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Forces on small plane sputter targets that are exposed to an ion beam at different angles of incidence are investigated. The force exerted on the sputter target is determined in two dimensions by means of an interferometric technique that measures the displacement of the target which is mounted at the end of an elastic cantilever. Different target materials made of silver, copper, aluminum, titanium, graphite, and carbon fiber velvet are studied. The experimental results are compared with a simulation based on the popular SRIM code. The forces are found to be caused predominantly by implanted beam particles and sputtered target atoms and insignificantly by re-emitted beam particles. The material dependent forces are discussed in connection with the simulations and in terms of the sputtering yield and surface topography. In case of the carbon fiber velvet, and in good approximation for graphite, the transferred momentum corresponds almost entirely to the momentum of the impinging beam particles. [ABSTRACT FROM AUTHOR]

Forces on a small plane measurement target caused by sputtered atomic particles originated at plane sputter targets by a beam of argon particles are investigated. The rotatable sputter targets are centrally mounted in front of the ion source and allow a variation of the angle of incidence. The measurement surface of the force probe is arranged laterally beside the sputter target; it collects the particles released perpendicularly to the beam direction. Sputter targets of silver, copper, aluminum, titanium, and carbon are studied. The measurements are compared with a model that traces the trajectories of the argon ions and the sputtered target atoms between the ion source, the sputter target, and the force probe. The sputtering is calculated with the popular SRIM code based on binary collision cascades. The measured forces are found to be in general greater than the simulated forces. The dependence on the angle of incidence is similar in case of the elements heavier than the ions. In case of the lighter elements, only the simulation exhibits a pronounced maximum at angles between 65° and 70°. Graphical abstract: [ABSTRACT FROM AUTHOR]

A radio frequency (RF) hollow discharge configuration is presented, which makes use of a combination of RF plasma generation and the hollow cathode effect. The system was especially designed for the treatment of nanoparticles, plasma polymerization, and nanocomposite fabrication. The process gas streams through the plasma in the inner of the cylindrical electrode system. In the here presented measurements, pure argon and argon with oxygen admixtures are exemplarily used. The discharge is characterized by probe measurements in the effluent, electrical measurements of the discharge parameters, and visual observations of the plasma glow. It is found that the RF fluctuations of the plasma potential are weak. The plasma potential resembles the one of a DC hollow cathode discharge, the RF hollow electrode acts as a cathode due to the self-bias, and a high voltage sheath forms in its inner cylinder. [ABSTRACT FROM AUTHOR]

The force on microparticles in an energetic ion beam is investigated experimentally. Hollow glass microspheres are injected into the vertically upward directed beam and their trajectories are recorded with a charge-coupled device camera. The net force on the particles is determined by means of the measured vertical acceleration. The resulting beam pressures are compared with Faraday cup measurements of the ion current density and calorimetric measurements of the beam power density. Due to the neutral gas background, the beam consists, besides the ions, of energetic neutral atoms produced by charge-exchange collisions. It is found that the measured composition of the drag force by an ion and a neutral atom component agrees with a beam model that takes charge-exchange collisions into account. Special attention is paid to the momentum contribution from sputtered atoms, which is shown to be negligible in this experiment, but should become measurable in case of materials with high sputtering yields. [ABSTRACT FROM AUTHOR]

Forces on microparticles in energetic ion beams are investigated experimentally. For this purpose, hollow glass microspheres are injected into a vertically upward directed beam. The particles are illuminated by a diode laser, and their scattered light is recorded with a charge-coupled device camera. From the trajectories, the acceleration and net force on the particles are determined. It is found that the force is significantly higher than the expected ion drag force. This additional part of the total force is explained with fast neutral atoms produced by charge-exchange collisions. Special attention is paid to the momentum contribution from sputtered atoms, which is shown to be negligible in this experiment. [ABSTRACT FROM AUTHOR]

A calorimetric probe for plasma diagnostics is presented, which allows measurements of the power taken by a test substrate. The substrate can be biased and used as an electric probe in order to obtain information about the composition of the total heating power. A new calibration technique for calorimetric probes, which uses monoenergetic electrons at low pressure, has been developed for an improved accuracy. The use of the probe is exemplified with an experiment where both energetic neutral atoms and ions heat the test substrate. [ABSTRACT FROM AUTHOR]

