Deep Brain Stimulation

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Antipsychotic Accelerated Turnover of Dopamine

The finding of Ehringer and Hornykiewicz naturally stimulated brain research on dopamine. Carlsson and Lindqvist 30 soon reported that chlorpromazine and haloperidol increased the production of normetanephrine and methoxytyramine, metabolites of epinephrine and dopamine, respectively. To explain the increased production of these metabolites, these authors suggested that the most likely mechanism appears to be that chlorpromazine and haloperidol block monoamin-ergic receptors in brain as is well known, they block the effects of accumulated 5-hydroxytryptamine____

In Vitro Electrophysiological Recordings From Brain Slices

Adapted from Grace AA The Regulation of Dopamine Neuron Activity as Determined by In Vivo and In Vitro Intracellular Recordings, in The Neurophysiology of Dopamine Systems. Edited by Chiodo LA, Freeman AS. Detroit, MI, Lake Shore Publications, 1987, pp. 1-67 (Copyright 1987, Lake Shore Publications. Used with permission) and Grace AA, Bunney BS Intracellular and Extracellular Electrophysiology of Nigral Dopaminergic Neurons, I Identification and Characterization. Neuroscience 10 301-315, 1983. Copyright 1983, International Brain Research Organization. Used with permission.

Neurotransmitter Synthesizing Systems

Appropriate availability of neurotransmitters and neuromodulators is essential to normal neurological and psychological function. Dysfunction or degeneration of neurons that synthesize these substances can lead to various disorders. For example, Parkinson's disease is caused by selective degeneration of the dopamine-synthesizing neurons of the nigrostriatal system. Uptake of 18F DOPA, which selectively labels aromatic L-amino acid decarboxylase (AADC), a critical enzyme in the synthesis of dopamine, has been used to estimate both the number of surviving cells and AADC activity among nigral neurons, thus providing a tool to understand the connection between dopamine dysfunction and clinical symptom evolution (Cropley et al. 2006 Ravina et al. 2005). PET scanning using 11C methyl-L-tryptophan, which is a marker of serotonin (5-HT) synthesis, is being used in identifying overactive serotonin-synthesizing systems in differentiating epileptogenic from nonepileptogenic lesions in tuberous...

Treatment Of Cluster Headache

Shown that infiltration of the greater occipital nerve with steroids on the side of the pain is an effective prophylactic treatment.123 II Invasive procedures, such as deep brain stimulation and occipital nerve stimulation, are under evaluation and there is no general consensus.

Behavioral and Neurochemical Consequences of Iipopolysaccharide

5.1.1, Angiogenic Effects of Lipopolysacchuride. In a series of recent experiments (Lacosta, Kulczycki, Merali. & Anisman, 1996 Borowski, Kokkinidis. Merali, & Anisman, 199 ). some conducted in mice and others in rats, we assessed the effects of lipopolysaccharide (LPS) on anxiety-like responses and on responding for rewarding brain stimulation. In mice, administration of low doses of LPS provoked classic signs of illness, including apparent soporific effects, reduced open-field exploration, reduced consumption of a palatable food (chocolate milk) and increased latency to approach a novel stimulus. As seen in Figure 1. in an elevated plus-maze, which has been used as a test of anxiety, animals treated with LPS reduced the frequency of open-arm visits, whereas visits to the closed arms of the ma e were unaffected. When animals ventured onto the open arms they did not remain there long, supporting the view that the reduced visits were not secondary to motor disturbances. Paralleling the...

Nicotine or Nicotineplus

Nicotine is only mildly rewarding in standard animal models (intravenous self-administration and conditioned place preference), although it does reliably increase the reinforcing strength of electrical brain stimulation. How, then, might it be critical to tobacco addiction Several explanations have been proposed. First, standard behavioral procedures may not capture the full reinforcing potential of this drug. For example, animal studies tend to be of short duration, lasting at most a few weeks. This limitation may be important because it is known that in the case of cocaine, rats become much more motivated to seek the drug after they have had several months of drug exposure. Equally, if cigarette smokers use nicotine as a cognitive tool or for emotional support, these aspects would not be modeled in standard self-administration and place preference animal tests. A second possibility is that nicotine simply serves as a stronger reinforcer in humans, or perhaps primates in general,...

