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Special Issue "Clinical Advances in Neuromodulation Therapy for Brain Functional Disorders"

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Clinical Neurology".

Deadline for manuscript submissions: 16 July 2023 | Viewed by 3916

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Special Issue Editor

Prof. Dr. Jianguo Zhang

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Guest Editor

1. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
2. Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
3. Beijing Key Laboratory of Neurostimulation, Beijing, China
Interests: deep brain stimulation; Parkinson’s disease; dystonia;tremor; epilepsy; neuromodulation; functional neurosurgery

Special Issue Information

Dear Colleagues,

Neuromodulation is a new field of neurosurgery which has rapidly evolved with advanced technology in the past two decades. Today, neuromodulation is used in the treatment of a wide range of brain functional disorders, including movement disorders, epilepsy, psychiatry disorders, pain, dementia, etc. Currently, no cures are available for these diseases, and neuromodulation has made a remarkable contribution to controlling clinical symptoms and improving patients’ quality of life. In the meantime, neuromodulation techniques are also continuing to improve. Currently, technologies widely used in clinical practice include: deep brain stimulation (DBS), vagus nerve stimulation (VNS), spinal cord stimulation (SCS), transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), etc. The development of these technologies has brought benefits to an increased number of patients with brain functional disorders, greatly expanding the indications for neuromodulation. Nevertheless, the lack of clinical evidence on patient selection, long-term efficacy, postoperative patient management, and programmed parameters still hinders the further development of neuromodulation. Thus, research on all of the advances, innovations, and outcomes in the field of neuromodulation are of interest in this Special Issue. In this Special Issue, we invite researchers to contribute with original research articles, review articles, case reports, or short communications to be considered for inclusion, given the comprehensive interest of this Special Issue.

Prof. Dr. Jianguo Zhang
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Keywords

neuromodulation
deep brain stimulation
vagus nerve stimulation
spinal cord stimulation
movement disorders
epilepsy
pain
psychiatry disorders

Published Papers (5 papers)

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Research

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Open AccessArticle

Deep Brain Stimulation Electrode Reconstruction: Comparison between Lead-DBS and Surgical Planning System

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J. Clin. Med. 2023, 12(5), 1781; https://doi.org/10.3390/jcm12051781 - 23 Feb 2023

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Abstract

Background: Electrode reconstruction for postoperative deep brain simulation (DBS) can be achieved manually using a surgical planning system such as Surgiplan, or in a semi-automated manner using software such as the Lead-DBS toolbox. However, the accuracy of Lead-DBS has not been thoroughly addressed. Methods: In our study, we compared the DBS reconstruction results of Lead-DBS and Surgiplan. We included 26 patients (21 with Parkinson’s disease and 5 with dystonia) who underwent subthalamic nucleus (STN)-DBS, and reconstructed the DBS electrodes using the Lead-DBS toolbox and Surgiplan. The electrode contact coordinates were compared between Lead-DBS and Surgiplan with postoperative CT and MRI. The relative positions of the electrode and STN were also compared between the methods. Finally, the optimal contact during follow-up was mapped onto the Lead-DBS reconstruction results to check for overlap between the contacts and the STN. Results: We found significant differences in all axes between Lead-DBS and Surgiplan with postoperative CT, with the mean variance for the X, Y, and Z coordinates being −0.13, −1.16, and 0.59 mm, respectively. Y and Z coordinates showed significant differences between Lead-DBS and Surgiplan with either postoperative CT or MRI. However, no significant difference in the relative distance of the electrode and the STN was found between the methods. All optimal contacts were located in the STN, with 70% of them located within the dorsolateral region of the STN in the Lead-DBS results. Conclusions: Although significant differences in electrode coordinates existed between Lead-DBS and Surgiplan, our results suggest that the coordinate difference was around 1 mm, and Lead-DBS can capture the relative distance between the electrode and the DBS target, suggesting it is reasonably accurate for postoperative DBS reconstruction. Full article

(This article belongs to the Special Issue Clinical Advances in Neuromodulation Therapy for Brain Functional Disorders)

