scholarly journals Deep brain stimulation for intractable neuropathic facial pain

2018 ◽  
Vol 45 (2) ◽  
pp. E15 ◽  
Author(s):  
Sharona Ben-Haim ◽  
Zaman Mirzadeh ◽  
William S. Rosenberg
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Facial Pain ◽  
Short Form ◽  
Therapeutic Option ◽  
Mcgill Pain Questionnaire ◽  
Pain Disability Index ◽  
Pain Outcomes ◽  
Maximum Improvement ◽  
Deep Brain

OBJECTIVEDeep brain stimulation (DBS) is a well-established, evidence-based therapy with FDA approval for Parkinson’s disease and essential tremor. Despite the early successful use of DBS to target the sensory thalamus for intractable facial pain, subsequent studies pursuing various chronic pain syndromes reported variable efficacy, keeping DBS for pain as an investigational and “off-label” use. The authors report promising results for a contemporary series of patients with intractable facial pain who were treated with DBS.METHODSPain outcomes for 7 consecutive patients with unilateral, intractable facial pain undergoing DBS of the ventral posteromedial nucleus of the thalamus (VPM) and the periaqueductal gray (PAG) were retrospectively reviewed. Pain was assessed preoperatively and at multiple postoperative time points using the visual analog scale (VAS), the Short-Form McGill Pain Questionnaire-2 (SF-MPQ-2), and the Pain Disability Index (PDI).RESULTSVAS scores significantly decreased from a mean ± SD of 9.0 ± 1.3 preoperatively to 2.6 ± 1.5 at 1 year postoperatively (p = 0.001). PDI scores decreased from a mean total of 48.5 to 28.5 (p = 0.01). SF-MPQ-2 scores decreased from a mean of 4.6 to 2.4 (p = 0.03). Notably, several patients did not experience maximum improvement until 6–9 months postoperatively, correlating with repeated programming adjustments.CONCLUSIONSDBS of the VPM and PAG is a potential therapeutic option for patients suffering from severe, intractable facial pain refractory to other interventions. Improved efficacy may be observed over time with close follow-up and active DBS programming adjustments.

Deep Brain Stimulation for Facial Pain

2020 ◽  
pp. 1-21
Author(s):  
William G.B. Singleton ◽  
Reiko Ashida ◽  
Nikunj K. Patel
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Facial Pain ◽  
Deep Brain

scholarly journals Intestinal Levodopa/Carbidopa Infusion as a Therapeutic Option for Unresponsive Freezing of Gait after Deep Brain Stimulation in Parkinson’s Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Belén González-Herrero ◽  
Serge Jauma-Classen ◽  
Roser Gómez-Llopico ◽  
Gerard Plans ◽  
Matilde Calopa
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Therapeutic Option ◽  
Freezing Of Gait ◽  
Disease Rating ◽  
Deep Brain

Background. Treatment of freezing of gait (FOG) is always challenging because of its unpredictable nature and multifactorial physiopathology. Intestinal levodopa infusion has been proposed in recent years as a valuable option for its improvement. FOG in Parkinson’s disease (PD) can appear after deep brain stimulation in patients who never had gait symptoms. Objective. To study the effects of intestinal levodopa/carbidopa infusion in unresponsive-FOG that appears in PD patients treated with subthalamic nucleus deep brain stimulation. Methods. We retrospectively collected and analyzed demographic, clinical, and therapeutic data from five PD patients treated with subthalamic nucleus stimulation who developed unresponsive-FOG and received intestinal levodopa/carbidopa infusion as an alternative therapy. FOG was measured based on scores in item 14 of the Unified Parkinson’s Disease Rating Scale before and after intestinal levodopa infusion. Results. Administration of intestinal levodopa caused improvement of FOG in the “ON” state in four patients (80%) by 2 or more points in item 14 of the Unified Parkinson’s Disease Rating Scale. The improvement was maintained for at least 12 months. Conclusions. Intestinal levodopa infusion may be a valuable therapeutic option for unresponsive-FOG developed after subthalamic nucleus deep brain stimulation.

