopulmonary function were evaluated by a multi-disciplinary team (MDT) before surgery. Post-operative clinical outcome and complications were collected until 1-year follow-up. Results: A total of 38 patients (26 men/12 women) of mean body mass index (BMI) 24.36 ± 3.11 kg/m2, with different CVD comorbidity were finally speculated in the study. These CVD include mainly hypertension, coronary artery disease, thoracic aortic aneurysm, heart valve replacement, pacemaker implantation, atrial fibrillation, patent foramen ovale, and so on. The mean systolic blood pressure (SBP) of 38 patients at admission day, pre-operation day, and discharge day timepoint was 135.63 ± 18.08 mmHg, 137.66 ± 12.26 mmHg, and 126.87 ± 13.36 mmHg, respectively. This showed that blood pressure was controlled well under stable and normal state. The indicators of myocardial infarction Troponin T (Tn T-T) levels at pre-operation, 1 day and 7 days after operation timepoint were 0.014 ± 0.011 ng/mL, 0.015 ± 0.011 ng/mL, and 0.014 ± 0.008 ng/mL, showing no significant fluctuation (F = 0.038, p = 0.962). STN-DBS improved PD patients’ UPDRS III scores by 51.38% (t = 12.33, p < 0.0001) at 1-year follow-up compared with pre-operative baseline. A total of 11 adverse events were recorded until 1-year follow-up. No obvious cardiovascular complications such as intracranial hematoma or clot-related events occurred within 1 year after surgery except 1 case of hematuria. Conclusions: STN-DBS under general anesthesia is safe and effective for treating PD patients with CVD comorbidity. Our clinical experience and protocol of the MDT offers comprehensive perioperative evaluation for DBS surgery and mitigates bleeding and cardiovascular-associated events in PD patients with CVD comorbidity. Full article
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<p>Trends in blood pressure. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) change trends in three different timepoint during the STN-DBS perioperative period. Normal SBP &lt; 140 mmHg; normal DBP &lt; 90 mmHg.</p>
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<p>Trends in myocardial markers. This shows trends of the myocardial markers CK-MB (<b>a</b>), MYO (<b>b</b>), and Tn T-T (<b>c</b>) at three different timepoints during the STN-DBS perioperative period. pre-op: pre-operation; post-op: post-operation.</p>
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<p>Trends in blood coagulation indicators. It shows trends of the PT, APTT (<b>a</b>), and INR (<b>b</b>) at three different timepoints during the STN-DBS perioperative period. post-op: post-operation.</p>
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10 pages, 661 KiB  
Article
Risk Factors for Delirium after Deep Brain Stimulation Surgery under Total Intravenous Anesthesia in Parkinson’s Disease Patients
by Wenbin Lu, Xinning Chang, Lulong Bo, Yiqing Qiu, Mingyang Zhang, Jiali Wang, Xi Wu and Xiya Yu
Brain Sci. 2023, 13(1), 25; https://doi.org/10.3390/brainsci13010025 - 22 Dec 2022
Cited by 8 | Viewed by 1416
Abstract
Background: Postoperative delirium (POD) is associated with perioperative complications and mortality. Data on the risk factors for delirium after subthalamic nucleus deep brain stimulation (STN-DBS) surgery is not clarified in Parkinson’s disease (PD) patients receiving total intravenous anesthesia. We aimed to investigate the [...] Read more.
Background: Postoperative delirium (POD) is associated with perioperative complications and mortality. Data on the risk factors for delirium after subthalamic nucleus deep brain stimulation (STN-DBS) surgery is not clarified in Parkinson’s disease (PD) patients receiving total intravenous anesthesia. We aimed to investigate the risk factors for delirium after STN-DBS surgery in PD patients. Methods:The retrospective cohort study was conducted, including 131 PD patients who underwent STN-DBS for the first time under total intravenous anesthesia from January to December 2021. Delirium assessments were performed twice daily for 7 days after surgery or until hospital discharge using the confusion assessment method for the intensive care unit. Multivariate logistic regression analysis was used to determine the risk factor of POD. Results: In total, 22 (16.8%) of 131 patients were in the POD group, while the other 109 patients were in the Non-POD group. Multivariate logistic regression analysis showed that preoperative Mini-mental State Examination score [odds ratio = 0.855, 95% confidence interval = 0.768–0.951, p = 0.004] and unified Parkinson’s disease rating scale part 3 (on state) score (odds ratio = 1.061, 95% confidence interval = 1.02–1.104, p = 0.003) were independently associated with delirium after surgery. Conclusions: In this retrospective cohort study of PD patients, a lower Mini-mental State Examination score and a higher unified Parkinson’s disease rating scale part 3 (on state) score were the independent risk factors for delirium after STN-DBS surgery in PD patients under total intravenous anesthesia. Full article
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<p>Flow chart of participants in the study.</p>
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<p>Receiver operating characteristic (ROC) curve for preoperative MMSE score combined with UPDRS part 3 (on state) score as a predictor of POD.</p>
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12 pages, 978 KiB  
Article
Optimal Contact Position of Subthalamic Nucleus Deep Brain Stimulation for Reducing Restless Legs Syndrome in Parkinson’s Disease Patients: One-Year Follow-Up with 33 Patients
by Hongbing Lei, Chunhui Yang, Mingyang Zhang, Yiqing Qiu, Jiali Wang, Jinyu Xu, Xiaowu Hu and Xi Wu
Brain Sci. 2022, 12(12), 1645; https://doi.org/10.3390/brainsci12121645 - 1 Dec 2022
Cited by 4 | Viewed by 1518
Abstract
Objectives: To determine the short- and medium-term therapeutic effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on restless legs syndrome (RLS) in patients with Parkinson’s disease (PD) and to study the optimal position of activated contacts for RLS symptoms. Methods: We preoperatively [...] Read more.
Objectives: To determine the short- and medium-term therapeutic effects of subthalamic nucleus (STN) deep brain stimulation (DBS) on restless legs syndrome (RLS) in patients with Parkinson’s disease (PD) and to study the optimal position of activated contacts for RLS symptoms. Methods: We preoperatively and postoperatively assessed PD Patients with RLS undergoing STN-DBS. Additionally, we recorded the stimulation parameters that induced RLS or relieved RLS symptoms during a follow-up. Finally, we reconstructed the activated contacts’ position that reduced or induced RLS symptoms. Results: 363 PD patients were enrolled. At the 1-year follow-up, we found that the IRLS sum significantly decreased in the RLS group (preoperative 18.758 ± 7.706, postoperative 8.121 ± 7.083, p < 0.05). The results of the CGI score, MOS sleep, and RLS QLQ all showed that the STN-DBS improved RLS symptoms after one year. Furthermore, the activated contacts that relieved RLS were mainly located in the central sensorimotor region of the STN. Activated contacts in the inferior sensorimotor part of the STN or in the substantia nigra might have induced RLS symptoms. Conclusions: STN-DBS improved RLS in patients with PD in one year, which reduced their sleep disorders and increased their quality of life. Furthermore, the central sensorimotor region part of the STN is the optimal stimulation site. Full article
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<p>Location of effective stimulation contacts for STN-DBS to reduce RLS. (<b>A</b>) (left posterior—anterior view), and (<b>B</b>) (right posterior—anterior view) show the locations of all activated contacts (red spheres) and inactive contacts (blue) for 33 patients. (<b>C</b>) (posterior–anterior view) shows effective programmed contacts in nine patients with exacerbated RLS symptoms. (<b>D</b>) shows activation contact locations in five patients with acute RLS symptoms induced by electrical stimulation. In the figures, the yellow sphere is the subthalamic nucleus, the green sphere is the globus pallidus internal segment, the blue sphere is the globus pallidus external segment (GPe), and the red sphere is the red nucleus.</p>
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<p>Overlapping of VTA contact activation area and the STN (including frontal, left, and right lateral views, respectively). (<b>A</b>–<b>C</b>) VTA contact activation area covered by the STN nucleus in 33 patients. The VTA covered the sensorimotor and associative parts of the STN, as well as the zona incerta (ZI). (<b>D</b>–<b>F</b>) In 9 patients with recurrent RLS, after program-controlled adjustment of stimulation parameters, RLS symptoms were significantly improved, while PD motor symptom scores did not change significantly. The VTA contact activation area at this point primarily covers the central sensorimotor area medial to the STN. (<b>G</b>–<b>I</b>) Activation of the lowermost VTA contact area induced RLS symptoms in 5 patients. The area overlapped with the lower border of the STN, and the common activation area is close to the substantia nigra.</p>
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13 pages, 784 KiB  
Article
Short- and Long-Term Efficacy and Safety of Deep-Brain Stimulation in Parkinson’s Disease Patients aged 75 Years and Older
by Chao Jiang, Jian Wang, Tong Chen, Xuemei Li and Zhiqiang Cui
Brain Sci. 2022, 12(11), 1588; https://doi.org/10.3390/brainsci12111588 - 20 Nov 2022
Cited by 2 | Viewed by 2086
Abstract
Objective: The aim of this study was to investigate the efficacy and safety of deep-brain stimulation (DBS) in the treatment of patients with Parkinson’s disease aged 75 years and older. Methods: From March 2013 to June 2021, 27 patients with Parkinson’s disease (≥75 [...] Read more.
