• 대한의용생체공학회:의공학회지
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• 제33권1호
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• pp.47-52
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• 2012

The purpose of this study is to investigate whether medication and deep brain stimulation (DBS) have differential effects on the speed and amplitude of bradykinesia in patients with Parkinson's disease (PD). Five PD patients with implanted DBS electrodes (age: $60.6{\pm}7.4yrs$, H&Y stage: $3.1{\pm}0.2$) participated in this study. FT (finger tapping) movement was measured using a gyrosensor system in four treatment conditions: Med (Medication)-off/DBS-off, Med-off/DBS-on, Med-on/DBS-off and Med-on/DBS-on. Quantitative measures representing average speed and amplitude of FT movement included root-mean-squared (RMS) angular velocity and RMS angle. One-way repeated measures ANOVA showed that RMS angular velocity of Med-on/DBS-on was significantly greater than those of Med-off/DBS-off and Med-off/DBS-on (p < 0.01) whereas RMS angle was not different among conditions (p = 0.06). Two way repeated measures ANOVA showed that only medication improved RMS angular velocity (p < 0.01), whereas both medication and DBS had no significant effect on RMS angle (p > 0.02). Effect size of RMS angular velocity was greater than that of RMS angle in both medication and DBS. This suggests that medication and DBS have differential effects on FT bradykinesia and velocity and amplitude impairments may be associated with different functional aspects in PD.

• Journal of Korean Neurosurgical Society
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• 제46권4호
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• pp.346-350
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• 2009

Objective : The purpose of this study was to analyze in detail the relationship between outcome and time course of effect in medically refractory primary cervical dystonia (CD) with phasic type that was treated by bilateral globus pallidus internus (Gpi) deep brain stimulation (DBS). Methods : Six patients underwent bilateral implantation of DBS into the Gpi under the guide of microelectrode recording and were followed for $18.7{\pm}11.1$ months. The mean duration of the CD was $5.8{\pm}3.4$ years. The mean age at time of surgery was $54.2{\pm}10.2$ years. Patients were evaluated with the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and relief scale using patient self-reporting. Results : The TWSTRS total scores improved by 64.5%, 65.5%, 75.8%, and 76.0% at 3, 6, 12 months, and at the last available follow-up after surgery, respectively. Statistically significant improvements in the TWSTRS scores were observed 3 months after surgery (p=0.028) with gradual improvement up to 12 months after surgery, thereafter, the improvement was sustained. However, there was no statistically significant difference between the scores at 3 and 12 months. Subjective improvement reported averaged $81.7{\pm}6.8%$ at last follow-up. Mild dysarthria, the most frequent adverse event, occurred in 3 patients. Conclusions : Our results show that the bilateral Gpi-DBS can offer a significant therapeutic effect from 3 months postoperatively in patients with primary CD with phasic type, without significant side effects.

• Journal of Korean Neurosurgical Society
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• 제37권5호
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• pp.325-328
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• 2005

Objective: Stereotactic thalamic procedure is well known to be a effective treatment for disabling upper limb tremor of essential tremor. However, the effect of this procedure for head tremor, which is midline symptom of that disease entity, has not been sufficiently established. The authors discuss the result of stereotactic thalamic operations for head tremor of their patients who suffered from essential tremor. Methods: We evaluated 4 patients of essential tremor who had head tremor combined with both upper limb tremor. One patient underwent unilateral ventralis intermedius thalamotomy, two patients had unilateral Vim deep brain stimulation(DBS) and one patient had unilateral Vim thalamotomy and contralateral DBS. Postoperative results of tremor were evaluated using our proposed scale. Results: Contralateral upper limb tremors to surgical side were markedly resolved in all patients but there was no meaningful effect for head tremor in 3 patients who underwent unilateral thalamic surgery. In a patient having simultaneously unilateral thalamotomy and contralateral DBS, remarkable improvement of head tremor was observed. Conclusion: Although it is difficult to evaluate the efficacy of thalamic surgery for axial symptom of essential tremor with a few cases, simultaneous unilateral thalamotomy and contralateral DBS would be expected to induce favorable outcomes for head tremor with significant economical advantages.

• 재활복지
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• 제18권4호
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• pp.237-255
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• 2014

특발성 파킨슨병(idiopathic Parkinson disease, IPD)은 알 수 없는 원인으로 인해 중뇌의 흑질신경세포가 손실되는 대표적인 퇴행성 신경계 질환이다. IPD 환자는 신체 운동 이상을 주로 호소하지만 이들 중 70~90%가 운동저하형 마비말장애(hypokinetic dysarthria)를 동반하는 것으로 알려져 있다. 진행된 심도의 IPD 환자의 운동 증상 호전에 가장 효과적인 치료 방법으로 알려진 시상밑부핵 심부뇌자극술(subthalamic nucleus deep brain stimulation, STN-DBS)은 말 산출에서는 그 효과가 일관되지 않게 보고된다. 이에 본 연구에서는 STN-DBS가 말 산출에 미치는 영향을 살펴보고, 연구에서 어떠한 말 평가 과제가 사용되었는지를 조사하기 위하여 medline을 통해 2012까지 이루어진 연구 논문을 수집하였다. 총 32편 중, 연구대상자들에서 술 후 말 상태의'호전'이 관찰된 논문은 42%,'악화'는 29%,'엇갈리는 결과'는 26%,'변화 없음'은 3%로 확인되었다. 말 효과 간에는 문맥발화(contextual speech)가 연구에 사용된 비중이 높을수록 술 후 말 상태는 부정적인 결과로 보고되었으며, 말 산출 단계 중 일부 단계(예: 호흡 및 발성만, 혹은 조음만)만이 반영된 평가 과제가 연구마다 선택적으로 사용되었음을 확인하였다. 이에 본 연구는 STN-DBS를 받은 IPD 환자의 말 평가는 말 산출 하부 단계를 모두 반영하는 문맥발화 과제를 통일적으로 사용할 것을 제안한다.

