Deep Brain Stimulation

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Deep Brain Stimulation

Nonablative surgical procedures for treatment of PD involve either unilateral or bilateral implantation of high-frequency stimulation electrodes into deep brain nuclei. Studies detailing neuropsychological outcomes after unilateral globus pallidus (GPi) deep brain stimulation (DBS) have supported the neurobehavioral safety of this technique (113,157), although a few studies have demonstrated minor postoperative declines in verbal fluency (158-160). The majority of studies indicate that even bilateral GPi stimulation is cognitively well tolerated (161-163), although in isolated cases, cognitive declines can occur (152,164).

Neuronal Mechanisms Of Subthalamic Nucleus Deep Brain Stimulation

FIGURE 4 Microelectrode recording of the extracellular action potentials of a globus pallidus internal segment neuron in response to deep brain stimulation in the vicinity of the subthalamic nucleus. This is a 30-second baseline recording followed by 30 seconds of stimulation and then recording for an additional 30 seconds. FIGURE 6 Representative examples of normalized poststimulation histograms for individual neurons in various structures. Each graph represents the changes in probability of neuronal activity in time bins during the inter deep brain stimulation (DBS) stimulus interval. The graphs are represented as z-score changes from the no-DBS condition (31). Each graph represents data obtained during DBS at 130 Hz, 100 Hz, and 50 Hz. Visual inspection classified the poststimulation histograms into those where there is no difference in the responses with different DBS frequencies and those with differences. The numbers in each class are expressed as a ratio to the total number of...

Deep Brain Stimulation Of The Globus Pallidus Interna

Kumar et al. (19) reported 22 PD patients who were treated with either unilateral (n 5) or bilateral (n 17) GPi stimulation. Evaluations performed in the medication off stimulation on state at six months reported a 32 improvement in UPDRS motor scores and a 40 improvement in UPDRS activities of daily living (ADL) scores compared to baseline medication off scores. There was also a 68 reduction in dyskinesia. The Deep Brain Stimulation for Parkinson's Disease Study Group (16) reported a multinational, prospective study of bilateral GPi stimulation in PD. Forty-one patients were enrolled and electrodes were implanted in 38 patients. Two patients had cerebral hemorrhages and one patient had intraoperative confusion. In comparison to baseline, there was a significant improvement of 33 in UPDRS motor scores in the medication off stimulation on state. More specifically, tremor was reduced by 59 , rigidity was reduced 31 , bradykinesia was reduced 26 , gait improved by 35 , and postural...

Effect Of Surgical Treatments For Parkinsons Disease On Speech And Swallowing Deep Brain Stimulation

Many studies of deep brain stimulation (DBS) of the subthalamic nucleus (STN), globus pallidus internus (GPi), and ventral intermediate (Vim) nucleus of the thalamus have reported dysarthria and dysphagia as side effects (88-90). Several studies examined specific aspects of voice, speech, swallowing and related orofacial, and respira-tory-laryngeal functions associated with DBS treatment of PD. Santens et al. (91) found that left-brain stimulation had a profound negative effect on prosody, articulation, and intelligibility not seen with right-brain stimulation. With bilateral stimulation, no differences in speech characteristics were observed on- and off-stimulation. Wang et al. (92) also studied the effects of unilateral STN DBS on respiratory phonatory subsystems of speech production in PD. Speech recordings were made in the medication-off state at baseline and three months post-DBS with stimulation-on and -off, in six right-handed patients. Three patients who received left-brain...

Deep Brain Stimulation Of The Subthalamic Nucleus

Multiple reports have demonstrated the short-term benefits of STN DBS in controlling the cardinal features of PD and reducing dyskinesia and antiparkinsonian medications (16,24-31). One of the largest studies was conducted by the Deep Brain Stimulation for Parkinson's Disease Study Group (16). This was a multicenter study in which 96 PD patients received bilateral STN DBS and 91 completed the Several studies have demonstrated the long-term benefits of STN DBS (23,32-37) (Table 2). Rodriguez-Oroz et al. (23) examined 49 PD patients who received bilateral STN DBS as part of the original Deep Brain Stimulation for Parkinson's Disease Study Group trial (16), three to four years after initial implant. They demonstrated a 43 improvement in UPDRS ADL scores and a 50 improvement in UPDRS motor scores in the medication off stimulation on condition compared to the baseline medication off state. More specifically, there was an 87 improvement in tremor, a 59 improvement in rigidity, a 42...

