Sample records for stimulation dbs electrodes

  1. Lead-DBS: a toolbox for deep brain stimulation electrode localizations and visualizations.

    PubMed

    Horn, Andreas; Kühn, Andrea A

    2015-02-15

    To determine placement of electrodes after deep brain stimulation (DBS) surgery, a novel toolbox that facilitates both reconstruction of the lead electrode trajectory and the contact placement is introduced. Using the toolbox, electrode placement can be reconstructed and visualized based on the electrode-induced artifacts on post-operative magnetic resonance (MR) or computed tomography (CT) images. Correct electrode placement is essential for efficacious treatment with DBS. Post-operative knowledge about the placement of DBS electrode contacts and trajectories is a promising tool for clinical evaluation of DBS effects and adverse effects. It may help clinicians in identifying the best stimulation contacts based on anatomical target areas and may even shorten test stimulation protocols in the future. Fifty patients that underwent DBS surgery were analyzed in this study. After normalizing the post-operative MR/CT volumes into standard Montreal Neurological Institute (MNI)-stereotactic space, electrode leads (n=104) were detected by a novel algorithm that iteratively thresholds each axial slice and isolates the centroids of the electrode artifacts within the MR/CT-images (MR only n=32, CT only n=10, MR and CT n=8). Two patients received four, the others received two quadripolar DBS leads bilaterally, summing up to a total of 120 lead localizations. In a second reconstruction step, electrode contacts along the lead trajectories were reconstructed by using templates of electrode tips that had been manually created beforehand. Reconstructions that were made by the algorithm were finally compared to manual surveys of contact localizations. The algorithm was able to robustly accomplish lead reconstructions in an automated manner in 98% of electrodes and contact reconstructions in 69% of electrodes. Using additional subsequent manual refinement of the reconstructed contact positions, 118 of 120 electrode lead and contact reconstructions could be localized using the toolbox. Taken together, the toolbox presented here allows for a precise and fast reconstruction of DBS contacts by proposing a semi-automated procedure. Reconstruction results can be directly exported to two- and three-dimensional views that show the relationship between DBS contacts and anatomical target regions. The toolbox is made available to the public in form of an open-source MATLAB repository. PMID:25498389

  2. Temperature Control at DBS Electrodes using Heat Sink: Experimentally Validated FEM Model of DBS lead Architecture

    PubMed Central

    Elwassif, Maged M.; Datta, Abhishek; Rahman, Asif; Bikson, Marom

    2012-01-01

    There is a growing interest in the use of Deep Brain Stimulation for the treatment of medically refractory movement disorders and other neurological and psychiatric conditions. The extent of temperature increases around DBS electrodes during normal operation (joule heating and increased metabolic activity) or coupling with an external source (e.g. MRI) remains poorly understood and methods to mitigate temperature increases are being actively investigated. We developed a heat transfer finite element method simulation of DBS incorporating the realistic architecture of Medtronic 3389 leads. The temperature changes were analyzed considering different electrode configurations, stimulation protocols, and tissue properties. The heat-transfer model results were then validated using micro-thermocouple measurements during DBS lead stimulation in a saline bath. FEM results indicate that lead design (materials and geometry) may have a central role in controlling temperature rise by conducting heat. We show how modifying lead design can effectively control temperature increases. The robustness of this heat-sink approach over complimentary heat-mitigation technologies follows from several features: 1) it is insensitive to the mechanisms of heating (e.g. nature of magnetic coupling); 2) does not interfere with device efficacy; and 3) can be practically implemented in a broad range of implanted devices without modifying the normal device operations or the implant procedure. PMID:22764359

  3. Temperature control at DBS electrodes using a heat sink: experimentally validated FEM model of DBS lead architecture

    NASA Astrophysics Data System (ADS)

    Elwassif, Maged M.; Datta, Abhishek; Rahman, Asif; Bikson, Marom

    2012-08-01

    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 DBS electrodes 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 mitigate temperature increases are being actively investigated. We developed a heat transfer finite element method (FEM) simulation of DBS incorporating the realistic architecture of Medtronic 3389 leads. The temperature changes were analyzed considering different electrode configurations, stimulation protocols and tissue properties. The heat-transfer model results were then validated using micro-thermocouple measurements during DBS lead stimulation in a saline bath. FEM results indicate that lead design (materials and geometry) may have a central role in controlling temperature rise by conducting heat. We show how modifying lead design can effectively control temperature increases. The robustness of this heat-sink approach over complimentary heat-mitigation technologies follows from several features: (1) it is insensitive to the mechanisms of heating (e.g. nature of magnetic coupling); (2) it does not interfere with device efficacy; and (3) can be practically implemented in a broad range of implanted devices without modifying the normal device operations or the implant procedure.

  4. A critical reflection on the technological development of deep brain stimulation (DBS)

    PubMed Central

    Ineichen, Christian; Glannon, Walter; Temel, Yasin; Baumann, Christian R.; Sürücü, Oguzkan

    2014-01-01

    Since the translational research findings of Benabid and colleagues which partly led to their seminal paper regarding the treatment of mainly tremor-dominant Parkinson patients through thalamic high-frequency-stimulation (HFS) in 1987, we still struggle with identifying a satisfactory mechanistic explanation of the underlying principles of deep brain stimulation (DBS). Furthermore, the technological advance of DBS devices (electrodes and implantable pulse generators, IPG’s) has shown a distinct lack of dynamic progression. In light of this we argue that it is time to leave the paleolithic age and enter hellenistic times: the device-manufacturing industry and the medical community together should put more emphasis on advancing the technology rather than resting on their laurels. PMID:25278864

  5. In vivo impedance spectroscopy of deep brain stimulation electrodes

    NASA Astrophysics Data System (ADS)

    Lempka, Scott F.; Miocinovic, Svjetlana; Johnson, Matthew D.; Vitek, Jerrold L.; McIntyre, Cameron C.

    2009-08-01

    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 DBS electrode 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 DBS electrodes 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 DBS electrode 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.

  6. High frequency stimulation of the subthalamic nucleus evokes striatal dopamine release in a large animal model of human DBS neurosurgery

    Microsoft Academic Search

    Young-Min Shon; Kendall H. Lee; Stephan J. Goerss; In Yong Kim; Chris Kimble; Jamie J. Van Gompel; Kevin Bennet; Charles D. Blaha; Su-Youne Chang

    2010-01-01

    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 DBS

  7. Functional preservation of deep brain stimulation electrodes after brain shift induced by traumatic subdural haematoma - case report.

    PubMed

    Yang, Yu-Jen; Jhang, Shang-Wun; Chen, Chien-Min; Chen, Yung-Hsiang; Cheng, Chun-Yuan

    2013-02-01

    A Parkinson's disease patient with deep brain stimulation (DBS) implantation experienced an acute subdural haematoma (SDH) after a fall. The DBS electrodes 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

  8. Effect Transformation of the Micro Electrode Recording (MER) Data to Fast Fourier Transform (FFT) for the Main Target Nucleus Determination for STN-DBS

    PubMed Central

    Kaptan, Hulagu; Ayaz, Murat; Ekmekçi, Hakan

    2014-01-01

    Introduction: Advanced PD stimulation of the STN reduces tremor, rigidity, and bradykinesia. Due to hemorrhagic complications the use of micro electrode recordings during DBS operation was still questioning for some of surgeons. But use micro electrodes were still the best choice for the positioning during surgery of DBS. Aim: The aim of the current study was to investigate the effect transformation of the micro electrode recording data to fast fourier transform for the main target nucleus determination. This process needs a multidisciplinary approach from neurosurgery, neurology and specialists on electrophysiology such as biophysics. Case report: We present the case of a 63 year-old male with medically intractable PD is focused on behalf of the surgical treatment. Patient had a 4-year history of progressively severe hand tremor on right side. The patient was successfully treated unilaterally with the STN DBS. PMID:25684852

  9. Modeling deep brain stimulation: point source approximation versus realistic representation of the electrode

    NASA Astrophysics Data System (ADS)

    Zhang, Tianhe C.; Grill, Warren M.

    2010-12-01

    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 DBS electrode 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 DBS electrode 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 DBS electrode. 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.

  10. Introduction In a number of problems, including Brain-Computer Interfaces (BCI), deep brain stimulation (DBS),

    E-print Network

    Winfree, Erik

    brain stimulation (DBS), sensory prosthetics, and spinal cord injury (SCI) therapy, complex electronic of the expense and relative inaccessibility of expert hand-tuning. The present work proposes to use a family in simulation and shows that GP-BUCB and GP-AUCB are competitive with the state of the art. A variant of GP

  11. Deep brain stimulation induces BOLD activation in motor and non-motor networks: An fMRI comparison study of STN and EN/GPi DBS in large animals

    PubMed Central

    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.

    2012-01-01

    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 analogue 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 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 DBS electrode configurations and human neuroanatomy, may be a useful platform for translational studies investigating the global neuromodulatory effects of DBS. PMID:22967832

  12. Pathological Alterations and Stress Responses near DBS Electrodes after MRI Scans at 7.0T, 3.0T and 1.5T: An In Vivo Comparative Study

    PubMed Central

    Meng, Da-Wei; Li, Shao-Wu; Liu, Huan-Guang; Li, Jun-Ju; Wang, Xiu; Zhang, Xin; Zhang, Jian-Guo

    2014-01-01

    Objective The purpose of this study was to investigate the pathological alterations and the stress responses around deep brain stimulation (DBS) electrodes after magnetic resonance imaging (MRI) scans at 7.0T, 3.0T and 1.5T. Materials and Methods DBS devices were stereotactically implanted into the brains of New Zealand rabbits, targeting the left nucleus ventralis posterior thalami, while on the right side, a puncture passage pointing to the same target was made. MRI scans at 7.0T, 3.0T and 1.5T were performed using transmit/receive head coils. The pathological alterations of the surrounding tissue were evaluated by hematoxylin and eosin staining (H&E staining) and transmission electron microscopy (TEM). The levels of the 70 kDa heat shock protein (HSP-70), Neuronal Nuclei (NeuN) and Caspase-3 were determined by western-blotting and quantitative polymerase chain reaction (QPCR) to assess the stress responses near the DBS electrodes. Results H&E staining and TEM showed that the injury around the DBS electrodes was featured by a central puncture passage with gradually weakened injurious alterations. Comparisons of the injury across the groups manifested similar pathological alterations near the DBS electrodes in each group. Moreover, western-blotting and QPCR assay showed that the level of HSP-70 was not elevated by MRI scans (p>0.05), and the levels of NeuN and Caspase-3 were equal in each group, regardless of the field strengths applied (p>0.05). Conclusions Based on these findings, it is reasonable to conclude that in this study the MRI scans at multiple levels failed to induce additional tissue injury around the DBS electrodes. These preliminary data furthered our understanding of MRI-related DBS heating and encouraged revisions of the current MRI guidelines for patients with DBS devices. PMID:24988329

  13. Influences of Interpolation Error, Electrode Geometry, and the Electrode-Tissue Interface on Models of Electric Fields Produced by Deep Brain Stimulation

    PubMed Central

    Howell, Bryan; Naik, Sagar; Grill, Warren M.

    2014-01-01

    Deep brain stimulation (DBS) is an established therapy for movement disorders, but the fundamental mechanisms by which DBS has its effects remain unknown. Computational models can provide insights into the mechanisms of DBS, but to be useful, the models must have sufficient detail to predict accurately the electric fields produced by DBS. We used a finite element method model of the Medtronic 3387 electrode array, coupled to cable models of myelinated axons, to quantify how interpolation errors, electrode geometry, and the electrode-tissue interface affect calculation of electrical potentials and stimulation thresholds for populations of model nerve fibers. Convergence of the potentials was not a sufficient criterion for ensuring the same degree of accuracy in subsequent determination of stimulation thresholds, because the accuracy of the stimulation thresholds depended on the order of the elements. Simplifying the 3387 electrode array by ignoring the inactive contacts and extending the terminated end of the shaft had position dependent effects on the potentials and excitation thresholds, and these simplifications may impact correlations between DBS parameters and clinical outcomes. When the current density in the bulk tissue is uniform, the effect of the electrode-tissue interface impedance could be approximated by filtering the potentials calculated with a static lumped electrical equivalent circuit. Further, for typical DBS parameters during voltage-regulated stimulation, it was valid to approximate the electrode as an ideal polarized electrode with a nonlinear capacitance. Validation of these computational considerations enables accurate modeling of the electric field produced by DBS. PMID:24448594

  14. A Numerical Study to Compare Stimulations by Intraoperative Microelectrodes and Chronic Macroelectrodes in the DBS Technique

    PubMed Central

    Paffi, A.; Apollonio, F.; Puxeddu, M. G.; Parazzini, M.; d'Inzeo, G.; Ravazzani, P.; Liberti, M.

    2013-01-01

    Deep brain stimulation is a clinical technique for the treatment of parkinson's disease based on the electric stimulation, through an implanted electrode, of specific basal ganglia in the brain. To identify the correct target of stimulation and to choose the optimal parameters for the stimulating signal, intraoperative microelectrodes are generally used. However, when they are replaced with the chronic macroelectrode, the effect of the stimulation is often very different. Here, we used numerical simulations to predict the stimulation of neuronal fibers induced by microelectrodes and macroelectrodes placed in different positions with respect to each other. Results indicate that comparable stimulations can be obtained if the chronic macroelectrode is correctly positioned with the same electric center of the intraoperative microelectrode. Otherwise, some groups of fibers may experience a completely different electric stimulation. PMID:24222899

  15. Evaluation of high-perimeter electrode designs for deep brain stimulation

    NASA Astrophysics Data System (ADS)

    Howell, Bryan; Grill, Warren M.

    2014-08-01

    Objective. Deep brain stimulation (DBS) is an effective treatment for movement disorders and a promising therapy for treating epilepsy and psychiatric disorders. Despite its clinical success, complications including infections and mis-programing following surgical replacement of the battery-powered implantable pulse generator adversely impact the safety profile of this therapy. We sought to decrease power consumption and extend battery life by modifying the electrode geometry to increase stimulation efficiency. The specific goal of this study was to determine whether electrode contact perimeter or area had a greater effect on increasing stimulation efficiency. Approach. Finite-element method (FEM) models of eight prototype electrode designs were used to calculate the electrode access resistance, and the FEM models were coupled with cable models of passing axons to quantify stimulation efficiency. We also measured in vitro the electrical properties of the prototype electrode designs and measured in vivo the stimulation efficiency following acute implantation in anesthetized cats. Main results. Area had a greater effect than perimeter on altering the electrode access resistance; electrode (access or dynamic) resistance alone did not predict stimulation efficiency because efficiency was dependent on the shape of the potential distribution in the tissue; and, quantitative assessment of stimulation efficiency required consideration of the effects of the electrode-tissue interface impedance. Significance. These results advance understanding of the features of electrode geometry that are important for designing the next generation of efficient DBS electrodes.

  16. Electrode array for neural stimulation

    DOEpatents

    Wessendorf, Kurt O. (Albuquerque, NM); Okandan, Murat (Edgewood, NM); Stein, David J. (Albuquerque, NM); Yang, Pin (Albuquerque, NM); Cesarano, III, Joseph (Albuquerque, NM); Dellinger, Jennifer (Albuquerque, NM)

    2011-08-16

    An electrode array for neural stimulation is disclosed which has particular applications for use in a retinal prosthesis. The electrode array can be formed as a hermetically-sealed two-part ceramic package which includes an electronic circuit such as a demultiplexer circuit encapsulated therein. A relatively large number (up to 1000 or more) of individually-addressable electrodes are provided on a curved surface of a ceramic base portion the electrode array, while a much smaller number of electrical connections are provided on a ceramic lid of the electrode array. The base and lid can be attached using a metal-to-metal seal formed by laser brazing. Electrical connections to the electrode array can be provided by a flexible ribbon cable which can also be used to secure the electrode array in place.

  17. Analysis of deep brain stimulation electrode characteristics for neural recording

    NASA Astrophysics Data System (ADS)

    Kent, Alexander R.; Grill, Warren M.

    2014-08-01

    Objective. Closed-loop deep brain stimulation (DBS) systems have the potential to optimize treatment of movement disorders by enabling automatic adjustment of stimulation parameters based on a feedback signal. Evoked compound action potentials (ECAPs) and local field potentials (LFPs) recorded from the DBS electrode may serve as suitable closed-loop control signals. The objective of this study was to understand better the factors that influence ECAP and LFP recording, including the physical presence of the electrode, the geometrical dimensions of the electrode, and changes in the composition of the peri-electrode space across recording conditions. Approach. Coupled volume conductor-neuron models were used to calculate single-unit activity as well as ECAP responses and LFP activity from a population of model thalamic neurons. Main results. Comparing ECAPs and LFPs measured with and without the presence of the highly conductive recording contacts, we found that the presence of these contacts had a negligible effect on the magnitude of single-unit recordings, ECAPs (7% RMS difference between waveforms), and LFPs (5% change in signal magnitude). Spatial averaging across the contact surface decreased the ECAP magnitude in a phase-dependent manner (74% RMS difference), resulting from a differential effect of the contact on the contribution from nearby or distant elements, and decreased the LFP magnitude (25% change). Reductions in the electrode diameter or recording contact length increased signal energy and increased spatial sensitivity of single neuron recordings. Moreover, smaller diameter electrodes (500 µm) were more selective for recording from local cells over passing axons, with the opposite true for larger diameters (1500 µm). Changes in electrode dimensions had phase-dependent effects on ECAP characteristics, and generally had small effects on the LFP magnitude. ECAP signal energy and LFP magnitude decreased with tighter contact spacing (100 µm), compared to the original dimensions (1500 µm), with the opposite effect on the ECAP at longer contact-to-contact distances (2000 µm). Finally, acute edema reduced the single neuron and population ECAP signal energy, as well as LFP magnitude, and glial encapsulation had the opposite effect, after accounting for loss of cells in the peri-electrode space. Significance. This study determined recording conditions and electrode designs that influence ECAP and LFP recording fidelity.

  18. Selection of the optimal microelectrode during DBS surgery in Parkinson's patients

    E-print Network

    Ras, Zbigniew W.

    Selection of the optimal microelectrode during DBS surgery in Parkinson's patients Konrad Abstract. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is effective treatment of Parkinson: Parkinson's Disease, DBS, STN, Wavelet, Filtering, PCA, FFT, Spike detection, Spike discrimination, Spike

  19. Anatomo-clinical atlases correlate clinical data and electrode contact coordinates: application to subthalamic deep brain stimulation.

    PubMed

    Lalys, Florent; Haegelen, Claire; Mehri, Maroua; Drapier, Sophie; Vérin, Marc; Jannin, Pierre

    2013-01-30

    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

  20. Micro-machined, polyimide stimulating electrodes with electroplated iridium oxide

    Microsoft Academic Search

    James D. Weiland; Stuart Cogan; Mark S. Humayun

    1999-01-01

    Iridium oxide neural stimulating electrodes 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

  1. DBS-relevant electric fields increase hydraulic conductivity of in vitro endothelial monolayers

    NASA Astrophysics Data System (ADS)

    Lopez-Quintero, S. V.; Datta, A.; Amaya, R.; Elwassif, M.; Bikson, M.; Tarbell, J. M.

    2010-02-01

    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 DBS electrodes. Further studies are necessary to address potential BBB disruption during clinical studies, with safety and efficacy implications.

  2. Numerical characterization of intraoperative and chronic electrodes in deep brain stimulation

    PubMed Central

    Paffi, Alessandra; Camera, Francesca; Apollonio, Francesca; d’Inzeo, Guglielmo; Liberti, Micaela

    2015-01-01

    An intraoperative electrode (microelectrode) is used in the deep brain stimulation (DBS) technique to pinpoint the brain target and to choose the best parameters for the electrical stimulus. However, when the intraoperative electrode is replaced with the chronic one (macroelectrode), the observed effects do not always coincide with predictions. To investigate the causes of such discrepancies, a 3D model of the basal ganglia has been considered and realistic models of both intraoperative and chronic electrodes have been developed and numerically solved. Results of simulations of the electric potential (V) and the activating function (AF) along neuronal fibers show that the different geometries and sizes of the two electrodes do not change the distributions and polarities of these functions, but rather the amplitudes. This effect is similar to the one produced by the presence of different tissue layers (edema or glial tissue) in the peri-electrode space. Conversely, an inaccurate positioning of the chronic electrode with respect to the intraoperative one (electric centers not coincident) may induce a completely different electric stimulation in some groups of fibers.

  3. Numerical characterization of intraoperative and chronic electrodes in deep brain stimulation.

    PubMed

    Paffi, Alessandra; Camera, Francesca; Apollonio, Francesca; d'Inzeo, Guglielmo; Liberti, Micaela

    2015-01-01

    An intraoperative electrode (microelectrode) is used in the deep brain stimulation (DBS) technique to pinpoint the brain target and to choose the best parameters for the electrical stimulus. However, when the intraoperative electrode is replaced with the chronic one (macroelectrode), the observed effects do not always coincide with predictions. To investigate the causes of such discrepancies, a 3D model of the basal ganglia has been considered and realistic models of both intraoperative and chronic electrodes have been developed and numerically solved. Results of simulations of the electric potential (V) and the activating function (AF) along neuronal fibers show that the different geometries and sizes of the two electrodes do not change the distributions and polarities of these functions, but rather the amplitudes. This effect is similar to the one produced by the presence of different tissue layers (edema or glial tissue) in the peri-electrode space. Conversely, an inaccurate positioning of the chronic electrode with respect to the intraoperative one (electric centers not coincident) may induce a completely different electric stimulation in some groups of fibers. PMID:25745397

  4. Disrupting neuronal transmission: mechanism of DBS?

    PubMed Central

    Chiken, Satomi; Nambu, Atsushi

    2014-01-01

    Applying high-frequency stimulation (HFS) to deep brain structure, known as deep brain stimulation (DBS), has now been recognized an effective therapeutic option for a wide range of neurological and psychiatric disorders. DBS targeting the basal ganglia thalamo-cortical loop, especially the internal segment of the globus pallidus (GPi), subthalamic nucleus (STN) and thalamus, has been widely employed as a successful surgical therapy for movement disorders, such as Parkinson’s disease, dystonia and tremor. However, the neurophysiological mechanism underling the action of DBS remains unclear and is still under debate: does DBS inhibit or excite local neuronal elements? In this review, we will examine this question and propose the alternative interpretation: DBS dissociates inputs and outputs, resulting in disruption of abnormal signal transmission. PMID:24672437

  5. New targets for DBS.

    PubMed

    Benabid, Alim Louis; Torres, Napoleon

    2012-01-01

    The specific effect of DBS at high frequency, discovered during a VIM thalamotomy, was extended to the older targets of ablative neurosurgery such as the pallidum, for tremor in Parkinson's disease (PD), dyskinesias, essential tremor, as well as the internal capsule to treat psychiatric disorders (OCD). A second wave of targets came from basic research, enabled by the low morbidity, reversibility, and adaptability of DBS. This was the case for the subthalamic nucleus (STN) which improves the triad of dopaminergic symptoms, and the pedunculopontine nucleus (PPN) for gait disorders in PD. The new concepts of the role of basal ganglia in psychiatric disorders indicate the subgenual cortex CG 25 for severe resistant depression, the accumbens nucleus for depression, anorexia nervosa, and addiction, and the thalamus intralaminar nuclei for minimally conscious states. Serendipity and a scientific approach have provided several instances where targets have produced unexpected effects (such as STN in OCD), as well as limbic effects observed during attempts at VMH stimulation for obesity: this might offer a novel way to treat mild cognitive impairment, or memory deficits reported in Alzheimer's disease. While these might provide solutions for as yet unsolved problems, attention must be paid to ethical considerations. PMID:22166437

  6. Construction of an electrode for intraoperative nerve stimulation.

    PubMed

    Ashley, R A; Wee, A S

    1991-07-01

    The electrode described in this paper consist of a barrel or handle with its conducting cable and a detachable stimulating tip. It is constructed of inexpensive and commercially available materials and is disposable. During the course of a stimulation study, electrode tips of different lengths or curvatures may be substituted without the need to replace the electrode barrel and cable. PMID:1942021

  7. Long-term experience with intraoperative microrecording during DBS neurosurgery in STN and GPi

    PubMed Central

    Contarino, M. Fiorella; Foncke, Elisabeth M. J.; de Bie, Rob M. A.; van den Munckhof, Pepijn; Speelman, Johannes D.; Schuurman, P. Richard

    2010-01-01

    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. PMID:20949292

  8. MRI-Based Multiscale Model for Electromagnetic Analysis in the Human Head with Implanted DBS

    PubMed Central

    Iacono, Maria Ida; Makris, Nikos; Mainardi, Luca; Angelone, Leonardo M.; Bonmassar, Giorgio

    2013-01-01

    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 DBS electrodes 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. PMID:23956789

  9. Differential effects of deep brain stimulation on verbal fluency.

    PubMed

    Ehlen, Felicitas; Schoenecker, Thomas; Kühn, Andrea A; Klostermann, Fabian

    2014-07-01

    We aimed at gaining insights into principles of subcortical lexical processing. Therefore, effects of deep brain stimulation (DBS) in different target structures on verbal fluency (VF) were tested. VF was assessed with active vs. inactivated DBS in 13 and 14 patients with DBS in the vicinity of the thalamic ventral intermediate nucleus (VIM) and, respectively, of the subthalamic nucleus (STN). Results were correlated to electrode localizations in postoperative MRI, and compared to those of 12 age-matched healthy controls. Patients' VF performance was generally below normal. However, while activation of DBS in the vicinity of VIM provoked marked VF decline, it induced subtle phonemic VF enhancement in the vicinity of STN. The effects correlated with electrode localizations in left hemispheric stimulation sites. The results show distinct dependencies of VF on DBS in the vicinity of VIM vs. STN. Particular risks for deterioration occur in patients with relatively ventromedial thalamic electrodes. PMID:24815947

  10. Chronic neural stimulation with thin-film, iridium oxide electrodes

    Microsoft Academic Search

    James D. Weiland; David J. Anderson

    2000-01-01

    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 stimulating electrodes (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,

  11. Stereotactic implantation of deep brain stimulation electrodes: a review of technical systems, methods and emerging tools

    Microsoft Academic Search

    Simone Hemm; Karin Wårdell

    2010-01-01

    Deep brain stimulation (DBS) has become increasingly important for the treatment and relief of neurological disorders such\\u000a as Parkinson’s disease, tremor, dystonia and psychiatric illness. As DBS implantations and any other stereotactic and functional\\u000a surgical procedure require accurate, precise and safe targeting of the brain structure, the technical aids for preoperative\\u000a planning, intervention and postoperative follow-up have become increasingly important.

  12. Alexithymia in patients with Parkinson’s disease treated with DBS of the subthalamic nucleus: a case-control study

    PubMed Central

    Castelli, Lorys; Tonello, Debora; Rizzi, Laura; Zibetti, Maurizio; Lanotte, Michele; Lopiano, Leonardo

    2014-01-01

    Objectives: To evaluate the effect of deep brain stimulation of the subthalamic nucleus (STN-DBS) on alexithymia, a deficit in affective regulation, comparing patients with Parkinson’s disease (PD) submitted to STN-DBS (DBS group) to PD patients not yet treated with STN-DBS (pre-DBS group) and to healthy participants (C group). Methods: We recruited 27 consecutive STN-DBS PD patients, 38 consecutive pre-DBS patients and 27 healthy participants. Patients were assessed for alexithymia (Toronto Alexithymia Scale), depression, [beck depression inventory (BDI)], and cognitive functions (reasoning, memory, attentional, and executive tests). Results: The DBS patients performed worse than the pre-DBS patients in the corsi’s block-tapping test, in the phonemic fluency task and in the Frontal Assessment Battery. Around 30% of DBS (29.6%) and pre-DBS (31.6%) patients resulted alexithymic, compared with 14.8% in the C group. The results pointed out significantly higher alexithymia scores in both the DBS and pre-DBS groups compared with the C group, while no difference emerged between the DBS and pre-DBS groups. Pre-DBS group showed a significantly higher BDI score than the C group, while DBS group did not. Conclusion: Although the results suggest that STN-DBS does not affect alexithymia, both the DBS and pre-DBS patients reported higher prevalence (about 30%) of alexithymia than did healthy subjects (14.8%). PMID:25352821

  13. Analysis of fractal electrodes for efficient neural stimulation

    PubMed Central

    Golestanirad, Laleh; Elahi, Behzad; Molina, Alberto; Mosig, Juan R.; Pollo, Claudio; Chen, Robert; Graham, Simon J.

    2013-01-01

    Planar electrodes are increasingly used in therapeutic neural stimulation techniques such as functional electrical stimulation, epidural spinal cord stimulation (ESCS), and cortical stimulation. Recently, optimized electrode geometries have been shown to increase the efficiency of neural stimulation by increasing the variation of current density on the electrode surface. In the present work, a new family of modified fractal electrode geometries is developed to enhance the efficiency of neural stimulation. It is shown that a promising approach in increasing the neural activation function is to increase the “edginess” of the electrode surface, a concept that is explained and quantified by fractal mathematics. Rigorous finite element simulations were performed to compute electric potential produced by proposed modified fractal geometries. The activation of 256 model axons positioned around the electrodes was then quantified, showing that modified fractal geometries required a 22% less input power while maintaining the same level of neural activation. Preliminary in vivo experiments investigating muscle evoked potentials due to median nerve stimulation showed encouraging results, supporting the feasibility of increasing neural stimulation efficiency using modified fractal geometries. PMID:23874290

  14. Computational modeling of an endovascular approach to deep brain stimulation

    NASA Astrophysics Data System (ADS)

    Teplitzky, Benjamin A.; Connolly, Allison T.; Bajwa, Jawad A.; Johnson, Matthew D.

    2014-04-01

    Objective. Deep brain stimulation (DBS) therapy currently relies on a transcranial neurosurgical technique to implant one or more electrode leads into the brain parenchyma. In this study, we used computational modeling to investigate the feasibility of using an endovascular approach to target DBS therapy. Approach. Image-based anatomical reconstructions of the human brain and vasculature were used to identify 17 established and hypothesized anatomical targets of DBS, of which five were found adjacent to a vein or artery with intraluminal diameter ?1 mm. Two of these targets, the fornix and subgenual cingulate white matter (SgCwm) tracts, were further investigated using a computational modeling framework that combined segmented volumes of the vascularized brain, finite element models of the tissue voltage during DBS, and multi-compartment axon models to predict the direct electrophysiological effects of endovascular DBS. Main results. The models showed that: (1) a ring-electrode conforming to the vessel wall was more efficient at neural activation than a guidewire design, (2) increasing the length of a ring-electrode had minimal effect on neural activation thresholds, (3) large variability in neural activation occurred with suboptimal placement of a ring-electrode along the targeted vessel, and (4) activation thresholds for the fornix and SgCwm tracts were comparable for endovascular and stereotactic DBS, though endovascular DBS was able to produce significantly larger contralateral activation for a unilateral implantation. Significance. Together, these results suggest that endovascular DBS can serve as a complementary approach to stereotactic DBS in select cases.

  15. Electrodes for bio-application: recording and stimulation

    NASA Astrophysics Data System (ADS)

    Fontes, M. B. A.

    2013-03-01

    Recording and stimulation electrodes 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.

  16. DBS in the basolateral amygdala improves symptoms of autism and related self-injurious behavior: a case report and hypothesis on the pathogenesis of the disorder

    PubMed Central

    Sturm, Volker; Fricke, Oliver; Bührle, Christian P.; Lenartz, Doris; Maarouf, Mohammad; Treuer, Harald; Mai, Jürgen K.; Lehmkuhl, Gerd

    2013-01-01

    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. PMID:23346052

  17. Electrodic voltages accompanying stimulated bioremediation of a uraniumcontaminated aquifer

    E-print Network

    Hubbard, Susan

    Click Here for Full Article Electrodic voltages accompanying stimulated bioremediation microbial activity during stimulated bioremediation has limited its implementation. We used spatiotemporal bioremediation of a uraniumcontaminated aquifer, J. Geophys. Res., 115, G00G05, doi:10.1029/2009JG001142. 1

  18. High-porous platinum electrodes for functional electrical stimulation.

    PubMed

    Boretius, Tim; Jurzinsky, Tilman; Koehler, Christian; Kerzenmacher, Sven; Hillebrecht, Harald; Stieglitz, Thomas

    2011-01-01

    This paper reports on the preparation and characterization of highly porous platinum electrodes for functional electrical stimulation. Thin-film platinum electrodes were roughened by electrochemical deposition of platinum-copper alloys and subsequent removal of copper using cyclic voltammetry (CV). Prepared samples were characterized by electrochemical impedance spectroscopies (EIS), CVs and long-term pulse testing. The electrodes exhibited an increased porosity by a factor of ~238 when compared to sputtered platinum electrodes. EIS measurements showed a decreased impedance of about 85% and pulse tests suggested a stable coating over at least 250 million pulses. PMID:22255559

  19. Bio-heat transfer model of deep brain stimulation-induced temperature changes

    NASA Astrophysics Data System (ADS)

    Elwassif, Maged M.; Kong, Qingjun; Vazquez, Maribel; Bikson, Marom

    2006-12-01

    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 provide information on the thermal effects of DBS using finite element models to investigate the magnitude and spatial distribution of DBS-induced temperature changes. The parameters investigated include stimulation waveform, lead selection, brain tissue electrical and thermal conductivities, blood perfusion, metabolic heat generation during the stimulation and lead thermal conductivity/heat dissipation through the electrode. Our results show that clinical DBS protocols will increase the temperature of surrounding tissue by up to 0.8 °C depending on stimulation/tissue parameters.

  20. Recruitment characteristics of nerve fascicles stimulated by a multigroove electrode

    Microsoft Academic Search

    Paul Koole; Jan Holsheimer; Johannes J. Struijk; Anton J. Verloop

    1997-01-01

    The recruitment characteristics of fascicle-selective nerve stimulation by a multigroove electrode have been investigated both theoretically and in acute experiments. A three-dimensional (3-D) volume conductor model of fascicles in a multigroove device and a model of myelinated nerve fiber stimulation were used to calculate threshold stimuli of nerve fibers in these fascicles. After their exposition, fascicles from rat sciatic nerve

  1. Chronic neural stimulation with thin-film, iridium oxide electrodes

    Microsoft Academic Search

    James D. Weiland; David J. Anderson

    2000-01-01

    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 stimulating electrodes (400-1600 m ) were implanted in guinea pig cortex. A 10-17 day post-operative recovery period was followed by five days

  2. Enhanced tissue integration of implantable electrodes for sensing, and stimulation, via radio frequency glow discharge

    Microsoft Academic Search

    Laurie M. O'Connor

    2010-01-01

    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 \\

  3. Rescue GPi-DBS for a Stroke-associated Hemiballism in a Patient with STN-DBS

    PubMed Central

    Oyama, Genko; Maling, Nicholas; Avila-Thompson, Amanda; Zeilman, Pam R.; Foote, Kelly D.; Malaty, Irene A.; Rodriguez, Ramon L.; Okun, Michael S.

    2014-01-01

    Background Hemiballism/hemichorea commonly occurs as a result of a lesion in the subthalamic region. Case Report A 38-year-old male with Parkinson’s disease developed intractable hemiballism in his left extremities due to a small lesion that was located adjacent to the right deep brain stimulation (DBS) lead, 10 months after bilateral subthalamic nucleus (STN)-DBS placement. He underwent a right globus pallidus internus (GPi)-DBS lead implantation. GPi-DBS satisfactorily addressed his hemiballism. Discussion This case offered a unique look at basal ganglia physiology in human hemiballism. GPi-DBS is a reasonable therapeutic option for the treatment of medication refractory hemiballism in the setting of Parkinson’s disease. PMID:24587970

  4. Microchannel Electrodes for Recording and Stimulation: In Vitro Evaluation

    Microsoft Academic Search

    James J. FitzGerald; S. P. Lacour; S. B. McMahon; J. W. Fawcett

    2009-01-01

    Previously we reported a finite-element model that predicted that microchannels could be sensitive recording devices, amplifying the extracellular signal as action potentials pass through them, and making recording independent of node of Ranvier location. Here, we present an in vitro experimental study that validates these predictions and also demonstrates that microchannel electrodes can be highly efficient stimulators. Several aspects of

  5. Electrodeposited iridium oxide for neural stimulation and recording electrodes

    Microsoft Academic Search

    Ross D. Meyer; Stuart F. Cogan; Trung H. Nguyen; R. David Rauh

    2001-01-01

    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

  6. [Safety and neuroethical consideration of deep brain stimulation as a psychiatric treatment].

    PubMed

    Takagi, Miyako

    2009-01-01

    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 DBS electrodes 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

  7. Micro-Reaction Chamber Electrodes for Neural Stimulation and Recording

    PubMed Central

    Shanmugasundaram, Balaji; Gluckman, Bruce J.

    2012-01-01

    Biocompatible electrodes with smaller geometric area are preferred to improve the selectivity of the neural recording and stimulation applications. We introduce the concept of a micro-reaction chamber (µRC) in which a volume within the electrode back plane is used to confine and sequester the electrochemical reactions used for charge passage. The µRC electrode design helps decrease impedance and improves the charge storage capacity without altering the geometry of the active site. Here we demonstrate that µRC electrodes fabricated from 50 µm diameter microwire have significantly improved charge storage capacity and lowered impedance at physiologically relevant frequencies in phosphate buffered saline solution compared with other designs. PMID:22254394

  8. Access resistance of stimulation electrodes as a function of electrode proximity to the retina

    NASA Astrophysics Data System (ADS)

    Majdi, Joseph A.; Minnikanti, Saugandhika; Peixoto, Nathalia; Agrawal, Anant; Cohen, Ethan D.

    2015-02-01

    Objective. Epiretinal prostheses seek to effectively stimulate the retina by positioning electrode arrays close to its surface so current pulses generate narrow retinal electric fields. Our objective was to evaluate the use of the electrical impedance of insulated platinum electrodes as a measure of the proximity of insulated platinum electrodes to the inner surface of the retina. Approach. We examined the impedance of platinum disk electrodes, 0.25 mm in diameter, insulated with two widths (0.8 and 1.6 mm outer diameter) of transparent fluoropolymer in a rabbit retinal eyecup preparation. Optical coherence tomography measured the electrode’s proximity to the retinal surface which was correlated with changes in the voltage waveform at the electrode. Electrode impedance changes during retinal deformation were also studied. Main results. When the 1.6 mm diameter insulated electrodes advanced towards the retinal surface from 1000 ?m, their voltage step at current pulse onset increased, reflecting an access resistance increase of 3880 ± 630 ?, with the 50% midpoint averaging 30 ?m, while thin 0.8 mm insulated electrode advancement showed an access resistance increase 50% midpoint averaging 16 ?m. Using impedance spectroscopy, electrode–retina proximity differences were seen in the 1.6 mm insulated electrode impedance modulus between 1 and 100 kHz and the waveform phase angle at 0.3–10 kHz, while thin 0.8 mm insulated electrode advancement produced smaller impedance modulus changes with retinal proximity between 3 and 100 kHz. These impedance changes with retinal proximity may reflect different sized zones of eye wall being coupled in series with the insulated platinum electrode. Significance. The proximity of stimulus electrodes to neural tissue in fluid-filled spaces can be estimated from access resistance changes in the stimulus pulse waveform. Because many prosthetic devices allow back telemetry communication of the stimulus electrode waveform, it is possible these series resistance increases observed with retinal proximity could be used as a metric of stimulus electrode placement.

  9. Access resistance of stimulation electrodes as a function of electrode proximity to the retina.

    PubMed

    Majdi, Joseph A; Minnikanti, Saugandhika; Peixoto, Nathalia; Agrawal, Anant; Cohen, Ethan D

    2015-02-01

    Objective. Epiretinal prostheses seek to effectively stimulate the retina by positioning electrode arrays close to its surface so current pulses generate narrow retinal electric fields. Our objective was to evaluate the use of the electrical impedance of insulated platinum electrodes as a measure of the proximity of insulated platinum electrodes to the inner surface of the retina. Approach. We examined the impedance of platinum disk electrodes, 0.25 mm in diameter, insulated with two widths (0.8 and 1.6 mm outer diameter) of transparent fluoropolymer in a rabbit retinal eyecup preparation. Optical coherence tomography measured the electrode's proximity to the retinal surface which was correlated with changes in the voltage waveform at the electrode. Electrode impedance changes during retinal deformation were also studied. Main results. When the 1.6 mm diameter insulated electrodes advanced towards the retinal surface from 1000 ?m, their voltage step at current pulse onset increased, reflecting an access resistance increase of 3880 ± 630 ?, with the 50% midpoint averaging 30 ?m, while thin 0.8 mm insulated electrode advancement showed an access resistance increase 50% midpoint averaging 16 ?m. Using impedance spectroscopy, electrode-retina proximity differences were seen in the 1.6 mm insulated electrode impedance modulus between 1 and 100 kHz and the waveform phase angle at 0.3-10 kHz, while thin 0.8 mm insulated electrode advancement produced smaller impedance modulus changes with retinal proximity between 3 and 100 kHz. These impedance changes with retinal proximity may reflect different sized zones of eye wall being coupled in series with the insulated platinum electrode. Significance. The proximity of stimulus electrodes to neural tissue in fluid-filled spaces can be estimated from access resistance changes in the stimulus pulse waveform. Because many prosthetic devices allow back telemetry communication of the stimulus electrode waveform, it is possible these series resistance increases observed with retinal proximity could be used as a metric of stimulus electrode placement. PMID:25474329

  10. Spinal stimulator peri-electrode masses: case report.

    PubMed

    Scranton, Robert A; Skaribas, Ioannis M; Simpson, Richard K

    2015-01-01

    The authors describe a case of delayed spastic quadriparesis caused by a peri-electrode mass following the implantation of a minimally invasive percutaneous spinal cord stimulator (SCS). Prior reports with paddle-type electrodes are reviewed, and a detailed histological and pathophysiological comparison with the present case is made. The patient developed tolerance to a cervical percutaneous SCS 4 months after implantation, followed by the onset of spastic quadriparesis 9 months after implantation. The stimulator was removed, and contrast-enhanced MRI revealed an enhancing epidural mass where the system had been placed, with severe spinal cord compression. Decompression was carried out, and the patient experienced neurological improvement. Pathological examination revealed fibrotic tissue with granulomatous and multinucleated giant cell reactions. No evidence of infection or hemorrhage was found. Professionals treating patients with SCSs or contemplating their insertion should be aware of this delayed complication and associated risk factors. PMID:25380541

  11. Performance of conducting polymer electrodes for stimulating neuroprosthetics

    NASA Astrophysics Data System (ADS)

    Green, R. A.; Matteucci, P. B.; Hassarati, R. T.; Giraud, B.; Dodds, C. W. D.; Chen, S.; Byrnes-Preston, P. J.; Suaning, G. J.; Poole-Warren, L. A.; Lovell, N. H.

    2013-02-01

    Objective. Recent interest in the use of conducting polymers (CPs) for neural stimulation electrodes has been growing; however, concerns remain regarding the stability of coatings under stimulation conditions. These studies examine the factors of the CP and implant environment that affect coating stability. The CP poly(ethylene dioxythiophene) (PEDOT) is examined in comparison to platinum (Pt), to demonstrate the potential performance of these coatings in neuroprosthetic applications. Approach. PEDOT is coated on Pt microelectrode arrays and assessed in vitro for charge injection limit and long-term stability under stimulation in biologically relevant electrolytes. Physical and electrical stability of coatings following ethylene oxide (ETO) sterilization is established and efficacy of PEDOT as a visual prosthesis bioelectrode is assessed in the feline model. Main results. It was demonstrated that PEDOT reduced the potential excursion at a Pt electrode interface by 72% in biologically relevant solutions. The charge injection limit of PEDOT for material stability was found to be on average 30× larger than Pt when tested in physiological saline and 20× larger than Pt when tested in protein supplemented media. Additionally stability of the coating was confirmed electrically and morphologically following ETO processing. It was demonstrated that PEDOT-coated electrodes had lower potential excursions in vivo and electrically evoked potentials (EEPs) could be detected within the visual cortex. Significance. These studies demonstrate that PEDOT can be produced as a stable electrode coating which can be sterilized and perform effectively and safely in neuroprosthetic applications. Furthermore these findings address the necessity for characterizing in vitro properties of electrodes in biologically relevant milieu which mimic the in vivo environment more closely.

  12. Deep Brain Stimulation: Technology at the Cutting Edge

    PubMed Central

    Shah, Rahul S.; Chang, Su-Youne; Min, Hoon-Ki; Cho, Zang-Hee; Blaha, Charles D.

    2010-01-01

    Deep brain stimulation (DBS) surgery has been performed in over 75,000 people worldwide, and has been shown to be an effective treatment for Parkinson's disease, tremor, dystonia, epilepsy, depression, Tourette's syndrome, and obsessive compulsive disorder. We review current and emerging evidence for the role of DBS in the management of a range of neurological and psychiatric conditions, and discuss the technical and practical aspects of performing DBS surgery. In the future, evolution of DBS technology may depend on several key areas, including better scientific understanding of its underlying mechanism of action, advances in high-spatial resolution imaging and development of novel electrophysiological and neurotransmitter microsensor systems. Such developments could form the basis of an intelligent closed-loop DBS system with feedback-guided neuromodulation to optimize both electrode placement and therapeutic efficacy. PMID:21264197

  13. Anatomical Targets Associated with Abrupt versus Gradual Washout of Subthalamic Deep Brain Stimulation Effects on Bradykinesia

    PubMed Central

    Cooper, Scott E.; Driesslein, Klaus G.; Noecker, Angela M.; McIntyre, Cameron C.; Machado, Andre M.; Butson, Christopher R.

    2014-01-01

    The subthalamic nucleus (STN) is a common anatomical target for deep brain stimulation (DBS) for the treatment of Parkinson’s disease. However, the effects of stimulation may spread beyond the STN. Ongoing research aims to identify nearby anatomical structures where DBS-induced effects could be associated with therapeutic improvement or side effects. We previously found that DBS lead location determines the rate – abrupt vs. gradual – with which therapeutic effect washes out after stimulation is stopped. Those results suggested that electrical current spreads from the electrodes to two spatially distinct stimulation targets associated with different washout rates. In order to identify these targets we used computational models to predict the volumes of tissue activated during DBS in 14 Parkinson’s patients from that study. We then coregistered each patient with a stereotaxic atlas and generated a probabilistic stimulation atlas to obtain a 3-dimensional representation of regions where stimulation was associated with abrupt vs. gradual washout. We found that the therapeutic effect which washed out gradually was associated with stimulation of the zona incerta and fields of Forel, whereas abruptly-disappearing therapeutic effect was associated with stimulation of STN itself. This supports the idea that multiple DBS targets exist and that current spread from one electrode may activate more than one of them in a given patient, producing a combination of effects which vary according to electrode location and stimulation settings. PMID:25098453

  14. Localization of electrodes in the subthalamic nucleus on magnetic resonance imaging

    Microsoft Academic Search

    Claudio Pollo; François Vingerhoets; Etienne Pralong; Joseph Ghika; Philippe Maeder; Reto Meuli; Jean-Philippe Thiran; Jean-Guy Villemure

    2007-01-01

    Object. The authors describe a new method of localizing electrodes on magnetic resonance (MR) images and focus on the positions of both the most efficient contact and the electrode related to the MR imaging target. Methods. Thirty-one patients who had undergone bilateral subthalamic nucleus (STN) deep brain stimulation (DBS) were included in this study. Target coordinates were calculated in the

  15. Mechanisms and Targets of Deep Brain Stimulation in Movement Disorders

    PubMed Central

    Johnson, Matthew D.; Miocinovic, Svjetlana; McIntyre, Cameron C.; Vitek, Jerrold L.

    2008-01-01

    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 DBS electrode 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. PMID:18394571

  16. Effects of stimulation parameters and electrode location on thresholds for epidural stimulation of cat motor cortex

    NASA Astrophysics Data System (ADS)

    Wongsarnpigoon, Amorn; Grill, Warren M.

    2011-12-01

    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.

  17. United States DBS systems - The alternatives

    NASA Astrophysics Data System (ADS)

    Clark, J. F.

    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.

  18. Comparison of electrode sites in electrical stimulation of the cochlea.

    PubMed

    Lusted, H S; Shelton, C; Simmons, F B

    1984-07-01

    There is considerable controversy about the "best" location for single channel cochlear implant electrodes. We measured the electrically induced auditory brain stem response (EABR) in a series of normal to totally denervated cat ears in response to promontory (P), round window (RW) and scala tympani (ST) stimulation. The status of the ganglion cell population was then assessed by light microscopy. In ears with light to medium ganglion cell loss the ST EABR yielded the most definitive input-output functions. RW responses were present at increased thresholds and smaller peak amplitudes. P responses were worse or even missing completely. In severely damaged ears, including some with no detectable ganglion cells, ST and RW EABRs were both markedly reduced with considerable overlap between the two sites. P responses, when present, were almost buried in the electrical noise near threshold. Extrapolating these results to humans suggests that when ganglion cell loss is very severe the RW or ST is an acceptable stimulation site. When ganglion cell loss is moderate or better, ST electrodes are superior. PMID:6738264

  19. Optimizing a Rodent Model of Parkinson's Disease for Exploring the Effects and Mechanisms of Deep Brain Stimulation

    PubMed Central

    Nowak, Karl; Mix, Eilhard; Gimsa, Jan; Strauss, Ulf; Sriperumbudur, Kiran Kumar; Benecke, Reiner; Gimsa, Ulrike

    2011-01-01

    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. PMID:21603182

  20. Development of very large electrode arrays for epiretinal stimulation (VLARS)

    PubMed Central

    2014-01-01

    Background Retinal implants have been developed to treat blindness causing retinal degenerations such as Retinitis pigmentosa (RP). The retinal stimulators are covering only a small portion of the retina usually in its center. To restore not only central vision but also a useful visual field retinal stimulators need to cover a larger area of the retina. However, large area retinal stimulators are much more difficult to implant into an eye. Some basic questions concerning this challenge should be answered in a series of experiments. Methods Large area retinal stimulators were fabricated as flexible multielectrode arrays (MEAs) using silicon technology with polyimide as the basic material for the substrate. Electrodes were made of gold covered with reactively sputtered iridium oxide. Several prototype designs were considered and implanted into enucleated porcine eyes. The prototype MEAs were also used as recording devices. Results Large area retinal stimulator MEAs were fabricated with a diameter of 12 mm covering a visual angle of 37.6° in a normal sighted human eye. The structures were flexible enough to be implanted in a folded state through an insertion nozzle. The implants could be positioned onto the retinal surface and fixated here using a retinal tack. Recording of spontaneous activity of retinal neurons was possible in vitro using these devices. Conclusions Large flexible MEAs covering a wider area of the retina as current devices could be fabricated using silicon technology with polyimide as a base material. Principal surgical techniques were established to insert such large devices into an eye and the devices could also be used for recording of retinal neural activity. PMID:24502253

  1. Novel fingerprinting method characterises the necessary and sufficient structural connectivity from deep brain stimulation electrodes for a successful outcome

    NASA Astrophysics Data System (ADS)

    Fernandes, Henrique M.; Van Hartevelt, Tim J.; Boccard, Sandra G. J.; Owen, Sarah L. F.; Cabral, Joana; Deco, Gustavo; Green, Alex L.; Fitzgerald, James J.; Aziz, Tipu Z.; Kringelbach, Morten L.

    2015-01-01

    Deep brain stimulation (DBS) is a remarkably effective clinical tool, used primarily for movement disorders. DBS relies on precise targeting of specific brain regions to rebalance the oscillatory behaviour of whole-brain neural networks. Traditionally, DBS targeting has been based upon animal models (such as MPTP for Parkinson’s disease) but has also been the result of serendipity during human lesional neurosurgery. There are, however, no good animal models of psychiatric disorders such as depression and schizophrenia, and progress in this area has been slow. In this paper, we use advanced tractography combined with whole-brain anatomical parcellation to provide a rational foundation for identifying the connectivity ‘fingerprint’ of existing, successful DBS targets. This knowledge can then be used pre-surgically and even potentially for the discovery of novel targets. First, using data from our recent case series of cingulate DBS for patients with treatment-resistant chronic pain, we demonstrate how to identify the structural ‘fingerprints’ of existing successful and unsuccessful DBS targets in terms of their connectivity to other brain regions, as defined by the whole-brain anatomical parcellation. Second, we use a number of different strategies to identify the successful fingerprints of structural connectivity across four patients with successful outcomes compared with two patients with unsuccessful outcomes. This fingerprinting method can potentially be used pre-surgically to account for a patient’s individual connectivity and identify the best DBS target. Ultimately, our novel fingerprinting method could be combined with advanced whole-brain computational modelling of the spontaneous dynamics arising from the structural changes in disease, to provide new insights and potentially new targets for hitherto impenetrable neuropsychiatric disorders.

  2. Deep brain stimulation of the nucleus accumbens shell increases impulsive behavior and tissue levels of dopamine and serotonin.

    PubMed

    Sesia, Thibaut; Bulthuis, Vincent; Tan, Sonny; Lim, Lee Wei; Vlamings, Rinske; Blokland, Arjan; Steinbusch, Harry W M; Sharp, Trevor; Visser-Vandewalle, Veerle; Temel, Yasin

    2010-10-01

    The nucleus accumbens (NAc) is gaining interest as a target for deep brain stimulation (DBS) in refractory neuropsychiatric disorders with impulsivity as core symptom. The nucleus accumbens is composed of two subterritories, core and shell, which have different anatomical connections. In animal models, it has been shown that DBS of the NAc changes impulsive action. Here, we tested the hypothesis that a change in impulsive action by DBS of the NAc is associated with changes in dopamine levels. Rats received stimulating electrodes either in the NAc core or shell, and underwent behavioral testing in a reaction time task. In addition, in a second experiment, the effect of DBS of the NAc core and shell on extracellular dopamine and serotonin levels was assessed in the NAc and medial prefrontal cortex. Control subjects received sham surgery. We have found that DBS of the NAc shell stimulation induced more impulsive action but less perseverative checking. These effects were associated with increased levels of dopamine and serotonin in the NAc, but not in the medial prefrontal cortex. DBS of the NAc core had no effect on impulsive action, but decreased perseverative responses indicative of a better impulse control. In these subjects, no effects were found on neurotransmitter levels. Our data point out that DBS of the NAc shell has negative effects on impulsive action which is accompanied by increases of dopamine and serotonin levels in the NAc, whereas DBS of the NAc core has beneficial behavioral effects. PMID:20615406

  3. Electrical stimulation with a penetrating optic nerve electrode array elicits visuotopic cortical responses in cats

    NASA Astrophysics Data System (ADS)

    Lu, Yiliang; Yan, Yan; Chai, Xinyu; Ren, Qiushi; Chen, Yao; Li, Liming

    2013-06-01

    Objective. A visual prosthesis based on penetrating electrode stimulation within the optic nerve (ON) is a potential way to restore partial functional vision for blind patients. We investigated the retinotopic organization of ON stimulation and its spatial resolution. Approach. A five-electrode array was inserted perpendicularly into the ON or a single electrode was advanced to different depths within the ON (˜1-2 mm behind the eyeball, 13 cats). A sparse noise method was used to map ON electrode position and the visual cortex. Cortical responses were recorded by a 5 × 6 array. The visuotopic correspondence between the retinotopic position of the ON electrode was compared with the visual evoked cortical map and the electrical evoked potentials elicited in response to ON stimulation. Main results. Electrical stimulation with penetrating ON electrodes elicited cortical responses in visuotopographically corresponding areas of the cortex. Stimulation of the temporal side of the ON elicited cortical responses corresponding to the central visual field. The visual field position shifted from the lower to central visual field as the electrode penetrated through the depth of the ON. A spatial resolution of ˜ 2° to 3° within a limited cortical visuotopic representation could be obtained by this approach. Significance. Visuotopic electrical stimulation with a relatively fine spatial resolution can be accomplished using penetrating electrodes implanted at multiple sites and at different depths within the ON just behind the globe. This study also provides useful experimental data for the design of electrode density and the distribution of penetrating ON electrodes for a visual prosthesis.

  4. Stimulation of the Human Lumbar Spinal Cord With Implanted and Surface Electrodes: A Computer Simulation Study

    Microsoft Academic Search

    Josef Ladenbauer; Karen Minassian; Ursula S. Hofstoetter; Milan R. Dimitrijevic; Frank Rattay

    2010-01-01

    Human lumbar spinal cord networks controlling stepping and standing can be activated through posterior root stimulation using implanted electrodes. A new stimulation method utilizing surface electrodes has been shown to excite lumbar posterior root fibers similarly as with implants, an unexpected finding considering the distance to these target neurons. In the present study we apply computer modeling to compare the

  5. Stability of the input-output properties of chronically implanted multiple contact nerve cuff stimulating electrodes

    Microsoft Academic Search

    Warren M. Grill; J. Thomas Mortimer

    1998-01-01

    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

  6. Increased Precursor Cell Proliferation after Deep Brain Stimulation for Parkinson's Disease: A Human Study

    PubMed Central

    Vedam-Mai, Vinata; Gardner, Bronwen; Okun, Michael S.; Siebzehnrubl, Florian A.; Kam, Monica; Aponso, Palingu; Steindler, Dennis A.; Yachnis, Anthony T.; Neal, Dan; Oliver, Brittany U.; Rath, Sean J.; Faull, Richard L. M.

    2014-01-01

    Objective Deep brain stimulation (DBS) has been used for more than a decade to treat Parkinson's disease (PD); however, its mechanism of action remains unknown. Given the close proximity of the electrode trajectory to areas of the brain known as the “germinal niches,” we sought to explore the possibility that DBS influences neural stem cell proliferation locally, as well as more distantly. Methods We studied the brains of a total of 12 idiopathic Parkinson's disease patients that were treated with DBS (the electrode placement occurred 0.5–6 years before death), and who subsequently died of unrelated illnesses. These were compared to the brains of 10 control individuals without CNS disease, and those of 5 PD patients with no DBS. Results Immunohistochemical analyses of the subventricular zone (SVZ) of the lateral ventricles, the third ventricle lining, and the tissue surrounding the DBS lead revealed significantly greater numbers of proliferating cells expressing markers of the cell cycle, plasticity, and neural precursor cells in PD-DBS tissue compared with both normal brain tissue and tissue from PD patients not treated with DBS. The level of cell proliferation in the SVZ in PD-DBS brains was 2–6 fold greater than that in normal and untreated PD brains. Conclusions Our data suggest that DBS is capable of increasing cellular plasticity in the brain, and we hypothesize that it may have more widespread effects beyond the electrode location. It is unclear whether these effects of DBS have any symptomatic or other beneficial influences on PD. PMID:24594681

  7. Probabilistic analysis of activation volumes generated during deep brain stimulation.

    PubMed

    Butson, Christopher R; Cooper, Scott E; Henderson, Jaimie M; Wolgamuth, Barbara; McIntyre, Cameron C

    2011-02-01

    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. PMID:20974269

  8. The Effects of Concentric Ring Electrode Electrical Stimulation on Rat Skin

    Microsoft Academic Search

    W. Besio; V. Sharma; J. Spaulding

    2010-01-01

    Surface electrodes are commonly used electrodes clinically, in applications such as functional electrical stimulation for\\u000a the restoration of motor functions, pain relief, transcutaneous electrical nerve stimulation, electrocardiographic monitoring,\\u000a defibrillation, surface cardiac pacing, and advanced drug delivery systems. Common to these applications are occasional reports\\u000a of pain, tissue damage, rash, or burns on the skin at the point where electrodes are

  9. Comparison of motor effects following subcortical electrical stimulation through electrodes in the globus pallidus internus and cortical transcranial magnetic stimulation

    Microsoft Academic Search

    Andrea A. Kühn; Stephan A. Brandt; Andreas Kupsch; Thomas Trottenberg; Jan Brocke; Kerstin Irlbacher; Gerd H. Schneider; Bernd-Ulrich Meyer

    2004-01-01

    Current concepts of transcranial magnetic stimulation (TMS) over the primary motor cortex are still under debate as to whether inhibitory motor effects are exclusively of cortical origin. To further elucidate a potential subcortical influence on motor effects, we combined TMS and unilateral subcortical electrical stimulation (SES) of the corticospinal tract. SES was performed through implanted depth electrodes in eight patients

  10. Investigating the interfacial properties of electrochemically roughened platinum electrodes for neural stimulation.

    PubMed

    Weremfo, Alexander; Carter, Paul; Hibbert, D Brynn; Zhao, Chuan

    2015-03-01

    Platinum electrodes have been electrochemically roughened (roughness factors up to 430) and evaluated for use as neural stimulation electrodes. The roughened electrodes show superior interfacial properties with increasing surface roughness. The roughened electrode (fR = 250) has a charge injection limit of 1.0 mC cm(-2) (400 ?s pulse width), which is superior to that of titanium nitride (0.87 mC cm(-2)) but comparable to that of carbon nanotubes (1.0-1.6 mC cm(-2)). The surface roughness can also be optimized for different neural stimulation applications based on the available charge density at a particular pulse width of stimulation. The roughened platinum electrodes demonstrated good mechanical stability under harsh ultrasonication and electrochemical stability under continuous biphasic stimulation, indicating the potential of this biological interface to be safe and stable. PMID:25669232

  11. PEDOT-CNT coated electrodes stimulate retinal neurons at low voltage amplitudes and low charge densities.

    PubMed

    Samba, R; Herrmann, T; Zeck, G

    2015-02-01

    Objective. The aim of this study was to compare two different microelectrode materials-the conductive polymer composite poly-3,4-ethylenedioxythiophene (PEDOT)-carbon nanotube(CNT) and titanium nitride (TiN)-at activating spikes in retinal ganglion cells in whole mount rat retina through stimulation of the local retinal network. Stimulation efficacy of the microelectrodes was analyzed by comparing voltage, current and transferred charge at stimulation threshold. Approach. Retinal ganglion cell spikes were recorded by a central electrode (30 ?m diameter) in the planar grid of an electrode array. Extracellular stimulation (monophasic, cathodic, 0.1-1.0 ms) of the retinal network was performed using constant voltage pulses applied to the eight surrounding electrodes. The stimulation electrodes were equally spaced on the four sides of a square (400 × 400 ?m). Threshold voltage was determined as the pulse amplitude required to evoke network-mediated ganglion cell spiking in a defined post stimulus time window in 50% of identical stimulus repetitions. For the two electrode materials threshold voltage, transferred charge at threshold, maximum current and the residual current at the end of the pulse were compared. Main results. Stimulation of retinal interneurons using PEDOT-CNT electrodes is achieved with lower stimulation voltage and requires lower charge transfer as compared to TiN. The key parameter for effective stimulation is a constant current over at least 0.5 ms, which is obtained by PEDOT-CNT electrodes at lower stimulation voltage due to its faradaic charge transfer mechanism. Significance. In neuroprosthetic implants, PEDOT-CNT may allow for smaller electrodes, effective stimulation in a safe voltage regime and lower energy-consumption. Our study also indicates, that the charge transferred at threshold or the charge injection capacity per se does not determine stimulation efficacy. PMID:25588201

  12. PEDOT–CNT coated electrodes stimulate retinal neurons at low voltage amplitudes and low charge densities

    NASA Astrophysics Data System (ADS)

    Samba, R.; Herrmann, T.; Zeck, G.