• Journal of Korean Neurosurgical Society
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• 제37권2호
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• pp.112-115
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• 2005

Objective: Thalamic lesioning and deep brain stimulation(DBS) have proved to be beneficial to the treatment of essential tremor(ET). The authors compared the effects and complications of two modalities. Methods: A total of 34 patients with ET were treated with ventral intermediate(Vim) nucleus thalamotomy or Vim DBS from May 1999 to May 2003. The procedure of lesioning or stimulation were performed as usual manner with or without microelectrode recording. Postoperatively, utilizing the various combinations of frequency, voltage and pulse width optimized the stimulation. The degree of improvements of tremor and the occurrence of the complications were evaluated postoperatively and at follow-up. Results: There were 38 procedures, including 27 with Vim thalamotomy and 11 with DBS, in 34 patients. Of the thalamotomy group, left Vim lesioning is 25 and right one is 2. Follow-up duration ranged from 12 to 57 months. In the thalamotomy group, the rate of overall good outcome was 88.9% but 12 patients (44.4%) showed permanent adverse effects. In the cases of stimulation, the rate of overall good outcome was 90.9% and two patients had acceptable dysarthria. Conclusion: Both Vim thalamotomy and Vim DBS were effective for the treatment of ET, although perioperative adverse effects tended to be higher in patients who had thalamotomy. In cases of DBS, adjustments of stimulation parameters enabled an acceptable position to be achieved with tremor control and unwanted effects.

• Journal of Korean Neurosurgical Society
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• 제61권4호
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• pp.427-433
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• 2018

Obsessive compulsive disorder is a debilitating condition characterized by recurrent obsessive thoughts and compulsive reactions. A great portion of the obsessive compulsive disorder (OCD) patients are managed successfully with psychiatric treatment such as selective serotonin-reuptake inhibitor and cognitive behavioral psychotherapy, but more than 10% of patients are remained as non-responder who needs neurosurgical treatments. These patients are potential candidates for the neurosurgical management. There had been various kind of operation, lesioning such as leucotomy or cingulotomy or capsulotomy or limbic leucotomy, and with advent of stereotaxic approach and technical advances, deep brain stimulation was more chosen by neurosurgeon due to its characteristic of reversibility and adjustability. Gamma knife radiosurgery are also applied to make lesion targeting based on magnetic resonance (MR) imaging, but the complication of adverse radiation effect is not predictable. In the neurosurgical field, MR guided focused ultrasound has advantage of less invasiveness, real-time monitored procedure which is now growing to attempt to apply for various brain disorder. In this review, the neurosurgical treatment modalities for the treatment of OCD will be briefly reviewed and the current state of MR guided focused ultrasound for OCD will be suggested.

• 한국정밀공학회:학술대회논문집
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• 한국정밀공학회 2011년도 춘계학술대회 논문집
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• pp.943-944
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• 2011

• Journal of Acupuncture Research
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• 제27권6호
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• pp.123-131
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• 2010

Objectives : The purpose of these case is to observe the effect of prescription of liver supplementation on essential tremor patient who was operated DBS. Methods : The patient was treated by prescription of liver supplementation. The improvement of patient was judged by tremor scale and VAS(visual analog scale). Results : After treatment patient's tremor scale grade and VAS score were generally decreased. Conclusions : The prescription of liver supplementation might be an effective method to treat the essential tremor patient who was operated DBS.

• 한국정밀공학회지
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• 제29권9호
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• pp.1035-1040
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• 2012

Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been found to be effective treatment of Parkinson's disease (PD). This study aims to evaluate the effect of DBS for rigidity during DBS surgery. Six Parkinsonian patients who received STN-DBS surgery participated in this study. The examiner imposed flexion and extension of a patient's wrist randomly. Resistance to passive movement was quantified by viscoelastic properties (two damping constants for each of flexion and extension phase and one spring constant throughout both phases). All Viscoelastic constants decreased by DBS (p<0.01). Specifically, reduction in damping constant during flexion ($B_f$) was greater than those of damping constant during extension ($B_e$) and of spring constant (p<0.05). $B_f$ would be appropriate for evaluation of effect of DBS for rigidity during DBS surgery.

• Journal of Korean Neurosurgical Society
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• 제60권2호
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• pp.138-145
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• 2017

Objective : High frequency stimulation (HFS) of the subthalamic nucleus (STN) is recognized as an effective treatment of advanced Parkinson's disease. However, the neurochemical basis of its effects remains unknown. The aim of this study is to investigate the effects of STN HFS in intact and 6-hydroxydopamine (6-OHDA)-lesioned hemiparkinsonian rat model on changes of principal neurotransmitters, glutamate, and gamma-aminobutyric acid (GABA) in the striatum. Methods : The authors examined extracellular glutamate and GABA change in the striatum on sham group, 6-OHDA group, and 6-OHDA plus deep brain stimulation (DBS) group using microdialysis methods. Results : High-pressure liquid chromatography was used to quantify glutamate and GABA. The results show that HFS-STN induces a significant increase of extracellular glutamate and GABA in the striatum of 6-OHDA plus DBS group compared with sham and 6-OHDA group. Conclusion : Therefore, the clinical results of STN-HFS are not restricted to the direct STN targets but involve widespread adaptive changes within the basal ganglia.