Deep brain stimulation for Parkinson's disease

Journal of Internal Medicine, Год журнала: 2022, Номер 292(5), С. 764 - 778

Опубликована: Июль 8, 2022

Abstract Parkinson's disease (PD) is a progressive neurodegenerative illness with both motor and nonmotor symptoms. Deep brain stimulation (DBS) an established safe neurosurgical symptomatic therapy for eligible patients advanced in whom medical treatment fails to provide adequate symptom control good quality of life, or dopaminergic medications induce severe side effects such as dyskinesias. DBS can be tailored the patient's symptoms targeted various nodes along basal ganglia–thalamus circuitry, which mediates illness; thalamus most efficient tremors, pallidum rigidity dyskinesias, whereas subthalamic nucleus (STN) treat akinesia, allows decrease doses even stages disease, makes it preferred target DBS. However, STN assumes that patient not too old, no cognitive decline relevant depression, does exhibit medically resistant axial balance gait disturbances, falls. Dysarthria common effect DBS, regardless target. has long‐lasting on appendicular symptoms, but progression nondopaminergic features become less responsive PD highly specialised; enable selection follow‐up patients, requires dedicated multidisciplinary teams movement disorder neurologists, functional neurosurgeons, specialised nurses neuropsychologists.

Язык: Английский

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Non-invasive temporal interference electrical stimulation of the human hippocampus

Nature Neuroscience, Год журнала: 2023, Номер 26(11), С. 1994 - 2004

Опубликована: Окт. 19, 2023

Deep brain stimulation (DBS) via implanted electrodes is used worldwide to treat patients with severe neurological and psychiatric disorders. However, its invasiveness precludes widespread clinical use deployment in research. Temporal interference (TI) a strategy for non-invasive steerable DBS using multiple kHz-range electric fields difference frequency within the range of neural activity. Here we report validation concept humans. We field modeling measurements human cadaver verify that locus transcranial TI can be steerably focused hippocampus minimal exposure overlying cortex. then functional magnetic resonance imaging behavioral experiments show focally modulate hippocampal activity enhance accuracy episodic memories healthy Our results demonstrate targeted, electrical deep structures brain.

Язык: Английский

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Elevating the field for applying neuroimaging to individual patients in psychiatry

Translational Psychiatry, Год журнала: 2024, Номер 14(1)

Опубликована: Фев. 10, 2024

Abstract Although neuroimaging has been widely applied in psychiatry, much of the exuberance decades past tempered by failed replications and a lack definitive evidence to support utility imaging inform clinical decisions. There are multiple promising ways forward demonstrate relevance for psychiatry at individual patient level. Ultra-high field magnetic resonance is developing as sensitive measure neurometabolic processes particular that holds promise new way characterize abnormalities well variability response treatment. Neuroimaging may also be particularly suited science brain stimulation interventions given can both targeting changes circuit communication function how effectively improve symptoms. We argue greater focus on data will pave stronger care psychiatry. stress importance using symptom-relevant experimental manipulations best demonstrated pairing with differential treatment prediction outcome measurement. The priorities shifting, which compels solidify patients over exploratory associations biomarkers ultimately fail replicate.

Язык: Английский

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Deep Brain Stimulation beyond the Clinic: Navigating the Future of Parkinson’s and Alzheimer’s Disease Therapy

Cells, Год журнала: 2023, Номер 12(11), С. 1478 - 1478

Опубликована: Май 25, 2023

Deep brain stimulation (DBS) is a surgical procedure that uses electrical neuromodulation to target specific regions of the brain, showing potential in treatment neurodegenerative disorders such as Parkinson’s disease (PD) and Alzheimer’s (AD). Despite similarities pathology, DBS currently only approved for use PD patients, with limited literature on its effectiveness AD. While has shown promise ameliorating circuits PD, further research needed determine optimal parameters address any side effects. This review emphasizes need foundational clinical different treat AD recommends development classification system adverse Furthermore, this suggests either low-frequency (LFS) or high-frequency (HFS) depending symptoms patient both

Язык: Английский

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Combining Transcranial Magnetic Stimulation and Deep Brain Stimulation: Current Knowledge, Relevance and Future Perspectives

Brain Sciences, Год журнала: 2023, Номер 13(2), С. 349 - 349

Опубликована: Фев. 18, 2023

Deep brain stimulation (DBS) has emerged as an invasive neuromodulation technique for the treatment of several neurological disorders, but mechanisms underlying its effects remain partially elusive. In this context, application Transcranial Magnetic Stimulation (TMS) in patients treated with DBS represents intriguing approach to investigate neurophysiology cortico-basal networks. Experimental studies combining TMS and that have been performed so far mainly aimed evaluate on cerebral cortex thus provide insights into DBS’s action. The modulation cortical excitability plasticity by is emerging a potential contributor therapeutic effects. Moreover, pairing stimuli could represent method induce synaptic plasticity, which still unexplored. Furthermore, advent new technologies novel targets will present research opportunities prospects However, combined TMS-DBS currently limited safety concerns. review, we sought overview well available evidence recommendations their combination. Additionally, outline perspectives future highlighting knowledge gaps possible applications approach.

