共查询到20条相似文献，搜索用时 46 毫秒
1.
Haidar Salimi Dafsari Luisa Weiß Monty Silverdale Alexandra Rizos Prashanth Reddy Keyoumars Ashkan Julian Evans Paul Reker Jan Niklas Petry-Schmelzer Michael Samuel Veerle Visser-Vandewalle Angelo Antonini Pablo Martinez-Martin K. Ray-Chaudhuri Lars Timmermann 《Brain stimulation》2018,11(4):867-874
Background
Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in advanced Parkinson's disease (PD). However, considerable inter-individual variability has been observed for QoL outcome.Hypothesis
We hypothesized that demographic and preoperative NMS characteristics can predict postoperative QoL outcome.Methods
In this ongoing, prospective, multicenter study (Cologne, Manchester, London) including 88 patients, we collected the following scales preoperatively and on follow-up 6 months postoperatively: PDQuestionnaire-8 (PDQ-8), NMSScale (NMSS), NMSQuestionnaire (NMSQ), Scales for Outcomes in PD (SCOPA)-motor examination, -complications, and –activities of daily living, levodopa equivalent daily dose. We dichotomized patients into “QoL responders”/“non-responders” and screened for factors associated with QoL improvement with (1) Spearman-correlations between baseline test scores and QoL improvement, (2) step-wise linear regressions with baseline test scores as independent and QoL improvement as dependent variables, (3) logistic regressions using aforementioned “responders/non-responders” as dependent variable.Results
All outcomes improved significantly on follow-up. However, approximately 44% of patients were categorized as “QoL non-responders”. Spearman-correlations, linear and logistic regression analyses were significant for NMSS and NMSQ but not for SCOPA-motor examination. Post-hoc, we identified specific NMS (flat moods, difficulties experiencing pleasure, pain, bladder voiding) as significant contributors to QoL outcome.Conclusions
Our results provide evidence that QoL improvement after STN-DBS depends on preoperative NMS characteristics. These findings are important in the advising and selection of individuals for DBS therapy. Future studies investigating motor and non-motor PD clusters may enable stratifying QoL outcomes and help predict patients' individual prospects of benefiting from DBS. 相似文献2.
Doreen Gruber Martin Südmeyer Günther Deuschl Daniela Falk Joachim K. Krauss Joerg Mueller Jan-Uwe Müller Werner Poewe Gerd-Helge Schneider Christoph Schrader Jan Vesper Jens Volkmann Christine Winter Andreas Kupsch Alfons Schnitzler 《Brain stimulation》2018,11(6):1368-1377
Introduction
Growing evidence suggests that pallidal deep brain stimulation represents a potential new therapeutic avenue in tardive dystonia/dyskinesia, but controlled and blinded randomized studies (RCT) are missing. The present RCT compares dystonia/dyskinesia severity of pallidal neurostimulation in patients with tardive dystonia using a delayed-start design paradigm.Methods
Dystonia/dyskinesia severity was assessed via blinded videos following pallidal neurostimulation at 3 (blinded phase) and 6 months (open extension phase). Primary endpoint was the percentage change of dystonia severity (Burke-Fahn-Marsden-Dystonia-Rating-Scale, BFMDRS) at 3 months between active vs. sham neurostimulation using blinded-video assessment. Secondary endpoints comprised clinical rating scores for movement disorders. Clinicaltrials.gov NCT00331669.Results
Twenty-five patients were randomized (1:1) to active (n?=?12) or sham neurostimulation (n?=?13). In the intention-to-treat analyses the between group difference of dystonia severity (BFMDRS) between active vs. sham stimulation was not significant at 3 months. Three months post-randomisation dystonia severity improved significantly within the neurostimulation by 22.8% and non-significantly within the sham group (12.0%) compared to their respective baseline severity. During the open-label extension with both groups being actively treated, significant and pronounced improvements of 41.5% were observed via blinded evaluation. Adverse events (n?=?10) occurred in 10/25 of patients during the 6 months, mostly related to surgical implantation of the device; all resolved without sequelae.Conclusion
The primary endpoint of this randomized trial was not significant, most likely due to incomplete recruitment. However, pronounced improvements of most secondary endpoints at 3 and 6 months provide evidence for efficacy and safety of pallidal neurostimulation in tardive dystonia. 相似文献3.
