TY - THES A1 - Volkmann, Thorsten T1 - Lattice gas models and simulations of epitaxial growth T1 - Gittergasmodelle und Simulationen von Epitaktischem Wachstum N2 - In this PhD thesis, we develop models for the numerical simulation of epitaxial crystal growth, as realized, e.g., in molecular beam epitaxy (MBE). The basic idea is to use a discrete lattice gas representation of the crystal structure, and to apply kinetic Monte Carlo (KMC) simulations for the description of the growth dynamics. The main advantage of the KMC approach is the possibility to account for atomistic details and at the same time cover MBE relevant time scales in the simulation. In chapter 1, we describe the principles of MBE, pointing out relevant physical processes and the influence of experimental control parameters. We discuss various methods used in the theoretical description of epitaxial growth. Subsequently, the underlying concepts of the KMC method and the lattice gas approach are presented. Important aspects concerning the design of a lattice gas model are considered, e.g. the solid-on-solid approximation or the choice of an appropriate lattice topology. A key element of any KMC simulation is the selection of allowed events and the evaluation of Arrhenius rates for thermally activated processes. We discuss simplifying schemes that are used to approximate the corresponding energy barriers if detailed knowledge about the barriers is not available. Finally, the efficient implementation of the MC kinetics using a rejection-free algorithm is described. In chapter 2, we present a solid-on-solid lattice gas model which aims at the description of II-VI(001) semiconductor surfaces like CdTe(001). The model accounts for the zincblende structure and the relevant surface reconstructions of Cd- and Te-terminated surfaces. Particles at the surface interact via anisotropic nearest and next nearest neighbor interactions, whereas interactions in the bulk are isotropic. The anisotropic surface interactions reflect known properties of CdTe(001) like the small energy difference between the c(2x2) and (2x1) vacancy structures of Cd-terminated surfaces. A key element of the model is the presence of additional Te atoms in a weakly bound Te* state, which is motivated by experimental observations of Te coverages exceeding one monolayer at low temperatures and high Te fluxes. The true mechanism of binding excess Te to the surface is still unclear. Here, we use a mean-field approach assuming a Te* reservoir with limited occupation. In chapter 3, we perform KMC simulations of atomic layer epitaxy (ALE) of CdTe(001). We study the self-regulation of the ALE growth rate and demonstrate how the interplay of the Te* reservoir occupation with the surface kinetics results in two different regimes: at high temperatures the growth rate is limited to one half layer of CdTe per ALE cycle, whereas at low enough temperatures each cycle adds a complete layer. The temperature where the transition between the two regimes occurs depends mainly on the particle fluxes. The temperature dependence of the growth rate and the flux dependence of the transition temperature are in good qualitative agreement with experimental results. Comparing the macroscopic activation energy for Te* desorption in our model with experimental values we find semiquantitative agreement. In chapter 4, we study the formation of nanostructures with alternating stripes during submonolayer heteroepitaxy of two different adsorbate species on a given substrate. We evaluate the influence of two mechanisms: kinetic segregation due to chemically induced diffusion barriers, and strain relaxation by alternating arrangement of the adsorbate species. KMC simulations of a simple cubic lattice gas with weak inter-species binding energy show that kinetic effects are sufficient to account for stripe formation during growth. The dependence of the stripe width on control parameters is investigated. We find an Arrhenius temperature dependence, in agreement with experimental investigations of phase separation in binary or ternary material systems. Canonical MC simulations show that the observed stripes are not stable under equilibrium conditions: the adsorbate species separate into very large domains. Off-lattice simulations which account for the lattice misfit of the involved particle species show that, under equilibrium conditions, the competition between binding and strain energy results in regular stripe patterns with a well-defined width depending on both misfit and binding energies. In KMC simulations, the stripe-formation and the experimentally reported ramification of adsorbate islands are reproduced. To clarify the origin of the island