    2015-02-01

    Objective. The aim of this study was to compare two different microelectrode materials—the conductive polymer composite poly-3,4-ethylenedioxythiophene (PEDOT)–carbon nanotube(CNT) and titanium nitride (TiN)—at activating spikes in retinal ganglion cells in whole mount rat retina through stimulation of the local retinal network. Stimulation efficacy of the microelectrodes was analyzed by comparing voltage, current and transferred charge at stimulation threshold. Approach. Retinal ganglion cell spikes were recorded by a central electrode (30 ?m diameter) in the planar grid of an electrode array. Extracellular stimulation (monophasic, cathodic, 0.1–1.0 ms) of the retinal network was performed using constant voltage pulses applied to the eight surrounding electrodes. The stimulation electrodes were equally spaced on the four sides of a square (400 × 400 ?m). Threshold voltage was determined as the pulse amplitude required to evoke network-mediated ganglion cell spiking in a defined post stimulus time window in 50% of identical stimulus repetitions. For the two electrode materials threshold voltage, transferred charge at threshold, maximum current and the residual current at the end of the pulse were compared. Main results. Stimulation of retinal interneurons using PEDOT–CNT electrodes is achieved with lower stimulation voltage and requires lower charge transfer as compared to TiN. The key parameter for effective stimulation is a constant current over at least 0.5 ms, which is obtained by PEDOT–CNT electrodes at lower stimulation voltage due to its faradaic charge transfer mechanism. Significance. In neuroprosthetic implants, PEDOT–CNT may allow for smaller electrodes, effective stimulation in a safe voltage regime and lower energy-consumption. Our study also indicates, that the charge transferred at threshold or the charge injection capacity per se does not determine stimulation efficacy.

  13. Optimized Multi-Electrode Stimulation Increases Focality and Intensity at Target

    E-print Network

    Parra, Lucas C.

    @ccny.cuny.edu Abstract. Transcranial direct current stimulation (tDCS) provides a noninvasive tool to elicit-Electrode Stimulation 2 1. Introduction Transcranial direct current stimulation (tDCS) is an emerging neurotechnology involving the application of small direct currents to the surface of the scalp to elicit modulation

  14. Surface-patterned electrode bioreactor for electrical stimulation Nina Tandon,ae

    E-print Network

    Voldman, Joel

    Surface-patterned electrode bioreactor for electrical stimulation Nina Tandon,ae Anna Marsano for electrical stimulation of cultured cells. The system has been characterized in a range of geometeries and human adipose derived stem cells. Over 6 days of culture with electrical stimulation (2 ms duration, 1

  15. Construction of a Simple Suction Electrode for Extracellular Recording and Stimulation

    PubMed Central

    Johnson, Bruce R.; Hauptman, Stephen A.; Bonow, Robert H.

    2007-01-01

    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. The electrode parts are relatively inexpensive, easily available from established scientific and electronic distributors and local hardware stores, and the electrode is resilient to student handling. Our undergraduate students use this electrode design for high resolution, extracellular recordings of action potentials from crayfish motor and sensory nerves and insect muscle, and for stimulation of crustacean and insect motor nerves. PMID:23493751

  16. Characteristics of electrode impedance and stimulation efficacy of a chronic cortical implant using novel annulus electrodes in rat motor cortex

    NASA Astrophysics Data System (ADS)

    Wang, Chun; Brunton, Emma; Haghgooie, Saman; Cassells, Kahli; Lowery, Arthur; Rajan, Ramesh

    2013-08-01

    Objective. Cortical neural prostheses with implanted electrode arrays have been used to restore compromised brain functions but concerns remain regarding their long-term stability and functional performance. Approach. Here we report changes in electrode impedance and stimulation thresholds for a custom-designed electrode array implanted in rat motor cortex for up to three months. Main Results. The array comprises four 2000 µm long electrodes with a large annular stimulating surface (7860-15700 µm2) displaced from the penetrating insulated tip. Compared to pre-implantation in vitro values there were three phases of impedance change: (1) an immediate large increase of impedance by an average of two-fold on implantation; (2) a period of continued impedance increase, albeit with considerable variability, which reached a peak at approximately four weeks post-implantation and remained high over the next two weeks; (3) finally, a period of 5-6 weeks when impedance stabilized at levels close to those seen immediately post-implantation. Impedance could often be temporarily decreased by applying brief trains of current stimulation, used to evoke motor output. The stimulation threshold to induce observable motor behaviour was generally between 75-100 µA, with charge density varying from 48-128 µC cm-2, consistent with the lower current density generated by electrodes with larger stimulating surface area. No systematic change in thresholds occurred over time, suggesting that device functionality was not compromised by the factors that caused changes in electrode impedance. Significance. The present results provide support for the use of annulus electrodes in future applications in cortical neural prostheses.

  17. Computational modeling of pedunculopontine nucleus deep brain stimulation

    NASA Astrophysics Data System (ADS)

    Zitella, Laura M.; Mohsenian, Kevin; Pahwa, Mrinal; Gloeckner, Cory; Johnson, Matthew D.

    2013-08-01

    Objective. Deep brain stimulation (DBS) near the pedunculopontine nucleus (PPN) has been posited to improve medication-intractable gait and balance problems in patients with Parkinson's disease. However, clinical studies evaluating this DBS target have not demonstrated consistent therapeutic effects, with several studies reporting the emergence of paresthesia and oculomotor side effects. The spatial and pathway-specific extent to which brainstem regions are modulated during PPN-DBS is not well understood. Approach. Here, we describe two computational models that estimate the direct effects of DBS in the PPN region for human and translational non-human primate (NHP) studies. The three-dimensional models were constructed from segmented histological images from each species, multi-compartment neuron models and inhomogeneous finite element models of the voltage distribution in the brainstem during DBS. Main Results. The computational models predicted that: (1) the majority of PPN neurons are activated with -3 V monopolar cathodic stimulation; (2) surgical targeting errors of as little as 1 mm in both species decrement activation selectivity; (3) specifically, monopolar stimulation in caudal, medial, or anterior PPN activates a significant proportion of the superior cerebellar peduncle (up to 60% in the human model and 90% in the NHP model at -3 V) (4) monopolar stimulation in rostral, lateral or anterior PPN activates a large percentage of medial lemniscus fibers (up to 33% in the human model and 40% in the NHP model at -3 V) and (5) the current clinical cylindrical electrode design is suboptimal for isolating the modulatory effects to PPN neurons. Significance. We show that a DBS lead design with radially-segmented electrodes may yield improved functional outcome for PPN-DBS.

  18. Computational modeling of pedunculopontine nucleus deep brain stimulation

    PubMed Central

    Zitella, Laura M.; Mohsenian, Kevin; Pahwa, Mrinal; Gloeckner, Cory; Johnson, Matthew D.

    2013-01-01

    Objective Deep brain stimulation (DBS) near the pedunculopontine nucleus (PPN) has been posited to improve medication-intractable gait and balance problems in patients with Parkinson’s disease. However, clinical studies evaluating this DBS target have not demonstrated consistent therapeutic effects, with several studies reporting the emergence of paresthesia and oculomotor side effects. The spatial and pathway-specific extent to which brainstem regions are modulated during PPN-DBS is not well understood. Approach Here, we describe two computational models that estimate the direct effects of DBS in the PPN region for human and translational non-human primate (NHP) studies. The three-dimensional models were constructed from segmented histological images from each species, multi-compartment neuron models, and inhomogeneous finite element models of the voltage distribution in the brainstem during DBS. Main Results The computational models predicted that: 1) the majority of PPN neurons are activated with ?3V monopolar cathodic stimulation; 2) surgical targeting errors of as little as 1 mm in both species decrement activation selectivity; 3) specifically, monopolar stimulation in caudal, medial, or anterior PPN activates a significant proportion of the superior cerebellar peduncle (up to 60% in the human model and 90% in the NHP model at -3V); 4) monopolar stimulation in rostral, lateral, or anterior PPN activates a large percentage of medial lemniscus fibers (up to 33% in the human model and 40% in the NHP model at ?3V); and, 5) the current clinical cylindrical electrode design is suboptimal for isolating the modulatory effects to PPN neurons. Significance We show that a DBS lead design with radially-segmented electrodes may yield improved functional outcome for PPN-DBS. PMID:23723145

  19. Synthesis and redox behavior of PEDOT\\/PSS and PPy\\/DBS structures

    Microsoft Academic Search

    V Syritski; K Idla; A Öpik

    2004-01-01

    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

  20. Flexible Split-Ring Electrode for Insect Flight Biasing Using Multisite Neural Stimulation

    E-print Network

    Stone, Alice L.

    We describe a flexible multisite microelectrode for insect flight biasing using neural stimulation. The electrode is made of two layers of polyimide (PI) with gold sandwiched in between in a split-ring geometry. The ...

  1. Brain Stimulation in Neurology and Psychiatry

    PubMed Central

    Little, Simon; Brown, Peter

    2012-01-01

    Feedback control of deep brain stimulation (DBS) in Parkinson's disease has great potential to improve efficacy, reduce side effects, and decrease the cost of treatment. In this, the timing and intensity of stimulation are titrated according to biomarkers that capture current clinical state. Stimulation may be at standard high frequency or intelligently patterned to directly modify specific pathological rhythms. The search for and validation of appropriate feedback signals are therefore crucial. Signals recorded from the DBS electrode currently appear to be the most promising source of feedback. In particular, beta-frequency band oscillations in the local field potential recorded at the stimulation target may capture variation in bradykinesia and rigidity across patients, but this remains to be confirmed within patients. Biomarkers that reliably reflect other impairments, such as tremor, also need to be established. Finally, whether brain signals are causally important needs to be established before stimulation can be specifically patterned rather than delivered at empirically defined high frequency. PMID:22830645

  2. Acute and chronic implantation of coiled wire intraneural electrodes during cyclical electrical stimulation

    Microsoft Academic Search

    Bruce R. Bowman; Robert C. Erickson

    1985-01-01

    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

  3. A multi-pad electrode based functional electrical stimulation system for restoration of grasp

    PubMed Central

    2012-01-01

    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. PMID:23009589

  4. Determination of optimal electrode positions for transcranial direct current stimulation (tDCS)

    Microsoft Academic Search

    Chang-Hwan Im; Hui-Hun Jung; Jung-Do Choi; Soo Yeol Lee; Ki-Young Jung

    2008-01-01

    The present study introduces a new approach to determining optimal electrode positions in transcranial direct current stimulation (tDCS). Electric field and 3D conduction current density were analyzed using 3D finite element method (FEM) formulated for a dc conduction problem. The electrode positions for minimal current injection were optimized by changing the Cartesian coordinate system into the spherical coordinate system and

  5. Opposite effects of internal globus pallidus stimulation on pallidal neurones activity.

    PubMed

    Pralong, Etienne; Pollo, Claudio; Villemure, Jean-Guy; Debatisse, Damien

    2007-10-15

    Besides clinical efficacy, the mechanisms of action of deep brain stimulation (DBS) are still debated. To shed light on this complex issue, we have taken the opportunity to record the response of globus pallidus internus (GPi) neurones to 100 Hz stimulations in a case of Lesch-Nyhan syndrome (LNS) where four pallidal electrodes were implanted. Three types of response were observed, 2/19 neurones were unaffected by DBS. About 7/19 neurones were inhibited during DBS stimulation and 10/19 neurones were excited during DBS stimulation. Both effects ceased when DBS was turned off. Inhibited neurones were situated lower that exited ones on the trajectory (1.25 and 4.65 mm above the center of GPi respectively). These observations suggest that locally DBS induces a reversible inhibition of neurone firing rate while at the same time distantly exciting the main afferents to and/or efferents from the GPi. Both actions would result in a strong GPi inhibition that does not preclude increased outflow from the GPi. PMID:17595035

  6. Selectivity for specific cardiovascular effects of vagal nerve stimulation with a multi-contact electrode cuff.

    PubMed

    Ordelman, Simone C M A; Kornet, Lilian; Cornelussen, Richard; Buschman, Hendrik P J; Veltink, Peter H

    2013-01-01

    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

  7. In vitro electrical properties for iridium oxide versus titanium nitride stimulating electrodes

    Microsoft Academic Search

    James D. Weiland; David J. Anderson; Mark S. Humayun

    2002-01-01

    Stimulating electrode 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

  8. A neurochemical closed-loop controller for deep brain stimulation: toward individualized smart neuromodulation therapies

    PubMed Central

    Grahn, Peter J.; Mallory, Grant W.; Khurram, Obaid U.; Berry, B. Michael; Hachmann, Jan T.; Bieber, Allan J.; Bennet, Kevin E.; Min, Hoon-Ki; Chang, Su-Youne; Lee, Kendall H.; Lujan, J. L.

    2014-01-01

    Current strategies for optimizing deep brain stimulation (DBS) therapy involve multiple postoperative visits. During each visit, stimulation parameters are adjusted until desired therapeutic effects are achieved and adverse effects are minimized. However, the efficacy of these therapeutic parameters may decline with time due at least in part to disease progression, interactions between the host environment and the electrode, and lead migration. As such, development of closed-loop control systems that can respond to changing neurochemical environments, tailoring DBS therapy to individual patients, is paramount for improving the therapeutic efficacy of DBS. Evidence obtained using electrophysiology and imaging techniques in both animals and humans suggests that DBS works by modulating neural network activity. Recently, animal studies have shown that stimulation-evoked changes in neurotransmitter release that mirror normal physiology are associated with the therapeutic benefits of DBS. Therefore, to fully understand the neurophysiology of DBS and optimize its efficacy, it may be necessary to look beyond conventional electrophysiological analyses and characterize the neurochemical effects of therapeutic and non-therapeutic stimulation. By combining electrochemical monitoring and mathematical modeling techniques, we can potentially replace the trial-and-error process used in clinical programming with deterministic approaches that help attain optimal and stable neurochemical profiles. In this manuscript, we summarize the current understanding of electrophysiological and electrochemical processing for control of neuromodulation therapies. Additionally, we describe a proof-of-principle closed-loop controller that characterizes DBS-evoked dopamine changes to adjust stimulation parameters in a rodent model of DBS. The work described herein represents the initial steps toward achieving a “smart” neuroprosthetic system for treatment of neurologic and psychiatric disorders. PMID:25009455

  9. Electroconvulsive therapy in the presence of deep brain stimulation implants: electric field effects.

    PubMed

    Deng, Zhi-De; Hardesty, David E; Lisanby, Sarah H; Peterchev, Angel V

    2010-01-01

    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 DBS electrode 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

  10. Optimized multi-electrode stimulation increases focality and intensity at target

    NASA Astrophysics Data System (ADS)

    Dmochowski, Jacek P.; Datta, Abhishek; Bikson, Marom; Su, Yuzhuo; Parra, Lucas C.

    2011-08-01

    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.

  11. Recording evoked potentials during deep brain stimulation: development and validation of instrumentation to suppress the stimulus artefact

    NASA Astrophysics Data System (ADS)

    Kent, A. R.; Grill, W. M.

    2012-06-01

    The clinical efficacy of deep brain stimulation (DBS) for the treatment of movement disorders depends on the identification of appropriate stimulation parameters. Since the mechanisms of action of DBS remain unclear, programming sessions can be time consuming, costly and result in sub-optimal outcomes. Measurement of electrically evoked compound action potentials (ECAPs) during DBS, generated by activated neurons in the vicinity of the stimulating electrode, could offer insight into the type and spatial extent of neural element activation and provide a potential feedback signal for the rational selection of stimulation parameters and closed-loop DBS. However, recording ECAPs presents a significant technical challenge due to the large stimulus artefact, which can saturate recording amplifiers and distort short latency ECAP signals. We developed DBS-ECAP recording instrumentation combining commercial amplifiers and circuit elements in a serial configuration to reduce the stimulus artefact and enable high fidelity recording. We used an electrical circuit equivalent model of the instrumentation to understand better the sources of the stimulus artefact and the mechanisms of artefact reduction by the circuit elements. In vitro testing validated the capability of the instrumentation to suppress the stimulus artefact and increase gain by a factor of 1000 to 5000 compared to a conventional biopotential amplifier. The distortion of mock ECAP (mECAP) signals was measured across stimulation parameters, and the instrumentation enabled high fidelity recording of mECAPs with latencies of only 0.5 ms for DBS pulse widths of 50 to 100 µs/phase. Subsequently, the instrumentation was used to record in vivo ECAPs, without contamination by the stimulus artefact, during thalamic DBS in an anesthetized cat. The characteristics of the physiological ECAP were dependent on stimulation parameters. The novel instrumentation enables high fidelity ECAP recording and advances the potential use of the ECAP as a feedback signal for the tuning of DBS parameters.

  12. Deep Brain Stimulation of Different Pedunculopontine Targets in a Novel Rodent Model of Parkinsonism

    PubMed Central

    Winn, Philip

    2015-01-01

    The pedunculopontine tegmental nucleus (PPTg) has been proposed as a target for deep brain stimulation (DBS) in parkinsonian patients, particularly for symptoms such as gait and postural difficulties refractory to dopaminergic treatments. Several patients have had electrodes implanted aimed at the PPTg, but outcomes have been disappointing, with little evidence that gait and posture are improved. The PPTg is a heterogeneous structure. Consequently, exact target sites in PPTg, possible DBS mechanisms, and potential benefits still need systematic investigation in good animal models. We have investigated the role of PPTg in gait, developed a refined model of parkinsonism including partial loss of the PPTg with bilateral destruction of nigrostriatal dopamine neurons that mimics human pathophysiology, and investigated the effect of DBS at different PPTg locations on gait and posture using a wireless device that lets rats move freely while receiving stimulation. Neither partial nor complete lesions of PPTg caused gait deficits, underlining questions raised previously about the status of PPTg as a motor control structure. The effect of DBS in the refined and standard model of parkinsonism were very different despite minimal behavioral differences in nonstimulation control conditions. Anterior PPTg DBS caused severe episodes of freezing and worsened gait, whereas specific gait parameters were mildly improved by stimulation of posterior PPTg. These results emphasize the critical importance of intra-PPTg DBS location and highlight the need to take PPTg degeneration into consideration when modeling parkinsonian symptoms. They also further implicate a role for PPTg in the pathophysiology of parkinsonism. PMID:25810510

  13. Effects of Anterior Thalamic Nucleus Deep Brain Stimulation in Chronic Epileptic Rats

    PubMed Central

    Amorim, Beatriz; Cavarsan, Clarissa; Miranda, Maisa Ferreira; Aarão, Mayra C.; Madureira, Ana Paula; Rodrigues, Antônio M.; Nobrega, José N.; Mello, Luiz E.; Hamani, Clement

    2014-01-01

    Deep brain stimulation (DBS) has been investigated for the treatment of epilepsy. In rodents, an increase in the latency for the development of seizures and status epilepticus (SE) has been reported in different animal models but the consequences of delivering stimulation to chronic epileptic animals have not been extensively addressed. We study the effects of anterior thalamic nucleus (AN) stimulation at different current intensities in rats rendered epileptic following pilocarpine (Pilo) administration. Four months after Pilo-induced SE, chronic epileptic rats were bilaterally implanted with AN electrodes or had sham-surgery. Stimulation was delivered for 6 h/day, 5 days/week at 130 Hz, 90 µsec. and either 100 µA or 500 µA. The frequency of spontaneous recurrent seizures in animals receiving stimulation was compared to that recorded in the preoperative period and in rats given sham treatment. To investigate the effects of DBS on hippocampal excitability, brain slices from animals receiving AN DBS or sham surgery were studied with electrophysiology. We found that rats treated with AN DBS at 100 µA had a 52% non-significant reduction in the frequency of seizures as compared to sham-treated controls and 61% less seizures than at baseline. Animals given DBS at 500 µA had 5.1 times more seizures than controls and a 2.8 fold increase in seizure rate as compared to preoperative values. In non-stimulated controls, the average frequency of seizures before and after surgery remained unaltered. In vitro recordings have shown that slices from animals previously given DBS at 100 µA had a longer latency for the development of epileptiform activity, shorter and smaller DC shifts, and a smaller spike amplitude compared to non-stimulated controls. In contrast, a higher spike amplitude was recorded in slices from animals given AN DBS at 500 µA. PMID:24892420

  14. A versatile all-channel stimulator for electrode arrays, with real-time control.

    PubMed

    Wagenaar, Daniel A; Potter, Steve M

    2004-03-01

    Over the last few decades, technology to record through ever increasing numbers of electrodes has become available to electrophysiologists. For the study of distributed neural processing, however, the ability to stimulate through equal numbers of electrodes, and thus to attain bidirectional communication, is of paramount importance. Here, we present a stimulation system for multi-electrode arrays which interfaces with existing commercial recording hardware, and allows stimulation through any electrode in the array, with rapid switching between channels. The system is controlled through real-time Linux, making it extremely flexible: stimulation sequences can be constructed on-the-fly, and arbitrary stimulus waveforms can be used if desired. A key feature of this design is that it can be readily and inexpensively reproduced in other labs, since it interfaces to standard PC parallel ports and uses only off-the-shelf components. Moreover, adaptation for use with in vivo multi-electrode probes would be straightforward. In combination with our freely available data-acquisition software, MeaBench, this system can provide feedback stimulation in response to recorded action potentials within 15 ms. PMID:15876621

  15. Improved spatial targeting with directionally segmented deep brain stimulation leads for treating essential tremor

    NASA Astrophysics Data System (ADS)

    Keane, Maureen; Deyo, Steve; Abosch, Aviva; Bajwa, Jawad A.; Johnson, Matthew D.

    2012-08-01

    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.

  16. Polymer neural interface with dual-sided electrodes for neural stimulation and recording.

    PubMed

    Tooker, Angela; Tolosa, Vanessa; Shah, Kedar G; Sheth, Heeral; Felix, Sarah; Delima, Terri; Pannu, Satinderpall

    2012-01-01

    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

  17. Effect of electrode surface area on thresholds for AC stimulation and ventricular fibrillation.

    PubMed

    Patel, Shivani Govind; Malkin, Robert A

    2007-10-01

    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 with isoflurane, a tracheotomy and thoracotomy were performed, and vitals were monitored using the lead II ECG and an optical plethysmograph. The circular flat ends of eleven stainless steel rods were used as electrodes with areas ranging from 0.1 to 26.79 mm2. In the first study, 60-Hz AC stimuli of 5 s duration were delivered with strengths from 25-3000 microA or until VF was induced. In the second group, the current thresholds at 20, 40, 80, and 160 Hz were determined at electrode areas of 0.2, 2.01, and 16.4 mm2. Reactions were categorized as having no effect, having some effect (EFFECT, typically blood pressure collapse), and inducing VF. On a log-log scale, electrode radii had a piecewise-linear relationship with the current thresholds for EFFECT (p < 0.005) and VF (p < 0.01). The liminal area determined by the piecewise-linear fit was 2.0 and 2.84 mm2 for EFFECT and VF, respectively. Above the liminal area, the threshold increased proportional to r(1.25) and r(0.95) (r = radius of electrode), for EFFECT and VF, respectively. Based on these experimental results, we present a theoretical framework to explain the electrode size-stimulation threshold variation for both low strength AC stimulation and VF initiation. PMID:17926681

  18. Multi-electrode stimulation in somatosensory cortex increases probability of detection

    NASA Astrophysics Data System (ADS)

    Zaaimi, Boubker; Ruiz-Torres, Ricardo; Solla, Sara A.; Miller, Lee E.

    2013-10-01

    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-electrode stimulation 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.

  19. A prototype 64-electrode stimulator in 65 nm CMOS process towards a high density epi-retinal prosthesis.

    PubMed

    Tran, N; Skafidas, E; Yang, J; Bai, S; Fu, M; Ng, D; Halpern, M; Mareels, I

    2011-01-01

    This paper presents a highly flexible 64-electrode stimulator using 65 nm CMOS process fabricated as a stage towards a 1024-electrode epi-retinal prosthesis, which aims to restore partial vision in patients suffering from eye diseases such as retinitis pigmentosa (RP) and age-related macular degradation (AMD). The stimulator drives 64 electrodes with many flexible features, which are necessary before making a complete 1024-electrode implant chip. Each electrode driver can provide a bi-phasic stimulus current with fully programmable parameters such as amplitude, pulse duration, inter-phase gap, and stimulation rate. The electrode driver operates in an alternately pull-push manner with only one current source working at a time, which helps reduce headroom voltage while controlling charge balance at the active electrode. The stimulator varies both stimulus current amplitude and stimulation rate to represent phosphene brightness. The stimulus current amplitude starts from the tissue depolarization threshold with 64 different levels. The selection of active and return electrodes is arbitrary, any electrodes and any number of them can be selected at any time. The power consumption of the stimulator is 400 ?W excluding the stimulus power. Measurement results verify correct operation. The stimulator is easily scaled up to drive 1024 electrodes. PMID:22255883

  20. Effects of Bilateral Deep Brain Stimulation of the Subthalamic Nucleus on Olfactory Function in Parkinson’s Disease Patients

    Microsoft Academic Search

    Xiaodong Guo; Guodong Gao; Xuelian Wang; Lihong Li; Weixin Li; Qinchuan Liang; Hua Zhang

    2008-01-01

    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

  1. Compact Nonlinear Model of an Implantable Electrode Array for Spinal Cord Stimulation (SCS).

    PubMed

    Scott, Jonathan; Single, Peter

    2013-07-23

    We describe the construction of a model of the electrode-electrolyte interface and surrounding electrolyte in the case of a platinum-electrode array intended for spinal-cord stimulation (SCS) application. We show that a finite, two-dimensional, resistor array provides a satisfactory model of the bulk electrolyte, and we identify the complexity required of that resistor array. The electrode-electrolyte interface is modelled in a fashion suitable for commonly-available, compact simulators using a nonlinear extension of the model of Franks (IEEE Trans. Biomed. Eng., vol. 52 , no. 7 , pp. 1295-1302, Jul. 2005) that incorporates diodes and a memristor. The electrode-electrolyte interface model accounts for the nonlinear current-overpotential characteristic and diffusion-limiting effects. We characterise a commercial, implantable, electrode array, fit the model to it, and show that the model successfully predicts subtle operational characteristics. PMID:23893748

  2. Intracranial electrode implantation produces regional neuroinflammation and memory deficits in rats

    SciTech Connect

    Kuttner-Hirshler, Y.; Biegon, A.; Kuttner-Hirshler, Y.; Polat, U.; Biegon, A.

    2009-12-21

    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 1 or 8 weeks post-implantation and processed for in vitro autoradiography with [(3)H]PK11195, an established marker of microglial activation. Memory function was assessed by the novel object recognition test (ORT) before surgery and 2 and 8 weeks after surgery. Electrode implantation produced region-dependent changes in ligand binding density in the implanted brains at 1 as well as 8 weeks post-implantation. Cortical regions showed more intense and widespread neuroinflammation than striatal or thalamic structures. Furthermore, implanted animals showed deficits in ORT performance 2 and 8 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.

  3. An Implantable Versatile Electrode-Driving ASIC for Chronic Epidural Stimulation in Rats.

    PubMed

    Giagka, Vasiliki; Eder, Clemens; Donaldson, Nick; Demosthenous, Andreas

    2014-08-13

    This paper presents the design and testing of an electrode driving application specific integrated circuit (ASIC) intended for epidural spinal cord electrical stimulation in rats. The ASIC can deliver up to 1 mA fully programmable monophasic or biphasic stimulus current pulses, to 13 electrodes selected in any possible configuration. It also supports interleaved stimulation. Communication is achieved via only 3 wires. The current source and the control of the stimulation timing were kept off-chip to reduce the heat dissipation close to the spinal cord. The ASIC was designed in a 0.18- ? m high voltage CMOS process. Its output voltage compliance can be up to 25 V. It features a small core area ( mm (2)) and consumes a maximum of 114 ?W during a full stimulation cycle. The layout of the ASIC was developed to be suitable for integration on the epidural electrode array, and two different versions were fabricated and electrically tested. Results from both versions were almost indistinguishable. The performance of the system was verified for different loads and stimulation parameters. Its suitability to drive a passive epidural 12-electrode array in saline has also been demonstrated. PMID:25134089

  4. Deep brain stimulation with simultaneous FMRI in rodents.

    PubMed

    Younce, John Robert; Albaugh, Daniel L; Shih, Yen-Yu Ian

    2014-01-01

    In order to visualize the global and downstream neuronal responses to deep brain stimulation (DBS) at various targets, we have developed a protocol for using blood oxygen level dependent (BOLD) functional magnetic resonance imaging (fMRI) to image rodents with simultaneous DBS. DBS fMRI presents a number of technical challenges, including accuracy of electrode implantation, MR artifacts created by the electrode, choice of anesthesia and paralytic to minimize any neuronal effects while simultaneously eliminating animal motion, and maintenance of physiological parameters, deviation from which can confound the BOLD signal. Our laboratory has developed a set of procedures that are capable of overcoming most of these possible issues. For electrical stimulation, a homemade tungsten bipolar microelectrode is used, inserted stereotactically at the stimulation site in the anesthetized subject. In preparation for imaging, rodents are fixed on a plastic headpiece and transferred to the magnet bore. For sedation and paralysis during scanning, a cocktail of dexmedetomidine and pancuronium is continuously infused, along with a minimal dose of isoflurane; this preparation minimizes the BOLD ceiling effect of volatile anesthetics. In this example experiment, stimulation of the subthalamic nucleus (STN) produces BOLD responses which are observed primarily in ipsilateral cortical regions, centered in motor cortex. Simultaneous DBS and fMRI allows the unambiguous modulation of neural circuits dependent on stimulation location and stimulation parameters, and permits observation of neuronal modulations free of regional bias. This technique may be used to explore the downstream effects of modulating neural circuitry at nearly any brain region, with implications for both experimental and clinical DBS. PMID:24561922

  5. Evaluation of a suture electrode for direct bladder stimulation in a lower motor neuron lesioned animal model

    Microsoft Academic Search

    James S. Walter; John S. Wheeler; Wuying Cai; William W. King; Robert D. Wurster

    1999-01-01

    The purpose of this study was to evaluate a “suture” type electrode for direct bladder stimulation in an animal model of a lower motor neuron lesion. During an initial surgery, 5 male cats were instrumented under anesthesia using multistranded, 316 LVM, stainless-steel, wire electrodes implanted on the bladder wall serosa above the trigone area. Electrodes were constructed with a needle

  6. Multi-channel metallic electrode for threshold stimulation of frog's retina.

    PubMed

    Kuras, A; Gutmaniene, N

    1997-07-18

    A simple method for making a stimulating multi-channel metallic electrode is proposed. The method uses furnace-shaped multiple fine glass tubes as channel guides for inserted tungsten wires that are pulled as a unit to produce multi-channel metallic electrode with a tapered tip. By shortening the tip, the desired inter-channels distances (from tens to hundreds of micrometers) can be established with a high degree of accuracy. Such an electrode was used to stimulate the layer of ganglion cells in a frog's retina. The responses to stimuli were recorded extracellularly in the contralateral tectum from the terminal arborizations of the excited ganglion cells' axons. A larger area of the retina may be excited when several channels are used as a cathode and several others as an anode. By varying the stimulating pairs of the channels it is possible to change the site of excitation without displacing the electrode. Separate ganglion cells may be stimulated, provided the appropriate pair of channels is selected. In this case 'all-or-none' responses to the threshold stimuli are obtained in the tectum. The artefact of the stimulus is diminished effectively by joining additional channels to the anodic one. PMID:9262150

  7. Construction of a Simple Suction Electrode for Extracellular Recording and Stimulation

    NSDL National Science Digital Library

    Bruce R. Johnson, Stephen A. Hauptman, and Robert H. Bonow (Cornell University; )

    2008-06-12

    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.

  8. Sputtered iridium oxide films (SIROFs) for low-impedance neural stimulation and recording electrodes

    Microsoft Academic Search

    S. F. Cogan; T. D. Plante; J. Ehrlich

    2004-01-01

    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

  9. A prototype 64-electrode stimulator in 65 nm CMOS process towards a high density epi-retinal prosthesis

    Microsoft Academic Search

    N. Tran; E. Skafidas; J. Yang; S. Bai; M. Fu; D. Ng; M. Halpern; I. Mareels

    2011-01-01

    This paper presents a highly flexible 64-electrode stimulator using 65 nm CMOS process fabricated as a stage towards a 1024-electrode epi-retinal prosthesis, which aims to restore partial vision in patients suffering from eye diseases such as retinitis pigmentosa (RP) and age-related macular degradation (AMD). The stimulator drives 64 electrodes with many flexible features, which are necessary before making a complete

  10. Surface Electrical Stimulation for Treating Swallowing Disorders after Stroke: A Review of the Stimulation Intensity Levels and the Electrode Placements

    PubMed Central

    Poorjavad, Marziyeh; Talebian Moghadam, Saeed; Daemi, Mostafa

    2014-01-01

    Neuromuscular electrical stimulation (NMES) for treating dysphagia is a relatively new therapeutic method. There is a paucity of evidence about the use of NMES in patients with dysphagia caused by stroke. The present review aimed to introduce and discuss studies that have evaluated the efficacy of this method amongst dysphagic patients following stroke with emphasis on the intensity of stimulation (sensory or motor level) and the method of electrode placement on the neck. The majority of the reviewed studies describe some positive effects of the NMES on the neck musculature in the swallowing performance of poststroke dysphagic patients, especially when the intensity of the stimulus is adjusted at the sensory level or when the motor electrical stimulation is applied on the infrahyoid muscles during swallowing. PMID:24804147

  11. Quantitative analysis of axonal fiber activation evoked by deep brain stimulation via activation density heat maps

    PubMed Central

    Hartmann, Christian J.; Chaturvedi, Ashutosh; Lujan, J. Luis

    2015-01-01

    Background: Cortical modulation is likely to be involved in the various therapeutic effects of deep brain stimulation (DBS). However, it is currently difficult to predict the changes of cortical modulation during clinical adjustment of DBS. Therefore, we present a novel quantitative approach to estimate anatomical regions of DBS-evoked cortical modulation. Methods: Four different models of the subthalamic nucleus (STN) DBS were created to represent variable electrode placements (model I: dorsal border of the posterolateral STN; model II: central posterolateral STN; model III: central anteromedial STN; model IV: dorsal border of the anteromedial STN). Axonal fibers of passage near each electrode location were reconstructed using probabilistic tractography and modeled using multi-compartment cable models. Stimulation-evoked activation of local axon fibers and corresponding cortical projections were modeled and quantified. Results: Stimulation at the border of the STN (models I and IV) led to a higher degree of fiber activation and associated cortical modulation than stimulation deeply inside the STN (models II and III). A posterolateral target (models I and II) was highly connected to cortical areas representing motor function. Additionally, model I was also associated with strong activation of fibers projecting to the cerebellum. Finally, models III and IV showed a dorsoventral difference of preferentially targeted prefrontal areas (models III: middle frontal gyrus; model IV: inferior frontal gyrus). Discussion: The method described herein allows characterization of cortical modulation across different electrode placements and stimulation parameters. Furthermore, knowledge of anatomical distribution of stimulation-evoked activation targeting cortical regions may help predict efficacy and potential side effects, and therefore can be used to improve the therapeutic effectiveness of individual adjustments in DBS patients. PMID:25713510

  12. Effects of vestibular prosthesis electrode implantation and stimulation on hearing in rhesus monkeys.

    PubMed

    Dai, Chenkai; Fridman, Gene Y; Della Santina, Charles C

    2011-07-01

    To investigate the effects of vestibular prosthesis electrode implantation and activation on hearing in rhesus monkeys, we measured auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE) in four rhesus monkeys before and after unilateral implantation of vestibular prosthesis electrodes in each of 3 left semicircular canals (SCC). Each of the 3 left SCCs were implanted with electrodes via a transmastoid approach. Right ears, which served as controls, were not surgically manipulated. Hearing tests were conducted before implantation (BI) and then 4 weeks post-implantation both without electrical stimulation (NS) and with electrical stimulation (S). During the latter condition, prosthetic electrical stimuli encoding 3 dimensions of head angular velocity were delivered to the 3 ampullary branches of the left vestibular nerve via each of 3 electrode pairs of a multichannel vestibular prosthesis. Electrical stimuli comprised charge-balanced biphasic pulses at a baseline rate of 94 pulses/s, with pulse frequency modulated from 48 to 222 pulses/s by head angular velocity. ABR hearing thresholds to clicks and tone pips at 1, 2, and 4 kHz increased by 5-10 dB from BI to NS and increased another ?5 dB from NS to S in implanted ears. No significant change was seen in right ears. DPOAE amplitudes decreased by 2-14 dB from BI to NS in implanted ears. There was a slight but insignificant decrease of DPOAE amplitude and a corresponding increase of DPOAE/Noise floor ratio between NS and S in implanted ears. Vestibular prosthesis electrode implantation and activation have small but measurable effects on hearing in rhesus monkeys. Coupled with the clinical observation that patients with cochlear implants only rarely exhibit signs of vestibular injury or spurious vestibular nerve stimulation, these results suggest that although implantation and activation of multichannel vestibular prosthesis electrodes in human will carry a risk of hearing loss, that loss is not likely to be severe. PMID:21195755

  13. Effects of Vestibular Prosthesis Electrode Implantation and Stimulation on Hearing in Rhesus Monkeys

    PubMed Central

    Dai, Chenkai; Fridman, Gene Y.; Della Santina, Charles C.

    2011-01-01

    To investigate the effects of vestibular prosthesis electrode implantation and activation on hearing in rhesus monkeys, we measured auditory brainstem responses (ABR) and distortion product otoacoustic emissions (DPOAE) in four rhesus monkeys before and after unilateral implantation of vestibular prosthesis electrodes in each of 3 left semicircular canals (SCC). Each of the 3 left SCCs were implanted with electrodes via a transmastoid approach. Right ears, which served as controls, were not surgically manipulated. Hearing tests were conducted before implantation (BI) and then 4 weeks post implantation both without electrical stimulation (NS) and with electrical stimulation (S). During the latter condition, prosthetic electrical stimuli encoding 3 dimensions of head angular velocity were delivered to the 3 ampullary branches of the left vestibular nerve via each of 3 electrode pairs of a multichannel vestibular prosthesis. Electrical stimuli comprised charge-balanced biphasic pulses at a baseline rate of 94 pulses/sec, with pulse frequency modulated from 48–222 pulses/s by head angular velocity. ABR hearing thresholds to clicks and tone pips at 1, 2, and 4 kHz increased by 5–10 dB from BI to NS and increased another ~5 dB from NS to S in implanted ears. No significant change was seen in right ears. DPOAE amplitudes decreased by 2–14 dB from BI to NS in implanted ears. There was a slight but insignificant decrease of DPOAE amplitude and a corresponding increase of DPOAE/Noise floor ratio between NS and S in implanted ears. Vestibular prosthesis electrode implantation and activation have small but measurable effects on hearing in rhesus monkeys. Coupled with the clinical observation that patients with cochlear implants only rarely exhibit signs of vestibular injury or spurious vestibular nerve stimulation, these results suggest that although implantation and activation of multichannel vestibular prosthesis electrodes in human will carry a risk of hearing loss, that loss is not likely to be severe. PMID:21195755

  14. Enhanced control of electrochemical response in metallic materials in neural stimulation electrode applications

    SciTech Connect

    Watkins, K.G.; Steen, W.M.; Manna, I. [Univ. of Liverpool (United Kingdom)] [and others

    1996-12-31

    New means have been investigated for the production of electrode devices (stimulation electrodes) which could be implanted in the human body in order to control pain, activate paralysed limbs or provide electrode arrays for cochlear implants for the deaf or for the relief of tinitus. To achieve this ion implantation and laser materials processing techniques were employed. Ir was ion implanted in Ti-6Al-4V alloy and the surface subsequently enriched in the noble metal by dissolution in sulphuric acid. For laser materials processing techniques, investigation has been carried out on the laser cladding and laser alloying of Ir in Ti wire. A particular aim has been the determination of conditions required for the formation of a two phase Ir, Ir-rich, and Ti-rich microstructure which would enable subsequent removal of the non-noble phase to leave a highly porous noble metal with large real surface area and hence improved charge carrying capacity compared with conventional non porous electrodes. Evaluation of the materials produced has been carried out using repetitive cyclic voltammetry, amongst other techniques. For laser alloyed Ir on Ti wire, it has been found that differences in the melting point and density of the materials makes control of the cladding or alloying process difficult. Investigation of laser process parameters for the control of alloying and cladding in this system was carried out and a set of conditions for the successful production of two phase Ir-rich and Ti-rich components in a coating layer with strong metallurgical bonding to the Ti alloy substrate was derived. The laser processed material displays excellent potential for further development in providing stimulation electrodes with the current carrying capacity of Ir but in a form which is malleable and hence capable of formation into smaller electrodes with improved spatial resolution compared with presently employed electrodes.

  15. Integration of pre-aligned liquid metal electrodes for neural stimulation within a user-friendly microfluidic platform

    PubMed Central

    Hallfors, Nicholas; Khan, Asif; Dickey, Michael D.; Taylor, Anne Marion

    2015-01-01

    Electrical stimulation of nervous tissue is used clinically for the treatment of multiple neurological disorders and experimentally for basic research. With the increase of optical probes to record neuronal activity, simple and user-friendly methods are desired to stimulate neurons and their subcellular compartments for biological experimentation. Here we describe the novel integration of liquid metal electrodes with microfluidic culture platforms to accomplish this goal. We integrated electrode and cell channels into a single poly(dimethylsiloxane) (PDMS) chip, eliminating entirely the need to align electrodes with microchannels. We designed the electrode channels such that the metal can be injected by hand and when the device is non-covalently bound to glass. We demonstrated the biocompatibility of the electrodes for long-term cultures (12 days) using hippocampal neurons. We demonstrated the use of these electrodes to depolarize neurons and recorded neuronal activity using the calcium indicator dye, Fluo-4. We established optimal stimulation parameters that induce neuronal spiking without inducing damage. We showed that the liquid metal electrode evoked larger calcium responses in somata than bath electrodes using the same stimulus parameters. Lastly we demonstrated the use of these liquid metal electrodes to target and depolarize axons. In summary, the integration of liquid metal electrodes with neuronal culture platforms provides a user-friendly and targeted method to stimulate neurons and their subcellular compartments, thus providing a novel tool for future biological investigations. PMID:23232866

  16. Multimicroelectrode stimulation within the cat L6 spinal cord: influences of electrode combinations and stimulus interleave time on knee joint extension torque

    Microsoft Academic Search

    Changfeng Tai; August M. Booth; Charles J. Robinson; William C. de Groat; James R. Roppolo

    2000-01-01

    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 electrode stimulation. A similar difference was noted

  17. A Long Term Effects of a New Onset Psychosis after DBS Treated with Quetiapine in a Patient with Parkinson's Disease

    PubMed Central

    Perini, Giulia; Pizzighello, Silvia; Vestri, Alec; Ferri, Giovanni; Toffanin, Tommaso; Follador, Halima; Martinuzzi, Andrea

    2015-01-01

    Deep Brain Stimulation represents a therapeutic option for PD patients. In this paper, we present and discuss a case of acute delirium and psychosis manifesting after DBS in a 58-years-old man affected by Parkinson's Disease. We highlight the importance of an exhaustive psychiatric evaluation in candidates for DBS and we underline the severity and non-reversibility of some adverse events associated with the implantation, suggesting the use of Quetiapine in the management of these effects. Acute psychosis may be listed as a potential severe adverse event associated with DBS, even in patients without a clear cut previous history of psychiatric disorders. PMID:25670958

  18. Simulating pad-electrodes with high-definition arrays in transcranial electric stimulation

    NASA Astrophysics Data System (ADS)

    Kempe, René; Huang, Yu; Parra, Lucas C.

    2014-04-01

    Objective. Research studies on transcranial electric stimulation, including direct current, often use a computational model to provide guidance on the placing of sponge-electrode pads. However, the expertise and computational resources needed for finite element modeling (FEM) make modeling impractical in a clinical setting. Our objective is to make the exploration of different electrode configurations accessible to practitioners. We provide an efficient tool to estimate current distributions for arbitrary pad configurations while obviating the need for complex simulation software. Approach. To efficiently estimate current distributions for arbitrary pad configurations we propose to simulate pads with an array of high-definition (HD) electrodes and use an efficient linear superposition to then quickly evaluate different electrode configurations. Main results. Numerical results on ten different pad configurations on a normal individual show that electric field intensity simulated with the sampled array deviates from the solutions with pads by only 5% and the locations of peak magnitude fields have a 94% overlap when using a dense array of 336 electrodes. Significance. Computationally intensive FEM modeling of the HD array needs to be performed only once, perhaps on a set of standard heads that can be made available to multiple users. The present results confirm that by using these models one can now quickly and accurately explore and select pad-electrode montages to match a particular clinical need.

  19. Effectiveness of diaphragmatic stimulation with single-channel electrodes in rabbits*

    PubMed Central

    Ghedini, Rodrigo Guellner; Espinel, Julio de Oliveira; Felix, Elaine Aparecida; Paludo, Artur de Oliveira; Mariano, Rodrigo; Holand, Arthur Rodrigo Ronconi; Andrade, Cristiano Feijó

    2013-01-01

    Every year, a large number of individuals become dependent on mechanical ventilation because of a loss of diaphragm function. The most common causes are cervical spinal trauma and neuromuscular diseases. We have developed an experimental model to evaluate the performance of electrical stimulation of the diaphragm in rabbits using single-channel electrodes implanted directly into the muscle. Various current intensities (10, 16, 20, and 26 mA) produced tidal volumes above the baseline value, showing that this model is effective for the study of diaphragm performance at different levels of electrical stimulation PMID:24068272

  20. A latent force model for describing electric propagation in deep brain stimulation: a simulation study.

    PubMed

    Alvarado, Pablo A; Alvarez, Mauricio A; Daza-Santacoloma, Genaro; Orozco, Alvaro; Castellanos-Dominguez, Germán

    2014-01-01

    Deep brain stimulation (DBS) is a neurosurgical method used to treat symptoms of movement disorders by implanting electrodes in deep brain areas. Often, the DBS modeling approaches found in the literature assume a quasi-static approximation, and discard any dynamic behavior. Nevertheless, in a real DBS system the stimulus corresponds to a wave that changes as a function of time. It is clear that DBS demands an approach that takes into account the time-varying behavior of the input stimulus. In this work, we present a novel latent force model for describing the dynamic electric propagation occurred during DBS. The performance of the proposed model was studied by simulations under different conditions. The results show that our approach is able to take into account the time variations of the source and the produced field. Moreover, by restricting our model it is possible to obtain solutions for electrostatic formulations, here experimental results were compared with the finite element method. Additionally, our approach allows a solution to the inverse problem, which is a valuable clinical application allowing the appropriate tuning of the DBS device by the expert physician. PMID:25570527

  1. Predictors of cognitive and psychosocial outcome after STN DBS in Parkinson Disease

    Microsoft Academic Search

    H. M. M. Smeding; J. D. Speelman; H. M. Huizenga; P. R. Schuurman; B. Schmand

    2010-01-01

    Objective: To find predictors of cognitive decline and quality of life one year after bilateral subthalamic nucleus stimulation (STN DBS) in Parkinson’s disease (PD). Methods: A total of 105 patients were evaluated with a comprehensive neuropsychological assessment before and 12 months after surgery. A control group of 40 PD patients was included to control for effects of repeated testing and

  2. Deep brain stimulation for obsessive-compulsive disorder and treatment-resistant depression: systematic review

    PubMed Central

    2010-01-01

    Background In spite of advances in psychotherapy and pharmacotherapy, there are still a significant number of patients with depression and obsessive-compulsive disorder that are not aided by either intervention. Although still in the experimental stage, deep brain stimulation (DBS) offers many advantages over other physically-invasive procedures as a treatment for these psychiatric disorders. The purpose of this study is to systematically review reports on clinical trials of DBS for obsessive-compulsive disorder (OCD) and treatment-resistant depression (TRD). Locations for stimulation, success rates and effects of the stimulation on brain metabolism are noted when available. The first observation of the effects of DBS on OCD and TRD came in the course of using DBS to treat movement disorders. Reports of changes in OCD and depression during such studies are reviewed with particular attention to electrode locations and associated adverse events; although these reports were adventitious observations rather than planned. Subsequent studies have been guided by more precise theories of structures involved in DBS and OICD. This study suggests stimulation sites and prognostic indicators for DBS. We also briefly review tractography, a relatively new procedure that holds great promise for the further development of DBS. Methods Articles were retrieved from MEDLINE via PubMed. Relevant references in retrieved articles were followed up. We included all articles reporting on studies of patients selected for having OCD or TRD. Adequacy of the selected studies was evaluated by the Jadad scale. Evaluation criteria included: number of patients, use of recognized psychiatric rating scales, and use of brain blood flow measurements. Success rates classified as "improved" or "recovered" were recorded. Studies of DBS for movement disorders were included if they reported coincidental relief of depression or reduction in OCD. Most of the studies involved small numbers of subjects so individual studies were reviewed. Results While the number of cases was small, these were extremely treatment-resistant patients. While not everyone responded, about half the patients did show dramatic improvement. Associated adverse events were generally trivial in younger psychiatric patients but often severe in older movement disorder patients. The procedures differed from study to study, and the numbers of patients was usually too small to do meaningful statistics or make valid inferences as to who will respond to treatment. Conclusions DBS is considered a promising technique for OCD and TRD. Outstanding questions about patient selection and electrode placement can probably be resolved by (a) larger studies, (b) genetic studies and (c) imaging studies (MRI, fMRI, PET, and tractography). PMID:20202203

  3. Direct binary search (DBS) algorithm with constraints

    NASA Astrophysics Data System (ADS)

    Chandu, Kartheek; Stanich, Mikel; Wu, Chai Wah; Trager, Barry

    2013-02-01

    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.

  4. Pulse electrical arc stimulator based on single-electrode for active exercise in tail-suspension rat

    Microsoft Academic Search

    Lian-wen Sun; Tian Xie; Yu-bo Fan; Xiao-wei Zhang; Yao Sun; Xiao Yang

    2008-01-01

    To make rat do active exercise to counteract bone loss in the rat tail-suspension model, a pulse electrical stimulator based\\u000a on single-electrode with a low-current and a high-voltage was designed. The stimulator was controlled by SCM (single chip\\u000a micyoco) that could accurately control the stimulation duration and the interval between stimulations, and cease the operation\\u000a after the recorded number of

  5. What is the optimal anodal electrode position for inducing corticomotor excitability changes in transcranial direct current stimulation?

    PubMed

    Lee, Minji; Kim, Yun-Hee; Im, Chang-Hwan; Kim, Jung-Hoon; Park, Chang-hyun; Chang, Won Hyuk; Lee, Ahee

    2015-01-01

    Transcranial direct current stimulation (tDCS) non-invasively modulates brain function by inducing neuronal excitability. The conventional hot spot for inducing the highest current density in the hand motor area may not be the optimal site for effective stimulation. In this study, we investigated the influence of the center position of the anodal electrode on changes in motor cortical excitability. We considered three tDCS conditions in 16 healthy subjects: (i) real stimulation with the anodal electrode located at the conventional hand motor hot spot determined by motor evoked potentials (MEPs); (ii) real stimulation with the anodal electrode located at the point with the highest current density in the hand motor area as determined by electric current simulation; and (iii) sham stimulation. Motor cortical excitability as measured by MEP amplitude increased after both real stimulation conditions, but not after sham stimulation. Stimulation using the simulation-derived anodal electrode position, which was found to be posterior to the MEP hot spot for all subjects, induced higher motor cortical excitability. Individual positioning of the anodal electrode, based on the consideration of anatomical differences between subjects, appears to be important for maximizing the effects of tDCS. PMID:25450146

  6. Non-penetrating round window electrode stimulation for tinnitus therapy followed by cochlear implantation.

    PubMed

    Wenzel, Gentiana I; Sarnes, Petra; Warnecke, Athanasia; Stöver, Timo; Jäger, Burkard; Lesinski-Schiedat, Anke; Lenarz, Thomas

    2014-12-01

    One main theory behind the origin of tinnitus is based on the idea that alterations of the spontaneous electrical activity within the auditory system lead to abnormal firing patterns in the affected nervous structures [1]. A possible therapeutic option is the use of electrical stimulation of the auditory nerve for the recovery or at least limitation of the abnormal firing pattern to a level that can be easily tolerated by the patient. The Tinnelec Implant consists of a single non-penetrating stimulation electrode connected to a Neurelec cochlear implant system. As a first feasibility study, before starting implantations in hearing patients, we thought to assess the potential of the Tinnelec stimulation to treat tinnitus in unilateral deaf patients, analysing hereby its effectivity and risks. Three patients suffering from unilateral tinnitus resistant to pharmacological treatment and ipsilateral severe to profound sensorineural hearing loss/deafness were implanted with a Tinnelec system between September 2007 and July 2008, at the ENT Department of Hannover Medical School. The stimulation strategy was chosen to induce alleviation of the tinnitus through suppression, masking and/or habituation and the response of each patient on the treatment was monitored using a visual analogue scale (VAS) on loudness and annoyance of tinnitus, mood of the patient, as well as the tinnitus handicap inventory (THI). All patients had a benefit from the electrical stimulation for their tinnitus (THI-score improvement of 20-70), however, not all participants profited from the Tinnelec system in same way and degree. In one patient, despite good results, the device had to be replaced with a conventional cochlear implant because of Tinnelec-independent increase in hearing loss on the contralateral ear. Additionally, due to the extension of cochlear implant indications, the devices of the other two patients have been meanwhile replaced with a conventional cochlear implant to benefit additionally from hearing improvement. As demonstrated in the present study, sensorineural tinnitus in humans may be suppressed/masked/habituated by electrical stimulation. The main advantage of the Tinnelec implant would be the option to treat patients with normal and usable hearing, stimulating the affected ear with the cochlear non-penetrating stimulation electrode of the device, and extend the treatment in cases of progressive hearing loss by explanation and reimplantation with a penetrating electrode addressing tinnitus as well as the hearing impairment. The present study is the first report on a long-term follow-up on tinnitus patients implanted with Tinnelec. Further clinical studies to implant tinnitus patients with residual or normal hearing on the affected ear are on the way. PMID:25480476

  7. Postoperative delirium in Parkinson's disease patients following deep brain stimulation surgery.

    PubMed

    Carlson, Jonathan D; Neumiller, Joshua J; Swain, Lindy D W; Mark, Jamie; McLeod, Pam; Hirschauer, Jeff

    2014-07-01

    Deep brain stimulation (DBS) surgery is an effective treatment for patients with advanced Parkinson's disease. Delirium in hospitalized Parkinson's disease patients is common and often leads to prolonged hospital stays. This study reports on the incidence and etiology of postoperative delirium following DBS surgery. Patients (n=59) with advanced Parkinson's disease underwent bilateral (n=56) or unilateral (n=3) DBS electrode implant surgery, followed 1 week later with surgical placement of DBS generators. The development of delirium during either hospital stay was evaluated retrospectively from the hospital chart. Potential causes of delirium were evaluated, including history of delirium, opiate equivalents, medication administration delays and missed doses during hospitalization, and Parkinson's disease duration. Delirium following implantation of DBS electrodes was common (22% of patients). It was less commonly associated with generator placement (10%). A history of delirium, age, and disease duration were positive predictors of delirium. Opiate equivalent doses were negatively correlated with delirium. Missed Parkinson's medication doses (53% of patients) and delayed administration (81% of patients) were common, and had a slight relation with delirium. Delirium was not related to complexity of medication regimen or use of dementia medications. Despite the presence of delirium most patients still only required a single night in the hospital post-surgery (67%). Prolonged hospital stay was due not only to delirium but also severe off states and other medical issues. Recognition and expectant management of delirium is best accomplished in a multidisciplinary setting, including the patient's family and nursing, pharmacy and neurological surgery staff. PMID:24518269

  8. Electrodic voltages accompanying stimulated bioremediation of a uranium-contaminated aquifer

    SciTech Connect

    Williams, K.H.; N'Guessan, A.L.; Druhan, J.; Long, P.E.; Hubbard, S.S.; Lovley, D.R.; Banfield, J.F.

    2009-11-15

    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/m{sup 2} 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 {mu}M, a level still below the background value of 1.5 {mu}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.

  9. Frequency-dependent effects of electrical stimulation in the globus pallidus of dystonia patients.

    PubMed

    Liu, Liu D; Prescott, Ian A; Dostrovsky, Jonathan O; Hodaie, Mojgan; Lozano, Andres M; Hutchison, William D

    2012-07-01

    Deep brain stimulation (DBS) in the globus pallidus internus (GPi) has been shown to improve dystonia, a movement disorder of repetitive twisting movements and postures. DBS at frequencies above 60 Hz improves dystonia, but the mechanisms underlying this frequency dependence are unclear. In patients undergoing dual-microelectrode mapping of the GPi, microstimulation has been shown to reduce neuronal firing, presumably due to synaptic GABA release. This study examined the effects of different microstimulation frequencies (1-100 Hz) and train length (0.5-20 s), with and without prior high-frequency stimulation (HFS) on neuronal firing and evoked field potentials (fEPs) in 13 dystonia patients. Pre-HFS, the average firing decreased as stimulation frequency increased and was silenced above 50 Hz. The average fEP amplitudes increased up to frequencies of 20-30 Hz but then declined and at 50 Hz, were only at 75% of baseline. In some cases, short latency fiber volleys and antidromic-like spikes were observed and followed high frequencies. Post-HFS, overall firing was reduced compared with pre-HFS, and the fEP amplitudes were enhanced at low frequencies, providing evidence of inhibitory synaptic plasticity in the GPi. In a patient with DBS electrodes already implanted in the GPi, recordings from four neurons in the subthalamic nucleus showed almost complete inhibition of firing with clinically effective but not clinically ineffective stimulation parameters. These data provide additional support for the hypothesis of stimulation-evoked GABA release from afferent synaptic terminals and reduction of neuronal firing during DBS and additionally, implicate excitation of GPi axon fibers and neurons and enhancement of inhibitory synaptic transmission by high-frequency GPi DBS as additional putative mechanisms underlying the clinical benefits of DBS in dystonia. PMID:22457462

  10. Deep brain stimulation for dystonia

    PubMed Central

    2014-01-01

    Deep brain stimulation (DBS) is an effective surgical treatment for medication-refractory movement disorders, and has been approved by the United States Food and Drug Administration for treatment of dystonia. The success of DBS in the treatment of dystonia depends on our understanding of the anatomy and physiology of this disorder and close collaboration between neurosurgeons, neurologists, clinical neurophysiologists, neuroradiologists and neuropsychologists. Currently, pallidal DBS is an established treatment option for medically refractive dystonia. This review is intended to provide a comprehensive review of the use of DBS for dystonia, focusing mainly on the surgical aspects, clinical outcome, MRI findings and side effects of DBS. PMID:24444300

  11. Artifact properties of carbon nanotube yarn electrode in magnetic resonance imaging

    NASA Astrophysics Data System (ADS)

    Jiang, C. Q.; Hao, H. W.; Li, L. M.

    2013-04-01

    Objective. Deep brain stimulating (DBS) is a rapidly developing therapy that can treat many refractory neurological diseases. However, the traditional DBS electrodes which are made of Pt-Ir alloy may induce severe field distortions in magnetic resonance imaging (MRI) which leads to artifacts that will lower the local image quality and cause inconvenience or interference. A novel DBS electrode made from carbon nanotube yarns (CNTYs) is brought up to reduce the artifacts. This study is therefore to evaluate the artifact properties of the novel electrode. Approach. We compared its MR artifact characteristics with the Pt-Ir electrode in water phantom, including its artifact behaviors at different orientations as well as at various off-center positions, using both spin echo (SE) and gradient echo (GE) sequences, and confirmed its performance in vivo. Main results. The results in phantom showed that the CNTY electrode artifacts reduced as much as 62% and 74% on GE and SE images, respectively, compared to the Pt-Ir one. And consistent behaviors were confirmed in vivo. The susceptibility difference was identified as the dominant cause in producing artifacts. Significance. Employing the CNTY electrode may generate much less field distortion in the vicinity, improve local MR image quality and possibly be beneficial in various aspects.

  12. Measures to Evaluate the Effects of DBS on Speech Production

    PubMed Central

    Weismer, Gary; Yunusova, Yana; Bunton, Kate

    2011-01-01

    The purpose of this paper is to review and evaluate measures of speech production that could be used to document effects of Deep Brain Stimulation (DBS) on speech performance, especially in persons with Parkinson disease (PD). A small set of evaluative criteria for these measures is presented first, followed by consideration of several speech physiology and speech acoustic measures that have been studied frequently and reported on in the literature on normal speech production, and speech production affected by neuromotor disorders (dysarthria). Each measure is reviewed and evaluated against the evaluative criteria. Embedded within this review and evaluation is a presentation of new data relating speech motions to speech intelligibility measures in speakers with PD, amyotrophic lateral sclerosis (ALS), and control speakers (CS). These data are used to support the conclusion that at the present time the slope of second formant transitions (F2 slope), an acoustic measure, is well suited to make inferences to speech motion and to predict speech intelligibility. The use of other measures should not be ruled out, however, and we encourage further development of evaluative criteria for speech measures designed to probe the effects of DBS or any treatment with potential effects on speech production and communication skills. PMID:24932066

  13. Individualized current-shaping reduces DBS-induced dysarthria in patients with essential tremor

    PubMed Central

    Dembek, Till A.; Becker, Johannes; Raethjen, Jan; Hartinger, Mariam; Meister, Ingo G.; Runge, Matthias; Maarouf, Mohammad; Fink, Gereon R.; Timmermann, Lars

    2014-01-01

    Objective: To investigate in patients with essential tremor (ET) treated with thalamic/subthalamic deep brain stimulation (DBS) whether stimulation-induced dysarthria (SID) can be diminished by individualized current-shaping with interleaving stimulation (cs-ILS) while maintaining tremor suppression (TS). Methods: Of 26 patients screened, 10 reported SID and were invited for testing. TS was assessed by the Tremor Rating Scale and kinematic analysis of postural and action tremor. SID was assessed by phonetic and logopedic means. Additionally, patients rated their dysarthria on a visual analog scale. Results: In 6 of the 10 patients with ET, DBS-ON (relative to DBS-OFF) led to SID while tremor was successfully reduced. When comparing individualized cs-ILS with a non–current-shaped interleaving stimulation (ILS) in these patients, there was no difference in TS while 4 of the 6 patients showed subjective improvement of speech during cs-ILS. Phonetic analysis (ILS vs cs-ILS) revealed that during cs-ILS there was a reduction of voicing during the production of voiceless stop consonants and also a trend toward an improvement in oral diadochokinetic rate, reflecting less dysarthria. Logopedic rating showed a trend toward deterioration in the diadochokinesis task when comparing ON with OFF but no difference between ILS and cs-ILS. Conclusion: This is a proof-of-principle evaluation of current-shaping in patients with ET treated with thalamic/subthalamic DBS and experiencing SID. Data suggest a benefit on SID from individual shaping of current spread while TS is preserved. Classification of evidence: This study provides Class IV evidence that in patients with ET treated with DBS with SID, individualized cs-ILS reduces dysarthria while maintaining tremor control. PMID:24443448

  14. Deep Brain Stimulation for Parkinson's Disease

    MedlinePLUS

    NINDS Deep Brain Stimulation for Parkinson's Disease Information Page Condensed from Deep Brain Stimulation for Parkinson's Disease Fact Sheet Table of ... being done? Clinical Trials Organizations What is Deep Brain Stimulation for Parkinson's Disease? Deep brain stimulation (DBS) ...

  15. Active books: the design of an implantable stimulator that minimizes cable count using integrated circuits very close to electrodes.

    PubMed

    Liu, Xiao; Demosthenous, Andreas; Vanhoestenberghe, Anne; Jiang, Dai; Donaldson, Nick

    2012-06-01

    This paper presents an integrated stimulator that can be embedded in implantable electrode books for interfacing with nerve roots at the cauda equina. The Active Book overcomes the limitation of conventional nerve root stimulators which can only support a small number of stimulating electrodes due to cable count restriction through the dura. Instead, a distributed stimulation system with many tripole electrodes can be configured using several Active Books which are addressed sequentially. The stimulator was fabricated in a 0.6-?m high-voltage CMOS process and occupies a silicon area of 4.2 × 6.5 mm(2). The circuit was designed to deliver up to 8 mA stimulus current to tripole electrodes from an 18 V power supply. Input pad count is limited to five (two power and three control lines) hence requiring a specific procedure for downloading stimulation commands to the chip and extracting information from it. Supported commands include adjusting the amplitude of stimulus current, varying the current ratio at the two anodes in each channel, and measuring relative humidity inside the chip package. In addition to stimulation mode, the chip supports quiescent mode, dissipating less than 100 nA current from the power supply. The performance of the stimulator chip was verified with bench tests including measurements using tripoles in saline. PMID:23853144

  16. Enhanced tissue integration of implantable electrodes for sensing, and stimulation, via radio frequency glow discharge

    NASA Astrophysics Data System (ADS)

    O'Connor, Laurie M.

