RESUMEN
BACKGROUND: The use of checklists to reduce error rates in procedural literature has led our group to employ this strategy during deep brain stimulation (DBS) surgery. OBJECTIVES: We sought to examine the improvement in the number of errors made during DBS surgery after long-term use of a checklist. METHODS: Our checklist has been used for all DBS cases at our institution since the beginning of this study's enrollment in 2008. The number of cases in which errors were detected after 1 year of routine use (group B, n = 11) was compared in one cohort of DBS subjects to that of an earlier cohort of patients (group A, n = 17), which underwent DBS exactly 1 year prior. RESULTS: Eleven of the 14 cases where major errors were detected occurred in group A; 6 of the 9 cases where only minor errors were detected were also in group A; of the patients without any error, all 5 were in group B. We found a significant difference in these proportions between group A and group B [χ(2)(2) = 9.73; p < 0.008]. CONCLUSIONS: After 1 year of checklist use, the total number of major and minor errors made was reduced, indicating an improvement in error rate after long-term routine incorporation of this checklist.
Asunto(s)
Lista de Verificación , Estimulación Encefálica Profunda/métodos , Temblor Esencial/cirugía , Enfermedad de Parkinson/cirugía , Núcleo Subtalámico/cirugía , Tálamo/cirugía , Electrodos Implantados , Humanos , Resultado del TratamientoRESUMEN
We aimed to determine whether our targeting method for the subthalamic nucleus (STN) in Parkinson's disease informs the initial programming sequence. We evaluated 100 STN-lead pairs from 50 patients who underwent bilateral STN-deep brain stimulation operations. All patients had at least one year of follow-up. In each patient, we measured coordinates of the STN borders and determined the center from special T2-weighted MRI. We then measured the postoperative location of the lead tip by MRI registered to preoperative images. Finally, we determined the mode and active contact(s). Programming was monopolar 71% of the time. A total of 52% of left and 72% of right STN active contacts were located posterolateral to the STN center. In z, only 14% of the active contact(s) were >1mm below the STN center. Contacts 1 or 2 were active 90% of the time. The consistent location of active contacts suggests that initial programming began with contact 1 or 2.
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Estimulación Encefálica Profunda/métodos , Núcleo Subtalámico/fisiología , Distribución de Chi-Cuadrado , Electrodos/efectos adversos , Lateralidad Funcional , Humanos , Imagen por Resonancia Magnética , Enfermedad de Parkinson/terapia , Núcleo Subtalámico/anatomía & histologíaRESUMEN
The subthalamic nucleus (STN), which receives excitatory inputs from the cortex and has direct connections with the inhibitory pathways of the basal ganglia, is well positioned to efficiently mediate action selection. Here, we use microelectrode recordings captured during deep brain stimulation surgery as participants engage in a decision task to examine the role of the human STN in action selection. We demonstrate that spiking activity in the STN increases when participants engage in a decision and that the level of spiking activity increases with the degree of decision conflict. These data implicate the STN as an important mediator of action selection during decision processes.
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Conflicto Psicológico , Toma de Decisiones/fisiología , Neuronas/fisiología , Núcleo Subtalámico/fisiología , Potenciales de Acción/fisiología , Anciano , Estimulación Encefálica Profunda/instrumentación , Estimulación Encefálica Profunda/métodos , Femenino , Humanos , Aprendizaje/fisiología , Masculino , Microelectrodos , Persona de Mediana Edad , Núcleo Subtalámico/citologíaRESUMEN
BACKGROUND/AIMS: Microelectrode recording (MER) is necessary for precision localization of target structures such as the subthalamic nucleus during deep brain stimulation (DBS) surgery. Attempts to automate this process have produced quantitative temporal trends (feature activity vs. time) extracted from mobile MER data. Our goal was to evaluate computational methods of generating spatial profiles (feature activity vs. depth) from temporal trends that would decouple automated MER localization from the clinical procedure and enhance functional localization in DBS surgery. METHODS: We evaluated two methods of interpolation (standard vs. kernel) that generated spatial profiles from temporal trends. We compared interpolated spatial profiles to true spatial profiles that were calculated with depth windows, using correlation coefficient analysis. RESULTS: Excellent approximation of true spatial profiles is achieved by interpolation. Kernel-interpolated spatial profiles produced superior correlation coefficient values at optimal kernel widths (r = 0.932-0.940) compared to standard interpolation (r = 0.891). The choice of kernel function and kernel width resulted in trade-offs in smoothing and resolution. CONCLUSIONS: Interpolation of feature activity to create spatial profiles from temporal trends is accurate and can standardize and facilitate MER functional localization of subcortical structures. The methods are computationally efficient, enhancing localization without imposing additional constraints on the MER clinical procedure during DBS surgery.