ramification, we investigate an enhanced lattice gas model whose parameters are fitted to match characteristic off-lattice diffusion barriers. The simulation results show that a satisfactory explanation of experimental observations within the lattice gas framework requires a detailed incorporation of long-range elastic interactions. In the appendix we discuss supplementary topics related to the lattice gas simulations in chapter 4. N2 - Diese Doktorarbeit behandelt die Modellierung und Simulation von epitaktischem Kristallwachstum, wie es in der Molekularstrahlepitaxie (MBE) realisiert ist. Die Kristallstruktur wird dabei durch ein Gittergasmodell dargestellt, während die Wachstumsdynamik mit Hilfe kinetischer Monte Carlo (KMC) Simulationen beschrieben wird. Der Hauptvorteil des KMC-Ansatzes besteht darin, atomistische Details des Wachstums berücksichtigen zu können und gleichzeitig MBE-relevante Zeitskalen in der Simulation zu erreichen. In Kapitel 1 wird das Prinzip der MBE erläutert, wobei wichtige Oberflächenprozesse und der Einfluss experimenteller Kontrollparameter diskutiert werden. Es folgt eine Darstellung wichtiger Methoden zur theoretischen Beschreibung epitaktischen Wachstums. Danach werden der KMC-Ansatz und das Gittergaskonzept erläutert. Für den Entwurf eines Gittergasmodells relevante Aspekte wie die solid-on-solid Näherung oder die Wahl einer geeigneten Gittertopologie werden diskutiert. Ein Hauptbestandteil jeder KMC-Simulation ist die Auswahl erlaubter Ereignisse und die Berechnung der Arrhenius-Raten thermisch aktivierter Prozesse. Hierzu sind Kenntnisse über zugehörige Energiebarrieren notwendig. Wir diskutieren vereinfachende Ansätze zur Näherung der Barrieren. Abschließend wird die Umsetzung der KMC-Methode in einem effizienten Simulationsalgorithmus beschrieben. In Kapitel 2 wird ein Gittergasmodell zur Beschreibung von II-VI(001) Halbleiteroberflächen wie z.B. CdTe(001) vorgestellt. Das Modell berücksichtigt die Zinkblendestruktur sowie relevante Rekonstruktionen Cd- und Te-terminierter Oberflächen. Wir nehmen anisotrope Wechselwirkungen zwischen NN und NNN an der Oberfläche an, während Teilchen im Bulk isotrop wechselwirken. Die anisotropen Wechselwirkungen spiegeln bekannte Eigenschaften von CdTe(001) wie den geringen Energieunterschied zwischen der c(2x2)- und der (2x1)-Leerstellenstruktur der Cd-terminierten Oberfläche wider. Ein Hauptbestandteil des Modells ist die Einbindung von Te-Atomen in einem schwach gebundenen Te*-Zustand. Dessen Existenz wird gestützt durch experimentell beobachtete Te-Bedeckungen von mehr als einer Monolage bei tiefen Temperaturen und hohen Te-Flüssen. Der tatsächliche Bindungsmechanismus der Te*-Atome wurde bisher nicht geklärt. Im Modell wird im Rahmen eines mean-field Ansatzes ein Te*-Reservoir mit begrenzter Kapazität angenommen. In Kapitel 3 wird die Atomlagenepitaxie (ALE) von CdTe(001) simuliert. Wir untersuchen die Selbstregulierung der ALE-Wachstumsrate und zeigen, dass das Zusammenspiel der Te*-Reservoir-Besetzung mit kinetischen Effekten an der Oberfläche zu zwei verschiedenen Wachstumsbereichen führt. Bei hohen Temperaturen ist die Wachstumsrate auf eine halbe Lage CdTe pro ALE-Zyklus beschränkt, während bei tiefen Temperaturen eine volle Lage pro Zyklus deponiert wird. Die Temperatur, bei der der Übergang zwischen beiden Bereichen eintritt, hängt im Wesentlichen nur vom Teilchenfluss ab. Die Temperaturabhängigkeit der ALE-Wachstumsrate sowie die Flussabhängigkeit der Übergangstemperatur stimmen qualitativ gut mit experimentellen Ergebnissen überein. Eine Abschätzung der makroskopischen Aktivierungsenergie für die Desorption schwach gebundener Te*-Atome in unserem Modell ergibt eine semiquantitative Übereinstimmung mit experimentellen Werten. In Kapitel 4 simulieren wir die Bildung von Nanostrukturen mit alternierenden Streifen während der Submonolagen-Heteroepitaxie. Zwei Mechanismen werden untersucht: Trennung zweier Adsorbatsorten aufgrund verschieden hoher Diffusionsbarrieren, und Verspannungsabbau durch abwechselnde Anordnung der Adsorbatsorten. KMC-Simulationen eines einfach kubischen Gittergasmodells mit schwacher Bindung zwischen unterschiedlichen Adsorbatsorten zeigen, dass die Streifenbildung allein durch kinetische Effekte während des Wachstums hervorgerufen werden kann. Der Einfluss von Kontrollparametern auf die Streifenbreite wird untersucht. Wir finden ein Arrhenius-Verhalten für die Temperaturabhängigkeit, in Übereinstimmung mit experimentellen Untersuchungen. Kanonische MC-Simulationen zeigen, dass unter Gleichgewichtsbedingungen eine fast vollständige Separation der Adsorbatsorten eintritt. Gleichgewichtssimulationen mit einem gitterfreien Modell