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The influence of deep brain stimulation on the brain connectivity
Horváthová, Ľubica ; Výtvarová, Eva (referee) ; Klimeš, Petr (advisor)
Hĺbková mozgová stimulácia (DBS) predstavuje účinnú liečbu pre pacientov s Parkinsonovou chorobou (PD) alebo farmakorezistentnou epilepsiou. Avšak mechanizmy, ktorými znižuje počet záchvatov a zlepšuje pohyb, zostávajú ešte do značnej miery neznáme. Pre lepšie pochopenie a určenie, v ktorých frekvenčných pásmach je zmena najdôležitejšia, boli urobené porovnania medzi vypnutou a zapnutou DBS pomocou korelačnej metódy a indexu fázového posunu. Jedenásť pacientov s PD a naimplantovanými neurostimulátormi z firiem Medtronic a St.Jude Medical bolo predmetom nahraných dát použitých v tejto práci. Výsledky dokazujú, že zmena konektivity počas DBS nastane a zároveň, že najviac ovplyvňuje najvyššie frekvencie ako beta, nízka gama a vysoká gama. Zmeny v týchto frekvenciách, zodpovedné za motorickú aktivitu, sústredenie a spracovanie informácií, sú v súlade s klinickou teóriou o PD. Počas tejto choroby je patologická beta aktivita hypersynchronizovaná a gama aktivita je znížená práve v motorických oblastiach. Ak sa gama aktivita počas zapnutej stimulácie zvyšuje, fyziologický stav pacientov sa čiastočne znovuobnovuje a tým zlepšuje ich hybnosť. Metódy a výsledky tejto práce budú použité pre ďalší výskum pacientov s PD a epilepsiou.
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Treatment of eating disorders through neurostimulation methods
Baumann, Silvie ; Papežová, Hana (advisor) ; Ustohal, Libor (referee) ; Stárková, Libuše (referee)
Background: Eating disorders are psychiatric illnesses whose treatment is difficult and usually the classic procedures fail. Recently, the number of researches in neuromodulatory methods has increased. I present an overview of basic stimulation methods, their use in the treatment of anorexia nervosa (AN), bulimia nervosa and binge-eating and the results of our study focused on the treatment of AN by transcranial direct current stimulation (tDCS). Methods: It was a randomized, double-blind, sham-controlled trial. Forty-three inpatients with AN were divided to receive either active (n=22) or sham (n=21) tDCS over the left DLPFC (anode F3/cathode Fp2, 2mA for 30 minutes). All patients filled the Eating Disorder Examination Questionnaire (EDE-Q) and Zung depression scale (ZUNG), we measured them the thermal pain threshold, the objective dissatisfaction with their own body by Anamorfic program and evaluated BMI before the first and after the last tDCS. Follow-up was after 2 and 4 weeks. It was evaluated using ANOVA and OPLS model. Results: Compared to sham tDCS, active tDCS improved self-evaluation based on one's body shape (p < 0,05) and significantly decreased the need of excessive control over calorie intake (p < 0,05) in 4-week follow-up (questions 4 and 23 in EDE-Q). Question 21 in EDE-Q was more...
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Neuroanatomical aspects of nonGmotor effects of deep brain stimulation
Růžička, Filip ; Růžička, Evžen (advisor) ; Papežová, Hana (referee) ; Druga, Rastislav (referee)
Summery The underlying mechanisms of weight gain and other affective and cognitive changes after initiation of deep brain stimulation in Parkinson's disease are still unclear. Considering the functional organization within the subthalamic nucleus (STN); limbic, associative and sensorimotor regions residing in the medial, central and later STN respectively, we hypothesized that weight gain may be related to medial localization of stimulation, while motor improvement may be related to lateral localization of stimulation within the STN (study 1). We further hypothesized that stimulation close to the limbic and associative part of the STN may be associated with negative impact on limbic system leading to enhanced anxiety and changes in the hypothalamic- pituitary- adrenal axis (HPA)(study 2). Therefore, the primary aims our study were to assess changes in body weight (study 1) and the hypothalamic- pituitary- adrenal axis (HPA) (study 2) in relation to the position of the active stimulating contact within the nucleus. ...
