ABSTRACT
In Parkinson's disease (PD), on-demand deep brain stimulation is required so that stimulation is regulated to reduce side effects resulting from continuous stimulation and PD exacerbation due to untimely stimulation. Also, the progressive nature of PD necessitates the use of dynamic detection schemes that can track the nonlinearities in PD. This paper proposes the use of dynamic feature extraction and dynamic pattern classification to achieve dynamic PD detection taking into account the demand for high accuracy, low computation, and real-time detection. The dynamic feature extraction and dynamic pattern classification are selected by evaluating a subset of feature extraction, dimensionality reduction, and classification algorithms that have been used in brain-machine interfaces. A novel dimensionality reduction technique, the maximum ratio method (MRM) is proposed, which provides the most efficient performance. In terms of accuracy and complexity for hardware implementation, a combination having discrete wavelet transform for feature extraction, MRM for dimensionality reduction, and dynamic k-nearest neighbor for classification was chosen as the most efficient. It achieves a classification accuracy of 99.29%, an F1-score of 97.90%, and a choice probability of 99.86%.
Subject(s)
Deep Brain Stimulation/methods , Parkinson Disease/rehabilitation , Algorithms , Computer Simulation , Computer Systems , Deep Brain Stimulation/classification , Electroencephalography/classification , Fourier Analysis , Humans , Nonlinear Dynamics , Normal Distribution , Reproducibility of Results , Subthalamic Nucleus , Support Vector Machine , Wavelet AnalysisABSTRACT
In this study, we present long-term results from patients with medial temporal lobe (MTL) epilepsy treated with deep brain stimulation (DBS). Since 2001, 11 patients (8M) with refractory MTL epilepsy underwent MTL DBS. When unilateral DBS failed to decrease seizures by > 90%, a switch to bilateral MTL DBS was proposed. After a mean follow-up of 8.5 years (range: 67-120 months), 6/11 patients had a ≥ 90% seizure frequency reduction with 3/6 seizure-free for > 3 years; three patients had a 40%-70% reduction and two had a < 30% reduction. In 3/5 patients switching to bilateral DBS further improved outcome. Uni- or bilateral MTL DBS did not affect neuropsychological functioning. This open study with an extended long-term follow-up demonstrates maintained efficacy of DBS for MTL epilepsy. In more than half of the patients, a seizure frequency reduction of at least 90% was reached. Bilateral MTL DBS may herald superior efficacy in unilateral MTL epilepsy.
Subject(s)
Deep Brain Stimulation/methods , Epilepsy, Temporal Lobe/therapy , Adult , Anticonvulsants/therapeutic use , Combined Modality Therapy , Deep Brain Stimulation/adverse effects , Deep Brain Stimulation/classification , Deep Brain Stimulation/instrumentation , Electrodes, Implanted , Electroencephalography/instrumentation , Electroencephalography/methods , Epilepsy, Temporal Lobe/drug therapy , Epilepsy, Temporal Lobe/physiopathology , Follow-Up Studies , Humans , Seizures/drug therapy , Seizures/physiopathology , Seizures/therapy , Treatment OutcomeABSTRACT
Introduccion. La estimulación cerebral profunda (ECP) es un tratamiento muy efectivo para las complicaciones motoras de la enfermedad de Parkinson (EP) avanzada, pero como todo procedimiento neuroquirúrgico intracerebral no está libre de complicaciones. Objetivo. Revisión bibliográfica sobre las complicaciones de la ECP en la EP. Desarrollo. Las complicaciones de la ECP ocurren en todas las etapas del procedimiento: antes, durante y después de la cirugía (en el postoperatorio inmediato y remoto). En la precirugía el aspecto más importante es la selección del candidato apropiado, no solo referido a beneficio sintomático, sino también en cuanto a conocer su estado cognitivo y comorbilidades. Durante la cirugía la complicación más grave y temida es la hemorragia cerebral. En el postoperatorio las complicaciones pueden relacionarse con la intervención (por ejemplo, síndrome confusional en el postoperatorio inmediato), con la estimulación (contracciones musculares tónicas, desviación ocular, midriasis, hipersudoración hemicorporal, empeoramiento de la acinesia, alteraciones de determinadas áreas cognitivas o conductuales), con el sistema implantado (rotura de electrodos, desconexión, desplazamientos, infecciones), con cambios en la medicación (por ejemplo, depresión) o con cambios en la funcionalidad y otras de origen desconocido (como aumento de peso). Conclusion. La ECP mejora la discapacidad y la calidad de vida de la EP avanzada, pero conlleva complicaciones o efectos adversos. Conocer estas complicaciones contribuye a minimizarlas y al perfeccionamiento de la técnica (AU)
Introduction. Deep brain stimulation (DBS) is a very effective treatment for the motor complications that appear in advanced Parkinson's disease (PD), but like all intracerebral neurochemical procedures it is not free of complications. Aims. The purpose of this work is to carry out a review of the literature on the complications of DBS in PD. Development. The complications of DBS occur in all the different stages of the procedure, that it to say, before, during and after the intervention (in the immediate and remote post-operative period). The most important aspect before the operation is to ensure an appropriate candidate is selected, not only with regard to the symptomatic benefits, but also in terms of knowing his or her cognitive status and comorbidities. During the surgical intervention the most severe and feared complication is a brain haemorrhage. In the post-operative period, complications can be related with the intervention (for example, confusional syndrome in the immediate post-operative period), with the stimulation (tonic muscular contractions, eye deviation, mydriasis, hyperhidrosis in half of the body, exacerbation of the akinesia, alterations of certain cognitive or behavioural areas), with the system implemented (breakage of electrodes, disconnection, movements, infections), with changes in the medication (for example, depression) or with changes in functionality, as well as others of an unknown origin (such as an increase in weight). Conclusions. DBS improves disability and the quality of life in advanced PD, but entails complications or side (AU)
