Relevant papers:
- 1 PMID-11948771[0] Intraoperative micro- and macrostimulation of the subthalamic nucleus in Parkinson's disease.
- Suggest using microelectrodes for precise mapping of suitable target area.
- 2 PMID-11948758[1] Mechanisms of deep brain stimulation.
- The mechanism could be either one or a combination of several causes: jamming of a feedback loop, activation of inhibitory structures included in a more complex network, blockade of membrane ion channels, deplorisation blockade, synaptic exhaustion, induction of early genes, changes in local blood flow, neuroplasticity. (I think that it's likely some sort of information block, since it's so immediately efficacious).
- Emphasis on neuroplasticity.
- 3 PMID-9400514[2] Stimulation of subthalamic nucleus alleviates tremor in Parkinson's disease.
-
- Stimulation of the ventral intermediate nucleus of the thalamus (Vim) greatly improves tremor in 88% of patients with PD, but rigidity is only moderately improved and akinesia is not improved.
- In patients with tremor-dominated PD, STN stimulation should be preferred to Vim stimulation since most of these patients will develop disabling akinesia not improved by Vim stimulation.
- 4 PMID-7631092[3] Acute and long-term effects of subthalamic nucleus stimulation in Parkinson's disease.
- The final position of the chronic electrodes was optimized using electrophysiological recording and stimulation along with clinical assessment and surface EMG of agonist and antagonist muscles of the examined limbs.
- things have not changed much since then - 130 Hz, quadripolar medtronic electrode, electrophysiological and stereotaxic guidance.
- no dyskinesia or hemiballismus observed.
- 5 PMID-8235208[4] [Effects of the stimulation of the subthalamic nucleus in Parkinson disease].
- same as above, but in French, and first.
- 6 PMID-19081516[5] Deep brain stimulation of the subthalamic nucleus for the treatment of Parkinson's disease.
- Side effects are mainly neurocognitive, with side-effects created by spread of stimulation to surrounding structures, depending on the precise location of electrodes.
- Little pressure to optimize in the present system.
- Needs to be extended to developing countries, too.
- 7 PMID-17960811[6] Lifetime of Itrel II pulse generators for subthalamic nucleus stimulation in Parkinson's disease.
- They last 83 +- 14 months -- wow!
- Replace the device when the battery gets low. duh.
- 8 PMID-15975946[7] Bilateral deep brain stimulation in Parkinson's disease: a multicentre study with 4 years follow-up.
- DBS to the STN is effective.
- assessed 3-4 years relative to baseline, UPDRS-III score.
- Good mobility wityhout dyskinesias, better activities of daily living.
- side effects: cognitive decline, speech difficulty, instability, gait disorders and depression.
- 9 PMID-15040711[8] Deep brain stimulation of the subthalamic nucleus in Parkinson's disease 1993-2003: where are we 10 years on?
- Efficacy still somewhat not clear.
- STN improves motor function by at least 60% (!), and reduces the levodopa requirement.
- Reviews some pathophysiology & basic science.
VIM:
- 10 PMID-15197715[9] Partial lesion of thalamic ventral intermediate nucleus after chronic high-frequency stimulation.
- 60% cell loss within 0.5mm of the electrode tip.
- still, tremor improvement attributable to chronic stimulation, not microthalamotomy.
- 11 PMID-8592222[10] Chronic electrical stimulation of the ventralis intermedius nucleus of the thalamus as a treatment of movement disorders.
- Ventralis intermedius stimulation has since been used by the authors over the last 8 years as a treatment in 117 patients with movement disorders (80 cases of Parkinson's disease, 20 cases of essential tremor, and 17 cases of various dyskinesias and dystonias including four multiple sclerosis)
- Chronic VIM stimulation, which is reversible, adaptable, and well tolerated even by patients undergoing bilateral surgery (74 of 117 patients) and by elderly patients, should replace thalamotomy in the regular surgical treatment of parkinsonian and essential tremors.
- 12 PMID-8748831[11] Stimulation of the ventral intermediate thalamic nucleus in tremor dominated Parkinson's disease and essential tremor.
- LFS of VIM increases tremor, whereas HFS decreases it.
- 13 PMID-8453462[12] Thalamic stimulation and suppression of parkinsonian tremor. Evidence of a cerebellar deactivation using positron emission tomography.
- The suppression of tremor was specifically associated with a decrease of rCBF (PET) in the cerebellum, whereas the ineffective stimulation induced a decrease of rCBF in ipsilateral cerebral cortex.
- 14 PMID-8420163[13] Long-term effects of chronic stimulation of the ventral intermediate thalamic nucleus in different types of tremor.
- folow up.
- HFS to the VIM in 26 PD, 6 ET patients.
- Of the 43 thalami stimulated, 27 showed complete relief from tremor and 11 major improvement (88%).
- Much better than thalamotomy.
- 15 PMID-1671433[14] Long-term suppression of tremor by chronic stimulation of the ventral intermediate thalamic nucleus.
- same as above, but with abstract. 1991 -- original.
Stem cells / Gene therapy:
- 16 PMID-16902198[15] Functional neuronal differentiation of bone marrow-derived mesenchymal stem cells.
- cells express markers for neurons (shape, NF-L beta-tubulin.
- cells can differentiate along the neural pathway.
- but how will they migrate properly? hum, need a review on this.
- 17 PMID-21087733[16] Gene therapy for Parkinson's disease: do we have the cure?
- Levodopa dyskinesias occur 5-10 years after treatment start and decrease the benefit of treatment.
- Levodopa does not alter the course of PD.
- Neural grafts for PD have been in development for three decades now, yet they are still considered experimental as they have not provided therapeutic benefit.
- Marks and colleagues report results of the first double-blind phase 2 trial for gene therapy of PD.
- This involves growth factors, retrogradely transported from the striatum to the SNpc.
- only saw effect at 18 months -- may have taken a long time for the gene to be expressed?
- Gene therapy can cure. DBS cannot.
- need to test with dopa-radiography PET scans.
- might cause cancer.
- See [17][18][19][20][21]
Non-dbs:
- PMID-12725785[22] An unsupervised automatic method for sorting neuronal spike waveforms in awake and freely moving animals.
- PMID-19882716[23] Neuroprotection of midbrain dopaminergic cells in MPTP-treated mice after near-infrared light treatment.
____References____
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