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Da Cunha C, Boschen SL, Gómez-A A, Ross EK, Gibson WSJ, Min HK, Lee KH, Blaha CD. Toward sophisticated basal ganglia neuromodulation: Review on basal ganglia deep brain stimulation. Neurosci Biobehav Rev 2015; 58:186-210. [PMID: 25684727 DOI: 10.1016/j.neubiorev.2015.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 02/01/2015] [Accepted: 02/05/2015] [Indexed: 12/11/2022]
Abstract
This review presents state-of-the-art knowledge about the roles of the basal ganglia (BG) in action-selection, cognition, and motivation, and how this knowledge has been used to improve deep brain stimulation (DBS) treatment of neurological and psychiatric disorders. Such pathological conditions include Parkinson's disease, Huntington's disease, Tourette syndrome, depression, and obsessive-compulsive disorder. The first section presents evidence supporting current hypotheses of how the cortico-BG circuitry works to select motor and emotional actions, and how defects in this circuitry can cause symptoms of the BG diseases. Emphasis is given to the role of striatal dopamine on motor performance, motivated behaviors and learning of procedural memories. Next, the use of cutting-edge electrochemical techniques in animal and human studies of BG functioning under normal and disease conditions is discussed. Finally, functional neuroimaging studies are reviewed; these works have shown the relationship between cortico-BG structures activated during DBS and improvement of disease symptoms.
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Affiliation(s)
- Claudio Da Cunha
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Suelen L Boschen
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Alexander Gómez-A
- Departamento de Farmacologia, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Erika K Ross
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Hoon-Ki Min
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Kendall H Lee
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | - Charles D Blaha
- Department of Psychology, The University of Memphis, Memphis, TN, USA.
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Chechko N, Vocke S, Habel U, Toygar T, Kuckartz L, Berthold-Losleben M, Laoutidis ZG, Orfanos S, Wassenberg A, Karges W, Schneider F, Kohn N. Effects of overnight fasting on working memory-related brain network: an fMRI study. Hum Brain Mapp 2014; 36:839-51. [PMID: 25393934 DOI: 10.1002/hbm.22668] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 10/05/2014] [Accepted: 10/14/2014] [Indexed: 12/21/2022] Open
Abstract
Glucose metabolism serves as the central source of energy for the human brain. Little is known about the effects of blood glucose level (BGL) on higher-order cognitive functions within a physiological range (e.g., after overnight fasting). In this randomized, placebo-controlled, double blind study, we assessed the impact of overnight fasting (14 h) on brain activation during a working memory task. We sought to mimic BGLs that occur naturally in healthy humans after overnight fasting. After standardized periods of food restriction, 40 (20 male) healthy participants were randomly assigned to receive either glucagon to balance the BGL or placebo (NaCl). A parametric fMRI paradigm, including 2-back and 0-back tasks, was used. Subclinically low BGL following overnight fasting was found to be linked to reduced involvement of the bilateral dorsal midline thalamus and the bilateral basal ganglia, suggesting high sensitivity of those regions to minimal changes in BGLs. Our results indicate that overnight fasting leads to physiologically low levels of glucose, impacting brain activation during working memory tasks even when there are no differences in cognitive performance.