Isaac Acosta Guilherme Borges Rebeca Aguirre-Hernandez Ana Luisa Sosa Martin Prince 《Alzheimer's & dementia》2018,14(3):271-279
Introduction
Cognitive and/or memory impairment are the main clinical markers currently used to identify subjects at risk of developing dementia. This study aimed to explore the relationship between the presence of neuropsychiatric symptoms and dementia incidence.Methods
We analyzed the association between neuropsychiatric symptoms and incident dementia in a cohort of 1355 Mexican older adults from the general population over 3 years of follow-up, modeling cumulative incidence ratios using Poisson models.Results
Five neuropsychiatric symptoms were associated with incident dementia: delusions, hallucinations, anxiety, aberrant motor behavior, and depression. The simultaneous presence of two symptoms had a relative risk, adjusted for mild cognitive impairment, diabetes, indicators of cognitive function, and sociodemographic factors, of 1.9 (95% confidence interval, 1.2–2.9), whereas the presence of three to five, similarly adjusted, had a relative risk of 3.0 (95% confidence interval, 1.9–4.8).Discussion
Neuropsychiatric symptoms are common in predementia states and may independently contribute as risk factors for developing dementia. 相似文献4.
Mahsa Malekmohammadi Nicholas AuYong Joni Ricks-Oddie Yvette Bordelon Nader Pouratian 《Brain stimulation》2018,11(3):607-617
Objective
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) and globus pallidus internus (GPi) are equally efficacious in the management of Parkinson disease (PD). Studies of STN-DBS have revealed a therapeutic reduction in excessive cortical β-γ phase-amplitude coupling (PAC). It is unclear whether this is specific to STN-DBS and potentially mediated by modulation of the hyperdirect pathway or if it is a generalizable mechanism seen with DBS of other targets. Moreover, it remains unclear how cortical signals are differentially modulated by movement versus therapy. To clarify, the effects of GPi-DBS and movement on cortical β power and β-γ PAC were examined.Methods
Right sensorimotor electrocorticographic signals were recorded in 10 PD patients undergoing GPi-DBS implantation surgery. We evaluated cortical β power and β-γ PAC during blocks of rest and contralateral hand movement (finger tapping) with GPi-DBS off and on.Results
Movement suppressed cortical low β power (P?=?0.008) and high β-γ PAC (P?=?0.028). Linear mixed effect modeling (LMEM) showed that power in low and high β bands are differentially modulated by movement (P?=?0.022). GPi-DBS also results in a significant suppression of high β-γ PAC but without power modulation in either β sub-band (P?=?0.008). Cortical high β-γ PAC is significantly correlated with severity of bradykinesia (Rho?=?0.59, P?=?0.045) and changes proportionally with therapeutic improvement (Rho?=?0.61, P?=?0.04).Conclusions
Similar to STN-DBS, GPi-DBS reduces motor cortical β-γ PAC, like that also reported with dopaminergic mediations, suggesting it is a generalizable symptom biomarker in PD, independent of therapeutic target or proximity to the hyperdirect pathway. 相似文献5.
