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Trends in Clinical Deep Brain Stimulation
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Trends in Clinical Deep Brain Stimulation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: closed (31 August 2020) | Viewed by 50334

Printed Edition Available!
A printed edition of this Special Issue is available here.

Special Issue Editors

Dr. Marcus L. F. Janssen

E-Mail Website
Guest Editor
1. Department of Clinical Neurophysiology, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
2. Mental Health and Neuroscience Research Insitute, Maastricht University, 6229 ER Maastricht, The Netherlands
Interests: deep brain stimulation; neuromodulation; neurophysiology; tinnitus; movement disorders
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Yasin Temel

E-Mail Website
Guest Editor
1. Department of Neurosurgery, Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
2. Academic Alliance for Skull Base Pathology, Maastricht and Radboud University Medical Centers, 6229 ER Maastricht, The Netherlands
Interests: chordoma; meningioma; vestibular schwannoma; deep brain stimulation for movement and psychiatric disorders
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

To date, Deep Brain Stimulation is considered standard care in patients with movement disorders. Treatment with Deep Brain Stimulation is currently also considered in several other neurologic and psychiatric disorders, such as epilepsy and obsessive compulsive disorder. The number of clinical indications in which Deep Brain Stimulation therapy is applied, keeps expanding. Controlled trials are compulsory to proof safety and efficacy. Exploring new indications for this invasive therapy remains challenging. In this respect, scientific findings in both human and animal studies are essential to define new indications, but also to specify the optimal brain target and stimulation parameters.

Technical advances are evolving rapidly, not only Deep Brain Stimulation devices and software are improving, also pre- and intraoperative imaging and electrophysiology techniques are being refined. This has resulted in the use of a variety of devices, imaging modalities and intraoperative assessments between clinics. Outcome of Deep Brain Stimulation therapy also depends on correct patient selection. Novel machine learning tools have the potential to assist clinicians to predict outcome more accurately.

This Special Issue of the Journal of Clinical Medicine will provide the current trends in clinical Deep Brain Stimulation.


Dr. Marcus L. F. Janssen
Prof. Dr. Yasin Temel
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Deep brain stimulation
  • Closed-loop
  • Sensing
  • Wearable
  • Electrophysiology
  • Imaging

Published Papers (13 papers)

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Editorial

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3 pages, 159 KiB  
Editorial
Special Issue: Trends in Clinical Deep Brain Stimulation
by Marcus L. F. Janssen and Yasin Temel
J. Clin. Med. 2021, 10(2), 178; https://doi.org/10.3390/jcm10020178 - 6 Jan 2021
Viewed by 1778
Abstract
Deep brain stimulation (DBS) has been successfully applied in several neurological and psychiatric disorders [...] Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)