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Affiliation(s)
- Natalia Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, RWTH Aachen University, Aachen, Germany; JARA Brain - Translational Brain Medicine, Jülich - Aachen, Germany
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Karamintziou SD, Tsirogiannis GL, Stathis PG, Tagaris GA, Boviatsis EJ, Sakas DE, Nikita KS. Supporting clinical decision making during deep brain stimulation surgery by means of a stochastic dynamical model. J Neural Eng 2014; 11:056019. [DOI: 10.1088/1741-2560/11/5/056019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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54
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Pearlman DM, Vora HS, Marquis BG, Najjar S, Dudley LA. Anti-basal ganglia antibodies in primary obsessive-compulsive disorder: systematic review and meta-analysis. Br J Psychiatry 2014; 205:8-16. [PMID: 24986387 DOI: 10.1192/bjp.bp.113.137018] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Autoimmune-mediated basal ganglia dysfunction is implicated in the pathophysiology of neuropsychiatric disorders commonly manifesting with obsessive-compulsive features (e.g. Sydenham chorea). The relationship between autoimmunity and primary obsessive-compulsive disorder (OCD), however, is less clear. AIMS To pool data on serum and cerebrospinal fluid (CSF) anti-basal ganglia antibody (ABGA) positivity in primary OCD (without neurological or autoimmune comorbidity) relative to controls or neuropsychiatric disorders previously associated with increased odds of ABGA positivity. METHOD We performed electronic database and hand-searches for studies meeting pre-specified eligibility criteria from which we extracted data using a standardised form. We calculated pooled estimates of ABGA positivity using a random-effects model. RESULTS Seven case-control studies totalling 844 participants met the eligibility criteria. Meta-analysis showed that a significantly greater proportion of those with primary OCD were ABGA seropositive compared with various controls (odds ratio (OR) = 4.97, 95% CI 2.88-8.55, P<0.00001). This effect was not associated with heterogeneity or publication bias, and remained significant after stratifying the analysis by age, gender, disease severity, illness duration, immunostaining methodology, study quality, publication type, kind of control group, and sample size. There were no significant differences in ABGA seropositivity for comparisons between primary OCD and Tourette syndrome, attention-deficit hyperactivity disorder or paediatric acute-onset neuropsychiatric syndrome. RESULTS of one study testing CSF samples showed that a significantly greater proportion of participants with primary OCD were ABGA CSF-positive compared with healthy controls (OR = 5.60, 95% CI 1.04-30.20, P = 0.045). CONCLUSIONS Odds of ABGA seropositivity are increased fivefold in primary OCD compared with controls, but are comparable to those associated with disorders previously associated with ABGA, providing circumstantial evidence of autoimmunity in a subset of those with primary OCD. Further experimental studies are needed to ascertain whether this relationship is causal.
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Affiliation(s)
- Daniel M Pearlman
- Daniel M. Pearlman, MPH, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Haily S. Vora, MPH, Brian G. Marquis, MS,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Souhel Najjar, MD, Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Lauren A. Dudley, MD, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and Section of Rheumatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Haily S Vora
- Daniel M. Pearlman, MPH, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Haily S. Vora, MPH, Brian G. Marquis, MS,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Souhel Najjar, MD, Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Lauren A. Dudley, MD, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and Section of Rheumatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Brian G Marquis
- Daniel M. Pearlman, MPH, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Haily S. Vora, MPH, Brian G. Marquis, MS,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Souhel Najjar, MD, Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Lauren A. Dudley, MD, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and Section of Rheumatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Souhel Najjar
- Daniel M. Pearlman, MPH, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Haily S. Vora, MPH, Brian G. Marquis, MS,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Souhel Najjar, MD, Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Lauren A. Dudley, MD, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and Section of Rheumatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Lauren A Dudley
- Daniel M. Pearlman, MPH, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, and Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Haily S. Vora, MPH, Brian G. Marquis, MS,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Souhel Najjar, MD, Neuroinflammation Research Group, Epilepsy Center Division, Department of Neurology, NYU School of Medicine, New York; Lauren A. Dudley, MD, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, and Section of Rheumatology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Lapidus KAB, Stern ER, Berlin HA, Goodman WK. Neuromodulation for obsessive-compulsive disorder. Neurotherapeutics 2014; 11:485-95. [PMID: 24981434 PMCID: PMC4121444 DOI: 10.1007/s13311-014-0287-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Neuromodulation shows increasing promise in the treatment of psychiatric disorders, particularly obsessive-compulsive disorder (OCD). Development of tools and techniques including deep brain stimulation, transcranial magnetic stimulation, and electroconvulsive therapy may yield additional options for patients who fail to respond to standard treatments. This article reviews the motivation for and use of these treatments in OCD. We begin with a brief description of the illness followed by discussion of the circuit models thought to underlie the disorder. These circuits provide targets for intervention. Basal ganglia and talamocortical pathophysiology, including cortico-striato-thalamo-cortical loops is a focus of this discussion. Neuroimaging findings and historical treatments that led to the use of neuromodulation for OCD are presented. We then present evidence from neuromodulation studies using deep brain stimulation, electroconvulsive therapy, and transcranial magnetic stimulation, with targets including nucleus accumbens, subthalamic nucleus inferior thalamic peduncle, dorsolateral prefrontal cortex, supplementary motor area, and orbitofrontal cortex. Finally, we explore potential future neuromodulation approaches that may further refine and improve treatment.
