BACKGROUND: Deep brain stimulation (DBS) is a highly effective treatment for severe obsessive-compulsive disorder (OCD) by regulating neural activity within the cortico-striato-thalamo-cortical (CSTC) circuit. However, its effects on co-occurring conditions are not well understood. This report highlights an extraordinary case where DBS, used to treat OCD, unexpectedly resolved pedophilic tendencies in a patient. CASE PRESENTATION: A 36-year-old man with severe refractory OCD underwent DBS surgery after failing multiple treatments. He also had comorbid pedophilia, diagnosed according to DSM-5 criteria. Following Bed Nucleus of the Stria Terminalis and the Anterior Limb of the Internal Capsule (BNST/ALIC) DBS, his OCD symptoms improved significantly, with a 32% reduction in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score over six months. Notably, his pedophilic desires resolved gradually post-surgery, documented through serial psychiatrist-led clinical interviews conducted across follow-up visits. At 58-month follow-up, both conditions remained in remission without medication. The patient’s autonomy and consent were respected throughout the process. CONCLUSION: A patient with severe OCD and pedophilia underwent DBS, experiencing significant improvement in OCD symptoms and unexpected resolution of pedophilic desires, raising complex ethical considerations for future treatments.

Study Design Retrospective Cohort. Objective To investigate whether the timing of surgery, defined by admission-to-surgery intervals, influences short-term in-hospital outcomes and motor recovery in adult patients with Central Cord Syndrome (CCS). This single-center study aimed to investigate the optimal timing for surgery in patients with CCS by using a new categorization of surgical timing. Methods This study includes adult patients with clinically and radiologically confirmed traumatic CCS who received surgical care at a tertiary academic center between March 2012 and July 2022 (n = 70). Patients were classified by time of surgery as ultra-early (<24 h, n = 11), early (24-48 h, n = 33), late (48 h-14 days, n = 22), or ultra-late (>14 days, n = 4). The studied outcomes were in-hospital mortality, mechanical ventilation requirement, ventilation duration, intensive care unit (ICU) length of stay, ambulatory status at last follow-up, and changes in motor score in each group. Chi-square and Kruskal-Wallis tests were used to compare groups. The correlation between surgical timing and motor improvement was identified using correlation analysis. Results The four timing subgroups showed no significant differences in in-hospital mortality, ambulatory status, need for mechanical ventilation, ventilation duration, or ICU length of stay (p = 0.7, 0.4, 0.6, 0.8, and 0.3, respectively). Moreover, although there was a notable postoperative improvement in the total (four limbs), bilateral upper extremity (BUE), and bilateral lower extremity (BLE) motor scores, these improvements were not significantly different across subgroups (p = 0.7, 0.7, and 0.6, respectively). There was no significant correlation between surgery time and motor improvement (p = 0.63). Conclusions In this single-center study, the timing of surgery after admission did not appear to influence short-term in-hospital outcomes or early motor recovery in adult patients with CCS. Key limitations of this study include the retrospective design, the small sample sizes in some surgical timing subgroups, and the reliance on admission-to-surgery timing rather than injury-to-surgery intervals. Furthermore, long-term follow-up data were not consistently available.

ABSTRACT Psychosis may emerge after subthalamic deep brain stimulation in Parkinson's disease, regardless of prior psychiatric history. Early recognition of stimulation‐related behavioral changes, careful dopaminergic adjustment, and multidisciplinary postoperative monitoring are essential to differentiate DBS‐induced psychotic symptoms from disease progression and improve neuropsychiatric and functional outcomes.

