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There is a growing interest in the use of deep brain stimulation (DBS) for the treatment of medically refractory movement disorders and other neurological and psychiatric conditions. The extent of temperature increases around DBSelectrodes during normal operation (joule heating and increased metabolic activity) or coupling with an external source (e.g. magnetic resonance imaging) remains poorly understood and methods to
Maged M Elwassif; Abhishek Datta; Asif Rahman; Marom Bikson
Subthalamic nucleus deep brain stimulation (STN DBS) ameliorates motor symptoms of Parkinson’s disease, but the precise mechanism is still unknown. Here, using a large animal (pig) model of human STN DBS neurosurgery, we utilized fast-scan cyclic voltammetry in combination with a carbon-fiber microelectrode (CFM) implanted into the striatum to monitor dopamine release evoked by electrical stimulation at a human DBSelectrode (Medtronic 3389) that was stereotactically implanted into the STN using MRI and electrophysiological guidance. STN electrical stimulation elicited a stimulus time-locked increase in striatal dopamine release that was both stimulus intensity- and frequency-dependent. Intensity-dependent (1–7 V) increases in evoked dopamine release exhibited a sigmoidal pattern attaining a plateau between 5 to 7 V of stimulation, while frequency-dependent dopamine release exhibited a linear increase from 60 to 120 Hz and attained a plateau thereafter (120–240 Hz). Unlike previous rodent models of STN DBS, optimal dopamine release in the striatum of the pig was obtained with stimulation frequencies that fell well within the therapeutically effective frequency range of human DBS (120–180 Hz). These results highlight the critical importance of utilizing a large animal model that more closely represents implanted DBSelectrode configurations and human neuroanatomy to study neurotransmission evoked by STN DBS. Taken together, these results support a dopamine neuronal activation hypothesis suggesting that STN DBS evokes striatal dopamine release by stimulation of nigrostriatal dopaminergic neurons.
Shon, Young-Min; Lee, Kendall H.; Goerss, Stephan J.; Kim, In Yong; Kimble, Chris; Van Gompel, Jamie J.; Bennet, Kevin; Blaha, Charles D.; Chang, Su-Youne
Deep brain stimulation (DBS) electrodes are designed to stimulate specific areas of the brain. The most widely used DBSelectrode has a linear array of 4 cylindrical contacts that can be selectively turned on depending on the placement of the electrode and the specific area of the brain to be stimulated. The efficacy of DBS therapy can be improved by
Deep brain stimulation (DBS) represents a powerful clinical technology, but a systematic characterization of the electrical interactions between the electrode and the brain is lacking. The goal of this study was to examine the in vivo changes in the DBSelectrode impedance that occur after implantation and during clinically relevant stimulation. Clinical DBS devices typically apply high-frequency voltage-controlled stimulation, and as a result, the injected current is directly regulated by the impedance of the electrode-tissue interface. We monitored the impedance of scaled-down clinical DBSelectrodes implanted in the thalamus and subthalamic nucleus of a rhesus macaque using electrode impedance spectroscopy (EIS) measurements ranging from 0.5 Hz to 10 kHz. To further characterize our measurements, equivalent circuit models of the electrode-tissue interface were used to quantify the role of various interface components in producing the observed electrode impedance. Following implantation, the DBSelectrode impedance increased and a semicircular arc was observed in the high-frequency range of the EIS measurements, commonly referred to as the tissue component of the impedance. Clinically relevant stimulation produced a rapid decrease in electrode impedance with extensive changes in the tissue component. These post-operative and stimulation-induced changes in impedance could play an important role in the observed functional effects of voltage-controlled DBS and should be considered during clinical stimulation parameter selection and chronic animal research studies.
Lempka, Scott F.; Miocinovic, Svjetlana; Johnson, Matthew D.; Vitek, Jerrold L.; McIntyre, Cameron C.
Deep brain stimulation (DBS) represents a powerful clinical technology, but a systematic characterization of the electrical interactions between the electrode and the brain are lacking. The goal of this study was to examine the in vivo changes in DBSelectrode impedance that occur after implantation and during clinically-relevant stimulation. Clinical DBS devices typically apply high-frequency voltage-controlled stimulation, and as a result the injected current is directly regulated by the impedance of the electrode-tissue interface. We monitored the impedance of scaled-down clinical DBSelectrodes implanted in the thalamus and subthalamic nucleus of a rhesus macaque using electrode impedance spectroscopy (EIS) measurements ranging from 0.5 Hz to 10 kHz. To further characterize our measurements, equivalent circuit models of the electrode-tissue interface were used to quantify the role of various interface components in producing the observed electrode impedance. Following implantation, DBSelectrode impedance increased and a semicircular arc was observed in the high frequency range of the EIS measurements, commonly referred to as the tissue component of the impedance. Clinically-relevant stimulation produced a rapid decrease in electrode impedance with extensive changes in the tissue component. These post-operative and stimulation-induced changes in impedance could play an important role in the observed functional effects of voltage-controlled DBS and should be considered during clinical stimulation parameter selection and chronic animal research studies.
Lempka, Scott F.; Miocinovic, Svjetlana; Johnson, Matthew D.; Vitek, Jerrold L.; McIntyre, Cameron C.
Deep brain stimulation (DBS) is a therapy of movement disorders including Parkinson's disease (PD). Commercially available electrodes for animal models of Parkinson's disease vary in geometry and material. We characterized such electrodes and found a drift in their properties within minutes and up to about 60h after immersion in cell culture medium, both with and without a stimulation signal. Electrode
Jan Gimsa; Beate Habel; Ute Schreiber; Ursula van Rienen; Ulf Strauss; Ulrike Gimsa
ObjectiveClinical impedance measurements for deep brain stimulation (DBS) electrodes in human patients are normally in the range 500–1500?. DBS devices utilize voltage-controlled stimulation; therefore, the current delivered to the tissue is inversely proportional to the impedance. The goals of this study were to evaluate the effects of various electrical properties of the tissue medium and electrode-tissue interface on the impedance
Christopher R. Butson; Christopher B. Maks; Cameron C. McIntyre
A Parkinson's disease patient with deep brain stimulation (DBS) implantation experienced an acute subdural haematoma (SDH) after a fall. The DBSelectrodes and brain parenchyma were shifted. Fortunately, the patient recovered after craniectomy and removal of SDH, and the DBS was re-activated with the same parameters. Patients with DBS implants who suffer a traumatic brain injury do not necessarily incur permanent implant failure; there is every chance that the DBS may continue to work as reported here. PMID:23121068
Objective: To examine interictal epileptiform and sleep potentials recorded intracranially from deep brain stimulation (DBS) electrodes in patients treated with DBS for epilepsy. Specifically, this study sought to determine whether the DBS-recorded potentials represent: (a) volume conduction from surface neocortical discharges or (b) transsynaptic propagation along cortical–subcortical pathways with local generation of the subcortical potentials near the DBS targets.Methods: Six
Deep brain stimulation (DBS) has emerged as an effective treatment for movement disorders; however, the fundamental mechanisms by which DBS works are not well understood. Computational models of DBS can provide insights into these fundamental mechanisms and typically require two steps: calculation of the electrical potentials generated by DBS and, subsequently, determination of the effects of the extracellular potentials on neurons. The objective of this study was to assess the validity of using a point source electrode to approximate the DBSelectrode when calculating the thresholds and spatial distribution of activation of a surrounding population of model neurons in response to monopolar DBS. Extracellular potentials in a homogenous isotropic volume conductor were calculated using either a point current source or a geometrically accurate finite element model of the Medtronic DBS 3389 lead. These extracellular potentials were coupled to populations of model axons, and thresholds and spatial distributions were determined for different electrode geometries and axon orientations. Median threshold differences between DBS and point source electrodes for individual axons varied between -20.5% and 9.5% across all orientations, monopolar polarities and electrode geometries utilizing the DBS 3389 electrode. Differences in the percentage of axons activated at a given amplitude by the point source electrode and the DBSelectrode were between -9.0% and 12.6% across all monopolar configurations tested. The differences in activation between the DBS and point source electrodes occurred primarily in regions close to conductor-insulator interfaces and around the insulating tip of the DBSelectrode. The robustness of the point source approximation in modeling several special cases—tissue anisotropy, a long active electrode and bipolar stimulation—was also examined. Under the conditions considered, the point source was shown to be a valid approximation for predicting excitation of populations of neurons in response to DBS.
Deep brain stimulation (DBS) is an established clinical treatment for a range of neurological disorders. Depending on the disease state of the patient, different anatomical structures such as the ventral intermediate nucleus of the thalamus (VIM), the subthalamic nucleus or the globus pallidus are targeted for stimulation. However, the same electrode design is currently used in nearly all DBS applications,
PURPOSE : Deep brain stimulation (DBS) surgery is used to reduce motor symptoms when movement disorders are refractory to medical treatment. Post-operative brain morphology can induce electrode deformations as the brain recovers from an intervention. The inverse brain shift has a direct impact on accuracy of the targeting stage, so analysis of electrode deformations is needed to predict final positions. METHODS: DBSelectrode curvature was evaluated in 76 adults with movement disorders who underwent bilateral stimulation, and the key variables that affect electrode deformations were identified. Non-linear modelling of the electrode axis was performed using post-operative computed tomography (CT) images. A mean curvature index was estimated for each patient electrode. Multivariate analysis was performed using a regression decision tree to create a hierarchy of predictive variables. The identification and classification of key variables that determine electrode curvature were validated with statistical analysis. RESULTS: The principal variables affecting electrode deformations were found to be the date of the post-operative CT scan and the stimulation target location. The main pathology, patient's gender, and disease duration had a smaller although important impact on brain shift. CONCLUSIONS: The principal determinants of electrode location accuracy during DBS procedures were identified and validated. These results may be useful for improved electrode targeting with the help of mathematical models. PMID:23780571
Lalys, Florent; Haegelen, Claire; D'albis, Tiziano; Jannin, Pierre
This paper presents an automatic surgical target and trajectory identification technique for planning deep brain stimulation\\u000a (DBS) procedures. The probabilistic functional maps, constructed from population-based actual stimulating field information\\u000a and intra-operative electrophysiological activities, were integrated into a neurosurgical visualization and navigation system\\u000a to facilitate the surgical planning and guidance. In our preliminary studies, we compared the actual surgical target locations
The accuracy and precision of frameless neuronavigation as compared to conventional frame-based stereotaxy for implantation of deep brain stimulation (DBS) electrodes were studied in 14 patients with essential tremor. DBSelectrodes were implanted bilaterally in the ventrolateral thalamus [ventrointermediate nucleus (VIM)] in one procedure. Frameless neuronavigation was used on one side and the conventional frame-based technique on the other. Targeting
The combination of deep brain stimulation (DBS) and functional MRI (fMRI) is a powerful means of tracing brain circuitry and testing the modulatory effects of electrical stimulation on a neuronal network in vivo. The goal of this study was to trace DBS-induced global neuronal network activation in a large animal model by monitoring the blood oxygenation level-dependent (BOLD) response on fMRI. We conducted DBS in normal anesthetized pigs, targeting the subthalamic nucleus (STN) (n=7) and the entopeduncular nucleus (EN), the non-primate analog of the primate globus pallidus interna (n=4). Using a normalized functional activation map for group analysis and the application of general linear modeling across subjects, we found that both STN and EN/GPi DBS significantly increased BOLD activation in the ipsilateral sensorimotor network (FDR<0.001). In addition, we found differential, target-specific, non-motor network effects. In each group the activated brain areas showed a distinctive correlation pattern forming a group of network connections. Results suggest that the scope of DBS extends beyond an ablation-like effect and that it may have modulatory effects not only on circuits that facilitate motor function but also on those involved in higher cognitive and emotional processing. Taken together, our results show that the swine model for DBS fMRI, which conforms to human implanted DBSelectrode configurations and human neuroanatomy, may be a useful platform for translational studies investigating the global neuromodulatory effects of DBS. PMID:22967832
Min, Hoon-Ki; Hwang, Sun-Chul; Marsh, Michael P; Kim, Inyong; Knight, Emily; Striemer, Bryan; Felmlee, Joel P; Welker, Kirk M; Blaha, Charles D; Chang, Su-Youne; Bennet, Kevin E; Lee, Kendall H
Deep brain stimulation (DBS) is an effective therapy for medically refractory movement disorders like Parkinson’s disease. The electrodes, implanted in the target area within the human brain, generate an electric field which activates nerve fibers and cell bodies in the vicinity. Even though the different target nuclei display considerable differences in their anatomical structure, only few types of electrodes are currently commercially available. It is desirable to adjust the electric field and in particular the volume of tissue activated around the electrode with respect to the corresponding target nucleus in a such way that side effects can be reduced. Furthermore, a more selective and partial activation of the target structure is desirable for an optimal application of novel stimulation strategies, e.g., coordinated reset neuromodulation. Hence we designed a DBSelectrode with a segmented design allowing a more selective activation of the target structure. We created a finite element model (FEM) of the electrode and analyzed the volume of tissue activated for this electrode design. The segmented electrode activated an area in a targeted manner, of which the dimension and position relative to the electrode could be controlled by adjusting the stimulation parameters for each electrode contact. According to our computational analysis, this directed stimulation might be superior with respect to the occurrence of side effects and it enables the application of coordinated reset neuromodulation under optimal conditions.
Buhlmann, J.; Hofmann, L.; Tass, P. A.; Hauptmann, C.
ObjectiveThe growing clinical acceptance of neurostimulation technology has highlighted the need to accurately predict neural activation as a function of stimulation parameters and electrode design. In this study we evaluate the effects of the tissue and electrode capacitance on the volume of tissue activated (VTA) during deep brain stimulation (DBS).
Deep brain stimulation (DBS) is an established clinical treatment for a range of neurological disorders. Depending on the disease state of the patient, different anatomical structures such as the ventral intermediate nucleus of the thalamus (VIM), the subthalamic nucleus or the globus pallidus are targeted for stimulation. However, the same electrode design is currently used in nearly all DBS applications, even though substantial morphological and anatomical differences exist between the various target nuclei. The fundamental goal of this study was to develop a theoretical understanding of the impact of changes in the DBSelectrode contact geometry on the volume of tissue activated (VTA) during stimulation. Finite element models of the electrodes and surrounding medium were coupled to cable models of myelinated axons to predict the VTA as a function of stimulation parameter settings and electrode design. Clinical DBSelectrodes have cylindrical contacts 1.27 mm in diameter (d) and 1.5 mm in height (h). Our results show that changes in contact height and diameter can substantially modulate the size and shape of the VTA, even when contact surface area is preserved. Electrode designs with a low aspect ratio (d/h) maximize the VTA by providing greater spread of the stimulation parallel to the electrode shaft without sacrificing lateral spread. The results of this study provide the foundation necessary to customize electrode design and VTA shape for specific anatomical targets, and an example is presented for the VIM. A range of opportunities exist to engineer DBS systems to maximize stimulation of the target area while minimizing stimulation of non-target areas. Therefore, it may be possible to improve therapeutic benefit and minimize side effects from DBS with the design of target-specific electrodes.
Objectives: Deep brain stimulation (DBS) is nowadays considered a safe and effective procedure for various movement disorders in which conservative treatments have failed to show significant therapeutic results. One of the most common complications of definitive electrode positioning is intraparenchymal hemorrhage. Materials and methods: Authors report the case of a 55-year-old female patient treated for Parkinson’s disease in which intraparenchymal hemorrhage developed after DBS procedure, leading to significant (about 8 mm at the neuroradiological controls) displacement of an otherwise correctly positioned DBSelectrode. Results: After conservative management, the hematoma spontaneously resolved. Late neuroradiological controls documented correct, symmetrically positioned electrodes, comparable to the immediate postoperative controls. Conclusions: Six months follow-up endpoint results of the DBS treatment were considered satisfying by an independent neurologist, with modest residual neurological deficits, demonstrating that re-positioning of the electrode was unnecessary in this rare complication.
A number of methods have been developed to assist surgeons at various stages of deep brain stimulation (DBS) therapy. These include construction of anatomical atlases, functional databases, and electrophysiological atlases and maps. But, a complete system that can be integrated into the clinical workflow has not been developed. In this paper we present a system designed to assist physicians in pre-operative target planning, intra-operative target refinement and implantation, and post-operative DBS lead programming. The purpose of this system is to centralize the data acquired a the various stages of the procedure, reduce the amount of time needed at each stage of the therapy, and maximize the efficiency of the entire process. The system consists of a central repository (CranialVault), of a suite of software modules called CRAVE (CRAnialVault Explorer) that permit data entry and data visualization at each stage of the therapy, and of a series of algorithms that permit the automatic processing of the data. The central repository contains image data for more than 400 patients with the related pre-operative plans and position of the final implants and about 10,550 electrophysiological data points (micro-electrode recordings or responses to stimulations) recorded from 222 of these patients. The system has reached the stage of a clinical prototype that is being evaluated clinically at our institution. A preliminary quantitative validation of the planning component of the system performed on 80 patients who underwent the procedure between January 2009 and December 2009 shows that the system provides both timely and valuable information.
D'Haese, Pierre-Francois; Pallavaram, Srivatsan; Li, Rui; Remple, Michael S.; Kao, Chris; Neimat, Joseph S.; Konrad, Peter E.; Dawant, Benoit M.
Objective: To describe a method for the measurement of the accuracy of deep brain stimulation (DBS) electrode placement with the use of image fusion technologies. Patients and Methods: Ten consecutive patients suffering from movement disorders underwent DBSelectrode placement. Postoperative MR images were fused with the pre-operative stereotactic CT. The placement error in the anteroposterior, lateral and vertical planes was
Paolo Ferroli; Angelo Franzini; Carlo Marras; Elio Maccagnano; Ludovico D’Incerti; Giovanni Broggi
The objective of this study was to quantify the electrode-tissue interface impedance of electrodes used for deep brain stimulation (DBS). We measured the impedance of DBSelectrodes using electrochemical impedance spectroscopy in vitro in carbonate and phosphate buffered saline solution and in vivo following acute implantation in the brain. The components of the impedance, including the series resistance (Rs), the Faradaic resistance (Rf) and the double layer capacitance (Cdl), were estimated using an equivalent electrical circuit. Both Rf and Cdl decreased as the sinusoidal frequency was increased, but the ratio of capacitive charge transfer to Faradaic charge transfer was relatively insensitive to the change of frequency. Rf decreased and Cdl increased as the current density was increased, and above a critical current density the interface impedance became nonlinear. Thus the magnitude of the interface impedance was strongly dependent on the intensity (pulse amplitude and duration) of stimulation. The temporal dependence and spatial non-uniformity of Rf and Cdl suggested that a distributed network, with each element of the network having dynamics tailored to a specific stimulus waveform, is required to describe adequately the impedance of the DBSelectrode-tissue interface. Voltage transients to biphasic square current pulses were measured and suggested that the electrode-tissue interface did not operate in a linear range at clinically-relevant current amplitudes, and that the assumption of the DBSelectrode being ideally polarizable was not valid under clinical stimulating conditions.
ObjectiveComplex regional pain syndrome-1 (CRPS) is characterised by allodynia, autonomia and, sometimes, dystonia. Its course varies from mild and self-limiting to chronic fixed dystonia. We describe treatment of CRPS-1 related dystonia by deep brain stimulation (DBS).MethodsPatient-1 was diagnosed with CRPS-1 aged 13. A minor blow triggered severe leg pain, allodynia and autonomia. Dystonia progressed to involve trunk and all limbs,
Heating induced near deep brain stimulation (DBS) lead electrodes during magnetic resonance imaging with a 3 T transceive head coil was measured, modeled, and imaged in three cadaveric porcine heads (mean body weight = 85.47 ± 3.19 kg, mean head weight = 5.78 ± 0.32 kg). The effect of the placement of the extra-cranial portion of the DBS lead on
Devashish Shrivastava; Aviva Abosch; John Hughes; Ute Goerke; Lance DelaBarre; Rachana Visaria; Noam Harel; J Thomas Vaughan
Deep brain stimulation (DBS) is used to reduce the motor symptoms such as rigidity or bradykinesia, in patients with Parkinson's disease (PD). The Subthalamic Nucleus (STN) has emerged as prime target of DBS in idiopathic PD. However, DBS surgery is a difficult procedure requiring the exact positioning of electrodes in the pre-operative selected targets. This positioning is usually planned using patients' pre-operative images, along with digital atlases, assuming that electrode's trajectory is linear. However, it has been demonstrated that anatomical brain deformations induce electrode's deformations resulting in errors in the intra-operative targeting stage. In order to meet the need of a higher degree of placement accuracy and to help constructing a computer-aided-placement tool, we studied the electrodes' deformation in regards to patients' clinical data (i.e., sex, mean PD duration and brain atrophy index). Firstly, we presented an automatic algorithm for the segmentation of electrode's axis from post-operative CT images, which aims to localize the electrodes' stimulated contacts. To assess our method, we applied our algorithm on 25 patients who had undergone bilateral STNDBS. We found a placement error of 0.91+/-0.38 mm. Then, from the segmented axis, we quantitatively analyzed the electrodes' curvature and correlated it with patients' clinical data. We found a positive significant correlation between mean curvature index of the electrode and brain atrophy index for male patients and between mean curvature index of the electrode and mean PD duration for female patients. These results help understanding DBSelectrode' deformations and would help ensuring better anticipation of electrodes' placement.
Mehri, Maroua; Lalys, Florent; Maumet, Camille; Haegelen, Claire; Jannin, Pierre
Reversibility and adaptability are preferred features of long-term therapeutic deep brain stimulation (DBS). In such therapy, a permanent stimulatingelectrode with four contact points is placed at the stimulation site and, generally speaking, bipolar stimulation is induced by various pairs of adjacent contact points on one electrode. The stimulation sites are thus all located along the trajectory of the implanted electrode. In a patient with unilateral severe essential tremor, the authors implanted two electrodes side by side and parallel to each other in the unilateral thalamic ventralis intermedius nucleus. Using these electrodes, the authors were able to deliver current flow not only along the electrode trajectory, but also between the two electrodes in a direction parallel to the anterior commissure-posterior commissure line. Although individual stimulations, delivered by each of the two electrodes using all parameters and all stimulation points, were unable to stop the patient's tremor completely without adverse effects, the new stimulation method, in which electrical currents passed between the two electrodes, effected complete abolition of the tremor without adverse effects. With the aid of this method, one can use two electrodes, implanted in parallel and side by side, to achieve maximum efficacy and to reduce adverse effects in some instances of DBS therapy. PMID:11765826
Yamamoto, T; Katayama, Y; Fukaya, C; Oshima, H; Kasai, M; Kobayashi, K
Electrical stimulation can cause significant damage to clinical electrodes as well as patient injury. In this study, the effects of stimulation on pure metal electrodes were investigated without the complexities introduced by the multiple elements that make up the clinical electrode. As with the clinical electrodes, there was significant decomposition of pure stainless steel anodes with no associated significant changes in the cathodes when stimulation employed long pulse durations. Effects of stimulation were greater when the anode and cathode were closer under constant voltage stimulation but were distance independent under constant current stimulation. High ionic content of the solution also increased the degree of damage to the anode as did the presence of chloride in the solution. Electrode composition also influenced the amount damage to the anode. Platinum and platinum-iridium electrodes showed no damage with any stimulus while stainless steel showed the lowest resistance to corrosion for direct current (DC) stimulation. Tungsten electrodes behaved very differently than stainless steel, decomposing with pulse stimulation and resisting decomposition during DC stimulation because of the formation of surface protective layers. Because platinum was able to maintain high levels of current over time, prolonged stimulation produced dramatic increases in the temperature of the solution; however, even short periods of stimulation were sufficient to produce dramatic changes in pH in the neighborhood of the electrode. PMID:21313789
Stevenson, Matthew; Baylor, Kelly; Netherton, Brett L; Stecker, Mark M
BACKGROUND: Deep brain stimulation (DBS) has emerged as a promising therapy for movement disorders. During the implantation procedure for the electrodes, the patient emerges from anesthesia repeatedly to facilitate neurological testing. We investigated whether Bispectral Index (BIS™) monitoring would be beneficial in patients receiving \\
Uwe Schulz; Didier Keh; Christoph Barner; Udo Kaisers; Willehad Boemke
Objective Clinical deep brain stimulation (DBS) systems typically utilize voltage-controlled stimulation and thus the voltage distribution generated in the brain can be affected by electrode impedance fluctuations. The goal of this study was to experimentally evaluate the theoretical advantages of using current-controlled pulse generators for DBS applications. Methods Time-dependent changes in the voltage distribution generated in the brain during voltage-controlled and current-controlled DBS were monitored with in vivo experimental recordings performed in non-human primates implanted with scaled-down clinical DBSelectrodes. Results In the days following DBS lead implantation, electrode impedance progressively increased. Application of continuous stimulation through the DBSelectrode produced a decrease in the electrode impedance in a time dependent manner, with the largest changes occurring within the first hour of stimulation. Over that time period, voltage-controlled stimuli exhibited an increase in the voltage magnitudes generated in the tissue near the DBSelectrode, while current-controlled DBS showed minimal changes. Conclusion Large electrode impedance changes occur during DBS. During voltage-controlled stimulation, these impedance changes were significantly correlated with changes in the voltage distribution generated in the brain. However, these effects can be minimized with current-controlled stimulation. Significance The use of current-controlled DBS may help minimize time-dependent changes in therapeutic efficacy that can complicate patient programming when using voltage-controlled DBS.
Lempka, Scott F.; Johnson, Matthew D.; Miocinovic, Svjetlana; Vitek, Jerrold L.; McIntyre, Cameron C.
Deep Brain Stimulation (DBS) for neuromodulation is now commonplace. However little is known about the incidence of either procedural related seizures or epilepsy following chronic DBS. This study aims to provide estimates of these complications for movement disorders, pain and psychiatric conditions. A literature review was performed. Because searches using the terms seizure, epilepsy, and deep brain stimulation revealed only papers dealing with experimental and clinical application of DBS to treat chronic seizures disorders, a search strategy trawling through papers that described clinical case series of DBS was used. Thirty-two papers were reviewed that described stereotactic placement of DBSelectrodes for movement disorders, pain syndromes and psychiatric conditions with cohorts of n > 5. Sixteen of these papers describing at least 1418 DBSelectrode placements in 1254 patients did not mention seizures as a complication (i.e., it was not possible to know whether seizures had or had not occurred). In 16 papers, describing at least 2101 electrode placements in 1555 patients, seizures were described in 42 patients (incidence 2.7%). The range of seizure incidence varied from 0% (three series encompassing 317 patients and 576 electrode placements) up to 10% (n = 130) and 13% (n = 15). The reasons for this variance were not obvious. At least 74% of seizures occurred around the time of electrode implantation and many of these patients also suffered intracranial hemorrhage. Follow up times were variable (range 6 mths to 5 years). The analysis was complicated by multiple publications from some centres with duplication of some data. The quality of literature on seizures following DBS insertion for neuromodulation is highly variable. Analysis of the available data, after making corrections for publication of duplicate data, suggests strongly that the risk of seizures associated with DBS placement is probably lower than 2.4% (95% CI 1.7 to 3.3 %). The risk of postprocedural seizures associated with chronic deep brain stimulation is even lower with best estimates around 0.5% (95% CI .02 to 1.0%). PMID:19306174
BackgroundDeep brain stimulation (DBS) is a treatment for patients with Parkinson's disease (PD) who are not adequately controlled with medications. An artist reported changes in her artistic creativity and art appreciation when treated with left DBS. We sought to study her artistic productions and her appreciation of art while both “on” and “off” left DBS.
V. Drago; P. S. Foster; M. S. Okun; I. Haq; A. Sudhyadhom; F. M. Skidmore; K. M. Heilman
This paper describes a new tripolar spiral cuff electrode, composed of a thin (10 ?m) and flexible polyimide insulating carrier and three circumneural platinum electrodes, suitable for stimulation of peripheral nerves. The cuffs were implanted around the sciatic nerve of two groups of ten rats each, one in which the polyimide ribbon was attached to a plastic connector to characterize
Francisco J. Rodri´guez; Dolores Ceballos; Antoni Valero; Elena Valderrama; Thomas Stieglitz; Xavier Navarro
Deep brain stimulation (DBS) is an accepted treatment of movement disorders, but little research on tissue changes induced by these devices has been made. We report findings of MRI signal changes in patients with unilateral DBS implantation and no clinically detectable symptoms. A retrospective review of preoperative stereotactic MRI scans for staged placement of second-side DBS was performed in 38
Virtual electrodestimulation can provide extra selective spatial stimulation sites given if there is a highly configurable and controllable multi-channel stimulator system. The system has to have low latency between the loaded input data and output stimulation pulse, precise timing on simultaneously stimulation and an interface with external device such that a computer or FPGA can directly control each of the stimulation channels. This paper presents a general concept of virtual electrodestimulation and a multi-channel stimulation system that can support such operation. The system is designed in CMOS 0.35µm occupies 3.4×2.7mm(2) and consumes 2.3mW. PMID:23366779
A nerve clamp electrode was developed to indirectly stimulate skeletal muscle innervated by alpha motor neurons as an alternative to conventional electrodes. The stimulatingelectrode device consists of a spring coil-activated nerve clamp mounted inside a...
Weight gain following bilateral subthalamic nucleus deep brain stimulation (STN DBS) in Parkinson disease (PD) has been characterized previously, but little is known about changes in weight following unilateral STN DBS. Weight gain of approximately 10kg at one year after bilateral STN DBS for PD has been noted in previous studies, and PD in the absence of DBS has been
Harrison C. Walker; Michael Lyerly; Gary Cutter; Johnson Hagood; Natividad P. Stover; Stephanie L. Guthrie; Barton L. Guthrie; Ray L. Watts
We compared the surgical outcome with electrode positions after bilateral subthalamic nucleus (STN) stimulation surgery for Parkinson's disease. Fifty-seven patients treated with bilateral STN stimulations were included in this study. Electrode positions were determined in the fused images of preoperative MRI and postoperative CT taken at six months after surgery. The patients were divided into three groups: group I, both electrodes in the STN; group II, only one electrode in the STN; group III, neither electrode in the STN. Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn and Yahr stage, and activities of daily living scores significantly improved at 6 and 12 months after STN stimulation in both group I and II. The off-time UPDRS III speech subscore significantly improved (1.6 ± 0.7 at baseline vs 1.3 ± 0.8 at 6 and 12 months, P < 0.01) with least L-dopa equivalent daily dose (LEDD) (844.6 ± 364.1 mg/day at baseline; 279.4 ± 274.6 mg/day at 6 months; and 276.0 ± 301.6 mg/day at 12 months, P < 0.001) at 6 and 12 months after STN deep brain stimulation (DBS) in the group I. Our findings suggest that the better symptom relief including speech with a reduced LEDD is expected in the patients whose electrodes are accurately positioned in both STN.
Paek, Sun Ha; Lee, Jee-Young; Kim, Han-Joon; Kang, Daehee; Lim, Yong Hoon; Kim, Mi Ryoung; Kim, Cheolyoung; Kim, Dong Gyu
We present a visualization system to explore data col- lected on Deep Brain Stimulation (DBS) for Obsessive Com- pulsive Disorder (OCD). DBS is a new surgical treatment in which electrodes are inserted into a patient's brain. After surgery, settings for the electrodes must be adjusted to find the stimulation that best reduces symptoms. Our tool is de- signed for interactively
David Eigen; Daniel Grollman; David Laidlaw; Benjamin Greenberg; Erin Einbinder
Iridium oxide neural stimulatingelectrodes were formed by electroplating iridium oxide onto thin-film gold electrodes on a polyimide substrate. 18 million current pulses were applied to 4 electrodes over 7 days. 1 electrode delaminated on day 1. The remaining three electrodes showed characteristics altered by current pulsing. However, the electrodes maintained the ability to deliver large amounts of charge
For patients suffering from Parkinson's disease with severe movement disorders, functional surgery may be required when medical therapy is not effective. In Deep Brain Stimulation (DBS), electrodes are implanted within the brain to stimulate deep structures such as SubThalamic Nucleus (STN). The quality of patient surgical outcome is generally related to the accuracy of nucleus targeting during surgery. In this paper, we focused on identifying optimum sites for STN DBS by studying symptomatic motor improvement along with neuropsychological side effects. We described successive steps for constructing digital atlases gathering patient's location of electrode contacts automatically segmented from postoperative images, and clinical scores. Three motor and five neuropsychological scores were included in the study. Correlations with active contact locations were carried out using an adapted hierarchical ascendant classification. Such analysis enabled the extraction of representative clusters to determine the optimum site for therapeutic STN DBS. For each clinical score, we built an anatomo-clinical atlas representing its improvement or deterioration in relation with the anatomical location of electrodes and from a population of implanted patients. To the best of our knowledge, we reported for the first time a discrepancy between a very good motor improvement by targeting the postero-superior region of the STN and an inevitable deterioration of the categorical and phonemic fluency in the same region. Such atlases and associated analysis may help better understanding of functional mapping in deep structures and may help pre-operative decision-making process and especially targeting. PMID:23147008
In difficult epileptic patients, the brain structures are explored by means of depth multicontact electrodes [stereoelectroencephalography (SEEG)]. Recently, a novel diagnostic technique allows an accurate definition of the epileptogenic zone using deep brain stimulation (DBS). The stimulation signal propagates in the brain and thus it appears on most of the other SEEG electrodes, masking the local brain electrophysiological activity. The objective of this paper is the DBS-SEEG signals detrending and denoising in order to recover the masked physiological sources. We review the main filtering methods and put forward an approach based on the combination of filtering with generalized eigenvalue decomposition (GEVD). An experimental study on simulated and real SEEG shows that our approach is able to separate DBS sources from brain activity. The best results are obtained by an original singular spectrum analysis-GEVD approach. PMID:23674415
Hofmanis, Janis; Caspary, Olivier; Louis-Dorr, Valerie; Ranta, Radu; Maillard, Louis
Deep brain stimulation (DBS) therapy is a continually expanding field in the functional neurosurgical treatment of movement disorders. However, the occurrence of adverse events related to implanted hardware cannot be overlooked. We report on a specific feature noted in our experience of DBS-related complications. From 1998 until present we have found an overall rate of 5.3% of DBSelectrode lead
J Yianni; D Nandi; A Shad; P Bain; Ralph Gregory; Tipu Aziz
Objective: The goal of this project was to develop a quantitative understanding of the volume of axonal tissue directly activated by deep brain stimulation (DBS) of the subthalamic nucleus (STN).Methods: The 3-dimensionally inhomogeneous and anisotropic tissue medium surrounding DBSelectrodes complicates our understanding of the electric field and tissue response generated by the stimulation. We developed finite element computer models
Cameron C. McIntyre; Susumu Mori; David L. Sherman; Nitish V. Thakor; Jerrold L. Vitek
Deep brain stimulation (DBS) achieves therapeutic outcome through generation of electric fields (EF) in the vicinity of energized electrodes. Targeted brain regions are highly vascularized, and it remains unknown if DBS electric fields modulate blood-brain barrier (BBB) function, either through electroporation of individual endothelial cells or electro-permeation of barrier tight junctions. In our study, we calculated the intensities of EF generated around energized Medtronic 3387 and 3389 DBS leads by using a finite element model. Then we designed a novel stimulation system to study the effects of such fields with DBS-relevant waveforms and intensities on bovine aortic endothelial cell (BAEC) monolayers, which were used as a basic analog for the blood-brain barrier endothelium. Following 5 min of stimulation, we observed a transient increase in endothelial hydraulic conductivity (Lp) that could be related to the disruption of the tight junctions (TJ) between cells, as suggested by zonula occludens-1 (ZO-1) protein staining. This 'electro-permeation' occurred in the absence of cell death or single cell electroporation, as indicated by propidium iodide staining and cytosolic calcein uptake. Our in vitro results, using uniform fields and BAEC monolayers, thus suggest that electro-permeation of the BBB may occur at electric field intensities below those inducing electroporation and within intensities generated near DBSelectrodes. Further studies are necessary to address potential BBB disruption during clinical studies, with safety and efficacy implications.
Lopez-Quintero, S. V.; Datta, A.; Amaya, R.; Elwassif, M.; Bikson, M.; Tarbell, J. M.
Deep brain stimulation (DBS) is a new neurosurgical method principally used for the treatment of Parkinson disease (PD). Many new applications of DBS are under development, including the treatment of intractable psychiatric diseases. Brain imaging is used for the selection of patients for DBS, to localize the target nucleus, to detect complications, and to evaluate the final electrode contact position. In patients with implanted DBS systems, there is a risk of electrode heating when MR imaging is performed. This contraindicates MR imaging unless specific precautions are taken. Involvement of neuroradiologists in DBS procedures is essential to optimize presurgical evaluation, targeting, and postoperative anatomic results. The precision of the neuroradiologic correlation with anatomic data and clinical outcomes in DBS promises to yield significant basic science and clinical advances in the future. PMID:19749225
Control of the electrode offset voltage is an important issue related to the processes of functional electrical stimulation because excess charge accumulation over time damages both the tissue and the electrodes. This paper proposes a new feedback control scheme to regulate the electrode offset voltage to a predetermined reference value. The electrode offset voltage was continuously monitored using a sample-and-hold (S/H) circuit during stimulation and non-stimulation periods. The stimulation current was subsequently adjusted using a proportional-integral (PI) controller to minimise the error between the reference value and the electrode offset voltage. During the stimulation period, the electrode offset voltage was maintained through the S/H circuit, and the PI controller did not affect the amplitude of the stimulation current. In contrast, during the non-stimulation period, the electrode offset voltage was sampled through the S/H circuit and rapidly regulated through the PI controller. The experimental results obtained using a nerve cuff electrode showed that the electrode offset voltage was successfully controlled in terms of the performance specifications, such as the steady- and transient-state responses and the constraint of the controller output. Therefore, the proposed control scheme can potentially be used in various nerve stimulation devices and applications requiring control of the electrode offset voltage. PMID:23685268
Background\\/Aims: During the placement of electrodes for deep brain stimulation (DBS), patients are commonly in a seated position, awake, and spontaneously breathing. Air may be entrained through bone or dural veins causing venous air emboli (VAE) and this phenomenon can result in significant hemodynamic changes. Although VAEs have been described in many types of neurosurgical procedures, their incidence during DBS
Amanda K. Hooper; Michael S. Okun; Kelly D. Foote; Ihtsham U. Haq; Hubert H. Fernandez; Dustin Hegland; Steven A. Robicsek
\\u000a In current practice, optimal placement of deep brain stimulators (DBSs) is an iterative procedure. A target is chosen pre-operatively\\u000a based on anatomical landmarks identified on MR images. This point is used as an initial position that is refined intra-operatively\\u000a using both micro-electrode recordings and macro-stimulation. We hypothesize that boundaries of nuclei and sub-nuclei not visible\\u000a in the anatomic images can
Pierre-François D’Haese; Ebru Cetinkaya; Chris Kao; J. Michael Fitzpatrick; Peter E. Konrad; Benoit M. Dawant
Background Intraoperative microelectrode recording (MER) for targeting during deep brain stimulation (DBS) procedures has been evaluated over a period of 4 years, in 57 consecutive patients with Parkinson’s disease, who received DBS in the subthalamic nucleus (STN-DBS), and 28 consecutive patients with either dystonia (23) or Parkinson’s disease (five), in whom the internal segment of the globus pallidus (GPi-DBS) was targeted. Methods The procedure for DBS was a one-stage bilateral stereotactic approach using a combined electrode for both MER and macrostimulation. Up to five micro/macro-electrodes were used in an array with a central, lateral, medial, anterior, and posterior position. Final target location was based on intraoperative test stimulation. Findings For the STN, the central trajectory was chosen for implantation in 50% of the cases and for the globus pallidus internus (GPi) in 57% of the cases. Furthermore, in 64% of the cases, the channel selected for the permanent electrode corresponded with the trajectory having the longest segment of STN MER activity. For the GPi, this was the case in 61%. The mean and standard deviation of the deepest contact point with respect to the magnetic resonance imaging (MRI)-based target for the STN was 2.1?±?1.5 mm and for the GPi was ?0.5?±?1.2 mm. Conclusions MER facilitates the selection of the final electrode location in STN-DBS and GPi-DBS, and based on the observed MER activity, a pre-selection could be made as to which channel would be the best candidate for macro-test stimulation and at which depth should be stimulated. The choice of the final location is based on intraoperative test stimulation, and it is demonstrated that regularly it is not the central channel that is chosen for implantation. On average, the target as defined by MER activity intensity was in accordance with the MRI-based targets both for the STN and GPi. However, the position of the best MER activity did not necessarily correlate with the locus that produced the most beneficial clinical response on macroelectrode testing intraoperatively.
Contarino, M. Fiorella; Foncke, Elisabeth M. J.; de Bie, Rob M. A.; van den Munckhof, Pepijn; Speelman, Johannes D.; Schuurman, P. Richard
Animal and clinical observations of a reduction in electrode impedance following electrical stimulation encouraged the development of an in vitro model of the electrode-tissue interface. This model was used previously to show an increase in impedance with cell and protein cover over electrodes. In this paper, the model was used to assess the changes in electrode impedance and cell cover following application of a charge-balanced biphasic current pulse train. Following stimulation, a large and rapid drop in total impedance (Zt) and access resistance (Ra) occurred. The magnitude of this impedance change was dependent on the current amplitude used, with a linear relationship determined between Ra and the resulting cell cover over the electrodes. The changes in impedance due to stimulation were shown to be transitory, with impedance returning to pre-stimulation levels several hours after cessation of stimulation. A loss of cells over the electrode surface was observed immediately after stimulation suggesting that the level of stimulation applied was creating localised changes to cell adhesion. Similar changes in electrode impedance were observed for in vivo and in vitro work, thus helping to verify the in vitro model, although the underlying mechanisms may differ. A change in the porosity of the cellular layer was proposed to explain the alterations in electrode impedance in vitro. These in vitro studies provide insight into the possible mechanisms occurring at the electrode-tissue interface in association with electrical stimulation.
