Sheng-Tzung Tsai

Pilot study of deep brain stimulation in refractory obsessive-compulsive disorder ethnic Chinese patients

Aims:  Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) is a promising alternative to ablative surgery in treatment of refractory obsessive–compulsive disorder (OCD). A pilot study was conducted to assess 15‐month outcomes of DBS in patients with refractory OCD in Taiwan.

Hypomania with hypersexuality following bilateral anterior limb stimulation in obsessive-compulsive disorder

This 28-year-old Chinese man was referred for deep brain stimulation (DBS) evaluation for an 8-year history of refractory obsessive-compulsive disorder. After the patient had signed an informed consent, the authors implanted DBS leads. Hypomania with hypersexuality was noted on stimulation at Contact 2 and became aggravated with a higher voltage (> or = 3 V) during chronic bilateral DBS. After the voltage was decreased to 1 V, the patients hypomanic symptoms subsided and his libido returned to baseline.

Acute stimulation effect of the ventral capsule/ventral striatum in patients with refractory obsessive–compulsive disorder – a double-blinded trial

Objective Deep-brain stimulation (DBS) for treating refractory obsessive–compulsive disorder (OCD) has shown positive results in small clinical trials. Ventral capsule/ventral striatum (VC/VS) is one of the promising targets; however, whether or not acute stimulation test can provide substantial information for chronic stimulation is not yet known. We evaluated postoperative test stimulation and examined the relationship of acute simulation-induced smile/laughter and 15-month clinical outcome. Methods Four adult patients with refractory OCD were implanted with Model 3387 leads bilaterally in an area of VC/VS. Postoperative test stimulation was performed at least 2 weeks after surgery. We performed double-blinded postoperative test stimulation with different contact and voltage. The relationship of stimulation-induced smile/laughter and chronic response was examined. Results Patients presented smile, laughter, euphoria, increased heart rate, increased blood pressure, smell, chest vibration, dizziness, nausea, heat, or increased sexual drive during acute stimulation. We found that the higher the percentage of smile/laughter (34.3%, 31.3%, 56.3%, and 12.5% for four cases), the greater the reduction in the Yale-Brown Obsessive Compulsive Scale (30.6%, 38.9%, 58.8%, and 7.7% respectively at 15-month DBS). Conclusion This study showed that acute DBS of the VC/VS might cause mood change, cardiovascular, sensory, or motor effects. These effects were transient or habituated over six months. We suggest stimulation-induced smile/laughter may be a possible predictor for long-term DBS outcome. Larger studies, genetic studies, and imaging studies are needed to evaluate the effects of different parameters and possible predictors in the treatment of OCD.

Dorsolateral subthalamic neuronal activity enhanced by median nerve stimulation characterizes Parkinson's disease during deep brain stimulation with general anesthesia.

OBJECT Deep brain stimulation (DBS) surgery under general anesthesia is an alternative option for patients with Parkinsons disease (PD). However, few studies are available that report whether neuronal firing can be accurately recorded during this condition. In this study the authors attempted to characterize the neuronal activity of the subthalamic nucleus (STN) and elucidate the influence of general anesthetics on neurons during DBS surgery in patients with PD. The benefit of median nerve stimulation (MNS) for localization of the dorsolateral subterritory of the STN, which is involved in sensorimotor function, was explored. METHODS Eight patients with PD were anesthetized with desflurane and underwent contralateral MNS at the wrist during microelectrode recording of the STN. The authors analyzed the spiking patterns and power spectral density (PSD) of the background activity along each penetration track and determined the spatial correlation to the target location, estimated mated using standard neurophysiological procedures. RESULTS The dorsolateral STN spiking pattern showed a more prominent bursting pattern without MNS and more oscillation with MNS. In terms of the neural oscillation of the background activity, beta-band oscillation dominated within the sensorimotor STN and showed significantly more PSD during MNS (p < 0.05). CONCLUSIONS Neuronal firing within the STN could be accurately identified and differentiated when patients with PD received general anesthetics. Median nerve stimulation can enhance the neural activity in beta-band oscillations, which can be used as an index to ensure optimal electrode placement via successfully tracked dorsolateral STN topography.

The Epidemiology of Parkinson's Disease

Abstract Parkinsons disease (PD) is the second most common neurodegenerative disorder and manifests as bradykinesia, rigidity, resting tremor and posture instability. Although the disease symptomatology can be well controlled by levodopa, related medications and deep brain stimulation, the etiology of PD remains obscure. The epidemiological features have been discussed in depth in the literature, but the methodologies used to approach the issues have varied greatly, and the results cover a wide range of factors and are generally inconclusive. The crude prevalence rate of PD has been reported to range from 15 per 100,000 to 12,500 per 100,000, and the incidence of PD from 15 per 100,000 to 328 per 100,000, with the disease being less common in Asian countries. Risk factor studies have pinpointed cigarette smoking, coffee/tea consumption and alcohol drinking as being mostly related to a lower risk of PD. The relationship between a higher risk of PD and drinking well-water and being exposed to herbicides/pesticides is controversial. Systemic diseases including gout, hyperlipidemia and hypertension may be related to a reduced risk of PD. A family history of PD, tremor, depression and head injury are related to a higher risk of PD. Genetic studies of the glucocerebrosidase, parkin and LRRK2 genes have contributed to our understanding of familial PD but not of sporadic PD. The health-related quality of life of PD patients is related not only to their motor disability, but also to their non-motor symptoms of depression, sleep disturbance, bladder and sexual dysfunction. The economic burden of PD is enormous, and the annual cost of medical service per PD patient can reach €13,804 (NT