A novel experiment for the study of forces on microparticles in ion beams is presented. A broad beam ion source provides a vertically upward directed beam wherein 100 μm hollow glass spheres are injected. The particles are illuminated by a diode laser and recorded with a charge-coupled device camera. From the trajectories the acceleration and the net force on the particles are determined. Information on energetic neutral atoms is achieved, which is not accessible by electrostatic methods. [ABSTRACT FROM AUTHOR]

Abstract: Enhanced oscillatory local field potential (LFP) activities over a broad frequency range (5–30 Hz) have been consistently reported from the basal ganglia in patients with Parkinson''s disease (PD) and in animal models of this disease. Here we test the hypothesis that these activities may have different functional connotations according to their frequency, by seeking a relatively differentiated distribution within the different functional territories of the subthalamic nucleus (STN). To this end we made intra-operative microelectrode recordings of LFP activities within the STN of 8 PD patients undergoing functional neurosurgery. A significantly larger beta (13–30 Hz) power was found in the dorsolateral part of STN, which is related to motor cortical areas, compared to the ventral (associative/limbic) part of STN. This specific topography was not observed for low frequency activity (5–12 Hz). Our data suggest that the relative distribution of oscillatory activity within the STN of patients with PD may differ according to frequency and confirm previously reported findings that beta activity may provide a functional marker for the ‘motor’ STN in functional neurosurgery. [Copyright &y& Elsevier]

Abstract: Depth recordings in patients with Parkinson''s disease (PD) have demonstrated oscillatory activity in the gamma frequency (60–100 Hz) band in local field potentials (LFPs) recorded from the region of the subthalamic nucleus (STN). Although this activity has been hypothesised to contribute to movement preparation, it is unclear to what extent these LFP oscillations arise in the STN and are synchronous with local neuronal discharge. We therefore recorded LFPs and neuronal activity from microelectrodes inserted into the STN in PD patients during functional neurosurgery. Eight sides in seven patients out of 15 sides in 12 patients were identified that had peaks in the gamma band in spectra of LFPs. As microelectrodes descended towards STN, there was a pronounced increase in gamma frequency band LFP activity 1 mm above the line joining the anterior and posterior commissures and 2 mm above the microelectrode defined dorsal border of the STN. Gamma activity dropped again 3 mm below the microelectrode defined dorsal border of the STN. Spike-triggered averages of LFP activity suggested that the discharges of neurons in this region were locked to gamma oscillations in the LFP. Gamma band oscillations in the LFP are therefore likely to represent synchronous activity in populations of neurons in the upper STN and bordering zona incerta of patients with PD. [Copyright &y& Elsevier]

Experiments on dust-acoustic waves (DAW) in a magnetized anodic plasma are presented for the regime of low collisionality. The dust trapping and the self-excited and synchronized DAW dynamics are studied. Based on Langmuir and emissive probe measurements the dust confinement is found to be well described with respect to size, stability, and position of the dust cloud by an effective potential well formed by ion drag and Coulomb forces. Moreover, the measurements indicate the necessity for a kinetic model for the wave dispersion. By means of singular value decomposition the local wavelengths and growth rates of the waves are measured systematically. It is found that the measured mean wave number is well described by kinetic theory, while the theoretical growth rates overestimate the experiments. A novel observation for the DAW is a systematic variation of the wavelength inside the dust cloud. [ABSTRACT FROM AUTHOR]

Abstract: Depth recordings in patients with Parkinson''s disease (PD) have demonstrated prominent oscillatory activity in the beta frequency (13–35 Hz) band in local field potentials (LFPs) recorded from the region of the subthalamic nucleus (STN). Although this activity has been hypothesized to contribute to bradykinesia, it is unclear to what extent the LFP oscillations arise in the STN and are synchronous with local neuronal discharge. We therefore recorded both LFPs and multi-neuronal activity from microelectrodes inserted into STN in six PD patients (8 sides) during functional neurosurgery. As microelectrodes passed from above STN into STN, there was a pronounced increase in beta frequency band LFP activity. Furthermore, spike-triggered averages of LFP activity suggested that the discharges of neurons in STN were locked to beta oscillations in the LFP. The LFP is therefore likely to represent synchronous activity in populations of neurons in the STN of patients with PD. [Copyright &y& Elsevier]

