Posts Tagged ‘neuromodulation’
Free Editor Choice with CME: Deep Brain Stimulation for Obsessive-Compulsive Disorder: Systematic Review and Evidence-Based Guideline
Background: It is estimated that 40% to 60% of patients with obsessive-compulsive disorder (OCD) continue to experience symptoms despite adequate medical management. For this population of treatment-refractory patients, promising results have been reported with the use of deep brain stimulation (DBS).
Objective: To conduct a systematic review of the literature and develop evidence-based guidelines on DBS for OCD.
Methods: A systematic literature search was undertaken using the PubMed database for articles published between 1966 and October 2012 combining the following words: “deep brain stimulation and obsessive-compulsive disorder” or “electrical stimulation and obsessive-compulsive disorder.” Of 353 articles, 7 were retrieved for full-text review and analysis. The quality of the articles was assigned to each study and the strength of recommendation graded according to the guidelines development methodology of the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Guidelines Committee.
Background: The expansion of neuromodulation and its indications has resulted in hundreds of thousands of patients implanted with devices worldwide. As all patients require programming, this growth has created a heavy burden on neuromodulation centers and patients. Remote point-of-care programming may provide patients with real-time access to neuromodulation expertise in their communities.
Objective: To test the feasibility of remotely programming a neuromodulation device using a remote presence robot, and to determine the ability of an expert programmer to telementor a non-expert in programming the device.
Methods: A remote presence robot (RP-7, In Touch Health Inc., Santa Barbara, CA) was used for remote programming. Twenty patients were randomly assigned to either conventional programming or a robotic session. The expert remotely mentored ten nurses, with no previous experience, to program the devices of patients assigned to the remote presence sessions. Accuracy of programming, adverse events, and satisfaction scores for all participants were assessed.
Objective: To report on the 1-year safety and efficacy of unilateral extradural motor cortex stimulation in Parkinson’s disease.
Methods: A quadripolar electrode strip was extradurally implanted over the motor cortex. Stimulation was continuously delivered through the electrode paddle contralateral to the most affected clinical side. Subjects were prospectively evaluated by the Unified Parkinson’s Disease Rating Scale (UPDRS) and the Parkinson’s disease quality of life questionnaire. In addition, an extensive cognitive and behavioral assessment and EEG recording was performed. Read the rest of this entry »
Obesity is a growing health problem worldwide and is responsible for a significant proportion of health expenditures in developed nations. It is also notoriously difficult to treat. Prior attempts at pharmacological or neurological modulation, including deep brain stimulation, have primarily targeted homeostatic mechanisms of weight control centered in the hypothalamus. To date, these attempts have had limited success. Multiple lines of independent data suggest that dysregulated reward circuitry in the brain underlies behaviors leading to obesity. Read the rest of this entry »
Background: Failed back surgery syndrome represents one of the most frequent etiologies of chronic back pain and is a major public health issue. Neurostimulation has currently not been validated in the treatment of back pain because of technological limitations in implantable spinal cord stimulation (SCS) systems. New-generation leads using several columns of stimulation can generate longitudinal and/or transverse stimulation fields into the spinal cord.
Objective: To investigate, through extensive stimulation testing, the capacity of multicolumn tripolar leads to achieve back territory paresthesia coverage in refractory failed back surgery syndrome patients.
Methods: Eleven patients implanted with a 16-contact spinal cord stimulation lead (Specify 5-6-5, Medtronic Inc) were assessed with a systematic exploration of 43 selected stimulation configurations to generate bilateral back paresthesia in addition to leg territory coverage.
Background: Deep brain stimulation (DBS) of subcortical brain areas such as the periaqueductal grey (PAG) and subthalamic nucleus (STN) has been shown to alter cardiovascular autonomic performance. The supramedullary circuitry controlling respiratory airways is not well defined and has not been tested in humans.
Objective: Direct electrical stimulation via DBS macroelectrodes was used to test whether airway resistance could be manipulated by these areas in awake humans.
Methods: Thirty-seven patients with in-dwelling deep brain electrodes for movement disorders or chronic pain underwent spirometry as per the European Respiratory Society guidelines. Testing was performed three times On and three times Off stimulation, randomly, in which patients were blinded. Thoracic diameter changes were measured by a circumferential pressure-sensitive thoracic band. Ten PAG and ten STN patients were tested. To control for confounding pain and movement disorder relief, the sensory thalamus in seven patients and globus pallidus interna in ten patients, respectively, were also tested.
Ahead of Print: Sub-Thalamic Nucleus Targeting Using Inter-Peduncular Cistern As An Internal Landmark
BACKGROUND: Internal landmarks for subthalamic nucleus (STN) have been used in past. This study uses a yet unused internal landmark to refine STN targeting.
OBJECTIVE: To determine the effect of the width of interpeduncular cistern (IPC) on STN targeting during placement of deep brain stimulation (DBS) for Parkinson’s disease (PD).
METHODS: 50 consecutive patients with PD underwent 90 STN DBS implantations. X, Y and Z coordinates for the tip of the DBS electrodes and the active contact were recorded. Internal landmarks such as width of the third ventricle, width of IPC at a predefined point, and AC-PC length were measured. Statistical analysis was done using linear regression analysis and Pearson’s correlation coefficient.