Cerebral Tissue Response to Electrode Implantation

Rf, Dodson; Chu, Leung Wing; Ishihara, Naoki

doi:10.1017/s0317167100024240

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…As expected, the UPDRS-III decline in the early postoperative phase correlated inversely with the grade of subcortical but not cortical oedema. The histopathological picture of collateral oedema near the electrode [33] suggests similar mechanisms similar to common traumatic brain oedema [55]. Damaged neurons show axonal swelling with subsequent dieback of distal segment accompanied by proximal swelling developing within 48 hours after injury [56].…”

Section: Discussionmentioning

confidence: 88%

“…Unlike previous studies, we explored the microlesion phenomenon while using an active motor task involving finger tapping well known from the Unified Parkinson's Disease Rating Scale (UPDRS-III). We hypothesized that apart from neuronal loss caused by electrode insertion, clinical consequences would also arise from a collateral oedema developing around the electrode [3], [33], [34]. Therefore, we introduced simple scales for quantifying the extent of cortical and subcortical oedema to compare it with the postoperative changes in the UPDRS-III and fMRI.…”

Section: Introductionmentioning

confidence: 99%

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The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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Electrode implantation into the subthalamic nucleus for deep brain stimulation in Parkinson's disease (PD) is associated with a temporary motor improvement occurring prior to neurostimulation. We studied this phenomenon by functional magnetic resonance imaging (fMRI) when considering the Unified Parkinson's Disease Rating Scale (UPDRS-III) and collateral oedema. Twelve patients with PD (age 55.9± (SD)6.8 years, PD duration 9–15 years) underwent bilateral electrode implantation into the subthalamic nucleus. The fMRI was carried out after an overnight withdrawal of levodopa (OFF condition): (i) before and (ii) within three days after surgery in absence of neurostimulation. The motor task involved visually triggered finger tapping. The OFF/UPDRS-III score dropped from 33.8±8.7 before to 23.3±4.8 after the surgery (p<0.001), correlating with the postoperative oedema score (p<0.05). During the motor task, bilateral activation of the thalamus and basal ganglia, motor cortex and insula were preoperatively higher than after surgery (p<0.001). The results became more enhanced after compensation for the oedema and UPDRS-III scores. In addition, the rigidity and axial symptoms score correlated inversely with activation of the putamen and globus pallidus (p<0.0001). One month later, the OFF/UPDRS-III score had returned to the preoperative level (35.8±7.0, p = 0.4).In conclusion, motor improvement induced by insertion of an inactive electrode into the subthalamic nucleus caused an acute microlesion which was at least partially related to the collateral oedema and associated with extensive impact on the motor network. This was postoperatively manifested as lowered movement-related activation at the cortical and subcortical levels and differed from the known effects of neurostimulation or levodopa. The motor system finally adapted to the microlesion within one month as suggested by loss of motor improvement and good efficacy of deep brain stimulation.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

et al. 2012

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“…Laboratory studies have also addressed issues of biocompatibility of electrodes used for stimulation [15][16][17][18] and have expressed concerns about reactions to foreign objects and potential chemical reactions such as electrolysis. Increased scarring around electrodes has been attributed to the need to increase stimulation in some patients.…”

Section: Discussionmentioning

confidence: 99%

“…Animal studies, though, have shown only minor changes consistent with fibrillary gliosis that are comparable to human responses. In one study in which a platinum electrode was implanted for 8 days into subcortical tissue, hemorrhagic lesions and edematous tissue alterations were found within 200-350 Ìm of the electrode and were more pronounced in the subcortical white matter [16]. Electrode penetration itself is likely to cause some tissue injury by breaching the blood-brain barrier [3].…”

Section: Discussionmentioning

confidence: 99%

Asymptomatic Transient MRI Signal Changes after Unilateral Deep Brain Stimulation Electrode Implantation for Movement Disorder

Ryu

Romanelli

Heit

2004

Stereotact Funct Neurosurg

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Deep brain stimulation (DBS) is an accepted treatment of movement disorders, but little research on tissue changes induced by these devices has been made. We report findings of MRI signal changes in patients with unilateral DBS implantation and no clinically detectable symptoms. A retrospective review of preoperative stereotactic MRI scans for staged placement of second-side DBS was performed in 38 patients to assess the frequency of signal changes along the previously implanted DBS track. No abnormal signal changes were noted in 23 patients (61%). Increased subcortical signals on T₂-weighted fast spin echo MRI sequences along the DBS track were noted in 15 patients (39%) and varied from circumferential hyperintensity along the electrode track to significant involvement of the subcortical white matter. The changes were only detected in scans performed within 3 months of DBS implantation (15 of 27 patients). Despite these changes, the patients were totally asymptomatic. The etiology of the changes is unknown but may reflect a transient tissue response to the implantation of the electrode.

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A correlative anatomical and clinical study of pain suppression by deep brain stimulation

Boivie

Meyerson

1982

Pain

103

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The clinical results of electrical stimulation in medial thalamic regions for cancer pain have been correlated with the exact location of the stimulation sites. Five brains were examined by post-mortem histology. Chronic implantation of enamel coated platinum-iridium electrodes for up to 17 months caused relatively mild glial and neuronal reactions and no significant haemorrhage or infarction. The anatomical verifications showed that the electrodes were close to, but not exactly in, the regions defined by the stereotactic coordinates. From the clinico-anatomical correlations it appears that good pain relief can be obtained by electrical stimulation in the periventricular gray region of the posterior thalamus.

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Cerebral Tissue Response to Electrode Implantation

Cited by 7 publications

References 12 publications

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

The Subthalamic Microlesion Story in Parkinson's Disease: Electrode Insertion-Related Motor Improvement with Relative Cortico-Subcortical Hypoactivation in fMRI

Asymptomatic Transient MRI Signal Changes after Unilateral Deep Brain Stimulation Electrode Implantation for Movement Disorder

A correlative anatomical and clinical study of pain suppression by deep brain stimulation

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