This contribution introduces a new experiment for the investigation of magnetized complex plasmas. Its basic features are discussed and first experiments on free-falling dust particles are presented. By means of Langmuir probes and the resonance cone technique, the influence of dust particles on the free electron density is studied. With both methods, significant electron density reductions are observed. [ABSTRACT FROM AUTHOR]

A new diagnostic method for magnetized dusty plasmas, the excitation of lower hybrid resonance cones, is investigated experimentally. The resonance cone is excited with a small antenna, and the angular distribution of the wave field with respect to the magnetic field shows a resonant enhancement, which shifts according to the free electron density. It is demonstrated that dust reduces the free electron density in agreement with Langmuir probe results. Wave damping by scattering effects is found negligible. © 2003 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Small dust clouds, which are confined in an anodic plasma, are studied with respect to their structure and their response to modulation of the anode bias. The dust cloud is displaced from the center of the discharge by a process similar to the void mechanism in radio-frequency discharges under microgravity. The top layers of the dust cloud are in a crystalline state and the cloud performs a slow rotation about the magnetic field direction. For modulation frequencies below 15 Hz, a sloshing and stretching motion in the confining potential well is found. Spontaneously excited dust density waves are observed when the dust cloud exceeds a minimum size. The waves are characterized by sickle-shaped wave fronts. No standing waves were found. The wave dispersion shows an influence of the boundedness of the system in terms of a frequency cutoff. [ABSTRACT FROM AUTHOR]

Abstract: Pallidal recordings of local field potentials (LFPs) in patients with dystonia have demonstrated semi-oscillatory activity over 3–12 Hz. Although this activity has been hypothesized to contribute to dystonia, it is unclear to what extent these LFP oscillations arise in the globus pallidus interna (GPi) and are synchronous with local neuronal discharge. We therefore recorded LFPs and neuronal activity from microelectrodes inserted into the pallidum on nine sides in six awake patients with primary dystonia during functional neurosurgery. Mean normalized LFP power over 3–12 Hz was higher in GPi than globus pallidus externa. Spike triggered averages were computed, and 11 exhibited significant features in the 3–12 Hz band, indicating that the discharges of local neurons were locked to 3–12 Hz oscillations in the LFP. All but two of these STAs were in GPi. We conclude that pallidal oscillations at 3–12 Hz are maximal in GPi, the surgical target, in patients with dystonia and that they can be synchronized to activity in local neurons. This lends support to a pathophysiological relationship between LFP activity at 3–12 Hz and dystonia. [Copyright &y& Elsevier]

Abstract: Local field potential (LFP) gamma (55–95 Hz) activity has been recorded in the vicinity of the subthalamic nucleus with both microelectrodes and macroelectrodes in patients with Parkinson''s disease undergoing functional neurosurgery. Although this activity increases with movement its functional significance remains unknown. We hypothesised that elevations in local gamma activity might be associated with an increase in the capacity of individual spike trains to code information. Changes in the median firing frequency, entropy and baud were determined during spontaneous variations in the level of simultaneously recorded LFP gamma activity in a sample of 31 neurons. The latter were recorded from the zona incerta (n =5) and subthalamic nucleus (n =26) in 10 parkinsonian patients. Although 19% of neurons showed a decrease in firing rate, overall there was a net increase in spike frequency and baud of 18.0±5.5% and 16.9±5.3%, when periods of high gamma were compared to periods of low gamma LFP activity. In contrast, entropy dropped by only 0.8±0.2% across the sampled neuronal population during periods of high gamma. All net changes were significant. We conclude that overall there was a net elevation in firing rate and potential information coding capacity, assessed in terms of baud, amongst neurons during periods of elevated gamma LFP activity in the subthalamic region. [Copyright &y& Elsevier]