zeigen, dass die Konkurrenz zwischen Teilchenbindungen und Gitterunterschied zu regelmäßigen Streifen mit wohldefinierter Breite führt. In KMC-Simulationen werden die Streifenbildung sowie die experimentell berichtete Verästelung der Adsorbatinseln reproduziert. Eine Untersuchung der Verästelung mit einem erweiterten Gittergasmodell, dessen Parameter an charakteristische Diffusionsbarrieren des gitterfreien Modells angepasst wurden, zeigt, dass eine zufriedenstellende Beschreibung im Rahmen eines Gittergases die explizite Berücksichtigung langreichweitiger elastischer Wechselwirkungen erfordert. Im Anhang werden ergänzende Themen behandelt, die im Zusammenhang mit den Gittergassimulationen aus Kapitel 4 stehen. KW - Kristallwachstum KW - Epitaxie KW - Monte-Carlo-Simulation KW - Gittergas KW - Gittergas KW - Monte Carlo KW - Simulation KW - Epitaxie KW - Halbleiter KW - Lattice Gas KW - Monte Carlo KW - Simulation KW - Epitaxy KW - Semiconductor Y1 - 2004 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-13812 ER - TY - JOUR A1 - Karikari, Akua A. A1 - McFleder, Rhonda L. A1 - Ribechini, Eliana A1 - Blum, Robert A1 - Bruttel, Valentin A1 - Knorr, Susanne A1 - Gehmeyr, Mona A1 - Volkmann, Jens A1 - Brotchie, Jonathan M. A1 - Ahsan, Fadhil A1 - Haack, Beatrice A1 - Monoranu, Camelia-Maria A1 - Keber, Ursula A1 - Yeghiazaryan, Rima A1 - Pagenstecher, Axel A1 - Heckel, Tobias A1 - Bischler, Thorsten A1 - Wischhusen, Jörg A1 - Koprich, James B. A1 - Lutz, Manfred B. A1 - Ip, Chi Wang T1 - Neurodegeneration by α-synuclein-specific T cells in AAV-A53T-α-synuclein Parkinson’s disease mice JF - Brain, Behavior, and Immunity N2 - Background Antigen-specific neuroinflammation and neurodegeneration are characteristic for neuroimmunological diseases. In Parkinson’s disease (PD) pathogenesis, α-synuclein is a known culprit. Evidence for α-synuclein-specific T cell responses was recently obtained in PD. Still, a causative link between these α-synuclein responses and dopaminergic neurodegeneration had been lacking. We thus addressed the functional relevance of α-synuclein-specific immune responses in PD in a mouse model. Methods We utilized a mouse model of PD in which an Adeno-associated Vector 1/2 serotype (AAV1/2) expressing human mutated A53T-α-Synuclein was stereotactically injected into the substantia nigra (SN) of either wildtype C57BL/6 or Recombination-activating gene 1 (RAG1)\(^{-/-}\) mice. Brain, spleen, and lymph node tissues from different time points following injection were then analyzed via FACS, cytokine bead assay, immunohistochemistry and RNA-sequencing to determine the role of T cells and inflammation in this model. Bone marrow transfer from either CD4\(^{+}\)/CD8\(^{-}\), CD4\(^{-}\)/CD8\(^{+}\), or CD4\(^{+}\)/CD8\(^{+}\) (JHD\(^{-/-}\)) mice into the RAG-1\(^{-/-}\) mice was also employed. In addition to the in vivo studies, a newly developed A53T-α-synuclein-expressing neuronal cell culture/immune cell assay was utilized. Results AAV-based overexpression of pathogenic human A53T-α-synuclein in dopaminergic neurons of the SN stimulated T cell infiltration. RNA-sequencing of immune cells from PD mouse brains confirmed a pro-inflammatory gene profile. T cell responses were directed against A53T-α-synuclein-peptides in the vicinity of position 53 (68–78) and surrounding the pathogenically relevant S129 (120–134). T cells were required for α-synuclein-induced neurodegeneration in vivo and in vitro, while B cell deficiency did not protect from dopaminergic neurodegeneration. Conclusions Using T cell and/or B cell deficient mice and a newly developed A53T-α-synuclein-expressing neuronal cell culture/immune cell assay, we confirmed in vivo and in vitro that pathogenic α-synuclein peptide-specific T cell responses can cause dopaminergic neurodegeneration and thereby contribute to PD-like pathology. KW - Parkinson’s disease KW - α-synuclein-specific T cells KW - neurodegeneration Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-300600 VL - 101 SP - 194 EP - 210 ER - TY - JOUR A1 - Peterka, Manuel A1 - Odorfer, Thorsten A1 - Schwab, Michael A1 - Volkmann, Jens A1 - Zeller, Daniel T1 - LSVT-BIG therapy in Parkinson's disease: physiological evidence for proprioceptive recalibration JF - BMC Neurology N2 - Background There is growing evidence for proprioceptive dysfunction in patients with Parkinson's disease (PD). The Lee Silvermann Voice Treatment-BIG therapy (LSVT-BIG), a special training program aiming at an increase of movement amplitudes in persons with PD (PwPD), has shown to be effective on motor symptoms. LSVT-BIG is conceptionally based on improving bradykinesia, in particular the decrement of repetitive movements, by proprioceptive