Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
Parkinson Disease: HELP
Articles by Christopher R. Butson
Based on 11 articles published since 2010
(Why 11 articles?)
||||

Between 2010 and 2020, Christopher Butson wrote the following 11 articles about Parkinson Disease.
 
+ Citations + Abstracts
1 Review Pedunculopontine nucleus deep brain stimulation in Parkinson's disease: A clinical review. 2018

Thevathasan, Wesley / Debu, Bettina / Aziz, Tipu / Bloem, Bastiaan R / Blahak, Christian / Butson, Christopher / Czernecki, Virginie / Foltynie, Thomas / Fraix, Valerie / Grabli, David / Joint, Carole / Lozano, Andres M / Okun, Michael S / Ostrem, Jill / Pavese, Nicola / Schrader, Christoph / Tai, Chun-Hwei / Krauss, Joachim K / Moro, Elena / Anonymous640921. ·Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Australia and the Bionics Institute of Australia, Melbourne, Australia. · Movement Disorders Center, Division of Neurology, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble Alpes University, Grenoble, France. · Department of Neurosurgery, John Radcliffe Hospital, University of Oxford, Oxford, UK. · Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands. · Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg, Germany. · Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, USA. · Department of Neurology, Institut de Cerveau et de la Moelle épinière, Sorbonne Universités, University Pierre-and-Marie-Curie (UPMC) Université, Paris, France. · Sobell Department of Motor Neuroscience, University College London (UCL) Institute of Neurology, United Kingdom. · Department of Neurology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtière University Hospital, Paris, France. · Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, Canada. · Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders, Gainesville, Florida, USA. · Department of Neurology, UCSF Movement Disorder and Neuromodulation Center, University of California, San Francisco, USA. · Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK. · Department of Clinical Medicine, Centre for Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark. · Department of Neurology, Hannover Medical School, Hannover, Germany. · Department of Neurology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. · Department of Neurosurgery, Hannover Medical School, Hannover, Germany. ·Mov Disord · Pubmed #28960543.

ABSTRACT: Pedunculopontine nucleus region deep brain stimulation (DBS) is a promising but experimental therapy for axial motor deficits in Parkinson's disease (PD), particularly gait freezing and falls. Here, we summarise the clinical application and outcomes reported during the past 10 years. The published dataset is limited, comprising fewer than 100 cases. Furthermore, there is great variability in clinical methodology between and within surgical centers. The most common indication has been severe medication refractory gait freezing (often associated with postural instability). Some patients received lone pedunculopontine nucleus DBS (unilateral or bilateral) and some received costimulation of the subthalamic nucleus or internal pallidum. Both rostral and caudal pedunculopontine nucleus subregions have been targeted. However, the spread of stimulation and variance in targeting means that neighboring brain stem regions may be implicated in any response. Low stimulation frequencies are typically employed (20-80 Hertz). The fluctuating nature of gait freezing can confound programming and outcome assessments. Although firm conclusions cannot be drawn on therapeutic efficacy, the literature suggests that medication refractory gait freezing and falls can improve. The impact on postural instability is unclear. Most groups report a lack of benefit on gait or limb akinesia or dopaminergic medication requirements. The key question is whether pedunculopontine nucleus DBS can improve quality of life in PD. So far, the evidence supporting such an effect is minimal. Development of pedunculopontine nucleus DBS to become a reliable, established therapy would likely require a collaborative effort between experienced centres to clarify biomarkers predictive of response and the optimal clinical methodology. © 2017 International Parkinson and Movement Disorder Society.