BACKGROUND:Researchers have studied transcranial direct current stimulation (tDCS) as a possible treatment for major depressive disorder (MDD), especially for people with treatment-resistant depression (TRD). This systematic review and meta-analysis evaluate the effectiveness and safety of tDCS for TRD by analyzing data from randomized clinical trials. METHODS:To evaluate the impact of tDCS on TRD, we adhered to the 2020 PRISMA guidelines and registered our protocol with PROSPERO (CRD42024606468). A comprehensive search was performed using keywords related to tDCS and TRD across six databases, focusing on English-language studies published until June 10, 2024. RCTs were included based on specific PICO criteria, with a thorough risk of bias assessment using the Cochrane ROB-2 tool. Statistical analyses were conducted using Stata-17 software. RESULTS:A total of 448 studies were initially identified, with six studies (200 participants) meeting inclusion criteria for assessing immediate post-treatment effects of tDCS on TRD. Meta-analysis showed active tDCS significantly reduced depressive symptoms compared to sham (SMD: -1.17 [-1.85, -0.49]; P < 0.001). Significant outcome predictors included session number, age, male percentage, and duration. A follow-up analysis of delayed effects (30-day post-treatment), using four studies (154 participants), found no significant difference between active and sham tDCS (SMD: -0.12 [-1.98, 1.74]; P = 0.90). CONCLUSIONS:This review suggests tDCS may provide modest, short-term benefits in TRD, but findings were inconsistent, highly heterogeneous, and based on limited small trials. Standardized, large-scale studies with optimized protocols and longer follow-up are needed to confirm efficacy and safety.

Deep Brain Stimulation (DBS) is an established treatment for advanced Parkinson’s disease (PD), yet registry-based data from developing countries remain limited. This study reports the establishment and feasibility of the Iranian Deep Brain Stimulation Registry for Parkinson’s Disease (IDBSR-PD). We conducted a single-center feasibility study at the Research Center for Neuromodulation and Pain, including all PD patients undergoing DBS implantation since 2014. Primary feasibility outcomes included patient enrollment coverage, follow-up adherence, data completeness, multidisciplinary implementation, and the sustainability of technical infrastructure. Secondary outcomes included descriptive patient characteristics. Only descriptive statistics were performed; no hypothesis testing or longitudinal outcome analyses were conducted. A total of 208 patients were enrolled (65.4

Neurological soft signs (NSS) are subtle motor control impairments that include involuntary movements and abnormalities of motor coordination, sensory integration and lateralization. They engage different brain networks, including the prefrontal networks that support the higher cognitive functions that are dysfunctional in obsessive-compulsive disorder (OCD). This study investigated the relationships between the presence of NSS and patients’ severity of OCD symptoms, insight, and treatment resistance in a sample of 63 patients. Treatment-resistance was assessed considering all the treatments the patients received during the course of their disease. The four dimensions of OCD defined in the dimensional obsessive-compulsive scale were considered. Links between the patients’ cognitive abilities and NSS were assessed using tests targeting specifically the core components of executive functions.As expected, OCD patients displayed more NSS than individually matched control participants. In OCD patients, high NSS scores were associated with poor insight and lower cognitive abilities. Multiple regression analysis identified worse visuospatial working memory, attentional control, and verbal fluency as predictive factors of high NSS scores among cognitive functions. Unexpectedly, the patients displaying symptoms in the contamination/washing dimension displayed less NSS than the other patients. In contrast, neither the severity of OCD symptoms nor long-range treatment resistance was significantly related to patients’ NSS scores. Altogether, our findings suggest that high NSS scores may be a trait marker of a subset of OCD patients with low insight and particularly altered cognitive abilities who would not express the contamination/washing dimension of the pathology.