Asunto(s)
Estimulación Encefálica Profunda/métodos , Procesamiento de Señales Asistido por Computador , Fenómenos Electrofisiológicos , Humanos , Microelectrodos , Reproducibilidad de los Resultados , Subtálamo/fisiologíaRESUMEN
BACKGROUND: Brain shift during deep brain stimulation (DBS) surgery may compromise target localization. Loss of cerebrospinal fluid is believed to be the underlying mechanism, thus an intraventricular trajectory during DBS surgery may be associated with increased shift, in addition to other complications, such as intraventricular hemorrhage. OBJECTIVE: We set out to assess the effect of traversing the lateral ventricle on brain shift during DBS surgery. METHODS: We performed a retrospective review of 65 pre- and postoperative MR images of patients who underwent bilateral subthalamic nucleus deep brain stimulator placement to treat advanced Parkinson's disease. Patients were separated into two groups: Group A (intraventricular trajectory, n = 46) and Group B (no intraventricular trajectory, n = 19). In these patients, we compared pre- and postoperative frame coordinates of the red nucleus (RN). RESULTS: Group B demonstrated significantly more posterior shift of the center of the RN (1.40 ± 1.32 mm) than Group A (0.64 ± 1.76 mm; p < 0.02). We found no increase in incidence of intraventricular hemorrhage or the number of microelectrode trajectory attempts. CONCLUSIONS: Intraventricular trajectories during DBS surgery do not appear to compromise safety or targeting accuracy.
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Estimulación Encefálica Profunda/efectos adversos , Estimulación Encefálica Profunda/métodos , Enfermedad de Parkinson/terapia , Anciano , Femenino , Humanos , Incidencia , Hemorragias Intracraneales/epidemiología , Hemorragias Intracraneales/etiología , Imagen por Resonancia Magnética , Masculino , Microelectrodos , Persona de Mediana Edad , Enfermedad de Parkinson/patología , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Prevention of surgical site infections is critical in deep brain stimulation (DBS). In the present study, we tested the ability of a self-administered preoperative alcohol-based (70% ethyl alcohol) preparation to reduce the rate of postoperative infection after DBS surgery. METHODS: This Institutional Review Board-approved retrospective review was conducted at our institution between January 2005 and October 2007 (mean follow-up, 23 months). The participants comprised a consecutive sample of 172 patients with movement disorders who underwent DBS surgery at our institution. Starting in January 2007, all patients were required to use the alcohol-based preparation. These patients (n = 48) were instructed to self-administer the wash on the night before surgery and the morning of surgery. Before this time, no self-administered wash was used (n = 122). RESULTS: There was no difference in preoperative skin cleansing between the 2 groups, and all patients received intravenous antibiotics immediately before and after surgery for 24 hours. We compared the rate of postoperative infection in the 2 groups and reviewed other possible factors underlying infection. We found 11 cases of infection (6.47%), all in the group without the preoperative antiseptic wash. The infection rate was 9.02% in the group without the preoperative wash and 0 in the group with the preoperative wash (P < .029). There was no difference between the 2 groups in terms of mean age, duration of operative procedure, or number of microelectrode tracts attempted. CONCLUSIONS: Our results support the incorporation of this self-administered antiseptic wash into our standard antiseptic protocol for patients undergoing DBS surgery.
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Antiinfecciosos Locales/administración & dosificación , Estimulación Encefálica Profunda/efectos adversos , Cuidados Preoperatorios/métodos , Autoadministración/métodos , Infección de la Herida Quirúrgica/prevención & control , Anciano , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Accumulated evidence from animal studies implicates the ventral striatum in the processing of reward information. Recently, deep brain stimulation (DBS) surgery has enabled researchers to analyze neurophysiological recordings from humans engaged in reward tasks. We present data recorded from the human ventral striatum during deep brain stimulation surgery as a participant played a video game coupled to the receipt of visual reward images. To our knowledge, we identify the first instances of reward-sensitive single unit activity in the human ventral striatum. Local field potential data suggest that alpha oscillations are sensitive to positive feedback, whereas beta oscillations exhibit significantly higher power during unrewarded trials. We report evidence of alpha-gamma cross-frequency coupling that differentiates between positive and negative feedback.
