Neuromodulation最新文献

Background: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) relieves motor symptoms, including levodopa-responsive gait disorders in Parkinson's disease (PD). Traditionally, STN-DBS is not indicated to treat severe, clinically resistant axial symptoms. In this scenario, field H1 of Forel (FF) stimulation (FF-DBS) is likely a feasible option, given it improves motor symptoms, including freezing of gait (FOG), as shown by a short-term study. However, no data are available about the long-term effects of this therapy. Finally, no study has compared the long-term effects of FF and STN-DBS.

Objective: We report the long-term outcome (>five years) of bilateral FF-DBS in patients with PD. We also compare the effects of FF-DBS and STN-DBS on motor symptoms, cognition, and quality of life.

Materials and methods: We studied 22 patients (ten with FF-DBS and 12 with STN-DBS). Motor symptoms, cognition, quality of life, and gait symptoms were assessed using the motor part of the Movement Disorders Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS III), the Mattis Dementia Rating Scale, the 39-item PD quality of life (PDQ-39), and the FOG questionnaire (FOG score) respectively. The levodopa equivalent daily dose was recorded. Comparisons of the FF and STN-DBS results were conducted.

Result: The mean follow-up was 6.18 years (95% CI: 5.57-6.78). Compared with the preoperative period, patients with FF had an average reduction of 32.2% in the MDS-UPDRS III scores (p < 0.01), a decrease of 35.3% in the FOG scores (p < 0.01), and an improvement of 25.9% in the PDQ-39 (p < 0.01). There was a 7.5% decrease in cognition (p < 0.01). Levodopa equivalent dose (LED) was reduced by 26.3% (p < 0.01). The STN group had an average reduction of 39.4% in the MDS-UPDRS III scores (p < 0.01), a decrease of 23.7% in the FOG scores (p < 0.01), and an improvement of 33.2% in the PDQ-39 scores (p < 0.01). Cognition decreased by 1.6% (p < 0.01) and LED by 15.06% (p = 0.02). Patients with FF-DBS were older than those with STN-DBS at the time of surgery: 61.2 years and 55.7 years, respectively (p = 0.02), and had longer duration of disease (p = 0.02). Patients with FF-DBS had a greater reduction in FOG (p = 0.02) than did the STN group and presented with a greater decrease in cognition (p < 0.01) after five years. STN-DBS had a greater effect on quality of life.

Conclusions: Both FF-DBS and STN-DBS relieved motor symptoms and improved quality of life over a long-term period. Patients with FF-DBS had a higher reduction in both FOG and in LED than did those with STN-DBS. These data support our hypothesis that FF-DBS is a safe and efficient option for treating motor symptoms in PD, including FOG in advanced stages.

Objectives: Transcranial direct current stimulation (tDCS) is an emerging neuromodulation technique. The effect of tDCS can vary significantly depending on electrode position and current intensity, making it crucial to find an optimized tDCS montage. However, because of the high computational load, most tDCS optimization approaches have been performed with a limited number of candidates for electrode positions, such as 10-10 or 10-20 international channel configurations. This study introduced the Bayesian optimization and hyperband (BOHB) method to seek optimal tDCS montage for the entire human scalp without conventional constraints.

Materials and methods: The BOHB method is a probabilistic approach that iteratively refines the selection of the optimal montage on the basis of previous results. To determine the suitability of this approach for tDCS simulation, we compared it with random search, which randomly selects montages, and greedy search, which, considers all candidates. Next, the conditions in the greedy search were used as the initial conditions for BOHB for fast learning. The objective function of tDCS optimization was set to maximize the average electric field norm (|E|) in the region of interest (ROI), which is the motor area (M1) and left dorsal lateral prefrontal cortex.

Results: The BOHB method performed better than the conventional random search for the same number of iterations in both ROIs. For M1, the iteration index yielding the maximum evaluation metric in each trial was statistically smaller in the BOHB method than in the random search (p < 0.0001). Regarding the normalized |E|, the BOHB method showed a higher normalized |E| than did the random search for the M1 region.

Conclusions: The BOHB method performed better than did the random search approach. Thus, the BOHB method is feasible for tDCS optimization and can be used as an optimal stimulation montage seeker by fine-tuning some control parameters.

Objectives: Transcranial temporal interference stimulation (tTIS) is a novel, noninvasive neuromodulation technique to modulate deep brain neural activity. Despite its potential, direct electrophysiological evidence of tTIS effects remains limited. This study investigates the impact of tTIS on local field potentials (LFPs) in the deep brain using minipigs implanted with deep brain electrodes.

Materials and methods: Three minipigs were implanted with electrodes in the subthalamic nucleus, and tTIS was applied using patch electrode pairs positioned on both sides of the scalp. Stimulation was delivered in sinewave voltage mode with intensities ≤2V. We evaluated the stimulus-response relationship, effects of different carrier frequencies, the range of entrained envelope oscillations, and changes resulting from adjusting the left-right stimulation intensity ratio.

Results: The results indicated that tTIS modulates deep-brain LFPs in an intensity-dependent manner. Carrier frequencies of 1 or 2 kHz were most effective in influencing LFP. Envelope oscillations <200 Hz were effectively entrained into deep-brain LFPs. Adjustments to the stimulation intensity ratio between the left and right sides yielded inconsistent responses, with right-sided stimulation playing a dominant role.

Conclusion: These findings indicate that tTIS can regulate LFP changes in the deep brain, highlighting its potential as a promising tool for future noninvasive neuromodulation applications.

Objectives: YouTube is an important source of medical information for various medical topics and procedures. The purpose of the present study is to appraise the quality of medical information available on YouTube on the topic of peripheral nerve stimulation (PNS) for chronic pain.

Materials and methods: A total of 53 videos were appraised by four individuals using three scales for appraisal: 1) the Modified DISCERN scale, 2) the Journal of American Medical Association (JAMA) Benchmark scoring, and 3) the Global Quality Scale. Descriptive characteristics and author type of each video were recorded. The mean scores of these scales among all four reviewers based on author type were calculated. One-way analysis of variance was used to compare mean scores of the three scales among author types, and post hoc pairwise Tukey's honestly significant difference test was used to evaluate for significant differences between mean scores. Furthermore, mean scale scores of videos above and below the total average-view count and total average "thumbs ups" were calculated and compared.

Results: Most videos (n = 31, 58.5%) were submitted from private practice. The mean Modified DISCERN and JAMA scores of videos by academic and society authors (M = 3.54 and 2.83, respectively) were significantly higher (p < 0.05) than the mean Modified DISCERN and JAMA scores of videos by private practice authors (M = 2.10 and 2.03, respectively). Interestingly, the mean scale scores of videos with above-average view counts were found to be lower than scores of videos with below-average view counts across all three scoring instruments.

Conclusions: YouTube videos on PNS stimulation for chronic pain are low to moderate in quality. Videos from academic sources were higher in quality than were private practice videos. Furthermore, videos with above-average view counts had lower mean scores on all three instruments, suggesting most of the viewership had watched lower-quality video content.