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Kim JP, Min HK, Knight EJ, Duffy PS, Abulseoud OA, Marsh MP, Kelsey K, Blaha CD, Bennet KE, Frye MA, Lee KH. Centromedian-parafascicular deep brain stimulation induces differential functional inhibition of the motor, associative, and limbic circuits in large animals. Biol Psychiatry 2013; 74:917-926. [PMID: 23993641 PMCID: PMC3910443 DOI: 10.1016/j.biopsych.2013.06.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 06/05/2013] [Accepted: 06/19/2013] [Indexed: 12/17/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the centromedian-parafascicular (CM-Pf) thalamic nuclei has been considered an option for treating Tourette syndrome. Using a large animal DBS model, this study was designed to explore the network effects of CM-Pf DBS. METHODS The combination of DBS and functional magnetic resonance imaging is a powerful means of tracing brain circuitry and testing the modulatory effects of electrical stimulation on a neuronal network in vivo. With a within-subjects design, we tested the proportional effects of CM and Pf DBS by manipulating current spread and varying stimulation contacts in healthy pigs (n = 5). RESULTS Our results suggests that CM-Pf DBS has an inhibitory modulating effect in areas that have been suggested as contributing to impaired sensory-motor and emotional processing. The results also help to define the differential neural circuitry effects of the CM and Pf with evidence of prominent sensorimotor/associative effects for CM DBS and prominent limbic/associative effects for Pf DBS. CONCLUSIONS Our results support the notion that stimulation of deep brain structures, such as the CM-Pf, modulates multiple networks with cortical effects. The networks affected by CM-Pf stimulation in this study reinforce the conceptualization of Tourette syndrome as a condition with psychiatric and motor symptoms and of CM-Pf DBS as a potentially effective tool for treating both types of symptoms.
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Affiliation(s)
- Joo Pyung Kim
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA, Department of Neurosurgery, CHA University, Bundang CHA Medical Center, Sungnam, Republic of Korea
| | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA, Division of Engineering, Mayo Clinic, Rochester, Minnesota, USA, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Emily J. Knight
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Penelope S. Duffy
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Osama A. Abulseoud
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael P. Marsh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Katherine Kelsey
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles D. Blaha
- Department of Psychology, University of Memphis, Memphis, TN, USA
| | - Kevin E. Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA, Division of Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark A. Frye
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA, Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
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Hardenacke K, Shubina E, Bührle CP, Zapf A, Lenartz D, Klosterkötter J, Visser-Vandewalle V, Kuhn J. Deep brain stimulation as a tool for improving cognitive functioning in Alzheimer's dementia: a systematic review. Front Psychiatry 2013; 4:159. [PMID: 24363647 PMCID: PMC3850165 DOI: 10.3389/fpsyt.2013.00159] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 11/18/2013] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation (DBS) is an established, in selected cases therapeutically effective, non-lesional treatment method delivering current rectangular pulses into dysfunctional brain structures via chronically implanted stimulation electrodes. DBS is a recognized method applied in movement disorders and is increasingly evaluated as a possible therapeutic option for psychiatric diseases such as refractory obsessive-compulsive disorders, Gilles de la Tourette syndrome, major depression, and substance-related addiction. Latest research indicates that DBS may be a method for improving cognitive functions in Alzheimer's dementia (AD). Translational data in healthy and AD animals appear to support this notion. Nevertheless, many aspects remain unclear, particularly with regard to the optimal target structure. The objective of this review is to present a systematic overview regarding published research on DBS and cognitive functioning in animal and human studies as well as to provide a systematic overview of the feasibility and efficacy of the treatment. We describe three studies investigating the effects of DBS in patients with dementia, using either the fornix or the nucleus basalis of Meynert (NBM) as a target. In total, we identified 25 animal studies with 10 brain structures being targeted: fornix, NBM, anterior caudate nucleus, dorsal striatum, anterior thalamic nucleus, midline thalamic nuclei, central thalamus, lateral hypothalamus, hippocampus (entorhinal cortex, perforant path), and amygdala. Considering the wide and diverse spectrum of targets, we add to this review a supposition about possible underlying mechanisms of operation and recommendations for further research.
