المؤلفون: Robert Peach, Maximilian Friedrich, Lara Fronemann, Muthuraman Muthuraman, Sebastian R. Schreglmann, Daniel Zeller, Christoph Schrader, Joachim K. Krauss, Alfons Schnitzler, Matthias Wittstock, Ann-Kristin Helmers, Steffen Paschen, Andrea Kühn, Inger Marie Skogseid, Wilhelm Eisner, Joerg Mueller, Cordula Matthies, Martin Reich, Jens Volkmann, Chi Wang Ip

المصدر: npj Digital Medicine, Vol 7, Iss 1, Pp 1-11 (2024)

مصطلحات موضوعية: Computer applications to medicine. Medical informatics, R858-859.7

الوصف: Abstract Dystonia is a neurological movement disorder characterised by abnormal involuntary movements and postures, particularly affecting the head and neck. However, current clinical assessment methods for dystonia rely on simplified rating scales which lack the ability to capture the intricate spatiotemporal features of dystonic phenomena, hindering clinical management and limiting understanding of the underlying neurobiology. To address this, we developed a visual perceptive deep learning framework that utilizes standard clinical videos to comprehensively evaluate and quantify disease states and the impact of therapeutic interventions, specifically deep brain stimulation. This framework overcomes the limitations of traditional rating scales and offers an efficient and accurate method that is rater-independent for evaluating and monitoring dystonia patients. To evaluate the framework, we leveraged semi-standardized clinical video data collected in three retrospective, longitudinal cohort studies across seven academic centres. We extracted static head angle excursions for clinical validation and derived kinematic variables reflecting naturalistic head dynamics to predict dystonia severity, subtype, and neuromodulation effects. The framework was also applied to a fully independent cohort of generalised dystonia patients for comparison between dystonia sub-types. Computer vision-derived measurements of head angle excursions showed a strong correlation with clinically assigned scores. Across comparisons, we identified consistent kinematic features from full video assessments encoding information critical to disease severity, subtype, and effects of neural circuit interventions, independent of static head angle deviations used in scoring. Our visual perceptive machine learning framework reveals kinematic pathosignatures of dystonia, potentially augmenting clinical management, facilitating scientific translation, and informing personalized precision neurology approaches.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2398-6352Test

الوصول الحر: https://doaj.org/article/0fbad953609640cea57e36f47712b111Test

المؤلفون: Clemens Jacksch, Kirsten E. Zeuner, Ann-Kristin Helmers, Karsten Witt, Günther Deuschl, Steffen Paschen

المصدر: Neurological Research and Practice, Vol 4, Iss 1, Pp 1-9 (2022)

مصطلحات موضوعية: Idiopathic cervical dystonia, Deep brain stimulation, Long-term effectiveness, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571, Neurology. Diseases of the nervous system, RC346-429

الوصف: Abstract Background Cervical dystonia (CD) is characterized by involuntary contractions of the cervical muscles. Data on long-term effectiveness of deep brain stimulation (DBS) are rare. The aim of this study was to evaluate the longitudinal ten years treatment efficacy of DBS in the globus pallidus internus (GPI). Methods A retrospective single-center data analysis was performed on patients with idiopathic CD, who were treated with GPI DBS for at least 10 years. TWSTR severity score and individual sub-items were compared between pre and post DBS surgery (n = 15) over time. Results There was a significant and persistent positive effect regarding the severity of TWSTRS between the conditions immediately before and 1, 5, and 10 years after establishment of GPI DBS (mean difference: 6.6–7 ± 1.6). Patients with increasing CD complexity showed a poorer response to established treatment forms, such as injection of botulinum toxin and were thus DBS candidates. Especially a predominant torticollis was significantly improved by DBS. Conclusion GPI DBS is an effective procedure especially in severely affected patients with a positive 10-year outcome. It should be considered in more complex CD-forms or predominant torticollis.