Background Multi-contact stimulatingelectrodes are gaining acceptance as a means for interfacing with the peripheral nervous system. These electrodes can potentially activate many independent populations of motor units within a single peripheral nerve, but quantifying their recruitment properties and the overlap in stimulation between contacts is difficult and time consuming. Further, current methods for quantifying overlap between contacts are ambiguous and can lead to suboptimal selective stimulation parameters. This study describes a novel method for optimizing stimulation parameters for multi-contact peripheral stimulatingelectrodes to produce strong, selective muscle contractions. The method is tested with four-contact spiral nerve-cuff electrodes implanted on bilateral femoral nerves of two individuals with spinal cord injury, but it is designed to be extendable to other electrode technologies with higher densities of contacts. Methods To optimize selective stimulation parameters for multi-contact electrodes, first, recruitment and overlap are characterized for all contacts within an electrode. Recruitment is measured with the twitch response to single stimulus pulses, and overlap between pairs of contacts is quantified by the deviation in their combined response from linear addition of individual responses. Simple mathematical models are fit to recruitment and overlap data, and a cost function is defined to maximize recruitment and minimize overlap between all contacts. Results Results are presented for four-contact nerve-cuff electrodesstimulating bilateral femoral nerves of two human subjects with spinal cord injury. Knee extension moments between 11.6 and 43.2 Nm were achieved with selective stimulation through multiple contacts of each nerve-cuff with less than 10% overlap between pairs of contacts. The overlap in stimulation measured in response to selective stimulation parameters was stable at multiple repeated time points after implantation. Conclusions These results suggest that the method described here can provide an automated means of determining stimulus parameters to achieve strong muscle contractions via selective stimulation through multi-contact peripheral nerve electrodes.
Purpose To study the effect of the extra-cranial portion of a deep brain stimulation (DBS) lead on radiofrequency (RF) heating with a transmit and receive 9.4 tesla head coil. Material and Methods The RF heating was studied in four excised porcine heads (mean animal head weight = 5.46 ± 0.14 kg) for each of the following two extra-cranial DBS lead orientations: one, parallel to the coil axial direction; two, perpendicular to the coil axial direction (i.e., azimuthal). Temperatures were measured using fluoroptic probes at four locations: one, scalp; two, near the second DBS lead electrode-brain contact; three, near the distal tip of the DBS lead; and four, air surrounding the head. A continuous wave RF power was delivered to each head for 15 minutes using the coil. Net, delivered RF power was measured at the coil (mean whole head average specific absorption rate = 2.94 ± 0.08 W/kg). Result RF heating was significantly reduced when the extra-cranial DBS lead was placed in the axial direction (temperature change = 0-5 °C) compared to the azimuthal direction (temperature change = 1-27 °C). Conclusion Development of protocols seems feasible to keep RF heating near DBSelectrodes clinically safe during ultra-high field head imaging.
Shrivastava, Devashish; Abosch, Aviva; Hanson, Timothy; Tian, Jinfeng; Gupte, Akshay; Iaizzo, Paul A.; Vaughan, J. Thomas
Experiments were conducted to assess the effect of chronic stimulation on the electrical properties of the electrode-tissue system, as measured using electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV). Silicon, micromachined probes with multiple iridium oxide stimulatingelectrodes (400-1600 ?m2) were implanted in guinea pig cortex. A 10-17 day post-operative recovery period was followed by five days of monopolar stimulation,
Heating induced near deep brain stimulation (DBS) lead electrodes during magnetic resonance imaging with a 3 T transceive head coil was measured, modeled, and imaged in three cadaveric porcine heads (mean body weight = 85.47 ± 3.19 kg, mean head weight = 5.78 ± 0.32 kg). The effect of the placement of the extra-cranial portion of the DBS lead on the heating was investigated by looping the extra-cranial lead on the top, side, and back of the head, and placing it parallel to the coil's longitudinal axial direction. The heating was induced using a 641 s long turbo spin echo sequence with the mean whole head average specific absorption rate of 3.16 W kg-1. Temperatures were measured using fluoroptic probes at the scalp, first and second electrodes from the distal lead tip, and 6 mm distal from electrode 1 (T6 mm). The heating was modeled using the maximum T6 mm and imaged using a proton resonance frequency shift-based MR thermometry method. Results showed that the heating was significantly reduced when the extra-cranial lead was placed in the longitudinal direction compared to the other placements (peak temperature change = 1.5-3.2 °C versus 5.1-24.7 °C). Thermal modeling and MR thermometry may be used together to determine the heating and improve patient safety online.
Shrivastava, Devashish; Abosch, Aviva; Hughes, John; Goerke, Ute; DelaBarre, Lance; Visaria, Rachana; Harel, Noam; Vaughan, J. Thomas
Heating induced near deep brain stimulation (DBS) lead electrodes during magnetic resonance imaging with a 3 T transceive head coil was measured, modeled, and imaged in three cadaveric porcine heads (mean body weight = 85.47 ± 3.19 kg, mean head weight = 5.78 ± 0.32 kg). The effect of the placement of the extra-cranial portion of the DBS lead on the heating was investigated by looping the extra-cranial lead on the top, side, and back of the head, and placing it parallel to the coil's longitudinal axial direction. The heating was induced using a 641 s long turbo spin echo sequence with the mean whole head average specific absorption rate of 3.16 W kg(-1). Temperatures were measured using fluoroptic probes at the scalp, first and second electrodes from the distal lead tip, and 6 mm distal from electrode 1 (T(6 mm)). The heating was modeled using the maximum T(6 mm) and imaged using a proton resonance frequency shift-based MR thermometry method. Results showed that the heating was significantly reduced when the extra-cranial lead was placed in the longitudinal direction compared to the other placements (peak temperature change = 1.5-3.2 °C versus 5.1-24.7 °C). Thermal modeling and MR thermometry may be used together to determine the heating and improve patient safety online. PMID:22892760
Heating induced near deep brain stimulation (DBS) lead electrodes during MRI with a 3T transceive head coil was measured, modeled, and imaged in three cadaveric porcine heads (mean body weight = 85.47±3.19 kg, mean head weight = 5.78±0.32 kg). The effect of the placement of the extra-cranial portion of the DBS lead on the heating was investigated by looping the extra-cranial lead on the top, side, and back of the head; and placing it parallel to the coil’s longitudinal axial direction. The heating was induced using a 641 s long turbo spin echo sequence with the mean whole head average SAR of 3.16 W/kg. Temperatures were measured using fluoroptic probes at the scalp, first and second electrodes from the distal lead tip, and 6 mm distal from electrode 1 (T6mm). The heating was modeled using the maximum T6mm and imaged using a proton resonance frequency shift based MR thermometry method. Results showed that the heating was significantly reduced when the extra-cranial lead was placed in the longitudinal direction compared to the other placements (peak temperature change = 1.5–3.2 °C vs 5.1–24.7 °C). Thermal modeling and MR thermometry may be used together to determine the heating and improve patient safety online.
Shrivastava, Devashish; Abosch, Aviva; Hughes, John; Goerke, Ute; DelaBarre, Lance; Visaria, Rachana; Harel, Noam; Vaughan, J. Thomas
Magnetic resonance imaging (MRI) of patients with implanted deep brain stimulation (DBS) devices poses a challenge for healthcare providers. As a consequence of safety concerns about magnetic field interactions with the device, induced electrical currents and thermal damage due to radiofrequency heating, a number of stringent guidelines have been proposed by the device manufacturer. Very few detailed investigations of these safety issues have been published to date, and the stringent manufacturer guidelines have gone unchallenged, leading some hospitals and imaging centers around the world to ban or restrict the use of MRI in DBS patients. The purpose of this review is to stimulate research towards defining appropriate guidelines for the use of MRI in patients with DBS. Additionally, this review is intended to help healthcare providers and researchers make sound clinical judgments about the use of MRI in the setting of implanted DBS devices. PMID:21494064
Deep brain stimulation (DBS) surgery can significantly improve the quality of life for patients suffering from movement disorders, but the success of the procedure depends on the implantation accuracy of the DBSelectrode array. Pre-operative surgical planning and navigation are based on the assumption that the brain tissue is rigid between the time of the acquisition of the pre-operative image
Muhammad Faisal Khan; Klaus Mewes; Robert E. Gross; Oskar Škrinjar
Deep brain stimulation (DBS) is an established procedure for the treatment of movement and affective disorders. Patients with DBS may benefit from magnetic resonance imaging (MRI) to evaluate injuries or comorbidities. However, the MRI radio-frequency (RF) energy may cause excessive tissue heating particularly near the electrode. This paper studies how the accuracy of numerical modeling of the RF field inside a DBS patient varies with spatial resolution and corresponding anatomical detail of the volume surrounding the electrodes. A multiscale model (MS) was created by an atlas-based segmentation using a 1?mm3 head model (mRes) refined in the basal ganglia by a 200??m2 ex-vivo dataset. Four DBSelectrodes targeting the left globus pallidus internus were modeled. Electromagnetic simulations at 128?MHz showed that the peak of the electric field of the MS doubled (18.7?kV/m versus 9.33?kV/m) and shifted 6.4?mm compared to the mRes model. Additionally, the MS had a sixfold increase over the mRes model in peak-specific absorption rate (SAR of 43.9?kW/kg versus 7?kW/kg). The results suggest that submillimetric resolution and improved anatomical detail in the model may increase the accuracy of computed electric field and local SAR around the tip of the implant.
Iacono, Maria Ida; Makris, Nikos; Mainardi, Luca; Angelone, Leonardo M.; Bonmassar, Giorgio
Cognitive functioning has been described as largely impervious to chronic STN-DBS administered over 12-month periods. In relation to the domain of language, however, the effects of STN-DBS are yet to be thoroughly delineated. Verbal fluency tasks represent an almost exclusively applied index of linguistic proficiency relative to neuropsychological research within this population. Comprehensive investigations of the impact of STN-DBS on language function, however, have never been undertaken. The more precise elucidation of the role of the STN in the mediation of language processes, by way of assessments which probe language comprehension and production mechanisms, served as the primary focus of this research. Longitudinal analysis also afforded consideration of the way in which cognitive-linguistic circuits respond to STN-DBS over time. Bilateral STN-DBS primarily effected clinically reliable fluctuations (i.e., both improvements and declines) in performance in both subjects on tasks demanding cognitive-linguistic flexibility in the formulation and comprehension of complex language. Of particular note, both subjects demonstrated a cumulative increase in the proportion of reliable post-operative improvements achieved over time. The findings of this research lend support to models of subcortical participation in language which endorse a role for the STN, and suggest that bilateral STN-DBS may serve to enhance the proficiency of basal ganglia-thalamocortical linguistic circuits over time. PMID:16036464
Whelan, Brooke-Mai; Murdoch, Bruce E; Theodoros, Deborah G; Silburn, Peter; Hall, Bruce
For restoration of neuro-muscular functions in disabled people, cuff type electrodes have been used for several 10 years. A lot of experiences were collected using 12polar electrodes, which consisted of silicone tubes, carrying 4 stimulation tripoles, each tripole orientated longitudinally to the nerve. The tripoles were at 0°, 90°, 180°, and 270° position around the nerve. It is obvious that
Recording and stimulationelectrodes applied on excitable tissue are the basis of electrophysiological research, such as brain, muscles, peripheral nerves or sensory systems. Electrode-electrolyte impedance is one of the important characteristics due to its influence on the signal/noise ratio, signal distortion and built-up voltage. Strategies to lowering and tuning the impedance are achieved by biasing iridium oxide modified platinum microelectrodes. Surface and impedance analysis after pulse stimulation are also addressed.
Iridium is one of the main electrode materials for applications like neural stimulation. Iridium has a higher charge injection capacity when activated and transformed into AIROF (activated iridium oxide film) using specific electrical signals. Activation is not possible in stimulating devices, if they do not include the necessary circuitry for activation. We introduce a method for iridium electrode activation requiring minimum additional on-chip hardware. In the main part, the lifetime behavior of iridium electrodes is investigated. These results may be interesting for applications not including on-chip activation hardware, and also because activation has drawbacks such as worse mechanical properties and reproducibility of AIROF. PMID:23366018
Summary Chronic electrical stimulation of the brain, known as deep brain stimulation (DBS), has become a preferred surgical treatment for medication-refractory movement disorders. Despite its remarkable clinical success, the therapeutic mechanisms of DBS are still not completely understood, limiting opportunities to improve treatment efficacy and simplify selection of stimulation parameters. In this review three questions, essential to understanding the mechanisms of DBS, are discussed: 1) how does DBS affect neuronal tissue in the vicinity of the active electrode(s); 2) how do these changes translate into therapeutic benefit on motor symptoms; and 3) how do these effects depend on the particular site of stimulation? Early hypotheses proposed that stimulation inhibited neuronal activity at the site of stimulation, mimicking the outcome of ablative surgeries. Recent studies have challenged that view and suggested that while somatic activity near the DBSelectrode may exhibit substantial inhibition or complex modulation patterns, the output from the stimulated nucleus follows the DBS pulse train by direct axonal excitation. The intrinsic activity is thus replaced by high frequency activity that is time-locked to the stimulus and more regular in pattern. These changes in firing pattern are thought to prevent transmission of pathologic bursting and oscillatory activity resulting in the reduction of disease symptoms through compensatory processing of sensorimotor information. While promising, this theory does not entirely explain why DBS improves motor symptoms at different latencies. Understanding these processes on a physiological level will be critically important if we are to reach the full potential of this powerful tool.
Johnson, Matthew D.; Miocinovic, Svjetlana; McIntyre, Cameron C.; Vitek, Jerrold L.
We present a microscale cell culture system with an interdigitated microarray of excimer-laser-ablated indium tin oxide electrodes for electrical stimulation of cultured cells. The system has been characterized in a range of geometeries and stimulation regimes via electrochemical impedance spectroscopy and used to culture primary cardiomyocytes and human adipose derived stem cells. Over 6 days of culture with electrical stimulation (2 ms duration, 1 Hz, 180 ?m wide electrodes with 200 ?m spacing), both cell types exhibited enhanced proliferation, elongation and alignment, and adipose derived stem cells exhibited higher numbers of Connexin-43-composed gap junctions.
Several recent publications have stated that the use of microelectrode recording (MER) during pallidotomy or deep brain stimulation (DBS) contributes to decreasing risks and side effects of surgery, and that such a technique is a prerequisite for minimizing lesion size and for accurate placement of the stereotactic lesion or the DBSelectrode. To evaluate the consistency of these statements, we
In the last years, TV documentaries, articles in popular magazines, and Internet content have increased the public visibility of deep brain stimulation (DBS). The media may have also provoked significant clinical and public interest in potential future applications for treating psychiatric disorders beyond the current use of DBS in neurological disorders. In this article, we review and discuss the topic
Deep brain stimulation (DBS) for the treatment of advanced Parkinson’s disease involves implantation of a lead with four small contacts usually within the subthalamic nucleus (STN) or globus pallidus internus (GPi). While generally safe from a cognitive standpoint, STN DBS has been commonly associated with a decrease in the speeded production of words, a skill referred to as verbal fluency. Virtually all studies comparing pre-surgical to post-surgical verbal fluency performance have detected a decrease with DBS. The decline may be attributable in part to the surgical procedures, yet the relative contributions of stimulation effects are not known. In the present study, we used patient-specific DBS computer models to investigate the effects of stimulation on verbal fluency performance. Specifically, we investigated relationships of the volume and locus of activated STN tissue to verbal fluency outcome. Stimulation of different electrode contacts within the STN did not affect total verbal fluency scores. However, models of activation revealed subtle relationships between the locus and volume of activated tissue and verbal fluency performance. At ventral contacts, more tissue activation inside the STN was associated with decreased letter fluency performance. At optimal contacts, more tissue activation within the STN was associated with improved letter fluency performance. These findings suggest subtle effects of stimulation on verbal fluency performance, consistent with the functional non-motor subregions/somatopy of the STN.
Mikos, A.; Bowers, D.; Noecker, A.M.; McIntyre, C.C.; Won, M.; Chaturvedi, A.; Foote, K.D.; Okun, M.S.
Implanted wire electrodes are increasingly being used for the functional electrical stimulation of muscles in partially paralysed\\u000a patients, yet many of their basic characteristics are poorly understood. In this study we investigated the selectivity, recruitment\\u000a characteristics and range of control of several types of electrode in triceps surae and plantaris muscles of anaesthetized\\u000a cats. We found that nerve cuffs are
Dejan Popovic; Tessa Gordon; Victor F. Rafuse; Arthur Prochazka
Deep brain stimulation, the electric stimulation of basal ganglia nuclei, is a treatment for movement disorders such as Parkinson's disease. The underlying mechanisms are studied in animals, e.g. rodents. Designs and materials of commercially available microelectrodes, as well as experimentally applied driving signals vary tremendously. We used finite integration modeling to compare the electric field and current density distributions induced by various electrodes. Current density or field strength "hot spots", which are located particularly at sites of high curvature and material interfaces coincided with corrosion and erosion at poles and insulation, respectively, as shown by scanning electron microscopy of stainless steel electrodes. Cell constants, i.e. geometry factors relating the electrode impedance to the specific medium conductivity, were calculated to determine the electrode voltage for a given stimulation current. Nevertheless, for electrodes of the same cell constant but of different geometry, current and field distributions may be very dissimilar. We found geometry-dependent limiting values of the stimulation current, above which electric tissue damage may occur. These values limit the reach of the stimulation signal for a given electrode geometry. Also, electrode geometries determine the shape of the stimulated tissue volume. This study provides tools for choosing the most appropriate geometry for targeting different-sized brain areas. PMID:16095718
Gimsa, Ulrike; Schreiber, Ute; Habel, Beate; Flehr, Jürgen; van Rienen, Ursula; Gimsa, Jan
We treated a 13-year-old boy for life-threatening self-injurious behavior (SIB) and severe Kanner's autism with deep brain stimulation (DBS) in the amygdaloid complex as well as in the supra-amygdaloid projection system. Two DBS-electrodes were placed in both structures of each hemisphere. The stimulation contacts targeted the paralaminar, the basolateral (BL), the central amygdala as well as the supra-amygdaloid projection system. DBS was applied to each of these structures, but only stimulation of the BL part proved effective in improving SIB and core symptoms of the autism spectrum in the emotional, social, and even cognitive domains over a follow up of now 24 months. These results, which have been gained for the first time in a patient, support hypotheses, according to which the amygdala may be pivotal in the pathogeneses of autism and point to the special relevance of the BL part.
Sturm, Volker; Fricke, Oliver; Buhrle, Christian P.; Lenartz, Doris; Maarouf, Mohammad; Treuer, Harald; Mai, Jurgen K.; Lehmkuhl, Gerd
This work deals with the reactive RF-powered sputter deposition of iridium oxide for use as the active stimulation layer in functional medical implants. The oxygen gettered by the growing films is determined by an approach based on generic curves. Films deposited at different stages of oxygen integration show strong differences in electrochemical behaviour, caused by different morphologies. The dependence of
Experiments were conducted to assess the effect of chronic stimulation on the electrical properties of the elec- trode-tissue system, as measured using electrochemical impedance spectroscopy (EIS) and cyclic voltammetry (CV). Silicon, mi- cromachined probes with multiple iridium oxide stimulatingelectrodes (400-1600 m ) were implanted in guinea pig cortex. A 10-17 day post-operative recovery period was followed by five days
Deep brain simulation (DBS) is a widely accepted surgical therapy for Parkinson's disease, dystonia and tremor in Japan. In other countries, DBS has been applied to neuropsychiatric or neurodegenerative diseases, such as Tourette syndrome, depression, obsessive compulsive disorder, Alzheimer disease, etc. So far, these diseases have been treated mainly by neurologists or psychiatrists, however after the invention of DBS, neurosurgeons now play an important role in the treatment of these diseases, especially in Parkinson's disease. Several reports showed that better postoperative outcomes can be obtained when patient is managed by a neurologist who is responsible for stimulation programming and drug adjustments. The therapy should be done while adjusting both the drugs and the stimulation (DBS) simultaneously. Hence, neurologists should be familiar with programming of DBS, as well as the medical therapy. PMID:23196530
Magnetic resonance imaging (MRI) of patients with implanted deep brain stimulation (DBS) devices poses a challenge for healthcare providers. As a consequence of safety concerns about magnetic field interactions with the device, induced electrical currents and thermal damage due to radiofrequency heating, a number of stringent guidelines have been proposed by the device manufacturer. Very few detailed investigations of these
Akshay A. Gupte; Devashish Shrivastava; Maggie A. Spaniol; Aviva Abosch
Iridium oxide films formed by electrodeposition onto noniridium metal substrates are compared with activated iridium oxide films (AIROFs) as a low impedance, high charge capacity coating for neural stimulation and recording electrodes. The electrodeposited iridium oxide films (EIROFs) were deposited on Au, Pt, PtIr, and 316 LVM stainless steel substrates from a solution of IrCl 4, oxalic acid, and K
Ross D. Meyer; Stuart F. Cogan; Trung H. Nguyen; R. David Rauh
A nerve cuff electrode interface capable of both stimulating and recording from a nerve is described. The interface also rejects the EMG contamination in the recordings using reactive components without adding noise to the ENG signal. A transformer is added to the design for noise matching and the signal-to-noise ratio improvement is evaluated for a specific amplifier (AMP-O1)
Iridium films having near-bulk properties were formed by electron-beam evaporation with simultaneous bombardment of Ar ion beam. The charge-injection capabilities of Ir film were investigated, and the detrusor pressure induced by S2 stimulation with Ir-coated Pt electrode was measured and compared with the uncoated Pt electrode. The charge densities of Ir film were continuously increased with increase in the number of cycles in 0.1 M H2SO4 due to the accumulation of the iridium oxide phase. The iridium oxide formed contained nano-pores, and oxides had different dielectric properties. The Ir film could inject various amounts of charge in physiological solution under the identical stimulating condition depending on the degree of activation in 0.1 M H2SO4. S2 stimulation by Ir-coated Pt electrode caused more efficient bladder contraction of the male dog than the uncoated Pt electrode under the identical stimulus condition. PMID:12013185
Historically the rectangular pulse waveform has been the choice for neural stimulation. The strength–duration curve is thus defined for rectangular pulses. Not much attention has been paid to alternative waveforms to determine if the pulse shape has an effect on the strength–duration relation. Similarly the charge injection capacity of neural electrodes has also been measured with rectangular pulses. In this study we questioned if non-rectangular waveforms can generate a stronger stimulation effect, when applied through practical electrodes, by minimizing the neural activation threshold and maximizing the charge injection capacity of the electrode. First, the activation threshold parameters were studied with seven different pulse shapes using computer simulations of a local membrane model. These waveforms were rectangular, linear increase and decrease, exponential increase and decrease, Gaussian, and sinusoidal. The chronaxie time was found to be longer with all the non-rectangular pulses and some provided more energy efficient stimulation than the rectangular waveform. Second, the charge injection capacity of titanium nitride microelectrodes was measured experimentally for the same waveforms. Linearly decreasing ramp provided the best charge injection for all pulse widths tested from 0.02 to 0.5 ms. Finally, the most efficient waveform that maximized the charge injection capacity of the electrode while providing the lowest threshold charge for neural activation was searched. Linear and exponential decrease, and Gaussian waveforms were found to be the most efficient pulse shapes.
Transcranial direct current stimulation (tDCS) is a technique that has been intensively investigated in the past decade as this method offers a non-invasive and safe alternative to change cortical excitability2. The effects of one session of tDCS can last for several minutes, and its effects depend on polarity of stimulation, such as that cathodal stimulation induces a decrease in cortical excitability, and anodal stimulation induces an increase in cortical excitability that may last beyond the duration of stimulation6. These effects have been explored in cognitive neuroscience and also clinically in a variety of neuropsychiatric disorders – especially when applied over several consecutive sessions4. One area that has been attracting attention of neuroscientists and clinicians is the use of tDCS for modulation of pain-related neural networks3,5. Modulation of two main cortical areas in pain research has been explored: primary motor cortex and dorsolateral prefrontal cortex7. Due to the critical role of electrode montage, in this article, we show different alternatives for electrode placement for tDCS clinical trials on pain; discussing advantages and disadvantages of each method of stimulation.
DaSilva, Alexandre F.; Volz, Magdalena Sarah; Bikson, Marom; Fregni, Felipe
Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device, which sends electrical impulses to specific parts of the brain. DBS in select brain regions has provided remarkable therapeutic benefits for treatment-resistant movement and affective disorders such as Parkinson's disease. DBS directly alters brain activity in a controlled manner, and its effects are reversible. Lately, DBS treatment has been used for the treatment of various psychiatric disorders, such as obsessive compulsive disorder, Tourette syndrome, and severe depression. However, DBS therapies for affective disorders are still at their experimental stage, and some scientists point out that there may be a risk involved, because the device implanted in a person's brain may alter his/her brain function and hence his personal identity. With support from the New Energy and Industrial Technology Development Organization (NEDO), Japanese government, we conducted international research on the effects of DBS therapies for psychiatric disorders, examined the safety of such therapies, and clarified the conditions for proper application of the DBS technique. The research items were as follows: (1) safety issues concerning the deterioration of DBSelectrodes and the possibilities of developing new and better materials, (2) the role of coordinators who mediate between patients and DBS devices, (3) social concerns regarding personality changes/brain plasticity, (4) re-examination of ethical debates on prefrontal lobotomy (lessons from the past), (5) possible use of DBS for the purpose of brain enhancement, and (6) end users' expectations and fears toward DBS. PMID:19177805
Preservation of the facial nerve during acoustic neuroma resection may be enhanced by the use of intraoperative electrical stimulation. Although stimulation of the extratemporal facial nerve is an effective and established procedure, anatomic differences of the intradural facial nerve and its microenvironment demand more exacting stimulus protocols. The absence of epineurium may make the intradural nerve more susceptible to mechanical or electrical trauma while intermittent pooling of cerebrospinal fluid (CSF) at the cerebellopontine angle may shunt current away from nerve. Four stimulus configurations were examined under varying conditions simulating CSF pooling. The results indicated that: 1. insulation of stimulatingelectrodes prevents CSF current shunting and allows utilization of a constant current source, and 2. monopolar and bipolar configurations demonstrate significantly different electrical characteristics which may be employed selectively based upon specific clinical goals. PMID:4068872
Kartush, J M; Niparko, J K; Bledsoe, S C; Graham, M D; Kemink, J L
Planar electrodes are used in epidural spinal cord stimulation and epidural cortical stimulation. Electrode geometry is one approach to increase the efficiency of neural stimulation and reduce the power required to produce the level of activation required for clinical efficacy. Our hypothesis was that electrode geometries that increased the variation of current density on the electrode surface would increase stimulation efficiency. High-perimeter planar disk electrodes were designed with sinuous (serpentine) variation in the perimeter. Prototypes were fabricated that had equal surface areas but perimeters equal to two, three or four times the perimeter of a circular disk electrode. The interface impedance of high-perimeter prototype electrodes measured in vitro did not differ significantly from that of the circular electrode over a wide range of frequencies. Finite element models indicated that the variation of current density was significantly higher on the surface of the high-perimeter electrodes. We quantified activation of 100 model axons randomly positioned around the electrodes. Input–output curves of the percentage of axons activated as a function of stimulation intensity indicated that the stimulation efficiency was dependent on the distance of the axons from the electrode. The high-perimeter planar electrodes were more efficient at activating axons a certain distance away from the electrode surface. These results demonstrate the feasibility of increasing stimulation efficiency through the design of novel electrode geometries.
Diamond is well known to possess many favourable qualities for implantation into living tissue including biocompatibility, biostability, and for some applications hardness. However, conducting diamond has not, to date, been exploited in neural stimulationelectrodes due to very low electrochemical double layer capacitance values that have been previously reported. Here we present electrochemical characterization of ultra-nanocrystalline diamond electrodes grown in the presence of nitrogen (N-UNCD) that exhibit charge injection capacity values as high as 163 µC cm-2 indicating that N-UNCD is a viable material for microelectrode fabrication. Furthermore, we show that the maximum charge injection of N-UNCD can be increased by tailoring growth conditions and by subsequent electrochemical activation. For applications requiring yet higher charge injection, we show that N-UNCD electrodes can be readily metalized with platinum or iridium, further increasing charge injection capacity. Using such materials an implantable neural stimulation device fabricated from a single piece of bio-permanent material becomes feasible. This has significant advantages in terms of the physical stability and hermeticity of a long-term bionic implant.
Garrett, David J.; Ganesan, Kumaravelu; Stacey, Alastair; Fox, Kate; Meffin, Hamish; Prawer, Steven
Diamond is well known to possess many favourable qualities for implantation into living tissue including biocompatibility, biostability, and for some applications hardness. However, conducting diamond has not, to date, been exploited in neural stimulationelectrodes due to very low electrochemical double layer capacitance values that have been previously reported. Here we present electrochemical characterization of ultra-nanocrystalline diamond electrodes grown in the presence of nitrogen (N-UNCD) that exhibit charge injection capacity values as high as 163 µC cm(-2) indicating that N-UNCD is a viable material for microelectrode fabrication. Furthermore, we show that the maximum charge injection of N-UNCD can be increased by tailoring growth conditions and by subsequent electrochemical activation. For applications requiring yet higher charge injection, we show that N-UNCD electrodes can be readily metalized with platinum or iridium, further increasing charge injection capacity. Using such materials an implantable neural stimulation device fabricated from a single piece of bio-permanent material becomes feasible. This has significant advantages in terms of the physical stability and hermeticity of a long-term bionic implant. PMID:22156061
Garrett, David J; Ganesan, Kumaravelu; Stacey, Alastair; Fox, Kate; Meffin, Hamish; Prawer, Steven
The ideal electrode for stimulation of the nervous system is one that will inject charge by purely capacitive processes. One approach is to exploit the type of metal-oxide combination used in electrolytic capacitors, e.g., Ta/Ta2O5. For this purpose, fine tantalum wire (0.25 mm diam) was etched electrolytically at constant current in a methanol solution of NH4Br containing 1.5 wt % H2O. Electrolytic etching produced a conical tip with a length of ca. 0.5 mm and shaft diameters ranging from 0.10 to 0.16 mm. The etched electrodes were anodized to 10 V (vs. SCE) in 0.1 vol % H3PO4. The capacitance values normalized to geometric area of etched electrodes ranged from 0.13 to 0.33 micro F mm-2. Comparison of these values to the capacitance of "smooth" tantalum anodized to 10 V (0.011 micro F mm-2) indicated that the degree of surface enhancement, or etch ratio, was 12-30. The surface roughness was confirmed by scanning electron microscopy studies which revealed an intricate array of irregularly shaped surface projections about 1-2 micrometers wide. The etched electrodes were capable of delivering 0.06-0.1 micro C of charge with 0.1 ms pulses at a pulse repetition rate of 400 Hz when operated at 50% of the anodization voltage. This quantity of charge corresponded to volumetric charge densities of 20-30 micro C mm-3 and area charge densities of 0.55-0.88 micro C mm-2. Charge storage was proportionately higher at higher fractional values of the formation voltage. Leakage currents at 5 V were ca. 2 nA. Neither long-term passive storage (1500 h) nor extended pulsing time (18 h) had a deleterious effect on electrode performance. The trend in electrical stimulation work is toward smaller electrodes. The procedures developed in this study should be particularly well-suited to the fabrication of even smaller electrodes because of the favorable electrical and geometric characteristics of the etched surface. PMID:6841372
Robblee, L S; Kelliher, E M; Langmuir, M E; Vartanian, H; McHardy, J
The goal of this study was to evaluate the feasibility of active deep brain stimulation (DBS) during the application of standard clinical sequences for functional MRI (fMRI) in phantom measurements. During active DBS, we investigated induced voltage, temperature at the electrode tips and lead, forces on the electrode and lead, consequences of defective leads and loose connections, proper operation of the neurostimulator, and image quality. Sequences for diffusion- and perfusion-weighted imaging, fMRI, and morphologic MRI were used. The DBSelectrode and lead were placed in a NaCl solution-filled phantom. The results indicate that there are severe potential hazards for patients. Strong heating, high induced voltage, and even sparking at defects in the connecting cable could be observed. However, it was demonstrated that under certain conditions, safe MR examinations during active DBS are feasible. Certain safety precautions are recommended in this report. PMID:14755664
Georgi, J-C; Stippich, C; Tronnier, V M; Heiland, S
Sputtered iridium oxide films (SIROFs) deposited by DC reactive sputtering from an iridium metal target have been characterized in vitro for their potential as neural recording and stimulationelectrodes. SIROFs were deposited over gold metallization on flexible multielectrode arrays fabricated on thin (15 µm) polyimide substrates. SIROF thickness and electrode areas of 200–1300 nm and 1960–125600 µm2, respectively, were investigated. The charge-injection capacities of the SIROFs were evaluated in an inorganic interstitial fluid model in response to charge-balanced, cathodal-first current pulses. Charge injection capacities were measured as a function of cathodal pulse width (0.2 – 1 ms) and potential bias in the interpulse period (0.0 to 0.7 V vs. Ag|AgCl). Depending on the pulse parameters and electrode area, charge-injection capacities ranged from 1–9 mC/cm2, comparable with activated iridium oxide films (AIROFs) pulsed under similar conditions. Other parameters relevant to the use of SIROF on nerve electrodes, including the thickness dependence of impedance (0.05–105 Hz) and the current necessary to maintain a bias in the interpulse region were also determined.
Cogan, Stuart F.; Ehrlich, Julia; Plante, Timothy D.; Smirnov, Anton; Shire, Douglas B.; Gingerich, Marcus; Rizzo, Joseph F.
The vibratory sensitivity of the skin was studied by means of an electrostatic force, and the effects of electrode-area and site of stimulation were determined. Electrostatic stimulation provided an effective means of determining vibratory sensitivity of ...
Summary Objective. To report our experience on hardware-related infections following deep brain stimulation (DBS). Methods. The present article presents the retrospective clinical notes review of gained in a two-centre, single-surgeon study experience of 108 consecutive DBS cases between 1996 and 2002. In all patients the minimum follow-up was six months. One hundred and eight patients received an intracerebral electrode implantation
Y. Temel; L. Ackermans; H. Celik; G. H. Spincemaille; C. van der Linden; G. H. Walenkamp; T. van de Kar; V. Visser-Vandewalle
Objective: We investigated the effect of bilateral subthalamic nucleus (STN) and internal globus pallidus (GPi) deep brain stimulation (DBS) on intracortical inhibition (ICI) in patients with advanced Parkinson's disease (PD).Methods: The activity of intracortical inhibitory circuits was studied in 4 PD patients implanted with stimulatingelectrodes both in STN and GPi by means of paired-pulse transcranial magnetic stimulation, delivered in
M Pierantozzi; M. G Palmieri; P Mazzone; M. G Marciani; P. M Rossini; A Stefani; P Giacomini; A Peppe; P Stanzione
Epidural electrical stimulation (ECS) of the motor cortex is a developing therapy for neurological disorders. Both placement and programming of ECS systems may affect the therapeutic outcome, but the treatment parameters that will maximize therapeutic outcomes and minimize side effects are not known. We delivered ECS to the motor cortex of anesthetized cats and investigated the effects of electrode placement and stimulation parameters on thresholds for evoking motor responses in the contralateral forelimb. Thresholds were inversely related to stimulation frequency and the number of pulses per stimulus train. Thresholds were lower over the forelimb representation in motor cortex (primary site) than surrounding sites (secondary sites), and thresholds at sites <4 mm away from the primary site were significantly lower than at sites >4 mm away. Electrode location and montage influenced the effects of polarity on thresholds: monopolar anodic and cathodic thresholds were not significantly different over the primary site, cathodic thresholds were significantly lower than anodic thresholds over secondary sites and bipolar thresholds were significantly lower with the anode over the primary site than with the cathode over the primary site. A majority of bipolar thresholds were either between or equal to the respective monopolar thresholds, but several bipolar thresholds were greater than or less than the monopolar thresholds of both the anode and cathode. During bipolar stimulation, thresholds were influenced by both electric field superposition and indirect, synaptically mediated interactions. These results demonstrate the influence of stimulation parameters and electrode location during cortical stimulation, and these effects should be considered during the programming of systems for therapeutic cortical stimulation.
A mathematical description of pH excursions produced in interstitial fluid by a spherical stimulationelectrode is presented.\\u000a The pH is calculated as a function of current density, electrode radius, distance, time, and pulsing regimen for an electrode\\u000a driven by biphasic current pulses. Calculations indicate that large pH excursions occur around electrodes pulsed at current\\u000a densities used for neural stimulation. For
Cindy L. Ballestrasse; Robert T. Ruggeri; Theodore R. Beck
The unilateral 6-hydroxydopamine (6-OHDA) lesioned rat model is frequently used to study the effects of subthalamic nucleus (STN) deep brain stimulation (DBS) for the treatment of Parkinson’s disease. However, systematic knowledge of the effects of DBS parameters on behavior in this animal model is lacking. The goal of this study was to characterize the effects of DBS on methamphetamine-induced circling in the unilateral 6-OHDA lesioned rat. DBS parameters tested include stimulation amplitude, stimulation frequency, methamphetamine dose, stimulation polarity, and anatomical location of the electrode. When an appropriate stimulation amplitude and dose of methamphetamine were applied, high frequency stimulation (> 130 Hz), but not low frequency stimulation (< 10 Hz), reversed the bias in ipsilateral circling without inhibiting movement. This characteristic frequency tuning profile was only generated when at least one electrode used during bipolar stimulation was located within the STN. No difference was found between bipolar stimulation and monopolar stimulation when the most effective electrode contact was selected, indicating that monopolar stimulation could be used in future experiments. Methamphetamine-induced circling is a simple, reliable, and sensitive behavioral test and holds potential for high-throughput study of the effects of STN DBS in unilaterally lesioned rats.
So, Rosa Q.; McConnell, George C.; August, Auriel T.; Grill, Warren M.
Objective: To provide an analysis of stimulation parameters for deep brain stimulation (DBS).Methods: Synthesis of theoretical and empirical findings is used to provide guidance for the selection of stimulus parameters. Finite element modeling is used to investigate the effects of contact location and electrode geometry on the electric field, and to estimate the effects of current density distribution on the
In the past decade deep brain stimulation (DBS)-the application of electrical stimulation to specific target structures via implanted depth electrodes-has become the standard treatment for medically refractory Parkinson's disease and essential tremor. These diseases are characterized by pathological synchronized neuronal activity in particular brain areas. We present an external trial DBS device capable of administering effectively desynchronizing stimulation techniques developed with methods from nonlinear dynamics and statistical physics according to a model-based approach. These techniques exploit either stochastic phase resetting principles or complex delayed-feedback mechanisms. We explain how these methods are implemented into a safe and user-friendly device. PMID:19837998
Hauptmann, C; Roulet, J-C; Niederhauser, J J; Döll, W; Kirlangic, M E; Lysyansky, B; Krachkovskyi, V; Bhatti, M A; Barnikol, U B; Sasse, L; Bührle, C P; Speckmann, E-J; Götz, M; Sturm, V; Freund, H-J; Schnell, U; Tass, P A
The development and potential of U.S. direct-to-home broadcast satellite (DBS) service is discussed. The outcome of the RARC-83 conference for planning Broadcasting Satellite Service (BSS) is examined, giving BSS downlink noise performance parameters for planning and 12-GHz BSS plans. The characteristics of U.S. DBS service are given and the different DBS service choices are described, including low-power, medium-power, and high power DBS-like service. Active high-power DBS system applicants are listed. The types of DBS business are summarized, and DBS systems standards are discussed.
The feasibility of selectively stimulating the hypoglossal nerve (XII) with a multi-contact flat-interface-nerve -electrode (FIE) was investigated for the potential application of treating obstructive sleep apnea (OSA) The main trunk of the XII was stimul...
Deep brain stimulation (DBS) is a safe and successful therapeutic option for patients with dystonia and tremor syndrome who do not respond sufficiently to conservative therapies. The most common target of DBS in patients with dystonia is the internal region of the globus pallidus (GPI). DBS of the GPI leads to long-lasting and remarkable improvement of dystonic movements in about 80% of patients. Recently it could be shown that not only patients with idiopathic dystonia but also patients with secondary dystonia can benefit from DBS although to a somewhat lesser extent. In patients with tremor syndromes, such as essential tremor, tremor-dominant Parkinson's disease or tremor in multiple sclerosis (MS) the intermediate ventral nucleus of the thalamus (VIM) as well as the subthalamic region proved to be promising targets for DBSelectrodes. Especially in patients with essential tremor VIM-DBS leads to an often acute reduction of the tremor syndrome. In long-term observations, however, patients with essential tremor showed some tolerability to VIM-DBS leading to a slow increase of stimulation parameters to maintain a stable effect. VIM-DBS in patients with Parkinson's disease is rare and is reserved for elderly patients with pronounced tremor syndrome and little disease progression. Controlled studies and data on DBS in MS tremor are lacking and data are sparse and heterogeneous. Therefore, VIM-DBS in MS tremor patients has to be evaluated individually with caution. In summary patients with tremor syndromes as well as dystonia who cannot be adequately controlled with conservative therapy are good candidates for deep brain stimulation, a therapeutic option with moderate complications and risks and very good outcome for most patients. PMID:20495777
Stereotactic deep brain stimulation (DBS) is the surgical treatment of choice for medication-refractory patients with Parkinson’s disease and essential tremor. The subthalamic nucleus and ventral intermediate nucleus of the thalamus appear to be effective targets for electrode placement. Because these targets are small and encased in fiber tracts, their localization can be exceedingly difficult. However, the precision of electrode placement
Scott L. Simon; Pamela Douglas; Gordon H. Baltuch; Jurg L. Jaggi
The objective of this investigation was to measure the input-output (EO) properties of chronically implanted nerve cuff electrodes. Silicone rubber spiral nerve cuff electrodes, containing 12 individual platinum electrode contacts, were implanted on the sciatic nerve of 7 adult cats for 28-34 weeks. Measurements of the torque generated at the ankle joint by electrical stimulation of the sciatic nerve were
We describe a cuff-type electrode specifically designed for recording from, and electrical stimulation of, cut nerves in acute experiments on small animals. Unlike existing designs of cuff electrodes, it is simple to manufacture, inexpensive and takes little time to implant. The electrode was tested on the hypoglossal, phrenic, recurrent laryngeal, and superior laryngeal nerves in anesthetized rats. It provides satisfactory
A hexagonal electrode configuration has been proposed as an advantageous alternative to conventional electrode arrangements used in retinal prosthesis design. In the present study, the aim was to characterize retinal ganglion cell axonal responses to epiretinal electrical stimulation. 50 and 125 ?m disk electrodes, arranged in a hexagonal configuration, were tested using in vitro rabbit retinal preparations. 100 ?s\\/phase anodic-first
Miganoosh Abramian; Socrates Dokos; John W. Morley; Nigel H. Lovell
Unintended, weak AC stimulation (leakage currents) from medical devices can cause blood pressure collapse and ventricular fibrillation (VF), potentially even death. Yet, little is understood about AC cardiac stimulation. The objective of this paper is to establish the relationship between the stimulation and VF thresholds for electrode size and stimulation frequency. Twenty- four retired male breeder guinea pigs were anesthetized
The performance of cathode-anode configurations in a cuff electrode to stimulate a single fascicle in a nerve trunk has been investigated theoretically. A three-dimensional volume conductor model of a nerve trunk with four fascicles in a cuff electrode and a model of myelinated nerve fiber stimulation were used to calculate the recruitment of 15 m fibers in each fascicle. The
Kirsten E. I. Deurloo; Jan Holsheimer; Piet Bergveld
Nine spiral nerve cuff electrodes were implanted in two human subjects for up to three years with no adverse functional effects. The objective of this study was to look at the long term nerve and muscle response to stimulation through nerve cuff electrodes. The nerve conduction velocity remained within the clinically accepted range for the entire testing period. The stimulation
Katharine H. Polasek; Harry A. Hoyen; Michael W. Keith; Robert F. Kirsch; Dustin J. Tyler
The present study evaluated tripolar stimulatingelectrodes for eliciting dopamine release in the rat brain in vivo. Stimulatingelectrodes were placed either in the medial forebrain bundle or in the ventral mesencephalon associated with the ventral tegmental area and substantia nigra. The concentration of extracellular dopamine was monitored in dopamine terminal fields at 100-ms intervals using fast-scan cyclic voltammetry at
Deep brain stimulation (DBS) has become a treatment for a growing number of neurological and psychiatric disorders, especially for therapy-refractory Parkinson's disease (PD). However, not all of the symptoms of PD are sufficiently improved in all patients, and side effects may occur. Further progress depends on a deeper insight into the mechanisms of action of DBS in the context of disturbed brain circuits. For this, optimized animal models have to be developed. We review not only charge transfer mechanisms at the electrode/tissue interface and strategies to increase the stimulation's energy-efficiency but also the electrochemical, electrophysiological, biochemical and functional effects of DBS. We introduce a hemi-Parkinsonian rat model for long-term experiments with chronically instrumented rats carrying a backpack stimulator and implanted platinum/iridium electrodes. This model is suitable for (1) elucidating the electrochemical processes at the electrode/tissue interface, (2) analyzing the molecular, cellular and behavioral stimulation effects, (3) testing new target regions for DBS, (4) screening for potential neuroprotective DBS effects, and (5) improving the efficacy and safety of the method. An outlook is given on further developments of experimental DBS, including the use of transgenic animals and the testing of closed-loop systems for the direct on-demand application of electric stimulation.