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Affiliation(s)
- Katja Hardenacke
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Elena Shubina
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Christian Philipp Bührle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne , Cologne , Germany
| | - Alexandra Zapf
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Doris Lenartz
- Department of Stereotactic and Functional Neurosurgery, University of Cologne , Cologne , Germany
| | - Joachim Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University of Cologne , Cologne , Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, University of Cologne , Cologne , Germany
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Motlagh MG, Smith ME, Landeros-Weisenberger A, Kobets AJ, King RA, Miravite J, de Lotbinière ACJ, Alterman RL, Mogilner AY, Pourfar MH, Okun MS, Leckman JF. Lessons Learned from Open-label Deep Brain Stimulation for Tourette Syndrome: Eight Cases over 7 Years. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2013; 3. [PMID: 24255802 PMCID: PMC3822402 DOI: 10.7916/d8m32tgm] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/23/2013] [Indexed: 12/26/2022]
Abstract
Background Deep brain stimulation (DBS) remains an experimental but promising treatment for patients with severe refractory Gilles de la Tourette syndrome (TS). Controversial issues include the selection of patients (age and clinical presentation), the choice of brain targets to obtain optimal patient-specific outcomes, and the risk of surgery- and stimulation-related serious adverse events. Methods This report describes our open-label experience with eight patients with severe refractory malignant TS treated with DBS. The electrodes were placed in the midline thalamic nuclei or globus pallidus, pars internus, or both. Tics were clinically assessed in all patients pre- and postoperatively using the Modified Rush Video Protocol and the Yale Global Tic Severity Scale (YGTSS). Results Although three patients had marked postoperative improvement in their tics (>50% improvement on the YGTSS), the majority did not reach this level of clinical improvement. Two patients had to have their DBS leads removed (one because of postoperative infection and another because of lack of benefit). Discussion Our clinical experience supports the urgent need for more data and refinements in interventions and outcome measurements for severe, malignant, and medication-refractory TS. Because TS is not an etiologically homogenous clinical entity, the inclusion criteria for DBS patients and the choice of brain targets will require more refinement.
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Affiliation(s)
- Maria G Motlagh
- Child Study Center, Yale University, New Haven, Connecticut, United States of America
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Williams NR, Okun MS. Deep brain stimulation (DBS) at the interface of neurology and psychiatry. J Clin Invest 2013; 123:4546-56. [PMID: 24177464 DOI: 10.1172/jci68341] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) is an emerging interventional therapy for well-screened patients with specific treatment-resistant neuropsychiatric diseases. Some neuropsychiatric conditions, such as Parkinson disease, have available and reasonable guideline and efficacy data, while other conditions, such as major depressive disorder and Tourette syndrome, have more limited, but promising results. This review summarizes both the efficacy and the neuroanatomical targets for DBS in four common neuropsychiatric conditions: Parkinson disease, Tourette syndrome, major depressive disorder, and obsessive-compulsive disorder. Based on emerging new research, we summarize novel approaches to optimization of stimulation for each neuropsychiatric disease and we review the potential positive and negative effects that may be observed following DBS. Finally, we summarize the likely future innovations in the field of electrical neural-network modulation.
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Abstract
Gilles de la Tourette syndrome is a movement disorder characterized by repetitive stereotyped motor and phonic movements with varying degrees of psychiatric comorbidity. Deep brain stimulation (DBS) has emerged as a novel therapeutic intervention for patients with refractory Tourette syndrome. Since 1999, more than 100 patients have undergone DBS at various targets within the corticostriatothalamocortical network thought to be implicated in the underlying pathophysiology of Tourette syndrome. Future multicenter clinical trials and the use of a centralized online database to compare the results are necessary to determine the efficacy of DBS for Tourette syndrome.
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Affiliation(s)
- Won Kim
- Department of Neurosurgery, University of California, Los Angeles 10945, Le Conte Avenue, Suite 2120, Los Angeles, CA 90095, USA.
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Gelabert-González M, Relova Quinteiro JL, Castro-García A. [Deep brain stimulation. Twenty-five years later]. Med Clin (Barc) 2013; 141:29-32. [PMID: 23540386 DOI: 10.1016/j.medcli.2013.01.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/22/2013] [Accepted: 01/31/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Miguel Gelabert-González
- Departamento de Cirugía, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, España.
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Deep brain electrophysiological recordings provide clues to the pathophysiology of Tourette syndrome. Neurosci Biobehav Rev 2013; 37:1063-8. [PMID: 23333267 DOI: 10.1016/j.neubiorev.2013.01.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 12/13/2012] [Accepted: 01/03/2013] [Indexed: 01/12/2023]
Abstract
Although ample evidence suggests that high-frequency deep brain stimulation (DBS) is an effective therapy in patients with Tourette syndrome (TS), its pathophysiology and the neurophysiological mechanisms underlying these benefits remain unclear. The DBS targets mainly used to date in TS are located within the basal ganglia-thalamo-cortical circuit compromised in this syndrome: the medial and ventral thalamic nuclei, which are way stations within the circuit, the globus pallidus and the nucleus accumbens. Neuronal activity can be electrophysiologically recorded from deep brain structures during DBS surgery (intraoperative microrecordings) or within few days after DBS electrode implantation (local field potentials, LFPs). Recordings from the thalamus in patients with TS showed that the power in low-frequency oscillations (2-15 Hz) was higher than power in high frequency oscillations (<45 Hz) and that activity in gamma band (25-45 Hz) increases when patients' clinical status improved. Effective thalamic DBS for tic reduction seems to increase high frequency band oscillations (25-45 Hz). The same oscillatory pattern persists after DBS for 1 year, therefore showing that in TS DBS does not induce persistent neuroplastic changes in the neural activity in the stimulated structures. Neurophysiological recordings from deep brain structures suggest that tics originate not from the cortex but from neuronal dysfunction in deep brain structures such as the thalamus and globus pallidus. In conclusion, DBS can induce its beneficial effects in TS by modulating specific neural rhythms in the cortico-basal ganglia thalamic network. DBS could reduce tics related increased low-frequency activity by shifting the basal ganglia-thalamic oscillation power to higher frequencies.
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