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Affiliation(s)
- Kyle A B Lapidus
- Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY, 10029, USA,
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Bastin J, Polosan M, Piallat B, Krack P, Bougerol T, Chabardès S, David O. Changes of oscillatory activity in the subthalamic nucleus during obsessive-compulsive disorder symptoms: two case reports. Cortex 2014; 60:145-50. [PMID: 24552693 DOI: 10.1016/j.cortex.2013.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 08/26/2013] [Accepted: 12/13/2013] [Indexed: 11/20/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has positive and negative effects on mood and cognition, as shown in patients suffering from Parkinson's disease (PD) and severe obsessive-compulsive disorders (OCD). Such behavioural and clinical effects suggest that the STN has an important function in limbic circuitry, which still needs to be clarified from electrophysiological recordings. Here we report two exceptional cases of OCD patients in whom local field potentials (LFP) of the anterior STN were directly recorded during acute obsessive-compulsive symptoms. We found significant symptom-related changes in different frequency bands, with no clear preferential oscillatory pattern. The overall modified STN activity during OCD symptoms suggests a mixture of both pathological and compensatory mechanisms that would reflect the maintenance of an over stable motor/cognitive/emotional set. Whether this activity propagates throughout the entire cognitive-limbic loops that are impaired in OCD is an interesting question for future research in larger series of patients.
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Affiliation(s)
- Julien Bastin
- Fonctions Cérébrales et Neuromodulation, Université Joseph Fourier, Grenoble, France; Grenoble Institut des Neurosciences, INSERM, U836, Grenoble, France.
| | - Mircea Polosan
- Fonctions Cérébrales et Neuromodulation, Université Joseph Fourier, Grenoble, France; Grenoble Institut des Neurosciences, INSERM, U836, Grenoble, France; Clinique de Psychiatrie, Pôle Neurologie Psychiatrie, Centre Hospitalier Universitaire, Grenoble, France
| | - Brigitte Piallat
- Fonctions Cérébrales et Neuromodulation, Université Joseph Fourier, Grenoble, France; Grenoble Institut des Neurosciences, INSERM, U836, Grenoble, France
| | - Paul Krack
- Fonctions Cérébrales et Neuromodulation, Université Joseph Fourier, Grenoble, France; Grenoble Institut des Neurosciences, INSERM, U836, Grenoble, France; Clinique de Neurologie, Pôle Neurologie Psychiatrie, Centre Hospitalier Universitaire, Grenoble, France
| | - Thierry Bougerol
- Clinique de Psychiatrie, Pôle Neurologie Psychiatrie, Centre Hospitalier Universitaire, Grenoble, France
| | - Stéphan Chabardès
- Fonctions Cérébrales et Neuromodulation, Université Joseph Fourier, Grenoble, France; Grenoble Institut des Neurosciences, INSERM, U836, Grenoble, France; Clinique de Neurochirurgie, Pôle Tête et Cou, Centre Hospitalier Universitaire, Grenoble, France
| | - Olivier David
- Fonctions Cérébrales et Neuromodulation, Université Joseph Fourier, Grenoble, France; Grenoble Institut des Neurosciences, INSERM, U836, Grenoble, France
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Carron R, Chaillet A, Filipchuk A, Pasillas-Lépine W, Hammond C. Closing the loop of deep brain stimulation. Front Syst Neurosci 2013; 7:112. [PMID: 24391555 PMCID: PMC3868949 DOI: 10.3389/fnsys.2013.00112] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 11/28/2013] [Indexed: 01/20/2023] Open
Abstract