Phantom electrode (PE) stimulation consists of out-of-phase stimulation of two electrodes. When presented at the apex of the electrode array, phantom stimulation is known to produce a lower pitch sensation than monopolar (MP) stimulation on the most apical electrode. The ratio of the current between the primary electrode (PEL) and the compensating electrode (CEL) is represented by the coefficient ?, which ranges from 0 (monopolar) to 1 (full bipolar). The exact mechanism by which PE stimulation produces a lower pitch sensation is unclear. In the present study, unmasked and masked thresholds were obtained using a forward masking paradigm to estimate the spread of current for MP and PE stimulation. Masked thresholds were measured for two phantom electrode configurations (1) PEL = 4, CEL = 5 (lower pitch phantom) and (2) PEL = 4, CEL = 3 (higher pitch phantom). The unmasked thresholds were subtracted from the masked thresholds to obtain masking patterns which were normalized to their peak. The masking patterns reveal (1) differences in the spread of excitation that are consistent with the direction of pitch shift produced by PE stimulation, and (2) narrower spread of electrical excitation for PE stimulation relative to MP stimulation.
Saoji, Aniket A.; Landsberger, David M.; Padilla, Monica; Litvak, Leonid M.
Phantom electrode (PE) stimulation consists of out-of-phase stimulation of two electrodes. When presented at the apex of the electrode array, phantom stimulation is known to produce a lower pitch sensation than monopolar (MP) stimulation on the most apical electrode. The ratio of the current between the primary electrode (PEL) and the compensating electrode (CEL) is represented by the coefficient ?, which ranges from 0 (monopolar) to 1 (full bipolar). The exact mechanism by which PE stimulation produces a lower pitch sensation is unclear. In the present study, unmasked and masked thresholds were obtained using a forward masking paradigm to estimate the spread of current for MP and PE stimulation. Masked thresholds were measured for two phantom electrode configurations (1) PEL = 4, CEL = 5 (lower pitch phantom) and (2) PEL = 4, CEL = 3 (higher pitch phantom). The unmasked thresholds were subtracted from the masked thresholds to obtain masking patterns which were normalized to their peak. The masking patterns reveal (1) differences in the spread of excitation that are consistent with the direction of pitch shift produced by PE stimulation, and (2) narrower spread of electrical excitation for PE stimulation relative to MP stimulation. PMID:23299125
Saoji, Aniket A; Landsberger, David M; Padilla, Monica; Litvak, Leonid M
Abstract—We have investigated the scattering of the Magnetic Resonance Imaging (MRI) radiofrequency (RF) field by implants for Deep Brain Stimulation (DBS) and the resultant heating of the tissue surrounding the DBSelectrodes. The finite element method,has been used to perform full 3-D realistic simulations. The near field has been computed,for varying distances of the connecting portion of the lead from
Syed Ali Mohsin; Noor Muhammad Sheikh; Usman Saeed
Deep Brain Stimulation (DBS) is a treatment involving the implantation of electrodes into the brain. Presently, it is used\\u000a for neurological disorders like Parkinson’s disease, but indications are expanding to psychiatric disorders such as depression,\\u000a addiction and Obsessive Compulsive Disorder (OCD). Theoretically, it may be possible to use DBS for the enhancement of various\\u000a mental functions. This article discusses a
The CMS experiment has implemented a flexible and powerful system enabling users to find data within the CMS physics data catalog. The Dataset Bookkeeping Service (DBS) comprises a database and the services used to store and access metadata related to CMS physics data. To this, we have added a generalized query system in addition to the existing web and programmatic interfaces to the DBS. This query system is based on a query language that hides the complexity of the underlying database structure by discovering the join conditions between database tables. This provides a way of querying the system that is simple and straightforward for CMS data managers and physicists to use without requiring knowledge of the database tables or keys. The DBS Query Language uses the ANTLR tool to build the input query parser and tokenizer, followed by a query builder that uses a graph representation of the DBS schema to construct the SQL query sent to underlying database. We will describe the design of the query system, provide details of the language components and overview of how this component fits into the overall data discovery system architecture.
Thalamic deep brain stimulation (DBS) is proven therapy for essential tremor, Parkinson's disease and Tourette's syndrome. We tested the hypothesis that high-frequency electrical stimulation results in local thalamic glutamate release. Enzyme-linked glutamate amperometric biosensors were implanted in anesthetized rat thalamus adjacent to the stimulatingelectrode. Electrical stimulation was delivered to investigate the effect of frequency, pulse width, voltage-controlled or current-controlled stimulation, and charge balancing. Monophasic electrical stimulation-induced glutamate release was linearly dependent on stimulation frequency, intensity and pulse width. Prolonged stimulation evoked glutamate release to a plateau that subsequently decayed back to baseline after stimulation. Glutamate release was less pronounced with voltage-controlled stimulation and not present with charge balanced current-controlled stimulation. Using fixed potential amperometry in combination with a glutamate bioprobe and adjacent microstimulating electrode, the present study has shown that monophasic current-controlled stimulation of the thalamus in the anesthetized rat evoked linear increases in local extracellular glutamate concentrations that were dependent on stimulation duration, frequency, intensity and pulse width. However, the efficacy of monophasic voltage-controlled stimulation, in terms of evoking glutamate release in the thalamus, was substantially lower compared to monophasic current-controlled stimulation and entirely absent with biphasic (charge balanced) current-controlled stimulation. It remains to be determined whether similar glutamate release occurs with human DBSelectrodes and similar charge balanced stimulation. As such, the present results indicate the importance of evaluating local neurotransmitter dynamics in studying the mechanism of action of DBS.
Agnesi, Filippo; Blaha, Charles D.; Lin, Jessica; Lee, Kendall H.
Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) gained general acceptance in the treatment of Parkinson’s disease (PD). Objective: To study the clinical outcome and the predicting factors of efficacy of chronic STN stimulation, while DBSelectrodes were implanted under local or general anaesthesia with intra-operative electrophysiological guidance based on multi-unit recordings. Methods: We included a large single-centre
Jean-Pascal Lefaucheur; Jean-Marc Gurruchaga; Bernard Pollin; Florian von Raison; Nabil Mohsen; Masahiro Shin; Isabelle Ménard-Lefaucheur; Satoru Oshino; Haruhiko Kishima; Gilles Fénelon; Philippe Rémy; Pierre Cesaro; Inana Gabriel; Pierre Brugières; Yves Keravel; Jean-Paul Nguyen
An implantable micromachined neural probe with multichannel electrode arrays for both neural signal recording and electrical stimulation was designed, simulated and experimentally validated for deep brain stimulation (DBS) applications. The developed probe has a rough three-dimensional microstructure on the electrode surface to maximize the electrode–tissue contact area. The flexible, polyimide-based microelectrode arrays were each composed of a long shaft (14.9
Electroencephalogram (EEG) is a useful tool for brain research. However, during Deep-Brain Stimulation (DBS), there are large artifacts that obscure the physiological EEG signals. In this paper, we aim at suppressing the DBS artifacts by means of a time-frequency-domain filter. As a pre-processing step, Empirical-Mode Decomposition (EMD) is applied to detrend the raw data. The detrended signals are then filtered iteratively until, by visual inspection, the quality is good enough for interpretation. The proposed algorithm is demonstrated by an application to a clinical DBS-EEG data set in resting state and in finger-tapping condition. Moreover, a comparison with a Low-Pass filter (LPF) is provided, by visual inspection and by a quantitative measure. PMID:24110812
Santillan-Guzman, Alina; Heute, Ulrich; Muthuraman, Muthuraman; Stephani, Ulrich; Galka, Andreas
Background Deep brain stimulation (DBS) surgery is used for treating movement disorders, including Parkinson disease, essential tremor, and dystonia. Successful DBS surgery is critically dependent on precise placement of DBSelectrodes into target structures. Frequently, DBS surgery relies on normalized atlas-derived diagrams that are superimposed on patient brain magnetic resonance imaging (MRI) scans, followed by microelectrode recording and macrostimulation to refine the ultimate electrode position. Microelectrode recording carries a risk of hemorrhage and requires active patient participation during surgery. Objective To enhance anatomic imaging for DBS surgery using high-field MRI with the ultimate goal of improving the accuracy of anatomic target selection. Methods Using a 7-T MRI scanner combined with an array of acquisition schemes using multiple image contrasts, we obtained high-resolution images of human deep nuclei in healthy subjects. Results Superior image resolution and contrast obtained at 7 T in vivo using susceptibility-weighted imaging dramatically improved anatomic delineation of DBS targets and allowed the identification of internal architecture within these targets. A patient-specific, 3-dimensional model of each target area was generated on the basis of the acquired images. Conclusion Technical developments in MRI at 7 T have yielded improved anatomic resolution of deep brain structures, thereby holding the promise of improving anatomic-based targeting for DBS surgery. Future study is needed to validate this technique in improving the accuracy of targeting in DBS surgery.
Deep brain stimulation (DBS) is an established therapy for the treatment of Parkinson’s disease (PD) and shows great promise for the treatment of several other disorders. However, while the clinical analysis of DBS has received great attention, a relative paucity of quantitative techniques exists to define the optimal surgical target and most effective stimulation protocol for a given disorder. In this study we describe a methodology that represents an evolutionary addition to the concept of a probabilistic brain atlas, which we call a probabilistic stimulation atlas (PSA). We outline steps to combine quantitative clinical outcome measures with advanced computational models of DBS to identify regions where stimulation-induced activation could provide the best therapeutic improvement on a per-symptom basis. While this methodology is relevant to any form of DBS, we present example results from subthalamic nucleus (STN) DBS for PD. We constructed patient-specific computer models of the volume of tissue activated (VTA) for 163 different stimulation parameter settings which were tested in six patients. We then assigned clinical outcome scores to each VTA and compiled all of the VTAs into a PSA to identify stimulation-induced activation targets that maximized therapeutic response with minimal side effects. The results suggest that selection of both electrode placement and clinical stimulation parameter settings could be tailored to the patient’s primary symptoms using patient-specific models and PSAs.
Butson, Christopher R.; Cooper, Scott E.; Henderson, Jaimie M.; Wolgamuth, Barbara; McIntyre, Cameron C.
Deep brain stimulation (DBS) is used to treat a variety of severe medically intractable movement disorders, including Parkinson's disease, tremor and dystonia. There have been few studies examining the effect of chronic DBS on the brains of Parkinson's disease patients. Most of these post mortem studies concluded that chronic DBS caused mild gliosis around the lead track and did not damage brain tissue. There have been no similar histopathological studies on brains from dystonic patients who have undergone DBS. In this study, our objective was to discover whether tissue would be attached to DBSelectrodes removed from patients for routine clinical reasons. We hoped that by examining explanted DBSelectrodes using scanning (SEM) and/or transmission (TEM) electron microscopy we might visualize any attached tissue and thus understand the electrode-human brain tissue interaction more accurately. Initially, SEM was performed on one control DBSelectrode that had not been implanted. Then 21 (one subthalamic nucleus and 20 globus pallidus internus) explanted DBSelectrodes were prepared, after fixation in 3% glutaraldehyde, for SEM (n = 9) or TEM (n = 10), or both (n = 2), according to departmental protocol. The electrodes were sourced from two patients with Parkinson's disease, one with myoclonic dystonia, two with cervical dystonia and five with primary generalized dystonia, and had been in situ for 11 and 31 months (Parkinson's disease), 16 months (myoclonic dystonia), 14 and 24 months (cervical dystonia) and 3-24 months (primary generalized dystonia). Our results showed that a foreign body multinucleate giant cell-type reaction was present in all TEM samples and in SEM samples, prewashed to remove surface blood and fibrin, regardless of the diagnosis. Some of the giant cells were >100 microm in diameter and might have originated from either fusion of parenchymal microglia, resident perivascular macrophage precursors and/or monocytes/macrophages invading from the blood stream. The presence of mononuclear macrophages containing lysosomes and sometimes having conspicuous filopodia was detected by TEM. Both types of cell contained highly electron-dense inclusions, which probably represent phagocytosed material. Similar material, the exact nature of which is unknown, was also seen in the vicinity of these cells. This reaction was present irrespective of the duration of implantation and may be a response to the polyurethane component of the electrodes' surface coat. These findings may be relevant to our understanding of the time course of the clinical response to DBS in Parkinson's disease and various forms of dystonia, as well as contributing to the design characteristics of future DBSelectrodes. PMID:15329356
Moss, J; Ryder, T; Aziz, T Z; Graeber, M B; Bain, P G
Although deep brain stimulation (DBS) has been proven to be an effective treatment for several neuropsychiatric disorders, such as Parkinson's disease, the underlying working mechanisms are still largely unknown. Behavioral animal models are essential in examining the working mechanisms of DBS and especially mouse models are necessary to investigate the genetic component underlying specific behaviors related to psychiatric diseases. Unfortunately, currently available stimulation devices are unsuitable to test behavior in freely-moving mice. As such, no DBS studies in behaving mice have been reported thus far. In order to overcome this limitation we have developed a new light-weight wireless implantable micro stimulator device for mice that delivers biphasic pulse patterns to two individual electrode pairs, mimicking partly the clinical situation. This paper describes in detail the bench-top validation and in vivo implementation of this device. The results in this study indicate that the wireless implantable stimulator in mice reliably delivers continuous bilateral stimulation, importantly, does not restrict the animals mobility and hygiene (grooming behavior). In vivo testing furthermore showed that stimulation of the mice ventral striatum yields similar results as previously shown by others in rats where conventional deep brain stimulation techniques were used. This newly designed device can now be used in the highly needed DBS behavioral studies in mice, to further investigate the underlying mechanisms of DBS in behavioral animal models for psychiatric disorders. PMID:22677175
de Haas, Ria; Struikmans, Rolf; van der Plasse, Geoffrey; van Kerkhof, Linda; Brakkee, Jan H; Kas, Martien J H; Westenberg, Herman G M
The report describes the technology developed for intracerebral implantation of multiple electrodes in the chimpanzee and subsequent multichannel radio stimulation and telemetric recording of brain activity. In conjunction with this study a photographic-h...
J. M. R. Delgado R. J. Bradley V. S. Johnston G. Weiss J. D. Wallace
Presently, platinum, platinum-iridium, and carbon (glossy and pyrographite) are the preferred materials to be used as stimulatingelectrodes. Electrochemical tests revealed higher thresholds with Pt-Ir, which possibly are a result of excessive connective tissue growth. A porous structure appears to be preferred especially if the electrode materials are smooth and activated glassy carbon. When comparing power consumption, glassy carbon was found to be a superior electrode material. PMID:2432538
The extent to which oxygen reduction occurs on sputtered iridium oxide (SIROF) and platinum neural stimulationelectrodes was quantified by cyclic voltammetry and voltage-transient measurements in oxygen-saturated physiological saline. Oxygen reduction was the dominant charge-admittance reaction on platinum electrodes during slow-sweep-rate cyclic voltammetry, contributing ~12 mC\\/cm2 (88% of total charge) to overall cathodal charge capacity. For a 300-nm-thick SIROF electrode,
Stuart F. Cogan; Julia Ehrlich; Timothy D. Plante; Marcus D. Gingerich; Douglas B. Shire
A bipolar cuff electrode for electrical stimulation of small diameter peripheral nerves is described. The cuff is made of a highly flexible rubber-impression material, and the electrode assembly is suited for chronic implantation. Its manual construction is easy and reliable, utilizing only simple tools. The cuff completely envelopes nerves of varying diameter and requires a minimal amount of manipulations of
The aim of the present work is to develop a method to propel colon contents by electrical stimulation of the colon wall. Six to 8 wire electrodes, and a cannula to irrigate and fill the gut were implanted in the descending colon of 4 pigs. In the next 2 months, weekly experiments were performed to measure the electrode impedance, propel
Rijkhoff NJM; Nygaard Lærke H; Jørgensen H; Mark M
Background: In the setting of a deep brain stimulation (DBS) lead with defective electrical circuitry, potential patient morbidity and additional surgery may be avoided if impedance testing of the brain lead is performed prior to final lead implantation. In the present report, detection of a short circuit upon lead placement and prior to lead anchoring was detected utilizing recently released DBS hardware and software (Medtronic, Minneapolis, MN). This report suggests that neurosurgeons need to be aware and consider the use of the newly available DBS testing equipment. Methods: During the first DBS lead placement in a 69-year-old man with advanced idiopathic Parkinson's disease undergoing bilateral subthalamic nucleus DBS over staged procedures, test stimulation and lead impedance testing were accomplished prior to lead anchoring. An external neurostimulator (ENS) was affixed to an updated clinician programmer and connected to the DBS lead with a screening cable specific for the ENS and DBS. Results: Impedance testing demonstrated a short circuit involving the 1 and 3 lead-electrode bipolar combination in a visually intact lead. The lead was replaced, repeat impedance testing and test stimulation were completed and the intact lead was secured. Subsequent DBS surgeries were completed uneventfully. The lead abnormality was verified by the manufacturer. Conclusions: This case highlights a new method to test DBS lead circuitry at the time of placement. The method may also be employed to directly test lead integrity when localizing a DBS system short or open circuit of unclear etiology. Our case suggests that the method is valuable and should be utilized.
Nazzaro, Jules M.; Lyons, Kelly E.; Pahwa, Rajesh; Ridings, Larry W
The inability to track the products of subsurface microbial activity during stimulated bioremediation has limited its implementation. We used spatiotemporal changes in electrodic potentials (EP) to track the onset and persistence of stimulated sulfate-reducing bacteria in a uranium-contaminated aquifer undergoing acetate amendment. Following acetate injection, anomalous voltages approaching -900 mV were measured between copper electrodes within the aquifer sediments and
K. H. Williams; A. L. NGuessan; J. Druhan; P. E. Long; S. S. Hubbard; D. R. Lovley; J. F. Banfield
The inability to track the products of subsurface microbial activity during stimulated bioremediation has limited its implementation. We used spatiotemporal changes in electrodic potentials (EP) to track the onset and persistence of stimulated sulfate-reducing bacteria in a uranium-contaminated aquifer undergoing acetate amendment. Following acetate injection, anomalous voltages approaching ?900 mV were measured between copper electrodes within the aquifer sediments and
Kenneth H. Williams; A. Lucie N'Guessan; Jennifer Druhan; Philip E. Long; Susan S. Hubbard; Derek R. Lovley; Jillian F. Banfield
The inability to track the products of subsurface microbial activity during stimulated bioremediation has limited its implementation. We used spatiotemporal changes in electrodic potentials (EP) to track the onset and persistence of stimulated sulfate-reducing bacteria in a uranium-contaminated aquifer undergoing acetate amendment. Following acetate injection, anomalous voltages approaching -900 mV were measured between copper electrodes within the aquifer sediments and
Kenneth H. Williams; A. Lucie N'Guessan; Jennifer Druhan; Philip E. Long; Susan S. Hubbard; Derek R. Lovley; Jillian F. Banfield
The posterior tibial nerves of 18 rabbits were intraneurally implanted with coiled wire electrodes for up to 9 weeks to evaluate\\u000a their usefulness for neuromuscular electrical stimulation. In one group an electrode was implanted and removed in one leg\\u000a while the other leg was chronically implanted. A second group was chronically implanted without electrical stimulation in\\u000a one leg and implanted
Background Functional electrical stimulation (FES) applied via transcutaneous electrodes is a common rehabilitation technique for assisting grasp in patients with central nervous system lesions. To improve the stimulation effectiveness of conventional FES, we introduce multi-pad electrodes and a new stimulation paradigm. Methods The new FES system comprises an electrode composed of small pads that can be activated individually. This electrode allows the targeting of motoneurons that activate synergistic muscles and produce a functional movement. The new stimulation paradigm allows asynchronous activation of motoneurons and provides controlled spatial distribution of the electrical charge that is delivered to the motoneurons. We developed an automated technique for the determination of the preferred electrode based on a cost function that considers the required movement of the fingers and the stabilization of the wrist joint. The data used within the cost function come from a sensorized garment that is easy to implement and does not require calibration. The design of the system also includes the possibility for fine-tuning and adaptation with a manually controllable interface. Results The device was tested on three stroke patients. The results show that the multi-pad electrodes provide the desired level of selectivity and can be used for generating a functional grasp. The results also show that the procedure, when performed on a specific user, results in the preferred electrode configuration characteristics for that patient. The findings from this study are of importance for the application of transcutaneous stimulation in the clinical and home environments.
In 1954, Penfield and Jasper briefly described that percepts of unpleasant odor were elicited by intraoperative electrical stimulation of the olfactory bulb in patients with epilepsy. Since then, few peer-reviewed studies have reported such phenomena elicited by stimulation mapping via subdural electrodes implanted on the ventral surface of frontal lobe. Here, we determined what types of olfactory hallucinations could be reproduced by such stimulation in children with focal epilepsy. This study included 16 children (age range: 5 to 17 years), who underwent implantation of subdural electrodes to localize the presumed epileptogenic zone and eloquent areas. Pairs of electrodes were electrically stimulated and clinical responses were observed. In case a patient reported a perception, she/he was asked to describe its nature. We also described the stimulus parameters to elicit a given symptom. Eleven patients reported a perception of smell in response to electrical stimulation while the remaining five did not. Nine patients perceived an unpleasant smell (like bitterness, smoke, or garbage), while two perceived a pleasant smell (like strawberry or good food). Such olfactory hallucinations were induced by stimulation proximal to the olfactory bulb or tract on either hemisphere but not by that of orbitofrontal gyri lateral to the medial orbital sulci. The range of stimulus parameters employed to elicit olfactory hallucinations was comparable to those for other sensorimotor symptoms. Our systematic study of epileptic children replicated stimulation-induced olfactory hallucinations. We failed to provide evidence that a positive olfactory perception could be elicited by conventional stimulation of secondary olfactory cortex alone.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for Parkinson's disease, but can lead to adverse effects including psychiatric disturbance. Little is known about the risk factors and treatment options for such effects. Here, we describe a patient who reproducibly developed stimulation-induced hypomania when using ventrally located electrodes and responded well to pharmacological intervention while
L. Schilbach; P. H. Weiss; J. Kuhn; L. Timmermann; J. Klosterkötter; W. Huff
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for Parkinson's disease, but can lead to adverse effects including psychiatric disturbance. Little is known about the risk factors and treatment options for such effects. Here, we describe a patient who reproducibly developed stimulation-induced hypomania when using ventrally located electrodes and responded well to pharmacological intervention while
L. Schilbach; P. H. Weiss; J. Kuhn; L. Timmermann; J. Klosterkötter; W. Huff
Objective. Epiretinal stimulation, which uses an array of electrodes implanted on the inner retinal surface to relay a representation of the visual scene to the neuronal elements of the retina, has seen considerable success. The objective of the present study was to quantify the effects of multi-electrodestimulation on the patterns of neural excitation in a computational model of epiretinal stimulation. Approach. A computational model of retinal ganglion cells was modified to represent the morphology of human retinal ganglion cells and validated against published experimental data. The ganglion cell model was then combined with a model of an axon of the nerve fiber layer to produce a population model of the inner retina. The response of the population of model neurons to epiretinal stimulation with a multi-electrode array was quantified across a range of electrode geometries using a novel means to quantify the model response—the minimum radius circle bounding the activated model neurons as a proxy for the evoked phosphene. Main results. Multi-electrodestimulation created unique phosphenes, such that the number of potential phosphenes can far exceed the number of electrode contacts. Significance. The ability to exploit the spatial and temporal interactions of stimulation may be critical to improvements in the performance of epiretinal prostheses.
Electrochemical synthesis of dodecylbenzenesulfonate (DBS?) doped polypyrrole (PPy\\/DBS) onto polystyrenesulphonate (PSS?) doped poly(3,4-ethylenedioxythiophene) (PEDOT\\/PSS) modified gold EQCM electrode was studied. Monitoring of mass and potential response during PPy growth onto PEDOT underlayer revealed at least three different stages in this process. AFM study confirmed that PEDOT film morphology constantly changed during the synthesis of PPy film onto its surface. Studying
A new type of newe cuff electrode consisting of conduc- tive segments embedded within a self-curling sheath of biocompatihle insulation has been developed. This spiral nerve cuff is biased to self- wrap around peripheral nerves and possesses a \\
GREGORY G. NAPLES; J. THOMAS MORTIMER; AVRAM SCHEINER; JAMES D. SWEENEY
The aim of this research, which was performed as a Lincoln Laboratory Innovative Research Program (IRP) project, was to apply advanced digital speech and signal-processing techniques toward improving cochlear implant electrode simulators. By providing a f...
J. Tierney M. A. Zissman D. K. Eddington W. M. Rabinowitz
We present a method for automatic determination of the shape and position of the surface electrode for selective control of fingers extension and flexion by means of electrical stimulation. The multi-pad electrodes used in the experiments comprised 24 pads (1cm diameter) distributed over an area (7 cm x 10 cm) positioned over dorsal and volar aspects of the forearm. The four-channel stimulation system for grasping comprised also an oval reference electrode over the carpal tunnel, and two oval electrodes over the thenar and thumb extensor muscles. We measured seven angles: proximal inter-phalangeal and metacarpal phalangeal index and ring finger joint rotations, wrist extension/flexion and ulnar/radial rotation, and pronation/supination of the forearm. The optimal electrode was determined as the combination of pads that led to fingers, wrist and forearm rotations being similar to the trajectories of healthy individuals when grasping. The similarity of trajectories was assessed by analyzing the aggregate error defined as the sum of squares of differences between the angles measured when stimulating the forearm in tetraplegics and the angles measured in healthy individuals. The aggregate errors were determined from measurements during sequential stimulation of each of the 24 pads. The analysis comprised hand opening and closing for palmar and lateral grasps. The time for determining the optimal electrode was about 10 min. The optimal electrodes had different branched shapes in each of the six tetraplegics; however, once determined they remained unchanged when tested on different days. PMID:19109996
Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. We have developed a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals are to identify the intersection between the VTA and surrounding anatomical structures and to compare activation of these structures with clinical outcomes. The model system consists of three fundamental components: 1) a 3D anatomical model of the subcortical nuclei and DBSelectrode position in the brain, each derived from magnetic resonance imaging (MRI); 2) a finite element model of the DBSelectrode and electric field transmitted to the brain, with tissue conductivity properties derived from diffusion tensor MRI; 3) VTA prediction derived from the response of myelinated axons to the applied electric field, which is a function of the stimulation parameters (contact, impedance, voltage, pulse width, frequency). We used this model system to analyze the effects of subthalamic nucleus (STN) DBS in a patient with Parkinson’s disease. Quantitative measurements of bradykinesia, rigidity, and corticospinal tract (CST) motor thresholds were evaluated over a range of stimulation parameter settings. Our model predictions showed good agreement with CST thresholds. Additionally, stimulation through electrode contacts that improved bradykinesia and rigidity generated VTAs that overlapped the zona incerta / fields of Forel (ZI/H2). Application of DBS technology to various neurological disorders has preceded scientific characterization of the volume of tissue directly affected by the stimulation. Synergistic integration of clinical analysis, neuroimaging, neuroanatomy, and neurostimulation modeling provides the opportunity to address wide ranging questions on the factors linked with the therapeutic benefits and side effects of DBS.
Butson, Christopher R.; Cooper, Scott E.; Henderson, Jaimie M.; McIntyre, Cameron C.
Stimulatingelectrode materials must be capable of supplying high-density electrical charge to effectively activate neural tissue. Platinum is the most commonly used material for neural stimulation. Two other materials have been considered: iridium oxide and titanium nitride. This study directly compared the electrical characteristics of iridium oxide and titanium nitride by fabricating silicon substrate probes that differed only in the
James D. Weiland; David J. Anderson; Mark S. Humayun
The cardiovascular system can be influenced by electrically stimulating the vagal nerve. Selectivity for specific cardiac fibers may be limited when stimulating at the cervical level. Our objective was to increase effectiveness and selectivity for cardiovascular effects of vagal nerve stimulation by using local bipolar stimulation in one nerve cross section using a multi-contact cuff instead of less localized stimulation using a tripolar ring electrode. Both types of cuff electrodes were compared with respect to their relative effects on R-R interval (RRI), P-Q interval (PQI), left ventricular contractility (LVC), and left ventricular pressure (P(LV)) in seven pigs. Stimulation using the optimal bipolar configuration on the multi-contact cuff significantly affected RRI, PQI, LVC, and P(LV), whereas stimulation with the ring electrode only significantly affected RRI and PQI. The cardiovascular parameters that could be significantly influenced varied between the bipolar configurations. These novel findings may be relevant for optimizing electrode configurations for clinical cardiac applications of vagal nerve stimulation. PMID:22987542
Ordelman, Simone C M A; Kornet, Lilian; Cornelussen, Richard; Buschman, Hendrik P J; Veltink, Peter H
Transcranial direct current stimulation (tDCS) provides a non-invasive tool to elicit neuromodulation by delivering current through electrodes placed on the scalp. The present clinical paradigm uses two relatively large electrodes to inject current through the head resulting in electric fields that are broadly distributed over large regions of the brain. In this paper, we present a method that uses multiple small electrodes (i.e. 1.2 cm diameter) and systematically optimize the applied currents to achieve effective and targeted stimulation while ensuring safety of stimulation. We found a fundamental trade-off between achievable intensity (at the target) and focality, and algorithms to optimize both measures are presented. When compared with large pad-electrodes (approximated here by a set of small electrodes covering 25cm2), the proposed approach achieves electric fields which exhibit simultaneously greater focality (80% improvement) and higher target intensity (98% improvement) at cortical targets using the same total current applied. These improvements illustrate the previously unrecognized and non-trivial dependence of the optimal electrode configuration on the desired electric field orientation and the maximum total current (due to safety). Similarly, by exploiting idiosyncratic details of brain anatomy, the optimization approach significantly improves upon prior un-optimized approaches using small electrodes. The analysis also reveals the optimal use of conventional bipolar montages: maximally intense tangential fields are attained with the two electrodes placed at a considerable distance from the target along the direction of the desired field; when radial fields are desired, the maximum-intensity configuration consists of an electrode placed directly over the target with a distant return electrode. To summarize, if a target location and stimulation orientation can be defined by the clinician, then the proposed technique is superior in terms of both focality and intensity as compared to previous solutions and is thus expected to translate into improved patient safety and increased clinical efficacy.
Dmochowski, Jacek P.; Datta, Abhishek; Bikson, Marom; Su, Yuzhuo; Parra, Lucas C.
Transcranial direct current stimulation (tDCS) provides a non-invasive tool to elicit neuromodulation by delivering current through electrodes placed on the scalp. The present clinical paradigm uses two relatively large electrodes to inject current through the head resulting in electric fields that are broadly distributed over large regions of the brain. In this paper, we present a method that uses multiple small electrodes (i.e. 1.2 cm diameter) and systematically optimize the applied currents to achieve effective and targeted stimulation while ensuring safety of stimulation. We found a fundamental trade-off between achievable intensity (at the target) and focality, and algorithms to optimize both measures are presented. When compared with large pad-electrodes (approximated here by a set of small electrodes covering 25 cm(2)), the proposed approach achieves electric fields which exhibit simultaneously greater focality (80% improvement) and higher target intensity (98% improvement) at cortical targets using the same total current applied. These improvements illustrate the previously unrecognized and non-trivial dependence of the optimal electrode configuration on the desired electric field orientation and the maximum total current (due to safety). Similarly, by exploiting idiosyncratic details of brain anatomy, the optimization approach significantly improves upon prior un-optimized approaches using small electrodes. The analysis also reveals the optimal use of conventional bipolar montages: maximally intense tangential fields are attained with the two electrodes placed at a considerable distance from the target along the direction of the desired field; when radial fields are desired, the maximum-intensity configuration consists of an electrode placed directly over the target with a distant return electrode. To summarize, if a target location and stimulation orientation can be defined by the clinician, then the proposed technique is superior in terms of both focality and intensity as compared to previous solutions and is thus expected to translate into improved patient safety and increased clinical efficacy. PMID:21659696
Dmochowski, Jacek P; Datta, Abhishek; Bikson, Marom; Su, Yuzhuo; Parra, Lucas C
Background: Simple basic visual perception may be restored by epiretinal electrical stimulation in patients that are blind due to photoreceptor\\u000a loss. To stimulate ganglion cells, epiretinally flat platinum microelectrodes embedded in thin polyimide film were developed\\u000a and tested in the cat. Methods: After remo-val of the lens and the vitreous body a thin microfilm electrode array was implanted through a
Lutz Hesse; Thomas Schanze; Marcus Wilms; Marcus Eger
Deep brain stimulation (DBS) is an established therapy for the treatment of a wide range of neurological disorders. Historically, DBS and other neurostimulation technologies have relied on rectangular stimulation waveforms to impose their effects on the nervous system. Recent work has suggested that non-rectangular waveforms may have advantages over the traditional rectangular pulse. Therefore, we used detailed computer models to compare a range of charge-balanced biphasic waveforms with rectangular, exponential, triangular, Gaussian, and sinusoidal stimulus pulse shapes. We explored the neural activation energy of these waveforms in both intracellular and extracellular stimulation. In the context of extracellular stimulation, we compared their effects on both axonal fibers of passage and projection neurons. Finally, we evaluated the impact of delivering the waveforms through a clinical DBSelectrode, as opposed to a theoretical point source. Our results suggest that DBS with a 1 ms centered-triangular pulse can decrease energy consumption by 64 % when compared to the standard 100 ?s rectangular pulse (energy cost of 48 nJ and 133 nJ, respectively, to stimulate 50 % of a distributed population of axons) and can decrease energy consumption by 10 % when compared to the most energy efficient rectangular pulse (1.25 ms duration). In turn, there may be measureable energy savings when using appropriately designed non-rectangular pulses in clinical DBS applications, thereby warranting further experimental investigation.
Factors determining the design of DBS terminals and their development in Canada are described. Early experience indicated the acceptability of terminals with 1.2 to 1.8m diameter reflectors capable of receiving signals in Ku-band with 47-50 dBW satellite ERIP. This experience, the perception that the Canadian customer base consisted of a few million widely dispersed inhabitants, and the possibility of using Anik C in the 11.7 to 12.2 GHz band led to emphasis in studies of medium power systems (50-57 dBW). Accordingly Ku band terminal development has been strongly influenced towards medium power systems. The desirability of uniform standards in terminal design, at least for North America, is also recognized. In the absence of suitable Ku band signals Canadian industrial activity in Ku band terminals is relatively small compared to C-band terminal activity where the emergence of inexpensive home terminals for reception of the numerous available unscrambled C-band signals has opened up an immediate market. The direction and the timing of an introduction of a Ku band DBS system in Canada is uncertain at this time.
Objective Deep brain stimulation (DBS) surgeries commonly rely on brain atlases and microelectrode recordings (MER) to help identify the target location for electrode implantation. We present an automated method for optimally fitting a 3-dimensional brain atlas to intraoperative MER and predicting a target DBSelectrode location in stereotactic coordinates for the patient. Methods We retrospectively fit a 3-dimensional brain atlas to MER points from 10 DBS surgeries targeting the subthalamic nucleus (STN). We used a constrained optimization algorithm to maximize the MER points correctly fitted (i.e., contained) within the appropriate atlas nuclei. We compared our optimization approach to conventional anterior commissure-posterior commissure (AC/PC) scaling, and to manual fits performed by four experts. A theoretical DBSelectrode target location in the dorsal STN was customized to each patient as part of the fitting process and compared to the location of the clinically defined therapeutic stimulation contact. Results The human expert and computer optimization fits achieved significantly better fits than the AC/PC scaling (80, 81, and 41% of correctly fitted MER, respectively). However, the optimization fits were performed in less time than the expert fits and converged to a single solution for each patient, eliminating interexpert variance. Conclusions and Significance DBS therapeutic outcomes are directly related to electrode implantation accuracy. Our automated fitting techniques may aid in the surgical decision-making process by optimally integrating brain atlas and intraoperative neurophysiological data to provide a visual guide for target identification.
Lujan, J. Luis; Noecker, Angela M.; Butson, Christopher R.; Cooper, Scott E.; Walter, Benjamin L.; Vitek, Jerrold L.; McIntyre, Cameron C.
Effects of conditioning peripheral nerve stimulation with different types of stimulatingelectrodes on pain thresholds in various deep tissues were measured in human subjects. Cone-shaped metal (? 13 mm), rubber (? 13 mm), and large soft surface electrodes (50 × 150 mm) were used for transcutaneous electrical nerve stimulation (TENS), and insulated and non-insulated acupuncture needles (diameter: 240 ?m) were
Objectives: To investigate the oscillatory activity in the Parkinsonian subthalamic nucleus using the macro-electrodes for deep brain stimulation.Methods: During bilateral deep brain stimulatingelectrode implantation, spontaneous and evoked field potentials were recorded from the subthalamic nucleus (STN) in two patients with Parkinson's disease (PD) during spontaneous resting tremor, passive manipulation of the wrist, and following electrical stimulation of the contralateral
X. Liu; H. L Ford-Dunn; G. N Hayward; D Nandi; R. C Miall; T. Z Aziz; J. F. Stein
In retinal neuroprostheses, spatial interaction between electric fields from various electrodes – electric crosstalk – may occur in multielectrode arrays during simultaneous stimulation of the retina. Depending on the electrode design and placement, this crosstalk can either enhance or degrade the functional characteristics of a visual prosthesis. To optimize the device performance, a balance must be satisfied between the constructive interference of crosstalk on dynamic range and power consumption and its negative effect on artificial visual acuity. In the present computational modeling study, we have examined the trade-off in these positive and negative effects using a range of currently available electrode array configurations, compared to a recently proposed stimulation strategy – the quasi monopolar (QMP) configuration – in which the return current is shared between local bipolar guards and a distant monopolar electrode. We evaluate the performance of the QMP configuration with respect to the implantation site and electrode geometry parameters. Our simulation results demonstrate that the beneficial effects of QMP are only significant at electrode-to-cell distances greater than the electrode dimensions. Possessing a relatively lower activation threshold, QMP was found to be superior to the bipolar configuration in terms of providing a relatively higher visual acuity. However, the threshold for QMP was more sensitive to the topological location of the electrode in the array, which may need to be considered when programming the manner in which electrode are simultaneously activated. This drawback can be offset with a wider dynamic range and lower power consumption of QMP. Furthermore, the ratio of monopolar return current to total return can be used to adjust the functional performance of QMP for a given implantation site and electrode parameters. We conclude that the QMP configuration can be used to improve visual information-to-stimulation mapping in a visual prosthesis, while maintaining low power consumption.
The safety of electroconvulsive therapy (ECT) in patients who have deep brain stimulation (DBS) implants represents a significant clinical issue. A major safety concern is the presence of burr holes and electrode anchoring devices in the skull, which may alter the induced electric field distribution in the brain. We simulated the electric field using finite-element method in a five-shell spherical head model. Three DBSelectrode anchoring techniques were modeled, including ring/cap, microplate, and burr-hole cover. ECT was modeled with bilateral (BL), right unilateral (RUL), and bifrontal (BF) electrode placements and with clinically-used stimulus current amplitude. We compared electric field strength and focality among the DBS implantation techniques and ECT electrode configurations. The simulation results show an increase in the electric field strength in the brain due to conduction through the burr holes, especially when the burr holes are not fitted with nonconductive caps. For typical burr hole placement for subthalamic nucleus DBS, the effect on the electric field strength and focality is strongest for BF ECT, which runs contrary to the belief that more anterior ECT electrode placements are safer in patients with DBS implants. PMID:21096149
Deng, Zhi-De; Hardesty, David E; Lisanby, Sarah H; Peterchev, Angel V
We present here a demonstration of a dual-sided, 4-layer metal, polyimide-based electrode array suitable for neural stimulation and recording. The fabrication process outlined here utilizes simple polymer and metal deposition and etching steps, with no potentially harmful backside etches or long exposures to extremely toxic chemicals. These polyimide-based electrode arrays have been tested to ensure they are fully biocompatible and suitable for long-term implantation; their flexibility minimizes the injury and glial scarring that can occur at the implantation site. The creation of dual-side electrode arrays with more than two layers of trace metal enables the fabrication of neural probes with more electrodes without a significant increase in probe size. This allows for more stimulation/recording sites without inducing additional injury and glial scarring. PMID:23367296
A 59-year-old woman with levodopa-responsive parkinsonism complicated by motor fluctuations and generalized levodopa dyskinesia underwent bilateral subthalamic deep brain stimulation (STN DBS) 7 years after symptom onset. DBS improved levodopa-responsive upper extremity bradykinesia but aggravated speech, swallowing, and gait. Motor fluctuations were not improved and levodopa dose remained unchanged. Pulse generators were turned off. Clinical features and brain MRI in this case were indicative of multiple system atrophy (MSA). STN DBS is not recommended for patients with MSA. PMID:12874410
The feasibility of an electrical stimulation method selectively for activating skeletal muscles innervated by a common peripheral\\u000a nerve trunk has been investigated. The method utilises ‘snugly’ fitting nerve cuffs that incorporate an array of 12 electrodes.\\u000a These electrodes have been tested as four longitudinally aligned tripoles (located 90 apart on the cuff inner surface). In\\u000a acute experiments on rabbit sciatic
BACKGROUND AND PURPOSE: Recent work has shown a potential for excessive heating of deep brain stimulationelectrodes during MR imaging. This in vitro study investigates the relationship between electrode heating and the specific absorption rate (SAR) of several MR images. METHODS: In vitro testing was performed by using a 1.5-T MR imaging system and a head transmit-receive coil, with bilateral
Daniel A. Finelli; Ali R. Rezai; Paul M. Ruggieri; Jean A. Tkach; John A. Nyenhuis; Greg Hrdlicka; Ashwini Sharan; Jorge Gonzalez-Martinez; Paul H. Stypulkowski; Frank G. Shellock
Purpose: The goal of epilepsy surgery is to determine as accurately as possible the epileptogenic zone and eloquent areas preoperatively. We studied functional brain mapping using chronically intracranial electrodestimulation in 37 cases of partial epilepsy. Methods: The mean age was 28 (2–67) years. The average number of implanted electrodes was 88. Alternating electric currents with 1–10-s duration were used.
