scholarly journals A probabilistic map of negative motor areas of the upper limb and face: a brain stimulation study

Brain ◽  
2019 ◽  
Vol 142 (4) ◽  
pp. 952-965 ◽  
Author(s):  
Fabien Rech ◽  
Guillaume Herbet ◽  
Yann Gaudeau ◽  
Sophie Mézières ◽  
Jean-Marie Moureau ◽  
...  
Keyword(s):  
Upper Limb ◽  
Brain Stimulation ◽  
Probabilistic Map ◽  
Motor Areas

Mapping efficacious deep brain stimulation for pediatric dystonia

2021 ◽  
pp. 1-11
Author(s):  
Ailish Coblentz ◽  
Gavin J. B. Elias ◽  
Alexandre Boutet ◽  
Jurgen Germann ◽  
Musleh Algarni ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Brain Stimulation ◽  
Pediatric Patients ◽  
Rating Scale ◽  
Structural Connectivity ◽  
Response To Treatment ◽  
Internal Globus Pallidus ◽  
Probabilistic Map ◽  
Deep Brain

OBJECTIVEThe objective of this study was to report the authors’ experience with deep brain stimulation (DBS) of the internal globus pallidus (GPi) as a treatment for pediatric dystonia, and to elucidate substrates underlying clinical outcome using state-of-the-art neuroimaging techniques.METHODSA retrospective analysis was conducted in 11 pediatric patients (6 girls and 5 boys, mean age 12 ± 4 years) with medically refractory dystonia who underwent GPi-DBS implantation between June 2009 and September 2017. Using pre- and postoperative MRI, volumes of tissue activated were modeled and weighted by clinical outcome to identify brain regions associated with clinical outcome. Functional and structural networks associated with clinical benefits were also determined using large-scale normative data sets.RESULTSA total of 21 implanted leads were analyzed in 11 patients. The average follow-up duration was 19 ± 20 months (median 5 months). Using a 7-point clinical rating scale, 10 patients showed response to treatment, as defined by scores < 3. The mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale motor score was 40% ± 23%. The probabilistic map of efficacy showed that the voxel cluster most associated with clinical improvement was located at the posterior aspect of the GPi, comparatively posterior and superior to the coordinates of the classic GPi target. Strong functional and structural connectivity was evident between the probabilistic map and areas such as the precentral and postcentral gyri, parietooccipital cortex, and brainstem.CONCLUSIONSThis study reported on a series of pediatric patients with dystonia in whom GPi-DBS resulted in variable clinical benefit and described a clinically favorable stimulation site for this cohort, as well as its structural and functional connectivity. This information could be valuable for improving surgical planning, simplifying programming, and further informing disease pathophysiology.

Effect of Subthalamic Deep Brain Stimulation on Upper Limb Dexterity in Patients with Parkinson Disease

2018 ◽  
Vol 115 ◽  
pp. e206-e217 ◽  
Author(s):  
Takao Nozaki ◽  
Tetsuya Asakawa ◽  
Kenji Sugiyama ◽  
Yuki Koda ◽  
Ayumi Shimoda ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Deep Brain

scholarly journals Brain stimulation for arm recovery after stroke (B-STARS): protocol for a randomised controlled trial in subacute stroke patients

BMJ Open ◽  
2017 ◽  
Vol 7 (8) ◽  
pp. e016566
Author(s):  
Eline C C van Lieshout ◽  
Johanna M A Visser-Meily ◽  
Sebastiaan F W Neggers ◽  
H Bart van der Worp ◽  
Rick M Dijkhuizen
Keyword(s):  
Motor Cortex ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Primary Outcome ◽  
Primary Motor Cortex ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Stroke Patients ◽  
Post Stroke ◽  
Subacute Stroke