High-frequency deep brain stimulation is used to treat a wide range of brain disorders, like Parkinson's disease. The stimulated networks usually share common electrophysiological signatures, including hyperactivity and/or dysrhythmia. From a clinical perspective, HFS is expected to alleviate clinical signs without generating adverse effects. Here, we consider whether the classical open-loop HFS fulfills these criteria and outline current experimental or theoretical research on the different types of closed-loop DBS that could provide better clinical outcomes. In the first part of the review, the two routes followed by HFS-evoked axonal spikes are explored. In one direction, orthodromic spikes functionally de-afferent the stimulated nucleus from its downstream target networks. In the opposite direction, antidromic spikes prevent this nucleus from being influenced by its afferent networks. As a result, the pathological synchronized activity no longer propagates from the cortical networks to the stimulated nucleus. The overall result can be described as a reversible functional de-afferentation of the stimulated nucleus from its upstream and downstream nuclei. In the second part of the review, the latest advances in closed-loop DBS are considered. Some of the proposed approaches are based on mathematical models, which emphasize different aspects of the parkinsonian basal ganglia: excessive synchronization, abnormal firing-rate rhythms, and a deficient thalamo-cortical relay. The stimulation strategies are classified depending on the control-theory techniques on which they are based: adaptive and on-demand stimulation schemes, delayed and multi-site approaches, stimulations based on proportional and/or derivative control actions, optimal control strategies. Some of these strategies have been validated experimentally, but there is still a large reservoir of theoretical work that may point to ways of improving practical treatment.
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Affiliation(s)
- Romain Carron
- Aix Marseille Université UMR 901 Marseille, France ; Institut national de la Recherche Médicale et de la Santé Inserm, INMED UMR 901 Marseille, France ; APHM, Hopital de la Timone, Service de Neurochirurgie Fonctionnelle et Stereotaxique Marseille, France
| | - Antoine Chaillet
- Laboratoire des Signaux et Systèmes(L2S), CNRS UMR 8506 Gif-sur-Yvette, France ; Université Paris Sud 11, UMR 8506, Supélec Gif-sur-Yvette, France
| | - Anton Filipchuk
- Aix Marseille Université UMR 901 Marseille, France ; Institut national de la Recherche Médicale et de la Santé Inserm, INMED UMR 901 Marseille, France
| | - William Pasillas-Lépine
- Laboratoire des Signaux et Systèmes(L2S), CNRS UMR 8506 Gif-sur-Yvette, France ; Centre national de la recherche scientifique Paris, France
| | - Constance Hammond
- Aix Marseille Université UMR 901 Marseille, France ; Institut national de la Recherche Médicale et de la Santé Inserm, INMED UMR 901 Marseille, France
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Tierney TS, Abd-El-Barr MM, Stanford AD, Foote KD, Okun MS. Deep brain stimulation and ablation for obsessive compulsive disorder: evolution of contemporary indications, targets and techniques. Int J Neurosci 2013; 124:394-402. [PMID: 24099662 DOI: 10.3109/00207454.2013.852086] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Surgical therapy for treatment-resistant obsessive compulsive disorder (OCD) remains an effective option for well-selected patients managed within a multidisciplinary setting. Historically, lesions within the limbic system have been used to control both obsessive thoughts and repetitive compulsions associated with this disease. We discuss classical targets as well as contemporary neuromodulatory approaches that have been shown to provide symptomatic relief. Recently, deep brain stimulation (DBS) of the anterior limb of the internal capsule/ventral striatum received Conformité Européene (CE) mark and Food and Drug Administration (FDA) approvals for treatment of intractable OCD. Remarkably, this is the first such approval for neurosurgical intervention in a strictly psychiatric indication in modern times. This target is discussed in detail along with alternative targets currently being proposed. We close with a discussion of gamma knife capsulotomy, a modality with deep historical roots. Further directions in the surgical treatment of OCD will require better preoperative predictors of postoperative responses, optimal selection of individualized targets, and rigorous reporting of adverse events and standardized outcomes. To meet these challenges, centers must be equipped with a multidisciplinary team and patient-centered approach to ensure adequate screening and follow up of patients with this difficult-to-treat condition.