وصف الملف: electronic resource

العلاقة: https://doaj.org/toc/2524-3489Test

الوصول الحر: https://doaj.org/article/92b76a79e67c4176b502c9269cf978b2Test

المؤلفون: Bassam Al-Fatly, Inken Tödt, Martha Tischer, Joseph Neimat, Peter Hedera, Joshua Wong, Michael Okun, Andreas Nowacki, Tipu Aziz, Thomas Prokop, Volker Coenen, Panagiotis Bargiotas, Lenard Lachenmayer, Ann-Kristin Helmers, Steffen Paschen, Andrea Kühn, Andreas Horn, Michael Fox, Jos Becktepe, Günther Deuschl

المصدر: Brain Stimulation, Vol 16, Iss 1, Pp 296-297 (2023)

مصطلحات موضوعية: Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

وصف الملف: electronic resource

العلاقة: http://www.sciencedirect.com/science/article/pii/S1935861X23005314Test; https://doaj.org/toc/1935-861XTest

الوصول الحر: https://doaj.org/article/b9735b265b45425c9f3b42b284066142Test

المؤلفون: Mevlüt Yalaz, Nicholas Maling, Günther Deuschl, León M. Juárez-Paz, Markus Butz, Alfons Schnitzler, Ann-Kristin Helmers, Michael Höft

المصدر: Brain Sciences, Vol 12, Iss 1, p 86 (2022)

مصطلحات موضوعية: deep brain stimulation, magnetoencephalography, segmented DBS electrode, bipolar electrode configuration, localization, rotational orientation detection, Neurosciences. Biological psychiatry. Neuropsychiatry, RC321-571

الوصف: Background: Current approaches to detect the positions and orientations of directional deep brain stimulation (DBS) electrodes rely on radiative imaging data. In this study, we aim to present an improved version of a radiation-free method for magnetic detection of the position and the orientation (MaDoPO) of directional electrodes based on a series of magnetoencephalography (MEG) measurements and a possible future solution for optimized results using emerging on-scalp MEG systems. Methods: A directional DBS system was positioned into a realistic head–torso phantom and placed in the MEG scanner. A total of 24 measurements of 180 s each were performed with different predefined electrode configurations. Finite element modeling and model fitting were used to determine the position and orientation of the electrode in the phantom. Related measurements were fitted simultaneously, constraining solutions to the a priori known geometry of the electrode. Results were compared with the results of the high-quality CT imaging of the phantom. Results: The accuracy in electrode localization and orientation detection depended on the number of combined measurements. The localization error was minimized to 2.02 mm by considering six measurements with different non-directional bipolar electrode configurations. Another six measurements with directional bipolar stimulations minimized the orientation error to 4°. These values are mainly limited due to the spatial resolution of the MEG. Moreover, accuracies were investigated as a function of measurement time, number of sensors, and measurement direction of the sensors in order to define an optimized MEG device for this application. Conclusion: Although MEG introduces inaccuracies in the detection of the position and orientation of the electrode, these can be accepted when evaluating the benefits of a radiation-free method. Inaccuracies can be further reduced by the use of on-scalp MEG sensor arrays, which may find their way into clinics in the foreseeable future.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/2076-3425/12/1/86Test; https://doaj.org/toc/2076-3425Test

الوصول الحر: https://doaj.org/article/2441c4f7933d4d6aa2362fa2d6cfdc86Test

المؤلفون: Mevlüt Yalaz, Günther Deuschl, Markus Butz, Alfons Schnitzler, Ann-Kristin Helmers, Michael Höft

المصدر: Sensors, Vol 21, Iss 7, p 2527 (2021)

مصطلحات موضوعية: magnetoelectric sensor, SQUID, MEG, deep brain stimulation (DBS), directional DBS electrode, magnetic field measurement, Chemical technology, TP1-1185

الوصف: Correct position and orientation of a directional deep brain stimulation (DBS) electrode in the patient’s brain must be known to fully exploit its benefit in guiding stimulation programming. Magnetoelectric (ME) sensors can play a critical role here. The aim of this study was to determine the minimum required limit of detection (LOD) of a ME sensor that can be used for this application by measuring the magnetic field induced by DBS. For this experiment, a commercial DBS system was integrated into a head phantom and placed inside of a state-of-the-art Superconducting Quantum Interference Device (SQUID)-based magnetoencephalography system. Measurements were performed and analyzed with digital signal processing. Investigations have shown that the minimum required detection limit depends on various factors such as: measurement distance to electrode, bandwidth of magnetic sensor, stimulation amplitude, stimulation pulse width, and measurement duration. For a sensor that detects only a single DBS frequency (stimulation frequency or its harmonics), a LOD of at least 0.04 pT/Hz0.5 is required for 3 mA stimulation amplitude and 60 μμs pulse width. This LOD value increases by an order of magnitude to 0.4 pT/Hz0.5 for a 1 kHz, and by approximately two orders to 3 pT/Hz0.5 for a 10 kHz sensor bandwidth. By averaging, the LOD can be reduced by at least another 2 orders of magnitude with a measurement duration of a few minutes.