Research

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14 pages, 1013 KiB  
Article
Deep Brain Stimulation Is Effective for Treatment-Resistant Depression: A Meta-Analysis and Meta-Regression
by Frederick L. Hitti, Andrew I. Yang, Mario A. Cristancho and Gordon H. Baltuch
J. Clin. Med. 2020, 9(9), 2796; https://doi.org/10.3390/jcm9092796 - 30 Aug 2020
Cited by 26 | Viewed by 5556
Abstract
Major depressive disorder (MDD) is a leading cause of disability and a significant cause of mortality worldwide. Approximately 30–40% of patients fail to achieve clinical remission with available pharmacological treatments, a clinical course termed treatment-resistant depression (TRD). Numerous studies have investigated deep brain [...] Read more.
Major depressive disorder (MDD) is a leading cause of disability and a significant cause of mortality worldwide. Approximately 30–40% of patients fail to achieve clinical remission with available pharmacological treatments, a clinical course termed treatment-resistant depression (TRD). Numerous studies have investigated deep brain stimulation (DBS) as a therapy for TRD. We performed a meta-analysis to determine efficacy and a meta-regression to compare stimulation targets. We identified and screened 1397 studies. We included 125 citations in the qualitative review and considered 26 for quantitative analysis. Only blinded studies that compared active DBS to sham stimulation (k = 12) were included in the meta-analysis. The random-effects model supported the efficacy of DBS for TRD (standardized mean difference = −0.75, <0 favors active stimulation; p = 0.0001). The meta-regression did not demonstrate a statistically significant difference between stimulation targets (p = 0.45). While enthusiasm for DBS treatment of TRD has been tempered by recent randomized trials, this meta-analysis reveals a significant effect of DBS for the treatment of TRD. Additionally, the majority of trials have demonstrated the safety and efficacy of DBS for this indication. Further trials are required to determine the optimal stimulation parameters and patient populations for which DBS would be effective. Particular attention to factors including electrode placement technique, patient selection, and long-term follow-up is essential for future trial design. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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13 pages, 634 KiB  
Article
Optimal Parameters of Deep Brain Stimulation in Essential Tremor: A Meta-Analysis and Novel Programming Strategy
by I. Daria Bogdan, Teus van Laar, D.L. Marinus Oterdoom, Gea Drost, J. Marc C. van Dijk and Martijn Beudel
J. Clin. Med. 2020, 9(6), 1855; https://doi.org/10.3390/jcm9061855 - 14 Jun 2020
Cited by 8 | Viewed by 3144
Abstract
The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, [...] Read more.
The programming of deep brain stimulation (DBS) parameters for tremor is laborious and empirical. Despite extensive efforts, the end-result is often suboptimal. One reason for this is the poorly understood relationship between the stimulation parameters’ voltage, pulse width, and frequency. In this study, we aim to improve DBS programming for essential tremor (ET) by exploring a new strategy. At first, the role of the individual DBS parameters in tremor control was characterized using a meta-analysis documenting all the available parameters and tremor outcomes. In our novel programming strategy, we applied 10 random combinations of stimulation parameters in eight ET-DBS patients with suboptimal tremor control. Tremor severity was assessed using accelerometers and immediate and sustained patient-reported outcomes (PRO’s), including the occurrence of side-effects. The meta-analysis showed no substantial relationship between individual DBS parameters and tremor suppression. Nevertheless, with our novel programming strategy, a significantly improved (accelerometer p = 0.02, PRO p = 0.02) and sustained (p = 0.01) tremor suppression compared to baseline was achieved. Less side-effects were encountered compared to baseline. Our pilot data show that with this novel approach, tremor control can be improved in ET patients with suboptimal tremor control on DBS. In addition, this approach proved to have a beneficial effect on stimulation-related complications. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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14 pages, 1142 KiB  
Article
Influence of Anesthesia and Clinical Variables on the Firing Rate, Coefficient of Variation and Multi-Unit Activity of the Subthalamic Nucleus in Patients with Parkinson’s Disease