Impact of Psychoactive Drugs

Preclinical evaluation of the potential efficacy of putative anxiolytic agents has relied heavily upon the use of a variety of punishment procedures in experimental animals. Punishment is operationally defined as a decrease in the future probability of behavior subsequent to the response-dependent presentation of a stimulus (punish-er). Punishment procedures have been studied widely and have been used for both behavioral analyses as well as for assessing drug action, yielding a wealth of information on both behavior and pharmacology. For the most part, the behavioral procedures have employed electric shock as the punishing event, mainly because it is discrete, readily controllable, and manipulable over a wide range of intensities. Other events have been employed (e.g., blasts of compressed air, electrical brain stimulation) but these have typically yielded a similar behavioral and pharmacological outcome. One of the earliest punishment methods to be used was the so-called passive...

Authors recommendations

Many treatments I have seen colleagues endorse, e.g. local injections, TENS, desensitization therapy, continuing search for an effective drug, hypnosis, herbal treatment or other forms of complementary therapy, are not in my armamentarium. I have used spinal cord stimulation with variable success and in relatively young (

Research and Education in Molecular and Functional Imaging at Tohoku University

In 1977, the Cyclotron and Radioisotope Center (CYRIC) was founded at Tohoku University for the multipurpose use of a cyclotron, including nuclear physics, nuclear chemistry, solid-state physics, and radioisotope production for biology and medicine. Clinical studies were started at CYRIC in 1982 following the first installation of a PET scanner in 1981. In 1976, the production of 18F FDG had already been successfully done, initially for brain research at CYRIC, and the use of 18F FDG was later applied to oncology research. The challenge of using 18F FDG for cancer imaging was based on Matsuzawa's concept of fishing for cancer with baits. He claimed that cancer cells were always hungry and almost blind, therefore they try to eat anything including false sugars, amino acids, and nucleic acids. Soon, Fukuda and colleagues reported the applicability of 18F FDG PET for diagnosing metastatic liver cancer, in 1982 1 . Later, in 1983, nC methionine was proven to be useful for lung cancer...

Other Effects of Delta Agonists Related to Reinforcement

Reinforcement-related effects of delta agonists have also been examined in procedures that assess drug effects on responding for electrical brain stimulation. In this procedure, electrodes are implanted into a target brain site, such as the ventral tegmental area or the medial forebrain bundle at the level of the lateral hypothalamus, and stimulation of this electrode is contingent on some simple behavior, such as pressing a response lever 44 . Responding is usually evaluated at multiple frequencies of electrical stimulation, and techniques have been developed to measure threshold frequencies necessary to maintain responding or to determine the complete function that relates response rate to stimulation frequency. Many drugs of abuse facilitate responding for electrical brain stimulation, as demonstrated by a decrease in the frequency threshold for responding or a leftward shift in the rate-frequency curves 44 . Administration of the peptidic delta agonists DPDPE or DSTBULET into the...

Conclusion evidencebased treatment of central pain

New trials on single and repetitive transcranial magnetic stimulation suggest transient efficacy in central pain (Level B recommendation) and may be predictive of efficacy with implanted motor cortex stimulation 56 -58 . Motor cortex stimulation may reduce pain in about 50 of CPSP patients as shown by two class III studies (for review see reference 58). Very few studies have been conducted evaluating the efficacy of deep brain stimulation (DBS) on central pain and the results are conflicting. Therefore the recommendation of the European Federation of Neurological Societies (EFNS) is only to perform DBS in experienced centers with established outcome measures 58 .

Cocaine and Other Stimulants

Results with delta antagonists have also been inconsistent in studies of other abuse-related effects of cocaine. Naltrindole attenuated cocaine-induced place preferences 139,140 and cocaine-induced facilitation of electrical brain stimulation 141 . Cocaine-induced place preferences were also blocked by the putative delta-2 antagonist naltriben, but not by the delta-1 antagonist BNTX, and these results were interpreted to suggest that delta-2 receptors may be especially important in modulating these abuse-related effects of cocaine 140 . However, other studies found that naltrindole did not block cocaine-induced place preferences 137 , and naltrindole also failed to alter the discriminative stimulus effects of cocaine in rats or monkeys 28,61,62 . Also, the importance of delta-2 receptors in mediating abuse-related effects of cocaine is challenged by the finding that the putative delta-2 antagonist NTII produced only modest effects on cocaine self-administration in rats 94 . Finally,...