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Affiliation(s)
- Travis S Tierney
- 1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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59
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Karas PJ, Mikell CB, Christian E, Liker MA, Sheth SA. Deep brain stimulation: a mechanistic and clinical update. Neurosurg Focus 2013; 35:E1. [DOI: 10.3171/2013.9.focus13383] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Deep brain stimulation (DBS), the practice of placing electrodes deep into the brain to stimulate subcortical structures with electrical current, has been increasing as a neurosurgical procedure over the past 15 years. Originally a treatment for essential tremor, DBS is now used and under investigation across a wide spectrum of neurological and psychiatric disorders. In addition to applying electrical stimulation for clinical symptomatic relief, the electrodes implanted can also be used to record local electrical activity in the brain, making DBS a useful research tool. Human single-neuron recordings and local field potentials are now often recorded intraoperatively as electrodes are implanted. Thus, the increasing scope of DBS clinical applications is being matched by an increase in investigational use, leading to a rapidly evolving understanding of cortical and subcortical neurocircuitry. In this review, the authors discuss recent innovations in the clinical use of DBS, both in approved indications as well as in indications under investigation. Deep brain stimulation as an investigational tool is also reviewed, paying special attention to evolving models of basal ganglia and cortical function in health and disease. Finally, the authors look to the future across several indications, highlighting gaps in knowledge and possible future directions of DBS treatment.
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Affiliation(s)
- Patrick J. Karas
- 1Department of Neurosurgery, The Neurological Institute, Columbia University Medical Center, New York, New York; and
| | - Charles B. Mikell
- 1Department of Neurosurgery, The Neurological Institute, Columbia University Medical Center, New York, New York; and
| | - Eisha Christian
- 2Department of Neurosurgery, Keck Hospital of the University of Southern California, Los Angeles, California
| | - Mark A. Liker
- 2Department of Neurosurgery, Keck Hospital of the University of Southern California, Los Angeles, California
| | - Sameer A. Sheth
- 1Department of Neurosurgery, The Neurological Institute, Columbia University Medical Center, New York, New York; and
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Lai HY, Younce JR, Albaugh DL, Kao YCJ, Shih YYI. Functional MRI reveals frequency-dependent responses during deep brain stimulation at the subthalamic nucleus or internal globus pallidus. Neuroimage 2013; 84:11-8. [PMID: 23988274 DOI: 10.1016/j.neuroimage.2013.08.026] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/20/2013] [Accepted: 08/13/2013] [Indexed: 11/15/2022] Open
Abstract
Deep brain stimulation (DBS) represents a widely used therapeutic tool for the symptomatic treatment of movement disorders, most commonly Parkinson's disease (PD). High frequency stimulation at both the subthalamic nucleus (STN) and internal globus pallidus (GPi) has been used with great success for the symptomatic treatment of PD, although the therapeutic mechanisms of action remain elusive. To better understand how DBS at these target sites modulates neural circuitry, the present study used functional blood-oxygenation-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to map global brain responses to DBS at the STN and GPi of the rat. Robust activation centered in the ipsilateral motor cortex was observed during high frequency stimulation at either target site, with peak responses observed at a stimulation frequency of 100Hz. Of note, frequency tuning curves were generated, demonstrating that cortical activation was maximal at clinically-relevant stimulation frequencies. Divergent responses to stimulation were noted in the contralateral hemisphere, with strong cortical and striatal negative BOLD signal during stimulation of the GPi, but not STN. The frequency-dependence of the observed motor cortex activation at both targets suggests a relationship with the therapeutic effects of STN and GPi DBS, with both DBS targets being functionally connected with motor cortex at therapeutic stimulation frequencies.