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Neuromodulation in treatment of selected dystonic syndromes
Havránková, Petra ; Jech, Robert (advisor) ; Štětkářová, Ivana (referee) ; Rokyta, Richard (referee)
Dystonia is a neurological syndrome characterized by the involuntary contraction of opposing muscles, causing twisting movements or abnormal postures (modified by Fahn, 1987). Writer's cramp is the most common form of task-specific focal dystonia. In the first study, patients with writer's cramp were evaluated for differences in cortical activation during movements likely to induce cramps (complex movements) and movements which rarely lead to dystonia (simple movements). Although complex patient movements during fMRI were never associated with dystonic cramps, they exhibited abnormally decreased cortical activity. This was not observed in simple movements and was unrelated to the character of handwriting or the presence/absence of visual feedback. Our results support the theory of dualistic sensorimotor system behavior in writer's cramp. As the somatosensory system is believed to be affected in focal dystonia, we focused on modulation of the primary somatosensory cortex (SI) induced by repetitive transcranial magnetic stimulation (rTMS) in the second study, in order to improve writer's cramp. In conclusion, 1 Hz rTMS of the SI cortex can improve manifestations of writer's cramp while increasing cortical activity in both hemispheres. Handwriting as well as subjective assessment improved in most...
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Pathophysiological mechanisms of the pallidal deep brain stimulation in dystonic syndromes
Fečíková, Anna ; Jech, Robert (advisor) ; Nevrlý, Martin (referee) ; Škorvánek, Matej (referee)
Deep brain stimulation (DBS) of the globus pallidus internus (GPi) is an effective symptomatic treatment for pharmacoresistant dystonic syndromes. The relationship between grey matter volume and intracortical inhibition of the primary motor cortex (MI) in regard to the effectiveness and the state (ON/OFF) of GPi DBS was analysed in the first study. The grey matter of chronically treated patients showed hypertrophy of the supplementary motor area and cerebellar vermis whereas this difference was more significant in patients with a better clinical outcome. The grey matter of the cerebellar hemispheres of the patients showed positive correlation with the improvement of an intracortical inhibition which was generally less effective in patients regardless of the GPi DBS state. Moreover, we showed the same level of SICI in the good responders as in the healthy controls, while in non-responders was the SICI decreased. In the second study, by using paired associative stimulation (PAS) we studied the influence of primary somatosensory cortex (SI) on the MI excitability in dystonia in regards to the effectiveness of GPi DBS. SI PAS decreased the MI excitability in the GPi DBS ON state while switching the stimulation off decreased an inhibitory effect of SI on MI excitability. Non-responders showed a...
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Weight changes in patients with Parkinson's disease treated with Deep Brain Stimulation.
Undus, Lucie ; Růžička, Evžen (advisor) ; Baláž, Marek (referee) ; Haninec, Pavel (referee)
1 Abstract Body weight changes have been described in the course of Parkinson's disease (PD) as well as following bilateral deep brain stimulation of the subthalamic nucleus (STN DBS) performed in advanced PD. According to the literature weight changes occur in 50-100% of patients who undergo STN DBS. In the last 15 years extensive efforts have been put in understanding the underlying mechanisms behind the weight changes following STN DBS in advanced PD patients however many sources still report conflicting evidence. Improved motor status, reduction in dyskinesias, decrease in energy expenditure, dopaminergic medication reduction, modification of food intake, hormonal factors, regional effects of stimulation were all speculated to cause this weight gain. We hypothesized that patients who underwent STN DBS procedure in our center would gain weight as reported in the literature (study 1, study 2). The etiology of post STN DBS weight gain has not been fully elucidated up to date, in our second study we further hypothesized that the weight changes are due to dysregulation of food related hormones and parameters (study 2). In the third study we hypothesized that weight gain is associated with position of active electrode contact (study 3). Aims of the study: The primary aims of our studies were to assess body...
