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7 results

  • 9 - What to Do When Your Patient Fails Two Antiseizure Medicines

  • Patrick Landazuri, University of Kansas Medical Centre, Nuria Lacuey Lecumberri, University of Texas Health Science Center, Houston, Laura Vilella Bertran, University of Texas Health Science Center, Houston, Mark Farrenburg, University of Kansas Medical Centre, Samden Lhatoo, University of Texas Health Science Center, Houston
  • Book:
    Seizure and Epilepsy Care
    Published online:
    28 January 2023
    Print publication:
    09 February 2023, pp 156-174

  • Summary

    Around a third of patients have drug-resistant epilepsy (DRE). This is crucially and easily determined if a patient continues to have seizures after being on two adequately dosed and appropriately selected antiseizure medicines (ASMs). For these patients, your initial efforts to make a specific and localized diagnosis will inform next treatment decisions. If a patient presents suddenly with DRE, it is key to assess for a possible autoimmune cause, as a separate treatment pathway should be considered. Otherwise, consider epilepsy surgery as an effective treatment. These treatments include brain resections and neuromodulation. Minimally invasive techniques have recently become more common, including laser surgery as well as stereotactically placed depth electrodes. Given the prevalence of neurostimulators, consideration for obtaining MRIs in patients with these devices is addressed, as pathways exist for all of these patients to safely undergo MRI testing.

  • Pregnancy in Generalized Dystonia: A Case of DBS Discontinuation

  • Ali Abusrair, Veronica Bruno
  • Journal:
    Canadian Journal of Neurological Sciences / Volume 51 / Issue 2 / March 2024
    Published online by Cambridge University Press:
    12 December 2022, pp. 312-313
    • Article
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      • Open access
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  • First case of new-onset psychosis due to DBS in the ventralis intermediate nucleus (Vim) of the thalamus

  • S. Petrykiv, M. Arts, L. De Jonge
  • Journal:
    European Psychiatry / Volume 65 / Issue S1 / June 2022
    Published online by Cambridge University Press:
    01 September 2022, p. S249
    • Article
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  • Introduction

    Known risk factors for developing of first-time psychosis in patients with deep brain stimulator (DBS) include older age, short time after implant placement and cerebral target for stimulation. In particular, stimulation of subtalamic nucleus and globus pallidus internus has been shown to elicit psychotic symptoms in various case reports. To date, there are no cases describing onset of psychosis due to DBS in the ventralis intermediate nucleus (Vim) of the thalamus.

    Objectives

    Case describtion of psychotic episode provoked by DBS in Vim region

    Methods

    Case report of 70 y.o. female with unilateral DBS from 2012 in Vim for essential tremor, who developed therapy resistant psychotic symptoms right after adjusted settings of the DBS.

    Results

    Psychotic onset of otherwise healthy 70 y.o. patient occurred and gradually worsened after adjustment of DBS settings in absence of other iatrogenic factors, including medication and comorbidity, and required involuntary hospitalization one week after beginning of psychosis. Treatment after hospitalization comprised olanzapine 10 mg. 1dd1 did not cause resolvent of psychosis. Because of therapy resistance to psychofarmaca and worsening of psychotic symptoms, by way of exception neurologists had to change the settings back to basic leading to complete and sustained remission of psychosis within two days.

    Conclusions

    Among side effects of DBS in Vim, psychotic symptoms have never been reported. However, as in our patient, psychosis occurred after changes of settings in DBS and presented acutely, was severe, resulted in involuntary hospitalization and was therapy resistant. Pathophysiology of DBS-induced psychosis in Vim region is not known and requires further investigation.

    Disclosure

    No significant relationships.

  • Chapter 18 - Ethical Challenges in Psychosurgery: A New Start or More of the Same?