2 Review Proceedings of the Second Annual Deep Brain Stimulation Think Tank: What's in the Pipeline. 2015

Gunduz, Aysegul / Morita, Hokuto / Rossi, P Justin / Allen, William L / Alterman, Ron L / Bronte-Stewart, Helen / Butson, Christopher R / Charles, David / Deckers, Sjaak / de Hemptinne, Coralie / DeLong, Mahlon / Dougherty, Darin / Ellrich, Jens / Foote, Kelly D / Giordano, James / Goodman, Wayne / Greenberg, Benjamin D / Greene, David / Gross, Robert / Judy, Jack W / Karst, Edward / Kent, Alexander / Kopell, Brian / Lang, Anthony / Lozano, Andres / Lungu, Codrin / Lyons, Kelly E / Machado, Andre / Martens, Hubert / McIntyre, Cameron / Min, Hoon-Ki / Neimat, Joseph / Ostrem, Jill / Pannu, Sat / Ponce, Francisco / Pouratian, Nader / Reymers, Donnie / Schrock, Lauren / Sheth, Sameer / Shih, Ludy / Stanslaski, Scott / Steinke, G Karl / Stypulkowski, Paul / Tröster, Alexander I / Verhagen, Leo / Walker, Harrison / Okun, Michael S. ·University of Florida , Gainesville, FL , USA. ·Int J Neurosci · Pubmed #25526555.

ABSTRACT: The proceedings of the 2nd Annual Deep Brain Stimulation Think Tank summarize the most contemporary clinical, electrophysiological, and computational work on DBS for the treatment of neurological and neuropsychiatric disease and represent the insights of a unique multidisciplinary ensemble of expert neurologists, neurosurgeons, neuropsychologists, psychiatrists, scientists, engineers and members of industry. Presentations and discussions covered a broad range of topics, including advocacy for DBS, improving clinical outcomes, innovations in computational models of DBS, understanding of the neurophysiology of Parkinson's disease (PD) and Tourette syndrome (TS) and evolving sensor and device technologies.

3 Clinical Trial Acute and Chronic Mood and Apathy Outcomes from a randomized study of unilateral STN and GPi DBS. 2014

Okun, Michael S / Wu, Samuel S / Fayad, Sarah / Ward, Herbert / Bowers, Dawn / Rosado, Christian / Bowen, Lauren / Jacobson, Charles / Butson, Christopher / Foote, Kelly D. ·Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Biostatistics, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Psychiatry, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America; Department of Clinical and Health Psychology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. · Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States of America. · Department of Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida, Gainesville, Gainesville, FL, United States of America. ·PLoS One · Pubmed #25469706.

ABSTRACT: OBJECTIVE: To study mood and behavioral effects of unilateral and staged bilateral subthalamic nucleus (STN) and globus pallidus internus (GPi) deep brain stimulation (DBS) for Parkinson's disease (PD). BACKGROUND: There are numerous reports of mood changes following DBS, however, most have focused on bilateral simultaneous STN implants with rapid and aggressive post-operative medication reduction. METHODS: A standardized evaluation was applied to a subset of patients undergoing STN and GPi DBS and who were also enrolled in the NIH COMPARE study. The Unified Parkinson Disease Rating Scale (UPDRS III), the Hamilton depression (HAM-D) and anxiety rating scales (HAM-A), the Yale-Brown obsessive-compulsive rating scale (YBOCS), the Apathy Scale (AS), and the Young mania rating scale (YMRS) were used. The scales were repeated at acute and chronic intervals. A post-operative strategy of non-aggressive medication reduction was employed. RESULTS: Thirty patients were randomized and underwent unilateral DBS (16 STN, 14 GPi). There were no baseline differences. The GPi group had a higher mean dopaminergic dosage at 1-year, however the between group difference in changes from baseline to 1-year was not significant. There were no differences between groups in mood and motor outcomes. When combining STN and GPi groups, the HAM-A scores worsened at 2-months, 4-months, 6-months and 1-year when compared with baseline; the HAM-D and YMRS scores worsened at 4-months, 6-months and 1-year; and the UPDRS Motor scores improved at 4-months and 1-year. Psychiatric diagnoses (DSM-IV) did not change. No between group differences were observed in the cohort of bilateral cases. CONCLUSIONS: There were few changes in mood and behavior with STN or GPi DBS. The approach of staging STN or GPi DBS without aggressive medication reduction could be a viable option for managing PD surgical candidates. A study of bilateral DBS and of medication reduction will be required to better understand risks and benefits of a bilateral approach.

