詳細検索結果
以下の条件での結果を表示する:
全文: "Deep brain stimulation"
359件中 1-20の結果を表示しています
  • Michael S. Okun, Genko Oyama
    臨床神経学
    2013年 53 巻 9 号 691-694
    発行日: 2013/09/01
    公開日: 2013/10/04
    ジャーナル フリー
    Deep brain stimulation (DBS) has become an important treatment option for carefully screened medication resistant neurological and neuropsychiatric disorders. DBS therapy is not always applied deep to the brain; does not have to be applied exclusively to the brain; and the mechanism for DBS is not simply stimulation of structures. The applications and target locations for DBS devices are rapidly expanding, with many new regions of the brain, spinal cord, peripheral nerves, and muscles now possibly accessed through this technology. We will review the idea of “electrical neuro-network modulation (ENM)”; discuss the importance of the complex neural networks underpinning the effects of DBS; discuss the expansion of brain targets; discuss the use of fiber based targets; and discuss the importance of tailoring DBS therapy to the symptom, rather than the disease.
  • Christos Constantinidis
    認知神経科学
    2018年 20 巻 2 号 83
    発行日: 2018年
    公開日: 2018/06/29
    ジャーナル フリー
  • Atsushi UMEMURA, Yuichi OKA, Kenichi YAMAMOTO, Kenji OKITA, Noriyuki MATSUKAWA, Kazuo YAMADA
    Neurologia medico-chirurgica
    2011年 51 巻 11 号 749-755
    発行日: 2011年
    公開日: 2011/11/25
    ジャーナル オープンアクセス
    Subthalamic nucleus deep brain stimulation (STN-DBS) is effective for medically refractory Parkinson's disease. We retrospectively analyzed complications in 180 consecutive patients who underwent bilateral STN-DBS. Surgery-related complications were symptomatic intracerebral hemorrhage in 2, chronic subdural hematoma in 1, and transient deterioration of medication-induced psychosis in 2 patients. Device-related complications involved device infection in 5, skin erosion in 5, and implantable pulse generator malfunction in 2 patients. All of these patients required surgical repair. Surgery and device-related complications could be reduced with increased surgical experience and the introduction of new surgical equipment and technology. Treatment or stimulation-related complications were intractable dyskinesia/dystonia in 11, problematic dysarthria in 7, apraxia of eyelid opening (ALO) in 11, back pain in 10, and restless leg syndrome in 6 patients. Neuropsychiatric complications were transient mood changes in some, impulse control disorder in 2, severe depression related to excessive reduction of dopaminergic medications in 2, rapid progression of dementia in 1, and suicide attempts in 2 patients. Most complications were mild and transient. Dysarthria and ALO were the most frequent permanent sequelae after STN-DBS. Treatment-related adverse events may be caused not only by the effect of stimulation effect but also excessive reduction of dopaminergic medication, or progression of the disease. In conclusion, STN-DBS seems to be a relatively safe procedure. Although serious complications with permanent sequelae are rare, significant incidences of adverse effects occur. Physicians engaged in this treatment should have a comprehensive understanding of the probable complications and how to avoid them.
  • 梅村 淳, 大山 彦光, 下 泰司, 服部 信孝
    臨床神経学
    2013年 53 巻 11 号 911-914
    発行日: 2013/11/01
    公開日: 2013/11/29
    ジャーナル フリー
    近年種々の運動障害疾患に対して脳深部刺激療法(DBS)が行われている.パーキンソン病(PD)には視床下核(STN)または淡蒼球内節(GPi)のDBSが行われ,その有効性や長期成績が示されている.DBSはPDの全般的な運動症状を改善し,STN刺激ではドパミン作動性薬剤が大幅に減量できる.DBSと薬物治療との併用でより長期的な症状の進行に対処可能となる.難治性振戦には視床Vim核のDBSが行われるが,最近posterior subthalamic area(PSA)も注目されている.また全身性ジストニアにはGPi DBSが有効である.薬物で症状改善が困難な運動障害疾患に対してDBSを検討すべきである.
