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DBS-evoked cortical responses index optimal contact orientations and motor outcomes in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:37. [PMID: 36906723 PMCID: PMC10008535 DOI: 10.1038/s41531-023-00474-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 02/13/2023] [Indexed: 03/13/2023] Open
Abstract
Although subthalamic deep brain stimulation (DBS) is a highly-effective treatment for alleviating motor dysfunction in patients with Parkinson's disease (PD), clinicians currently lack reliable neurophysiological correlates of clinical outcomes for optimizing DBS parameter settings, which may contribute to treatment inefficacies. One parameter that could aid DBS efficacy is the orientation of current administered, albeit the precise mechanisms underlying optimal contact orientations and associated clinical benefits are not well understood. Herein, 24 PD patients received monopolar stimulation of the left STN during magnetoencephalography and standardized movement protocols to interrogate the directional specificity of STN-DBS current administration on accelerometer metrics of fine hand movements. Our findings demonstrate that optimal contact orientations elicit larger DBS-evoked cortical responses in the ipsilateral sensorimotor cortex, and importantly, are differentially predictive of smoother movement profiles in a contact-dependent manner. Moreover, we summarize traditional evaluations of clinical efficacy (e.g., therapeutic windows, side effects) for a comprehensive review of optimal/non-optimal STN-DBS contact settings. Together, these data suggest that DBS-evoked cortical responses and quantitative movement outcomes may provide clinical insight for characterizing the optimal DBS parameters necessary for alleviating motor symptoms in patients with PD in the future.
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Sun S, Wang X, Shi X, Fang H, Sun Y, Li M, Han H, He Q, Wang X, Zhang X, Zhu ZW, Chen F, Wang M. Neural pathway connectivity and discharge changes between M1 and STN in hemiparkinsonian rats. Brain Res Bull 2023; 196:1-19. [PMID: 36878325 DOI: 10.1016/j.brainresbull.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 03/07/2023]
Abstract
Alterations of electrophysiological activities, such as changed spike firing rates, reshaping the firing patterns, and aberrant frequency oscillations between the subthalamic nucleus (STN) and the primary motor cortex (M1), are thought to contribute to motor impairment in Parkinson's disease (PD). However, the alterations of electrophysiological characteristics of STN and M1 in PD are still unclear, especially under specific treadmill movement. To examine the relationship between electrophysiological activity in the STN-M1 pathway, extracellular spike trains and local field potential (LFPs) of STN and M1 were simultaneously recorded during resting and movement in unilateral 6-hydroxydopamine (6-OHDA) lesioned rats. The results showed that the identified STN neurons and M1 neurons exhibited abnormal neuronal activity after dopamine loss. The dopamine depletion altered the LFP power in STN and M1 whatever in rest or movement states. Furthermore, the enhanced synchronization of LFP oscillations after dopamine loss was found in 12-35 Hz (beta frequencies) between the STN and M1 during rest and movement. In addition, STN neurons were phase-locked firing to M1 oscillations at 12-35 Hz during rest epochs in 6-OHDA lesioned rats. The dopamine depletion also impaired the anatomical connectivity between the M1 and STN by injecting anterograde neuroanatomical tracing virus into M1 in control and PD rats. Collectively, impairment of' electrophysiological activity and anatomical connectivity in the M1-STN pathway may be the basis for dysfunction of the cortico-basal ganglia circuit, correlating with motor symptoms of PD.
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Affiliation(s)
- Shuang Sun
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China
| | - Xuenan Wang
- Shandong Institute of Brain Science and Brain-inspired Research, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan 250117, China
| | - Xiaoman Shi
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China
| | - Heyi Fang
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China
| | - Yue Sun
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China
| | - Min Li
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China
| | - Hongyu Han
- Weifang Middle School, Weifang 261031, China
| | - Qin He
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China
| | - Xiaojun Wang
- The First Hospital Affiliated with Shandong First Medicine University, Jinan 250014, China
| | - Xiao Zhang
- Editorial Department of Journal, Shandong Jianzhu University, Jinan 250014, China
| | - Zhi Wei Zhu
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China
| | - Feiyu Chen
- School of International Education, Qilu University of Technology, Jinan 250014, China.
| | - Min Wang
- Key Laboratory of Animal Resistance Biology of Shandong Province, College of Life Science, Shandong Normal University, 88# Wenhua Road, Jinan 250014, China.
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Wiest C, He S, Duchet B, Pogosyan A, Benjaber M, Denison T, Hasegawa H, Ashkan K, Baig F, Bertaina I, Morgante F, Pereira EA, Torrecillos F, Tan H. Evoked resonant neural activity in subthalamic local field potentials reflects basal ganglia network dynamics. Neurobiol Dis 2023; 178:106019. [PMID: 36706929 PMCID: PMC7614125 DOI: 10.1016/j.nbd.2023.106019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
Evoked resonant neural activity (ERNA) is induced by subthalamic deep brain stimulation (DBS) and was recently suggested as a marker of lead placement and contact selection in Parkinson's disease. Yet, its underlying mechanisms and how it is modulated by stimulation parameters are unclear. Here, we recorded local field potentials from 27 Parkinson's disease patients, while leads were externalised to scrutinise the ERNA. First, we show that ERNA in the time series waveform and spectrogram likely represent the same activity, which was contested before. Second, our results show that the ERNA has fast and slow dynamics during stimulation, consistent with the synaptic failure hypothesis. Third, we show that ERNA parameters are modulated by different DBS frequencies, intensities, medication states and stimulation modes (continuous DBS vs. adaptive DBS). These results suggest the ERNA might prove useful as a predictor of the best DBS frequency and lowest effective intensity in addition to contact selection. Changes with levodopa and DBS mode suggest that the ERNA may indicate the state of the cortico-basal ganglia circuit making it a putative biomarker to track clinical state in adaptive DBS.