recalibration. Objective To assess proprioceptive impairment in PwPD as compared to matched controls and to probe potential recalibration effects of the LSVT-BIG therapy on proprioception. Methods Proprioceptive performance and fine motor skills were assessed in 30 PwPD and 15 matched controls. Measurements with significant impairment in PwPD were chosen as outcome parameters for a standardized 4 weeks amplitude-based training intervention (LSVT-BIG) in 11 PwPD. Proprioceptive performance served as primary outcome measure. Secondary outcome measures included the motor part of the MDS-UPDRS, the nine-hole-peg test, and a questionnaire on quality of life. Post-interventional assessments were conducted at weeks 4 and 8. Results Compared to the control group, PwPD showed significantly larger pointing errors. After 4 weeks of LSVT-BIG therapy and even more so after an additional 4 weeks of continued training, proprioceptive performance improved significantly. In addition, quality of life improved as indicated by a questionnaire. Conclusion LSVT-BIG training may achieve a recalibration of proprioceptive processing in PwPD. Our data indicates a probable physiological mechanism of a symptom-specific, amplitude-based behavioral intervention in PwPD. KW - Proprioception KW - Amplitude KW - Training KW - Pointing error KW - LSVT-big therapy Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-230084 VL - 20 ER - TY - JOUR A1 - Lange, Florian A1 - Steigerwald, Frank A1 - Malzacher, Tobias A1 - Brandt, Gregor Alexander A1 - Odorfer, Thorsten Michael A1 - Roothans, Jonas A1 - Reich, Martin M. A1 - Fricke, Patrick A1 - Volkmann, Jens A1 - Matthies, Cordula A1 - Capetian, Philipp D. T1 - Reduced Programming Time and Strong Symptom Control Even in Chronic Course Through Imaging-Based DBS Programming JF - Frontiers in Neurology N2 - 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. KW - directional deep brain stimulation KW - image-guided programming KW - subthalamic nucleus KW - chronic stimulation KW - randomized controlled double-blind study KW - Parkinson's disease Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249634 SN - 1664-2295 VL - 12 ER - TY - JOUR A1 - Odorfer, Thorsten M. A1 - Homola, György A. A1 - Reich, Martin M. A1 - Volkmann, Jens A1 - Zeller, Daniel T1 - Increased finger-tapping related cerebellar activation in cervical dystonia, enhanced by transcranial stimulation: an indicator of compensation? JF - Frontiers in Neurology N2 - Background: Cervical dystonia is a movement disorder causing abnormal postures and movements of the head. While the exact pathophysiology of cervical dystonia has not yet been fully elucidated, a growing body of evidence points to the cerebellum as an important node. Methods: Here, we examined the impact of cerebellar interference by transcranial magnetic stimulation on finger-tapping related brain activation and neurophysiological measures of cortical excitability and inhibition in cervical dystonia and controls. Bilateral continuous theta-burst stimulation was used to modulate cerebellar cortical excitability in 16 patients and matched healthy controls. In a functional magnetic resonance imaging arm, data were acquired during simple finger tapping before and after cerebellar stimulation. In a neurophysiological arm, assessment comprised motor-evoked potentials amplitude and cortical silent period duration. Theta-burst stimulation over the dorsal premotor cortex and sham stimulation (neurophysiological arm only) served as control conditions. Results: At baseline, finger tapping was associated with increased activation in the ipsilateral cerebellum in patients compared to controls. Following cerebellar theta-burst stimulation, this pattern was even more pronounced, along with an additional movement-related activation in the contralateral somatosensory region and angular gyrus. Baseline motor-evoked potential amplitudes were higher and cortical silent period duration shorter in patients compared to controls. After cerebellar theta-burst stimulation, cortical silent period duration increased significantly in dystonia patients. Conclusion: We conclude that in cervical dystonia, finger movements—though clinically non-dystonic—are associated with increased activation of the lateral cerebellum, possibly pointing to general motor disorganization, which remains subclinical in most body regions. Enhancement of this activation together with an increase of silent period duration by cerebellar continuous theta-burst stimulation may indicate predominant disinhibitory effects on Purkinje cells, eventually resulting in an inhibition of cerebello-thalamocortical circuits. KW - cervical dystonia KW - functional