Brain ; physiology ; Deep Brain Stimulation ; methods ; Epilepsy ; therapy ; Humans

Transcranial electric stimulation (TES) is a non-invasive, economical, and well-tolerated neuromodulation technique. However, traditional TES is a whole-brain stimulation with a small current, which cannot satisfy the need for effectively focused stimulation of deep brain areas in clinical treatment. With the deepening of the clinical application of TES, researchers have constantly investigated new methods for deeper, more intense, and more focused stimulation, especially multi-electrode stimulation represented by high-precision TES and temporal interference stimulation. This paper reviews the stimulation optimization schemes of TES in recent years and further analyzes the characteristics and limitations of existing stimulation methods, aiming to provide a reference for related clinical applications and guide the following research on TES. In addition, this paper proposes the viewpoint of the development direction of TES, especially the direction of optimizing TES for deep brain stimulation, aiming to provide new ideas for subsequent research and application.
Transcranial Direct Current Stimulation/methods* ; Deep Brain Stimulation ; Brain/physiology* ; Head ; Electric Stimulation/methods*

Adult ; Deep Brain Stimulation ; methods ; Female ; Humans ; Tardive Dyskinesia ; therapy

OBJECTIVEWe review the targets of the deep brain and the responsive neurostimulation system (RNS) to identify the best optimal stimulation parameters and the best mode of stimulation, whether cyclical, continuous, or smarter.

DATA SOURCESThis review is based on data obtained from published articles from 1950 to 2013. To perform the PubMed literature search, the following keywords were input: deep brain stimulation (DBS), RNS, and refractory epilepsy.

STUDY SELECTIONArticles containing information related to brain stimulation or RNS for the treatment of refractory epilepsy were selected.

RESULTSThe currently available treatment options for those patients who resist multiple antiepileptic medications and surgical procedures include electric stimulation, both direct and indirect, of brain nuclei thought to be involved in epileptogenesis. The number of potential targets has increased over the years to include the anterior nucleus of the thalamus, the centromedian nucleus of the thalamus, the hippocampus, the subthalamic nucleus, the caudate nucleus, and the cerebellum, among others. The results of a randomized controlled trial and the RNS trial were published to reveal the effectiveness.

CONCLUSIONSAlthough statistically significant reductions in seizures have been observed using several different stimulation techniques, including vagus nerve stimulation, DBS, and RNS, these effects are currently only palliative and do not approach the efficacy comparable with that seen in resection in appropriately selected patients. More research is needed to determine optimal stimulation targets and techniques as well as to determine which epilepsy patients will benefit most from this technology.

Deep Brain Stimulation ; methods ; Epilepsy ; therapy ; Female ; Humans ; Male ; Vagus Nerve Stimulation ; methods

Tinnitus is defined as a perception of sound without any external sound source. Chronic tinnitus is a frequent condition that can affect the quality of life. So far, no causal cure for tinnitus has been documented, and most pharmacologic and psychosomatic treatment modalities aim to diminish tinnitus' impact on the quality of life. Neuromodulation, a novel therapeutic modality, which aims at alternating nerve activity through a targeted delivery of a stimulus, has emerged as a potential option in tinnitus treatment. This review provides a brief overview of the current neuromodulation techniques as tinnitus treatment options. The main intention is to provide updated knowledge especially for medical professionals counselling tinnitus patients in this emerging field of medicine. Non-invasive methods such as repetitive transcranial magnetic stimulation, transcranial electrical stimulation, neurofeedback, and transcutaneous vagus nerve stimulation were included, as well as invasive methods such as implanted vagus nerve stimulation and invasive brain stimulation. Some of these neuromodulation techniques revealed promising results; nevertheless, further research is needed, especially regarding the pathophysiological principle as to how these neuromodulation techniques work and what neuronal change they induce. Various studies suggest that individually different brain states and networks are involved in the generation and perception of tinnitus. Therefore, in the future, individually tailored neuromodulation strategies could be a promising approach in tinnitus treatment for achieving a more substantial and longer lasting improvement of complaints.
Deep Brain Stimulation/methods* ; Humans ; Neurofeedback/methods* ; Tinnitus/therapy* ; Transcranial Direct Current Stimulation/methods* ; Transcranial Magnetic Stimulation/methods* ; Vagus Nerve Stimulation/methods*