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Affiliation(s)
- Christoph Wiest
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shenghong He
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Benoit Duchet
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Moaad Benjaber
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Timothy Denison
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Harutomo Hasegawa
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital, Denmark Hill, London, UK
| | - Fahd Baig
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK,Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George’s, University of London, London, UK
| | - Ilaria Bertaina
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George’s, University of London, London, UK,Neurology Department, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George’s, University of London, London, UK
| | - Erlick A. Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George’s, University of London, London, UK
| | - Flavie Torrecillos
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
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Xie Y, Zhang H, Pan Y, Chai Y. Combined effect of stimulation and electromagnetic induction on absence seizure inhibition in coupled thalamocortical circuits. Eur J Neurosci 2023; 57:867-879. [PMID: 36696966 DOI: 10.1111/ejn.15923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Abstract
Deep brain stimulation (DBS) and electromagnetic induction are new techniques that are increasingly used in modern epilepsy treatments; however, the mechanism of action remains unclear. In this study, we constructed a bidirectional-coupled cortico-thalamic model, based on which we proposed three regulation schemes: isolated regulation of DBS, isolated regulation of electromagnetic induction and combined regulation of the previous two. In particular, we introduced DBS with a lower amplitude and considered the influence of electromagnetic induction caused by the transmembrane current on the membrane potential. The most striking finding of this study is that the three therapeutic schemes could effectively control abnormal discharge, and combined regulation could reduce the occurrence of epileptic seizures more effectively. The present study bridges the gap between the bidirectional coupling model and combined control. In this way, the damage induced by electrical stimulation of the patient's brain tissue could be reduced, and the abnormal physiological discharge pattern of the cerebral cortex was simultaneously regulated by different techniques. This work opens new avenues for improving brain dysfunction in patients with epilepsy, expands ideas for promoting the development of neuroscience and is meaningful for improving the health of modern society and developing the field of science.
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Affiliation(s)
- Yan Xie
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, China
| | - Hudong Zhang
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, China
| | - Yufeng Pan
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, China
| | - Yuan Chai
- School of Mathematics and Physics, Shanghai University of Electric Power, Shanghai, China
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Wiest C, Morgante F, Torrecillos F, Pogosyan A, He S, Baig F, Bertaina I, Hart MG, Edwards MJ, Pereira EA, Tan H. Subthalamic Nucleus Stimulation-Induced Local Field Potential Changes in Dystonia. Mov Disord 2023; 38:423-434. [PMID: 36562479 PMCID: PMC7614354 DOI: 10.1002/mds.29302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) stimulation is an effective treatment for Parkinson's disease and induced local field potential (LFP) changes that have been linked with clinical improvement. STN stimulation has also been used in dystonia although the internal globus pallidus is the standard target where theta power has been suggested as a physiomarker for adaptive stimulation. OBJECTIVE We aimed to explore if enhanced theta power was also present in STN and if stimulation-induced spectral changes that were previously reported for Parkinson's disease would occur in dystonia. METHODS We recorded LFPs from 7 patients (12 hemispheres) with isolated craniocervical dystonia whose electrodes were placed such that inferior, middle, and superior contacts covered STN, zona incerta, and thalamus. RESULTS We did not observe prominent theta power in STN at rest. STN stimulation induced similar spectral changes in dystonia as in Parkinson's disease, such as broadband power suppression, evoked resonant neural activity (ERNA), finely-tuned gamma oscillations, and an increase in aperiodic exponents in STN-LFPs. Both power suppression and ERNA localize to STN. Based on this, single-pulse STN stimulation elicits evoked neural activities with largest amplitudes in STN, which are relayed to the zona incerta and thalamus with changing characteristics as the distance from STN increases. CONCLUSIONS Our results show that STN stimulation-induced spectral changes are a nondisease-specific response to high-frequency stimulation, which can serve as placement markers for STN. This broadens the scope of STN stimulation and makes it an option for other disorders with excessive oscillatory peaks in STN. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Christoph Wiest
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital, University of OxfordOxfordUnited Kingdom
| | - Francesca Morgante
- Neurosciences Research CentreMolecular and Clinical Sciences Institute, St. George's, University of LondonLondonUnited Kingdom
| | - Flavie Torrecillos
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital, University of OxfordOxfordUnited Kingdom
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital, University of OxfordOxfordUnited Kingdom
| | - Shenghong He
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital, University of OxfordOxfordUnited Kingdom
| | - Fahd Baig
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital, University of OxfordOxfordUnited Kingdom
- Neurosciences Research CentreMolecular and Clinical Sciences Institute, St. George's, University of LondonLondonUnited Kingdom
| | - Ilaria Bertaina
- Neurosciences Research CentreMolecular and Clinical Sciences Institute, St. George's, University of LondonLondonUnited Kingdom
| | - Michael G. Hart
- Neurosciences Research CentreMolecular and Clinical Sciences Institute, St. George's, University of LondonLondonUnited Kingdom
| | - Mark J. Edwards
- Institute of Psychiatry, Psychology and NeurosciencesKing's College LondonLondonUnited Kingdom
| | - Erlick A. Pereira
- Neurosciences Research CentreMolecular and Clinical Sciences Institute, St. George's, University of LondonLondonUnited Kingdom
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical NeurosciencesJohn Radcliffe Hospital, University of OxfordOxfordUnited Kingdom
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Hell F, Eißner A, Mehrkens JH, Bötzel K. Subthalamic oscillatory activity during normal and impaired speech. Clin Neurophysiol 2023; 149:42-50. [PMID: 36893498 DOI: 10.1016/j.clinph.2023.02.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/16/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE We studied the relationship between oscillatory activity in the subthalamic nucleus (STN) and speech production in order to better understand the functional role of the STN. METHODS We simultaneously recorded subthalamic local field potentials and audio recordings from 5 patients with Parkinson's disease while they performed verbal fluency tasks. We then analyzed the oscillatory signals present in the subthalamic nucleus during these tasks. RESULTS We report that normal speech leads to a suppression of subthalamic alpha and beta power. Contrarily, a patient with motor blocks during speech initiation showed a low beta power increase. We also report an increase in error rates in the phonemic non-alternating verbal fluency task during deep brain stimulation (DBS). CONCLUSIONS We confirm previous findings that intact speech leads to desynchronization in the beta range in the STN. The speech related narrowband beta power increase in a patient with speech problems suggests that exaggerated synchronization in this frequency band is associated with motor blocks during speech initiation. The increased number of errors in verbal fluency tasks during DBS might be caused by an impairment of the response inhibition network caused by stimulation of the STN. SIGNIFICANCE We suggest that the inability to attenuate beta activity during motor processes is associated with motor freezing across motor behaviours such as speech and gait, as previously shown for freezing of gait.
