Lars Wojtecki

Heinrich Heine University Düsseldorf | HHU · Institute for clinical neuroscience and medical psychology

Deep brain stimulation of the dorsal pallidum (globus pallidus, GP) is increasingly considered as a surgical therapeutic option in Huntington’s disease (HD), but there is need to identify outcome measures useful for clinical trials. Computational models consider the GP to be part of a basal ganglia network involved in cognitive processes related to...

Background Movement disorders in Huntington’s disease are often medically refractive. The aim of the trial was assessment of procedure safety of deep brain stimulation, equality of internal- and external-pallidal stimulation and efficacy followed-up for 6 months in a prospective pilot trial. Methods In a controlled double-blind phase six patients...

Deep brain stimulation has become a well-established symptomatic treatment for Parkinson's disease during the last 25 years. Besides improving motor symptoms and long-term motor complications, positive effects on patients' mobility, activities of daily living, emotional well-being and health-related quality of life have been recognized. Apart from...

Background: Deep brain stimulation of the subthalamic nucleus, although highly effective for the treatment of motor impairment in Parkinson’s disease (PD), can induce speech deterioration in a subgroup of patients. The aim of the current study was to survey (1) if there are distinctive stimulation effects on the different parameters of voice and sp...

Alzheimer’s disease (AD) is a neurodegenerative disorder that dramatically affects cognitive abilities and represents the most common cause of dementia. Currently, pharmacological interventions represent the main treatment to deal with the symptoms of AD; however, alternative approaches are readily sought. Transcranial pulse stimulation (TPS) is an...

Background Cognitive decline is a major factor for the deterioration of the quality of life in patients suffering from Parkinson’s disease (PD). Recently, it was reported that cognitive training (CT) in PD patients with mild cognitive impairment (PD-MCI) led to an increase of physical activity (PA) accompanied by improved executive function (EF). M...

Background Neurological symptoms are common manifestation in acute COVID-19. This includes hyper- and hypokinetic movement disorders. Data on their outcome, however, is limited. Methods Cases with new-onset COVID-19-associated movement disorders were identified by searching the literature. Authors were contacted for outcome data which were reviewe...

Introduction: Cognitive impairment in Parkinson's disease (PD), especially in patients with mild cognitive impairment (PD-MCI), coincides with less physical activity. Cognitive trainings (CT) have been found to promote laboratory environment-based movement. Knowledge about their effect in natural home-based environment, reflecting everyday functio...

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a powerful treatment in Parkinson’s disease (PD), which provides a positive effect on motor symptoms although the way it operates on high cognitive processes such as metacognition remains unclear. To address this issue, we recorded electroencephalogram (EEG) of PD patients treated with...

So far, deep repetitive transcranial magnetic stimulation (drTMS) has shown promising results as an add-on treatment for Parkinson’s disease (PD) but not for non-idiopathic Parkinson Syndromes (PS). We aimed to investigate the safety and feasibility of drTMS application in patients with different Parkinson Syndromes and medical refractory symptoms....

Background: The EARLYSTIM trial demonstrated for Parkinson's disease patients with early motor complications that deep brain stimulation of the subthalamic nucleus (STN-DBS) and best medical treatment (BMT) was superior to BMT alone. Objective: This prospective, ancillary study on EARLYSTIM compared changes in blinded speech intelligibility asse...

Introduction Transcranial pulse stimulation (TPS) is a non-invasive neuromodulation therapy that uses short, repetitive shockwaves through a neuro-navigated device. Current research suggests that these pulses lead to a wide range of vascular, metabolic, and neurotrophic changes. This relatively new CE-marked treatment provided first promising resul...

Purpose The decision for subthalamic deep brain stimulation (STN-DBS) in Parkinson's disease (PD) relies on clinical predictors. Whether genetic variables could predict favourable or unfavourable decisions is under investigation. Objective First, we aimed to reproduce the previous observation that SNCA rs356220 was associated with favourable STN-D...

Introduction: Deep transcranial magnetic stimulation (dTMS) is a relatively novel, non-invasive therapeutic tool whereby magnetic fields are utilized to assert neuromodulatory effects in targeted brain area. The aim of the current study was to investigate the safety and feasibility of dTMS as an add-on treatment for patients with Parkinson syndrome...