MRI KW - cortical excitability KW - transcranial magnetic simulation (TMS) KW - continuous theta burst stimulation (cTBS) KW - motor-evoked potentials (MEP) KW - cortical silent period Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-196249 SN - 1664-2295 VL - 10 IS - 231 ER - TY - JOUR A1 - Odorfer, Thorsten M. A1 - Yabe, Marie A1 - Hiew, Shawn A1 - Volkmann, Jens A1 - Zeller, Daniel T1 - Topological differences and confounders of mental rotation in cervical dystonia and blepharospasm JF - Scientific Reports N2 - Mental rotation (mR) bases on imagination of actual movements. It remains unclear whether there is a specific pattern of mR impairment in focal dystonia. We aimed to investigate mR in patients with cervical dystonia (CD) and blepharospasm (BS) and to assess potential confounders. 23 CD patients and 23 healthy controls (HC) as well as 21 BS and 19 hemifacial spasm (HS) patients were matched for sex, age, and education level. Handedness, finger dexterity, general reaction time, and cognitive status were assessed. Disease severity was evaluated by clinical scales. During mR, photographs of body parts (head, hand, or foot) and a non-corporal object (car) were displayed at different angles rotated within their plane. Subjects were asked to judge laterality of the presented image by keystroke. Both speed and correctness were evaluated. Compared to HC, CD and HS patients performed worse in mR of hands, whereas BS group showed comparable performance. There was a significant association of prolonged mR reaction time (RT) with reduced MoCA scores and with increased RT in an unspecific reaction speed task. After exclusion of cognitively impaired patients, increased RT in the mR of hands was confined to CD group, but not HS. While the question of whether specific patterns of mR impairment reliably define a dystonic endophenotype remains elusive, our findings point to mR as a useful tool, when used carefully with control measures and tasks, which may be capable of identifying specific deficits that distinguish between subtypes of dystonia. KW - neurology KW - neuroscience Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357713 VL - 13 ER - TY - JOUR A1 - Binder, Tobias A1 - Lange, Florian A1 - Pozzi, Nicolò A1 - Musacchio, Thomas A1 - Daniels, Christine A1 - Odorfer, Thorsten A1 - Fricke, Patrick A1 - Matthies, Cordula A1 - Volkmann, Jens A1 - Capetian, Philipp T1 - 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 JF - Brain Stimulation N2 - 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. KW - beta power KW - deep brain stimulation KW - local field potentials KW - Parkinson's disease KW - DBS programming KW - DBS biomarkers Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-350280 VL - 16 IS - 5 ER - TY - JOUR A1 - Odorfer, Thorsten M. A1 - Volkmann, Jens T1 - Deep brain stimulation for focal or segmental craniocervical dystonia in patients who have failed botulinum neurotoxin therapy - a narrative review of the literature JF - Toxins N2 - (1) Background: The first-line treatment for patients with focal or segmental dystonia with a craniocervical distribution is still the intramuscular injection of botulinum neurotoxin (BoNT). However, some patients experience primary or secondary treatment failure from this potential immunogenic therapy. Deep brain stimulation (DBS) may then be used as a backup strategy in this situation. (2) Methods: Here, we reviewed the current study literature to answer a specific question regarding the efficacy and safety of the use of DBS, particularly for cervical dystonia (CD) and Meige syndrome (MS) in patients with documented treatment failure under BoNT. (3) Results: There are only two studies with the highest level of evidence in this area. Despite this clear limitation, in the context of the narrowly defined research question of this paper, it is possible to report 161 patients with CD or MS who were included in studies that were able to show a statistically significant reduction in dystonic symptoms using DBS. Safety and tolerability data appeared adequate. However, much of the information is based on retrospective observations. (4) Conclusions: The evidence base in this area is in need of further scientific investigation. Most importantly, more randomized, controlled and double-blind trials are needed, possibly including a head-to-head comparison of DBS and BoNT. KW - cervical dystonia KW - Meige syndrome KW - deep brain stimulation KW - internal globus pallidus KW - subthalamic nucleus KW - botulinum neurotoxin KW - medication therapy failure KW - symptom control KW - safety and tolerability Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357707 SN - 2072-6651 VL - 15 IS - 10 ER -