    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.

  17. Comparative analysis of transverse intrafascicular multichannel, longitudinal intrafascicular and multipolar cuff electrodes for the selective stimulation of nerve fascicles

    NASA Astrophysics Data System (ADS)

    Badia, Jordi; Boretius, Tim; Andreu, David; Azevedo-Coste, Christine; Stieglitz, Thomas; Navarro, Xavier

    2011-06-01

    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.

  18. The anteromedial GPi as a new target for deep brain stimulation in obsessive compulsive disorder.

    PubMed

    Nair, Girish; Evans, Andrew; Bear, Renee E; Velakoulis, Dennis; Bittar, Richard G

    2014-05-01

    Deep brain stimulation (DBS) is now well established in the treatment of intractable movement disorders. Over the past decade the clinical applications have expanded into the realm of psychosurgery, including depression and obsessive compulsive disorder (OCD). The optimal targets for electrode placement in psychosurgery remain unclear, with numerous anatomical targets reported for the treatment of OCD. We present four patients with Tourette's syndrome and prominent features of OCD who underwent DBS of the anteromedial globus pallidus internus (GPi) to treat their movement disorder. Their pre-operative and post-operative OCD symptoms were compared, and responded dramatically to surgery. On the basis of these results, we propose the anteromedial (limbic) GPi as a potential surgical target for the treatment of OCD, and furnish data supporting its further investigation as a DBS target for the treatment of psychiatric conditions. PMID:24524950

  19. Multichannel DBS halftoning for improved texture quality

    NASA Astrophysics Data System (ADS)

    Slavuj, Radovan; Pedersen, Marius

    2015-01-01

    The paper aims to develop a method for multichannel halftoning based on the Direct Binary Search (DBS) algorithm. We integrate specifics and benefits of multichannel printing into the halftoning method in order to further improve texture quality of DBS and to create halftoning that would suit for multichannel printing. Originally, multichannel printing is developed for an extended color gamut, at the same time additional channels can help to improve individual and combined texture of color halftoning. It does so in a similar manner to the introduction of the light colors (diluted inks) in printing. Namely, if one observes Red, Green and Blue inks as the light version of the M+Y, C+Y, C+M combinations, the visibility of the unwanted halftoning textures can be reduced. Analogy can be extent to any number of ink combinations, or Neugebauer Primaries (NPs) as the alternative building blocks. The extended variability of printing spatially distributed NPs could provide many practical solution and improvements in color accuracy, image quality, and could enable spectral printing. This could be done by selection of NPs per dot area location based on the constraint of the desired reproduction. Replacement with brighter NP at the location could induce a color difference where a tradeoff between image quality and color accuracy is created. With multichannel enabled DBS haftoning, we are able to reduce visibility of the textures, to provide better rendering of transitions, especially in mid and dark tones.

  20. The RAI DBS experiment with Olympus

    NASA Astrophysics Data System (ADS)

    Castelli, Enzo

    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.

  1. Chronic deep brain stimulation in mesial temporal lobe epilepsy.

    PubMed

    Boëx, Colette; Seeck, Margitta; Vulliémoz, Serge; Rossetti, Andrea O; Staedler, Claudio; Spinelli, Laurent; Pegna, Alan J; Pralong, Etienne; Villemure, Jean-Guy; Foletti, Giovanni; Pollo, Claudio

    2011-07-01

    The objective of this study was to evaluate the efficiency and the effects of changes in parameters of chronic amygdala-hippocampal deep brain stimulation (AH-DBS) in mesial temporal lobe epilepsy (TLE). Eight pharmacoresistant patients, not candidates for ablative surgery, received chronic AH-DBS (130 Hz, follow-up 12-24 months): two patients with hippocampal sclerosis (HS) and six patients with non-lesional mesial TLE (NLES). The effects of stepwise increases in intensity (0-Off to 2 V) and stimulation configuration (quadripolar and bipolar), on seizure frequency and neuropsychological performance were studied. The two HS patients obtained a significant decrease (65-75%) in seizure frequency with high voltage bipolar DBS (?1 V) or with quadripolar stimulation. Two out of six NLES patients became seizure-free, one of them without stimulation, suggesting a microlesional effect. Two NLES patients experienced reductions of seizure frequency (65-70%), whereas the remaining two showed no significant seizure reduction. Neuropsychological evaluations showed reversible memory impairments in two patients under strong stimulation only. AH-DBS showed long-term efficiency in most of the TLE patients. It is a valuable treatment option for patients who suffer from drug resistant epilepsy and who are not candidates for resective surgery. The effects of changes in the stimulation parameters suggest that a large zone of stimulation would be required in HS patients, while a limited zone of stimulation or even a microlesional effect could be sufficient in NLES patients, for whom the importance of the proximity of the electrode to the epileptogenic zone remains to be studied. Further studies are required to ascertain these latter observations. PMID:21489828

  2. Evaluation of poly(3,4-ethylenedioxythiophene)/carbon nanotube neural electrode coatings for stimulation in the dorsal root ganglion.

    PubMed

    Kolarcik, Christi L; Catt, Kasey; Rost, Erika; Albrecht, Ingrid N; Bourbeau, Dennis; Du, Zhanhong; Kozai, Takashi D Y; Luo, Xiliang; Weber, Douglas J; Tracy Cui, X

    2015-02-01

    Objective. The dorsal root ganglion is an attractive target for implanting neural electrode arrays that restore sensory function or provide therapy via stimulation. However, penetrating microelectrodes designed for these applications are small and deliver low currents. For long-term performance of microstimulation devices, novel coating materials are needed in part to decrease impedance values at the electrode-tissue interface and to increase charge storage capacity. Approach. Conductive polymer poly(3,4-ethylenedioxythiophene) (PEDOT) and multi-wall carbon nanotubes (CNTs) were coated on the electrode surface and doped with the anti-inflammatory drug, dexamethasone. Electrode characteristics and the tissue reaction around neural electrodes as a result of stimulation, coating and drug release were characterized. Hematoxylin and eosin staining along with antibodies recognizing Iba1 (microglia/macrophages), NF200 (neuronal axons), NeuN (neurons), vimentin (fibroblasts), caspase-3 (cell death) and L1 (neural cell adhesion molecule) were used. Quantitative image analyses were performed using MATLAB. Main results. Our results indicate that coated microelectrodes have lower in vitro and in vivo impedance values. Significantly less neuronal death/damage was observed with coated electrodes as compared to non-coated controls. The inflammatory response with the PEDOT/CNT-coated electrodes was also reduced. Significance. This study is the first to report on the utility of these coatings in stimulation applications. Our results indicate PEDOT/CNT coatings may be valuable additions to implantable electrodes used as therapeutic modalities. PMID:25485675

  3. Evaluation of poly(3,4-ethylenedioxythiophene)/carbon nanotube neural electrode coatings for stimulation in the dorsal root ganglion

    NASA Astrophysics Data System (ADS)

    Kolarcik, Christi L.; Catt, Kasey; Rost, Erika; Albrecht, Ingrid N.; Bourbeau, Dennis; Du, Zhanhong; Kozai, Takashi D. Y.; Luo, Xiliang; Weber, Douglas J.; Cui, X. Tracy

    2015-02-01

    Objective. The dorsal root ganglion is an attractive target for implanting neural electrode arrays that restore sensory function or provide therapy via stimulation. However, penetrating microelectrodes designed for these applications are small and deliver low currents. For long-term performance of microstimulation devices, novel coating materials are needed in part to decrease impedance values at the electrode-tissue interface and to increase charge storage capacity. Approach. Conductive polymer poly(3,4-ethylenedioxythiophene) (PEDOT) and multi-wall carbon nanotubes (CNTs) were coated on the electrode surface and doped with the anti-inflammatory drug, dexamethasone. Electrode characteristics and the tissue reaction around neural electrodes as a result of stimulation, coating and drug release were characterized. Hematoxylin and eosin staining along with antibodies recognizing Iba1 (microglia/macrophages), NF200 (neuronal axons), NeuN (neurons), vimentin (fibroblasts), caspase-3 (cell death) and L1 (neural cell adhesion molecule) were used. Quantitative image analyses were performed using MATLAB. Main results. Our results indicate that coated microelectrodes have lower in vitro and in vivo impedance values. Significantly less neuronal death/damage was observed with coated electrodes as compared to non-coated controls. The inflammatory response with the PEDOT/CNT-coated electrodes was also reduced. Significance. This study is the first to report on the utility of these coatings in stimulation applications. Our results indicate PEDOT/CNT coatings may be valuable additions to implantable electrodes used as therapeutic modalities.

  4. Lateralized effect of pallidal stimulation on self-mutilation in Lesch-Nyhan disease.

    PubMed

    Abel, Taylor J; Dalm, Brian D; Grossbach, Andrew J; Jackson, Adam W; Thomsen, Teri; Greenlee, Jeremy D W

    2014-12-01

    Lesch-Nyhan disease (LND) is an X-linked hereditary disorder caused by a deficiency of hypoxanthine-guanine phosphoribosyltransferase. This syndrome is characterized by hyperuricemia, self-mutilation, cognitive impairment, and movement disorders such as spasticity and dystonia. The authors describe the case of a 15-year-old boy who underwent bilateral placement of globus pallidus internus (GPi) deep brain stimulation (DBS) electrodes for the treatment of generalized dystonia. His self-mutilating behavior gradually disappeared several weeks after the start of GPi stimulation. The dystonia and self-mutilating behavior returned on the left side only after a right lead fracture. This case is the first reported instance of LND treated with DBS in which the stimulation was interrupted and the self-mutilation returned in a lateralized fashion. The findings indicate that the neurobehavioral aspect of LND is lateralized and that contralateral GPi stimulation is responsible for lateralized improvement in self-injurious behavior. PMID:25303157

  5. Anesthetic Challenges for Deep Brain Stimulation: A Systematic Approach

    PubMed Central

    Chakrabarti, Rajkalyan; Ghazanwy, Mahmood; Tewari, Anurag

    2014-01-01

    Ablative intracranial surgery for Parkinson's disease has advanced to embedding electrodes into precise areas of the basal ganglia. Electrode implantation surgery, referred to as deep brain stimulation (DBS), is preferred in view of its reversibility, adjustability, and capability to be safely performed bilaterally. DBS is been increasingly used for other movement disorders, intractable tremors epilepsy, and sometimes chronic pain. Anesthesiologists need to amalgamate the knowledge of neuroanatomical structures and surgical techniques involved in placement of microelectrodes in defined cerebral target areas. Perioperative verbal communication with the patient during the procedure is quintessential and may attenuate the need for pharmacological agents. This review will endeavor to assimilate the present knowledge regarding the patient selection, available/practiced anesthesia regimens, and perioperative complications after our thorough search for literature published between 1991 and 2013. PMID:25210668

  6. Computational Study on Subdural Cortical Stimulation - The Influence of the Head Geometry, Anisotropic Conductivity, and Electrode Configuration

    PubMed Central

    Kim, Donghyeon; Seo, Hyeon; Kim, Hyoung-Ihl; Jun, Sung Chan

    2014-01-01

    Subdural cortical stimulation (SuCS) is a method used to inject electrical current through electrodes beneath the dura mater, and is known to be useful in treating brain disorders. However, precisely how SuCS must be applied to yield the most effective results has rarely been investigated. For this purpose, we developed a three-dimensional computational model that represents an anatomically realistic brain model including an upper chest. With this computational model, we investigated the influence of stimulation amplitudes, electrode configurations (single or paddle-array), and white matter conductivities (isotropy or anisotropy). Further, the effects of stimulation were compared with two other computational models, including an anatomically realistic brain-only model and the simplified extruded slab model representing the precentral gyrus area. The results of voltage stimulation suggested that there was a synergistic effect with the paddle-array due to the use of multiple electrodes; however, a single electrode was more efficient with current stimulation. The conventional model (simplified extruded slab) far overestimated the effects of stimulation with both voltage and current by comparison to our proposed realistic upper body model. However, the realistic upper body and full brain-only models demonstrated similar stimulation effects. In our investigation of the influence of anisotropic conductivity, model with a fixed ratio (1?10) anisotropic conductivity yielded deeper penetration depths and larger extents of stimulation than others. However, isotropic and anisotropic models with fixed ratios (1?2, 1?5) yielded similar stimulation effects. Lastly, whether the reference electrode was located on the right or left chest had no substantial effects on stimulation. PMID:25229673

  7. Deep brain stimulation of the subthalamic nucleus for control of extrapyramidal features in advanced idiopathic Parkinson's disease: one year follow-up

    Microsoft Academic Search

    M. M. Pinter; F. Alesch; M. Murg; M. Seiwald; R. J. Helscher; H. Binder

    1999-01-01

    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

  8. Analytical theory for extracellular electrical stimulation of nerve with focal electrodes. II. Passive myelinated axon.

    PubMed Central

    Rubinstein, J T

    1991-01-01

    The cable model of a passive, myelinated fiber is derived using the theory of electromagnetic propagation in periodic structures. The cable may be excited by an intracellular source or by an arbitrary, time-varying, applied extracellular field. When the cable is stimulated by a distant source, its properties are qualitatively similar to an unmyelinated fiber. Under these conditions relative threshold is proportional to the cube of the source distance and inversely proportional to the square of the fiber diameter. Electrical parameters of the model are chosen where possible, from mammalian peripheral nerve and anatomic parameters from cat auditory nerve. Several anatomic representations of the paranodal region are analyzed for their effects on the length and time constants of the fibers. Sensitivity of the model to parameter changes is studied. The linear model reliably predicts the effects of fiber size and electrode-fiber separation on threshold of cat dorsal column fibers to extracellular electrical stimulation. Images FIGURE 2 PMID:1932546

  9. Deep brain stimulation: Current status.

    PubMed

    Pandey, Sanjay; Sarma, Neelav

    2015-01-01

    In the last two decades, applications of deep brain stimulation (DBS) have expanded rapidly in the field of neurosciences. The most common indications for DBS are Parkinson's disease, medically refractory seizures, essential tremors, and primary dystonia. This device has also been used as an investigational tool in patients having Tourette's syndrome, tardive dyskinesia, and refractory seizures. In the field of psychiatry, DBS has been used for the treatment of refractory obsessive compulsive disorder and depression. The complications are mainly related to surgery, the device, and its stimulation. This article provides an overview of the current status and recent advances in the field of DBS. PMID:25751463

  10. Deep brain stimulation of the nucleus accumbens shell attenuates cue-induced reinstatement of both cocaine and sucrose seeking in rats.

    PubMed

    Guercio, Leonardo A; Schmidt, Heath D; Pierce, R Christopher

    2015-03-15

    Stimuli previously associated with drug taking can become triggers that can elicit craving and lead to relapse of drug-seeking behavior. Here, we examined the influence of deep brain stimulation (DBS) in the nucleus accumbens shell on cue-induced reinstatement of cocaine seeking, an animal model of relapse. Rats were allowed to self-administer cocaine (0.254 mg, i.v.) for 2 h daily for 21 days, with each infusion of cocaine being paired with a cue light. After 21 days of self-administration, cocaine-taking behavior was extinguished by replacing cocaine with saline in the absence of the cue light. Next, during the reinstatement phase, DBS was administered bilaterally into the nucleus accumbens shell through bipolar stainless steel electrodes immediately prior to re-exposure to cues previously associated with cocaine reinforcement. DBS continued throughout the 2 h reinstatement session. Parallel studies examined the influence of accumbens shell DBS on reinstatement induced by cues previously associated with sucrose reinforcement. Results indicated that DBS of the nucleus accumbens shell significantly attenuated cue-induced reinstatement of cocaine and sucrose seeking. Together, these results indicate that DBS of the accumbens shell disrupts cue-induced reinstatement associated with both a drug and a natural reinforcer. PMID:25529183

  11. Aggressive behavior as a rare side effect of subthalamic stimulation in Parkinson's disease.

    PubMed

    Papu?, Ewa; Trojanowski, Tomasz; Obsza?ska, Katarzyna; Stelmasiak, Zbigniew

    2015-01-01

    Although deep brain stimulation (DBS) has a well-established position in the treatment of Parkinson's disease (PD), it may be accompanied by different side effects including behavioral changes. We present a patient with advanced PD after bilateral stimulation of the subthalamic nucleus (STN) who developed attacks of aggressive behavior. The patient with a 12 year history of PD underwent the procedure of DBS with one-stage bilateral stereotactic approach using the Leksel G stereotactic frame. For STN identification microrecording technique was applied (5 microelectrodes). Four weeks after surgery STN stimulation was switched on. With increasing the amplitude of stimulation on the right (active contacts 1 and 2) the patient experienced transient episodes of aggression. Change of stimulation mode led to withdrawal of all side effects. We hypothesize that aggression episodes in the patient were caused by stimulation of limbic circuit probable within STN although we cannot exclude simultaneous stimulation of neighboring structures. Aggression episodes are rare side effect of STN-DBS, nevertheless they may be expected in more posteromedial placement of the electrode within STN. The presented case extends the evidence for non-motor functions of STN and highlights its role as an integrating structure within the basal ganglia system. PMID:24564255

  12. Selectivity of direct and network-mediated stimulation of the retinal ganglion cells with epi-, sub- and intraretinal electrodes

    NASA Astrophysics Data System (ADS)

    Boinagrov, David; Pangratz-Fuehrer, Susanne; Goetz, Georges; Palanker, Daniel

    2014-04-01

    Objective. Intra-retinal placement of stimulating electrodes can provide close and stable proximity to target neurons. We assessed improvement in stimulation thresholds and selectivity of the direct and network-mediated retinal stimulation with intraretinal electrodes, compared to epiretinal and subretinal placements. Approach. Stimulation thresholds of the retinal ganglion cells (RGCs) in wild-type rat retina were measured using the patch-clamp technique. Direct and network-mediated responses were discriminated using various synaptic blockers. Main results. Three types of RGC responses were identified: short latency (SL, ? < 5 ms) originating in RGCs, medium latency (ML, 3 < ? < 70 ms) originating in the inner nuclear layer and long latency (LL, ? > 40 ms) originating in photoreceptors. Cathodic epiretinal stimulation exhibited the lowest threshold for direct RGC response and the highest direct selectivity (network/direct thresholds ratio), exceeding a factor of 3 with pulse durations below 0.5 ms. For network-mediated stimulation, the lowest threshold was obtained with anodic pulses in OPL position, and its network selectivity (direct/network thresholds ratio) increased with pulse duration, exceeding a factor of 4 at 10 ms. Latency of all three types of responses decreased with increasing strength of the stimulus. Significance. These results define the optimal range of pulse durations, pulse polarities and electrode placement for the retinal prostheses aiming at direct or network-mediated stimulation of RGCs.

  13. Chronic stability and selectivity of four-contact spiral nerve-cuff electrodes in stimulating the human femoral nerve

    NASA Astrophysics Data System (ADS)

    Fisher, L. E.; Tyler, D. J.; Anderson, J. S.; Triolo, R. J.

    2009-08-01

    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 weeks post-implantation: 23.3 ± 8.5 nC) for all nerve-cuff electrode contacts over 63 weeks after implantation, indicating a stable interface with the peripheral nervous system. The ability of individual nerve-cuff electrode contacts to selectively stimulate separate components of the femoral nerve to activate individual heads of the quadriceps was assessed with fine-wire intramuscular electromyography while measuring isometric twitch knee extension moment. Six of eight electrode contacts could selectively activate one head of the quadriceps while selectively excluding others to produce maximum twitch responses of between 3.8 and 8.1 N m. The relationship between isometric twitch and tetanic knee extension moment was quantified, and selective twitch muscle responses scaled to between 15 and 35 N m in tetanic response to pulse trains with similar stimulation parameters. These results suggest that this nerve-cuff electrode can be an effective and chronically stable tool for selectively stimulating distal nerve branches in the lower extremities for neuroprosthetic applications.

  14. Delayed cerebritis after bilateral stereotactic implantation of globus pallidus interna electrodes for treatment of dystonia

    PubMed Central

    Jankowski, Pawel P; Lessig, Stephanie; Nguyen, Andrew D; Barba, David

    2013-01-01

    Deep brain stimulation (DBS) is being used to treat an increasing number of movement and psychiatric disorders. However, the risk of infection remains as a problem that can hinder the usefulness of this technology. We report a case of a patient with dystonia who underwent bilateral globus pallidus interna electrode and impulse generator (IPG) placement, developed an infection of his IPG, and later cerebritis. The patient was initially treated with antibiotics and partial hardware removal. Follow-up cranial imaging showed an area concerning for cerebritis around one of the intracranial electrodes. The patient was then treated with complete hardware removal followed by a course of intravenous antibiotics. Four-month follow-up imaging showed resolution of the infection. This case demonstrates the importance of following cranial imaging in DBS patients with delayed infection, continued vigilance for infection in implanted patients and that partial hardware removal may not be successful in the setting of methicillin-sensitive Staphylococcus aureus infections. PMID:23378545

  15. Electrochemomechanical deformation (ECMD) of PPyDBS in free standing film formation and trilayer designs

    NASA Astrophysics Data System (ADS)

    Aydemir, Nihan; Tamm, Tarmo; Travas-Sejdic, Jadranka; Kilmartin, Paul A.; Aabloo, Alvo; Kiefer, Rudolf

    2014-03-01

    An investigation is reported into the electrochemomechanical deformation (ECMD) of polypyrrole (PPy) doped with dodecylbenzenesulfonate (DBS) in the form of freestanding films and deposited onto conductive substrates (chemically fixed poly-3,4-(ethylenedioxythiophene, PEDOT) based on PVdF (poly(vinylidenefluoride)). Linear actuation has been achieved starting from a trilayer bending actuator design with a stretchable middle layer. To allow evaluation of the proposed design, commercially available PVdF membranes were chosen as model material. For bending trilayer functionality, electronic separation of both electrode layers is essential, but in order to obtain linear actuation, the CP layers on either side are connected to form a single working electrode. The PPyDBS free standing films and PPyDBS deposited on PEDOT-PVdF-PEDOT were investigated by electrochemical methods (cyclic voltammetry, square wave potentials) in a 4-methyl-1,3-dioxolan-2-one (propylene carbonate, PC) solution of tetrabutylammonium trifluoromethanesulfonate (TBACF3SO3). This study also presents a novel method of utilizing scanning ion-conductance microscopy (SICM) to accurately examine the electrochemical redox behavior of the surface layer of the linear actuator using a micropipette tip.

  16. JAMA Patient Page: Deep Brain Stimulation

    MedlinePLUS

    ... of the American Medical Association JAMA PATIENT PAGE Deep Brain Stimulation D eep brain stimulation ( DBS ) is ... Disorders and Stroke www.ninds.nih.gov/disorders /deep_brain_stimulation INFORM YOURSELF To find this and ...

  17. Measurements of RF Heating during 3.0T MRI of a Pig Implanted with Deep Brain Stimulator

    PubMed Central

    Gorny, Krzysztof R; Presti, Michael F; Goerss, Stephan J; Hwang, Sun C; Jang, Dong-Pyo; Kim, Inyong; Shu, Yunhong; Favazza, Christopher P; Lee, Kendall H; Bernstein, Matt A

    2012-01-01

    Purpose To present preliminary, in vivo temperature measurements during MRI of a pig implanted with a deep brain stimulation (DBS) system. Materials and Methods DBS system (Medtronic Inc., Minneapolis, MN) was implanted in the brain of an anesthetized pig. 3.0T MRI was performed with a T/R head coil using the low-SAR GRE EPI and IR-prepped GRE sequences (SAR: 0.42 W/kg and 0.39 W/kg, respectively), and the high-SAR 4-echo RF spin echo (SAR: 2.9 W/kg). Fluoroptic thermometry was used to directly measure RF-related heating at the DBS electrodes, and at the implantable pulse generator (IPG). For reference the measurements were repeated in the same pig at 1.5T and, at both field strengths, in a phantom. Results At 3.0T, the maximal temperature elevations at DBS electrodes were 0.46 °C and 2.3 °C, for the low- and high-SAR sequences, respectively. No heating was observed on the implanted IPG during any of the measurements. Measurements of in-vivo heating differed from those obtained in the phantom. Conclusion The 3.0T MRI using GRE EPI and IR-prepped GRE sequences resulted in local temperature elevations at DBS electrodes of no more than 0.46°C. Although no extrapolation should be made to human exams and much further study will be needed, these preliminary data are encouraging for the future use 3.0T MRI in patients with DBS. PMID:23228310

  18. Somatic therapies for treatment-resistant depression: ECT, TMS, VNS, DBS

    PubMed Central

    2012-01-01

    The field of non-pharmacological therapies for treatment resistant depression (TRD) is rapidly evolving and new somatic therapies are valuable options for patients who have failed numerous other treatments. A major challenge for clinicians (and patients alike) is how to integrate the results from published clinical trials in the clinical decision-making process. We reviewed the literature for articles reporting results for clinical trials in particular efficacy data, contraindications and side effects of somatic therapies including electroconvulsive therapy (ECT), transcranial magnetic stimulation (TMS), vagal nerve stimulation (VNS) and deep brain stimulation (DBS). Each of these devices has an indication for patients with different level of treatment resistance, based on acuteness of illness, likelihood of response, costs and associated risks. ECT is widely available and its effects are relatively rapid in severe TRD, but its cognitive adverse effects may be cumbersome. TMS is safe and well tolerated, and it has been approved by FDA for adults who have failed to respond to one antidepressant, but its use in TRD is still controversial as it is not supported by rigorous double-blind randomized clinical trials. The options requiring surgical approach are VNS and DBS. VNS has been FDA-approved for TRD, however it is not indicated for management of acute illness. DBS for TRD is still an experimental area of investigation and double-blind clinical trials are underway. PMID:22901565

  19. High-Frequency Stimulation of the Subthalamic Nucleus Restores Neural and Behavioral Functions During Reaction Time Task in a Rat Model of Parkinson’s Disease

    PubMed Central

    Li, Xiang-Hong; Wang, Jin-Yan; Gao, Ge; Chang, Jing-Yu; Woodward, Donald J.; Luo, Fei

    2015-01-01

    Deep brain stimulation (DBS) has been used in the clinic to treat Parkinson’s disease (PD) and other neuropsychiatric disorders. Our previous work has shown that DBS in the subthalamic nucleus (STN) can improve major motor deficits, and induce a variety of neural responses in rats with unilateral dopamine (DA) lesions. In the present study, we examined the effect of STN DBS on reaction time (RT) performance and parallel changes in neural activity in the cortico-basal ganglia regions of partially bilateral DA- lesioned rats. We recorded neural activity with a multiple-channel single-unit electrode system in the primary motor cortex (MI), the STN, and the substantia nigra pars reticulata (SNr) during RT test. RT performance was severely impaired following bilateral injection of 6-OHDA into the dorsolateral part of the striatum. In parallel with such behavioral impairments, the number of responsive neurons to different behavioral events was remarkably decreased after DA lesion. Bilateral STN DBS improved RT performance in 6-OHDA lesioned rats, and restored operational behavior-related neural responses in cortico-basal ganglia regions. These behavioral and electrophysiological effects of DBS lasted nearly an hour after DBS termination. These results demonstrate that a partial DA lesion-induced impairment of RT performance is associated with changes in neural activity in the cortico-basal ganglia circuit. Furthermore, STN DBS can reverse changes in behavior and neural activity caused by partial DA depletion. The observed long-lasting beneficial effect of STN DBS suggests the involvement of the mechanism of neural plasticity in modulating corticobasal ganglia circuits. PMID:20025062

  20. Probabilistic Modeling of Selective Stimulation of the Human Sciatic Nerve with a Flat Interface Nerve Electrode

    PubMed Central

    Schiefer, Matthew A.; Tyler, Dustin J.; Triolo, Ronald J.

    2012-01-01

    Ankle control is critical to both standing balance and efficient walking. This 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

  1. Intracranial electrode implantation produces regional neuroinflammation and memory deficits in rats

    PubMed Central

    Hirshler, Yafit (Kuttner); Polat, Uri; Biegon, Anat

    2009-01-01

    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. PMID:20026042

  2. A Groove Technique for Securing an Electrode Connector on the Cranial Bone: Case Analysis of Efficacy

    PubMed Central

    Lee, Sung-Woo; Seo, Il; Kim, Ho-Sang; Kim, Jeong-Ho; Kim, Yun-Suk

    2014-01-01

    Objective A groove technique for securing an electrode connector was described as an alternative surgical technique in deep brain stimulation (DBS) surgery to avoid electrode connector-related complications, such as skin erosion, infection, and migration. Methods We retrospectively reviewed 109 patients undergoing one of two techniques; the standard technique (52 patients using 104 electrodes) and the groove technique (57 patients using 109 electrodes) for securing the electrode connector in DBS surgery, regardless of patient disease. In the standard percutaneous tunneling technique, the connector was placed on the vertex of the cranial surface. The other technique, so called the groove technique, created a groove (about 4 cm long, 8 mm wide) in the cranial bone at the posterior parietal area. Wound erosion and migration related to the connectors were compared between the two techniques. Results The mean follow-up period was 73 months for the standard method and 46 months for the groove technique. Connector-related complications were observed in three patients with the groove technique and in seven patients with the standard technique. Wound erosion at the connector sites per electrode was one (0.9%) with the groove technique and six (5.8%) with the standard technique. This difference was statistically significant. The electrode connector was migrated in two patients with the groove technique and in one patient with the standard technique. Conclusions The groove technique, which involves securing an electrode using a groove in the cranial bone at the posterior parietal area, offers an effective and safe method to avoid electrode connector-related complications during DBS surgery. PMID:25328650

  3. ELECTRICAL STIMULATION RESEARCH TECHNIQUES Intracellular Stimulation

    E-print Network

    Byrne, John H.

    ELECTRICAL STIMULATION RESEARCH TECHNIQUES Chapter 2 Intracellular Stimulation John H. Byrne Introduction . . . . . . . . . 37 II. Intracellular Stimulation and Recording with Separate Electrodes 38 Ill. A Simple Circuit for Intracellular Stimulation with Two Electrodes 42 IV. Intracellular Stimulation

  4. DBS systems - Perspectives from a profit seeking company

    Microsoft Academic Search

    E. R. Martin

    1984-01-01

    The relationships between various factors necessary for building a successful DBS system are discussed. The system will comprise one satellite with multiple channels for each centerminous U.S. time zone. Operations in the Eastern time zone are scheduled to commence in 1986. Constraints on the establishment of the DBS system include minimizing the star-up costs, particularly for the home antennas and

  5. Delayed and lasting effects of deep brain stimulation on locomotion in Parkinson's disease

    NASA Astrophysics Data System (ADS)

    Beuter, Anne; Modolo, Julien

    2009-06-01

    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.

  6. Design, simulation and experimental validation of a novel flexible neural probe for deep brain stimulation and multichannel recording

    NASA Astrophysics Data System (ADS)

    Lai, Hsin-Yi; Liao, Lun-De; Lin, Chin-Teng; Hsu, Jui-Hsiang; He, Xin; Chen, You-Yin; Chang, Jyh-Yeong; Chen, Hui-Fen; Tsang, Siny; Shih, Yen-Yu I.

    2012-06-01

    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.

  7. Deep brain stimulation for intractable psychiatric disorders.

    PubMed

    Goodman, Wayne K; Alterman, Ron L

    2012-01-01

    Deep brain stimulation (DBS) has virtually replaced ablative neurosurgery for use in medication-refractory movement disorders. DBS is now being studied in severe psychiatric conditions, such as treatment-resistant depression (TRD) and intractable obsessive-compulsive disorder (OCD). Effects of DBS have been reported in ?100 cases of OCD and ?50 cases of TRD for seven (five common) anatomic targets. Although these published reports differ with respect to study design and methodology, the overall response rate appears to exceed 50% in OCD for some DBS targets. In TRD, >50% of patients responded during acute and long-term bilateral electrical stimulation in a different target. DBS was generally well tolerated in both OCD and TRD, but some unique, target- and stimulation-specific adverse effects were observed (e.g., hypomania). Further research is needed to test the efficacy and safety of DBS in psychiatric disorders, compare targets, and identify predictors of response. PMID:22034866

  8. Electrical Stimulation of NIH-3T3 Cells with Platinum-PEDOT-Electrodes Integrated in a Bioreactor

    PubMed Central

    Blume, Grit; Müller-Wichards, Wiebke; Goepfert, Christiane; Pörtner, Ralf; Müller, Jörg

    2013-01-01

    The objective of this work involves the development and integration of electrodes for the electrical stimulation of cells within a bioreactor. Electrodes need to fit properties such as biocompatibility, large reversible charge transfer and high flexibility in view of their future application as implants on the tympanic membrane. Flexible thin-film platinum-poly(3,4-ethylene-dioxythiophene)-electrodes on a poly(ethylene terephthalate)-foil manufactured using microsystems technology were integrated into a bioreactor based on the design of a 24 well plate. The murine fibroblast cell line NIH-3T3 was cultured on the foil electrodes and the cells were stimulated with direct voltage and unipolar pulsed voltage. The amplitude, the pulse length and the ratio of pulse to pause were varied. The stimulated cells were stained in order to determine the angle between the cell cleavage plane of the dividing cells and the vector of the electric field. These angles were subsequently used to calculate the polarization index, which is a measure of the orientation of the metaphase plane of dividing cells that occurs for example during wound healing or embryonic morphogenesis. PMID:24358059

  9. EEG Power Asymmetry and Functional Connectivity as a Marker of Treatment Effectiveness in DBS Surgery for Depression

    PubMed Central

    Quraan, Maher A; Protzner, Andrea B; Daskalakis, Zafiris J; Giacobbe, Peter; Tang, Chris W; Kennedy, Sidney H; Lozano, Andres M; McAndrews, Mary P

    2014-01-01

    Recently, deep brain stimulation (DBS) has been evaluated as an experimental therapy for treatment-resistant depression. Although there have been encouraging results in open-label trials, about half of the patients fail to achieve meaningful benefit. Although progress has been made in understanding the neurobiology of MDD, the ability to characterize differences in brain dynamics between those who do and do not benefit from DBS is lacking. In this study, we investigated EEG resting-state data recorded from 12 patients that have undergone DBS surgery. Of those, six patients were classified as responders to DBS, defined as an improvement of 50% or more on the 17-item Hamilton Rating Scale for Depression (HAMD-17). We compared hemispheric frontal theta and parietal alpha power asymmetry and synchronization asymmetry between responders and non-responders. Hemispheric power asymmetry showed statistically significant differences between responders and non-responders with healthy controls showing an asymmetry similar to responders but opposite to non-responders. This asymmetry was characterized by an increase in frontal theta in the right hemisphere relative to the left combined with an increase in parietal alpha in the left hemisphere relative to the right in non-responders compared with responders. Hemispheric mean synchronization asymmetry showed a statistically significant difference between responders and non-responders in the theta band, with healthy controls showing an asymmetry similar to responders but opposite to non-responders. This asymmetry resulted from an increase in frontal synchronization in the right hemisphere relative to the left combined with an increase in parietal synchronization in the left hemisphere relative to the right in non-responders compared with responders. Connectivity diagrams revealed long-range differences in frontal/central-parietal connectivity between the two groups in the theta band. This pattern was observed irrespective of whether EEG data were collected with active DBS or with the DBS stimulation turned off, suggesting stable functional and possibly structural modifications that may be attributed to plasticity. PMID:24285211

  10. Deep brain stimulation macroelectrodes compared to multiple microelectrodes in rat hippocampus

    PubMed Central

    Arcot Desai, Sharanya; Gutekunst, Claire-Anne; Potter, Steve M.; Gross, Robert E.

    2014-01-01

    Microelectrode arrays (wire diameter <50 ?m) were compared to traditional macroelectrodes for deep brain stimulation (DBS). Understanding the neuronal activation volume may help solve some of the mysteries associated with DBS, e.g., its mechanisms of action. We used c-fos immunohistochemistry to investigate neuronal activation in the rat hippocampus caused by multi-micro- and macroelectrode stimulation. At ± 1V stimulation at 25 Hz, microelectrodes (33 ?m diameter) had a radius of activation of 100 ?m, which is 50% of that seen with 150 ?m diameter macroelectrode stimulation. Macroelectrodes activated about 5.8 times more neurons than a single microelectrode, but displaced ~20 times more neural tissue. The sphere of influence of stimulating electrodes can be significantly increased by reducing their impedance. By ultrasonic electroplating (sonicoplating) the microelectrodes with platinum to increase their surface area and reduce their impedance by an order of magnitude, the radius of activation increased by 50 ?m and more than twice the number of neurons were activated within this increased radius compared to unplated microelectrodes. We suggest that a new approach to DBS, one that uses multiple high-surface area microelectrodes, may be more therapeutically effective due to increased neuronal activation. PMID:24971060

  11. Deep brain stimulation macroelectrodes compared to multiple microelectrodes in rat hippocampus.

    PubMed

    Arcot Desai, Sharanya; Gutekunst, Claire-Anne; Potter, Steve M; Gross, Robert E

    2014-01-01

    Microelectrode arrays (wire diameter <50 ?m) were compared to traditional macroelectrodes for deep brain stimulation (DBS). Understanding the neuronal activation volume may help solve some of the mysteries associated with DBS, e.g., its mechanisms of action. We used c-fos immunohistochemistry to investigate neuronal activation in the rat hippocampus caused by multi-micro- and macroelectrode stimulation. At ± 1V stimulation at 25 Hz, microelectrodes (33 ?m diameter) had a radius of activation of 100 ?m, which is 50% of that seen with 150 ?m diameter macroelectrode stimulation. Macroelectrodes activated about 5.8 times more neurons than a single microelectrode, but displaced ~20 times more neural tissue. The sphere of influence of stimulating electrodes can be significantly increased by reducing their impedance. By ultrasonic electroplating (sonicoplating) the microelectrodes with platinum to increase their surface area and reduce their impedance by an order of magnitude, the radius of activation increased by 50 ?m and more than twice the number of neurons were activated within this increased radius compared to unplated microelectrodes. We suggest that a new approach to DBS, one that uses multiple high-surface area microelectrodes, may be more therapeutically effective due to increased neuronal activation. PMID:24971060

  12. Supporting clinical decision making during deep brain stimulation surgery by means of a stochastic dynamical model

    NASA Astrophysics Data System (ADS)

    Karamintziou, Sofia D.; Tsirogiannis, George L.; Stathis, Pantelis G.; Tagaris, George A.; Boviatsis, Efstathios J.; Sakas, Damianos E.; Nikita, Konstantina S.

    2014-10-01

    Objective. During deep brain stimulation (DBS) surgery for the treatment of advanced Parkinson's disease (PD), microelectrode recording (MER) in conjunction with functional stimulation techniques are commonly applied for accurate electrode implantation. However, the development of automatic methods for clinical decision making has to date been characterized by the absence of a robust single-biomarker approach. Moreover, it has only been restricted to the framework of MER without encompassing intraoperative macrostimulation. Here, we propose an integrated series of novel single-biomarker approaches applicable to the entire electrophysiological procedure by means of a stochastic dynamical model. Approach. The methods are applied to MER data pertinent to ten DBS procedures. Considering the presence of measurement noise, we initially employ a multivariate phase synchronization index for automatic delineation of the functional boundaries of the subthalamic nucleus (STN) and determination of the acceptable MER trajectories. By introducing the index into a nonlinear stochastic model, appropriately fitted to pre-selected MERs, we simulate the neuronal response to periodic stimuli (130 Hz), and examine the Lyapunov exponent as an indirect indicator of the clinical effectiveness yielded by stimulation at the corresponding sites. Main results. Compared with the gold-standard dataset of annotations made intraoperatively by clinical experts, the STN detection methodology demonstrates a false negative rate of 4.8% and a false positive rate of 0%, across all trajectories. Site eligibility for implantation of the DBS electrode, as implicitly determined through the Lyapunov exponent of the proposed stochastic model, displays a sensitivity of 71.43%. Significance. The suggested comprehensive method exhibits remarkable performance in automatically determining both the acceptable MER trajectories and the optimal stimulation sites, thereby having the potential to accelerate precise target finalization during DBS surgery for PD.

  13. Genome Sequence of Mycoplasma hyorhinis Strain DBS 1050

    PubMed Central

    Soika, Valerii; Volokhov, Dmitriy; Simonyan, Vahan; Chizhikov, Vladimir

    2014-01-01

    Mycoplasma hyorhinis is known as one of the most prevalent contaminants of mammalian cell and tissue cultures worldwide. Here, we present the complete genome sequence of the fastidious M. hyorhinis strain DBS 1050. PMID:24604646

  14. The influence of electrolyte composition on the in vitro charge-injection limits of activated iridium oxide (AIROF) stimulation electrodes

    Microsoft Academic Search

    Stuart F Cogan; Philip R Troyk; Julia Ehrlich; Christina M Gasbarro; Timothy D Plante

    2007-01-01

    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 stimulation electrodes 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

  15. Multiple-input single-output closed-loop isometric force control using asynchronous intrafascicular multi-electrode stimulation.

    PubMed

    Frankel, Mitchell A; Dowden, Brett R; Mathews, V John; Normann, Richard A; Clark, Gregory A; Meek, Sanford G

    2011-06-01

    Although asynchronous intrafascicular multi-electrode stimulation (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-electrode stimulation applications to restore lost motor function. PMID:21385670

  16. Utilizing fast spin echo MRI to reduce image artifacts and improve implant/tissue interface detection in refractory Parkinson's patients with deep brain stimulators.

    PubMed

    Sarkar, Subhendra N; Sarkar, Pooja R; Papavassiliou, Efstathios; Rojas, Rafael R

    2014-01-01

    Introduction. In medically refractory Parkinson's disease (PD) deep-brain stimulation (DBS) is an effective therapeutic tool. Postimplantation MRI is important in assessing tissue damage and DBS lead placement accuracy. We wanted to identify which MRI sequence can detect DBS leads with smallest artifactual signal void, allowing better tissue/electrode edge conspicuity. Methods. Using an IRB approved protocol 8 advanced PD patients were imaged within MR conditional safety guidelines at low RF power (SAR ? 0.1?W/kg) in coronal plane at 1.5T by various sequences. The image slices were subjectively evaluated for diagnostic quality and the lead contact diameters were compared to identify a sequence least affected by metallic leads. Results and Discussion. Spin echo and fast spin echo based low SAR sequences provided acceptable image quality with comparable image blooming (enlargement) of stimulator leads. The mean lead diameters were 2.2 ± 0.1?mm for 2D, 2.1 ± 0.1?mm for 3D, and 4.0 ± 0.2?mm for 3D MPRAGE sequence. Conclusion. Low RF power spin echo and fast spin echo based 2D and 3D FSE sequences provide acceptable image quality adjacent to DBS leads. The smallest artifactual blooming of stimulator leads is present on 3D FSE while the largest signal void appears in the 3D MPRAGE sequence. PMID:24724036

  17. Estimation of electrode location in a rat motor cortex by laminar analysis of electrophysiology and intracortical electrical stimulation

    NASA Astrophysics Data System (ADS)

    Yazdan-Shahmorad, A.; Lehmkuhle, M. J.; Gage, G. J.; Marzullo, T. C.; Parikh, H.; Miriani, R. M.; Kipke, D. R.

    2011-08-01

    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.

  18. Pillar-shaped stimulus electrode array for high-efficiency stimulation of fully implantable epiretinal prosthesis

    NASA Astrophysics Data System (ADS)

    Lee, Kang-Wook; Watanabe, Yoshinobu; Kigure, Chikashi; Fukushima, Takafumi; Koyanagi, Mitsumasa; Tanaka, Tetsu

    2012-10-01

    We developed a pillar-shaped microelectrode array (MEA) with varying heights for enhancing the spherical conformity of fully implantable epiretinal prosthesis comprising a 3D stacked retinal chip. The fabricated MEA is composed of 100 pillar electrodes with heights ranging from 60 to 80 µm. The Pt-coated Cu pillar electrode with a surface diameter of 70 µm and a height of 75 µm and the Pt planar electrode with a surface diameter of 70 µm have 24.6 and 125 k? impedances, respectively, at 1 kHz in vitro experiment. The pillar electrode shows lower impedance than the planar electrode because of a larger surface area. However, to avoid cross-talking between pillar electrodes, we developed a sidewall passivation process of the pillar electrode by using the surface tension of polyimide. The impedance of the isolated pillar electrode 116 k? at 1 kHz is similar to the impedance of the planar electrode, because they have similar electrode surface areas. The pillar-shaped MEA shows a better spherical conformity.

  19. Electrode alignment of transverse tripoles using a percutaneous triple-lead approach in spinal cord stimulation

    NASA Astrophysics Data System (ADS)

    Sankarasubramanian, V.; Buitenweg, J. R.; Holsheimer, J.; Veltink, P.

    2011-02-01

    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.

  20. Idiopathic intracranial hypertension following deep brain stimulation for Parkinson's disease.

    PubMed

    Finet, Patrice; Delavallée, Maxime; Raftopoulos, Christian

    2015-03-01

    Idiopathic intracranial hypertension (IIH) is a syndrome characterized by an increased intracranial pressure of unknown origin arising mainly in overweight females. The typical symptoms of IIH are headaches and papilledema associated with visual disorders, which can often evolve to blindness. We describe the first patient who developed a clinical syndrome related to an IIH following a bilateral subthalamic deep brain stimulation (DBS) procedure for Parkinson's disease with the particularity that the clinical expression of the IIH syndrome was atypical because of the presence of intracerebral electrodes. PMID:25626428

  1. Clinical Cases where Lesion Therapy Was Chosen over Deep Brain Stimulation

    Microsoft Academic Search

    Amanda K. Hooper; Michael S. Okun; Kelly D. Foote; Hubert H. Fernandez; Charles Jacobson; Pamela Zeilman; Janet Romrell; Ramon L. Rodriguez

    2008-01-01

    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

  2. Optimized beamforming for simultaneous MEG and intracranial local field potential recordings in deep brain stimulation patients

    PubMed Central

    Litvak, Vladimir; Eusebio, Alexandre; Jha, Ashwani; Oostenveld, Robert; Barnes, Gareth R.; Penny, William D.; Zrinzo, Ludvic; Hariz, Marwan I.; Limousin, Patricia; Friston, Karl J.; Brown, Peter

    2010-01-01

    Insight into how brain structures interact is critical for understanding the principles of functional brain architectures and may lead to better diagnosis and therapy for neuropsychiatric disorders. We recorded, simultaneously, magnetoencephalographic (MEG) signals and subcortical local field potentials (LFP) in a Parkinson's disease (PD) patient with bilateral deep brain stimulation (DBS) electrodes in the subthalamic nucleus (STN). These recordings offer a unique opportunity to characterize interactions between the subcortical structures and the neocortex. However, high-amplitude artefacts appeared in the MEG. These artefacts originated from the percutaneous extension wire, rather than from the actual DBS electrode and were locked to the heart beat. In this work, we show that MEG beamforming is capable of suppressing these artefacts and quantify the optimal regularization required. We demonstrate how beamforming makes it possible to localize cortical regions whose activity is coherent with the STN-LFP, extract artefact-free virtual electrode time-series from regions of interest and localize cortical areas exhibiting specific task-related power changes. This furnishes results that are consistent with previously reported results using artefact-free MEG data. Our findings demonstrate that physiologically meaningful information can be extracted from heavily contaminated MEG signals and pave the way for further analysis of combined MEG-LFP recordings in DBS patients. PMID:20056156

  3. Bilateral deep brain stimulation of the subthalamic nucleus effectively relieves dystonia secondary to Fahr's disease: a case report.

    PubMed

    Ma, Yu; Ge, Ming; Meng, Fangang; Zhang, Kai; Zhang, Jianguo

    2013-08-01

    Fahr's disease (FD) is a rare movement disorder characterized by bilateral intracranial calcifications that is refractory to most treatments. We present the case of a 26-year-old male with FD who was unable to walk independently and could not eat solid food because of poor swallowing capability and severe cervical dystonia. Injections of botulin toxin into the neck muscles, as well as biperiden, tiapride, amantadine, L-dopa and clonazepam were ineffective. Deep brain stimulation (DBS) was performed with two permanent electrodes containing four contact sites implanted bilaterally into the subthalamic nucleus (STN). The antidystonic effect was evident immediately after STN stimulation, and it was sustained during a 24-month follow-up period. There was a marked reduction of cervical dystonia, and he could eat solid food and was able to walk independently. This case demonstrates that DBS of the STN can be effective for the treatment of dystonia associated with FD. PMID:23384486

  4. Subthalamic nucleus deep brain stimulation in elderly patients – analysis of outcome and complications

    PubMed Central

    Vesper, Jan; Haak, Susanne; Ostertag, Christoph; Nikkhah, Guido

    2007-01-01

    Background There is an ongoing discussion about age limits for deep brain stimulation (DBS). Current indications for DBS are tremor-dominant disorders, Parkinson's disease, and dystonia. Electrode implantation for DBS with analgesia and sedation makes surgery more comfortable, especially for elderly patients. However, the value of DBS in terms of benefit-risk ratio in this patient population is still uncertain. Methods Bilateral electrode implantation into the subthalamic nucleus (STN) was performed in a total of 73 patients suffering from Parkinson's disease. Patients were analyzed retrospectively. For this study they were divided into two age groups: group I (age <65 years, n = 37) and group II (age ? 65 years, n = 36). Examinations were performed preoperatively and at 6-month follow-up intervals for 24 months postoperatively. Age, UPDRS motor score (part III) on/off, Hoehn & Yahr score, Activity of Daily Living (ADL), L-dopa medication, and complications were determined. Results Significant differences were found in overall performance determined as ADL scores (group I: 48/71 points, group II: 41/62 points [preoperatively/6-month postoperatively]) and in the rate of complications (group I: 4 transient psychosis, 4 infections in a total of 8 patients, group II: 2 deaths [unrelated to surgery], 1 intracerebral hemorrhage, 7 transient psychosis, 3 infections, 2 pneumonia in a total of 13 patients), (p < 0.05). Interestingly, changes in UPDRS scores, Hoehn & Yahr scores, and L-dopa medication were not statistically different between the two groups. Conclusion DBS of the STN is clinically as effective in elderly patients as it is in younger ones. However, a more careful selection and follow-up of the elderly patients are required because elderly patients have a higher risk of surgery-related complications and a higher morbidity rate. PMID:17367531

  5. Improvement of Electrical Stimulation Protocol for Simultaneous Measurement of Extracellular Potential with On-Chip Multi-Electrode Array System

    NASA Astrophysics Data System (ADS)

    Kaneko, Tomoyuki; Nomura, Fumimasa; Hattori, Akihiro; Yasuda, Kenji

    2012-06-01

    Cardiotoxicity testing with a multi-electrode array (MEA) system requires the stable beating of cardiomyocytes for the measurement of the field potential duration (FPD), because different spontaneous beating rates cause different responses of FPD prolongation induced by drugs, and the beating rate change effected by drugs complicates the FPD prolongation assessment. We have developed an on-chip MEA system with electrical stimulation for the measurement of the FPD during the stable beating of human embryonic stem (ES) cell-derived cardiomyocyte clusters. Using a conventional bipolar stimulation protocol, we observed such large artifacts in electrical stimulation that we could not estimate the FPD quantitatively. Therefore, we improved the stimulation protocol by using sequential rectangular pulses in which the positive and negative stimulation voltages and number of pulses could be changed flexibly. The balanced voltages and number of pulses for sequential rectangular pulses enabled the recording of small negative artifacts only, which hardly affected the FPD measurement of human-ES-cell-derived cardiomyocyte clusters. These conditions of electrical stimulation are expected to find applications for the control of constant beating for cardiotoxicity testing.

  6. Atlas of the muscle motor points for the lower limb: implications for electrical stimulation procedures and electrode positioning.

    PubMed

    Botter, Alberto; Oprandi, Gianmosè; Lanfranco, Fabio; Allasia, Stefano; Maffiuletti, Nicola A; Minetto, Marco Alessandro

    2011-10-01

    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

  7. Stability and selectivity of a chronic, multi-contact cuff electrode for sensory stimulation in human amputees

    NASA Astrophysics Data System (ADS)

    Tan, Daniel W.; Schiefer, Matthew A.; Keith, Michael W.; Anderson, J. Robert; Tyler, Dustin J.

    2015-04-01

    Objective. Stability and selectivity are important when restoring long-term, functional sensory feedback in individuals with limb-loss. Our objective is to demonstrate a chronic, clinical neural stimulation system for providing selective sensory response in two upper-limb amputees. Approach. Multi-contact cuff electrodes were implanted in the median, ulnar, and radial nerves of the upper-limb. Main results. Nerve stimulation produced a selective sensory response on 19 of 20 contacts and 16 of 16 contacts in subjects 1 and 2, respectively. Stimulation elicited multiple, distinct percept areas on the phantom and residual limb. Consistent threshold, impedance, and percept areas have demonstrated that the neural interface is stable for the duration of this on-going, chronic study. Significance. We have achieved selective nerve response from multi-contact cuff electrodes by demonstrating characteristic percept areas and thresholds for each contact. Selective sensory response remains consistent in two upper-limb amputees for 1 and 2 years, the longest multi-contact sensory feedback system to date. Our approach demonstrates selectivity and stability can be achieved through an extraneural interface, which can provide sensory feedback to amputees.

  8. Deep Brain Stimulation: An Evolving Technology

    Microsoft Academic Search

    Mark A. Liker; Deborah S. Won; Vikas Y. Rao; Sherwin E. Hua

    2008-01-01

    Deep brain stimulation (DBS) is widely used as a safe and effective medical treatment for certain neurological disorders. It continues to evolve with improving techniques in functional neurosurgery and biomedical device engineering. This paper provides an overview of the enabling science and technology that have allowed DBS to successfully treat certain neurological disorders. It also points toward some of the

  9. Thalamic stimulation alleviates levodopa-resistant rigidity in a patient with non-Parkinson's disease parkinsonian syndrome.

    PubMed

    Yamada, Kazumichi; Hamasaki, Tadashi; Kuratsu, Jun-Ichi

    2014-05-01

    Deep brain stimulation (DBS) to the thalamic ventrointermediate nucleus (Vim) is a useful treatment in patients with tremor-dominant Parkinson's disease (PD). Efficacy to alleviate rigidity remains controversial. We report a 65-year-old right-handed man with persistent severe rigidity and bradykinesia on the right side despite daily administration of levodopa/carbidopa (600/60mg). His right-hand tremor was continuous at rest and present at action. His antiparkinsonian medications appeared ineffective and he reported difficulties with writing and eating. Repeated (123)I-meta-iodobenzylguanidine myocardial scintigraphy studies demonstrated a non-PD pattern. He underwent the stereotactic implantation of a DBS electrode into the left Vim. Using contacts 1 and 2 we started continuous unipolar stimulation with a pulse generator implanted in a subclavian pocket. This improved the tremor and the rigidity and bradykinesia of his right hand. Postoperative image analysis revealed the likelihood of simultaneous stimulation of the Vim and the nucleus ventralis oralis posterior. Our findings suggest thalamic stimulation as a therapeutic option for drug-resistant rigidity (and tremor) in patients with parkinsonian syndromes ineligible for DBS targeted at the globus pallidus internus or subthalamic nucleus. PMID:24291482

  10. The choice of pulse duration for chronic electrical stimulation via surface, nerve, and intramuscular electrodes

    Microsoft Academic Search

    Patrick E. Crago; P. Hunter Peckham; J. Thomas Mortimer; Joseph P. Van Der Meulen

    1974-01-01

    The peak current, peak voltage, charge transfer and energy dissipation necessary for equivalent stimulation were measured\\u000a for several pulse durations in the range from 0.01 to 1.0 msec. The unidirectional, regulated current, rectangular waveform\\u000a was studied for subcutaneous nerve and intramuscular stimulation in animals and for surface stimulation in humans. In addition,\\u000a the unidirectional, regulated current, exponential waveform was studied

  11. Possible therapeutic effects of transcutaneous electrical stimulation via concentric ring electrodes

    E-print Network

    Besio, Walter G.

    induced by penicillin G, pilocarpine, and pentylenetetrazole (PTZ). KEY WORDS: Epilepsy, Penicillin G noninvasive stimulation technique dem- onstrated excellent efficacy with both penicillin and pilo- carpine

  12. Effect of Chronic Deep Brain Stimulation of the Subthalamic Nucleus for Frontal Lobe Epilepsy: Subtraction SPECT Analysis

    Microsoft Academic Search

    Young-Min Shon; Kyung Jin Lee; Hye Jin Kim; Yong-An Chung; Kook Jin Ahn; Dong Won Yang; Bum Saeng Kim

    2005-01-01

    Objectives: Experimental data and case reports of patients with intractable epilepsy treated with deep brain stimulation (DBS) of the subthalamic nucleus (STN) suggest a considerable anticonvulsant effect. However, no satisfactory mechanisms of action have yet been elucidated. We investigated the putative therapeutic mechanisms of DBS from cerebral perfusion changes as measured by subtracting the SPECT image of the pre-DBS period

  13. [Modification of the detection and stimulation behavior of active and passive fixed bipolar pacemaker electrodes by depot dexamethasone].

    PubMed

    Burkhardt, D; Lauck, G; Badenheim, W; Höblinger, K H; Manz, M

    1997-07-01

    In a prospective, non-randomised study, two atrial steroid-eluting screw-in leads were evaluated (CapSureFix 4068, Medtronic, n = 17; Accufix II DEC 033-812, Telectronics, n = 16); in the same way, measurements were obtained of three steroid eluting ventricular electrodes (two screw-in leads: CapSureFix 4068, Medtronic, n = 11; Accufix II DEC 033-212, Telectronics, n = 20 and one tined lead Encor DEC 033-448, Telectronics, n = 18). Measurements were performed during implantation (= acute), 7 +/- 3 days after implantation (= subacute) and during follow-up at 3 and 6 months. After atrial implantation, there were no significant differences of the stimulation thresholds (Accufix II DEC: 0.76 +/- 0.23 V-CapSureFix: 0.75 +/- 0.16 V). During follow-up, a slight but not significant increase of the stimulation threshold was observed (Accufix II DEC: subacute 0.99 +/- 0.45 V; 3 months 0.79 +/- 0.43 V; 6 months: 0.84 +/- 0.45 V.-CapSureFix: subacute 0.76 +/- 0.18 V; 3 months 0.87 +/- 0.31 V; 6 months 0.88 +/- 0.32 V). The acute atrial thresholds were significantly lower in the right atrial appendage than in the right lateral wall, while there was no difference during measurements at 3 and 6 months (atrial appendage n = 20 acute 0.69 +/- 0.11 V; right lateral wall n = 13 acute 0.85 +/- 0.25 V). The ventricular Encor DEC and Accufix II DEC electrodes had similar thresholds at implantation, whereas the CapSureFix electrode showed significantly higher stimulation thresholds (Encor DEC 0.56 +/- 0.15 V; Accufix II DEC 0.53 +/- 0.13 V; CapSureFix 0.8 +/- 0.16 V). During follow-up the stimulation threshold increased significantly with each ventricular electrode (Encor DEC: subacute 0.71 +/- 0.22 V; 3 months 0.77 +/- 0.23 V; 6 months 0.8 +/- 0.28 V-Accufix II DEC: subacute 0.86 +/- 0.44 V; 3 months 0.8 +/- 0.25 V; 6 months 0.74 +/- 0.21 V-CapSureFix: subacute 0.92 +/- 0.17 V; 3 months 1.14 +/- 0.46 V; 6 months 1.12 +/- 0.32 V). With regard to the sensing of the intracardiac signals, no differences among the electrodes were detected at the atrial as well as the ventricular level. Subacutely all electrodes had a significant decrease of sensing level without changes after 3 and 6 months (atrium: CapSureFix acute 4.08 +/- 1.34 mV, subacute 3.09 +/- 0.88 mV, 3 months 2.91 +/- 1.02 mV, 6 months 3.0 +/- 1.22 mV; Accufix II DEC acute 4.34 +/- 1.49 mV, subacute 2.86 +/- 1.18 mV, 3 months 3.07 +/- 1.04 mV, 6 months 2.91 +/- 1.16 mV-ventricle: CapSureFix acute 11.55 +/- 4.5 mV, subacute 9.99 +/- 3.51 mV, 3 months 9.36 +/- 3.23 mV, 6 months 9.13 +/- 3.4 mV; Accufix II DEC acute 10.66 +/- 3.0 mV, subacute 7.49 +/- 4.04 mV, 3 months 7.25 +/- 3.64 mV, 6 months 7.52 +/- 4.1 mV; Encor DEC acute 11.65 +/- 3.9 mV, subacute 9.04 +/- 3.29 mV, 3 months 8.69 +/- 3.83 mV, 6 months 8.78 +/- 3.32 mV). The impedance of the Accufix II DEC electrode was significantly lower than the CapSureFix electrode at the time of implantation in the atrium. The ventricular electrodes with active fixation showed a decrease of impedance 7 days after implantation, which diminished during chronic follow-up. On the other hand, the Encor DEC electrode did not exhibit any change of impedance at the different times of determination. In summary, the dexamethasone depots prevented the rise of the stimulation threshold in all the atrial electrodes with active fixation. There remained a small increase of the stimulation threshold after ventricular implantation, which did not reach clinical significance. Thus, the energy saving output of 2.5 volt could be programmed in almost every patient. PMID:9340944

  14. Hindlimb Movement in the Cat Induced by Amplitude-Modulated Stimulation Using Extra-Spinal Electrodes

    PubMed Central

    Tai, Changfeng; Wang, Jicheng; Shen, Bing; Wang, Xianchun; Roppolo, James R.; de Groat, William C.

    2010-01-01

    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. PMID:18369283

  15. Hindlimb movement in the cat induced by amplitude-modulated stimulation using extra-spinal electrodes

    NASA Astrophysics Data System (ADS)

    Tai, Changfeng; Wang, Jicheng; Shen, Bing; Wang, Xianchun; Roppolo, James R.; de Groat, William C.

    2008-06-01

    Hindlimb movement in the cat induced by electrical stimulation with an amplitude-modulated waveform of the dorsal surface of the 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.