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Open AccessArticle

Vagus Nerve Stimulation for Drug Resistant Epilepsy: Clinical Outcome, Adverse Events, and Potential Prognostic Factors in a Single Center Experience

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J. Clin. Med. 2022, 11(24), 7536; https://doi.org/10.3390/jcm11247536 - 19 Dec 2022

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Abstract

Objective: Vagus nerve stimulation (VNS) has been used for adjunctive treatment in drug resistant epilepsy (DRE) for decades. Nevertheless, information is lacking on possible potential prognostic factors. Our study presents the efficacy and safety of VNS with a focus on prognostic factors in 45 patients with DRE. Methods: We retrospectively evaluated the clinical outcome of 45 consecutive patients with DRE undergoing VNS implantation in The First Affiliated Hospital of Anhui Medical University between November 2016 and August 2021. Medical records were aggregated across all patient visits. Cox proportional hazards regression was used to estimate the prognostic factors. Results: Significant decrease in seizure frequency was observed after intermittent stimulation of the vagus nerve. According to the modified McHugh classification, 11 patients (24.4%) were Class I, 11 patients (24.4%) were Class II, four patients (8.9%) were Class III, 10 patients (22.2%) were Class IV, and nine patients (20.0%) were Class V. Notably, 22 patients (48.9%) were responders and four patients (8.9%) were seizure-free at the final follow-up. No significant prognostic factors were found in this cohort. Furthermore, 37 patients reported improved quality of life. Of the patients, 22 (48.9%) experienced adverse events after surgery; hoarseness, discomfort at the surgical site, and coughing were the most common. Conclusion: The results confirmed the efficacy and safety of VNS. No prognostic factors were identified. Full article

(This article belongs to the Special Issue Clinical Advances in Neuromodulation Therapy for Brain Functional Disorders)

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Open AccessArticle

Efficacy of Neurostimulations for Upper Extremity Function Recovery after Stroke: A Systematic Review and Network Meta-Analysis

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J. Clin. Med. 2022, 11(20), 6162; https://doi.org/10.3390/jcm11206162 - 19 Oct 2022

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Abstract

Background: Neurostimulations for the post-stroke recovery of upper extremity function has been explored in previous research, but there remains a controversy about the superiority of different neurostimulations. Methods: Randomized controlled trials (RCTs) were searched in MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov, from 1 January 2000 to 1 June 2022. A conventional pair-wise meta-analysis with a random-effect model was used to evaluate direct evidence. Bayesian random effect models were used for network meta-analysis. The grading of the recommendations assessment, development and evaluation (GRADE) approach was applied to assess the clinical quality of the results. Results: A total of 88 RCTs, which enrolled 3491 participants, were included. For the Fugl-Meyer Assessment-Upper Extremity score change from the baseline to the longest follow-up, the following interventions showed a significant difference: VNS (MD = 4.12, 95%CrI: 0.54 to 7.80, moderate certainty), cNMES (MD = 3.98, 95%CrI: 1.05 to 6.92, low certainty), FES (MD = 7.83, 95%CrI: 4.42 to 11.32, very low certainty), drTMS (MD = 7.94, 95%CrI: 3.71 to 12.07, moderate certainty), LFrTMS (MD = 2.64, 95%CrI: 1.20 to 4.11, moderate certainty), HFrTMS (MD = 6.73, 95%CrI: 3.26 to 10.22, moderate certainty), and iTBS combined with LFrTMS (MD = 5.41, 95%CrI: 0.48 to 10.35, moderate certainty). Conclusions: The neurostimulations above the revealed significant efficacy for improving the upper limb function after stroke eased the suffering of the patient. Full article

(This article belongs to the Special Issue Clinical Advances in Neuromodulation Therapy for Brain Functional Disorders)

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Open AccessArticle

Effects of Subthalamic Nucleus Deep Brain Stimulation on Depression in Patients with Parkinson’s Disease