Background and objectives Freezing of gait (FOG) is a disabling gait disorder in patients with Parkinson's disease (PD), characterized by recurrent episodes of halting steps. Dopaminergic drugs are common treatments for PD and FOG; however, these drugs may worsen FOG. Deep brain stimulation (DBS) is another option used to treat selected patients. The device needs to be programmed at a specific frequency, amplitude, and pulse width to achieve optimum effects for each patient. This systematic review aimed to evaluate the efficacy of DBS for FOG and its correlation with programmed parameters and the location of the electrodes in the brain.Materials and methods Data for this systematic review were gathered from five online databases: Medline (via PubMed), Scopus, Embase, Web of Science, and Cochrane Library (including both Cochrane Reviews and Cochrane Trials) with a broad search strategy. We included those articles that reported clinical trials and a specific measurement for FOG.Results This review included 13 studies of DBS that targeted the subthalamic nucleus (STN), substantia nigra (SNr), or pedunculopontine nucleus (PPN). Our analysis showed that low-frequency stimulation (LFS) was superior to high-frequency stimulation (HFS) for improving FOG. In the long term, the efficacy of both LFS and HFS decreased. The effect of amplitude was variable, and this parameter needed to be adjusted for each patient. Bilateral stimulation was better than unilateral stimulation.Conclusion DBS is a promising choice for the treatment of severe FOG in patients with PD. Bilateral, low-frequency stimulation combined with medical therapy is associated with better responses, especially in the first 2 years of treatment. However, individualizing the DBS parameters should be considered to optimize treatment response.

Introduction Fibromyalgia (FM) is a chronic pain condition that affects millions of people worldwide. Transcranial Direct Current Stimulation (tDCS) is a non-invasive brain stimulation technique that has shown promise as a potential treatment for FM by modulating pain perception and reducing symptoms, such as fatigue and depression. We aimed to systematically review studies that assess the effect of tDCS on pain reduction in FM patients. Methods Seven electronic databases (PubMed, Scopus, Embase, PsycINFO, Web of Science, Cochrane, and CINAHL Complete) were searched for records in English. Studies that measured the effect of tDCS on pain intensity in FM patients were included. The Cochrane Collaboration’s tool was used to assess the quality of the included studies. A random-effect model was preferred, and statistical analysis was performed by Stata software version 17. Results Twenty studies were included for qualitative, and eleven for quantitative analysis. Out of 664 patients included in the study, 443 were in the stimulation group. The left M1 area was the most common stimulation target ( n = 12), and 2 mA was the most common stimulation amplitude ( n = 19). The analysis showed that active tDCS significantly reduced pain intensity in FM patients in comparison to the sham group (SMD= -1.55; 95% CI -2.10, -0.99); also, no publication bias was noted. Conclusion Our systematic review highlights the potential effect of tDCS on the reduction of pain intensity in FM patients. Additionally, this current evidence could suggest that tDCS applied at an intensity of 2mA to the left M1 is the most effective strategy.

Around 50% of the patients with obsessive-compulsive disorder (OCD) are resistant to treatment, and patients with OCD show alterations in a broad range of cognitive abilities. The present study investigated the links between treatment-resistance, executive and working memory abilities, and the severity of OCD symptoms among 66 patients with OCD. The patients performed seven tests gauging their executive functions and working memory and filled in questionnaires for OCD severity and insight into their pathology. In addition, the executive and working memory abilities of a subset of these patients were compared with those of individually matched control participants. In contrast with previous studies, patients' treatment resistance was evaluated by considering the clinical outcomes of all the treatments that they received during the course of their disease. Higher treatment resistance was associated with lower performance in one particular executive test, the Stroop test, which assessed patients' ability to inhibit prepotent/automatic responses. Older age and more severe OCD symptoms were also associated with higher treatment resistance. Regardless of OCD severity, the patients displayed small to moderate deficits across most components of executive functions compared to control participants. Interestingly, patients with OCD took more time than control participants to perform speeded neuropsychological tests but never made more errors. Altogether, this study shows that the treatment-resistance of patients with OCD may be reliably quantified over the course of years and treatments using Pallanti and Quercioli's (2006) treatment resistance-related scales. The data suggest that the Stroop test could be used clinically to anticipate treatment outcomes in to-be-treated patients.