Pallidal deep brain stimulation in primary Meige syndrome: clinical outcomes and psychiatric features

2020 ◽  
Vol 91 (12) ◽  
pp. 1343-1348
Author(s):  
Qingpei Hao ◽  
Dongliang Wang ◽  
Jia OuYang ◽  
Hu Ding ◽  
Gaungyong Wu ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Sleep Quality ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Short Form ◽  
Depression Scale ◽  
Motor Symptoms ◽  
Meige Syndrome ◽  
Sf 36 ◽  
Deep Brain

ObjectivesTo study the efficacy and safety of bilateral globus pallidus internus deep brain stimulation (GPi-DBS) in refractory Meige syndrome (MS) and evaluate the psychiatric disorders before and after surgery.MethodsTwenty-two patients with MS treated with bilateral GPi-DBS were retrospectively analysed before surgery and after continuous neurostimulation. Before surgery, patients were assessed by the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS), Self-Rating Depression Scale, Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36) and Pittsburgh Sleep Quality Index (PQSI), which corresponded to motor symptoms, depressive state, quality of life and sleep quality, respectively. The implantable pulse generator of each patient was activated at 1 month after surgery. At 1 month, 3 months, 6 months and 12 months after continuous neurostimulation, all patients were evaluated by the same scales above.ResultsThe BFMDRS movement scores decreased from 15.0±5.3 before surgery to 3.5±4.5 at 12 months after neurostimulation, with a mean improvement of 78% (p<0.001). The BFMDRS disability scores improved from 7.4±4.9 before surgery to 4.0±4.6 at 12 months after neurostimulation, with a mean improvement of 56% (p<0.001). The postoperative SF-36 scores had the remarkable improvement compared with baseline scores. Impaired sleep quality was found in 82% of patients and depression in 64% before surgery, which didn’t neither obtained amelioration after continuous neurostimulation.ConclusionsBilateral pallidal neurostimulation is a beneficial therapeutic option for refractory MS, which could improve the motor symptoms except for depression and sleep quality.

scholarly journals The Canadian multicenter trial of pallidal deep brain stimulation for cervical dystonia: preliminary results in three patients

2004 ◽  
Vol 17 (1) ◽  
pp. 32-38 ◽  
Author(s):  
Zelma H. T. Kiss ◽  
Kristina Doig ◽  
Michael Eliasziw ◽  
Ranjiit Ranawaya ◽  
Oksana Suchowersky
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Cervical Dystonia ◽  
Rating Scale ◽  
Short Form ◽  
Spasmodic Torticollis ◽  
Secondary Outcome ◽  
Preliminary Results ◽  
Abnormal Movements ◽  
Deep Brain

Object Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is beneficial for generalized dystonia and has been proposed as a treatment for cervical dystonia. The Canadian Stereotactic/Functional and Movement Disorders Groups designed a pilot project to investigate the following hypothesis: that bilateral DBS of the GPi will reduce the severity of cervical dystonia at 1 year of follow up, as scored in a blinded fashion by two neurologists using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Secondary outcome measures included pain and disability subscores of the TWSTRS, Short Form–36 quality of life index, and the Beck Depression Inventory. Methods Three patients have undergone surgery in Calgary with a followup duration of 7.4 ± 5.9 months (mean ± standard deviation). One patient underwent inadvertent ineffective stimulation for the first 3 months and did not experience a benefit until DBS programming was corrected. All three patients had rapid response to stimulation, with the muscles relaxing immediately and abnormal movements improving within days. Total TWSTRS scores improved by 79%, and severity subscores improved significantly, from 15.7 ± 2.1 to 7.7 ± 2.9 (paired ttest, p = 0.02). Pain and disability subscores improved from 25.5 ± 4.1 to 3.3 ± 3.1 (paired ttest, p = 0.002) and from 13.3 ± 4.9 to 3.3 ± 4.2 (paired ttest, p = 0.06), respectively. Conclusions Although it is too early to reach broad conclusions, this report of preliminary results confirms the efficacy of DBS of the GPi for cervical dystonia.