Rapid Eye Movement Behavior Disorder and Restless Legs Syndrome

The treatment of choice for RBD is clonazepam, a benzodiazepine, although the mechanism is unknown and there are no controlled trials (13). Other drugs thought to be helpful for RBD include pramipexole, levodopa, carbamazepine, donepezil, and melatonin (64,89-91). Caution needs to be exercised with the use of clonazepam, as in some cases, RBD may be confused with sleep apnea, which can be worsened by clonazepam. Nighttime dosing with drugs such as selegiline may aggravate RBD. Others have reported a paradoxical worsening of RBD with deep brain stimulation (DBS) of the subthalamic nucleus (STN) (92).

Pathophysiology of Psychosis and Risk Factors

Nucleus (STN) deep brain stimulation (DBS) surgery only when the stimulators were turned on (43), leading the authors to hypothesize that this resulted from stimulation of limbic fibers near the STN. Finally, a functional MRI study demonstrated greater activation in the frontal lobe in PD patients with chronic visual hallucinations compared to nonhallucinators (44). The exact contribution of these neurotransmitters and structures to the genesis of psychosis is unclear.


The administration of MPTP through a number of different dosing regimens has led to the development of several distinct models of parkinsonism in the nonhuman primate. Each model is characterized by unique behavioral and neurochem-ical parameters. As a result, numerous studies addressing a variety of hypotheses have been conducted. These studies consist of new pharmacological treatments, transplantation, mechanisms of motor complications, deep brain stimulation, behavioral recovery, cognitive impairment, and the development of novel neuro-protective and restorative therapies. For example, in some models, there is profound striatal dopamine depletion and denervation with little or no dopaminergic axons or terminals remaining. This model provides an optimal setting to test fetal tissue grafting since the presence of any tyrosine hydroxylase positive axons or sprouting cells would be due to transplanted tissue survival. Other models have less extensive dopamine depletion and only partial...

Move too much Whats happening

Stopping deprenyl (selegiline), a drug that prolongs Sinemet's duration of action, may help. Deprenyl is long acting, and its effect on Sinemet is variable and sometimes unpredictable. Stopping it results in a more predictable, although shorter, duration of action of Sinemet. This, in turn, makes it easier to regulate dyskinesias. Comtan, a drug that also prolongs Sinemet's duration of action, is short acting, and its effect on Sinemet is predictable. If you're taking Comtan with each dose of Sinemet and you're having peak-dose dyskinesia, eliminating one or more doses of Comtan may help. Adding amantadine (Symmetrel) may decrease peak-dose dyskinesia. The reason is unclear. Peak-dose dyskinesias severe enough to interfere with daily activities and unresponsive to the previously mentioned treatments usually respond to deep brain stimulation (see Question 70). Prevention is the best treatment for dyskinesias. This fact has led doctors to start newly diagnosed people on...

Memory Storage Modulation of

Clinical and experimental evidence strongly supports the hypothesis that memory storage is time-dependent. Disruption of brain activity shortly after learning impairs long-term memory. In humans, acute brain trauma produces retrograde amnesia, a selective loss of memory for recent experiences (Burnham 1903 Russell and Nathan 1946) and in animals retrograde amnesia is induced by many treatments that impair brain functioning, including electrical brain stimulation and drugs (McGaugh and Herz 1972). Additionally, and more importantly, in humans as well as animals (Soetens et al. 1995), stimulant drugs administered shortly after learning enhance memory. Drugs affecting many neurotransmitter and hormonal systems improve long-term memory when they are administered within a few minutes or hours after training (McGaugh 1973, 1983). Extensive evidence indicates that the drugs enhance the consolidation of long-term memory.

