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Blomstedt, Patric
Publications (10 of 85) Show all publications
Blomstedt, P. & Hariz, M. (2019). Closed loop stimulation for tremor was invented in 1980 [Letter to the editor]. Brain Stimulation, 12(4), 1072-1073
Open this publication in new window or tab >>Closed loop stimulation for tremor was invented in 1980
2019 (English)In: Brain Stimulation, ISSN 1935-861X, E-ISSN 1876-4754, Vol. 12, no 4, p. 1072-1073Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Deep brain stimulation, Tremor, Adaptive stimulation, History
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-161571 (URN)10.1016/j.brs.2019.03.075 (DOI)000472482500032 ()30979640 (PubMedID)
Available from: 2019-07-25 Created: 2019-07-25 Last updated: 2019-07-25Bibliographically approved
Sandström, L., Blomstedt, P. & Karlsson, F. (2019). Long-term effects of unilateral deep brain stimulation on voice tremor in patients with essential tremor. Parkinsonism & Related Disorders, 60, 70-75
Open this publication in new window or tab >>Long-term effects of unilateral deep brain stimulation on voice tremor in patients with essential tremor
2019 (English)In: Parkinsonism & Related Disorders, ISSN 1353-8020, E-ISSN 1873-5126, Vol. 60, p. 70-75Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Voice tremor (VT) is a common symptom of Essential tremor (ET). Deep brain stimulation (DBS) is an established treatment for ET overall, however, its effect on VT is less clear. The aim of this study was to evaluate long-term effects of DBS on VT and to investigate how VT symptoms develop over time in patients with ET.

METHODS: VT scores for the cohort of 81 ET patients that had undergone DBS surgery in the caudal zona incerta (cZi) were analyzed retrospectively. Thirty-four patients had preoperative VT and long-term evaluations were available for 19 patients. Longitudinal effects of cZi-DBS were investigated 1, 3 and 5 years postoperatively. VT progression was evaluated based on preoperative-, and off stimulation postoperative assessments.

RESULTS: Unilateral cZi-DBS reduced average voice tremor by 58% at the 3-year follow-up and by 67% 5 years after surgery. Four patterns of VT development were identified among patients, and the effectiveness of cZi-DBS in alleviating voice tremor symptoms showed differing patterns for these subgroups.

CONCLUSIONS: This retrospective analysis of a small cohort of patients suggests that cZi-DBS may reduce VT in the long-term for patients with ET overall, but the pattern of VT progression likely influences the effectiveness of the treatment. These results also suggest that unilateral cZi-DBS may be more efficacious when treating patients with mild to moderate VT. A prospective, blinded, controlled clinical trial in patients with ET is needed to determine developmental patterns of VT, and the safety and efficacy of cZi-DBS for the treatment of VT.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Deep brain stimulation, Essential tremor, Long-term evaluation, Voice tremor
National Category
Neurology Otorhinolaryngology
Research subject
Neurosurgery; Oto-Rhino-Laryngology
Identifiers
urn:nbn:se:umu:diva-152704 (URN)10.1016/j.parkreldis.2018.09.029 (DOI)000466258400013 ()30297208 (PubMedID)
Available from: 2018-10-19 Created: 2018-10-19 Last updated: 2019-10-16Bibliographically approved
Karlsson, F., Malinova, E., Olofsson, K., Blomstedt, P., Linder, J. & Nordh, E. (2019). Voice Tremor Outcomes of Subthalamic Nucleus and Zona Incerta Deep Brain Stimulation in Patients With Parkinson Disease. Journal of Voice, 33(4), 545-549
Open this publication in new window or tab >>Voice Tremor Outcomes of Subthalamic Nucleus and Zona Incerta Deep Brain Stimulation in Patients With Parkinson Disease
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2019 (English)In: Journal of Voice, ISSN 0892-1997, E-ISSN 1873-4588, Vol. 33, no 4, p. 545-549Article in journal (Refereed) Published
Abstract [en]

Objectives: We aimed to study the effect of deep brain stimulation (DBS) in the subthalamic nucleus (STN) and caudal zona incerta (cZi) on level of perceived voice tremor in patients with Parkinson disease (PD).

Study Design: This is a prospective nonrandomized design with consecutive patients.