IntroductionMany patients with stroke have moderate to severe long-term sensorimotor impairments, often including inability to execute movements of the affected arm or hand. Limited recovery from stroke may be partly caused by imbalanced interaction between the cerebral hemispheres, with reduced excitability of the ipsilesional motor cortex while excitability of the contralesional motor cortex is increased. Non-invasive brain stimulation with inhibitory repetitive transcranial magnetic stimulation (rTMS) of the contralesional hemisphere may aid in relieving a post-stroke interhemispheric excitability imbalance, which could improve functional recovery. There are encouraging effects of theta burst stimulation (TBS), a form of TMS, in patients with chronic stroke, but evidence on efficacy and long-term effects on arm function of contralesional TBS in patients with subacute hemiparetic stroke is lacking.Methods and analysisIn a randomised clinical trial, we will assign 60 patients with a first-ever ischaemic stroke in the previous 7–14 days and a persistent paresis of one arm to 10 sessions of real stimulation with TBS of the contralesional primary motor cortex or to sham stimulation over a period of 2 weeks. Both types of stimulation will be followed by upper limb training. A subset of patients will undergo five MRI sessions to assess post-stroke brain reorganisation. The primary outcome measure will be the upper limb function score, assessed from grasp, grip, pinch and gross movements in the action research arm test, measured at 3 months after stroke. Patients will be blinded to treatment allocation. The primary outcome at 3 months will also be assessed in a blinded fashion.Ethics and disseminationThe study has been approved by the Medical Research Ethics Committee of the University Medical Center Utrecht, The Netherlands. The results will be disseminated through (open access) peer-reviewed publications, networks of scientists, professionals and the public, and presented at conferences.Trial registration numberNTR6133

scholarly journals Influence of basal ganglia on upper limb locomotor synergies. Evidence from deep brain stimulation and L-DOPA treatment in Parkinson's disease

Brain ◽  
2008 ◽  
Vol 131 (12) ◽  
pp. 3410-3420 ◽  
Author(s):  
P. Crenna ◽  
I. Carpinella ◽  
L. Lopiano ◽  
A. Marzegan ◽  
M. Rabuffetti ◽  
...  
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Basal Ganglia ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Deep Brain

FC5.3 Navigated brain stimulation for exact mapping of several discrete motor areas

2006 ◽  
Vol 117 ◽  
pp. 1-2
Author(s):  
S. Teitti ◽  
S. Määttä ◽  
L. Eskola ◽  
M. Könönen ◽  
R. Vanninen ◽  
...  
Keyword(s):  
Brain Stimulation ◽  
Navigated Brain Stimulation ◽  
Motor Areas

Abstract 104: Navigated Brain Stimulation for Upper Limb Recovery After Stroke: A Randomized Sham Controlled Clinical Trial of Low Frequency r-TMS to Non-injured Hemisphere Combined With Upper Limb Rehabilitation

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Richard L Harvey ◽  
Charles Liu ◽  
Dylan Edwards ◽  
Kari Dunning ◽  
Felipe Fregni ◽  
...  
Keyword(s):  
Upper Limb ◽  
Brain Stimulation ◽  
Repeated Measures ◽  
Low Frequency ◽  
Post Treatment ◽  
Upper Limb Rehabilitation ◽  
Navigated Brain Stimulation ◽  
Significant Difference ◽  
Limb Rehabilitation