Objective: We examine the effect of intracranial air on stereotactic accuracy during bilateral deep brain stimulation (DBS) surgery for Parkinson’s disease (PD). We also assess factors that may predict an increased risk of intracranial air during these surgeries. Methods: 32 patients with PD underwent bilateral DBS surgery. The technique used for implantation of the leads has been standardized in over
Hooman Azmi; Andre Machado; Milind Deogaonkar; Ali Rezai
Objective. Brain machine interfaces (BMIs) that decode control signals from motor cortex have developed tremendously in the past decade, but virtually all rely exclusively on vision to provide feedback. There is now increasing interest in developing an afferent interface to replace natural somatosensation, much as the cochlear implant has done for the sense of hearing. Preliminary experiments toward a somatosensory neuroprosthesis have mostly addressed the sense of touch, but proprioception, the sense of limb position and movement, is also critical for the control of movement. However, proprioceptive areas of cortex lack the precise somatotopy of tactile areas. We showed previously that there is only a weak tendency for neighboring neurons in area 2 to signal similar directions of hand movement. Consequently, stimulation with the relatively large currents used in many studies is likely to activate a rather heterogeneous set of neurons. Approach. Here, we have compared the effect of single-electrodestimulation at subthreshold levels to the effect of stimulating as many as seven electrodes in combination. Main results. We found a mean enhancement in the sensitivity to the stimulus (d') of 0.17 for pairs compared to individual electrodes (an increase of roughly 30%), and an increase of 2.5 for groups of seven electrodes (260%). Significance. We propose that a proprioceptive interface made up of several hundred electrodes may yield safer, more effective sensation than a BMI using fewer electrodes and larger currents. PMID:23985904
Zaaimi, Boubker; Ruiz-Torres, Ricardo; Solla, Sara A; Miller, Lee E
Objective. Brain machine interfaces (BMIs) that decode control signals from motor cortex have developed tremendously in the past decade, but virtually all rely exclusively on vision to provide feedback. There is now increasing interest in developing an afferent interface to replace natural somatosensation, much as the cochlear implant has done for the sense of hearing. Preliminary experiments toward a somatosensory neuroprosthesis have mostly addressed the sense of touch, but proprioception, the sense of limb position and movement, is also critical for the control of movement. However, proprioceptive areas of cortex lack the precise somatotopy of tactile areas. We showed previously that there is only a weak tendency for neighboring neurons in area 2 to signal similar directions of hand movement. Consequently, stimulation with the relatively large currents used in many studies is likely to activate a rather heterogeneous set of neurons. Approach. Here, we have compared the effect of single-electrodestimulation at subthreshold levels to the effect of stimulating as many as seven electrodes in combination. Main results. We found a mean enhancement in the sensitivity to the stimulus (d?) of 0.17 for pairs compared to individual electrodes (an increase of roughly 30%), and an increase of 2.5 for groups of seven electrodes (260%). Significance. We propose that a proprioceptive interface made up of several hundred electrodes may yield safer, more effective sensation than a BMI using fewer electrodes and larger currents.
Zaaimi, Boubker; Ruiz-Torres, Ricardo; Solla, Sara A.; Miller, Lee E.
A new, scalable process for microfabrication of a silicone-based, elastic multi-electrode array (MEA) is presented. The device is constructed by spinning poly(dimethylsiloxane) (PDMS) silicone elastomer onto a glass slide, depositing and patterning gold to construct wires and electrodes, spinning on a second PDMS layer, and then micropatterning the second PDMS layer to expose electrode contacts. The micropatterning of PDMS involves a custom reactive ion etch (RIE) process that preserves the underlying gold thin film. Once completed, the device can be removed from the glass slide for conformal interfacing with neural tissue. Prototype MEAs feature electrodes smaller than those known to be reported on silicone substrate (60 ?m diameter exposed electrode area) and were capable of selectively stimulating the surface of the in vitro isolated spinal cord of the juvenile rat. Stretchable serpentine traces were also incorporated into the functional PDMS-based MEA, and their implementation and testing is described.
Meacham, Kathleen W.; Giuly, Richard J.; Guo, Liang; Hochman, Shawn; DeWeerth, Stephen P.
Surface electrodes are commonly used electrodes clinically, in applications such as functional electrical stimulation for the restoration of motor functions, pain relief, transcutaneous electrical nerve stimulation, electrocardiographic monitoring, defibrillation, surface cardiac pacing, and advanced drug delivery systems. Common to these applications are occasional reports of pain, tissue damage, rash, or burns on the skin at the point where electrodes are placed. In this study, we quantitatively analyzed the effects of acute noninvasive electrical stimulation from concentric ring electrodes (CRE) to determine the maximum safe current limit. We developed a three-dimensional multi-layer model and calculated the temperature profile under the CRE and the corresponding energy density with electrical-thermal coupled field analysis. Infrared thermography was used to measure skin temperature during electrical stimulation to verify the computer simulations. We also performed histological analysis to study cell morphology and characterize any resulting tissue damage. The simulation results are accurate for low energy density distributions. It can also be concluded that as long as the specified energy density applied is kept below 0.92 (A2/cm4·s?1), the maximum temperature will remain within the safe limits. Future work should focus on the effects of the electrode paste.
The mechanism and time course of emotional side effects of subthalamic deep brain stimulation in Parkinson's disease are a matter for discussion. We report a 53-month follow-up of a patient with affective lability. Postoperative lesion plus bilateral stimulation strongly influenced mood in the first week in terms of laughing behavior, while voltage changes had only minor long-term impact up to 37 months on negative emotion, possibly caused by the right electrodestimulating the subthalamic nucleus and adjacent fiber tracts involving the internal capsule. Thus we conclude that affective lability can occur with different temporal dynamics of microlesion, and early and chronic stimulation. PMID:21707232
BackgroundThe influence of Parkinson's disease (PD) as well as deep brain stimulation (DBS) on visual-artistic production of people who have been artists is unclear. We systematically assessed the artistic-creative productions of a patient with PD who was referred to us for management of a left subthalamic region (STN) DBS. The patient was an artist before her disease started, permitting us
V. Drago; P. S. Foster; M. S. Okun; F. I. I. Cosentino; R. Conigliaro; I. Haq; A. Sudhyadhom; F. M. Skidmore; K. M. Heilman
The therapy of refractory hypertension is an increasing problem for health care systems and a frontend in research in both pharmacology and neuroelectronic engineering. Overriding the baroreceptive information of afferent nerve fibers, originating from pressure sensors in the aortic arch, can trigger the baroreflex, a systemic control system that lowers the blood pressure (BP) almost instantaneously. Using a multichannel cuff electrode, wrapped around a rat vagal nerve, we were able to regulate the BP using selective, tripolar stimulation. The tripolar stimulation was sufficiently selective to not trigger any unwanted side effects like bradycardia or bradypnea. The BP was reduced best with charge balanced stimulation amplitudes of 1 mA and pulse duration of 0.3 ms. The stimulation frequency had only a mild influence on the effectiveness of the stimulation and did work best at 40 Hz. We found that the BP took up to five times the stimulation period to recover to the value prior to stimulation. PMID:24109797
Plachta, Dennis T T; Gierthmuehlen, Mortimer; Cota, Oscar; Boeser, Fabian; Stieglitz, Thomas
Deep brain stimulation is an effective treatment for different types of dystonia; nevertheless dystonic movements could provoke hardware-related complications, including fractures or electrodes displacement. This study focuses on a morphological and structural analysis of a malfunctioning electrode removed from a dystonic patient. In this case, high impedance values and worsening of symptoms were observed. Scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) were performed on the explanted electrode. The qualitative and quantitative data collected from the damaged electrode were compared with a new electrode, used as a control. The SEM analysis of the damaged electrode revealed fissurations and crack-like forms of the outer jacket tubing, degeneration of the internal core and wires stretching. The EDX analysis permitted to appreciate an increase of chemical elements, especially sodium, suggesting an alteration of the electrode-brain interface. This study shows the qualitative and quantitative alterations of a malfunctioning electrode and, to reduce the rate of hardware-related complications, it suggests the development of more reliable polymers. PMID:23563791
Objective. Clinical deep brain stimulation (DBS) systems can be programmed with thousands of different stimulation parameter combinations (e.g. electrode contact(s), voltage, pulse width, frequency). Our goal was to develop novel computational tools to characterize the effects of stimulation parameter adjustment for DBS. Approach. The volume of tissue activated (VTA) represents a metric used to estimate the spatial extent of DBS for a given parameter setting. Traditional methods for calculating the VTA rely on activation function (AF)-based approaches and tend to overestimate the neural response when stimulation is applied through multiple electrode contacts. Therefore, we created a new method for VTA calculation that relied on artificial neural networks (ANNs). Main results. The ANN-based predictor provides more accurate descriptions of the spatial spread of activation compared to AF-based approaches for monopolar stimulation. In addition, the ANN was able to accurately estimate the VTA in response to multi-contact electrode configurations. Significance. The ANN-based approach may represent a useful method for fast computation of the VTA in situations with limited computational resources, such as a clinical DBS programming application on a tablet computer. PMID:24060691
Chaturvedi, Ashutosh; Luján, J Luis; McIntyre, Cameron C
Objective. Clinical deep brain stimulation (DBS) systems can be programmed with thousands of different stimulation parameter combinations (e.g. electrode contact(s), voltage, pulse width, frequency). Our goal was to develop novel computational tools to characterize the effects of stimulation parameter adjustment for DBS. Approach. The volume of tissue activated (VTA) represents a metric used to estimate the spatial extent of DBS for a given parameter setting. Traditional methods for calculating the VTA rely on activation function (AF)-based approaches and tend to overestimate the neural response when stimulation is applied through multiple electrode contacts. Therefore, we created a new method for VTA calculation that relied on artificial neural networks (ANNs). Main results. The ANN-based predictor provides more accurate descriptions of the spatial spread of activation compared to AF-based approaches for monopolar stimulation. In addition, the ANN was able to accurately estimate the VTA in response to multi-contact electrode configurations. Significance. The ANN-based approach may represent a useful method for fast computation of the VTA in situations with limited computational resources, such as a clinical DBS programming application on a tablet computer.
Chaturvedi, Ashutosh; Luján, J. Luis; McIntyre, Cameron C.
Stimulatingelectrode materials must be capable of supplying high-density electrical charge to effectively activate neural tissue. Platinum is the most commonly used material for neural stimulation. Two other materials have been considered: iridium oxide and titanium nitride. This study directly compared the electrical characteristics of iridium oxide and titanium nitride by fabricating silicon substrate probes that differed only in the material used to form the electrode. Electrochemical measurements indicated that iridium oxide had lower impedance and a higher charge storage capacity than titanium nitride, suggesting better performance as a stimulatingelectrode. Direct measurement of the electrode potential in response to a biphasic current pulse confirmed that iridium oxide uses less voltage to transfer the same amount of charge, therefore using less power. The charge injection limit for titanium nitride was 0.87 mC/cm2, contradicting other reports estimating that titanium nitride was capable of injecting 22 mC/cm2. Iridium oxide charge storage was 4 mC/cm2, which is comparable to other published values for iridium oxide. Electrode efficiency will lead to an overall more efficient and effective device. PMID:12549739
Weiland, James D; Anderson, David J; Humayun, Mark S
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become the surgical therapy of choice for medically intractable Parkinson’s disease. However, quantitative understanding of the interaction between the electric field generated by DBS and the underlying neural tissue is limited. Recently, computational models of varying levels of complexity have been used to study the neural response to DBS. The goal of this study was to evaluate the quantitative impact of incrementally incorporating increasing levels of complexity into computer models of STN DBS. Our analysis focused on the direct activation of experimentally measureable fiber pathways within the internal capsule (IC). Our model system was customized to an STN DBS patient and stimulation thresholds for activation of IC axons were calculated with electric field models that ranged from an electrostatic, homogenous, isotropic model to one that explicitly incorporated the voltage-drop and capacitance of the electrode-electrolyte interface, tissue encapsulation of the electrode, and diffusion-tensor based 3D tissue anisotropy and inhomogeneity. The model predictions were compared to experimental IC activation defined from electromyographic (EMG) recordings from eight different muscle groups in the contralateral arm and leg of the STN DBS patient. Coupled evaluation of the model and experimental data showed that the most realistic predictions of axonal thresholds were achieved with the most detailed model. Furthermore, the more simplistic neurostimulation models substantially overestimated the spatial extent of neural activation.
Chaturvedi, Ashutosh; Butson, Christopher R.; Lempka, Scott F.; Cooper, Scott E.; McIntyre, Cameron C.
For deep brain stimulation (DBS) of the subthalamic nucleus (STN), it would be an advantage if the STN could be visualized with fast acquisition of MR images, allowing direct and individual targeting. We present a protocol for T2-weighted, nonvolumetric fast-acquisition MRI, implemented at 8 centers in 6 countries. Acquisition time varied between 3 min 5 s and 7 min 48
Marwan I. Hariz; Paul Krack; Roger Melvill; Jan V. Jorgensen; Wolfgang Hamel; Hidehiro Hirabayashi; Mathieu Lenders; Nils Wesslen; Magnus Tengvar; Tarek A. Yousry
The links between Stn DBS and advanced Parkinson disease, and between GPi DBS and dystonia are nearly universally accepted by the neurologists and neurosurgeons. Nevertheless, in some conditions, targets such as the ventral thalamus and the Zona Incerta may be considered to optimize the results and avoid the side effects. Positive and negative aspects of current DBS treatments justify the research of new targets, new stimulation programs and new hardware. Since 1993, at the Istituto Nazionale Neurologico "Carlo Besta" in Milan, 580 deep brain electrodes were implanted in 332 patients. 276 patients were affected by movement disorders. The DBS targets included Stn, GPi, Voa, Vop, Vim, CM-pf, cZi, IC. The long-term follow-up is reported and related to the chosen target. DBS gave a new therapeutic option to patients affected by severe movement disorders, and in some cases resolved life-threatening pathological conditions that would otherwise result in the death of the patient, such as in status dystonicus, and post-stroke hemiballismus. Nevertheless, the potential occurrence of severe complications still limit a wider use of DBS. At today, the use of DBS in severe movement disorders is strongly positive even if further investigations and studies are needed to unveil potential new applications, and to refine the selection criteria for the actual indications and targets. The experience of different targets may be useful to guide and tailor the target choice to the individual clinical condition. PMID:21597941
Franzini, Angelo; Cordella, Roberto; Messina, Giuseppe; Marras, Carlo Efisio; Romito, Luigi Michele; Carella, Francesco; Albanese, Alberto; Rizzi, Michele; Nardocci, Nardo; Zorzi, Giovanna; Zekay, Edvin; Broggi, Giovanni
Given the profound negative public health effects of major depressive disorder (MDD), and data suggesting only modest effectiveness of existing psychological and pharmacological treatments for this condition, there has been increasing interest in exploring the antidepressant potential of non-pharmacological, brain-based interventions, such as deep brain stimulation (DBS). The use of the DBS for psychiatric indications follows a decade of data suggesting that DBS is an effective, evidence-based strategy for the treatment of movement disorders such as Parkinson's disease. At the present time there is open-label case series data to suggest that DBS in the subgenual cingulate gyrus, ventral caudate/ventral striatum, and the nucleus accumbens, is associated with antidepressant effects in individuals who fail to respond to conventional treatments for MDD. However a number of unresolved issues about the optimal use of DBS for MDD remain, such as the optimal anatomical placement of the electrodes and the mechanisms of its antidepressant effects. This review summarizes the clinical experience of DBS for treatment resistant depression (TRD). The rationale for the use of DBS for TRD is reviewed in the context of the growing neuroimaging literatures exploring the biomarkers of antidepressant response, and the neural substrates of emotional regulation in both normal and pathological states. PMID:19426730
Giacobbe, Peter; Mayberg, Helen S; Lozano, Andres M
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is efficacious in treating the motor symptoms of Parkinson’s disease (PD). However, the impact of STN-DBS on the progression of PD is unknown. Previous preclinical studies have demonstrated that STN-DBS can attenuate the degeneration of a relatively intact nigrostriatal system from dopamine (DA)-depleting neurotoxins. The present study examined whether STN-DBS can provide neuroprotection in the face of prior significant nigral DA neuron loss similar to PD patients at the time of diagnosis. STN-DBS between two and four weeks after intrastriatal 6-hydroxydopamine (6-OHDA) provided significant sparing of DA neurons in the SN of rats. This effect was not due to inadvertent lesioning of the STN and was dependent upon proper electrode placement. Since STN-DBS appears to have significant neuroprotective properties, initiation of STN-DBS earlier in the course of PD may provide added neuroprotective benefits in addition to its ability to provide symptomatic relief.
Spieles-Engemann, A. L.; Behbehani, M. M.; Collier, T. J.; Wohlgenant, S. L.; Steece-Collier, K.; Paumier, K.; Daley, B. F.; Gombash, S.; Madhavan, L.; Mandybur, G. T.; Lipton, J.W.; Terpstra, B.T.; Sortwell, C.E.
Deep brain stimulation (DBS) in the ventral intermediate nucleus of thalamus (Vim) is known to exert a therapeutic effect on postural and kinetic tremor in patients with essential tremor (ET). For DBS leads implanted near the caudal border of Vim, however, there is an increased likelihood that one will also induce paresthesia side-effects by stimulating neurons within the sensory pathway of the ventral caudal (Vc) nucleus of thalamus. The aim of this computational study was to (1) investigate the neuronal pathways modulated by therapeutic, sub-therapeutic and paresthesia-inducing DBS settings in three patients with ET and (2) determine how much better an outcome could have been achieved had these patients been implanted with a DBS lead containing directionally segmented electrodes (dDBS). Multi-compartment neuron models of the thalamocortical, cerebellothalamic and medial lemniscal pathways were first simulated in the context of patient-specific anatomies, lead placements and programming parameters from three ET patients who had been implanted with Medtronic 3389 DBS leads. The models showed that in these patients, complete suppression of tremor was associated most closely with activating an average of 62% of the cerebellothalamic afferent input into Vim (n = 10), while persistent paresthesias were associated with activating 35% of the medial lemniscal tract input into Vc thalamus (n = 12). The dDBS lead design demonstrated superior targeting of the cerebello-thalamo-cortical pathway, especially in cases of misaligned DBS leads. Given the close proximity of Vim to Vc thalamus, the models suggest that dDBS will enable clinicians to more effectively sculpt current through and around thalamus in order to achieve a more consistent therapeutic effect without inducing side-effects. PMID:22732947
Keane, Maureen; Deyo, Steve; Abosch, Aviva; Bajwa, Jawad A; Johnson, Matthew D
Deep brain stimulation (DBS) in the ventral intermediate nucleus of thalamus (Vim) is known to exert a therapeutic effect on postural and kinetic tremor in patients with essential tremor (ET). For DBS leads implanted near the caudal border of Vim, however, there is an increased likelihood that one will also induce paresthesia side-effects by stimulating neurons within the sensory pathway of the ventral caudal (Vc) nucleus of thalamus. The aim of this computational study was to (1) investigate the neuronal pathways modulated by therapeutic, sub-therapeutic and paresthesia-inducing DBS settings in three patients with ET and (2) determine how much better an outcome could have been achieved had these patients been implanted with a DBS lead containing directionally segmented electrodes (dDBS). Multi-compartment neuron models of the thalamocortical, cerebellothalamic and medial lemniscal pathways were first simulated in the context of patient-specific anatomies, lead placements and programming parameters from three ET patients who had been implanted with Medtronic 3389 DBS leads. The models showed that in these patients, complete suppression of tremor was associated most closely with activating an average of 62% of the cerebellothalamic afferent input into Vim (n = 10), while persistent paresthesias were associated with activating 35% of the medial lemniscal tract input into Vc thalamus (n = 12). The dDBS lead design demonstrated superior targeting of the cerebello-thalamo-cortical pathway, especially in cases of misaligned DBS leads. Given the close proximity of Vim to Vc thalamus, the models suggest that dDBS will enable clinicians to more effectively sculpt current through and around thalamus in order to achieve a more consistent therapeutic effect without inducing side-effects.
Keane, Maureen; Deyo, Steve; Abosch, Aviva; Bajwa, Jawad A.; Johnson, Matthew D.
Iridium oxide films formed by electrochemical activation of iridium metal (AIROF) or by electrochemical deposition (EIROF) are being evaluated as low-impedance charge-injection coatings for neural stimulation and recording. Iridium oxide may also be deposited by reactive sputtering from iridium metal in an oxidizing plasma. The characterization of sputtered iridium oxide films (SIROFs) as coatings for nerve electrodes is reported. SIROFs
Principles of signal transmission in nervous systems are commonly demonstrated in the undergraduate neuroscience laboratory through extracellular recording of nerve and muscle action potentials. Here we describe the construction of a simple suction electrode that we use routinely in our laboratory classes for nerve recording and stimulation.
Bruce R. Johnson, Stephen A. Hauptman, and Robert H. Bonow (Cornell University;)
A high-voltage stimulator has been designed to allow transcutaneous stimulation of tactile fibers of the fingertip. The stimulator's output stage was based upon an improved Howland current pump topology, modified to allow high load impedances and small currents, The compliance voltage of approximately 800 V is achieved using commercially available high-voltage operational amplifiers. The output current accuracy is better than
The delivery of stimulus by a deep brain stimulation (DBS) contact electrode at a particular location may lead to a quantifiable physiologic effect, both intraoperatively and postoperatively. Consequently, measured data values can be attributed to discrete scattered points in neuroanatomic space, allowing for interpolative techniques to generate a topographic map of spatial patterns. Ultimately, by relating the topographies of various
Mahesh B. Shenai; Harrison Walker; Stephanie Guthrie; Ray Watts; Barton L. Guthrie
Objective: The goal of the present study was to evaluate the effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on olfaction in patients with Parkinson’s disease (PD). Methods: 15 patients suffering from sporadic PD-related dysosmia were implanted with bilateral electrodes aimed at the STN. One week before the surgery, odor detection threshold (DT) and identification threshold
The use of DBS is an appealing approach to employing microsampling techniques for the bioanalysis of samples, as has been demonstrated for the past 50 years in the metabolic screening of metabolites and diseases. In addition to its minimally invasive sample collection procedures and its economical merits, DBS microsampling benefits from the very high sensitivity, selectivity and multianalyte capabilities of LC-MS, which has been especially well demonstrated in newborn screening applications. Only a few microliters of a biological fluid are required for analysis, which also translates to significantly reduced demands on clinical samples from patients or from animals. Recently, the pharmaceutical industry and other arenas have begun to explore the utility and practicality of DBS microsampling. This review discusses the basis for why DBS techniques are likely to be part of the future, as well as offering insights into where these benefits may be realized. PMID:24138627
Background: The subthalamic nucleus is the preferred target for deep brain stimulation in patients with advanced Parkinson's disease. The site of permanent stimulation is the subject of ongoing debate, as stimulation both within and adjacent to the subthalamic nucleus may be effective. Objective: To assess the position of active electrode contacts in relation to the dorsal margin of the subthalamic nucleus as determined by intraoperative microrecordings and magnetic resonance imaging (MRI). Methods: In 25 patients suffering from severe levodopa sensitive parkinsonism, deep brain stimulatingelectrodes (n = 49) were implanted following mapping of the subthalamic nucleus by microrecording and microstimulation along five parallel tracks. Postoperative stereotactic radiography and fusion of pre- and postoperative MRI studies were used to determine the stereotactic position relative to the midcommissural point of the most effective electrode contacts selected for permanent stimulation (n = 49). Intraoperative microrecordings were analysed retrospectively to define the dorsal margin of the subthalamic nucleus. In cases where the dorsal margin could be defined in at least three microrecording tracks (n = 37) it was correlated with the position of the active contact using an algorithm developed for direct three dimensional comparisons. Results: Stimulation of the subthalamic nucleus resulted in marked improvement in levodopa sensitive parkinsonian symptoms and levodopa induced dyskinesias, with significant improvement in UPDRS III scores. In several instances, projection of the electrode artefacts onto the T2 weighted MRI visualised subthalamic nucleus of individual patients suggested that the electrodes had passed through the subthalamic nucleus. When the actual position of active electrode contacts (n = 35) was correlated with the dorsal margin of the subthalamic nucleus as defined neurophysiologically, most contacts were located either in proximity (± 1.0 mm) to the dorsal border of the subthalamic nucleus (32.4%) or further dorsal within the subthalamic region (37.8%). The other active contacts (29.7%) were detected within the dorsal (sensorimotor) subthalamic nucleus. The average position of all active contacts (n = 49) was 12.8 mm (± 1.0) lateral, 1.9 mm (± 1.4) posterior, and 1.6 mm (± 2.1) ventral to the midcommissural point. Conclusions: Subthalamic nucleus stimulation appears to be most effective in the border area between the upper subthalamic nucleus (sensorimotor part) and the subthalamic area containing the zona incerta, fields of Forel, and subthalamic nucleus projections.
The inability to track the products of subsurface microbial activity during stimulated bioremediation has limited its implementation. We used spatiotemporal changes in electrodic potentials (EP) to track the onset and persistence of stimulated sulfate-reducing bacteria in a uranium-contaminated aquifer undergoing acetate amendment. Following acetate injection, anomalous voltages approaching -900 mV were measured between copper electrodes within the aquifer sediments and a single reference electrode at the ground surface. Onset of EP anomalies correlated in time with both the accumulation of dissolved sulfide and the removal of uranium from groundwater. The anomalies persisted for 45 days after halting acetate injection. Current-voltage and current-power relationships between measurement and reference electrodes exhibited a galvanic response, with a maximum power density of 10 mW/m2 during sulfate reduction. We infer that the EP anomalies resulted from electrochemical differences between geochemically reduced regions and areas having higher oxidation potential. Following the period of sulfate reduction, EP values ranged from -500 to -600 mV and were associated with elevated concentrations of ferrous iron. Within 10 days of the voltage decrease, uranium concentrations rebounded from 0.2 to 0.8 ?M, a level still below the background value of 1.5 ?M. These findings demonstrate that EP measurements provide an inexpensive and minimally invasive means for monitoring the products of stimulated microbial activity within aquifer sediments and are capable of verifying maintenance of redox conditions favorable for the stability of bioreduced contaminants, such as uranium.
Williams, Kenneth H.; N'guessan, A. Lucie; Druhan, Jennifer; Long, Philip E.; Hubbard, Susan S.; Lovley, Derek R.; Banfield, Jillian F.
Monolayer networks, obtained from murine spinal cord tissue and grown on a matrix of 64 photo-etched, indium-tin oxide (ITO) microelectrodes, can be electrically stimulated through such thin-film recording electrodes. Multichannel coordinated network activity can be evoked and spontaneous network activity can be modified by generation of additional, multichannel bursting. Although single pulses through 1 electrode may trigger network responses, networks generally react best to short trains of pulses. Response thresholds approximate standard physiological strength/duration relationships. Repetitive stimulation trains often generate network activity patterns akin to epileptiform activity. The ITO conductors remain stable for recording under warm saline for long periods of time (maximum test period: 8 months). However, most electrodes show a reduction in impedance after several thousand stimulus pulses. Electrode breakdown in the form of ITO oxidation and loss of light transmittance occurs before hydrolysis is observed but requires a combination of voltage levels and pulse lengths beyond that needed for effective network stimulation. PMID:8107494
Gross, G W; Rhoades, B K; Reust, D L; Schwalm, F U
A significant problem with clinical deep brain stimulation (DBS) is the high variability of its efficacy and the frequency of side effects, related to the spreading of current beyond the anatomical target area. This is the result of the lack of control that current DBS systems offer on the shaping of the electric potential distribution around the electrode. This paper presents a stimulator ASIC with a tripolar current-steering output stage, aiming at achieving more selectivity and field shaping than current DBS systems. The ASIC was fabricated in a 0.35-? m CMOS technology occupying a core area of 0.71 mm(2). It consists of three current sourcing/sinking channels. It is capable of generating square and exponential-decay biphasic current pulses with five different time constants up to 28 ms and delivering up to 1.85 mA of cathodic current, in steps of 4 ?A, from a 12 V power supply. Field shaping was validated by mapping the potential distribution when injecting current pulses through a multicontact DBSelectrode in saline. PMID:23853142
Valente, Virgilio; Demosthenous, Andreas; Bayford, Richard
Purpose To investigate the response properties of the electrically evoked potentials (EEPs) elicited by intraorbital optic nerve stimulation\\u000a with penetrating electrodes using different stimulus parameters.\\u000a \\u000a \\u000a \\u000a Methods Visually evoked potentials (VEPs) were recorded as a control and for comparative purposes. Teflon-coated tungsten wire electrodes\\u000a (100 ?m core-diameter, 300 ?m exposed tip) were inserted intraorbitally into the optic nerve. A charge-balanced biphasic current\\u000a was delivered to
Brain-machine interfaces (BMIs) that can precisely monitor and control neural activity will likely require new hardware with improved resolution and specificity. New nanofabricated electrodes with feature sizes and densities comparable to neural circuits may lead to such improvements. In this perspective, we review the recent development of vertical nanowire (NW) electrodes that could provide highly parallel single-cell recording and stimulation for future BMIs. We compare the advantages of these devices and discuss some of the technical challenges that must be overcome for this technology to become a platform for next-generation closed-loop BMIs. PMID:23486552
Robinson, Jacob T; Jorgolli, Marsela; Park, Hongkun
A clinically effective retinal prosthesis must evoke localized phosphenes in a retinotopic manner in response to stimulation of each of the retinal electrodes, evoke brightness cues over a wide dynamic range and function within safe stimulus limits. The effects of varying return configuration for retinal stimulation are currently unknown. To investigate this, we implanted a flexible, 7 × 12 electrode array into the suprachoroidal space of normally-sighted, anesthetized cats. Multi-unit activity in the primary visual cortex was recorded in response to electrical stimulation using various return configurations: monopolar vitreous (MPV), common ground (CG), hexagonal (HX), monopolar remote (MPR) and bipolar (BP_N). MPV stimulation was found to be the most charge efficient and was most likely to induce cortical activity within safe charge limits. HX and CG stimulation were found to exhibit greater retinal selectivity compared to the MPV return at the expense of lower cortical yield and higher P50 charge levels, while cortical selectivity was unaffected by choice of return. Responses using MPR and widely spaced BP_N configurations were similar to those using the MPV return. These results suggest that choice of return configuration for a retinal prosthesis will be balanced between resolution and stimulation within safe charge limits. PMID:22595310
Cicione, Rosemary; Shivdasani, Mohit N; Fallon, James B; Luu, Chi D; Allen, Penny J; Rathbone, Graeme D; Shepherd, Robert K; Williams, Chris E
During multimicroelectrode stimulation within the cat L6 spinal cord, the number of electrodes activated, their separation distance, and the stimulus interleave time all influenced isometric knee joint extension torque. The torque evoked by stimulation with a three electrode combination could be enhanced or suppressed when compared with that evoked by single or paired electrodestimulation. A similar difference was noted
Changfeng Tai; August M. Booth; Charles J. Robinson; William C. de Groat; James R. Roppolo
This study describes a method for optimizing selective stimulus parameters for multi-contact peripheral electrodes. Overlap between pairs of contacts is quantified by the deviation in their combined response from linear addition of their individual responses. Mathematical models are fit to recruitment and overlap data, and a cost function is defined to maximize recruitment and minimize overlap between all contacts. Results are presented for two four-contact nerve-cuff electrodesstimulating bilateral femoral nerves of one human subject with spinal cord injury. Knee extension moments between 11.6 and 17.2 Nm are achieved through two contacts of each nerve-cuff with less than 10% overlap between each pair of contacts. These results suggest that optimization can provide an automated means of determining stimulus parameters to achieve strong, selective muscle contractions through multi-contact peripheral nerve electrodes. PMID:22254980
Fisher, Lee E; Anderson, James S; Tyler, Dustin J; Triolo, Ronald J
This paper provides a theoretical assessment of the safety considerations encountered in the simultaneous use of transcranial magnetic stimulation (TMS) and neurological interventions involving implanted metallic electrodes, such as electrocorticography. Metal implants are subject to magnetic forces due to fast alternating magnetic fields produced by the TMS coil. The question of whether the mechanical movement of the implants leads to irreversible damage of brain tissue is addressed by an electromagnetic simulation which quantifies the magnitude of imposed magnetic forces. The assessment is followed by a careful mechanical analysis determining the maximum tolerable force which does not cause irreversible tissue damage. Results of this investigation provide useful information on the range of TMS stimulator output powers which can be safely used in patients having metallic implants. It is shown that conventional TMS applications can be considered safe when applied on patients with typical electrode implants as the induced stress in the brain tissue remains well below the limit of tissue damage.
Golestanirad, Laleh; Rouhani, Hossein; Elahi, Behzad; Shahim, Kamal; Chen, Robert; Mosig, Juan R.; Pollo, Claudio; Graham, Simon J.
Smaller, more charge-intensive electrodes are needed for "safe" stimulation of the nervous system. In this paper we review critical concepts and the state of the art in electrodes. Control of charge density and charge balance are essential to avoid tissue electrolysis. Chemical criteria for "safe" stimulation are reviewed ("safe" is equated with "chemically reversible"). An example of a safe, but generally impractical, charge-injection process is double-layer charging. The limit here is the onset of irreversible faradaic processes. More charge can be safely injected with so-called "capacitor" electrodes, such as porous intermixtures of Ta/Ta2O5. BaTiO3 has excellent dielectric properties and may provide a new generation of capacitor electrodes. Faradaic charge injection is usually partially irreversible since some of the products escape into the solution. With Pt, up to 400 muc/cm2 real area can be absorbed by faradaic reactions of surface-adsorbed species, but a small part is lost due to metal dissolution. The surface of "activated" Ir is covered with a multilayer hydrated oxide. Charge injection occurs via rapid valence change within this oxide. Little or no metal dissolution is observed, and gassing limits are not exceeded even under stringent conditions. PMID:6575640
The response of cardiac tissue to strong electric fields is determined by 3-D cable properties, bidomain anisotropy, nonlinearities, and, most importantly, heterogeneities. Langrill and Roth (IEEE Trans. BME. 48:1207 (2001)) numerically studied the effect of a plunge electrode and found alternating regions of hyperpolarization and depolarization around the electrode in response to field shock. We sought to experimentally verify their results by using field stimulation and optical imaging of di-4-ANEPPS stained rabbit right ventricles with an insulated needle serving as a plunge electrode/heterogeneity. The experimental and numerical results agree qualitatively. The key discrepancy is the larger spatial extent of the polarization in the experimental data. The combination of transmural fiber rotation and fluorescence averaging over depth may cause the spatial scale to be larger than was predicted numerically. Because adjacent regions of opposite polarization are potential sources of wave front generation, our results suggest that plunge electrodes or similar-sized heterogeneities may play a role in far-field stimulation.
Wikswo, J.; Woods, M.; Sidorov, V.; Langrill, D.; Roth, B.
A comparative study of 5 different designs of nerve cuff electrodes was undertaken to determine their relative merits for stimulating and recording whole-nerve activity over extended periods of chronic implantation on large and small peripheral nerves in 8 cats. Four of the designs represent novel fabrication strategies, including 2 based on flexible, thin-film substrates and 2 based on dip-coating silicone
A non-invasive method was developed to determine the input-output (IO) properties of peripheral nerve stimulatingelectrodes. An apparatus was fabricated to measure the 3-dimensional (3-D) isometric torque generated at the cat ankle joint by electrical activation of the sciatic nerve. The performance of the apparatus was quantified, and the utility of the method was demonstrated by measuring the recruitment properties
In order to study the underlying electrode-nerve functional mechanism, optimize the electrode design and guide the prosthesis application, we applied finite element method to analyze the spatial distribution of electric field generated by optic nerve electrical stimulation with spiral cuff electrode. A macroscopic cylindrical model of optic nerve was elaborated, taking into account of electrode contact configurations and possible variations of the thickness of cerebrospinal fluid (CSF). By building an appropriate mesh on this model and under some boundary conditions, the finite element method was applied to compute the 3D electric field generated by the electrode with finite element software COMSOL Multiphysics. The stimulation results indicated that, under the same conditions of stimulation, the longitudinal tripolar electrode structure could generate larger current density than that of biopolar electrode structure (located in the opposite of nerve trunk). However biopolar electrode structure requirs less leads, and is more easily implanted. By means of parametric sweep, the results suggest that, with the increase of the CSF thickness and a higher conductivity of CSF than those of other tissues, the distribution of electric field generated by electrodes is extended but scattered, and the diffuse current distribution makes nerve stimulation less effective. PMID:23198414
Objective: Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson disease (PD). Following STN-DBS, speech intelligibility can deteriorate, limiting its beneficial effect. Here we prospectively examined the short- and long-term speech response to STN-DBS in a consecutive series of patients to identify clinical and surgical factors associated with speech change. Methods: Thirty-two consecutive patients were assessed before surgery, then 1 month, 6 months, and 1 year after STN-DBS in 4 conditions on- and off-medication with on- and off-stimulation using established and validated speech and movement scales. Fifteen of these patients were followed up for 3 years. A control group of 12 patients with PD were followed up for 1 year. Results: Within the surgical group, speech intelligibility significantly deteriorated by an average of 14.2% ± 20.15% off-medication and 16.9% ± 21.8% on-medication 1 year after STN-DBS. The medical group deteriorated by 3.6% ± 5.5% and 4.5% ± 8.8%, respectively. Seven patients showed speech amelioration after surgery. Loudness increased significantly in all tasks with stimulation. A less severe preoperative on-medication motor score was associated with a more favorable speech response to STN-DBS after 1 year. Medially located electrodes on the left STN were associated with a significantly higher risk of speech deterioration than electrodes within the nucleus. There was a strong relationship between high voltage in the left electrode and poor speech outcome at 1 year. Conclusion: The effect of STN-DBS on speech is variable and multifactorial, with most patients exhibiting decline of speech intelligibility. Both medical and surgical issues contribute to deterioration of speech in STN-DBS patients. Classification of evidence: This study provides Class III evidence that STN-DBS for PD results in deterioration in speech intelligibility in all combinations of medication and stimulation states at 1 month, 6 months, and 1 year compared to baseline and to control subjects treated with best medical therapy.
Zrinzo, L.; Martinez-Torres, I.; Frost, E.; Pinto, S.; Foltynie, T.; Holl, E.; Petersen, E.; Roughton, M.; Hariz, M.I.; Limousin, P.
For the last century, many neuroscientists around the world have dedicated their lives to understanding how neuronal networks work and why they stop working in various diseases. Studies have included neuropathological observation, fluorescent microscopy with genetic labeling, and intracellular recording in both dissociated neurons and slice preparations. This protocol discusses another technology, which involves growing dissociated neuronal cultures on micro-electrode arrays (also called multi-electrode arrays, MEAs). There are multiple advantages to using this system over other technologies. Dissociated neuronal cultures on MEAs provide a simplified model in which network activity can be manipulated with electrical stimulation sequences through the array's multiple electrodes. Because the network is small, the impact of stimulation is limited to observable areas, which is not the case in intact preparations. The cells grow in a monolayer making changes in morphology easy to monitor with various imaging techniques. Finally, cultures on MEAs can survive for over a year in vitro which removes any clear time limitations inherent with other culturing techniques.1 Our lab and others around the globe are utilizing this technology to ask important questions about neuronal networks. The purpose of this protocol is to provide the necessary information for setting up, caring for, recording from and electrically stimulating cultures on MEAs. In vitro networks provide a means for asking physiologically relevant questions at the network and cellular levels leading to a better understanding of brain function and dysfunction.
Hales, Chadwick M.; Rolston, John D.; Potter, Steve M.
