Deep brain stimulation and bowstringing: Case report and pathological correlation

Herschman, Yehuda; Fellig, Yakov; Israel, Zvi

doi:10.1016/j.inat.2019.04.003

Cited by 7 publications

(6 citation statements)

References 10 publications

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“…Cheung et al reported one serious adverse effect in a patient who attempted suicide, which was felt to be unrelated to DBS as the subject had been off stimulation for 2 months prior to the event [19]. All six patients in the Cheung et al trial [19] experienced transiently worsening tinnitus, six had post-op incisional pain, four experienced post-op headache, three reported a pulling sensation at the internal pulse generator (IPG) site (bowstringing) [28], two experienced facial/neck tingling and lightheadedness/dizziness, two reported post-operative fatigue and sleep disturbances, two had worsened depression, and there was one report each of increased energy, post-operative nausea, and visual phantoms (Table 2). According to the authors, all of the reported adverse effects were temporary, with the exception of elevated electrode impedances in one participant [19].…”

Section: Side/adverse Effectsmentioning

confidence: 99%

Deep Brain Stimulation for Primary Refractory Tinnitus: A Systematic Review

Basner,

Smit,

Zeitler

et al. 2024

Brain Sciences

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Background: tinnitus is a common and often debilitating condition with limited evidence-based treatment options. Deep brain stimulation (DBS) is an approved treatment modality for certain neurological conditions; its experimental use as a treatment modality for severe tinnitus is novel and beginning to show promise. This systematic review focuses on the current evidence for the safety and efficacy of DBS for treatment of refractory tinnitus. Methods: a systematic search in PubMed and EMBASE was performed to identify peer-reviewed studies on DBS of non-cortical structures for the primary indication of tinnitus treatment. Three studies were identified as meeting these criteria, one of which had two related sub-studies. Results: seven patients with available data who underwent DBS for tinnitus were identified. DBS targets included nucleus accumbens (NAc), ventral anterior limb of the internal capsule (vALIC), caudate nucleus, and the medial geniculate body (MGB) of the thalamus. All studies used the Tinnitus Functional Index (TFI) as a primary outcome measure. DBS of the caudate was most commonly reported (n = 5), with a mean TFI improvement of 23.3 points. Only one subject underwent DBS targeting the NAc/vALIC (extrapolated TFI improvement 46.8) and one subject underwent DBS targeting the MGB (TFI improvement 59 points). Conclusions: DBS is a promising treatment option for refractory subjective tinnitus, with early data, from small patient cohorts in multiple studies, suggesting its safety and efficacy. Further studies with a larger patient population are needed to support this safety and efficacy before implementing this treatment to daily practice.

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Section: Side/adverse Effectsmentioning

confidence: 99%

Deep Brain Stimulation for Primary Refractory Tinnitus: A Systematic Review

Basner,

Smit,

Zeitler

et al. 2024

Brain Sciences

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“…Motion-based states of interest include tremor (oscillations), general activity, gait and freezing, absolute posture, falls, and transient shocks. The detection of these motion states can then be applied by researchers exploring improved therapies for postural and gait instability in Parkinson's disease [30], transient stress events in mixed incontinence [31], posture effects such as orthostatic hypertension [32], and titration of stimulation through circadian (sleep-wake) cycles [33]. In addition to automated stimulation titration, inertial sensing also provides diagnostic information on patient activity without an added instrument burden on the user.…”

Section: User Needs: the Mental Model For Operation And Preservation Of Existing Actuationmentioning

confidence: 99%

“…The surgical procedure for device placement has some similarities to cochlear implant devices, and the infection risk might potentially be lowered compared to existing DBS procedures [24]. Most notably, the cranial-mounting avoids tunnelling leads through the neck, that could reduce the risk of lead wire breakage or fibrosis in the surrounding tissue, a potential cause of stiffness and pain [25]. The Picostim firmware and software can also be modified to enable novel adaptive algorithms, including time- and inertial-based inputs, which supports its utility as a flexible therapy research tool [26, 27].…”

