The capability of the brain to control the body has been recognised for millennia. This thesis evaluates the ability of neurosurgery, in the form of DBS, to manipulate the motor system, in which it is already established as a therapy, and the cardiovascular and respiratory systems, in which its application as a therapy would represent a major paradigm shift in medical practice. Patients with in-dwelling deep brain stimulators were enrolled in a series of experiments. Methodological techniques included the recording and analysis of cardiovascular and lung function indices, deep brain local field potentials, tremor severity scores and diffusion tensor tractograms. The results demonstrate that DBS at specific subcortical sites can ameliorate the abnormal response to autonomic challenges in Parkinson's disease and improve lung function by up to 15% with a coincident synchronisation of local field potential frequency. Further, the results demonstrate that probabilistic tractography in humans confirms the connections of the motor thalamus seen in animal tracer studies and that motor thalamus DBS for essential tremor is efficacious based on novel trial design and analysis methods. In conclusion, the thesis provides the first Level I evidence for the efficacy of DBS in essential tremor and suggests that probabilistic tractography can aid surgical targeting of the motor thalamus. It also finds that DBS reduces the cardiovascular dysfunction seen in Parkinson's disease and improves respiratory performance in humans with a coincident electrophysiological correlate in the subcortical brain. These findings have important implications for the future application of neurosurgery in diseases of not just the motor system but also the cardiovascular and respiratory systems.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:589612 |
| Date | January 2011 |
| Creators | Hyam, Jonathan A. |
| Publisher | University of Oxford |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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