Methods: Perceived voice tremor was assessed in patients with PD having received either STN-DBS (8 patients, 5 bilateral and 3 unilateral, aged 43.1-73.6 years; median = 61.2 years) or cZi-DBS (14 bilateral patients, aged 39.0-71.9 years; median = 56.6 years) 12 months before the assessment. Sustained vowels that were produced OFF and ON stimulation (with simultaneous L-DOPA medication) were assessed perceptually in terms of voice tremor by two raters on a four-point rating scale. The assessments were repeated five times per sample and rated in a blinded and randomized procedure.

Results: Three out of the 22 patients (13%) were concluded to have voice tremor OFF stimulation. Patients with PD with STN-DBS showed mild levels of perceived voice tremor OFF stimulation and a group level improvement. Patients with moderate/severe perceived voice tremor and cZi-DBS showed marked improvements, but there was no overall group effect. Six patients with cZi-DBS showed small increases in perceived voice tremor severity.

Conclusions: STN-DBS decreased perceived voice tremor on a group level. cZi-DBS decreased perceived voice tremor in patients with PD with moderate to severe preoperative levels of the symptom.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
DBS; Parkinson disease; STN; Voice tremor; cZi
National Category
Other Clinical Medicine
Research subject
Oto-Rhino-Laryngology; Neurosurgery
Identifiers
urn:nbn:se:umu:diva-144189 (URN)10.1016/j.jvoice.2017.12.012 (DOI)000476489700020 ()29361338 (PubMedID)
Funder
Swedish Research Council, 2009-946
Available from: 2018-01-25 Created: 2018-01-25 Last updated: 2019-09-06Bibliographically approved
Blomstedt, P., Stenmark Persson, R., Hariz, G.-M., Linder, J., Fredricks, A., Häggström, B., . . . Hariz, M. (2018). Deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson's disease: a randomised blinded evaluation. Journal of Neurology, Neurosurgery and Psychiatry, 89(7), 710-716
Open this publication in new window or tab >>Deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson's disease: a randomised blinded evaluation
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2018 (English)In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 89, no 7, p. 710-716Article in journal (Refereed) Published
Abstract [en]

Background: Several open-label studies have shown good effect of deep brain stimulation (DBS) in the caudal zona incerta (cZi) on tremor, including parkinsonian tremor, and in some cases also a benefit on akinesia and axial symptoms. The aim of this study was to evaluate objectively the effect of cZi DBS in patients with Parkinson's disease (PD).

Method: 25 patients with PD were randomised to either cZi DBS or best medical treatment. The primary outcomes were differences between the groups in the motor scores of the Unified Parkinson's Disease Rating Scale (UPDRS-III) rated single-blindly at 6 months and differences in the Parkinson's Disease Questionnaire 39 items (PDQ-39). 19 patients, 10 in the medical arm and 9 in the DBS arm, fulfilled the study.

Results: The DBS group had 41% better UPDRS-III scores off-medication on-stimulation compared with baseline, whereas the scores of the non-surgical patients off-medication were unchanged. In the on-medication condition, there were no differences between the groups, neither at baseline nor at 6 months. Subitems of the UPDRS-III showed a robust effect of cZi DBS on tremor. The PDQ-39 domains 'stigma' and 'ADL' improved only in the DBS group. The PDQ-39 summary index improved in both groups.

Conclusion: This is the first randomised blinded evaluation of cZi DBS showing its efficacy on PD symptoms. The most striking effect was on tremor; however, the doses of dopaminergic medications could not be decreased. cZi DBS in PD may be an addition to existing established targets, enabling tailoring the surgery to the needs of the individual patient.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-150375 (URN)10.1136/jnnp-2017-317219 (DOI)000438044100010 ()29386253 (PubMedID)
Available from: 2018-08-08 Created: 2018-08-08 Last updated: 2019-05-07Bibliographically approved
Åstrom, M., Samuelsson, J., Roothans, J., Fytagoridis, A., Ryzhkov, M., Nijlunsing, R. & Blomstedt, P. (2018). Prediction of Electrode Contacts for Clinically Effective Deep Brain Stimulation in Essential Tremor. Stereotactic and Functional Neurosurgery, 96(5), 281-288
Open this publication in new window or tab >>Prediction of Electrode Contacts for Clinically Effective Deep Brain Stimulation in Essential Tremor
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2018 (English)In: Stereotactic and Functional Neurosurgery, ISSN 1011-6125, E-ISSN 1423-0372, Vol. 96, no 5, p. 281-288Article in journal (Refereed) Published
Abstract [en]