4 Article Interleaved deep brain stimulation for dyskinesia management in Parkinson's disease. 2019

Aquino, Camila C / Duffley, Gordon / Hedges, David M / Vorwerk, Johannes / House, Paul A / Ferraz, Henrique B / Rolston, John D / Butson, Christopher R / Schrock, Lauren E. ·Sleep and Movement Disorder Division, University of Utah, Salt Lake City, Utah, USA. · Department of Neurology and Neurosurgery, Universidade Federal de Sao Paulo, Sao Paulo, Brazil. · Department of Health, Evidence and Impact, McMaster University, Hamilton, Minnesota, Canada. · Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, Utah, USA. · Neurosurgical Associates, LLC, Murray, Utah. · Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA. · Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA. · Department of Neurology, University of Utah, Salt Lake City, Utah, USA. · Department of Psychiatry, University of Utah, Salt Lake City, Utah, USA. · Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA. ·Mov Disord · Pubmed #31483534.

ABSTRACT: BACKGROUND: In patients with Parkinson's disease, stimulation above the subthalamic nucleus (STN) may engage the pallidofugal fibers and directly suppress dyskinesia. OBJECTIVES: The objective of this study was to evaluate the effect of interleaving stimulation through a dorsal deep brain stimulation contact above the STN in a cohort of PD patients and to define the volume of tissue activated with antidyskinesia effects. METHODS: We analyzed the Core Assessment Program for Surgical Interventional Therapies dyskinesia scale, Unified Parkinson's Disease Rating Scale parts III and IV, and other endpoints in 20 patients with interleaving stimulation for management of dyskinesia. Individual models of volume of tissue activated and heat maps were used to identify stimulation sites with antidyskinesia effects. RESULTS: The Core Assessment Program for Surgical Interventional Therapies dyskinesia score in the on medication phase improved 70.9 ± 20.6% from baseline with noninterleaved settings (P < 0.003). With interleaved settings, dyskinesia improved 82.0 ± 27.3% from baseline (P < 0.001) and 61.6 ± 39.3% from the noninterleaved phase (P = 0.006). The heat map showed a concentration of volume of tissue activated dorsally to the STN during the interleaved setting with an antidyskinesia effect. CONCLUSION: Interleaved deep brain stimulation using the dorsal contacts can directly suppress dyskinesia, probably because of the involvement of the pallidofugal tract, allowing more conservative medication reduction. © 2019 International Parkinson and Movement Disorder Society.

5 Article Effect of STN DBS on vesicular monoamine transporter 2 and glucose metabolism in Parkinson's disease. 2019

Smith, Gwenn S / Mills, Kelly A / Pontone, Greg M / Anderson, W Stanley / Perepezko, Kate M / Brasic, James / Zhou, Yun / Brandt, Jason / Butson, Christopher R / Holt, Daniel P / Mathews, William B / Dannals, Robert F / Wong, Dean F / Mari, Zoltan. ·Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: gsmith95@jhmi.edu. · Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Scientific Computing & Imaging (SCI) Institute, Departments of Biomedical Engineering, Neurology, Neurosurgery & Psychiatry, University of Utah, USA. · Division of Nuclear Medicine and Molecular Imaging, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Section of High Resolution Brain PET, Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Solomon H. Snyder Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA. ·Parkinsonism Relat Disord · Pubmed #31053531.