Localization and Functional Implications of Dopamine Receptor Subtypes

Postsynaptic D2 receptors are present in DA-ergic projection areas, such as the striatum, limbic areas (nucleus accumbens, olfactory tubercle), hypothalamus and pituitary (Table 3). D2 receptors are also present presynaptically in the substantia nigra, ventral tegmental area and striatum. Bromocriptine has been proven to be efficacious in treating PD because of its D2 agonist activity, whereas, D2 antagonists (e.g. haloperidol and chlorpromazine) are commonly used in the treatment of psychiatric illness. The D3 and D4 dopamine receptors are differently distributed, and are much less abundant than the D2 subtype. D3 receptors are primarily expressed in limbic regions in mammals with low density in the striatum 67-68 . The selective D3 receptor antagonists (SB-277011 and NGB-2904) block cocaine- or nicotine-enhanced brain stimulation reward, implicating their role in drug dependence and addiction 67,69 . A necessary role for D3 receptor has been suggested for ethanol sensitization but...

Neurochemical Consequences of Cytokines Stressorlike Effects

As indicated earlier, there is reason to believe that immune activation and cytokine changes may be associated with depressive illness. Furthermore, as anhedo-nia is a characteristic feature of depression, it was of interest to assess whether LPS or cytokine challenge would engender anhedonic-like effects. While consumption of palatable substances have been used to assess anhedonia, this type paradigm does not readily distinguish anorexic from anhedonic effects of a given treatment. This is not to disparage the use of feeding paradigms, as they certainly have been used effectively. Rather, it was felt that in this instance it would be advantageous to employ a test devoid of appetitive motivation. Accordingly, we opted to assess the effects of LPS and cytokine treatments on responding for rewarding brain stimulation in rats, a behavioral test previously shown to be sensitive to the effects of stressors (Anisman, Zalcman, Shanks, & Zacharko, 1991). stantia nigra, ventral tegmentum),...

Series Preface

Our goal in creating the Frontiers in Neuroscience Series is to present the insights of experts on emerging fields and theoretical concepts that are, or will be, in the vanguard of neuroscience. Books in the series cover genetics, ion channels, apoptosis, electrodes, neural ensemble recordings in behaving animals, and even robotics. The series also covers new and exciting multidisciplinary areas of brain research, such as computational neuroscience and neuroengineering, and describes breakthroughs in classical fields like behavioral neuroscience. We hope every neuroscientist will use these books to become acquainted with new ideas and frontiers in brain research. These books can be given to graduate students and postdoctoral fellows when they are looking for guidance to start a new line of research. Each book is edited by an expert and consists of chapters written by the leaders in a particular field. Books are richly illustrated and contain comprehensive bibliographies. Chapters...

Conclusions

Peptides and the blood-brain barrier Lipophilicity as a predictor of permeability. Brain Research Bulletin, 15, 287-292. Emerich, D. F., Snodgrass, P., Pink, M., Bloom, F., & Bartus, R. T. (1998). Central analgesic actions of loperamide following transient permeation of the blood-brain barrier with Cereport (RMP-7). Brain Research, 801, 259-266. barrier with colloidal polymer particles (nanoparticles). Brain Research, 674, 171-174. Wilson, B., Samanta, M. K., Santhi, K., Kumar, K. P., Paramak-rishnan, N., & Suresh, B. (2008). Poly (n-butylcyanoacrylate) nanoparticles coated with polysorbate 80 for the targeted delivery of rivastigmine into the brain to treat Alzheimer's disease. Brain Research, 1200, 159-168. Progress in Brain Research, Vol. 180

Indications

Stimulation of central neuronal targets has been performed for several decades with variable results. Deep brain stimulation and motor cortex stimulation have emerged as the most commonly employed and successful uses of this rapidly evolving field. While deep brain stimulation is quite commonly utilized for movement disorders and Parkinson's disease, it is useful in some painful disorders as well. As many of these painful neurological conditions are highly resistant to multiple therapies, cranial stimulation may be preferable to long-term opioids or many ablative neurosurgical techniques. Motor cortex stimulation is a technique of delivering a subthreshold stimulus to the contralateral motor cortex. This stimulation is, therefore, not perceived by the patient subsequent to initial intraoperative testing, and as the brain tissue is not broached, has less risk of hemorrhage than does deep brain stimulation. Motor cortex stimulation does not require stereotactic frame application, and...