Maurizio Fava Marlene P. Freeman Martina Flynn Bettina B. Hoeppner Richard Shelton Dan V. Iosifescu James W. Murrough David Mischoulon Cristina Cusin Mark Rapaport Boadie W. Dunlop Madhukar H. Trivedi Manish Jha Gerard Sanacora Gretchen Hermes George I. Papakostas 《Brain stimulation》2018,11(1):75-84
Background
Low-Field Magnetic Stimulation (LFMS) is a novel, non-invasive, sub-threshold neuromodulation technique, shown in preliminary studies to have immediate mood elevating effects in both unipolar and bipolar depressed patients.Objective
We aimed to assess the antidepressant augmentation effects at 48 h of LFMS administered on two consecutive days compared to sham treatment in treatment resistant depression (TRD) subjects, using the Sequential Parallel Comparison Design (SPCD).Methods
Eighty-four eligible subjects with TRD were randomly assigned to double-blind treatment with LFMS 20 min/day for four days, sham treatment 20 min/day for four days, or sham treatment 20 min/day for 2 days followed by LFMS treatment 20 min/day for two days, using the pre-randomization version of the SPCD (randomization 1:1:1). The SPCD analyses used a repeated measures linear modeling approach with maximum likelihood estimation to use all available data, and using a 60–40 weighting of Stage 1 vs. 2 responses, with the primary outcome being measured after 2 and 4 days.Results
Both primary and secondary outcome measures consistently showed no differences between LFMS-treated patients and those treated with sham, with the exception of a slight, non-significantly greater improvement than sham in the visual analogue scale (VAS) sad mood on LFMS-treated patients. LFMS treatment was relatively well tolerated.Conclusions
We did not observe a significantly greater, rapid efficacy of LFMS compared to sham therapy. Future studies need to examine the possible therapeutic effects of more intensive forms of LFMS, as other forms of neurostimulation typically require longer duration of exposure. 相似文献6.
Michael H. Connors Katrin M. Seeher John Crawford David Ames Michael Woodward Henry Brodaty 《Alzheimer's & dementia》2018,14(7):880-888
Introduction
Neuropsychiatric symptoms are common in Alzheimer's disease. Previous research has attempted to identify subsyndromes—sets of symptoms related to one another—to clarify underlying mechanisms and treatment targets. We examined the stability of these subsyndromes over time.Methods
We administered the Neuropsychiatric Inventory annually for 3 years to 447 patients with Alzheimer's disease recruited from memory clinics. We conducted principal component analyses at each time point and multiple-group confirmatory factor analyses across time.Results
Principal component analyses showed that no two time points shared the same factor structure. Factor solutions did not exhibit strong simple structures and substantial cross-loadings were common. Confirmatory analysis revealed significant differences in factor loadings and model fit over time.Discussion
Symptoms cannot be neatly partitioned into discrete clusters that are stable over time. The findings highlight the significant challenges that clinicians and caregivers face and may help explain the lack of success in intervention studies. 相似文献7.
Background
TMS is safe and effective in the treatment of MDD, but as with other treatments, relapse may occur on cessation of treatment.Objective
To prevent relapse in MDD, following successful acute TMS treatment.Method
5 TMS treatments over 3 days, repeated at about monthly intervals.Results
14 patients received this care for more than 12 months. At the commencement of each series the mood scores were close to relapse, but at completion they were in the remitted range.Conclusion
Such treatment is useful. It is better conceptualized as relapse prevention rather than remittance maintenance. 相似文献8.
Krista L. Lanctôt Luis Agüera-Ortiz Henry Brodaty Paul T. Francis Yonas E. Geda Zahinoor Ismail Gad A. Marshall Moyra E. Mortby Chiadi U. Onyike Prasad R. Padala Antonios M. Politis Paul B. Rosenberg Emma Siegel David L. Sultzer Eleenor H. Abraham 《Alzheimer's & dementia》2017,13(1):84-100
Introduction
Apathy is common in neurocognitive disorders (NCDs) such as Alzheimer's disease and mild cognitive impairment. Although the definition of apathy is inconsistent in the literature, apathy is primarily defined as a loss of motivation and decreased interest in daily activities.Methods
The Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Neuropsychiatric Syndromes Professional Interest Area (NPS-PIA) Apathy workgroup reviewed the latest research regarding apathy in NCDs.Results
Progress has recently been made in three areas relevant to apathy: (1) phenomenology, including the use of diagnostic criteria and novel instruments for measurement, (2) neurobiology, including neuroimaging, neuropathological and biomarker correlates, and (3) interventions, including pharmacologic, nonpharmacologic, and noninvasive neuromodulatory approaches.Discussion
Recent progress confirms that apathy has a significant impact on those with major NCD and those with mild NCDs. As such, it is an important target for research and intervention. 相似文献9.