Objective: The aim of this study was to investigate the efficacy and safety of deep-brain stimulation (DBS) in the treatment of patients with Parkinson’s disease aged 75 years and older. Methods: From March 2013 to June 2021, 27 patients with Parkinson’s disease (≥75 years old) who underwent DBS surgery at the First Medical Center of the PLA General Hospital were selected. The Unified Parkinson’s Disease Rating Scale Part 3 (UPDRS-III), 39-item Parkinson’s Disease Questionnaire (PDQ-39), and Barthel Index for Activities of Daily Living (BI) scores were used to evaluate motor function and quality of life before surgery and during on and off periods of DBS at 1 year post operation and at the final follow-up. A series of non-motor scales were used to evaluate sleep, cognition, and mood, and the levodopa equivalent daily dose (LEDD) was also assessed. Adverse events related to surgery were noted. Results: The average follow-up time was 55.08 (21–108) months. Symptoms were significantly improved at 1 year post operation. The median UPDRS-III score decreased from 35 points (baseline) to 19 points (improvement of 45.7%) in the stimulation-on period at 1 year post operation (t = 19.230, p < 0.001) and to 32 points (improvement of 8.6%) at the final follow-up (t = 3.456, p = 0.002). In the stimulation-off period, the median score of UPDRS-III increased from 35 points to 39 points (deterioration of −11.4%) at 1 year post operation (Z = −4.030, p < 0.001) and 45 points (deterioration of −28.6%) at the final follow-up (Z = −4.207, p < 0.001). The PDQ-39 overall scores decreased from 88 points (baseline) to 55 points (improvement of 37.5%) in the stimulation-on period at 1 year post operation (t = 11.390, p < 0.001) and 81 points (improvement of 8.0%) at the final follow-up (t = 2.142, p = 0.044). In the stimulation-off period, the median PDQ-39 score increased from 88 points to 99 points (deterioration of −12.5%) at the final follow-up (Z = −2.801, p = 0.005). The ADL-Barthel Index score increased from 25 points (baseline) to 75 points (improvement of 66.7%) at 1 year post operation (Z = −4.205, p < 0.001) and to 35 points (improvement of 28.6%) at the final follow-up (Z = −4.034, p < 0.001). In the stimulation-off period, BI scores decreased from 25 points to 15 points (deterioration of −40%) at 1 year post operation (Z = −3.225, p = 0.01) and to 15 points (deterioration of −40%) at the final follow-up (Z = −3.959, p = 0.001). Sleep, cognition, and mood were slightly improved at 1 year post operation (p < 0.05), and LEDD was reduced from 650 mg (baseline) to 280 mg and 325 mg at 1 year post operation and the final follow-up, respectively (p < 0.05). One patient had a cortical hemorrhage in the puncture tract on day 2 after surgery, five patients had hallucinations in the acute stage after surgery, and one patient had an exposed left-brain electrode lead at 4 months post operation; there were no infections or death. Conclusion: DBS showed efficacy and safety in treating older patients (≥75 years old) with Parkinson’s disease. Motor function, quality of life, activities of daily living, LEDD, and sleep all showed long-term improvements with DBS; short-term improvements in emotional and cognitive function were also noted. Full article
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<p>Visual analysis of histograms. * <span class="html-italic">p</span> &lt; 0.05; ** <span class="html-italic">p</span> &lt; 0.01.</p>
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<p>DBS operation with intracranial hemorrhage: (<b>a</b>) left frontal hematoma at 1 day post operation; (<b>b</b>) the hematoma was mostly absorbed at 21 days post operation.</p>
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10 pages, 1917 KiB  
Article
Risk Factors for Hiccups after Deep Brain Stimulation of Subthalamic Nucleus for Parkinson’s Disease
by Bin Wu, Yuting Ling, Changming Zhang, Yi Liu, Ruoheng Xuan, Jiakun Xu, Yongfu Li, Qianqian Guo, Simin Wang, Lige Liu, Lulu Jiang, Zihuan Huang, Jianping Chu, Ling Chen, Nan Jiang and Jinlong Liu
Brain Sci. 2022, 12(11), 1447; https://doi.org/10.3390/brainsci12111447 - 26 Oct 2022
Cited by 2 | Viewed by 1772
Abstract
Background: After deep brain stimulation (DBS), hiccups as a complication may lead to extreme fatigue, sleep deprivation, or affected prognosis. Currently, the causes and risk factors of postoperative hiccups are unclear. In this study, we investigated the risk factors for hiccups after DBS [...] Read more.
Background: After deep brain stimulation (DBS), hiccups as a complication may lead to extreme fatigue, sleep deprivation, or affected prognosis. Currently, the causes and risk factors of postoperative hiccups are unclear. In this study, we investigated the risk factors for hiccups after DBS of the subthalamic nucleus (STN) for Parkinson’s disease (PD) under general anesthesia. Methods: We retrospectively included patients who underwent STN DBS in the study, and collected data of demographic characteristics, clinical evaluations, and medications. According to the occurrence of hiccups within seven days after operation, the patients were divided into a hiccups group and non-hiccups group. The potentially involved risk factors for postoperative hiccups were statistically analyzed by logistic regression analysis. Results: A total of 191 patients were included in the study, of which 34 (17.80%) had postoperative transient persistent hiccups. Binary univariate logistic regression analysis showed that male, higher body mass index (BMI), smoker, Hoehn and Yahr stage (off), preoperative use of amantadine, hypnotic, Hamilton anxiety scale and Hamilton depression scale scores, and postoperative limited noninfectious peri-electrode edema in deep white matter were suspected risk factors for postoperative hiccups (p < 0.1). In binary multivariate logistic regression analysis, male (compared to female, OR 14.00; 95% CI, 1.74–112.43), postoperative limited noninfectious peri-electrode edema in deep white matter (OR, 7.63; 95% CI, 1.37–42.37), preoperative use of amantadine (OR, 3.64; 95% CI, 1.08–12.28), and higher BMI (OR, 3.50; 95% CI, 1.46–8.36) were independent risk factors for postoperative hiccups. Conclusions: This study is the first report about the risk factors of hiccups after STN DBS under general anesthesia for PD patients. The study suggests that male, higher BMI, preoperative use of amantadine, and postoperative limited noninfectious peri-electrode edema in deep white matter are independent risk factors for postoperative hiccups of STN-DBS for PD patients. Most hiccups after STN-DBS for PD patients were transient and self-limiting. Full article
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<p>Data collection and analysis flowchart.</p>
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<p>The yellow arrow indicates limited non-infectious peri-electrode edema in deep white matter on postoperative T2-MRI image.</p>
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9 pages, 918 KiB  
Article
Effects of High Cervical Spinal Cord Stimulation on Gait Disturbance and Dysarthropneumophonia in Parkinson’s Disease and Parkinson Variant of Multiple System Atrophy: A Case Series
by Linbin Wang, Rui Zhu, Yixin Pan, Peng Huang, Yuyan Tan, Boyan Fang, Jun Liu and Dianyou Li
Brain Sci. 2022, 12(9), 1222; https://doi.org/10.3390/brainsci12091222 - 10 Sep 2022
Cited by 2 | Viewed by 1727
Abstract
High cervical spinal cord stimulation (HCSCS) was found to have therapeutic effects on Parkinsonian gait disturbance. However, the results were inconsistent and confounded with symptoms of pain. This study aimed to reveal the gait and dysarthric effects of HCSCS in PD (Parkinson’s disease) [...] Read more.