by Michael J. Bos, Ana Maria Alzate Sanchez, Raffaella Bancone, Yasin Temel, Bianca T.A. de Greef, Anthony R. Absalom, Erik D. Gommer, Vivianne H.J.M. van Kranen-Mastenbroek, Wolfgang F. Buhre, Mark J. Roberts and Marcus L.F. Janssen
J. Clin. Med. 2020, 9(4), 1229; https://doi.org/10.3390/jcm9041229 - 24 Apr 2020
Cited by 12 | Viewed by 3422
Abstract
Background: Microelectrode recordings (MER) are used to optimize lead placement during subthalamic nucleus deep brain stimulation (STN-DBS). To obtain reliable MER, surgery is usually performed while patients are awake. Procedural sedation and analgesia (PSA) is often desirable to improve patient comfort, anxiolysis and [...] Read more.
Background: Microelectrode recordings (MER) are used to optimize lead placement during subthalamic nucleus deep brain stimulation (STN-DBS). To obtain reliable MER, surgery is usually performed while patients are awake. Procedural sedation and analgesia (PSA) is often desirable to improve patient comfort, anxiolysis and pain relief. The effect of these agents on MER are largely unknown. The objective of this study was to determine the effects of commonly used PSA agents, dexmedetomidine, clonidine and remifentanil and patient characteristics on MER during DBS surgery. Methods: Data from 78 patients with Parkinson’s disease (PD) who underwent STN-DBS surgery were retrospectively reviewed. The procedures were performed under local anesthesia or under PSA with dexmedetomidine, clonidine or remifentanil. In total, 4082 sites with multi-unit activity (MUA) and 588 with single units were acquired. Single unit firing rates and coefficient of variation (CV), and MUA total power were compared between patient groups. Results: We observed a significant reduction in MUA, an increase of the CV and a trend for reduced firing rate by dexmedetomidine. The effect of dexmedetomidine was dose-dependent for all measures. Remifentanil had no effect on the firing rate but was associated with a significant increase in CV and a decrease in MUA. Clonidine showed no significant effect on firing rate, CV or MUA. In addition to anesthetic effects, MUA and CV were also influenced by patient-dependent variables. Conclusion: Our results showed that PSA influenced neuronal properties in the STN and the dexmedetomidine (DEX) effect was dose-dependent. In addition, patient-dependent characteristics also influenced MER. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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14 pages, 262 KiB  
Article
Illness Representations and Coping Strategies in Patients Treated with Deep Brain Stimulation for Parkinson’s Disease
by Marc Baertschi, Nicolas Favez, João Flores Alves Dos Santos, Michalina Radomska, François Herrmann, Pierre R. Burkhard, Alessandra Canuto, Kerstin Weber and Paolo Ghisletta
J. Clin. Med. 2020, 9(4), 1186; https://doi.org/10.3390/jcm9041186 - 21 Apr 2020
Cited by 5 | Viewed by 2144
Abstract
There is a debate on possible alterations of self-identity following deep brain stimulation for neurological disorders including Parkinson’s disease. Among the psychological variables likely to undergo changes throughout such a medical procedure, illness representations and coping strategies have not been the target of [...] Read more.
There is a debate on possible alterations of self-identity following deep brain stimulation for neurological disorders including Parkinson’s disease. Among the psychological variables likely to undergo changes throughout such a medical procedure, illness representations and coping strategies have not been the target of much research to this day. In order to remedy this, we investigated the dynamics of illness representations and coping strategies in an 18-month longitudinal study involving 45 patients undergoing deep brain stimulation for idiopathic Parkinson’s disease. Two research hypotheses were formulated and investigated through repeated measures of ANOVAs and structural equation modelling with full information maximum likelihood and Bayesian estimations. Representations of Parkinson’s disease as a cyclical condition and perception of control over the disease diminished after surgery. Use of instrumental coping strategies was not modified after deep brain stimulation. These changes were identified by SEM but not ANOVAs; their magnitude was nevertheless relatively small, implying general stability in representations. These findings suggest that psychological variables do not undergo major changes after deep brain stimulation for Parkinson’s disease. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)