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The influence of deep brain stimulation on the brain connectivity
Horváthová, Ľubica ; Výtvarová, Eva (referee) ; Klimeš, Petr (advisor)
Hĺbková mozgová stimulácia (DBS) predstavuje účinnú liečbu pre pacientov s Parkinsonovou chorobou (PD) alebo farmakorezistentnou epilepsiou. Avšak mechanizmy, ktorými znižuje počet záchvatov a zlepšuje pohyb, zostávajú ešte do značnej miery neznáme. Pre lepšie pochopenie a určenie, v ktorých frekvenčných pásmach je zmena najdôležitejšia, boli urobené porovnania medzi vypnutou a zapnutou DBS pomocou korelačnej metódy a indexu fázového posunu. Jedenásť pacientov s PD a naimplantovanými neurostimulátormi z firiem Medtronic a St.Jude Medical bolo predmetom nahraných dát použitých v tejto práci. Výsledky dokazujú, že zmena konektivity počas DBS nastane a zároveň, že najviac ovplyvňuje najvyššie frekvencie ako beta, nízka gama a vysoká gama. Zmeny v týchto frekvenciách, zodpovedné za motorickú aktivitu, sústredenie a spracovanie informácií, sú v súlade s klinickou teóriou o PD. Počas tejto choroby je patologická beta aktivita hypersynchronizovaná a gama aktivita je znížená práve v motorických oblastiach. Ak sa gama aktivita počas zapnutej stimulácie zvyšuje, fyziologický stav pacientov sa čiastočne znovuobnovuje a tým zlepšuje ich hybnosť. Metódy a výsledky tejto práce budú použité pre ďalší výskum pacientov s PD a epilepsiou.
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Neuromodulation in treatment of selected dystonic syndromes
Havránková, Petra ; Jech, Robert (advisor) ; Štětkářová, Ivana (referee) ; Rokyta, Richard (referee)
Dystonia is a neurological syndrome characterized by the involuntary contraction of opposing muscles, causing twisting movements or abnormal postures (modified by Fahn, 1987). Writer's cramp is the most common form of task-specific focal dystonia. In the first study, patients with writer's cramp were evaluated for differences in cortical activation during movements likely to induce cramps (complex movements) and movements which rarely lead to dystonia (simple movements). Although complex patient movements during fMRI were never associated with dystonic cramps, they exhibited abnormally decreased cortical activity. This was not observed in simple movements and was unrelated to the character of handwriting or the presence/absence of visual feedback. Our results support the theory of dualistic sensorimotor system behavior in writer's cramp. As the somatosensory system is believed to be affected in focal dystonia, we focused on modulation of the primary somatosensory cortex (SI) induced by repetitive transcranial magnetic stimulation (rTMS) in the second study, in order to improve writer's cramp. In conclusion, 1 Hz rTMS of the SI cortex can improve manifestations of writer's cramp while increasing cortical activity in both hemispheres. Handwriting as well as subjective assessment improved in most...
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Influence of deep brain stimulation on postural stability in patients with Parkinson disease
Zelenková, Jana ; Kobesová, Alena (advisor) ; Zárubová, Kateřina (referee)
Parkinson's disease is a neurodegenerative disease of the basal ganglia. Its main symptoms are rigidity, tremor, bradykinesia, hypokinesia and postural instability. One possible way how to infuence diseases is neurosurgical treatment - deep brain stimulation. The principle is the implantation of electrodes in the basal ganglia and modulation of activity of the basal ganglia circuits due to electrical stimulation. Stimulation affects the motor symptoms of Parkinson's disease. This thesis deals with the influence of deep brain stimulation on postural stability in patients with Parkinson's disease.
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