High cervical spinal cord stimulation (HCSCS) was found to have therapeutic effects on Parkinsonian gait disturbance. However, the results were inconsistent and confounded with symptoms of pain. This study aimed to reveal the gait and dysarthric effects of HCSCS in PD (Parkinson’s disease) and MSA-P (Parkinson variant of multiple system atrophy) patients without pain. Three PD and five MSA-P patients without painful comorbidities were assessed for gait performance and speech before SCS surgery and at 3- and 6-month follow-up. Stride length and the time spent in the Timed Up-and-Go task showed little change after HCSCS surgery. Overall voice quality (measured by dysphonia severity index) and perceptual speech intelligence improved significantly at 3 months, but improvements slightly diminished at 6 months postoperatively. Change in quality of life (measured by 8-item Parkinson’s disease questionnaire) was also notable at 3 months but narrowed over time following HCSCS. In conclusion, HCSCS showed therapeutic effects in improving the dysarthria but not gait disturbance in pain-free PD and MSA-P patients. Full article
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<p>Representative example showing the correct positioning of the octopolar electrode at C2-C5 level by postoperative radiography. (<b>A</b>) Medial-lateral plane, (<b>B</b>) Anterior-posterior plane.</p>
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<p>Effects of HCSCS on gait and dysarthria in PD and MSA-P patients at 3-month and 6-month postoperative treatment states when patients were off-medication. Upper left: time to complete TUG task; Upper right: stride length; Bottom left: DSI score; Bottom right: speech intelligence, as measured by the speech item of MDS UPDRS-III. Means are plotted with error bars representing the standard errors of the mean. PD and MSA-P data are plotted separately by hollow circle and solid circle. * <span class="html-italic">p</span> &lt; 0.05 indicates significant difference between conditions.</p>
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9 pages, 1200 KiB  
Article
Retrospective Multicenter Study on Outcome Measurement for Dyskinesia Improvement in Parkinson’s Disease Patients with Pallidal and Subthalamic Nucleus Deep Brain Stimulation
by Fangang Meng, Shanshan Cen, Zhiqiang Yi, Weiguo Li, Guoen Cai, Feng Wang, Stephan S. Quintin, Grace E. Hey, Jairo S. Hernandez, Chunlei Han, Shiying Fan, Yuan Gao, Zimu Song, Junfei Yi, Kailiang Wang, Liangwen Zhang, Adolfo Ramirez-Zamora and Jianguo Zhang
Brain Sci. 2022, 12(8), 1054; https://doi.org/10.3390/brainsci12081054 - 9 Aug 2022
Viewed by 2023
Abstract
Deep brain stimulation (DBS) is an effective treatment for dyskinesia in patients with Parkinson’s disease (PD), among which the therapeutic targets commonly used include the subthalamic nucleus (STN) and the globus pallidus internus (GPi). Levodopa-induced dyskinesia (LID) is one of the common motor [...] Read more.
Deep brain stimulation (DBS) is an effective treatment for dyskinesia in patients with Parkinson’s disease (PD), among which the therapeutic targets commonly used include the subthalamic nucleus (STN) and the globus pallidus internus (GPi). Levodopa-induced dyskinesia (LID) is one of the common motor complications arising in PD patients on chronic treatment with levodopa. In this article, we retrospectively evaluated the outcomes of LID with the Unified Dyskinesia Rating Scale (UDysRS) in patients who underwent DBS in multiple centers with a GPi or an STN target. Meanwhile, the Med off MDS-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS-Ⅲ) and the levodopa equivalent daily dose (LEDD) were also observed as secondary indicators. PD patients with a GPi target showed a more significant improvement in the UDysRS compared with an STN target (92.9 ± 16.7% vs. 66.0 ± 33.6%, p < 0.0001). Both the GPi and the STN showed similar improvement in Med off UPDRS-III scores (49.8 ± 22.6% vs. 52.3 ± 29.5%, p = 0.5458). However, the LEDD was obviously reduced with the STN target compared with the GPi target (44.6 ± 28.1% vs. 12.2 ± 45.8%, p = 0.006). Full article
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<p>The STN-DBS and GPi-DBS influence on the Med off MDS-UPDRS-III score and UDysRS score in 56 patients who have LID. (<b>A</b>) UDysRS scores of GPi-DBS and STN-DBS patients at the last follow-up and baseline. (<b>B</b>) Contrast of the improvement of UDysRS score by GPi-DBS and STN-DBS. (<b>C</b>) Med off MDS-UPDRS-III scores of GPi-DBS and STN-DBS patients at the last follow-up and baseline. (<b>D</b>) Contrast of the improvement of Med off MDS-UPDRS-III score by GPi-DBS and STN-DBS. UDysRS, Unified Dyskinesia Rating Scale; DBS, deep brain stimulation; STN, subthalamic nucleus; GPi, globus pallidus interna; MDS-UPDRS-III, Unified Parkinson’s Disease Rating Scale part III; ns, non-significant.</p>
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16 pages, 49902 KiB  
Article
Optimized Deep Brain Stimulation Surgery to Avoid Vascular Damage: A Single-Center Retrospective Analysis of Path Planning for Various Deep Targets by MRI Image Fusion
by Xin Wang, Nan Li, Jiaming Li, Huijuan Kou, Jing Wang, Jiangpeng Jing, Mingming Su, Yang Li, Liang Qu and Xuelian Wang
Brain Sci. 2022, 12(8), 967; https://doi.org/10.3390/brainsci12080967 - 22 Jul 2022
Cited by 7 | Viewed by 1733
Abstract
Co-registration of stereotactic and preoperative magnetic resonance imaging (MRI) images can serve as an alternative for trajectory planning. However, the role of this strategy has not yet been proven by any control studies, and the trajectories of commonly used targets have not been [...] Read more.