  • 山本 隆充, 片山 容一, 坪川 孝志, 平山 晃康, 小山 誠剛
    PAIN RESEARCH
    1990年 5 巻 1 号 63-67
    発行日: 1990/05/31
    公開日: 2014/06/19
    ジャーナル フリー
  • Yasumasa NISHIKAWA, Kazutaka KOBAYASHI, Hideki OSHIMA, Chikashi FUKAYA, Takamitu YAMAMOTO, Yoichi KATAYAMA, Akira OGAWA, Kuniaki OGASAWARA
    Neurologia medico-chirurgica
    2010年 50 巻 3 号 257-259
    発行日: 2010年
    公開日: 2010/03/25
    ジャーナル オープンアクセス
    A 71-year-old woman with a 25-year history of levodopa (LD)-responsive Parkinson's disease (PD) developed on-off motor fluctuation and severe peak dose dyskinesia. She underwent deep brain stimulation of the subthalamic nucleus (STN-DBS). STN-DBS induced attenuation of her cardinal PD symptoms and marked improvement of dyskinesia without reduction of LD dosage perioperatively. STN-DBS thus markedly attenuated the cardinal symptoms of PD. LD-induced dyskinesia can also be controlled via reduction of LD dosage as an indirect effect of STN-DBS. The present case provides evidence of the direct antidyskinetic effect of STN-DBS, and suggests that LD-induced dyskinesia can be inhibited by stimulation in the area above the STN.
  • ATSUSHI UMEMURA
    順天堂醫事雑誌
    2016年 62 巻 4 号 315-317
    発行日: 2016年
    公開日: 2016/12/10
    ジャーナル フリー

    Deep brain stimulation (DBS) is a surgical procedure to treat motor symptoms in Parkinson disease (PD). DBS modulates neurological function of the target region using implanted medical devices to deliver electrical stimulation to the brain. The most common target for PD is the subthalamic nucleus (STN). STN DBS improves motor function in the medication-off state, motor fluctuations and dyskinesia with reduction of dopaminergic medication. Long-term outcomes are favorable for cardinal motor symptoms. However, refractory axial symptoms concerning speech, swallowing, gait and postural stability gradually deteriorated with progression of disease. New strategy to treat these axial symptoms is the future subject.

  • Anand TEKRIWAL, Gordon BALTUCH
    Neurologia medico-chirurgica
    2015年 55 巻 12 号 861-877
    発行日: 2015年
    公開日: 2015/12/15
    [早期公開] 公開日: 2015/10/15
    ジャーナル オープンアクセス
    For over two decades, deep brain stimulation (DBS) has shown significant efficacy in treatment for refractory cases of dyskinesia, specifically in cases of Parkinson’s disease and dystonia. DBS offers potential alleviation from symptoms through a well-tolerated procedure that allows personalized modulation of targeted neuroanatomical regions and related circuitries. For clinicians contending with how to provide patients with meaningful alleviation from often debilitating intractable disorders, DBSs titratability and reversibility make it an attractive treatment option for indications ranging from traumatic brain injury to progressive epileptic supra-synchrony. The expansion of our collective knowledge of pathologic brain circuitries, as well as advances in imaging capabilities, electrophysiology techniques, and material sciences have contributed to the expanding application of DBS. This review will examine the potential efficacy of DBS for neurologic and psychiatric disorders currently under clinical investigation and will summarize findings from recent animal models.
  • Takashi ISHIMORI, Satoru NAKANO, Yasutane MORI, Reiko SEO, Taro TOGAMI, Tetsuya MASADA, Toshiaki KUSUHARA, Motoomi OHKAWA, Seigo NAGAO, Yuichi YAMASHITA, Satoshi SUGIURA
    Magnetic Resonance in Medical Sciences
    2007年 6 巻 4 号 225-229
    発行日: 2007年
    公開日: 2008/02/01
    ジャーナル オープンアクセス
    Purpose: We assessed the feasibility of utilizing three-dimensional (3D) phase sensitive inversion recovery (IR) images for preoperatively determining deep brain stimulator position.
    Methods: We measured geometric distortion with a grid phantom and evaluated images of 3 volunteers to determine optimum imaging parameters for 3D phase sensitive IR.
    Results: Geometric distortion measured less than 1.0%. Respective inversion and recovery times, which provided high T1 contrast between the subthalamic nucleus and adjacent tissue, were 200 and 4000 ms. In studies of 3 volunteers and 2 patients, the subthalamic nucleus was clearly depicted in 3D phase sensitive IR images. The measured coordinates of the subthalamic nucleus agreed well with those calculated by conventional estimation from midpoint of the anterior and posterior commissure.
