Directional stimulation of subthalamic nucleus sweet spot predicts clinical efficacy: Proof of conceptDirectional deep brain stimulation (dDBS) of the subthalamic nucleus for Parkinson's disease (PD) increases the therapeutic window. However, empirical programming of the neurostimulator becomes more complex given the increasing number of stimulation parameters. A better understanding of dDBS is needed to improve therapy and help guide postoperative programming.
Is awake physiological confirmation necessary for DBS treatment of Parkinson's disease today? A comparison of intraoperative imaging, physiology, and physiology imaging-guided DBS in the past decadeDeep brain stimulation (DBS) is a well-established surgical therapy for Parkinson's disease (PD). Intraoperative imaging (IMG), intraoperative physiology (PHY) and their combination (COMB) are the three mainstream DBS guidance methods.
Dual threshold neural closed loop deep brain stimulation in Parkinson disease patientsClosed loop deep brain stimulation (clDBS) in Parkinson's disease (PD) using subthalamic (STN) neural feedback has been shown to be efficacious only in the acute post-operative setting, using externalized leads and stimulators.
Decreasing battery life in subthalamic deep brain stimulation for Parkinson's disease with repeated replacements: Just a matter of energy delivered?People with Parkinson's disease (PD) treated with deep brain stimulation (DBS) with non-rechargeable implantable pulse generators (IPGs) require elective IPG replacement operations involving surgical and anesthesiologic risk. Life expectancy and the number of replacements per patient with DBS are increasing.
Subthalamic nucleus deep brain stimulation reduces freezing of gait subtypes and patterns in Parkinson's diseaseFreezing of gait (FOG) is a specific gait disorder in Parkinson's Disease (PD). FOG occurs mainly in the medication-off state and usually improves with dopaminergic medication. FOG episodes can be clinically grouped into three patterns (small steps forward, trembling in place, complete akinesia) and five provoking subtypes (starting to walk hesitation, moving in tight quarters hesitation, reaching destination hesitation, turning hesitation, and walking in open space hesitation) . FOG is a debilitating symptom, limiting activities of daily living, leading to falls or fall-related injuries, and diminishing quality of life .
Histopathology after microelectrode recording and twelve years of deep brain stimulationDespite the widespread use of deep brain stimulation (DBS), studies on the histological alterations induced by the DBS electrode remain relatively scarce. Typical findings include fibrous sheaths of 5–25 μm surrounding the electrode track, a chronic inflammation with reactive astrocytes, multinucleated giant cells, macrophages, mononuclear leucocytes and T-lymphocytes, fibrillary gliosis and Rosenthal fibers [1,2].
Subthreshold stochastic vestibular stimulation induces complex multi-planar effects during standing in Parkinson's diseasePostural instability (PI) is a cardinal symptom and major source of morbidity in Parkinson's disease (PD). As current treatments (e.g. levodopa and deep brain stimulation) show mixed results for PI [1,2], alternative treatments are critical. Subthreshold stochastic vestibular stimulation (SVS) has been shown to improve walking and standing stability [3–5], which makes this technique promising for clinical use. In people with PD, SVS improves sway, a marker of postural stability, using both monopolar (SVS-AP)  and bipolar (SVS-ML)  stimulation, which modulate the mediolateral (ML) and anterior/posterior (AP) planes, respectively .
Effect of Repetitive Transcranial Magnetic Stimulation on Physical Function and Motor Signs in Parkinson's Disease: A Systematic Review and Meta-AnalysisThe progressive loss of dopaminergic neurons in Parkinson's disease (PD) results in functional disruption within the cortico-basal ganglia–thalamo-cortical motor circuit [1,2]. In particular, there is an excessive inhibition of thalamocortical projection to various cortical targets, including the primary motor cortex (M1), supplementary motor cortex (SMA) and dorsolateral prefrontal cortex (DLPFC) [2–4]. Abnormal neural activities in these cortical areas were evident in neuroimaging studies that showed hypo-activations of SMA and DLPFC .
Beneficial Effects of Bilateral Subthalamic Stimulation on Non-Motor Symptoms in Parkinson's DiseaseSubthalamic nucleus (STN) deep brain stimulation (DBS) is well established for the symptomatic treatment of Parkinson's disease (PD) improving motor symptoms, activities of daily living (ADL), and quality of life (QoL) [1–3]. Non-motor symptoms (NMS) play a crucial role for QoL in patients with PD [4,5]. Long-term effects of DBS on neuropsychological [6,7] and neuropsychiatric symptoms [8,9] have been studied. However, these symptoms contribute only to a part of NMS in patients with PD. Previously published studies on a wider range of NMS have methodological limitations due to a lack of objective clinician-based , patient-based [11,12] or any validated assessment at all , and small cohort sizes of only 10 [13,14] or 11 subjects followed up on 6 month .
Machine Learning Approach to Optimizing Combined Stimulation and Medication Therapies for Parkinson's DiseaseDeep brain stimulation (DBS) of the subthalamic region is an established therapy for advanced Parkinson's disease (PD). However, patients often require time-intensive post-operative management to balance their coupled stimulation and medication treatments. Given the large and complex parameter space associated with this task, we propose that clinical decision support systems (CDSS) based on machine learning algorithms could assist in treatment optimization.
Effects of Stochastic Vestibular Galvanic Stimulation and LDOPA on Balance and Motor Symptoms in Patients With Parkinson's DiseaseBalance problems contribute to reduced quality of life in Parkinson's disease (PD) and available treatments are often insufficient for treating axial and postural motor symptoms.
TMS Enhances Retention of a Motor Skill in Parkinson's DiseaseIn Parkinson's disease (PD), skill retention is poor, even when acquisition rate is generally preserved. Recent work in normal subjects suggests that 5 Hz-repetitive transcranial magnetic stimulation (5Hz-rTMS) may induce phenomena of long-term potentiation at the cortical level.
Effects of Pedunculopontine Area and Pallidal DBS on Gait Ignition in Parkinson's DiseaseFreezing of gait is a disabling feature of Parkinson's disease, and so far no established treatment exists. Deep brain stimulation of the pedunculopontine area has been proposed to treat refractory gait disorders, yet data on measurable effects, especially in combination with stimulation of other targets, are scarce.
High-Frequency Repetitive Transcranial Magnetic Stimulation over the Primary Foot Motor Area in Parkinson's DiseaseRepetitive transcranial magnetic stimulation (rTMS) has been reported to be clinically effective for treating motor symptoms in Parkinson's disease (PD). Few studies have been performed reporting the effects of rTMS on non-motor symptoms such as depression and apathy in PD.
Parieto-motor functional connectivity is impaired in Parkinson's diseaseBradykinesia in Parkinson's disease is associated with a difficulty in selecting and executing motor actions, likely due to alterations in the functional connectivity of cortico-cortical circuits.
Modulation of verbal fluency networks by transcranial direct current stimulation (tDCS) in Parkinson’s diseaseVerbal fluency relies on the coordinated activity between left frontal and temporal areas. Patients with Parkinson’s disease (PD) present phonemic and semantic fluency deficits. Recent studies suggest that transcranial direct current stimulation (tDCS) enhances adaptative patterns of brain activity between functionally connected areas.