Hypothalamic Deep Brain Stimulation for Cluster Headache: Experience From a New Multicase Series

Cephalalgia ◽  
2008 ◽  
Vol 28 (3) ◽  
pp. 285-295 ◽  
Author(s):  
T Bartsch ◽  
MO Pinsker ◽  
D Rasche ◽  
T Kinfe ◽  
F Hertel ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Cluster Headache ◽  
Brain Stimulation ◽  
Discharge Rate ◽  
Therapeutic Option ◽  
Case Series ◽  
Chronic Cluster Headache ◽  
Posterior Hypothalamus ◽  
Attack Frequency ◽  
Deep Brain

Deep brain stimulation (DBS) of the posterior hypothalamus was found to be effective in the treatment of drug-resistant chronic cluster headache. We report the results of a multicentre case series of six patients with chronic cluster headache in whom a DBS in the posterior hypothalamus was performed. Electrodes were implanted stereotactically in the ipsilateral posterior hypothalamus according to published coordinates 2 mm lateral, 3 mm posterior and 5 mm inferior referenced to the mid-AC-PC line. Microelectrode recordings at the target revealed single unit activity with a mean discharge rate of 17 Hz (range 13-35 Hz, n = 4). Out of six patients, four showed a profound decrease of their attack frequency and pain intensity on the visual analogue scale during the first 6 months. Of these, one patient was attack free for 6 months under neurostimulation before returning to the baseline which led to abortion of the DBS. Two patients had experienced only a marginal, non-significant decrease within the first weeks under neurostimulation before returning to their former attack frequency. After a mean follow-up of 17 months, three patients are almost completely attack free, whereas three patients can be considered as treatment failures. The stimulation was well tolerated and stimulation-related side-effects were not observed on long term. DBS of the posterior inferior hypothalamus is an effective therapeutic option in a subset of patients. Future controlled multi-centre trials will need to confirm this open-label experience and should help to better define predictive factors for non-responders.

scholarly journals Deep Brain Stimulation in KMT2B-Related Dystonia: Case Report and Review of the Literature With Special Emphasis on Dysarthria and Speech

2021 ◽  
Vol 12 ◽  
Author(s):  
Maria Abel ◽  
Robert Pfister ◽  
Iman Hussein ◽  
Fahd Alsalloum ◽  
Christina Onyinzo ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Brain Stimulation ◽  
Speech Intelligibility ◽  
De Novo ◽  
Therapeutic Option ◽  
Electrical Current ◽  
Positive Outcome ◽  
Corticobulbar Tract ◽  
The Impact ◽  
Deep Brain

Objective: KMT2B-related dystonia is a progressive childhood-onset movement disorder, evolving from lower-limb focal dystonia into generalized dystonia. With increasing age, children frequently show prominent laryngeal or facial dystonia manifesting in dysarthria. Bilateral deep brain stimulation of the globus pallidus internus (GPi-DBS) is reported to be an efficient therapeutic option. Especially improvement of dystonia and regaining of independent mobility is commonly described, but detailed information about the impact of GPi-DBS on dysarthria and speech is scarce.Methods: We report the 16-months outcome after bilateral GPi-DBS in an 8-year-old child with KMT2B-related dystonia caused by a de-novo c.3043C&gt;T (p.Arg1015*) non-sense variant with special emphasis on dysarthria and speech. We compare the outcome of our patient with 59 patients identified through a PubMed literature search.Results: A remarkable improvement of voice, articulation, respiration and prosodic characteristics was seen 16 months after GPi-DBS. The patients' speech intelligibility improved. His speech became much more comprehensible not only for his parents, but also for others. Furthermore, his vocabulary and the possibility to express his feelings and wants expanded considerably.Conclusion: A positive outcome of GPi-DBS on speech and dysarthria is rarely described in the literature. This might be due to disease progression, non-effectiveness of DBS or due to inadvertent spreading of the electrical current to the corticobulbar tract causing stimulation induced dysarthria. This highlights the importance of optimal lead placement, the possibility of horizontal steering of the electrical field by applying directional stimulation with segmented leads as well as the use of the lowest possible effective stimulation intensity.