Язык: Английский

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A survey on puncture models and path planning algorithms of bevel-tipped flexible needles

Heliyon, Год журнала: 2024, Номер 10(3), С. e25002 - e25002

Опубликована: Янв. 23, 2024

Percutaneous needle insertion is a minimally invasive surgery with broad medical application prospects, such as biopsy and brachytherapy. However, the currently adopted rigid needles have limitations, they cannot bypass obstacles or correct puncture deviations can only travel along straight path. Bevel-tip flexible are increasingly being to address these issues, owing their body's ease of deformation bending. Successful relies on accurate models path planning, ensuring reaches target while avoiding vital tissues. This review investigates path-planning algorithms by reviewing recent literature, focusing part. According be divided into three types: mechanical, finite element method (FEM), kinematic models, categorized discussed following division used for mobile robots, which differs from conventional approach needles—an innovation in this review. systematically summarizes categories: graph theory search, sampling-based, intelligent local obstacle avoidance, other algorithms, including implementation, advantages, disadvantages, further explore potential overcome planning needles. Finally, study proposes future development trends providing possible directions subsequent research bevel-tipped aims provide resource researchers quickly learn about common backgrounds, models.

Язык: Английский

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Temporal interference electrical neurostimulation at 20 Hz beat frequency leads to increased fMRI BOLD activation in orbitofrontal cortex in humans

Brain stimulation, Год журнала: 2024, Номер 17(4), С. 867 - 875

Опубликована: Июль 1, 2024

Язык: Английский

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Advances in Deep Brain Stimulation: From Mechanisms to Applications

Journal of Neuroscience, Год журнала: 2023, Номер 43(45), С. 7575 - 7586

Опубликована: Ноя. 8, 2023

Deep brain stimulation (DBS) is an effective therapy for various neurologic and neuropsychiatric disorders, involving chronic implantation of electrodes into target regions electrical delivery. Despite its safety efficacy, DBS remains underutilized therapy. Advances in the field DBS, including technology, mechanistic understanding, applications have potential to expand access use while also improving clinical outcomes. Developments such as MRI compatibility bidirectional systems capable sensing neural activity providing therapeutic stimulation, enabled advances our understanding mechanisms application. In this review, we summarize recent work exploring modulation networks. We cover current focusing on improved programming development novel paradigms that go beyond standards many which are by sensing-enabled DBS.

Язык: Английский

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Diffusion and functional MRI in surgical neuromodulation

Neurotherapeutics, Год журнала: 2024, Номер 21(3), С. e00364 - e00364

Опубликована: Апрель 1, 2024

Surgical neuromodulation has witnessed significant progress in recent decades. Notably, deep brain stimulation (DBS), delivered precisely within therapeutic targets, revolutionized the treatment of medication-refractory movement disorders and is now expanding for refractory psychiatric disorders, epilepsy, post-stroke motor recovery. In parallel, advent incisionless with focused ultrasound ablation (FUSA) can offer patients life-changing symptomatic relief. Recent research underscored potential to further optimize DBS FUSA outcomes by conceptualizing targets as critical nodes embedded specific networks instead strictly anatomical structures. This paradigm shift was facilitated integrating two imaging modalities used regularly connectomics research: diffusion MRI (dMRI) functional (fMRI). These advanced techniques have helped targeting programming surgical neuromodulation, all while holding immense promise investigations into treating other neurological conditions. review aims provide a fundamental background clinicians scientists, exploring synergy between current future approaches they relate dMRI fMRI capabilities. Focused this area required existing, neurosurgical treatments serving build an investigative infrastructure unlock novel alleviate burden disorders.

Язык: Английский

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Multimodal neuroimaging to characterize symptom-specific networks in movement disorders

npj Parkinson s Disease, Год журнала: 2024, Номер 10(1)

Опубликована: Авг. 14, 2024

Movement disorders, such as Parkinson's disease, essential tremor, and dystonia, are characterized by their predominant motor symptoms, yet diseases causing abnormal movement also encompass several other including non-motor symptoms. Here we review recent advances from studies of brain lesions, neuroimaging, neuromodulation that provide converging evidence on symptom-specific networks in disorders. Although disorders have traditionally been conceptualized the basal ganglia, cumulative data lesions parkinsonism, tremor dystonia now demonstrated this view is incomplete. Several shown a given disorder occur heterogeneous locations, but disrupt common networks, which appear to be specific each phenotype. In addition, findings structural functional neuroimaging abnormalities extend far beyond associated with fact, strongly influenced constellation patients' symptoms seem map rather than individual anatomical structures or single neurotransmitters. Finally, observations deep stimulation clinical changes, both symptom improvement side effects, dependent modulation large-scale instead purely local effects neuromodulation. Combined, multimodal suggests arise distinct encouraging imaging better characterize underlying mechanisms individually tailor treatment approaches.

Язык: Английский

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