Hypomania-like syndrome induced by deep brain stimulation of bilateral anterior limbs of the internal capsules

599,547).

Controversial Issues in Deep Brain Stimulation in Parkinson's Disease

Deep brain stimulation (DBS) is an experimental treatment for medication-refractory obsessive-compulsive disorder (OCD). The data from four centers support its therapeutic promise (Greenberg et al., 2008), but adverse effects such as panic induced by stimulation were reported (Shapira et al., 2006). In this case, we discuss hypomania-like syndrome induced by bilateral stimulation of the anterior limbs of the internal capsules.

Superficial temporal artery-middle cerebral artery bypass for the treatment of complex middle cerebral artery aneurysms

Since 1992, the application of subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson’s disease (PD) has been shown to induce dramatic and stable long-term improvement of patients’ motor symptoms. However, some of the motor symptoms, and most of the non-motor symptoms, may not be improved by STN-DBS; in fact, they may deteriorate after surgery. Even after the successful introduction of STN-DBS as a treatment for PD, controversy still exists over a variety of issues: patient selection criteria, the anatomical target such as STN or globus pallidus (GPi), targeting methods (MRI alone, CT scan with image fusion, or ventriculography), microelectrode recordings (yes/no), and anesthetic procedures (awake with sedative or under general anesthesia). In this chapter we will discuss these controversial issues by integrating our experience with a review of the literature.

Quality of life in patients with Parkinson's disease after subthalamic stimulation: An observational cohort study for outcome prediction

Objectives: Direct microsurgical clipping for complex middle cerebral artery (MCA) aneurysms may require a long ischemic time. Sacrifice of the parent artery with trapping or endovascular coiling also may lead to ischemic stroke. We described our institutional experience with the treatment of complex MCA aneurysms using extracranial-intracranial (EC-IC) (superficial temporal artery [STA]-MCA) bypass. Materials and Methods: We retrospectively reviewed patients who had treatment of IC aneurysms with the assistance of STA-MCA bypass from July 2002 to December 2016. Six patients with complex MCA aneurysms were identified, and we reviewed their clinical characteristics. Results: There were three men and three women with age ranging from 27 to 59 (mean 49) years old. Image studies showed subarachnoid hemorrhage in three cases. All patients underwent STA-MCA anastomosis, and the follow-up period ranged from 2 to 116 months (mean 51.5 months). Two of the six MCA aneurysms were fusiform, two aneurysms had bizarre configurations, one was a dissecting saccular aneurysm, and one had a blister configuration. Three patients received direct vessel trapping, two patients received aneurysm clipping, and one received aneurysm coiling. The postoperative bypass patency rate was 100%. The modified Rankin scale showed good outcomes in the six patients. Conclusions: EC-IC bypass plays an important role as a salvage procedure in the treatment of complex MCA aneurysms which have a fusiform, bizarre, or blister configuration.

Compulsive skin-picking behavior after deep brain stimulation in a patient with refractory obsessive–compulsive disorder: A case report

Objective: The objective of this study was to investigate the changes in health-related quality of life (HRQoL) and motor and depressive symptoms in patients with Parkinsons disease (PD) from baseline to 12 months following subthalamic nucleus deep brain stimulation (STN-DBS). Materials and Methods: The study utilized a prospective observational cohort design. Thirty-three PD patients with a good levodopa response but drug-related morbidity were included. PD Questionnaire-39 (PDQ-39) scores, unified PD rating scale (UPDRS) scores, Hoehn and Yahr stages, Beck Depression Inventory-II scores, and levodopa equivalent daily doses (LEDD) were obtained at baseline and 1 year after surgery. Results: The enrolled patients showed a significant HRQoL improvement of 21.43% at 12 months after STN-DBS as assessed by the PDQ-39 total score. There was a 34.92% improvement in UPDRS scores after STN-DBS at 1 year follow-up. Subitem analysis revealed significant improvement in UPDRS part II, III, and IV scores. The LEDD was significantly reduced by up to 27.36% 12 months after surgery. The preoperative PDQ-39 total score and LEDD predicted postoperative HRQoL in PD following STN-DBS. Conclusions: The current study demonstrated that STN-DBS surgery significantly improved HRQoL and motor outcomes of patients with PD. The preoperative PDQ-39 score and LEDD were predictors of the efficacy of postoperative HRQoL following surgery.