Dopamine Agonists And Dopamine Receptors

The dopamine agonists used in the treatment of PD include apomorphine, bromocrip-tine, cabergoline, lisuride, pergolide, pramipexole, ropinirole, and rotigotine. All of these agents activate D2 receptors, whereas pergolide has been shown to be a mild D1 agonist, and pramipexole may have higher affinity for D3 receptors (Table 1). Five subtypes of dopamine agonist receptors have been identified and may be classified into striatal (D1 and D2) receptors or cortical (D3, D4, and D5) receptors. The D3-5 receptors are present in the mesolimbic and mesocortical dopaminergic pathways. The D1-receptor (D1,5) family is associated with activation of adenylate cyclase and dopamine, and dopamine agonists activate the D2-receptor family (D2-4) (6). Postmortem examination of brains of patients with PD revealed upregulation of stri-atal D2 and downregulation of the D1 receptors. It is postulated that these changes lead to alteration of the indirect D2-mediated pathway and disinhibition of the...

Kenzie L Preston Sharon L Walsh

Incentive motivation is the term applied to the most influential psychological theory that explains how the stimulus properties of biologically relevant stimuli, and the environmental stimuli associated with them, control specific patterns of appetitive behavior (Bolles, 1972). According to this theory, the initiation and selection of specific behaviors are triggered by external (incentive) stimuli that also guide the individual toward a primary natural incentive, such as food, fluid, or a mate. Drugs of abuse and electrical brain-stimulation reward can serve as artificial incentives. In a further refinement of this theory, Berridge and Valenstein (1991) defined incentive motivation as the final stage in a three-part process. The first phase involves the activation of neural substrates for pleasure, which in

Lin Lu and Yavin Shaham

Due to space limitations, the review is restricted to rat studies using opiate and psychostimulant drugs. We also do not cover two relevant topics the early studies on the effects of stressors on oral opiate self-administration (for reviews, see Alexander and Hadaway, 1982 Shaham et al., 1996), and studies on food deprivation-induced potentiation of opiate and psychostimulant reinforcement, as measured by the drug self-administration, conditioned place preference and brain stimulation reward procedures (for reviews, see Carroll, 1999 Carr, 2002).

Reward Pathways And Drugs

The observation that animals would work in order to receive electrical stimulation to discrete brain areas was first described by Olds and Milner (1954). In this paper, they stated, ''It is clear that electrical stimulation in certain parts of the brain, particularly the septal area, produces acquisition and extinction curves which compare favorably with those produced by conventional primary reward.'' This phenomenon is usually referred to as brain-stimulation reward (BSR), intracranial self-stimulation (ICSS), or intracranial stimulation (ICS).

Kelly E Lyons and Rajesh Pahwa

Stereotactic surgeries for movement disorders were introduced in the late 1940s (1-3) but were not widely accepted due to significant morbidity, mortality, and limited knowledge of the appropriate target for symptomatic benefit. With advances in pharmacological therapy, particularly the availability of levodopa, these surgeries were rarely performed for Parkinson's disease (PD) until the late 1980s (4). Based on the limitations of drug treatments for PD, and a better understanding of the physiology and circuitry of the basal ganglia there has been a marked increase in the use of surgical treatments for PD. In addition, advances in surgical techniques, neu-roimaging, and improved electrophysiological recordings allow stereotactic procedures to be done more accurately leading to reduced morbidity. Deep brain stimulation (DBS) has largely replaced lesion surgery as the preferred procedure for PD. There are currently three targets for DBS in PD the ventral intermediate (VIM) nucleus of...