Subject(s)
Humans , Male , Female , Parkinson Disease/genetics , Parkinson Disease/metabolism , Deep Brain Stimulation/methods , Cerebral Hemorrhage/metabolism , Quality of Life/psychology , Pulmonary Embolism/pathology , Embolic Protection Devices/classification , Paresthesia/diagnosis , Parkinson Disease/complications , Parkinson Disease/pathology , Deep Brain Stimulation/classification , Cerebral Hemorrhage/blood , Quality of Life , Pulmonary Embolism/metabolism , Embolic Protection Devices , Paresthesia/complicationsABSTRACT
La estimulación cerebral profunda (ECP) es un técnica invasiva y reversible instaurada en los últimos tiempos para el tratamiento de enfermedades neurológicas y psiquiátricas. Si nos centramos en su uso en psiquiatría, se han publicado hasta la actualidad diferentes trabajos con buenos resultados en trastorno obsesivo compulsivo, en el trastorno de ansiedad generalizada y en el trastorno depresivo mayor recurrente (TDM). En el Hospital de Sant Pau de Barcelona hemos realizado un estudio aleatorizado, cruzado y doble ciego de ECP en 8 pacientes con TDM resistente a múltiples tratamientos, utilizando la ECP bilateral en el área subcallosa del cíngulo o área Cg25. Tras un año de seguimiento, en este estudio hemos obtenido unos resultados esperanzadores: 87 % de respuesta y 70 % de remisión clínica, sin que los pacientes presentaran efectos secundarios remarcables. Centrándonos en el uso de la ECP en adicciones, hay muy poco publicado, y casi todos los estudios son preclínicos. Nombraremos algunos de ellos, así como varios de los artículos que hay publicados en humanos, y abriremos una puerta a la futura investigación de técnicas invasivas que incidan en el circuito de recompensa y puedan así ayudar a controlar el craving de los pacientes con problemas adictivos (AU)
Deep brain stimulation (DBS) is an invasive and reversible technique recently introduced in the treatment of neurological and psychiatric diseases. To date, there have been published different jobs in psychiatry with good results in OCD, MDD and GAD. In our centre, (Hospital de Sant Pau, in Barcelona), we have made a randomized, double-blind and crossover study in 8 patients with MDD resistant to multiple treatments, using bilateral DBS in the subgenual area or Cg25. We obtained after 1 year follow up encouraging results: 87 % response and 70 % of clinical remission, with unimportant side effects. Focusing on the use of ECP in addictions, there is very little published, and almost all studies are preclinical. We'll give some data about some of them, as well as 2 of the articles that have been published in humans. This may open the door to future research on invasive techniques that affect the reward circuitry, and give the key to control craving in addictive disorders (AU)
Subject(s)
Humans , Male , Adult , Middle Aged , Deep Brain Stimulation/instrumentation , Deep Brain Stimulation/methods , Substance-Related Disorders/psychology , Depression/complications , Depression/psychology , Nucleus Accumbens/metabolism , Subthalamic Nucleus/metabolism , Deep Brain Stimulation/classification , Deep Brain Stimulation/psychology , Deep Brain Stimulation/trends , Electric Stimulation/methods , Reward , Gyrus Cinguli/blood supply , Gyrus Cinguli/metabolismABSTRACT
Introducción y desarrollo. La estimulación cerebral profunda (ECP) es una técnica quirúrgica basada en la implantaciónde un electrodo programable en el sistema nervioso central mediante técnicas estereotáxicas. La ECP es, en la actualidad,una técnica bien conocida, empleada en pacientes con enfermedad de Parkinson (EP) y complicaciones motoras.Aunque hay diversas series publicadas en pacientes con EP intervenidos mediante ECP, existen aún controversias sobre algunospuntos, incluyendo la correcta selección de candidatos y, sobre todo, el momento de la cirugía. En los últimos años setiende a intervenir a pacientes con EP en un grado no tan avanzado como en los primeros años del uso de esta técnica. Ungrupo de expertos ha redactado este documento, fruto de una reunión del Grupo de Cirugía Funcional de la Sociedad Españolade Neurocirugía con el Grupo de Estudio de Trastornos del Movimiento de la Sociedad Española de Neurología, en unintento de clarificar en lo posible estos y otros puntos(AU)
Introduction and development. Deep brain stimulation (DBS) is a surgical technique based on the placement of aprogrammable electrode into certain areas of central nervous system. DBS is nowadays a well established treatment forpatients with Parkinsons disease (PD) and motor complications. However, there are controversies about several items,including the correct selection of patients and the best time for DBS. There is a current trend for DBS to be carried out atearlier stages of PD. A group of experts from Spanish Neurosurgical Society (Functional Surgery Study Group) and SpanishNeurological Society (Movement Disorders Study Group) wrote this consensus statement in order to clarify these and otheritems(AU)