وصف الملف: electronic resource

العلاقة: https://www.mdpi.com/1424-8220/21/7/2527Test; https://doaj.org/toc/1424-8220Test

الوصول الحر: https://doaj.org/article/0162384bf7e64eeca0a859c12ff3b2b4Test

المؤلفون: Johannes Meyne, Mirjam Domschikowski, Johannes Hensler, Ann-Kristin Helmers, Daniela Berg, Günther Deuschl, Steffen Paschen

المصدر: Journal of Neurology.

مصطلحات موضوعية: Neurology, Neurology (clinical)

الوصف: Background Intravenous thrombolysis (IVT) and endovascular mechanical thrombectomy therapy (MT) are well established in the treatment of acute ischemic stroke. It is currently unclear whether these treatments can be applied in patients with previous deep brain stimulation (DBS) surgery and how long the interval to the DBS operation should be. Methods Four patients with ischemic stroke and IVT or MT were included in this retrospective case series. Data on demographics, genesis, severity and course of the stroke and the DBS indication were extracted and evaluated. Furthermore, a literature review was conducted. Outcomes and hemorrhagic complications after IVT, MT or intra-arterial thrombolysis in patients with prior deep brain stimulation surgery and intracranial surgery were analyzed. Results Four patients with acute ischaemic stroke and previous DBS surgery were treated with IVT (2 patients), MT (1) or a combined therapy of IVT and MT (1). The time interval to the previous DBS surgery was between 6 and 135 months. In these four patients, no bleeding complications occurred. The literature review revealed four publications with a total of 18 patients, who were treated with IVT, MT or intra-arterial thrombolysis. Of these 18 patients, only 1 had undergone deep brain stimulation surgery, the other 17 patients had received brain surgery for other reasons. Bleeding complications occurred in four of the 18 reported patients, but not in the DBS case. All four patients with bleeding complications were reported to have died as a result. In three of the four patients with fatal outcome, surgery was less than 90 days before the onset of stroke. Conclusion IVT and MT were tolerated by four patients with ischemic stroke more than 6 months after DBS surgery without bleeding complications.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::0aaddff7e8720dce762fd0fb262a995aTest
https://doi.org/10.1007/s00415-023-11765-4Test

المؤلفون: Steffen Paschen, Ann-Kristin Helmers, Günter Deuschl

المصدر: Deutsches Ärzteblatt Online.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_________::733971de6bc153b091b51ad350bdd004Test
https://doi.org/10.3238/persneuro.2022.12.16.05Test

المؤلفون: Andreas Horn, Martin M. Reich, Siobhan Ewert, Ningfei Li, Bassam Al-Fatly, Florian Lange, Jonas Roothans, Simon Oxenford, Isabel Horn, Steffen Paschen, Joachim Runge, Fritz Wodarg, Karsten Witt, Robert C. Nickl, Matthias Wittstock, Gerd-Helge Schneider, Philipp Mahlknecht, Werner Poewe, Wilhelm Eisner, Ann-Kristin Helmers, Cordula Matthies, Joachim K. Krauss, Günther Deuschl, Jens Volkmann, Andrea A. Kühn

المصدر: Proceedings of the National Academy of Sciences. 119

مصطلحات موضوعية: Treatment Outcome, Multidisciplinary, Thalamus, Dystonic Disorders, Deep Brain Stimulation, Humans, Globus Pallidus, Torticollis

الوصف: Dystonia is a debilitating disease with few treatment options. One effective option is deep brain stimulation (DBS) to the internal pallidum. While cervical and generalized forms of isolated dystonia have been targeted with a common approach to the posterior third of the nucleus, large-scale investigations regarding optimal stimulation sites and potential network effects have not been carried out. Here, we retrospectively studied clinical results following DBS for cervical and generalized dystonia in a multicenter cohort of 80 patients. We model DBS electrode placement based on pre- and postoperative imaging and introduce an approach to map optimal stimulation sites to anatomical space. Second, we investigate which tracts account for optimal clinical improvements, when modulated. Third, we investigate distributed stimulation effects on a whole-brain functional connectome level. Our results show marked differences of optimal stimulation sites that map to the somatotopic structure of the internal pallidum. While modulation of the striatopallidofugal axis of the basal ganglia accounted for optimal treatment of cervical dystonia, modulation of pallidothalamic bundles did so in generalized dystonia. Finally, we show a common multisynaptic network substrate for both phenotypes in the form of connectivity to the cerebellum and somatomotor cortex. Our results suggest a brief divergence of optimal stimulation networks for cervical vs. generalized dystonia within the pallidothalamic loop that merge again on a thalamo-cortical level and share a common whole-brain network.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9782f22b25e222f1bc29fb114a4cbbcfTest
https://doi.org/10.1073/pnas.2114985119Test