Background. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is one of the standard surgical treatments for advanced Parkinson's disease. However, it has been difficult to accurately localize the stimulated contact area of the electrode in the subthalamic nucleus and its adjacent structures using a two-dimensional atlas. The goal of this study is to verify the real and detailed localization of stimulated contact of the DBSelectrode therapeutically inserted into the STN and its adjacent structures using a novel computed three-dimensional atlas built by a personal computer. Method. A three-dimensional atlas of the STN and its adjacent structures (3D-Subthalamus atlas) was elaborated on the basis of sagittal slices from the Schaltenbrand and Wahren stereotactic atlas on a personal computer utilizing a commercial software. The electrode inserted into the STN and its adjacent structures was superimposed on our 3D-Subthalamus atlas based on intraoperative third ventriculography in 11 cases. Findings. Accurate localization of the DBSelectrode was identified using the 3D-Subthalamus atlas, and its clinical efficacy of the electrodestimulation was investigated in all 11 cases. Conclusion. This study demonstrates that the 3D-Subthalamus atlas is a useful tool for understanding the morphology of deep brain structures and for the precise anatomical position findings of the stimulated contact of a DBSelectrode. The clinical analysis using the 3D atlas supports the contention that the stimulation of structures adjacent to the STN, particularly the zona incerta or the field of Forel H, is as effective as the stimulation of the STN itself for the treatment of advanced Parkinson's disease. PMID:22389840
We demonstrate the efficacy of amorphous macroporous carbon substrates as electrodes to support neuronal cell proliferation and differentiation in electric field mediated culture conditions. The electric field was applied perpendicular to carbon substrate electrode, while growing mouse neuroblastoma (N2a) cells in vitro. The placement of the second electrode outside of the cell culture medium allows the investigation of cell response to electric field without the concurrent complexities of submerged electrodes such as potentially toxic electrode reactions, electro-kinetic flows and charge transfer (electrical current) in the cell medium. The macroporous carbon electrodes are uniquely characterized by a higher specific charge storage capacity (0.2 mC/cm(2)) and low impedance (3.3 k? at 1 kHz). The optimal window of electric field stimulation for better cell viability and neurite outgrowth is established. When a uniform or a gradient electric field was applied perpendicular to the amorphous carbon substrate, it was found that the N2a cell viability and neurite length were higher at low electric field strengths (?2.5 V/cm) compared to that measured without an applied field (0 V/cm). While the cell viability was assessed by two complementary biochemical assays (MTT and LDH), the differentiation was studied by indirect immunostaining. Overall, the results of the present study unambiguously establish the uniform/gradient vertical electric field based culture protocol to either enhance or to restrict neurite outgrowth respectively at lower or higher field strengths, when neuroblastoma cells are cultured on porous glassy carbon electrodes having a desired combination of electrochemical properties. PMID:24034501
Deep brain stimulation of the posterior hypothalamus is a therapeutic approach to the treatment of refractory chronic cluster headache, but the precise anatomical location of the electrode contacts has not been clearly assessed. Our aim was to study the location of the contacts used for chronic stimulation, projecting each contact centre on anatomic atlases. Electrodes were implanted in a series of 10 patients (prospective controlled trial) in the so-called 'posteroinferior hypothalamus' according to previously described coordinates, i.e. 2 mm lateral, 3 mm posterior and 5 mm below the mid-commissural point. The coordinates of the centre of each stimulating contact were measured on postoperative computed tomography or magnetic resonance imaging scans, taking into account the artefact of the electrode. Each contact centre (n=10; left and right hemispheres pooled) was displayed on the Schaltenbrand atlas and a stereotactic three dimensional magnetic resonance imaging atlas (4.7 tesla) of the diencephalon-mesencephalic junction for accurate anatomical location. Of the 10 patients with 1-year follow-up, 5 responded to deep brain stimulation (weekly frequency of attacks decrease >50%). In responders, the mean (standard deviation) coordinates of the contacts were 2.98 (1.16) mm lateral, 3.53 (1.97) mm posterior and 3.31 (1.97) mm below the mid-commissural point. All the effective contacts were located posterior to the hypothalamus. In responders, structures located <2 mm from the centres of effective contacts were: the mesencephalic grey substance (5/5), the red nucleus (4/5), the fascicle retroflexus (4/5), the fascicle longitudinal dorsal (3/5), the nucleus of ansa lenticularis (3/5), the fascicle longitudinal medial (1/5) and the thalamus superficialis medial (1/5). The contact coordinates (Wilcoxon test) and the structures (Fisher's exact test) were not significantly different between responders and non-responders. These findings suggest that failure of deep brain stimulation treatment in cluster headache may be due to factors unrelated to electrode misplacement. They also suggest that the therapeutic effect is probably not related to direct hypothalamic stimulation. Deep brain stimulation might modulate either a local cluster headache generator, located in the hypothalamus or in the mesencephalic grey substance, or non-specific anti-nocioceptive systems. PMID:20237130
Fontaine, Denys; Lanteri-Minet, Michel; Ouchchane, Lemlih; Lazorthes, Yves; Mertens, Patrick; Blond, Serge; Geraud, G; Fabre, Nelly; Navez, Malou; Lucas, Christian; Dubois, Francois; Sol, Jean Christophe; Paquis, Philippe; Lemaire, Jean Jacques
Background Thalamic deep brain stimulation (DBS) is proven therapy for essential tremor, Parkinson's disease, and Tourette's Syndrome. We tested the hypothesis that high-frequency electrical stimulation results in local thalamic glutamate release. Methods Enzyme-linked glutamate amperometric biosensors were implanted in anesthetized rat thalamus adjacent to the stimulatingelectrode. Electrical stimulation was delivered to investigate the effect of frequency, pulse width, voltage-controlled or current-controlled stimulation, and charge balancing. Results Monophasic electrical stimulation-induced glutamate release was linearly dependent on stimulation frequency, intensity and pulse width. Prolonged stimulation evoked glutamate release to a plateau that subsequently decayed back to baseline after stimulation. Glutamate release was less pronounced with voltage-controlled stimulation and not present with charge balanced current-controlled stimulation. Conclusions Using fixed potential amperometry in combination with a glutamate bioprobe and adjacent microstimulating electrode, the present study has shown that monophasic current-controlled stimulation of the thalamus in the anesthetized rat evoked linear increases in local extracellular glutamate concentrations that were dependent on stimulation duration, frequency, intensity, and pulse width. However, the efficacy of monophasic voltage-controlled stimulation, in terms of evoking glutamate release in the thalamus, was substantially lower compared to monophasic current-controlled stimulation and entirely absent with biphasic (charge balanced) current-controlled stimulation. It remains to be determined whether similar glutamate release occurs with human DBSelectrodes and similar charge balanced stimulation. As such, the present results indicate the importance of evaluating local neurotransmitter dynamics in studying the mechanism of action of DBS.
Agnesi, Filippo; Blaha, Charles D.; Lin, Jessica; Lee, Kendall H.
Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) is an effective therapy option for controlling the motor symptoms of medication-refractory Parkinson's disease and dystonia. Despite the clinical successes of GPi DBS, the precise therapeutic mechanisms are unclear and questions remain on the optimal electrode placement and stimulation parameter selection strategies. In this study, we developed a three-dimensional computational model of GPi-DBS in nonhuman primates to investigate how membrane channel dynamics, synaptic inputs, and axonal collateralization contribute to the neural responses generated during stimulation. We focused our analysis on three general neural elements that surround GPi-DBSelectrodes: GPi somatodendritic segments, GPi efferent axons, and globus pallidus pars externa (GPe) fibers of passage. During high-frequency electrical stimulation (136 Hz), somatic activity in the GPi showed interpulse excitatory phases at 1–3 and 4–5.5 ms. When including stimulation-induced GABAA and AMPA receptor dynamics into the model, the somatic firing patterns continued to be entrained to the stimulation, but the overall firing rate was reduced (78.7 to 25.0 Hz, P < 0.001). In contrast, axonal output from GPi neurons remained largely time-locked to each pulse of the stimulation train. Similar entrainment was also observed in GPe efferents, a majority of which have been shown to project through GPi en route to the subthalamic nucleus. The models suggest that pallidal DBS may have broader network effects than previously realized and the modes of therapy may depend on the relative proportion of GPi and/or GPe efferents that are directly affected by the stimulation.
We conducted a retrospective analysis of long-term results of deep brain stimulation (DBS) for the treatment of neuropathic pain. Twenty-one patients had electrodes implanted in the ventrocaudalis thalamic nucleus (Vc) (n=13) or in both Vc and periaqueductal\\/periventricular gray matter (PAG\\/PVG) (n=8). After insertion of the electrodes, 9 patients (43%) had a substantial reduction in pain scores in the absence of
Clement Hamani; Jason M. Schwalb; Ali R. Rezai; Jonathan O. Dostrovsky; Karen D. Davis; Andres M. Lozano
OBJECTIVES: Occipital nerve stimulation (ONS), an established treatment for medically intractable headache syndromes, has lead migration rates quoted up to 24%. In a series of patients with ideal characteristics for this treatment modality, we describe an operative technique for ONS involving the novel use of narrow paddle electrodes: "S8 Lamitrode" (St. Jude Medical [SJM], St. Paul, MN, USA). MATERIALS AND METHODS: Five patients (occipital neuralgia [ON]?=?4; chronic migraine [CM]?=?1) were treated with ONS between 2010 and 2011. All patients had a successful trial of peripheral neurostimulation (Algotec Ltd, Crawley, UK) therapy. Operative technique involved the use of a park-bench position, allowing simultaneous exposure of the occipital and infraclavicular regions. Through a retromastoid/occipital incision just beneath the external occipital protruberance, exposing the extrafascial plane, the S8 Lamitrode is implanted to intersect both greater occipital nerves for bilateral pain or unilateral greater and lesser occipital nerves for unilateral ON or with significant component of the pain relating to the lesser occipital nerve. RESULTS: Over the median follow-up of 12 months, there were no episodes of lead migration or revision. There also was significant improvement in symptoms in all patients. CONCLUSIONS: This is the first reported use of S8 Lamitrode electrode for ONS. This narrow electrode is suited for this role leading to minimal trauma during surgical placement, facilitates resolution of problems with lead migration, and optimizes effect with stimulation focused more in direction of the occipital nerves without skin involvement. To date, the SJM Genesis neurostimulation system, with percutaneous electrodes only, is CE mark approved in Europe for peripheral nerve stimulation of the occipital nerves for the management of pain and disability for patients diagnosed with intractable CM. Further developments and studies are required for better devices to suit ONS, thereby avoiding frequently encountered problems and which may clarify the role of paddle leads in ONS. PMID:23106950
Abhinav, Kumar; Park, Nicholas D; Prakash, Savithru K; Love-Jones, Sarah; Patel, Nikunj K
Several multi-electrode array devices integrating planar metal electrodes were designed in the past 30 years for extracellular stimulation and recording from cultured neuronal cells and organotypic brain slices. However, these devices are not well suited for recordings from acute brain slice preparations due to a dead cell layer at the tissue slice border that appears during the cutting procedure. To
Marc Olivier Heuschkel; Michael Fejtl; Mario Raggenbass; Daniel Bertrand; Philippe Renaud
Trans-radial amputee subjects were implanted with intrafascicular electrodes in the stumps of the median and ulnar nerves. Electrical stimulation through these electrodes was used to provide sensations of touch and finger position referred to the amputated hand. Two subjects were asked to identify different ob- jects as to size and stiffness by manipulating them with a myo-elec- tric hand without
Kenneth Horch; Sanford Meek; Tyson G. Taylor; Douglas T. Hutchinson
A chronically implantable electrode design permitting alternate extracellular nerve recording and axon stimulation in freely behaving crayfish was developed. The electrode consists of a double hook made from 20 ?m thin platinum wire that can be fitted to various nerve diameters, and is easily implantable. A fast curing, flexible two-component silicone was used for insulation. The double hook was connected
Purpose Intraoperative neuromonitoring has the limitation that the recurrent laryngeal nerve (RLN) is still at risk for damage between\\u000a two stimulations with a handheld bipolar stimulationelectrode. The purpose of this study was to establish the vagal anchor\\u000a electrode for real-time monitoring of the RLN in surgical routine and to be alerted to imminent nerve failure by electromyography\\u000a (EMG) signal analysis
Rick Schneider; Joanna Przybyl; Michael Hermann; Johann Hauss; Sven Jonas; Steffen Leinung
In late 1980, a request was made for approval of a direct broadcast satellite (DBS) system. The considered DBS system is to provide nationwide pay-television service on a subscription basis. The system proposed in the application to the Federal Communications Commission would provide three channels of television, using four three-channel satellites. Attention is given to the system configuration, system tradeoffs, a plan of the 1983 Regional Administrative Radio Conference, orbit locations and channel frequencies, satellite status, home equipment status, advanced concepts, and the status of the Las Vegas Broadcast Complex. AIAA Paper 84-0664
Planar extracellular electrode arrays provide a non-toxic, non-invasive method of making long-term, multisite recordings with moderately high spatial frequency (recording sites per unit area). This paper reports advances in the use of this approach to record from and stimulate single identified leech neurons in vitro. A modified enzyme treatment allowed identified neurons to be extracted with very long processes. Multisite extracellular recordings from the processes of such isolated neurons revealed both the velocity and direction of action potential propagation. Propagation in two cell types examined was from the broken stump towards the cell body (antidromic). This was true for spontaneous action potentials, action potentials produced by injecting current into the cell body and extracellular stimulation of the extracted process via a planar extracellular electrode. These results extend previous findings which have shown that the tip of the broken stump of extracted neurons has a high density of voltage-activated sodium channels. Moreover they demonstrate the applicability of extracellular electrode arrays for recording the electrical excitability of single cells. PMID:7990507
Wilson, R J; Breckenridge, L; Blackshaw, S E; Connolly, P; Dow, J A; Curtis, A S; Wilkinson, C D
Biopotential electrodes are conductive materials that convert electronic currents to or from ionic currents for sensing, and stimulating specific tissue sites for medical applications. Implanted electrodes become "walled off" by the foreign body tissue reactions producing poorly attached scar capsules dominated by surrounding dense collagenous lamellae and source fibroblasts which are electrically resistive. The conductive interstitial fluid that is typical between an electrode and the resistive capsule allows spurious current paths. The insulating layer increases the distance between the electrode and the target sites and poor attachment often results in electrode migration within the host tissue. This investigation tested the hypothesis that surface-energy modulation of electrodes, via Radio Frequency Glow Discharge Treatment (RFGDT), can improve the performance of tissue-implantable electrodes by reducing the foreign body tissue reaction and enhancing interfacial bonding between the tissue and electrode material. Previously published findings were reproduced in a pilot study of explanted reference grade medical-grade methyl silicone (PDMS) and commercially pure titanium (cpTi) materials and their tissue capsules from 30-day subcutaneous exposures in Balb/C mice. The low-critical surface tension PDMS produced thick, dense, poorly attached scar capsules while the higher-surface-energy commercially pure titanium (cpTi) produced more cellular and strongly attached tissue layers difficult to delaminate from the biomaterial. For the main body of work, cpTi, capacitor-grade Tantalum (Ta), and synthetic heart valve-quality Pyrolytic Carbon (PyC) were evaluated, representative of potential high-surface-energy implant electrode materials. Their surface characteristics were determined as-manufactured and after Radio Frequency Glow Discharge Treatment (RFGDT) by Critical Surface Tension (CST) measurement, Scanning Electron Microscopy (SEM), Energy Dispersive X-Ray Spectroscopy (EDS), and Electron Spectroscopy for Chemical Analysis (ESCA). Representative tissue/electrode interfaces were created through subcutaneous implantation and harvest from Balb/C mice after 7, 28 and 56 days. The recovered, formalin preserved conductive implant/tissue specimens were examined by Electrical Impedance Spectroscopy (EIS) over the range from 0.1 Hz to 100,000 Hz, in Bode plot and Nyquist plot formats. After EIS the implants were extracted from the tissue for surface examination by SEM and the separated tissue capsules were evaluated by histological examination in hematoxylin and eosin (H&E)-stained light microscopic thin sections. The differential findings were that the RFGDT PyC and Ta implants had significantly increased interface resistance and capacitance over their sterilized-only controls, correlating with more flattened cellular layers retained on the RFGDT specimens. The cpTi specimens, earlier identified as promoting hard tissue-to-surface integration in dental implants, showed only marginal improvements in soft tissue attachment following RFGDT. These experimental findings were confirmed through equivalent circuit modeling by the conversion from a standard Randles model with constant phase elements, which described the pre-implant materials, to a modified Randles model with additional resistance and capacitance to describe the implants with well-integrated surface coatings. Future work with RFGDT-modified electrode materials must include actual signal acquisition/stimulation trials in implant host tissues, to assess possible improvements in electrical energy-transfer efficiency and battery lifetime extensions.
In this paper, we describe adding constraints to the Direct Binary Search (DBS) algorithm. An example of a useful constraint, illustrated in this paper, is having only one dot per column and row. DBS with such constraints requires greater than two toggles during each trial operation. Implementations of the DBS algorithm traditionally limit operations to either one toggle or swap during each trial. The example case in this paper produces a wrap-around pattern with uniformly distributed ON pixels which will have a pleasing appearance with precisely one ON pixel per each column and row. The algorithm starts with an initial continuous tone image and an initial pattern having only one ON pixel per column and row. The auto correlation function of Human Visual System (HVS) model is determined along with an initial perceived error. Multiple operation pixel error processing during each iteration is used to enforce the one ON pixel per column and row constraint. The constraint of a single ON pixel per column and row is used as an example in this paper. Further modification of the DBS algorithm for other constraints is possible, based on the details given in the paper. A mathematical framework to extend the algorithm to the more general case of Direct Multi-bit Search (DMS) is presented.
Chandu, Kartheek; Stanich, Mikel; Wu, Chai Wah; Trager, Barry
Background: A patient controller (PC) is an optional device for patients with deep brain stimulation (DBS) to have limited control of their stimulator system. Objectives: We investigated the impact of a PC on DBS safety, most notably the handling\\/prevention of unexpected DBS failure in patients with Parkinson’s disease (PD). Methods: PD patients with subthalamic DBS were educated in the use
Niels Allert; Caroline Mehnert; Ralph Lehrke; Mohammed Maarouf; Volker Sturm
The selection of a suitable nerve electrode for neuroprosthetic applications implies a trade-off between invasiveness and selectivity, wherein the ultimate goal is achieving the highest selectivity for a high number of nerve fascicles by the least invasiveness and potential damage to the nerve. The transverse intrafascicular multichannel electrode (TIME) is intended to be transversally inserted into the peripheral nerve and to be useful to selectively activate subsets of axons in different fascicles within the same nerve. We present a comparative study of TIME, LIFE and multipolar cuff electrodes for the selective stimulation of small nerves. The electrodes were implanted on the rat sciatic nerve, and the activation of gastrocnemius, plantar and tibialis anterior muscles was recorded by EMG signals. Thus, the study allowed us to ascertain the selectivity of stimulation at the interfascicular and also at the intrafascicular level. The results of this study indicate that (1) intrafascicular electrodes (LIFE and TIME) provide excitation circumscribed to the implanted fascicle, whereas extraneural electrodes (cuffs) predominantly excite nerve fascicles located superficially; (2) the minimum threshold for muscle activation with TIME and LIFE was significantly lower than with cuff electrodes; (3) TIME allowed us to selectively activate the three tested muscles when stimulating through different active sites of one device, both at inter- and intrafascicular levels, whereas selective activation using multipolar cuff (with a longitudinal tripolar stimulation configuration) was only possible for two muscles, at the interfascicular level, and LIFE did not activate selectively more than one muscle in the implanted nerve fascicle. PMID:21558601
In recent years there has been significant growth in the use of patient-specific models to predict the effects of neuromodulation therapies such as deep brain stimulation (DBS). However, translating these models from a research environment to the everyday clinical workflow has been a challenge, primarily due to the complexity of the models and the expertise required in specialized visualization software. In this paper, we deploy the interactive visualization system ImageVis3D Mobile, which has been designed for mobile computing devices such as the iPhone or iPad, in an evaluation environment to visualize models of Parkinson’s disease patients who received DBS therapy. Selection of DBS settings is a significant clinical challenge that requires repeated revisions to achieve optimal therapeutic response, and is often performed without any visual representation of the stimulation system in the patient. We used ImageVis3D Mobile to provide models to movement disorders clinicians and asked them to use the software to determine: 1) which of the four DBSelectrode contacts they would select for therapy; and 2) what stimulation settings they would choose. We compared the stimulation protocol chosen from the software versus the stimulation protocol that was chosen via clinical practice (independently of the study). Lastly, we compared the amount of time required to reach these settings using the software versus the time required through standard practice. We found that the stimulation settings chosen using ImageVis3D Mobile were similar to those used in standard of care, but were selected in drastically less time. We show how our visualization system, available directly at the point of care on a device familiar to the clinician, can be used to guide clinical decision making for selection of DBS settings. In our view, the positive impact of the system could also translate to areas other than DBS.
...and agree to their DBS system receiving MVDDS...signal levels from its system, under its deployment...calculations, terrain and building structure characteristics...provide the following information to the DBS licensee...transmitting antenna system; (iii) Height...
Iridium was sputtered as the top layer of stimulationelectrodes. The coatings were varied in their morphology by adjusting the total deposition pressure and the working distance (WD) of target and substrate. It is shown that the resulting different kinds of morphologies have a strong influence on stimulation characteristics. The combination of high working gas pressure and small WD as
Boerge Wessling; André van Ooyen; Wilfried Mokwa; Uwe Schnakenberg
Transcutaneous electrical stimulation is applied in a range of biomedical applications including Transcranial Direct Current Stimulation (tDCS). tDCS is a non-invasive procedure where a weak direct current (<2 mA) is applied across the scalp to modulate brain function. High-Definition tDCS (HD-tDCS) is a technique used to increase the spatial focality of tDCS by passing current across the scalp using <12 mm diameter electrodes. The purpose of this study was to design and optimize “high-definition” electrode-gel parameters for electrode durability, skin safety, and subjective pain. Anode and cathode electrode potential, temperature, pH, and subjective sensation over time were assessed during application of 2 mA direct current, for up to 22 minutes on agar gel or subject forearms. A selection of 5 types of solid-conductors (Ag pellet, Ag/AgCl pellet, Rubber pellet, Ag/AgCl ring, and Ag/AgCl disc) and 7 conductive gels (Signa, Spectra, Tensive, Redux, BioGel, Lectron, and CCNY-4) were investigated. The Ag/AgCl ring in combination with CCNY-4 gel resulted in the most favorable outcomes. Under anode stimulations, electrode potential and temperature rises were generally observed in all electrode-gel combinations except for Ag/AgCl ring and disc electrodes. pH remained constant for all solid-conductors except for both Ag and Rubber pellet electrodes with Signa and CCNY-4 gels. Sensation ratings were independent of stimulation polarity. Ag/AgCl ring electrodes were found to be the most comfortable followed by Ag, Rubber, and Ag/AgCl pellet electrodes across all gels.
Due to its low electric conductivity, the skull has a major impact on the electric field distribution in the brain in transcranial current stimulation (tCS). However, the skull has several openings that are filled with higher conductivity soft tissues, and through which a significant fraction of the injected current may pass. We show that current entering the brain via the orbital openings increases the electric field intensity in the cortical regions near the orbit. Furthermore, this depends on the how far electrodes are placed from the orbital openings. PMID:23366021
Mekonnen, A; Salvador, R; Ruffini, G; Miranda, P C
...2009-10-01 false MVDDS protection of DBS. 101.1440 Section 101.1440 Telecommunication...Band Â§ 101.1440 MVDDS protection of DBS. (a) An MVDDS licensee shall not...EPFD from its transmitting antenna at all DBS customers of record locations is...
...2010-10-01 false MVDDS protection of DBS. 101.1440 Section 101.1440 Telecommunication...Band Â§ 101.1440 MVDDS protection of DBS. (a) An MVDDS licensee shall not...EPFD from its transmitting antenna at all DBS customers of record locations is...
Consonant recognition was measured as a function of the number of stimulation channels for Hybrid short-electrode cochlear implant (CI) users, long-electrode CI users, and normal-hearing (NH) listeners in quiet and background noise. Short-electrode CI subjects were tested with 1-6 channels allocated to a frequency range of 1063-7938 Hz. Long-electrode CI subjects were tested with 1-6, 8, or 22 channels allocated to 188-7938 Hz, or 1-6 or 15 channels from the basal 15 electrodes allocated to 1063-7938 Hz. NH listeners were tested with simulations of each CI group/condition. Despite differences in intracochlear electrode spacing for equivalent channel conditions, all CI subject groups performed similarly at each channel condition and improved up to at least four channels in quiet and noise. All CI subject groups underperformed relative to NH subjects. These preliminary findings suggest that the limited channel benefit seen for CI users may not be due solely to increases in channel interactions as a function of electrode density. Other factors such as pre-operative patient history, location of stimulation in the base versus apex, or a limit on the number of electric channels that can be processed cognitively, may also interact with the effects of electrode contact spacing along the cochlea. PMID:23145621
Reiss, Lina A J; Turner, Christopher W; Karsten, Sue A; Erenberg, Sheryl R; Taylor, Jessica; Gantz, Bruce J
A novel, anatomically-accurate model of a tibialis anterior muscle is used to investigate the electro-physiological properties of denervated muscles following functional electrical stimulation. The model includes a state-of-the-art description of cell electro-physiology. The main objective of this work is to develop a computational framework capable of predicting the effects of different stimulation trains and electrode configurations on the excitability and fatigue of skeletal muscle tissue. Utilizing a reduced but computationally amenable model, the effects of different electrode sizes and inter-electrode distances on the number of activated muscle fibers are investigated and qualitatively compared to existing literature. To analyze muscle fatigue, the sodium current, specifically the K+ ion concentrations within the t-tubule and the calcium release from the sarcoplasmic reticulum, is used to quantify membrane and metabolic fatigue. The simulations demonstrate that lower stimulation frequencies and biphasic pulse waveforms cause less fatigue than higher stimulation frequencies and monophasic pulses. A comparison between single and dual electrode configurations (with the same overall stimulation surface) is presented to locally investigate the differences in muscle fatigue. The dual electrode configuration causes the muscle tissue to fatigue quicker. PMID:22841365
Kim, Juliana H K; Trew, Mark L; Pullan, Andrew J; Röhrle, Oliver
The current Food and Drug Administration approved system for the treatment of tremor disorders through Deep Brain Stimulation (DBS) of the area of the brain that controls movement, operates open-loop. It does not automatically adapt to the instantaneous patient's needs or to the progression of the disease. This paper demonstrates an adaptive closed-loop controlled DBS that, after switching off stimulation, tracks few physiological signals to predict the reappearance of tremor before the patient experiences discomfort, at which point it instructs the DBS controller to switch on stimulation again. The core of the proposed approach is a Neural Network (NN) which effectively extracts tremor predictive information from non-invasively recorded surface-electromyogram(sEMG) and accelerometer signals measured at the symptomatic extremities. A simple feed-forward back-propagation NN architecture is shown to successfully predict tremor in 31 out of 33 trials in two Parkinson's Disease patients with an overall accuracy of 75.8% and sensitivity of 92.3%. This work therefore shows that closed-loop DBS control is feasible in the near future and that it can be achieved without modifications of the electrodes implanted in the brain, i.e., is backward compatible with approved DBS systems. PMID:23366839
Shukla, Pitamber; Basu, Ishita; Graupe, Daniel; Tuninetti, Daniela; Slavin, Konstantin V
Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor, cognitive, neuropsychiatric, autonomic, and other nonmotor symptoms. The efficacy of deep brain stimulation (DBS) for the motor symptoms of ad- vanced PD is well established. However, the effects of DBS on the cognitive and neuropsychiatric symptoms are less clear. The neuropsychiatric aspects of DBS for PD have recently been of
Valerie Voon; Cynthia Kubu; Paul Krack; Jean-Luc Houeto; Alexander I. Tröster
Background: Targeting in deep brain stimulation (DBS) relies heavily on the ability to accurately localize particular anatomic brain structures. Direct targeting of subcortical structures has been limited by the ability to visualize relevant DBS targets. Methods and Results: In this work, we describe the development and implementation, of a methodology utilized to create a three dimensional deformable atlas for DBS surgery. This atlas was designed to correspond to the print version of the Schaltenbrand-Bailey atlas structural contours. We employed a smoothing technique to reduce artifacts inherent in the print version. Conclusions: We present the methodology used to create a three dimensional patient specific DBS atlas which may in the future be tested for clinical utility.
Sudhyadhom, Atchar; Okun, Michael S; Foote, Kelly D; Rahman, Maryam; Bova, Frank J
Deep brain stimulation (DBS) is an important treatment option for neuropathic pain. DBS has a considerable history, and it\\u000a can be used successfully for a wide number of pain syndromes. Epidural motor cortex stimulation (MCS) also is a treatment\\u000a option for neuropathic pain. Less invasive than DBS, MCS has been rapidly adopted and studied since first described in 1991.\\u000a A
James A. Stadler; Damien J. Ellens; Joshua M. Rosenow
The Italian broadcasting network (RAI) has studied the development of a national DBS service in an effort to outline a proposal for a space segment configuration compatible with development of new services, including HDTV. Proposals so far considered feature the integration of RAI's channel on Olympus in a future operational system and after extensive experimental use. Contents of the experimental program are discussed, and need for a broadcasting standard which considers projected introduction of HDTV is noted. The debate between RAI and consumer electronic industries on the use of broadcasting standards is outlined. The position of RAI in the context of HDTV and DBS is defined and the issue of determining the most effective transmission standard during the experimental stage is raised. It is pointed out that, in the absence of new production facilities for HDTV, the maximum quality which MAC will yield will be that of PAL since programs must be produced in PAL and then converted into MAC. Two alternatives for strategy on the use of broadcasting standards for DBS are offered. Finally, technical experiments and a market survey are discussed.
Parkinson's disease (PD) is marked by excessive synchronous activity in the beta (8–35 Hz) band throughout the cortico-basal ganglia network. The optimal location of high frequency deep brain stimulation (HF DBS) within the subthalamic nucleus (STN) region and the location of maximal beta hypersynchrony are currently matters of debate. Additionally, the effect of STN HF DBS on neural synchrony in functionally connected regions of motor cortex is unknown and is of great interest. Scalp EEG studies demonstrated that stimulation of the STN can activate motor cortex antidromically, but the spatial specificity of this effect has not been examined. The present study examined the effect of STN HF DBS on neural synchrony within the cortico-basal ganglia network in patients with PD. We measured local field potentials dorsal to and within the STN of PD patients, and additionally in the motor cortex in a subset of these patients. We used diffusion tensor imaging (DTI) to guide the placement of subdural cortical surface electrodes over the DTI-identified origin of the hyperdirect pathway (HDP) between motor cortex and the STN. The results demonstrated that local beta power was attenuated during HF DBS both dorsal to and within the STN. The degree of attenuation was monotonic with increased DBS voltages in both locations, but this voltage-dependent effect was greater in the central STN than dorsal to the STN (p < 0.05). Cortical signals over the estimated origin of the HDP also demonstrated attenuation of beta hypersynchrony during DBS dorsal to or within STN, whereas signals from non-specific regions of motor cortex were not attenuated. The spatially-specific suppression of beta synchrony in the motor cortex support the hypothesis that DBS may treat Parkinsonism by reducing excessive synchrony in the functionally connected sensorimotor network.
Whitmer, Diane; de Solages, Camille; Hill, Bruce; Yu, Hong; Henderson, Jaimie M.; Bronte-Stewart, Helen
Background/Aims Deep brain stimulation (DBS) is widely used to treat motor symptoms in patients with advanced Parkinson's disease. The aim of this study was to investigate the anatomical aspects of the electric field in relation to effects on speech and movement during DBS in the subthalamic nucleus. Methods Patient-specific finite element models of DBS were developed for simulation of the electric field in 10 patients. In each patient, speech intelligibility and movement were assessed during 2 electrical settings, i.e. 4 V (high) and 2 V (low). The electric field was simulated for each electrical setting. Results Movement was improved in all patients for both high and low electrical settings. In general, high-amplitude stimulation was more consistent in improving the motor scores than low-amplitude stimulation. In 6 cases, speech intelligibility was impaired during high-amplitude electrical settings. Stimulation of part of the fasciculus cerebellothalamicus from electrodes positioned medial and/or posterior to the center of the subthalamic nucleus was recognized as a possible cause of the stimulation-induced dysarthria. Conclusion Special attention to stimulation-induced speech impairments should be taken in cases when active electrodes are positioned medial and/or posterior to the center of the subthalamic nucleus.
Quantitative evaluation of the sensory disturbance of the tongue is important clinically. However, because the conventional electrophysiological approach to the peripheral nerve cannot be used in the mandible owing to the deep route of the lingual nerve, we applied evoked potentials in the central nervous system. Somatosensory evoked magnetic fields (SEFs) following electric stimulation were recorded in 10 healthy subjects by means of pin electrodes placed on the tongue mucosa. Three or four components (P25m, P40m, P60m, and P80m) were identified over the contralateral hemisphere with unilateral stimulation. Because none of the components were consistently detected in all subjects, we evaluated the root mean square (RMS) of 18 channels over the contralateral hemisphere. To estimate the activated cortical response, we calculated the difference in mean RMS amplitude between 10 and 150 ms and that of the baseline period (aRMS=RMS[10, 150]-RMS[-50, -5]). The aRMS values for right-sided and left-sided stimulation were 10.18+/-7.92 and 10.99+/-8.98 fT/cm, respectively, and the mean laterality index, expressed by [(left-right)/(left+right)] was 0.025+/-0.104. This parameter can be useful for evaluating patients with unilateral sensory abnormality of the tongue. PMID:18708103
Summary. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) with a quadripolar electrode was carried out in 9 patients\\u000a with advanced idiopathic Parkinson's disease (PD) affected with severe diurnal motor fluctuations. The effect of bilateral\\u000a STN stimulation was evaluated by clinical methods in all patients after 3 and 12 months.\\u000a \\u000a Assessment was based on the Unified Parkinson's Disease Rating
M. M. Pinter; F. Alesch; M. Murg; M. Seiwald; R. J. Helscher; H. Binder
There is growing evidence for exaggerated oscillatory neuronal synchronisation in patients with Parkinson's disease (PD). In particular, oscillations at around 20 Hz, in the so-called beta frequency band, relate to the cardinal symptoms of bradykinesia and rigidity. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) can significantly improve these motor impairments. Recent evidence has demonstrated reduction of beta oscillations concurrent with alleviation of PD motor symptoms, raising the possibility that suppression of aberrant activity may mediate the effects of DBS. Here we review the evidence supporting suppression of pathological oscillations during stimulation and discuss how this might underlie the efficacy of DBS. We also consider how beta activity may provide a feedback signal suitable for next generation closed-loop and intelligent stimulators.
Ankle control is critical to both standing balance and efficient walking. The hypothesis presented in this paper is that a Flat Interface Nerve Electrode (FINE) placed around the sciatic nerve with a fixed number of contacts at predetermined locations and without a priori knowledge of the nerve's underlying neuroanatomy can selectively control each ankle motion. Models of the human sciatic nerve surrounded by a FINE of varying size were created and used to calculate the probability of selective activation of axons within any arbitrarily designated, contiguous group of fascicles. Simulations support the hypothesis and suggest that currently available implantable technology cannot selectively recruit each target plantar flexor individually but can restore plantar flexion or dorsiflexion from a site on the sciatic nerve without spillover to antagonists. Successful activation of individual ankle muscles in 90% of the population can be achieved by utilizing bipolar stimulation and/or by using a cuff with at least 20 contacts. PMID:22222951
Schiefer, Matthew A; Tyler, Dustin J; Triolo, Ronald J
Proper ankle control is critical to both standing balance and efficient walking. This study hypothesized that a Flat Interface Nerve Electrode (FINE) placed around the sciatic nerve with a fixed number of contacts at predetermined locations and without a priori knowledge of the nerve's underlying neuroanatomy can selectively control each ankle motion. Models of the human sciatic nerve surrounded by a FINE of varying size were created and used to calculate the probability of selective activation of axons within any arbitrarily designated group of fascicles. Simulations suggest that currently available implantable technology cannot selectively recruit each target plantar flexor individually but can restore plantar flexion or dorsiflexion from a site on the sciatic nerve without spillover to antagonists. Successful activation of individual ankle muscles in 90% of the population can be achieved by utilizing bipolar stimulation and/or by increasing the number of contacts within the cuff. PMID:22255234
Schiefer, Matthew A; Tyler, Dustin J; Triolo, Ronald J
Proper ankle control is critical to both standing balance and efficient walking. This study hypothesized that a Flat Interface Nerve Electrode (FINE) placed around the sciatic nerve with a fixed number of contacts at predetermined locations and without a priori knowledge of the nerve’s underlying neuroanatomy can selectively control each ankle motion. Models of the human sciatic nerve surrounded by a FINE of varying size were created and used to calculate the probability of selective activation of axons within any arbitrarily designated group of fascicles. Simulations suggest that currently available implantable technology cannot selectively recruit each target plantar flexor individually but can restore plantar flexion or dorsiflexion from a site on the sciatic nerve without spillover to antagonists. Successful activation of individual ankle muscles in 90% of the population can be achieved by utilizing bipolar stimulation and/or by increasing the number of contacts within the cuff.
Schiefer, Matthew A.; Tyler, Dustin J.; Triolo, Ronald J.
Deep brain stimulation (DBS) is an established treatment for advanced Parkinson’s disease (PD). The procedure entails intracranial implantation of an electrode in a specific brain structure followed by chronic stimulation. Although the beneficial effects of DBS on motor symptoms in PD are well known, it is often accompanied by cognitive impairments the origin of which is not fully understood. To explore the possible contribution of the surgical procedure itself, we studied the effect of electrode implantation in the subthalamic nucleus (STN) on regional neuroinflammation and memory function in rats implanted bilaterally with stainless steel electrodes. Age-matched sham and intact rats were used as controls. Brains were removed one week or eight weeks post implantation and processed for in vitro autoradiography with [3H]PK11195, an established marker of microglial activation. Memory function was assessed by the novel object recognition test (ORT) before surgery and two and eight weeks after surgery. Electrode implantation produced region-dependent changes in ligand binding density in the implanted brains at one week as well as eight weeks post implantation. Cortical regions showed more intense and widespread neuroinflammation than striatal or thalamic structures. Furthermore, implanted animals showed deficits in ORT performance two and eight weeks post implantation. Thus, electrode implantation resulted in a widespread and persistent neuroinflammation and sustained memory impairment. These results suggest that the insertion and continued presence of electrodes in the brain, even without stimulation, may lead to inflammation-mediated cognitive deficits in susceptible individuals, as observed in patients treated with DBS.
The ability to stimulate subareas of a nerve selectively is highly desirable, since it has the potential of simplifying surgery to implanting one cuff on a large nerve instead of many cuffs on smaller nerves or muscles, or alternatively can improve function where surgical access to the smaller nerves is limited. In this paper, stimulation was performed with a four-channel multipolar cuff electrode implanted on the sciatic nerve of nine rabbits to compare the extensively researched longitudinal tripolar configuration with the transverse tripolar configuration, which has received less interest. The performance of these configurations was evaluated in terms of selectivity in recruitment of the three branches of the sciatic nerve. The results showed that the transverse configuration was able to selectively activate the sciatic nerve branches to a functionally relevant level in more cases than the longitudinal configuration (20/27 versus 11/27 branches) and overall achieved a higher mean selectivity [0.79 ± 0.13 versus 0.61 ± 0.09 (mean ± standard deviation)]. The transverse configuration was most successful at recruiting the small cutaneous and medium-sized peroneal branches, and less successful at recruiting the large tibial nerve. PMID:21421427
Nielsen, Thomas N; Kurstjens, G A Mathijs; Struijk, Johannes J
|Roberts Bartholow's 1874 experiment on Mary Rafferty is widely cited as the first demonstration, by direct application of stimulatingelectrodes, of the motor excitability of the human cerebral cortex. The many accounts of the experiment, however, leave certain questions and details unexamined or unresolved, especially about Bartholow's goals,…
This study describes the stability and selectivity of four-contact spiral nerve-cuff electrodes implanted bilaterally on distal branches of the femoral nerves of a human volunteer with spinal cord injury as part of a neuroprosthesis for standing and transfers. Stimulation charge threshold, the minimum charge required to elicit a visible muscle contraction, was consistent and low (mean threshold charge at 63
Computer simulations were performed to investigate the timing of action potential production and propagation in nerve fibers ranging in diameter from 5 to 15 ?m during stimulation with a tripolar cuff electrode. The influence of stimulus pulse amplitude and duration on size selective excitation and blocking was considered. Because the stimulus duration required to produce anodal blocking depends on the
Eleanor V. Goodall; L. Martin Kosterman; Jan Holsheimer; Johannes J. Struijk
Organic field effect transistors can be integrated into micromachined polyimide-based neural stimulationelectrode arrays in order to build active switching matrices. With this approach, a matrix of N × M electrode contacts requires only N + M interconnects to a stimulator when active switching elements are used instead of N × M interconnects. In this paper, we demonstrated that pentacene-based organic field effect transistors (OFETs) can be used to drive stimulation currents through neural electrodes in a physiological-like environment. In order to prove the general applicability as an implant material, the cytotoxicity of pentacene was evaluated with respect to potential effects on cell viability. The results of these tests indicate that extracts from pentacene inhibit neither proliferation nor metabolism of the tested mouse fibroblasts. However, some effect on cell spreading was observed when cells were in direct contact to pentacene for 48 h. In pilot experiments it was demonstrated for the very first time that pentacene transistors can be used as switching elements, acting as voltage-controlled current sources, capable of driving currents suitable for electrical stimulation of a peripheral nerve via a tripolar cuff electrode.
Feili, Dara; Schuettler, Martin; Stieglitz, Thomas
Restoration of the voluntary use of paralyzed limbs using functional neuromuscular stimulation (FNS) is limited by complex muscle properties and unpredictable load behaviors; closed-loop control of FNS would improve performance but requires reliable sensory feedback modalities. Sensory nerve signals recorded by cuff electrodes provide accurate information about forces acting on the skin in anesthetized animals; however, nerve cuff signals are
Objective The goal of this study was to develop, evaluate, and apply a method to quantify the unknown spatial extent of activation in deep brain stimulation (DBS) of the ventral intermedius nucleus (Vim) of the thalamus. Methods The amplitude-distance relationship and the threshold amplitudes to elicit clinical responses were combined to estimate the unknown amplitude-distance constant and the distance between the electrode and the border between the Vim and the ventrocaudal nucleus (Vc) of the thalamus. We tested the sensitivity of the method to errors in the input parameters, and subsequently, applied the method to estimate the amplitude-distance constant from clinically-measured threshold amplitudes. Results The method enabled estimation of the amplitude-distance constant with a median squared error of 0.07–0.23 V/mm2 and provided an estimate of the distance between the electrode and the Vc/Vim border with a median squared error of 0.01–0.04 mm. Application of the method to clinically-measured threshold amplitudes to elicit paresthesias estimated the amplitude-distance constant to be 0.22 V/mm2. Conclusions The method enabled robust quantification of the spatial extent of activation in thalamic DBS and predicted that stimulation amplitudes of 1–3.5 V would produce a mean effective radius of activation of 2.0–3.9 mm. Significance Knowing the spatial extent of activation may improve methods of electrode placement and stimulation parameter selection in DBS.
Kuncel, Alexis M.; Cooper, Scott E.; Grill, Warren M.
Deep brain stimulator (DBS) implantation is a promising treatment alternative for suppressing the motor tremor symptoms in Parkinson disease (PD) patient. The main objective is to develop a minimally invasive approach using high spatial resolution and soft-tissue contrast MR imaging techniques to guide the surgical placement of DBS. In the MR-guided procedure, the high spatial resolution MR images were obtained intra-operatively and used to target stereotactically a specific deep brain location. The neurosurgery for craniotomy was performed in the front of the magnet outside of the 10 Gauss line. Aided with positional registration assembly for the stereotactic head frame, the target location (VIM or GPi or STN) in deep brain areas was identified and measured from the MR images in reference to the markers in the calibration assembly of the head frame before the burrhole prep. In 20 patients, MR- guided DBS implantations have been performed according to the new methodology. MR-guided DBS implantation at high magnetic field strength has been shown to be feasible and desirable. In addition to the improved outcome, this offers a new surgical approach in which intra-operative visualization is possible during intervention, and any complications such as bleeding can be assessed in situ immediately prior to dural closure.
