Cholinergic neurons of the medial forebrain are considered important contributors to brain plasticity and neuromodulation. A reduction of cholinergic innervation can lead to pathophysiological ...changes of neurotransmission and is observed in Alzheimer's disease. Here we report on six patients with mild to moderate Alzheimer's disease (AD) treated with bilateral low-frequency deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM). During a four-week double-blind sham-controlled phase and a subsequent 11-month follow-up open label period, clinical outcome was assessed by neuropsychological examination using the Alzheimer's Disease Assessment Scale-cognitive subscale as the primary outcome measure. Electroencephalography and (18)F-fluoro-desoxyglucose positron emission tomography were, besides others, secondary endpoints. On the basis of stable or improved primary outcome parameters twelve months after surgery, four of the six patients were considered responders. No severe or non-transitional side effects related to the stimulation were observed. Taking into account all limitations of a pilot study, we conclude that DBS of the NBM is both technically feasible and well tolerated.
Question First reports on the application of deep brain stimulation of the Nucleus basalis of Meynert reported feasibility and safety of the intervention in patients with Alzheimer’s disease. ...However, clinical effects vary and the mechanisms of actions are still not well understood. Methods We studied preoperative T1-weighted MR images of ten patients with Alzheimer’s disease and correlated the clinical outcome with volumetric differences in a vertex-based analysis, controlling for age, sex and the total intracranial volume. Clinical assessments, 12 months after the intervention, included the Alzheimer’s Disease Assessment Scale with its subitems for cognition and memory as well as the mini mental status examination. Results A fronto-parietal pattern including significant clusters covering the inferior and superior parietal gyrus, the precuneus, the superior and middle frontal gyrus were found to be correlated with a beneficial outcome. Conclusion Our results support the assumption, that patients with less advanced morphological changes may benefit more from deep brain stimulation of the Nucleus basalis of Meynert. Furthermore, we conclude that positive effects are mediated by a preserved fronto-parietal interplay.
Objective
The progression of Alzheimer’s disease (AD) is associated with impaired nutritional status. New methods, such as deep brain stimulation (DBS), are currently being tested to decrease the ...progression of AD. DBS is an approved method in the treatment of Parkinson’s disease, and its suitability for the treatment of AD patients is currently under experimental investigation. To evaluate the advantages and disadvantages of this new treatment, it is important to assess potential side effects of DBS regarding the nucleus basalis of Meynert; this new treatment is thought to positively affect cognition and might counteract the deterioration of nutritional status and progressive weight loss observed in AD. This study aims to assess the nutritional status of patients with AD before receiving DBS of the nucleus basalis of Meynert and after 1 year, and to analyze potential associations between changes in cognition and nutritional status.
Design
A 1-year phase I proof-of-concept study.
Setting
The Department of Psychiatry and Psychotherapy at the University of Cologne.
Participants
We assessed a consecutive sample of patients with mild to moderate AD (n=6) who fulfilled the inclusion criteria and provided written informed consent. Intervention: Bilateral low-frequency DBS of the nucleus basalis of Meynert.
Measurements
Nutritional status was assessed using a modified Mini Nutritional Assessment, bioelectrical impedance analysis, a completed 3-day food diary, and analysis of serum levels of vitamin B12 and folate.
Results
With a normal body mass index (BMI) at baseline (mean 23.75 kg/m
2
) and after 1 year (mean 24.59 kg/m
2
), all but one patient gained body weight during the period of the pilot study (mean 2.38 kg, 3.81% of body weight). This was reflected in a mainly stable or improved body composition, assessed by bioelectrical impedance analysis, in five of the six patients. Mean energy intake increased from 1534 kcal/day (min 1037, max 2370) at baseline to 1736 kcal/day (min 1010, max 2663) after 1 year, leading to the improved fulfillment of energy needs in four patients. The only nutritional factors that were associated with changes in cognition were vitamin B12 level at baseline (Spearman’s rho = 0.943, p = 0.005) and changes in vitamin B12 level (Spearman’s rho = −0.829, p = 0.042).
Conclusion
Patients with AD that received DBS of the nucleus basalis of Meynert demonstrated a mainly stable nutritional status within a 1-year period. Whether DBS is causative regarding these observations must be investigated in additional studies.
Deep brain stimulation (DBS), which is already established as an effective treatment for movement disorders, such as Parkinson's disease, is increasingly being considered as a therapy option for ...mental diseases. Due to the increasing number of successful applications of DBS for otherwise therapy-resistant psychiatric diseases, DBS is becoming more and more of interest in fields of fundamental research as well as clinical care. However, the stimulation system is a medical product which has to be neurosurgically implanted and this fact is often used to draw certain analogies to earlier psychosurgical approaches in the era of Freeman. But, looking at the historical development of DBS, as is the aim of the present systematic and literature-based overview, it becomes obvious that DBS did not arise exclusively from the inglorious period of psychosurgery. In fact, two partly in parallel evolving lines of medical progress have contributed to the development of DBS as it is applied today. One of these lines is the use of lesional neurosurgical procedures, such as incision of capsules and cingulotomy, which in contrast to psychosurgical interventions in the era of Freeman, is aimed at subcortical structures and provides important basic knowledge for the choice of target points. In addition DBS is rooted in the application of an electrical charge with the goal to stimulate neuronal networks.