  16. Error analysis of MRI and leksell stereotactic frame target localization in deep brain stimulation surgery.

    PubMed

    Simon, Scott L; Douglas, Pamela; Baltuch, Gordon H; Jaggi, Jurg L

    2005-01-01

    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 is crucial for obtaining successful results. Currently, surgeons rely on preoperative MRI or CT images to derive stereotactic coordinates for targeting sites such as the subthalamic nucleus and ventral intermediate nucleus of the thalamus coupled with microelectrode recordings during surgery for proper electrode placement. However, it has been argued that the stereotactic head frame produces detrimental artifacts during MRI. We examined MRI images taken from 11 patients undergoing repeat DBS surgery, and determined the coordinates of the previously placed electrode. We then set the Leksell G stereotactic frame to these coordinates and obtained fluoroscope-localizing images. Using MATLAB image analysis tools, we were able to quantify the 3-dimensional error in target localization by measuring the distance from the electrode tip to the targeted coordinate. The mean errors were 0.09 +/- 0.34 mm perpendicular, lateral to medial, 0.01 +/- 0.32 perpendicular, posterior to anterior, and -0.08 +/- 0.33 mm parallel to the electrode, superior to inferior. According to statistical analysis, the error was random and did not seem to move in any predictable fashion. Therefore, we conclude that preoperative MRI images can be safely used in DBS surgery, and they do not negatively affect its accuracy. PMID:15695925

  17. Effects of dopaminergic and subthalamic stimulation on musical performance.

    PubMed

    van Vugt, Floris T; Schüpbach, Michael; Altenmüller, Eckart; Bardinet, Eric; Yelnik, Jérôme; Hälbig, Thomas D

    2013-05-01

    Although subthalamic-deep brain stimulation (STN-DBS) is an efficient treatment for Parkinson's disease (PD), its effects on fine motor functions are not clear. We present the case of a professional violinist with PD treated with STN-DBS. DBS improved musical articulation, intonation and emotional expression and worsened timing relative to a timekeeper (metronome). The same effects were found for dopaminergic treatment. These results suggest that STN-DBS, mimicking the effects of dopaminergic stimulation, improves fine-tuned motor behaviour whilst impairing timing precision. PMID:23232663

  18. A Multiple Electrode Scheme for Optimal Non-Invasive Electrical Stimulation

    E-print Network

    Parra, Lucas C.

    site is identified by a clinician. I. INTRODUCTION Transcranial direct current stimulation (t 10005 Abstract--Transcranial electrical stimulation involves the de- livery of weak electrical currentsDCS) is an emerg- ing neurotechnology involving the application of small direct currents to the surface

  19. Nonmotor outcomes in Parkinson’s disease: is deep brain stimulation better than dopamine replacement therapy?

    PubMed Central

    Kandadai, Rukmini Mridula; Jabeen, Afshan; Kannikannan, Meena A.

    2012-01-01

    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. PMID:22276074

  20. Development of the Mayo Investigational Neuromodulation Control System: toward a closed-loop electrochemical feedback system for deep brain stimulation

    PubMed Central

    Chang, Su-Youne; Kimble, Christopher J.; Kim, Inyong; Paek, Seungleal B.; Kressin, Kenneth R.; Boesche, Joshua B.; Whitlock, Sidney V.; Eaker, Diane R.; Kasasbeh, Aimen; Horne, April E.; Blaha, Charles D.; Bennet, Kevin E.; Lee, Kendall H.

    2014-01-01

    Object Conventional deep brain stimulation (DBS) devices continue to rely on an open-loop system in which stimulation is independent of functional neural feedback. The authors previously proposed that as the foundation of a DBS “smart” device, a closed-loop system based on neurochemical feedback, may have the potential to improve therapeutic outcomes. Alterations in neurochemical release are thought to be linked to the clinical benefit of DBS, and fast-scan cyclic voltammetry (FSCV) has been shown to be effective for recording these evoked neurochemical changes. However, the combination of FSCV with conventional DBS devices interferes with the recording and identification of the evoked analytes. To integrate neurochemical recording with neurostimulation, the authors developed the Mayo Investigational Neuromodulation Control System (MINCS), a novel, wirelessly controlled stimulation device designed to interface with FSCV performed by their previously described Wireless Instantaneous Neurochemical Concentration Sensing System (WINCS). Methods To test the functionality of these integrated devices, various frequencies of electrical stimulation were applied by MINCS to the medial forebrain bundle of the anesthetized rat, and striatal dopamine release was recorded by WINCS. The parameters for FSCV in the present study consisted of a pyramidal voltage waveform applied to the carbon-fiber microelectrode every 100 msec, ramping between ?0.4 V and +1.5 V with respect to an Ag/AgCl reference electrode at a scan rate of either 400 V/sec or 1000 V/sec. The carbon-fiber microelectrode was held at the baseline potential of ?0.4 V between scans. Results By using MINCS in conjunction with WINCS coordinated through an optic fiber, the authors interleaved intervals of electrical stimulation with FSCV scans and thus obtained artifact-free wireless FSCV recordings. Electrical stimulation of the medial forebrain bundle in the anesthetized rat by MINCS elicited striatal dopamine release that was time-locked to stimulation and increased progressively with stimulation frequency. Conclusions Here, the authors report a series of proof-of-principle tests in the rat brain demonstrating MINCS to be a reliable and flexible stimulation device that, when used in conjunction with WINCS, performs wirelessly controlled stimulation concurrent with artifact-free neurochemical recording. These findings suggest that the integration of neurochemical recording with neurostimulation may be a useful first step toward the development of a closed-loop DBS system for human application. PMID:24116724

  1. Acute and Chronic Mood and Apathy Outcomes from a Randomized Study of Unilateral STN and GPi DBS

    PubMed Central

    Okun, Michael S.; Wu, Samuel S.; Fayad, Sarah; Ward, Herbert; Bowers, Dawn; Rosado, Christian; Bowen, Lauren; Jacobson, Charles; Butson, Christopher; Foote, Kelly D.

    2014-01-01

    Objective To study mood and behavioral effects of unilateral and staged bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for Parkinson's disease (PD). Background There are numerous reports of mood changes following DBS, however, most have focused on bilateral simultaneous STN implants with rapid and aggressive post-operative medication reduction. Methods A standardized evaluation was applied to a subset of patients undergoing STN and GPi DBS and who were also enrolled in the NIH COMPARE study. The Unified Parkinson Disease Rating Scale (UPDRS III), the Hamilton depression (HAM-D) and anxiety rating scales (HAM-A), the Yale-Brown obsessive-compulsive rating scale (YBOCS), the Apathy Scale (AS), and the Young mania rating scale (YMRS) were used. The scales were repeated at acute and chronic intervals. A post-operative strategy of non-aggressive medication reduction was employed. Results Thirty patients were randomized and underwent unilateral DBS (16 STN, 14 GPi). There were no baseline differences. The GPi group had a higher mean dopaminergic dosage at 1-year, however the between group difference in changes from baseline to 1-year was not significant. There were no differences between groups in mood and motor outcomes. When combining STN and GPi groups, the HAM-A scores worsened at 2-months, 4-months, 6-months and 1-year when compared with baseline; the HAM-D and YMRS scores worsened at 4-months, 6-months and 1-year; and the UPDRS Motor scores improved at 4-months and 1-year. Psychiatric diagnoses (DSM-IV) did not change. No between group differences were observed in the cohort of bilateral cases. Conclusions There were few changes in mood and behavior with STN or GPi DBS. The approach of staging STN or GPi DBS without aggressive medication reduction could be a viable option for managing PD surgical candidates. A study of bilateral DBS and of medication reduction will be required to better understand risks and benefits of a bilateral approach. PMID:25469706

  2. DBS Radio: Deathstar or Dud? Info. Packets No. 24.

    ERIC Educational Resources Information Center

    Pizzi, Skip

    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…

  3. DBS systems : Perspectives from a profit seeking company

    Microsoft Academic Search

    Ernesto R. Martin

    1985-01-01

    Considerable work has been reported on the tradeoffs associated with direct broadcast satellite (DBS) systems. These studies have considered total investment costs (space segment plus ground segment), but have not dealt with a number of other business-related parameters which affect system design. This article addresses some of these issues from the viewpoint of a commercial entity in the USA. It

  4. Evaluation of local electric fields generated by transcranial direct current stimulation with an extracephalic reference electrode based on realistic 3D body modeling

    NASA Astrophysics Data System (ADS)

    Im, Chang-Hwan; Park, Ji-Hye; Shim, Miseon; Chang, Won Hyuk; Kim, Yun-Hee

    2012-04-01

    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.

  5. Flexible Nerve Stimulation Electrode With Iridium Oxide Sputtered on Liquid Crystal Polymer

    Microsoft Academic Search

    Kevin Wang; Chung-Chiun Liu; Dominique M. Durand

    2009-01-01

    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 (LCPs) have very little water absorption compared to other flexible substrates. Therefore, the combination of sputtered iridium oxide film on LCP substrate was

  6. Modeling Selective Stimulation With A Flat Interface Nerve Electrode for Standing Neuroprosthetic Systems

    Microsoft Academic Search

    Matthew A. Schiefer; Ronald J. Triolo; Dominique M. Durand; Dustin J. Tyler

    2005-01-01

    The long-term goal of our research is to restore standing function through selective activation of target fascicles within the femoral nerve by a flat interface nerve electrode (FINE). The optimal number and location of contacts within a FINE had not been determined previously. A realistic three-dimensional finite element model based on a cross section of human femoral nerve and FINE

  7. Models of Selective Stimulation with a Flat Interface Nerve Electrode for Standing Neuroprosthetic Systems

    Microsoft Academic Search

    Matthew A. Schiefer; Ronald J. Triolo; Dustin J. Tyler

    2006-01-01

    The long-term goal of our research is to restore standing function via selective activation of target fascicles in the femoral nerve by a flat interface nerve electrode (FINE). The optimal number and location of contacts within a FINE had not been determined previously. A realistic three-dimensional finite element model based on a cross section of human femoral nerve and FINE

  8. Noninvasive measurement of torque development in the rat foot: measurement setup and results from stimulation of the sciatic nerve with polyimide-based cuff electrodes.

    PubMed

    Stieglitz, Thomas; Schuettler, Martin; Schneider, Andreas; Valderrama, Elena; Navarro, Xavier

    2003-12-01

    In neural rehabilitation, selective activation of muscles after electrical stimulation is mandatory for control of paralyzed limbs. For an evaluation of electrode selectivity, a setup to noninvasively measure the force development after electrical stimulation in the rat foot was developed. The setup was designed in accordance to the anatomical features of the rat model to test the isometric torque development at given ankle positions in an intact leg. In this paper, the setup design and development is presented and discussed. In a first study, the selectivity of small nerve cuffs with 12 electrodes implanted around the rat sciatic nerve was investigated. Special attention was drawn to the performance of the torque measurement setup in comparison to electrophysiological data obtained from compound muscle action potential recordings. Using one cuff around the nerve, electrical stimulation on different electrode tripoles led to plantarflexion and dorsiflexion of the foot without an a priori alignment of the cuff. PMID:14960120

  9. Globus Pallidus Deep Brain Stimulation for Parkinson's Disease

    Microsoft Academic Search

    Frances Weaver; Kenneth Follett; Matthew Stern

    \\u000a Deep brain stimulation (DBS) has become the treatment of choice for patients with Parkinson' disease (PD) who are experiencing\\u000a unmanageable complications of long-term medical therapy. The two established sites for DBS for PD are the subthalamic nucleus\\u000a (STN) and the globus pallidus interna (GPi). Although most providers have already decided that STN is the preferred site for\\u000a DBS, only one

  10. Web-Based Telemonitoring and Delivery of Caregiver Support for Patients With Parkinson Disease After Deep Brain Stimulation: Protocol

    PubMed Central

    Rossi, Elena; Rosa, Manuela; Cogiamanian, Filippo; Rossi, Lorenzo; Bertolasi, Laura; Vogrig, Alberto; Pinciroli, Francesco; Barbieri, Sergio; Priori, Alberto

    2015-01-01

    Background The increasing number of patients, the high costs of management, and the chronic progress of the disease that prevents patients from performing even simple daily activities make Parkinson disease (PD) a complex pathology with a high impact on society. In particular, patients implanted with deep brain stimulation (DBS) electrodes face a highly fragile stabilization period, requiring specific support at home. However, DBS patients are followed usually by untrained personnel (caregivers or family), without specific care pathways and supporting systems. Objective This projects aims to (1) create a reference consensus guideline and a shared requirements set for the homecare and monitoring of DBS patients, (2) define a set of biomarkers that provides alarms to caregivers for continuous home monitoring, and (3) implement an information system architecture allowing communication between health care professionals and caregivers and improving the quality of care for DBS patients. Methods The definitions of the consensus care pathway and of caregiver needs will be obtained by analyzing the current practices for patient follow-up through focus groups and structured interviews involving health care professionals, patients, and caregivers. The results of this analysis will be represented in a formal graphical model of the process of DBS patient care at home. To define the neurophysiological biomarkers to be used to raise alarms during the monitoring process, neurosignals will be acquired from DBS electrodes through a new experimental system that records while DBS is turned ON and transmits signals by radiofrequency. Motor, cognitive, and behavioral protocols will be used to study possible feedback/alarms to be provided by the system. Finally, a set of mobile apps to support the caregiver at home in managing and monitoring the patient will be developed and tested in the community of caregivers that participated in the focus groups. The set of developed apps will be connected to the already existing WebBioBank Web-based platform allowing health care professionals to manage patient electronic health records and neurophysiological signals. New modules in the WebBioBank platform will be implemented to allow integration and data exchange with mobile health apps. Results The results of this project will provide a novel approach to long-term evaluation of patients with chronic, severe conditions in the homecare environment, based on caregiver empowerment and tailored applications developed according to consensus care pathways established by clinicians. Conclusions The creation of a direct communication channel between health care professionals and caregivers can benefit large communities of patients and would represent a scalable experience in integrating data and information coming from a clinical setting to those in home monitoring. PMID:25803512

  11. Electrochemical Considerations for Safe Electrical Stimulation of the Nervous System with Platinum Electrodes

    Microsoft Academic Search

    S. B. BRUMMERANDM; M. J. Turner

    1977-01-01

    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

  12. Microelectrode Technologies for Deep Brain Stimulation

    Microsoft Academic Search

    Martin Han; Douglas B. McCreery

    This chapter discusses stimulation and recording microelectrodes used in deep brain stimulation (DBS). DBS has become an established\\u000a treatment for movement disorders and a promising treatment for a number of other neurological conditions. However, there is\\u000a need for improved implantable devices, better tailored to specific neurological disorders and the corresponding targets in\\u000a the brain. The development of miniaturized devices would

  13. Electrical stimulation by semi-implantable electrodes decreases the levels of proteins associated with sciatic nerve injury-induced muscle atrophy.

    PubMed

    Liu, Jun; Li, Kuangwen; Huang, Xiongjie; Xie, Junfeng; Huang, Xinfeng

    2013-07-01

    Muscle atrophy is a disease that is usually caused by denervation. The aim of the present study was to determine whether electrical stimulation by semi-implantable electrodes is capable of decreasing the levels of specific proteins associated with sciatic nerve injury-induced muscle atrophy. Male Sprague Dawley (SD) rats with damaged sciatic nerves were maintained on a 12?h light/dark cycle. Thirty-two SD rats were randomly allocated into 4 groups (each group, n=8). The rats in group C received no electrical stimulation; the rats in groups D, N and DN received electrical stimulation by semi-implantable electrodes during the daytime alone, nighttime alone and both the daytime and nighttime, respectively. Immunoblot assays were performed to detect the expression of cellular proteins associated with muscle atrophy. The number of muscle satellite cells was determined using a microscope, indicating that electrical stimulation increased the number of muscle satellite cells. Immunoblot assay results showed that electrical stimulation reduced the expression levels of cathepsin L, calpain 1 and the ubiquitinated muscle ring finger?1 (MuRF-1) protein. In conclusion, electrical stimulation by semi-implantable electrodes constitutes a potential method for the treatment of sciatic nerve injury-induced muscle atrophy. The decreased expression levels of the cellular proteins cathepsin L and calpain 1, as well as the ubiquitinated protein MuRF-1, are associated with the attenuation of sciatic nerve injury-induced muscle atrophy. PMID:23703220

  14. Invasive stimulation therapies for the treatment of refractory pain.

    PubMed

    Nizard, Julien; Raoul, Sylvie; Nguyen, Jean-Paul; Lefaucheur, Jean-Pascal

    2012-10-01

    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

  15. Deep brain stimulation devices: a brief technical history and review.

    PubMed

    Coffey, Robert J

    2009-03-01

    Deep brain stimulation (DBS)--a broadly accepted therapeutic modality with tens of thousands of patients currently implanted--is the application of implantable electrical stimulation devices to treat neurological disorders. Approved indications include involuntary movement disorders; investigational applications include epilepsy, selected psychiatric disorders, and other conditions. DBS differs fundamentally from functional electrical stimulation and sensory prosthetics in that DBS therapies do not substitute for or replace injured tissues, organs, or body functions. DBS--targeted to particular brain nuclei or pathways that are specific for the disorder under treatment--influences brain function and behavioral output in ways that can relieve symptoms and improve the overall functioning of the patient. We will briefly review the history and present status of DBS from a technical and device-oriented perspective, with an eye toward future advances. PMID:18684199

  16. Dynamics of Parkinsonian tremor during deep brain stimulation Miche`le S. Titcombe

    E-print Network

    Glass, Leon

    Dynamics of Parkinsonian tremor during deep brain stimulation Miche`le S. Titcombe Centre, high frequency, electrical deep brain stimulation HF-DBS suppresses tremor in Parkinson's disease is unknown. Rest tremor in subjects with Parkinson's disease receiving HF-DBS was recorded continuously

  17. Post-operative assessment in Deep Brain Stimulation based on multimodal images: registration workflow and validation

    NASA Astrophysics Data System (ADS)

    Lalys, Florent; Haegelen, Claire; Abadie, Alexandre; Jannin, Pierre

    2009-02-01

    Object Movement disorders in Parkinson disease patients may require functional surgery, when medical therapy isn't effective. In Deep Brain Stimulation (DBS) electrodes are implanted within the brain to stimulate deep structures such as SubThalamic Nucleus (STN). This paper describes successive steps for constructing a digital Atlas gathering patient's location of electrodes and contacts for post operative assessment. Materials and Method 12 patients who had undergone bilateral STN DBS have participated to the study. Contacts on post-operative CT scans were automatically localized, based on black artefacts. For each patient, post operative CT images were rigidly registered to pre operative MR images. Then, pre operative MR images were registered to a MR template (super-resolution Collin27 average MRI template). This last registration was the combination of global affine, local affine and local non linear registrations, respectively. Four different studies were performed in order to validate the MR patient to template registration process, based on anatomical landmarks and clinical scores (i.e., Unified Parkinson's disease rating Scale). Visualisation software was developed for displaying into the template images the stimulated contacts represented as cylinders with a colour code related to the improvement of the UPDRS. Results The automatic contact localization algorithm was successful for all the patients. Validation studies for the registration process gave a placement error of 1.4 +/- 0.2 mm and coherence with UPDRS scores. Conclusion The developed visualization tool allows post-operative assessment for previous interventions. Correlation with additional clinical scores will certainly permit to learn more about DBS and to better understand clinical side-effects.

  18. Deep brain stimulation for psychiatric diseases: what are the risks?

    PubMed

    Saleh, Christian; Fontaine, Denys

    2015-05-01

    Despite the application of deep brain stimulation (DBS) as an efficient treatment modality for psychiatric disorders, such as obsessive-compulsive disorder (OCD), Gilles de la Tourette Syndrome (GTS), and treatment refractory major depression (TRD), few patients are operated or included in clinical trials, often for fear of the potential risks of an approach deemed too dangerous. To assess the surgical risks, we conducted an analysis of publications on DBS for psychiatric disorders. A PubMed search was conducted on reports on DBS for OCD, GTS, and TRD. Forty-nine articles were included. Only reports on complications related to DBS were selected and analyzed. Two hundred seventy-two patients with a mean follow-up of 22 months were included in our analysis. Surgical mortality was nil. The overall mortality was 1.1 %: two suicides were unrelated to DBS and one death was reported to be unlikely due to DBS. The majority of complications were transient and related to stimulation. Long-term morbidity occurred in 16.5 % of cases. Three patients had permanent neurological complications due to intracerebral hemorrhage (2.2 %). Complications reported in DBS for psychiatric diseases appear to be similar to those reported for DBS in movement disorders. But class I evidence is lacking. Our analysis was based mainly on small non-randomized studies. A significant number of patients (approximately 150 patients) who were treated with DBS for psychiatric diseases had to be excluded from our analysis as no data on complications was available. The exact prevalence of complications of DBS in psychiatric diseases could not be established. DBS for psychiatric diseases is promising, but remains an experimental technique in need of further evaluation. A close surveillance of patients undergoing DBS for psychiatric diseases is mandatory. PMID:25795265

  19. Brittle Dyskinesia Following STN but not GPi Deep Brain Stimulation

    PubMed Central

    Sriram, Ashok; Foote, Kelly D.; Oyama, Genko; Kwak, Joshua; Zeilman, Pam R.; Okun, Michael S.

    2014-01-01

    Background The aim was to describe the prevalence and characteristics of difficult to manage dyskinesia associated with subthalamic nucleus (STN) deep brain stimulation (DBS). A small subset of STN DBS patients experience troublesome dyskinesia despite optimal programming and medication adjustments. This group of patients has been referred to by some practitioners as brittle STN DBS-induced dyskinesia, drawing on comparisons with brittle diabetics experiencing severe blood sugar regulation issues and on a single description by McLellan in 1982. We sought to describe, and also to investigate how often the “brittle” phenomenon occurs in a relatively large DBS practice. Methods An Institutional Review Board-approved patient database was reviewed, and all STN and globus pallidus internus (GPi) DBS patients who had surgery at the University of Florida from July 2002 to July 2012 were extracted for analysis. Results There were 179 total STN DBS patients and, of those, four STN DBS (2.2%) cases were identified as having dyskinesia that could not be managed without the induction of an “off state,” or by the precipitation of a severe dyskinesia despite vigorous stimulation and medication adjustments. Of 75 GPi DBS cases reviewed, none (0%) was identified as having brittle dyskinesia. One STN DBS patient was successfully rescued by bilateral GPi DBS. Discussion Understanding the potential risk factors for postoperative troublesome and brittle dyskinesia may have an impact on the initial surgical target selection (STN vs. GPI) in DBS therapy. Rescue GPi DBS therapy may be a viable treatment option, though more cases will be required to verify this observation. PMID:24932426

  20. Deep Brain Stimulation of Caudal Zona Incerta and Subthalamic Nucleus in Patients with Parkinson's Disease: Effects on Voice Intensity

    PubMed Central

    Lundgren, Sofie; Saeys, Thomas; Karlsson, Fredrik; Olofsson, Katarina; Blomstedt, Patric; Linder, Jan; Nordh, Erik; Zafar, Hamayun; van Doorn, Jan

    2011-01-01

    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. PMID:22028987

  1. The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model

    PubMed Central

    de Haan, Sanneke; Rietveld, Erik; Stokhof, Martin; Denys, Damiaan

    2013-01-01

    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

  2. The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model.

    PubMed

    de Haan, Sanneke; Rietveld, Erik; Stokhof, Martin; Denys, Damiaan

    2013-01-01

    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

  3. Probing the human brain with stimulating electrodes: the story of Roberts Bartholow's (1874) experiment on Mary Rafferty.

    PubMed

    Harris, Lauren Julius; Almerigi, Jason B

    2009-06-01

    Roberts Bartholow's 1874 experiment on Mary Rafferty is widely cited as the first demonstration, by direct application of stimulating electrodes, 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

  4. Modulating Endogenous Electric Currents in Human Corneal Wounds—A Novel Approach of Bioelectric Stimulation Without Electrodes

    PubMed Central

    Reid, Brian; Graue-Hernandez, Enrique O.; Mannis, Mark J.; Zhao, Min

    2011-01-01

    Purpose To measure electric current in human corneal wounds and test the feasibility of pharmacologically enhancing the current to promote corneal wound healing. Methods Using a noninvasive vibrating probe, corneal electric current was measured before and after wounding of the epithelium of donated postmortem human corneas. The effects of drug aminophylline and chloride-free solution on wound current were also tested. Results Unwounded cornea had small outward currents (0.07 ?A/cm2). Wounding increased the current more than 5 fold (0.41 ?A/cm2). Monitoring the wound current over time showed that it seemed to be actively regulated and maintained above normal unwounded levels for at least 6 hours. The time course was similar to that previously measured in rat cornea. Drug treatment or chloride-free solution more than doubled the size of wound currents. Conclusions Electric current at human corneal wounds can be significantly increased with aminophylline or chloride-free solution. Because corneal wound current directly correlates with wound healing rate, our results suggest a role for chloride-free and/or aminophylline eyedrops to enhance healing of damaged cornea in patients with reduced wound healing such as the elderly or diabetic patient. This novel approach offers bioelectric stimulation without electrodes and can be readily tested in patients. PMID:21099404

  5. Electrical engram: how deep brain stimulation affects memory.

    PubMed

    Lee, Hweeling; Fell, Jürgen; Axmacher, Nikolai

    2013-11-01

    Deep brain stimulation (DBS) is a surgical procedure involving implantation of a pacemaker that sends electric impulses to specific brain regions. DBS has been applied in patients with Parkinson's disease, depression, and obsessive-compulsive disorder (among others), and more recently in patients with Alzheimer's disease to improve memory functions. Current DBS approaches are based on the concept that high-frequency stimulation inhibits or excites specific brain regions. However, because DBS entails the application of repetitive electrical stimuli, it primarily exerts an effect on extracellular field-potential oscillations similar to those recorded with electroencephalography. Here, we suggest a new perspective on how DBS may ameliorate memory dysfunction: it may enhance normal electrophysiological patterns underlying long-term memory processes within the medial temporal lobe. PMID:24126128

  6. Role of adenosine in the antiepileptic effects of deep brain stimulation

    PubMed Central

    Miranda, Maisa F.; Hamani, Clement; de Almeida, Antônio-Carlos G.; Amorim, Beatriz O.; Macedo, Carlos E.; Fernandes, Maria José S.; Nobrega, José N.; Aarão, Mayra C.; Madureira, Ana Paula; Rodrigues, Antônio M.; Andersen, Monica L.; Tufik, Sergio; Mello, Luiz E.; Covolan, Luciene

    2014-01-01

    Despite the effectiveness of anterior thalamic nucleus (AN) deep brain stimulation (DBS) for the treatment of epilepsy, mechanisms responsible for the antiepileptic effects of this therapy remain elusive. As adenosine modulates neuronal excitability and seizure activity in animal models, we hypothesized that this nucleoside could be one of the substrates involved in the effects of AN DBS. We applied 5 days of stimulation to rats rendered chronically epileptic by pilocarpine injections and recorded epileptiform activity in hippocampal slices. We found that slices from animals given DBS had reduced hippocampal excitability and were less susceptible to develop ictal activity. In live animals, AN DBS significantly increased adenosine levels in the hippocampus as measured by microdialysis. The reduced excitability of DBS in vitro was completely abolished in animals pre-treated with A1 receptor antagonists and was strongly potentiated by A1 receptor agonists. We conclude that some of the antiepileptic effects of DBS may be mediated by adenosine. PMID:25324724

  7. Role of adenosine in the antiepileptic effects of deep brain stimulation.

    PubMed

    Miranda, Maisa F; Hamani, Clement; de Almeida, Antônio-Carlos G; Amorim, Beatriz O; Macedo, Carlos E; Fernandes, Maria José S; Nobrega, José N; Aarão, Mayra C; Madureira, Ana Paula; Rodrigues, Antônio M; Andersen, Monica L; Tufik, Sergio; Mello, Luiz E; Covolan, Luciene

    2014-01-01

    Despite the effectiveness of anterior thalamic nucleus (AN) deep brain stimulation (DBS) for the treatment of epilepsy, mechanisms responsible for the antiepileptic effects of this therapy remain elusive. As adenosine modulates neuronal excitability and seizure activity in animal models, we hypothesized that this nucleoside could be one of the substrates involved in the effects of AN DBS. We applied 5 days of stimulation to rats rendered chronically epileptic by pilocarpine injections and recorded epileptiform activity in hippocampal slices. We found that slices from animals given DBS had reduced hippocampal excitability and were less susceptible to develop ictal activity. In live animals, AN DBS significantly increased adenosine levels in the hippocampus as measured by microdialysis. The reduced excitability of DBS in vitro was completely abolished in animals pre-treated with A1 receptor antagonists and was strongly potentiated by A1 receptor agonists. We conclude that some of the antiepileptic effects of DBS may be mediated by adenosine. PMID:25324724

  8. Reduction of thalamic tremor with deep brain stimulation performed for post stroke chronic central pain.

    PubMed

    Papu?, Ewa; Obsza?ska, Katarzyna; Trojanowski, Tomasz; Szczepa?ska-Szerej, Hanna; Rejdak, Konrad; Stelmasiak, Zbigniew

    2013-01-01

    Deep brain stimulation (DBS) of the sensory thalamus and the periventricular/ peri-aqueductal grey area complex may be applied for the treatment of intractable neuropathic pain syndrome. The presented study concerns a patient who experienced ischemic stroke within the posterolateral part of the left hypothalamus, with subsequent severe burning pain localized in the right upper limb, predominantly within the hand, and thalamic tremor which occurred 4 months after the stroke. After 2 years of ineffective pain treatment, the patient was offered implantation of electrodes to the periventricular grey matter (PVG)/periaqueductal grey matter (PAG), as well as implantation of an electrode to the ventroposterolateral thalamic nucleus (VPL). Soon after starting simultaneous PAG/PVG and PVL stimulation, significant alleviation of the patient's thalamic tremor in the hand was observed, which persisted over subsequent months. The presented study discusses possible mechanism underlying tremor suppression in the patient concerned, probably at the level of the cerebellar outflow pathways. The study highlights the fact that DBS provide more insight into the functional anatomy of the thalamus, which used to be available only from animal studies. PMID:25000841

  9. High frequency stimulation abolishes thalamic network oscillations: an electrophysiological and computational analysis

    NASA Astrophysics Data System (ADS)

    Lee, Kendall H.; Hitti, Frederick L.; Chang, Su-Youne; Lee, Dongchul C.; Roberts, David W.; McIntyre, Cameron C.; Leiter, James C.

    2011-08-01

    Deep brain stimulation (DBS) of the thalamus has been demonstrated to be effective for the treatment of epilepsy. To investigate the mechanism of action of thalamic DBS, we examined the effects of high frequency stimulation (HFS) on spindle oscillations in thalamic brain slices from ferrets. We recorded intracellular and extracellular electrophysiological activity in the nucleus reticularis thalami (nRt) and in thalamocortical relay (TC) neurons in the lateral geniculate nucleus, stimulated the slice using a concentric bipolar electrode, and recorded the level of glutamate within the slice. HFS (100 Hz) of TC neurons generated excitatory post-synaptic potentials, increased the number of action potentials in both TC and nRt neurons, reduced the input resistance, increased the extracellular glutamate concentration, and abolished spindle wave oscillations. HFS of the nRt also suppressed spindle oscillations. In both locations, HFS was associated with significant and persistent elevation in extracellular glutamate levels and suppressed spindle oscillations for many seconds after the cessation of stimulation. We simulated HFS within a computational model of the thalamic network, and HFS also disrupted spindle wave activity, but the suppression of spindle activity was short-lived. Simulated HFS disrupted spindle activity for prolonged periods of time only after glutamate release and glutamate-mediated activation of a hyperpolarization-activated current (Ih) was incorporated into the model. Our results suggest that the mechanism of action of thalamic DBS as used in epilepsy may involve the prolonged release of glutamate, which in turn modulates specific ion channels such as Ih, decreases neuronal input resistance, and abolishes thalamic network oscillatory activity.

  10. Adaptive control of deep brain stimulator for essential tremor: entropy-based tremor prediction using surface-EMG.

    PubMed

    Basu, Ishita; Tuninetti, Daniela; Graupe, Daniel; Slavin, Konstantin V

    2011-01-01

    Entropy, as a measure of randomness in time-varying signals, is widely used in areas such as thermodynamics, statistical mechanics and information theory. This paper investigates the use of two commonly employed entropy measures, namely Wavelet Entropy and Approximate Entropy, as a predictor of tremor reappearance in Essential Tremor patients; the predictor input is a raw surface-electromyographic (sEMG) signal measured from tremor affected muscles of patients implanted with a Deep Brain Stimulator (DBS). A combination of both types of entropy measure is shown to successfully predict the occurrence of tremor few seconds before its visual manifestation. This result can potentially lead to a novel sEMG-based adaptive on-off DBS controller that can be added on to existing open-loop DBS systems with minimal changes; an adaptive DBS system provides stimulation only when needed thereby reducing the risk of brain over stimulation, delaying DBS intolerance and prolonging DBS battery life. PMID:22256125

  11. Model-based analysis and design of nerve cuff electrodes for restoring bladder function by selective stimulation of the pudendal nerve

    NASA Astrophysics Data System (ADS)

    Kent, Alexander R.; Grill, Warren M.

    2013-06-01

    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.

  12. Steady or not following thalamic deep brain stimulation for essential tremor

    Microsoft Academic Search

    Nelson Hwynn; Christopher J. Hass; Pamela Zeilman; Janet Romrell; Yunfeng Dai; Sam S. Wu; Kelly D. Foote; S. H. Subramony; Genko Oyama; Frances Velez-Lago; Hubert H. Fernandez; Andrew S. Resnick; Irene A. Malaty; Michael S. Okun

    Deep brain stimulation (DBS) has become an important option for medication-refractory essential tremor (ET), but may contribute\\u000a to worsened gait and falling. This study evaluates impaired gait in a cohort of patients treated with DBS with a retrospective\\u000a review of ET patients before and after DBS implantation. Factors examined included: age, duration of symptoms, pre-morbid\\u000a gait difficulties\\/falls, Fahn-Tolosa-Marin tremorrating scale

  13. Regulation of vesicle transport and cell motility by Golgi-localized Dbs.

    PubMed

    Fitzpatrick, Ethan R; Hu, Tinghui; Ciccarelli, Bryan T; Whitehead, Ian P

    2014-01-01

    DBS/MCF2L has been recently identified as a risk locus for osteoarthritis. It encodes a guanine nucleotide exchange factor (Dbs) that has been shown to regulate both normal and tumor cell motility. In the current study, we have determined that endogenous Dbs is predominantly expressed as 2 isoforms, a 130 kDa form (Dbs-130) that is localized to the Golgi complex, and an 80 kDa form (Dbs-80) that is localized to the endoplasmic reticulum (ER). We have previously described an inhibitor that binds to the RhoGEF domain of Dbs and blocks its transforming activity. Here we show that the inhibitor localizes to the Golgi, where it specifically interacts with Dbs-130. Inhibition of endogenous Dbs-130 activity is associated with reduced levels of activated Cdc42, enlarged Golgi, and resistance to Brefeldin A-mediated Golgi dispersal, suggesting a role for Dbs in vesicle transport. Cells treated with the inhibitor exhibit normal protein transport from the ER to the Golgi, but are defective in transport from the Golgi to the plasma membrane. Inhibition of Dbs-130 in MDA-MB-231 human breast tumor cells limits motility in both transwell and wound healing assays, but appears to have no effect on the organization of the microtubule cytoskeleton. The reduced motility is associated with a failure to reorient the Golgi toward the leading edge. This is consistent with the Golgi localization, and suggests that the Dbs-130 regulates aspects of the secretory pathway that are required to support cell polarization during directed migration. PMID:25483302

  14. Disparities in deep brain stimulation surgery among insured elders with Parkinson disease

    PubMed Central

    Schootman, Mario; Kung, Nathan; Wang, Xiao-Yu; Perlmutter, Joel S.; Racette, Brad A.

    2014-01-01

    Objective: To identify sociodemographic, clinical, and physician/practice factors associated with deep brain stimulation (DBS). DBS is a proven surgical therapy for Parkinson disease (PD), but is recommended only for patients with excellent health, results in significant out-of-pocket costs, and requires substantial physician involvement. Methods: Retrospective cohort study of more than 657,000 Medicare beneficiaries with PD. Multivariable logistic regression models examined the association between demographic, clinical, socioeconomic status (SES), and physician/practice factors, and DBS therapy. Results: There were significant disparities in the use of DBS therapy among Medicare beneficiaries with PD. The greatest disparities were associated with race: black (adjusted odds ratio [AOR] 0.20, 95% confidence interval [CI] 0.16–0.25) and Asian (AOR 0.55, 95% CI 0.44–0.70) beneficiaries were considerably less likely to receive DBS than white beneficiaries. Women (AOR 0.79, 95% CI 0.75–0.83) also had lower odds of receiving DBS compared with men. Eighteen percent of procedures were performed on patients with PD who had cognitive impairment/dementia, a reported contraindication to DBS. Beneficiaries treated in minority-serving PD practices were less likely to receive DBS, regardless of individual race (AOR 0.76, 95% CI 0.66–0.87). Even after adjustment for demographic and clinical covariates, high neighborhood SES was associated with 1.4-fold higher odds of receiving DBS (AOR 1.42, 95% CI 1.33–1.53). Conclusions: Among elderly Medicare beneficiaries with PD, race, sex, and neighborhood SES are strong independent predictors of DBS receipt. Racial disparities are amplified when adjusting for physician/clinic characteristics. Future investigations of the demographic differences in clinical need/usefulness of DBS, ease of DBS attainment, and actual/opportunity DBS costs are needed to inform policies to reduce DBS disparities and improve PD quality of care. PMID:24336138

  15. Optimizing deep brain stimulation settings using wearable sensing technology

    E-print Network

    Patel, Shyamal

    Parkinson's disease is a neurodegenerative movement disorder resulting in rigidity, bradykinesia (slowness), tremor and gait disorder. Deep brain stimulation (DBS) of the subthalamic nucleus has been shown to be effective ...

  16. Effects of amygdala-hippocampal stimulation on interictal epileptic discharges.

    PubMed

    Tyrand, R; Seeck, M; Spinelli, L; Pralong, E; Vulliémoz, S; Foletti, G; Rossetti, A O; Allali, G; Lantz, G; Pollo, C; Boëx, C

    2012-03-01

    Deep brain stimulation (DBS) of different nuclei is being evaluated as a treatment for epilepsy. While encouraging results have been reported, the effects of changes in stimulation parameters have been poorly studied. Here the effects of changes of pulse waveform in high frequency DBS (130 Hz) of the amygdala-hippocampal complex (AH) are presented. These effects were studied on interictal epileptic discharge rates (IEDRs). AH-DBS was implemented with biphasic versus pseudo monophasic charge balanced pulses, in two groups of patients: six with temporal lobe epilepsy (TLE) associated with hippocampal sclerosis (HS) and six with non lesional (NLES) temporal epilepsy. In patients with HS, IEDRs were significantly reduced with AH-DBS applied with biphasic pulses in comparison with monophasic pulse. IEDRs were significantly reduced in only two patients with NLES independently to stimulus waveform. Comparison to long-term seizure outcome suggests that IEDRs could be used as a neurophysiological marker of chronic AH-DBS and they suggest that the waveform of the electrical stimuli can play a major role in DBS. We concluded that biphasic stimuli are more efficient than pseudo monophasic pulses in AH-DBS in patients with HS. In patients with NLES epilepsy, other parameters relevant for efficacy of DBS remain to be determined. PMID:22079883

  17. Verbal fluency in patients receiving bilateral versus left-sided deep brain stimulation of the subthalamic nucleus for Parkinson's disease.

    PubMed

    Sjöberg, Rickard L; Lidman, Elin; Häggström, Björn; Hariz, Marwan I; Linder, Jan; Fredricks, Anna; Blomstedt, Patric

    2012-05-01

    The purpose of this study was to investigate the relative effects of unilateral (left-sided) versus bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on verbal fluency. To do this, 10 Parkinson's disease patients with predominantly bilateral motor symptoms who received bilateral STN DBS were compared with 6 patients suffering from predominantly unilateral symptoms who received STN DBS on the left side only. The results suggest that unilateral STN DBS of the speech dominant hemisphere is associated with significantly less declines in measures of verbal fluency as compared to bilateral stimulation. PMID:22264411

  18. Focused current density imaging using internal electrode in magnetic resonance electrical impedance tomography (MREIT).

    PubMed

    Jeong, Woo Chul; Sajib, Saurav; Kim, Hyung Joong; Kwon, Oh In

    2014-07-01

    Magnetic resonance electrical impedance tomography (MREIT) is an imaging modality capable of visualizing cross-sectional current density and/or conductivity distributions inside an electrically conducting object. It uses an MRI scanner to measure one component of the magnetic flux density induced by an externally injected current through a pair of surface electrodes. For the cases of deep brain stimulation (DBS), electroporation, and radio frequency (RF) ablation, internal electrodes can be used to improve the quality of the MREIT images. In this paper, we propose a new MREIT imaging method using internal electrodes to visualize a current density distribution within a local region around them. To evaluate its performance, we conducted and analyzed a series of numerical simulations and phantom imaging experiments. We compared the reconstructed current density images using the internal electrodes with the obtained using only the external electrodes. We found that the proposed method using the internal electrodes stably determines the current density in the focused region with better accuracy. PMID:24956612

  19. Exploiting commercial DBS technologies to provide a military Global Broadcast Service (GBS)

    Microsoft Academic Search

    T. Ellington; R. Barker

    1996-01-01

    The technical innovations and high power satellites incorporated in commercial direct broadcast service (DBS) systems provide the technology basis for the implementation of a military Global Broadcast Service (GBS). The major DBS systems in the US (PRIMESTAR, DirecTV, USSB, ECHOSTAR) use packet-based digital data streams for the delivery of tailored broadcast “video” information into very small antennas located at distributed

  20. Electrical stimulation of the lateral habenula produces an inhibitory effect on sucrose self-administration

    PubMed Central

    Friedman, Alexander; Lax, Elad; Dikshtein, Yahav; Abraham, Lital; Flaumenhaft, Yakov; Sudai, Einav; Ben-Tzion, Moshe; Yadid, Gal

    2011-01-01

    The lateral habenula (LHb) plays a role in prediction of negative reinforcement, punishment and aversive responses. In the current study, we examined the role that the LHb plays in the regulation of negative reward responses and aversion. First, we tested the effect of intervention in LHb activity on sucrose reinforcing behavior. An electrode was implanted into the LHb and rats were trained to self-administer sucrose (20%; 16 days) until at least three days of stable performance were achieved (as represented by the number of active lever presses in self-administration cages). Rats subsequently received deep brain stimulation (DBS) of the LHb, which significantly reduced sucrose self-administration levels. In contrast, lesion of the LHb increased sucrose-seeking behavior, as demonstrated by a delayed extinction response to substitution of sucrose with water. Furthermore, in a modified non-rewarding conditioned-place-preference paradigm, DBS of the LHb led to aversion to the context associated with stimulation of this brain region. We postulate that electrical stimulation of the LHb attenuates positive reward-associated reinforcement by natural substances. PMID:20955718

  1. Magnetic resonance imaging safety of deep brain stimulator devices.

    PubMed

    Oluigbo, Chima O; Rezai, Ali R

    2013-01-01

    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

  2. Network Perspectives on the Mechanisms of Deep Brain Stimulation

    PubMed Central

    McIntyre, Cameron C.; Hahn, Philip J.

    2009-01-01

    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. PMID:19804831

  3. Subthalamic Nucleus Deep Brain Stimulation Changes Velopharyngeal Control in Parkinson's Disease

    ERIC Educational Resources Information Center

    Hammer, Michael J.; Barlow, Steven M.; Lyons, Kelly E.; Pahwa, Rajesh

    2011-01-01

    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…

  4. Brain Shift during Deep Brain Stimulation Surgery for Parkinson’s Disease

    Microsoft Academic Search

    Casey H. Halpern; Shabbar F. Danish; Gordon H. Baltuch; Jurg L. Jaggi

    2008-01-01

    Background: Brain shift may occur during deep brain stimulation (DBS) surgery, which may affect the position of subcortical structures, compromising target localization. Methods: We retrospectively evaluated pre- and postoperative magnetic resonance imaging in 50 Parkinson’s disease patients who underwent bilateral subthalamic nucleus (STN) DBS. Patients were separated into two groups: group A – those with <2 mm cortical displacement (66

  5. Three-Year Outcomes in Deep Brain Stimulation for Highly Resistant Obsessive–Compulsive Disorder

    Microsoft Academic Search

    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

    2006-01-01

    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

  6. Progressive brain metabolic changes under deep brain stimulation of subthalamic nucleus in parkinsonian rats.

    PubMed

    Melon, Christophe; Chassain, Carine; Bielicki, Guy; Renou, Jean-Pierre; Kerkerian-Le Goff, Lydia; Salin, Pascal; Durif, Franck

    2015-03-01

    Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an efficient neurosurgical treatment for advanced Parkinson's disease. Non-invasive metabolic neuroimaging during the course of DBS in animal models may contribute to our understanding of its action mechanisms. Here, DBS was adapted to in vivo proton magnetic resonance spectroscopy at 11.7 T in the rat to follow metabolic changes in main basal ganglia structures, the striatum, and the substantia nigra pars reticulata (SNr). Measurements were repeated OFF and ON acute and subchronic (7 days) STN-DBS in control and parkinsonian (6-hydroxydopamine lesion) conditions. Acute DBS reversed the increases in glutamate, glutamine, and GABA levels induced by the dopamine lesion in the striatum but not in the SNr. Subchronic DBS normalized GABA in both the striatum and SNr, and glutamate in the striatum. Taurine levels were markedly decreased under subchronic DBS in the striatum and SNr in both lesioned and unlesioned rats. Microdialysis in the striatum further showed that extracellular taurine was increased. These data reveal that STN-DBS has duration-dependent metabolic effects in the basal ganglia, consistent with development of adaptive mechanisms. In addition to counteracting defects induced by the dopamine lesion, prolonged DBS has proper effects independent of the pathological condition. Non-invasive metabolic neuroimaging might be useful to understand the physiological mechanisms of deep brain stimulation (DBS). Here, we demonstrate the feasibility of repeated high-field proton magnetic resonance spectroscopy of basal ganglia structures under subthalamic nucleus DBS in control and parkinsonian rats. Results show that DBS has both rapid and delayed effects either dependent or independent of disease state. PMID:25533782

  7. Modulation of stimulation frequency of spinal cord afferents with unchanged intensity and electrode site can induce a variety of movements

    Microsoft Academic Search

    Winfried Mayr; Christian Hofer; Karen Minassian; Ursula Hofstötter; Helmut Kern; Manfred Bijak; Ewald Unger; Frank Rattay; Milan Dimitrijevic

    \\u000a In this report we shall review the finding that selective stimulation of tibial nerve large afferents and selective stimulation\\u000a of lumbar sacral afferents to the spinal cord can elicit modification of motor output only by changing of the rate of the\\u000a train of stimuli without changing the stimulus strength or site of stimulation. After a brief description of the applied

  8. Dynamic Stereotypic Responses of Basal Ganglia Neurons to Subthalamic Nucleus High-Frequency Stimulation in the Parkinsonian Primate

    PubMed Central

    Moran, Anan; Stein, Edward; Tischler, Hadass; Belelovsky, Katya; Bar-Gad, Izhar

    2011-01-01

    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. PMID:21559345

  9. No Impact of Deep Brain Stimulation on Fear-Potentiated Startle in Obsessive–Compulsive Disorder

    PubMed Central

    Baas, Johanna M. P.; Klumpers, Floris; Mantione, Mariska H.; Figee, Martijn; Vulink, Nienke C.; Schuurman, P. Richard; Mazaheri, Ali; Denys, Damiaan

    2014-01-01

    Deep brain stimulation (DBS) of the ventral internal capsule is effective in treating therapy refractory obsessive–compulsive disorder (OCD). Given the close proximity of the stimulation site to the stria terminalis (BNST), we hypothesized that the striking decrease in anxiety symptoms following DBS could be the result of the modulation of contextual anxiety. However, the effect of DBS in this region on contextual anxiety is as of yet unknown. Thus, the current study investigated the effect of DBS on contextual anxiety in an experimental threat of shock paradigm. Eight patients with DBS treatment for severe OCD were tested in a double-blind crossover design with randomly assigned 2-week periods of active and sham stimulation. DBS resulted in significant decrease of obsessive–compulsive symptoms, anxiety, and depression. However, even though the threat manipulation resulted in a clear context-potentiated startle effect, none of the parameters derived from the startle recordings was modulated by the DBS. This suggests that DBS in the ventral internal capsule is effective in treating anxiety symptoms of OCD without modulating the startle circuitry. We hypothesize that the anxiety symptoms present in OCD are likely distinct from the pathological brain circuits in defensive states of other anxiety disorders. PMID:25249953

  10. March 23, 2008 Databases: Intro. to DBs 1 Introduction to Databases

    E-print Network

    Adam, Salah

    : Intro. to DBs 2 Objectives Data + Managing Data + Database + Database Management System + Characteristics of database approach + Database Management System (DBMS) + Advantages of Using DBMS + Workers program defines and manages its own data. Database approach: An approach that data is collected

  11. Determination of trace amount of oxalic acid with zirconium(IV)–(DBS-arsenazo) by spectrophotometry

    Microsoft Academic Search

    Qing-Zhou Zhai

    2008-01-01

    A novel method is proposed for the determination of trace amount of oxalic acid in the present article. In 1.0M hydrochloric acid medium, oxalic acid can react with the zirconium(IV) in Zr(IV)–(DBS-arsenazo) complex and replaces the DBS-arsenazo to produce a hyperchromic effect at 520nm. The hyperchromic degree is proportional to the concentration of the oxalic acid added over a defined

  12. Perceived articulatory precision in patients with Parkinson's disease after deep brain stimulation of subthalamic nucleus and caudal zona incerta.

    PubMed

    Eklund, Elisabeth; Qvist, Johanna; Sandström, Lena; Viklund, Fanny; Van Doorn, Jan; Karlsson, Fredrik

    2015-02-01

    The effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and caudal zona incerta (cZi) on speech articulation in patients with Parkinson's disease (PD) was investigated. Read speech samples were collected from nine patients with STN-DBS and 10 with cZi-DBS. The recordings were made pre-operatively and 12 months post-operatively with stimulator on and off (on medication). Blinded, randomised, repeated perceptual assessments were performed on words and isolated fricatives extracted from the recordings to assess (1) overall articulatory quality ratings, (2) frequency of occurrence of misarticulation patterns and (3) fricative production. Statistically significant worsening of articulatory measures on- compared with off-stimulation occurred in the cZi-DBS group, with deteriorated articulatory precision ratings, increased presence of misarticulations (predominately altered realisations of plosives and fricatives) and a reduced accuracy in fricative production. A similar, but not significant, trend was found for the STN-DBS group. PMID:25333411

  13. Effects of different stimulation parameters on the antidepressant-like response of medial prefrontal cortex deep brain stimulation in rats

    Microsoft Academic Search

    Clement Hamani; Mustansir Diwan; Silvia Isabella; Andres M. Lozano; José N. Nobrega

    2010-01-01

    Subcallosal cingulate gyrus (SCG) deep brain stimulation (DBS) is currently being investigated as a treatment for major depression. Despite the encouraging findings of the initial clinical series, several questions remain unanswered, including the most effective stimulation parameters (i.e., current intensity and frequency) and whether unilateral stimulation is also beneficial. We have recently found that some of the effects of SCG

  14. Treatment of Wilson's disease motor complications with deep brain stimulation.

    PubMed

    Hedera, Peter

    2014-05-01

    A considerable proportion of patients with Wilson's disease (WD) experience neurologic symptoms that are functionally disabling. The most common neurologic problems in advanced WD include dystonia and tremor. Medically refractory idiopathic dystonia and essential tremor (ET) have been successfully treated with deep brain stimulation (DBS), functional surgical therapy targeting the globus pallidus pars interna (GPi), or the ventral intermediate (Vim) thalamic nucleus. Even though the pathophysiology of tremor is different in WD and ET, available experience supports DBS targeting the Vim for WD patients. Dystonia associated with WD is classified as secondary dystonia and GPi stimulation has yielded mixed results in these patients. The presence of structural changes in the basal ganglia may limit the therapeutic success of DBS for WD dystonia compared with idiopathic dystonia. In spite of these limitations, DBS in WD may be an effective approach to treat medically refractory residual neurologic symptoms in carefully selected patients. PMID:24547944

  15. Deep brain stimulation of the nucleus accumbens shell increases impulsive behavior and tissue levels of dopamine and serotonin

    Microsoft Academic Search

    Thibaut Sesia; Vincent Bulthuis; Sonny Tan; Lee Wei Lim; Rinske Vlamings; Arjan Blokland; Harry W. M. Steinbusch; Trevor Sharp; Veerle Visser-Vandewalle; Yasin Temel

    2010-01-01

    The nucleus accumbens (NAc) is gaining interest as a target for deep brain stimulation (DBS) in refractory neuropsychiatric disorders with impulsivity as core symptom. The nucleus accumbens is composed of two subterritories, core and shell, which have different anatomical connections. In animal models, it has been shown that DBS of the NAc changes impulsive action. Here, we tested the hypothesis

  16. Pitch Variability in Patients with Parkinson's Disease: Effects of Deep Brain Stimulation of Caudal Zona Incerta and Subthalamic Nucleus

    ERIC Educational Resources Information Center

    Karlsson, Fredrik; Olofsson, Katarina; Blomstedt, Patric; Linder, Jan; van Doorn, Jan

    2013-01-01

    Purpose: The purpose of the present study was to examine the effect of deep brain stimulation (DBS) of the subthalamic nucleus (STN) and the caudal zona incerta (cZi) pitch characteristics of connected speech in patients with Parkinson's disease (PD). Method: The authors evaluated 16 patients preoperatively and 12 months after DBS surgery. Eight…

  17. Subthalamic Nucleus Stimulation Modulates Thalamic Neuronal Activity

    PubMed Central

    Xu, Weidong; Russo, Gary S.; Hashimoto, Takao; Zhang, Jianyu; Vitek, Jerrold L.

    2009-01-01

    Deep brain stimulation (DBS) in the subthalamic nucleus (STN) is an effective tool for the treatment of advanced Parkinson’s disease. The mechanism by which STN DBS elicits its beneficial effect, however, remains unclear. We previously reported STN stimulation increased the rate and produced a more regular and periodic pattern of neuronal activity in the internal segment of the globus pallidus (GPi). Here we extend our observations to neurons in the pallidal (ventralis lateralis pars oralis (VLo) and ventralis anterior (VA)) and cerebellar (ventralis lateralis posterior pars oralis (VPLo)) receiving areas of the motor thalamus during STN DBS. Stimulation parameters that produced improvement in rigidity and bradykinesia resulted in changes in the pattern and power of oscillatory activity of neuronal activity that were similar in both regions of the motor thalamus. Neurons in both VA/VLo and VPLo tended to become more periodic and regular with a shift in oscillatory activity from low to high frequencies. Burst activity was reduced in VA/VLo, but was not significantly changed in VPLo. There was also a significant shift in the population of VA/VLo neurons that were inhibited during STN DBS, while VPLo neurons tended to be activated. These data are consistent with the hypothesis that STN DBS increases output from the nucleus and produces a change in the pattern and periodicity of neuronal activity in the basal ganglia thalamic network, and that these changes include cerebellar pathways likely via activation of adjacent cerebello-thalamic fiber bundles. PMID:19005057

  18. Antibiotic impregnated catheter coverage of deep brain stimulation leads facilitates lead preservation after hardware infection.

    PubMed

    Dlouhy, Brian J; Reddy, Ambur; Dahdaleh, Nader S; Greenlee, Jeremy D W

    2012-10-01

    Deep brain stimulation (DBS) has become a reliable and effective treatment for many disorders. However, the risk of long-term hardware-related complications is notable, and most concerning is hardware-related infections. Given the risk of hardware removal in the setting of infection, we retrospectively examined the implementation of a novel technique using antibiotic covered catheter protection of DBS leads after infection. The effect on hardware salvage and ease of reimplantation of the DBS extension and implantable pulse generator (IPG) was examined. A total of nine (9%) out of 100 DBS patients met the inclusion criteria with 11 DBS hardware-related infections at either the frontal, parietal, or IPG sites, from June 2003 to November 2010, at our institution. Subsequent to the initial patient in the series, a total of eight patients had placement of a short segment (approx. 4 cm long) of antibiotic impregnated catheter (Bactiseal, Codman, Johnson & Johnson, Raynham, MA, USA) over the distal end of the DBS leads at the parietal incision. Seven of these eight patients presented with pus and deep tissue infections around the hardware at either the frontal, parietal, or chest incisions. In seven of these eight patients (87.5%) we were able to protect and salvage their DBS leads without need for removal. In conclusion, this novel technique provides a simple reimplantation operation, with a decreased risk of DBS lead damage. It may improve the preservation of DBS leads when hardware infection occurs, is inexpensive, and confers no additional risks to patients. PMID:22854128

  19. Moving Forward: Advances in the Treatment of Movement Disorders with Deep Brain Stimulation

    PubMed Central

    Schiefer, Terry K.; Matsumoto, Joseph Y.; Lee, Kendall H.

    2011-01-01

    The modern era of stereotactic and functional neurosurgery has ushered in state of the art technologies for the treatment of movement disorders, particularly Parkinson’s disease (PD), tremor, and dystonia. After years of experience with various surgical therapies, the eventual shortcomings of both medical and surgical treatments, and several serendipitous discoveries, deep brain stimulation (DBS) has risen to the forefront as a highly effective, safe, and reversible treatment for these conditions. Idiopathic advanced PD can be treated with thalamic, globus pallidus internus (GPi), or subthalamic nucleus (STN) DBS. Thalamic DBS primarily relieves tremor while GPi and STN DBS alleviate a wide range of Parkinsonian symptoms. Thalamic DBS is also used in the treatment of other types of tremor, particularly essential tremor, with excellent results. Both primary and various types of secondary dystonia can be treated very effectively with GPi DBS. The variety of anatomical targets for these movement disorders is indicative of the network-level dysfunction mediating these movement disturbances. Despite an increasing understanding of the clinical benefits of DBS, little is known about how DBS can create such wide sweeping neuromodulatory effects. The key to improving this therapeutic modality and discovering new ways to treat these and other neurologic conditions lies in better understanding the intricacies of DBS. Here we review the history and pertinent clinical data for DBS treatment of PD, tremor, and dystonia. While multiple regions of the brain have been targeted for DBS in the treatment of these movement disorders, this review article focuses on those that are most commonly used in current clinical practice. Our search criteria for PubMed included combinations of the following terms: DBS, neuromodulation, movement disorders, PD, tremor, dystonia, and history. Dates were not restricted. PMID:22084629

  20. Movement-Related Discharge in the Macaque Globus Pallidus during High-Frequency Stimulation of the Subthalamic Nucleus.

    PubMed

    Zimnik, Andrew J; Nora, Gerald J; Desmurget, Michel; Turner, Robert S

    2015-03-01

    Deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) has largely replaced ablative therapies for Parkinson's disease. Because of the similar efficacies of the two treatments, it has been proposed that DBS acts by creating an "informational lesion," whereby pathologic neuronal firing patterns are replaced by low-entropy, stimulus-entrained firing patterns. The informational lesion hypothesis, in its current form, states that DBS blocks the transmission of all information from the basal ganglia, including both pathologic firing patterns and normal, task-related modulations in activity. We tested this prediction in two healthy rhesus macaques by recording single-unit spiking activity from the globus pallidus (232 neurons) while the animals completed choice reaction time reaching movements with and without STN-DBS. Despite strong effects of DBS on the activity of most pallidal cells, reach-related modulations in firing rate were equally prevalent in the DBS-on and DBS-off states. This remained true even when the analysis was restricted to cells affected significantly by DBS. In addition, the overall form and timing of perimovement modulations in firing rate were preserved between DBS-on and DBS-off states in the majority of neurons (66%). Active movement and DBS had largely additive effects on the firing rate of most neurons, indicating an orthogonal relationship in which both inputs contribute independently to the overall firing rate of pallidal neurons. These findings suggest that STN-DBS does not act as an indiscriminate informational lesion but rather as a filter that permits task-related modulations in activity while, presumably, eliminating the pathological firing associated with parkinsonism. PMID:25740526

  1. Globus Pallidus Interna Deep Brain Stimulation for Chorea-Acanthocytosis

    PubMed Central

    Lee, Jae-Hyeok; Cho, Won-Ho; Cha, Seung-Heon

    2015-01-01

    Chorea-acanthocytosis (ChAc) is a rare hereditary disorder characterized by involuntary choreiform movements and erythrocytic acanthocytosis. Pharmacotherapy for control of involuntary movements has generally been of limited benefit. Deep brain stimulation (DBS) has recently been used for treatment of some refractory cases of ChAc. We report here on the effect of bilateral high-frequency DBS of globus pallidus interna in a patient with ChAc. PMID:25733999

  2. Current perspectives on deep brain stimulation for severe neurological and psychiatric disorders

    PubMed Central

    Kocabicak, Ersoy; Temel, Yasin; Höllig, Anke; Falkenburger, Björn; Tan, Sonny KH

    2015-01-01

    Deep brain stimulation (DBS) has become a well-accepted therapy to treat movement disorders, including Parkinson’s disease, essential tremor, and dystonia. Long-term follow-up studies have demonstrated sustained improvement in motor symptoms and quality of life. DBS offers the opportunity to selectively modulate the targeted brain regions and related networks. Moreover, stimulation can be adjusted according to individual patients’ demands, and stimulation is reversible. This has led to the introduction of DBS as a treatment for further neurological and psychiatric disorders and many clinical studies investigating the efficacy of stimulating various brain regions in order to alleviate severe neurological or psychiatric disorders including epilepsy, major depression, and obsessive–compulsive disorder. In this review, we provide an overview of accepted and experimental indications for DBS therapy and the corresponding anatomical targets.

  3. A Bayesian statistical analysis of behavioral facilitation associated with deep brain stimulation

    E-print Network

    Smith, Anne C.

    Deep brain stimulation (DBS) is an established therapy for Parkinson's Disease and is being investigated as a treatment for chronic depression, obsessive compulsive disorder and for facilitating functional recovery of ...