Background/Aim: Deep brain stimulation (DBS) is an established neurosurgical treatment that can be used to alleviate symptoms in essential tremor (ET) and other movement disorders. The aim was to develop a method and software tool for the prediction of effective DBS electrode contacts based on probabilistic stimulation maps (PSMs) in patients with ET treated with caudal zona incerta (cZi) DBS. Methods: A total of 33 patients (37 leads) treated with DBS were evaluated with the Essential Tremor Rating Scale (ETRS) 12 months after surgery. In addition, hand tremor and hand function (ETRS items 5/6 and 11-14) were evaluated for every contact during stimulation with best possible outcome without inducing side effects. Prediction of effective DBS electrode contacts was carried out in a retrospective leave-one-out manner based on PSMs, simulated stimulation fields, and a scoring function. Electrode contacts were ranked according to their likelihood of being included in the clinical setting. Ranked electrode contacts were compared to actual clinical settings. Results: Predictions made by the software tool showed that electrode contacts with rank 1 matched the clinically used contacts in 60% of the cases. Contacts with a rank of 1-2 and 1-3 matched the clinical contacts in 83 and 94% of the cases, respectively. Mean improvement of hand tremor and hand function was 79 +/- 21% and 77 +/- 22% for the clinically used and the predicted electrode contacts, respectively. Conclusions: Effective electrode contacts can be predicted based on PSMs in patients treated with cZi DBS for ET. Predictions may in the future be used to reduce the number of clinical assessments that are carried out before a satisfying stimulation setting is defined.

Place, publisher, year, edition, pages
S. Karger, 2018
Keywords
Prediction, Electrode contacts, Deep brain stimulation, Essential tremor, Simulations
National Category
Neurosciences Surgery
Identifiers
urn:nbn:se:umu:diva-155256 (URN)10.1159/000492230 (DOI)000454181200001 ()30269142 (PubMedID)
Available from: 2019-01-11 Created: 2019-01-11 Last updated: 2019-01-11Bibliographically approved
Blomstedt, P. & Hariz, M. (2018). The paper that wrote itself – A ghost story [Letter to the editor]. Movement Disorders, 33(9), 1509-1510
Open this publication in new window or tab >>The paper that wrote itself – A ghost story
2018 (English)In: Movement Disorders, ISSN 0885-3185, E-ISSN 1531-8257, Vol. 33, no 9, p. 1509-1510Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-153138 (URN)10.1002/mds.27467 (DOI)000447153500025 ()30199595 (PubMedID)2-s2.0-85054727411 (Scopus ID)
Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2018-11-08Bibliographically approved
Philipsson, J., Sjöberg, R. L., Yelnik, J. & Blomstedt, P. (2017). Acute severe depression induced by stimulation of the right globus pallidus internus. Neurocase, 23(1), 84-87
Open this publication in new window or tab >>Acute severe depression induced by stimulation of the right globus pallidus internus
2017 (English)In: Neurocase, ISSN 1355-4794, E-ISSN 1465-3656, Vol. 23, no 1, p. 84-87Article in journal (Refereed) Published
Abstract [en]

Depressive symptoms may occur after Deep Brain Stimulation (DBS) in the subthalamic nucleus. This is often explained by reduced pharmacological treatment after surgery, and not as a direct effect of DBS. Pallidal DBS seems not to be associated with such side effects and have not, to our knowledge, previously been reported. We present a patient with acute depressive symptoms induced by pallidal DBS. We believe this case strengthen the hypothesis that the basal ganglia and structures involved in the functional connectome of these nucleuses play a role not only in regulation of movement but also in regulation of mood.