OBJECTIVEThe progression of Alzheimer's disease (AD) is associated with impaired nutritional status. New methods, such as deep brain stimulation (DBS), are currently being tested to decrease the ...progression of AD. DBS is an approved method in the treatment of Parkinson's disease, and its suitability for the treatment of AD patients is currently under experimental investigation. To evaluate the advantages and disadvantages of this new treatment, it is important to assess potential side effects of DBS regarding the nucleus basalis of Meynert; this new treatment is thought to positively affect cognition and might counteract the deterioration of nutritional status and progressive weight loss observed in AD. This study aims to assess the nutritional status of patients with AD before receiving DBS of the nucleus basalis of Meynert and after 1 year, and to analyze potential associations between changes in cognition and nutritional status.DESIGNA 1-year phase I proof-of-concept study.SETTINGThe Department of Psychiatry and Psychotherapy at the University of Cologne.PARTICIPANTSWe assessed a consecutive sample of patients with mild to moderate AD (n=6) who fulfilled the inclusion criteria and provided written informed consent.INTERVENTIONBilateral low-frequency DBS of the nucleus basalis of Meynert.MEASUREMENTSNutritional status was assessed using a modified Mini Nutritional Assessment, bioelectrical impedance analysis, a completed 3-day food diary, and analysis of serum levels of vitamin B12 and folate.RESULTSWith a normal body mass index (BMI) at baseline (mean 23.75 kg/m²) and after 1 year (mean 24.59 kg/m²), all but one patient gained body weight during the period of the pilot study (mean 2.38 kg, 3.81% of body weight). This was reflected in a mainly stable or improved body composition, assessed by bioelectrical impedance analysis, in five of the six patients. Mean energy intake increased from 1534 kcal/day (min 1037, max 2370) at baseline to 1736 kcal/day (min 1010, max 2663) after 1 year, leading to the improved fulfillment of energy needs in four patients. The only nutritional factors that were associated with changes in cognition were vitamin B12 level at baseline (Spearman's rho = 0.943, p = 0.005) and changes in vitamin B12 level (Spearman's rho = -0.829, p = 0.042).CONCLUSIONPatients with AD that received DBS of the nucleus basalis of Meynert demonstrated a mainly stable nutritional status within a 1-year period. Whether DBS is causative regarding these observations must be investigated in additional studies.
Tourette syndrome (TS) is a neuropsychiatric disorder with typical onset in childhood and characterized by chronic occurrence of motor and vocal tics. The disorder can lead to serious impairments of ...both quality of life and psychosocial functioning, particularly for those individuals displaying complex tics. In such patients, drug treatment is recommended. The pathophysiology of TS is thought to involve a dysfunction of basal ganglia-related circuits and hyperactive dopaminergic innervations. Congruently, dopamine receptor antagonism of neuroleptics appears to be the most efficacious approach for pharmacological intervention. To assess the efficacy of the different neuroleptics available, a systematic, keyword-related search in PubMed (National Library of Medicine, Washington, DC) was undertaken. Much information on the use of antipsychotics in the treatment of TS is based on older data. Our objective was to give an update and therefore we focused on papers published in the last decade (between 2001 and 2011). Accordingly, the present review aims to summarize the current and evidence-based knowledge on the risk-benefit ratio of both first and second generation neuroleptics in TS.
Zusammenfassung
Die für Bewegungsstörungen wie M. Parkinson bereits etablierte und nachgewiesenermaßen wirksame tiefe Hirnstimulation (THS) wird zunehmend auch als Therapiemöglichkeit für psychische ...Erkrankungen in Betracht gezogen. Da sich auch für dieses Anwendungsgebiet vielversprechende Behandlungsergebnisse bei anderweitig therapieresistenten psychiatrischen Erkrankungen häufen, stößt die THS sowohl vonseiten der Grundlagenforschung als auch im Bereich der klinischen Versorgung auf zunehmendes Interesse. Gleichwohl handelt es sich bei dem Stimulationssystem um ein neurochirurgisch zu implantierendes Medizinprodukt – eine Tatsache, die nicht selten dazu veranlasst, Analogien zu früheren psychochirurgischen Ansätzen der Ära Freeman zu ziehen. Zeigt man jedoch die historische Entwicklung der THS auf, was mit der vorliegenden systematischen, literaturgestützten Übersichtsarbeit beabsichtigt ist, wird deutlich, dass dieses Therapieverfahren keineswegs ausschließlich aus dem unrühmlichen Zeitalter der Psychochirurgie hervorging. Vielmehr sind zwei andere, zum Teil parallel verlaufende Entwicklungsstränge zu berücksichtigen, auf denen das moderne Verfahren der THS basiert: Dabei handelt es sich einerseits um die läsionellen neurochirurgischen Verfahren wie Kapsulotomie oder Zingulotomie, die im Gegensatz zu den psychochirurgischen Eingriffen der Ära Freeman subkortikale Strukturen betreffen und wichtige Grundlagen für die Zielpunktauswahl bei der THS lieferten, sowie andererseits um die Verwendung elektrischer Ladung zur Stimulation neuronaler Netzwerke.
PDF