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Affiliation(s)
- Hsin-Yi Lai
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA; Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
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The organization of prefrontal-subthalamic inputs in primates provides an anatomical substrate for both functional specificity and integration: implications for Basal Ganglia models and deep brain stimulation. J Neurosci 2013; 33:4804-14. [PMID: 23486951 DOI: 10.1523/jneurosci.4674-12.2013] [Citation(s) in RCA: 369] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The identification of a hyperdirect cortico-subthalamic nucleus connection highlighted the important role of the subthalamic nucleus (STN) in regulating behavior. However, this pathway was shown primarily from motor areas. Hyperdirect pathways associated with cognitive and motivational cortical regions are particularly relevant given recent data from deep brain stimulation, both for neurologic and psychiatric disorders. Our experiments were designed to demonstrate the existence and organization of prefrontal-STN projections, help delineate the "limbic" STN, and determine whether convergence between cortico-STN fibers from functionally diverse cortical areas exists in the STN. We injected anterograde tracers in the ventromedial prefrontal, orbitofrontal, anterior cingulate, and dorsal prefrontal cortices of Macaca nemestrina and Macaca fascicularis to analyze the organization of terminals and passing fibers in the STN. Results show a topographically organized prefrontal hyperdirect pathway in primates. Limbic areas project to the medial tip of the nucleus, straddling its border and extending into the lateral hypothalamus. Associative areas project to the medial half, motor areas to the lateral half. Limbic projections terminated primarily rostrally and motor projections more caudally. The extension of limbic projections into the lateral hypothalamus, suggests that this region be included in the STN. A high degree of convergence exists between projections from functionally diverse cortical areas, creating potentially important interfaces between terminal fields. Taken together, the results provide an anatomical substrate to extend the role of the hyperdirect pathway in models of basal ganglia function, and new keys for understanding deep brain stimulation effects on cognitive and motivational aspects of behavior.
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Burbaud P, Clair AH, Langbour N, Fernandez-Vidal S, Goillandeau M, Michelet T, Bardinet E, Chéreau I, Durif F, Polosan M, Chabardès S, Fontaine D, Magnié-Mauro MN, Houeto JL, Bataille B, Millet B, Vérin M, Baup N, Krebs MO, Cornu P, Pelissolo A, Arbus C, Simonetta-Moreau M, Yelnik J, Welter ML, Mallet L. Neuronal activity correlated with checking behaviour in the subthalamic nucleus of patients with obsessive-compulsive disorder. ACTA ACUST UNITED AC 2013; 136:304-17. [PMID: 23365104 DOI: 10.1093/brain/aws306] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Doubt, and its behavioural correlate, checking, is a normal phenomenon of human cognition that is dramatically exacerbated in obsessive-compulsive disorder. We recently showed that deep brain stimulation in the associative-limbic area of the subthalamic nucleus, a central core of the basal ganglia, improved obsessive-compulsive disorder. To understand the physiological bases of symptoms in such patients, we recorded the activity of individual neurons in the therapeutic target during surgery while subjects performed a cognitive task that gave them the possibility of unrestricted repetitive checking after they had made a choice. We postulated that the activity of neurons in this region could be influenced by doubt and checking behaviour. Among the 63/87 task-related neurons recorded in 10 patients, 60% responded to various combinations of instructions, delay, movement or feedback, thus highlighting their role in the integration of different types of information. In addition, task-related activity directed towards decision-making increased during trials with checking in comparison with those without checking. These results suggest that the associative-limbic subthalamic nucleus plays a role in doubt-related repetitive thoughts. Overall, our results not only provide new insight into the role of the subthalamic nucleus in human cognition but also support the fact that subthalamic nucleus modulation by deep brain stimulation reduced compulsive behaviour in patients with obsessive-compulsive disorder.