Deep brain stimulation has drawn more and more concerns as a method to treat neuropsychological diseases. Compared with surgery and other methods using electrical stimulation, deep brain stimulation has advantages of clear targets, high selectivity, reversibility, titratability and non-ablation. A large body of clinical trials has shown that deep brain stimulation targeting various brain structures is able to alleviate the symptoms of Parkinson's disease, epilepsy, chronic pain and depression that are intractable with medicines and other methods, with few complications or side effects. Deep brain stimulation is now emerging as a promising approach for the treatment of resistant neuropsychological diseases.
Deep Brain Stimulation ; methods ; trends ; Depressive Disorder ; therapy ; Electric Stimulation ; methods ; Epilepsy ; therapy ; Humans ; Parkinson Disease ; physiopathology ; therapy

Posttraumatic tremor is often one of the causes of disability in head injury patients. Usually, pharmacotherapy for this type of tremor is not effective. Since early 1970s, surgical ablation of the ventral thalamus has been used to treat various types of tremor. Nowadays, deep brain stimulation (DBS) confirms its efficacy in alleviating different forms of tremor, including posttraumatic tremor. Such therapy has been reported achieving around 80% success rate in the treatment of posttraumatic tremor. These successful results suggest that the application of DBS therapy can be considered as one of the alternative treatments for minimizing the tremor occurring from different pathologies.
Adult ; Craniocerebral Trauma ; complications ; Deep Brain Stimulation ; methods ; Electrodes ; Humans ; Male ; Tremor ; therapy

Deep Brain Stimulation ; methods ; Essential Tremor ; therapy ; Female ; Humans ; Middle Aged

Medical image registration is a key step of image processing and analysis and the first problem of medical image fusion to be solved. In this paper, we focus on magnetic resonance images registration for preoperative and postoperative of deep brain stimulation for the Parkinson's disease. First of all, mutual distance is brought into the mutual information in this paper, realize the two groups of MR slices (for both preoperative and postoperative) mapping, and then 3D images are reconstructed from the corresponding MR slices. Finally, we use Powell algorithm to register 3D images. After the 3D images is registered, we can analyze the relative position between planted electrode (postoperative) and the subthalamic nucleus (preoperative), and measure the quality of deep brain stimulation scientifically.
Algorithms ; Deep Brain Stimulation ; methods ; Electric Stimulation ; Humans ; Image Processing, Computer-Assisted ; methods ; Imaging, Three-Dimensional ; Magnetic Resonance Imaging ; methods ; Parkinson Disease ; pathology ; therapy ; Subthalamic Nucleus ; pathology

BACKGROUNDThe goal of surgery in the treatment of intrinsic cerebral tumors is to resect the maximum tumor volume, and to spare the eloquent areas. However, it is difficult to discover the eloquent areas intraoperatively due to individual anatomo-functional variability both for sensori-motor and language functions. Consequently, the surgery of intrinsic cerebral tumors frequently results in poor extent of resection or permanent postoperative deficits, or both, and remains a difficult problem for neurosurgeons.

METHODSFrom January 2003 to January 2010, 112 patients with neuroepithelial tumors in/close to the eloquent areas were operated on under awake anesthesia with the intraoperative direct electrical stimulation for functional mapping of the eloquent areas. The extent of the tumors was verified by intraoperative ultrasonography. The maximal resection of the tumors and minimal damage of the eloquent areas were the surgical goal of all patients.

RESULTSTotally 356 cortical sites in 99 patients were detected for motor response by intraoperative direct electrical stimulation, 50 sites in 16 patients for sensory, 72 sites in 48 patients for language. Sixty-six patients (58.9%) achieved total resection, 34 (30.4%) subtotal and 12 (10.7%) partial. Fifty-eight patients (51.8%) had no postoperative deficit, while 37 patients (33.0%) had transitory postoperative paralysis, 26 patients (23.2%) with transitory postoperative language disturbance and 3 patients (2.7%) with permanent neurological deficits. No patient complained of pain recollection following operation.

CONCLUSIONSAwake anesthesia, intraoperative direct electrical stimulation and ultrasonography are three core techniques for the resection of intrinsic cerebral tumors near the eloquent areas. This new concept allows an improvement in the quality of surgery for neuroepithelial tumors in/adjacent to eloquent areas.

Adolescent ; Adult ; Aged ; Anesthesia ; methods ; Brain Mapping ; methods ; Brain Neoplasms ; diagnostic imaging ; surgery ; Deep Brain Stimulation ; methods ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Neuroepithelial ; diagnostic imaging ; surgery ; Ultrasonography