ABSTRACT: INTRODUCTION: Deep brain stimulation (DBS) is an established treatment for Parkinson's Disease (PD). Despite the improvement of motor symptoms in most patients by sub-thalamic nucleus (STN) DBS and its widespread use, the neurobiological mechanisms are not completely understood. The objective of the present study was to elucidate the effects of subthalamic nucleus (STN) DBS in PD on the dopamine system and neural circuitry, employing high-resolution positron emission tomography (PET) imaging. The hypotheses tested were that STN DBS would decrease the striatal vesicular monoamine transporter (VMAT2), secondary to an increase in dopamine concentrations, and would decrease striatal cerebral metabolism and increase cortical cerebral metabolism. METHODS: PET imaging of the vesicular monoamine transporter (VMAT2) and cerebral glucose metabolism was performed prior to DBS surgery and after 4-6 months of STN stimulation in seven PD patients (mean age 67 ± 7). RESULTS: The patients demonstrated significant improvement in motor and neuropsychiatric symptoms after STN DBS. Decreased VMAT2 was observed in the caudate, putamen and associative striatum and in extra-striatal, cortical and limbic regions. Cerebral glucose metabolism was decreased in striatal sub-regions and increased in temporal and parietal cortices and the cerebellum. Decreased striatal VMAT2 was correlated with decreased striatal and increased cortical and limbic metabolism. Improvement of depressive symptoms was correlated with decreased VMAT2 in striatal and extra-striatal regions and with striatal decreases and cortical increases in metabolism. CONCLUSIONS: The present results support further investigation of the role of VMAT2, and associated changes in neural circuitry in the improvement of motor and non-motor symptoms with STN DBS in PD.

6 Article Proceedings of the Fourth Annual Deep Brain Stimulation Think Tank: A Review of Emerging Issues and Technologies. 2016

Deeb, Wissam / Giordano, James J / Rossi, Peter J / Mogilner, Alon Y / Gunduz, Aysegul / Judy, Jack W / Klassen, Bryan T / Butson, Christopher R / Van Horne, Craig / Deny, Damiaan / Dougherty, Darin D / Rowell, David / Gerhardt, Greg A / Smith, Gwenn S / Ponce, Francisco A / Walker, Harrison C / Bronte-Stewart, Helen M / Mayberg, Helen S / Chizeck, Howard J / Langevin, Jean-Philippe / Volkmann, Jens / Ostrem, Jill L / Shute, Jonathan B / Jimenez-Shahed, Joohi / Foote, Kelly D / Wagle Shukla, Aparna / Rossi, Marvin A / Oh, Michael / Pourfar, Michael / Rosenberg, Paul B / Silburn, Peter A / de Hemptine, Coralie / Starr, Philip A / Denison, Timothy / Akbar, Umer / Grill, Warren M / Okun, Michael S. ·Department of Neurology, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA. · Department of Neurology, and Neuroethics Studies Program, Pellegrino Center for Clinical Bioethics, Georgetown University Medical Center Washington, DC, USA. · Department of Neurosurgery, Center for Neuromodulation, New York University Langone Medical Center New York, NY, USA. · Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; J. Crayton Pruitt Family Department of Biomedical Engineering, University of FloridaGainesville, FL, USA. · Department of Neurology, Mayo Clinic Rochester, MN, USA. · Department of Bioengineering, Scientific Computing and Imaging Institute, University of Utah Salt Lake City, UT, USA. · Department of Neurosurgery, University of Kentucky Chandler Medical Center Lexington, KY, USA. · Department of Psychiatry, Academic Medical Center, University of Amsterdam Amsterdam, Netherlands. · Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA. · Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland Brisbane, QLD, Australia. · Department of Anatomy and Neurobiology, University of Kentucky Chandler Medical Center Lexington, KY, USA. · Departments of Psychiatry and Behavioral Sciences and Radiology and Radiological Sciences, Johns Hopkins University School of Medicine Baltimore, MD, USA. · Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center Phoenix Arizona, AZ, USA. · Department of Neurology and Department of Biomedical Engineering, University of Alabama at Birmingham Birmingham, AL, USA. · Departments of Neurology and Neurological Sciences and Neurosurgery, Stanford University Stanford, CA, USA. · Department of Psychiatry, Emory University School of Medicine Atlanta, GA, USA. · Electrical Engineering Department, University of WashingtonSeattle, WA, USA; NSF Engineering Research Center for Sensorimotor Neural EngineeringSeattle, WA, USA. · Department of Neurosurgery, VA Greater Los Angeles Healthcare System Los Angeles, CA, USA. · Department of Neurology, University Clinic of Würzburg Würzburg, Germany. · Department of Neurology, University of California San Francisco San Francisco, CA, USA. · J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida Gainesville, FL, USA. · Department of Neurology, Baylor College of Medicine Houston, TX, USA. · Department of Neurology, Center for Movement Disorders and Neurorestoration, University of FloridaGainesville, FL, USA; Department of Neurological Sciences, University of FloridaGainesville, FL, USA. · Departments of Neurological Sciences, Diagnostic Radiology, and Nuclear Medicine, Rush University Medical Center Chicago, IL, USA. · Division of Functional Neurosurgery, Department of Neurosurgery, Allegheny General Hospital Pittsburgh, PA, USA. · Department of Neurology, New York University Langone Medical Center New York, NY, USA. · Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Johns Hopkins School of Medicine Baltimore, MD, USA. · Graduate Program in Neuroscience, Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco San Francisco, CA, USA. · Medtronic Modulation Minneapolis, MN, USA. · Movement Disorders Program, Department of Neurology, Alpert Medical School, Rhode Island Hospital, Brown University Providence, RI, USA. · Department of Biomedical Engineering, Duke University Durham, NC, USA. ·Front Integr Neurosci · Pubmed #27920671.