Despite increasing attention to the application of transcranial Direct Current Stimulation (tDCS) for enhancing cognitive functions in subjects exposing to varying degree of cerebral atrophy such as Alzheimer's disease (AD), aging, and mild cognitive impairment (MCI), there is no general information for customizing stimulation protocol.
Objective
The objective of this study is to examine how cerebral shrinkage associated with cognitive impairment and aging can perturb current density distribution through the brain.Methods
We constructed three high-resolution human head models representing young, elder, and MCI subjects and modeled two electrode configurations using rectangular electrodes.Results
Our results showed that decreasing gray matter volume in MCI, as well as aging, reduced the magnitude of the current density in the brain compared to the young model. Also, morphology alterations of the cerebral sulcus could shape the vectors of the current density to flow in the depth of cortical regions by cerebrospinal fluid.Conclusion
This study provides a framework for further advanced studies in establishing new methodologies or modifying stimulation parameters. 相似文献10.
Background
Theories of executive control propose that communication between medial frontal cortex (MFC) and lateral prefrontal cortex (lPFC) is critical for learning. 6-Hz phase synchronization may be the mechanism by which neural activity between MFC and lPFC is coordinated into a functional network. Recent evidence suggests that switching from eyes closed to open may induce a change in brain-state reflected by enhanced executive control and related functional connectivity.Objective/Hypothesis
To examine whether causal manipulation of MFC and lPFC can improve learning according to the brain-state induced by switching from eyes closed to open.Methods
Within-subjects, sham-controlled, double-blind study of 30 healthy subjects, each receiving 6-Hz in-phase high definition transcranial alternating-current stimulation (HD-tACS) applied to MFC and right lPFC prior to performing a time estimation task.Results
HD-tACS with eyes open improved learning ability relative to sham, whereas HD-tACS with eyes closed had no significant effect on behavior.Conclusion
Results suggest a phase-sensitive mechanism in frontal cortex mediates components of learning performance in a state-dependent manner. 相似文献11.
12.
Martin Schecklmann Carmen Weidler Peter Eichhammer Göran Hajak Berthold Langguth 《Brain stimulation》2018,11(5):1080-1082
Background
Schizophrenia is associated with changes in inhibitory and facilitatory brain networks which can be assessed by motor cortex excitability.Objective
Here, we investigate differences between large cross-sectional samples of un-medicated and medicated patients with schizophrenia and healthy controls in single- and double-pulse transcranial magnetic stimulation parameters.Methods
We measured right abductor digiti minimi muscle activity in 71 un-medicated, 43 medicated patients and 131 healthy controls. To exclude sample bias analyses were repeated with groups comparable for age and gender (un-medicated: n?=?43; medicated: n?=?38; controls: n?=?49).Results
Un-medicated patients showed increased short-interval intracortical inhibition (SICI) in contrast to medicated patients and healthy controls. No group differences were found for resting and active motor threshold, cortical silent period and intracortical facilitation.Conclusion
Increases in SICI are in contrast to literature and highlight the necessity for large-scaled multi-centric studies with high methodological standards. 相似文献13.
Background
It is not known whether results of clinical research in ECT can be used to guide treatment decisions for those having involuntary ECT, who are not represented in trial populations.Objective
We aimed to compare courses of involuntary ECT with matched voluntary ECT courses in terms of clinical and demographic factors, treatment requirements, and outcomes.Method
We performed a retrospective case-control study examining a five-year sample of involuntary ECT courses and an age-, gender- and time-matched voluntary ECT control sample.Results
We examined 48 involuntary and 96 control voluntary ECT courses. While groups differed at baseline in terms of diagnosis, illness severity and illness characteristics, there were no differences in treatment outcomes after ECT or six-month readmission rates.Conclusion
Our findings suggest that research on capacitous ECT patients is applicable to those having involuntary ECT. 相似文献14.
