Download or read book Using Quantified Motor Behavior Outcomes to Improve Deep Brain Stimulation in Parkinson s Disease written by Kenneth Howard Louie and published by . This book was released on 2020 with total page 113 pages. Available in PDF, EPUB and Kindle. Book excerpt: Deep brain stimulation (DBS) is a highly effective therapeutic option for Parkinson’s disease (PD). However, it can take 50 or more hours to obtain stimulation settings that optimally treat a patient’s symptoms. Additionally, axial symptoms, such as gait, are not adequately treated in the long term. In my work I explore the use of quantified motor behavior outcomes to reduce the time needed to obtain optimal stimulation parameters, and to develop a novel stimulation delivery approaches to better treat gait. First, I tested a Bayesian optimization approach to quickly and accurately model the input/output response of rigidity to stimulation frequency. I found, for PD patients that have a high degree of rigidity, Bayesian optimization models their response needing fewer samples than a traditional trial-and-error approach. Next, I tested a novel closed-loop stimulation delivery approach that delivered short duration pulse trains at specific phases of gait. I found that the patients that respond strongly to this type of stimulation delivery have a worse gait with their clinical settings. Overall, many patients saw small changes to their gait with this approach. Lastly, I analyzed the effects of turning stimulation on and off on gait. I found that a repeated measures of gait with short duration, 1 minute, wash-in and -out can detect significant changes. This is in contrast to previous reports that significant changes are only seen between 30-60 minutes. Through these studies I demonstrate the use of quantified motor behavior outcomes to improve DBS for PD.
Download or read book Deep Brain Stimulation Management written by William J. Marks, Jr and published by Cambridge University Press. This book was released on 2015-09-03 with total page 251 pages. Available in PDF, EPUB and Kindle. Book excerpt: Essential reference guide for clinicians working with DBS patients, fully revised throughout with new chapters on epilepsy and psychiatric disorders.
Download or read book Deep Brain Stimulation for Parkinson s Disease written by Gordon H. Baltuch and published by CRC Press. This book was released on 2007-03-19 with total page 374 pages. Available in PDF, EPUB and Kindle. Book excerpt: Considered the largest breakthrough in the treatment of Parkinson's disease in the past 40 years, Deep Brain Stimulation (DBS) is a pioneering procedure of neurology and functional neurosurgery, forging enormous change and growth within the field. The first comprehensive text devoted to this surgical therapy, Deep Brain Stimulation for Parkinson's
Download or read book Brain Stimulation written by Günther Deuschl and published by Elsevier Inc. Chapters. This book was released on 2013-11-11 with total page 50 pages. Available in PDF, EPUB and Kindle. Book excerpt: Deep brain stimulation is one of the most effective treatments of Parkinson’s disease (PD). This report summarizes the state of the art as at January 2013. Stimulation of the subthalamic nucleus is the most commonly used approach. It improves the core motor symptoms better than medication in patients with advanced disease. It also improves the majority of nonmotor symptoms, such as mood, impulse control disorders, sleep, and some autonomic dysfunctions. Quality of life (QoL) is improved significantly more than with medication. Long-term data show that the treatment is effective for up to 10 years, but the late appearance of l-dopa-resistant symptoms is seemingly not influenced. Internal globus pallidus (GPi) stimulation is less well studied but seems to have similar short-term efficacy. Importantly l-dopa use cannot be reduced with GPi DBS, which is a major disadvantage for patients suffering from medication side-effects, although gait may be influenced more positively. Although short-term QoL improvement seems to be similar to that for subthalamic nucleus (STN) DBS – gait and speech may be better improved – long-term data are rare for GPi DBS. Thalamic stimulation in the ventral intermediate nucleus (VIM) is applied only in tremor-dominant elderly patients. The treatment improves the dopa-sensitive symptoms and effectively reduces fluctuations leading to an overall QoL improvement. Although most of the controlled studies have been on advanced PD, the recently published EARLYSTIM study suggests that even patients with a very short duration of their fluctuations and dyskinesia are doing significantly better with neurostimulation in terms of QoL and all major motor outcome parameters.
Download or read book Disorders of Movement written by Davide Martino and published by Springer. This book was released on 2015-12-17 with total page 458 pages. Available in PDF, EPUB and Kindle. Book excerpt: This concise but comprehensive book will help interested readers in the health care professions to navigate their way through the jungle of movement disorders, including the potentially complex differential diagnosis and management. The different disorders are discussed in individual sections that explain how to examine the patient and recognize the disorder from its basic phenomenology, how to confirm a diagnosis, how to distinguish a particular disorder from related conditions, and how to treat each disorder effectively. The book makes liberal use of diagrams, algorithms, tables, summary boxes, and illustrations to facilitate solution of clinical problems at the bedside and to solidify previously learned clinical and therapeutic concepts. It will be of interest to a broad audience of health professionals, scientists, and medical students.