  4. Long-term follow-up of deep brain stimulation of peduncolopontine nucleus in progressive supranuclear palsy: Report of three cases

    PubMed Central

    Servello, Domenico; Zekaj, Edvin; Saleh, Christian; Menghetti, Claudia; Porta, Mauro

    2014-01-01

    Background: Progressive supranuclear palsy (PSP) is a neurodegenerative disease due to mitochondrial dysfunction. The PSP syndrome presents generally with gait disorder, Parkinsonism, ophthalmoparesis and cognitive alteration. Few reports exist on deep brain stimulation (DBS) in patients with atypical Parkinsonism. The aim of our study was to evaluate further the potential role of DBS in PSP. Case Description: We report three patients with PSP with long-term follow up undergoing DBS. Two patients had right peripedunculopontine nucleus (PPN) stimulation and one patient had simultaneous right PPN and bilateral globus pallidus internus DBS. DBS of the PPN alone or combined with globus pallidus internus (GPi) determined an improvement in gait and a reduction in falls sustained over time. Combined target stimulation (GPi-PPN) was correlated with better clinical outcome than single target (PPN) DBS for PSP. Conclusions: Although few data on DBS for PSP exist, reported clinical results are encouraging. DBS might be considered as an alternative therapeutic option for patients with PSP presenting with relevant gait imbalance and frequent falls, who fail to respond to pharmacological treatment. Larger cohorts with longer follow-ups are needed to evaluate more exhaustively the efficacy of DBS in PSP. PMID:25289173

  5. Thinking Ahead on Deep Brain Stimulation: An Analysis of the Ethical Implications of a Developing Technology.

    PubMed

    Johansson, Veronica; Garwicz, Martin; Kanje, Martin; Halldenius, Lena; Schouenborg, Jens

    2014-01-01

    Deep brain stimulation (DBS) is a developing technology. New generations of DBS technology are already in the pipeline, yet this particular fact has been largely ignored among ethicists interested in DBS. Focusing only on ethical concerns raised by the current DBS technology is, albeit necessary, not sufficient. Since current bioethical concerns raised by a specific technology could be quite different from the concerns it will raise a couple of years ahead, an ethical analysis should be sensitive to such alterations, or it could end up with results that soon become dated. The goal of this analysis is to address these changing bioethical concerns, to think ahead on upcoming and future DBS concerns both in terms of a changing technology and changing moral attitudes. By employing the distinction between inherent and noninherent bioethical concerns we identify and make explicit the particular limits and potentials for change within each category, respectively, including how present and upcoming bioethical concerns regarding DBS emerge and become obsolete. Many of the currently identified ethical problems with DBS, such as stimulation-induced mania, are a result of suboptimal technology. These challenges could be addressed by technical advances, while for instance perceptions of an altered body image caused by the mere awareness of having an implant may not. Other concerns will not emerge until the technology has become sophisticated enough for new uses to be realized, such as concerns on DBS for enhancement purposes. As a part of the present analysis, concerns regarding authenticity are used as an example. PMID:24587963

  6. Thinking Ahead on Deep Brain Stimulation: An Analysis of the Ethical Implications of a Developing Technology

    PubMed Central

    Johansson, Veronica; Garwicz, Martin; Kanje, Martin; Halldenius, Lena; Schouenborg, Jens

    2014-01-01

    Deep brain stimulation (DBS) is a developing technology. New generations of DBS technology are already in the pipeline, yet this particular fact has been largely ignored among ethicists interested in DBS. Focusing only on ethical concerns raised by the current DBS technology is, albeit necessary, not sufficient. Since current bioethical concerns raised by a specific technology could be quite different from the concerns it will raise a couple of years ahead, an ethical analysis should be sensitive to such alterations, or it could end up with results that soon become dated. The goal of this analysis is to address these changing bioethical concerns, to think ahead on upcoming and future DBS concerns both in terms of a changing technology and changing moral attitudes. By employing the distinction between inherent and noninherent bioethical concerns we identify and make explicit the particular limits and potentials for change within each category, respectively, including how present and upcoming bioethical concerns regarding DBS emerge and become obsolete. Many of the currently identified ethical problems with DBS, such as stimulation-induced mania, are a result of suboptimal technology. These challenges could be addressed by technical advances, while for instance perceptions of an altered body image caused by the mere awareness of having an implant may not. Other concerns will not emerge until the technology has become sophisticated enough for new uses to be realized, such as concerns on DBS for enhancement purposes. As a part of the present analysis, concerns regarding authenticity are used as an example. PMID:24587963

  7. Me, Myself and My Brain Implant: Deep Brain Stimulation Raises Questions of Personal Authenticity and Alienation.

    PubMed

    Kraemer, Felicitas

    2013-01-01

    In this article, I explore select case studies of Parkinson patients treated with deep brain stimulation (DBS) in light of the notions of alienation and authenticity. While the literature on DBS has so far neglected the issues of authenticity and alienation, I argue that interpreting these cases in terms of these concepts raises new issues for not only the philosophical discussion of neuro-ethics of DBS, but also for the psychological and medical approach to patients under DBS. In particular, I suggest that the experience of alienation and authenticity varies from patient to patient with DBS. For some, alienation can be brought about by neurointerventions because patients no longer feel like themselves. But, on the other hand, it seems alienation can also be cured by DBS as other patients experience their state of mind as authentic under treatment and retrospectively regard their former lives without stimulation as alienated. I argue that we must do further research on the relevance of authenticity and alienation to patients treated with DBS in order to gain a deeper philosophical understanding, and to develop the best evaluative criterion for the behavior of DBS patients. PMID:24273619

  8. Deep brain stimulation in ireland for Parkinson's disease and essential tremor.

    PubMed

    Mulroy, E; Quigley, G; Roberts, K; Cummins, G; Magennis, B; Fortune, G; O'Brien, D; Blunnie, W P; Harrington, E; Gillivan-Murphy, P; Kavanagh, E; Gilligan, P; Reilly, R; Scolaí, P O; Kelly, S; Murray, M; Lynch, T

    2012-09-01

    Deep brain stimulation (DBS) is highly effective neurosurgery for idiopathic Parkinson's disease (IPD), essential tremor (ET) and primary dystonia. DBS involves stereotactic surgical implantation of a battery-operated stimulator into deep brain nuclei. Irish patients are referred abroad for DBS and have to travel repeatedly for pre and post-operative care resulting in stress, anxiety and hardship. Safe pre and post-operative care of these complex, ageing patients is compromised by the absence of a DBS service in Ireland. Moreover, both DBS surgery and the subsequent post-operative care abroad incurs substantial cost to the state. The Dublin Neurological Institute at the Mater Misericordiae University Hospital (DNI) is a non-profit institute for the care of patients with neurological diseases. The DNI developed, in collaboration with the Mater Private Hospital (MPH) and the Walton Centre, Liverpool, a DBS programme in 2008/2009. We performed DBS at the Mater Campus on three carefully selected patients from a cohort of movement disorder patients attending the DNI and continue to provide pre-operative assessment and post operative care for patients following DBS in Ireland and abroad. PMID:23155918

  9. Brain stimulation in posttraumatic stress disorder.

    PubMed

    Novakovic, Vladan; Sher, Leo; Lapidus, Kyle A B; Mindes, Janet; A Golier, Julia; Yehuda, Rachel

    2011-01-01

    Posttraumatic stress disorder (PTSD) is a complex, heterogeneous disorder that develops following trauma and often includes perceptual, cognitive, affective, physiological, and psychological features. PTSD is characterized by hyperarousal, intrusive thoughts, exaggerated startle response, flashbacks, nightmares, sleep disturbances, emotional numbness, and persistent avoidance of trauma-associated stimuli. The efficacy of available treatments for PTSD may result in part from relief of associated depressive and anxiety-related symptoms in addition to treatment of core symptoms that derive from reexperiencing, numbing, and hyperarousal. Diverse, heterogeneous mechanisms of action and the ability to act broadly or very locally may enable brain stimulation devices to address PTSD core symptoms in more targeted ways. To achieve this goal, specific theoretical bases derived from novel, well-designed research protocols will be necessary. Brain stimulation devices include both long-used and new electrical and magnetic devices. Electroconvulsive therapy (ECT) and Cranial electrotherapy stimulation (CES) have both been in use for decades; transcranial magnetic stimulation (TMS), magnetic seizure therapy (MST), deep brain stimulation (DBS), transcranial Direct Current Stimulation (tDCS), and vagus nerve stimulation (VNS) have been developed recently, over approximately the past twenty years. The efficacy of brain stimulation has been demonstrated as a treatment for psychiatric and neurological disorders such as anxiety (CES), depression (ECT, CES, rTMS, VNS, DBS), obsessive-compulsive disorder (OCD) (DBS), essential tremor, dystonia (DBS), epilepsy (DBS, VNS), Parkinson Disease (DBS), pain (CES), and insomnia (CES). To date, limited data on brain stimulation for PTSD offer only modest guidance. ECT has shown some efficacy in reducing comorbid depression in PTSD patients but has not been demonstrated to improve most core PTSD symptoms. CES and VNS have shown some efficacy in reducing anxiety, findings that may suggest possible utility in relieving PTSD-associated anxiety. Treatment of animal models of PTSD with DBS suggests potential human benefit. Additional research and novel treatment options for PTSD are urgently needed. The potential usefulness of brain stimulation in treating PTSD deserves further exploration. PMID:22893803

  10. PET functional imaging of deep brain stimulation in Parkinson’s disease

    Microsoft Academic Search

    Stéphane Thobois; Emmanuel Broussolle

    Deep brain stimulation (DBS) has become a recognized treatment for several movement disorders. Functional imaging provides a unique window to better understand in vivo its mechanisms of action. This is the case for Parkinson’s disease (PD) and subthalamic nucleus (STN) stimulation, dystonia and internal globus pallidus (GPi) stimulation or tremor and thalamic stimulation. The aim of this review is to summarize

  11. Supraspinal stimulation for treatment of refractory pain.

    PubMed

    Parmar, V K; Gee, L; Smith, H; Pilitsis, J G

    2014-08-01

    Refractory pain syndromes often have far reaching effects and are quite a challenge for primary care providers and specialists alike to treat. With the help of site-specific neuromodulation and appropriate patient selection these difficult to treat pain syndromes may be managed. In this article, we focus on supraspinal stimulation (SSS) for treatment of intractable pain and discuss off-label uses of deep brain stimulation (DBS) and motor cortex stimulation (MCS) in context to emerging indications in neuromodulation. Consideration for neuromodulatory treatment begins with rigorous patient selection based on exhaustive conservative management, elimination of secondary gains, and a proper psychology evaluation. Trial stimulation prior to DBS is nearly always performed while trial stimulation prior to MCS surgery is symptom dependent. Overall, a review of the literature demonstrates that DBS should be considered for refractory conditions including nociceptive/neuropathic pain, phantom limb pain, and chronic cluster headache (CCH). MCS should be considered primarily for trigeminal neuropathic pain (TNP) and central pain. DBS outcome studies for post-stroke pain as well as MCS studies for complex regional pain syndrome (CRPS) show more modest results and are also discussed in detail. PMID:24956545

  12. Potential-biased, asymmetric waveforms for charge-injection with activated iridium oxide (AIROF) neural stimulation electrodes

    Microsoft Academic Search

    Stuart F. Cogan; Philip R. Troyk; Julia Ehrlich; Timothy D. Plante; David E. Detlefsen

    2006-01-01

    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

  13. Evaluation of Sex-Specific Gene Expression in Archived Dried Blood Spots (DBS)

    PubMed Central

    Resau, James H.; Ho, Nhan T.; Dykema, Karl; Faber, Matthew S.; Busik, Julia V.; Nickolov, Radoslav Z.; Furge, Kyle A.; Paneth, Nigel; Jewell, Scott; Khoo, Sok Kean

    2012-01-01

    Screening newborns for treatable serious conditions is mandated in all US states and many other countries. After screening, Guthrie cards with residual blood (whole spots or portions of spots) are typically stored at ambient temperature in many facilities. The potential of archived dried blood spots (DBS) for at-birth molecular studies in epidemiological and clinical research is substantial. However, it is also challenging as analytes from DBS may be degraded due to preparation and storage conditions. We previously reported an improved assay for obtaining global RNA gene expression from blood spots. Here, we evaluated sex-specific gene expression and its preservation in DBS using oligonucleotide microarray technology. We found X inactivation-specific transcript (XIST), lysine-specific demethylase 5D (KDM5D) (also known as selected cDNA on Y, homolog of mouse (SMCY)), uncharacterized LOC729444 (LOC729444), and testis-specific transcript, Y-linked 21 (TTTY21) to be differentially-expressed by sex of the newborn. Our finding that trait-specific RNA gene expression is preserved in unfrozen DBS, demonstrates the technical feasibility of performing molecular genetic profiling using such samples. With millions of DBS potentially available for research, we see new opportunities in using newborn molecular gene expression to better understand molecular pathogenesis of perinatal diseases. PMID:22949818

  14. Stump nerve signals during transcranial magnetic motor cortex stimulation recorded in an amputee via longitudinal intrafascicular electrodes

    Microsoft Academic Search

    P. M. Rossini; Jacopo Rigosa; Silvestro Micera; Giovanni Assenza; Luca Rossini; Florinda Ferreri

    2011-01-01

    Do central and peripheral motor pathways associated with an amputated limb retain at least some functions over periods of\\u000a years? This problem could be addressed by evaluating the response patterns of nerve signals from peripheral motor fibers during\\u000a transcranial magnetic stimulation (TMS) of corticospinal tracts. The aim of this study was to record for the first time TMS-related\\u000a responses from

  15. Chronic Deep Brain Stimulation of the Subthalamic Nucleus for Parkinson’s Disease: Effects on Cognition, Mood, Anxiety and Personality Traits

    Microsoft Academic Search

    L. Castelli; P. Perozzo; M. Zibetti; B. Crivelli; U. Morabito; M. Lanotte; F. Cossa; B. Bergamasco; L. Lopiano; O. Kastrup; M. Obermann; S. Esser; H. Wilhelm; C. Ley; J. Beilby; M. Bulsara; S. Hurnaus; W. Mueller-Felber

    2006-01-01

    Objective: To evaluate modifications occurring in cognitive functions and behavioural aspects in a group of 72 consecutive patients with Parkinson’s disease (PD) 15 months after bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN). Methods: 72 consecutive PD patients bilaterally implanted for DBS of the STN were evaluated before and after surgery with a mean follow-up of 15 months.

  16. Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation on Tongue Movements in Speakers with Parkinson's Disease Using Electropalatography: A Pilot Study

    ERIC Educational Resources Information Center

    Hartinger, Mariam; Tripoliti, Elina; Hardcastle, William J.; Limousin, Patricia

    2011-01-01

    Parkinson's disease (PD) affects speech in the majority of patients. Subthalamic nucleus deep brain stimulation (STN-DBS) is particularly effective in reducing tremor and rigidity. However, its effect on speech is variable. The aim of this pilot study was to quantify the effects of bilateral STN-DBS and medication on articulation, using…

  17. Micromachined electrode array

    DOEpatents

    Okandan, Murat (Edgewood, NM); Wessendorf, Kurt O. (Albuquerque, NM)

    2007-12-11

    An electrode array is disclosed which has applications for neural stimulation and sensing. The electrode array, in certain embodiments, can include a plurality of electrodes each of which is flexibly attached to a common substrate using a plurality of springs to allow the electrodes to move independently. In other embodiments of the electrode array, the electrodes can be fixed to the substrate. The electrode array can be formed from a combination of bulk and surface micromachining, and can include electrode tips having an electroplated metal (e.g. platinum, iridium, gold or titanium) or a metal oxide (e.g. iridium oxide) for biocompatibility. The electrode array can be used to form a part of a neural prosthesis, and is particularly well adapted for use in an implantable retinal prosthesis.

  18. Flexible retinal electrode array

    DOEpatents

    Okandan, Murat (Albuquerque, NM); Wessendorf, Kurt O. (Albuquerque, NM); Christenson, Todd R. (Albuquerque, NM)

    2006-10-24

    An electrode array which has applications for neural stimulation and sensing. The electrode array can include a large number of electrodes each of which is flexibly attached to a common substrate using a plurality of springs to allow the electrodes to move independently. The electrode array can be formed from a combination of bulk and surface micromachining, with electrode tips that can include an electroplated metal (e.g. platinum, iridium, gold or titanium) or a metal oxide (e.g. iridium oxide) for biocompatibility. The electrode array can be used to form a part of a neural prosthesis, and is particularly well adapted for use in an implantable retinal prosthesis where the electrodes can be tailored to provide a uniform gentle contact pressure with optional sensing of this contact pressure at one or more of the electrodes.

  19. Deep Brain Stimulation of Caudal Zona Incerta and Subthalamic Nucleus in Patients with Parkinson's Disease: Effects on Diadochokinetic Rate

    PubMed Central

    Karlsson, Fredrik; Unger, Elin; Wahlgren, Sofia; Blomstedt, Patric; Linder, Jan; Nordh, Erik; Zafar, Hamayun; van Doorn, Jan

    2011-01-01

    The hypokinetic dysarthria observed in Parkinson's disease (PD) affects the range, speed, and accuracy of articulatory gestures in patients, reducing the perceived quality of speech acoustic output in continuous speech. Deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) and of the caudal zona incerta (cZi-DBS) are current surgical treatment options for PD. This study aimed at investigating the outcome of STN-DBS (7 patients) and cZi-DBS (7 patients) in two articulatory diadochokinesis tasks (AMR and SMR) using measurements of articulation rate and quality of the plosive consonants (using the percent measurable VOT metric). The results indicate that patients receiving STN-DBS increased in articulation rate in the Stim-ON condition in the AMR task only, with no effect on production quality. Patients receiving cZi-DBS decreased in articulation rate in the Stim-ON condition and further showed a reduction in production quality. The data therefore suggest that cZi-DBS is more detrimental for extended articulatory movements than STN-DBS. PMID:22007342

  20. Deep brain stimulation of caudal zona incerta and subthalamic nucleus in patients with Parkinson's disease: effects on diadochokinetic rate.

    PubMed

    Karlsson, Fredrik; Unger, Elin; Wahlgren, Sofia; Blomstedt, Patric; Linder, Jan; Nordh, Erik; Zafar, Hamayun; van Doorn, Jan

    2011-01-01

    The hypokinetic dysarthria observed in Parkinson's disease (PD) affects the range, speed, and accuracy of articulatory gestures in patients, reducing the perceived quality of speech acoustic output in continuous speech. Deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) and of the caudal zona incerta (cZi-DBS) are current surgical treatment options for PD. This study aimed at investigating the outcome of STN-DBS (7 patients) and cZi-DBS (7 patients) in two articulatory diadochokinesis tasks (AMR and SMR) using measurements of articulation rate and quality of the plosive consonants (using the percent measurable VOT metric). The results indicate that patients receiving STN-DBS increased in articulation rate in the Stim-ON condition in the AMR task only, with no effect on production quality. Patients receiving cZi-DBS decreased in articulation rate in the Stim-ON condition and further showed a reduction in production quality. The data therefore suggest that cZi-DBS is more detrimental for extended articulatory movements than STN-DBS. PMID:22007342

  1. Amelioration of binge eating by nucleus accumbens shell deep brain stimulation in mice involves D2 receptor modulation.

    PubMed

    Halpern, Casey H; Tekriwal, Anand; Santollo, Jessica; Keating, Jeffrey G; Wolf, John A; Daniels, Derek; Bale, Tracy L

    2013-04-24

    Hedonic overconsumption contributing to obesity involves altered activation within the mesolimbic dopamine system. Dysregulation of dopamine signaling in the nucleus accumbens shell (NAS) has been implicated in reward-seeking behaviors, such as binge eating, which contributes to treatment resistance in obesity (Wise, 2012). Direct modulation of the NAS with deep brain stimulation (DBS), a surgical procedure currently under investigation in humans for the treatment of major depression, obsessive-compulsive disorder, and addiction, may also be effective in ameliorating binge eating. Therefore, we examined the ability of DBS of the NAS to block this behavior in mice. c-Fos immunoreactivity was assessed as a marker of DBS-mediated neuronal activation. NAS DBS was found to reduce binge eating and increased c-Fos levels in this region. DBS of the dorsal striatum had no influence on this behavior, demonstrating anatomical specificity for this effect. The dopamine D2 receptor antagonist, raclopride, attenuated the action of DBS, whereas the D1 receptor antagonist, SCH-23390, was ineffective, suggesting that dopamine signaling involving D2 receptors underlies the effect of NAS DBS. To determine the potential translational relevance to the obese state, chronic NAS DBS was also examined in diet-induced obese mice and was found to acutely reduce caloric intake and induce weight loss. Together, these findings support the involvement of the mesolimbic dopamine pathways in the hedonic mechanisms contributing to obesity, and the efficacy of NAS DBS to modulate this system. PMID:23616522

  2. Amelioration of binge eating by nucleus accumbens shell deep brain stimulation in mice involves D2 receptor modulation

    PubMed Central

    Halpern, Casey H.; Tekriwal, Anand; Santollo, Jessica; Keating, Jeffrey G.; Wolf, John A.; Daniels, Derek; Bale, Tracy L.

    2013-01-01

    Hedonic over-consumption contributing to obesity involves altered activation within the mesolimbic dopamine system. Dysregulation of dopamine signaling in the nucleus accumbens shell (NAS) has been implicated in reward-seeking behaviors, such as binge eating, which contributes to treatment resistance in obesity (Wise, 2012). Direct modulation of the NAS with deep brain stimulation (DBS), a surgical procedure currently under investigation in humans for the treatment of major depression, obsessive-compulsive disorder, and addiction, may also be effective in ameliorating binge eating. Therefore, we examined the ability of DBS of the NAS to block this behavior in mice. c-Fos immunoreactivity was assessed as a marker of DBS-mediated neuronal activation. NAS DBS was found to reduce binge eating, and increased c-Fos levels in this region. DBS of the dorsal striatum had no influence on this behavior, demonstrating anatomical specificity for this effect. The dopamine D2 receptor antagonist, raclopride, attenuated the action of DBS, while the D1 receptor antagonist, SCH-23390, was ineffective, suggesting that dopamine signaling involving D2 receptors underlies the effect of NAS DBS. To determine the potential translational relevance to the obese state, chronic NAS DBS was also examined in diet-induced obese mice, and was found to acutely reduce caloric intake and induce weight loss. Taken together, these findings support the involvement of the mesolimbic dopamine pathways in the hedonic mechanisms contributing to obesity, and the efficacy of NAS DBS to modulate this system. PMID:23616522

  3. Immediate effects of deep brain stimulation of anterior thalamic nuclei on executive functions and emotion-attention interaction in humans

    PubMed Central

    Sun, Lihua; Polvaara, Markus; Brause, Maarja; Lehtimäki, Kai; Haapasalo, Joonas; Möttönen, Timo; Väyrynen, Kirsi; Ogawa, Keith H.; Öhman, Juha; Peltola, Jukka

    2014-01-01

    Background Deep brain stimulation (DBS) of anterior thalamic nuclei (ANT) is a novel promising therapeutic method for treating refractory epilepsy. Despite reports of subjective memory impairments and mood disturbances in patients with ANT-DBS, little is known of its effects on cognitive and affective processes. Hypothesis The anterior thalamus has connections to prefrontal and limbic networks important for cognitive control and emotional reactivity. More specifically, anterior cingulate cortex (ACC), linked with ANT, has been assigned roles related to response inhibition and attention allocation to threat. Thus, we hypothesized ANT-DBS to influence executive functions, particularly response inhibition, and modulate emotional reactivity to threat. Method Twelve patients having undergone ANT-DBS for intractable epilepsy participated in the study. Patients performed a computer-based executive reaction time (RT) test—that is, a go/ no-go visual discrimination task with threat-related emotional distractors and rule switching, while the DBS was switched ON (5/5 mA constant current) and OFF every few minutes. Results ANT-DBS increased the amount of commission errors—that is, errors where subjects failed to withhold from responding. Furthermore, ANT-DBS slowed RTs in context of threat-related distractors. When stimulation was turned off, threat-related distractors had no distinct effect on RTs. Conclusion We found immediate objective effects of ANT-DBS on human cognitive control and emotion-attention interaction. We suggest that ANT-DBS compromised response inhibition and enhanced attention allocation to threat due to altered functioning of neural networks that involve the DBS-target, ANT, and the regions connected to it such as ACC. The results highlight the need to consider affective and cognitive side-effects in addition to the therapeutic effect when adjusting stimulation parameters. Furthermore, this study introduces a novel window into cognitive and affective processes by modulating the associative and limbic networks with direct stimulation of key nodes in the thalamus. PMID:24839985

  4. Deep-brain stimulation associates with improved microvascular integrity in the subthalamic nucleus in Parkinson's disease.

    PubMed

    Pienaar, Ilse S; Lee, Cecilia Heyne; Elson, Joanna L; McGuinness, Louisa; Gentleman, Stephen M; Kalaria, Raj N; Dexter, David T

    2015-02-01

    Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an accepted treatment for motor symptoms in a subset of Parkinson's disease (PD) patients. The mechanisms why DBS is effective are incompletely understood, but previous studies show that DBS targeted in brain structures other than the STN may modify the microvasculature. However, this has not been studied in PD subjects who have received STN-DBS. Here we investigated the extent and nature of microvascular changes in post-mortem STN samples from STN-DBS PD patients, compared to aged controls and PD patients who had not been treated with STN-DBS. We used immunohistochemical and immunofluorescent methods to assess serial STN-containing brain sections from PD and STN-DBS PD cases, compared to similar age controls using specific antibodies to detect capillaries, an adherens junction and tight junction-associated proteins as well as activated microglia. Cellular features in stained sections were quantified by confocal fluorescence microscopy and stereological methods in conjunction with in vitro imaging tools. We found significant upregulation of microvessel endothelial cell thickness, length and density but lowered activated microglia density and striking upregulation of all analysed adherens junction and tight junction-associated proteins in STN-DBS PD patients compared to non-DBS PD patients and controls. Moreover, in STN-DBS PD samples, expression of an angiogenic factor, vascular endothelial growth factor (VEGF), was significantly upregulated compared to the other groups. Our findings suggest that overexpressed VEGF and downregulation of inflammatory processes may be critical mechanisms underlying the DBS-induced microvascular changes. PMID:25533682

  5. Programmed deep brain stimulation synchronizes VTA gamma band field potential and alleviates depressive-like behavior in rats.

    PubMed

    Gazit, Tomer; Friedman, Alexander; Lax, Elad; Samuel, Merav; Zahut, Roy; Katz, Moshe; Abraham, Lital; Tischler, Hadass; Teicher, Mina; Yadid, Gal

    2015-04-01

    Deep brain stimulation (DBS) significantly alleviates symptoms in various neurological disorders. Current research focuses on developing programmed stimulation protocols for customization to individual symptoms. However, the therapeutic mechanism of action of programmed DBS (pDBS) is poorly understood. We previously demonstrated that pDBS in the ventral tegmental area (VTA) normalizes molecular and behavioral abnormalities in the Flinders Sensitive Line (FSL) rat model for depression. Herein, we examined the effect of a short-duration, low-frequency DBS template on local field potential (LFP) synchronization patterns along the anterior-posterior axis of the VTA of FSL rats, and correlation of this effect with depressive-like behavior, as compared with non-programmed, continuous low-frequency DBS (npDBS). We used the wavelet phase coherence (WPC) measure for effective representation of time and frequency of LFP patterns, and the forced swim test to measure immobility (despair). Baseline WPC values were lower in FSLs as compared with SD controls, at the low and high gamma frequency range (above 30 Hz). Baseline immobility scores for FSL rats were higher than those of SD rats, while pDBS, and not npDBS, significantly reduced FSL immobility scores to control SD levels, up to day 14. pDBS also significantly increased the change (between baseline and day 14) in WPC values, in beta, low gamma and high gamma frequency ranges. The change in high gamma (60-100 Hz) WPC values correlated with improvement in depressive-like behavior. Our results suggest that programmed DBS of the VTA increases interaction among local neuronal populations, an effect that may underlie the normalization of depressive-like behavior. PMID:25497452

  6. Optimizing deep brain stimulation settings using wearable sensing technology

    Microsoft Academic Search

    S. Patel; C. Mancinelli; R. Hughes; A. Dalton; Ludy Shih; Paolo Bonato

    2009-01-01

    Parkinson's disease is a neurodegenerative movement disorder resulting in rigidity, bradykinesia (slowness), tremor and gait disorder. Deep brain stimulation (DBS) of the subthalamic nucleus has been shown to be effective in managing symptoms, but quantitative methods to facilitate the adjustment of the stimulator settings are needed. In this paper, we present preliminary results from a study aimed at investigating the

  7. [Ethical aspects of deep brain stimulation in the treatment of psychiatric disorders].

    PubMed

    Schmetz, M-K; Heinemann, T

    2010-05-01

    Deep brain stimulation (DBS) is currently being tested as a possible treatment for treatment-refractory psychiatric disorders. Besides the hope set on this new therapeutic approach of DBS, there are at the same time doubts concerning the ethical acceptability in the treatment of individuals suffering from mental disorders. Taking the therapeutic benefit of DBS into account, the manuscript analyses ethical aspects of DBS application in psychiatry. In particular, possible effects on the patient's personality and self-determination are scrutinized. It is shown that personality changes may either occur as unintended and potentially ethically troublesome side effects or may even be intended as legitimate therapy goals. The patient's self-determination may be both, endangered and supported by DBS. The ethical assessment of DBS considers therapeutic benefits, the method's minimal invasiveness and reversibility on the one hand, as well as surgery-related risks of DBS treatment, an insufficient data-base due to currently missing long-term studies and the possibility of as yet inestimable, potentially long-term effects on the patient's personality and self-determination on the other hand. The ethical balancing arrives at the conclusion that DBS may be considered as ultima ratio in the treatment of psychiatric disorders and should preferably be combined with psychosocial measures. Furthermore, a prospective scientific evaluation of the procedure should include a systematic investigation of personality changes. PMID:20422491

  8. The Application of Vagus Nerve Stimulation and Deep Brain Stimulation in Depression

    Microsoft Academic Search

    Pavel Mohr; Mabel Rodriguez; Jan Hanka

    2011-01-01

    Despite the progress in the pharmacotherapy of depression, there is a substantial proportion of treatment-resistant patients. Recently, reversible invasive stimulation methods, i.e. vagus nerve stimulation (VNS) and deep brain stimulation (DBS), have been introduced into the management of treatment-resistant depression (TRD). VNS has already received regulatory approval for TRD. This paper reviews the available clinical evidence and neurobiology of VNS

  9. A Non-Invasive Imaging Approach to Understanding Speech Changes following Deep Brain Stimulation in Parkinson’s Disease

    PubMed Central

    Narayana, Shalini; Jacks, Adam; Robin, Donald A.; Poizner, Howard; Zhang, Wei; Franklin, Crystal; Liotti, Mario; Vogel, Deanie; Fox, Peter T.

    2009-01-01

    Purpose To explore the use of non-invasive functional imaging and “virtual” lesion techniques to study the neural mechanisms underlying motor speech disorders in Parkinson’s disease. Here, we report the use of Positron Emission Tomography (PET) and transcranial magnetic stimulation (TMS) to explain exacerbated speech impairment following subthalamic nucleus deep brain stimulation (STN-DBS) in a patient with Parkinson’s disease. Method Perceptual and acoustic speech measures as well as cerebral blood flow (CBF) during speech as measured by PET were obtained with STN-DBS on and off. TMS was applied to a region in the speech motor network found to be abnormally active during DBS. Speech disruption by TMS was compared both perceptually and acoustically with that resulting from DBS on. Results Speech production was perceptually inferior and acoustically less contrastive during left STN stimulation compared to no stimulation. Increased neural activity in left dorsal premotor cortex (PMd) was observed during DBS on. “Virtual” lesioning of this region resulted in speech characterized by decreased speech segment duration, increased pause duration, and decreased intelligibility. Conclusions This case report provides evidence that impaired speech production accompanying STN-DBS may be resulting from unintended activation of PMd. Clinical application of functional imaging and TMS may lead to optimizing the delivery of STN-DBS to improve outcomes for speech production as well as general motor abilities. PMID:19029533

  10. 1 Introduction The increasing demand for the use of database systems (DBS)

    E-print Network

    Kriegel, Hans-Peter

    ] for example) is used, that also includes the translation of the geometry of CAD­objects in a neutral format. 2 in CAD/CAM applications has necessi­ tated the development of DBS with appropriate modelling and retrieval capabilities. One essential problem is the treatment of geometric data which has led

  11. EFFECT OF MOLECULAR ARCHITECTURE ON DBS-INDUCED BLOCK COPOLYMER GELS: A RHEOLOGICAL STUDY

    EPA Science Inventory

    Dibenzylidene sorbitol (DBS) is capable of gelling a variety of organic solvents and polymeric materials by forming a rigid, 3-D hydrogen-bonded network. In this work, two poly(siloxane)/poly(propylene oxide) segmented copolymers of equal composition and molecular weight, but di...

  12. The incidence of deep brain stimulator hardware infection: the effect of change in antibiotic prophylaxis regimen and review of the literature.

    PubMed

    Bhatia, Robin; Dalton, Arthur; Richards, Mike; Hopkins, Chris; Aziz, Tipu; Nandi, Dipankar

    2011-10-01

    The complication of hardware infection related to deep brain stimulator implantation (or revision) varies between 0 and 15.2% in the literature. However, no national guidelines exist at present to define an average or acceptable rate of infection associated with, nor the preferred antibiotic prophylaxis required for, this procedure. The aim of this study was to examine the effect of changing the antibiotic prophylaxis regimen used in a single neurosurgical centre on the incidence and outcome of hardware infection. A prospective cohort of 38 patients undergoing deep brain stimulation (DBS) implantation or internal pulse generator (IPG) replacement and receiving perioperative vancomycin (including intravenous gentamicin on induction) and pouch-installed gentamicin, was compared to a historical cohort of 35 patients receiving perioperative cefuroxime in the same unit. The infection rate over 2 years in the prospective group for DBS surgery was 0 compared to 1 (5.6%) in the historical cohort (p?=?0.11, ?(2)); the infection rate for IPG replacements was 1(3.6%) in the prospective cohort, versus 3 (17.6%) in the historical (p?=?0.44, ?(2)). In this article, we have also systematically reviewed the literature to date and derived an average infection rate of 4.7% (PI 0.9-22%, Random Effects Meta-analysis, Stata) for 35 studies comprising 3550 patients. There is no significant difference in infection rates between DBS procedures that are primarily internalised (n?=?9) compared to those in which there is a period of electrode externalisation (n?=?23) (p?=?0.9, Meta-regression analysis, Stata). PMID:21501065

  13. Deep brain stimulation of the ventral striatum increases BDNF in the fear extinction circuit

    PubMed Central

    Do-Monte, Fabricio H.; Rodriguez-Romaguera, Jose; Rosas-Vidal, Luis E.; Quirk, Gregory J.

    2013-01-01

    Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) reduces the symptoms of treatment-resistant obsessive compulsive disorder (OCD), and improves response to extinction-based therapies. We recently reported that DBS-like stimulation of a rat homologue of VC/VS, the dorsal-VS, reduced conditioned fear and enhanced extinction memory (Rodriguez-Romaguera et al., 2012). In contrast, DBS of the ventral-VS had the opposite effects. To examine possible mechanisms of these effects, we assessed the effects of VS DBS on the expression of the neural activity marker Fos and brain-derived neurotrophic factor (BDNF), a key mediator of extinction plasticity in prefrontal-amygdala circuits. Consistent with decreased fear expression, DBS of dorsal-VS increased Fos expression in prelimbic and infralimbic prefrontal cortices and in the lateral division of the central nucleus of amygdala, an area that inhibits amygdala output. Consistent with improved extinction memory, we found that DBS of dorsal-VS, but not ventral-VS, increased neuronal BDNF expression in prelimbic and infralimbic prefrontal cortices. These rodent findings are consistent with the idea that clinical DBS of VC/VS may augment fear extinction through an increase in BDNF expression. PMID:23964215

  14. Mixed Effects of Deep Brain Stimulation on Depressive Symptomatology in Parkinson’s Disease: A Review of Randomized Clinical Trials

    PubMed Central

    Gökbayrak, N. Simay; Piryatinsky, Irene; Gavett, Rebecca A.; Ahmed, Omar J.

    2014-01-01

    Although ~50% of patients with Parkinson’s disease (PD) experience depression, treatment for this important and debilitating comorbidity is relatively understudied. Deep brain stimulation (DBS) has been increasingly utilized for the management of tremors in progressive PD. Several preliminary studies have shown the potential benefit of DBS for non-motor PD symptoms such as depression. Here, we critically evaluate seven recent randomized clinical trials of the effectiveness of DBS in reducing depressive symptomatology among individuals with PD. Findings are mixed for the effectiveness of DBS as a treatment for depression in PD. Our review suggests that this is due, in large part, to the anatomical and methodological variation across the DBS studies. We provide a comprehensive discussion of these variations and highlight the need to conduct larger, more controlled studies aimed specifically at evaluating the treatment of depression in PD patients. PMID:25157240

  15. Voice and fluency changes as a function of speech task and deep brain stimulation

    PubMed Central

    Sidtis, D.; Rogers, T.; Godier, V.; Tagliati, M.; Sidtis, J.J.

    2015-01-01

    Speaking, which naturally occurs in different modes or “tasks” such as conversation and repetition, relies on intact basal ganglia nuclei. Recent studies suggest that voice and fluency parameters are differentially affected by speech task. This study examines the effects of subcortical functionality on voice and fluency, comparing measures obtained from spontaneous and matched repeated speech samples. Parkinson subjects who are being treated with bilateral deep brain stimulation (DBS) of the subthalamic nuclei (STN) were tested with stimulators ON and OFF. Results indicated that a voice measure, harmonic to noise ratio, is improved in repetition and in DBS-ON, and that dysfluencies are more plentiful in conversation with little or variable influence of DBS condition. These findings suggest that voice and fluency are differentially affected by DBS treatment and that task conditions, interacting with subcortical functionality, influence motor speech performance. PMID:20643796

  16. Deep brain stimulation of the inferior colliculus: a possible animal model to study paradoxical kinesia observed in some parkinsonian patients?

    PubMed

    Melo-Thomas, Liana; Thomas, Uwe

    2015-02-15

    The inferior colliculus (IC) plays an important role in the normal processing of the acoustic message and is also involved in the filtering of acoustic stimuli of aversive nature. The neural substrate of the IC can also influence haloperidol-induced catalepsy. Considering that (i) paradoxical kinesia, observed in some parkinsonian patients, seems to be dependent of their emotional state and (ii) deep brain stimulation (DBS) represents an alternative therapeutic route for the relief of parkinsonian symptoms, the present study investigated the consequence of DBS at the IC on the catalepsy induced by haloperidol in rats. Additionally, we investigated if DBS of the IC can elicit motor responses in anesthetized rats and whether DBS elicits distinct neural firing patterns of activity at the dorsal cortex (DCIC) or central nucleus (CNIC) of the IC. A significant reduction of the catalepsy response was seen in rats previously given haloperidol and receiving DBS at the IC. In addition, electrical stimulation to the ventral part of the CNIC induced immediate motor responses in anesthetized rats. The neuronal spontaneous activity was higher at the ventral part of the CNIC than the dorsal part. DBS to the ventral part but not to the dorsal part of the CNIC increased the spike rate at neurons a few hundred microns away from the stimulation site. It is possible that the IC plays a role in the sensorimotor gating activated by emotional stimuli, and that DBS at the IC can be a promising new animal model to study paradoxical kinesia in rats. PMID:25446814

  17. Validation of CT-MRI fusion for intraoperative assessment of stereotactic accuracy in DBS surgery.

    PubMed

    Mirzadeh, Zaman; Chapple, Kristina; Lambert, Meg; Dhall, Rohit; Ponce, Francisco A

    2014-12-01

    Deep brain stimulation is typically performed with intraoperative microelectrode recording and test stimulation for target confirmation. Recent studies have shown accurate, clinically efficacious results after lead placement without microelectrode recording or test stimulation, using interventional magnetic resonance imaging (MRI) or intraoperative computed tomography (CT; iCT) for verification of accuracy. The latter relies on CT-MRI fusion. To validate CT-MRI fusion in this setting, we compared stereotactic coordinates determined intraoperatively using CT-MRI fusion with those obtained on postoperative MRI. Deep brain stimulation electrodes were implanted with patients under general anesthesia. Direct targeting was performed on preoperative MRI, which was merged with preimplantation iCT images for stereotactic registration and postimplantation iCT images for accuracy confirmation. Magnetic resonance imaging was obtained 6 weeks postoperatively for comparison. Postoperative MRI was obtained for 48 patients, with 94 leads placed over a 1-year period. Vector error of the targeted contact relative to the initial plan was 1.1?±?0.7 mm on iCT and 1.6?±?0.7 mm on postoperative MRI. Variance comparisons (F-tests) showed that the discrepancy between iCT- and postoperative MRI-determined errors was attributable to measurement error on postoperative MRI, as detected in inter-rater reliability testing. In multivariate analysis, improved lead placement accuracy was associated with frame-based stereotaxy with the head of the bed at 0° compared with frameless stereotaxy with the head of the bed at 30° (P?=?0.037). Intraoperative CT can be used to determine lead placement accuracy in deep brain stimulation surgery. The discrepancy between coordinates determined intraoperatively by CT-MRI fusion and postoperatively by MRI can be accounted for by inherent measurement error. PMID:25377213

  18. Deep brain stimulation, brain maps and personalized medicine: lessons from the human genome project.

    PubMed

    Fins, Joseph J; Shapiro, Zachary E

    2014-01-01

    Although the appellation of personalized medicine is generally attributed to advanced therapeutics in molecular medicine, deep brain stimulation (DBS) can also be so categorized. Like its medical counterpart, DBS is a highly personalized intervention that needs to be tailored to a patient's individual anatomy. And because of this, DBS like more conventional personalized medicine, can be highly specific where the object of care is an N = 1. But that is where the similarities end. Besides their differing medical and surgical provenances, these two varieties of personalized medicine have had strikingly different impacts. The molecular variant, though of a more recent vintage has thrived and is experiencing explosive growth, while DBS still struggles to find a sustainable therapeutic niche. Despite its promise, and success as a vetted treatment for drug resistant Parkinson's Disease, DBS has lagged in broadening its development, often encountering regulatory hurdles and financial barriers necessary to mount an adequate number of quality trials. In this paper we will consider why DBS-or better yet neuromodulation-has encountered these challenges and contrast this experience with the more successful advance of personalized medicine. We will suggest that personalized medicine and DBS's differential performance can be explained as a matter of timing and complexity. We believe that DBS has struggled because it has been a journey of scientific exploration conducted without a map. In contrast to molecular personalized medicine which followed the mapping of the human genome and the Human Genome Project, DBS preceded plans for the mapping of the human brain. We believe that this sequence has given personalized medicine a distinct advantage and that the fullest potential of DBS will be realized both as a cartographical or electrophysiological probe and as a modality of personalized medicine. PMID:23749308

  19. Exploiting pallidal plasticity for stimulation in Parkinson’s disease

    NASA Astrophysics Data System (ADS)

    Lourens, Marcel A. J.; Schwab, Bettina C.; Nirody, Jasmine A.; Meijer, Hil G. E.; van Gils, Stephan A.

    2015-04-01

    Objective. Continuous application of high-frequency deep brain stimulation (DBS) often effectively reduces motor symptoms of Parkinson’s disease patients. While there is a growing need for more effective and less traumatic stimulation, the exact mechanism of DBS is still unknown. Here, we present a methodology to exploit the plasticity of GABAergic synapses inside the external globus pallidus (GPe) for the optimization of DBS. Approach. Assuming the existence of spike-timing-dependent plasticity (STDP) at GABAergic GPe–GPe synapses, we simulate neural activity in a network model of the subthalamic nucleus and GPe. In particular, we test different DBS protocols in our model and quantify their influence on neural synchrony. Main results. In an exemplary set of biologically plausible model parameters, we show that STDP in the GPe has a direct influence on neural activity and especially the stability of firing patterns. STDP stabilizes both uncorrelated firing in the healthy state and correlated firing in the parkinsonian state. Alternative stimulation protocols such as coordinated reset stimulation can clearly profit from the stabilizing effect of STDP. These results are widely independent of the STDP learning rule. Significance. Once the model settings, e.g., connection architectures, have been described experimentally, our model can be adjusted and directly applied in the development of novel stimulation protocols. More efficient stimulation leads to both minimization of side effects and savings in battery power.

  20. Tremor reduction by subthalamic nucleus stimulation and medication in advanced Parkinson’s disease

    Microsoft Academic Search

    Christian Blahak; Johannes C. Wöhrle; Hans-Holger Capelle; Hansjörg Bäzner; Eva Grips; Ralf Weigel; Michael G. Hennerici; Joachim K. Krauss

    2007-01-01

    Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has proved to be effective for tremor in Parkinson’s disease\\u000a (PD). Most of the recent studies used only clinical data to analyse tremor reduction. The objective of our study was to quantify\\u000a tremor reduction by STN DBS and antiparkinsonian medication in elderly PD patients using an objective measuring system. Amplitude\\u000a and

  1. Deep brain stimulation for camptocormia in dystonia and Parkinson’s disease

    Microsoft Academic Search

    Hans-Holger CapelleChristoph; Christoph Schrader; Christian Blahak; Wolfgang Fogel; Thomas M. Kinfe; Hansjoerg Baezner; Joachim K. Krauss

    2011-01-01

    Camptocormia, or “bent spine syndrome”, may occur in various movement disorders such as primary dystonia or idiopathic Parkinson’s\\u000a disease (PD). Although deep brain stimulation (DBS) is an established treatment in refractory primary dystonia and advanced\\u000a PD, few data are available on the effect of DBS on camptocormia comparing these two conditions. Seven patients (4 with dystonia,\\u000a 3 with PD; mean

  2. Chronic deep brain stimulation for the treatment of tremor in multiple sclerosis: review and case reports

    Microsoft Academic Search

    H A Wishart; D W Roberts; R M Roth; B C McDonald; D J Coffey; A C Mamourian; C Hartley; L A Flashman; C E Fadul; A J Saykin

    2003-01-01

    Background: Deep brain stimulation (DBS) offers a non-ablative alternative to thalamotomy for the surgical treatment of medically refractory tremor in multiple sclerosis. However, relatively few outcomes have been reported.Objective: To provide a systematic review of the published cases of DBS use in multiple sclerosis and to present four additional patients.Methods: Quantitative and qualitative review of the published reports and description

  3. Me, Myself and My Brain Implant: Deep Brain Stimulation Raises Questions of Personal Authenticity and Alienation

    Microsoft Academic Search

    Felicitas Kraemer

    In this article, I explore select case studies of Parkinson patients treated with deep brain stimulation (DBS) in light of\\u000a the notions of alienation and authenticity. While the literature on DBS has so far neglected the issues of authenticity and\\u000a alienation, I argue that interpreting these cases in terms of these concepts raises new issues for not only the philosophical

  4. Globus Pallidus Interna Deep Brain Stimulation in a Patient with Medically Intractable Meige Syndrome

    PubMed Central

    Bae, Dae-Woong; Son, Byung-chul; Kim, Joong-Seok

    2014-01-01

    Medical therapies in patients with Meige syndrome, including botulinum toxin injection, have been limited because of incomplete response or adverse side effects. We evaluated a patient with Meige syndrome who was successfully treated with deep brain stimulation (DBS) in the globus pallidus interna (GPi). This case report and other previous reports suggest that bilateral GPi DBS may be an effective treatment for medically refractory Meige syndrome, without significant adverse effects. PMID:25360233

  5. Changes in GABA and glutamate concentrations during memory tasks in patients with Parkinson’s disease undergoing DBS surgery

    PubMed Central

    Buchanan, Robert J.; Darrow, David P.; Meier, Kevin T.; Robinson, Jennifer; Schiehser, Dawn M.; Glahn, David C.; Nadasdy, Zoltan

    2014-01-01

    Until now direct neurochemical measurements during memory tasks have not been accomplished in the human basal ganglia. It has been proposed, based on both functional imaging studies and psychometric testing in normal subjects and in patients with Parkinson’s disease (PD), that the basal ganglia is responsible for the performance of feedback-contingent implicit memory tasks. To measure neurotransmitters, we used in vivo microdialysis during deep brain stimulation (DBS) surgery. We show in the right subthalamic nucleus (STN) of patients with PD a task-dependent change in the concentrations of glutamate and GABA during an implicit memory task relative to baseline, while no difference was found between declarative memory tasks. The five patients studied had a significant decrease in the percent concentration of GABA and glutamate during the performance of the weather prediction task (WPT). We hypothesize, based on current models of basal ganglia function, that this decrease in the concentration is consistent with expected dysfunction in basal ganglia networks in patients with PD. PMID:24639638

  6. Changes in Vowel Articulation with Subthalamic Nucleus Deep Brain Stimulation in Dysarthric Speakers with Parkinson's Disease

    PubMed Central

    Langlois, Mélanie; Prud'Homme, Michel; Cantin, Léo

    2014-01-01

    Purpose. To investigate changes in vowel articulation with the electrical deep brain stimulation (DBS) of the subthalamic nucleus (STN) in dysarthric speakers with Parkinson's disease (PD). Methods. Eight Quebec-French speakers diagnosed with idiopathic PD who had undergone STN DBS were evaluated ON-stimulation and OFF-stimulation (1 hour after DBS was turned off). Vowel articulation was compared ON-simulation versus OFF-stimulation using acoustic vowel space and formant centralization ratio, calculated with the first (F1) and second formant (F2) of the vowels /i/, /u/, and /a/. The impact of the preceding consonant context on articulation, which represents a measure of coarticulation, was also analyzed as a function of the stimulation state. Results. Maximum vowel articulation increased during ON-stimulation. Analyses also indicate that vowel articulation was modulated by the consonant context but this relationship did not change with STN DBS. Conclusions. Results suggest that STN DBS may improve articulation in dysarthric speakers with PD, in terms of range of movement. Optimization of the electrical parameters for each patient is important and may lead to improvement in speech fine motor control. However, the impact on overall speech intelligibility may still be small. Clinical considerations are discussed and new research avenues are suggested. PMID:25400977

  7. Swallowing and deep brain stimulation in Parkinson's disease: a systematic review.

    PubMed

    Troche, Michelle S; Brandimore, Alexandra E; Foote, Kelly D; Okun, Michael S

    2013-09-01

    The purpose of this review is to assess the current state of the literature on the topic of deep brain stimulation (DBS) and its effects on swallowing function in Parkinson's disease (PD). Pubmed, Cochrane review, and web of science searches were completed on all articles addressing DBS that contained a swallowing outcome measure. Outcome measures included the penetration/aspiration scale, pharyngeal transit time, oropharyngeal residue, drooling, aspiration pneumonia, death, hyolaryngeal excursion, epiglottic inversion, UPDRS scores, and presence of coughing/throat clearing during meals. The search identified 13 studies specifically addressing the effects of DBS on swallowing. Critical assessment of the 13 identified peer-reviewed publications revealed nine studies employing an experimental design, (e.g. "on" vs. "off", pre- vs. post-DBS) and four case reports. None of the nine experimental studies were found to identify clinically significant improvement or decline in swallowing function with DBS. Despite these findings, several common threads were identified across experimental studies and will be examined in this review. Additionally, available data demonstrate that, although subthalamic nucleus (STN) stimulation has been considered to cause more impairment to swallowing function than globus pallidus internus (GPi) stimulation, there are no experimental studies directly comparing swallowing function in STN vs. GPi. Moreover, there has been no comparison of unilateral vs. bilateral DBS surgery and the coincident effects on swallowing function. This review includes a critical analysis of all experimental studies and discusses methodological issues that should be addressed in future studies. PMID:23726461

  8. Pathways of Translation: Deep Brain Stimulation

    PubMed Central

    Gionfriddo, Michael R.; Greenberg, Alexandra J.; Wahegaonkar, Abhijeet L.; Lee, Kendall H.

    2014-01-01

    Electrical stimulation of the brain has a 2000 year history. Deep brain stimulation (DBS), one form of neurostimulation, is a functional neurosurgical approach in which a high frequency electric current stimulates targeted brain structures for therapeutic benefit. It is an effective treatment for certain neuropathologic movement disorders and an emerging therapy for psychiatric conditions and epilepsy. Its translational journey did not follow the typical bench-to-bedside path, but rather reversed the process. The shift from ancient and medieval folkloric remedy to accepted medical practice began with independent discoveries about electricity during the 17th century and was fostered by technological advances of the 20th. In this article we review that journey and discuss how the quest to expand its applications and continue to improve outcomes is taking DBS from the bedside back to the bench. PMID:24330698

  9. Abstract--As epilepsy affects approximately one percent of the world population, electrical stimulation of the brain has

    E-print Network

    Besio, Walter G.

    stimulation including transcranial magnetic stimulation [2], [3] and transcranial direct current stimulation applied noninvasive transcranial focal stimulation via tripolar concentric ring electrodes on the scalp electrical stimulation via conventional disc electrodes applied across the head, transcranial electrical

  10. Quantitation of tenofovir and emtricitabine in dried blood spots (DBS) with LC-MS/MS.

    PubMed

    Zheng, Jia-Hua; Guida, Louis A; Rower, Caitlin; Castillo-Mancilla, Jose; Meditz, Amie; Klein, Brandon; Kerr, Becky Jo; Langness, Jacob; Bushman, Lane; Kiser, Jennifer; Anderson, Peter L

    2014-01-01

    A reversed-phase high performance liquid chromatographic (LC), tandem mass spectrometry (MS/MS) assay for the determination of tenofovir (TFV) and emtricitabine (FTC) in dried blood spots (DBS) from human whole blood was developed and validated. Whole blood samples were spotted, dried, and a 3mm punch was extracted with methanol for analysis by LC-MS/MS utilizing stable isotope labeled internal standards. The assay was validated over the range of 2.5-1000ng/mL for TFV and 2.5-5000ng/mL for FTC. The method was accurate (within ±15% of control) and precise (coefficient of variation ?15%) for hematocrit concentrations ranging from 25% to 76%; using edge punches vs. center punches; and spot volumes of 10-50?L. Analytes were stable for five freeze/thaw cycles and up to 6 days at room temperature, whereas long-term storage required -20°C or -80°C. Comparison of TFV and FTC in DBS vs. plasma yielded r(2)?0.96, indicating that DBS can be used as a plasma alternative for pharmacokinetic analyses in vivo. PMID:24055850

  11. A new high-density (25 electrodes/mm2) penetrating microelectrode array for recording and stimulating sub-millimeter neuroanatomical structures

    NASA Astrophysics Data System (ADS)

    Wark, H. A. C.; Sharma, R.; Mathews, K. S.; Fernandez, E.; Yoo, J.; Christensen, B.; Tresco, P.; Rieth, L.; Solzbacher, F.; Normann, R. A.; Tathireddy, P.

    2013-08-01

    Objective. Among the currently available neural interface devices, there has been a need for a penetrating electrode array with a high electrode-count and high electrode-density (the number of electrodes/mm2) that can be used for electrophysiological studies of sub-millimeter neuroanatomical structures. We have developed such a penetrating microelectrode array with both a high electrode-density (25 electrodes/mm2) and high electrode-count (up to 96 electrodes) for small nervous system structures, based on the existing Utah Slanted Electrode Array (USEA). Such high electrode-density arrays are expected to provide greater access to nerve fibers than the conventionally spaced USEA especially in small diameter nerves. Approach. One concern for such high density microelectrode arrays is that they may cause a nerve crush-type injury upon implantation. We evaluated this possibility during acute (<10 h) in vivo experiments with electrode arrays implanted into small diameter peripheral nerves of anesthetized rats (sciatic nerve) and cats (pudendal nerve). Main results. Successful intrafascicular implantation and viable nerve function was demonstrated via microstimulation, single-unit recordings and histological analysis. Measurements of the electrode impedances and quantified electrode dimensions demonstrated fabrication quality. The results of these experiments show that such high density neural interfaces can be implanted acutely into neural tissue without causing a complete nerve crush injury, while mediating intrafascicular access to fibers in small diameter peripheral nerves. Significance. This new penetrating microelectrode array has characteristics un-matched by other neural interface devices currently available for peripheral nervous system neurophysiological research.

  12. Myoclonus and tremor response to thalamic deep brain stimulation parameters in a patient with inherited myoclonus-dystonia syndrome

    PubMed Central

    Kuncel, Alexis M.; Turner, Dennis A.; Ozelius, Laurie J.; Greene, Paul E.; Grill, Warren M.; Stacy, Mark A.

    2011-01-01

    We present a 74-year old woman with inherited myoclonus-dystonia, with predominant myoclonus and a novel mutation in the ?-sarcoglycan gene. The patient reports a life-long history of rapid, jerking movements, most severe in the upper extremities as well as a postural and action tremor. Bilateral deep brain stimulation (DBS) of the ventral intermediate nucleus of the thalamus was performed, and the patient demonstrated moderate clinical improvement in myoclonus. We studied the effects on myoclonus and tremor of varying DBS frequency and amplitude. The frequency tuning curve for myoclonus was similar to that of tremor, suggesting similar mechanisms by which DBS alleviates both disorders. PMID:19081669

  13. The Treatment of Movement Disorders by Deep Brain Stimulation

    E-print Network

    Sergio, Lauren E.

    The Treatment of Movement Disorders by Deep Brain Stimulation Hong Yu and Joseph S. Neimat targets for DBS treatment include the subthalamic nucleus for the treatment of advanced Parkinson's disease, the ventral intermediate nucleus of the thalamus for the treatment of medically refractory

  14. Effect of Deep Brain Stimulation on Speech Performance in Parkinson's Disease

    PubMed Central

    Skodda, Sabine

    2012-01-01

    Deep brain stimulation (DBS) has been reported to be successful in relieving the core motor symptoms of Parkinson's disease (PD) and motor fluctuations in the more advanced stages of the disease. However, data on the effects of DBS on speech performance are inconsistent. While there are some series of patients documenting that speech function was relatively unaffected by DBS of the nucleus subthalamicus (STN), other investigators reported on improvements of distinct parameters of oral control and voice. Though, these ameliorations of single speech modalities were not always accompanied by an improvement of overall speech intelligibility. On the other hand, there are also indications for an induction of dysarthria as an adverse effect of STN-DBS occurring at least in some patients with PD. Since a deterioration of speech function has more often been observed under high stimulation amplitudes, this phenomenon has been ascribed to a spread of current-to-adjacent pathways which might also be the reason for the sporadic observation of an onset of dysarthria under DBS of other basal ganglia targets (e.g., globus pallidus internus/GPi or thalamus/Vim). The aim of this paper is to review and evaluate reports in the literature on the effects of DBS on speech function in PD. PMID:23227426

  15. Deep brain stimulation of the ventral striatum enhances extinction of conditioned fear

    PubMed Central

    Rodriguez-Romaguera, Jose; Do Monte, Fabricio H. M.; Quirk, Gregory J.

    2012-01-01

    Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) reduces symptoms of intractable obsessive-compulsive disorder (OCD), but the mechanism of action is unknown. OCD is characterized by avoidance behaviors that fail to extinguish, and DBS could act, in part, by facilitating extinction of fear. We investigated this possibility by using auditory fear conditioning in rats, for which the circuits of fear extinction are well characterized. We found that DBS of the VS (the VC/VS homolog in rats) during extinction training reduced fear expression and strengthened extinction memory. Facilitation of extinction was observed for a specific zone of dorsomedial VS, just above the anterior commissure; stimulation of more ventrolateral sites in VS impaired extinction. DBS effects could not be obtained with pharmacological inactivation of either dorsomedial VS or ventrolateral VS, suggesting an extrastriatal mechanism. Accordingly, DBS of dorsomedial VS (but not ventrolateral VS) increased expression of a plasticity marker in the prelimbic and infralimbic prefrontal cortices, the orbitofrontal cortex, the amygdala central nucleus (lateral division), and intercalated cells, areas known to learn and express extinction. Facilitation of fear extinction suggests that, in accord with clinical observations, DBS could augment the effectiveness of cognitive behavioral therapies for OCD. PMID:22586125

  16. Preserving cortico-striatal function: deep brain stimulation in Huntington’s disease

    PubMed Central

    Nagel, Sean J.; Machado, Andre G.; Gale, John T.; Lobel, Darlene A.; Pandya, Mayur

    2015-01-01

    Huntington’s disease (HD) is an incurable neurodegenerative disease characterized by the triad of chorea, cognitive dysfunction and psychiatric disturbances. Since the discovery of the HD gene, the pathogenesis has been outlined, but to date a cure has not been found. Disease modifying therapies are needed desperately to improve function, alleviate suffering, and provide hope for symptomatic patients. Deep brain stimulation (DBS), a proven therapy for managing the symptoms of some neurodegenerative movement disorders, including Parkinson’s disease, has been reported as a palliative treatment in select cases of HD with debilitating chorea with variable success. New insights into the mechanism of action of DBS suggest it may have the potential to circumvent other manifestations of HD including cognitive deterioration. Furthermore, because DBS is already widely used, reversible, and has a risk profile that is relatively low, new studies can be initiated. In this article we contend that new clinical trials be considered to test the effects of DBS for HD.

  17. Current Status of Deep Brain Stimulation for Obsessive-Compulsive Disorder: A Clinical Review of Different Targets

    Microsoft Academic Search

    Pelle P. de Koning; Martijn Figee; Pepijn van den Munckhof; P. Richard Schuurman; Damiaan Denys

    2011-01-01

    Obsessive-compulsive disorder (OCD) is a chronic psychiatric disorder that affects 2% of the general population. Despite optimal\\u000a cognitive-behavioral and pharmacologic therapy, approximately 10% of patients remain treatment resistant. Currently, deep\\u000a brain stimulation (DBS) is being investigated as an experimental therapy for treatment-refractory OCD. This review focuses\\u000a on the efficacy and adverse events of all published DBS targets for OCD: anterior

  18. Surgical and hardware complications of deep brain stimulation. A seven-year experience and review of the literature

    Microsoft Academic Search

    Efstathios J. Boviatsis; Lampis C. Stavrinou; Marios Themistocleous; Andreas T. Kouyialis; Damianos E. Sakas

    2010-01-01

    Purpose  Deep brain stimulation (DBS) has been established as a safe and efficient method for the treatment of various movement disorders.\\u000a As the emerging applications continue to expand and more centers become eligible for the procedure, complication rates and\\u000a complication avoidance become increasingly important. Our aim was to report the DBS-related complication in our department\\u000a over the last 7 years, compare our

  19. 21 CFR 882.1320 - Cutaneous electrode.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... A cutaneous electrode is an electrode that is applied directly to a patient's skin either to record...e.g., the electroencephalogram) or to apply electrical stimulation. (b) Classification. Class II...

  20. 21 CFR 882.1310 - Cortical electrode.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...Identification. A cortical electrode is an electrode which is temporarily placed on the surface of the brain for stimulating the brain or recording the brain's electrical activity. (b) Classification. Class II (performance...

  1. Deep Brain Stimulation may Reduce Tremor by Preferential Blockade of Slower Axons via Antidromic Activation

    E-print Network

    Pearlmutter, Barak

    Deep Brain Stimulation may Reduce Tremor by Preferential Blockade of Slower Axons via Antidromic Abstract-- Deep brain stimulation (DBS) has been used to ameliorate essential and Parkinsonian tremor, however the detailed mechanism by which tremor reduction is achieved remains unclear. We hypothesize

  2. PET functional imaging of deep brain stimulation in movement disorders and psychiatry

    Microsoft Academic Search

    Benedicte Ballanger; Marjan Jahanshahi; Emmanuel Broussolle; Stéphane Thobois

    2009-01-01

    Deep brain stimulation (DBS) represents a major advance in the treatment of various severe movement disorders or neuropsychiatric diseases. Our understanding of the mechanism of action of this surgical treatment has greatly benefited from functional imaging studies. Most of these studies have been conducted in patients with Parkinson's disease (PD) treated by bilateral subthalamic nucleus (STN) stimulation. These studies have

  3. Short Communication fMRI of Deep Brain Stimulation at the Rat Ventral Posteromedial Thalamus

    E-print Network

    Duong, Timothy Q.

    Short Communication fMRI of Deep Brain Stimulation at the Rat Ventral Posteromedial Thalamus Q3 Yen stimulation fMRI Thalamus Rat Isoflurane a b s t r a c t Background: Functional magnetic resonance imaging (fMRI of the thalamocortical tract using DBS fMRI at the rat ventral posteromedial thalamus. Methods: Blood oxygenation level

  4. Subthalamic deep brain stimulation improves smooth pursuit and saccade performance in patients with Parkinson’s disease

    PubMed Central

    2013-01-01

    Background Deep brain stimulation (DBS) in the subthalamic nucleus (STN) significantly reduces symptoms of Parkinson’s disease (PD) such as bradykinesia, tremor and rigidity. It also reduces the need for anti-PD medication, and thereby potential side-effects of L-Dopa. Although DBS in the STN is a highly effective therapeutic intervention in PD, its mechanism and effects on oculomotor eye movement control and particularly smooth pursuit eye movements have to date rarely been investigated. Furthermore, previous reports provide conflicting information. The aim was to investigate how DBS in STN affected oculomotor performance in persons with PD using novel analysis techniques. Methods Twenty-five patients were eligible (22 males, 3 females) according to the clinical inclusion criteria: idiopathic PD responsive to L-Dopa and having had bilateral STN stimulation for at least one year to ensure stable DBS treatment. Fifteen patients were excluded due to the strict inclusion criteria applied to avoid interacting and confounding factors when determining the effects of DBS applied alone without PD medication. One patient declined participation. Nine PD patients (median age 63, range 59–69 years) were assessed after having their PD medications withdrawn overnight. They were examined with DBS ON and OFF, with the ON/OFF order individually randomized. Results DBS ON increased smooth pursuit velocity accuracy (p?DBS ON generally increased saccade amplitude accuracy (p?=?0.007) and tended to increase peak saccade velocity also (p?=?0.087), specifically both saccade velocity and amplitude accuracy for the 20 and 40 degree saccades (p?DBS ON. Saccade latency was unaffected. Conclusions STN stimulation from DBS alone significantly improved both smooth pursuit and saccade performance in patients with PD. The STN stimulation enhancement found for oculomotor performance suggests clear positive implications for patients’ ability to perform tasks that rely on visual motor control and visual feedback. The new oculomotor analysis methods provide a sensitive vehicle to detect subtle pathological modifications from PD and the functional enhancements produced by STN stimulation from DBS alone. PMID:23551890

  5. Identification of target areas for deep brain stimulation in human basal ganglia substructures based on median nerve sensory evoked potential criteria

    PubMed Central

    Klostermann, F; Vesper, J; Curio, G

    2003-01-01

    Objective: In the interventional treatment of movement disorders, the thalamic ventral intermediate nucleus (VIM) and the subthalamic nucleus (STN) are the most relevant electrode targets for deep brain stimulation (DBS). This study tested the value of somatosensory evoked potentials (SEP) for the functional identification of VIM and STN. Methods: Median nerve SEP were recorded from the final stimulation electrodes targeted at STN and VIM. Throughout the stereotactic procedure SEP were recorded during short electrode stops above STN/VIM and within the presumed target areas. After digital filtering, high and low frequency SEP components were analysed separately to parameterise both the 1000 Hz SEP burst and low frequency (<100 Hz) components. Results: SEP recorded in the VIM target region could unequivocally be distinguished from SEP recorded in STN. The 1000 Hz burst signal was significantly larger in VIM than in STN without any overlap of amplitude values. In the low frequency band, a primary high amplitude negativity was obtained in VIM, contrasting with a low amplitude positivity in STN. SEP waveshapes in recordings above target positions resembled SEP obtained in STN. When entering VIM, a sharp amplitude increase was observed over a few millimetres only. Conclusions: Based on SEP criteria, the VIM target but not the STN region can be identified by typical SEP configuration changes, when penetrating the target zone. The approach is independent of the patient's cooperation and vigilance and therefore feasible in general anaesthesia. It provides an easy, reliable, and robust tool for the final assessment of electrode positions at the last instance during electrode implantation when eventual electrode revisions can easily be performed. PMID:12876229

  6. Subthalamic nucleus stimulation does not influence basal glucose metabolism or insulin sensitivity in patients with Parkinson's disease

    PubMed Central

    Lammers, Nicolette M.; Sondermeijer, Brigitte M.; Twickler, Th. B. (Marcel); de Bie, Rob M.; Ackermans, Mariëtte T.; Fliers, Eric; Schuurman, P. Richard; La Fleur, Susanne E.; Serlie, Mireille J.

