Skip to main content

Lead Repositioning Guided by Both Physiology and Atlas Based Targeting in Tourette Deep Brain Stimulation

Congratulations Jackson N. Cagle, Wissam Deeb, Robert S. Eisinger, Rene Molina, Enrico Opri, Marshall T. Holland,  Kelly D. Foote, Michael S. Okun, and Aysegul Gunduz on the publication of “Lead Repositioning Guided by Both Physiology and Atlas Based Targeting in Tourette Deep Brain Stimulation,” in Tremor and Other Hyperkinetic Movements.

Abstract

Background: The centromedian (CM) region of the thalamus is a common target for deep brain stimulation (DBS) treatment for Tourette Syndrome (TS). However, there are currently no standard microelectrode recording or macrostimulation methods to differentiate CM thalamus from other nearby structures and nuclei.

Case Report: Here we present a case of failed conventional stereotactic targeting in TS DBS. Postoperative local field potential recordings (LFPs) showed features including beta power desynchronization during voluntary movement and thalamo-cortical phase amplitude coupling at rest. These findings suggested that the DBS lead was suboptimally placed in the ventral intermediate (VIM) nucleus of the thalamus rather than the intended CM region. Due to a lack of clinical improvement in tic severity scales three months following the initial surgery, the patient underwent lead revision surgery. Slight repositioning of the DBS leads resulted in a remarkably different clinical outcome. Afterwards, LFPs revealed less beta desynchronization and disappearance of the thalamo-cortical phase amplitude coupling. Follow-up clinical visits documented improvement of the patient’s global tic scores.

Discussion: This case provides preliminary evidence that combining physiology with atlas based targeting may possibly enhance outcomes in some cases of Tourette DBS. A larger prospective study will be required to confirm these findings.

Highlight: This report demonstrates a case of failed centromedian nucleus region deep brain stimulation (DBS). We observed suboptimal tic improvement several months following DBS surgery and subsequent lead revision improved the outcome. The neurophysiology provided an important clue suggesting the possibility of suboptimally placed DBS leads. Repeat LFPs during lead revision revealed less beta desynchronization and disappearance of the thalamo-cortical phase amplitude coupling. There was improvement in tic outcome following slight repositioning during bilateral DBS lead revision. This case provides preliminary evidence supporting the use of physiology to augment the atlas based targeting of Tourette DBS cases.



from Department of Neurology » College of Medicine » University of Florida https://ift.tt/2P6nljF

Labels

Labels:

Comments

Post a Comment

Popular posts from this blog

UPI: Kids with psych disorders most likely to take dangerous viral challenges

The “choking game” — and other clearly ill-advised and dangerous internet challenges — leave many parents wondering what drives teens to take the bait and participate. Now, a new study suggests that an underlying psychological disorder may be one reason why some kids jump at online dares such as the “Bird Box” challenge, where people walk around blindfolded, and the Tide Pod challenge, daring people to eat laundry detergent. (January 28, 2019) Read the full article here from Brain Health Daily http://bit.ly/2DIWHbD
Post a Comment
Read more

Menopause Symptoms Reduced by Cold Water Swimming

Cold water swimming significantly eases menopausal symptoms. Surveying 1114 women, with 785 experiencing menopause, researchers found improvements in anxiety, mood swings, low mood, and hot flushes among participants. from Neuroscience News https://ift.tt/9AqHsEa
Post a Comment
Read more

The emerging influential role of microglia in neurology

In her most catchily titled book, The Angel and the Assassin , Donna Jackson Nakazawa highlighed nerve cells which have hitherto been very little acknowledged – microglia . Long ignored as bit players in the big league of the nervous system, Nakazawa colourfully illustrated what many neuroscientists are beginning to realise: the small size of microglia belies their huge influence ; m icroglia are, after all, the defence force of the nervous system, protecting the brain from microbial invaders . In keeping with their small size, their role is to surreptitiously  present the antigens of invading bugs to T cells , the toffs who actually carry out the final hatchet job . It is therefore not surprising that any dysfunction of microglia will come with significant clinical consequences .  By GerryShaw – Own work , CC BY-SA 3.0 , Link The most important clinical fallout of dysfunctional microglia appears to be the emergence of dementia. It is indeed spec...
Post a Comment
Read more