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Ganglios Basales/fisiología , Relojes Biológicos/fisiología , Ondas Encefálicas/fisiología , Neuronas/fisiología , Núcleo Accumbens/fisiología , Recompensa , Adulto , Femenino , HumanosRESUMEN
BACKGROUND: The indications for deep brain stimulation (DBS) are expanding, and the feasibility and efficacy of this surgical procedure in various neurologic and neuropsychiatric disorders continue to be tested. This review attempts to provide background and rationale for applying this therapeutic option to obesity and addiction. We review neural targets currently under clinical investigation for DBSthe hypothalamus and nucleus accumbensin conditions such as cluster headache and obsessive-compulsive disorder. These brain regions have also been strongly implicated in obesity and addiction. These disorders are frequently refractory, with very high rates of weight regain or relapse, respectively, despite the best available treatments. METHODS: We performed a structured literature review of the animal studies of DBS, which revealed attenuation of food intake, increased metabolism, or decreased drug seeking. We also review the available radiologic evidence in humans, implicating the hypothalamus and nucleus in obesity and addiction. RESULTS: The available evidence of the promise of DBS in these conditions combined with significant medical need, support pursuing pilot studies and clinical trials of DBS in order to decrease the risk of dietary and drug relapse. CONCLUSIONS: Well-designed pilot studies and clinical trials enrolling carefully selected patients with obesity or addiction should be initiated.
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Estimulación Encefálica Profunda/métodos , Estimulación Encefálica Profunda/tendencias , Hipotálamo/cirugía , Núcleo Accumbens/cirugía , Obesidad/terapia , Trastornos Relacionados con Sustancias/terapia , Animales , Modelos Animales de Enfermedad , Humanos , Hipotálamo/anatomía & histología , Hipotálamo/fisiopatología , Núcleo Accumbens/anatomía & histología , Núcleo Accumbens/fisiopatología , Obesidad/fisiopatología , Trastornos Relacionados con Sustancias/fisiopatología , Resultado del TratamientoRESUMEN
OBJECTIVE: There continues to be debate about the surgical technique, electrophysiology, and hardware used in deep brain stimulation (DBS), despite its widespread use in medically intractable Parkinson's disease and essential tremor. This article is the first, to our knowledge, to compare the longevity of the available internal pulse generators (IPGs) of DBS (Kinetra and Soletra, Medtronics). METHODS: We compared the elapsed time from the initial surgery to the first replacement of IPGs in patients with bilateral Soletra IPGs to those with the unilateral Kinetra IPG and analyzed the various stimulation parameters of each device. RESULTS: The battery life of the Soletra system was significantly longer than that of the Kinetra and also allowed for higher voltages, longer use of monopolar mode, and a greater number of electrode contacts. CONCLUSIONS: Our findings support superior battery life and a greater capacity for titration to symptom control with bilateral Soletra IPGs.
Asunto(s)
Estimulación Encefálica Profunda/instrumentación , Neuroestimuladores Implantables/estadística & datos numéricos , Suministros de Energía Eléctrica/normas , Suministros de Energía Eléctrica/estadística & datos numéricos , Diseño de Equipo , Humanos , Neuroestimuladores Implantables/normas , Estudios RetrospectivosRESUMEN
Deep brain stimulation (DBS) is the treatment of choice for otherwise healthy patients with advanced Parkinson disease who are suffering from disabling dyskinesias and motor fluctuations related to dopaminergic therapy. As DBS is an elective procedure, it is essential to minimize the risk of morbidity. Further, precision in targeting deep brain structures is critical to optimize efficacy in controlling motor features. The authors have already established an operational checklist in an effort to minimize errors made during DBS surgery. Here, they set out to standardize a strict, step-by-step approach to the DBS surgery used at their institution, including preoperative evaluation, the day of surgery, and the postoperative course. They provide careful instruction on Leksell frame assembly and placement as well as the determination of indirect coordinates derived from MR images used to target deep brain structures. Detailed descriptions of the operative procedure are provided, outlining placement of the stereotactic arc as well as determination of the appropriate bur hole location, lead placement using electrophysiology, and placement of the internal pulse generator. The authors also include their approach to preventing postoperative morbidity. They believe that a strategic, step-by-step approach to DBS surgery combined with a standardized checklist will help to minimize operating room mistakes that can compromise targeting and increase the risk of complication.