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Affiliation(s)
- Franz Hell
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Grosshadernerstr. 2, 82152 Martinsried, Germany.
| | - Annika Eißner
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377 Munich, Germany; Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Grosshadernerstr. 2, 82152 Martinsried, Germany
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57
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Wiest C, Torrecillos F, Pogosyan A, Bange M, Muthuraman M, Groppa S, Hulse N, Hasegawa H, Ashkan K, Baig F, Morgante F, Pereira EA, Mallet N, Magill PJ, Brown P, Sharott A, Tan H. The aperiodic exponent of subthalamic field potentials reflects excitation/inhibition balance in Parkinsonism. eLife 2023; 12:e82467. [PMID: 36810199 PMCID: PMC10005762 DOI: 10.7554/elife.82467] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
Periodic features of neural time-series data, such as local field potentials (LFPs), are often quantified using power spectra. While the aperiodic exponent of spectra is typically disregarded, it is nevertheless modulated in a physiologically relevant manner and was recently hypothesised to reflect excitation/inhibition (E/I) balance in neuronal populations. Here, we used a cross-species in vivo electrophysiological approach to test the E/I hypothesis in the context of experimental and idiopathic Parkinsonism. We demonstrate in dopamine-depleted rats that aperiodic exponents and power at 30-100 Hz in subthalamic nucleus (STN) LFPs reflect defined changes in basal ganglia network activity; higher aperiodic exponents tally with lower levels of STN neuron firing and a balance tipped towards inhibition. Using STN-LFPs recorded from awake Parkinson's patients, we show that higher exponents accompany dopaminergic medication and deep brain stimulation (DBS) of STN, consistent with untreated Parkinson's manifesting as reduced inhibition and hyperactivity of STN. These results suggest that the aperiodic exponent of STN-LFPs in Parkinsonism reflects E/I balance and might be a candidate biomarker for adaptive DBS.
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Affiliation(s)
- Christoph Wiest
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Flavie Torrecillos
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Manuel Bange
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Natasha Hulse
- Department of Neurosurgery, King's College LondonLondonUnited Kingdom
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College LondonLondonUnited Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College LondonLondonUnited Kingdom
| | - Fahd Baig
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George' s, University of LondonLondonUnited Kingdom
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George' s, University of LondonLondonUnited Kingdom
| | - Erlick A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George' s, University of LondonLondonUnited Kingdom
| | - Nicolas Mallet
- Institut des Maladies Neurodégénératives, CNRS UMR5293, Université de BordeauxBordeauxFrance
| | - Peter J Magill
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Andrew Sharott
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
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Anderson AJ, Perone S. Predicting individual differences in behavioral activation and behavioral inhibition from functional networks in the resting EEG. Biol Psychol 2023; 177:108483. [PMID: 36587892 DOI: 10.1016/j.biopsycho.2022.108483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 12/09/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022]
Abstract
The behavioral activation system (BAS) and behavioral inhibition system (BIS) are thought to underly affective dispositions and self-regulatory processes. The BAS is sensitive to reward and involved in approach behaviors, and the BIS is sensitive to punishment and involved in avoidance behaviors. Trait BAS and BIS relate to distinct behavioral profiles and neural activity, but little is known about how trait BAS and BIS relate to functional networks in EEG. We applied a data-driven method called connectome predictive modeling (CPM) to identify networks relating to trait BAS and BIS and tested whether the strength of those networks predicted trait BAS and BIS in novel subjects using a leave-one-out cross-validation procedure. Adult participants (N = 107) completed a resting state task with eyes closed and eyes open, and trait BAS and BIS were measured via Carver and White's (1994) BIS and BAS scales. We hypothesized distinct positive (more synchronization) and negative (less synchronization) networks would relate to trait BAS and BIS. For eyes closed, we identified two negative networks, one in theta and one in alpha predicted BIS. We identified three positive networks, one in theta and one in beta predicted Fun Seeking and one in theta predicted Drive. For eyes open, negative theta and alpha networks predicted BIS, a positive theta network predicted Fun Seeking, and a negative gamma network predicted mean BAS. Visualization of the networks are presented. Discussion centers on the observed networks and how to advance application of CPM to EEG, including with clinical implications.
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Affiliation(s)
- Alana J Anderson
- Department of Human Development, Washington State University, USA.
| | - Sammy Perone
- Department of Human Development, Washington State University, USA
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Effects of Contralateral Deep Brain Stimulation and Levodopa on Subthalamic Nucleus Oscillatory Activity and Phase-Amplitude Coupling. Neuromodulation 2023; 26:310-319. [PMID: 36513587 DOI: 10.1016/j.neurom.2022.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The modulatory effects of medication and deep brain stimulation (DBS) on subthalamic nucleus (STN) neural activity in Parkinson's disease have been widely studied. However, effects on the contralateral side to the stimulated STN, in particular, changes in local field potential (LFP) oscillatory activity and phase-amplitude coupling (PAC), have not yet been reported. OBJECTIVE The aim of this study was to examine changes in STN LFP activity across a range of frequency bands and STN PAC for different combinations of DBS and medication on/off on the side contralateral to the applied stimulation. MATERIALS AND METHODS We examined STN LFPs that were recorded using externalized leads from eight parkinsonian patients during unilateral DBS from the side contralateral to the stimulation. LFP spectral power in alpha (5 to ∼13 Hz), low beta (13 to ∼20 Hz), high beta (20-30 Hz), and high gamma plus high-frequency oscillation (high gamma+HFO) (100-400 Hz) bands were estimated for different combinations of medication and unilateral stimulation (off/on). PAC between beta and high gamma+HFO in the STN LFPs was also investigated. The effect of the condition was examined using linear mixed models. RESULTS PAC in the STN LFP was reduced by DBS when compared to the baseline condition (no medication and stimulation). Medication had no significant effect on PAC. Alpha power decreased with DBS, both alone and when combined with medication. Beta power decreased with DBS, medication, and DBS and medication combined. High gamma+HFO power increased during the application of contralateral DBS and was unaltered by medication. CONCLUSIONS The results provide new insights into the effects of DBS and levodopa on STN LFP PAC and oscillatory activity on the side contralateral to stimulation. These may have important implications in understanding mechanisms underlying motor improvements with DBS, including changes on both contralateral and ipsilateral sides, while suggesting a possible role for contralateral sensing during unilateral DBS.