Alberto Benussi Valentina Dell&#x;Era Valentina Cantoni Clarissa Ferrari Salvatore Caratozzolo Luca Rozzini Antonella Alberici Alessandro Padovani Barbara Borroni 《Brain stimulation》2018,11(2):366-373
Background
Differential diagnosis of atypical parkinsonian disorders, i.e. dementia with Lewy bodies (DLB), progressive supranuclear palsy (PSP) or corticobasal syndrome (CBS) still remains problematic. Furthermore, DLB may overlap with Alzheimer's disease (AD) in the early stages of disease.Objective
To determine whether transcranial magnetic stimulation (TMS) can be used to classify atypical parkinsonian disorders and AD.Methods
A paired-pulse TMS multi-paradigm approach assessing multiple intracortical circuits, as short interval intracortical inhibition-facilitation and short latency afferent inhibition, was used to model a decision tree analysis and determine diagnostic accuracy in classifying different neurodegenerative disorders.Results
We observed a significant impairment in short latency afferent inhibition in AD and DLB and a significant impairment in short interval intracortical inhibition-facilitation in DLB, PSP and CBS patients. These parameters were used to model a decision tree analysis which yielded an overall diagnostic accuracy of 88.3%, with 90.5% for AD, 85.2% for DLB, 76.0% for CBS-PSP, and 94.9% for healthy controls.Conclusions
The assessment of intracortical connectivity with TMS may aid in the differential diagnosis of AD and the atypical parkinsonian disorders. 相似文献15.
Gabriel Amador de Lara Ivan Alekseichuk Zsolt Turi Albert Lehr Andrea Antal Walter Paulus 《Brain stimulation》2018,11(3):509-517
Background
Phase-amplitude cross-frequency coupling (PAC) is characterized by the modulation of the power of a fast brain oscillation (e.g., gamma) by the phase of a slow rhythm (e.g., theta). PAC in different sub- and neocortical regions is known to underlie effective neural communication and correlates with successful long-term memory formation.Objective/Hypothesis
The present work aims to extend earlier observational data, by probing the functional role of theta-gamma PAC in the left temporal cortex in humans during verbal long-term memory encoding.Methods
In three double-blinded, placebo-controlled experiments (n?=?72), we employed cross-frequency transcranial alternating current stimulation (tACS) to externally modulate ongoing PAC during a verbal-associative learning task. Three types of cross-frequency tACS protocols were used: bursts of high gamma tACS were coupled to the peak or trough of the theta tACS cycle, and a control condition where gamma tACS was continuously superimposed at theta tACS cycles.Results
Gamma bursts coupled to the trough of theta tACS induced robust behavioral impairment in memory performance (p?<?.01), whereas gamma burst coupled to the peak or continuously superimposed with theta tACS had no significant behavioral effects.Conclusions
Our results demonstrate direct evidence regarding the importance of theta-gamma coupling in verbal long-term memory formation. 相似文献16.
Elisa Kallioniemi Petri Savolainen Gustaf Järnefelt Päivi Koskenkorva Jari Karhu Petro Julkunen 《Brain stimulation》2018,11(2):322-326
Background
Transcranial magnetic stimulation (TMS) induced I-wave behavior can be demonstrated at neuronal population level using paired-pulses and by observing short-interval cortical facilitation (SICF). Advancements in stimulator technology have made it possible to apply biphasic paired-pulses to induce SICF.Objective
Our aim was to characterize the SICF I-wave interaction by biphasic paired-pulses with the ultimate objective to enhance TMS effects via SICF in various TMS-applications.Methods
We used biphasic paired-pulses in 15 volunteers to characterize corticospinal SICF using various 1.2–8.0ms inter-stimulus intervals, and measuring SICF input-output response.Results
SICF interaction with the first I-wave (I1) was observed in the output responses (motor evoked potentials; MEPs) in all subjects. Most subjects (≥80%) also exhibited later SICF I-wave interaction. SICF at I1 was present at all applied intensities below 140% of resting motor threshold. At I2, we observed SICF only with intensities just above motor threshold.Conclusions
Biphasic paired-pulses can reliably induce SICF shown by the facilitatory I-wave interaction, and could therefore be applied with repetitive bursts to enhance responsiveness to TMS. 相似文献17.