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Protocolos Clínicos , Estimulación Encefálica Profunda/métodos , Trastornos del Movimiento/terapia , Mapeo Encefálico , Lista de Verificación/normas , Fluoroscopía , Humanos , Imagen por Resonancia Magnética , Trastornos del Movimiento/cirugía , Enfermedad de Parkinson/cirugía , Enfermedad de Parkinson/terapia , Complicaciones Posoperatorias/prevención & control , Técnicas Estereotáxicas , Núcleo Subtalámico/fisiologíaRESUMEN
BACKGROUND: This report describes the use of microdialysis in conjunction with deep brain stimulation (DBS) surgery to assess extracellular levels of neurotransmitters within the human basal ganglia (BG). Electrical stimulation of the subthalamic nucleus (STN) is an efficacious treatment for advanced Parkinson's disease, yet the mechanisms of STN DBS remain poorly understood. Measurement of neurotransmitter levels within the BG may provide insight into mechanisms of DBS, but such an approach presents technical challenges. METHODS: After microelectrode recordings confirmed location of STN, a custom microdialysis guide cannula was inserted. A CMA (Stockholm, Sweden) microdialysis probe was then positioned to the same depth as the microrecording electrode in STN or 2mm inferiorly to record in the substantia nigra. The catheter was perfused at a rate of 2.0 microL/min with a sterile mock CSF solution and samples of extracellular fluid were collected at regular intervals. Dialysate samples were analyzed using high-pressure liquid chromatography (HPLC) detection procedures for quantitation of glutamate, gamma-aminobutyric acid (GABA), and dopamine. RESULTS: Levels of neurotransmitters were reliably identified in dialysate samples using HPLC. By monitoring concentrations of glutamate, GABA and dopamine, we were able to demonstrate what seemed to be a steady state baseline within approximately 30 min. CONCLUSION: Microdialysis during DBS surgery is a feasible method for assessing levels of glutamate, GABA and dopamine within the human BG. Obtaining a steady state baseline of neurotransmitter levels appears feasible, thus making future studies of intraoperative microdialysis during DBS meaningful.
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Estimulación Encefálica Profunda , Microdiálisis/métodos , Monitoreo Intraoperatorio/métodos , Procedimientos Neuroquirúrgicos/métodos , Sustancia Negra/metabolismo , Cateterismo , Cromatografía Líquida de Alta Presión , Dopamina/metabolismo , Líquido Extracelular/metabolismo , Estudios de Factibilidad , Ácido Glutámico/metabolismo , Humanos , Microdiálisis/instrumentación , Microelectrodos , Persona de Mediana Edad , Monitoreo Intraoperatorio/instrumentación , Procedimientos Neuroquirúrgicos/instrumentación , Factores de Tiempo , Ácido gamma-Aminobutírico/metabolismoRESUMEN
Deep brain stimulation for epilepsy has garnered attention from epileptologists due to its well-documented success in treating movement disorders and the low morbidity associated with the implantation of electrodes. Given the large proportion of patients who fail medical therapy and are not candidates for surgical amelioration, as well as the suboptimal seizure control offered by vagus nerve stimulation, the search for appropriate brain structures to serve as targets for deep brain stimulation has generated a useful body of evidence to serve as the basis for larger investigations. Early results of the SANTE trial should lay the foundation for widespread implementation of DBS for epilepsy targeting the anterior thalamic nucleus. Other targets also offer promise, including the caudate nucleus, the subthalamic nucleus, the cerebellum, the centromedian nucleus of the thalamus, and the hippocampus. This paper reviews the logic which underlies these potential targets and recapitulates the current data from limited human trials supporting each one. It also provides a succinct overview of the surgical procedure used for electrode implantation.
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Estimulación Encefálica Profunda/métodos , Epilepsia/terapia , Animales , Encéfalo/fisiopatología , Epilepsia/fisiopatología , HumanosRESUMEN
OBJECTIVE: The addition of subcutaneous heparin (SQH) to mechanical prophylaxis for venous thromboembolism (VTE) involves a balance between the benefit of greater protection from VTE and the added risk of intracranial hemorrhage. There is evidence that the hemorrhage risk outweighs the benefits for patients undergoing craniotomy. We investigated the safety of SQH in patients undergoing deep brain stimulation (DBS) surgery. METHODS: A retrospective analysis was performed of all patients with movement disorders (n = 254) undergoing DBS surgery at our institution from 2003 to 2007. Before September 2005, none of the patients undergoing DBS received SQH (non-SQH group) (n = 121). Thereafter, all patients were administered SQH perioperatively (SQH group) (n = 133). All patients wore graduated compression stockings and pneumatic compression boots postoperatively in bed. A postoperative brain magnetic resonance imaging scan was obtained on the day of surgery. RESULTS: Five (3.8%) of 133 SQH patients and 1 (0.8%) of 121 non-SQH patients developed asymptomatic intracranial hemorrhage. None of the SQH patients developed clinically significant VTE, whereas 3 (2.5%) non-SQH patients developed VTE (1 deep venous thrombosis, 2 pulmonary embolisms). Using a decision-analysis model, we have shown that the use of SQH plus mechanical prophylaxis together yielded outcomes at least as good as mechanical prophylaxis alone. CONCLUSION: Our findings suggest that SQH for VTE prophylaxis in patients with movement disorders undergoing DBS surgery is safe. SQH protects against VTE in this patient population and merits further investigation.