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Darmani G, Drummond NM, Ramezanpour H, Saha U, Hoque T, Udupa K, Sarica C, Zeng K, Cortez Grippe T, Nankoo JF, Bergmann TO, Hodaie M, Kalia SK, Lozano AM, Hutchison WD, Fasano A, Chen R. Long-Term Recording of Subthalamic Aperiodic Activities and Beta Bursts in Parkinson's Disease. Mov Disord 2023; 38:232-243. [PMID: 36424835 DOI: 10.1002/mds.29276] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/19/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Local field potentials (LFPs) represent the summation of periodic (oscillations) and aperiodic (fractal) signals. Although previous studies showed changes in beta band oscillations and burst characteristics of the subthalamic nucleus (STN) in Parkinson's disease (PD), how aperiodic activity in the STN is related to PD pathophysiology is unknown. OBJECTIVES The study aimed to characterize the long-term effects of STN-deep brain stimulation (DBS) and dopaminergic medications on aperiodic activities and beta bursts. METHODS A total of 10 patients with PD participated in this longitudinal study. Simultaneous bilateral STN-LFP recordings were conducted in six separate visits during a period of 18 months using the Activa PC + S device in the off and on dopaminergic medication states. We used irregular-resampling auto-spectral analysis to separate oscillations and aperiodic components (exponent and offset) in the power spectrum of STN-LFP signals in beta band. RESULTS Our results revealed a systematic increase in both the exponent and the offset of the aperiodic spectrum over 18 months following the DBS implantation, independent of the dopaminergic medication state of patients with PD. In contrast, beta burst durations and amplitudes were stable over time and were suppressed by dopaminergic medications. CONCLUSIONS These findings indicate that oscillations and aperiodic activities reflect at least partially distinct yet complementary neural mechanisms, which should be considered in the design of robust biomarkers to optimize adaptive DBS. Given the link between increased gamma-aminobutyric acidergic (GABAergic) transmission and higher aperiodic activity, our findings suggest that long-term STN-DBS may relate to increased inhibition in the basal ganglia. © 2022 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Neil M Drummond
- Krembil Research Institute, University Health Network, Toronto, Canada
| | | | - Utpal Saha
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Tasnuva Hoque
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health & Neurosciences, Bengaluru, India
| | - Can Sarica
- Krembil Research Institute, University Health Network, Toronto, Canada
| | - Ke Zeng
- Krembil Research Institute, University Health Network, Toronto, Canada
| | | | | | - Til Ole Bergmann
- Neuroimaging Center, Johannes Gutenberg University Medical Center, Mainz, Germany
- Leibniz Institute for Resilience Research, Mainz, Germany
| | - Mojgan Hodaie
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Suneil K Kalia
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - William D Hutchison
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Canada
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, University Health Network, Toronto, Canada
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61
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Madadi Asl M, Valizadeh A, Tass PA. Decoupling of interacting neuronal populations by time-shifted stimulation through spike-timing-dependent plasticity. PLoS Comput Biol 2023; 19:e1010853. [PMID: 36724144 PMCID: PMC9891531 DOI: 10.1371/journal.pcbi.1010853] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/05/2023] [Indexed: 02/02/2023] Open
Abstract
The synaptic organization of the brain is constantly modified by activity-dependent synaptic plasticity. In several neurological disorders, abnormal neuronal activity and pathological synaptic connectivity may significantly impair normal brain function. Reorganization of neuronal circuits by therapeutic stimulation has the potential to restore normal brain dynamics. Increasing evidence suggests that the temporal stimulation pattern crucially determines the long-lasting therapeutic effects of stimulation. Here, we tested whether a specific pattern of brain stimulation can enable the suppression of pathologically strong inter-population synaptic connectivity through spike-timing-dependent plasticity (STDP). More specifically, we tested how introducing a time shift between stimuli delivered to two interacting populations of neurons can effectively decouple them. To that end, we first used a tractable model, i.e., two bidirectionally coupled leaky integrate-and-fire (LIF) neurons, to theoretically analyze the optimal range of stimulation frequency and time shift for decoupling. We then extended our results to two reciprocally connected neuronal populations (modules) where inter-population delayed connections were modified by STDP. As predicted by the theoretical results, appropriately time-shifted stimulation causes a decoupling of the two-module system through STDP, i.e., by unlearning pathologically strong synaptic interactions between the two populations. Based on the overall topology of the connections, the decoupling of the two modules, in turn, causes a desynchronization of the populations that outlasts the cessation of stimulation. Decoupling effects of the time-shifted stimulation can be realized by time-shifted burst stimulation as well as time-shifted continuous simulation. Our results provide insight into the further optimization of a variety of multichannel stimulation protocols aiming at a therapeutic reshaping of diseased brain networks.