The influence of the brainstem motor system on cerebral motor areas may play an important role in motor control in health and disease. A new approach to investigate this interaction in man is combining acoustic stimulation activating the startle system with transcranial magnetic stimulation (TMS) over the motor cortex. However, it is unclear whether the inhibition of TMS responses following acoustic stimulation occurs at the level of the motor cortex through reticulo-cortical projections or subcortically, perhaps through reticulo-spinal projections. We compared the influence of acoustic stimulation on motor effects elicited by TMS over motor cortical areas to those evoked with subcortical electrical stimulation (SES) through depth electrodes in five patients treated with deep brain stimulation for Parkinson’s disease. SES bypasses the motor cortex, demonstrating any interaction with acoustic stimuli at the subcortical level. EMG was recorded from the contralateral biceps brachii muscle. Acoustic stimulation was delivered binaurally through headphones and used as a conditioning stimulus at an interstimulus interval of 50 ms. When TMS was used as the test stimulus, the area and amplitude of the conditioned motor response was significantly inhibited (area: 57.5±12.9%, amplitude: 47.9±7.4%, as percentage of unconditioned response) whereas facilitation occurred with SES (area: 110.1±4.3%, amplitude: 116.9±6.9%). We conclude that a startle-evoked activation of reticulo-cortical projections transiently inhibits the motor cortex. [ABSTRACT FROM AUTHOR]

Objectives Purpose of this in vitro study was to evaluate the effect of surface modifications on the tensile bond strength between zirconia ceramic and resin. Methods Zirconia ceramic surfaces were treated with 150-μm abrasive alumina particles, 150-μm abrasive zirconia particles, argon-ion bombardment, gas plasma, and piranha solution (H 2 SO 4 :H 2 O 2 = 3:1). In addition, slip casting surfaces were examined. Untreated surfaces were used as the control group. Tensile bond strengths (TBS) were measured after water storage for 3 days or 150 days with additional 37,500 thermal cycling for artificial aging. Statistical analyses were performed with 1-way and 3-way ANOVA , followed by comparison of means with the Tukey HSD test. Results After storage in distilled water for three days at 37 °C, the highest mean tensile bond strengths (TBS) were observed for zirconia ceramic surfaces abraded with 150-μm abrasive alumina particles (TBS AAP = 37.3 MPa, TBS CAAP = 40.4 MPa), and 150-μm abrasive zirconia particles (TBS AZP = 34.8 MPa, TBS CAZP = 35.8 MPa). Also a high TBS was observed for specimens treated with argon-ion bombardment (TBS BAI = 37.8 MPa). After 150 days of storage, specimens abraded with 150-μm abrasive alumina particles and 150-μm abrasive zirconia particles revealed high TBS (TBS AAP = 37.6 MPa, TBS CAAP = 33.0 MPa, TBS AZP = 22.1 MPa and TBS CAZP = 22.8 MPa). A high TBS was observed also for specimens prepared with slip casting (TBS SC = 30.0 MPa). A decrease of TBS was observed for control specimens (TBS UNT = 12.5 MPa, TBS CUNT = 9.0 MPa), specimens treated with argon-ion bombardment (TBS BAI = 10.3 MPa) and gas plasma (TBS GP = 11.0 MPa). A decrease of TBS was observed also for specimens treated with piranha solution (TBS PS = 3.9 MPa, TBS CPS = 4.1 MPa). A significant difference in TBS after three days storage was observed for specimens treated with different methods ( p < 0.001). Thermal cycling significantly reduced TBS for all groups ( p < 0.001) excluding groups: AAP( p > 0.05), CAAP( p > 0.05) and SC( p > 0.05). However, the failure patterns of debonded specimens prepared with 150-μm abrasive zirconia particles were 96.7% cohesive. Conclusion Treatment of zirconia ceramic surfaces with abrasive zirconia particles is a promising method to increase the tensile bond strength without significant damage of the ceramic surface itself. An alternative promising method is slip casting. [ABSTRACT FROM AUTHOR]

