Neuromodulation : journal of the International Neuromodulation Society
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Ventralis intermedius thalamic deep brain stimulation (VIM DBS) has shown to be safe and effective for medically refractory essential tremor (ET). We evaluate the use of quantitative tremor measurement methods for head tremor in ET using a "smart" hat and a smartphone application. ⋯ Our results show that Lift Pulse and modified Nizet are both effective techniques to quantitatively measure head and arm tremor severity. We also show the utility of a "smart" hat to measure head tremor. Modified Nizet technique is more effective for measuring head tremor, while Lift Pulse is an effective measure of tremor severity, especially arm tremor improvement.
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The aim of this study was to evaluate the degree of brain tissue injury that could be potentially induced by the introduction of a) microrecording electrodes, b) macrostimulation electrodes, or c) chronic stimulation electrodes. We aimed to evaluate whether the use of five simultaneous microrecording tracks is associated with any brain injury not detectable by conventional imaging such as CT or MRI. ⋯ These results strongly indicate that the insertion of either multiple recording electrodes or the implantation of chronic electrodes in DBS does not increase the risk of brain hemorrhage or of other intracranial complications, and furthermore it does not cause any biochemically detectable brain tissue damage.
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High frequency stimulation (HFS) of the subthalamic nucleus (STN) is a well-established therapy for Parkinson's disease (PD), particularly the cardinal motor symptoms and levodopa induced motor complications. Recent studies have suggested the possible role of 60 Hz stimulation in STN-deep brain stimulation (DBS) for patients with gait disorder. The objective of this study was to develop a computational model, which stratifies patients a priori based on symptomatology into different frequency settings (i.e., high frequency or 60 Hz). ⋯ Computational models were developed using preoperative clinical indicators in PD patients treated with STN-DBS. These models were able to accurately stratify PD patients into 60 Hz stimulation or HFS (130-185 Hz) groups a priori, offering a unique potential to enhance the utilization of this therapy based on clinical subtypes.
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In deep brain stimulation (DBS) of the subthalamic nucleus for treatment of Parkinson's Disease, a commonly encountered stimulation side effect is involuntary muscle contractions from spread of electrical current to cortico-spinal and cortico-bulbar fibers in the internal capsule. During surgery, a variety of techniques, including microelectrode recording (MER), are used to avoid positioning the DBS electrode too close to the internal capsule. At some centers, MER includes stimulating through the microelectrode (microstimulation). ⋯ intraoperative microstimulation can help avoid positioning the DBS electrode too close to the internal capsule.
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Deep brain stimulation (DBS) is a well-recognized treatment for patients with movement disorders and other neurological diseases. The implantable pulse generator (IPG) is a fundamental component of the DBS system. Although IPG implantation and replacement surgeries are comparatively minor procedures relative to the brain lead insertion, patients often require multiple IPG replacements during their lifetime with each operation carrying a small but possibly cumulative risk of complications. To better educate our patients and improve surgical outcomes, we reviewed our series of patients at our institution. ⋯ We did not find increasing rates of infection with subsequent IPG replacement procedures.