Introduction: Upper limb function following stroke is limited, with only 50% regaining some function and less than 20% regaining normal function. Repetitive TMS has promise as an adjunct to upper limb therapy after stroke. We aimed to determine if navigated brain stimulation (NBS) with a low-frequency (1 Hz) protocol to non-injured hemisphere combined with upper limb rehabilitation would improve arm motor function better than rehabilitation alone. Method: We enrolled 199 patients with hemiplegia from ischemic or hemorrhagic stroke within 3-12 m post ictus. Randomization was in a 2:1 ratio to NBS with 18 sessions of rehabilitation over 6 weeks, or to sham NBS with therapy. The primary end-point was rate of achieving a 5-point improvement on the upper limb Fugl-Myer (ULFM) score at 6 m post-treatment and safety. Secondary outcomes included post-treatment, 1 m, 3 m and 6 m change on ULFM, action research arm test (ARAT), and EQ-5D-3L health questionnaire. Results: Of 199 subjects enrolled, 167 completed treatment and follow-up due to early stoppage of data collection after interim futility analysis. All subjects improved significantly on each outcome measure at each point of follow up, including 6 m post-treatment ULFM: treatment (8.1±7.4, p<0.001) and sham (8.5±8.7, p<0.001). In the ITT analysis, there was no difference on achievement of 5 points on ULFM at 6 m post-treatment: 67% treatment vs. 65% sham (chi-sq 1.105, p=0.76). Repeated measures ANCOVA group*time interaction showed no significant difference between groups for ULFM (p=0.87), ARAT (p=0.80) and the EQ 5D (p=0.96). There were no study or device related serious adverse events and no difference in SAE’s between groups. Conclusion: NBS can be safely used in the clinical setting. Clinically important gains were observed in both study arms suggesting no additional effect of 1 Hz NBS in stroke subjects within 3-12 m post ictus. The lack of NBS effects may be explained by the large effect size (ceiling effect) or potentially that the sham coil unintentionally induced cortical currents. Further analysis of the sham method and also secondary subgroup analyses will provide further insights and generate novel hypothesis to be confirmed in future NBS trials.

scholarly journals Models to Tailor Brain Stimulation Therapies in Stroke

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
E. B. Plow ◽  
V. Sankarasubramanian ◽  
D. A. Cunningham ◽  
K. Potter-Baker ◽  
N. Varnerin ◽  
...  
Keyword(s):  
Upper Limb ◽  
Brain Stimulation ◽  
Stroke Rehabilitation ◽  
Theoretical Models ◽  
Present Evidence ◽  
Heterogeneous Samples ◽  
Lack Of Information ◽  
Pros And Cons ◽  
Mixed Efficacy

A great challenge facing stroke rehabilitation is the lack of information on how to derive targeted therapies. As such, techniques once considered promising, such as brain stimulation, have demonstrated mixed efficacy across heterogeneous samples in clinical studies. Here, we explain reasons, citing its one-type-suits-all approach as the primary cause of variable efficacy. We present evidence supporting the role of alternate substrates, which can be targeted instead in patients with greater damage and deficit. Building on this groundwork, this review will also discuss different frameworks on how to tailor brain stimulation therapies. To the best of our knowledge, our report is the first instance that enumerates and compares across theoretical models from upper limb recovery and conditions like aphasia and depression. Here, we explain how different models capture heterogeneity across patients and how they can be used to predict which patients would best respond to what treatments to develop targeted, individualized brain stimulation therapies. Our intent is to weigh pros and cons of testing each type of model so brain stimulation is successfully tailored to maximize upper limb recovery in stroke.

scholarly journals Using theoretical models from adult stroke recovery to improve use of noninvasive brain stimulation for children with congenital hemiparesis

2017 ◽  
Vol 118 (3) ◽  
pp. 1435-1438 ◽  
Author(s):  
Yin-Liang Lin ◽  
Kelsey A. Potter-Baker
Keyword(s):  
Motor Function ◽  
Upper Limb ◽  
Brain Stimulation ◽  
Theoretical Models ◽  
Cortical Reorganization ◽  
Stroke Recovery ◽  
Noninvasive Brain Stimulation ◽  
Motor Improvement

Noninvasive brain stimulation has been widely used for adults with stroke to improve upper limb motor function. A recent study by Kirton and colleagues (Kirton A, Ciechanski P, Zewdie E, Andersen J, Nettel-Aguirre A, Carlson H, Carsolio L, Herrero M, Quigley J, Mineyko A, Hodge J, Hill M. Neurology 88: 259–267, 2017) applied noninvasive brain stimulation to children with congenital hemiparesis but found no significant effect of noninvasive brain stimulation on motor function. Here, we explore theories about cortical reorganization in both adult and children with hemiparesis and discuss how to improve the approaches of noninvasive brain stimulation to generate optimal motor improvement and development for children with congenital hemiparesis.

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