Nucleus Accumbens

Systemically injected 5-HT2C receptor agonists reduce cocaine stimulated locomotor activity and attenuate the discriminative stimulus properties of cocaine (see Sects. 15.3.1.1 and 15.3.1.2). In contrast, infusions of MK212 or Ro60-0175 into the shell region of the nucleus accumbens enhanced the locomotor activating effect of cocaine (Filip and Cunningham 2002). In the drug discrimination procedure both drugs elicited some cocaine-like responding and enhanced the discriminative stimulus properties of a submaximal dose of cocaine (Filip and Cunningham 2002). The same study also reported that blocking 5-HT2C receptors with RS102221 dose-dependently attenuated the locomotor activating and stimulus effects of cocaine. These results clearly demonstrate some functional importance for 5-HT2C receptors in the nucleus accumbens in modulating the behavioral effects of cocaine. However, in all cases the effects are opposite to those resulting from systemically injected 5-HT2C receptor agonists...

Mexiletine

One controversial nondrug treatment for CPSP is deep brain stimulation (DBS). DBS has been found to be effective for patients who have had a thalamic type of stroke (Nicholson, 2004), but it may not work for every patient with CPSP (Kumar et al., 2009). Repetitive transcranial magnetic stimulation has been used to treat CPSP of the face, legs, and arms. It has proved effective for pain relief, and the treatments have maintained the pain relief for 2 weeks after the last session (Kumar et al., 2009).

Interventions

Surgery on amputation neuromas and more extensive amputation previously played important roles in the treatment of stump and phantom pain. Today, stump revision is probably performed only in cases of obvious stump pathology, and in properly healed stumps there is almost never any indication for proximal extension of the amputation because of pain. The results of other invasive techniques such as, for example, dorsal root entry zone lesion sympath-etectomy and cordotomy have generally been unfavorable, and most of them have been abandoned. Surgery may produce short-term pain relief but the pain often reappears. Spinal cord stimulation and deep brain stimulation are probably effective for the treatment of phantom limb pain. As the methods are invasive and associated with considerable costs, they should only be used for carefully selected patients.

Treatment

Motor functioning are still missing 123 . Moreover, safety data show that about 30 of the patients who received stimulation experienced treatment-related adverse events 121, 123 . Cervical and lumbar devices seem to be equally effective 124 . SCS was also effective in selected CRPS patients with sympathetically maintained pain 125 but further predicting factors beside test stimulations are still under investigation 126 . Other stimulation techniques, e.g. peripheral nerve stimulation with implanted electrodes, repetitive transcranial magnetic stimulation, and deep brain stimulation (sensory thalamus and medial lemniscus, motor cortex), have been reported to be effective in selected cases of CRPS 4, 127, 128 . In summary, there is limited evidence for the use of SCS in selected cases of CRPS but there is no evidence for using other invasive stimulation techniques as part of commonly used therapy algorithms.

Opioids

15.4 Effects of 5-HT2C Receptor Ligands on Brain Stimulation Reward Rats will readily self-administer brief trains of electrical stimulation to specific brain regions such as the lateral hypothalamus or VTA. Measuring changes in brain stimulation reward (BSR) can be used as a technique for investigating the circuitry of the brain's reward systems and for determining the effects of drugs on that circuitry (Carlezon and Chartoff 2007 Wise 2002). Manipulations of brain 5-HT function have long been known to modulate BSR (Redgrave 1978 van der Kooy et al. 1977). Greenshaw and colleagues have recently examined the effects of 5-HT2C receptor ligands on BSR via electrodes placed in the VTA (Hayes et al. 2008). Using a rate-frequency threshold analysis, it was found that systemic administration of the 5-HT1A 1B 2C agonist trifluromethylphenylpiperazine (TFMPP) and the selective 5-HT2C agonist WAY 161503 increased rate-frequency thresholds without altering maximal response rates. The effect of...

Parkinson Disease

Therapy of Parkinson disease consists mainly of amelioration of the symptoms with classical dopaminomimetics (Hagan et al. 1997). This treatment, however, is characterized by declining efficacy and occurrence of disabling side effects (Agid 1998). Functional inhibition of GPi or STN has provided an alternative to lesion-ing, by deep brain stimulation associated with modest side effects (Rodriguez et al. 1998). As already mentioned, 5-HT2C receptors are located in the SNr and medial segment of the pallidal complex in the rat and human brain (Azmitia and Segal 1978 Pasqualetti et al. 1999), and enhanced 5-HT2C receptor-mediated transmission within the output regions of the basal ganglia in parkinsonism appears to contribute to their overactivity (Fox and Brotchie 1999). In addition, 5-HT2C-like receptor binding is increased in a rat model of Parkinsonism (Radja et al. 1993) and in human Parkinsonian patients (Fox and Brotchie 2000a). Interestingly, systemic administration of SB 206553...

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