Section: Introductionmentioning

confidence: 99%

DyNeuMo Mk-1: Design and Pilot Validation of an Investigational Motion-Adaptive Neurostimulator with Integrated Chronotherapy

Zamora

Toth

Morgante

et al. 2020

Preprint

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There is growing interest in using adaptive neuro-modulation to provide a more personalized therapy experience that might improve patient outcomes. This paper describes the design of the ‘DyNeuMo Mk-1’, a fully-implantable, motion-adaptive research stimulator that titrates stimulation based on the patient’s movement state (e.g. posture, activity, shock, free-fall). The design leverages off-the-shelf consumer technology that provides inertial sensing with low-power, high reliability and modest cost. We used a three-axis accelerometer and its embedded digital motion processor to enable real-time stimulation adaption based on configurable motion parameters. The algorithm configurability and expanded stimulation parameter space allows for a number of applications to be explored in both central and peripheral applications. The implantable system was designed, prototyped and verified using ISO 13485 design controls, including ISO 14971 risk management techniques to ensure patient safety, while enabling novel algorithms. With the design controls in place, first-in-human research trials are now being prepared to explore the utility of automated motion-adaptive algorithms. The design highlights how consumer electronics technology can be leveraged for efficient and reliable medical device development. The implantable system automatically provides activity- and posture-based responsive stimulation which can be configured by the clinician to optimize therapy. Intended applications include adaptive stimulation for movement disorders, synchronizing stimulation with circadian patterns, and reacting to transient inertial events such as shocks for urinary incontinence.

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“…(B) Schematic illustration of conventional electrode-induced vessel damage (top) and optical image of the tensioned vessel, called “bowstringing”, of a patient (bottom). Reproduced with permission from ref . Copyright 2019 Elsevier.…”

Section: Introductionmentioning

confidence: 99%

“…Because of immune response, nonfunctional glial cells and astrocytes are recruited around the implant, eventually interfering with the brain–electrode interfacing. Furthermore, bulky and stiff wire electrode can exacerbate constant abrasion and damage to the soft interior wall of blood vessels, − leading to thrombosis − and stenosis − (Figure B). The implantation of rigid devices on moving organs such as heart , can lead to endocardial fibrosis, which lowers systolic contraction, and even perforation on the wall of myocardium − (Figure C).…”

Section: Introductionmentioning

confidence: 99%

Soft Bioelectronics Based on Nanomaterials

et al. 2021

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Recent advances in nanostructured materials and unconventional device designs have transformed the bioelectronics from a rigid and bulky form into a soft and ultrathin form and brought enormous advantages to the bioelectronics. For example, mechanical deformability of the soft bioelectronics and thus its conformal contact onto soft curved organs such as brain, heart, and skin have allowed researchers to measure high-quality biosignals, deliver real-time feedback treatments, and lower long-term side-effects in vivo. Here, we review various materials, fabrication methods, and device strategies for flexible and stretchable electronics, especially focusing on soft biointegrated electronics using nanomaterials and their composites. First, we summarize top-down material processing and bottom-up synthesis methods of various nanomaterials. Next, we discuss state-of-the-art technologies for intrinsically stretchable nanocomposites composed of nanostructured materials incorporated in elastomers or hydrogels. We also briefly discuss unconventional device design strategies for soft bioelectronics. Then individual device components for soft bioelectronics, such as biosensing, data storage, display, therapeutic stimulation, and power supply devices, are introduced. Afterward, representative application examples of the soft bioelectronics are described. A brief summary with a discussion on remaining challenges concludes the review.

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Deep brain stimulation and bowstringing: Case report and pathological correlation

Cited by 7 publications

References 10 publications

Deep Brain Stimulation for Primary Refractory Tinnitus: A Systematic Review

Deep Brain Stimulation for Primary Refractory Tinnitus: A Systematic Review

DyNeuMo Mk-1: Design and Pilot Validation of an Investigational Motion-Adaptive Neurostimulator with Integrated Chronotherapy

Soft Bioelectronics Based on Nanomaterials

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