    Conclusion: Three-dimensional phase sensitive inversion recovery was useful in visualizing the subthalamic nucleus for effective deep brain stimulation.
  • Hiroki TODA, Hidemoto SAIKI, Namiko NISHIDA, Koichi IWASAKI
    Neurologia medico-chirurgica
    2016年 56 巻 5 号 236-248
    発行日: 2016年
    公開日: 2016/05/15
    [早期公開] 公開日: 2016/04/06
    ジャーナル オープンアクセス
    Deep brain stimulation (DBS) has been an established surgical treatment option for dyskinesia from Parkinson disease and for dystonia. The present article deals with the timing of surgical intervention, selecting an appropriate target, and minimizing adverse effects. We provide an overview of current evidences and issues for dyskinesia and dystonia as well as emerging DBS technology.
  • Ali R. Rezai, Mayur Sharma
    脳神経外科ジャーナル
    2014年 23 巻 8 号 648-660
    発行日: 2014年
    公開日: 2014/08/25
    ジャーナル フリー
      Deep brain stimulation (DBS) is a safe and effective treatment for medically refractory movement disorders such as Parkinson's disease, essential tremor and dystonia. The success of DBS in treating movement disorders with over 100,000 patient implants has revived interest in the use of DBS for the neurosurgical management of refractory conditions including epilepsy, psychiatric disorders (obsessive compulsive disorder, major depressive disorder, addictions, and eating disorders), neuropathic chronic pain, headaches, cognitive disorders, and traumatic brain injury. This manuscript provides a review of the current application of DBS surgery in movement disorders, psychiatric and other conditions.
      Additionally, an overview of the recent advances in our understanding of the neural circuitry underpinning the pathophysiology of these disorders is provided. The use of imaging and the latest surgical techniques to target these structures will be highlighted. Furthermore, new technology such as the introduction of the “closed loop system”, smart DBS devices, responsive brain stimulation and emerging neuromodulation approaches will be discussed.
  • Atsushi UMEMURA, Genko OYAMA, Yasushi SHIMO, Madoka NAKAJIMA, Asuka NAKAJIMA, Takayuki JO, Satoko SEKIMOTO, Masanobu ITO, Takumi MITSUHASHI, Nobutaka HATTORI, Hajime ARAI
    Neurologia medico-chirurgica
    2016年 56 巻 10 号 613-625
    発行日: 2016年
    公開日: 2016/10/15
    [早期公開] 公開日: 2016/06/24
    ジャーナル オープンアクセス
    There is a long history of surgical treatment for Parkinson disease (PD). After pioneering trials and errors, the current primary surgical treatment for PD is deep brain stimulation (DBS). DBS is a promising treatment option for patients with medically refractory PD. However, there are still many problems and controversies associated with DBS. In this review, we discuss current issues in DBS for PD, including patient selection, clinical outcomes, complications, target selection, long-term outcomes, management of axial symptoms, timing of surgery, surgical procedures, cost-effectiveness, and new technology.
  • 深江 治郎, 深谷 親, 大島 秀規, 石井 賢二, 坪井 義夫, 片山 容一, 服部 信孝
    臨床神経学
    2014年 54 巻 6 号 511-514
    発行日: 2014/06/01
    公開日: 2014/07/01
    ジャーナル フリー
    症例は62歳の男性である.安静時振戦および姿勢時振戦を両上肢にみとめ,筋強剛はなく無動はごく軽度であった.[11C]CFT-PET所見では線条体ドパミン神経のシナプス前機能の低下がみとめ,[11C]RAC-PET 所見ではシナプス後機能はわずかに亢進していた.Benign tremulous parkinsonism(BTP)と診断し内服薬による加療を開始したが効果がみられず,振戦は徐々に増悪しQOLの低下がみられた.そのため,両側視床下核-深部脳刺激術(subthalamic nucleus-deep brain stimulation; STN-DBS)を施行したところ,振戦は消失し経過は良好である.BTPで難治性の振戦はSTN-DBSの適応になると思われる.
