@article{LangeSteigerwaldMalzacheretal.2021, author = {Lange, Florian and Steigerwald, Frank and Malzacher, Tobias and Brandt, Gregor Alexander and Odorfer, Thorsten Michael and Roothans, Jonas and Reich, Martin M. and Fricke, Patrick and Volkmann, Jens and Matthies, Cordula and Capetian, Philipp D.}, title = {Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming}, series = {Frontiers in Neurology}, volume = {12}, journal = {Frontiers in Neurology}, issn = {1664-2295}, doi = {10.3389/fneur.2021.785529}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-249634}, year = {2021}, abstract = {Objectives: Deep brain stimulation (DBS) programming is based on clinical response testing. Our clinical pilot trial assessed the feasibility of image-guided programing using software depicting the lead location in a patient-specific anatomical model. Methods: Parkinson's disease patients with subthalamic nucleus-DBS were randomly assigned to standard clinical-based programming (CBP) or anatomical-based (imaging-guided) programming (ABP) in an 8-week crossover trial. Programming characteristics and clinical outcomes were evaluated. Results: In 10 patients, both programs led to similar motor symptom control (MDS-UPDRS III) after 4 weeks (medicationOFF/stimulationON; CPB: 18.27 ± 9.23; ABP: 18.37 ± 6.66). Stimulation settings were not significantly different, apart from higher frequency in the baseline program than CBP (p = 0.01) or ABP (p = 0.003). Time spent in a program was not significantly different (CBP: 86.1 ± 29.82\%, ABP: 88.6 ± 29.0\%). Programing time was significantly shorter (p = 0.039) with ABP (19.78 ± 5.86 min) than CBP (45.22 ± 18.32). Conclusion: Image-guided DBS programming in PD patients drastically reduces programming time without compromising symptom control and patient satisfaction in this small feasibility trial.}, language = {en} } @phdthesis{Fricke2013, author = {Fricke, Patrick}, title = {Hyperextensionsverletzungen der thorakolumbalen Wirbels{\"a}ule}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-83062}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2013}, abstract = {Eine der seltensten Formen thorakolumbaler Wirbels{\"a}ulenverletzungen stellen Hyperextensionsl{\"a}sionen dar. In dieser retrospektiven Studie wurden 27 F{\"a}lle thorakolumbaler Hyperextensionsverletzungen, die zwischen 1997 und 2010 in der Universit{\"a}tsklinik W{\"u}rzburg behandelt wurden, analysiert und die Besonderheiten dieser Verletzungen verdeutlicht. Ergebnisse: In dem untersuchten Patientenkollektiv waren zu 74 \% M{\"a}nner von den Hyperextensionsverletzungen betroffen. Das Durchschnittsalter aller Patienten lag bei 70,6 Jahren (25 - 92 Jahre, SD 15,8). 22 Patienten litten zum Unfallzeitpunkt an Vorerkrankungen der Wirbels{\"a}ule: in 17 F{\"a}llen (63 \%) lag eine diffuse idiopathic skeletal hyperostosis (DISH) vor, bei 4 Patienten (14,8 \%) ein M. Bechterew und bei einer Patientin (3,7 \%) ausschließlich degenerative Ver{\"a}nderungen im Sinne einer Osteoporose. In 29,6 \% der F{\"a}lle war ein leichtes Trauma urs{\"a}chlich, bei 70,4 \% f{\"u}hrte ein hochenergetischer Unfall zu der Hyperextensionsverletzung. Bei 14 Patienten verliefen die Verletzungen der vorderen S{\"a}ule transdiskal (52 \%) und bei 13 transoss{\"a}r (48 \%). Bei allen Patienten ohne Vorsch{\"a}den der Wirbels{\"a}ule kam es dabei zu einer transdiskalen L{\"a}sion. 6 Patienten (22,2 \%) erlitten initial durch die Hyperextensionsverletzung ein neurologisches Defizit. Alle Patienten wurden operativ mittels Implantation eines Fixateur interne von dorsal stabilisiert. Schlussfolgerung: Im Vergleich mit der Literatur zeigte sich anhand der Daten dieser Studie, dass Hyperextensionsverletzungen der thorakolumbalen Wirbels{\"a}ule mit einem h{\"o}heren Risiko f{\"u}r neurologische Defizite einhergingen als andere thorakolumbale Verletzungen der Gruppe B. Dabei traten neurologische Defizite nur bei hochenergetischen Unf{\"a}llen auf. Ein durch M. Bechterew oder DISH versteiftes Achsenskelett