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Affiliation(s)
- Mojtaba Madadi Asl
- School of Biological Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
- Pasargad Institute for Advanced Innovative Solutions (PIAIS), Tehran, Iran
| | - Alireza Valizadeh
- Pasargad Institute for Advanced Innovative Solutions (PIAIS), Tehran, Iran
- Department of Physics, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, Iran
| | - Peter A. Tass
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States of America
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Feldmann LK, Lofredi R, Al-Fatly B, Busch JL, Mathiopoulou V, Roediger J, Krause P, Schneider GH, Faust K, Horn A, Kühn AA, Neumann WJ. Christmas-Related Reduction in Beta Activity in Parkinson's Disease. Mov Disord 2023; 38:692-697. [PMID: 36718788 DOI: 10.1002/mds.29334] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/20/2022] [Accepted: 01/09/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) beta (13 - 35 Hz) activity is a biomarker reflecting motor state in Parkinson's disease (PD). Adaptive deep brain stimulation (DBS) aims to use beta activity for therapeutic adjustments, but many aspects of beta activity in real-life situations are unknown. OBJECTIVE The aim was to investigate Christmas-related influences on beta activity in PD. METHODS Differences in Christmas Day to nonfestive daily averages in chronic biomarker recordings in 4 PD patients with a sensing-enabled STN DBS implant were retrospectively analyzed. Sweet-spot and whole-brain network connectomic analyses were performed. RESULTS Beta activity was significantly reduced on Christmas Eve in all patients (4.00-9.00 p.m.: -12.30 ± 10.78%, P = 0.015). A sweet spot in the dorsolateral STN connected recording sites to motor, premotor, and supplementary motor cortices. CONCLUSIONS We demonstrate that festive events can reduce beta biomarker activity. We conclude that circadian and holiday-related changes should be considered when tailoring adaptive DBS algorithms to patient demands. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Lucia K Feldmann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Roxanne Lofredi
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Bassam Al-Fatly
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes L Busch
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Varvara Mathiopoulou
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Roediger
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Krause
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Katharina Faust
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA.,Center for Brain Circuit Therapeutics, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Charité University Medicine, Berlin, Germany.,NeuroCure Clinical Research Centre, Charité University Medicine, Berlin, Germany.,DZNE, German Center for Degenerative Diseases, Berlin, Germany
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Einstein Center for Neurosciences Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
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63
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Bahadori-Jahromi F, Salehi S, Madadi Asl M, Valizadeh A. Efficient suppression of parkinsonian beta oscillations in a closed-loop model of deep brain stimulation with amplitude modulation. Front Hum Neurosci 2023; 16:1013155. [PMID: 36776221 PMCID: PMC9908610 DOI: 10.3389/fnhum.2022.1013155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 12/09/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a movement disorder characterized by the pathological beta band (15-30 Hz) neural oscillations within the basal ganglia (BG). It is shown that the suppression of abnormal beta oscillations is correlated with the improvement of PD motor symptoms, which is a goal of standard therapies including deep brain stimulation (DBS). To overcome the stimulation-induced side effects and inefficiencies of conventional DBS (cDBS) and to reduce the administered stimulation current, closed-loop adaptive DBS (aDBS) techniques were developed. In this method, the frequency and/or amplitude of stimulation are modulated based on various disease biomarkers. Methods Here, by computational modeling of a cortico-BG-thalamic network in normal and PD conditions, we show that closed-loop aDBS of the subthalamic nucleus (STN) with amplitude modulation leads to a more effective suppression of pathological beta oscillations within the parkinsonian BG. Results Our results show that beta band neural oscillations are restored to their normal range and the reliability of the response of the thalamic neurons to motor cortex commands is retained due to aDBS with amplitude modulation. Furthermore, notably less stimulation current is administered during aDBS compared with cDBS due to a closed-loop control of stimulation amplitude based on the STN local field potential (LFP) beta activity. Discussion Efficient models of closed-loop stimulation may contribute to the clinical development of optimized aDBS techniques designed to reduce potential stimulation-induced side effects of cDBS in PD patients while leading to a better therapeutic outcome.
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Affiliation(s)
| | - Sina Salehi
- Shiraz Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,*Correspondence: Sina Salehi ✉
| | - Mojtaba Madadi Asl
- School of Biological Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran,Pasargad Institute for Advanced Innovative Solutions (PIAIS), Tehran, Iran,Mojtaba Madadi Asl ✉
| | - Alireza Valizadeh
- Department of Physics, Institute for Advanced Studies in Basic Sciences (IASBS), Zanjan, Iran,Pasargad Institute for Advanced Innovative Solutions (PIAIS), Tehran, Iran
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64
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Subthalamic beta bursts correlate with dopamine-dependent motor symptoms in 106 Parkinson's patients. NPJ Parkinsons Dis 2023; 9:2. [PMID: 36611027 PMCID: PMC9825387 DOI: 10.1038/s41531-022-00443-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/21/2022] [Indexed: 01/09/2023] Open
Abstract
Pathologically increased beta power has been described as a biomarker for Parkinson's disease (PD) and related to prolonged bursts of subthalamic beta synchronization. Here, we investigate the association between subthalamic beta dynamics and motor impairment in a cohort of 106 Parkinson's patients in the ON- and OFF-medication state, using two different methods of beta burst determination. We report a frequency-specific correlation of low beta power and burst duration with motor impairment OFF dopaminergic medication. Furthermore, reduction of power and burst duration correlated significantly with symptom alleviation through dopaminergic medication. Importantly, qualitatively similar results were yielded with two different methods of beta burst definition. Our findings validate the robustness of previous results on pathological changes in subcortical oscillations both in the frequency- as well as in the time-domain in the largest cohort of PD patients to date with important implications for next-generation adaptive deep brain stimulation control algorithms.
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65
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Johnson KA, Cagle JN, Lopes JL, Wong JK, Okun MS, Gunduz A, Shukla AW, Hilliard JD, Foote KD, de Hemptinne C. Globus pallidus internus deep brain stimulation evokes resonant neural activity in Parkinson's disease. Brain Commun 2023; 5:fcad025. [PMID: 36895960 PMCID: PMC9989134 DOI: 10.1093/braincomms/fcad025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 10/07/2022] [Accepted: 02/06/2023] [Indexed: 02/10/2023] Open
Abstract
Globus pallidus internus deep brain stimulation is an established therapy for patients with medication-refractory Parkinson's disease. Clinical outcomes are highly dependent on applying stimulation to precise locations in the brain. However, robust neurophysiological markers are needed to determine the optimal electrode location and to guide postoperative stimulation parameter selection. In this study, we evaluated evoked resonant neural activity in the pallidum as a potential intraoperative marker to optimize targeting and stimulation parameter selection to improve outcomes of deep brain stimulation for Parkinson's disease. Intraoperative local field potential recordings were acquired in 22 patients with Parkinson's disease undergoing globus pallidus internus deep brain stimulation implantation (N = 27 hemispheres). A control group of patients undergoing implantation in the subthalamic nucleus (N = 4 hemispheres) for Parkinson's disease or the thalamus for essential tremor (N = 9 patients) were included for comparison. High-frequency (135 Hz) stimulation was delivered from each electrode contact sequentially while recording the evoked response from the other contacts. Low-frequency stimulation (10 Hz) was also applied as a comparison. Evoked resonant neural activity features, including amplitude, frequency and localization were measured and analysed for correlation with empirically derived postoperative therapeutic stimulation parameters. Pallidal evoked resonant neural activity elicited by stimulation in the globus pallidus internus or externus was detected in 26 of 27 hemispheres and varied across hemispheres and across stimulating contacts within individual hemispheres. Bursts of high-frequency stimulation elicited evoked resonant neural activity with similar amplitudes (P = 0.9) but a higher frequency (P = 0.009) and a higher number of peaks (P = 0.004) than low-frequency stimulation. We identified a 'hotspot' in the postero-dorsal pallidum where stimulation elicited higher evoked resonant neural activity amplitudes (P < 0.001). In 69.6% of hemispheres, the contact that elicited the maximum amplitude intraoperatively matched the contact empirically selected for chronic therapeutic stimulation by an expert clinician after 4 months of programming sessions. Pallidal and subthalamic nucleus evoked resonant neural activity were similar except for lower pallidal amplitudes. No evoked resonant neural activity was detected in the essential tremor control group. Given its spatial topography and correlation with postoperative stimulation parameters empirically selected by expert clinicians, pallidal evoked resonant neural activity shows promise as a potential marker to guide intraoperative targeting and to assist the clinician with postoperative stimulation programming. Importantly, evoked resonant neural activity may also have the potential to guide directional and closed-loop deep brain stimulation programming for Parkinson's disease.