Background
Alpha (8–14?Hz) oscillatory power is linked to cortical excitability and corresponding modulations of sensory evoked potentials and perceptual detection performance. In somatosensory cortex (S1), negative linear and inverted U-shape relationships exist, whereas its effect on the primary motor cortex (M1) is hardly known.Objective
We used real-time EEG-triggered transcranial magnetic stimulation (TMS) of M1 to characterize the relationship between spontaneous sensorimotor mu-alpha power fluctuations at rest and corticospinal excitability.Methods
In 16 subjects, mu-alpha power was continuously monitored over the left sensorimotor cortex, and each 10%-percentile bin of the individual mu-alpha power distribution was repeatedly targeted in pseudorandomized order by single-pulse TMS of left M1, measuring motor evoked potentials (MEP) in the contralateral hand.Results
We found a weak positive relationship between mu-alpha power and MEP amplitude.Conclusion
Sensorimotor mu-alpha power may reflect a net facilitation or disinhibition of M1, possibly resulting from mu-alpha based suppression of excitatory and inhibitory input from S1. 相似文献18.
Background
Deeper short-interval intracortical inhibition (SICI), a marker of GABAA activity, correlates with better motor performance in patients with moderate to severe hand impairments in the chronic phase after stroke.Objectives
We evaluated the correlation between SICI in the affected hemisphere and pinch force of the paretic hand in well-recovered patients. We also investigated the correlation between SICI and pinch force in controls.Methods
Twenty-two subjects were included in the study. SICI was measured with a paired-pulse paradigm. The correlation between lateral pinch strength and SICI was assessed with Spearman's rho.Results
There was a significant correlation (rho?=?0.69, p?=?0.014) between SICI and pinch strength in patients, but not in controls. SICI was significantly deeper in patients with greater hand weakness.Conclusions
These preliminary findings suggest that decreased GABAA activity in M1AH correlates with better hand motor performance in well-recovered subjects with stroke in the chronic phase. 相似文献19.
《Brain stimulation》2020,13(6):1697-1705
BackgroundSubthalamic (STN) and pallidal (GPi) deep brain stimulation (DBS) improve quality of life, motor, and nonmotor symptoms (NMS) in advanced Parkinson’s disease (PD). However, few studies have compared their nonmotor effects.ObjectiveTo compare nonmotor effects of STN-DBS and GPi-DBS.MethodsIn this prospective, observational, multicenter study including 60 PD patients undergoing bilateral STN-DBS (n = 40) or GPi-DBS (n = 20), we examined PDQuestionnaire (PDQ), NMSScale (NMSS), Unified PD Rating Scale-activities of daily living, -motor impairment, -complications (UPDRS-II, –III, -IV), Hoehn&Yahr, Schwab&England Scale, and levodopa-equivalent daily dose (LEDD) preoperatively and at 6-month follow-up. Intra-group changes at follow-up were analyzed with Wilcoxon signed-rank or paired t-test, if parametric tests were applicable, and corrected for multiple comparisons. Inter-group differences were explored with Mann-Whitney-U/unpaired t-tests. Analyses were performed before and after propensity score matching which balanced out demographic and preoperative clinical characteristics. Strength of clinical changes was assessed with effect size.ResultsIn both groups, PDQ, UPDRS-II, -IV, Schwab&England Scale, and NMSS improved significantly at follow-up. STN-DBS was significantly better for LEDD reduction, GPi-DBS for UPDRS-IV. While NMSS total score outcomes were similar, explorative NMSS domain analyses revealed distinct profiles: Both targets improved sleep/fatigue and mood/cognition, but only STN-DBS the miscellaneous (pain/olfaction) and attention/memory and only GPi-DBS cardiovascular and sexual function domains.ConclusionsTo our knowledge, this is the first study to report distinct patterns of beneficial nonmotor effects of STN-DBS and GPi-DBS in PD. This study highlights the importance of NMS assessments to tailor DBS target choices to patients’ individual motor and nonmotor profiles. 相似文献
20.
F. Fregni I.C. Macedo L.N. Spezia-Adachi V.L. Scarabelot G. Laste A. Souza Paulo Roberto Stefani Sanches W. Caumo I.L.S. Torres 《Brain stimulation》2018,11(2):299-301