ABSTRACT: This paper provides an overview of current progress in the technological advances and the use of deep brain stimulation (DBS) to treat neurological and neuropsychiatric disorders, as presented by participants of the Fourth Annual DBS Think Tank, which was convened in March 2016 in conjunction with the Center for Movement Disorders and Neurorestoration at the University of Florida, Gainesveille FL, USA. The Think Tank discussions first focused on policy and advocacy in DBS research and clinical practice, formation of registries, and issues involving the use of DBS in the treatment of Tourette Syndrome. Next, advances in the use of neuroimaging and electrochemical markers to enhance DBS specificity were addressed. Updates on ongoing use and developments of DBS for the treatment of Parkinson's disease, essential tremor, Alzheimer's disease, depression, post-traumatic stress disorder, obesity, addiction were presented, and progress toward innovation(s) in closed-loop applications were discussed. Each section of these proceedings provides updates and highlights of new information as presented at this year's international Think Tank, with a view toward current and near future advancement of the field.

7 Article Coordinate-based lead location does not predict Parkinson's disease deep brain stimulation outcome. 2014

Nestor, Kelsey A / Jones, Jacob D / Butson, Christopher R / Morishita, Takashi / Jacobson, Charles E / Peace, David A / Chen, Dennis / Foote, Kelly D / Okun, Michael S. ·Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America; Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America. · Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States of America. · Department of Neurology, Biotechnology and Bioengineering Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America. · Department of Neurosurgery, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America. · Department of Neurology, University of Florida, Center for Movement Disorders and Neurorestoration, McKnight Brain Institute, Gainesville, Florida, United States of America. ·PLoS One · Pubmed #24691109.