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Affiliation(s)
- Kara A Johnson
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Jackson N Cagle
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Janine Lobo Lopes
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Joshua K Wong
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Aparna Wagle Shukla
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Justin D Hilliard
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurosurgery, University of Florida, Gainesville, FL, USA
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.,Department of Neurology, University of Florida, Gainesville, FL, USA
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Trevarrow MP, Munoz MJ, Rivera YM, Arora R, Drane QH, Rosenow JM, Sani SB, Pal GD, Verhagen Metman L, Goelz LC, Corcos DM, David FJ. The Effects of Subthalamic Nucleus Deep Brain Stimulation and Retention Delay on Memory-Guided Reaching Performance in People with Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2023; 13:917-935. [PMID: 37522216 PMCID: PMC10578280 DOI: 10.3233/jpd-225041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) improves intensive aspects of movement (velocity) in people with Parkinson's disease (PD) but impairs the more cognitively demanding coordinative aspects of movement (error). We extended these findings by evaluating STN-DBS induced changes in intensive and coordinative aspects of movement during a memory-guided reaching task with varying retention delays. OBJECTIVE We evaluated the effect of STN-DBS on motor control during a memory-guided reaching task with short and long retention delays in participants with PD and compared performance to healthy controls (HC). METHODS Eleven participants with PD completed the motor section of the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS III) and performed a memory-guided reaching task under four different STN-DBS conditions (DBS-OFF, DBS-RIGHT, DBS-LEFT, and DBS-BOTH) and two retention delays (0.5 s and 5 s). An additional 13 HC completed the memory-guided reaching task. RESULTS Unilateral and bilateral STN-DBS improved the MDS-UPDRS III scores. In the memory-guided reaching task, both unilateral and bilateral STN-DBS increased the intensive aspects of movement (amplitude and velocity) in the direction toward HC but impaired coordinative aspects of movement (error) away from the HC. Furthermore, movement time was decreased but reaction time was unaffected by STN-DBS. Shorter retention delays increased amplitude and velocity, decreased movement times, and decreased error, but increased reaction times in the participants with PD. There were no interactions between STN-DBS condition and retention delay. CONCLUSION STN-DBS may affect cognitive-motor functioning by altering activity throughout cortico-basal ganglia networks and the oscillatory activity subserving them.
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Affiliation(s)
- Michael P. Trevarrow
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Miranda J. Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Yessenia M. Rivera
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Rishabh Arora
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Quentin H. Drane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sepehr B. Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Gian D. Pal
- Department of Neurology, Division of Movement Disorders, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Leonard Verhagen Metman
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa C. Goelz
- Department of Kinesiology and Nutrition, UIC College of Applied Health Sciences, Chicago, IL, USA
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
- McCormick School of Engineering, Northwestern University, Evanston, IL, USA
| | - Fabian J. David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, USA
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Verma AK, Yu Y, Acosta-Lenis SF, Havel T, Sanabria DE, Molnar GF, MacKinnon CD, Howell MJ, Vitek JL, Johnson LA. Parkinsonian daytime sleep-wake classification using deep brain stimulation lead recordings. Neurobiol Dis 2023; 176:105963. [PMID: 36521781 PMCID: PMC9869648 DOI: 10.1016/j.nbd.2022.105963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/01/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Excessive daytime sleepiness is a recognized non-motor symptom that adversely impacts the quality of life of people with Parkinson's disease (PD), yet effective treatment options remain limited. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for PD motor signs. Reliable daytime sleep-wake classification using local field potentials (LFPs) recorded from DBS leads implanted in STN can inform the development of closed-loop DBS approaches for prompt detection and disruption of sleep-related neural oscillations. We performed STN DBS lead recordings in three nonhuman primates rendered parkinsonian by administrating neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Reference sleep-wake states were determined on a second-by-second basis by video monitoring of eyes (eyes-open, wake and eyes-closed, sleep). The spectral power in delta (1-4 Hz), theta (4-8 Hz), low-beta (8-20 Hz), high-beta (20-35 Hz), gamma (35-90 Hz), and high-frequency (200-400 Hz) bands were extracted from each wake and sleep epochs for training (70% data) and testing (30% data) a support vector machines classifier for each subject independently. The spectral features yielded reasonable daytime sleep-wake classification (sensitivity: 90.68 ± 1.28; specificity: 88.16 ± 1.08; accuracy: 89.42 ± 0.68; positive predictive value; 88.70 ± 0.89, n = 3). Our findings support the plausibility of monitoring daytime sleep-wake states using DBS lead recordings. These results could have future clinical implications in informing the development of closed-loop DBS approaches for automatic detection and disruption of sleep-related neural oscillations in people with PD to promote wakefulness.
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Affiliation(s)
- Ajay K Verma
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Ying Yu
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Sergio F Acosta-Lenis
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Tyler Havel
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | | | - Gregory F Molnar
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Michael J Howell
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Luke A Johnson
- Department of Neurology, University of Minnesota, Minneapolis, United States of America.