    2014-01-01

    Animal studies have shown that central dopamine signaling influences glucose metabolism. As a first step to show this association in an experimental setting in humans, we studied whether deep brain stimulation (DBS) of the subthalamic nucleus (STN), which modulates the basal ganglia circuitry, alters basal endogenous glucose production (EGP) or insulin sensitivity in patients with Parkinson's disease (PD). We studied 8 patients with PD treated with DBS STN, in the basal state and during a hyperinsulinemic euglycemic clamp using a stable glucose isotope, in the stimulated and non-stimulated condition. We measured EGP, hepatic insulin sensitivity, peripheral insulin sensitivity (Rd), resting energy expenditure (REE), glucoregulatory hormones, and Parkinson symptoms, using the Unified Parkinson's Disease Rating Scale (UPDRS). Basal plasma glucose and EGP did not differ between the stimulated and non-stimulated condition. Hepatic insulin sensitivity was similar in both conditions and there were no significant differences in Rd and plasma glucoregulatory hormones between DBS on and DBS off. UPDRS was significantly higher in the non-stimulated condition. DBS of the STN in patients with PD does not influence basal EGP or insulin sensitivity. These results suggest that acute modulation of the motor basal ganglia circuitry does not affect glucose metabolism in humans. PMID:24860415

  7. Deep brain stimulation: Are astrocytes a key driver behind the scene?

    PubMed Central

    Fenoy, Albert J.; Goetz, Laurent; Chabardès, Stéphan; Xia, Ying

    2014-01-01

    Despite its widespread use, the underlying mechanism of deep brain stimulation (DBS) remains unknown. Once thought to impart a "functional inactivation", there is now increasing evidence showing that DBS actually can both inhibit neurons and activate axons, generating a wide range of effects. This implies that the mechanisms that underlie DBS work not only locally but also at the network level. Therefore, not only may DBS induce membrane or synaptic plastic changes in neurons over a wide network, but it may also trigger celllular and molecular changes in other cells, especially astrocytes, where together the glial-neuronal interactions may explain effects that are not clearly rationalized by simple activation/inhibition theories alone. Recent studies suggest that 1) High frequency stimulation (HFS) activates astrocytes and leads to the release of gliotransmitters that can regulate surrounding neurons at the synapse; 2) Activated astrocytes modulate synaptic activity and increase axonal activation; 3) Activated astrocytes can signal further astrocytes across large networks, contributing to observed network effects induced by DBS; 4) Activated astrocytes can help explain the disparate effects of activation and inhibition induced by HFS at different sites; 5) Astrocytes contribute to synaptic plasticity through long-term potentiation (LTP) and depression (LTD), possibly helping to mediate the long term effects of DBS; and 6) DBS may increase delta-opioid receptor activity in astrcoytes to confer neuroprotection. Together, the plastic changes in these glial-neuronal interactions network-wide likely underlie the range of effects seen, from the variable temporal latencies to observed effect to global activation patterns. This article reviews recent research progress in the literature on how astrocytes play a key role in DBS efficacy. PMID:24456263

  8. Deep brain stimulation: are astrocytes a key driver behind the scene?

    PubMed

    Fenoy, Albert J; Goetz, Laurent; Chabardès, Stéphan; Xia, Ying

    2014-03-01

    Despite its widespread use, the underlying mechanism of deep brain stimulation (DBS) remains unknown. Once thought to impart a "functional inactivation", there is now increasing evidence showing that DBS actually can both inhibit neurons and activate axons, generating a wide range of effects. This implies that the mechanisms that underlie DBS work not only locally but also at the network level. Therefore, not only may DBS induce membrane or synaptic plastic changes in neurons over a wide network, but it may also trigger cellular and molecular changes in other cells, especially astrocytes, where, together, the glial-neuronal interactions may explain effects that are not clearly rationalized by simple activation/inhibition theories alone. Recent studies suggest that (1) high-frequency stimulation (HFS) activates astrocytes and leads to the release of gliotransmitters that can regulate surrounding neurons at the synapse; (2) activated astrocytes modulate synaptic activity and increase axonal activation; (3) activated astrocytes can signal further astrocytes across large networks, contributing to observed network effects induced by DBS; (4) activated astrocytes can help explain the disparate effects of activation and inhibition induced by HFS at different sites; (5) astrocytes contribute to synaptic plasticity through long-term potentiation (LTP) and depression (LTD), possibly helping to mediate the long-term effects of DBS; and (6) DBS may increase delta-opioid receptor activity in astrcoytes to confer neuroprotection. Together, the plastic changes in these glial-neuronal interactions network-wide likely underlie the range of effects seen, from the variable temporal latencies to observed effect to global activation patterns. This article reviews recent research progress in the literature on how astrocytes play a key role in DBS efficacy. PMID:24456263

  9. Deep Brain Stimulation for Pantothenate Kinase-Associated Neurodegeneration

    PubMed Central

    Garcia-Ruiz, Pedro J.; Ayerbe, Joaquin; Vela Desojo, Lydia; Feliz, Cici E.; del Val Fernandez, Javier

    2015-01-01

    Pantothenate kinase-associated neurodegeneration (PKAN) is usually associated with dystonia, which is typically severe and progressive over time. Pallidal stimulation (GPi DBS) has been carried out in selected cases of PKAN with drug-resistant dystonia with variable results. We report a 30-month follow-up study of a 30-year-old woman with PKAN-related dystonia treated with GPi DBS. Postoperatively, the benefit quickly became evident, as the patient exhibited a marked improvement in her dystonia, including her writing difficulty. This result has been maintained up to the present. GPi DBS should be considered in dystonic PKAN patients provided fixed contractures and/or pyramidal symptoms are not present.

  10. Balancing the Brain: Resting State Networks and Deep Brain Stimulation

    PubMed Central

    Kringelbach, Morten L.; Green, Alexander L.; Aziz, Tipu Z.

    2011-01-01

    Over the last three decades, large numbers of patients with otherwise treatment-resistant disorders have been helped by deep brain stimulation (DBS), yet a full scientific understanding of the underlying neural mechanisms is still missing. We have previously proposed that efficacious DBS works by restoring the balance of the brain's resting state networks. Here, we extend this proposal by reviewing how detailed investigations of the highly coherent functional and structural brain networks in health and disease (such as Parkinson's) have the potential not only to increase our understanding of fundamental brain function but of how best to modulate the balance. In particular, some of the newly identified hubs and connectors within and between resting state networks could become important new targets for DBS, including potentially in neuropsychiatric disorders. At the same time, it is of essence to consider the ethical implications of this perspective. PMID:21577250

  11. Deep Brain Stimulation for Tremor Associated with Underlying Ataxia Syndromes: A Case Series and Discussion of Issues

    PubMed Central

    Oyama, Genko; Thompson, Amanda; Foote, Kelly D.; Limotai, Natlada; Abd-El-Barr, Muhammad; Maling, Nicholas; Malaty, Irene A.; Rodriguez, Ramon L.; Subramony, Sankarasubramoney H.; Ashizawa, Testuo; Okun, Michael S.

    2014-01-01

    Background Deep brain stimulation (DBS) has been utilized to treat various symptoms in patients suffering from movement disorders such as Parkinson's disease, dystonia, and essential tremor. Though ataxia syndromes have not been formally or frequently addressed with DBS, there are patients with ataxia and associated medication refractory tremor or dystonia who may potentially benefit from therapy. Methods A retrospective database review was performed, searching for cases of ataxia where tremor and/or dystonia were addressed by utilizing DBS at the University of Florida Center for Movement Disorders and Neurorestoration between 2008 and 2011. Five patients were found who had DBS implantation to address either medication refractory tremor or dystonia. The patient's underlying diagnoses included spinocerebellar ataxia type 2 (SCA2), fragile X associated tremor ataxia syndrome (FXTAS), a case of idiopathic ataxia (ataxia not otherwise specified [NOS]), spinocerebellar ataxia type 17 (SCA17), and a senataxin mutation (SETX). Results DBS improved medication refractory tremor in the SCA2 and the ataxia NOS patients. The outcome for the FXTAS patient was poor. DBS improved dystonia in the SCA17 and SETX patients, although dystonia did not improve in the lower extremities of the SCA17 patient. All patients reported a transient gait dysfunction postoperatively, and there were no reports of improvement in ataxia-related symptoms. Discussion DBS may be an option to treat tremor, inclusive of dystonic tremor in patients with underlying ataxia; however, gait and other symptoms may possibly be worsened. PMID:25120941

  12. Chronic Deep Brain Stimulation of the Hypothalamic Nucleus in Wistar Rats Alters Circulatory Levels of Corticosterone and Proinflammatory Cytokines

    PubMed Central

    Calleja-Castillo, Juan Manuel; De La Cruz-Aguilera, Dora Luz; Manjarrez, Joaquín; Velasco-Velázquez, Marco Antonio; Morales-Espinoza, Gabriel; Moreno-Aguilar, Julia; Hernández, Maria Eugenia; Aguirre-Cruz, Lucinda

    2013-01-01

    Deep brain stimulation (DBS) is a therapeutic option for several diseases, but its effects on HPA axis activity and systemic inflammation are unknown. This study aimed to detect circulatory variations of corticosterone and cytokines levels in Wistar rats, after 21 days of DBS-at the ventrolateral part of the ventromedial hypothalamic nucleus (VMHvl), unilateral cervical vagotomy (UCVgX), or UCVgX plus DBS. We included the respective control (C) and sham (S) groups (n = 6 rats per group). DBS treated rats had higher levels of TNF-? (120%; P < 0.01) and IFN-? (305%; P < 0.001) but lower corticosterone concentration (48%; P < 0.001) than C and S. UCVgX animals showed increased corticosterone levels (154%; P < 0.001) versus C and S. UCVgX plus DBS increased IL-1? (402%; P < 0.001), IL-6 (160%; P < 0.001), and corsticosterone (178%; P < 0.001 versus 48%; P < 0.001) compared with the C and S groups. Chronic DBS at VMHvl induced a systemic inflammatory response accompanied by a decrease of HPA axis function. UCVgX rats experienced HPA axis hyperactivity as result of vagus nerve injury; however, DBS was unable to block the HPA axis hyperactivity induced by unilateral cervical vagotomy. Further studies are necessary to explore these findings and their clinical implication. PMID:24235973

  13. Stochastic Modeling of Mouse Motor Activity under Deep Brain Stimulation: The Extraction of Arousal Information

    PubMed Central

    Keenan, Daniel M.; Quinkert, Amy W.; Pfaff, Donald W.

    2015-01-01

    In the present paper, we quantify, with a rigorous approach, the nature of motor activity in response to Deep Brain Stimulation (DBS), in the mouse. DBS is currently being used in the treatment of a broad range of diseases, but its underlying principles are still unclear. Because mouse movement involves rapidly repeated starting and stopping, one must statistically verify that the movement at a given stimulation time was not just coincidental, endogenously-driven movement. Moreover, the amount of activity changes significantly over the circadian rhythm, and hence the means, variances and autocorrelations are all time varying. A new methodology is presented. For example, to discern what is and what is not impacted by stimulation, velocity is classified (in a time-evolving manner) as being zero-, one- and two-dimensional movement. The most important conclusions of the paper are: (1) (DBS) stimulation is proven to be truly effective; (2) it is two-dimensional (2-D) movement that strongly differs between light and dark and responds to stimulation; and, (3) stimulation in the light initiates a manner of movement, 2-D movement, that is more commonly seen in the (non-stimulated) dark. Based upon these conclusions, it is conjectured that the above patterns of 2-D movement could be a straightforward, easy to calculate correlate of arousal. The above conclusions will aid in the systematic evaluation and understanding of how DBS in CNS arousal pathways leads to the activation of behavior. PMID:25720000

  14. Personality Changes after Deep Brain Stimulation in Parkinson's Disease

    PubMed Central

    Pham, Uyen; Solbakk, Anne-Kristin; Skogseid, Inger-Marie; Pripp, Are Hugo; Konglund, Ane Eidahl; Andersson, Stein; Haraldsen, Ira Ronit; Aarsland, Dag; Dietrichs, Espen; Malt, Ulrik Fredrik

    2015-01-01

    Objectives. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a recognized therapy that improves motor symptoms in advanced Parkinson's disease (PD). However, little is known about its impact on personality. To address this topic, we have assessed personality traits before and after STN-DBS in PD patients. Methods. Forty patients with advanced PD were assessed with the Temperament and Character Inventory (TCI): the Urgency, Premeditation, Perseverance, Sensation Seeking impulsive behaviour scale (UPPS), and the Neuroticism and Lie subscales of the Eysenck Personality Questionnaire (EPQ-N, EPQ-L) before surgery and after three months of STN-DBS. Collateral information obtained from the UPPS was also reported. Results. Despite improvement in motor function and reduction in dopaminergic dosage patients reported lower score on the TCI Persistence and Self-Transcendence scales, after three months of STN-DBS, compared to baseline (P = 0.006; P = 0.024). Relatives reported significantly increased scores on the UPPS Lack of Premeditation scale at follow-up (P = 0.027). Conclusion. STN-DBS in PD patients is associated with personality changes in the direction of increased impulsivity. PMID:25705545

  15. Modulation of Stimulation Frequency of Spinal Cord Afferents with Constant Electrode Site and Stimulus Intensity Can Induce a Variety of Movements

    Microsoft Academic Search

    W. Mayr; C. Hofer; K. Minassian; U. Hofstotter; H. Kern; M. Bijak; E. Unger; F. Rattay; M. Dimitrijevic

    \\u000a With methodological development for external control of afferents in order to evoke functional movements - afferent functional\\u000a electrical stimulation (aFES) - we have noticed that frequency of delivered stimuli can have specific influence on motor control.\\u000a \\u000a \\u000a In this report we shall review the finding that selective stimulation of tibial nerve large afferents and selective stimulation\\u000a of lumbar sacral afferents to

  16. Origin and Evolution of Deep Brain Stimulation

    PubMed Central

    Sironi, Vittorio A.

    2011-01-01

    This paper briefly describes how the electrical stimulation, used since antiquity to modulate the nervous system, has been a fundamental tool of neurophysiologic investigation in the second half of the eighteenth century and was subsequently used by the early twentieth century, even for therapeutic purposes. In mid-twentieth century the advent of stereotactic procedures has allowed the drift from lesional to stimulating technique of deep nuclei of the brain for therapeutic purposes. In this way, deep brain stimulation (DBS) was born, that, over the last two decades, has led to positive results for the treatment of medically refractory Parkinson’s disease, essential tremor, and dystonia. In recent years, the indications for therapeutic use of DBS have been extended to epilepsy, Tourette’s syndrome, psychiatric diseases (depression, obsessive–compulsive disorder), some kinds of headache, eating disorders, and the minimally conscious state. The potentials of the DBS for therapeutic use are fascinating, but there are still many unresolved technical and ethical problems, concerning the identification of the targets for each disease, the selection of the patients and the evaluation of the results. PMID:21887135

  17. Determination of trace amount of oxalic acid with zirconium(IV)-(DBS-arsenazo) by spectrophotometry.

    PubMed

    Zhai, Qing-Zhou

    2008-11-15

    A novel method is proposed for the determination of trace amount of oxalic acid in the present article. In 1.0M hydrochloric acid medium, oxalic acid can react with the zirconium(IV) in Zr(IV)-(DBS-arsenazo) complex and replaces the DBS-arsenazo to produce a hyperchromic effect at 520 nm. The hyperchromic degree is proportional to the concentration of the oxalic acid added over a defined range. Based on this property, a new method for the spectrophotometric determination of trace oxalic acid was developed. Beer's law is held over the concentration range of 9.0 x 10(-6) to 5.0 x 10(-4)M for oxalic acid with a correlation coefficient of 0.9995. The apparent molar absorptivity of the method is epsilon520 nm = 1.16 x 10(3)L mol(-1)cm(-1) and the detection limit for oxalic acid is 0.815 microg/mL. The developed method was directly applied to the determination of oxalic acid in tomato samples with satisfactory results. PMID:18262838

  18. Determination of trace amount of oxalic acid with zirconium(IV)-(DBS-arsenazo) by spectrophotometry

    NASA Astrophysics Data System (ADS)

    Zhai, Qing-Zhou

    2008-11-01

    A novel method is proposed for the determination of trace amount of oxalic acid in the present article. In 1.0 M hydrochloric acid medium, oxalic acid can react with the zirconium(IV) in Zr(IV)-(DBS-arsenazo) complex and replaces the DBS-arsenazo to produce a hyperchromic effect at 520 nm. The hyperchromic degree is proportional to the concentration of the oxalic acid added over a defined range. Based on this property, a new method for the spectrophotometric determination of trace oxalic acid was developed. Beer's law is held over the concentration range of 9.0 × 10 -6 to 5.0 × 10 -4 M for oxalic acid with a correlation coefficient of 0.9995. The apparent molar absorptivity of the method is ?520 nm = 1.16 × 10 3 L mol -1 cm -1 and the detection limit for oxalic acid is 0.815 ?g/mL. The developed method was directly applied to the determination of oxalic acid in tomato samples with satisfactory results.

  19. Uncommon Applications of Deep Brain Stimulation in Hyperkinetic Movement Disorders

    PubMed Central

    Smith, Kara M.; Spindler, Meredith A.

    2015-01-01

    Background In addition to the established indications of tremor and dystonia, deep brain stimulation (DBS) has been utilized less commonly for several hyperkinetic movement disorders, including medication-refractory myoclonus, ballism, chorea, and Gilles de la Tourette (GTS) and tardive syndromes. Given the lack of adequate controlled trials, it is difficult to translate published reports into clinical use. We summarize the literature, draw conclusions regarding efficacy when possible, and highlight concerns and areas for future study. Methods A Pubmed search was performed for English-language articles between January 1980 and June 2014. Studies were selected if they focused primarily on DBS to treat the conditions of focus. Results We identified 49 cases of DBS for myoclonus-dystonia, 21 for Huntington's disease, 15 for choreacanthocytosis, 129 for GTS, and 73 for tardive syndromes. Bilateral globus pallidus interna (GPi) DBS was the most frequently utilized procedure for all conditions except GTS, in which medial thalamic DBS was more common. While the majority of cases demonstrate some improvement, there are also reports of no improvement or even worsening of symptoms in each condition. The few studies including functional or quality of life outcomes suggest benefit. A limited number of studies included blinded on/off testing. There have been two double-blind controlled trials performed in GTS and a single prospective double-blind, uncontrolled trial in tardive syndromes. Patient characteristics, surgical target, stimulation parameters, and duration of follow-up varied among studies. Discussion Despite these extensive limitations, the literature overall supports the efficacy of DBS in these conditions, in particular GTS and tardive syndromes. For other conditions, the preliminary evidence from small studies is promising and encourages further study. PMID:25713746

  20. Tourette syndrome deep brain stimulation: A review and updated recommendations.

    PubMed

    Schrock, Lauren E; Mink, Jonathan W; Woods, Douglas W; Porta, Mauro; Servello, Dominico; Visser-Vandewalle, Veerle; Silburn, Peter A; Foltynie, Thomas; Walker, Harrison C; Shahed-Jimenez, Joohi; Savica, Rodolfo; Klassen, Bryan T; Machado, Andre G; Foote, Kelly D; Zhang, Jian-Guo; Hu, Wei; Ackermans, Linda; Temel, Yasin; Mari, Zoltan; Changizi, Barbara K; Lozano, Andres; Auyeung, M; Kaido, Takanobu; Agid, Yves; Welter, Marie L; Khandhar, Suketu M; Mogilner, Alon Y; Pourfar, Michael H; Walter, Benjamin L; Juncos, Jorge L; Gross, Robert E; Kuhn, Jens; Leckman, James F; Neimat, Joseph A; Okun, Michael S

    2015-04-01

    Deep brain stimulation (DBS) may improve disabling tics in severely affected medication and behaviorally resistant Tourette syndrome (TS). Here we review all reported cases of TS DBS and provide updated recommendations for selection, assessment, and management of potential TS DBS cases based on the literature and implantation experience. Candidates should have a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM V) diagnosis of TS with severe motor and vocal tics, which despite exhaustive medical and behavioral treatment trials result in significant impairment. Deep brain stimulation should be offered to patients only by experienced DBS centers after evaluation by a multidisciplinary team. Rigorous preoperative and postoperative outcome measures of tics and associated comorbidities should be used. Tics and comorbid neuropsychiatric conditions should be optimally treated per current expert standards, and tics should be the major cause of disability. Psychogenic tics, embellishment, and malingering should be recognized and addressed. We have removed the previously suggested 25-year-old age limit, with the specification that a multidisciplinary team approach for screening is employed. A local ethics committee or institutional review board should be consulted for consideration of cases involving persons younger than 18 years of age, as well as in cases with urgent indications. Tourette syndrome patients represent a unique and complex population, and studies reveal a higher risk for post-DBS complications. Successes and failures have been reported for multiple brain targets; however, the optimal surgical approach remains unknown. Tourette syndrome DBS, though still evolving, is a promising approach for a subset of medication refractory and severely affected patients. © 2014 International Parkinson and Movement Disorder Society. PMID:25476818

  1. Electric stimulation of the tuberomamillary nucleus affects epileptic activity and sleep-wake cycle in a genetic absence epilepsy model.

    PubMed

    Blik, Vitaliya

    2015-01-01

    Deep brain stimulation (DBS) is a promising approach for epilepsy treatment, but the optimal targets and parameters of stimulation are yet to be investigated. Tuberomamillary nucleus (TMN) is involved in EEG desynchronization-one of the proposed mechanisms for DBS action. We studied whether TMN stimulation could interfere with epileptic spike-wave discharges (SWDs) in WAG/Rij rats with inherited absence epilepsy and whether such stimulation would affect sleep-wake cycle. EEG and video registration were used to determine SWD occurrence and stages of sleep and wake during three-hours recording sessions. Stimulation (100Hz) was applied in two modes: closed-loop (with previously determined interruption threshold intensity) or open-loop mode (with 50% or 70% threshold intensity). Closed-loop stimulation successfully interrupted SWDs but elevated their number by 148 ± 54% compared to baseline. It was accompanied by increase in number of episodes but not total duration of both active and passive wakefulness. Open-loop stimulation with amplitude 50% threshold did not change measured parameters, though 70% threshold stimulation reduced SWDs number by 40 ± 9%, significantly raised the amount of active wakefulness and decreased the amount of both slow-wave and rapid eye movement sleep. These results suggest that the TMN is unfavorable as a target for DBS as its stimulation may cause alterations in sleep-wake cycle. A careful choosing of parameters and control of sleep-wake activity is necessary when applying DBS in epilepsy. PMID:25524851

  2. Comparison of manual and automated DNA purification for measuring TREC in dried blood spot (DBS) samples with qPCR.

    PubMed

    Lang, Pierre-Olivier; Govind, Sheila; Dramé, Moustapha; Aspinall, Richard

    2012-10-31

    Automated nucleic acid extractions from dried blood spot (DBS) samples promises standardized sample treatment, low error rates, avoidance of contamination and requirement of less hands-on time. In the present study, non-automated and automated column based extraction processes using the QIAamp Investigator procedure were compared for the extraction of DNA from DBS samples. The concentration and the purity of DNA generated were determined by optical density readings. Furthermore qPCR downstream applications using the nucleic acids extracted with the two processes and albumin and T-cell receptor excision circles (TREC) copy numbers were measured and compared. The influence of the time of storage was also investigated by analyzing samples freshly dried and stored up to 11weeks at -20°C from the same individual. Finally, we provide arguments of preferentially choosing the automated procedure for extracting DNAs from DBS samples when downstream qPCR applications are required. PMID:22867745

  3. Behavioral and Neurobiological Effects of Deep Brain Stimulation in a Mouse Model of High Anxiety- and Depression-Like Behavior

    PubMed Central

    Schmuckermair, Claudia; Gaburro, Stefano; Sah, Anupam; Landgraf, Rainer; Sartori, Simone B; Singewald, Nicolas

    2013-01-01

    Increasing evidence suggests that high-frequency deep brain stimulation of the nucleus accumbens (NAcb-DBS) may represent a novel therapeutic strategy for individuals suffering from treatment-resistant depression, although the underlying mechanisms of action remain largely unknown. In this study, using a unique mouse model of enhanced depression- and anxiety-like behavior (HAB), we investigated behavioral and neurobiological effects of NAcb-DBS. HAB mice either underwent chronic treatment with one of three different selective serotonin reuptake inhibitors (SSRIs) or received NAcb-DBS for 1?h per day for 7 consecutive days. Animals were tested in established paradigms revealing depression- and anxiety-related behaviors. The enhanced depression-like behavior of HAB mice was not influenced by chronic SSRI treatment. In contrast, repeated, but not single, NAcb-DBS induced robust antidepressant and anxiolytic responses in HAB animals, while these behaviors remained unaffected in normal depression/anxiety animals (NAB), suggesting a preferential effect of NAcb-DBS on pathophysiologically deranged systems. NAcb-DBS caused a modulation of challenge-induced activity in various stress- and depression-related brain regions, including an increase in c-Fos expression in the dentate gyrus of the hippocampus and enhanced hippocampal neurogenesis in HABs. Taken together, these findings show that the normalization of the pathophysiologically enhanced, SSRI-insensitive depression-like behavior by repeated NAcb-DBS was associated with the reversal of reported aberrant brain activity and impaired adult neurogenesis in HAB mice, indicating that NAcb-DBS affects neuronal activity as well as plasticity in a defined, mood-associated network. Thus, HAB mice may represent a clinically relevant model for elucidating the neurobiological correlates of NAcb-DBS. PMID:23325324

  4. Subthalamic nucleus stimulation for Parkinson's disease preferentially improves akinesia of proximal arm movements compared to finger movements.

    PubMed

    Wenzelburger, Roland; Kopper, Florian; Zhang, Bao-Rong; Witt, Karsten; Hamel, Wolfgang; Weinert, Dieter; Kuhtz-Buschbeck, Johann; Gölge, Mukaddes; Illert, Michael; Deuschl, Günther; Krack, Paul

    2003-10-01

    Deep brain stimulation of the subthalamic nucleus (STN-DBS) reduces akinesia in Parkinson's disease but its impact on fine motor functions was unknown. We assessed the effects of DBS and a levodopa (L-dopa) test on the timing of the precision grip in 18 patients. Improvement on UPDRS-items reflecting hand functions and the shortening of the first phases of the precision grip were more distinct in the L-dopa test than in the pure STN-DBS condition. Other akinesia items and the time for build-up of lifting force were equally improved in both conditions. This suggests that routine STN-DBS might not be equally effective on all aspects of fine motor functions. PMID:14534921

  5. Negative impact of borderline global cognitive scores on quality of life after subthalamic nucleus stimulation in Parkinson's disease.

    PubMed

    Witt, Karsten; Daniels, Christine; Krack, Paul; Volkmann, Jens; Pinsker, Markus O; Kloss, Manja; Tronnier, Volker; Schnitzler, Alfons; Wojtecki, Lars; Bötzel, Kai; Danek, Adrian; Hilker, Rüdiger; Sturm, Volker; Kupsch, Andreas; Karner, Elfriede; Deuschl, Günther

    2011-11-15

    Deep brain stimulation (DBS) of the subthalamic nucleus (STN) significantly improves quality of life (QoL) in Parkinson's disease (PD). Dementia is considered as a contraindication for STN-DBS. However, no controlled study assessed the impact of STN-DBS on the QoL and motor outcome in PD patients with a borderline global cognitive impairment. We studied clinical baseline and progression parameters in a cohort of STN-DBS patients with a global cognitive score still in the non-demented range but scoring in the lowest quartile of the Mattis Dementia Rating Scale (MDRS), a measure of global cognitive functioning. Data from a German randomised controlled study comparing DBS (60 patients) with best medical treatment (BMT, 59 patients) were analysed. Changes in patients' QoL scores were assessed using the Parkinson's disease questionnaire (PDQ-39) at baseline and at the 6 months follow up. Patients were split into four groups according to their MDRS performance at baseline and these groups were compared in the context of motor outcome and QoL. Twelve out of sixty patients of the STN-DBS group scored in the lowest quartile of the MDRS (range between one hundred thirty and one hundred thirty seven points). An individual analysis revealed that 3 of 12 patients showed a clinical relevant improvement in QoL whereas the group statistics did not reveal any significant improvement in QoL measures after STN-DBS compared to the BMT group. Since this failure to improve in QoL cannot be explained by a failure to improve in motor functions, stimulation settings and psychiatric scales after STN-DBS, the failure to improve in QoL in patients with a borderline global cognitive score might be specifically related to lower cognitive functioning. PMID:21733529

  6. DEEP BRAIN STIMULATION IN MIDLINE THALAMIC REGION FACILITATES SYNAPTIC TRANSMISSION AND SHORTTERM MEMORY IN A MOUSE MODEL OF ALZHEIMER’S DISEASE

    PubMed Central

    Arrieta-Cruz, Isabel; Pavlides, Constantine; Pasinetti, Giulio Maria

    2012-01-01

    Based on evidence suggesting that deep brain stimulation (DBS) may promote certain cognitive processes, we have been interested in developing DBS as a means of mitigating memory and learning impairments in Alzheimer’s disease (AD). In this study we used an animal model of AD (TgCRND8 mice) to determine the effects of high-frequency stimulation (HFS) on non-amyloidogenic ?-secretase activity and DBS in short-term memory. We tested our hypothesis using hippocampal slices (in vitro studies) from TgCRND8 mice to evaluate whether HFS increases ?-secretase activity (non-amyloidogenic pathway) in the CA1 region. In a second set of experiments, we performed in vivo studies to evaluate whether DBS in midline thalamic region re-establishes hippocampal dependent short-term memory in TgCRND8 mice. The results showed that application of HFS to isolated hippocampal slices significantly increased synaptic plasticity in the CA1 region and promoted a 2-fold increase of non-amyloidogenic ?-secretase activity, in comparison to low frequency stimulated controls from TgCRND8 mice. In the in vivo studies, DBS treatment facilitated acquisition of object recognition memory in TgCRND8 mice, in comparison to their own baseline before treatment. These results provide evidence that DBS could enhance short-term memory in the CA1 region of hippocampus in a mouse model of AD. PMID:23227306

  7. Cerebellar Ataxia from Multiple Potential Causes: Hypothyroidism, Hashimoto's Thyroiditis, Thalamic Stimulation, and Essential Tremor

    PubMed Central

    Shneyder, Natalya; Lyons, Mark K.; Driver-dunckley, Erika; Evidente, Virgilio Gerald H.

    2012-01-01

    Background Both hypothyroidism and Hashimoto's thyroiditis (HT) can rarely be associated with cerebellar ataxia. Severe essential tremor (ET) as well as bilateral thalamic deep brain stimulation (DBS) may lead to subtle cerebellar signs. Case Report We report a 74-year-old male with hypothyroidism and a 20-year history of ET who developed cerebellar ataxia after bilateral thalamic DBS. Extensive workup revealed elevated thyroid stimulating hormone and thyroperoxidase antibody titers confirming the diagnosis of HT. Discussion Our case demonstrates multiple possible causes of cerebellar ataxia in a patient, including hypothyroidism, HT, chronic ET, and bilateral thalamic DBS. Counseling of patients may be appropriate when multiple risk factors for cerebellar ataxia coexist in one individual. PMID:23439792

  8. Role of radiology in central nervous system stimulation.

    PubMed

    Minks, D P; Pereira, E A C; Young, V E L; Hogarth, K M; Quaghebeur, G

    2015-04-01

    Central nervous system (CNS) stimulation is becoming increasingly prevalent. Deep brain stimulation (DBS) has been proven to be an invaluable treatment for movement disorders and is also useful in many other neurological conditions refractory to medical treatment, such as chronic pain and epilepsy. Neuroimaging plays an important role in operative planning, target localization and post-operative follow-up. The use of imaging in determining the underlying mechanisms of DBS is increasing, and the dependence on imaging is likely to expand as deep brain targeting becomes more refined. This article will address the expanding role of radiology and highlight issues, including MRI safety concerns, that radiologists may encounter when confronted with a patient with CNS stimulation equipment in situ. PMID:25715044

  9. G51DBS 2009-2010 coursework 5 answer Consider a relation Listing with attributes Cinema, Film, Day, Time,

    E-print Network

    Alechina, Natasha

    G51DBS 2009-2010 coursework 5 answer Consider a relation Listing with attributes Cinema, Film, Day, Time, Certificate: Listing Cinema Film Day Time Certificate Savoy Green Zone Wed 18 : 00 15 Savoy Green of Film Classifi- cation; certificate 15 means that nobody younger than 15 can see this film in a cinema

  10. Is deep brain stimulation a treatment option for anorexia nervosa?

    PubMed Central

    2013-01-01

    Anorexia nervosa (AN) is a severe psychiatric disorder with high rates of morbidity, comorbidity and mortality, which in a subset of patients (21%) takes on a chronic course. Since an evidence based treatment for AN is scarce, it is crucial to investigate new treatment options, preferably focused on influencing the underlying neurobiological mechanisms of AN. The objective of the present paper was to review the evidence for possible neurobiological correlates of AN, and to hypothesize about potential targets for Deep brain stimulation (DBS) as a treatment for chronic, therapy-refractory AN. One avenue for exploring new treatment options based on the neurobiological correlates of AN, is the search for symptomatologic and neurobiologic parallels between AN and other compulsivity- or reward-related disorders. As in other compulsive disorders, the fronto-striatal circuitry, in particular the insula, the ventral striatum (VS) and the prefrontal, orbitofrontal, temporal, parietal and anterior cingulate cortices, are likely to be implicated in the neuropathogenesis of AN. In this paper we will review the few available cases in which DBS has been performed in patients with AN (either as primary diagnosis or as comorbid condition). Given the overlap in symptomatology and neurocircuitry between reward-related disorders such as obsessive compulsive disorder (OCD) and AN, and the established efficacy of accumbal DBS in OCD, we hypothesize that DBS of the nucleus accumbens (NAc) and other areas associated with reward, e.g. the anterior cingulated cortex (ACC), might be an effective treatment for patients with chronic, treatment refractory AN, providing not only weight restoration, but also significant and sustained improvement in AN core symptoms and associated comorbidities and complications. Possible targets for DBS in AN are the ACC, the ventral anterior limb of the capsula interna (vALIC) and the VS. We suggest conducting larger efficacy studies that also explore the functional effects of DBS in AN. PMID:24175936

  11. Superparamagnetic-bead Based Method: An Effective DNA Extraction from Dried Blood Spots (DBS) for Diagnostic PCR

    PubMed Central

    2014-01-01

    Introduction: Storing blood as dried spots on filter paper is a trustworthy approach used in genetic screening issues which justifies the necessity for a reliable DNA extraction method. The present work aims to investigate the effectiveness of superparamagnetic-bead based method in extracting DNA from dried blood spots (DBS). Materials and Methods: Sixteen venous blood samples collected in K3-EDTA tubes (400?l of whole blood) were used for the spotting (4 circles each 100?l) on Ahlstrom 226 grad filter papers, for extraction and comparison. To ensure effectiveness, the extracted DNA was checked for quantity using the Quant-iT™ dsDNA Broad-Range Assay Kit and for quality by polymerase chain reaction (PCR) amplification of 344 bp segment of the HBB gene. Hybridization assays based on the dynamic allele specific hybridization (DASH) technique for two hemoglobin beta (HBB) mutations in genomic DNA extracted from DBS of ß-thalassemia patients were also performed to ensure the quality of extraction. Results: The results revealed a compatible effectiveness of the superparamagnetic-bead based method in extracting DNA from DBS particularly when incubating the DBS with lysis buffers BL+BLM overnight. A mean concentration of 21ng/ ?l was obtained with lysis buffers BL+BLM overnight incubation compared to 5.2 ng/?l for 2 h incubation with lysis buffers BL+BLM and 4.7 ng/?l when extraction performed using the lysis buffer BLM alone. Moreover, PCR amplification of 344 bp segment of the HBB showed a good quality of the extracted DNA. Conclusion: It was concluded that the superparamagnetic-bead based method is a reliable and effective method for DNA extraction from DBS and can be adopted for genetic diagnostic purposes. PMID:24959449

  12. Deep brain stimulation of the anterior cingulate cortex: targeting the affective component of chronic pain.

    PubMed

    Boccard, Sandra G J; Pereira, Erlick A C; Moir, Liz; Van Hartevelt, Tim J; Kringelbach, Morten L; FitzGerald, James J; Baker, Ian W; Green, Alexander L; Aziz, Tipu Z

    2014-01-22

    Deep brain stimulation (DBS) has shown promise for relieving nociceptive and neuropathic symptoms of refractory chronic pain. We assessed the efficacy of a new target for the affective component of pain, the anterior cingulate cortex (ACC). A 49-year-old man with neuropathic pain underwent bilateral ACC DBS. Patient-reported outcome measures were collected before and 2 years after surgery using a Visual Analogue Scale, Short-Form 36 quality of life survey, McGill pain questionnaire, EuroQol-5D questionnaires (EQ-5D; Health State) and neuropsychological assessments. The patient improved with DBS. Two years after surgery, the Visual Analogue Scale decreased from 6.7 to 3.0, McGill pain questionnaire improved by 42% and EQ-5D Health State increased by 150%. Stimulating the ACC at 130 Hz, 330 µs and 3 V facilitated neuropathic pain relief. The DBS remained efficacious during the 2-year follow-up period. Affective ACC DBS can relieve chronic neuropathic pain refractory to pharmacotherapy and restore quality of life. PMID:24100411

  13. Role of deep brain stimulation in modulating memory formation and recall

    PubMed Central

    Hu, Rollin; Eskandar, Emad; Williams, Ziv

    2010-01-01

    Deep brain stimulation (DBS) has become an increasingly popular tool for treating a variety of medically refractory neurological and psychiatric disorders such as Parkinson disease, essential tremor, depression, and obsessive-compulsive disorder. Several targets have been identified for ablation or stimulation based on their anatomical location and presumed function. Areas such as the subthalamic nucleus, globus pallidus, and thalamus, for example, are believed to play a key role in motor control and execution, and they are commonly used in the treatment of motor disorders. Limbic structures such as the cingulate cortex and ventral striatum, believed to be important in motivation, emotion, and higher cognition, have also been targeted for treatment of a number of psychiatric disorders. In all of these settings, DBS is largely aimed at addressing the deleterious aspects of these diseases. In Parkinson disease, for example, DBS has been used to reduce rigidity and tremor, whereas in obsessive-compulsive disorder it has been used to limit compulsive behavior. More recently, however, attention has also turned to the potential use of DBS for enhancing or improving otherwise nonpathological aspects of cognitive function. This review explores the potential role of DBS in augmenting memory formation and recall, and the authors discuss recent studies and future trends in this emerging field. PMID:19569891

  14. Conducting Polymers in Neural Stimulation Applications

    Microsoft Academic Search

    David D. Zhou; X. Tracy Cui; Amy Hines; Robert J. Greenberg

    \\u000a With advances in neural prostheses, the demand for high-resolution and site-specific stimulation is driving microelectrode\\u000a research to develop electrodes that are much smaller in area and longer in lifetime. For such arrays, the choice of electrode\\u000a material has become increasingly important. Currently, most neural stimulation devices use platinum, iridium oxide, or titanium\\u000a nitride electrodes. Although those metal electrodes have low

  15. Recording evoked potentials during deep brain stimulation: development and validation of instrumentation to suppress the stimulus artefact

    PubMed Central

    Kent, A R; Grill, W M

    2012-01-01

    Deep brain stimulation (DBS) is an effective treatment for movement disorders, but the selection of stimulus parameters is a clinical burden and often yields sub-optimal outcomes for patients. Measurement of electrically evoked compound action potentials (ECAPs) during DBS could offer insight into the type and spatial extent of neural element activation and provide a potential feedback signal for the rational selection of stimulus parameters and closed-loop DBS. However, recording ECAPs presents a significant technical challenge due to the large stimulus artefact, which can saturate recording amplifiers and distort short latency ECAP signals. We developed DBS-ECAP recording instrumentation combining commercial amplifiers and circuit elements in a serial configuration to reduce the stimulus artefact and enable high fidelity recording. We used an electrical circuit equivalent model of the instrumentation to understand better the sources of the stimulus artefact and the mechanisms of artefact reduction by the circuit elements. In vitro testing validated the capability of the instrumentation to suppress the stimulus artefact and increase gain by a factor of 1,000 to 5,000 compared to a conventional biopotential amplifier. The distortion of mock ECAP (mECAP) signals was measured across stimulation parameters, and the instrumentation enabled high fidelity recording of mECAPs with latencies of only 0.5 ms for DBS pulse widths of 50 to 100 ?s/phase. Subsequently, the instrumentation was used to record in vivo ECAPs, without contamination by the stimulus artefact, during thalamic DBS in an anesthetized cat. The characteristics of the physiological ECAP were dependent on stimulation parameters. The novel instrumentation enables high fidelity ECAP recording and advances the potential use of the ECAP as a feedback signal for the tuning of DBS parameters. PMID:22510375

  16. Effects of ketamine and propofol on motor evoked potentials elicited by intracranial microstimulation during deep brain stimulation

    PubMed Central

    Furmaga, Havan; Park, Hyun-Joo; Cooperrider, Jessica; Baker, Kenneth B.; Johnson, Matthew; Gale, John T.; Machado, Andre G.

    2014-01-01

    Few preclinical or clinical studies have evaluated the effect of anesthetics on motor evoked potentials (MEPs), either alone or in the presence of conditioning stimuli such as deep brain stimulation (DBS). In this study we evaluated the effects of two commonly used anesthetic agents, propofol and ketamine (KET), on MEPs elicited by intra-cortical microstimulation of the motor cortex in a rodent model with and without DBS of the dentatothalamocortical (DTC) pathway. The effects of propofol anesthesia on MEP amplitudes during DTC DBS were found to be highly dose dependent. Standard, but not high, dose propofol potentiated the facilitatory effects of 30 Hz DTC DBS on MEPs. This facilitation was sustained and phase-dependent indicating that, compared to high dose propofol, standard dose propofol has a beta-band excitatory effect on cortical networks. In contrast, KET anesthetic demonstrated a monotonic relationship with increasing frequencies of stimulation, such that the highest frequency of stimulation resulted in the greatest MEP amplitude. KET also showed phase dependency but less pronounced than standard dose propofol. The results underscore the importance of better understanding the complex effects of anesthetics on cortical networks and exogenous stimuli. Choice of anesthetic agents and dosing may significantly confound or even skew research outcomes, including experimentation in novel DBS indications and paradigms. PMID:24904312

  17. Design of electrical stimulation bioreactors for cardiac tissue engineering.

    PubMed

    Tandon, N; Marsano, A; Cannizzaro, C; Voldman, J; Vunjak-Novakovic, G

    2008-01-01

    Electrical stimulation has been shown to improve functional assembly of cardiomyocytes in vitro for cardiac tissue engineering. Carbon electrodes were found in past studies to have the best current injection characteristics. The goal of this study was to develop rational experimental design principles for the electrodes and stimulation regime, in particular electrode configuration, electrode ageing, and stimulation amplitude. Carbon rod electrodes were compared via electrochemical impedance spectroscopy (EIS) and we identified a safety range of 0 to 8 V/cm by comparing excitation thresholds and maximum capture rates for neonatal rat cardiomyocytes cultured with electrical stimulation. We conclude with recommendations for studies involving carbon electrodes for cardiac tissue engineering. PMID:19163486

  18. Axonal and synaptic failure suppress the transfer of firing rate oscillations, synchrony and information during high frequency deep brain stimulation.

    PubMed

    Rosenbaum, Robert; Zimnik, Andrew; Zheng, Fang; Turner, Robert S; Alzheimer, Christian; Doiron, Brent; Rubin, Jonathan E

    2014-02-01

    High frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a widely used treatment for Parkinson's disease, but its effects on neural activity in basal ganglia circuits are not fully understood. DBS increases the excitation of STN efferents yet decouples STN spiking patterns from the spiking patterns of STN synaptic targets. We propose that this apparent paradox is resolved by recent studies showing an increased rate of axonal and synaptic failures in STN projections during DBS. To investigate this hypothesis, we combine in vitro and in vivo recordings to derive a computational model of axonal and synaptic failure during DBS. Our model shows that these failures induce a short term depression that suppresses the synaptic transfer of firing rate oscillations, synchrony and rate-coded information from STN to its synaptic targets. In particular, our computational model reproduces the widely reported suppression of parkinsonian ? oscillations and synchrony during DBS. Our results support the idea that short term depression is a therapeutic mechanism of STN DBS that works as a functional lesion by decoupling the somatic spiking patterns of STN neurons from spiking activity in basal ganglia output nuclei. PMID:24051279

  19. The clinical significance of neuropsychological changes following bilateral subthalamic nucleus deep brain stimulation for Parkinson's disease

    Microsoft Academic Search

    Christopher I. Higginson; Vicki L. Wheelock; Dawn Levine; David S. King; Conrad T. E. Pappas; Karen A. Sigvardt

    2009-01-01

    Despite the clinical importance of the question, a number of methodological issues have limited firm conclusions regarding the cognitive safety of deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD). Amongst these issues, studies have generally failed to consider the postoperative changes that occur within individual patients. This study utilized reliable change indices (RCIs) derived from

  20. Deep brain stimulation in childhood: an effective treatment for early onset idiopathic generalised dystonia

    Microsoft Academic Search

    Jeremy R Parr; Alex L Green; Carole Joint; Morag Andrew; Ralph P Gregory; Richard B Scott; Michael A McShane; Tipu Z Aziz

    2007-01-01

    Background: Early onset idiopathic generalised dystonia is a progressive and profoundly disabling condition. Medical treatment may ameliorate symptoms. However, many children have profound, intractable disability including the loss of ambulation and speech, and difficulties with feeding. Following the failure of medical management, deep brain stimulation (DBS) of the globus pallidus internus (GPi) has emerged as an alternative treatment for the

  1. The Virtual Patient Simulator of Deep Brain Stimulation in the Obsessive Compulsive Disorder Based on Connectome and 7 Tesla MRI Data

    PubMed Central

    Bonmassar, Giorgio; Makris, Nikos

    2014-01-01

    We present work in progress on the virtual patient model for patients with Deep Brain Stimulation (DBS) implants based on Connectome and 7 Tesla Magnetic Resonance Imaging (MRI) data. Virtual patients are realistic computerized models of patients that allow medical-device companies to test new products earlier, helping the devices get to market more quickly and cheaply according to the Food and Drug Administration. We envision that the proposed new virtual patient simulator will enable radio frequency power dosimetry on patients with the DBS implant undergoing MRI. Future patients with DBS implants may profit from the proposed virtual patient by allowing for a MRI investigation instead of more invasive Computed Tomography (CT) scans. The virtual patient will be flexible and morphable to relate to neurological and psychiatric conditions such as Obsessive Compulsive Disorder (OCD), which benefit from DBS. PMID:25506052

  2. Electrode compositions

    DOEpatents

    Block, Jacob (Rockville, MD); Fan, Xiyun (Orange, TX)

    1998-01-01

    An electrode composition for use as an electrode in a non-aqueous battery system. The electrode composition contains an electrically active powder in a solid polymer and, as a dispersant, a C.sub.8 -C.sub.15 alkyl capped oligomer of a hexanoic acid that is electrochemically inert at 2.5-4.5 volts.

  3. Electrode compositions

    DOEpatents

    Block, J.; Fan, X.

    1998-10-27

    An electrode composition is described for use as an electrode in a non-aqueous battery system. The electrode composition contains an electrically active powder in a solid polymer and, as a dispersant, a C{sub 8}-C{sub 15} alkyl capped oligomer of a hexanoic acid that is electrochemically inert at 2.5--4.5 volts.

  4. Timing of Deep Brain Stimulation in Parkinson Disease: A Need for Reappraisal?

    PubMed Central

    deSouza, Ruth-Mary; Moro, Elena; Lang, Anthony E; Schapira, Anthony H V

    2013-01-01

    We review the current application of deep brain stimulation (DBS) in Parkinson disease (PD) and consider the evidence that earlier use of DBS confers long-term symptomatic benefit for patients compared to best medical therapy. Electronic searches were performed of PubMed, Web of Knowledge, Embase, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials to identify all article types relating to the timing of DBS in PD. Current evidence suggests that DBS is typically performed in late stage PD, a mean of 14 to 15 years after diagnosis. Current guidelines recommend that PD patients who are resistant to medical therapies, have significant medication side effects and lengthening off periods, but are otherwise cognitively intact and medically fit for surgery be considered for DBS. If these criteria are rigidly interpreted, it may be that, by the time medical treatment options have been exhausted, the disease has progressed to the point that the patient may no longer be fit for neurosurgical intervention. From the evidence available, we conclude that surgical management of PD alone or in combination with medical therapy results in greater improvement of motor symptoms and quality of life than medical treatment alone. There is evidence to support the use of DBS in less advanced PD and that it may be appropriate for earlier stages of the disease than for which it is currently used. The improving short and long-term safety profile of DBS makes early application a realistic possibility. Ann Neurol 2013;73:565–575 PMID:23483564

  5. Invasive Circuitry-Based Neurotherapeutics: Stereotactic Ablation and Deep Brain Stimulation for OCD

    PubMed Central

    Greenberg, Benjamin D; Rauch, Scott L; Haber, Suzanne N

    2010-01-01

    Psychiatric neurosurgery, specifically stereotactic ablation, has continued since the 1940s, mainly at a few centers in Europe and the US. Since the late 1990s, the resurgence of interest in this field has been remarkable; reports of both lesion procedures and the newer technique of deep brain stimulation (DBS) have increased rapidly. In early 2009, the US FDA granted limited humanitarian approval for DBS for otherwise intractable obsessive-compulsive disorder (OCD), the first such approval for a psychiatric illness. Several factors explain the emergence of DBS and continued small-scale use of refined lesion procedures. DBS and stereotactic ablation have been successful and widely used for movement disorders. There remains an unmet clinical need: current drug and behavioral treatments offer limited benefit to some seriously ill people. Understandings of the neurocircuitry underlying psychopathology and the response to treatment, while still works in progress, are much enhanced. Here, we review modern lesion procedures and DBS for OCD in the context of neurocircuitry. A key issue is that clinical benefit can be obtained after surgeries targeting different brain structures. This fits well with anatomical models, in which circuits connecting orbitofrontal cortex (OFC), medial prefrontal cortex (mPFC), basal ganglia, and thalamus are central to OCD pathophysiology and treatment response. As in movement disorders, dedicated interdisciplinary teams, here led by psychiatrists, are required to implement these procedures and maintain care for patients so treated. Available data, although limited, support the promise of stereotactic ablation or DBS in carefully selected patients. Benefit in such cases appears not to be confined to obsessions and compulsions, but includes changes in affective state. Caution is imperative, and key issues in long-term management of psychiatric neurosurgery patients deserve focused attention. DBS and contemporary ablation also present different patterns of potential benefits and burdens. Translational research to elucidate how targeting specific nodes in putative OCD circuitry might lead to therapeutic gains is accelerating in tandem with clinical use. PMID:19759530

  6. Beta-band frequency peaks inside the subthalamic nucleus as a biomarker for motor improvement after deep brain stimulation in Parkinson's disease.

    PubMed

    Michmizos, Konstantinos P; Frangou, Polytimi; Stathis, Pantelis; Sakas, Damianos; Nikita, Konstantina S

    2015-01-01

    Deep brain stimulation (DBS) of the subthalamic nucleus (STN) remains an empirical, yet highly effective, surgical treatment for advanced Parkinson's disease (PD). DBS outcome depends on accurate stimulation of the STN sensorimotor area which is a trial-and-error procedure taking place during and after surgery. Pathologically enhanced beta-band (13-35 Hz) oscillatory activity across the cortico-basal ganglia pathways is a prominent neurophysiological phenomenon associated with PD. We hypothesized that weighing together beta-band frequency peaks from simultaneous microelectrode recordings in "off-state" PD patients could map the individual neuroanatomical variability and serve as a biomarker for the location of the STN sensorimotor neurons. We validated our hypothesis with 9 and 11 patients that, respectively, responded well and poorly to bilateral DBS, after at least two years of follow up. We categorized "good" and "poor" DBS responders based on their clinical assessment alongside a > 40% and <30% change, respectively, in "off" unified PD rating scale motor scores. Good (poor) DBS responders had, in average, 1 mm (3.5 mm) vertical distance between the maximum beta-peak weighted across the parallel microelectrodes and the center of the stimulation area. The distances were statistically different in the two groups ( p = 0.0025 ). Our biomarker could provide personalized intra- and postoperative support in stimulating the STN sensorimotor area associated with optimal long-term clinical benefits. PMID:25095273

  7. 21 CFR 882.5820 - Implanted cerebellar stimulator.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ...cerebellar stimulator is a device used to stimulate electrically a patient's cerebellar cortex for the treatment of intractable epilepsy, spasticity, and some movement disorders. The stimulator consists of an implanted receiver with electrodes that are...

  8. Conjugated Polymer Actuators for Articulating Neural Probes and Electrode Interfaces

    NASA Astrophysics Data System (ADS)

    Daneshvar, Eugene Dariush

    This thesis investigated the potential use of polypyrrole (PPy) doped with dodecylbenzenesulfonate (DBS) to controllably articulate (bend or guide) flexible neural probes and electrodes. PPy(DBS) actuation performance was characterized in the ionic mixture and temperature found in the brain. Nearly all the ions in aCSF were exchanged into the PPy---the cations Na +, K+, Mg2+, Ca2+, as well as the anion PO43-; Cl- was not present. Nevertheless, deflections in aCSF were comparable to those in NaDBS and they were monotonic with oxidation level: strain increased upon reduction, with no reversal of motion despite the mixture of ionic charges and valences being exchanged. Actuation depended on temperature. Upon warming, the cyclic voltammograms showed additional peaks and an increase of 70% in the consumed charge. Actuation strain was monotonic under these conditions, demonstrating that conducting polymer actuators can indeed be used for neural interface and neural probe applications. In addition, a novel microelectro-mechanical system (MEMS) was developed to measure previously disregarded residual stress in a bilayer actuator. Residual stresses are a major concern for MEMS devices as that they can dramatically influence their yield and functionality. This device introduced a new technique to measure micro-scaled actuation forces that may be useful for characterization of other MEMS actuators. Finally, a functional movable parylene-based neural electrode prototype was developed. Employing PPy(DBS) actuators, electrode projections were successfully controlled to either remain flat or actuate out-of-plane and into a brain phantom during insertion. An electrode projection 800 microm long and 50 microm wide was able to deflect almost 800 microm away from the probe substrate. Applications that do not require insertion into tissue may also benefit from the electrode projections described here. Implantable neural interface devices are a critical component to a broad class of emerging neuroprosthetic and neurostimulation systems aimed to restore functionality, or abate symptoms related to physical impairments, loss of sensory abilities, and neurological disorders. The therapeutic outcome and performance of these systems hinge to a large degree on the proximity, size, and placement of the device or interface with respect to the targeted neurons or tissue.

  9. Deep brain stimulation of the subthalamic nucleus: All that glitters isn't gold?

    PubMed

    Galati, Salvatore; Stefani, Alessandro

    2015-04-15

    With the silver anniversary of deep brain stimulation (DBS) behind us, this would seem to be a good juncture to consider its successes and unanswered questions. Bilateral subthalamic nucleus (STN) stimulation has changed the clinical perspective of several thousand Parkinson's disease (PD) patients worldwide. A recent reappraisal animates the field with strong arguments in favor of an anticipation of the stereotactic approach in patients with as little as 5 to 6 years of disease history if they manifest motor complications. From what was once a no-choice option, STN-DBS is now becoming more and more attractive to neurologists dealing with movement disorders. Despite the development of new pharmacological treatment and renewed rehabilitation programs able to modify the severity of drug-related complications, a resurgence of stimulation therapy reminiscent of an old era of medicine with an attendant blinkered mindset has emerged. Yet, the DBS-mediated effects are modest on critical aspects such as gait impairment and extremely variable depending on the clinical phenotype and individual clinical profile. Hence, the indication for DBS should become more, and not less, individually tailored. Those physicians considering deep brain stimulation (DBS) as a therapeutic option need to evaluate results beyond short-term quality of life, giving the correct weight to the direct and indirect costs over the longer term as well as to life prognosis. Unequivocal recourse to early-stimulation surgery necessitates investigations not limited to a mere comparative assessment versus drug-mediated benefits, but instead showing evidence of a clear degree of disease-modifying effect or a rescue of basal ganglia plasticity. © 2015 International Parkinson and Movement Disorder Society. PMID:25649375

  10. Deep brain stimulation for psychiatric disorders — state of the art

    Microsoft Academic Search

    T. E. Schläpfer; B. H. Bewernick

    A substantial number of patients suffering from severe neuropsychiatric disorders do not respond to conventional therapeutic\\u000a approaches. Results from functional neuroimaging research and the development of neuromodulatory treatments lead to novel\\u000a putative strategies. Recently, one of those methods, deep brain stimulation (DBS) has been applied in selected patient with\\u000a major depression and obsessive-compulsive disorder (OCD) and major depression.\\u000a \\u000a We summarize

  11. Demultiplexer circuit for neural stimulation

    DOEpatents

    Wessendorf, Kurt O; Okandan, Murat; Pearson, Sean

    2012-10-09

    A demultiplexer circuit is disclosed which can be used with a conventional neural stimulator to extend the number of electrodes which can be activated. The demultiplexer circuit, which is formed on a semiconductor substrate containing a power supply that provides all the dc electrical power for operation of the circuit, includes digital latches that receive and store addressing information from the neural stimulator one bit at a time. This addressing information is used to program one or more 1:2.sup.N demultiplexers in the demultiplexer circuit which then route neural stimulation signals from the neural stimulator to an electrode array which is connected to the outputs of the 1:2.sup.N demultiplexer. The demultiplexer circuit allows the number of individual electrodes in the electrode array to be increased by a factor of 2.sup.N with N generally being in a range of 2-4.

  12. [New indications for deep brain stimulation: ethical criteria for research and therapy].