  • Chikashi FUKAYA, Takamitsu YAMAMOTO
    Neurologia medico-chirurgica
    2015年 55 巻 5 号 422-431
    発行日: 2015年
    公開日: 2015/05/15
    [早期公開] 公開日: 2015/04/28
    ジャーナル オープンアクセス
    To date, deep brain stimulation (DBS) has already been performed on more than 120,000 patients worldwide and in more than 7,000 patients in Japan. However, fundamental understanding of DBS effects on the pathological neural circuitry remains insufficient. Recent studies have specifically shown the importance of cortico-striato-thalamo-cortical (CSTC) loops, which were identified as functionally and anatomically discrete units. Three main circuits exist in the CSTC loops, namely, the motor, associative, and limbic circuits. From these theoretical backgrounds, it is determined that DBS sometimes influences not only motor functions but also the cognitive and affective functions of Parkinson’s disease (PD) patients. The main targets of DBS for PD are subthalamic nucleus (STN) and globus pallidus interna (GPi). Ventralis intermedius (Vim)-DBS was found to be effective in improving tremor. However, Vim-DBS cannot sufficiently improve akinesia and rigidity. Therefore, Vim-DBS is seldom carried out for the treatment of PD. In this article, we review the present state of DBS, mainly STN-DBS and GPi-DBS, for PD. In the first part of the article, appropriate indications and practical effects established in previous studies are discussed. The findings of previous investigations on the complications caused by the surgical procedure and on the adverse events induced by DBS itself are reviewed. In the second part, we discuss target selection (GPi vs. STN) and the effect of DBS on nonmotor symptoms. In the final part, as issues that should be resolved, the suitable timing of surgery, symptoms unresponsive to DBS such as on-period axial symptoms, and the related postoperative programing of stimulation parameters, are discussed.
  • Jens Volkmann
    脳神経外科ジャーナル
    2006年 15 巻 4 号 360-
    発行日: 2006/04/20
    公開日: 2017/06/02
    ジャーナル フリー
  • Yutaka HIRASHIMA, Hiroaki IKEDA, Takashi ASAHI, Takashi SHIBATA, Kyo NOGUCHI, Fumio SHIMA, Shunro ENDO
    Neurologia medico-chirurgica
    2005年 45 巻 9 号 484-486
    発行日: 2005年
    公開日: 2005/09/26
    ジャーナル オープンアクセス
    A 50-year-old man had undergone right nucleus ventrointermedius (Vim) thalamotomy 1 year previously, resulting in the disappearance of left hand tremor. However, he presented with right distal and proximal tremor including the axial trunk, neck, and head. Deep brain stimulation (DBS) of the left Vim for these symptoms was unsuccessful. Attempts were made to stimulate the left Vim, nucleus ventralis lateralis, and subthalamic nucleus (STN), but no significant improvement was obtained after repeat surgery. However, subsequent improvement of the symptoms including proximal tremor was very marked even without DBS stimulation. Brain magnetic resonance imaging demonstrated lesion and edema in the posteromedial area of the STN. Mechanical injury of the area caused by the surgical procedures may have contributed to the improvement in his persistent symptoms.
  • 鈴木 淳一郎, 田中 康博, 渡辺 宏久, 伊藤 瑞規, 梶田 泰一, 祖父江 元
    臨床神経学
    2013年 53 巻 4 号 304-307
    発行日: 2013/04/01
    公開日: 2013/04/19
    ジャーナル フリー
    症例は61歳男性である.49歳時に動作緩慢が出現し,パーキンソン病と診断された.発症7年後に脳深部刺激術を施行後,反復性発話異常が出現,増悪し,会話が困難になり,発症12年後に当科を受診した.声量低下,粗糙性嗄声をみとめ,音のくりかえしが顕著だった.薬物調整,刺激部位や強度の調整,Lee Silverman Voice Treatment®をおこなったが,反復性発話異常は改善しなかった.そこでペーシングボードを導入したところ,改善がえられ,意思疎通が良好になった.ペーシングボードは,パーキンソン病でみとめる反復性発話異常に有用であると思われた.