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Albano L, Agosta F, Basaia S, Cividini C, Stojkovic T, Sarasso E, Stankovic I, Tomic A, Markovic V, Canu E, Stefanova E, Mortini P, Kostic VS, Filippi M. Altered Functional Connectivity of the Subthalamic Nucleus in Parkinson's Disease: Focus on Candidates for Deep Brain Stimulation. JOURNAL OF PARKINSON'S DISEASE 2023; 13:797-809. [PMID: 37270810 PMCID: PMC10473091 DOI: 10.3233/jpd-230005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The hypothesis that the effectiveness of deep brain stimulation (DBS) in Parkinson's disease (PD) would be related to connectivity dysfunctions between the site of stimulation and other brain regions is growing. OBJECTIVE To investigate how the subthalamic nucleus (STN), the most frequently used DBS target for PD, is functionally linked to other brain regions in PD patients according to DBS eligibility. METHODS Clinical data and resting-state functional MRI were acquired from 60 PD patients and 60 age- and sex-matched healthy subjects within an ongoing longitudinal project. PD patients were divided into 19 patients eligible for DBS and 41 non-candidates. Bilateral STN were selected as regions of interest and a seed-based functional MRI connectivity analysis was performed. RESULTS A decreased functional connectivity between STN and sensorimotor cortex in both PD patient groups compared to controls was found. Whereas an increased functional connectivity between STN and thalamus was found in PD patient groups relative to controls. Candidates for DBS showed a decreased functional connectivity between bilateral STN and bilateral sensorimotor areas relative to non-candidates. In patients eligible for DBS, a weaker STN functional connectivity with left supramarginal and angular gyri was related with a more severe rigidity and bradykinesia whereas a higher connectivity between STN and cerebellum/pons was related to poorer tremor score. CONCLUSION Our results suggest that functional connectivity of STN varies among PD patients eligible or not for DBS. Future studies would confirm whether DBS modulates and restores functional connectivity between STN and sensorimotor areas in treated patients.
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Affiliation(s)
- Luigi Albano
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Federica Agosta
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Silvia Basaia
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Camilla Cividini
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Tanja Stojkovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Elisabetta Sarasso
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Iva Stankovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Tomic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladana Markovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Elisa Canu
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Elka Stefanova
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Pietro Mortini
- Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Vladimir S. Kostic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurorehabilitation Unit, IRCCS Ospedale San Raffaele, Milan, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milan, Italy
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Local Field Potential-Guided Contact Selection Using Chronically Implanted Sensing Devices for Deep Brain Stimulation in Parkinson's Disease. Brain Sci 2022; 12:brainsci12121726. [PMID: 36552185 PMCID: PMC9776002 DOI: 10.3390/brainsci12121726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Intra- and perioperatively recorded local field potential (LFP) activity of the nucleus subthalamicus (STN) has been suggested to guide contact selection in patients undergoing deep brain stimulation (DBS) for Parkinson's disease (PD). Despite the invention of sensing capacities in chronically implanted devices, a comprehensible algorithm that enables contact selection using such recordings is still lacking. We evaluated a fully automated algorithm that uses the weighted average of bipolar recordings to determine effective monopolar contacts based on elevated activity in the beta band. LFPs from 14 hemispheres in seven PD patients with newly implanted directional DBS leads of the STN were recorded. First, the algorithm determined the stimulation level with the highest beta activity. Based on the prior determined level, the directional contact with the highest beta activity was chosen in the second step. The mean clinical efficacy of the contacts chosen using the algorithm did not statistically differ from the mean clinical efficacy of standard contact selection as performed in clinical routine. All recording sites were projected into MNI standard space to investigate the feasibility of the algorithm with respect to the anatomical boundaries of the STN. We conclude that the proposed algorithm is a first step towards LFP-based contact selection in STN-DBS for PD using chronically implanted devices.
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Loss of the Synuclein Family Members Differentially Affects Baseline- and Apomorphine-Associated EEG Determinants in Single-, Double- and Triple-Knockout Mice. Biomedicines 2022; 10:biomedicines10123128. [PMID: 36551884 PMCID: PMC9775760 DOI: 10.3390/biomedicines10123128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/14/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
Synucleins comprise a family of small proteins highly expressed in the nervous system of vertebrates and involved in various intraneuronal processes. The malfunction of alpha-synuclein is one of the key events in pathogenesis of Parkinson disease and certain other neurodegenerative diseases, and there is a growing body of evidence that malfunction of other two synucleins might be involved in pathological processes in the nervous system. The modulation of various presynaptic mechanisms of neurotransmission is an important function of synucleins, and therefore, it is feasible that their deficiency might affect global electrical activity detected of the brain. However, the effects of the loss of synucleins on the frequency spectra of electroencephalograms (EEGs) have not been systematically studied so far. In the current study, we assessed changes in such spectra in single-, double- and triple-knockout mice lacking alpha-, beta- and gamma-synucleins in all possible combinations. EEGs were recorded from the motor cortex, the putamen, the ventral tegmental area and the substantia nigra of 78 3-month-old male mice from seven knockout groups maintained on the C57BL/6J genetic background, and 10 wild-type C57BL/6J mice for 30 min before and for 60 min after the systemic injection of a DA receptor agonist, apomorphine (APO). We found that almost any variant of synuclein deficiency causes multiple changes in both basal and APO-induced EEG oscillation profiles. Therefore, it is not the absence of any particular synuclein but rather a disbalance of synucleins that causes widespread changes in EEG spectral profiles.
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van Rheede JJ, Feldmann LK, Busch JL, Fleming JE, Mathiopoulou V, Denison T, Sharott A, Kühn AA. Diurnal modulation of subthalamic beta oscillatory power in Parkinson’s disease patients during deep brain stimulation. NPJ Parkinsons Dis 2022; 8:88. [PMID: 35804160 PMCID: PMC9270436 DOI: 10.1038/s41531-022-00350-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/10/2022] [Indexed: 11/09/2022] Open
Abstract
Beta-band activity in the subthalamic local field potential (LFP) is correlated with Parkinson’s disease (PD) symptom severity and is the therapeutic target of deep brain stimulation (DBS). While beta fluctuations in PD patients are well characterized on shorter timescales, it is not known how beta activity evolves around the diurnal cycle, outside a clinical setting. Here, we obtained chronic recordings (34 ± 13 days) of subthalamic beta power in PD patients implanted with the Percept DBS device during high-frequency DBS and analysed their diurnal properties as well as sensitivity to artifacts. Time of day explained 41 ± 9% of the variance in beta power (p < 0.001 in all patients), with increased beta during the day and reduced beta at night. Certain movements affected LFP quality, which may have contributed to diurnal patterns in some patients. Future DBS algorithms may benefit from taking such diurnal and artifactual fluctuations in beta power into account.