Co-registration of stereotactic and preoperative magnetic resonance imaging (MRI) images can serve as an alternative for trajectory planning. However, the role of this strategy has not yet been proven by any control studies, and the trajectories of commonly used targets have not been systematically studied. The purpose of this study was to analyze the trajectories for various targets, and to assess the role of trajectories realized on fused images in preventing intracranial hemorrhage (ICH). Data from 1019 patients who underwent electrode placement for deep brain stimulation were acquired. Electrode trajectories were not planned for 396 patients, whereas trajectories were planned for 623 patients. Preoperative various MRI sequences and frame-placed MRI images were fused for trajectory planning. The patients’ clinical characteristics, the stereotactic systems, intracranial hemorrhage cases, and trajectory angles were recorded and analyzed. No statistically significant differences in the proportions of male patients, patients receiving local anesthesia, and diseases or target distributions (p > 0.05) were found between the trajectory planning group and the non-trajectory planning group, but statistically significant differences were observed in the numbers of both patients and leads associated with symptomatic ICH (p < 0.05). Regarding the ring and arc angle values, statistically significant differences were found among various target groups (p < 0.05). The anatomic structures through which leads passed were found to be diverse. Trajectory planning based on MRI fusion is a safe technique for lead placement. The electrode for each given target has its own relatively constant trajectory. Full article
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<p>Axial computed tomography (CT) slices at the hemorrhage sites taken after the health of a 53-year-old man with PD in the non-trajectory planning group deteriorated on the 6th postoperative day. He had suffered from a headache for a few days before falling into a coma. His hematomas were along the trajectory of the definitive electrode in the right frontal lobe (<b>A</b>), basal ganglia, and midbrain (<b>B</b>).</p>
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<p>Ring and arc angle values of trajectories (mean ± SD). (<b>A</b>) Left ring: between the STN and GPi groups, <span class="html-italic">p</span> = 0.795; between the STN and Vim groups, <span class="html-italic">p</span> = 0.098; between the Vim and GPi groups, <span class="html-italic">p</span> = 0.093; between the GPi and NAc/ALIC groups, <span class="html-italic">p</span> = 0.007; between the Vim and NAc/ALIC groups, <span class="html-italic">p</span> = 0.001; and between the STN and NAc/ALIC groups, <span class="html-italic">p</span> &lt; 0.001. (<b>B</b>) Left arc: between the STN and Vim groups, <span class="html-italic">p</span> = 0.903; and between any other two groups, <span class="html-italic">p</span> &lt; 0.001. (<b>C</b>) Right ring: between the STN and GPi groups, <span class="html-italic">p</span> = 0.678; between the STN and Vim groups, <span class="html-italic">p</span> = 0.637; between the Vim and GPi groups, <span class="html-italic">p</span> = 0.521; between the Vim and NAc/ALIC groups, <span class="html-italic">p</span> = 0.002; between the STN and NAc/ALIC groups, <span class="html-italic">p</span> &lt; 0.001; and between the GPi and NAc/ALIC groups, <span class="html-italic">p</span> &lt; 0.001. (<b>D</b>) Right arc: between the STN and Vim groups, <span class="html-italic">p</span> = 0.097; and between any other two groups, <span class="html-italic">p</span> &lt; 0.001.</p>
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<p>“Probe’s-eye” 3D BRAVO MRI images of different slices along the whole trajectory for main targets. (<b>A</b>–<b>D</b>) The trajectory enters the cortex. (<b>E</b>–<b>H</b>) The trajectory avoids the bilateral sulci. (<b>I</b>–<b>L</b>) The trajectory passes through the centrum ovale. (<b>M</b>–<b>P</b>) Upper part of the lateral ventricle; at this level, the planned trajectories for the STN and Vim both pass posterolaterally to the lateral ventricles close to their lateral walls (<b>M</b>,<b>N</b>); the trajectory for the GPi passes laterally to the lateral ventricle far from its lateral wall (<b>O</b>); the trajectory for the NAc passes anterolaterally to the lateral ventricle near its lateral wall (<b>P</b>). (<b>Q</b>–<b>T</b>) Internal capsule; at this level, the planned trajectory for the STN passes through the posterior limb of the internal capsule (PLIC) (<b>Q</b>); the trajectory for the Vim passes medially to the PLIC and enters the thalamus from its dorsolateral part (<b>R</b>); the trajectory for the GPi passes laterally to the PLIC and enters the globus pallidus from its dorsal part (<b>S</b>); the trajectory for the NAc passes through the ALIC (<b>T</b>); blue dotted line: thalamus; green dotted line: globus pallidus externa (GPe); yellow dotted line: GPi; orange dotted line: head of the caudate nucleus. (<b>U</b>–<b>X</b>) Locations of the targets.</p>
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<p>Deep brain stimulation (DBS) electrode reconstructions and computer simulations based on preoperative MRI imaging and postoperative CT imaging using the Lead-DBS toolbox (<a href="http://www.lead-dbs.org" target="_blank">www.lead-dbs.org</a>, accessed on 5 May 2022). These illustrations show the spatial relationship between bilateral leads for the STN (<b>A</b>), Vim (<b>B</b>), GPi (<b>C</b>), NAc (<b>D</b>), and their nearby structures. Ca: caudate nucleus; GPi: globus pallidus internus; GPe: globus pallidus externus; NAc: nucleus accumbens; RN: red nucleus; STN: subthalamic nucleus; Th: thalamus; Pu: putamen; Vim: ventralis intermedius nucleus of the thalamus.</p>
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<p>A rare non-hemorrhagic edematous lesion or infarction around the trajectory in a T2-weighted MRI image. An electrode placed for the left STN through the PLIC led to local edema of the PLIC and adjacent white matter (i.e., the medial medullary lamina), which appeared similar to a “hamburger”, together with the relatively normal GPi. (<b>A</b>) Lower layer. (<b>B</b>) Upper layer.</p>
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<p>A simulated trajectory (green line) and the cerebral arteries (red vessels) on 3D MRA (yellow nuclei: the STN). (<b>A</b>) Frontal view image. (<b>B</b>) Approximate path’s-eye image. The trajectory was safe for lead placement in the STN.</p>
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<p>Surgical planning snapshot images show the position of the planned trajectory and its surrounding vessels (two-dimensional probe’s-eye trajectory visualization by SWI, TOF MRA, and T1W-Gd). (<b>A</b>) The entry point is always placed anterior to the coronal suture to avoid injuring the motor region. (<b>B</b>) Preventing the guide tube from puncturing small and deep vessels in the corona radiata by SWI. (<b>C</b>) Confirming that the trajectory was kept far from the arteries in the lateral fissure by TOF MRA. (<b>D</b>) Gadolinium-enhanced MRI shows that the trajectory was kept at a distance from the surrounding arteries and veins in the basal ganglia area.</p>
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11 pages, 2499 KiB  
Article
Techniques of Frameless Robot-Assisted Deep Brain Stimulation and Accuracy Compared with the Frame-Based Technique
by Shanshan Mei, Kaijia Yu, Zhiwei Ren, Yongsheng Hu, Song Guo, Yongjie Li and Jianyu Li
Brain Sci. 2022, 12(7), 906; https://doi.org/10.3390/brainsci12070906 - 11 Jul 2022
Cited by 4 | Viewed by 1919
Abstract
Background: Frameless robot-assisted deep brain stimulation (DBS) is an innovative technique for leads implantation. This study aimed to evaluate the accuracy and precision of this technique using the Sinovation SR1 robot. Methods: 35 patients with Parkinson’s disease who accepted conventional frame-based DBS surgery [...] Read more.