Download or read book Enhancing Motor Performance in the Healthy and Parkinsonian Brain written by Raed A. Joundi and published by . This book was released on 2012 with total page 544 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Neurobehavioral Outcome and Subthalamic Deep Brain Stimulation in Parkinson s Disease written by Michelle Jedrzkiewicz and published by . This book was released on 2006 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Subthalamic deep brain stimulation (STN DBS) is known to improve motor functioning in Parkinson's Disease (PD), but the neurobehavioral impact is less clear. This study examined neurobehavioral outcome of bilateral STN DBS in advanced PD. Study participants were assigned to either a Surgical Group (n=19) or a waitlist Control Group (n=16) and assessed twice. Between assessments, there was a two month interval during which the Surgical Group had STN DBS surgery, while the Control Group had no surgery. In comparison to the Control Group, the Surgical Group showed significant decline in executive functioning, verbal delayed memory, verbal working memory, and verbal fluency. Nevertheless, the Surgical Group also reported significantly improved health and quality of life in several domains including vitality, mental health, general health, and social functioning. In summary, this study revealed that despite declines on several cognitive measures, participants who underwent STN DBS also reported improved quality of life.
Download or read book Brain Stimulation written by Anna Castrioto and published by Elsevier Inc. Chapters. This book was released on 2013-11-11 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: Deep brain stimulation has become an established treatment for advanced Parkinson’s disease. Its postoperative management is a delicate phase, dedicated to finding the optimal balance between stimulation and dopaminergic treatment. Postoperative management can be divided into an acute phase, aimed at the selection of the best stimulation contact, and a stabilization phase, aimed at the progressive adjustment of stimulation parameters and medications. A good knowledge of the electrophysiological anatomy of the target and surrounding structures, of the potential consequences of dopaminergic treatment modifications, and of the time course and interactions between stimulation and medication effects is mandatory for optimal outcome. This chapter focuses on the main strategies for the acute and chronic management of stimulation parameters and medication in the three main nuclei targeted in Parkinson’s disease, namely the subthalamic nucleus, the ventral intermediate thalamic nucleus, and the internal part of the globus pallidus.
Download or read book Data driven Optimization of Deep Brain Stimulation for Movement Disorders written by Andrew J. Haddock and published by . This book was released on 2017 with total page 126 pages. Available in PDF, EPUB and Kindle. Book excerpt: Deep brain stimulation (DBS) is an effective therapy for ameliorating motor symptoms associated with Parkinson's disease (PD) and essential tremor (ET). DBS is a surgical procedure in which implanted electrodes are placed near brain structures believed to cause pathological motor disorder behaviors. Subcortical brain structures in thalamus and basal ganglia are typical DBS targets for PD and ET therapy, and modern DBS systems allow customization of therapeutic stimulation patterns through control of stimulation location, amplitude, pulsewidth, and frequency in order to optimize therapy on a patient-specific basis. Despite the technological capabilities of implanted DBS systems, current clinical implementation is limited by a scarcity of DBS specialty clinics and variable, subjective clinician performance in assessing patient symptoms and systematically selecting optimal DBS settings for therapy, a process known as programming. Compounding this problem is a dated and inefficient healthcare system that requires patients to travel to clinic to receive DBS programming updates, oftentimes at great expense both to patients and healthcare providers. In this dissertation, we investigate and demonstrate experimental data-driven methodologies and algorithms aimed at improving DBS therapy for PD and ET patients. Particularly, we develop adaptive DBS systems by coupling low-cost commercial sensors with stimulation control and demonstrate the therapy potential through clinical experiments with human subjects diagnosed with PD and ET. We make use of a commercially available wearable smartwatch and show that clinical ratings for tremor and bradykinesia can accurately be classified on the basis of inertial measurement unit (IMU) data. We embed this feature in a software algorithm for automated DBS programming that is demonstrated to perform at the level of expert clinicians in selecting optimal DBS settings for therapy in PD and ET patients. We further use this platform to investigate neural correlates and biomarkers of effective DBS in ET patients using recorded local field potentials (LFPs) from an electrocorticographic (ECoG) strip placed over motor cortex. Scalable methods and algorithms for automatically programming DBS when considering a large number of candidate DBS settings are also developed in detail. Finally, we address the problem of closed-loop DBS, in which stimulation is delivered in a responsive manner to patient symptoms, by formulating a model-based approach using system identification experiments, hybrid systems modeling, and predictive control. The results presented in this dissertation may improve patient care, patient quality of life, and the cost-effectiveness of DBS therapy for PD and ET patients. Additionally, the novel results presented on neural stimulation optimization may be useful more broadly in the growing medical and research fields of neuromodulation and bioelectronic medicine. We conclude with a discussion concerning how to integrate this data-driven approach to DBS therapy in modern healthcare systems, and we discuss the relevance of these results in light of anticipated technological developments in DBS systems.