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Affiliation(s)
- Pierre Burbaud
- Institut des Maladies Neurodégénératives, CNRS UMR5293, Université Victor Segalen, 146, rue Léo Saignat, 33076 Bordeaux, France.
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Haynes WIA, Millet B, Mallet L. [Obsessive-compulsive disorder, a new model of basal ganglia dysfunction? Elements from deep brain stimulation studies]. Rev Neurol (Paris) 2012; 168:649-54. [PMID: 22898561 DOI: 10.1016/j.neurol.2012.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 05/25/2012] [Indexed: 11/25/2022]
Abstract
Deep brain stimulation was first developed for movement disorders but is now being offered as a therapeutic alternative in severe psychiatric disorders after the failure of conventional therapies. One of such pathologies is obsessive-compulsive disorder. This disorder which associates intrusive thoughts (obsessions) and repetitive irrepressible rituals (compulsions) is characterized by a dysfunction of a cortico-subcortical loop. After having reviewed the pathophysiological evidence to show why deep brain stimulation was an interesting path to take for severe and resistant cases of obsessive-compulsive disorder, we will present the results of the different clinical trials. Finally, we will provide possible mechanisms for the effects of deep brain stimulation in this pathology.
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Affiliation(s)
- W I A Haynes
- Team Behaviour Emotion and Basal Ganglia, centre de recherche de l'institut du cerveau et de la moelle épinière (CRICM), Inserm US975, CNRS 7225, UPMC, bâtiment ICM, Paris cedex, France.
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Chabardès S, Polosan M, Krack P, Bastin J, Krainik A, David O, Bougerol T, Benabid AL. Deep brain stimulation for obsessive-compulsive disorder: subthalamic nucleus target. World Neurosurg 2012; 80:S31.e1-8. [PMID: 22469523 DOI: 10.1016/j.wneu.2012.03.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2011] [Revised: 02/19/2012] [Accepted: 03/28/2012] [Indexed: 01/11/2023]
Abstract
Because of its reversibility and adaptability, deep brain stimulation (DBS) has recently gained interest in psychiatric disorders, such as obsessive-compulsive disorders (OCD) and depression. In OCD, DBS is now an alternative procedure to lesions of fascicles such as the anterior capsule, which links the orbitofrontal cortex, the cingulum, and the thalamus, and has been applied to new target such as the nucleus accumbens, with promising results. However, a recent interest has been developed toward the subthalamic nucleus (STN), a key structure of the basal ganglia that connects the motor, limbic, and associative systems. It is known from patients with Parkinson disease that STN-DBS can have significant effects on mood and cognition. Those transient effects are usually seen as "side effects" in Parkinson disease, but are clues to the underappreciated role that STN plays in the limbic circuitry, a role whose precise details are as yet unknown and under active investigation. We present the rationale supporting the use of nonmotor STN as a therapeutic target to treat OCD. In particular, we discuss the recent experience and preliminary results of our group after 6 months of nonmotor STN-DBS in patients with severe OCD.
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Affiliation(s)
- Stéphan Chabardès
- Université Joseph Fourier, Grenoble, France; Clinique de Neurochirurgie, Centre Hospitalier Universitaire, Grenoble, France; INSERM U836, Grenoble Institut des Neurosciences, Grenoble, France.
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Baunez C, Yelnik J, Mallet L. Six questions on the subthalamic nucleus: lessons from animal models and from stimulated patients. Neuroscience 2011; 198:193-204. [PMID: 22001680 DOI: 10.1016/j.neuroscience.2011.09.059] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 09/22/2011] [Accepted: 09/26/2011] [Indexed: 01/08/2023]
Affiliation(s)
- C Baunez
- Laboratoire de Neurobiologie de la Cognition-LNC, UMR6155 Centre National de la Recherche Scientifique-CNRS, 3 Place Victor Hugo, F-13000 Marseille, France.
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