Review

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14 pages, 477 KiB  
Review
Deep Brain Stimulation Selection Criteria for Parkinson’s Disease: Time to Go beyond CAPSIT-PD
by Carlo Alberto Artusi, Leonardo Lopiano and Francesca Morgante
J. Clin. Med. 2020, 9(12), 3931; https://doi.org/10.3390/jcm9123931 - 4 Dec 2020
Cited by 27 | Viewed by 5128
Abstract
Despite being introduced in clinical practice more than 20 years ago, selection criteria for deep brain stimulation (DBS) in Parkinson’s disease (PD) rely on a document published in 1999 called ‘Core Assessment Program for Surgical Interventional Therapies in Parkinson’s Disease’. These criteria are [...] Read more.
Despite being introduced in clinical practice more than 20 years ago, selection criteria for deep brain stimulation (DBS) in Parkinson’s disease (PD) rely on a document published in 1999 called ‘Core Assessment Program for Surgical Interventional Therapies in Parkinson’s Disease’. These criteria are useful in supporting the selection of candidates. However, they are both restrictive and out-of-date, because the knowledge on PD progression and phenotyping has massively evolved. Advances in understanding the heterogeneity of PD presentation, courses, phenotypes, and genotypes, render a better identification of good DBS outcome predictors a research priority. Additionally, DBS invasiveness, cost, and the possibility of serious adverse events make it mandatory to predict as accurately as possible the clinical outcome when informing the patients about their suitability for surgery. In this viewpoint, we analyzed the pre-surgical assessment according to the following topics: early versus delayed DBS; the evolution of the levodopa challenge test; and the relevance of axial symptoms; patient-centered outcome measures; non-motor symptoms; and genetics. Based on the literature, we encourage rethinking of the selection process for DBS in PD, which should move toward a broad clinical and instrumental assessment of non-motor symptoms, quantitative measurement of gait, posture, and balance, and in-depth genotypic and phenotypic characterization. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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49 pages, 981 KiB  
Review
A Decade of Progress in Deep Brain Stimulation of the Subcallosal Cingulate for the Treatment of Depression
by Sharafuddin Khairuddin, Fung Yin Ngo, Wei Ling Lim, Luca Aquili, Naveed Ahmed Khan, Man-Lung Fung, Ying-Shing Chan, Yasin Temel and Lee Wei Lim
J. Clin. Med. 2020, 9(10), 3260; https://doi.org/10.3390/jcm9103260 - 12 Oct 2020
Cited by 10 | Viewed by 4541
Abstract
Major depression contributes significantly to the global disability burden. Since the first clinical study of deep brain stimulation (DBS), over 446 patients with depression have now undergone this neuromodulation therapy, and 29 animal studies have investigated the efficacy of subgenual cingulate DBS for [...] Read more.
Major depression contributes significantly to the global disability burden. Since the first clinical study of deep brain stimulation (DBS), over 446 patients with depression have now undergone this neuromodulation therapy, and 29 animal studies have investigated the efficacy of subgenual cingulate DBS for depression. In this review, we aim to provide a comprehensive overview of the progress of DBS of the subcallosal cingulate in humans and the medial prefrontal cortex, its rodent homolog. For preclinical animal studies, we discuss the various antidepressant-like behaviors induced by medial prefrontal cortex DBS and examine the possible mechanisms including neuroplasticity-dependent/independent cellular and molecular changes. Interestingly, the response rate of subcallosal cingulate Deep brain stimulation marks a milestone in the treatment of depression. DBS achieved response and remission rates of 64–76% and 37–63%, respectively, from clinical studies monitoring patients from 6–24 months. Although some studies showed its stimulation efficacy was limited, it still holds great promise as a therapy for patients with treatment-resistant depression. Overall, further research is still needed, including more credible clinical research, preclinical mechanistic studies, precise selection of patients, and customized electrical stimulation paradigms. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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15 pages, 1414 KiB  
Review
A Deep Brain Stimulation Trial Period for Treating Chronic Pain
by Prasad Shirvalkar, Kristin K. Sellers, Ashlyn Schmitgen, Jordan Prosky, Isabella Joseph, Philip A. Starr and Edward F. Chang
J. Clin. Med. 2020, 9(10), 3155; https://doi.org/10.3390/jcm9103155 - 29 Sep 2020
Cited by 6 | Viewed by 4233
Abstract
Early studies of deep brain stimulation (DBS) for various neurological disorders involved a temporary trial period where implanted electrodes were externalized, in which the electrical contacts exiting the patient’s brain are connected to external stimulation equipment, so that stimulation efficacy could be determined [...] Read more.
Early studies of deep brain stimulation (DBS) for various neurological disorders involved a temporary trial period where implanted electrodes were externalized, in which the electrical contacts exiting the patient’s brain are connected to external stimulation equipment, so that stimulation efficacy could be determined before permanent implant. As the optimal brain target sites for various diseases (i.e., Parkinson’s disease, essential tremor) became better established, such trial periods have fallen out of favor. However, deep brain stimulation trial periods are experiencing a modern resurgence for at least two reasons: (1) studies of newer indications such as depression or chronic pain aim to identify new targets and (2) a growing interest in adaptive DBS tools necessitates neurophysiological recordings, which are often done in the peri-surgical period. In this review, we consider the possible approaches, benefits, and risks of such inpatient trial periods with a specific focus on developing new DBS therapies for chronic pain. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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Graphical abstract