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

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Juan Manuel Calleja-Castillo ◽  
Dora Luz De La Cruz-Aguilera ◽  
Joaquín Manjarrez ◽  
Marco Antonio Velasco-Velázquez ◽  
Gabriel Morales-Espinoza ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Hpa Axis ◽  
Brain Stimulation ◽  
Wistar Rats ◽  
Therapeutic Option ◽  
Hypothalamic Nucleus ◽  
Corticosterone Concentration ◽  
Cervical Vagotomy ◽  
Hpa Axis Activity ◽  
Deep Brain

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=6rats per group). DBS treated rats had higher levels of TNF-α(120%;P<0.01) and IFN-γ(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-1β(402%;P<0.001), IL-6 (160%;P<0.001), and corsticosterone (178%;P<0.001versus 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.

Subthalamic nucleus deep brain stimulation for severe idiopathic dystonia: impact on severity, neuropsychological status, and quality of life

2007 ◽  
Vol 107 (1) ◽  
pp. 29-36 ◽  
Author(s):  
Galit Kleiner-Fisman ◽  
Grace S. Lin Liang ◽  
Paul J. Moberg ◽  
Anthony C. Ruocco ◽  
Howard I. Hurtig ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Brain Stimulation ◽  
Subthalamic Nucleus ◽  
Brain Stimulation ◽  
Rating Scale ◽  
Short Form ◽  
Spasmodic Torticollis ◽  
Sf 36 ◽  
Deep Brain

Object Medically refractory dystonia has recently been treated using deep brain stimulation (DBS) targeting the globus pallidus internus (GPI). Outcomes have varied depending on the features of the dystonia. There has been limited literature regarding outcomes for refractory dystonia following DBS of the subthalamic nucleus (STN). Methods Four patients with medically refractory, predominantly cervical dystonia underwent STN DBS. Intraoperative assessments with the patients in a state of general anesthesia were performed to determine the extent of fixed deformities that might predict outcome. Patients were rated using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and the Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS) preoperatively and 3 and 12 months following surgery by a rater blinded to the study. Mean changes and standard errors of the mean in scores were calculated for each subscore of the two scales. Scores were also analyzed using analysis of variance and probability values were generated. Neuropsychological assessments and quality of life ratings using the 36-Item Short Form Health Survey (SF-36) were evaluated longitudinally. Results Significant improvements were seen in motor (p = 0.04), disability (p = 0.02), and total TWSTRS scores (p = 0.03). Better outcomes were seen in those patients who did not have fixed deformities. There was marked improvement in the mental component score of the SF-36. Neuropsychological function was not definitively impacted as a result of the surgery. Conclusions Deep brain stimulation of the STN is a novel target for dystonia and may be an alternative to GPI DBS. Further studies need to be performed to confirm these conclusions and to determine optimal candidates and stimulation parameters.

scholarly journals The Quantitative Measurement of Reversible Acute Depression after Subthalamic Deep Brain Stimulation in a Patient with Parkinson Disease

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Daniel B. Simmons ◽  
Khashayar Dashtipour
Keyword(s):  
Deep Brain Stimulation ◽  
Parkinson Disease ◽  
Brain Stimulation ◽  
Quantitative Measurement ◽  
Mood State ◽  
Short Form ◽  
Bipolar Stimulation ◽  
Monopolar Stimulation ◽  
The Right ◽  
Deep Brain

Background. Depression is the most commonly reported mood symptom affecting 2–8% of patients after deep brain stimulation (DBS). Usually, symptoms develop gradually; however there have been cases of reproducible events that the mood symptoms were elicited within seconds to minutes after stimulation and were immediately reversible upon cessation of the stimulus. In the current study, we applied a self-reported questionnaire to assess the patient’s mood state.Objective. To objectively measure the reversible acute depression induced by DBS in a patient with Parkinson disease (PD).Methods. A statistically validated Spanish version of the Beck Depression Inventory Short Form (BDI-SF) was used. The questionnaire was administered three times.Results. The patient became acutely depressed within ninety seconds of monopolar stimulation on the right side. His symptoms resolved immediately after changing the setting to bipolar stimulation. The BDI-SF scores during stimulation off, on, and off again were 15, 19, and 6, respectively.Conclusions. The BDI-SF scores increased during stimulation and decreased after cessation. This is consistent with a reversible depressive state. The poststimulation BDI-SF score decreased to less than half of the baseline score. This may suggest that the depression was more severe than the patient was able to express during the stimulation.

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