Deep brain stimulation (DBS) of the internal globus pallidus (GPi) and ventral intermediate thalamic nucleus (VIM) are established treatment options in primary dystonia and tremor syndromes and have been reported anecdotally to be efficacious in myoclonus-dystonia (MD). We investigated short- and long-term effects on motor function, cognition, affective state, and quality of life (QoL) of GPi- and VIM-DBS in MD. Ten MD-patients (nine ε-sarcoglycan-mutation-positive) were evaluated pre- and post-surgically following continuous bilateral GPi- and VIM-DBS at four time points: presurgical, 6, 12, and as a last follow-up at a mean of 62.3 months postsurgically, and in OFF-, GPi-, VIM-, and GPi-VIM-DBS conditions by validated motor [unified myoclonus rating scale (UMRS), TSUI Score, Burke-Fahn-Marsden dystonia rating scale (BFMDRS)], cognitive, affective, and QoL-scores. MD-symptoms significantly improved at 6 months post-surgery (UMRS: 61.5%, TSUI Score: 36.5%, BFMDRS: 47.3%). Beneficial effects were sustained at long-term evaluation post-surgery (UMRS: 65.5%, TSUI Score: 35.1%, BFMDRS: 48.2%). QoL was significantly ameliorated; affective status and cognition remained unchanged postsurgically irrespective of the stimulation conditions. No serious long-lasting stimulation-related adverse events (AEs) were observed. Both GPi- and VIM-DBS offer equally effective and safe treatment options for MD. With respect to fewer adverse, stimulation-induced events of GPi-DBS in comparison with VIM-DBS, GPi-DBS seems to be preferable. Combined GPi-VIM-DBS can be useful in cases of incapaciting myoclonus, refractory to GPi-DBS alone. © 2010 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Extreme forward flexion of the spine, named camptocormia (CC), and head drop syndrome (HD) may be among the most disabling symptoms in Parkinson's disease (PD). This study aims to eludicate the etiology of PD-associated CC and HD via a multidisciplinary approach (clinical examination, electromyography, MRI, genetic analysis, muscle morphology) centering on the histology of the paraspinal muscles. We studied 17 patients with the clinical diagnosis of PD and CC or head drop syndrome and six controls. We performed muscle biopsies of paraspinal muscles and deep neck extensor muscles. Mean age at onset of postural abnormality was 66 years and mean latency between onset of parkinsonian symptoms to first signs of CC or head drop was 7 years. The electromyogram of paraspinal muscles was abnormal in 13-14 patients. Histopathology revealed chronic myopathic changes in 14 of 17 biopsies, consisting of abnormal variation in fiber size, increase in internal nuclei, and increase in connective tissue, myofibrillar disarray and similarities to protein surplus myopathies. Interestingly, heterozygous variants in the Parkin gene were found in 2 of 9 investigated patients. We conclude that CC and HD in PD are predominantly myopathic. Aberrant protein aggregation may link PD and CC. © 2009 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Depth recordings in patients with Parkinson’s disease on dopaminergic therapy have revealed a tendency for oscillatory activity in the basal ganglia that is sharply tuned to frequencies of ∼70 Hz and increases with voluntary movement. It is unclear whether this activity is essentially physiological and whether it might be involved in arousal processes. Here we demonstrate an oscillatory activity with similar spectral characteristics and motor reactivity in the human thalamus. Depth signals were recorded in 29 patients in whom the ventral intermediate or centromedian nucleus were surgically targeted for deep brain stimulation. Thirteen patients with four different pathologies showed sharply tuned activity centred at ∼70 Hz in spectra of thalamic local field potential (LFP) recordings. This activity was modulated by movement and, critically, varied over the sleep–wake cycle, being suppressed during slow wave sleep and re-emergent during rapid eye movement sleep, which physiologically bears strong similarities with the waking state. It was enhanced by startle-eliciting stimuli, also consistent with modulation by arousal state. The link between this pattern of thalamic activity and that of similar frequency in the basal ganglia was strengthened by the finding that fast thalamic oscillations were lost in untreated parkinsonian patients, paralleling the behaviour of this activity in the basal ganglia. Furthermore, there was sharply tuned coherence between thalamic and pallidal LFP activity at ∼70 Hz in eight out of the 11 patients in whom globus pallidus and thalamus were simultaneously implanted. Subcortical oscillatory activity at ∼70 Hz may be involved in movement and arousal. [ABSTRACT FROM AUTHOR]