Download or read book The Effects of Deep Brain Stimulation Amplitude on Motor Performance in Parkinson s Disease written by Alison Conovaloff and published by . This book was released on 2013 with total page 139 pages. Available in PDF, EPUB and Kindle. Book excerpt: The efficacy of deep brain stimulation (DBS) in Parkinson's disease (PD) has been convincingly demonstrated in studies that compare motor performance with and without stimulation, but characterization of performance at intermediate stimulation amplitudes has been limited. This study investigated the effects of changing DBS amplitude in order to assess dose-response characteristics, inter-subject variability, consistency of effect across outcome measures, and day-to-day variability. Eight subjects with PD and bilateral DBS systems were evaluated at their clinically determined stimulation (CDS) and at three reduced amplitude conditions: approximately 70%, 30%, and 0% of the CDS (MOD, LOW, and OFF, respectively). Overall symptom severity and performance on a battery of motor tasks - gait, postural control, single-joint flexion-extension, postural tremor, and tapping - were assessed at each condition using the motor section of the Unified Parkinson's Disease Rating Scale (UPDRS-III) and quantitative measures. Data were analyzed to determine whether subjects demonstrated a threshold response (one decrement in stimulation resulted in ≥ 70% of the maximum change) or a graded response to reduced stimulation. Day-to-day variability was assessed using the CDS data from the three testing sessions. Although the cohort as a whole demonstrated a graded response on several measures, there was high variability across subjects, with subsets exhibiting graded, threshold, or minimal responses. Some subjects experienced greater variability in their CDS performance across the three days than the change induced by reducing stimulation. For several tasks, a subset of subjects exhibited improved performance at one or more of the reduced conditions. Reducing stimulation did not affect all subjects equally, nor did it uniformly affect each subject's performance across tasks. These results indicate that altered recruitment of neural structures can differentially affect motor capabilities and demonstrate the need for clinical consideration of the effects on multiple symptoms across several days when selecting DBS parameters.
Download or read book Deep Brain Stimulation written by Shilpa Chitnis MD, PhD and published by Oxford University Press. This book was released on 2020-06-30 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: Deep Brain Stimulation addresses the practical tips required to program and manage deep brain stimulation devices in the clinic. The number of deep brain stimulation devices worldwide will soon eclipse 200,000 and is an approved surgical treatment for medically refractory neurological movement disorders such as Parkinson disease, tremors, and dystonia. It is, therefore, inevitable that clinicians and nurses will require the necessary tools, and exemplary real-life cases, to manage these complex patients. This book offers a case-based approach to common and uncommon neurologic problems related to deep brain stimulator problems. Each case is a clinical pearl, accompanied by a discussion as well as practical tips to improve patient management.
Download or read book Non Motor Symptoms of Parkinson s Disease written by K. Ray Chaudhuri and published by Oxford University Press, USA. This book was released on 2014 with total page 517 pages. Available in PDF, EPUB and Kindle. Book excerpt: Patients with Parkinson's disease (PD) are known to suffer from motor symptoms of the disease, but they also experience non-motor symptoms (NMS) that are often present before diagnosis or that inevitably emerge with disease progression. The motor symptoms of Parkinson's disease have been extensively researched, and effective clinical tools for their assessment and treatment have been developed and are readily available. In contrast, researchers have only recently begun to focus on the NMS of Parkinson's Disease, which are poorly recognized and inadequately treated by clinicians. The NMS of PD have a significant impact on patient quality of life and mortality and include neuropsychiatric, sleep-related, autonomic, gastrointestinal, and sensory symptoms. While some NMS can be improved with currently available treatments, others may be more refractory and will require research into novel (non-dopaminergic) drug therapies for the future. Edited by members of the UK Parkinson's Disease Non-Motor Group (PD-NMG) and with contributions from international experts, this new edition summarizes the current understanding of NMS symptoms in Parkinson's disease and points the way towards future research.
Download or read book Parkinson s Disease and Related Disorders written by Peter Riederer and published by Springer Science & Business Media. This book was released on 2006-11-23 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book gives a comprehensive overview on current clinical and basic research issues related to Parkinson’s disease and its related disorders. The book is the result of the 16th International Congress of Parkinson’s Disease and Related disorders congress 2005. Its contents are suitable for neurologists, psychiatrists, neurosurgeons, basic researchers, geneticians and patients as well as their relatives.
Download or read book Trends in Clinical Deep Brain Stimulation written by Marcus L. F. Janssen and published by MDPI. This book was released on 2021-03-17 with total page 246 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book covers the current trends in clinical deep brain stimulation (DBS) research. This collection of papers from experts in the field provides state of the art knowledge and future perspectives in clinical DBS research. A range of topics involved in DBS is presented, ranging from high resolution imaging, electrophysiology and personalized medicine, in a broad range of brain disorders.