    PubMed

    Synofzik, M

    2013-10-01

    The applications of deep brain stimulation (DBS) are rapidly increasing and now include a large variety of neurological and psychiatric diseases, such as depression, obsessive compulsive disorders, addiction, Alzheimer's disease, anorexia nervosa and rare movement disorders. These new applications confer a huge therapeutic potential in diseases for which often no treatment exists or which are refractory to existing therapies. This spread of applications, however, implies ethical problems in several domains: clinical use, research and presentation in the media and public. Thus, a systematic ethical analysis is needed to inform and guide this process. In this article we identify ethical problems involved in research and clinical use of novel DBS applications, suggest criteria and distinctions for structuring the ethical analysis, and articulate ethical demands for DBS research of novel applications. PMID:23979358

  13. Effect of subthalamic nucleus deep brain stimulation on dual-task cognitive and motor performance in isolated dystonia

    PubMed Central

    Mills, Kelly A; Markun, Leslie C; Luciano, Marta San; Rizk, Rami; Allen, I Elaine; Racine, Caroline A; Starr, Philip A; Alberts, Jay L; Ostrem, Jill L

    2015-01-01

    Objective Subthalamic nucleus (STN) deep brain stimulation (DBS) can improve motor complications of Parkinson's disease (PD) but may worsen specific cognitive functions. The effect of STN DBS on cognitive function in dystonia patients is less clear. Previous reports indicate that bilateral STN stimulation in patients with PD amplifies the decrement in cognitive-motor dual-task performance seen when moving from a single-task to dual-task paradigm. We aimed to determine if the effect of bilateral STN DBS on dual-task performance in isolated patients with dystonia, who have less cognitive impairment and no dementia, is similar to that seen in PD. Methods Eight isolated predominantly cervical patients with dystonia treated with bilateral STN DBS, with average dystonia duration of 10.5?years and Montreal Cognitive Assessment score of 26.5, completed working memory (n-back) and motor (forced-maintenance) tests under single-task and dual-task conditions while on and off DBS. Results A multivariate, repeated-measures analysis of variance showed no effect of stimulation status (On vs Off) on working memory (F=0.75, p=0.39) or motor function (F=0.22, p=0.69) when performed under single-task conditions, though as working memory task difficulty increased, stimulation disrupted the accuracy of force-tracking. There was a very small worsening in working memory performance (F=9.14, p=0.019) when moving from single-task to dual-tasks when using the ‘dual-task loss’ analysis. Conclusions This study suggests the effect of STN DBS on working memory and attention may be much less consequential in patients with dystonia than has been reported in PD. PMID:25012202

  14. Deep brain stimulation induces rapidly reversible transcript changes in Parkinson's leucocytes

    PubMed Central

    Soreq, Lilach; Bergman, Hagai; Goll, Yael; Greenberg, David S; Israel, Zvi; Soreq, Hermona

    2012-01-01

    Abstract Subthalamic deep brain stimulation (DBS) reversibly modulates Parkinson's disease (PD) motor symptoms, providing an unusual opportunity to compare leucocyte transcripts in the same individuals before and after neurosurgery and 1 hr after stimulus cessation (ON- and OFF-stimulus). Here, we report DBS-induced reversibility and OFF-stimulus restoration in 12 of 16 molecular functions and 3 of 4 biological processes shown in exon microarrays to be differentially expressed between PD patients and controls, post-DBS from pre-DBS and OFF from ON states. Intriguingly, 6 of 18 inflammation and immune-related functions exhibited reversibility, and the extent of stimulus-induced changes correlated with the neurological DBS efficacy, suggesting mechanistic implications. A minimal list of 29 transcripts that changed in all three comparisons between states discriminated pre-surgery and OFF states from post-surgery and controls. Six of these transcripts were found to be able to distinguish between PD patients and both healthy controls and patients with other neurological diseases in a previously published whole blood 3’ array data study of early PD patients. Our findings support the future use of this approach for identifying targets for therapeutic intervention and assessing the efficacy of current and new treatments in this and other neurological diseases. PMID:21910823

  15. Influence of different extraction methods and PCR techniques on the sensitivity of HCMV-DNA detection in dried blood spot (DBS) filter cards

    Microsoft Academic Search

    Katharina Göhring; Klaus Dietz; Steffen Hartleif; Gerhard Jahn; Klaus Hamprecht

    2010-01-01

    BackgroundInfection with human cytomegalovirus (HCMV) is the most common congenital virus infection, affecting about 0.5–2% of newborns. Using DBS on Guthrie cards, it is possible to discriminate congenital from postnatal HCMV-infection. However, a recent European trial revealed serious problems in detection of low HCMV-DNA levels from DBS-filter-cards (Barbi et al., 2008).7

  16. Closing the loop of deep brain stimulation.

    PubMed

    Carron, Romain; Chaillet, Antoine; Filipchuk, Anton; Pasillas-Lépine, William; Hammond, Constance

    2013-01-01

    High-frequency deep brain stimulation is used to treat a wide range of brain disorders, like Parkinson's disease. The stimulated networks usually share common electrophysiological signatures, including hyperactivity and/or dysrhythmia. From a clinical perspective, HFS is expected to alleviate clinical signs without generating adverse effects. Here, we consider whether the classical open-loop HFS fulfills these criteria and outline current experimental or theoretical research on the different types of closed-loop DBS that could provide better clinical outcomes. In the first part of the review, the two routes followed by HFS-evoked axonal spikes are explored. In one direction, orthodromic spikes functionally de-afferent the stimulated nucleus from its downstream target networks. In the opposite direction, antidromic spikes prevent this nucleus from being influenced by its afferent networks. As a result, the pathological synchronized activity no longer propagates from the cortical networks to the stimulated nucleus. The overall result can be described as a reversible functional de-afferentation of the stimulated nucleus from its upstream and downstream nuclei. In the second part of the review, the latest advances in closed-loop DBS are considered. Some of the proposed approaches are based on mathematical models, which emphasize different aspects of the parkinsonian basal ganglia: excessive synchronization, abnormal firing-rate rhythms, and a deficient thalamo-cortical relay. The stimulation strategies are classified depending on the control-theory techniques on which they are based: adaptive and on-demand stimulation schemes, delayed and multi-site approaches, stimulations based on proportional and/or derivative control actions, optimal control strategies. Some of these strategies have been validated experimentally, but there is still a large reservoir of theoretical work that may point to ways of improving practical treatment. PMID:24391555

  17. Closing the loop of deep brain stimulation

    PubMed Central

    Carron, Romain; Chaillet, Antoine; Filipchuk, Anton; Pasillas-Lépine, William; Hammond, Constance

    2013-01-01

    High-frequency deep brain stimulation is used to treat a wide range of brain disorders, like Parkinson's disease. The stimulated networks usually share common electrophysiological signatures, including hyperactivity and/or dysrhythmia. From a clinical perspective, HFS is expected to alleviate clinical signs without generating adverse effects. Here, we consider whether the classical open-loop HFS fulfills these criteria and outline current experimental or theoretical research on the different types of closed-loop DBS that could provide better clinical outcomes. In the first part of the review, the two routes followed by HFS-evoked axonal spikes are explored. In one direction, orthodromic spikes functionally de-afferent the stimulated nucleus from its downstream target networks. In the opposite direction, antidromic spikes prevent this nucleus from being influenced by its afferent networks. As a result, the pathological synchronized activity no longer propagates from the cortical networks to the stimulated nucleus. The overall result can be described as a reversible functional de-afferentation of the stimulated nucleus from its upstream and downstream nuclei. In the second part of the review, the latest advances in closed-loop DBS are considered. Some of the proposed approaches are based on mathematical models, which emphasize different aspects of the parkinsonian basal ganglia: excessive synchronization, abnormal firing-rate rhythms, and a deficient thalamo-cortical relay. The stimulation strategies are classified depending on the control-theory techniques on which they are based: adaptive and on-demand stimulation schemes, delayed and multi-site approaches, stimulations based on proportional and/or derivative control actions, optimal control strategies. Some of these strategies have been validated experimentally, but there is still a large reservoir of theoretical work that may point to ways of improving practical treatment. PMID:24391555

  18. Spinal Cord Stimulation Exerts Neuroprotective Effects against Experimental Parkinson’s Disease

    PubMed Central

    Shinko, Aiko; Agari, Takashi; Kameda, Masahiro; Yasuhara, Takao; Kondo, Akihiko; Tayra, Judith Thomas; Sato, Kenichiro; Sasaki, Tatsuya; Sasada, Susumu; Takeuchi, Hayato; Wakamori, Takaaki; Borlongan, Cesario V.; Date, Isao

    2014-01-01

    In clinical practice, deep brain stimulation (DBS) is effective for treatment of motor symptoms in Parkinson’s disease (PD). However, the mechanisms have not been understood completely. There are some reports that electrical stimulation exerts neuroprotective effects on the central nervous system diseases including cerebral ischemia, head trauma, epilepsy and PD, although there are a few reports on neuroprotective effects of spinal cord stimulation (SCS). We investigated the neuroprotective effects of high cervical SCS on PD model of rats. Adult female Sprague-Dawley rats received hour-long SCS (2, 50 or 200 Hz) with an epidural electrode at C1–2 level for 16 consecutive days. At 2 days after initial SCS, 6-hydroxydopamine (6-OHDA) was injected into the right striatum of rats. Behavioral evaluations of PD symptoms were employed, including cylinder test and amphetamine-induced rotation test performed at 1 and 2 weeks after 6-OHDA injection. Animals were subsequently euthanized for immunohistochemical investigations. In order to explore neurotrophic and growth factor upregulation induced by SCS, another cohort of rats that received 50 Hz SCS was euthanized at 1 and 2 weeks after lesion for protein assays. Behavioral tests revealed that the number of amphetamine-induced rotations decreased in SCS groups. Immunohistochemically, tyrosine hydroxylase (TH)-positive fibers in the striatum were significantly preserved in SCS groups. TH-positive neurons in the substantia nigra pars compacta were significantly preserved in 50 Hz SCS group. The level of vascular endothelial growth factor (VEGF) was upregulated by SCS at 1 week after the lesion. These results suggest that high cervical SCS exerts neuroprotection in PD model of rats, at least partially by upregulation of VEGF. SCS is supposed to suppress or delay PD progression and might become a less invasive option for PD patients, although further preclinical and clinical investigations are needed to confirm the effectiveness and safety. PMID:25009993

  19. Liquid electrode

    DOEpatents

    Ekechukwu, Amy A. (Augusta, GA)

    1994-01-01

    A dropping electrolyte electrode for use in electrochemical analysis of non-polar sample solutions, such as benzene or cyclohexane. The liquid electrode, preferably an aqueous salt solution immiscible in the sample solution, is introduced into the solution in dropwise fashion from a capillary. The electrolyte is introduced at a known rate, thus, the droplets each have the same volume and surface area. The electrode is used in making standard electrochemical measurements in order to determine properties of non-polar sample solutions.

  20. EFFECTS OF DEEP BRAIN STIMULATION IN SUBTHALAMIC NUCLEUS OR GLOBUS PALLIDUS INTERNUS ON STEP INITIATION IN PARKINSON DISEASE

    PubMed Central

    Rocchi, Laura; Carlson-Kuhta, Patricia; Chiari, Lorenzo; Burchiel, Kim J.; Hogarth, Penelope; Horak, Fay B.

    2014-01-01

    Object Difficulty with step initiation, called ‘start hesitation,’ is related to bradykinesia of gait and an early hallmark of freezing of gait in Parkinson’s disease (PD). This study investigated the effects of deep brain stimulation (DBS) and levodopa on step initiation in 29 patients with PD before and six months after DBS surgery randomized to either the bilateral subthalamic nucleus (STN) or globus pallidus internus (GPi). Methods We measured the amplitude and duration of anticipatory postural adjustments (APAs), the feed-forward postural preparation that precedes the onset of voluntary step initiation, based on center of pressure displacements on a forceplate. We also measured the length and velocity of the first step from kinematic motion analysis. The subjects were a cohort from a large, multi-center, double-blinded, clinical trial randomized to DBS in either bilateral STN (15 subjects) or bilateral GPi (14 subjects). Twenty-eight elderly healthy control subjects were tested and nine PD control subjects, who met criteria for DBS, were tested at baseline and six months later. Differences in step initiation were investigated in two conditions before surgery (Off/On levodopa) and in four conditions after surgery (Off/On levodopa combined with Off/On DBS). Results The PD subjects had smaller amplitudes and longer durations of APAs compared to healthy control subjects in all conditions. Before surgery, APAs improved with levodopa. After surgery, the APAs were significantly worse than in the best treatment state before surgery and responsiveness to levodopa decreased. No differences were detected between STN and GPi groups. Comparison with PD control subjects who did not have surgery confirmed that deterioration of step preparation was not related to disease progression. Step length and velocity were smaller in PD-DBS group than control group in all conditions. Before surgery, levodopa improved both length and velocity of the first step. Both step length and velocity were unchanged in the best treatment state before surgery (DOPA condition) as compared with after surgery (DBS+DOPA), with only the step velocity in STN group getting worse after surgery. Conclusions Six months of DBS in the STN or GPi impaired the anticipatory postural preparation for step initiation, the opposite effect as levodopa. Step execution was not as disrupted as postural preparation by DBS, suggesting independent motor pathways for preparation and execution of gait. Although turning the stimulators on after surgery had an added benefit with levodopa on postural preparation to step, comparison pre- and post-surgery suggests that either the surgery itself or six months of continuous stimulation may result in alteration of circuits or plastic changes that impair step initiation. PMID:23039143

  1. Basal Ganglia and Behaviour: Behavioural Effects of Deep Brain Stimulation in Experimental Neurological and Psychiatric Disorders

    Microsoft Academic Search

    Thibault Sesia; Sonny Tan; Rinske Vlamings; Lee Wei Lim; Veerle Visser-Vandewalle; Yasin Temel

    \\u000a The use of deep brain stimulation (DBS) to control severely disabling neurological and psychiatric conditions is an exciting\\u000a and fast emerging area of neuroscience. Deep brain stimulation has generally the same clinical effects as a lesion with respect\\u000a to the improvement of clinical disability, but has more advantages such as its adjustability and reversibility. To this day,\\u000a fundamental knowledge regarding

  2. Accuracy Evaluation of microTargeting Platforms for Deep-Brain Stimulation Using Virtual Targets

    Microsoft Academic Search

    Ramya Balachandran; Jason E. Mitchell; Benoit M. Dawant; J. M. Fitzpatrick

    2009-01-01

    Deep-brain-stimulation (DBS) surgery requires implanting stimulators at target positions with sub millimetric accuracy. Traditional stereotactic frames can provide such accuracy, but a recent innovation called the micro Targeting Platform (FHC, Inc.) replaces this large, universal frame with a single-use, miniature, and custom-designed platform. Both single-target and dual-target platforms are available for unilateral and bilateral procedures, respectively. In this paper, their

  3. Neuroprotection trek--the next generation: neuromodulation I. Techniques--deep brain stimulation, vagus nerve stimulation, and transcranial magnetic stimulation

    NASA Technical Reports Server (NTRS)

    Andrews, Russell J.

    2003-01-01

    Neuromodulation denotes controlled electrical stimulation of the central or peripheral nervous system. The three forms of neuromodulation described in this paper-deep brain stimulation, vagus nerve stimulation, and transcranial magnetic stimulation-were chosen primarily for their demonstrated or potential clinical usefulness. Deep brain stimulation is a completely implanted technique for improving movement disorders, such as Parkinson's disease, by very focal electrical stimulation of the brain-a technique that employs well-established hardware (electrode and pulse generator/battery). Vagus nerve stimulation is similar to deep brain stimulation in being well-established (for the treatment of refractory epilepsy), completely implanted, and having hardware that can be considered standard at the present time. Vagus nerve stimulation differs from deep brain stimulation, however, in that afferent stimulation of the vagus nerve results in diffuse effects on many regions throughout the brain. Although use of deep brain stimulation for applications beyond movement disorders will no doubt involve placing the stimulating electrode(s) in regions other than the thalamus, subthalamus, or globus pallidus, the use of vagus nerve stimulation for applications beyond epilepsy-for example, depression and eating disorders-is unlikely to require altering the hardware significantly (although stimulation protocols may differ). Transcranial magnetic stimulation is an example of an external or non-implanted, intermittent (at least given the current state of the hardware) stimulation technique, the clinical value of which for neuromodulation and neuroprotection remains to be determined.

  4. Penfield’s Prediction: A Mechanism for Deep Brain Stimulation

    PubMed Central

    Murrow, Richard W.

    2014-01-01

    Context: Despite its widespread use, the precise mechanism of action of Deep Brain Stimulation (DBS) therapy remains unknown. The modern urgency to publish more and new data can obscure previously learned lessons by the giants who have preceded us and whose shoulders we now stand upon. Wilder Penfield extensively studied the effects of artificial electrical brain stimulation and his comments on the subject are still very relevant today. In particular, he noted two very different (and seemingly opposite) effects of stimulation within the human brain. In some structures, artificial electrical stimulation has an effect, which mimics ablation, while, in other structures, it produces a stimulatory effect on that tissue. Hypothesis: The hypothesis of this paper is fourfold. First, it proposes that some neural circuits are widely synchronized with other neural circuits, while some neural circuits are unsynchronized and operate independently. Second, it proposes that artificial high-frequency electrical stimulation of a synchronized neural circuit results in an ablative effect, but artificial high-frequency electrical stimulation of an unsynchronized neural circuit results in a stimulatory effect. Third, it suggests a part of the mechanism by which large-scale physiologic synchronization of widely distributed independently processed information streams may occur. This may be the neural mechanism underlying Penfield’s “centrencephalic system,” which he emphasized so many years ago. Fourth, it outlines the specific anatomic distribution of this physiologic synchronization, which Penfield has already clearly delineated as the distribution of his centrencephalic system. Evidence: This paper draws on a brief overview of previous theory regarding the mechanism of action of DBS and on historical, as well as widely known modern clinical data regarding the observed effects of stimulation delivered to various targets within the brain. Basic science investigations, which support the hypothesis are also cited. Conclusion: This paper proposes a novel hypothesis for the mechanism of action of DBS, which was conceptually foreshadowed by Wilder Penfield decades ago. PMID:25368601

  5. Deep brain stimulation modulates nonsense-mediated RNA decay in Parkinson’s patients leukocytes

    PubMed Central

    2013-01-01

    Background Nonsense-Mediated decay (NMD) selectively degrades mRNA transcripts that carry premature stop codons. NMD is often triggered by alternative splicing (AS) modifications introducing such codons. NMD plays an important regulatory role in brain neurons, but the in vivo dynamics of AS and NMD changes in neurological diseases and under treatment were scarcely explored. Results Here, we report exon arrays analysis of leukocyte mRNA AS events prior to and following Deep Brain Stimulation (DBS) neurosurgery, which efficiently improves the motor symptoms of Parkinson’s disease (PD), the leading movement disorder, and is increasingly applied to treat other diseases. We also analyzed publicly available exon array dataset of whole blood cells from mixed early and advanced PD patients. Our in-house exon array dataset of leukocyte transcripts was derived from advanced PD patients’ pre- and post-DBS stimulation and matched healthy control volunteers. The mixed cohort exhibited 146 AS changes in 136 transcripts compared to controls, including 9 NMD protein-level assessed events. In comparison, PD patients from our advanced cohort differed from healthy controls by 319 AS events in 280 transcripts, assessed as inducing 27 protein-level NMD events. DBS stimulation induced 254 AS events in 229 genes as compared to the pre-DBS state including 44 NMD inductions. A short, one hour electrical stimulus cessation caused 234 AS changes in 125 genes compared to ON-stimulus state, 22 of these were assessed for NMD. Functional analysis highlighted disease-induced DNA damage and inflammatory control and its reversal under ON and OFF stimulus as well as alternative splicing in all the tested states. Conclusions The study findings indicate a potential role for NMD both in PD and following electrical brain stimulation. Furthermore, our current observations entail future implications for developing therapies for PD, and for interfering with the impaired molecular mechanisms that underlie PD and other neurodegenerative and neurological disorders, as well as DBS-treatable conditions in general. PMID:23865419

  6. Assessment of the effects of subthalamic stimulation in Parkinson disease patients by artificial neural network.

    PubMed

    Muniz, A S; Nobre, F F; Liu, H; Lyons, K E; Pahwa, R; Liu, W; Nadal, J

    2008-01-01

    This study aims at applying an artificial neural network for the evaluation of the effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) on Parkinson disease (PD) patients with and without medication. A sample of 15 PD patients who have undergone STN DBS were evaluated under four test conditions: medication off and stimulation off (mof-sof), medication off and stimulation on (mof-son), medication on and stimulation off (mon-sof) and medication on and stimulation on (mon-son). A control group with 30 subjects was also evaluated. Principal component analysis (PCA) was applied on vertical ground reaction force (vGRF) and the first six principal component scores (PC score) were obtained in both groups. Those PCs scores were used as input in a probabilistic neural network (PNN). PNN presented satisfactory classification performance in the separation of controls and PD with 90.1% accuracy, 69.2% sensitivity and 100% specificity. The stimulation mof-son and mon-son conditions presented better results compared to mon-sof. In the mof-son condition, 41.7% were classified as normal, while further enhancement (63.3%) was given by the mon-son condition. These results indicated the potentiality of PNN to quantitatively evaluate treatment effects. Furthermore, STN DBS shows improvement on vGRF pattern in PD patients, most substantially when used with medication. PMID:19163765

  7. Subthalamic deep brain stimulation in Parkinson?s disease has no significant effect on perceptual timing in the hundreds of milliseconds range

    PubMed Central

    Cope, Thomas E.; Grube, Manon; Mandal, Arnab; Cooper, Freya E.; Brechany, Una; Burn, David J.; Griffiths, Timothy D.

    2014-01-01

    Bilateral, high-frequency stimulation of the basal ganglia (STN-DBS) is in widespread use for the treatment of the motor symptoms of Parkinson?s disease (PD). We present here the first psychophysical investigation of the effect of STN-DBS upon perceptual timing in the hundreds of milliseconds range, with both duration-based (absolute) and beat-based (relative) tasks; 13 patients with PD were assessed with their STN-DBS ‘on’, ‘off’, and then ‘on’ again. Paired parametric analyses revealed no statistically significant differences for any task according to DBS status. We demonstrate, from the examination of confidence intervals, that any functionally relevant effect of STN-DBS on relative perceptual timing is statistically unlikely. For absolute, duration-based timing, we demonstrate that the activation of STN-DBS may either worsen performance or have no effect, but that it is unlikely to lead to significant improvement. Although these results are negative they have important implications for our understanding of perceptual timing and its relationship to motor functions within the timing network of the brain. They imply that the mechanisms involved in the perceptual processing of temporal information are likely to be functionally independent from those that underpin movement. Further, they suggest that the connections between STN and the subtantia nigra and globus pallidus are unlikely to be critical to beat-based perceptual timing. PMID:24613477

  8. The cost-effectiveness of deep brain stimulation in combination with best medical therapy, versus best medical therapy alone, in advanced Parkinson's disease.

    PubMed

    Eggington, Simon; Valldeoriola, Francesc; Chaudhuri, K Ray; Ashkan, Keyoumars; Annoni, Elena; Deuschl, Günther

    2014-01-01

    Parkinson's disease (PD) is a complex progressive movement disorder leading to motor and non-motor symptoms that become increasingly debilitating as the disease advances, considerably reducing quality of life. Advanced treatment options include deep brain stimulation (DBS). While clinical effectiveness of DBS has been demonstrated in a number of randomised controlled trials (RCT), evidence on cost-effectiveness is limited. The cost-effectiveness of DBS combined with BMT, versus BMT alone, was evaluated from a UK payer perspective. Individual patient-level data on the effect of DBS on PD symptom progression from a large 6-month RCT were used to develop a Markov model representing clinical progression and capture treatment effect and costs. A 5-year time horizon was used, and an incremental cost-effectiveness ratio (ICER) was calculated in terms of cost per quality-adjusted life-years (QALY) and uncertainty assessed in deterministic sensitivity analyses. Total discounted costs in the DBS and BMT groups over 5 years were £68,970 and £48,243, respectively, with QALYs of 2.21 and 1.21, giving an incremental cost-effectiveness ratio of £20,678 per QALY gained. Utility weights in each health state and costs of on-going medication appear to be the key drivers of uncertainty in the model. The results suggest that DBS is a cost-effective intervention in patients with advanced PD who are eligible for surgery, providing good value for money to health care payers. PMID:24158271

  9. Subthalamic deep brain stimulation in Parkinson?s disease has no significant effect on perceptual timing in the hundreds of milliseconds range.

    PubMed

    Cope, Thomas E; Grube, Manon; Mandal, Arnab; Cooper, Freya E; Brechany, Una; Burn, David J; Griffiths, Timothy D

    2014-05-01

    Bilateral, high-frequency stimulation of the basal ganglia (STN-DBS) is in widespread use for the treatment of the motor symptoms of Parkinson?s disease (PD). We present here the first psychophysical investigation of the effect of STN-DBS upon perceptual timing in the hundreds of milliseconds range, with both duration-based (absolute) and beat-based (relative) tasks; 13 patients with PD were assessed with their STN-DBS 'on', 'off', and then 'on' again. Paired parametric analyses revealed no statistically significant differences for any task according to DBS status. We demonstrate, from the examination of confidence intervals, that any functionally relevant effect of STN-DBS on relative perceptual timing is statistically unlikely. For absolute, duration-based timing, we demonstrate that the activation of STN-DBS may either worsen performance or have no effect, but that it is unlikely to lead to significant improvement. Although these results are negative they have important implications for our understanding of perceptual timing and its relationship to motor functions within the timing network of the brain. They imply that the mechanisms involved in the perceptual processing of temporal information are likely to be functionally independent from those that underpin movement. Further, they suggest that the connections between STN and the subtantia nigra and globus pallidus are unlikely to be critical to beat-based perceptual timing. PMID:24613477

  10. Functional regeneration of severed peripheral nerve using an implantable electrical stimulator

    Microsoft Academic Search

    Tae Hyung Lee; Hui Pan; In Sook Kim; Soon Jung Hwang; S. J. Kim

    2010-01-01

    This paper presents functional regeneration of severed peripheral nerve using a polymer-based implantable electrical stimulator. A polyimide based conduit electrode was made by micro-fabrication and a stimulation chip was designed to generate biphasic current pulse for electrical stimulation. The stimulation chip was packaged with a battery using silicone elastomer, and integrated with the electrode. The implantable electrical stimulator was implanted

  11. Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases.

    PubMed

    Fox, Michael D; Buckner, Randy L; Liu, Hesheng; Chakravarty, M Mallar; Lozano, Andres M; Pascual-Leone, Alvaro

    2014-10-14

    Brain stimulation, a therapy increasingly used for neurological and psychiatric disease, traditionally is divided into invasive approaches, such as deep brain stimulation (DBS), and noninvasive approaches, such as transcranial magnetic stimulation. The relationship between these approaches is unknown, therapeutic mechanisms remain unclear, and the ideal stimulation site for a given technique is often ambiguous, limiting optimization of the stimulation and its application in further disorders. In this article, we identify diseases treated with both types of stimulation, list the stimulation sites thought to be most effective in each disease, and test the hypothesis that these sites are different nodes within the same brain network as defined by resting-state functional-connectivity MRI. Sites where DBS was effective were functionally connected to sites where noninvasive brain stimulation was effective across diseases including depression, Parkinson's disease, obsessive-compulsive disorder, essential tremor, addiction, pain, minimally conscious states, and Alzheimer's disease. A lack of functional connectivity identified sites where stimulation was ineffective, and the sign of the correlation related to whether excitatory or inhibitory noninvasive stimulation was found clinically effective. These results suggest that resting-state functional connectivity may be useful for translating therapy between stimulation modalities, optimizing treatment, and identifying new stimulation targets. More broadly, this work supports a network perspective toward understanding and treating neuropsychiatric disease, highlighting the therapeutic potential of targeted brain network modulation. PMID:25267639

  12. Resting-state networks link invasive and noninvasive brain stimulation across diverse psychiatric and neurological diseases

    PubMed Central

    Fox, Michael D.; Buckner, Randy L.; Liu, Hesheng; Chakravarty, M. Mallar; Lozano, Andres M.; Pascual-Leone, Alvaro

    2014-01-01

    Brain stimulation, a therapy increasingly used for neurological and psychiatric disease, traditionally is divided into invasive approaches, such as deep brain stimulation (DBS), and noninvasive approaches, such as transcranial magnetic stimulation. The relationship between these approaches is unknown, therapeutic mechanisms remain unclear, and the ideal stimulation site for a given technique is often ambiguous, limiting optimization of the stimulation and its application in further disorders. In this article, we identify diseases treated with both types of stimulation, list the stimulation sites thought to be most effective in each disease, and test the hypothesis that these sites are different nodes within the same brain network as defined by resting-state functional-connectivity MRI. Sites where DBS was effective were functionally connected to sites where noninvasive brain stimulation was effective across diseases including depression, Parkinson's disease, obsessive-compulsive disorder, essential tremor, addiction, pain, minimally conscious states, and Alzheimer’s disease. A lack of functional connectivity identified sites where stimulation was ineffective, and the sign of the correlation related to whether excitatory or inhibitory noninvasive stimulation was found clinically effective. These results suggest that resting-state functional connectivity may be useful for translating therapy between stimulation modalities, optimizing treatment, and identifying new stimulation targets. More broadly, this work supports a network perspective toward understanding and treating neuropsychiatric disease, highlighting the therapeutic potential of targeted brain network modulation. PMID:25267639

  13. Intensive Voice Treatment (LSVT[R]LOUD) for Parkinson's Disease Following Deep Brain Stimulation of the Subthalamic Nucleus

    ERIC Educational Resources Information Center

    Spielman, Jennifer; Mahler, Leslie; Halpern, Angela; Gilley, Phllip; Klepitskaya, Olga; Ramig, Lorraine

    2011-01-01

    Purpose: Intensive voice therapy (LSVT[R]LOUD) can effectively manage voice and speech symptoms associated with idiopathic Parkinson disease (PD). This small-group study evaluated voice and speech in individuals with and without deep brain stimulation of the subthalamic nucleus (STN-DBS) before and after LSVT LOUD, to determine whether outcomes…

  14. Effects of Stimulation of the Subthalamic Nucleus on Naming and Reading Nouns and Verbs in Parkinson's Disease

    ERIC Educational Resources Information Center

    Silveri, Maria Caterina; Ciccarelli, Nicoletta; Baldonero, Eleonora; Piano, Carla; Zinno, Massimiliano; Soleti, Francesco; Bentivoglio, Anna Rita; Albanese, Alberto; Daniele, Antonio

    2012-01-01

    An impairment for verbs has been described in patients with Parkinson's disease (PD), suggesting that a disruption of frontal-subcortical circuits may result in dysfunction of the neural systems involved in action-verb processing. A previous study suggested that deep brain stimulation (DBS) of the subthalamic nucleus (STN) during verb generation…

  15. Frequency-dependent functional neuromodulatory effects on the motor network by ventral lateral thalamic deep brain stimulation in swine.

    PubMed

    Paek, Seungleal B; Min, Hoon-Ki; Kim, Inyong; Knight, Emily J; Baek, James J; Bieber, Allan J; Lee, Kendall H; Chang, Su-Youne

    2015-01-15

    Thalamic deep brain stimulation (DBS) is an FDA-approved neurosurgical treatment for medication-refractory essential tremor. Its therapeutic benefit is highly dependent upon stimulation frequency and voltage parameters. We investigated these stimulation parameter-dependent effects on neural network activation by performing functional magnetic resonance imaging (fMRI) during DBS of the ventral lateral (VL) thalamus and comparing the blood oxygenation level-dependent (BOLD) signals induced by multiple stimulation parameter combinations in a within-subject study of swine. Low (10 Hz) and high (130 Hz) frequency stimulation was applied at 3, 5, and 7 V in the VL thalamus of normal swine (n = 5). We found that stimulation frequency and voltage combinations differentially modulated the brain network activity in the sensorimotor cortex, the basal ganglia, and the cerebellum in a parameter-dependent manner. Notably, in the motor cortex, high frequency stimulation generated a negative BOLD response, while low frequency stimulation increased the positive BOLD response. These frequency-dependent differential effects suggest that the VL thalamus is an exemplary target for investigating functional network connectivity associated with therapeutic DBS. PMID:25451479

  16. Expectation Modulates the Effect of Deep Brain Stimulation on Motor and Cognitive Function in Tremor-Dominant Parkinson's Disease

    PubMed Central

    Keitel, Ariane; Ferrea, Stefano; Südmeyer, Martin; Schnitzler, Alfons; Wojtecki, Lars

    2013-01-01

    Expectation contributes to placebo and nocebo responses in Parkinson's disease (PD). While there is evidence for expectation-induced modulations of bradykinesia, little is known about the impact of expectation on resting tremor. Subthalamic nucleus (STN) deep brain stimulation (DBS) improves cardinal PD motor symptoms including tremor whereas impairment of verbal fluency (VF) has been observed as a potential side-effect. Here we investigated how expectation modulates the effect of STN-DBS on resting tremor and its interaction with VF. In a within-subject-design, expectation of 24 tremor-dominant PD patients regarding the impact of STN-DBS on motor symptoms was manipulated by verbal suggestions (positive [placebo], negative [nocebo], neutral [control]). Patients participated with (MedON) and without (MedOFF) antiparkinsonian medication. Resting tremor was recorded by accelerometry and bradykinesia of finger tapping and diadochokinesia were assessed by a 3D ultrasound motion detection system. VF was quantified by lexical and semantic tests. In a subgroup of patients, the effect of STN-DBS on tremor was modulated by expectation, i.e. tremor decreased (placebo response) or increased (nocebo response) by at least 10% as compared to the control condition while no significant effect was observed for the overall group. Interestingly, nocebo responders in MedON were additionally characterized by significant impairment in semantic verbal fluency. In contrast, bradykinesia was not affected by expectation. These results indicate that the therapeutic effect of STN-DBS on tremor can be modulated by expectation in a subgroup of patients and suggests that tremor is also among the parkinsonian symptoms responsive to placebo and nocebo interventions. While positive expectations enhanced the effect of STN-DBS by further decreasing the magnitude of tremor, negative expectations counteracted the therapeutic effect and at the same time exacerbated a side-effect often associated with STN-DBS. The present findings underscore the potency of patients' expectation and its relevance for therapeutic outcomes. PMID:24312596

  17. Intracerebral haematomas after deep brain stimulation surgery in a patient with Tourette syndrome and low factor XIIIA activity.

    PubMed

    Idris, Zamzuri; Ghani, Abdul Rahman I; Mar, Winn; Bhaskar, Shalini; Wan Hassan, Wan N; Tharakan, John; Abdullah, Jafri M; Omar, Julia; Abass, Saruddin; Hussin, Suryati; Abdullah, Wan Z

    2010-10-01

    A 24-year-old male patient with refractory Tourette syndrome was treated with deep brain stimulation (DBS) and developed subsequent bilateral subcortical haematomas. Additional blood tests revealed abnormalities of plasma factor XIIIA and tryptophan levels, which may be associated with Tourette syndrome. Neurosurgeons who perform DBS surgery on patients with Tourette syndrome must be aware of possible disastrous complications resulting from factor XIIIA disorders of blood haemostasis. Routine screening for this condition is not typically performed prior to surgery in these patients. PMID:20620064

  18. Neuropsychological functions and rCBF SPECT in Parkinson’s disease patients considered candidates for deep brain stimulation

    Microsoft Academic Search

    Anna Paschali; Lambros Messinis; Epameinondas Lyros; Costas Constantoyannis; Zinovia Kefalopoulou; Velissarios Lakiotis; Panagiotis Papathanasopoulos; Paulos Vassilakos

    2009-01-01

    Purpose  In the present study, we examined relationships between neuropsychological functions and brain single photon emission computed\\u000a tomography (SPECT) regional cerebral blood flow (rCBF) observed at presurgical evaluation for deep brain stimulation (DBS)\\u000a of the subthalamic nucleus (STN) in advanced Parkinson’s disease (PD) patients.\\u000a \\u000a \\u000a \\u000a Methods  Twenty advanced non-demented PD patients, candidates for DBS surgery, underwent perfusion brain SPECT study and neuropsychological\\u000a assessment

  19. Liquid electrode

    DOEpatents

    Ekechukwu, A.A.

    1994-07-05

    A dropping electrolyte electrode is described for use in electrochemical analysis of non-polar sample solutions, such as benzene or cyclohexane. The liquid electrode, preferably an aqueous salt solution immiscible in the sample solution, is introduced into the solution in dropwise fashion from a capillary. The electrolyte is introduced at a known rate, thus, the droplets each have the same volume and surface area. The electrode is used in making standard electrochemical measurements in order to determine properties of non-polar sample solutions. 2 figures.

  20. Relationship between neural activation and electric field distribution during deep brain stimulation.

    PubMed

    Åström, Mattias; Diczfalusy, Elin; Martens, Hubert; Wårdell, Karin

    2015-02-01

    Models and simulations are commonly used to study deep brain stimulation (DBS). Simulated stimulation fields are often defined and visualized by electric field isolevels or volumes of tissue activated (VTA). The aim of the present study was to evaluate the relationship between stimulation field strength as defined by the electric potential V, the electric field E, and the divergence of the electric field ?(2) V, and neural activation. Axon cable models were developed and coupled to finite-element DBS models in three-dimensional (3-D). Field thresholds ( VT , ET, and ?(2) VT ) were derived at the location of activation for various stimulation amplitudes (1 to 5 V), pulse widths (30 to 120 ?s), and axon diameters (2.0 to 7.5 ?m). Results showed that thresholds for VT and ?(2) VT were highly dependent on the stimulation amplitude while ET were approximately independent of the amplitude for large axons. The activation field strength thresholds presented in this study may be used in future studies to approximate the VTA during model-based investigations of DBS without the need of computational axon models. PMID:25350910

  1. Hemisphere-Specific Effects of Subthalamic Nucleus Deep Brain Stimulation on Speaking Rate and Articulatory Accuracy of Syllable Repetitions in Parkinson's Disease.

    PubMed

    Wang, Emily Q; Metman, Leo Verhagen; Bakay, Roy A E; Arzbaecher, Jean; Bernard, Bryan; Corcos, Daniel M

    2006-01-01

    This study tested the hypothesis that left versus right deep brain stimulation (DBS) of the subthalamic nucleus (STN) would have differential effects on speech. Twenty right-handed individuals with advanced Parkinson's disease (PD) underwent unilateral STN DBS. Ten were operated on the right and 10 on the left hemisphere as indicated by severity of nonspeech motor function. Speech was evaluated before surgery and 3 to 6 months after surgery with stimulator-off and with stimulator-on, with all participants off anti-parkinsonian medication for 12 hours before evaluation. Evaluators and patient speakers were blinded to the stimulator status at the postsurgery evaluations. Motor performance was assessed with UPDRS-III. Each participant produced three samples of diadochokinetic syllables. Syllable rate, syllable and vowel duration, VOT, and F0 were obtained. The diadochokinetic syllables were rated for articulatory accuracy and speaking rate. Twenty graduate clinicians served as judges. The samples were randomly presented via headphones. A mixed ANOVA with repeated measures was used to assess the significance of the changes in UPRS-III scores and speech measures. The results indicated that unilateral STN DBS produced improvement in nonspeech motor function regardless of the side of stimulation. In contrast, the changes in articulatory accuracy and syllable rate associated with the STN DBS were hemisphere specific. PMID:18270553

  2. Hemisphere-Specific Effects of Subthalamic Nucleus Deep Brain Stimulation on Speaking Rate and Articulatory Accuracy of Syllable Repetitions in Parkinson’s Disease

    PubMed Central

    Wang, Emily Q.; Metman, Leo Verhagen; Bakay, Roy A. E.; Arzbaecher, Jean; Bernard, Bryan; Corcos, Daniel M.

    2007-01-01

    This study tested the hypothesis that left versus right deep brain stimulation (DBS) of the subthalamic nucleus (STN) would have differential effects on speech. Twenty right-handed individuals with advanced Parkinson’s disease (PD) underwent unilateral STN DBS. Ten were operated on the right and 10 on the left hemisphere as indicated by severity of nonspeech motor function. Speech was evaluated before surgery and 3 to 6 months after surgery with stimulator-off and with stimulator-on, with all participants off anti-parkinsonian medication for 12 hours before evaluation. Evaluators and patient speakers were blinded to the stimulator status at the postsurgery evaluations. Motor performance was assessed with UPDRS-III. Each participant produced three samples of diadochokinetic syllables. Syllable rate, syllable and vowel duration, VOT, and F0 were obtained. The diadochokinetic syllables were rated for articulatory accuracy and speaking rate. Twenty graduate clinicians served as judges. The samples were randomly presented via headphones. A mixed ANOVA with repeated measures was used to assess the significance of the changes in UPRS-III scores and speech measures. The results indicated that unilateral STN DBS produced improvement in nonspeech motor function regardless of the side of stimulation. In contrast, the changes in articulatory accuracy and syllable rate associated with the STN DBS were hemisphere specific. PMID:18270553

  3. Subdural Electrodes

    PubMed Central

    Lesser, Ronald P.; Crone, Nathan E.; Webber, W.R.S.

    2010-01-01

    Subdural electrodes are frequently used to aid in the neurophysiological assessment of patients with intractable seizures. We review the indications for these, their uses for localizing epileptogenic regions and for localizing cortical regions supporting movement, sensation, and language. PMID:20573543

  4. COMMUNICATION: Toward closed-loop optimization of deep brain stimulation for Parkinson's disease: concepts and lessons from a computational model

    NASA Astrophysics Data System (ADS)

    Feng, Xiao-jiang; Greenwald, Brian; Rabitz, Herschel; Shea-Brown, Eric; Kosut, Robert

    2007-06-01

    Deep brain stimulation (DBS) of the subthalamic nucleus with periodic, high-frequency pulse trains is an increasingly standard therapy for advanced Parkinson's disease. Here, we propose that a closed-loop global optimization algorithm may identify novel DBS waveforms that could be more effective than their high-frequency counterparts. We use results from a computational model of the Parkinsonian basal ganglia to illustrate general issues relevant to eventual clinical or experimental tests of such an algorithm. Specifically, while the relationship between DBS characteristics and performance is highly complex, global search methods appear able to identify novel and effective waveforms with convergence rates that are acceptably fast to merit further investigation in laboratory or clinical settings.

  5. The reorganization of motor network in hemidystonia from the perspective of deep brain stimulation.

    PubMed

    Gonzalez, Victoria; Le Bars, Emmanuelle; Cif, Laura; van Dokkum, Liesjet E H; Laffont, Isabelle; Bonafé, Alain; Menjot de Champfleur, Nicolas; Zanca, Michel; Coubes, Philippe

    2014-04-12

    Hemidystonia is usually 'secondary' to structural lesions within the cortico-striato-pallido-thalamic or the cerebello-thalamo-cortical loops. Globus pallidus internus Deep Brain Stimulation (GPi DBS) is a validated technique in the treatment of primary dystonia and still under assessment for secondary dystonia. Results of DBS in hemidystonia are limited and heterogeneous. Further knowledge concerning motor network organization after focal brain lesions might contribute to the understanding of this mitigated response to DBS and to the refinement of DBS indications and techniques in secondary dystonia. This study aimed to identify movement-related functional magnetic resonance imaging (fMRI) activation patterns in a group of hemidystonic patients in comparison to healthy controls (HC). Further analysis assessed recruitment pattern in different patient subgroups defined according to clinical and radiological criteria relevant to GPi DBS eligibility (hyperkinetic/hypokinetic and prepallidal/postpallidal). Eleven patients and nine HC underwent fMRI with a block-design alternating active and rest conditions. The motor paradigm consisted of self-paced elbow flexion-extension movements. The main results were as follows: single-subject studies revealed several activation patterns involving motor-related network regions; both ipsilesional and contralesional hemispheres showed abnormal patterns of activity; compared with HC, hemidystonic patients showed decreased brain activity in ipsilesional thalamus, pallidal and temporal areas during affected arm task execution; 'hypokinetic' subgroup was commonly related to widespread bilateral overactivity. This study provides additional arguments for case-by-case assessment of DBS surgery indication and target selection in hemidystonia. Single-lead approach might be unable to modulate a highly disorganized network activity in certain patients with this clinical syndrome. PMID:24728838

  6. Deep brain stimulation of the subthalamic nucleus reestablishes neuronal information transmission in the 6-OHDA rat model of parkinsonism.

    PubMed

    Dorval, Alan D; Grill, Warren M

    2014-05-01

    Pathophysiological activity of basal ganglia neurons accompanies the motor symptoms of Parkinson's disease. High-frequency (>90 Hz) deep brain stimulation (DBS) reduces parkinsonian symptoms, but the mechanisms remain unclear. We hypothesize that parkinsonism-associated electrophysiological changes constitute an increase in neuronal firing pattern disorder and a concomitant decrease in information transmission through the ventral basal ganglia, and that effective DBS alleviates symptoms by decreasing neuronal disorder while simultaneously increasing information transfer through the same regions. We tested these hypotheses in the freely behaving, 6-hydroxydopamine-lesioned rat model of hemiparkinsonism. Following the onset of parkinsonism, mean neuronal firing rates were unchanged, despite a significant increase in firing pattern disorder (i.e., neuronal entropy), in both the globus pallidus and substantia nigra pars reticulata. This increase in neuronal entropy was reversed by symptom-alleviating DBS. Whereas increases in signal entropy are most commonly indicative of similar increases in information transmission, directed information through both regions was substantially reduced (>70%) following the onset of parkinsonism. Again, this decrease in information transmission was partially reversed by DBS. Together, these results suggest that the parkinsonian basal ganglia are rife with entropic activity and incapable of functional information transmission. Furthermore, they indicate that symptom-alleviating DBS works by lowering the entropic noise floor, enabling more information-rich signal propagation. In this view, the symptoms of parkinsonism may be more a default mode, normally overridden by healthy basal ganglia information. When that information is abolished by parkinsonian pathophysiology, hypokinetic symptoms emerge. PMID:24554786

  7. Intensive Voice Treatment (LSVT®LOUD) for Parkinson’s disease following Deep Brain Stimulation of the Subthalamic Nucleus

    PubMed Central

    Spielman, Jennifer; Mahler, Leslie; Halpern, Angela; Gilley, Phllip; Klepitskaya, Olga; Ramig, Lorraine

    2011-01-01

    Purpose Intensive voice therapy (LSVT®LOUD) can effectively manage voice and speech symptoms associated with idiopathic Parkinson disease (PD). This small-group study evaluated voice and speech in individuals with and without deep brain stimulation of the subthalamic nucleus (STN-DBS) before and after LSVT LOUD, to determine whether outcomes for surgical subjects were comparable to non-surgical cohorts. Methods Eight subjects with PD (four with STN-DBS and four without) received LSVT LOUD four times a week for four weeks. Four additional subjects with PD remained untreated. Voice intensity (SPL), Vowel Articulation Index (VAI), the Voice Handicap Index (VHI), and a structured interview were evaluated before and after treatment and again six months later. Results Both treated groups showed significant increases in SPL from pre to post and six-month follow up. VAI was significantly higher for the treated groups compared to the untreated subjects at follow up. Several treated individuals had significant clinical improvement in VHI scores, particularly within the LSVT-DBS group. Treated individuals reported improvements in voice and speech in structured interviews; however, answers suggest more variable long-term maintenance within the LSVT-DBS group. The untreated group exhibited no significant changes in any measure throughout the study. Conclusions Results support LSVT LOUD for treating voice and speech in individuals with PD following STN-DBS surgery. However, modifications may be required to maintain functional improvements. PMID:21724193

  8. Randomized trial of deep brain stimulation for Parkinson disease

    PubMed Central

    Follett, Kenneth A.; Stern, Matthew; Luo, Ping; Harris, Crystal L.; Hur, Kwan; Marks, William J.; Rothlind, Johannes; Sagher, Oren; Moy, Claudia; Pahwa, Rajesh; Burchiel, Kim; Hogarth, Penelope; Lai, Eugene C.; Duda, John E.; Holloway, Kathryn; Samii, Ali; Horn, Stacy; Bronstein, Jeff M.; Stoner, Gatana; Starr, Philip A.; Simpson, Richard; Baltuch, Gordon; De Salles, Antonio; Huang, Grant D.; Reda, Domenic J.; Ippolito, Dolores; Barnett, Tammy; Bukowski, Ken; Carlson, Kimberly; Christine, Barbara; DeNicolo, Rosemarie; Jimenez, Joyce; Motyka, Jan; Patel, Unnati; Simon, Theresa; Thakkar, Bharat; Woolson, Robert; Fye, Carol; Gagne, William; Sheehy, Paul; O'Leary, Timothy; Atassi, Farah; Bello, Cecilia; Bunting-Perry, Lisette; Conn, Tina; Cugley, Alice; Eubank, Nanette; Fincher, Linda; Franks, Romay; Harris, Tammy; Haselman, Mariann; Heath, Susan; Hirsch, Miriam; Janovsky, Virginia; Lanier, Elaine; Lloyd, Mary; Loehner, Susan; O'Connor, Susan; Ordonez, Ligaya; Maccarone, Heather; Massey-Makhoul, Kelli; Matthews, Mary; Meyn, Elizabeth; Mimura, Keiko; Morrow, Wes; Searles, Tammy; Valotta, Jamye; Vasthare, Usha; Volz, Monica; Ward, Constance; Warker, Rebecca; Watson, Heidi; Willson, Pamela; Baron, Mark; Brodsky, Matthew; Calabrese, Vincent; Campbell, Gordon; Colcher, Amy; Farag, Emad; Henry, Eva; Hou, Jyh-Gong; Kang, Gail; Kleiner-Fisman, Galit; Kraakevik, Jeff; Nutt, John; Ostrem, Jill; Sarwar, Aliya; Subramanian, Indu; Vanek, Zeba; Carne, William; Erikson, Tom; Kreutzer, Jeffrey; Mendez, Mario; Moberg, Paul; Ragland, John; Seel, Ronald; Soety, Elizabeth; Storzbach, Daniel; Troster, Alexander; York, Michele; Jaggi, Jurg; Stroupe, Kevin; Koller, William

    2012-01-01

    Objectives: Our objective was to compare long-term outcomes of deep brain stimulation (DBS) of the globus pallidus interna (GPi) and subthalamic nucleus (STN) for patients with Parkinson disease (PD) in a multicenter randomized controlled trial. Methods: Patients randomly assigned to GPi (n = 89) or STN DBS (n = 70) were followed for 36 months. The primary outcome was motor function on stimulation/off medication using the Unified Parkinson's Disease Rating Scale motor subscale. Secondary outcomes included quality of life and neurocognitive function. Results: Motor function improved between baseline and 36 months for GPi (41.1 to 27.1; 95% confidence interval [CI] ?16.4 to ?10.8; p < 0.001) and STN (42.5 to 29.7; 95% CI ?15.8 to ?9.4; p < 0.001); improvements were similar between targets and stable over time (p = 0.59). Health-related quality of life improved at 6 months on all subscales (all p values significant), but improvement diminished over time. Mattis Dementia Rating Scale scores declined faster for STN than GPi patients (p = 0.01); other neurocognitive measures showed gradual decline overall. Conclusions: The beneficial effect of DBS on motor function was stable and comparable by target over 36 months. Slight declines in quality of life following initial gains and gradual decline in neurocognitive function likely reflect underlying disease progression and highlight the importance of nonmotor symptoms in determining quality of life. Classification of Evidence: This study provides Class III evidence that improvement of motor symptoms of PD by DBS remains stable over 3 years and does not differ by surgical target. Neurology® 2012;79:55–65 PMID:22722632

  9. Different clinical electrodes achieve similar electrical nerve conduction block

    NASA Astrophysics Data System (ADS)

    Boger, Adam; Bhadra, Narendra; Gustafson, Kenneth J.

    2013-10-01

    Objective. We aim to evaluate the suitability of four electrodes previously used in clinical experiments for peripheral nerve electrical block applications. Approach. We evaluated peripheral nerve electrical block using three such clinical nerve cuff electrodes (the Huntington helix, the Case self-sizing Spiral and the flat interface nerve electrode) and one clinical intramuscular electrode (the Memberg electrode) in five cats. Amplitude thresholds for the block using 12 or 25 kHz voltage-controlled stimulation, onset response, and stimulation thresholds before and after block testing were determined. Main results. Complete nerve block was achieved reliably and the onset response to blocking stimulation was similar for all electrodes. Amplitude thresholds for the block were lowest for the Case Spiral electrode (4 ± 1 Vpp) and lower for the nerve cuff electrodes (7 ± 3 Vpp) than for the intramuscular electrode (26 ± 10 Vpp). A minor elevation in stimulation threshold and reduction in stimulus-evoked urethral pressure was observed during testing, but the effect was temporary and did not vary between electrodes. Significance. Multiple clinical electrodes appear suitable for neuroprostheses using peripheral nerve electrical block. The freedom to choose electrodes based on secondary criteria such as ease of implantation or cost should ease translation of electrical nerve block to clinical practice.

  10. Long-Term Effects of Nucleus Accumbens Deep Brain Stimulation in Treatment-Resistant Depression: Evidence for Sustained Efficacy

    PubMed Central

    Bewernick, Bettina H; Kayser, Sarah; Sturm, Volker; Schlaepfer, Thomas E

    2012-01-01

    Deep brain stimulation (DBS) to the nucleus accumbens (NAcc-DBS) was associated with antidepressant, anxiolytic, and procognitive effects in a small sample of patients suffering from treatment-resistant depression (TRD), followed over 1 year. Results of long-term follow-up of up to 4 years of NAcc-DBS are described in a group of 11 patients. Clinical effects, quality of life (QoL), cognition, and safety are reported. Eleven patients were stimulated with DBS bilateral to the NAcc. Main outcome measures were clinical effect (Hamilton Depression Rating Scale, Montgomery-Asperg Rating Scale of Depression, and Hamilton Anxiety Scale) QoL (SF-36), cognition and safety at baseline, 12 months (n=11), 24 months (n=10), and last follow-up (maximum 4 years, n=5). Analyses were performed in an intent-to-treat method with last observation carried forward, thus 11 patients contributed to each point in time. In all, 5 of 11 patients (45%) were classified as responders after 12 months and remained sustained responders without worsening of symptoms until last follow-up after 4 years. Both ratings of depression and anxiety were significantly reduced in the sample as a whole from first month of NAcc-DBS on. All patients improved in QoL measures. One non-responder committed suicide. No severe adverse events related to parameter change were reported. First-time, preliminary long-term data on NAcc-DBS have demonstrated a stable antidepressant and anxiolytic effect and an amelioration of QoL in this small sample of patients suffering from TRD. None of the responders of first year relapsed during the observational period (up to 4 years). PMID:22473055

  11. Long-range correlation properties in timing of skilled piano performance: the influence of auditory feedback and deep brain stimulation

    PubMed Central

    Herrojo Ruiz, María; Hong, Sang Bin; Hennig, Holger; Altenmüller, Eckart; Kühn, Andrea A.

    2014-01-01

    Unintentional timing deviations during musical performance can be conceived of as timing errors. However, recent research on humanizing computer-generated music has demonstrated that timing fluctuations that exhibit long-range temporal correlations (LRTC) are preferred by human listeners. This preference can be accounted for by the ubiquitous presence of LRTC in human tapping and rhythmic performances. Interestingly, the manifestation of LRTC in tapping behavior seems to be driven in a subject-specific manner by the LRTC properties of resting-state background cortical oscillatory activity. In this framework, the current study aimed to investigate whether propagation of timing deviations during the skilled, memorized piano performance (without metronome) of 17 professional pianists exhibits LRTC and whether the structure of the correlations is influenced by the presence or absence of auditory feedback. As an additional goal, we set out to investigate the influence of altering the dynamics along the cortico-basal-ganglia-thalamo-cortical network via deep brain stimulation (DBS) on the LRTC properties of musical performance. Specifically, we investigated temporal deviations during the skilled piano performance of a non-professional pianist who was treated with subthalamic-deep brain stimulation (STN-DBS) due to severe Parkinson's disease, with predominant tremor affecting his right upper extremity. In the tremor-affected right hand, the timing fluctuations of the performance exhibited random correlations with DBS OFF. By contrast, DBS restored long-range dependency in the temporal fluctuations, corresponding with the general motor improvement on DBS. Overall, the present investigations demonstrate the presence of LRTC in skilled piano performances, indicating that unintentional temporal deviations are correlated over a wide range of time scales. This phenomenon is stable after removal of the auditory feedback, but is altered by STN-DBS, which suggests that cortico-basal ganglia-thalamocortical circuits play a role in the modulation of the serial correlations of timing fluctuations exhibited in skilled musical performance. PMID:25309487

  12. Long-range correlation properties in timing of skilled piano performance: the influence of auditory feedback and deep brain stimulation.

    PubMed

    Herrojo Ruiz, María; Hong, Sang Bin; Hennig, Holger; Altenmüller, Eckart; Kühn, Andrea A

    2014-01-01

    Unintentional timing deviations during musical performance can be conceived of as timing errors. However, recent research on humanizing computer-generated music has demonstrated that timing fluctuations that exhibit long-range temporal correlations (LRTC) are preferred by human listeners. This preference can be accounted for by the ubiquitous presence of LRTC in human tapping and rhythmic performances. Interestingly, the manifestation of LRTC in tapping behavior seems to be driven in a subject-specific manner by the LRTC properties of resting-state background cortical oscillatory activity. In this framework, the current study aimed to investigate whether propagation of timing deviations during the skilled, memorized piano performance (without metronome) of 17 professional pianists exhibits LRTC and whether the structure of the correlations is influenced by the presence or absence of auditory feedback. As an additional goal, we set out to investigate the influence of altering the dynamics along the cortico-basal-ganglia-thalamo-cortical network via deep brain stimulation (DBS) on the LRTC properties of musical performance. Specifically, we investigated temporal deviations during the skilled piano performance of a non-professional pianist who was treated with subthalamic-deep brain stimulation (STN-DBS) due to severe Parkinson's disease, with predominant tremor affecting his right upper extremity. In the tremor-affected right hand, the timing fluctuations of the performance exhibited random correlations with DBS OFF. By contrast, DBS restored long-range dependency in the temporal fluctuations, corresponding with the general motor improvement on DBS. Overall, the present investigations demonstrate the presence of LRTC in skilled piano performances, indicating that unintentional temporal deviations are correlated over a wide range of time scales. This phenomenon is stable after removal of the auditory feedback, but is altered by STN-DBS, which suggests that cortico-basal ganglia-thalamocortical circuits play a role in the modulation of the serial correlations of timing fluctuations exhibited in skilled musical performance. PMID:25309487

  13. Pattern electrical stimulation of the human retina

    Microsoft Academic Search

    Mark S. Humayun; De Juan E; James D. Weiland; Gislin Dagnelie; Steve Katona; Robert Greenberg; Satoshi Suzuki; Maumenee Bldg

    1999-01-01

    Experiments were conducted to study if electrical stimulation of the retinal surface can elicit visual sensation in individuals blind from end-stage retinitis pigmentosa (RP) or age-related macular degeneration (AMD). Under local anesthesia, different stimulating electrodes were inserted through the eyewall and positioned over the surface of the retina. Subjects' psychophysical responses to electrical stimulation were recorded. Subjects perceived simple forms

  14. Pattern electrical stimulation of the human retina

    Microsoft Academic Search

    Mark S. Humayun; Eugene de Juan Jr.; James D. Weiland; Gislin Dagnelie; Steve Katona; Robert Greenberg; Satoshi Suzuki

    1999-01-01

    Experiments were conducted to study if electrical stimulation of the retinal surface can elicit visual sensation in individuals blind from end-stage retinitis pigmentosa (RP) or age-related macular degeneration (AMD). Under local anesthesia, different stimulating electrodes were inserted through the eyewall and positioned over the surface of the retina. Subjects’ psychophysical responses to electrical stimulation were recorded. Subjects perceived simple forms

  15. Method of making biocompatible electrodes

    DOEpatents

    Wollam, John S. (Acton, MA)

    1992-01-01

    A process of improving the sensing function of biocompatible electrodes and the product so made are disclosed. The process is designed to alter the surfaces of the electrodes at their tips to provide increased surface area and therefore decreased contact resistance at the electrode-tissue interface for increased sensitivity and essentially includes rendering the tips atomically clean by exposing them to bombardment by ions of an inert gas, depositing an adhesion layer on the cleaned tips, forming a hillocked layer on the adhesion layer by increasing the temperature of the tips, and applying a biocompatible coating on the hillocked layer. The resultant biocompatible electrode is characterized by improved sensitivity, minimum voltage requirement for organ stimulation and a longer battery life for the device in which it is employed.

  16. An electrode configuration technique using an electrode matrix arrangement for FES-based upper arm rehabilitation systems

    Microsoft Academic Search

    S. B. O'Dwyer; D. T. O'Keeffe; Susan Coote; G. M. Lyons

    2006-01-01

    An upper limb electrical stimulation technique has been developed which features a novel self-configuration approach, to obtain an ideal wrist response from the patient. The system uses an analogue de-multiplexer in conjunction with an electrode matrix so that different electrode sites can be tested using only one channel of stimulation. A twin axis goniometer is attached to the patient's wrist

  17. IEEE TRANSACTIONS ON NEURAL SYSTEMS AND REHABILITATION ENGINEERING, VOL. 21, NO. 3, MAY 2013 383 Noninvasive Transcranial Focal Stimulation Via

    E-print Network

    Besio, Walter G.

    including transcranial magnetic stimulation(TMS)[18]­[21]andtranscra- nial direct current stimulation (t Noninvasive Transcranial Focal Stimulation Via Tripolar Concentric Ring Electrodes Lessens Behavioral Seizure developing a noninvasive transcranial focal electrical stimulation with our novel tripolar concentric ring

  18. Trimodal nanoelectrode array for precise deep brain stimulation: prospects of a new technology based on carbon nanofiber arrays

    Microsoft Academic Search

    J. Li; Russell J. Andrews

    Although deep brain stimulation (DBS) has recently been shown to be effective for neurological disorders such as Parkinson’s\\u000a disease, there are many limitations of the current technology: the large size of current microelectrodes (?1mm diameter);\\u000a the lack of monitoring of local brain electrical activity and neurotransmitters (e.g. dopamine in Parkinson’s disease); the\\u000a open-loop nature of the stimulation (i.e. not guided

  19. Basic functional electrical stimulation (FES) of extremities: an engineer's view.

    PubMed

    Bajd, Tadej; Munih, Marko

    2010-01-01

    The historical development of electrical stimulators producing contraction of paralyzed muscles is briefly presented. The influence of electrical stimulation parameters (amplitude of pulses, frequency, pulse duration, and duration of a pulse train) is explained. Special attention is paid to the description of the muscle recruitment curve. The phenomenon of reversed recruitment order, resulting in fatiguing of electrically stimulated muscle, is presented. The properties of surface electrodes (electrode size, polarity, resistance, and distance between electrodes) are examined. The use of surface electrodes made of metal plate or wire mesh, silicone impregnated with rubber, and conductive adhesive gel are discussed. The design of electrical stimulator circuits is also presented. PMID:21209485

  20. Impedance as a method to sense proximity at the electrode-retina interface.

    PubMed

    Ray, Aditi; Chan, Leanne Lai-Hang; Gonzalez, Alejandra; Humayun, Mark S; Weiland, James D

    2011-12-01

    Precise positioning of a stimulating electrode in the eye is not possible by simple visualization. However, reliable measurement of responses to retinal stimulation requires consistent positioning. The present study focuses on impedance measurement techniques to sense the proximity of the electrode to the retina. A platinum-iridium stimulation electrode was placed inside the rat eye and impedance was recorded at different positions of the stimulating electrode relative to the retina. The presence of robust electrically evoked response in the superior colliculus indicates that the electrode may not have to be in absolute contact in order to elicit a neural response. Optical coherence tomography imaging confirmed the distance-impedance relationship. PMID:21984523

  1. Cermet electrode

    DOEpatents

    Maskalick, Nicholas J. (Pittsburgh, PA)

    1988-08-30

    Disclosed is a cermet electrode consisting of metal particles of nickel, cobalt, iron, or alloys or mixtures thereof immobilized by zirconia stabilized in cubic form which contains discrete deposits of about 0.1 to about 5% by weight of praseodymium, dysprosium, terbium, or a mixture thereof. The solid oxide electrode can be made by covering a substrate with particles of nickel, cobalt, iron, or mixtures thereof, growing a stabilized zirconia solid oxide skeleton around the particles thereby immobilizing them, contacting the skeleton with a compound of praseodymium, dysprosium, terbium, or a mixture thereof, and heating the skeleton to a temperature of at least 500.degree. C. The electrode can also be made by preparing a slurry of nickel, cobalt, iron, or mixture and a compound of praseodymium, dysprosium, terbium, or a mixture thereof, depositing the slurry on a substrate, heating the slurry to dryness, and growing a stabilized zirconia skeleton around the metal particles.

  2. Health Related Quality of Life in Essential Tremor Patients Undergoing Deep Brain Stimulation Christopher Kenney, MD, Alan Diamond, DO, Anthony Davidson, BS

    E-print Network

    Lichtarge, Olivier

    Health Related Quality of Life in Essential Tremor Patients Undergoing Deep Brain Stimulation (DBS) on health-related quality of life (HRQoL) in essential tremor (ET) patients using disease implantation: Tremor Rating Scale (TRS), Quality of Life in Essential Tremor Questionnaire (QUEST), Questions

  3. Evaluation of the Effects of Deep Brain Stimulation of the Subthalamic Nucleus and Levodopa Treatment on Parkinsonian Voice Using Perturbation, Nonlinear Dynamic, and Perceptual Analysis

    Microsoft Academic Search

    Xiao Ping Zhou; Victoria S. Lee; Emily Q. Wang; Jack J. Jiang

    2009-01-01

    Background\\/Aims: To quantify aperiodic phonation, nonlinear dynamic methods of acoustic voice analysis, such as correlation dimension, have been shown to be useful. The purpose of this study is to evaluate the validity of nonlinear dynamic analysis as a voice analysis tool for the effects of deep brain stimulation (DBS) and levodopa on patients with Parkinson’s disease (PD). Methods: In this

  4. Articulatory Closure Proficiency in Patients with Parkinson's Disease Following Deep Brain Stimulation of the Subthalamic Nucleus and Caudal Zona Incerta

    ERIC Educational Resources Information Center

    Karlsson, Fredrik; Olofsson, Katarina; Blomstedt, Patric; Linder, Jan; Nordh, Erik; van Doorn, Jan

    2014-01-01

    Purpose: The present study aimed at comparing the effects of deep brain stimulation (DBS) treatment of the subthalamic nucleus (STN) and the caudal zona incerta (cZi) on the proficiency in achieving oral closure and release during plosive production of people with Parkinson's disease. Method: Nineteen patients participated preoperatively and…

  5. Health Related Quality of Life in Parkinson's Disease Patients Undergoing Deep Brain Stimulation Christopher Kenney, MD, Alan Diamond, DO, Anthony Davidson, BS

    E-print Network

    Lichtarge, Olivier

    Health Related Quality of Life in Parkinson's Disease Patients Undergoing Deep Brain Stimulation (DBS) on health-related quality of life (HRQoL) in Parkinson disease (PD) patients. RESULTSRESULTS: Unified Parkinson's Disease Rating Scale (UPDRS), Lang-Fahn Activities of Daily Living Dyskinesia Scale

  6. Pallidal stimulation that improves parkinsonian motor symptoms also modulates neuronal firing patterns in primary motor cortex in the MPTP-treated monkey.