Background: Frameless robot-assisted deep brain stimulation (DBS) is an innovative technique for leads implantation. This study aimed to evaluate the accuracy and precision of this technique using the Sinovation SR1 robot. Methods: 35 patients with Parkinson’s disease who accepted conventional frame-based DBS surgery (n = 18) and frameless robot-assisted DBS surgery (n = 17) by the same group of neurosurgeons were analyzed. The coordinate of the tip of the intended trajectory was recorded as xi, yi, and zi. The actual position of lead implantation was recorded as xa, ya, and za. The vector error was calculated by the formula of √(xi − xa)2 + (yi − ya)2 + (zi − za)2 to evaluate the accuracy. Results: The vector error was 1.52 ± 0.53 mm (range: 0.20–2.39 mm) in the robot-assisted group and was 1.77 ± 0.67 mm (0.59–2.98 mm) in the frame-based group with no significant difference between two groups (p = 0.1301). In 10.7% (n = 3) frameless robot-assisted implanted leads, the vector error was greater than 2.00 mm with a maximum offset of 2.39 mm, and in 35.5% (n = 11) frame-based implanted leads, the vector error was larger than 2.00 mm with a maximum offset of 2.98 mm. Leads were more posterior than planned trajectories in the robot-assisted group and more medial and posterior in the conventional frame-based group. Conclusions: Awake frameless robot-assisted DBS surgery was comparable to the conventional frame-based technique in the accuracy and precision for leads implantation. Full article
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<p>(<b>A</b>,<b>B</b>) The Sinovation SR1 robot is composed of a robot arm, computer control system, and display system. (<b>C</b>) Bilateral trajectories were designed to pass through the subthalamic nucleus (STN) on the Sinoplan 2.0 planning software (Sinovation).</p>
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<p>Implanting bone screws and frameless registration. (<b>A</b>) Bone screws were implanted under local anesthesia. (<b>B</b>–<b>D</b>) Frameless registration by the mechanical contact of the tip of the robot probe with bone screw markers.</p>
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<p>(<b>A</b>–<b>D</b>) The fusion image of postoperative CT scan with preoperative quantitative susceptibility mapping to display final electrodes positions. Red artifacts (high-density contacts on CT scans were manually set to red) were final positions of contacts of leads. The center of the distal contact (yellow dot) was recorded as x<sub>a</sub>, y<sub>a</sub>, and z<sub>a</sub> to represent the actual position of leads. The tip of the planned trajectory (blue dot) was recorded as x<sub>i</sub>, y<sub>i</sub>, and z<sub>i</sub> to represent the intended position of leads. The vector error was calculated by the formula of √(x<sub>i</sub> − x<sub>a</sub>)<sup>2</sup> + (y<sub>i</sub> − y<sub>a</sub>)<sup>2</sup> + (z<sub>i</sub> − z<sub>a</sub>)<sup>2</sup>. (<b>E</b>) The model of a Medtronic 3387 quadripolar lead has four contacts (the distal contact: contact 0) (<b>F</b>) The enlarged view of the planned trajectory (red) and the actual lead implantation (white). The actual distal contact is contact 0.</p>
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<p>The proportion of the vector error ≤ 2.00 mm and values &gt; 2.00 mm in two groups.</p>
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<p>(<b>A</b>) A significant difference was observed in the mean value of y<sub>i</sub> vs. y<sub>a</sub> in the robot-assisted group. (<b>B</b>) A significant difference was observed in the mean value of x<sub>i</sub> vs. x<sub>a</sub> and y<sub>i</sub> vs. y<sub>a</sub> in the conventional frame-based group. * represents <span class="html-italic">p</span> &lt; 0.05, ** represents <span class="html-italic">p</span> &lt; 0.01, *** represents <span class="html-italic">p</span> &lt; 0.001, **** represents <span class="html-italic">p</span> &lt; 0.0001, “ns” represents no significant difference.</p>
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<p>Leads deviations from the planned position in the robot-assisted group and the frame-based group. The planned position of the trajectory is in the center of circles and blue dots are positions of the actual distal contacts of leads implantations. The distance between each one of the circles is 0.5 mm. The final position of leads was more posterior than the planned position using the robot-assisted technique. The final position of leads was more posterior and medial than the planned position using the frame-based technique.</p>
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12 pages, 1216 KiB  
Article
The Long-Term Efficacy, Prognostic Factors, Safety, and Hospitalization Costs Following Denervation and Myotomy of the Affected Muscles and Deep Brain Stimulation in 94 Patients with Spasmodic Torticollis
by Zhiqiang Cui, Tong Chen, Jian Wang, Chao Jiang, Qingyao Gao, Zhiqi Mao, Longsheng Pan, Zhipei Ling, Jianning Zhang and Xuemei Li
Brain Sci. 2022, 12(7), 881; https://doi.org/10.3390/brainsci12070881 - 4 Jul 2022
Cited by 1 | Viewed by 1630
Abstract
The surgical methods for treating spasmodic torticollis include the denervation and myotomy (DAM) of the affected muscles and deep brain stimulation (DBS). This study reports on the long-term efficacy, prognostic factors, safety, and hospitalization costs following these two procedures. We collected data from [...] Read more.
The surgical methods for treating spasmodic torticollis include the denervation and myotomy (DAM) of the affected muscles and deep brain stimulation (DBS). This study reports on the long-term efficacy, prognostic factors, safety, and hospitalization costs following these two procedures. We collected data from 94 patients with spasmodic torticollis, of whom 41 and 53 were treated with DAM and DBS, respectively, from June 2008 to December 2020 at the Chinese People’s Liberation Army General Hospital. We used the Tsui scale and the global outcome score of the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) to evaluate the preoperative and postoperative clinical conditions in all patients. We also determined the costs of hospitalization, prognostic factors, and serious adverse events following the two surgical procedures. The mean follow-up time was 68.83 months (range = 13–116). Both resection surgery and DBS showed good results in terms of Tsui (Z = −5.103, p = 0.000; Z = −6.210, p = 0.000) and TWSTRS scores (t = 8.762, p = 0.000; Z = −6.308, p = 0.000). Compared with the DAM group, the preoperative (47.71, range 24–67.25) and postoperative (18.57, range 0–53) TWSTRS scores in the DBS group were significantly higher (Z = −3.161, p = 0.002). We found no correlation between prognostic factors and patient age, gender, or disease duration for either surgical procedure. However, prognostic factors were related to the length of the postoperative follow-up period in the DBS surgery group (Z = −2.068, p = 0.039; Z = −3.287, p = 0.001). The mean hospitalization cost in the DBS group was 6.85 times that found in the resection group (Z = −8.284, p = 0.000). The total complication rate was 4.26%. We found both resection surgery and DBS showed good results in the patients with spasmodic torticollis. Compared with DAM, DBS had a greater improvement in TWSTRS score; however, it was more expensive. Prognostic factors were related to the length of the postoperative follow-up period in patients who underwent DBS surgery. Full article
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<p>The improvement in Tsui scores in the DAM group and DBS group. TWSTRS: the Toronto Western Spasmodic Torticollis Rating Scale; DAM: denervation and myotomy; DBS: deep brain stimulation; Pre-O: preoperative; Post-O: postoperative; **: <span class="html-italic">p</span> &lt; 0.01.</p>
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<p>The improvement in TWSTRS scores in the DAM group and DBS group. TWSTRS: the Toronto Western Spasmodic Torticollis Rating Scale; DAM: denervation and myotomy; DBS: deep brain stimulation; Pre-O: preoperative; Post-O: postoperative; **: <span class="html-italic">p</span> &lt; 0.01.</p>
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<p>Globus pallidus internus DBS. (<b>a</b>–<b>d</b>): Axial and coronal T1-weighted intraoperative MR images (<b>a</b>,<b>b</b>). Intraoperative MR images were fused with preoperative MR images. The green “+” (<b>c</b>,<b>d</b>) indicates that the electrodes did not shift, despite a large hematoma. (<b>e</b>–<b>h</b>): A puncture trajectory was designed according to the intraoperative MR data, with the hematoma as the target. A drainage tube (black arrow) was placed in the hematoma (<b>f</b>). Several days later, CT showed that the hematoma had completely drained and that the electrode position was acceptable (<b>g</b>,<b>h</b>).</p>
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<p>DBS of the globus pallidus internus. (<b>a</b>): The intraoperative 3D T1-weighted image shows low signal around the left electrode. (<b>b</b>): A CT scan conducted on 1 day postoperation shows the low density of the ischemic infarct. (<b>c</b>,<b>d</b>): T1- and T2-weighted MRI images at 9 months postoperation show a slight abnormality around the leads.</p>
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10 pages, 1942 KiB  
Article
Correlation between Electrode Location and Anxiety Depression of Subthalamic Nucleus Deep Brain Stimulation in Parkinson’s Disease
by Feng Zhang, Feng Wang, Yu-Jing Xing, Man-Man Yang, Ji-Wei Wang, Cong-Hui Li, Chun-Lei Han, Shi-Ying Fan, Dong-Mei Gao, Chen Yang, Jian-Guo Zhang and Fan-Gang Meng
Brain Sci. 2022, 12(6), 755; https://doi.org/10.3390/brainsci12060755 - 8 Jun 2022
Cited by 2 | Viewed by 2024
Abstract
Objectives: our group explored the correlation between postoperative coordinates of the electrode contacts, VTA, and anxiety and depression symptoms in Parkinson’s disease (PD) patients after subthalamic nucleus deep brain stimulation (STN-DBS). Methods: STN-DBS was conducted on PD patients (n = 57) for six [...] Read more.