Download or read book Surgery for Parkinson s Disease written by Robert R. Goodman and published by Springer. This book was released on 2019-01-16 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Deep brain stimulation for the treatment of patients with Parkinson’s disease was introduced in the 1990s. Initially performed only at academic centers, over the past decade it has become a widespread surgical procedure. A variety of surgical techniques are employed and innovations are introduced frequently. This book is an ideal source of information for the many practicing neurosurgeons who did not learn this surgery during their training but would now like to add it to their practice, as well as an excellent update on exciting new developments in surgery for Parkinson’s disease. This book is designed to provide practicing neurosurgeons with current knowledge on the practical aspects of surgical treatment of patients with Parkinson’s disease. It explains how to identify surgical candidates and determine the optimal surgery, describes the various surgical techniques that are currently employed, and offers insights into how to optimize deep brain stimulation therapy after implantation. The keys to avoidance of surgical complications are carefully elucidated. In addition, an overview is provided of potential advances on the near-term horizon, including closed-loop deep brain stimulation, gene therapy, and optogenetics. All topics are covered by experienced Parkinson’s disease surgeons, in a concise and digestable format. The book will be an ideal source of information for the many practicing neurosurgeons who would like to add deep brain stimulation to their practice, as well as an excellent update on new developments in surgery for Parkinson’s disease.
Download or read book Stereotactic and Functional Neurosurgery written by Nader Pouratian and published by Springer Nature. This book was released on 2020-02-28 with total page 563 pages. Available in PDF, EPUB and Kindle. Book excerpt: This text presents a comprehensive and state-of the-art approach to stereotactic and functional neurosurgery. Overarching sections include achieving stereotactic precision, defining trajectories and targets, the biophysics of stereotactic therapies, diseases and targets, and the future of functional neurosurgery. Each section is designed to be inclusive of all relevant topics, serving as an unbiased resource to new clinicians in this field or established clinicians that are aiming to better understand complementary methods. Importantly, each section and the associated chapters can be used by basic and translational scientists as well as engineers and industry to better understand and deliver innovation to the field. Chapters within each section methodically analyze traditional and recently emerging concepts and techniques; address underlying principles with examples drawn from specific diseases and applications; and cover patient selection, target selection, available stereotactic methods, nuanced surgical methods, and clinical evidence across treatment options. Written by experts in each area, Stereotactic and Functional Neurosurgery is a definitive guide to the latest developments in stereotactic targeting, electrode implantation, surgical treatment of neurological and psychiatric disorders, the renaissance of stereotactic lesions, and the frontier of restorative neurosurgery for a variety of disorders that have no other therapeutic options.
Download or read book Effects of Aging Parkinson s Disease and Deep Brain Stimulation on Voluntary Upper Limb Movements written by Vivek J. Khandwala and published by . This book was released on 2012 with total page 190 pages. Available in PDF, EPUB and Kindle. Book excerpt: "Voluntary movements depend heavily on coordinated motor patterning that necessitates simultaneous motion at multiple joints and sensorimotor integration. Parkinson's disease (PD), a chronic neurodegenerative movement disorder, is typically characterized by impairments in voluntary movement observed clinically as akinesia/bradykinesia, rigidity, tremor, and postural instability. Clinical observations and experimental studies report impairments in sensorimotor integration and coordinated multijoint movements in PD. The therapeutic efficacy of deep brain stimulation (DBS) of the subthalamic nucleus (STN) to ameliorate PD motor symptoms has been well documented. However, both the effects of STN DBS at the level of individual joints and the mechanisms that underlie such motor improvements remain poorly characterized. We quantified the effects of healthy aging, PD, and PD treatment using STN DBS and medication on end-point and joint kinematics of upper limb movements during a set of visually guided button-pressing tasks. The movement kinematics of study participants were evaluated by analyzing index finger and joint kinematics. Participants included healthy age-matched subjects (baseline), untreated PD patients without STN DBS and medication (patient baseline), patients treated with DBS only and patients receiving both STN DBS and medication (optimal therapeutic state). Results revealed improved upper limb motor function in PD patients as a consequence of STN DBS, predominantly due to a change in the temporal profile of movement, especially during the deceleration phase. STN DBS has little to no effect on peak velocity, which only improves significantly in the presence of STN DBS and medication. These trends were representative of simple movements requiring movement of only one joint and complex movements that required simultaneous motion at multiple joints. To assess sensorimotor integration, the performance of tasks with and without visual precue were evaluated, resulting in the prolongation of deceleration times for patients in the untreated condition, which was not observed in control subjects and appeared to be a consequence of the disease process and was ameliorated with stimulation therapy. STN DBS normalized the sensorimotor integration such that deceleration times were similar during both tasks"--Pages vi-vii.