BackgroundDeep brain stimulation (DBS) is a surgical approach with electrical stimulation of certain parts of the brain, which reduce Parkinson's disease (PD) symptoms. Since the loss of dopaminergic neurons in the substantia nigra is the main pathophysiology of PD, we aimed to evaluate the association of response to DBS with preoperative dopamine transporter density (DAT) and its postoperative changes in PD patients who underwent the bilateral implantation of the electrodes in the subthalamic nucleus (STN).MethodA prospective evaluation of Parkinson's disease patients who underwent STN-DBS for 2 years was done. 99mTc-TRODAT-1 single-photon emission computed tomography (SPECT) scan and assessment of PD using unified Parkinson's disease rating scale (UPDRS) III were performed in both pre- and post-operation states. The correlation of response to DBS after 6 months was assessed with baseline findings and postoperative changes of 99mTc-TRODAT-1 SPECT parameters.ResultsCompared to the preoperative state, UPDRS III scores and Levodopa equivalent daily dose (LEDD) were significantly decreased after DBS. However, in 17 patients who underwent both pre-and post-operative 99mTc-TRODAT-1 SPECT, no significant change was seen in any quantitative parameters, including right and left striatal-binding ratio (SBR) as well as striatal asymmetry index (SAI). No significant correlation was also found between the percent of UPDRS III change after DBS and values of preoperative SBRs. The percentage of LEDD reduction also showed no significant correlation with the preoperative state of 99 m-TRODAT-1 SPECT.ConclusionOur results showed that the mechanism of DBS action is not accompanied by short-term compensation of DAT in basal ganglia in severely advanced PD

Background: Autism Spectrum Disorder (ASD) is a complex neurodevelopmental and pervasive developmental disorder characterized by major impairments in social communication and interaction, stereotyped and ritualistic behavior, and deficiency in sensory activity. Children and adults with ASD show deficit in several domains such as cognition, memory, attention, emotion recognition and regulation, and social skills. The aim of this study was to investigate the effects of Deep Brain Stimulation (DBS) on children and adults with autism spectrum disorder.Methods: This study was a systematic review. PubMed, Scopus, Cochrane library and Web of sciences were searched using terms for ASD and DBS. Eleven studies were selected for review. These studies investigated the effect of deep brain stimulation in reducing symptoms of ASD.Results: There have been 7 published articles about patients who underwent DBS for ASD accompanied by life threatening self-injurious behavior, not alleviated by antipsychotic medication. Also, 4 studies investigated autism-like behaviors. The target included the anterior limb of the internal capsule, globus pallidus internus, and basal latera nucleus of the amygdala. The patients' age ranged between 6 and 37 years.Conclusion: Results of this systematic review showed that DBS might be effective for severe, medically refractory symptoms in children and adults with autism spectrum disorders. Current evidence showed that the number of symptoms such as repetitive and compulsive behavior, obsessive thought, aberrant behavior, and self-injurious behaviors decreased after DBS. Further studies are suggested to be conducted on this topic.

Background:Holmes tremor is often refractory to medical treatment and deep brain stimulation of the ventralis intermedius nucleus of the thalamus (VIM-DBS) is the intervention of choice in controlling the tremor. Herein, we present a beneficial alternative strategy for the management of such situations, considering the posterior subthalamic area (PSA) as the target of stimulation.Case Description:We report a 57-year-old male with the right-sided tremor following a traumatic brain injury 20 years ago. He had been diagnosed with Holmes tremor that was not responsive to nonsurgical therapeutic options. When refractoriness confirmed, he became a candidate for VIM-DBS. During the operation, by performing macrostimulation with a maximum of 2 mA of amplitude, the tremor had no response to the stimulation of different tracts, and severe right hemi-body paresthesia occurred; therefore, we modified our approach and targeted the PSA, which resulted in satisfactory control of the tremor. The permanent lead was implanted into the left side PSA. At 1-year follow-up, the right side tremor was under complete control.Conclusion:Our case and other similar pieces of evidence are consistently indicating the potential regulatory effects of PSA-DBS in controlling the Holmes tremor as a feasible alternative strategy when VIM-DBS does not provide a satisfactory response. However, further studies with larger sample size are required to evaluate the long-term response and its possible long-term stimulation-related effects.