Introduction: Transcranial Pulse Stimulation (TPS) is a new non-invasive neuromodulation therapy that uses shockwaves for the treatment of Alzheimeŕs Disease (AD). In humans, there is first evidence for beneficial clinical effects after a series of six TPS sessions. Long-term results and controlled trials are not yet reported. Experience from other...

Background Japanese encephalitis is an arthropod-borne zoonotic flavivirus infection endemic to tropical and subtropical Asia. A minority of infections leads to a symptomatic course, but affected patients often develop life-threatening encephalitis with severe sequelae. Literature review Myelitis with flaccid paralysis is a rare complication of Ja...

Background Deep Brain Stimulation (DBS) has been proven to alleviate motor symptoms in Parkinson's Disease (PD). Regarding non-motor symptoms, however, inconsistencies have been reported, on whether DBS causes reductions in well-being and functioning. To assess motor and non-motor impairment in DBS-patients, the Deep Brain Stimulation Impairment Sc...

Background: Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms and quality of life (QoL) of advanced and fluctuating early Parkinson's disease. Little is known about the relation between electrode position and changes in symptom control and ultimately QoL. Objectives: The relation between the stimulated part o...

Background: Meta-analyses indicate positive effects of cognitive training (CT) in patients with Parkinson's disease (PD), however, most previous studies had small sample sizes and did not evaluate long-term follow-up. Therefore, a multicenter randomized controlled, single-blinded trial (Train-ParC study) was conducted to examine CT effects in PD pa...

Background. A randomized-controlled multicenter (MC, 4 centers) study showed the effect of cognitive training in PD-MCI on executive functions. In a sub-study biomarkers were examined in the resting-state EEG. Methods. First, data from one center was examined: 19 patients received a resting-state EEG (128 channels) before and after a 6-week trainin...

Objective: Depressive symptoms have a high prevalence in patients with Parkinson's disease (PD) and are associated with cognitive dysfunction. Especially in PD with mild cognitive impairment (MCI), a time-efficient and valid instrument for the assessment of depression primarily focusing on psychological symptoms and disregarding confounding somatic...

Background: Meta-analyses have demonstrated cognitive training (CT) benefits in Parkinson's disease (PD) patients. However, the patients' cognitive status has only rarely been based on established criteria. Also, prediction analyses of CT success have only sparsely been conducted. Objective: To determine CT effects in PD patients with mild cogni...

Neurologic initial symptom of COVID-19

Background: Effects of DBS on freezing of gait and other axial signs in PD patients are unclear. Objective: Secondary analysis to assess whether DBS affects these symptoms within a large randomized controlled trial comparing DBS of the STN combined with best medical treatment and best medical treatment alone in patients with early motor complica...

Background: Programming algorithms have never been tested for outcome. The EARLYSTIM study showed superior outcomes of deep brain stimulation of the subthalamic nucleus (STN-DBS) over best medical treatment in early Parkinson's disease (PD). Patients were programmed according to common guidelines but customized for each patient. Methods: Stimula...

The amygdala is a structure involved in emotions, fear, learning and memory and is highly interconnected with other brain regions, for example the motor cortex and the basal ganglia that are often targets of treatments involving electrical stimulation. Deep brain stimulation of the basal ganglia is successfully used to treat movement disorders, but...

Background: Data on pediatric DBS is still limited because of small numbers in single center series and lack of systematic multi-center trials. Objectives: We evaluate short- and long-term adverse events (AEs) of patients undergoing deep brain stimulation (DBS) during childhood and adolescence. Methods: Data collected by the German registry on...

During the last 30 years, deep brain stimulation (DBS) has evolved into the clinical standard of care as a highly effective treatment for advanced Parkinson’s disease. Careful patient selection, an individualized anatomical target localization and meticulous evaluation of stimulation parameters for chronic DBS are crucial requirements to achieve op...

Functional magnetic resonance imaging studies suggest that different subcortico-cortical circuits control different aspects of Parkinsonian rest tremor. The basal ganglia were proposed to drive tremor onset, and the cerebellum was suggested to be responsible for tremor maintenance (“dimmer-switch” hypothesis). Although several electrophysiological...

Objective: To investigate predictors for improvement of disease-specific quality of life (QOL) after deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson disease (PD) with early motor complications. Methods: We performed a secondary analysis of data from the previously published EARLYSTIM study, a prospective randomized tr...

Objective To investigate the spatial and temporal pattern of cortical responses evoked by deep brain stimulation (DBS) of the subthalamic nucleus (STN) and ventral intermediate nucleus of the thalamus (VIM). Methods We investigated 7 patients suffering from Essential tremor (ET) and 7 patients with Parkinson's Disease (PD) following the implantati...