Abstract: Several studies have confirmed that subthalamic and pallidal local field potential activity in the beta frequency band (13–30 Hz) is exaggerated in untreated patients with Parkinson''s disease (PD) and is suppressed by dopaminergic treatment. This particular spectral pattern differs from that in patients with dystonia in whom pallidal activity is prominent at low frequencies (<12 Hz). Here we demonstrate that tetrabenazine induced monoamine depletion and dopamine blockade is associated with increased activity in the low beta band (13–20 Hz) in the internal pallidum of patients with dystonia. Beta activity was elevated in six patients treated with tetrabenazine compared to six patients in whom this drug was not used. Our findings suggest that beta activity is enhanced in the chronically dopamine-depleted and blocked state irrespective of the underlying pathology, consistent with the idea that excessive synchrony in the beta band is directly related to dopaminergic hypofunction, rather than some degenerative disease-specific attribute of Parkinson''s disease. [Copyright &y& Elsevier]

High-frequency stimulation (HFS) of the subthalamic nucleus (STN) is a well-established therapy for patients with severe Parkinson's disease (PD), but its mechanism of action is unclear. Exaggerated oscillatory synchronization in the β (13-30 Hz) frequency band has been associated with bradykinesia in patients with PD. Accordingly, we tested the hypothesis that the clinical benefit exerted by STN HFS is accompanied by suppression of local β activity. To this end, we explored the after effects of STN HFS on the oscillatory local field potential (LFP) activity recorded from the STN immediately after the cessation of HFS in 11 PD patients. Only patients that demonstrated a temporary persistence of clinical benefit after cessation of HFS were analyzed. STN HFS led to a significant reduction in STN LFP β activity for 12 s after the end of stimulation and a decrease in motor cortical-STN coherence in the β band over the same time period. The reduction in LFP β activity correlated with the movement amplitude during a simple motor task, so that a smaller amount of β activity was associated with better task performance. These features were absent when power in the 5-12 Hz frequency band was considered. Our findings suggest that HFS may act by modulating pathological patterns of synchronized oscillations, specifically by reduction of pathological β activity in PD. [ABSTRACT FROM AUTHOR]

As part of the first randomized, sham-timulation controlled trial on deep brain stimulation (DBS) in primary segmental or generalized dystonia, health-related quality of life (HRQoL) was assessed by SF-36. After the 3-month sham-controlled phase, significant HRQoL improvement occurred only in the active-stimulation group. The open-label extension phase resulted in a significant improvement in all SF-36 domains following 6 months of neurostimulation. These results demonstrate a favorable impact of DBS on HRQoL in primary dystonia. © 2007 Movement Disorder Society [ABSTRACT FROM AUTHOR]

Abstract: Excessive synchronisation of basal ganglia activity at frequencies &#60;30Hz is a hallmark of the parkinsonian state, and may contribute to bradykinesia. Accordingly, we electrically stimulated chronically implanted subthalamic macroelectrodes in 10 Parkinson''s disease patients, after overnight withdrawal of anti-parkinsonian medication. We compared the effects of stimulation at 0, 5, 10, 15, 20, 25, 30, and ca. 130Hz by measuring kinesia time (KT) in a tapping task. Although the effects of direct stimulation were small, frequency–response curves demonstrated local peaks at 5–10Hz and at 20–25Hz, superimposed upon an overall tendency for KT to reduce with increasing stimulation frequency. This is consistent with the hypothesis that spontaneous activities in these bands might promote bradykinesia. [Copyright &y& Elsevier]