Objectives: our group explored the correlation between postoperative coordinates of the electrode contacts, VTA, and anxiety and depression symptoms in Parkinson’s disease (PD) patients after subthalamic nucleus deep brain stimulation (STN-DBS). Methods: STN-DBS was conducted on PD patients (n = 57) for six months with follow-up. Clinical outcomes were explored using the unified Parkinson’s disease rating scale Part III (UPDRS-III), the Hamilton Anxiety Rating Scale (HAM-A), and the Hamilton Depression Rating Scale (HAM-D) before and after surgery. At the Montreal Neurological Institute (MNI), the location of active contacts and the volume of tissue activated (VTA) were calculated. Results: patient evaluations took place preoperatively and follow-ups took place at 1 month, 3 months, and 6 months. The average patient improvement rates for HAM-A and HAM-D scores at the 6-month follow-up were 41.7% [interquartile range (IQR) 34.9%] and 37.5% (IQR 33.4%), respectively (both p < 0.001). In medication-off, there were negative correlations between the HAM-A improvement rate and the Z-axis coordinate of the active contact (left side: r = −0.308, p = 0.020; right side: r = −0.390, p = 0.003), and negative correlations between the HAM-D improvement rate and the Z-axis coordinate of the active contact (left side: r = −0.345, p = 0.009; right side: r = −0.521, p = 0.001). There were positive correlations between the HAM-A and HAM-D scores improvement rate at 6 months after surgery and bilateral VTA in the right STN limbic subregion (HAM-A: r = 0.314, p = 0.018; HAM-D: r = 0.321, p = 0.015). Conclusion: bilateral STN-DBS can improve anxiety and depression symptoms in PD patients. The closer the stimulation to the ventral limbic region of the STN, the more significant the improvement in anxiety and depression symptoms of PD patients. Full article
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<p>Comparison of preoperative and postoperative HAM-A and HAM-D scores: (<b>A</b>) HAM-A scores were improved by 23.5% (IQR 34.9%), 33.3% (IQR 30.9%), and 41.7% (IQR 34.9%) at 1, 3, and 6 months follow-up, respectively. (<b>B</b>) HAM-D scores were improved by 20.0% (IQR 33.3%), 31.0% (IQR 32.7%), and 37.5% (IQR 33.4%) at 1, 3, and 6 months follow-up, respectively. ** <span class="html-italic">p</span> &lt; 0.001; Baseline = preoperative; FU1 = follow-up 1 month after surgery; FU2 = follow-up 3 months after surgery; FU3 = follow-up 6 months after surgery.</p>
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<p>(<b>A</b>,<b>B</b>) Correlation analysis between the HAM-A scores improvement rate and the Z-axis coordinate. (<b>C</b>,<b>D</b>) Correlation analysis between the HAM-D scores improvement rate and the Z-axis coordinate. (<b>E</b>) Correlation analysis between the HAM-A scores improvement rate and the VTA of limbic STN. (<b>F</b>) Correlation analysis between the HAM-D scores improvement rate and the VTA of limbic STN.</p>
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<p>Imaging of electrode contacts. (<b>A</b>,<b>C</b>) Imaging of electrode contacts (posterior view). (<b>B</b>,<b>D</b>) Imaging of electrode contacts (right posterior view). (<b>A</b>,<b>B</b>) the Z-axes of active contact locations of an individual patient (blue dots) with lower HAM-A improvement rate (9.09%); the Z-axes of active contact locations of an individual patient (red dots) with higher HAM-A improvement rate (78.26%). (<b>C</b>,<b>D</b>) the Z-axes of active contact locations of an individual patient (blue dots) with lower HAM-D improvement rate (0%); the Z-axes of active contact locations of an individual patient (red dots) with higher HAM-D improvement rate (66.67%).</p>
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<p>Three-dimensional illustration of VTA and its relationship with the improvement rate of the HAM-A scores. (<b>A</b>,<b>C</b>) Three-dimensional illustration of VTA (posterior view). (<b>B</b>,<b>D</b>) Three-dimensional illustration of VTA (front view). (<b>A</b>,<b>B</b>) The red dot patient (the HAM-A improvement rate: 87.50%), the VTA in the right STN limbic subregion in this patient was 19.29 mm<sup>3</sup>. (<b>C</b>,<b>D</b>) The blue dot patient (the HAM-A improvement rate: 9.09%), the VTA in the right STN limbic subregion in this patient was 3.01 mm<sup>3</sup>. (The red ball: VTA; The orange area: STN sensorimotor subregion; The blue area: STN associative subregion; The yellow area: STN limbic subregion).</p>
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Review

Jump to: Research, Other

9 pages, 441 KiB  
Review
Music Therapy for Gait and Speech Deficits in Parkinson’s Disease: A Mini-Review
by Leon Fan, Ellen Y. Hu, Grace E. Hey and Wei Hu
Brain Sci. 2023, 13(7), 993; https://doi.org/10.3390/brainsci13070993 - 25 Jun 2023
Cited by 2 | Viewed by 2400
Abstract
Parkinson’s disease (PD) is a progressive central nervous system disease with a common motor symptom of gait disturbance in PD, which is more pronounced in the later stages. Although FDA-approved treatments, including dopaminergic pharmacotherapy, deep brain stimulation, and rehabilitation, have some benefits in [...] Read more.
Parkinson’s disease (PD) is a progressive central nervous system disease with a common motor symptom of gait disturbance in PD, which is more pronounced in the later stages. Although FDA-approved treatments, including dopaminergic pharmacotherapy, deep brain stimulation, and rehabilitation, have some benefits in improving gait dysfunction, a fair amount of advanced PD patients can develop a disability, social isolation, and high mortality and morbidity. Recently, clinicians and scientists have applied music to clinical therapy, namely music therapy. It has been used as a unique rehabilitation tool to improve PD-induced gait and speech disorders. Based on relevant studies in recent years, this paper reviews the published literature about music in treating gait disorders and speech problems in PD patients. Additionally, we discuss current studies’ limitations and emphasize the future potential research fields. Full article
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<p>Music therapy can induce greater inter-network connectivity between the auditory network and the executive control network in Parkinson disease.</p>
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23 pages, 6789 KiB  
Review
A Brief History of Stereotactic Atlases: Their Evolution and Importance in Stereotactic Neurosurgery
by Alfredo Conti, Nicola Maria Gambadauro, Paolo Mantovani, Canio Pietro Picciano, Vittoria Rosetti, Marcello Magnani, Sebastiano Lucerna, Constantin Tuleasca, Pietro Cortelli and Giulia Giannini
Brain Sci. 2023, 13(5), 830; https://doi.org/10.3390/brainsci13050830 - 21 May 2023
Cited by 2 | Viewed by 2150
Abstract
Following the recent acquisition of unprecedented anatomical details through state-of-the-art neuroimaging, stereotactic procedures such as microelectrode recording (MER) or deep brain stimulation (DBS) can now rely on direct and accurately individualized topographic targeting. Nevertheless, both modern brain atlases derived from appropriate histological techniques [...] Read more.