المؤلفون: Inken Tödt, Bassam Al‐Fatly, Oliver Granert, Andrea A. Kühn, Paul Krack, Joern Rau, Lars Timmermann, Alfons Schnitzler, Steffen Paschen, Ann‐Kristin Helmers, Andreas Hartmann, Eric Bardinet, Michael Schuepbach, Michael T. Barbe, Till A. Dembek, Valerie Fraix, Dorothee Kübler, Christine Brefel‐Courbon, Alireza Gharabaghi, Lars Wojtecki, Marcus O. Pinsker, Stephane Thobois, Philippe Damier, Tatiana Witjas, Jean‐Luc Houeto, Carmen Schade‐Brittinger, Marie Vidailhet, Andreas Horn, Günther Deuschl

المساهمون: University Medical Center of Schleswig–Holstein = Universitätsklinikum Schleswig-Holstein (UKSH), Kiel University, Charité - UniversitätsMedizin = Charité - University Hospital [Berlin], Bern University Hospital [Berne] (Inselspital), Philipps Universität Marburg = Philipps University of Marburg, Justus-Liebig-Universität Gießen = Justus Liebig University (JLU), Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf], Centre d'investigation clinique Neurosciences [CHU Pitié Salpêtrière] (CIC Neurosciences), Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Institut du Cerveau = Paris Brain Institute (ICM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Sorbonne Université (SU)-Sorbonne Université (SU)-Centre National de la Recherche Scientifique (CNRS), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), University Hospital of Cologne [Cologne], [GIN] Grenoble Institut des Neurosciences (GIN), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Eberhard Karls Universität Tübingen = Eberhard Karls University of Tuebingen, University of Freiburg [Freiburg], Hôpital neurologique et neurochirurgical Pierre Wertheimer [CHU - HCL], Hospices Civils de Lyon (HCL), Centre d’Investigation Clinique de Nantes (CIC Nantes), Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre hospitalier universitaire de Nantes (CHU Nantes), Institut de Neurosciences de la Timone (INT), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), Centre d'investigation clinique pluridisciplinaire [CHU Pitié Salpêtrière] (CIC-P 1421), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-CHU Pitié-Salpêtrière [AP-HP], Service de Neurologie [CHU Pitié-Salpêtrière], IFR70-CHU Pitié-Salpêtrière [AP-HP], HAL-SU, Gestionnaire

المصدر: Movement Disorders
Movement Disorders, 2022, ⟨10.1002/mds.28952⟩
Tödt, Inken; Al-Fatly, Bassam; Granert, Oliver; Kühn, Andrea A; Krack, Paul; Rau, Joern; Timmermann, Lars; Schnitzler, Alfons; Paschen, Steffen; Helmers, Ann-Kristin; Hartmann, Andreas; Bardinet, Eric; Schuepbach, Michael; Barbe, Michael T; Dembek, Till A; Fraix, Valerie; Kübler, Dorothee; Brefel-Courbon, Christine; Gharabaghi, Alireza; Wojtecki, Lars; ... (2022). The Contribution of Subthalamic Nucleus Deep Brain Stimulation to the Improvement in Motor Functions and Quality of Life. Movement disorders, 37(2), pp. 291-301. Wiley 10.1002/mds.28952 <http://dx.doi.org/10.1002/mds.28952Test>

مصطلحات موضوعية: [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, Parkinson's disease, 610 Medicine & health, Parkinson Disease, subthalamic nucleus deep brain stimulation, nervous system diseases, deep brain stimulation, Treatment Outcome, surgical procedures, operative, Neurology, nervous system, quality of life, Subthalamic Nucleus, Humans, Neurology (clinical), [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology

الوصف: BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms and quality of life (QoL) of advanced and fluctuating early Parkinson's disease. Little is known about the relation between electrode position and changes in symptom control and ultimately QoL. OBJECTIVES The relation between the stimulated part of the STN and clinical outcomes, including the motor score of the Unified Parkinson's Disease Rating Scale (UPDRS) and the quality-of-life questionnaire, was assessed in a subcohort of the EARLYSTIM study. METHODS Sixty-nine patients from the EARLYSTIM cohort who underwent DBS, with a comprehensive clinical characterization before and 24 months after surgery, were included. Intercorrelations of clinical outcome changes, correlation between the affected functional parts of the STN, and changes in clinical outcomes were investigated. We further calculated sweet spots for different clinical parameters. RESULTS Improvements in the UPDRS III and Parkinson's Disease Questionnaire (PDQ-39) correlated positively with the extent of the overlap with the sensorimotor STN. The sweet spots for the UPDRS III (x = 11.6, y = -13.1, z = -6.3) and the PDQ-39 differed (x = 14.8, y = -12.4, z = -4.3) ~3.8 mm. CONCLUSIONS The main influence of DBS on QoL is likely mediated through the sensory-motor basal ganglia loop. The PDQ sweet spot is located in a posteroventral spatial location in the STN territory. For aspects of QoL, however, there was also evidence of improvement through stimulation of the other STN subnuclei. More research is necessary to customize the DBS target to individual symptoms of each patient. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.

وصف الملف: application/pdf

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::9a282ea8279f90bc02c833161872fe74Test
https://hal.sorbonne-universite.fr/hal-03559813/documentTest

المؤلفون: Alexandru Andrusca, Steffen Paschen, Christian Schlenstedt, Ann-Kristin Helmers, Olga Gavriliuc, Günther Deuschl

المصدر: Parkinsonism & Related Disorders. 80:175-180

مصطلحات موضوعية: Adult, Male, 0301 basic medicine, Levodopa, medicine.medical_specialty, Deep brain stimulation, Parkinson's disease, genetic structures, Deep Brain Stimulation, medicine.medical_treatment, Video Recording, Psychological intervention, Antiparkinson Agents, 03 medical and health sciences, 0302 clinical medicine, Physical medicine and rehabilitation, Subthalamic Nucleus, Rating scale, medicine, Humans, Single-Blind Method, Gait Disorders, Neurologic, Aged, business.industry, Subthalamic nucleus deep brain stimulation, Parkinson Disease, Middle Aged, medicine.disease, Combined Modality Therapy, Video assessment, Treatment Outcome, 030104 developmental biology, Neurology, Female, Neurology (clinical), Geriatrics and Gerontology, business, 030217 neurology & neurosurgery, Follow-Up Studies, medicine.drug, Blinded study

الوصف: Freezing of gait (FOG) in Parkinson's disease (PD) is provoked by specific situations. The sensitivity of these situations to detect FOG and the relative FOG response to l-dopa and subthalamic nucleus deep brain stimulation (STN-DBS) is unknown.Two blinded reviewers analyzed the video recordings of a standardized patient assessment before and 10 months after DBS-implantation of 124 PD patients with positive FOG according to the Unified Parkinson Rating Scale part II item 14. Baseline evaluations were done under 2 conditions (OFF- and ON-drug states). Postoperatively, the patients were evaluated under 4 conditions (OFF-drug/OFF-stim, OFF-drug/ON-stim, ON-drug/OFF-stim, and ON-drug/ON-stim). FOG frequency and its severity was rated during different provoking situations (start, turning, reaching a destination and open space hesitations) during a standardized walking task. Cumulative link mixed models were calculated to investigate the immediate and carry-over effect of medication and stimulation.Eighty-one percent of patients presented FOG at least in one provoking situation on video assessment. During turning, the FOG severity was significantly worse than for the other subtypes (p 0.0001). Both interventions improve all FOG subtypes similarly. The effect size of l-dopa and STN-DBS on subtypes were similar (p 0.05), but the combined intervention had a stronger effect on FOG severity (p 0.0001) compared to each intervention separately. FOG severity was lower at follow-up OFF compared to baseline OFF condition (p 0.02) demonstrating a carry-over effect of STN-DBS.Turning is the most sensitive provoking situation for gait freezing. STN-DBS and l-dopa improve all FOG subtypes similarly, their effect is stronger in combination.

الوصول الحر: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::df19f29d58ac8f56733f0b3a53214571Test
https://doi.org/10.1016/j.parkreldis.2020.09.043Test