  • Kenji SUGIYAMA, Takao NOZAKI, Tetsuya ASAKAWA, Tetsuro SAMESHIMA, Schinichiro KOIZUMI, Hisaya HIRAMATSU, Hiroki NAMBA
    Neurologia medico-chirurgica
    2018年 58 巻 9 号 369-376
    発行日: 2018年
    公開日: 2018/09/15
    [早期公開] 公開日: 2018/08/09
    ジャーナル オープンアクセス

    Deep brain stimulation (DBS) is used to treat symptoms by modulating the cortico-striato-thalamo-cortical (CSTC) loop in the central nervous system (CNS), and attempts to research loop circuit disorders have been globally initiated among the intractable neurological and psychiatric disorders. DBS treatment has been evaluated for all these newly found CNS loop circuit disorders. In 2011, neurosurgical treatments for psychiatric disorders were renamed from “psychosurgery” to “neurosurgery for psychiatric disorders (NPD)” by the World Society for Stereotactic and Functional Neurosurgery (WSSFN). Moreover, in 2014, “Consensus on guidelines for stereotactic neurosurgery for psychiatric disorders” was published by the WSSFN to address the differences in correspondence of stereotactic NPD. Globally, two multicenter prospective randomized control trials regarding DBS of the subcallosal cingulated gyrus and ventral anterior internal capsule/ventral striatum for intractable depression have been terminated after futility analysis. However, DBS for intractable obsessive-compulsive disorder (OCD), unlike for intractable depression, is showing steady development. In Japan, NPDs have not been performed since 1975 following the adoption of “Resolution of total denial for psychosurgery” by the Japanese Society of Psychiatry and Neurology. Nevertheless, a trend to adopt new neuro-modulation techniques for psychiatric disorders, including DBS, are emerging. We have created a clinical research protocol for the use of DBS in intractable OCD, which has been approved by the ethical committee of Hamamatsu University School of Medicine, with the hope of commencing DBS treatment for intractable OCD patients in the near future.

  • Takafumi TANEI, Yasukazu KAJITA, Takashi NIHASHI, Yoshiki KANEOKE, Shigenori TAKEBAYASHI, Daisuke NAKATSUBO, Toshihiko WAKABAYASHI
    Neurologia medico-chirurgica
    2009年 49 巻 11 号 507-513
    発行日: 2009年
    公開日: 2009/11/25
    ジャーナル オープンアクセス
    Changes in regional cerebral blood flow (rCBF) induced by unilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) were investigated in 7 consecutive patients with Parkinson's disease, 4 men and 3 women (mean age 62.3 ± 8.1 years), who underwent rCBF measurement by N-isopropyl-p-(iodine-123)-iodoamphetamine single photon emission computed tomography at rest before and after unilateral STN DBS preoperatively in the on-drug condition, and postoperatively in the on-drug and on-stimulation condition. Statistical parametric mapping was used to identify significant changes in rCBF from the preoperative to the postoperative conditions. rCBF was increased in the bilateral cingulate cortices and bilateral cerebellar hemispheres. rCBF was decreased in the bilateral medial frontal cortices and left superior temporal cortex. Unilateral STN DBS produced rCBF changes in the bilateral cingulate cortices, cerebellar hemispheres, and medial frontal cortices. These findings indicate that unilateral STN DBS affects rCBF in both hemispheres.
  • Kenji SUGIYAMA, Takao NOZAKI, Tetsuya ASAKAWA, Shinichiro KOIZUMI, Osamu SAITOH, Hiroki NAMBA
    Neurologia medico-chirurgica
    2015年 55 巻 5 号 416-421
    発行日: 2015年
    公開日: 2015/05/15
    [早期公開] 公開日: 2015/04/28
    ジャーナル オープンアクセス
    The use of electrical stimulation to treat pain in human disease dates back to ancient Rome or Greece. Modern deep brain stimulation (DBS) was initially applied for pain treatment in the 1960s, and was later used to treat movement disorders in the 1990s. After recognition of DBS as a therapy for central nervous system (CNS) circuit disorders, DBS use showed drastic increase in terms of adaptability to disease and the patient’s population. More than 100,000 patients have received DBS therapy worldwide. The established indications for DBS are Parkinson’s disease, tremor, and dystonia, whereas global indications of DBS expanded to other neuronal diseases or disorders such as neuropathic pain, epilepsy, and tinnitus. DBS is also experimentally used to manage cognitive disorders and psychiatric diseases such as major depression, obsessive-compulsive disorder (OCD), Tourette’s syndrome, and eating disorders. The importance of ethics and conflicts surrounding the regulation and freedom of choice associated with the application of DBS therapy for new diseases or disorders is increasing. These debates are centered on the use of DBS to treat new diseases and disorders as well as its potential to enhance ability in normal healthy individuals. Here we present three issues that need to be addressed in the future: (1) elucidation of the mechanisms of DBS, (2) development of new DBS methods, and (3) miniaturization of the DBS system. With the use of DBS, functional neurosurgery entered into the new era that man can manage and control the brain circuit to treat intractable neuronal diseases and disorders.
feedback
Top