22 pages, 1734 KiB  
Review
Bilateral Subthalamic Nucleus Deep Brain Stimulation under General Anesthesia: Literature Review and Single Center Experience
by Hye Ran Park, Yong Hoon Lim, Eun Jin Song, Jae Meen Lee, Kawngwoo Park, Kwang Hyon Park, Woong-Woo Lee, Han-Joon Kim, Beomseok Jeon and Sun Ha Paek
J. Clin. Med. 2020, 9(9), 3044; https://doi.org/10.3390/jcm9093044 - 21 Sep 2020
Cited by 9 | Viewed by 3606
Abstract
Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson’s disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the [...] Read more.
Bilateral subthalamic nucleus (STN) Deep brain stimulation (DBS) is a well-established treatment in patients with Parkinson’s disease (PD). Traditionally, STN DBS for PD is performed by using microelectrode recording (MER) and/or intraoperative macrostimulation under local anesthesia (LA). However, many patients cannot tolerate the long operation time under LA without medication. In addition, it cannot be even be performed on PD patients with poor physical and neurological condition. Recently, it has been reported that STN DBS under general anesthesia (GA) can be successfully performed due to the feasible MER under GA, as well as the technical advancement in direct targeting and intraoperative imaging. The authors reviewed the previously published literature on STN DBS under GA using intraoperative imaging and MER, focused on discussing the technique, clinical outcome, and the complication, as well as introducing our single-center experience. Based on the reports of previously published studies and ours, GA did not interfere with the MER signal from STN. STN DBS under GA without intraoperative stimulation shows similar or better clinical outcome without any additional complication compared to STN DBS under LA. Long-term follow-up with a large number of the patients would be necessary to validate the safety and efficacy of STN DBS under GA. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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19 pages, 875 KiB  
Review
Deep Brain Stimulation for Treatment-Resistant Depression: Towards a More Personalized Treatment Approach
by Milaine Roet, Jackson Boonstra, Erdi Sahin, Anne E.P. Mulders, Albert F.G. Leentjens and Ali Jahanshahi
J. Clin. Med. 2020, 9(9), 2729; https://doi.org/10.3390/jcm9092729 - 24 Aug 2020
Cited by 25 | Viewed by 5204
Abstract
Major depressive disorder (MDD) affects approximately 4.4% of the world’s population. One third of MDD patients do not respond to routine psychotherapeutic and pharmacotherapeutic treatment and are said to suffer from treatment-resistant depression (TRD). Deep brain stimulation (DBS) is increasingly being investigated as [...] Read more.
Major depressive disorder (MDD) affects approximately 4.4% of the world’s population. One third of MDD patients do not respond to routine psychotherapeutic and pharmacotherapeutic treatment and are said to suffer from treatment-resistant depression (TRD). Deep brain stimulation (DBS) is increasingly being investigated as a treatment modality for TRD. Although early case studies showed promising results of DBS, open-label trials and placebo-controlled studies have reported inconsistent outcomes. This has raised discussion about the correct interpretation of trial results as well as the criteria for patient selection, the choice of stimulation target, and the optimal stimulation parameters. In this narrative review, we summarize recent studies of the effectiveness of DBS in TRD and address the relation between the targeted brain structures and clinical outcomes. Elaborating upon that, we hypothesize that the effectiveness of DBS in TRD can be increased by a more personalized and symptom-based approach. This may be achieved by using resting-state connectivity mapping for neurophysiological subtyping of TRD, by using individualized tractography to help decisions about stimulation target and electrode placement, and by using a more detailed registration of symptomatic improvements during DBS, for instance by using ‘experience sampling’ methods. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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10 pages, 353 KiB  
Review
Effectiveness, Timing and Procedural Aspects of Cognitive Behavioral Therapy after Deep Brain Stimulation for Therapy-Resistant Obsessive Compulsive Disorder: A Systematic Review
by Meltem Görmezoğlu, Tim Bouwens van der Vlis, Koen Schruers, Linda Ackermans, Mircea Polosan and Albert F.G. Leentjens
J. Clin. Med. 2020, 9(8), 2383; https://doi.org/10.3390/jcm9082383 - 26 Jul 2020
Cited by 8 | Viewed by 2731
Abstract
Background and aim: Deep brain stimulation (DBS) is an effective treatment for patients with severe therapy-resistant obsessive-compulsive disorder (OCD). After initiating DBS many patients still require medication and/or behavioral therapy to deal with persisting symptoms and habitual behaviors. The clinical practice of administering [...] Read more.
Background and aim: Deep brain stimulation (DBS) is an effective treatment for patients with severe therapy-resistant obsessive-compulsive disorder (OCD). After initiating DBS many patients still require medication and/or behavioral therapy to deal with persisting symptoms and habitual behaviors. The clinical practice of administering postoperative cognitive behavioral therapy (CBT) varies widely, and there are no clinical guidelines for this add-on therapy. The aim of this review is to assess the efficacy, timing and procedural aspects of postoperative CBT in OCD patients treated with DBS. Method: Systematic review of literature. Results: The search yielded 5 original studies, one case series and three reviews. Only two clinical trials have explicitly focused on the effectiveness of CBT added to DBS in patients with therapy-resistant OCD. These two studies both showed effectiveness of CBT. However, they had a distinctly different design, very small sample sizes and different ways of administering the therapy. Therefore, no firm conclusions can be drawn or recommendations made for administering CBT after DBS for therapy-resistant OCD. Conclusion: The effectiveness, timing and procedural aspects of CBT added to DBS in therapy-resistant OCD have hardly been studied. Preliminary evidence indicates that CBT has an added effect in OCD patients being treated with DBS. Since the overall treatment effect is the combined result of DBS, medication and CBT, future trials should be designed in such a way that they allow quantification of the effects of these add-on therapies in OCD patients treated with DBS. Only in this way information can be gathered that contributes to the development of an algorithm and clinical guidelines for concomittant therapies to optimize treatment effects in OCD patients being treated with DBS. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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15 pages, 7281 KiB  
Review
The Cerebral Localization of Pain: Anatomical and Functional Considerations for Targeted Electrical Therapies
by Rose M. Caston, Elliot H. Smith, Tyler S. Davis and John D. Rolston
J. Clin. Med. 2020, 9(6), 1945; https://doi.org/10.3390/jcm9061945 - 22 Jun 2020
Cited by 10 | Viewed by 3953
Abstract
Millions of people in the United States are affected by chronic pain, and the financial cost of pain treatment is weighing on the healthcare system. In some cases, current pharmacological treatments may do more harm than good, as with the United States opioid [...] Read more.
Millions of people in the United States are affected by chronic pain, and the financial cost of pain treatment is weighing on the healthcare system. In some cases, current pharmacological treatments may do more harm than good, as with the United States opioid crisis. Direct electrical stimulation of the brain is one potential non-pharmacological treatment with a long history of investigation. Yet brain stimulation has been far less successful than peripheral or spinal cord stimulation, perhaps because of our limited understanding of the neural circuits involved in pain perception. In this paper, we review the history of using electrical stimulation of the brain to treat pain, as well as contemporary studies identifying the structures involved in pain networks, such as the thalamus, insula, and anterior cingulate. We propose that the thermal grill illusion, an experimental pain model, can facilitate further investigation of these structures. Pairing this model with intracranial recording will provide insight toward disentangling the neural correlates from the described anatomic areas. Finally, the possibility of altering pain perception with brain stimulation in these regions could be highly informative for the development of novel brain stimulation therapies for chronic pain. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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Other