Liu, Haiying; Maxwell, Robert E.; Truwit, Charles L.
Growing evidence suggests that spontaneous oscillatory low-frequency synchronization in the subthalamic nuclei (STN) may modulate motor performance in patients with Parkinson's disease (PD). To explore this in more detail, 15 PD patients chronically implanted with deep brain stimulation (DBS) electrodes in both STN were stimulated bilaterally at 5, 10, 20, 50 and 130 Hz and the effects of the DBS on self-initiated isometric elbow flexion (FLEX) and finger pinch (PINCH) were compared to performance without DBS. Baseline performance was very much impaired. Peak force was significantly greater during 130 and 10 Hz stimulation when compared to no stimulation in both tasks. Cumulative sums of the changes in mean rising force and peak force in the two tasks upon stimulation at 10 and 20 Hz demonstrated that patients improved their performance on stimulation, except for those with the best performance off stimulation who deteriorated with stimulation at 20 Hz. Thus, no effect was detected with 20 Hz stimulation at the group level. The current study highlights the need to consider the baseline performance of a subject in a given task when determining the effects of low-frequency STN stimulation in PD patients. It also demonstrates that stimulation at 10 Hz can improve motor function in subjects with poor baseline function. PMID:23543103
Chen, Chiung Chu; Lin, Wey Yil; Chan, Hsiao Lung; Tu, Po Hsun; Lee, Shih Tseng; Lu, Chin Song; Brown, Peter
The possibility that electrodes might serve as an electron acceptor to simulate the degradation of aromatic hydrocarbons in anaerobic contaminated sediments was investigated. Initial studies with Geobacter metallireducens demonstrated that although toluene was rapidly adsorbed onto the graphite electrodes it was rapidly oxidized to carbon dioxide with the electrode serving as the sole electron acceptor. Providing graphite electrodes as an electron acceptor in hydrocarbon-contaminated sediments significantly stimulated the removal of added toluene and benzene. Rates of toluene and benzene removal accelerated with continued additions of toluene and benzene. [(14)C]-Toluene and [(14)C]-benzene were quantitatively recovered as [(14)C]-CO(2), demonstrating that even though the graphite adsorbed toluene and benzene they were degraded. Introducing an electrode as an electron acceptor also accelerated the loss of added naphthalene and [(14)C]-naphthalene was converted to [(14)C]-CO(2). The results suggest that graphite electrodes can serve as an electron acceptor for the degradation of aromatic hydrocarbon contaminants in sediments, co-localizing the contaminants, the degradative organisms and the electron acceptor. Once in position, they provide a permanent, low-maintenance source of electron acceptor. Thus, graphite electrodes may offer an attractive alternative for enhancing contaminant degradation in anoxic environments. PMID:20105223
Zhang, Tian; Gannon, Sarah M; Nevin, Kelly P; Franks, Ashley E; Lovley, Derek R
The lateral habenula (LHb) is critical for modulation of negative reinforcement, punishment and aversive responses. In light of the success of deep-brain-stimulation (DBS) in the treatment of neurological disorders, we explored the use of LHb DBS as a method of intervention in cocaine self-administration, extinction, and reinstatement in rats. An electrode was implanted into the LHb and rats were trained to self-administer cocaine (21 days; 0.25–1 mg/kg) until they achieved at least three days of stable performance (as measured by daily recordings of active lever presses in self-administration cages). Thereafter, rats received DBS in the presence or absence of cocaine. DBS reduced cocaine seeking behavior during both self-administration and extinction training. DBS also attenuated the rats' lever presses following cocaine reinstatement (5–20 mg/kg) in comparison to sham-operated rats. These results were also controlled by the assessment of physical performance as measured by water self-administration and an open field test, and by evaluation of depressive-like manifestations as measured by the swim and two-bottles-choice tests. In contrast, LHb lesioned rats demonstrated increased cocaine seeking behavior as demonstrated by a delayed extinction response. In the ventral tegmental area, cocaine self-administration elevated glutamatergic receptor subunits NR1 and GluR1 and scaffolding protein PSD95, but not GABAA?, protein levels. Following DBS treatment, levels of these subunits returned to control values. We postulate that the effect of both LHb modulation and LHb DBS on cocaine reinforcement may be via attenuation of the cocaine-induced increase in glutaminergic input to the VTA.
Between 1983 and 1992, 23 patients with complete ventilatory insufficiency of differing etiologies were treated with an eight channel implant (Medimplant Inc., Vienna) for fatigue free stimulation of both phrenic nerves. Data for 15 patients with high spinal cord lesions (ages: 9-51 years) are summarized: 1) level of lesion: C0, 3 patients; C1/C2, 4; C2/C3, 8; 2) time between incident and implantation: 3-14 months; 3) diaphragm training: 1-22 months; 4) chronic pacing: 5-83 months; 5) tracheostomy closed: 7 patients; 6) living permanently at home: 13 patients; 7) respiratory rate per minute: 12-17; 8) duration of inspiration: 1.0-1.3 sec; 9) tidal volume: 7-20 ml/kg body weight; 10) volume per minute: 121-198 ml/kg body weight; 11) pH: 7.39-7.42; 12) pCO2: 22.9-38.6 mmHg; 13) pO2: 81.2-104.5 mmHg; and 14) died by December 1992, 4 patients. All currently available implants for phrenic pacing need an external power supply and radio control. The authors have developed and tested the first fully implantable device. Features of this implant include an electronic circuit based on the microcontroller MC68HC705C8; surface mounted technology (SMD); eight channels; constant current source adjustable to 5 mA in 256 steps, impulse duration: 100-1000 musec, stimulation frequency: 1-33 Hz; and minimum lifetime: 3 years. The implant is programmed via bidirectional radio transmission using an IBM compatible computer. The dimensions, including battery, eight electrode connectors, and antenna, are 67 x 48 x 13 mm. The implant weights 58 g. This new device may improve patients' safety and quality of life in the near future. PMID:8268634
Mayr, W; Bijak, M; Girsch, W; Holle, J; Lanmüller, H; Thoma, H; Zrunek, M
Epilepsy affects approximately one percent of the world population. Antiepileptic drugs are ineffective in approximately 30% of patients and have side effects. We are developing a noninvasive, or minimally invasive, transcranial focal electrical stimulation system through our novel tripolar concentric ring electrodes to control seizures. In this study we demonstrate feasibility of an automatic seizure control system in rats with pentylenetetrazole-induced seizures through single and multiple stimulations. These stimulations are automatically triggered by a real-time electrographic seizure activity detector based on a disjunctive combination of detections from a cumulative sum algorithm and a generalized likelihood ratio test. An average seizure onset detection accuracy of 76.14% was obtained for the test set (n = 13). Detection of electrographic seizure activity was accomplished in advance of the early behavioral seizure activity in 76.92% of the cases. Automatically triggered stimulation significantly (p = 0.001) reduced the electrographic seizure activity power in the once stimulated group compared to controls in 70% of the cases. To the best of our knowledge this is the first closed-loop automatic seizure control system based on noninvasive electrical brain stimulation using tripolar concentric ring electrode electrographic seizure activity as feedback.
Makeyev, Oleksandr; Liu, Xiang; Luna-Munguia, Hiram; Rogel-Salazar, Gabriela; Mucio-Ramirez, Samuel; Liu, Yuhong; Sun, Yan L.; Kay, Steven M.; Besio, Walter G.
One of the important goals of peripheral nerve electrode development is to design an electrode for selective recruitment of the different functions of a common nerve trunk. A challenging task is gaining selective access to central axon populations. In this paper, a simple electrode that takes advantage of the neural plasticity to reshape the nerve is presented. The flat interface
Background: Deep brain stimulation (DBS) is widely used to treat advanced Parkinson’s disease, other movement and psychiatric disorders. DBS implantation requires application of a stereotactic frame throughout a lengthy procedure, making it uncomfortable and tiring. We designed a stereotactic cube to stage the operation, perform frameless microelectrode recording (MER) and fix the DBS. Methods: The 15-mm cube is implanted in
Deep brain stimulation (DBS) is a well-accepted treatment for movement disorders and is currently explored as a treatment\\u000a option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence\\u000a mental states critical to personality to such an extent that it affects an individual’s personal identity, i.e. the experience\\u000a of psychological continuity, of persisting
DART Bootstrap Services (dbs) is the first component of run-control for the DART Data Acquisition system -- the DA for the 96` round of experiments at Fermilab -- though it has potential usefulness as a powerful tool in other distributed applications. dbs is an rlogin session multiplexer. It allows a user, running a single program, to start up any number of remote login sessions, feed shell commands to them, and collect their output into a single (or multiple) log files (a server keeps the sessions open and collects their output). From this program, any session can be attached to interactively so it appears just like an rlogin session -- dbs becomes transparent. When finished with this interactive mode, the user can escape back to dbs and attach to a different session if so desired. Among many other useful features, dbs supplies a mechanism for cleanup (deletion) of all processes created under a session, allowing a fresh start.
Oleynik, G.; Appleton, L.; Udumula, L.; Votava, M.
The use of deep brain stimulation (DBS) for the treatment of neurological movement degenerative disorders requires the precise placement of the stimulatingelectrode and the determination of optimal stimulation parameters that maximize symptom relief (e.g. tremor, rigidity, movement difficulties, etc.) while minimizing undesired physiological side-effects. This study demonstrates the feasibility of determining the ideal electrode placement and stimulation current amplitude by performing a patient-specific multivariate optimization using electrophysiological atlases and a bioelectric finite element model of the brain. Using one clinical case as a preliminary test, the optimization routine is able to find the most efficacious electrode location while avoiding the high side-effect regions. Future work involves optimization validation clinically and improvement to the accuracy of the model.
Sun, Kay; Pallavaram, Srivatsan; Rodriguez, William; D'Haese, Pierre-Francois; Dawant, Benoit M.; Miga, Michael I.
Parkinson's disease (PD) is a neurodegenerative disorder characterized by a variety of motor signs affecting gait, postural stability, and tremor. These symptoms can be improved when electrodes are implanted in deep brain structures and electrical stimulation is delivered chronically at high frequency (>100 Hz). Deep brain stimulation (DBS) onset or cessation affects PD signs with different latencies, and the long-term improvements of symptoms affecting the body axis and those affecting the limbs vary in duration. Interestingly, these effects have not been systematically analyzed and modeled. We compare these timing phenomena in relation to one axial (i.e., locomotion) and one distal (i.e., tremor) signs. We suggest that during DBS, these symptoms are improved by different network mechanisms operating at multiple time scales. Locomotion improvement may involve a delayed plastic reorganization, which takes hours to develop, whereas rest tremor is probably alleviated by an almost instantaneous desynchronization of neural activity in subcortical structures. Even if all PD patients develop both distal and axial symptoms sooner or later, current computational models of locomotion and rest tremor are separate. Furthermore, a few computational models of locomotion focus on PD and none exploring the effect of DBS was found in the literature. We, therefore, discuss a model of a neuronal network during DBS, general enough to explore the subcircuits controlling locomotion and rest tremor simultaneously. This model accounts for synchronization and plasticity, two mechanisms that are believed to underlie the two types of symptoms analyzed. We suggest that a hysteretic effect caused by DBS-induced plasticity and synchronization modulation contributes to the different therapeutic latencies observed. Such a comprehensive, generic computational model of DBS effects, incorporating these timing phenomena, should assist in developing a more efficient, faster, durable treatment of distal and axial signs in PD.
The effects of spinal cord stimulation (SCS), deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (VC) and motor cortex stimulation (MCS) were analyzed in 19 patients with phantom limb pain. All of the patients underwent SCS and, if the SCS failed to reduce the pain, the patients were considered for DBS and\\/or MCS. Satisfactory pain control for the
An implantable micromachined neural probe with multichannel electrode arrays for both neural signal recording and electrical stimulation was designed, simulated and experimentally validated for deep brain stimulation (DBS) applications. The developed probe has a rough three-dimensional microstructure on the electrode surface to maximize the electrode-tissue contact area. The flexible, polyimide-based microelectrode arrays were each composed of a long shaft (14.9 mm in length) and 16 electrodes (5 µm thick and with a diameter of 16 µm). The ability of these arrays to record and stimulate specific areas in a rat brain was evaluated. Moreover, we have developed a finite element model (FEM) applied to an electric field to evaluate the volume of tissue activated (VTA) by DBS as a function of the stimulation parameters. The signal-to-noise ratio ranged from 4.4 to 5 over a 50 day recording period, indicating that the laboratory-designed neural probe is reliable and may be used successfully for long-term recordings. The somatosensory evoked potential (SSEP) obtained by thalamic stimulations and in vivo electrode-electrolyte interface impedance measurements was stable for 50 days and demonstrated that the neural probe is feasible for long-term stimulation. A strongly linear (positive correlation) relationship was observed among the simulated VTA, the absolute value of the SSEP during the 200 ms post-stimulus period (?SSEP) and c-Fos expression, indicating that the simulated VTA has perfect sensitivity to predict the evoked responses (c-Fos expression). This laboratory-designed neural probe and its FEM simulation represent a simple, functionally effective technique for studying DBS and neural recordings in animal models. PMID:22488106
An implantable micromachined neural probe with multichannel electrode arrays for both neural signal recording and electrical stimulation was designed, simulated and experimentally validated for deep brain stimulation (DBS) applications. The developed probe has a rough three-dimensional microstructure on the electrode surface to maximize the electrode-tissue contact area. The flexible, polyimide-based microelectrode arrays were each composed of a long shaft (14.9 mm in length) and 16 electrodes (5 µm thick and with a diameter of 16 µm). The ability of these arrays to record and stimulate specific areas in a rat brain was evaluated. Moreover, we have developed a finite element model (FEM) applied to an electric field to evaluate the volume of tissue activated (VTA) by DBS as a function of the stimulation parameters. The signal-to-noise ratio ranged from 4.4 to 5 over a 50 day recording period, indicating that the laboratory-designed neural probe is reliable and may be used successfully for long-term recordings. The somatosensory evoked potential (SSEP) obtained by thalamic stimulations and in vivo electrode-electrolyte interface impedance measurements was stable for 50 days and demonstrated that the neural probe is feasible for long-term stimulation. A strongly linear (positive correlation) relationship was observed among the simulated VTA, the absolute value of the SSEP during the 200 ms post-stimulus period (?SSEP) and c-Fos expression, indicating that the simulated VTA has perfect sensitivity to predict the evoked responses (c-Fos expression). This laboratory-designed neural probe and its FEM simulation represent a simple, functionally effective technique for studying DBS and neural recordings in animal models.
We examined whether electrical field stimulation with varying characteristics could excite isolated mammalian skeletal muscle through different sites. Supramaximal (20-V, 0.1-ms) pulse stimulation with transverse wire or parallel plate electrodes evoked similar forces in nonfatigued slow-twitch soleus and fast-twitch extensor digitorum longus (EDL) muscles from mice. d-tubocurarine shifted the twitch force-stimulation strength relationship toward higher pulse strengths with both electrode configurations in soleus muscle, suggesting that weaker pulses excite muscle via neuromuscular transmission. With wire stimulation, movement of the recording electrode along the muscle caused a delay between the stimulus artifact and the peak of the action potential, consistent with action potential propagation along the sarcolemma. TTX abolished all contractions evoked with 20-V, 0.1-ms pulses, suggesting that excitation occurred via voltage-dependent Na+ channels and, hence, muscle action potentials. TTX did not prevent force development with > or = 0.4-ms pulses in soleus or 1-ms pulses in EDL muscle. Furthermore, myoplasmic Ca2+ (i.e., the fura 2 ratio) and sarcomere shortening were greater during tetanic stimulation with 2.0-ms than with 0.5-ms pulses in flexor digitorum brevis fibers from rats. TTX prevented all shortening and Ca2+ release with 0.5-ms, but not 2.0-ms, pulses, indicating that longer pulses can directly trigger Ca2+ release. Hence, proper interpretation of mechanistic studies requires precise understanding of how muscles are excited; otherwise, incorrect conclusions can be made. Using this new understanding, we showed that disrupted propagation of action potentials along the surface membrane is a major cause of fatigue in soleus muscle that is focally and continuously stimulated at 125 Hz. PMID:17412789
The effects of ionic conductivity and buffer concentration of electrolytes used for in vitro measurement of the charge-injection limits of activated iridium oxide (AIROF) neural stimulationelectrodes have been investigated. Charge-injection limits of AIROF microelectrodes were measured in saline with a range of phosphate buffer concentrations from [PO43?] = 0 to [PO43?] = 103 mM and ionic conductivities from 2–28
Stuart F Cogan; Philip R Troyk; Julia Ehrlich; Christina M Gasbarro; Timothy D Plante
Roberts Bartholow’s 1874 experiment on Mary Rafferty is widely cited as the first demonstration, by direct application of stimulatingelectrodes, of the motor excitability of the human cerebral cortex. The many accounts of the experiment, however, leave certain questions and details unexamined or unresolved, especially about Bartholow’s goals, the nature and quality of the evidence, and the experiment’s role in
Although asynchronous intrafascicular multi-electrodestimulation (IFMS) can evoke fatigue-resistant muscle force, a priori determination of the necessary stimulation parameters for precise force production is not possible. This paper presents a proportionally-modulated, multiple-input single-output (MISO) controller that was designed and experimentally validated for real-time, closed-loop force-feedback control of asynchronous IFMS. Experiments were conducted on anesthetized felines with a Utah Slanted Electrode Array implanted in the sciatic nerve, either acutely or chronically ( n = 1 for each). Isometric forces were evoked in plantar-flexor muscles, and target forces consisted of up to 7 min of step, sinusoidal, and more complex time-varying trajectories. The controller was successful in evoking steps in force with time-to-peak of less than 0.45 s, steady-state ripple of less than 7% of the mean steady-state force, and near-zero steady-state error even in the presence of muscle fatigue, but with transient overshoot of near 20%. The controller was also successful in evoking target sinusoidal and complex time-varying force trajectories with amplitude error of less than 0.5 N and time delay of approximately 300 ms. This MISO control strategy can potentially be used to develop closed-loop asynchronous IFMS controllers for a wide variety of multi-electrodestimulation applications to restore lost motor function. PMID:21385670
Frankel, Mitchell A; Dowden, Brett R; Mathews, V John; Normann, Richard A; Clark, Gregory A; Meek, Sanford G
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for Parkinson's disease, but can lead to adverse effects including psychiatric disturbance. Little is known about the risk factors and treatment options for such effects. Here, we describe a patient who reproducibly developed stimulation-induced hypomania when using ventrally located electrodes and responded well to pharmacological intervention while leaving the stimulation parameters unchanged to preserve motor benefits. In spite of clinical remission, [¹?O]-positron-emission-tomography (PET) demonstrated activation patterns similar to those reported during mania. This case, therefore, highlights an important treatment option of adverse effects of DBS, but also points toward the need for investigations of its risk factors and their underlying neurobiological mechanisms. PMID:21919560
Schilbach, L; Weiss, P H; Kuhn, J; Timmermann, L; Klosterkötter, J; Huff, W
Neural prostheses require chronically implanted small area penetrating electrode arrays that can stimulate and record neural activity. The fundamental requirement of neural electrodes is to have low interface impedance and large charge injection capacity (CIC). To achieve this fundamental requirement, we developed a novel technique to modify the surface of the Utah Electrode Array (UEA) to increase the real surface area without changing the geometrical surface area. Pt was coated on modified and unmodified (control) UEAs and electrochemical characterization such as impedance and CIC was measured and compared. The surface modified electrode impedance and CIC was ?188 Ohm and ?24 mC/cm(2) respectively. Increasing the real surface area of electrodes decreases the impedance by 1000 times and increases the CIC by 80 times compared to the control samples. The CIC of modified UEA was significantly higher than of any material reported in the literature, higher than sputtered iridium oxide (4 mC/cm(2)) or PEDOT (15 mC/cm(2)). PMID:23367086
The aim of this modeling study is to determine the influence of electrode alignment of transverse tripoles on the paresthesia coverage of the pain area in spinal cord stimulation, using a percutaneous triple-lead approach. Transverse tripoles, comprising a central cathode and two lateral anodes, were modeled on the low-thoracic vertebral region (T10-T12) using percutaneous triple-lead configurations, with the center lead on the spinal cord midline. The triple leads were oriented both aligned and staggered. In the staggered configuration, the anodes were offset either caudally (caudally staggered) or rostrally (rostrally staggered) with respect to the midline cathode. The transverse tripolar field steering with the aligned and staggered configurations enabled the estimation of dorsal column fiber thresholds (IDC) and dorsal root fiber thresholds (IDR) at various anodal current ratios. IDC and IDR were considerably higher for the aligned transverse tripoles as compared to the staggered transverse tripoles. The aligned transverse tripoles facilitated deeper penetration into the medial dorsal columns (DCs). The staggered transverse tripoles always enabled broad and bilateral DC activation, at the expense of mediolateral steerability. The largest DC recruited area was obtained with the rostrally staggered transverse tripole. Transverse tripolar geometries, using percutaneous leads, allow for selective targeting of either medial or lateral DC fibers, if and only if the transverse tripole is aligned. Steering of anodal currents between the lateral leads of the staggered transverse tripoles cannot target medially confined populations of DC fibers in the spinal cord. An aligned transverse tripolar configuration is strongly recommended, because of its ability to provide more post-operative flexibility than other configurations.
Sankarasubramanian, V.; Buitenweg, J. R.; Holsheimer, J.; Veltink, P.
While the development of microelectrode arrays has enabled access to disparate regions of a cortex for neurorehabilitation, neuroprosthetic and basic neuroscience research, accurate interpretation of the signals and manipulation of the cortical neurons depend upon the anatomical placement of the electrode arrays in a layered cortex. Toward this end, this report compares two in vivo methods for identifying the placement of electrodes in a linear array spaced 100 µm apart based on in situ laminar analysis of (1) ketamine-xylazine-induced field potential oscillations in a rat motor cortex and (2) an intracortical electrical stimulation-induced movement threshold. The first method is based on finding the polarity reversal in laminar oscillations which is reported to appear at the transition between layers IV and V in laminar 'high voltage spindles' of the rat cortical column. Analysis of histological images in our dataset indicates that polarity reversal is detected 150.1 ± 104.2 µm below the start of layer V. The second method compares the intracortical microstimulation currents that elicit a physical movement for anodic versus cathodic stimulation. It is based on the hypothesis that neural elements perpendicular to the electrode surface are preferentially excited by anodic stimulation while cathodic stimulation excites those with a direction component parallel to its surface. With this method, we expect to see a change in the stimulation currents that elicits a movement at the beginning of layer V when comparing anodic versus cathodic stimulation as the upper cortical layers contain neuronal structures that are primarily parallel to the cortical surface and lower layers contain structures that are primarily perpendicular. Using this method, there was a 78.7 ± 68 µm offset in the estimate of the depth of the start of layer V. The polarity reversal method estimates the beginning of layer V within ±90 µm with 95% confidence and the intracortical stimulation method estimates it within ±69.3 µm. We propose that these methods can be used to estimate the in situ location of laminar electrodes implanted in the rat motor cortex.
Yazdan-Shahmorad, A.; Lehmkuhle, M. J.; Gage, G. J.; Marzullo, T. C.; Parikh, H.; Miriani, R. M.; Kipke, D. R.
Renewed interest in stereotaxy for dystonia followed the introduction of deep brain stimulation (DBS) in Parkinson's disease and essential tremor in the 1990s. DBS evolved from ablative surgery, which was applied with varying results in the 1950s in patients with movement disorders such as Parkinson's disease, essential tremor and dystonia. The present review summarizes the current knowledge on clinical aspects
Andreas Kupsch; Andrea Kuehn; Stefanie Klaffke; Wassilios Meissner; Daniel Harnack; Christine Winter; Thomas D. Haelbig; Anatol Kivi; Guy Arnold; Karl-Max Einhäupl; Gerd-Helge Schneider; Thomas Trottenberg
Chronic electrical stimulation of the thalamus is an effective treatment for essential and parkinsonian tremor. Although the preferred surgical target is generally accepted to lie within the ventral intermediate nucleus (Vim), the relationship between the surgically defined target and the true histologically defined target is addressed in only a few reports, due in large measure to the need for advanced cytoarchitectonic techniques to define the borders of the thalamic nuclei. The authors report on a patient who underwent effective thalamic deep brain stimulation (DBS) for tremor. By defining the boundaries of the thalamic nuclei, they were able to relate effective DBS to electrode location within the anterior region of the ventral posterior lateral nucleus--the proprioceptive shell of the sensory nucleus--and the posteroventral region of the ventral lateral nucleus, which are equivalent to the Vim defined by Hassler, et al. PMID:15035293
Gross, Robert E; Jones, Edward G; Dostrovsky, Jonathan O; Bergeron, Catherine; Lang, Anthony E; Lozano, Andres M
Object The authors discuss their method for placement of deep brain stimulation (DBS) electrodes using interventional MR (iMR) imaging and report on the accuracy of the technique, its initial clinical efficacy, and associated complications in a consecutive series of subthalamic nucleus (STN) DBS implants to treat Parkinson disease (PD). Methods A skull-mounted aiming device (Medtronic NexFrame) was used in conjunction with real-time MR imaging (Philips Intera 1.5T). Preoperative imaging, DBS implantation, and postimplantation MR imaging were integrated into a single procedure performed with the patient in a state of general anesthesia. Accuracy of implantation was assessed using 2 types of measurements: the “radial error,” defined as the scalar distance between the location of the intended target and the actual location of the guidance sheath in the axial plane 4 mm inferior to the commissures, and the “tip error,” defined as the vector distance between the expected anterior commissure–posterior commissure (AC-PC) coordinates of the permanent DBS lead tip and the actual AC-PC coordinates of the lead tip. Clinical outcome was assessed using the Unified Parkinson’s Disease Rating Scale part III (UPDRS III), in the off-medication state. Results Twenty-nine patients with PD underwent iMR imaging–guided placement of 53 DBSelectrodes into the STN. The mean (± SD) radial error was 1.2 ± 0.65 mm, and the mean absolute tip error was 2.2 ± 0.92 mm. The tip error was significantly smaller than for STN DBSelectrodes implanted using traditional frame-based stereotaxy (3.1 ± 1.41 mm). Eighty-seven percent of leads were placed with a single brain penetration. No hematomas were visible on MR images. Two device infections occurred early in the series. In bilaterally implanted patients, the mean improvement on the UPDRS III at 9 months postimplantation was 60%. Conclusions The authors’ technical approach to placement of DBSelectrodes adapts the procedure to a standard configuration 1.5-T diagnostic MR imaging scanner in a radiology suite. This method simplifies DBS implantation by eliminating the use of the traditional stereotactic frame and the subsequent requirement for registration of the brain in stereotactic space and the need for physiological recording and patient cooperation. This method has improved accuracy compared with that of anatomical guidance using standard frame-based stereotaxy in conjunction with preoperative MR imaging.
Starr, Philip A.; Martin, Alastair J.; Ostrem, Jill L.; Talke, Pekka; Levesque, Nadja; Larson, Paul S.
The aim of the study was to investigate the uniformity of the muscle motor point location for lower limb muscles in healthy subjects. Fifty-three subjects of both genders (age range: 18-50 years) were recruited. The muscle motor points were identified for the following ten muscles of the lower limb (dominant side): vastus medialis, rectus femoris, and vastus lateralis of the quadriceps femoris, biceps femoris, semitendinosus, and semimembranosus of the hamstring muscles, tibialis anterior, peroneus longus, lateral and medial gastrocnemius. The muscle motor point was identified by scanning the skin surface with a stimulation pen electrode and corresponded to the location of the skin area above the muscle in which an electrical pulse evoked a muscle twitch with the least injected current. For each investigated muscle, 0.15 ms square pulses were delivered through the pen electrode at low current amplitude (<10 mA) and frequency (2 Hz). 16 motor points were identified in the 10 investigated muscles of almost all subjects: 3 motor points for the vastus lateralis, 2 motor points for rectus femoris, vastus medialis, biceps femoris, and tibialis anterior, 1 motor point for the remaining muscles. An important inter-individual variability was observed for the position of the following 4 out of 16 motor points: vastus lateralis (proximal), biceps femoris (short head), semimembranosus, and medial gastrocnemius. Possible implications for electrical stimulation procedures and electrode positioning different from those commonly applied for thigh and leg muscles are discussed. PMID:21796408
Extracellular stimulation of single cultured neurons which are completely sealing a microelectrode is usually performed using anodic or biphasic currents of at least 200 nA. However, recently obtained experimental data demonstrate the possibility to stimulate a neuron using cathodic current pulses with less amplitude. Also, a stimulation window is observed. These findings can be explained by a finite-element model which
Jan Reinoud Buitenweg; Wim L. C. Rutten; Enrico Marani
Extracellular stimulation of single cultured neurons which are completely sealing a microelectrode is usually performed using anodic or biphasic currents of at least 200 nA. However, recently obtained experimental data demonstrate the possibility to stimulate a neuron using cathodic current pulses with less amplitude. Also, a stimulation window is observed. These findings can be explained by a finite-element model which
Jan Reinoud Buitenweg; Wim L. C. Rutten; Enrico Marani
We have recorded and characterized the spinal cord evoked potentials (SCEPs) from the epidural space in the halothane-anesthetized rats. A group of 11 adult Wistar male rats was chronically implanted with two pairs of epidural electrodes. SCEPs were repeatedly elicited by applying electrical stimuli via bipolar U-shaped electrodes to the dorsal aspect of the spinal cord at C3–4 or Th11–12
Tomáš Ondrej?ák; Ivo Vanický; Ján Gálik; Kamila Saganová
Do central and peripheral motor pathways associated with an amputated limb retain at least some functions over periods of years? This problem could be addressed by evaluating the response patterns of nerve signals from peripheral motor fibers during transcranial magnetic stimulation (TMS) of corticospinal tracts. The aim of this study was to record for the first time TMS-related responses from the nerves of a left arm stump of an amputee via intrafascicular longitudinal flexible multi-electrodes (tfLIFE4) implanted for a prosthetic hand control. After tfLIFE4 implant in the stump median and ulnar nerves, TMS impulses of increasing intensity were delivered to the contralateral motor cortex while tfLIFE4 recordings were carried out. Combining TMS of increasing intensity and tfLIFE4 electrodes recordings, motor nerve activity possibly related to the missing limb motor control and selectively triggered by brain stimulation without significant electromyographic contamination was identified. These findings are entirely original and indicate that tfLIFE4 signals are clearly driven from M1 stimulation, therefore witnessing the presence in the stump nerves of viable motor signals from the CNS possibly useful for artificial prosthesis control. PMID:21390489
Rossini, P M; Rigosa, Jacopo; Micera, Silvestro; Assenza, Giovanni; Rossini, Luca; Ferreri, Florinda
Background and aim Sacral nerve stimulation is the therapy of choice in patients with neurogenic faecal and urine incontinence, constipation\\u000a and some pelvic pain syndromes. The aim of this study is to determine the best insertion angles of the electrode under laparoscopic\\u000a visualization of the sacral nerves.\\u000a \\u000a \\u000a \\u000a Materials and methods Five fresh cadaver pelvises were dissected through an anterior approach of the
N. C. Buchs; J.-C. Dembe; J. Robert-Yap; B. Roche; J. Fasel
Objective Despite the clinical success of deep brain stimulation (DBS) for the treatment of Parkinson’s disease (PD), little is known about the electrical spread of the stimulation. The primary goal of this study was to integrate neuroimaging, neurophysiology, and neurostimulation data sets from 10 PD patients, unilaterally implanted with subthalamic nucleus (STN) DBSelectrodes, to identify the theoretical volume of tissue activated (VTA) by clinically defined therapeutic stimulation parameters. Methods Each patient-specific model was created with a series of five steps: 1) definition of the neurosurgical stereotactic coordinate system within the context of pre-operative imaging data; 2) entry of intra-operative microelectrode recording locations from neurophysiologically defined thalamic, subthalamic, and substantia nigra neurons into the context of the imaging data; 3) fitting a 3D brain atlas to the neuroanatomy and neurophysiology of the patient; 4) positioning the DBSelectrode in the documented stereotactic location, verified by post-operative imaging data; and 5) calculation of the VTA using a diffusion tensor based finite element neurostimulation model. Results The patient-specific models show that therapeutic benefit was achieved with direct stimulation of a wide range of anatomical structures in the subthalamic region. Interestingly, of the 5 patients exhibiting a greater than 40% improvement in their unified PD rating scale (UPDRS), all but one had the majority of their VTA outside the atlas defined borders of the STN. Further, of the 5 patients with less than 40% UPDRS improvement all but one had the majority of their VTA inside the STN. Conclusions Our results are consistent with previous studies suggesting that therapeutic benefit is associated with electrode contacts near the dorsal border of the STN, and provide quantitative estimates of the electrical spread of the stimulation in a clinically relevant context.
Maks, Christopher B.; Butson, Christopher R.; Walter, Benjamin L.; Vitek, Jerrold L.; McIntyre, Cameron C.
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is now widely used to alleviate symptoms of Parkinson's disease (PD). The long-term goal is to develop a quantitative tool to facilitate selection of DBS settings in the clinic since the typical parameter selection process may not adequately consider the effects of DBS on posture control. The aim of this study
K. Narayanan; Stefani Mulligan; Padma Mahant; Johan Samanta; James J. Abbas
BackgroundSleep disturbances are common in Parkinson’s disease (PD). Bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) is superior to best medical therapy in the treatment of motor symptoms in advanced PD, and observational studies suggest that bilateral STN DBS improves sleep in these patients as well. Unilateral STN DBS also improves motor function in PD, but its effects on sleep
Amy W. Amara; David G. Standaert; Stephanie Guthrie; Gary Cutter; Ray L. Watts; Harrison Walker
Deep brain stimulation (DBS) represents a major advance in the treatment of Parkinson’s disease (PD). As more neurosurgeons enter this field, technical descriptions of implantation techniques are needed. Here we present our technical approach to subthalamic nucleus (STN) and globus pallidus internus (GPi) DBS implantation, based on 180 STN implants and 75 GPi implants. The essential steps in DBS implantation
Deep brain stimulation (DBS) of the subthalamic nucleus markedly improves the motor symptoms of Parkinson's disease, but causes cognitive side effects such as impulsivity. We showed that DBS selectively interferes with the normal ability to slow down when faced with decision conflict. While on DBS, patients actually sped up their decisions under high-conflict conditions. This form of impulsivity was not
Michael J. Frank; Johan Samanta; Ahmed A. Moustafa; Scott J. Sherman
We describe dropped head syndrome in a patient with Parkinson's disease receiving subthalamic nucleus deep brain stimulation (DBS). Posterior occipitocervical instrumented fusion after transarticular screw fixation of an odontoid fracture is shown and its rationale explained. Pedunculopontine nucleus DBS as treatment for fall-predominant Parkinson's disease, and globus pallidus interna DBS for dystonia-predominant Parkinson's disease, are discussed. PMID:20167499
Pereira, E A C; Wilson-MacDonald, J; Green, A L; Aziz, T Z; Cadoux-Hudson, T A D
Deep brain stimulation (DBS) surgery has become the gold standard for treatment of select refractory cases of Parkinson disease and essential tremor. Despite the usefulness of DBS surgery in many cases, there remain situations where lesion therapy (subthalamotomy, pallidotomy or thalamotomy) may provide a reasonable alternative to DBS. We reviewed the University of Florida Institutional Review Board-approved database for movement
Amanda K. Hooper; Michael S. Okun; Kelly D. Foote; Hubert H. Fernandez; Charles Jacobson; Pamela Zeilman; Janet Romrell; Ramon L. Rodriguez
Hindlimb movement in the cat induced by electrical stimulation with an amplitude-modulated waveform of the dorsal surface of L5-S1 spinal cord or the L5-S1 dorsal/ventral roots was investigated before and after acute spinal cord transection at the T13-L1 level. Stimulation of the spinal cord or dorsal/ventral root at the same spinal segment induced similar movements including coordinated multi-joint flexion or extension. The induced movements changed from flexion to extension when the stimulation was moved from rostral (L5) to caudal (S1) spinal segments. Stimulation of a dorsal or ventral root on one side induced only ipsilateral hindlimb movement. However, stimulation on the dorsal surface of the spinal cord along the midline or across the spinal cord induced bilateral movements. The extension induced by stimulation of L7 dorsal root produced the largest ground reaction force that was strong enough to support body weight. Dorsal root stimulation induced a larger ground reaction force than ventral root stimulation and produced a more graded recruitment curve. Stepping at different speeds could be generated by combined stimulation of the rostral (L5) and the caudal (L6/L7) spinal segments with an appropriate timing between the different stimulation channels. Acute transection of the spinal cord did not change the responses indicating that the induced movements did not require the involvement of the supraspinal locomotor centers. The methods and the stimulation strategy developed in this study might be utilized to restore locomotor function after spinal cord injury.
Tai, Changfeng; Wang, Jicheng; Shen, Bing; Wang, Xianchun; Roppolo, James R.; de Groat, William C.
In this study, local electric field distributions generated by transcranial direct current stimulation (tDCS) with an extracephalic reference electrode were evaluated to address extracephalic tDCS safety issues. To this aim, we generated a numerical model of an adult male human upper body and applied the 3D finite element method to electric current conduction analysis. In our simulations, the active electrode was placed over the left primary motor cortex (M1) and the reference electrode was placed at six different locations: over the right temporal lobe, on the right supraorbital region, on the right deltoid, on the left deltoid, under the chin, and on the right buccinator muscle. The maximum current density and electric field intensity values in the brainstem generated by the extracephalic reference electrodes were comparable to, or even less than, those generated by the cephalic reference electrodes. These results suggest that extracephalic reference electrodes do not lead to unwanted modulation of the brainstem cardio-respiratory and autonomic centers, as indicated by recent experimental studies. The volume energy density was concentrated at the neck area by the use of deltoid reference electrodes, but was still smaller than that around the active electrode locations. In addition, the distributions of elicited cortical electric fields demonstrated that the use of extracephalic reference electrodes might allow for the robust prediction of cortical modulations with little dependence on the reference electrode locations.
Im, Chang-Hwan; Park, Ji-Hye; Shim, Miseon; Chang, Won Hyuk; Kim, Yun-Hee
Background A new method of stimulating the retina electrically, called suprachoroidal transretinal stimulation (STS), was shown to be effective in eliciting electrically evoked cortical potentials (EEPs) in Royal College of Surgeons (RCS) rats. Before extending this technique to patients, it is important to determine its safety and feasibility in eliciting EEPs from medium-size animal (rabbits). The purpose of this study
Essential tremor (ET) is a neurological disorder that can be treated effectively by means of bilateral thalamic ventral intermediate nucleus (VIM) deep brain stimulation (DBS). We present a rare case of stimulation-dependent reversible ageusia that poses a therapeutic dilemma on the one hand and serves as an instructive example to elucidate the as yet incompletely defined gustatory pathways on the other. A 69-year-old patient with successful reduction of his disabling upper extremity ET experienced an almost complete but during stimulation cessation reversible ageusia under bilateral VIM DBS. An evaluation of diffusion tensor (DTI) neuroimaging studies was performed in order to detect effective electrode positions and volumes of activated tissue (VTA) in relation to the medial lemniscus (ML) and dentato-rubro-thalamic tract (DRT). Repeated subjective gustometry was conducted with differential manipulation of stimulation settings. This case report stresses the importance of fiber tracts for DBS surgery. Reconciled with previous findings in lesion cases, we assume the coexistence of decussating and non-decussating fibers in the gustatory tract combined with hemispheric dominance in the processing of gustatory information. A therapeutic option for this dilemma may be a patient-selectable stimulation program or bipolar stimulation establishing a smaller ovoid VTA. PMID:21984073
Testing of the recruitment properties and selective activation capabilities of a multi-contact spiral nerve cuff electrode was performed intraoperatively in 21 human subjects. The study was conducted in two phases. An exploratory phase with ten subjects gave a preliminary overview of the data and data collection process and a systematic phase with eleven subjects provided detailed recruitment properties. The mean
Katharine H. Polasek; Harry A. Hoyen; Michael W. Keith; Dustin J. Tyler
The nucleus accumbens (NAc) has been considered as a novel target of deep brain stimulation (DBS) for intractable psychiatric disorders. Quite a few questions exist about this new treatment, and might be explored in nonhuman primate models. There are several reports on DBS of brain nucleus other than NAc in nonhuman primates. Therefore, we stereotactically implanted the electrodes into bilateral NAc under the guidance of MRI using a clinical Leksell stereotactic system in normal rhesus monkeys. NAc could be recognized as the area of continuity between the caudate nucleus and putamen in the coronal sections, which is beneath the internal capsule, and the gray matter nucleus between the ventromedial prefrontal cortex and anterior commissure in axial sections, which is medial to the putamen. NAc is mainly at a point 2.0-3.0 mm inferior, 3.0-4.0 mm anterior, and 4.5-5.5 mm lateral to the anterior commissure. The electrodes were implanted accurately and connected to an implantable pulse generator subcutaneously. After recovery from surgery, stimulation with a variety of parameters was trialed, and continuous stimulation at 90 ?s, 3.5 V, 160, or 60 Hz was administered individually for 7 days. The behaviors and spontaneous locomotor activity of the animals did not change significantly during stimulation. This is the first report on DBS of NAc in nonhuman primates to the best of our knowledge. Bilateral electrical stimulation of NAc is a safe treatment. This model could be helpful in further studies on the clinical use of NAc stimulation for psychiatric disorders and for a better understanding of the functions of this nucleus. PMID:23196414
Stereotactic technique and the introduction of deep brain stimulation (DBS) can be considered two milestones in the field of surgical neuromodulation. At present the role of DBS in the treatment of clinically and epidemiologically relevant movement disorders is widely accepted and DBS procedures are performed in many clinical centers worldwide. Here we review the current state of the art of DBS treatment for the most common movement disorders: Parkinson’s disease, essential tremor, and dystonia. In this review, we give a brief description of the candidate patient selection criteria, the different anatomical targets for each of these condition, and the expected outcomes as well as possible side effects.