ABSTRACT: BACKGROUND: Effective target regions for deep brain stimulation (DBS) in Parkinson's disease (PD) have been well characterized. We sought to study whether the measured Cartesian coordinates of an implanted DBS lead are predictive of motor outcome(s). We tested the hypothesis that the position and trajectory of the DBS lead relative to the mid-commissural point (MCP) are significant predictors of clinical outcomes. We expected that due to neuroanatomical variation among individuals, a simple measure of the position of the DBS lead relative to MCP (commonly used in clinical practice) may not be a reliable predictor of clinical outcomes when utilized alone. METHODS: 55 PD subjects implanted with subthalamic nucleus (STN) DBS and 41 subjects implanted with globus pallidus internus (GPi) DBS were included. Lead locations in AC-PC space (x, y, z coordinates of the active contact and sagittal and coronal entry angles) measured on high-resolution CT-MRI fused images, and motor outcomes (Unified Parkinson's Disease Rating Scale) were analyzed to confirm or refute a correlation between coordinate-based lead locations and DBS motor outcomes. RESULTS: Coordinate-based lead locations were not a significant predictor of change in UPDRS III motor scores when comparing pre- versus post-operative values. The only potentially significant individual predictor of change in UPDRS motor scores was the antero-posterior coordinate of the GPi lead (more anterior lead locations resulted in a worse outcome), but this was only a statistical trend (p<.082). CONCLUSION: The results of the study showed that a simple measure of the position of the DBS lead relative to the MCP is not significantly correlated with PD motor outcomes, presumably because this method fails to account for individual neuroanatomical variability. However, there is broad agreement that motor outcomes depend strongly on lead location. The results suggest the need for more detailed identification of stimulation location relative to anatomical targets.

8 Article Management of deep brain stimulator battery failure: battery estimators, charge density, and importance of clinical symptoms. 2013

Fakhar, Kaihan / Hastings, Erin / Butson, Christopher R / Foote, Kelly D / Zeilman, Pam / Okun, Michael S. ·Departments of Neurology and Neurosurgery, University of Florida Center for Movement Disorders and Neurorestoration, Gainesville, Florida, United States of America. ·PLoS One · Pubmed #23536810.

ABSTRACT: OBJECTIVE: We aimed in this investigation to study deep brain stimulation (DBS) battery drain with special attention directed toward patient symptoms prior to and following battery replacement. BACKGROUND: Previously our group developed web-based calculators and smart phone applications to estimate DBS battery life (http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator). METHODS: A cohort of 320 patients undergoing DBS battery replacement from 2002-2012 were included in an IRB approved study. Statistical analysis was performed using SPSS 20.0 (IBM, Armonk, NY). RESULTS: The mean charge density for treatment of Parkinson's disease was 7.2 µC/cm(2)/phase (SD = 3.82), for dystonia was 17.5 µC/cm(2)/phase (SD = 8.53), for essential tremor was 8.3 µC/cm(2)/phase (SD = 4.85), and for OCD was 18.0 µC/cm(2)/phase (SD = 4.35). There was a significant relationship between charge density and battery life (r = -.59, p<.001), as well as total power and battery life (r = -.64, p<.001). The UF estimator (r = .67, p<.001) and the Medtronic helpline (r = .74, p<.001) predictions of battery life were significantly positively associated with actual battery life. Battery status indicators on Soletra and Kinetra were poor predictors of battery life. In 38 cases, the symptoms improved following a battery change, suggesting that the neurostimulator was likely responsible for symptom worsening. For these cases, both the UF estimator and the Medtronic helpline were significantly correlated with battery life (r = .65 and r = .70, respectively, both p<.001). CONCLUSIONS: Battery estimations, charge density, total power and clinical symptoms were important factors. The observation of clinical worsening that was rescued following neurostimulator replacement reinforces the notion that changes in clinical symptoms can be associated with battery drain.

9 Article Evaluation of Interactive Visualization on Mobile Computing Platforms for Selection of Deep Brain Stimulation Parameters. 2013

Butson, Christopher R / Tamm, Georg / Jain, Sanket / Fogal, Thomas / Krüger, Jens. · ·IEEE Trans Vis Comput Graph · Pubmed #22450824.