Following the recent acquisition of unprecedented anatomical details through state-of-the-art neuroimaging, stereotactic procedures such as microelectrode recording (MER) or deep brain stimulation (DBS) can now rely on direct and accurately individualized topographic targeting. Nevertheless, both modern brain atlases derived from appropriate histological techniques involving post-mortem studies of human brain tissue and the methods based on neuroimaging and functional information represent a valuable tool to avoid targeting errors due to imaging artifacts or insufficient anatomical details. Hence, they have thus far been considered a reference guide for functional neurosurgical procedures by neuroscientists and neurosurgeons. In fact, brain atlases, ranging from the ones based on histology and histochemistry to the probabilistic ones grounded on data derived from large clinical databases, are the result of a long and inspiring journey made possible thanks to genial intuitions of great minds in the field of neurosurgery and to the technical advancement of neuroimaging and computational science. The aim of this text is to review the principal characteristics highlighting the milestones of their evolution. Full article
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<p>Spiegel and Wycis with their stereotactic apparatus.</p>
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<p>The intercommissural line (CA-CP-line) passes through the superior edge of the anterior commissure (red dot) and the inferior edge of the posterior commissure (yellow dot). The vertical line (VCA) passes through the posterior margin of the anterior commissure. These lines could be drawn directly on the ventriculograms.</p>
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<p>Reconstruction of the ventro-lateral nucleus of the thalamus in the lateral projection using the proportional system by Talairach. The dashed rectangle corresponds to the ventro-lateral nucleus of the thalamus. Schematic representation of the superimposition of the Talairach’s diagram (purple grid) over the patient’s ventriculogram.</p>
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<p>(<b>A</b>). Plate five from the Schaltenbrand–Wahren brain atlas showing the basal nuclei (from the Schaltenbrand and Wahren atlas, reproduced with permission; copyright Thieme: Stuttgart, Germany, 1977)) [<a href="#B21-brainsci-13-00830" class="html-bibr">21</a>]. (<b>B</b>). Plate 43, brain LXXVIII, myelin-stained sagittal Section 12.0 mm from the midline. It is likely that this particular atlas section has been used to guide most stereotactic operations for movement disorders involving the subthalamic nucleus region in the modern era of MR-image-guided deep brain stimulation for Parkinson’s disease.. (from the Schaltenbrand–Wahren brain atlas, reproduced with permission; copyright Thieme: Stuttgart, Germany, 1977) [<a href="#B21-brainsci-13-00830" class="html-bibr">21</a>].</p>
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<p>(<b>A</b>). Plate five from the Schaltenbrand–Wahren brain atlas showing the basal nuclei (from the Schaltenbrand and Wahren atlas, reproduced with permission; copyright Thieme: Stuttgart, Germany, 1977)) [<a href="#B21-brainsci-13-00830" class="html-bibr">21</a>]. (<b>B</b>). Plate 43, brain LXXVIII, myelin-stained sagittal Section 12.0 mm from the midline. It is likely that this particular atlas section has been used to guide most stereotactic operations for movement disorders involving the subthalamic nucleus region in the modern era of MR-image-guided deep brain stimulation for Parkinson’s disease.. (from the Schaltenbrand–Wahren brain atlas, reproduced with permission; copyright Thieme: Stuttgart, Germany, 1977) [<a href="#B21-brainsci-13-00830" class="html-bibr">21</a>].</p>
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<p>The Talairach’s space, represented by orthogonal rectangular prisms (‘‘parallelograms’’) encompassing the brain. Each sub-volume in the brain is identified by three dimensions that correspond to the principal axes of the brain, and these dimensions are represented by a capital letter, a lowercase letter, and a number, respectively. For example, the shaded area in the upper right-hand front corner can be identified as A-d-1 (information adapted from Talairach and Tournoux with permission; copyright Thieme: Stuttgart, Germany, 1988) [<a href="#B22-brainsci-13-00830" class="html-bibr">22</a>].</p>
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<p>To define the intercommissural plane, different intercommissural lines are introduced to be defined on MRI. (h): original intercommissural distance; (hc): central intercommissural distance between the central intercommissural landmarks; (hi): internal intercommissural distance between the internal intercommissural landmarks; (ht): tangential intercommissural distance between the tangential intercommissural landmarks (modified from Nowinski [<a href="#B28-brainsci-13-00830" class="html-bibr">28</a>]).</p>
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<p>Macroanatomic sections accompanied by a comprehensively annotated artist’s tracing at the same scale (from the freely available web-based version of the atlas): <a href="http://www.thehumanbrain.info/brain/bn_brain_atlas/brain.html" target="_blank">http://www.thehumanbrain.info/brain/bn_brain_atlas/brain.html</a>, accessed on 18 May 2023).</p>
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<p>Nuclear anatomy of thalamus according to the thalamic atlas of Morel<sup>10</sup>. <b>CeM</b>, central medial; <b>CL</b>, central lateral nucleus; <b>CM</b>, center median nucleus; <b>Hb</b>, habenular nucleus; <b>LD</b>, lateral dorsal nucleus; <b>LP</b>, lateral posterior nucleus; <b>MDpc</b> and <b>MDpl</b>, mediodorsal nucleus, parvocellular and paralamellar divisions; <b>MTT</b>, mammillothalamic tract; <b>MV</b>, medioventral; <b>PuA</b>, anterior pulvinar; <b>PuL</b>, lateral pulvinar; <b>PuM</b>, medial pulvinar; <b>Pv</b>, paraventricular; <b>R</b>, reticular nucleus; <b>VA</b> and <b>VAmc</b>, ventral anterior nucleus and magnocellular division; <b>VLa</b>, ventral lateral anterior nucleus; <b>VPLp</b> and <b>VPLa</b>, ventral posterior lateral nucleus, posterior and anterior divisions.</p>
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<p>Three-dimensional spatial limits in the 3D-MRI-based Atlas by Lucerna et al. [<a href="#B49-brainsci-13-00830" class="html-bibr">49</a>] (reprinted with permission; copyright: Springer: Wien, 2002).</p>
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<p>Three-dimensional rendering of the caudate nucleus (CDN), Putamen (PU), globus pallidus externus (GPE), globus pallidus internus (GPI), ansa lenticularis (AL) in the 3D-MRI-based Atlas by Lucerna et al. [<a href="#B49-brainsci-13-00830" class="html-bibr">49</a>] (reprinted with permission; copyright: Springer: Wien, 2002).</p>
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<p>A combined Shaltenbrand and Wahren Atlas (SWA) Probabilistic Functional Atlas (PFA) identification of the subthalamic nucleus ((<b>a</b>): coronal view; (<b>b</b>): sagittal view). The PFA is presented in gray scale, with a gray level proportional to probability. The SWA is displayed as blue contours. The coordinates of the atlas images are shown in the top left corner. (Reproduced from Nowinski with permission; copyright: Springer, Berlin/Heidelberg, 2009) [<a href="#B55-brainsci-13-00830" class="html-bibr">55</a>].</p>
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<p>Three-dimensional rendering of the basal ganglia from the 3D neuroimage public repository called NOWinBRAIN (<a href="http://www.nowinbrain.org" target="_blank">www.nowinbrain.org</a>, accessed on 18 May 2023).</p>
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<p>A three-dimensional rendering of arterial and venous structures. Three-dimensional atlas of human vasculature can be used to analyze in DBS to analyze track–brain spatial relationship allowing the DBS electrode to be placed more effectively (from <a href="http://www.nowinbrain.org" target="_blank">www.nowinbrain.org</a>, accessed on 18 May 2023).</p>
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Other

Jump to: Research, Review

5 pages, 2732 KiB  
Case Report
Acute Visual Impairment in a Patient with Parkinson’s Disease after Successful Bilateral Subthalamic Nucleus Deep Brain Stimulation with Low-Dose Levodopa: A Case Report
by Chao Zhang, Jinxing Sun, Zhenke Li, Na Liu and Chao Li
Brain Sci. 2023, 13(1), 103; https://doi.org/10.3390/brainsci13010103 - 5 Jan 2023
Cited by 2 | Viewed by 1256
Abstract
Background: Subthalamic nucleus deep brain stimulation (STN-DBS) is widely used for the treatment of primary motor symptoms in patients with Parkinson’s disease (PD). Further, recent evidence suggests that STN-DBS may relieve a few ophthalmic symptoms in PD, such as eye-blink rate and the [...] Read more.