Place, publisher, year, edition, pages
ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2017
Keywords
Deep brain stimulation (DBS), Parkinson's disease, pallidum, basal ganglia, depression
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-134830 (URN)10.1080/13554794.2017.1284243 (DOI)000399644200015 ()28165911 (PubMedID)
Available from: 2017-05-24 Created: 2017-05-24 Last updated: 2018-06-09Bibliographically approved
Naesström, M., Blomstedt, P., Hariz, M. & Bodlund, O. (2017). Deep brain stimulation for obsessive-compulsive disorder: knowledge and concerns among psychiatrists, psychotherapists and patients. Surgical neurology international, 8, Article ID 298.
Open this publication in new window or tab >>Deep brain stimulation for obsessive-compulsive disorder: knowledge and concerns among psychiatrists, psychotherapists and patients
2017 (English)In: Surgical neurology international, ISSN 2229-5097, Vol. 8, article id 298Article in journal (Refereed) Published
Abstract [en]

Background: Deep brain stimulation (DBS) is under investigation for severe obsessive-compulsive disorder (OCD) resistant to other therapies. The number of implants worldwide is slowly increasing. Therefore, it is of importance to explore knowledge and concerns of this novel treatment among patients and their psychiatric healthcare contacts. This information is relevant for scientific professionals working with clinical studies for DBS for this indication. Especially, for future study designs and the creation of information targeting healthcare professionals and patients. The aim of this study was to explore the knowledge and concerns toward DBS among patients with OCD, psychiatrists, and cognitive behavioral therapists.

Methods: The study was conducted through web-based surveys for the aimed target groups -psychiatrist, patients, and cognitive behavioral therapists. The surveys contained questions regarding previous knowledge of DBS, source of knowledge, attitudes, and concerns towards the therapy.

Results: The main source of information was from scientific sources among psychiatrists and psychotherapists. The patient's main source of information was the media. Common concerns among the groups included complications from surgery, anesthesia, stimulation side effects, and the novelty of the treatment. Specific concerns for the groups included; personality changes mentioned by patients and psychotherapists, and ethical concerns among psychiatrists.

Conclusion: There are challenges for DBS in OCD as identified by the participants of this study; source and quality of information, efficacy, potential adverse effects, and eligibility. In all of which the current evidence base still is limited. A broad research agenda is needed for studies going forward.

Place, publisher, year, edition, pages
Medknow Publications, 2017
Keywords
attitude, deep brain stimulation, obsessive-compulsive disorder, patient, psychiatrist, psychotherapist
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-146475 (URN)29285414 (PubMedID)
Available from: 2018-04-10 Created: 2018-04-10 Last updated: 2019-05-07Bibliographically approved
Blomstedt, P., Naesström, M. & Bodlund, O. (2017). Deep brain stimulation in the bed nucleus of the stria terminalis and medial forebrain bundle in a patient with major depressive disorder and anorexia nervosa. Clinical Case Reports, 5(5), 679-684
Open this publication in new window or tab >>Deep brain stimulation in the bed nucleus of the stria terminalis and medial forebrain bundle in a patient with major depressive disorder and anorexia nervosa
2017 (English)In: Clinical Case Reports, E-ISSN 2050-0904, Vol. 5, no 5, p. 679-684Article in journal (Refereed) Published
Abstract [en]

Key Clinical Message Deep brain stimulation (DBS) may be considered in severe cases of therapy-refractory major depressive disorder (MDD). However, DBS for MDD is still an experimental therapy. Therefore, it should only be administered in clinical studies driven by multidisciplinary teams, including surgeons with substantial experience of DBS in the treatment of other conditions.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017
Keywords
Anorexia nervosa, bed nucleus of the stria terminalis, deep brain stimulation, depression, medial forebrain bundle
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-136065 (URN)10.1002/ccr3.856 (DOI)000400580800028 ()28469875 (PubMedID)
Available from: 2017-06-19 Created: 2017-06-19 Last updated: 2018-06-09Bibliographically approved
Awad, A., Blomstedt, P., Westling, G. & Eriksson, J. (2017). Functional imaging of Essential Tremor treated with Deep Brain Stimulation In the caudal Zona incerta. In: : . Paper presented at 17th Quadrennial Meeting of the World Society for Stereotactic and Functional Neurosurgery (WSSFN), Berlin, June 26-29, 2017. Berlin
Open this publication in new window or tab >>Functional imaging of Essential Tremor treated with Deep Brain Stimulation In the caudal Zona incerta
2017 (English)Conference paper, Oral presentation with published abstract (Refereed)
Place, publisher, year, edition, pages
Berlin: , 2017
National Category
Neurosciences
Research subject
Neurosurgery; Physiology; Neurology
Identifiers
urn:nbn:se:umu:diva-163719 (URN)
Conference
17th Quadrennial Meeting of the World Society for Stereotactic and Functional Neurosurgery (WSSFN), Berlin, June 26-29, 2017
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2019-10-08Bibliographically approved
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