Reversal learning (RL) has been widely used for assessment of behavioral adaptation, impulsivity, obsession, and compulsion in healthy controls as well as people suffering from psychiatric and neurological disorders such as Parkinson’s disease (PD). Nevertheless, studies addressing high cognitive functions such as metacognition in PD are scarce. He...

Deep brain stimulation is an approved treatment for several neurodegenerative disorders but not for Huntington’s Disease. Because of the striking effects of pallidal deep brain stimulation (DBS) on choreodystonic movements induced by L-dopa in Parkinson’s disease and on dystonic symptoms, DBS of the GPi has recently been applied to a few single cas...

Objective To clarify whether high frequency oscillations (HFOs, >150 Hz) exist in the thalamus. So far, HFOs have only been observed in the basal ganglia. Methods Local field potentials from the ventral intermediate nucleus of the thalamus were recorded during implantation of electrodes for deep brain stimulation in 22 patients with different trem...

Background Recently, therapeutic attempts to control motor choreatic hyperkinesia of Huntington’s disease (HD) by means of pallidal deep brain stimulation (Gp-DBS) were successful. With respect to the clinical effects of Gp-DBS in juvenile hypokinetic-rigid HD (jHD; Westphal variant), only one single-case has been reported up to date. Oscillatory p...

Background: Deep brain stimulation (DBS) surgery for Parkinson's disease (PD) is usually performed as awake surgery allowing sufficient intraoperative testing. Recently, outcomes after asleep surgery have been assumed comparable. However, direct comparisons between awake and asleep surgery are scarce. Objective: To investigate the difference bet...

Background: Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving...

Deep brain stimulation (DBS) is an established therapy to treat motor symptoms in movement disorders such as Parkinson's disease (PD). The mechanisms leading to the high therapeutic effectiveness of DBS are poorly understood so far, but modulation of oscillatory activity is likely to play an important role. Thus, investigating the effect of DBS on...

Objective To assess whether high frequency oscillations (HFOs, >150 Hz), known to occur in basal ganglia nuclei, can be observed in the thalamus. Methods We recorded intraoperative local field potentials from the ventral intermediate nucleus (VIM) of the thalamus in patients with Essential Tremor (N=16), Parkinsonian Tremor (3), Holmes Tremor (2)...

Background: Target localization for deep brain stimulation (DBS) is a challenging step that determines not only the correct placement of stimulation electrodes, but also influences the success of the DBS procedure as reflected in the desired clinical outcome of a patient. Objective: We report on the feasibility of DBS target localization in the...

Background Currently, implantation of electrodes for Deep Brain Stimulation (DBS) as a treatment for patients with Parkinson’s Disease (PD) is usually performed under local anaesthesia (LA) to allow intraoperative testing of effects and side effects. Recently, several studies have indicated that surgery under general anaesthesia (GA) may lead to co...

Objective: Electrical median nerve somatosensory stimulation leads to a distinct modulation of cortical oscillations. Initial high frequency and gamma augmentation, as well as modulation of beta and alpha oscillations have been reported. We aimed at investigating the involvement of the subthalamic nucleus in somatosensory processing by means of lo...

[This corrects the article DOI: 10.1371/journal.pone.0168151.].

Somatosensory evoked potentials (SSEPs) are a viable way to measure processing of somatosensory information. SSEPs have been described at the scalp and the cortical level by electroencephalographic, magnetoencephalographic and intracranial cortical recordings focusing on short-latency (SL; latency<40 ms) and long-latency (LL; latency>40 ms) SSEPs a...

Regular medications and doses for each patient prior to DBS surgery. Note that medications for each patient were restricted to L-Dopa without agonists the day of recording after its withdrawal for DBS electrode implantation surgery. (DOCX)

Flow rate of apomorphine pump for each patient. In particular, the syringes of the pump were filled with 2 APO-go® ampoules so that 10 ml apomorphine (10 mg/ml)) were administered in total. It is worth emphasizing that L-Dopa test was taken at an inpatient stay before the operation. Thus the values of L-dopa-tests are considered to be independent o...

Background: Bilateral deep brain stimulation of the subthalamic nucleus (STN-DBS) has considerable influence on motor and non-motor symptoms in Parkinson's disease (PD). While improvements in motor functioning can be easily assessed with general quality of life questionnaires, the measurement of specific STN-DBS-associated impairments often remain...