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Anticoagulantes/administración & dosificación , Estimulación Encefálica Profunda/efectos adversos , Heparina/administración & dosificación , Procedimientos Neuroquirúrgicos/efectos adversos , Complicaciones Posoperatorias/tratamiento farmacológico , Tromboembolia Venosa/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anticoagulantes/efectos adversos , Hemorragia Cerebral/inducido químicamente , Hemorragia Cerebral/fisiopatología , Hemorragia Cerebral/prevención & control , Técnicas de Apoyo para la Decisión , Femenino , Heparina/efectos adversos , Humanos , Inyecciones Subcutáneas/efectos adversos , Inyecciones Subcutáneas/normas , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Trastornos del Movimiento/terapia , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Embolia Pulmonar/tratamiento farmacológico , Embolia Pulmonar/etiología , Embolia Pulmonar/prevención & control , Estudios Retrospectivos , Medición de Riesgo , Resultado del Tratamiento , Tromboembolia Venosa/etiología , Tromboembolia Venosa/prevención & control , Adulto JovenRESUMEN
The brain's sensitivity to unexpected outcomes plays a fundamental role in an organism's ability to adapt and learn new behaviors. Emerging research suggests that midbrain dopaminergic neurons encode these unexpected outcomes. We used microelectrode recordings during deep brain stimulation surgery to study neuronal activity in the human substantia nigra (SN) while patients with Parkinson's disease engaged in a probabilistic learning task motivated by virtual financial rewards. Based on a model of the participants' expected reward, we divided trial outcomes into expected and unexpected gains and losses. SN neurons exhibited significantly higher firing rates after unexpected gains than unexpected losses. No such differences were observed after expected gains and losses. This result provides critical support for the hypothesized role of the SN in human reinforcement learning.
Asunto(s)
Retroalimentación Psicológica , Aprendizaje , Neuronas/fisiología , Recompensa , Sustancia Negra/fisiología , Potenciales de Acción , Estimulación Encefálica Profunda , Dopamina/fisiología , Economía , Femenino , Humanos , Masculino , Microelectrodos , Persona de Mediana Edad , Modelos Psicológicos , Enfermedad de Parkinson/fisiopatología , Enfermedad de Parkinson/terapia , Probabilidad , Refuerzo en Psicología , Sustancia Negra/citologíaRESUMEN
OBJECTIVE: Tremor resulting from damage to midbrain structures is poorly understood and often difficult to treat. The authors report a case of cystic degeneration of the brainstem with resultant Holmes-like tremor which was successfully treated using a stimulating electrode placed in the contralateral ventralis intermedius nucleus (VIM) of the thalamus. CLINICAL PRESENTATION: A 31-year-old man presented with a multilobulated, multiseptated lesion of the upper brainstem diagnosed after subacute onset of headaches. The patient subsequently developed an incapacitating left-upper-extremity tremor refractory to medical treatment. INTERVENTION: The patient underwent implantation of a deep brain stimulator in the VIM with symptomatic and functional improvement. CONCLUSIONS: Deep brain stimulation is an effective and safe intervention for tremor of unusual etiology. Electrode placement should be based on an understanding of the structure-function relationships underlying the various and distinct types of tremor.
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Tronco Encefálico/patología , Estimulación Encefálica Profunda , Temblor/cirugía , Temblor/terapia , Núcleos Talámicos Ventrales/cirugía , Adulto , Quistes/complicaciones , Quistes/patología , Humanos , Imagen por Resonancia Magnética , Masculino , Enfermedades Neurodegenerativas/complicaciones , Enfermedades Neurodegenerativas/patología , Temblor/etiologíaRESUMEN
Despite the clinical success of deep brain stimulation (DBS), it remains to be elucidated where within the work process the surgical result could diverge from the surgical plan. We sought to determine this. We implemented a standardized checklist to detect and remediate procedural errors. A consecutive series of 13 patients was studied. Revisions, explantations and thermal lesions were excluded. We tabulated the number and type of errors that could occur when implementing a surgical plan. Errors were categorized as minor or major. The elapsed time was also assessed. A mean of two errors per case were identified: 1.15 major errors/case and 0.85 minor errors per case. The total number of errors identified per case did not change significantly over the course of the series. Time to complete the checklist decreased monotonically from 4 min 5 s to 1 min 10 s. The checklist applied in this scenario is a useful tool to identify and remediate errors during DBS, adding minimal additional operative time and consistently identifying errors.