    PubMed

    Johnson, Matthew D; Vitek, Jerrold L; McIntyre, Cameron C

    2009-09-01

    Deep brain stimulation (DBS), a surgical therapy for advanced Parkinson's disease (PD), is known to change neuronal activity patterns in the pallidothalamic circuit. Whether these effects translate to the motor cortex and, if so, how they might modulate the functional responses of individual neurons in primary motor cortex remains uncertain. A 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-treated monkey was implanted with a DBS lead spanning internal and external segments of globus pallidus. During therapeutic stimulation (135 Hz) for rigidity and bradykinesia, neurons in primary motor cortex (M1) exhibited an inhibitory phase-locking (2-5 ms) to the stimulus, an overall decrease in mean discharge rate, and an increase in response specificity to passive limb movement. Sub-therapeutic DBS (30 Hz) still produced entrainment to the stimulation, but the mean discharge rate and specificity to movement were not changed. Lower stimulation intensities (at 135 Hz), which no longer improved motor symptoms, had little effect on M1 activity. These findings suggest that DBS improves parkinsonian motor symptoms by inducing global changes in firing pattern and rate along the pallido-thalamocortical sensorimotor circuit. PMID:19409895

  7. Electrode Interaction in Cochlear Implant Recipients: Comparison of Straight and Contour Electrode Arrays

    Microsoft Academic Search

    Xin Xi; Fei Ji; Dongyi Han; Mengdi Hong; Aiting Chen

    2009-01-01

    The degree of overlap among cochlear nerve fibers stimulated by different electrodes results in electrode interaction, which has been shown to have a significantly deleterious effect on speech recognition performance in multi-electrode cochlear implant users. The Nucleus CI24R(CS) Contour array, which lies substantially closer to the modiolus than the CI24M straight array, is expected to exhibit narrower excitation patterns. The

  8. Photoelectrochemical electrodes

    NASA Technical Reports Server (NTRS)

    Williams, R. M.; Rembaum, A. (inventors)

    1983-01-01

    The surface of a moderate band gap semiconductor such as p-type molybdenum sulfide is modified to contain an adherent film of charge mediating ionene polymer containing an electroactive unit such as bipyridimium. Electron transport between the electrode and the mediator film is favorable and photocorrosion and recombination processes are suppressed. Incorporation of particles of catalyst such as platinum within the film provides a reduction in overvoltage. The polymer film is readily deposited on the electrode surface and can be rendered stable by ionic or addition crosslinking. Catalyst can be predispersed in the polymer film or a salt can be impregnated into the film and reduced therein.

  9. Advanced therapy learning algorithm for spinal cord stimulation

    E-print Network

    Gaudreau Balderrama, Amanda Dawn

    2010-01-01

    Spinal Cord Stimulation (SCS) is a technique used to treat chronic pain and has been shown to be an effective method of treatment, both financially and socioeconomically. Stimulating electrodes are surgically implanted ...

  10. Deep brain stimulation of the nucleus accumbens shell induces anti-obesity effects in obese rats with alteration of dopamine neurotransmission.

    PubMed

    Zhang, Chao; Wei, Nai-Li; Wang, Yao; Wang, Xiu; Zhang, Jian-Guo; Zhang, Kai

    2015-03-01

    The aim of this study was to assess the anti-obesity effects of nucleus accumbens shell (NAc-sh) deep brain stimulation (DBS) in diet-induced obese (DIO) and chow-fed (chow) rats. The influence of DBS on dopamine (DA) signaling in the NAc-sh was also evaluated. DIO and chow rats were subjected to DBS for 14 consecutive days. Food intake and weight gain were measured daily. The gene expression of the dopamine D1 and D2 receptors was evaluated by qPCR. In addition, the extracellular levels of DA and its metabolite, dihydroxyphenylacetic acid (DOPAC), were determined by microdialysis. We observed that chronic DBS induced significant reductions in total energy intake (596.0±65.0kcal vs. 1161.6±22.2kcal, p<0.001) and weight gain (1.45±0.57% vs. 9.64±0.38%, p<0.001) in DIO rats compared to sham-DIO rats. Up-regulated D2 receptor gene expression (2.43±0.12 vs. 0.64±0.04, p<0.001) and increased DA levels (2.73±0.15pmol/mL vs. 0.62±0.05pmol/mL, p<0.001) were observed in DIO rats compared to sham-DIO rats. DBS had no influence on food intake, weight gain, or DA neurotransmission in chow rats. Our results support an association of the anorexigenic effects of NAc-sh DBS with mesolimbic DA signaling and indicate that the positive alteration of DA function in DIO rats may be responsible for the different effects of DBS in DIO and chow rats. PMID:25578952

  11. Atrophy and Other Potential Factors Affecting Long Term Deep Brain Stimulation Response: A Case Series

    PubMed Central

    Martinez-Ramirez, Daniel; Morishita, Takashi; Zeilman, Pamela R.; Peng-Chen, Zhongxing; Foote, Kelly D.; Okun, Michael S.

    2014-01-01

    Objective To describe three DBS cases which presented with new side effects or loss of benefit from stimulation after long-term follow-up and to discuss the potential contributing factors. Methods A University of Florida (UF) database (INFORM) search was performed, identifying three patients, two Parkinson's disease (PD) and one Essential Tremor (ET), with an unexpected change in long-term programming thresholds as compared to initial evaluation. Clinical follow-up, programming, imaging studies, and lead measurements were reviewed. The UF Institutional Review Board (IRB) approved this study. Results A substantial increase in the 3rd ventricular width (120%), Evans index (6%), ventricular index (5%), and cella media index (17%) was uncovered. A change in thresholds across lead contacts with a decrease in current densities as well as a relative lateral change of lead location was also observed. Hardware-related complications, lead migration, and impedance variability were not identified. Conclusions Potential factors contributing to long-term side effects should be examined during a DBS troubleshooting assessment. Clinicians should be aware that in DBS therapy there is delivery of electricity to a changing brain, and atrophy may possibly affect DBS programming settings as part of long-term follow-up. PMID:25360599

  12. Combining cell transplants or gene therapy with deep brain stimulation for Parkinson's disease.

    PubMed

    Rowland, Nathan C; Starr, Philip A; Larson, Paul S; Ostrem, Jill L; Marks, William J; Lim, Daniel A

    2015-02-01

    Cell transplantation and gene therapy each show promise to enhance the treatment of Parkinson's disease (PD). However, because cell transplantation and gene therapy generally require direct delivery to the central nervous system, clinical trial design involves unique scientific, ethical, and financial concerns related to the invasive nature of the procedure. Typically, such biologics have been tested in PD patients who have not received any neurosurgical intervention. Here, we suggest that PD patients undergoing deep brain stimulation (DBS) device implantation are an ideal patient population for the clinical evaluation of cell transplantation and gene therapy. Randomizing subjects to an experimental group that receives the biologic concurrently with the DBS implantation-or to a control group that receives the DBS treatment alone-has several compelling advantages. First, this study design enables the participation of patients likely to benefit from DBS, many of whom simultaneously meet the inclusion criteria of biologic studies. Second, the need for a sham neurosurgical procedure is eliminated, which may reduce ethical concerns, promote patient recruitment, and enhance the blinding of surgical trials. Third, testing the biologic by "piggybacking" onto an established, reimbursable procedure should reduce the cost of clinical trials, which may allow a greater number of biologics to reach this critical stage of research translation. Finally, this clinical trial design may lead to combinatorial treatment strategies that provide PD patients with more durable control over disabling motor symptoms. By combining neuromodulation with biologics, we may also reveal important treatment paradigms relevant to other diseases of the brain. PMID:25521796

  13. Deep brain stimulation therapy for treatment-refractory Tourette’s syndrome

    Microsoft Academic Search

    Marco Sassi; Mauro Porta; Domenico Servello

    2011-01-01

    Tourette’s syndrome is a chronic neurobehavioral disorder that can demonstrate refractoriness to conservative treatments,\\u000a or to invasive nonsurgical treatments such as botulinum toxin infiltration, or to psychobehavioral treatments. In these cases,\\u000a the surgical option is often proposed, either with lesional interventions, or more recently with deep brain stimulation (DBS).\\u000a This latter modality is currently preferred because of its reversibility and

  14. A method of nerve electrical stimulation by magnetic induction

    Microsoft Academic Search

    Guanghao Zhang; Yue Li; Xiaolin Huo; Tao Song

    2009-01-01

    The implantable electrical stimulator is usually not suitable for long term use because of its large size and short battery life, besides the magnetic stimulation can not provide deep nerve stimulation. Therefore, this paper developed a method of the electrical stimulation by using the magnetic induction. We implanted a small inductive coil which was connected with nerve electrodes. When the

  15. Abstract--We propose a simple, robust, linear method to control the spike timing of a periodically firing neuron. The

    E-print Network

    Moehlis, Jeff

    algorithms to deliver high frequency stimulus pulses to the brain through implanted electrodes. The Food deep brain stimulation (DBS) [2, 3, 4]. Current technology for DBS uses open loop stimulation service life for the device and fewer side effects for the patient. We envision the algorithm presented

  16. Pathological tremor prediction using surface electromyogram and acceleration: potential use in ‘ON-OFF’ demand driven deep brain stimulator design

    NASA Astrophysics Data System (ADS)

    Basu, Ishita; Graupe, Daniel; Tuninetti, Daniela; Shukla, Pitamber; Slavin, Konstantin V.; Verhagen Metman, Leo; Corcos, Daniel M.

    2013-06-01

    Objective. We present a proof of concept for a novel method of predicting the onset of pathological tremor using non-invasively measured surface electromyogram (sEMG) and acceleration from tremor-affected extremities of patients with Parkinson’s disease (PD) and essential tremor (ET). Approach. The tremor prediction algorithm uses a set of spectral (Fourier and wavelet) and nonlinear time series (entropy and recurrence rate) parameters extracted from the non-invasively recorded sEMG and acceleration signals. Main results. The resulting algorithm is shown to successfully predict tremor onset for all 91 trials recorded in 4 PD patients and for all 91 trials recorded in 4 ET patients. The predictor achieves a 100% sensitivity for all trials considered, along with an overall accuracy of 85.7% for all ET trials and 80.2% for all PD trials. By using a Pearson’s chi-square test, the prediction results are shown to significantly differ from a random prediction outcome. Significance. The tremor prediction algorithm can be potentially used for designing the next generation of non-invasive closed-loop predictive ON-OFF controllers for deep brain stimulation (DBS), used for suppressing pathological tremor in such patients. Such a system is based on alternating ON and OFF DBS periods, an incoming tremor being predicted during the time intervals when DBS is OFF, so as to turn DBS back ON. The prediction should be a few seconds before tremor re-appears so that the patient is tremor-free for the entire DBS ON-OFF cycle and the tremor-free DBS OFF interval should be maximized in order to minimize the current injected in the brain and battery usage.

  17. Transcutaneous cranial electrical stimulation (TCES): A review 1998

    Microsoft Academic Search

    A. Limoge; C. Robert; T. H. Stanley

    1999-01-01

    The Transcutaneous Cranial Electrical Stimulation (TCES) technique appeared at the beginning of the 1960s and is aimed to act at the level of the central nervous system. The current, composed of high frequency pulses interrupted with a repetitive low frequency, is delivered through three electrodes (a negative electrode placed between the eyebrows while two positive electrodes are located in the

  18. Computational modeling of epidural cortical stimulation

    NASA Astrophysics Data System (ADS)

    Wongsarnpigoon, Amorn; Grill, Warren M.

    2008-12-01

    Epidural cortical stimulation (ECS) is a developing therapy to treat neurological disorders. However, it is not clear how the cortical anatomy or the polarity and position of the electrode affects current flow and neural activation in the cortex. We developed a 3D computational model simulating ECS over the precentral gyrus. With the electrode placed directly above the gyrus, about half of the stimulus current flowed through the crown of the gyrus while current density was low along the banks deep in the sulci. Beneath the electrode, neurons oriented perpendicular to the cortical surface were depolarized by anodic stimulation, and neurons oriented parallel to the boundary were depolarized by cathodic stimulation. Activation was localized to the crown of the gyrus, and neurons on the banks deep in the sulci were not polarized. During regulated voltage stimulation, the magnitude of the activating function was inversely proportional to the thickness of the CSF and dura. During regulated current stimulation, the activating function was not sensitive to the thickness of the dura but was slightly more sensitive than during regulated voltage stimulation to the thickness of the CSF. Varying the width of the gyrus and the position of the electrode altered the distribution of the activating function due to changes in the orientation of the neurons beneath the electrode. Bipolar stimulation, although often used in clinical practice, reduced spatial selectivity as well as selectivity for neuron orientation.

  19. Long-term evaluation of gait initiation in six Parkinson's disease patients with bilateral subthalamic stimulation.

    PubMed

    Muniz, A M S; Nadal, J; Lyons, K E; Pahwa, R; Liu, W

    2012-03-01

    Defined as the transient state between standing and walking, gait initiation is negatively affected in Parkinson's disease (PD), which often results in significant disability. Although deep brain stimulation (DBS) is the most common surgical procedure for PD, the long-term effects of DBS on gait initiation are not well studied. The present study evaluated the long-term effects of subthalamic nucleus (STN) DBS on the preparation phase of gait initiation using principal component (PC) analysis. Six patients with PD who had undergone STN DBS and 24 healthy control subjects were evaluated. PD subjects were assessed 11.3±10.3 (P1) and 78.9±10.6 (P2) months after surgery. PD subjects were tested with STN DBS in two conditions: without medication and with medication. PC analysis was applied separately for the vertical, anterior-posterior and medial-lateral components of ground reaction force (GRF) recorded during gait initiation. Three PC scores were chosen by the scree test for each GRF component and all these PC scores were used for calculating a standard distance between healthy controls and PD subjects. The Friedman test showed a significant difference in standard distance among conditions (P=0.004), with the post-hoc test recognizing differences among P1 conditions and P2 medication-on condition. The eigenvector loading factors pointed to major differences between PD conditions surrounding the maximum amplitude of vertical and anterior-posterior GRF. For the studied sample, all distances increased in the follow-up evaluation (P2) with and without medications, indicating a worsening in gait initiation after seven years. PMID:22154114

  20. INSECT FLIGHT CONTROL BY NEURAL STIMULATION OF PUPAE-IMPLANTED FLEXIBLE

    E-print Network

    Voldman, Joel

    INSECT FLIGHT CONTROL BY NEURAL STIMULATION OF PUPAE-IMPLANTED FLEXIBLE MULTISITE ELECTRODES W sexta flight control via pupae- implanted MEMS-based electrodes that directly interface with the central to a vertebrate's spinal cord). These electrodes were able to stimulate the abdomen motion of pupae and adult

  1. Spatially distributed sequential stimulation reduces muscle fatigue during neuromuscular electrical stimulation.

    PubMed

    Sayenko, Dimitry G; Popovic, Milos R; Masani, Kei

    2013-01-01

    A critical limitation with neuromuscular electrical stimulation (NMES) approach is the rapid onset of muscle fatigue during repeated contractions, which results in the muscle force decay and slowing of muscle contractile properties. In our previous study, we demonstrated that spatially distributed sequential stimulation (SDSS) show a drastically greater fatigue-reducing ability compared to a conventional, single active electrode stimulation (SES) with an individual with spinal cord injury when applied for plantar flexors. The purpose of the present study is to explore the fatigue-reducing ability of SDSS for major lower limb muscle groups in the able-bodied population as well as individuals with spinal cord injury (SCI). SDSS was delivered through four active electrodes applied to the muscle of interest, sending a stimulation pulse to each electrode one after another with 90° phase shift between successive electrodes. For comparison, SES was delivered through one active electrode. For both modes of stimulation, the resultant frequency to the muscle as a whole was 40 Hz. Using corresponding protocols for the fatiguing stimulation, we demonstrated the fatigue-reducing ability of SDSS by higher fatigue indices as compared with single active electrode setup for major leg muscles in both subject groups. The present work verifies and extends reported findings on the effectiveness of using spatially distributed sequential stimulation in the leg muscles to reduce muscle fatigue. Application of this technique can improve the usefulness of NMES during functional movements in the clinical setup. PMID:24110512

  2. The decision-making process leading to deep brain stimulation in men and women with parkinson’s disease – an interview study

    PubMed Central

    2014-01-01

    Background Deep brain stimulation (DBS) is an established treatment for patients with advanced parkinson’s disease (PD). Research shows that women are under-represented among patients undergoing DBS surgery. This may be due to gender-biased selection of patients, but patients’ wishes and attitudes may also contribute. This study investigated the decision making process to undergo DBS from the patient’s perspective, and explored any gender patterns in the participants’ decision-making. Methods All patients operated on with DBS for PD at the University Hospital of Northern Sweden between January 2002 and April 2010 were invited to an interview study. In this way 39 patients were recruited, 31 men and eight women. Three additional women, operated elsewhere, were recruited to acheive a more gender-balanced sample. In a mixed-method analysis, the interviews were analysed according to the constant comparison technique in grounded theory and descriptive statistics was used to present demographics and compare categories. Results Three different approaches to DBS were identified among the patients. ‘Taking own initiative’, included 48% of the patients and implied that the patients’ own initiatives and arguments had been crucial for having surgery. ‘Agreeing when offered’, and accepting DBS when suggested by doctors embraced 43%. The third approach, ‘Hesitating and waiting’ included?DBS. Half of the patients had held a leadership position at work or in another organisation, and among patients ‘taking own initiative’ the proportion with leadership experiences was 80%. At time for surgery ten men but no woman were professionally active. Conclusion This study suggests that many patients with advanced PD have to argue and struggle with their clinicians in order to be referred to a DBS-team. The study further suggests that patients’ wishes, behaviour and position in society may all contribute to the skewed gender distribution among patients treated with DBS. PMID:24761767

  3. An Ion-selective Electrode for Anion Perchlorate in Thick-film Technology

    PubMed Central

    Segui, María Jesús; Lizondo-Sabater, Josefa; Martínez-Máñez, Ramon; Sancenon, Félix; Soto, Juan; Garcia-Breijo, Eduardo; Gil, Luis

    2006-01-01

    The ionophore 1,4,7,10,13-penta(n-octyl)-1,4,7,10,13-pentaazacyclopentadecane (L1) was used for the development of miniaturised perchlorate-selective electrodes in thick-film technology. Different PVC membranes containing L1 and the plasticizers o-nitrophenyl octyl ether (NPOE), dibutyl phthalate (DBP), bis(2-ethylhexyl)sebacate (DOS) and dibutyl sebacate (DBS) were prepared and placed on a graphite working electrode manufactured by using thick film serigraphic technology. The perchlorate selective electrode containing DBS as plasticizer showed a potentiometric Nernstian response of -57 mV per decade in a range of perchlorate concentration from 1 × 10-4 to 1 × 10-1 M with a detection limit of 5 × 10-5 M. The ion selective electrodes containing DBP and NPOE as plasticizers exhibit a working range from 6.3 × 10-5 to 1 × 10-1 M and 7.4 × 10-5 to 1 × 10-1 M for perchlorate, respectively, with a detection limit of ca. 2.2 × 10-5 M. For all three electrodes a response time of ca. 5 s was found. The prepared electrodes do not show appreciable decay of the slope for at least 25 days. Potentiometric selectivity coefficients (log KpotClO4-,X-) with respect to the primary anion perchlorate were evaluated using the fixed interference method. These coefficients are of the order of 10-1.7 or smaller, indicating the relatively poor interference of the different anions studied.

  4. Digital electronic bone growth stimulator

    DOEpatents

    Kronberg, J.W.

    1995-05-09

    A device is described for stimulating bone tissue by applying a low level alternating current signal directly to the patient`s skin. A crystal oscillator, a binary divider chain and digital logic gates are used to generate the desired waveforms that reproduce the natural electrical characteristics found in bone tissue needed for stimulating bone growth and treating osteoporosis. The device, powered by a battery, contains a switch allowing selection of the correct waveform for bone growth stimulation or osteoporosis treatment so that, when attached to the skin of the patient using standard skin contact electrodes, the correct signal is communicated to the underlying bone structures. 5 figs.

  5. Digital electronic bone growth stimulator

    DOEpatents

    Kronberg, James W. (Aiken, SC)

    1995-01-01

    A device for stimulating bone tissue by applying a low level alternating current signal directly to the patient's skin. A crystal oscillator, a binary divider chain and digital logic gates are used to generate the desired waveforms that reproduce the natural electrical characteristics found in bone tissue needed for stimulating bone growth and treating osteoporosis. The device, powered by a battery, contains a switch allowing selection of the correct waveform for bone growth stimulation or osteoporosis treatment so that, when attached to the skin of the patient using standard skin contact electrodes, the correct signal is communicated to the underlying bone structures.

  6. Deep brain stimulation for movement disorders

    Microsoft Academic Search

    Wesley Thevathasan; Ralph Gregory

    2010-01-01

    Deep brain stimulation is now considered a routine treatment option for selected patients with advanced Parkinson’s disease, primary segmental and generalised dystonia, and essential tremor. The neurosurgeon is responsi ble for the accurate and safe placement of the electrodes and the neurologist for the careful selection of patients and titration of medication against the effects of stimulation. A multidisciplinary team

  7. An FPGA-Based Vision Prosthesis Prototype: Implementing an Efficient Multiplexing Method for Addressing Electrodes.

    PubMed

    Wong, Y; Suaning, G; Dokos, S; Preston, P; Dommel, N; Grace, D; Lovell, N H

    2005-01-01

    A prototype of an epi-retinal vision prosthesis based upon an efficient electrode addressing schema has been developed. This system has the ability to stimulate multiple electrode regions simultaneously, hence greatly improving the maximum rate of stimulation compared to many currently available neural stimulation devices based on serial stimulation protocols. To minimize the problem of cross talk between stimulating electrodes, a hexagon layout of electrodes was implemented. Basic tests were completed using a field programmable gate array logic system driving analogue circuitry to inject current into physiological saline via electrodes in hexagon arrangements and in a simple paired arrangement. The hexagon layout of electrodes was shown to clearly reduce the interaction between multiple current sources and hence cross talk. PMID:17281438

  8. Notice of Violation of IEEE Publication PrinciplesA single-chip digitally enhanced radio receiver for DBS satellite TV applications

    Microsoft Academic Search

    A. Maxim; R. Poorfard; R. Johnson; P. Crawley; J. Kao; Z. Dong; M. Chennam; D. Trager; M. Reid

    2008-01-01

    Notice of Violation of IEEE Publication Principles??A Single-chip Digitally Enhanced Radio Receiver for DBS Satellite TV Applications??by A. Maxim, R. Poorfard, R. Johnson, P. Crawley, J. Kao, Z. Dong, M. Chennam, D. Trager, M. Reidin the Proceedings of the 2008 IEEE Radio and Wireless Symposium,Page(s):787-790After careful and considered review, it has been determined that the above paper is in violation

  9. Stimulus features underlying reduced tremor suppression with temporally patterned deep brain stimulation

    PubMed Central

    Birdno, Merrill J.; Kuncel, Alexis M.; Dorval, Alan D.; Turner, Dennis A.; Gross, Robert E.

    2012-01-01

    Deep brain stimulation (DBS) provides dramatic tremor relief when delivered at high-stimulation frequencies (more than ?100 Hz), but its mechanisms of action are not well-understood. Previous studies indicate that high-frequency stimulation is less effective when the stimulation train is temporally irregular. The purpose of this study was to determine the specific characteristics of temporally irregular stimulus trains that reduce their effectiveness: long pauses, bursts, or irregularity per se. We isolated these characteristics in stimulus trains and conducted intraoperative measurements of postural tremor in eight volunteers. Tremor varied significantly across stimulus conditions (P < 0.015), and stimulus trains with pauses were significantly less effective than stimulus trains without (P < 0.002). There were no significant differences in tremor between trains with or without bursts or between trains that were irregular or periodic. Thus the decreased effectiveness of temporally irregular DBS trains is due to long pauses in the stimulus trains, not the degree of temporal irregularity alone. We also conducted computer simulations of neuronal responses to the experimental stimulus trains using a biophysical model of the thalamic network. Trains that suppressed tremor in volunteers also suppressed fluctuations in thalamic transmembrane potential at the frequency associated with cerebellar burst-driver inputs. Clinical and computational findings indicate that DBS suppresses tremor by masking burst-driver inputs to the thalamus and that pauses in stimulation prevent such masking. Although stimulation of other anatomic targets may provide tremor suppression, we propose that the most relevant neuronal targets for effective tremor suppression are the afferent cerebellar fibers that terminate in the thalamus. PMID:21994263

  10. Effects of deep brain stimulation of the subthalamic nucleus on inhibitory and executive control over prepotent responses in Parkinson's disease

    PubMed Central

    Jahanshahi, Marjan

    2013-01-01

    Inhibition of inappropriate, habitual or prepotent responses is an essential component of executive control and a cornerstone of self-control. Via the hyperdirect pathway, the subthalamic nucleus (STN) receives inputs from frontal areas involved in inhibition and executive control. Evidence is reviewed from our own work and the literature suggesting that in Parkinson's disease (PD), deep brain stimulation (DBS) of the STN has an impact on executive control during attention-demanding tasks or in situations of conflict when habitual or prepotent responses have to be inhibited. These results support a role for the STN in an inter-related set of processes: switching from automatic to controlled processing, inhibitory and executive control, adjusting response thresholds and influencing speed-accuracy trade-offs. Such STN DBS-induced deficits in inhibitory and executive control may contribute to some of the psychiatric problems experienced by a proportion of operated cases after STN DBS surgery in PD. However, as no direct evidence for such a link is currently available, there is a need to provide direct evidence for such a link between STN DBS-induced deficits in inhibitory and executive control and post-surgical psychiatric complications experienced by operated patients. PMID:24399941

  11. Surgical Site Infections after Deep Brain Stimulation Surgery: Frequency, Characteristics and Management in a 10-Year Period

    PubMed Central

    Bjerknes, Silje; Skogseid, Inger Marie; Sæhle, Terje; Dietrichs, Espen; Toft, Mathias

    2014-01-01

    Background/Aims Deep brain stimulation (DBS) implant infection is a feared complication, as it is difficult to manage and leads to increased patient morbidity. We wanted to assess the frequency and possible risk factors of DBS related infections at our centre. In the purpose of evaluating treatment options, we also analyzed treatment, and the clinical and microbiological characteristics of the infections. Methods Electronic medical records of all patients undergoing DBS surgery at our centre, from 2001 through 2010, were retrospectively reviewed. Results Of the 588 procedures performed 33 (5.6%) led to an infection. Some patients underwent several procedures, thus 32 out of totally 368 patients (8.7%), and 19 out of 285 patients (6.7%) who received primary lead implantation, developed an infection. Most infections (52%) developed within the first month and 79% within three months. In the majority of the infections (79%) hardware removal was performed. Staphylococcus aureus infections were the most frequent (36%), and more likely to have earlier onset, pus formation, a more aggressive development and lead to hardware removal. No risk factors were identified. Conclusions Our results indicate that infections with more severe symptoms and growth of staphylococcus aureus should be treated with local hardware removal and antibiotic therapy. In other infections, an initial trial of antibiotic treatment could be considered. New knowledge about the microbiology of DBS related infections may lead to more effective antimicrobial treatment. PMID:25122445

  12. sensor electrodes

    NASA Astrophysics Data System (ADS)

    Zhang, Zhiqiang; Ma, Congcong; He, Lian; Zhu, Shijin; Hao, Xiaodong; Xie, Wanyi; Zhang, Wei; Zhang, Yuxin

    2014-11-01

    In this work, an ultrafast and facile method is developed to synthesize Au(I)-dodecanethiolate nanotubes (Au(I)NTs) with the assistance of glycyl-glycyl-glycine (G-G-G). Transmission electron microscopy (TEM) images reveal that the as-prepared Au(I)NTs can be obtained in a 2-h reaction instead of a previous 24-h reaction and are uniform with a hollow structure and smooth surface by virtue of the G-G-G peptide tubular template. According to structural analysis, a possible preparative mechanism is proposed that the G-G-G peptide could help to curl into tube-like morphology in alkaline situation spontaneously to accelerate the formation of Au(I)NTs. Meanwhile, PVDF-stabilized Au(I)NT-modified glassy carbon electrodes present their promising potential for Hg2+ detection.

  13. Fabrication of Pillar Shaped Electrode Arrays for Artificial Retinal Implants

    PubMed Central

    Kim, Eui Tae; Seo, Jong-Mo; Woo, Se Joon; Zhou, Jing Ai; Chung, Hum; Kim, Sung June

    2008-01-01

    Polyimide has been widely applied to neural prosthetic devices, such as the retinal implants, due to its well-known biocompatibility and ability to be micropatterned. However, planar films of polyimide that are typically employed show a limited ability in reducing the distance between electrodes and targeting cell layers, which limits site resolution for effective multi-channel stimulation. In this paper, we report a newly designed device with a pillar structure that more effectively interfaces with the target. Electrode arrays were successfully fabricated and safely implanted inside the rabbit eye in suprachoroidal space. Optical Coherence Tomography (OCT) showed well-preserved pillar structures of the electrode without damage. Bipolar stimulation was applied through paired sites (6:1) and the neural responses were successfully recorded from several regions in the visual cortex. Electrically evoked cortical potential by the pillar electrode array stimulation were compared to visual evoked potential under full-field light stimulation.

  14. Assessment of the effects of subthalamic stimulation in Parkinson disease patients by artificial neural network.

    PubMed

    Muniz, A M S; Liu, W; Liu, H; Lyons, K E; Pahwa, R; Nobre, F F; Nadal, J

    2009-01-01

    This study aims at using a probabilistic neural network (PNN) for discriminating between normal and Parkinson disease (PD) subjects using as input the principal components (PCs) derived from vertical component of the ground reaction force (vGRF). The trained PNN was further used for evaluating the effects of deep brain stimulation of the subthalamic nucleus (STN DBS) on PD, with and without medication. A sample of 45 subjects (30 normal and 15 PD subjects who underwent STN DBS) was evaluated by gait analysis. PD subjects were assessed under four test conditions: without treatment (mof-sof), only with stimulation (mof-son) or medication (mon-sof), and with combined treatments (mon-son). PC analysis was applied on vGRF, where six PC scores were chosen by the broken stick test. Using a bootstrap approach for the PNN model, and the area under the receiver operating characteristic curve (AUC) as performance measurement, the first three and fifth PCs were selected as input variables. The PNN presented AUC = 0.995 for classifying controls and PD subjects in the mof-sof condition. When applied to classify the PD subjects under treatment, the PNN indicated that STN DBS alone is more effective than medication, and further vGRF enhancement is obtained with combined therapies. PMID:19964412

  15. Deep brain stimulation and cluster headache.

    PubMed

    Leone, M; Franzini, A; Felisati, G; Mea, E; Curone, M; Tullo, V; Broggi, G; Bussone, G

    2005-05-01

    In recent years, neuroimaging data have greatly improved the knowledge on trigeminal autonomic cephalalgias' (TACs) central mechanisms. Positron emission tomography studies have shown that the posterior inferior hypothalamic grey matter is activated during cluster headache attacks as well as in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). Voxel-based morphometric MRI has also documented alteration in the same area in cluster headache patients. These data suggest that the cluster headache generator is located in this region and leads us to hypothesise that stimulation of this brain area could relieve intractable cluster headache just as deep brain stimulation improves intractable movements disorders. This view received support by the observation that high frequency stimulation of the ipsilateral hypothalamus prevented attacks in an otherwise intractable chronic cluster headache patient previously treated unsuccessfully by surgical procedures to the trigeminal nerve. So far, 16 patients with intractable cronic cluster headache (CCH) and one intractable SUNCT patient have been successfully treated by hypothalamic stimulation. The procedures were well tolerated with no significant adverse events. Hypothalamic DBS is an efficacious and safe procedure to relieve otherwise intractable CCH and SUNCT. PMID:15926012

  16. Double-blind optimization of subcallosal cingulate deep brain stimulation for treatment-resistant depression: a pilot study

    PubMed Central

    Ramasubbu, Rajamannar; Anderson, Susan; Haffenden, Angela; Chavda, Swati; Kiss, Zelma H.T.

    2013-01-01

    Background Deep brain stimulation (DBS) of the subcallosal cingulate (SCC) is reported to be a safe and effective new treatment for treatment-resistant depression (TRD). However, the optimal electrical stimulation parameters are unknown and generally selected by trial and error. This pilot study investigated the relationship between stimulus parameters and clinical effects in SCC-DBS treatment for TRD. Methods Four patients with TRD underwent SCC-DBS surgery. In a double-blind stimulus optimization phase, frequency and pulse widths were randomly altered weekly, and corresponding changes in mood and depression were evaluated using a visual analogue scale (VAS) and the 17-item Hamilton Rating Scale for Depression (HAM-D-17). In the open-label postoptimization phase, depressive symptoms were evaluated biweekly for 6 months to determine long-term clinical outcomes. Results Longer pulse widths (270–450 ?s) were associated with reductions in HAM-D-17 scores in 3 patients and maximal happy mood VAS responses in all 4 patients. Only 1 patient showed acute clinical or mood effects from changing the stimulation frequency. After 6 months of open-label therapy, 2 patients responded and 1 patient partially responded. Limitations Limitations include small sample size, weekly changes in stimulus parameters, and fixed-order and carry-forward effects. Conclusion Longer pulse width stimulation may have a role in stimulus optimization for SCC-DBS in TRD. Longer pulse durations produce larger apparent current spread, suggesting that we do not yet know the optimal target or stimulus parameters for this therapy. Investigations using different stimulus parameters are required before embarking on large-scale randomized sham-controlled trials. PMID:23527884

  17. resterilizable electrode for electrosurgery

    NASA Technical Reports Server (NTRS)

    Engstrom, E. R.; Houge, J. C.

    1979-01-01

    Required properties of flexibility, electrical conductivity, tensile strength, and tear resistance of electrosurgical electrodes is retained through utilization of flexible-polymer/conductive particle composites for electrodes.

  18. Addiction therapy. Refining deep brain stimulation to emulate optogenetic treatment of synaptic pathology.

    PubMed

    Creed, Meaghan; Pascoli, Vincent Jean; Lüscher, Christian

    2015-02-01

    Circuit remodeling driven by pathological forms of synaptic plasticity underlies several psychiatric diseases, including addiction. Deep brain stimulation (DBS) has been applied to treat a number of neurological and psychiatric conditions, although its effects are transient and mediated by largely unknown mechanisms. Recently, optogenetic protocols that restore normal transmission at identified synapses in mice have provided proof of the idea that cocaine-adaptive behavior can be reversed in vivo. The most efficient protocol relies on the activation of metabotropic glutamate receptors, mGluRs, which depotentiates excitatory synaptic inputs onto dopamine D1 receptor medium-sized spiny neurons and normalizes drug-adaptive behavior. We discovered that acute low-frequency DBS, refined by selective blockade of dopamine D1 receptors, mimics optogenetic mGluR-dependent normalization of synaptic transmission. Consequently, there was a long-lasting abolishment of behavioral sensitization. PMID:25657248

  19. Hippocampal deep brain stimulation reverses physiological and behavioral deficits in a rodent model of schizophrenia

    PubMed Central

    Perez, Stephanie M.; Shah, Amiksha; Asher, Amber; Lodge, Daniel J.

    2013-01-01

    Summary Subcortical dopamine system dysregulation has been suggested to underlie the positive symptoms of schizophrenia. Recent preclinical investigations and human imaging studies have proposed that the augmented dopamine system function observed in schizophrenia patients may be secondary to aberrant hippocampal activity. Thus, we posit that the hippocampus represents a novel therapeutic target for the treatment of schizophrenia. Here we provide evidence of the effectiveness of a unique approach aimed at decreasing hippocampal function in a rodent model of schizophrenia. Specifically, in a rodent model of schizophrenia, we demonstrate that ventral hippocampal (vHipp) deep brain stimulation (DBS) can normalize aberrant dopamine neuron activity and behaviors associated with positive symptoms. In addition, we provide evidence that this approach may also be effective in restoring deficits in cognitive function, often left unaltered by conventional antipsychotic medications. Therefore, we have provided initial preclinical evidence demonstrating the feasibility of hippocampal DBS as a potential novel approach for the treatment of schizophrenia. PMID:23190686

  20. PTFOS: Flexible and Absorbable Intracranial Electrodes for Magnetic Resonance Imaging

    PubMed Central

    Bonmassar, Giorgio; Fujimoto, Kyoko; Golby, Alexandra J.

    2012-01-01

    Intracranial electrocortical recording and stimulation can provide unique knowledge about functional brain anatomy in patients undergoing brain surgery. This approach is commonly used in the treatment of medically refractory epilepsy. However, it can be very difficult to integrate the results of cortical recordings with other brain mapping modalities, particularly functional magnetic resonance imaging (fMRI). The ability to integrate imaging and electrophysiological information with simultaneous subdural electrocortical recording/stimulation and fMRI could offer significant insight for cognitive and systems neuroscience as well as for clinical neurology, particularly for patients with epilepsy or functional disorders. However, standard subdural electrodes cause significant artifact in MRI images, and concerns about risks such as cortical heating have generally precluded obtaining MRI in patients with implanted electrodes. We propose an electrode set based on polymer thick film organic substrate (PTFOS), an organic absorbable, flexible and stretchable electrode grid for intracranial use. These new types of MRI transparent intracranial electrodes are based on nano-particle ink technology that builds on our earlier development of an EEG/fMRI electrode set for scalp recording. The development of MRI-compatible recording/stimulation electrodes with a very thin profile could allow functional mapping at the individual subject level of the underlying feedback and feed forward networks. The thin flexible substrate would allow the electrodes to optimally contact the convoluted brain surface. Performance properties of the PTFOS were assessed by MRI measurements, finite difference time domain (FDTD) simulations, micro-volt recording, and injecting currents using standard electrocortical stimulation in phantoms. In contrast to the large artifacts exhibited with standard electrode sets, the PTFOS exhibited no artifact due to the reduced amount of metal and conductivity of the electrode/trace ink and had similar electrical properties to a standard subdural electrode set. The enhanced image quality could enable routine MRI exams of patients with intracranial electrode implantation and could also lead to chronic implantation solutions. PMID:22984396

  1. PTFOS: flexible and absorbable intracranial electrodes for magnetic resonance imaging.

    PubMed

    Bonmassar, Giorgio; Fujimoto, Kyoko; Golby, Alexandra J

    2012-01-01

    Intracranial electrocortical recording and stimulation can provide unique knowledge about functional brain anatomy in patients undergoing brain surgery. This approach is commonly used in the treatment of medically refractory epilepsy. However, it can be very difficult to integrate the results of cortical recordings with other brain mapping modalities, particularly functional magnetic resonance imaging (fMRI). The ability to integrate imaging and electrophysiological information with simultaneous subdural electrocortical recording/stimulation and fMRI could offer significant insight for cognitive and systems neuroscience as well as for clinical neurology, particularly for patients with epilepsy or functional disorders. However, standard subdural electrodes cause significant artifact in MRI images, and concerns about risks such as cortical heating have generally precluded obtaining MRI in patients with implanted electrodes. We propose an electrode set based on polymer thick film organic substrate (PTFOS), an organic absorbable, flexible and stretchable electrode grid for intracranial use. These new types of MRI transparent intracranial electrodes are based on nano-particle ink technology that builds on our earlier development of an EEG/fMRI electrode set for scalp recording. The development of MRI-compatible recording/stimulation electrodes with a very thin profile could allow functional mapping at the individual subject level of the underlying feedback and feed forward networks. The thin flexible substrate would allow the electrodes to optimally contact the convoluted brain surface. Performance properties of the PTFOS were assessed by MRI measurements, finite difference time domain (FDTD) simulations, micro-volt recording, and injecting currents using standard electrocortical stimulation in phantoms. In contrast to the large artifacts exhibited with standard electrode sets, the PTFOS exhibited no artifact due to the reduced amount of metal and conductivity of the electrode/trace ink and had similar electrical properties to a standard subdural electrode set. The enhanced image quality could enable routine MRI exams of patients with intracranial electrode implantation and could also lead to chronic implantation solutions. PMID:22984396

  2. Patterned, but not tonic, optogenetic stimulation in motor thalamus improves reaching in acute drug-induced Parkinsonian rats.

    PubMed

    Seeger-Armbruster, Sonja; Bosch-Bouju, Clémentine; Little, Shane T C; Smither, Roseanna A; Hughes, Stephanie M; Hyland, Brian I; Parr-Brownlie, Louise C

    2015-01-21

    High-frequency deep brain stimulation (DBS) in motor thalamus (Mthal) ameliorates tremor but not akinesia in Parkinson's disease. The aim of this study was to investigate whether there are effective methods of Mthal stimulation to treat akinesia. Glutamatergic Mthal neurons, transduced with channelrhodopsin-2 by injection of lentiviral vector (Lenti.CaMKII.hChR2(H134R).mCherry), were selectively stimulated with blue light (473 nm) via a chronically implanted fiber-optic probe. Rats performed a reach-to-grasp task in either acute drug-induced parkinsonian akinesia (0.03-0.07 mg/kg haloperidol, s.c.) or control (vehicle injection) conditions, and the number of reaches was recorded for 5 min before, during, and after stimulation. We compared the effect of DBS using complex physiological patterns previously recorded in the Mthal of a control rat during reaching or exploring behavior, with tonic DBS delivering the same number of stimuli per second (rate-control 6.2 or 1.8 Hz, respectively) and with stimulation patterns commonly used in other brain regions to treat neurological conditions (tonic 130 Hz, theta burst (TBS), and tonic 15 Hz rate-control for TBS). Control rats typically executed >150 reaches per 5 min, which was unaffected by any of the stimulation patterns. Acute parkinsonian rats executed <20 reaches, displaying marked akinesia, which was significantly improved by stimulating with the physiological reaching pattern or TBS (both p < 0.05), whereas the exploring and all tonic patterns failed to improve reaching. Data indicate that the Mthal may be an effective site to treat akinesia, but the pattern of stimulation is critical for improving reaching in parkinsonian rats. PMID:25609635

  3. Greater improvement in quality of life following unilateral deep brain stimulation surgery in the globus pallidus as compared to the subthalamic nucleus

    PubMed Central

    Okun, Michael S.; Foote, Kelly D.; Fernandez, Hubert H.; Rodriguez, Ramon L.; Wu, Samuel S.; Kirsch-Darrow, Lindsey; Jacobson, Charles E.; Rosado, Christian; Bowers, Dawn

    2011-01-01

    While deep brain stimulation (DBS) surgery is a well-accepted treatment for Parkinson disease (PD) that improves overall quality of life (QoL), its effects across different domains of QoL are unclear. The study reported here directly compared the effects of unilateral DBS in subthalamic nucleus (STN) or globus pallidus (GPi) on QoL in 42 non-demented patients with medication-refractory PD. Patients were enrolled in the COMPARE trial, a randomized clinical trial of cognitive and mood effects of STN versus GPi DBS conducted at the University of Florida Movement Disorders Center. Patients underwent motor, mood, verbal fluency and QoL (Parkinson disease questionnaire: PDQ-39) measures before and 6 months following surgery. Groups experienced motor and mood improvements that did not differ by target. Patients with STN DBS evidenced a slight decrement on letter fluency. On average, all patients endorsed better overall QoL after surgery. However, despite similar motor and mood improvements, GPi patients improved more than STN patients (38 vs. 14%, respectively; P = 0.03). Patients reported better QoL on subscales of mobility, activities of daily living (ADLs), emotional well-being, stigma, cognition and discomfort, but not on those of social support and communication. Improvements on the mobility, ADLs, stigma and social support subscales were greater amongst GPi patients. In regression analyses, only depression changes independently predicted changes in overall QoL as well as emotional well-being and social support changes. Within the STN group only, declining category fluency scores correlated with poorer QoL on the communication subscale. Unilateral DBS in both STN and GPi improved QoL overall and in disparate domains 6 months after surgery. Patients receiving GPi DBS reported greater improvements that cannot be explained by differential mood or motor effects; however, verbal fluency changes may have partially contributed to lesser QoL improvements amongst STN patients. PMID:19363633

  4. LC-MS/MS bioanalysis of loratadine (Claritin) in dried blood spot (DBS) samples collected by subjects in a clinical research study.

    PubMed

    Li, Wenkui; Doherty, John; Moench, Paul; Flarakos, Jimmy; Tse, Francis L S

    2015-03-01

    A high-performance liquid chromatography-tandem mass spectrometric (LC-MS/MS) method has been developed and validated for the quantitative analysis of loratadine, an H1 histamine antagonist, in human dried blood spot (DBS) samples following a single self-administered 10 or 20mg oral dose. The samples were produced by spotting approximately 30?l of whole blood onto PE-226 cards. Two 3-mm discs were cut from the DBS samples and extracted using aqueous methanol containing the internal standard. After transfer and drying of the resulting sample extract, the reconstituted residues were chromatographed using a Waters XSelect C18 column and isocratic elution for MS/MS detection. The possible impact due to hematocrit, volume of blood sample spotted, storage temperature, and humidity, on the accuracy of measured DBS results were investigated. The results showed that only spotted blood volume might have an impact; a small volume (10?l) tended to give a larger negative bias in the measured value than the large volume ones (?20?l). The current method was fully validated over a dynamic range of 0.200-20.0ng/ml with correlation coefficients (r(2)) for three validation batches equal to or better than 0.990. The intra-day accuracy and precision at the LLOQ were -11.5 to 0.0% bias and 6.4 to 8.9% CV, respectively. For the other QC samples (0.600, 3.00, 10.0 and 15.0ng/ml), the precision ranged from 4.2 to 9.8% CV and from 6.3 to 8.1% CV, respectively, in the intra-day and inter-day evaluations; the accuracy ranged from -1.7 to 10.0% and 2.7 to 5.3% bias, respectively, in the intra-day and inter-day batches. Loratadine is stable in the DBS samples for at least 271 days at ambient temperature in a desiccator, for at least 24h at 60°C and under 80% relative humidity, followed by re-conditioning at ambient temperature in a desiccator. The current methodology has been applied to determine the loratadine levels in DBS samples collected by subjects in a clinical research study to evaluate pharmacokinetic sampling in point-of-care setting. PMID:25645810

  5. Non-DBS DNA Repair Genes Regulate Radiation-induced Cytogenetic Damage Repair and Cell Cycle Progression

    NASA Technical Reports Server (NTRS)

    Zhang, Ye; Rohde, Larry H.; Emami, Kamal; Casey, Rachael; Wu, Honglu

    2008-01-01

    Changes of gene expression profile are one of the most important biological responses in living cells after ionizing radiation (IR) exposure. Although some studies have shown that genes up-regulated by IR may play important roles in DNA damage repair, the relationship between the regulation of gene expression by IR, particularly genes not known for their roles in DSB repair, and its impact on cytogenetic responses has not been systematically studied. In the present study, the expression of 25 genes selected on the basis of their transcriptional changes in response to IR was individually knocked down by transfection with small interfering RNA in human fibroblast cells. The purpose of this study is to identify new roles of these selected genes on regulating DSB repair and cell cycle progression , as measured in the micronuclei formation and chromosome aberration. In response to IR, the formation of MN was significantly increased by suppressed expression of 5 genes: Ku70 in the DSB repair pathway, XPA in the NER pathway, RPA1 in the MMR pathway, and RAD17 and RBBP8 in cell cycle control. Knocked-down expression of 4 genes (MRE11A, RAD51 in the DSB pathway, SESN1, and SUMO1) significantly inhibited cell cycle progression, possibly because of severe impairment of DNA damage repair. Furthermore, loss of XPA, P21, or MLH1 expression resulted in both significantly enhanced cell cycle progression and increased yields of chromosome aberrations, indicating that these gene products modulate both cell cycle control and DNA damage repair. Most of the 11 genes that affected cytogenetic responses are not known to have clear roles influencing DBS repair. Nine of these 11 genes were up-regulated in cells exposed to gamma radiation, suggesting that genes transcriptionally modulated by IR were critical to regulate the biological consequences after IR.

  6. Unilateral deep brain stimulation of the pedunculopontine tegmental nucleus in idiopathic Parkinson's disease: effects on gait initiation and performance.

    PubMed

    Mazzone, P; Paoloni, M; Mangone, M; Santilli, V; Insola, A; Fini, M; Scarnati, E

    2014-07-01

    The pedunculopontine tegmental nucleus (PPTg) is a component of the locomotor mesencephalic area. In recent years it has been considered a new surgical site for deep brain stimulation (DBS) in movement disorders. Here, using objective kinematic and spatio-temporal gait analysis, we report the impact of low frequency (40 Hz) unilateral PPTg DBS in ten patients suffering from idiopathic Parkinson's disease with drug-resistant gait and axial disabilities. Patients were studied for gait initiation (GI) and steady-state level walking (LW) under residual drug therapy. In the LW study, a straight walking task was employed. Patients were compared with healthy age-matched controls. The analysis revealed that GI, cadence, stride length and left pelvic tilt range of motion (ROM) improved under stimulation. The duration of the S1 and S2 sub-phases of the anticipatory postural adjustment phase of GI was not affected by stimulation, however a significant improvement was observed in the S1 sub-phase in both the backward shift of centre of pressure and peak velocity. Speed during the swing phase, step width, stance duration, right pelvic tilt ROM phase, right and left hip flexion-extension ROM, and right and left knee ROM were not modified. Overall, the results show that unilateral PPTg DBS may affect GI and specific spatio-temporal and kinematic parameters during unconstrained walking on a straight trajectory, thus providing further support to the importance of the PPTg in the modulation of gait in neurodegenerative disorders. PMID:24908195

  7. transparent electrode

    NASA Astrophysics Data System (ADS)

    Li, Fumin; Chen, Chong; Tan, Furui; Li, Chunxi; Yue, Gentian; Shen, Liang; Zhang, Weifeng

    2014-10-01

    We report a new semitransparent inverted polymer solar cell (PSC) with a structure of glass/FTO/nc-TiO2/P3HT:PCBM/MoO3/Ag/MoO3. Because high-temperature annealing which decreased the conductivity of indium tin oxide (ITO) must be handled in the process of preparation of nanocrystalline titanium oxide (nc-TiO2), we replace glass/ITO with a glass/fluorine-doped tin oxide (FTO) substrate to improve the device performance. The experimental results show that the replacing FTO substrate enhances light transmittance between 400 and 600 nm and does not change sheet resistance after annealing treatment. The dependence of device performances on resistivity, light transmittance, and thickness of the MoO3/Ag/MoO3 film was investigated. High power conversion efficiency (PCE) was achieved for FTO substrate inverted PSCs, which showed about 75% increase compared to our previously reported ITO substrate device at different thicknesses of the MoO3/Ag/MoO3 transparent electrode films illuminated from the FTO side (bottom side) and about 150% increase illuminated from the MoO3/Ag/MoO3 side (top side).

  8. Functional neuroimaging and repetitive transcranial magnetic stimulation in Parkinson's disease.

    PubMed

    Wu, Allan D

    2007-01-01

    Functional neuroimaging provides insights into the pathogenesis of motor symptoms in Parkinson's disease (PD) and improves our understanding of both established neuromodulatory therapies such as deep brain stimulation (DBS) and potential ones such as repetitive transcranial magnetic stimulation (rTMS). Functional imaging studies can reveal the consequences of the dopaminergic lesion in PD among a widespread network of subcortical-cortical regions. Characteristic patterns of normal cortical brain activation for motor tasks are systematically altered in PD. Recent work has emphasized the task dependence of these changes and their gradual evolution over the course of the disease. Clinically relevant PD treatment with medications or DBS tends to normalize these patterns. In this context, rTMS is discussed as a potential noninvasive alternative for neuromodulation of cortical function. Although rTMS is not a current treatment, we review recent rTMS studies in PD that suggest its promise, illustrate how functional imaging can guide application of rTMS, and suggest that subcortical dopamine release could be an rTMS mechanism of action. The combination of rTMS and functional neuroimaging broadens our knowledge of functional cortical networks in PD, which can eventually provide physicians with pathophysiologic information about different PD treatment options and rationales for neuromodulatory interventions. PMID:17514152

  9. Optical stimulation of the facial nerve: a surgical tool?

    Microsoft Academic Search

    Claus-Peter Richter; Ingo Ulrik Teudt; Adam E. Nevel; Agnella D. Izzo; Joseph T. Walsh Jr.

    2008-01-01

    One sequela of skull base surgery is the iatrogenic damage to cranial nerves. Devices that stimulate nerves with electric current can assist in the nerve identification. Contemporary devices have two main limitations: (1) the physical contact of the stimulating electrode and (2) the spread of the current through the tissue. In contrast to electrical stimulation, pulsed infrared optical radiation can

  10. Peripheral stimulation in treating Parkinson's disease: Is it a realistic idea or a romantic whimsicality?

    PubMed Central

    Asakawa, Tetsuya; Fang, Huan; Hong, Zhen; Sugiyama, Kenji; Nozaki, Takao; Namba, Hiroki

    2012-01-01

    Summary Parkinson's disease (PD) is a common, however, intractable neurodegenerative disorder in the aging population. Levodopa (l-dopa) administration is regarded as the most effective strategy in treating PD with prominent motor side-effects after undergoing long-term treatment. Surgical therapies such as deep brain stimulation (DBS) show certain efficacy, yet there are several limitations in adopting such surgical procedures. Therefore, performing electrical stimulation out of the brain, namely peripheral stimulation for PD has been a dream of many clinicians. Recently, the efficacy of dorsal column stimulation was verified in animal PD models; on the other hand, tons of acupunctural studies from East Asia claim good efficacy in treating PD both in bench and clinical studies. This review will introduce the progress of peripheral stimulation for PD, and will discuss the potential mechanisms involved in these strategies. PMID:25343088

  11. Occipital nerve stimulation.

    PubMed

    Mammis, Antonios; Agarwal, Nitin; Mogilner, Alon Y

    2015-01-01

    Occipital nerve stimulation (ONS) is a form of neuromodulation therapy aimed at treating intractable headache and craniofacial pain. The therapy utilizes neurostimulating electrodes placed subcutaneously in the occipital region and connected to a permanently implanted programmable pulse generator identical to those used for dorsal column/spinal cord stimulation. The presumed mechanisms of action involve modulation of the trigeminocervical complex, as well as closure of the physiologic pain gate. ONS is a reversible, nondestructive therapy, which can be tailored to a patient's individual needs. Typically, candidates for successful ONS include those patients with migraines, Chiari malformation, or occipital neuralgia. However, recent MRSA infections, unrealistic expectations, and psychiatric comorbidities are generally contraindications. As with any invasive procedure, complications may occur including lead migration, infection, wound erosion, device failure, muscle spasms, and pain. The success of this therapy is dependent on careful patient selection, a preimplantation trial, meticulous implantation technique, programming strategies, and complication avoidance. PMID:25411143

  12. Ion-Selective Electrodes.

    ERIC Educational Resources Information Center

    Arnold, Mark A.; Meyerhoff, Mark E.

    1984-01-01

    Literature on ion-selective electrodes (ISEs) is reviewed in seven sections: books, conferences, reviews; potentiometric membrane electrodes; glass and solid-state membrane electrodes; liquid and polymer membrane ISEs; coated wire electrodes, ion-selective field effect transistors, and microelectrodes; gas sensors and selective bioelectrode…

  13. Modulation of epileptic activity by deep brain stimulation: a model-based study of frequency-dependent effects

    PubMed Central

    Mina, Faten; Benquet, Pascal; Pasnicu, Anca; Biraben, Arnaud; Wendling, Fabrice

    2013-01-01

    A number of studies showed that deep brain stimulation (DBS) can modulate the activity in the epileptic brain and that a decrease of seizures can be achieved in “responding” patients. In most of these studies, the choice of stimulation parameters is critical to obtain desired clinical effects. In particular, the stimulation frequency is a key parameter that is difficult to tune. A reason is that our knowledge about the frequency-dependant mechanisms according to which DBS indirectly impacts the dynamics of pathological neuronal systems located in the neocortex is still limited. We address this issue using both computational modeling and intracerebral EEG (iEEG) data. We developed a macroscopic (neural mass) model of the thalamocortical network. In line with already-existing models, it includes interconnected neocortical pyramidal cells and interneurons, thalamocortical cells and reticular neurons. The novelty was to introduce, in the thalamic compartment, the biophysical effects of direct stimulation. Regarding clinical data, we used a quite unique data set recorded in a patient (drug-resistant epilepsy) with a focal cortical dysplasia (FCD). In this patient, DBS strongly reduced the sustained epileptic activity of the FCD for low-frequency (LFS, < 2 Hz) and high-frequency stimulation (HFS, > 70 Hz) while intermediate-frequency stimulation (IFS, around 50 Hz) had no effect. Signal processing, clustering, and optimization techniques allowed us to identify the necessary conditions for reproducing, in the model, the observed frequency-dependent stimulation effects. Key elements which explain the suppression of epileptic activity in the FCD include: (a) feed-forward inhibition and synaptic short-term depression of thalamocortical connections at LFS, and (b) inhibition of the thalamic output at HFS. Conversely, modeling results indicate that IFS favors thalamic oscillations and entrains epileptic dynamics. PMID:23882212

  14. A CURVATURE-CONTROLLED 3D MICRO-ELECTRODE ARRAY FOR COCHLEAR IMPLANTS

    E-print Network

    Tang, William C

    A CURVATURE-CONTROLLED 3D MICRO-ELECTRODE ARRAY FOR COCHLEAR IMPLANTS Jian Wu1 , Le Yan2 , Han Xu2-electrode array for cochlear implants. The main body of the device is fabricated using standard thin stimulation threshold. Keywords: Micro-electrode array, 3D, Cochlear implant INTRODUCTION In the last decade

  15. Impact of advancing age on post-operative complications of deep brain stimulation surgery for essential tremor.

    PubMed

    Verla, Terence; Marky, Andrew; Farber, Harrison; Petraglia, Frank W; Gallis, John; Lokhnygina, Yuliya; Parente, Beth; Hickey, Patrick; Turner, Dennis A; Lad, Shivanand P

    2015-05-01

    Essential tremor (ET) was the original indication for deep brain stimulation (DBS), with USA Food and Drug Administration approval since 1997. Despite the efficacy of DBS, it is associated with surgical complications that cause sub-optimal clinical outcomes. Given that ET is a progressive disease with increase in symptom severity with increasing age, this study evaluated the impact of increasing age on short-term complications following DBS surgery for ET. The Thomson-Reuters MarketScan database was utilized (New York, NY, USA). Patients selected were over age 18 and underwent DBS for ET between the years 2000 and 2009. Multivariable logistic regression analysis was used to calculate complication odds ratios (OR) for a 5year increase in age, after controlling for other covariates. Six hundred sixty-one patients were included in the analysis. The mean (standard deviation) age was 61.9 (14.3) years, with 17% of individuals aged ?75years. Overall 56.9% of patients were male, and 44.6% had a Charlson Comorbidity Score of ?1. Additionally, 7.1% of patients experienced at least one complication within 90days, including wound infections (3.0%), pneumonia (2.4%), hemorrhage or hematoma (1.5%), or pulmonary embolism (0.6%). Increasing age was not significantly associated with the overall 90day complication rates (OR 0.89; 95% confidence interval [CI] 0.77-1.02; p=0.102). The risk of the two most common procedure-related complications, hemorrhage and infection, did not significantly increase with age (hemorrhage: OR 1.02; 95%CI 0.77-1.37; p=0.873; and infection: OR 0.88; 95%CI 0.72-1.07; p=0.203). Our findings suggest that age should not be a primary exclusion factor for determining candidacy for DBS and also suggest a possible expansion of the traditional therapeutic window since post-operative complications remained relatively stable. PMID:25669119

  16. Emotion recognition in early Parkinson's disease patients undergoing deep brain stimulation or dopaminergic therapy: a comparison to healthy participants.

    PubMed

    McIntosh, Lindsey G; Mannava, Sishir; Camalier, Corrie R; Folley, Bradley S; Albritton, Aaron; Konrad, Peter E; Charles, David; Park, Sohee; Neimat, Joseph S

    2014-01-01

    Parkinson's disease (PD) is traditionally regarded as a neurodegenerative movement disorder, however, nigrostriatal dopaminergic degeneration is also thought to disrupt non-motor loops connecting basal ganglia to areas in frontal cortex involved in cognition and emotion processing. PD patients are impaired on tests of emotion recognition, but it is difficult to disentangle this deficit from the more general cognitive dysfunction that frequently accompanies disease progression. Testing for emotion recognition deficits early in the disease course, prior to cognitive decline, better assesses the sensitivity of these non-motor corticobasal ganglia-thalamocortical loops involved in emotion processing to early degenerative change in basal ganglia circuits. In addition, contrasting this with a group of healthy aging individuals demonstrates changes in emotion processing specific to the degeneration of basal ganglia circuitry in PD. Early PD patients (EPD) were recruited from a randomized clinical trial testing the safety and tolerability of deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) in early-staged PD. EPD patients were previously randomized to receive optimal drug therapy only (ODT), or drug therapy plus STN-DBS (ODT + DBS). Matched healthy elderly controls (HEC) and young controls (HYC) also participated in this study. Participants completed two control tasks and three emotion recognition tests that varied in stimulus domain. EPD patients were impaired on all emotion recognition tasks compared to HEC. Neither therapy type (ODT or ODT + DBS) nor therapy state (ON/OFF) altered emotion recognition performance in this study. Finally, HEC were impaired on vocal emotion recognition relative to HYC, suggesting a decline related to healthy aging. This study supports the existence of impaired emotion recognition early in the PD course, implicating an early disruption of fronto-striatal loops mediating emotional function. PMID:25653616

  17. Treatment of Essential Tremor

    MedlinePLUS

    ... options. Two types of brain surgery, deep brain stimulation (DBS) and thalamotomy, are used to treat essential tremor. Both treatments affect the thalamus. This is a cluster of nerve cells deep in the brain. In DBS, an electric probe (electrode) is placed in the thalamus. A ...

  18. HSPES membrane electrode assembly

    NASA Technical Reports Server (NTRS)

    Kindler, Andrew (Inventor); Yen, Shiao-Ping (Inventor)

    2000-01-01

    An improved fuel cell electrode, as well as fuel cells and membrane electrode assemblies that include such an electrode, in which the electrode includes a backing layer having a sintered layer thereon, and a non-sintered free-catalyst layer. The invention also features a method of forming the electrode by sintering a backing material with a catalyst material and then applying a free-catalyst layer.

  19. Field Emission Measurements from Niobium Electrodes

    SciTech Connect

    M. BastaniNejad, P.A. Adderley, J. Clark, S. Covert, J. Hansknecht, C. Hernandez-Garcia, R. Mammei, M. Poelker

    2011-03-01

    Increasing the operating voltage of a DC high voltage photogun serves to minimize space charge induced emittance growth and thereby preserve electron beam brightness, however, field emission from the photogun cathode electrode can pose significant problems: constant low level field emission degrades vacuum via electron stimulated desorption which in turn reduces photocathode yield through chemical poisoning and/or ion bombardment and high levels of field emission can damage the ceramic insulator. Niobium electrodes (single crystal, large grain and fine grain) were characterized using a DC high voltage field emission test stand at maximum voltage -225kV and electric field gradient > 10MV/m. Niobium electrodes appear to be superior to diamond-paste polished stainless steel electrodes.

  20. Materials analyses and electrochemical impedance of implantable metal electrodes.

    PubMed

    Howlader, Matiar M R; Alam, Arif Ul; Sharma, Rahul P; Deen, M Jamal

    2015-04-01

    Implantable electrodes with high flexibility, high mechanical fixation and low electrochemical impedance are desirable for neuromuscular activation because they provide safe, effective and stable stimulation. In this paper, we report on detailed materials and electrical analyses of three metal implantable electrodes - gold (Au), platinum (Pt) and titanium (Ti) - using X-ray photoelectron spectroscopy (XPS), scanning acoustic microscopy, drop shape analysis and electrochemical impedance spectroscopy. We investigated the cause of changes in electrochemical impedance of long-term immersed Au, Pt and Ti electrodes on liquid crystal polymers (LCPs) in phosphate buffered saline (PBS). We analyzed the surface wettability, surface and interface defects and the el