  • from Part II - Neurosurgery-Specific Bioethics
  • Edited by Stephen Honeybul
  • Book:
    Ethics in Neurosurgical Practice
    Published online:
    29 May 2020
    Print publication:
    18 June 2020, pp 175-192

  • Summary

    There has been a resurgence in the practice of psychosurgery in the last decade primarily for depression and obsessive compulsive disorder. This is due to the application of deep brain stimulation (which has largely replaced lesioning) and to a greater understanding of the imaging correlates of mental illness. Psychosurgery is expanding well beyond these indications. Many ethical challenges arise, including informed consent, establishing the efficacy of these procedures from the literature and in the design of new studies, the harm versus benefit ratio, and the role of institutional and governmental regulatory control over psychosurgery. Psychosurgery remains experimental or at least investigational and the ethical considerations should be of prime importance for any practitioner undertaking this surgery. We propose eighteen principles as a basis for a regulatory framework of psychosurgery. Neurosurgeons who perform psychosurgery have an immense responsibility to guard against a repeat of the failures of the past.

  • Impulsivity and decision-making in obsessive-compulsive disorder after effective deep brain stimulation or treatment as usual

  • Giacomo Grassi, Martijn Figee, Pieter Ooms, Lorenzo Righi, Takashi Nakamae, Stefano Pallanti, Rick Schuurman, Damiaan Denys
  • Journal:
    CNS Spectrums / Volume 23 / Issue 5 / October 2018
    Published online by Cambridge University Press:
    06 April 2018, pp. 333-339
  • Objective

    Impulsivity and impaired decision-making have been proposed as obsessive-compulsive disorder (OCD) endophenotypes, running in OCD and their healthy relatives independently of symptom severity and medication status. Deep brain stimulation (DBS) targeting the ventral limb of the internal capsule (vALIC) and the nucleus accumbens (Nacc) is an effective treatment strategy for treatment-refractory OCD. The effectiveness of vALIC-DBS for OCD has been linked to its effects on a frontostriatal network that is also implicated in reward, impulse control, and decision-making. While vALIC-DBS has been shown to restore reward dysfunction in OCD patients, little is known about the effects of vALIC-DBS on impulsivity and decision-making. The aim of the study was to compare cognitive impulsivity and decision-making between OCD patients undergoing effective vALIC-DBS or treatment as usual (TAU), and healthy controls.

    Methods

    We used decision-making performances under ambiguity on the Iowa Gambling Task and reflection impulsivity on the Beads Task to compare 20 OCD patients effectively treated with vALIC-DBS, 40 matched OCD patients undergoing effective TAU (medication and/or cognitive behavioural therapy), and 40 healthy subjects. Effective treatment was defined as at least 35% improvement of OCD symptoms.

    Results

    OCD patients, irrespective of treatment modality (DBS or TAU), showed increased reflection impulsivity and impaired decision-making compared to healthy controls. No differences were observed between OCD patients treated with DBS or TAU.

    Conclusion

    OCD patients effectively treated with vALIC-DBS or TAU display increased reflection impulsivity and impaired decision-making independent of the type of treatment.

  • Verbal Fluency in Parkinson’s Patients with and without Bilateral Deep Brain Stimulation of the Subthalamic Nucleus: A Meta-analysis

  • Kathryn A. Wyman-Chick
  • Journal:
    Journal of the International Neuropsychological Society / Volume 22 / Issue 4 / April 2016
    Published online by Cambridge University Press:
    02 February 2016, pp. 478-485

  • Objectives: Patients with Parkinson’s disease often experience significant decline in verbal fluency over time; however, deep brain stimulation of the subthalamic nucleus (STN-DBS) is also associated with post-surgical declines in verbal fluency. The purpose of this study was to determine if Parkinson’s patients who have undergone bilateral STN-DBS have greater impairment in verbal fluency compared to Parkinson’s patients treated by medication only. Methods: A literature search yielded over 140 articles and 10 articles met inclusion criteria. A total of 439 patients with Parkinson’s disease who underwent bilateral STN-DBS and 392 non-surgical patients were included. Cohen’s d, a measure of effect size, was calculated using a random effects model to compare post-treatment verbal fluency in patients with Parkinson’s disease who underwent STN-DBS versus those in the non-surgical comparison group. Results: The random effects model demonstrated a medium effect size for letter fluency (d=−0.47) and a small effect size for category fluency (d=−0.31), indicating individuals with bilateral STN-DBS had significantly worse verbal fluency performance than the non-surgical comparison group. Conclusions: Individuals with Parkinson’s disease who have undergone bilateral STN-DBS experience greater deficits in letter and category verbal fluency compared to a non-surgical group. (JINS, 2016, 22, 478–485)