A multielectrode array in silicon technology, as well as experimental paradigms and model calculations for sensitivity and selectivity measures, have been developed. The array consists of twelve platinum electrode sites (10×50 ¿m and 50 ¿m interdistance) on a 45-¿m thick tip-shaped silicon substrate and a Si3N 4 insulating glass cover layer. The tip is inserted in the peroneal nerve of
Wim L. C. Rutten; Wier van Harmen J; Johan H. M. Put
Current electrode designs require flexible substrates that absorb little moisture and provide large charge injection capability. Sputtered iridium oxide films have superior charge injection capabilities versus noble metals and can adhere to various substrates. Liquid crystal polymers (LCP) have very little water absorption compared to other flexible substrates. Therefore, the combination of sputtered iridium oxide film on liquid crystal polymer substrate was studied using 50Hz, 100?s duration, 10mA biphasic current waveforms for 700 hours at 67°C in bicarbonate buffer saline. Scanning electron micrograph (SEM) analysis showed no delamination and approximately 1% of electrode material was lost to the bicarbonate buffer. The charge injection limit and the cathodic charge storage capacity within the water window were 4.6 +/? 1.0mC/cm2 and 31.5 +/? 6.6mC/cm2 respectively. Additional electrochemical analysis revealed significant charge imbalance attributed to oxygen reduction within the water window. These results, along with the flexible, chemically inert, biocompatible substrate, indicate that sputtered iridium oxide films on liquid crystal polymer could become the method of choice for flexible substrate nerve electrodes.
Wang, Kevin; Liu, Chung-Chiun; Durand, Dominique M.
Background Stimulation of the spinal cord has been shown to have great potential for improving function after motor deficits caused by injury or pathological conditions. Using a wide range of animal models, many studies have shown that stimulation applied to the neural networks intrinsic to the spinal cord can result in a dramatic improvement of motor ability, even allowing an animal to step and stand after a complete spinal cord transection. Clinical use of this technology, however, has been slow to develop due to the invasive nature of the implantation procedures, the lack of versatility in conventional stimulation technology, and the difficulty of ascertaining specific sites of stimulation that would provide optimal amelioration of the motor deficits. Moreover, the development of tools available to control precise stimulation chronically via biocompatible electrodes has been limited. In this paper, we outline the development of this technology and its use in the spinal rat model, demonstrating the ability to identify and stimulate specific sites of the spinal cord to produce discrete motor behaviors in spinal rats using this array. Methods We have designed a chronically implantable, rapidly switchable, high-density platinum based multi-electrode array that can be used to stimulate at 1–100 Hz and 1–10 V in both monopolar and bipolar configurations to examine the electrophysiological and behavioral effects of spinal cord epidural stimulation in complete spinal cord transected rats. Results In this paper, we have demonstrated the effectiveness of using high-resolution stimulation parameters in the context of improving motor recovery after a spinal cord injury. We observed that rats whose hindlimbs were paralyzed can stand and step when specific sets of electrodes of the array are stimulated tonically (40 Hz). Distinct patterns of stepping and standing were produced by stimulation of different combinations of electrodes on the array located at specific spinal cord levels and by specific stimulation parameters, i.e., stimulation frequency and intensity, and cathode/anode orientation. The array also was used to assess functional connectivity between the cord dorsum to interneuronal circuits and specific motor pools via evoked potentials induced at 1 Hz stimulation in the absence of any anesthesia. Conclusions Therefore the high density electrode array allows high spatial resolution and the ability to selectively activate different neural pathways within the lumbosacral region of the spinal cord to facilitate standing and stepping in adult spinal rats and provides the capability to evoke motor potentials and thus a means for assessing connectivity between sensory circuits and specific motor pools and muscles.
Deep brain stimulation (DBS) represents a promising new frontier in medicine and neuroscience for managing disorders of mental health that represent an enormous burden of disease on our societies. The caution and significant restraint of leaders in the evolution of DBS today stand in sharp and refreshing contrast to previous episodes in history. In embracing the anticipatory and pragmatic problem-solving
The renaissance of functional neurosurgery in the treatment of Parkinson’s disease has sparked also the interest in other movement disorders which are refractory to medical treatment. Deep brain stimulation (DBS) has been used only since a few years in dystonia patients. This review summarizes the available data on pallidal and thalamic DBS for various dystonic syndromes. The major advantage of
Deep brain stimulation (DBS) is an effective surgical therapy for well-selected patients with medically intractable Parkinson's disease (PD) and essential tremor (ET). The purpose of this review is to describe the success of DBS in these two disorders and its promising application in dystonia, Tourette Syndrome (TS) and epilepsy. In the last 10 years, numerous short- and intermediate-term outcome studies
Casey Halpern; Howard Hurtig; Jurg Jaggi; Murray Grossman; Michelle Won; Gordon Baltuch
Deep brain stimulation (DBS) has shown remarkable therapeutic benefits for patients with otherwise treatment-resistant movement and affective disorders. This technique is not only clinically useful, but it can also provide new insights into fundamental brain functions through direct manipulation of both local and distributed brain networks in many different species. In particular, DBS can be used in conjunction with non-invasive
Ned Jenkinson; Sarah L. F. Owen; Morten L. Kringelbach; Tipu Z. Aziz
To cope with the growing needs in research towards the understanding of cellular function and network dynamics, advanced micro-electrode arrays (MEAs) based on integrated complementary metal oxide semiconductor (CMOS) circuits have been increasingly reported. Although such arrays contain a large number of sensors for recording and/or stimulation, the size of the electrodes on these chips are often larger than a typical mammalian cell. Therefore, true single-cell recording and stimulation remains challenging. Single-cell resolution can be obtained by decreasing the size of the electrodes, which inherently increases the characteristic impedance and noise. Here, we present an array of 16,384 active sensors monolithically integrated on chip, realized in 0.18 ?m CMOS technology for recording and stimulation of individual cells. Successful recording of electrical activity of cardiac cells with the chip, validated with intracellular whole-cell patch clamp recordings are presented, illustrating single-cell readout capability. Further, by applying a single-electrodestimulation protocol, we could pace individual cardiac cells, demonstrating single-cell addressability. This novel electrode array could help pave the way towards solving complex interactions of mammalian cellular networks. PMID:22337001
The beneficial effects of subthalamic nucleus deep brain stimulation (STN-DBS) on motor symptoms and quality of life in Parkinson's disease (PD) are well known, but little is known of the effects on autonomic function. Diffusion of current during stimulation of the STN may simultaneously involve the motor and nonmotor, limbic and associative areas of the STN. The aims of this study were to examine whether STN stimulation affects functions of the autonomic nervous system and, if so, to correlate the effects with the active contacts of electrodes in the STN. Eight PD patients with good motor control and quality of sleep after STN-DBS surgery were recruited. All patients had two days of recordings with portable polysomnography (PSG) (first night with stimulation "on" and second night "off"). From the PSG data, the first sleep cycle of each recording night was defined. Heart rate variability (HRV) was analyzed between the same uninterrupted periods of the two sleep nights. In addition, the optimal electrode positions were defined from postoperative MRI studies, and the coordinates of active contacts were confirmed. HRV spectral analysis showed that only low-frequency (LF)/high-frequency (HF) power was significantly activated in the stimulation "on" groups (P = 0.011). There was a significant negative correlation between power change of LF/HF and electrode position lateral to the midcommissural point (? = 0.857, P = 0.007) These results demonstrate that STN-DBS can enhance sympathetic regulation; the autonomic response may be due to electrical signals being distributed to limbic components of the STN or descending sympathetic pathways in the zona incerta. PMID:23381615
Liu, Kang-Du; Shan, Din-E; Kuo, Terry B J; Yang, Cheryl C H
Deep brain stimulation (DBS) is currently tested as an experimental therapy for patients with treatment-resistant depression (TRD). Here we report on the short- and long-term (1 yr) clinical outcomes and tolerance of DBS in eight TRD patients. Electrodes were implanted bilaterally in the subgenual cingulate gyrus (SCG; Broadman areas 24-25), and stimulated at 135 Hz (90-?s pulsewidth). Voltage and active electrode contacts were adjusted to maximize short-term responses. Clinical assessments included the 17-item Hamilton Depression Rating Scale (HAMD17; primary measure), the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Clinical Global Impression (CGI) Scale. In the first week after surgery, response and remission (HAMD ?7) rates were, respectively 87.5% and 50%. These early responses were followed by an overall worsening, with a response and remission rates of 37.5% (3/8) at 1 month. From then onwards, patients showed a progressive improvement, with response and remission rates of 87.5% and 37.5%, respectively, at 6 months. The corresponding figures at 1 yr were 62.5% and 50%, respectively. Clinical effects were seen in all HAMD subscales without a significant incidence of side-effects. Surgical procedure and post-operative period were well-tolerated for all patients. This is the second independent study on the use of DBS of the SCG to treat chronic depression resistant to current therapeutic strategies. DBS fully remitted 50% of the patients at 1 yr, supporting its validity as a new therapeutic strategy for TRD. PMID:21777510
|The Federal Communications Commission (FCC) has been progressing over the past 5 years toward the institution of Direct Broadcast Satellite Radio (DBS-R) which would institute a new type of radio service. The FCC refers to the service as Satellite DARS (Digital Audio Radio Service), and it would provide reliable, high-fidelity satellite-delivered…
The Federal Communications Commission (FCC) has been progressing over the past 5 years toward the institution of Direct Broadcast Satellite Radio (DBS-R) which would institute a new type of radio service. The FCC refers to the service as Satellite DARS (Digital Audio Radio Service), and it would provide reliable, high-fidelity satellite-delivered…
A novel step tracking algorithm for Ku-band mobile satellite communication that will be used in mobile direct broadcasting satellite (DBS) reception is presented in this paper. The main idea for this improved step tracking algorithm is to use a highly efficient simultaneous perturbation approximation to the gradient using only two noisy measurements of the received signal strength. The antenna beam
Electrical activation of the tongue protrusor muscle has been demonstrated as an effective technique for alleviating upper airway (UAW) obstructions and is considered a potential treatment for obstructive sleep apnea (OSA). Recent studies, however, have shown marked improvements in UAW patency by coactivating the tongue protrudor and retractor muscles. As such, selective stimulation of the hypoglossal nerve (XII) using a
Neural cuffs, implanted around various hindlimb nerves (sural, common peroneal, posterior tibial), were used to deliver brief stimulus trains to unrestrained cats walking on a treadmill. The resulting perturbations of the step cycle were evaluated by analyzing the EMG bursts recorded from the ankle extensors and by high speed cinematography. It was found that relatively weak stimulation (1.4 to 2
Electrical stimulation of the nervous system is of increasing importance for a variety of prospective neural prostheses. Electrochemical reactions which may occur at Pt or other noble metal-tissue interfaces are reviewed. Use of stimulus waveforms with a net direct current component increases the probability of tissue damage. There are three conceptually safe methods of injecting charge from a noble metal
Neuromuscular electrical stimulation (NMES) can alter the functioning of muscles and even assist muscle rehabilitation. In this paper, we evaluate the effect of NMES on the conduction velocity (CV) of the brachial biceps' motor units. We used a linear array of electrodes to acquire electromyographic signals, as different subjects perform isometric voluntary contractions (IVCs), with and without prior NMES. Our results show that, after NMES, the CVs at the beginning of the IVCs tend to increase, with respect to the case without NMES. Also, we observed that, while in the absence of NMES, the CVs tend to decrease over time with continued IVCs, this does not happen after 20 minutes of NMES, and the CVs can, in some cases, increase with the contractions. PMID:22255183
Pires, Kenia F; Pimenta, Leina A B; de Andrade, Marcelino M; Domingues, Diana G; Mendes, Cristiano J M R; da Rocha, Adson F
Nonmotor symptoms are an integral part of Parkinson’s disease and cause significant morbidity. Pharmacological therapy helps alleviate the disease but produces nonmotor manifestations. While deep brain stimulation (DBS) has emerged as the treatment of choice for motor dysfunction, the effect on nonmotor symptoms is not well known. Compared with pharmacological therapy, bilateral subthalamic nucleus (STN)-DBS or globus pallidum interna (GPi)-DBS has significant beneficial effects on pain, sleep, gastrointestinal and urological symptoms. STN-DBS is associated with a mild worsening in verbal fluency while GPi-DBS has no effect on cognition. STN-DBS may improve cardiovascular autonomic disturbances by reducing the dose of dopaminergic drugs. Because the motor effects of STN-DBS and GPi-DBS appear to be similar, nonmotor symptoms may determine the target choice in surgery of future patients.
Kandadai, Rukmini Mridula; Jabeen, Afshan; Kannikannan, Meena A.
The subthalamic nucleus (STN) has become an effective target of deep-brain stimulation (DBS) in severely disabled patients\\u000a with advanced Parkinson’s disease (PD). Clinical studies have reported DBS-induced adverse effects on cognitive functions,\\u000a mood, emotion and behavior. STN DBS seems to interfere with the limbic functions of the basal ganglia, but the limbic effects\\u000a of STN DBS are controversial. We measured
Claire Haegelen; Daniel García-Lorenzo; Florence Le Jeune; Julie Péron; Bernard Gibaud; Laurent Riffaud; Gilles Brassier; Christian Barillot; Marc Vérin; Xavier Morandi
Deep brain stimulation (DBS) has steadily evolved into an established surgical therapy for numerous neurological disorders, most notably Parkinson’s disease (PD). Traditional DBS technology relies on voltage-controlled stimulation with a single source; however, recent engineering advances are providing current-controlled devices with multiple independent sources. These new stimulators deliver constant current to the brain tissue, irrespective of impedance changes that occur around the electrode, and enable more specific steering of current towards targeted regions of interest. In this study, we examined the impact of current steering between multiple electrode contacts to directly activate three distinct neural populations in the subthalamic region commonly stimulated for the treatment of PD: projection neurons of the subthalamic nucleus (STN), globus pallidus internus (GPi) fibers of the lenticular fasiculus, and internal capsule (IC) fibers of passage. We used three-dimensional finite element electric field models, along with detailed multi-compartment cable models of the three neural populations to determine their activations using a wide range of stimulation parameter settings. Our results indicate that selective activation of neural populations largely depends on the location of the active electrode(s). Greater activation of the GPi and STN populations (without activating any side-effect related IC fibers) was achieved by current steering with multiple independent sources, compared to a single current source. Despite this potential advantage, it remains to be seen if these theoretical predictions result in a measurable clinical effect that outweighs the added complexity of the expanded stimulation parameter search space generated by the more flexible technology.
Chaturvedi, Ashutosh; Foutz, Thomas J.; McIntyre, Cameron C.
Object. We arranged a mini-invasive surgical approach for implantation of paddle electrodes for SCS under spinal anesthesia obtaining the best paddle electrode placement and minimizing patients' discomfort. We describe our technique supported by neurophysiological intraoperative monitoring and clinical results. Methods. 16 patients, affected by neuropathic pain underwent the implantation of paddle electrodes for spinal cord stimulation in lateral decubitus under spinal anesthesia. The paddle was introduced after flavectomy and each patient confirmed the correct distribution of paresthesias induced by intraoperative test stimulation. VAS and patients' satisfaction rate were recorded during the followup and compared to preoperative values. Results. No patients reported discomfort during the procedure. In all cases, paresthesias coverage of the total painful region was achieved, allowing the best final electrode positioning. At the last followup (mean 36.7 months), 87.5% of the implanted patients had a good rate of satisfaction with a mean VAS score improvement of 70.5%. Conclusions. Spinal cord stimulation under spinal anesthesia allows an optimal positioning of the paddle electrodes without any discomfort for patients or neurosurgeons. The best intraoperative positioning allows a better postoperative control of pain, avoiding the risk of blind placements of the paddle or further surgery for their replacement.
Sarubbo, S.; Latini, F.; Tugnoli, V.; Quatrale, R.; Granieri, E.; Cavallo, M. A.
Through electrodes implanted for deep brain stimulation in three patients (5 sides) with Parkinson's disease, we recorded the electrical activity from the human basal ganglia before, during and after voluntary contralateral finger movements, before and after L-DOPA. We analysed the movement-related spectral changes in the electroencephalographic signal from the subthalamic nucleus (STN) and from the internal globus pallidus (GPi). Before,
A. Priori; G. Foffani; A. Pesenti; A. Bianchi; V. Chiesa; G. Baselli; E. Caputo; F. Tamma; P. Rampini; M. Egidi; M. Locatelli; S. Barbieri
Summary Many patients suffer from medically refractory epilepsy and are not candidates for resective brain surgery. Success of deep brain stimulation (DBS) in relieving a significant amount of symptoms of various movement disorders paved the way for investigations into this modality for epilepsy. Open-label and small blinded-trials have provided promising evidence for the use of DBS in refractory seizures. However, the first randomized control trial of DBS of the anterior thalamic nucleus is currently underway. Furthermore, there are multiple potential targets as many neural regions have been implicated in seizure propagation. Thus, it is difficult at this time to make any definitive judgments about the efficacy of DBS for seizure control. Future study is necessary to identify a patient population for whom this technique would be indicated, the most efficacious target, and optimal stimulation parameters.
Halpern, Casey H.; Samadani, Uzma; Litt, Brian; Jaggi, Jurg L.; Baltuch, Gordon H.
\\u000a Deep brain stimulation (DBS) is an approved adjunct therapy for severe, medication-refractory movement disorders, though it\\u000a is currently investigational in neuropsychiatry and other neurological conditions. In movement disorders, DBS targets are\\u000a based mainly on rationales derived from earlier lesion procedures and on knowledge of anatomical networks thought to be involved\\u000a in pathophysiology of illness. In contrast to lesions DBS is
Background: The incidence of intracranial hemorrhage occurring during microelectrode-guided implantation of deep brain stimulators (DBS) for movement disorders has not been well defined. We report the incidence of hemorrhage in a large series of DBS implants into the subthalamic nucleus (STN), thalamus (VIM) and internal globus pallidus (GPi). Methods: All DBS procedures performed by a single surgeon (P.A.S.) between June
\\u000a A number of recent publications have reviewed complications of deep brain stimulation (DBS) implantation (1–11). A summary of the author's peri-operative and device-related complications using Medtronic DBS hardware is provided in Table\\u000a 7.1. This is based on a series of 637 new DBS leads in 358 patients implanted by a single surgeon (PAS). Procedures were performed\\u000a with frame-based stereotaxy using
INTRODUCTION: Postoperative programming in deep brain stimulation (DBS) therapy for movement disorders can be challenging and time consuming. Providing the neurologist with tools to visualize the electrode location relative to the patient's anatomy along with models of tissue activation and statistical data can therefore be very helpful. In this study, we evaluate the consistency between neurologists in interpreting and using such information provided by our DBS programming assistance software. METHODS: Five neurologists experienced in DBS programming were each given a dataset of 29 leads implanted in 17 patients. For each patient, probabilistic maps of stimulation response, anatomical images, models of tissue activation volumes, and electrode positions were presented inside a software framework called CRAnialVault Explorer (CRAVE) developed in house. Consistency between neurologists in optimal contact selection using the software was measured. RESULTS: With only the efficacy map, the average consistency among the five neurologists with respect to the mode and mean of their selections was 97% and 95%, respectively, while these numbers were 93% and 89%, respectively, when both efficacy and an adverse effect map were used simultaneously. Fleiss' kappa statistic also showed very strong agreement among the neurologists (0.87 when using one map and 0.72 when using two maps). CONCLUSION: Our five neurologists demonstrated high consistency in interpreting information provided by the CRAVE interactive visualization software for DBS postoperative programming assistance. Three of our five neurologists had no prior experience with the software, which suggests that the software has a short learning curve and contact selection is not dependent on familiarity with the program tools. PMID:23647701
Neurodegenerative movement disorders, such as Huntington's disease (HD), have become a promising field for Deep Brain Stimulation (DBS). This study aims to contribute to the establishment of a well-grounded database including both expected and unexpected effects of pallidal DBS in HD, and to discuss the ethical and legal restrictions of DBS in cognitively limited patients. Evaluation of the outcome data indicates that pallidal DBS exerted an independent effect on motor symptoms but probably also on the patient's cognitive and affective state. The cognitive decline, however, that characterizes the late stage of neurodegenerative disorders implicates ethical and legal problems given the patients' inability to give informed consent to DBS. PMID:23589113
Summary Many patients who suffer from medically refractory epilepsy are not candidates for resective brain surgery. Success of deep\\u000a brain stimulation (DBS) in relieving a significant number of symptoms of various movement disorders paved the way for investigations\\u000a into this modality for epilepsy. Open-label and small blinded trials have provided promising evidence for the use of DBS in\\u000a refractory seizures, and
Casey H. Halpern; Uzma Samadani; Brian Litt; Jurg L. Jaggi; Gordon H. Baltuch
Deep brain stimulation (DBS) is an effective therapy to treat movement disorders including essential tremor, dystonia, and Parkinson's disease. Despite over a decade of clinical experience the mechanisms of DBS are still unclear, and this lack of understanding makes the selection of stimulation parameters quite challenging. The objective of this work was to develop a closed-loop control system that automatically adjusted the stimulation amplitude to reduce oscillatory neuronal activity, based on feedback of electrical signals recorded from the brain using the same electrode as implanted for stimulation. We simulated a population of 100 intrinsically active model neurons in the Vim thalamus, and the local field potentials (LFPs) generated by the population were used as the feedback (control) variable for closed loop control of DBS amplitude. Based on the correlation between the spectral content of the thalamic activity and tremor (Hua , 1998), (Lenz , 1988), we implemented an adaptive minimum variance controller to regulate the power spectrum of the simulated LFPs and restore the LFP power spectrum present under tremor conditions to a reference profile derived under tremor free conditions. The controller was based on a recursively identified autoregressive model (ARX) of the relationship between stimulation input and LFP output, and showed excellent performances in tracking the reference spectral features through selective changes in the theta (2-7 Hz), alpha (7-13 Hz), and beta (13-35 Hz) frequency ranges. Such changes reflected modifications in the firing patterns of the model neuronal population, and, differently from open-loop DBS, replaced the tremor-related pathological patterns with patterns similar to those simulated in tremor-free conditions. The closed-loop controller generated a LFP spectrum that approximated more closely the spectrum present in the tremor-free condition than did open loop fixed intensity stimulation and adapted to match the spectrum after a change in the neuronal oscillation frequency. This computational study suggests the feasibility of closed-loop control of DBS amplitude to regulate the spectrum of the local field potentials and thereby normalize the aberrant pattern of neuronal activity present in tremor. PMID:20889437
Santaniello, Sabato; Fiengo, Giovanni; Glielmo, Luigi; Grill, Warren M
Deep brain stimulation (DBS) of the basal ganglia is an effective treatment for select movement disorders, including Parkinson’s disease, essential tremor and dystonia. Based on these successes, DBS has been explored as an experimental treatment for medication-resistant neuropsychiatric disease. During a multiyear experience employing DBS to treat patients for obsessive compulsive disorder (OCD) we encountered several unanticipated stimulation-induced psychiatric side
Ihtsham U. Haq; Kelly D. Foote; Wayne K. Goodman; Nicola Ricciuti; Herbert Ward; Atchar Sudhyadhom; Charles E. Jacobson; Mustafa S. Siddiqui; Michael S. Okun
Purpose The study aim was to validate the closed loop stimulation (CLS) vs. accelerometer (ACC) rate-responsive sensors with electrodes\\u000a placed in the right ventricular high septal (RVHS) or right ventricular apical (RVA) lead positions in patients following\\u000a ‘ablate and pace’ therapy for persistent atrial fibrillation.\\u000a \\u000a \\u000a \\u000a Methods ‘Ablate and pace’ patients were randomised to either RVHS or RVA electrode placement with a dual
John Silberbauer; Paul S. G. Hong; Rick A. Veasey; Nadeem A. Maddekar; Wasing Taggu; Nikhil R. Patel; Guy W. Lloyd; Neil Sulke
\\u000a The clinical success of deep brain stimulation (DBS) for treating advanced movement disorders is crucially dependent on the\\u000a quality of postoperative neurological management. A well-implanted lead in an appropriately selected patient is useless without\\u000a the application of proper stimulation settings. DBS therapy introduces in many cases a delicate balance of electrical and\\u000a pharmacological treatment that requires a critical understanding of
Roberts Bartholow's 1874 experiment on Mary Rafferty is widely cited as the first demonstration, by direct application of stimulatingelectrodes, of the motor excitability of the human cerebral cortex. The many accounts of the experiment, however, leave certain questions and details unexamined or unresolved, especially about Bartholow's goals, the nature and quality of the evidence, and the experiment's role in the history of theory and research on localisation of function. In this article, we try to fill these gaps and to tell the full story. We describe Bartholow's career up to 1874, review the theoretical and empirical background for the experiment, and present Bartholow's own account of the experiment as well as those of his supporters and critics. We then present our own analysis, assess the experiment's influence on contemporaneous scientific opinion about cortical excitability, and trace its citation record into our own time. We also review and assess ethical criticisms of Bartholow and their effects on his career, and we close by discussing the role we think the experiment deserves to play in the history of theory and research on cortical excitability. PMID:19286295
Invasive neurostimulation therapies may be proposed to patients with neuropathic pain refractory to conventional medical management, in order to improve pain relief, functional capacity, and quality of life. In this review, the respective mechanisms of action and efficacy of peripheral nerve stimulation (PNS), nerve root stimulation (NRS), spinal cord stimulation (SCS), deep brain stimulation (DBS), and motor cortex stimulation (MCS) are discussed. PNS appears to be useful in various refractory neuropathic pain indications (as long as there is some preservation of sensation in the painful area), such as intractable chronic headache, pelvic and perineal pain, and low back pain, but evidence for its efficacy is not strongly conclusive, and large-scale randomized controlled studies are necessary to confirm the efficacy in the long term. Spinal cord stimulation (SCS) has been validated for the treatment of selected types of chronic pain syndromes, such as Failed Back Surgery Syndrome, and Complex Regional Pain Syndrome type I. When neuropathic pain is secondary to a brain lesion (especially following stroke) or a trigeminal lesion, stimulation of brain structures is required. Deep brain stimulation (DBS), which can be proposed with targets like the periventricular/periaqueductal gray matter or the sensory thalamus, is increasingly replaced by motor cortex stimulation (MCS), mainly because it is safer, more easily performed, and probably more effective in a wider range of indications (including central post-stroke pain). The respective places of DBS and MCS in some selected indications, such as peripheral neuropathic pain and phantom limb pain, have yet to be clearly delineated. Controlled trials, with the stimulator switched ON or OFF in a double-blind procedure, have demonstrated the efficacy of MCS in the treatment of peripheral and central neuropathic pain, although these trials included a limited number of patients and need to be confirmed by large, controlled, multicenter studies. Despite technical progress in neurosurgical navigation, guided by neuroimaging and intraoperative electrophysiology to optimize electrode positioning, MCS results are still variable, and validated criteria for selecting good candidates for implantation are lacking, except clinical response to preoperative rTMS, which showed correlations with a good response to MCS-induced analgesia. However, the evidence in favor of this technique is sufficient to include it in the range of treatment options for refractory neuropathic pain. PMID:23114579
The renaissance of functional stereotactic neurosurgery was pioneered in the mid 1980s by Laitinen's introduction of Leksell's posteroventral pallidotomy for Parkinson´s disease (PD). This ablative procedure experienced a worldwide spread in the 1990s, owing to its excellent effect on dyskinesias and other symptoms of post-l-dopa PD. Modern deep brain stimulation (DBS), pioneered by Benabid and Pollak in 1987 for the treatment of tremor, first became popular when it was applied to the subthalamic nucleus (STN) in the mid 1990s, where it demonstrated a striking effect on all cardinal symptoms of advanced PD, and permitted reduced dosages of medication. DBS, as a nondestructive, adaptable, and reversible procedure that is proving safe in bilateral surgery on basal ganglia, has great appeal to clinicians and patients alike, despite the fact that it is expensive, laborious, and relies on very strict patient selection criteria, especially for STN DBS. Psychiatric surgery has experienced the same phenomenon, with DBS supplanting completely stereotactic ablative procedures. This chapter discusses the pros and cons of ablation versus stimulation and investigates the reasons why DBS has overshadowed proven efficient ablative procedures such as pallidotomy for PD, and capsulotomy and cingulotomy for obsessive-compulsive disorder and depression. PMID:24112885
Chronic deep brain stimulation (DBS) of subgenual cingulate white matter results in dramatic remission of symptoms in some previously treatment-resistant depression patients. The effects of stimulation may be mediated locally or via corticocortical or corticosubcortical connections. We use tractography to define the likely connectivity of cingulate regions stimulated in DBS- responsive patients using diffusion imaging data acquired in healthy control
H. Johansen-Berg; D. A. Gutman; T. E. J. Behrens; P. M. Matthews; M. F. S. Rushworth; E. Katz; A. M. Lozano; H. S. Mayberg
While deep brain stimulation (DBS) for patients with Parkinson's disease has typically raised ethical questions about autonomy, accountability and personal identity, recent research indicates that we need to begin taking into account issues surrounding the patients' feelings of authenticity and alienation as well. In order to bring out the relevance of this dimension to ethical considerations of DBS, I analyse a recent case study of a Dutch patient who, as a result of DBS, faced a dilemma between autonomy and authenticity. This case study is meant to point out the normatively meaningful tension patients under DBS experience between authenticity and autonomy. PMID:23355227
Deep brain stimulation (DBS) has proven a powerful treatment for medication refractory movement disorders. Success in this group of patients has allowed preliminary studies of DBS to proceed in severe and medication resistant cases of depression, obsessive-compulsive disorder (OCD) and Tourette's syndrome (TS). Pathophysiological and imaging studies along with attempts at lesioning the basal ganglia, have offered clues as to
Background\\/Aims: We report on deep brain stimulation (DBS) in the ventral intermediate part of the thalamus in 4 patients with complex tremor syndromes, 2 classified as Holmes tremor (HT) and 2 as thalamic tremor (TT). Results: Three out of 4 patients showed intraoperative improvement and underwent DBS implantation. One patient with TT without intraoperative improvement was not provided with an
N. J. Diederich; L. Verhagen Metman; R. A. Bakay; F. Alesch
To investigate the effects of central thalamic deep brain stimulation (CT\\/DBS) on behavior and frontal cortical function, we conducted experiments in an awake, behaving macaque monkey performing tasks that required sustained attention and working memory. Results of this preliminary study revealed that CT\\/DBS can lead to an improvement, a decrement, a mixed or have no effect on behavior.
Sudhin A. Shah; Jonathan L. Baker; Jae-Wook Ryou; Keith P. Purpura; Nicholas D. Schiff
The effects of spinal cord stimulation (SCS), deep brain stimulation (DBS) of the thalamic nucleus ventralis caudalis (VC) and motor cortex stimulation (MCS) were analyzed in 19 patients with phantom limb pain. All of the patients underwent SCS and, if the SCS failed to reduce the pain, the patients were considered for DBS and/or MCS. Satisfactory pain control for the long-term was achieved in 6 of 19 (32%) by SCS, 6 of 10 (60%) by DBS and 1 (20%) of 5 by MCS. SCS and DBS of the VC sometimes produced a dramatic effect on the pain, leading to a long pain-free interval and infrequent use of stimulation. The effects of both DBS of the VC and MCS were tested in four. One patient of them reported better pain control by MCS than by DBS, whereas two reported the opposite results. There is no evidence at present for an advantage of MCS over SCS and DBS of the VC in controlling phantom limb pain. PMID:12378068
Katayama, Y; Yamamoto, T; Kobayashi, K; Kasai, M; Oshima, H; Fukaya, C
Objective. Electrical stimulation of the pudendal nerve (PN) is being developed as a means to restore bladder function in persons with spinal cord injury. A single nerve cuff electrode placed on the proximal PN trunk may enable selective stimulation of distinct fascicles to maintain continence or evoke micturition. The objective of this study was to design a nerve cuff that enabled selective stimulation of the PN. Approach. We evaluated the performance of both flat interface nerve electrode (FINE) cuff and round cuff designs, with a range of FINE cuff heights and number of contacts, as well as multiple contact orientations. This analysis was performed using a computational model, in which the nerve and fascicle cross-sectional positions from five human PN trunks were systematically reshaped within the nerve cuff. These cross-sections were used to create finite element models, with electric potentials calculated and applied to a cable model of a myelinated axon to evaluate stimulation selectivity for different PN targets. Subsequently, the model was coupled to a genetic algorithm (GA) to identify solutions that used multiple contact activation to maximize selectivity and minimize total stimulation voltage. Main results. Simulations did not identify any significant differences in selectivity between FINE and round cuffs, although the latter required smaller stimulation voltages for target activation due to preserved localization of targeted fascicle groups. Further, it was found that a ten contact nerve cuff generated sufficient selectivity for all PN targets, with the degree of selectivity dependent on the relative position of the target within the nerve. The GA identified solutions that increased fitness by 0.7-45.5% over single contact activation by decreasing stimulation of non-targeted fascicles. Significance. This study suggests that using an optimal nerve cuff design and multiple contact activation could enable selective stimulation of the human PN trunk for restoration of bladder function.
This study describes the preliminary performance of an implanted neuroprosthesis for standing and transfers after spinal cord injury. The system is a 16-channel version of the 8-channel Case Western Reserve University\\/Veteran Affairs (CWRU\\/VA) standing\\/transfer neural prosthesis. It includes bilateral four channel femoral nerve cuff electrodes for stimulation of the vastii to provide knee extension. To date, the prosthesis has been
Lee E. Fisher; Michael E. Miller; Stephanie J. Nogan; John A. Davis; J. S. Anderson; Lori M. Murray; Dustin J. Tyler; Ronald J. Triolo
Tannase production by Aureobasidium pullulans DBS66 was optimized. The organism produced maximum tannase in the presence of 1% tannic acid after 36 h. Maximum gallic acid accumulation was observed within 36 h and tannic acid in the fermented broth was completely degraded after 42 h of growth. Glucose had a stimulatory effect on tannase synthesis at 0.1% (w/v) concentration. The organism showed maximum tannase production with (NH4)2HPO4 as nitrogen source. Shaking speed of 120 rpm and 50-ml broth volume have been found to be suitable for maximum tannase production. PMID:18050927
There is a growing interest in the use of chronic deep brain stimulation (DBS) for the treatment of medically refractory movement disorders and other neurological and psychiatric conditions. Fundamental questions remain about the physiologic effects of DBS. Previous basic research studies have focused on the direct polarization of neuronal membranes by electrical stimulation. The goal of this paper is to
Maged M. Elwassif; Qingjun Kong; Maribel Vazquez; Marom Bikson
High-frequency electrical stimulation (deep brain stimulation (DBS)) of the thalamus and basal ganglia (subthalamic nucleus, internal segment of the globus pallidus) is used to treat motor disorders arising in Parkinson’s disease, multiple sclerosis, and essential tremor. Although clinically effective, the mechanisms of action of DBS are unknown. A number of plausible hypotheses have been offered, however, until the effects of
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been shown to be an effective therapy for the treatment of advanced Parkinson's disease (PD). Fortyseven patients were bilaterally implanted for STN DBS and clinically evaluated according to the Core Assessment Program for Intracerebral Transplantations before surgery and 3, 12 and 24 months after surgery. Electrical stimulation led to a
A. Tavella; B. Bergamasco; E. Bosticco; M. Lanotte; P. Perozzo; M. Rizzone; E. Torre; L. Lopiano
High-frequency deep brain stimulation (DBS) of the thalamus or basal ganglia represents an effective clinical technique for the treatment of several medically refractory movement disorders. However, understanding of the mechanisms responsible for the therapeutic action of DBS remains elusive. The goal of this review is to address our present knowledge of the effects of high-frequency stimulation within the central nervous
Cameron C. McIntyre; Marc Savasta; Lydia Kerkerian-Le Goff; Jerrold L. Vitek
During the last decade deep brain stimulation (DBS) has become a routine method for the treatment of advanced Parkinson’s disease (PD), leading to striking improvements in motor function and quality of life of PD patients. It is associated with minimal morbidity. The rationale of targeting specific structures within basal ganglia such as the subthalamic nucleus (STN) or the internal segment
A stimulator for use in marital orgasmic therapy is provided. The stimulator uses a step-down transformer and a water-proof case. The stimulator oscillates at 2000-8000 (preferably 3000-3600) cycles per minute throughout an angle of operation chosen from the range of 10 to 80 (preferably 20 to 60) degrees. An integrated set includes several different detachable attachments and a handle with mechanical oscillating means.
Woog; Philippe-Guy E. (Geneva, CH); Moret; Michel A. (Geneva, CH)
Deep brain stimulation (DBS) provides a very effective treatment for a number of neurological diseases including Parkinson's disease, movement disorders and epilepsy. In DBS microelectrodes are positioned in defined cerebral target areas and connected to a pacemaker. It is most often performed as an awake craniotomy with intraoperative testing. Various anesthesiological regimes are used to protect the patient from surgical stress on the one hand and to achieve ideal test conditions on the other. They include local anesthesia or scalp blocks, intermittent general anesthesia or analgosedation with or without airway protection; however, anesthetic agents interfere with hemodynamic stability and ventilation, with vigilance and cooperation and in addition with the symptoms and microelectrode recording. Guidance and communication have a pivotal impact on patient needs for pharmacological interventions. With increasing numbers of DBS procedures, anesthesiologists are more often faced with patients carrying brain pacemakers. For anesthesia the characteristics of the disease as well as the respective long-term medication have to be considered. In addition, the rules for handling patients with pacemakers need to be followed to avoid both dysfunction of the generator and tissue damage due to overheating of the electrodes. PMID:23817843
Seemann, M; Zech, N; Lange, M; Hansen, J; Hansen, E
Patients receiving oral levodopa, the standard treatment for Parkinson's disease (PD), eventually develop motor fluctuations and dyskinesias. Treatment options for patients with these symptoms include high-frequency deep brain stimulation of the subthalamic nucleus (STN-DBS) or continuous dopaminergic stimulation (CDS). STN-DBS is the prevalent surgical therapy for PD and has shown efficacy, but behavioural disorders, including cognitive problems, depression and suicidality
People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10% of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). DBS involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioral measures of the severity of the symptoms. In this article we aim to capture the changes in the patients' phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients' experience of the world. We propose to specify the patients' world in terms of a field of affordances, with the three dimensions of broadness of scope ("width" of the field), temporal horizon ("depth"), and relevance of the perceived affordances ("height"). The second aspect is the person-side of the interaction, that is, the patients' self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take toward the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment. PMID:24133438
de Haan, Sanneke; Rietveld, Erik; Stokhof, Martin; Denys, Damiaan
People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10% of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). DBS involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioral measures of the severity of the symptoms. In this article we aim to capture the changes in the patients' phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients' experience of the world. We propose to specify the patients' world in terms of a field of affordances, with the three dimensions of broadness of scope (“width” of the field), temporal horizon (“depth”), and relevance of the perceived affordances (“height”). The second aspect is the person-side of the interaction, that is, the patients' self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take toward the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment.
de Haan, Sanneke; Rietveld, Erik; Stokhof, Martin; Denys, Damiaan
Summary Chronic electrical stimulation of the brain, known as deep brain stimulation (DBS), has become a preferred surgical treatment\\u000a for medication-refractory movement disorders. Despite its remarkable clinical success, the therapeutic mechanisms of DBS are\\u000a still not completely understood, limiting opportunities to improve treatment efficacy and simplify selection of stimulation\\u000a parameters. This review addresses three questions essential to understanding the mechanisms of
Matthew D. Johnson; Svjetlana Miocinovic; Cameron C. McIntyre; Jerrold L. Vitek
Deep brain stimulation of the subthalamic nucleus (STN-DBS) in patients with Parkinson's disease (PD) affects speech inconsistently. Recently, stimulation of the caudal zona incerta (cZi-DBS) has shown superior motor outcomes for PD patients, but effects on speech have not been systematically investigated. The aim of this study was to compare the effects of cZi-DBS and STN-DBS on voice intensity in PD patients. Mean intensity during reading and intensity decay during rapid syllable repetition were measured for STN-DBS and cZi-DBS patients (eight patients per group), before- and 12 months after-surgery on- and off-stimulation. For mean intensity, there were small significant differences on- versus off-stimulation in each group: 74.2 (2.0)?dB contra 72.1 (2.2)?dB (P = .002) for STN-DBS, and 71.6 (4.1)?dB contra 72.8 (3.4)?dB (P = .03) for cZi-DBS, with significant interaction (P < .001). Intensity decay showed no significant changes. The subtle differences found for mean intensity suggest that STN-DBS and cZi-DBS may influence voice intensity differently.
Lundgren, Sofie; Saeys, Thomas; Karlsson, Fredrik; Olofsson, Katarina; Blomstedt, Patric; Linder, Jan; Nordh, Erik; Zafar, Hamayun; van Doorn, Jan
The maximum, biphasically applied charge which can be injected without electrolyzing water has been determined for Pt electrodes in simulated cerebral spinal fluid at 37°C. Electrolysis of water would lead to gas bubble formation, which is thought to be harmful. The experimental method involved the use of electrical transients. With lead (anodic faist) electrodes, the theoretical non-gassing limit is 300
Purpose Adequate velopharyngeal control is essential for speech, but may be impaired in Parkinson’s disease (PD). Bilateral subthalamic nucleus deep brain stimulation (STN DBS) improves limb function in PD, but the effects on velopharyngeal control remain unknown. We tested whether STN DBS would change aerodynamic measures of velopharyngeal control, and whether these changes were correlated with limb function and stimulation settings. Methods Seventeen PD participants with bilateral STN DBS were tested within a morning session after a minimum of 12 h since their most recent dose of anti-PD medication. Testing occurred when STN DBS was on, and again 1 h after STN DBS was turned off, and included aerodynamic measures during syllable production, and standard neurological ratings of limb function. Results We found that PD participants exhibited changes with STN DBS, primarily consistent with increased intraoral pressure (n = 7) and increased velopharyngeal closure (n = 5). These changes were modestly correlated with measures of limb function, and were correlated with stimulation frequency. Conclusion Our findings suggest that STN DBS may change velopharyngeal control during syllable production in PD, with greater benefit associated with low frequency stimulation. However, DBS demonstrates a more subtle influence on speech-related velopharyngeal control than limb motor control. This distinction and its underlying mechanisms are important to consider when assessing the impact of STN DBS on PD.
