Performing functional magnetic resonance imaging in patients with Parkinson's disease treated with deep brain stimulation

Arantes, Paula Ricci; Cardoso, Ellison Fernando; Barreiros, Maria Angela M.; Teixeira, Manoel Jacobsen; Gonçalves, Mauro; Barbosa, Egberto Reis; Sukwinder, Sukhi Shergill; Leite, Cláudia da Costa; Amaro, Edson

doi:10.1002/mds.20912

Cited by 49 publications

(29 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies in STN-DBS patients using functional MRI (fMRI) are limited because of safety concerns and imaging artifacts (99, 100). Nonetheless, recent MR studies performed under specific experimental conditions with resting state and task-based fMRI have shown interesting results.…”

Section: Network Effects Of Dbsmentioning

confidence: 99%

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

et al. 2018

View full text Add to dashboard Cite

L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.

show abstract

Section: Network Effects Of Dbsmentioning

confidence: 99%

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Consequently, fMRI is ideally suited to individual subject analysis, and direct comparison of experimental data with patient-specific DBS computer models (McIntyre et al, 2008). However, due to safety concerns the number of DBS fMRI studies has been limited (Rezai et al, 1999; Jech et al, 2001; Stefurak et al, 2003; Arantes et al, 2006; Phillips et al, 2006). The general consensus from the available fMRI studies is that STN DBS generates activation throughout the network, with activation of the globus pallidus and thalamus being common across most patients.…”

Section: Functional Imagingmentioning

confidence: 99%

Network perspectives on the mechanisms of deep brain stimulation

McIntyre

Hahn

2010

Neurobiology of Disease

415

274

View full text Add to dashboard Cite

Deep brain stimulation (DBS) is an established medical therapy for the treatment of movement disorders and shows great promise for several other neurological disorders. However, after decades of clinical utility the underlying therapeutic mechanisms remain undefined. Early attempts to explain the mechanisms of DBS focused on hypotheses that mimicked an ablative lesion to the stimulated brain region. More recent scientific efforts have explored the wide-spread changes in neural activity generated throughout the stimulated brain network. In turn, new theories on the mechanisms of DBS have taken a systems-level approach to begin to decipher the network activity. This review provides an introduction to some of the network based theories on the function and pathophysiology of the cortico-basal-ganglia-thalamo-cortical loops commonly targeted by DBS. We then analyze some recent results on the effects of DBS on these networks, with a focus on subthalamic DBS for the treatment of Parkinson's disease. Finally we attempt to summarize how DBS could be achieving its therapeutic effects by overriding pathological network activity.

show abstract

“…In contrast to the popularity of PET/SPECT studies, to date functional magnetic resonance imaging (fMRI) studies performed with active DBS have been limited in number and particularly in the numbers of subjects studied (Rezai 1999, Jech 2001, Stefurak 2003, Hesselmann 2004, Arantes 2006, Phillips 2006. This is despite the potential advantages of fMRI as compared to PET (wider availability, improved spatial and temporal resolution, and absence of radioactive pharmaceuticals) and is largely a consequence of concerns regarding the safety of both MRI in the presence of metallic implants , and the possible effects of the MRI scanner electromagnetic fields upon IPG function.…”

Section: Deep Brain Stimulation (Dbs) Effected Using Implantable Neurmentioning

confidence: 99%

Functional MRI with active, fully implanted, deep brain stimulation systems: Safety and experimental confounds

Carmichael¹,

Pinto²,

Limousin-Dowsey³

et al. 2007

NeuroImage

102

View full text Add to dashboard Cite

We investigated safety issues and potential experimental confounds when performing functional magnetic resonance imaging (fMRI) investigations in human subjects with fully implanted, active, deep brain stimulation (DBS) systems. Measurements of temperature and induced voltage were performed in an in vitro arrangement simulating bilateral DBS during magnetic resonance imaging (MRI) using head transmit coils in both 1.5 and 3.0T MRI systems. For MRI sequences typical of an fMRI study with coil-averaged specific absorption rates (SARs) less than 0.4 W/Kg, no MRI-induced temperature change greater than the measurement sensitivity (0.1ºC) was detected at 1.5T, and at 3T temperature elevations were less than 0.5ºC, i.e. within safe limits. For the purposes of demonstration, MRI pulse sequences with SARs of 1.45 W/Kg and 2.34 W/kg (at 1.5T and 3T respectively) were prescribed and elicited temperature increases (>1ºC) greater than those considered safe for human subjects. Temperature increases were independent of the presence or absence of active stimulator pulsing. At both field strengths during echo planar MRI the perturbations of DBS equipment performance were sufficiently slight, and temperature increases sufficiently low to suggest that thermal or electromagnetically mediated experimental confounds to fMRI with DBS are unlikely. We conclude that fMRI studies performed in subjects with subcutaneously implanted DBS units can be both safe and free from DBS-specific experimental confounds. Furthermore, fMRI in subjects with fully-implanted rather than externalised DBS stimulator units may offer a significant safety advantage. Further studies are required to determine the safety of MRI with DBS for other MRI systems, transmit-coil configurations and DBS arrangements.3

show abstract

Performing functional magnetic resonance imaging in patients with Parkinson's disease treated with deep brain stimulation

Cited by 49 publications

References 32 publications

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease

Network perspectives on the mechanisms of deep brain stimulation

Functional MRI with active, fully implanted, deep brain stimulation systems: Safety and experimental confounds

Contact Info

Product

Resources

About