Two-year Follow-up of Chronic Stimulation of the Posterior Subthalamic White Matter for Tremor-dominant Parkinson's Disease

Kitagawa, Mayumi; Murata, Junko; Uesugi, Haruo; Kikuchi, Seiji; Saito, Hisatoshi; Tashiro, Kunio; Sawamura, Yutaka

doi:10.1227/01.neu.0000148167.49105.a3

Cited by 123 publications

(84 citation statements)

References 24 publications

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“…While our patient-specific model system suffers from a number of limitations, the comparisons with our clinical measurements are consistent with previous studies on location of therapeutically effective electrode contacts (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). The results of this study, though limited to a single patient, suggest that the therapeutic volume of tissue to activate is centered on ZI/H2 (Fig.…”

Section: Discussionsupporting

confidence: 89%

“…These studies have resulted in general guidelines on the selection of stimulation parameters, as well as clinical algorithms for programming the devices. Imaging studies have developed correlations between stimulation parameters and markers of brain activity (Hershey et al, 2003;Haslinger et al, 2005;Phillips et al, 2006;Trost et al, 2006), and identified the location of therapeutic DBS electrode contacts (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). Modeling studies have characterized the theoretical effects of DBS electric fields on the underlying neural tissue (McIntyre et al, 2004b;Miocinovic et al, 2006b).…”

Section: Discussionmentioning

confidence: 99%

“…However, there is substantial debate regarding the optimal anatomical location for the DBS electrodes in the STN region (Saint-Cyr et al, 2002;Voges and J, 2002;Herzog et al, 2004;Zonenshayn et al, 2004;Kitagawa et al, 2005;Nowinski et al, 2005;Plaha et al, 2006). And, while guidelines exist on stimulation parameter settings that are typically effective (Volkmann et al, 2006), it is infeasible to clinically evaluate each of the thousands of stimulation parameter combinations that are possible.…”

Section: Deep Brain Stimulation (Dbs) Is An Established Therapy For Tmentioning

confidence: 99%

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Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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Despite the clinical success of deep brain stimulation (DBS) for the treatment of movement disorders, many questions remain about its effects on the nervous system. We have developed a methodology to predict the volume of tissue activated (VTA) by DBS on a patient-specific basis. Our goals are to identify the intersection between the VTA and surrounding anatomical structures and to compare activation of these structures with clinical outcomes. The model system consists of three fundamental components: 1) a 3D anatomical model of the subcortical nuclei and DBS electrode position in the brain, each derived from magnetic resonance imaging (MRI); 2) a finite element model of the DBS electrode and electric field transmitted to the brain, with tissue conductivity properties derived from diffusion tensor MRI; 3) VTA prediction derived from the response of myelinated axons to the applied electric field, which is a function of the stimulation parameters (contact, impedance, voltage, pulse width, frequency). We used this model system to analyze the effects of subthalamic nucleus (STN) DBS in a patient with Parkinson's disease. Quantitative measurements of bradykinesia, rigidity, and corticospinal tract (CST) motor thresholds were evaluated over a range of stimulation parameter settings. Our model predictions showed good agreement with CST thresholds. Additionally, stimulation through electrode contacts that improved bradykinesia and rigidity generated VTAs that overlapped the zona incerta / fields of Forel (ZI/H2). Application of DBS technology to various neurological disorders has preceded scientific characterization of the volume of tissue directly affected by the stimulation. Synergistic integration of clinical analysis, neuroimaging, neuroanatomy, and neurostimulation modeling provides the opportunity to address wide ranging questions on the factors linked with the therapeutic benefits and side effects of DBS.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Deep Brain Stimulation (Dbs) Is An Established Therapy For Tmentioning

confidence: 99%

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Patient-specific analysis of the volume of tissue activated during deep brain stimulation

et al. 2007

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“…Stimulation of the caudal ZI may provide beneficial effects on parkinsonian tremor, and lesser benefits for rigidity and akinesia (Kitagawa et al, 2005;Plaha et al, 2006), most likely through its effects on ZI itself, but also through stimulation of ascending cerebellar projections and pallidofugal fibers to the thalamus that pass through the stimulated areas.…”

Section: New Targets For Dbs In Pdmentioning

confidence: 99%

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Smith

Wichmann

Factor

et al. 2011

Neuropsychopharmacol

194

137

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The demonstration that dopamine loss is the key pathological feature of Parkinson's disease (PD), and the subsequent introduction of levodopa have revolutionalized the field of PD therapeutics. This review will discuss the significant progress that has been made in the development of new pharmacological and surgical tools to treat PD motor symptoms since this major breakthrough in the 1960s. However, we will also highlight some of the challenges the field of PD therapeutics has been struggling with during the past decades. The lack of neuroprotective therapies and the limited treatment strategies for the nonmotor symptoms of the disease (ie, cognitive impairments, autonomic dysfunctions, psychiatric disorders, etc.) are among the most pressing issues to be addressed in the years to come. It appears that the combination of early PD nonmotor symptoms with imaging of the nigrostriatal dopaminergic system offers a promising path toward the identification of PD biomarkers, which, once characterized, will set the stage for efficient use of neuroprotective agents that could slow down and alter the course of the disease.

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“…Regarding DBS in the cZi and adjacent areas, promising results have been presented for motor effects [11][12][13][14][15][16] and it has been suggested as a possibly more effective target than the STN on axial symptoms of PD [17]. The effects of cZi-DBS on speech are, however, largely unknown, with the exception of two previous reports from our group, indicating it to be less beneficial to intensity and articulation rate and precision in articulatory coordination than STN- The present investigation aimed at investigating the laryngeal motor proficiency needed for regulating phonation in fluent speech in patients treated with either STN-DBS or cZi-DBS.…”

Section: Introductionmentioning

confidence: 99%

Control of phonatory onset and offset in Parkinson patients following deep brain stimulation of the subthalamic nucleus and caudal zona incerta

Karlsson

Blomstedt

Olofsson

et al. 2012

Parkinsonism & Related Disorders

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Two-year Follow-up of Chronic Stimulation of the Posterior Subthalamic White Matter for Tremor-dominant Parkinson's Disease

Abstract: Unilateral ZI/PRL stimulation is a reliable and long-term therapeutic modality and can be considered another surgical target for the treatment of tremor-dominant Parkinson's disease.

Cited by 123 publications

References 24 publications

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Patient-specific analysis of the volume of tissue activated during deep brain stimulation

Parkinson's Disease Therapeutics: New Developments and Challenges Since the Introduction of Levodopa

Control of phonatory onset and offset in Parkinson patients following deep brain stimulation of the subthalamic nucleus and caudal zona incerta

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