erh{\"o}hte das Risiko f{\"u}r eine Hyperextensionsverletzung. Im Vergleich zu anderen Verletzungsformen der thorakolumbalen Wirbels{\"a}ule traten Hyperextensionsverletzungen verh{\"a}ltnism{\"a}ßig h{\"a}ufiger bei vorgesch{\"a}digten Wirbels{\"a}ulen und somit bei {\"a}lteren Menschen auf. Nur im Falle einer Vorerkrankung der Wirbels{\"a}ule konnte bereits ein niederenergetisches Trauma zu einer Hyperextensionsverletzung f{\"u}hren. Dabei war dann vor allem der thorakolumbale {\"U}bergang und weniger die thorakale Wirbels{\"a}ule betroffen, bei der es haupts{\"a}chlich durch hochenergetische Unf{\"a}lle zu Verletzungen kam. Transoss{\"a}re Hyperextensionsverletzungen der vorderen und der hinteren S{\"a}ule traten nur bei alterierten Wirbels{\"a}ulen auf. Bei wirbels{\"a}ulengesunden Patienten verlief die Verletzung jeweils transdiskal und durch die hintere S{\"a}ule ligament{\"a}r.}, subject = {Wirbels{\"a}ulenverletzung}, language = {de} } @article{BinderLangePozzietal.2023, author = {Binder, Tobias and Lange, Florian and Pozzi, Nicol{\`o} and Musacchio, Thomas and Daniels, Christine and Odorfer, Thorsten and Fricke, Patrick and Matthies, Cordula and Volkmann, Jens and Capetian, Philipp}, title = {Feasibility of local field potential-guided programming for deep brain stimulation in Parkinson's disease: a comparison with clinical and neuro-imaging guided approaches in a randomized, controlled pilot trial}, series = {Brain Stimulation}, volume = {16}, journal = {Brain Stimulation}, number = {5}, doi = {10.1016/j.brs.2023.08.017}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350280}, pages = {1243-1251}, year = {2023}, abstract = {Highlights • Beta-Guided programming is an innovative approach that may streamline the programming process for PD patients with STN DBS. • While preliminary findings from our study suggest that Beta Titration may potentially mitigate STN overstimulation and enhance symptom control, • Our results demonstrate that beta-guided programming significantly reduces programming time, suggesting it could be efficiently integrated into routine clinical practice using a commercially available patient programmer. Background Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for advanced Parkinson's disease (PD). Clinical outcomes after DBS can be limited by poor programming, which remains a clinically driven, lengthy and iterative process. Electrophysiological recordings in PD patients undergoing STN-DBS have shown an association between STN spectral power in the beta frequency band (beta power) and the severity of clinical symptoms. New commercially-available DBS devices now enable the recording of STN beta oscillations in chronically-implanted PD patients, thereby allowing investigation into the use of beta power as a biomarker for DBS programming. Objective To determine the potential advantages of beta-guided DBS programming over clinically and image-guided programming in terms of clinical efficacy and programming time. Methods We conducted a randomized, blinded, three-arm, crossover clinical trial in eight Parkinson's patients with STN-DBS who were evaluated three months after DBS surgery. We compared clinical efficacy and time required for each DBS programming paradigm, as well as DBS parameters and total energy delivered between the three strategies (beta-, clinically- and image-guided). Results All three programming methods showed similar clinical efficacy, but the time needed for programming was significantly shorter for beta- and image-guided programming compared to clinically-guided programming (p < 0.001). Conclusion Beta-guided programming may be a useful and more efficient approach to DBS programming in Parkinson's patients with STN-DBS. It takes significantly less time to program than traditional clinically-based programming, while providing similar symptom control. In addition, it is readily available within the clinical DBS programmer, making it a valuable tool for improving current clinical practice.}, language = {en} }