Autism Spectrum Disorder (ASD) is a complex neurodevelopmental and pervasive developmental disorder characterized by major impairments in social communication and interaction, stereotyped and ritualistic behavior, and deficiency in sensory activity. Children and adults with ASD show deficit in several domains such as cognition, memory, attention, emotion recognition and regulation, and social skills. The aim of this study was to investigate the effects of Deep Brain Stimulation (DBS) on children and adults with autism spectrum disorder. This study was a systematic review. PubMed, Scopus, Cochrane library and Web of sciences were searched using terms for ASD and DBS. Eleven studies were selected for review. These studies investigated the effect of deep brain stimulation in reducing symptoms of ASD. There have been 7 published articles about patients who underwent DBS for ASD accompanied by life threatening self-injurious behavior, not alleviated by antipsychotic medication. Also, 4 studies investigated autism-like behaviors. The target included the anterior limb of the internal capsule, globus pallidus internus, and basal latera nucleus of the amygdala. The patients’ age ranged between 6 and 37 years. Results of this systematic review showed that DBS might be effective for severe, medically refractory symptoms in children and adults with autism spectrum disorders. Current evidence showed that the number of symptoms such as repetitive and compulsive behavior, obsessive thought, aberrant behavior, and self-injurious behaviors decreased after DBS. Further studies are suggested to be conducted on this topic.

PURPOSE:Recently, the feature of generating constant current output has been added to the implantable pulse generators (IPGs). The efficacy of the conventionally used constant voltage (CV) stimulation has been proved in different movement and psychiatric disorders. In this systematic review, we aimed to discuss the effect of constant current (CC) and constant voltage stimulation on patients with Parkinson's disease (PD) who had subthalamic nucleus deep brain stimulation implantation; we also compared these methods of stimulation with each other. METHODS:Using the words "Deep brain stimulation", "constant current" and "constant voltage", we developed a broad search strategy and a systematic search was conducted in PubMed, Scopus, Web of Science and Cochrane electronic bibliographic databases. Studies on the Parkinson's disease patients with subthalamic deep brain stimulation, which mentioned constant current or/and constant voltage setting stimulation were included. RESULTS:After screening of 284 articles, 10 reports were found eligible for this study. The score of unified Parkinson's disease rating scale part 3 was improved compared to the baseline, whether the stimulation was CV at baseline or CC. No significant change in non-motor outcomes was found. CONCLUSIONS:Although CC stimulation has shown a significant improvement in both motor and non-motor symptoms of PD, switching from CV to CC did not result in a significant change in the score of these items based on UPDRS. To sum up, implantation of constant current devices is safe and significantly improves motor function; it also maintains an acceptable safety profile in patients with PD.

The article's abstract is not available.

Parkinson's disease (PD) is a progressive degenerative disorder involving dopaminergic neurons in the substantia nigra. Besides impairment in motor activities, PD patients develop various neuropsychiatric, cognitive, and autonomic problems. Impulse control disorder (ICD) is one of the neuropsychiatric presentations of PD and is characterized by pathological repetition of daily “hedonic” activities including compulsive gambling, eating, shopping, and sexual behavior. The effect of DBS on ICD in PD is controversial; therefore, a comprehensive search was done using the words “Deep brain stimulation”, “Impulse control disease, and “Parkinson’s disease” in PubMed, Web of Science, and Scopus to answer whether DBS improves ICD in these patients or not. Totally 392 articles were included and after screening and deleting the duplicates, 3 articles were used for meta-analysis using QUIP-RS score. These three studies included 64, 38 and 16 patients. Quality assessment was determined using NIH tool for before and after the studies. The synthesized data suggested that the score of QUIP-RS decreased after surgery -compared to pre-operation status- in favor of symptoms improvement (CI −0.587 to −0.038). We conclude that DBS is a beneficial treatment in PD that reduces the ICD symptoms in midterm period, but more long-term studies are needed to confirm this effect. Lack of RCT, short follow up, and lack of any report on the subscales of QUIP were the major limitations in the included studies.

