Browsing by Subject "Deep brain stimulation (DBS)"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Effects of electrical and optogenetic deep brain stimulation on synchronized oscillatory activity in Parkinsonian basal ganglia
    (Office of the Vice Chancellor for Research, 2016-04-08) Ratnadurai-Giridharan, Shivakeshavan; Cheung, Chung C.; Rubchinsky, Leonid L.
    Objective. Deep brain stimulation (DBS) of basal ganglia targets with high-frequency regular electrical pulses is used to treat Parkinsonian motor symptoms. In spite of positive treatment effects, it has a series of limitations. In contrast, optogenetic stimulation, a new but fast growing area, is not yet at a point of clinical testing. Nevertheless, it emerges as an alternative experimental stimulation technique to affect pathological network dynamics, which may be responsible for motor symptoms. This paper compares the effects of electrical and optogenetic stimulation of the basal ganglia on the pathological parkinsonian rhythmic neural activity. Approach. We utilized a conductance-based model of the subthalamo-pallidal circuitry, which reproduces experimentally-observed patterns of neural activity in Parkinson’s disease, and consider the network response to electrical stimulation, excitatory optogenetic stimulation, and inhibitory optogenetic stimulation. Main Results. We found that different simulation types exhibit different interactions with pathological rhythmic activity in the network. We study these interactions for different network and stimulation parameter values. We show that, in the considered model, optogenetic stimulation may be more efficient in suppressing beta oscillations than electrical stimulation. Significance. These results indicate that optogenetic control may be more efficacious than electrical control of a network’s dynamics because of the different ways of how stimulations interact with network dynamics.
  • Thumbnail Image
    Item
    Efficacy and Safety of Deep Brain Stimulation in Tourette Syndrome: The International Tourette Syndrome Deep Brain Stimulation Public Database and Registry
    (American Medical Association, 2018-03-01) Martinez-Ramirez, Daniel; Jimenez-Shahed, Joohi; Leckman, James Frederick; Porta, Mauro; Servello, Domenico; Meng, Fan-Gang; Kuhn, Jens; Huys, Daniel; Baldermann, Juan Carlos; Foltynie, Thomas; Hariz, Marwan I.; Joyce, Eileen M.; Zrinzo, Ludvic; Kefalopoulou, Zinovia; Silburn, Peter; Coyne, Terry; Mogilner, Alon Y.; Pourfar, Michael H.; Khandhar, Suketu M.; Auyeung, Man; Ostrem, Jill Louise; Visser-Vandewalle, Veerle; Welter, Marie-Laure; Mallet, Luc; Karachi, Carine; Houeto, Jean Luc; Klassen, Bryan Timothy; Ackermans, Linda; Kaido, Takanobu; Temel, Yasin; Gross, Robert E.; Walker, Harrison C.; Lozano, Andres M.; Walter, Benjamin L.; Mari, Zoltan; Anderson, William S.; Changizi, Barbara Kelly; Moro, Elena; Zauber, Sarah Elizabeth; Schrock, Lauren E.; Zhang, Jian-Guo; Hu, Wei; Rizer, Kyle; Monari, Erin H.; Foote, Kelly D.; Malaty, Irene A.; Deeb, Wissam; Gunduz, Aysegul; Okun, Michael S.; Neurology, School of Medicine
    Importance: Collective evidence has strongly suggested that deep brain stimulation (DBS) is a promising therapy for Tourette syndrome. Objective: To assess the efficacy and safety of DBS in a multinational cohort of patients with Tourette syndrome. Design, Setting, and Participants: The prospective International Deep Brain Stimulation Database and Registry included 185 patients with medically refractory Tourette syndrome who underwent DBS implantation from January 1, 2012, to December 31, 2016, at 31 institutions in 10 countries worldwide. Exposures: Patients with medically refractory symptoms received DBS implantation in the centromedian thalamic region (93 of 163 [57.1%]), the anterior globus pallidus internus (41 of 163 [25.2%]), the posterior globus pallidus internus (25 of 163 [15.3%]), and the anterior limb of the internal capsule (4 of 163 [2.5%]). Main Outcomes and Measures: Scores on the Yale Global Tic Severity Scale and adverse events. Results: The International Deep Brain Stimulation Database and Registry enrolled 185 patients (of 171 with available data, 37 females and 134 males; mean [SD] age at surgery, 29.1 [10.8] years [range, 13-58 years]). Symptoms of obsessive-compulsive disorder were present in 97 of 151 patients (64.2%) and 32 of 148 (21.6%) had a history of self-injurious behavior. The mean (SD) total Yale Global Tic Severity Scale score improved from 75.01 (18.36) at baseline to 41.19 (20.00) at 1 year after DBS implantation (P < .001). The mean (SD) motor tic subscore improved from 21.00 (3.72) at baseline to 12.91 (5.78) after 1 year (P < .001), and the mean (SD) phonic tic subscore improved from 16.82 (6.56) at baseline to 9.63 (6.99) at 1 year (P < .001). The overall adverse event rate was 35.4% (56 of 158 patients), with intracranial hemorrhage occurring in 2 patients (1.3%), infection in 4 patients with 5 events (3.2%), and lead explantation in 1 patient (0.6%). The most common stimulation-induced adverse effects were dysarthria (10 [6.3%]) and paresthesia (13 [8.2%]). Conclusions and Relevance: Deep brain stimulation was associated with symptomatic improvement in patients with Tourette syndrome but also with important adverse events. A publicly available website on outcomes of DBS in patients with Tourette syndrome has been provided.