ABSTRACT: In recent years, there has been significant growth in the use of patient-specific models to predict the effects of neuromodulation therapies such as deep brain stimulation (DBS). However, translating these models from a research environment to the everyday clinical workflow has been a challenge, primarily due to the complexity of the models and the expertise required in specialized visualization software. In this paper, we deploy the interactive visualization system ImageVis3D Mobile, which has been designed for mobile computing devices such as the iPhone or iPad, in an evaluation environment to visualize models of Parkinson's disease patients who received DBS therapy. Selection of DBS settings is a significant clinical challenge that requires repeated revisions to achieve optimal therapeutic response, and is often performed without any visual representation of the stimulation system in the patient. We used ImageVis3D Mobile to provide models to movement disorders clinicians and asked them to use the software to determine: 1) which of the four DBS electrode contacts they would select for therapy; and 2) what stimulation settings they would choose. We compared the stimulation protocol chosen from the software versus the stimulation protocol that was chosen via clinical practice (independent of the study). Lastly, we compared the amount of time required to reach these settings using the software versus the time required through standard practice. We found that the stimulation settings chosen using ImageVis3D Mobile were similar to those used in standard of care, but were selected in drastically less time. We show how our visualization system, available directly at the point of care on a device familiar to the clinician, can be used to guide clinical decision making for selection of DBS settings. In our view, the positive impact of the system could also translate to areas other than DBS.

10 Article Probabilistic analysis of activation volumes generated during deep brain stimulation. 2011

Butson, Christopher R / Cooper, Scott E / Henderson, Jaimie M / Wolgamuth, Barbara / McIntyre, Cameron C. ·Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. ·Neuroimage · Pubmed #20974269.

ABSTRACT: Deep brain stimulation (DBS) is an established therapy for the treatment of Parkinson's disease (PD) and shows great promise for the treatment of several other disorders. However, while the clinical analysis of DBS has received great attention, a relative paucity of quantitative techniques exists to define the optimal surgical target and most effective stimulation protocol for a given disorder. In this study we describe a methodology that represents an evolutionary addition to the concept of a probabilistic brain atlas, which we call a probabilistic stimulation atlas (PSA). We outline steps to combine quantitative clinical outcome measures with advanced computational models of DBS to identify regions where stimulation-induced activation could provide the best therapeutic improvement on a per-symptom basis. While this methodology is relevant to any form of DBS, we present example results from subthalamic nucleus (STN) DBS for PD. We constructed patient-specific computer models of the volume of tissue activated (VTA) for 163 different stimulation parameter settings which were tested in six patients. We then assigned clinical outcome scores to each VTA and compiled all of the VTAs into a PSA to identify stimulation-induced activation targets that maximized therapeutic response with minimal side effects. The results suggest that selection of both electrode placement and clinical stimulation parameter settings could be tailored to the patient's primary symptoms using patient-specific models and PSAs.

11 Article Patient-specific models of deep brain stimulation: influence of field model complexity on neural activation predictions. 2010

Chaturvedi, Ashutosh / Butson, Christopher R / Lempka, Scott F / Cooper, Scott E / McIntyre, Cameron C. ·Department of Biomedical Engineering, Cleveland Clinic Foundation, Cleveland, OH 44195, USA. ·Brain Stimul · Pubmed #20607090.

ABSTRACT: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become the surgical therapy of choice for medically intractable Parkinson's disease. However, quantitative understanding of the interaction between the electric field generated by DBS and the underlying neural tissue is limited. Recently, computational models of varying levels of complexity have been used to study the neural response to DBS. The goal of this study was to evaluate the quantitative impact of incrementally incorporating increasing levels of complexity into computer models of STN DBS. Our analysis focused on the direct activation of experimentally measureable fiber pathways within the internal capsule (IC). Our model system was customized to an STN DBS patient and stimulation thresholds for activation of IC axons were calculated with electric field models that ranged from an electrostatic, homogenous, isotropic model to one that explicitly incorporated the voltage-drop and capacitance of the electrode-electrolyte interface, tissue encapsulation of the electrode, and diffusion-tensor based 3D tissue anisotropy and inhomogeneity. The model predictions were compared to experimental IC activation defined from electromyographic (EMG) recordings from eight different muscle groups in the contralateral arm and leg of the STN DBS patient. Coupled evaluation of the model and experimental data showed that the most realistic predictions of axonal thresholds were achieved with the most detailed model. Furthermore, the more simplistic neurostimulation models substantially overestimated the spatial extent of neural activation.