Avoiding Brain and Energy Drains When Youre Hurting or Tired

This piece of advice may sound like a no-brainer, but I'll say it anyway Don't try to tackle difficult problems when your symptoms are in the red (very high) zone of pain. Many people feel that they must still help their children with complicated science projects, drive five hours to family reunions, or perform other difficult tasks that require more brain power and energy than anyone can reasonably give when in pain. Is it any wonder, in such cases, that you become confused and a little foggy

Intracranial Self Stimulation ICSS

Electrical impulses was implanted in the brain of a rat. These animals could be trained to press a lever that would activate the implanted electrode, sending a small impulse to a specific brain region. In addition, animals could also be trained to press a lever that would ''shut off ' brain impulses in other regions. These animals will give up food and water, and even sexual activities, in order to perform tasks that lead to brain stimulation in certain regions. Based on these results, this procedure was recognized as a method by which mechanisms underlying drug addiction could be studied. Early work in brain stimulation involved mapping out which brain areas would support self-stimulation in animals, primarily rats. Animals were trained using operant procedures in which a press of the lever would deliver an electrical stimulus to the brain. Researchers found two systems of reward in the rat brain using ICSS a dorsal (closer to the back of the animal) system projecting from the...

Unilateral Subthalamic Nucleotomy

The target lesion in one series included the dorsolateral STN and pallidufugal fibers (Forel's field H2). Postoperative chorea was mild and transient, except in one patient in whom the lesion was confined to the STN only. The chorea in this instance was controlled by the subsequent insertion of a deep brain stimulator in the field H2 fibers and zona incerta. A similar phenomenon was described by comparison of two cases by Chen et al. (108) that is, a subthalamotomy that included the dorsal extranuclear fibers of the zona incerta led to less dyskinesia than a lesion confined to the STN only. Tseng et al. (109) described another patient with a lesion large


Affective and behavioral changes (e.g., aggression, depression, mania) have also been reported as complications of deep brain stimulation (DBS), especially subthalamic nucleus (STN) DBS (81). Interestingly, depression has been infrequently reported to develop, as a result of thalamic and pallidal DBS (82). In a review of 23 articles reporting on the effect of STN DBS on mood state in PD, nine studies reported a mood elevating or antidepressant effect in 16.7 to 76 of patients, 13 studies reported a depressant effect in 2 to 33.3 of patients, and eight studies reported a mania-inducing effect in 4.2 to 8.1 of patients (83). In one series of 24 consecutive patients undergoing STN DBS, six patients (25 ) experienced significant worsening of mood and three were transiently suicidal despite motor improvement (84). In a series of 137 patients who underwent STN DBS, 16 (12 ) developed depression (85). Mood disturbances induced by STN DBS could be the result of stimulation spreading to...

What is pallidotomy

Stimulation surgery or deep brain stimulation (DBS) refers to implanting a probe or electrode, a stimulator into a clearly defined, abnormally discharging brain region a region generating static. This is usually, but not always, the same region targeted in ablative or destructive surgery. By generating a blocking or inhibiting counter-current, the effects of the static are lessened or negated. Technically, DBS is a mis-nomer the abnormal discharging brain region isn't stimulated rather, it's blocked or inhibited by a reverse or counter-current. Deep brain stimulation


Because abused substances clearly enhance the rewarding value of the intracranial stimulation and not simply cause a general increase in motor behavior, the brain-stimulation-reward model directly allows for the study of the neuronal mechanisms involved in the rewarding effects of abused substances. Although this is not as homologous a model of drug-taking behavior as is the self-administration model, it predicts as well as the self-administration model the Abuse Liability of compounds, and it readily lends itself to analysis of the mechanisms involved in the rewarding effects of abused substances. Gardner, E. L., et al. (1988). Facilitation of brain stimulation reward by A9-tetrahydrocannabinol, Psy-chopharmacology 96, 142-144. Kornetsky, C., & Porrino, L. J. (1992). Brain mechanisms of drug-induced reinforcement. In C. P. O'Brien & J. H. Jaffe (Eds.), Addictive States. New York Raven Press. Olds, J., & Milner, P, (1954). Positive reinforcement produced by electrical...

Brain Blaster

Brain Blaster

Have you ever been envious of people who seem to have no end of clever ideas, who are able to think quickly in any situation, or who seem to have flawless memories? Could it be that they're just born smarter or quicker than the rest of us? Or are there some secrets that they might know that we don't?

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