ONS and DBS for the Treatment of Chronic Cluster Headache

Research focus: Chronic cluster headache (CCH) is a pathological entity leading to a severe degree of disability. It is characterized by pain attacks occurring daily or spaced out by remission periods of <1 month, contrarily to the episodic form. When the condition results to be refractory to conservative treatments (both prophylactic and abortive treatments) and when such condition is present for at least 2 years, surgical treatment is suggested

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more patients, 1 with focal motor epilepsy once again (resulting in status epilepticus) and the other with behavioural comorbidity and multifocal epilepsy. Results: A significant reduction in seizure frequency was observed, and the 2 patients with behavioural comorbidity also showed a dramatic improvement in their disruptive behaviour. The patient with motor focal seizures showed a 70% reduction in seizure frequency, and in the last patient remission from status epilepticus was obtained. Conclusion: Our data confirm DBS of deep brain structures modulates the functional activity of the cerebral cortex as suggested by Adrian Upton in 1985. In the reported series, deep-brain stimulation of 2 unconventional targets belonging to the reticulo-cortical system (the brainstem-diencephalon functional system including structures that act as remote controls in modulating cortical excitability) was found to be effective in controlling otherwise refractory multifocal (pHyp) and focal sensorimotor (CZi) epilepsy when resective surgery was not feasible

Deepbrain stimulation of the nucleus accumbens in obsessive compulsive disorder: clinical, surgical and electrophysiological considerations in two consecutive patients

Abstract Obsessive compulsive disorder is a highly disabling pathological condition which in the most severe and drug-resistant form can severely impair social, cognitive and interpersonal functioning. Deep-brain stimulation has been demonstrated to be an effective and safe interventional procedure in such refractory forms in selected cases. We here report the first Italian experience in the treatment of this pathology by means of nucleus accumbens stimulation, pointing out to some technical data which could be of help in localization of the target

A prospective international multi-center study on safety and efficacy of deep brain stimulation for resistant obsessive-compulsive disorder

Deep brain stimulation (DBS) has been proposed for severe, chronic, treatment-refractory obsessive-compulsive disorder (OCD) patients. Although serious adverse events can occur, only a few studies report on the safety profile of DBS for psychiatric disorders. In a prospective, open-label, interventional multi-center study, we examined the safety and efficacy of electrical stimulation in 30 patients with DBS electrodes bilaterally implanted in the anterior limb of the internal capsule. Safety, efficacy, and functionality assessments were performed at 3, 6, and 12 months post implant. An independent Clinical Events Committee classified and coded all adverse events (AEs) according to EN ISO14155:2011. All patients experienced AEs (195 in total), with the majority of these being mild (52% of all AEs) or moderate (37%). Median time to resolution was 22 days for all AEs and the etiology with the highest AE incidence was 'programming/stimulation' (in 26 patients), followed by 'New illness, injury, condition' (13 patients) and 'pre-existing condition, worsening or exacerbation' (11 patients). Sixteen patients reported a total of 36 serious AEs (eight of them in one single patient), mainly transient anxiety and affective symptoms worsening (20 SAEs). Regarding efficacy measures, Y-BOCS reduction was 42% at 12 months and the responder rate was 60%. Improvements in GAF, CGI, and EuroQol-5D index scores were also observed. In sum, although some severe AEs occurred, most AEs were mild or moderate, transient and related to programming/stimulation and tended to resolve by adjustment of stimulation. In a severely treatment-resistant population, this open-label study supports that the potential benefits outweigh the potential risks of DBS

S-Band cavity BPM readout electronics for the ELI-NP gamma beam source

The Extreme Light Infrastructure – Nuclear Physics Gamma Beam Source (ELI-NP GBS) facility will provide an high intensity laser and a very intense gamma beam for various experiments. The gamma beam is generated through incoherent Compton back-scattering of a laser light off a high brightness electron beam provided by a 720MeV warm LINAC. The electrons are organized in compact trains with up to 32 bunches, each separated by 16ns. To optimize the laser-electron interaction and therefore the generation of the gamma rays, one big challenge is to precisely monitor the trajectory of each electron bunch. To match this requirement, at the interaction point two S-band cavity beam position monitors will be used, and the related readout system should perform bunch-bybunch position measurements with sub-μm resolution. Using 500MS/s ADC converters and dedicated data processing, the readout system proposes an alternative measurement concept. In this paper the architecture of the system, the implemented signal processing and the results of the first laboratory tests will be presented

Shifting from constant-voltage to constant-current in Parkinson's disease patients with chronic stimulation

Objective. To evaluate safety and efficacy of shifting stimulation settings from constant-voltage (CV) to constant-current (CC) programming in patients with Parkinson disease (PD) and chronic subthalamic nucleus deep brain stimulation (STN DBS). Methods. 20 PD patients with chronic STN DBS set in CV programming were shifted to CC and followed for three months; the other stimulation settings and the medication regimen remained unchanged. Side effects, motor, non-motor, executive functions and impedance were assessed at baseline and during follow-up. Results. No adverse events were observed at time of change in programming or during CC stimulation. Motor and non-motor measures remained unchanged at follow-up despite impedance decreased. Compared to baseline, cognitive assessment showed improvement of inhibition processes. Conclusions. The shifting strategy was well tolerated and the clinical outcome was maintained with no need to adjust stimulation settings or medications notwithstanding a decrease of impedance. Improvement of inhibition processes towards normality is an important feature to consider