During the last few years, deep brain stimulation (DBS) of the subthalamic nucleus (STN) has emerged as a promising therapy, alleviating major motor symptoms of Parkinson’s disease (PD). However, in times of growing budgetary limitations, medical decisions are no longer merely based on clinical efficacy, but also on cost-effectiveness. Here we assess treatment costs (i. e. costs for conservative pharmacological treatment and all in-patient admissions) of 46 PD patients for one year before and two years after STN-DBS. The present data show that total treatment costs were increased by 32 % for the first year and decreased by 54 % for the second year of STN-DBS in comparison with preoperative values while the Unified Parkinon’s Disease Rating Scale (UPDRS III) was significantly improved. The increase for the first year after surgery was mainly due to the implantation of the STN electrodes and the stimulation device. Taken together, STNDBS pays off from the second year of stimulation while motor symptoms are significantly improved. The present study provides first data of an important number of patients on clinical effectiveness and expenses in relation to STNDBS. [ABSTRACT FROM AUTHOR]

Current concepts of transcranial magnetic stimulation (TMS) over the primary motor cortex are still under debate as to whether inhibitory motor effects are exclusively of cortical origin. To further elucidate a potential subcortical influence on motor effects, we combined TMS and unilateral subcortical electrical stimulation (SES) of the corticospinal tract. SES was performed through implanted depth electrodes in eight patients treated with deep brain stimulation (DBS) for severe dystonia. Chronaxie, conduction velocity (CV) of the stimulated fibres and poststimulus time histograms of single motor unit recordings were calculated to provide evidence of an activation of large diameter myelinated fibres by SES. Excitatory and inhibitory motor effects recorded bilaterally from the first dorsal interosseus muscle were measured after SES and focal TMS of the motor cortex. This allowed us to compare motor effects of subcortical (direct) and cortical (mainly indirect) activation of corticospinal neurons. SES activated a fast conducting monosynaptic pathway to the alpha motoneuron. Motor responses elicited by SES had significantly shorter onset latency and shorter duration of the contralateral silent period compared to TMS induced motor effects. Spinal excitability as assessed by H-reflex was significantly reduced during the silent period after SES. No ipsilateral motor effects could be elicited by SES while TMS was followed by an ipsilateral inhibition. The results suggest that SES activated the corticospinal neurons at the level of the internal capsule. Comparison of SES and TMS induced motor effects reveals that the first part of the TMS induced contralateral silent period should be of spinal origin while its later part is due to cortical inhibitory mechanisms. Furthermore, the present results suggest that the ipsilateral inhibition is predominantly mediated via transcallosal pathways. [ABSTRACT FROM AUTHOR]

Background: Neurostimulation of the internal globus pallidus has been shown to be effective in reducing symptoms of primary dystonia. We compared this surgical treatment with sham stimulation in a randomized, controlled clinical trial. Methods: Forty patients with primary segmental or generalized dystonia received an implanted device for deep-brain stimulation and were randomly assigned to receive either neurostimulation or sham stimulation for 3 months. The primary end point was the change from baseline to 3 months in the severity of symptoms, according to the movement subscore on the Burke–Fahn–Marsden Dystonia Rating Scale (range, 0 to 120, with higher scores indicating greater impairment). Two investigators who were unaware of treatment status assessed the severity of dystonia by reviewing videotaped sessions. Subsequently, all patients received open-label neurostimulation; blinded assessment was repeated after 6 months of active treatment. Results: Three months after randomization, the change from baseline in the mean (±SD) movement score was significantly greater in the neurostimulation group (−15.8±14.1 points) than in the sham-stimulation group (−1.4±3.8 points, P<0.001). During the open-label extension period, this improvement was sustained among patients originally assigned to the neurostimulation group, and patients in the sham-stimulation group had a similar benefit when they switched to active treatment. The combined analysis of the entire cohort after 6 months of neurostimulation revealed substantial improvement in all movement symptoms (except speech and swallowing), the level of disability, and quality of life, as compared with baseline scores. A total of 22 adverse events occurred in 19 patients, including 4 infections at the stimulator site and 1 lead dislodgment. The most frequent adverse event was dysarthria. Conclusions: Bilateral pallidal neurostimulation for 3 months was more effective than sham stimulation in patients with primary generalized or segmental dystonia. (ClinicalTrials.gov number, NCT00142259.) N Engl J Med 2006;355:1978-90. [ABSTRACT FROM AUTHOR]