28 pages, 1483 KiB  
Perspective
Methodological Considerations for Neuroimaging in Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson’s Disease Patients
by Bethany R. Isaacs, Max C. Keuken, Anneke Alkemade, Yasin Temel, Pierre-Louis Bazin and Birte U. Forstmann
J. Clin. Med. 2020, 9(10), 3124; https://doi.org/10.3390/jcm9103124 - 27 Sep 2020
Cited by 5 | Viewed by 3415
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus is a neurosurgical intervention for Parkinson’s disease patients who no longer appropriately respond to drug treatments. A small fraction of patients will fail to respond to DBS, develop psychiatric and cognitive side-effects, or incur surgery-related [...] Read more.
Deep brain stimulation (DBS) of the subthalamic nucleus is a neurosurgical intervention for Parkinson’s disease patients who no longer appropriately respond to drug treatments. A small fraction of patients will fail to respond to DBS, develop psychiatric and cognitive side-effects, or incur surgery-related complications such as infections and hemorrhagic events. In these cases, DBS may require recalibration, reimplantation, or removal. These negative responses to treatment can partly be attributed to suboptimal pre-operative planning procedures via direct targeting through low-field and low-resolution magnetic resonance imaging (MRI). One solution for increasing the success and efficacy of DBS is to optimize preoperative planning procedures via sophisticated neuroimaging techniques such as high-resolution MRI and higher field strengths to improve visualization of DBS targets and vasculature. We discuss targeting approaches, MRI acquisition, parameters, and post-acquisition analyses. Additionally, we highlight a number of approaches including the use of ultra-high field (UHF) MRI to overcome limitations of standard settings. There is a trade-off between spatial resolution, motion artifacts, and acquisition time, which could potentially be dissolved through the use of UHF-MRI. Image registration, correction, and post-processing techniques may require combined expertise of traditional radiologists, clinicians, and fundamental researchers. The optimization of pre-operative planning with MRI can therefore be best achieved through direct collaboration between researchers and clinicians. Full article
(This article belongs to the Special Issue Trends in Clinical Deep Brain Stimulation)
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