Tourette’s syndrome: improvement after DBS of the GPe

Behavioral and motor improvement after deep brain stimulation of the globus pallidus externus in a case of Tourette’s syndrome.
Neuromodulation. 2013 Jan-Feb;16(1):55-8; discussion 58.
Piedimonte F, et al.
http://www.ncbi.nlm.nih.gov/pubmed/23240689

OBJECTIVES:
The objective of our paper is to show the partial decrease of therapeutic effect with battery exhaustion in a previously successfully treated patient with refractory Tourette’s syndrome (TS).

MATERIALS AND METHODS:
We present a 47-year-old patient diagnosed with TS based on the TS Study Group Criteria and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Surgery was considered based on refractoriness to conservative management. Presurgical evaluation included magnetic resonance imaging (MRI), positron emission tomography scan, and neuropsychologic, neurologic, and psychiatric tests utilizing Yale Brown Obsessive Compulsive Scale, Yale Global Tics Severity Scale, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Global Assessment of Functioning Scale, and Mini-mental State Examination. Target coordinates were obtained from inversion recovery MRI. Quadripolar deep brain stimulation (DBS) electrodes were implanted bilaterally in the globus pallidus externus (GPe) and connected to the pulse generator in the same procedure. To determine the clinical response to DBS, the scores of the scales obtained preoperatively were compared with those obtained postoperatively.

RESULTS:
No surgical complications were detected and according to the clinical scales the patient experienced a marked improvement of his symptoms, although he never showed obsessive-compulsive disorder components of any type. The battery was exhausted after two years with the subsequent significant partial loss of therapeutic effect.

CONCLUSIONS:
GPe seems to be a highly promising target of DBS for the treatment of medically refractory TS. After battery exhaustion, the patient experienced a marked partial decrease in the therapeutic effect, which confirms the beneficial action of this method.

related:
Contrasting changes in cortical activation induced by acute high-frequency stimulation within the globus pallidus in Parkinson’s disease
Journal of Cerebral Blood Flow & Metabolism (2009) 29, 235–243
http://www.nature.com/jcbfm/journal/v29/n2/full/jcbfm2008107a.html

DBS for OCD affects language

Deep brain stimulation for obsessive-compulsive disorder affects language: a case report.
Neurosurgery. 2013 Nov;73(5):E907-10
Polak AR, et al.
http://www.ncbi.nlm.nih.gov/pubmed/23756741

BACKGROUND AND IMPORTANCE:
Deep brain stimulation (DBS) is an effective treatment for patients with refractory neuropsychiatric disorders. Along with symptom improvement, DBS may have concurrent behavioral effects that help to unravel the role of specific brain circuitries in complex human behavior.

CLINICAL PRESENTATION:
This article reports on 2 patients with obsessive-compulsive disorder who received DBS targeted at the nucleus accumbens that resulted in a temporary change of accent and use of vocabulary.

CONCLUSION:
Changes in accent and speaking manners are most likely related to direct DBS stimulation effects of the electrode targeted at the nucleus accumbens.
The shift in accent, resembling foreign accent syndrome after injuries in brain language centers, has not been reported before in the course of DBS.
Induction of aggressive vocabulary may be related to transient hypomanic behavior after DBS.

see also:
https://franzcalvo.wordpress.com/2013/12/22/foreign-accent-syndrome

Deep brain stimulation in Parkinson disease.

Adaptive deep brain stimulation in advanced Parkinson disease.
Ann Neurol. 2013 Sep;74(3):449-57.
http://www.ncbi.nlm.nih.gov/pubmed/23852650
Little S, et al.
Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford.

OBJECTIVE:
Brain-computer interfaces (BCIs) could potentially be used to interact with pathological brain signals to intervene and ameliorate their effects in disease states. Here, we provide proof-of-principle of this approach by using a BCI to interpret pathological brain activity in patients with advanced Parkinson disease (PD) and to use this feedback to control when therapeutic deep brain stimulation (DBS) is delivered. Our goal was to demonstrate that by personalizing and optimizing stimulation in real time, we could improve on both the efficacy and efficiency of conventional continuous DBS.

METHODS:
We tested BCI-controlled adaptive DBS (aDBS) of the subthalamic nucleus in 8 PD patients. Feedback was provided by processing of the local field potentials recorded directly from the stimulation electrodes. The results were compared to no stimulation, conventional continuous stimulation (cDBS), and random intermittent stimulation. Both unblinded and blinded clinical assessments of motor effect were performed using the Unified Parkinson’s Disease Rating Scale.

RESULTS:
Motor scores improved by 66% (unblinded) and 50% (blinded) during aDBS, which were 29% (p = 0.03) and 27% (p = 0.005) better than cDBS, respectively. These improvements were achieved with a 56% reduction in stimulation time compared to cDBS, and a corresponding reduction in energy requirements (p < 0.001). aDBS was also more effective than no stimulation and random intermittent stimulation.

INTERPRETATION:
BCI-controlled DBS is tractable and can be more efficient and efficacious than conventional continuous neuromodulation for PD.

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A Novel Brain-Computer Interface Approach to Deep Brain Stimulation for Parkinson’s Disease
October 31, 2013
S. Andrew Josephson, M.D.
Department of Neurology, UCSF, San Francisco, USA
http://www.accessmedicine.com/updatesContent.aspx?aid=1002060
Related To:  Chapter 372. Parkinson’s Disease and Other Movement Disorders

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Deep brain stimulation hinders Parkinson’s for ten years and counting
08 Aug 2011
http://blogs.nature.com/spoonful/2011/08/deep_brain_stimulation_hinders.html

The effects of DBS on the motor symptoms of Parkinson’s Disease

The effects of DBS on the motor symptoms of Parkinson’s Disease
Jun 12, 2013
http://www.youtube.com/watch?v=uBh2LxTW0s0
Andrew was diagnosed with Early Onset Parkinson’s Disease in 2009 when he was 35 years old.
He lives with his wife and two children in Auckland, New Zealand. In November 2012 and February 2013 he underwent a surgical procedure, Deep Brain Stimulation surgery, to help control his motor symptoms.
This has been hugely beneficial to his quality of life. He is the author of a blog youngandshaky.com which he created to raise awareness of the effects of Parkinson’s Disease. This is his experience of how DBS has helped him and in the usual manner, results may vary.

The Man With A ‘Battery Operated Brain’
by Robert Krulwich
June 25, 2013
http://www.npr.org/blogs/krulwich/2013/06/25/195521917/the-man-with-a-battery-operated-brain

http://youngandshaky.com

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Neurology – Topic 14 – Parkinsons disease – examining a patient
UCD Medicine