We investigated neurophysiological mechanisms of subthalamic nucleus involvement in verbal fluency by means of a verbal generation task. The subthalamic nucleus is thought to act as a behavioural go/no-go instance by means of oscillatory communication in theta band with the prefrontal cortex. Because subthalamic alpha-theta frequency stimulation ha...

Recent research revealed that cortical areas are substantially modulated by deep brain stimulation (DBS). To better understand the spatial and temporal pattern of cortical modulation, we recorded and localized responses evoked by low-frequency DBS using magnetoencephalography (MEG). We investigated nine patients suffering from Essential Tremor (ET)...

Reports about neural oscillatory activity in the globus pallidus internus (GPi) have targeted general (GD) and cervical (CD) dystonia, however they are nonexistent for tardive dystonia (TD). Sensory tricks (geste antagoniste) emphasize a role of sensory processing in CD rather than TD, however neural oscillatory correlates of that phenomenon have n...

Question Deep Brain stimulation (DBS) is a widely established, effective and well-tolerated treatment for Parkinson’s disease (PD). The patients’ way to receive this treatment usually consists of two steps: first, general neurologists refer them to a specialized DBS center where they undergo further diagnostic assessment and the final decision for...

Introduction Deep brain stimulation (DBS) is an established therapy to treat motor symptoms in movement disorders such as Parkinson’s disease (PD). However, its mechanisms are still poorly understood. Oscillatory activity,on the other hand, plays a crucial role in the pathophysiology of PD. Investigating the effect of DBS on oscillatory activity ca...

Introduction One interesting target for DBS in OCD is the STN as it can be regarded as an important modulator of movement and behavior. Especially in comparison to Parkinson’s disease (PD) local and network oscillations of the STN in OCD are of interest. Methods We report clinical results of a female patient that underwent anterior-STN DBS for the...

Huntington’s disease (HD) is a hereditary neurodegenerative disorder which is associated with severe disturbances of motor function, especially choreatic movements, cognitive decline and psychiatric symptoms. Various brain stimulation methods have been used to study brain function in patients with HD. Moreover, brain stimulation has evolved as an a...

Huntington's disease (HD) is one of the most disabling degenerative movement disorders, as it not only affects the motor system but also leads to cognitive disabilities and psychiatric symptoms. Deep brain stimulation (DBS) of the pallidum is a promising symptomatic treatment targeting the core motor symptom: chorea. This article gives an overview...

Background Given the high prevalence of cognitive impairment in Parkinson’s disease (PD), cognitive screening is important in clinical practice. The Montreal Cognitive Assessment (MoCA) is a frequently used screening test in PD to detect mild cognitive impairment (PD-MCI) and Parkinson’s disease dementia (PD-D). However, the proportion in which the...

Case report of a PD-MCI patient. (PDF)

Z-Scores of neuropsychological test battery for all cognitive groups in study 1. (PDF)

Z-Scores of neuropsychological test battery for all cognitive groups in study 2. (PDF)

Background: Data on paediatric deep brain stimulation (DBS) is limited, especially for long-term outcomes, because of small numbers in single center series and lack of systematic multi-center trials. Objectives: We seek to systematically evaluate the clinical outcome of paediatric patients undergoing DBS. Methods: A German registry on paediatr...

Die diesjahrige Jahrestagung der Deutschen Gesellschaft fur klinische Neurophysiologie und Funktionelle Bildgebung (DGKN) mit Fortbildungsakademie des Richard-Jung-Kollegs (RJK) fand vom 16. bis 19. Marz 2016 auf dem Campus der Heinrich-Heine-Universitat Dusseldorf statt. Die Landhauptstadt Nordrhein-Westfalens und pulsierende Rheinmetropole zeigte...

Huntington's disease (HD) is a hereditary neurodegenerative disorder which is associated with severe disturbances of motor function, especially choreatic movements, cognitive decline and psychiatric symptoms. Various brain stimulation methods have been used to study brain function in patients with HD. Moreover, brain stimulation has evolved as an a...

In spite of the success in applying non-invasive electroencephalography (EEG), magneto-encephalography (MEG) and functional magnetic resonance imaging (fMRI) for extracting crucial information about the mechanism of the human brain, such methods remain insufficient to provide information about physiological processes reflecting cognitive and emotio...