Background: Subthalamic nucleus deep brain stimulation (STN-DBS) is widely used for the treatment of primary motor symptoms in patients with Parkinson’s disease (PD). Further, recent evidence suggests that STN-DBS may relieve a few ophthalmic symptoms in PD, such as eye-blink rate and the flexibility of eye saccades. However, its exact effect on visual function remains unknown. Herein, we report the case of a patient with PD who underwent STN-DBS and experienced visual symptoms following levodopa reduction. Case presentation: A 63-year-old male patient with PD developed severe visual impairment after six months of high-frequency STN-DBS. His symptoms resolved after adjusting the levodopa dose prescribed to the patient. Conclusions: This case report suggests that DBS is beneficial in patients with PD in terms of eye-blink rate. However, the rapid reduction of medication after STN-DBS may lead to retinal atrophy and the shrinkage of vessel density in the ocular fundus. Thus, neurosurgeons should pay close attention to patients with visual symptoms when adjusting levodopa dosages. Full article
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<p>(<b>A</b>) The DBS contact locations. (<b>B</b>) The thickness of the patient’s retinal nerve fiber layer (RNFL) measured by OCT. (<b>C</b>) The vessel percentage areas of the patient before and after subthalamic nucleus deep brain stimulation (STN-DBS).</p>
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<p>Fluctuation of ophthalmic characteristics pre- and post-STN-DBS. (<b>A</b>) Eye-blink rate. (<b>B</b>) RNFL. (<b>C</b>) Vessel percentage area. (<b>D</b>) VIPD-Q.</p>
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11 pages, 2527 KiB  
Case Report
Subdural Effusion Evolves into Chronic Subdural Hematoma after Deep Brain Stimulation Surgery: Case Report and Review of the Literature
by Dongdong Wu, Yuanyuan Dang, Jian Wang and Zhiqiang Cui
Brain Sci. 2022, 12(10), 1375; https://doi.org/10.3390/brainsci12101375 - 10 Oct 2022
Viewed by 2396
Abstract
Background: Although chronic subdural hematoma (CSDH) has been known for over several hundred years, the etiology and pathogenesis of it are still not completely understood. Neurosurgical procedures resulting in CSDH are a rare clinical complication, and there was no report about how subdural [...] Read more.
Background: Although chronic subdural hematoma (CSDH) has been known for over several hundred years, the etiology and pathogenesis of it are still not completely understood. Neurosurgical procedures resulting in CSDH are a rare clinical complication, and there was no report about how subdural effusion (SDE) evolves into CSDH after deep brain stimulation (DBS) surgery. The formation mechanism of CSDH after surgery, especially in DBS surgery, and the effect of recovery, need to be explored. Methods: We present two cases, complicated with SDE after DBS surgery, serious dysfunction complications such as hemiplegia and aphasia occurred on the postoperative day 36 and 49 individually, and images showed CSDH. Fusion image showed the bilateral electrodes were significantly shifted. Then, they were performed to drill craniotomy with a closed system drainage. Result: The symptoms of hemiplegia and aphasia caused by CSDH were completely recovered, and the follow-up images showed CSDH was disappeared. However, DBS stimulation is poorly effective, it cannot reach the preoperative level, especially in the ipsilateral side of CSDH. Conclusions: The iatrogenic SDE that evolved into CSDH in the present two cases shows that SDE is one of the causes of CSDH. Patients develop SDE after DBS, which increases the risk of developing CSDH. CSDH after DBS can be successfully treated. however, the postoperative efficacy of DBS will decline. Full article
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<p>The change in MRI and CT images of the patient 1. (<b>a</b>) Conventional brain MRI, T2 image showed mild atrophy and dilation of the ventricles; (<b>b</b>) The image of the intraoperative 3 dimensional T1-weighted sequence showed no subdural effusion in bilateral frontal areas; (<b>c</b>) At 5 day after DBS surgery, CT shows a small amount of subdural effusion and pneumocephalus in the right frontal lobe; (<b>d</b>,<b>e</b>) At 36 days after DBS surgery, CT and T1 MRI images of the brain shows right chronic subdural hematoma, with the midline obviously shifted to the left, and a marked shift in electrode positioning; (<b>f</b>) At 2 days after drainage, CT shows that most of the hematomas were drained out and the electrode shift has been corrected.</p>
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<p>The change in CSDH volume in pre- and post-operative evacuation in case 1. At 5 day after DBS surgery, CT shows the volume of subdural effusion (SDE) in the right frontal lobe was 6 ml; at 36 days after DBS surgery, the volume of right chronic subdural hematoma is 75 mL; at 2 days after drainage, residual hematomas volume was 15 mL; until day 60, the hematoma was completely absorbed.</p>
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<p>MRI images in patient 2 before the formation of chronic subdural hematoma. (<b>a</b>,<b>b</b>) Preoperative MRI shows cerebral atrophy, and that the left subarachnoid space is wider than the right; (<b>c</b>–<b>f</b>) Five days postoperatively, MRI (3DT1 and T2 image)shows bilateral subdural effusion that is more obvious on the left side. The lateral ventricle is slightly reduced, and the fornix-hypothalamus electrode passes through the bilateral lateral ventricles.</p>
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<p>The change in CT images in patient 2. (<b>a</b>) On the first day after deep brain stimulation (DBS), CT shows bilateral subdural effusion and pneumocephalus, more obvious on the left side; (<b>b</b>) At 49 days after DBS, CT shows a CSDH on the left side, and a slight contralateral shift of the midline; (<b>c</b>,<b>d</b>) Fused with the early CT, the bilateral electrodes are substantially shifted; (<b>e</b>) At 3 days after drainage, CT fusion shows that the electrode shift is corrected; (<b>f</b>) At 77 days after drainage, CT shows complete hematoma absorption.</p>
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<p>The change in CSDH volume in pre- and post-operative evacuation in case 2. At 1 day after DBS surgery, CT shows the volume of subdural effusion (SDE) in the left frontal lobe was 13 mL; at 49 days after DBS surgery, the volume of right chronic subdural hematoma is 51 mL; at 3 days after drainage, residual hematomas volume was 18 mL; until day77, the hematoma was completely absorbed.</p>
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<p>PRISM flowchart of the selection of the studies for this review.</p>
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