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Estimulación Encefálica Profunda/normas , Errores Médicos/prevención & control , Trastornos del Movimiento/cirugía , Trastornos del Movimiento/terapia , Neurocirugia/normas , Administración de la Seguridad/métodos , Electrodos Implantados , Estudios de Factibilidad , Humanos , Complicaciones Intraoperatorias/prevención & control , Proyectos Piloto , Factores de TiempoRESUMEN
Obesity is a growing global health problem frequently intractable to current treatment options. Recent evidence suggests that deep brain stimulation (DBS) may be effective and safe in the management of various, refractory neuropsychiatric disorders, including obesity. The authors review the literature implicating various neural regions in the pathophysiology of obesity, as well as the evidence supporting these regions as targets for DBS, in order to explore the therapeutic promise of DBS in obesity. The lateral hypothalamus and ventromedial hypothalamus are the appetite and satiety centers in the brain, respectively. Substantial data support targeting these regions with DBS for the purpose of appetite suppression and weight loss. However, reward sensation associated with highly caloric food has been implicated in overconsumption as well as obesity, and may in part explain the failure rates of conservative management and bariatric surgery. Thus, regions of the brain's reward circuitry, such as the nucleus accumbens, are promising alternatives for DBS in obesity control. The authors conclude that deep brain stimulation should be strongly considered as a promising therapeutic option for patients suffering from refractory obesity.
Asunto(s)
Estimulación Encefálica Profunda , Hipotálamo/fisiología , Núcleo Accumbens/fisiología , Obesidad/fisiopatología , Obesidad/terapia , Animales , Humanos , RecompensaRESUMEN
The placement of deep brain stimulator leads requires a great deal of technology and equipment. We describe our 25-month experience with an integrated platform system, the StimPilot (Medtronic Inc., Minneapolis, MN), for the placement of deep brain stimulator leads. The platform consists of a neuronavigation station, microdrive control, and microelectrode recording display and control. This platform is run from a laptop-sized portable control unit. The unit was used in 147 patients for the placement of 262 leads. Leads were placed into the subthalamic nucleus, ventral intermediate nucleus, globus pallidus interna, and anterior thalamic nucleus. One patient required replacement of one lead during this time frame, with successful reimplantation. No system failures occurred.
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Estimulación Encefálica Profunda/instrumentación , Neuronavegación/instrumentación , Implantación de Prótesis/instrumentación , Robótica/instrumentación , Estimulación Encefálica Profunda/métodos , Diseño de Equipo , Análisis de Falla de Equipo , Neuronavegación/métodos , Implantación de Prótesis/métodos , Robótica/métodos , Integración de SistemasRESUMEN
Microelectrode recording during deep brain stimulation surgery is a useful adjunct for subthalamic nucleus (STN) localization. We hypothesize that information in the nonspike background activity can help identify STN boundaries. We present results from a novel quantitative analysis that accomplishes this goal. Thirteen consecutive microelectrode recordings were retrospectively analyzed. Spikes were removed from the recordings with an automated algorithm. The remaining "despiked" signals were converted via root mean square amplitude and curve length calculations into "feature profile" time series. Subthalamic nucleus boundaries determined by inspection, based on sustained deviations from baseline for each feature profile, were compared against those determined intraoperatively by the clinical neurophysiologist. Feature profile activity within STN exhibited a sustained rise in 10 of 13 tracks (77%). The sensitivity of STN entry was 60% and 90% for curve length and root mean square amplitude, respectively, when agreement within 0.5 mm of the neurophysiologist's prediction was used. Sensitivities were 70% and 100% for 1 mm accuracy. Exit point sensitivities were 80% and 90% for both features within 0.5 mm and 1.0 mm, respectively. Reproducible activity patterns in deep brain stimulation microelectrode recordings can allow accurate identification of STN boundaries. Quantitative analyses of this type may provide useful adjunctive information for electrode placement in deep brain stimulation surgery.