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J. Clin. Med. 2022, 11(19), 5844; https://doi.org/10.3390/jcm11195844 - 01 Oct 2022

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Abstract

Objective: In this study, we aimed to investigate the effects of STN-DBS on PD patients with different levels of depression and to identify predictors of the effects of STN-DBS on PD depression. Methods: We retrospectively collected data for 118 patients with PD depression who underwent STN-DBS at Beijing Tiantan Hospital. Neuropsychological, motor, and quality of life assessments were applied preoperatively and postoperatively. All patients were divided into two groups according to their HAM-D₂₄ total scores (group I: mild depression; group Ⅱ: moderate depression). A mixed repeated-measure analysis of variance (ANOVA) was performed to investigate whether there were differences in depression scores before and after STN-DBS between the two groups. The changes in depression scores were also compared between groups using ANCOVA, adjusting for gender and preoperative HAMA scores. Logistic regression was performed to identify predictors of STN-DBS’s effects on PD depression. Results: Both groups showed significant improvement in depression symptoms after STN-DBS. Compared with patients in group I, patients in group Ⅱ showed greater reductions in their HAM-D₂₄ total scores (p = 0.002) and in HAM-D₂₄ subitems including cognitive disturbances (p = 0.026) and hopelessness symptoms (p = 0.018). Logistic regression indicated that gender (female) (p = 0.014) and preoperative moderate depression (p < 0.001) patients had greater improvements in depression after STN-DBS. Conclusions: Patients with moderate depression showed better improvement than patients with mild depression. Gender (female) and preoperative HAMA scores are predictors of STN-DBS’s effects on PD depression. Full article

(This article belongs to the Special Issue Clinical Advances in Neuromodulation Therapy for Brain Functional Disorders)

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Open AccessSystematic Review

Real-Time fMRI Neurofeedback Training as a Neurorehabilitation Approach on Depressive Disorders: A Systematic Review of Randomized Control Trials

Pamela P. González Méndez

Julio Rodino Climent

Jeffrey A. Stanley

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Ranganatha Sitaram

J. Clin. Med. 2022, 11(23), 6909; https://doi.org/10.3390/jcm11236909 - 23 Nov 2022

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Abstract

Real-time functional magnetic resonance imaging neurofeedback (rt-fMRI-nf) training is an emerging intervention for neurorehabilitation. However, its translation into clinical use on participants with clinical depression is unclear, the effect estimates from randomized control trials and the certainty of the supporting evidence on the effect estimates are unknown. As the number of studies on neurofeedback increases every year, and better quality evidence becomes available, we evaluate the evidence of all randomized control trials available on the clinical application of rt-fMRI-nf training on participants with clinical depression. We performed electronic searches in Pubmed, Embase, CENTRAL, rtFIN database, Epistemonikos, trial registers, reference lists, other systematic reviews, conference abstracts, and cross-citation in Google Scholar. Reviewers independently selected studies, extracted data and evaluated the risk of bias. The certainty of the evidence was judged using the GRADE framework. This review complies with PRISMA guidelines and was submitted to PROSPERO registration. We found 435 results. After the selection process, we included 11 reports corresponding to four RCTs. The effect of rt-fMRI-nf on improving the severity of clinical depression scores demonstrated a tendency to favor the intervention; however, the general effect was not significant. At end of treatment, SMD (standardized mean difference): −0.32 (95% CI −0.73 to 0.10). At follow-up, SMD: −0.33 (95% CI −0.91, 1.25). All the studies showed changes in BOLD fMRI activation after training; however, only one study confirmed regulation success during a transfer run. Whole-brain analyses suggests that rt-fMRI nf may alter activity patterns in brain networks. More studies are needed to evaluate quality of life, acceptability, adverse effects, cognitive tasks, and physiology measures. We conclude that the current evidence on the effect of rt-fMRI-nf training for decision-making outcomes in patients with clinical depression is still based on low certainty of the evidence. Full article

(This article belongs to the Special Issue Clinical Advances in Neuromodulation Therapy for Brain Functional Disorders)

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