Hammer, Michael J.; Barlow, Steven M.; Lyons, Kelly E.; Pahwa, Rajesh
Excessive synchronization of basal ganglia neural activity at low frequencies is considered a hallmark of Parkinson's disease (PD). However, few studies have unambiguously linked this activity to movement impairment through direct stimulation of basal ganglia targets at low frequency. Furthermore, these studies have varied in their methodology and findings, so it remains unclear whether stimulation at any or all frequencies ? 20 Hz impairs movement and if so, whether effects are identical across this broad frequency band. To address these issues, 18 PD patients chronically implanted with deep brain stimulation (DBS) electrodes in both subthalamic nuclei were stimulated bilaterally at 5, 10 and 20 Hz after overnight withdrawal of their medication and the effects of the DBS on a finger tapping task were compared to performance without DBS (0 Hz). Tapping rate decreased at 5 and 20 Hz compared to 0 Hz (by 11.8 ± 4.9%, p = 0.022 and 7.4 ± 2.6%, p = 0.009, respectively) on those sides with relatively preserved baseline task performance. Moreover, the coefficient of variation of tap intervals increased at 5 and 10 Hz compared to 0 Hz (by 70.4 ± 35.8%, p = 0.038 and 81.5 ± 48.2%, p = 0.043, respectively). These data suggest that the susceptibility of basal ganglia networks to the effects of excessive synchronization may be elevated across a broad low-frequency band in parkinsonian patients, although the nature of the consequent motor impairment may depend on the precise frequencies at which synchronization occurs.
As the population of many countries ages, disorders of cognition and memory-such as Alzheimer's Disease (AD) and dementia associated with Parkinson's Disease-will become a major societal burden. At present, few effective medical therapies against these conditions are available. Deep brain stimulation (DBS) may be a potential therapeutic option, because it can directly target and modulate the activity of structures implicated in circuits subserving memory function. In this article, we review the scientific literature to address some of the mechanisms by which DBS may impact memory and cognition. We then summarize the results of recent clinical experience with DBS in AD and Parkinsonian dementia. PMID:23111294
An electrical stimulator system is described incorporating rechargeable batteries and a charging circuit. A charging set and electrode support are alternatively connected to the stimulator system via a single common two-pole terminal. The system is designed to prevent current from flowing directly from the battery to the electrode support along the charging circuit while allowing charge current to flow in the opposite direction along the charging circuit if the charging set is connected to the system instead of the electrode support.
Deep brain stimulation (DBS) of the internal globus pallidus (GPi) and ventral intermediate thalamic nucleus (VIM) are established treatment options in primary dystonia and tremor syndromes and have been reported anecdotally to be efficacious in myoclonus-dystonia (MD). We investigated short- and long-term effects on motor function, cognition, affective state, and quality of life (QoL) of GPi- and VIM-DBS in MD. Ten MD-patients (nine epsilon-sarcoglycan-mutation-positive) were evaluated pre- and post-surgically following continuous bilateral GPi- and VIM-DBS at four time points: presurgical, 6, 12, and as a last follow-up at a mean of 62.3 months postsurgically, and in OFF-, GPi-, VIM-, and GPi-VIM-DBS conditions by validated motor [unified myoclonus rating scale (UMRS), TSUI Score, Burke-Fahn-Marsden dystonia rating scale (BFMDRS)], cognitive, affective, and QoL-scores. MD-symptoms significantly improved at 6 months post-surgery (UMRS: 61.5%, TSUI Score: 36.5%, BFMDRS: 47.3%). Beneficial effects were sustained at long-term evaluation post-surgery (UMRS: 65.5%, TSUI Score: 35.1%, BFMDRS: 48.2%). QoL was significantly ameliorated; affective status and cognition remained unchanged postsurgically irrespective of the stimulation conditions. No serious long-lasting stimulation-related adverse events (AEs) were observed. Both GPi- and VIM-DBS offer equally effective and safe treatment options for MD. With respect to fewer adverse, stimulation-induced events of GPi-DBS in comparison with VIM-DBS, GPi-DBS seems to be preferable. Combined GPi-VIM-DBS can be useful in cases of incapaciting myoclonus, refractory to GPi-DBS alone. PMID:20623686
Deep brain stimulation (DBS) has been proposed as a potential treatment of drug addiction on the basis of its effects on drug\\u000a self-administration in animals and on addictive behaviours in some humans treated with DBS for other psychiatric or neurological\\u000a conditions. DBS is seen as a more reversible intervention than ablative neurosurgery but it is nonetheless a treatment that\\u000a carries
Adrian Carter; Emily Bell; Eric Racine; Wayne Hall
A case is described of a patient with levodopa responsive parkinsonism, dyskinesia, and off periods who underwent bilateral deep brain stimulation of the subthalamic nuclei (DBS-STN) with good result. As the disease progressed, the patient fit diagnostic criteria for progressive supranuclear palsy parkinsonism (PSP-P). Benefit of DBS for the parkinsonian phenomena is still apparent 4 years later. That DBS-STN provided
Although deep-brain stimulation (DBS) can be used to improve some of the severe symptoms of Parkinson's disease (e.g., Bradykinesia, rigidity, and tremors), the mechanisms by which the symptoms are eliminated are not well understood. Moreover, DBS does not prevent neurodegeneration that leads to dementia or death. In order to fully investigate DBS and to optimize its use, a comprehensive long-term
We describe dropped head syndrome in a patient with Parkinson’s disease receiving subthalamic nucleus deep brain stimulation (DBS). Posterior occipitocervical instrumented fusion after transarticular screw fixation of an odontoid fracture is shown and its rationale explained. Pedunculopontine nucleus DBS as treatment for fall-predominant Parkinson’s disease, and globus pallidus interna DBS for dystonia-predominant Parkinson’s disease, are discussed.
E. A. C. Pereira; J. Wilson-MacDonald; A. L. Green; T. Z. Aziz; T. A. D. Cadoux-Hudson
This paper considers issues related to the selection of an image compression algorithm and associated data transport format for all-digital DBS systems intended for the delivery of entertainment video. Several alternative approaches are described, including: (1) standard compression algorithm (e.g., ISO MPEG) without special transport; (2) standard MPEG algorithm with satellite-specific transport; and (3) modified MPEG with priority layering of video, custom transport format based on either (A) constant bit-rate (CBR) video, or (B) variable bit-rate (VBR) video with statistical multiplexing. Trade-offs between these contending system architectures are discussed in terms of system performance, system capacity, compatibility, service flexibility and equipment cost. The discussion is supported with some performance results for an example NTSC quality TV delivery scenario, illustrating the potential image quality/capacity/graceful degradation benefits of applicable custom transport, error concealment, layering and VBR statistical multiplexing techniques.
Deep brain stimulation (DBS) for pain was one of the earliest indications for the therapy. This study reports the outcome\\u000a of DBS of the sensory thalamus and the periventricular and peri-aqueductal grey area (PVG=PAG) complex for different intractable\\u000a neuropathic pain syndromes. Forty-seven patients (30 males and 17 females) were selected for surgery; they were suffering\\u000a from any of the following
S. L. F. Owen; A. L. Green; D. D. Nandi; R. G. Bittar; S. Wang; Tipu Z. Aziz
Ankle sprain is a common sports related injury that may be caused by incorrect positioning of the foot prior to and at initial contact during landing from a jump or gait. Furthermore a delayed reaction of the peroneal muscle may also contribute to the injury mechanism. A recent study demonstrated that myoelectric stimulation of the peroneal muscles within 15 ms of a simulated inversion event would significantly resist an ankle spraining motion. This study further investigated its effect with three different electrode sizes and three different lateral shank attachment positions. Twelve male subjects with healthy ankles performed simulated ankle supination spraining motion on a pair of mechanical sprain simulators. A pair of electrodes of one of the three sizes (large, medium, small) was attached to one of the three positions (upper 1/4, middle, lower 1/4) along the lateral shank to deliver an electrical signal of 130 V for 0.5s when the sprain simulator started. Ankle kinematics data were collected by a tri-axial gyroscope motion sensor and the peak inward heel tilting velocity was obtained to represent the effect in resisting the simulated ankle spraining motion. Repeated measures one-way analysis of variance was performed and showed a significant drop from 273.3 (control, no stimulation) to 215.8 deg/s (21%) when small electrodes were attached to the upper 1/4 position. Decrease was found in all other conditions but the drops (11-18%) were not statistically significant. The small electrodes used in this study fitted the width of the peroneal muscle belly at the upper 1/4 position, so the electrical current may have well flowed to the motor points of the muscles to initiate quick contraction. PMID:23453396
Fong, Daniel Tik-Pui; Wang, Dan; Chu, Vikki Wing-Shan; Chan, Kai-Ming
Executive Summary Objective To determine the effectiveness and adverse effects of deep brain stimulation (DBS) in the treatment of symptoms of idiopathic Parkinson’s disease, essential tremor, and primary dystonia and to do an economic analysis if evidence for effectiveness is established. The Technology Deep brain stimulation (DBS) is a surgical procedure indicated in the relief of motor function symptoms of Parkinson’s disease, essential tremor and dystonia. It involves the surgical implantation of the DBS device, which include the implantable pulse generator or stimulator, the extension, and the lead. The electric impulse is produced within the stimulator component, and transmitted to the brain site by the extension and the lead(s). DBS surgery can be either unilateral or bilateral. The laterality of the surgery and target area for brain stimulation may vary with the type of symptom or spectrum of symptoms, and such decisions are made on a case-by-case basis. Advantages of DBS over ablative surgery is that it is comparatively less invasive, it is reversible, and it allows for stimulation of both sides of the brain. Ablative surgery, which is not practiced in Ontario, results in a non-reversible lesion and is often not conducted on both sides. Thus far, DBS has been considered as an adjunct to drug therapy. Review Strategy The standard Medical Advisory Secretariat search strategy was conducted to identify international health technology assessments and English language journal articles published from January 1, 2001 onwards. Documents were reviewed separately for Parkinson’s disease, essential tremor and primary dystonia. Summary of Findings There is level 1b evidence that bilateral DBS of the subthalamic nucleus is effective in the short-term control of advanced parkinsonian symptoms, and there is level 3a evidence that the effect is sustained for at least 5 years. There is Level 3a evidence that DBS of the thalamus is effective in the control of tremor in patients with essential tremor and PD for at least 6 years. There is level 3a evidence that bilateral DBS of the globus pallidus is effective in the control of symptoms of primary dystonia for at least 1 year. Conclusion According to the estimates of prevalence and evidence of effectiveness, there is a shortfall in the numbers of DBS currently done in Ontario for drug-resistant PD, essential tremor, and primary dystonia. Since complication rates are lower if DBS is performed in specialized centres, the number of sites should be limited. The cost per procedure to institutions with the expertise to undertake DBS and the human resource considerations are likely to be limiting factors in the further diffusion of DBS.
...2010-10-01 false System specifications for double-sideband (DBS) modulated emissions in the HF broadcasting service. 73... Â§ 73.756 System specifications for double-sideband (DBS) modulated emissions in the HF broadcasting service....
...2009-10-01 false System specifications for double-sideband (DBS) modulated emissions in the HF broadcasting service. 73... Â§ 73.756 System specifications for double-sideband (DBS) modulated emissions in the HF broadcasting service....
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for the motor symptoms of Parkinson’s disease (PD). The effects of DBS depend strongly on stimulation frequency: high frequencies (>90Hz) improve motor symptoms, while low frequencies (<50Hz) are either ineffective or exacerbate symptoms. The neuronal basis for these frequency-dependent effects of DBS is unclear. The effects of different frequencies of STN-DBS on behavior and single-unit neuronal activity in the basal ganglia were studied in the unilateral 6-hydroxydopamine lesioned rat model of PD. Only high frequency DBS reversed motor symptoms and the effectiveness of DBS depended strongly on stimulation frequency in a manner reminiscent of its clinical effects in persons with PD. Quantification of single-unit activity in the globus pallidus externa (GPe) and substantia nigra reticulata (SNr) revealed that high frequency DBS, but not low frequency DBS, reduced pathological low frequency oscillations (~9Hz) and entrained neurons to fire at the stimulation frequency. Similarly, the coherence between simultaneously recorded pairs of neurons within and across GPe and SNr shifted from the pathological low frequency band to the stimulation frequency during high frequency DBS, but not during low frequency DBS. The changes in firing patterns in basal ganglia neurons were not correlated with changes in firing rate. These results indicate that high frequency DBS is more effective than low frequency DBS, not as a result of changes in firing rate, but rather due to its ability to replace pathological low frequency network oscillations with a regularized pattern of neuronal firing.
McConnell, George C.; So, Rosa Q.; Hilliard, Justin D; Lopomo, Paola; Grill, Warren M.
Deep brain stimulation (DBS) is a neurosurgical intervention whose efficacy, safety, and utility have been shown in the treatment of movement disorders. For the treatment of chronic pain refractory to medical therapies, many prospective case series have been reported, but few have published findings from patients treated during the past decade using current standards of neuroimaging and stimulator technology. We summarize the history, science, selection, assessment, surgery, and personal clinical experience of DBS of the ventral posterior thalamus, periventricular/periaqueductal gray matter, and, latterly, the rostral anterior cingulate cortex (Cg24) in 100 patients treated now at two centers (John Radcliffe Hospital, Oxford, UK, and Hospital de São João, Porto, Portugal) over 12 years. Several experienced centers continue DBS for chronic pain with success in selected patients, in particular those with pain after amputation, brachial plexus injury, stroke, and cephalalgias including anesthesia dolorosa. Other successes include pain after multiple sclerosis and spine injury. Somatotopic coverage during awake surgery is important in our technique, with cingulate DBS considered for whole-body pain or after unsuccessful DBS of other targets. Findings discussed from neuroimaging modalities, invasive neurophysiological insights from local field potential recording, and autonomic assessments may translate into improved patient selection and enhanced efficacy, encouraging larger clinical trials. PMID:24112902
Pereira, Erlick A C; Green, Alexander L; Aziz, Tipu Z
Photorelease of caged Ca2+ is a uniquely powerful tool to study the dynamics of Ca2+-triggered exocytosis from individual cells. Using photolithography and other microfabrication techniques, we have developed transparent microchip devices to enable photorelease of caged Ca2+ together with electrochemical detection of quantal catecholamine secretion from individual cells or cell arrays as a step towards developing high-throughput experimental devices. A 100 nm - thick transparent Indium-Tin-Oxide (ITO) film was sputter-deposited onto glass coverslips, which were then patterned into 24 cell-sized working electrodes (?20 ?m by 20 ?m). We loaded bovine chromaffin cells with acetoxymethyl (AM) ester derivatives of the Ca2+ cage NP-EGTA and Ca2+ indicator dye Fura-4F, then transferred these cells onto the working ITO electrodes for amperometric recordings. Upon flash photorelease of caged Ca2+, a uniform rise of [Ca2+]i within the target cell leads to quantal release of oxidizable catecholamines measured amperometrically by the underlying ITO electrode. We observed a burst of amperometric spikes upon rapid elevation of [Ca2+]i and a “priming” effect of sub-stimulatory [Ca2+]i on the response of cells to subsequent [Ca2+]i elevation, similar to previous reports using different techniques. We conclude that UV photolysis of caged Ca2+ is a suitable stimulation technique for higher-throughput studies of Ca2+-dependent exocytosis on transparent electrochemical microelectrode arrays.
Chen, Xiaohui; Gao, Yuanfang; Hossain, Maruf; Gangopadhyay, Shubhra; Gillis, Kevin D.
PURPOSE: Sacral spinal nerve stimulation is a new therapeutic approach for patients with severe fecal incontinence owing to functional deficits of the external anal sphincter. It aims to use the morphologically intact anatomy to recruit residual function. This study evaluates the long-term results of the first patients treated with this novel approach applying two techniques of sacral spinal nerve stimulator
Klaus E. Matzel; Uwe Stadelmaier; Markus Hohenfellner; Werner Hohenberger
Magnetic resonance imaging (MRI) has become the standard of care for the evaluation of different neurological disorders of the brain and spinal cord due to its multiplanar capabilities and excellent soft tissue resolution. With the large and increasing population of patients with implanted deep brain stimulation (DBS) devices, a significant proportion of these patients with chronic neurological diseases require evaluation of their primary neurological disease processes by MRI. The presence of an implanted DBS device in a magnetic resonance environment presents potential hazards. These include the potential for induction of electrical currents or heating in DBS devices, which can result in neurological tissue injury, magnetic field-induced device migration, or disruption of the operational aspects of the devices. In this chapter, we review the basic physics of potential interactions of the MRI environment with implanted DBS devices, summarize results from phantom studies and clinical series, and discuss present recommendations for safe MRI in patients with implanted DBS devices. PMID:24112886
Deep brain stimulation (DBS) has proven to be an effective and safe treatment option in patients with various advanced and treatment-refractory conditions. Thus far, most of the experience with DBS has been in the movement disorder literature, and more specifically in the adult population, where its use in conditions such as Parkinson disease has revolutionized management strategies. The pediatric population, however, can also be afflicted by functionally incapacitating neurological conditions that remain refractory despite the clinicians' best efforts. In such cases, DBS offers an additional treatment alternative. In this paper, the authors review their institution's experience with DBS in the pediatric population, and provide an overview of the literature on DBS in children. The authors conclude that DBS in children can and should be considered a valid and effective treatment option, albeit in highly specific and carefully selected cases. PMID:20672919
The influence of bilateral deep brain stimulation (DBS) of the nucleus nucleus (NAcc) on the processing of reward in a gambling paradigm was investigated using H2[15O]-PET (positron emission tomography) in a 38-year-old man treated for severe alcohol addiction. Behavioral data analysis revealed a less risky, more careful choice behavior under active DBS compared to DBS switched off. PET showed win- and loss-related activations in the paracingulate cortex, temporal poles, precuneus and hippocampus under active DBS, brain areas that have been implicated in action monitoring and behavioral control. Except for the temporal pole these activations were not seen when DBS was deactivated. These findings suggest that DBS of the NAcc may act partially by improving behavioral control.
Heldmann, Marcus; Berding, Georg; Voges, Jurgen; Bogerts, Bernhard; Galazky, Imke; Muller, Ulf; Baillot, Gunther; Heinze, Hans-Jochen; Munte, Thomas F.
Deep brain stimulation (DBS) is an established medical therapy for the treatment of movement disorders and shows great promise for several other neurological disorders. However, after decades of clinical utility the underlying therapeutic mechanisms remain undefined. Early attempts to explain the mechanisms of DBS focused on hypotheses that mimicked an ablative lesion to the stimulated brain region. More recent scientific efforts have explored the wide-spread changes in neural activity generated throughout the stimulated brain network. In turn, new theories on the mechanisms of DBS have taken a systems-level approach to begin to decipher the network activity. This review provides an introduction to some of the network based theories on the function and pathophysiology of the cortico-basal-ganglia-thalamo-cortical loops commonly targeted by DBS. We then analyze some recent results on the effects of DBS on these networks, with a focus on subthalamic DBS for the treatment of Parkinson's disease. Finally we attempt to summarize how DBS could be achieving its therapeutic effects by overriding pathological network activity.
|Aim: To examine the cognitive functioning of young people with pantothenate-kinase-associated neurodegeneration (PKAN) after pallidal deep brain stimulation (DBS). PKAN is characterized by progressive generalized dystonia and has historically been associated with cognitive decline. With growing evidence that DBS can improve motor function in…
Purpose: Adequate velopharyngeal control is essential for speech, but may be impaired in Parkinson's disease (PD). Bilateral subthalamic nucleus deep brain stimulation (STN DBS) improves limb function in PD, but the effects on velopharyngeal control remain unknown. We tested whether STN DBS would change aerodynamic measures of velopharyngeal…
Hammer, Michael J.; Barlow, Steven M.; Lyons, Kelly E.; Pahwa, Rajesh
Summary Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and antiparkinsonian medication have proved to be effective treatments for tremor in Parkinson's disease. To date it is not known how and to what extent STN DBS alone and in combination with antiparkinsonian medication alters the pathophysiology of resting and postural tremor in idiopathic Parkinson's disease. The purpose of this
Molly M. Sturman; David E. Vaillancourt; Leo Verhagen Metman; Roy A. E. Bakay; Daniel M. Corcos
Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression. Because a prominent clinical feature of depression is anhedonia—the inability to experience pleasure from previously pleasurable activities—and because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive
Thomas E Schlaepfer; Michael X Cohen; Caroline Frick; Markus Kosel; Daniela Brodesser; Nikolai Axmacher; Alexius Young Joe; Martina Kreft; Doris Lenartz; Volker Sturm
Deep brain stimulation (DBS) to different sites allows interfering with dysfunctional network function implicated in major depression. Because a prominent clinical feature of depression is anhedoniaFthe inability to experience pleasure from previously pleasurable activitiesFand because there is clear evidence of dysfunctions of the reward system in depression, DBS to the nucleus accumbens might offer a new possibility to target depressive
Thomas E Schlaepfer; Michael X Cohen; Caroline Frick; Markus Kosel; Daniela Brodesser; Nikolai Axmacher; Alexius Young Joe; Martina Kreft; Doris Lenartz; Volker Sturm
Deep Brain Stimulation (DBS) is FDA-approved for the treatment of Parkinson's disease and essential tremor. Currently, placement of DBS leads is guided through a combination of anatomical targeting and intraoperative microelectrode recordings. The physiological mapping process requires several hours, and each pass of the microelectrode into the brain increases the risk of hemorrhage. Optical Coherence Domain Reflectometry (OCDR) in combination
Sung W. Jeon; Mark A. Shure; Kenneth B. Baker; Ali Chahlavi; Nagi Hatoum; Massud Turbay; Andrew M. Rollins; Ali R. Rezai; David Huang
ObjectivePatients with Parkinson's disease (PD) are typically discharged from the hospital the day following deep brain stimulation (DBS) surgery; however, factors extending hospital stay are largely unknown. This study examined potential factors that might have corresponded to increased post-operative stays following unilateral DBS surgery.
Ania Mikos; Juliessa Pavon; Dawn Bowers; Kelly D. Foote; Andrew S. Resnick; Hubert H. Fernandez; Penelope Thomas; Cynthia Garvan; Ananya Roy; Michael S. Okun
|Purpose: Adequate velopharyngeal control is essential for speech, but may be impaired in Parkinson's disease (PD). Bilateral subthalamic nucleus deep brain stimulation (STN DBS) improves limb function in PD, but the effects on velopharyngeal control remain unknown. We tested whether STN DBS would change aerodynamic measures of velopharyngeal…
Hammer, Michael J.; Barlow, Steven M.; Lyons, Kelly E.; Pahwa, Rajesh
Aims: We explore whether clinical research on deep brain stimulation (DBS) of the nucleus accumbens (NAc) to treat addiction is justified besides theoretical speculation. Methods: Since 2004, 10 patients who were also smokers were treated at the University of Cologne for Tourette’s syndrome (TS), obsessive-compulsive disorders (OCD) or anxiety disorders (AD) by DBS of the NAc. We assessed their smoking
J. Kuhn; R. Bauer; S. Pohl; D. Lenartz; W. Huff; E. H. Kim; J. Klosterkoetter; V. Sturm
Deep brain stimulation (DBS) has become a common therapeutic approach to patients with movement disorders. We evaluated results from two centers in a large metropolitan area where DBS systems are implanted into the thalamus for patients with tremor. Although all implanted systems led to an improvement in tremor, morbidity related to the hardware system occurred. A total of 23 hardware
Douglas Kondziolka; Donald Whiting; Anand Germanwala; Michael Oh
Deep brain stimulation (DBS) of the anterior limb of the internal capsule has been shown to be beneficial in the short term for obsessive–compulsive disorder (OCD) patients who exhaust conventional therapies. Nuttin et al, who published the first DBS for OCD series, found promising results using a capsule target immediately rostral to the anterior commissure extending into adjacent ventral capsule\\/ventral
Benjamin D Greenberg; Donald A Malone; Gerhard M Friehs; Ali R Rezai; Cynthia S Kubu; Paul F Malloy; Stephen P Salloway; Michael S Okun; Wayne K Goodman; Steven A Rasmussen
This paper highlights the neuropsychological sequelae of posteroventral pallidotomy (PVP) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the internal segment of the globus pallidus (GPi) at 3\\/6 months postoperatively. Results are based on our extensive experience with PVP and our preliminary observations with DBS. Patients with borderline cognitive or psychiatric functioning risk postoperative decompensation. Nonlateralizing attentional
Lisa L. Trépanier; Rajeev Kumar; Andres M. Lozano; Anthony E. Lang; Jean A. Saint-Cyr
Deep brain stimulation (DBS) is a neurosurgical technique that has been widely applied for the treatment of tremor or motor symptoms associated with advanced Parkinson's disease. Large stimulus artifacts, however, have hampered investigations of physiological mechanisms underlying DBS effects using extracellular recording techniques. We have developed an off-line procedure for removing stimulus artifacts from recorded neuronal signals (monopolar) and applied
Takao Hashimoto; Christopher M Elder; Jerrold L Vitek
Deep brain stimulation (DBS) is associated with significant improvement of motor complications in patients with severe Parkinson's disease after some 6-12 months of treatment. Long-term results in a large number of patients have been reported only from a single study centre. We report 69 Parkinson's disease patients treated with bilateral DBS of the subthalamic nucleus (STN, n= 49) or globus
M. C. Rodriguez-Oroz; J. A. Obeso; A. E. Lang; J.-L. Houeto; P. Pollak; S. Rehncrona; J. Kulisevsky; A. Albanese; J. Volkmann; M. I. Hariz; N. P. Quinn; J. D. Speelman; J. Guridi; I. Zamarbide; A. Gironell; J. Molet; B. Pascual-Sedano; B. Pidoux; A. M. Bonnet; Y. Agid; J. Xie; A.-L. Benabid; A. M. Lozano; J. Saint-Cyr; L. Romito; M. F. Contarino; M. Scerrati; V. Fraix; N. Van Blercom
Objective: To descirbe smiling and euphoria induced by deep brain stimulation (DBS). Background and Significance: The brain systems inducing emotional experiences and displays are not entirely known, but the ventral striatum including the nucleus accumbens have been posited to play a critical role in mediating emotions with positive valence. DBS has been successfully employed for the treatment of movement disorders,
Michael S. Okun; Dawn Bowers; Utaka Springer; Nathan A. Shapira; Donald Malone; Ali R. Rezai; Bart Nuttin; Kenneth M. Heilman; Robert J. Morecraft; Steven A. Rasmussen; Benjamin D. Greenberg; Kelly D. Foote; Wayne K. Goodman
Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. This study presents a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals were to identify the intersection between the VTA and surrounding anatomical structures and to
Christopher R. Butson; Scott E. Cooper; Jaimie M. Henderson; Cameron C. McIntyre
The objective was to investigate the long term safety and efficacy of unilateral deep brain stimulation (DBS) of the VIM nucleus of the thalamus in Parkinson's disease.Twelve patients with Parkinson's disease underwent unilateral DBS of the thalamus for medication resistant tremor between 1994 and 1997. Patients were evaluated with the motor section of the unified Parkinson's disease rating scale (UPDRS)
K E Lyons; W C Koller; Steven B. Wilkinson; R Pahwa
Dystonia is a heterogeneous syndrome of movement disorders characterized by involuntary muscle contractions leading to abnormal movements and postures. While medical treatment is often ineffective, deep brain stimulation (DBS) of the internal pallidum improves dystonia. Here, we studied the impact of DBS in the entopeduncular nucleus (EP), the rodent equivalent of the human globus pallidus internus, on basal ganglia output
Arthur Leblois; René Reese; David Labarre; Melanie Hamann; Angelika Richter; Thomas Boraud; Wassilios G. Meissner
Deep brain stimulation (DBS) is currently in pivotal trials as an intervention for treatment-resistant depression (TRD). Although offering hope for TRD, DBS also provokes ethical concerns—particularly about decision-making capacity of people with depression—among bioethicists, investigators, institutional review boards, and the public. Here, we examine this critical issue of informed consent for DBS research using available evidence regarding decision-making capacity and
Laura B. Dunn; Paul E. Holtzheimer; Jinger G. Hoop; Helen S. Mayberg; Laura Weiss Roberts; Paul S. Appelbaum
Writer's cramp is a type of idiopathic focal hand dystonia characterized by muscle cramps that accompany execution of the writing task specifically. There has been renewed interest in neurosurgical procedures for the treatment of dystonia over the past several years. In particular, deep brain stimulation (DBS) has received increasing attention as a therapeutic option for patients with dystonia. However, to date, limited reporters made investigations into DBS in relation to the Writer's cramp. In this case, unilateral Ventro-oralis complex (Vo) DBS resulted in a major improvement in patient's focal dystonic movement disorders. Her post-operative Burke-Fahn-Marsden Dystonia Rating (BFMDR) scale demonstrated 1 compared with pre-operative BFMDR scale 4. We conclude that thalamic Vo complex DBS may be an important neurosurgical therapeutic option for Writer's cramp.
In this study we asked whether subthalamic nucleus deep brain stimulation (STN-DBS) alone, or in combination with l-dopa, modifies voluntary, spontaneous and reflex blinking in patients with Parkinson's disease (PD). Sixteen PD patients who underwent STN-DBS were studied in four experimental conditions: without STN-DBS and without l-dopa, STN-DBS alone, l-dopa alone and STN-DBS plus l-dopa. The results were compared with those obtained in 15 healthy controls. Voluntary blinking was assessed by asking participants to blink as fast as possible; spontaneous blinking was recorded during two 60s rest periods; reflex blinking was evoked by electrical stimulation of the supraorbital nerve. Blinking were recorded and analysed with the SMART motion system. STN-DBS increased the peak velocity and amplitude for both the closing and opening voluntary blink phases, but prolonged the inter-phase pause duration. l-dopa had no effects on voluntary blinking but reversed the increased inter-phase pause duration seen during STN-DBS. Spontaneous blink rate increased after either STN-DBS or l-dopa. Reflex blinking kinematics were not modified by STN-DBS or l-dopa. The STN-DBS effects on voluntary blinking kinematics and spontaneous blinking rate may occur as results of changes of cortico-basal ganglia activity. The prolonged pause duration of voluntary blinking indicates that STN-DBS has detrimental effects on the cranial region. These results also shed light on the pathophysiology of eyelids opening apraxia following STN-DBS. PMID:22366535
The consideration of ethical and social issues related to current uses of deep brain stimulation (DBS) as well as investigational uses should now be an integral part of contemporary DBS practice. Scholarship, interdisciplinary work groups, and peer processes have helped articulate standards that need to be respected and implemented in current DBS practice. Integrating new knowledge and interdisciplinary ethical perspectives could be considered a sign of the maturity and rigor of a DBS program. Still, investigational uses of DBS carry tremendous hope but also touch on sensitive and thorny ethical questions. These questions can benefit from the ethical wisdom generated for standard uses of DBS but also challenge current practices and professional conduct. Realizing this, interdisciplinary expert groups have been convened to identify and flesh out ethical guideposts for cutting-edge research in DBS. By implementing these ethical frameworks, DBS is an opportunity to develop promising treatments for a set of vulnerable and sometimes underserved patients while keeping their best interests in sight. PMID:24112905
This study aimed to find out whether preoperative diffusion tensor imaging (DTI) and probabilistic tractography could help with surgical planning for deep brain stimulation in the periaqueductal/periventricular grey area (PAG/PVG) in a patient with lower leg stump pain. A preoperative DTI was obtained from the patient, who then received DBS surgery in the PAG/PVG area with good pain relief. The postoperative MRI scan showing electrode placement was used to calculate four seed areas to represent the contacts on the Medtronic 3387 electrode. Probabilistic tractography was then performed from the pre-operative DTI image. Tracts were seen to connect to many areas within the pain network from the four different contacts. These initial findings suggest that preoperative DTI scanning and probabilistic tractography may be able to assist surgical planning in the future. PMID:17922322
Owen, S L F; Heath, J; Kringelbach, M L; Stein, J F; Aziz, T Z
The European Bioanalysis Forum dried blood spots/microsampling consortium is reporting back from the experiments they performed on further documenting the potential hurdles of the DBS technology. Their experiments focused on the impact of hematocrit changes, IS addition, spot homogeneity, aging of spots and stability of fresh blood and cards. Results from these experiments demonstrate that the issues of DBS in regulated bioanalysis are real and that the technology will need additional improvements to be ready for use as a general tool for regulated bioanalysis. In addition, results on fresh blood and card stability were shared at international meetings and will be reported at a later date. PMID:23829466
Timmerman, Philip; White, Steve; Cobb, Zoe; de Vries, Ronald; Thomas, Elizabeth; van Baar, Ben
Deep brain stimulation (DBS) is making a major impact in patients with advanced Parkinson's disease who continue to be disabled despite the best available medical therapy. Stimulation of the internal segment of the globus pallidus (GPi) or the subthalamic nucleus (STN) can improve tremor, rigidity, bradykinesia and gait disturbances in Parkinson's disease and improve the day-to-day activities of patients with
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) improves motor function including gait and stability in people with PD, but differences in DBS contact locations within the STN may contribute to variability in the degree of improvement. Based on anatomic connectivity, dorsal STN may be preferentially involved in motor function and ventral STN in cognitive function. To determine whether dorsal DBS affects gait and balance more than ventral DBS, we conducted a double-blind evaluation of 23 PD patients with bilateral STN DBS. Each participant underwent gait analysis and balance testing off Parkinson medication in three DBS conditions (unilateral DBS in dorsal STN region, unilateral DBS in ventral STN region, and both stimulators off) on one day. For UPDRS-III scores and velocity for Fast and Pref gait, as well as stride length for Fast and Pref gait, dorsal and ventral stimulation improved gait, compared to the off condition (post hoc tests, p<0.05). However, there were no differences with dorsal compared to ventral stimulation. Balance, assessed using a multi-item clinical balance test (mini-BESTest), was similar across conditions. Absence of differences in gait and balance between dorsal and ventral conditions suggests motor connections involved in gait and balance may be more diffusely distributed in STN than previously thought, as opposed to neural connections involved in cognitive processes, such as response inhibition, which are more affected by ventral stimulation.
Intercalation of hydrogen phosphate (HPO4) into Mg/Al-Layered Double Hydroxides (LDH) with DodecylBenzeneSulfonate (DBS) was investigated with regard to anion exchange, rehydration and a combination of delamination and anion exchange. HPO4 could not be intercalated into the interlayer space of LDH with DBS when using either anion exchange or rehydration methods. However, HPO4 was successfully intercalated into the Mg/Al-LDH using a combination of delamination and anion exchange methods.
Shimamura, Akihiro; Jones, Mark I.; Metson, James B.
Deep brain stimulation (DBS) in the subthalamic nucleus (STN) is a well-established therapy for patients with severe Parkinson's disease (PD); however, its mechanism of action is still unclear. In this study we explored static and dynamic activation patterns in the basal ganglia (BG) during high-frequency macro-stimulation of the STN. Extracellular multi-electrode recordings were performed in primates rendered parkinsonian using 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. Recordings were preformed simultaneously in the STN and the globus pallidus externus and internus. Single units were recorded preceding and during the stimulation. During the stimulation, STN mean firing rate dropped significantly, while pallidal mean firing rates did not change significantly. The vast majority of neurons across all three nuclei displayed stimulation driven modulations, which were stereotypic within each nucleus but differed across nuclei. The predominant response pattern of STN neurons was somatic inhibition. However, most pallidal neurons demonstrated synaptic activation patterns. A minority of neurons across all nuclei displayed axonal activation. Temporal dynamics were observed in the response to stimulation over the first 10 seconds in the STN and over the first 30 seconds in the pallidum. In both pallidal segments, the synaptic activation response patterns underwent delay and decay of the magnitude of the peak response due to short term synaptic depression. We suggest that during STN macro-stimulation the STN goes through a functional ablation as its upper bound on information transmission drops significantly. This notion is further supported by the evident dissociation between the stimulation driven pre-synaptic STN somatic inhibition and the post-synaptic axonal activation of its downstream targets. Thus, BG output maintains its firing rate while losing the deleterious effect of the STN. This may be a part of the mechanism leading to the beneficial effect of DBS in PD.
Electrical stimulation, which has long been known, has recently been complemented by electromagnetic stimulation. This method is based on the law of induction and employs coils in place of electrodes. The effect of this process is deduced from both the relationship between magnetic and electrical fields and the stimulating effect. A new type of stimulator has been developed from a resonant circuit, thus allowing nerves to be excited with low-frequency pulses up to fusion frequency. PMID:2372568
Eichhorn, K F; Arndt, B; Claus, D; Heinrich, W; Sembach, O; Schreivogel, K
Deep brain stimulation (DBS) is used increasingly in the field of movement disorders. The implanted electrodes create not only a prior risk to patient safety during MRI, but also a unique opportunity in the collection of functional MRI data conditioned by direct neural stimulation. We evaluated MRI-related heating for bilateral neurostimulation systems used for DBS with an emphasis on assessing clinically relevant imaging parameters. Magnetic resonance imaging was performed using transmit body radiofrequency (RF) coil and receive-only head RF coil at various specific absorption rates (SARs) of RF power. In vitro testing was performed using a gel-filled phantom with temperatures recorded at the electrode tips. Each DBSelectrode was positioned with a single extension loop around each pulse generator and a single loop at the "head" end of the phantom. Various pulse sequences were used for MRI including fast spin-echo, echo-planar imaging, magnetization transfer contrast and gradient-echo techniques. The MRI sequences had calculated whole-body averaged SARs and local head SARs ranging from 0.1 to 1.6 W/kg and 0.1 to 3.2 W/kg, respectively. Temperature elevations of less than 1.0 degrees C were found with the fast spin-echo, magnetization transfer contrast, gradient-echo and echo-planar clinical imaging sequences. Using the highest SAR levels, whole-body averaged, 1.6 W/kg, local exposed-body, 3.2 W/kg, and local head, 2.9 W/kg, the temperature increase was 2.1 degrees C. These results showed that temperature elevations associated with clinical sequences were within an acceptable physiologically safe range for the MR conditions used in this evaluation, especially for the use of relatively low SAR levels. Notably, these findings are highly specific to the neurostimulation systems, device positioning technique, MR system and imaging conditions used in this investigation. PMID:15919600
Bhidayasiri, Roongroj; Bronstein, Jeff M; Sinha, Shantanu; Krahl, Scott E; Ahn, Sinyeob; Behnke, Eric J; Cohen, Mark S; Frysinger, Robert; Shellock, Frank G
The use of potential biasing and biphasic, asymmetric current pulse waveforms to maximize the charge-injection capacity of activated iridium oxide (AIROF) microelectrodes used for neural stimulation is described. The waveforms retain overall zero net charge for the biphasic pulse, but employ an asymmetry in the current and pulse widths of each phase, with the second phase delivered at a lower
Stuart F. Cogan; Philip R. Troyk; Julia Ehrlich; Timothy D. Plante; David E. Detlefsen
Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor symptoms including tremor and bradykinesia (slowness of movement). Drug treatment, although capable of controlling these symptoms over a number of years, becomes less effective as the disease progresses and leads to motor complications such as drug-induced dyskinesia (involuntary abnormal movements). Deep brain stimulation (DBS) provides an alternative means of controlling motor symptoms in these patients, and while DBS has been effective in improving motor symptoms, these improvements are largely based on accurate placement of the lead and the ability of medical personnel to adequately program the DBS device following implantation. While guidelines exist for DBS programming, selection of stimulation parameters and patient outcome is greatly dependent on subjective clinical assessments and the experience of the medical personnel performing the programming. The aim of this project was to assess the feasibility of using a quantitative and objective approach to programming. Two subjects underwent standard procedures for DBS programming while wearing a small, compact motion sensor. Kinematic data were collected from subjects as they completed motor tasks to evaluate DBS efficacy. Quantitative variables characterizing tremor and bradykinesia were related to stimulation parameters. Results indicated different stimulation settings might be required for optimal improvement of different motor symptoms. A standardized method of programming DBS parameters utilizing motion analysis may provide an objective method of assessment that the programmer can use to better identify stimulation parameters to achieve optimal improvement across multiple motor symptoms. PMID:21459111
Mera, Thomas; Vitek, Jerrold L; Alberts, Jay L; Giuffrida, Joseph P
Background Over the last two decades, deep brain stimulation (DBS) has become a recognized and effective clinical therapy for numerous neurological conditions. Since its inception, clinical DBS technology has progressed at a relatively slow rate; however, advances in neural engineering research have the potential to improve DBS systems. One such advance is the concept of current steering, or the use of multiple stimulation sources to direct current flow through targeted regions of brain tissue. Objective The goals of this study were to develop a theoretical understanding of the effects of current steering in the context of DBS, and use that information to evaluate the potential utility of current steering during stimulation of the subthalamic nucleus. Methods We used finite element electric field models, coupled to multi-compartment cable axon models, to predict the volume of tissue activated (VTA) by DBS as a function of the stimulation parameter settings. Results Balancing current flow through adjacent cathodes increased the VTA magnitude, relative to monopolar stimulation, and current steering enabled us to sculpt the shape of the VTA to fit a given anatomical target. Conclusions These results provide motivation for the integration of current steering technology into clinical DBS systems, thereby expanding opportunities to customize DBS to individual patients, and potentially enhancing therapeutic efficacy.
Deep brain stimulation (DBS) in the thalamic ventrointermediate nucleus (VIM) is the traditional target for the surgical treatment of pharmacologically refractory essential tremor or parkinsonian tremor. Studies in recent years on DBS in posterior subthalamic area (PSA), including the zona incerta and the prelemniscal radiation, have shown promising results in tremor suppression, particularly for those tremors difficult to be well controlled by VIM DBS, such as the proximal postural tremor, distal intention tremor and some cerebellar outflow tremor in various diseases including essential tremor and multiple sclerosis. The adverse effect profile of the PSA DBS is mild and transient, without lasting or striking dysarthria, disequilibrium or tolerance, in contrast to VIM DBS, particularly bilateral DBS. However, the studies on PSA DBS so far are still limited, with a handful of studies on bilateral PSA, and a short follow up duration compared to VIM. More studies are needed for direct comparison of these targets in the future. A review here would help to gain more insight into the benefits and limits of the PSA DBS compared to that in VIM in the clinical management of various tremors, particularly for those difficult to be well controlled by traditional VIM DBS.
From a neuroimaging point of view, deep brain stimulation (DBS) in psychiatric disorders represents a unique source of information to probe results gained in functional, structural and molecular neuroimaging studies in vivo. However, the implementation has, up to now, been restricted by the heterogeneity of the data reported in DBS studies. The aim of the present study was therefore to provide a comprehensive and standardized database of currently used DBS targets in selected psychiatric disorders (obsessive-compulsive disorder (OCD), treatment-resistant depression (TRD), Gilles de la Tourette syndrome (GTS)) to enable topological comparisons between neuroimaging results and stimulation areas. A systematic literature research was performed and all peer-reviewed publications until the year 2012 were included. Literature research yielded a total of 84 peer-reviewed studies including about 296 psychiatric patients. The individual stimulation data of 37 of these studies meeting the inclusion criteria which included a total of 202 patients (63 OCD, 89 TRD, 50 GTS) was translated into MNI stereotactic space with respect to AC origin in order to identify key targets. The created database can be used to compare DBS target areas in MNI stereotactic coordinates with: 1) activation patterns in functional brain imaging (fMRI, phfMRI, PET, MET, E