Objectives: Our study aimed to apply the apparent diffusion coefficient (ADC) values to quantify the differences between low- and high-grade glioma tumors. Methods: We conducted a multicenter, retrospective study between September to December 2019. Magnetic resonance imaging (MRI) diffusion-weighted images (DWIs), and the pathologic findings of 56 patients with glioma tumors (low grade = 28 and high grade = 28) were assessed to measure the ADC values in the tumor center, tumor edema, boundary area between tumor with normal tissue, and inside the healthy hemisphere. These values were compared between the two groups, and cut-off values were calculated using the receiver operating characteristic curve. Results: We saw significant differences between the mean ADC values measured in the tumor center and edema between high- and low-grade tumors (p < 0.005). The ADC values in the boundary area between tumors with normal tissue and inside healthy hemisphere did not significantly differ in the groups. The ADC values at tumor center and edema were higher than 1.12 × 10-3 mm2/s (sensitivity = 100% and specificity = 96.0%) and 1.15 × 10-3 mm2/s (sensitivity = 75.0% and specificity = 64.0%), respectively, could be classified as low-grade tumors. Conclusions: The ADC values from the MRI DWIs in the tumor center and edema could be used as an appropriate method for investigating the differences between low- and high-grade glioma tumors. The ADC values in the boundary area and healthy tissues had no diagnostic values in grading the glioma tumors.

Background: Chronic stimulation of the thalamus is a surgical option in the management of intractable Holmes tremor. Patients with deep brain stimulation (DBS) can encounter infection as a postoperative complication, necessitating explantation of the hardware. Some studies have reported on the technique and the resulting efficacy of therapeutic lesioning through implanted DBS leads before their explantation. Case Description: We report the case of a patient with Holmes tremor who had stable control of symptoms with DBS of the nucleus ventralis intermedius of the thalamus (VIM) but developed localized infection over the extension at the neck, followed by gradual loss of a therapeutic effect as the neurostimulator reached the end of its service life. Three courses of systemic antibiotic therapy failed to control the infection. After careful consideration, we decided to make a rescue lesion through the implanted lead in the right VIM before explanting the complete DBS hardware. The tremor was well controlled after the rescue lesion procedure, and the effect was sustained during a 2-year follow-up period. Conclusion: This case and the previously discussed ones from the literature demonstrate that making a rescue lesion through the DBS lead can be the last plausible option in cases where the DBS system has to be explanted because of an infection and reimplantation is a remote possibility.

Background: Chronic stimulation of the thalamus is a surgical option in the management of intractable Holmes tremor. Patients with deep brain stimulation (DBS) can encounter infection as a postoperative complication, necessitating explantation of the hardware. Some studies have reported on the technique and the resulting efficacy of therapeutic lesioning through implanted DBS leads before their explantation. Case Description: We report the case of a patient with Holmes tremor who had stable control of symptoms with DBS of the nucleus ventralis intermedius of the thalamus (VIM) but developed localized infection over the extension at the neck, followed by gradual loss of a therapeutic effect as the neurostimulator reached the end of its service life. Three courses of systemic antibiotic therapy failed to control the infection. After careful consideration, we decided to make a rescue lesion through the implanted lead in the right VIM before explanting the complete DBS hardware. The tremor was well controlled after the rescue lesion procedure, and the effect was sustained during a 2-year follow-up period. Conclusion: This case and the previously discussed ones from the literature demonstrate that making a rescue lesion through the DBS lead can be the last plausible option in cases where the DBS system has to be explanted because of an infection and reimplantation is a remote possibility.