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72
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Salahi S, Mousavi MA, Azizi G, Hossein-Khannazer N, Vosough M. Stem Cell-based and Advanced Therapeutic Modalities for Parkinson's Disease: A Risk-effectiveness Patient-centered Analysis. Curr Neuropharmacol 2022; 20:2320-2345. [PMID: 35105291 PMCID: PMC9890289 DOI: 10.2174/1570159x20666220201100238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/29/2022] Open
Abstract
Treatment of Parkinson's disease (PD), the second most prevalent neurodegenerative disorder, is currently considered a challenging issue since it causes substantial disability, poor quality of life, and mortality. Despite remarkable progress in advanced conventional therapeutic interventions, the global burden of the disease has nearly doubled, prompting us to assess the riskeffectiveness of different treatment modalities. Each protocol could be considered as the best alternative treatment depending on the patient's situation. Prescription of levodopa, the most effective available medicine for this disorder, has been associated with many complications, i.e., multiple episodes of "off-time" and treatment resistance. Other medications, which are typically used in combination with levodopa, may have several adverse effects as well. As a result, the therapies that are more in line with human physiology and make the least interference with other pathways are worth investigating. On the other hand, remaining and persistent symptoms after therapy and the lack of effective response to the conventional approaches have raised expectations towards innovative alternative approaches, such as stem cell-based therapy. It is critical to not overlook the unexplored side effects of innovative approaches due to the limited number of research. In this review, we aimed to compare the efficacy and risk of advanced therapies with innovative cell-based and stemcell- based modalities in PD patients. This paper recapitulated the underlying factors/conditions, which could lead us to more practical and established therapeutic outcomes with more advantages and few complications. It could be an initial step to reconsider the therapeutic blueprint for patients with Parkinson's disease.
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Affiliation(s)
- Sarvenaz Salahi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Maryam Alsadat Mousavi
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
| | - Gholamreza Azizi
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nikoo Hossein-Khannazer
- Gastroenterology and Liver Diseases Research Center, Research, Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Massoud Vosough
- Department of Regenerative Medicine, Cell Science Research Center, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran, Iran
- Experimental Cancer Medicine, Institution for Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
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Guo J, Liu T, Wang J. Effects of auditory feedback on fine motor output and corticomuscular coherence during a unilateral finger pinch task. Front Neurosci 2022; 16:896933. [DOI: 10.3389/fnins.2022.896933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
Auditory feedback is important to reduce movement error and improve motor performance during a precise motor task. Accurate motion guided by auditory feedback may rely on the neural muscle transmission pathway between the sensorimotor area and the effective muscle. However, it remains unclear how neural activities and sensorimotor loops play a role in enhancing performance. The present study uses an auditory feedback system by simultaneously recording electroencephalogram (EEG), electromyography (EMG), and exert force information to measure corticomuscular coherence (CMC), neural activity, and motor performance during precise unilateral right-hand pinch by using the thumb and the index finger with and without auditory feedback. This study confirms three results. First, compared with no auditory feedback, auditory feedback decreases movement errors. Second, compared with no auditory feedback, auditory feedback decreased the power spectrum in the beta band in the bimanual sensorimotor cortex and the alpha band in the ipsilateral sensorimotor cortex. Finally, CMC was computed between effector muscle of right hand and contralateral sensorimotor cortex. Analyses reveals that the CMC of beta band significantly decreases in auditory feedback condition compared with no auditory feedback condition. The results indicate that auditory feedback decreases the power spectral in the alpha and beta bands and decreases corticospinal connection in the beta band during precise hand control. This study provides a new perspective on the effect of auditory feedback on behavior and brain activity and offers a new idea for designing more suitable and effective rehabilitation and training strategies to improve fine motor performance.
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Samuel N, Zeng K, Harmsen IE, Ding MYR, Darmani G, Sarica C, Santyr B, Vetkas A, Pancholi A, Fomenko A, Milano V, Yamamoto K, Saha U, Wennberg R, Rowland NC, Chen R, Lozano AM. Multi-modal investigation of transcranial ultrasound-induced neuroplasticity of the human motor cortex. Brain Stimul 2022; 15:1337-1347. [PMID: 36228977 DOI: 10.1016/j.brs.2022.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/25/2022] [Accepted: 10/03/2022] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION There is currently a gap in accessibility to neuromodulation tools that can approximate the efficacy and spatial resolution of invasive methods. Low intensity transcranial focused ultrasound stimulation (TUS) is an emerging technology for non-invasive brain stimulation (NIBS) that can penetrate cortical and deep brain structures with more focal stimulation compared to existing NIBS modalities. Theta burst TUS (tbTUS, TUS delivered in a theta burst pattern) is a novel repetitive TUS protocol that can induce durable changes in motor cortex excitability, thereby holding promise as a novel neuromodulation tool with durable effects. OBJECTIVE The aim of the present study was to elucidate the neurophysiologic effects of tbTUS motor cortical excitability, as well on local and global neural oscillations and network connectivity. METHODS An 80-s train of active or sham tbTUS was delivered to the left motor cortex in 15 healthy subjects. Motor cortical excitability was investigated through transcranial magnetic stimulation (TMS)-elicited motor-evoked potentials (MEPs), short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) using paired-pulse TMS. Magnetoencephalography (MEG) recordings during resting state and an index finger abduction-adduction task were used to assess oscillatory brain responses and network connectivity. The correlations between the changes in neural oscillations and motor cortical excitability were also evaluated. RESULTS tbTUS to the motor cortex results in a sustained increase in MEP amplitude and decreased SICI, but no change in ICF. MEG spectral power analysis revealed TUS-mediated desynchronization in alpha and beta spectral power. Significant changes in alpha power were detected within the supplementary motor cortex (Right > Left) and changes in beta power within bilateral supplementary motor cortices, right basal ganglia and parietal regions. Coherence analysis revealed increased local connectivity in motor areas. MEP and SICI changes correlated with both local and inter-regional coherence. CONCLUSION The findings from this study provide novel insights into the neurophysiologic basis of TUS-mediated neuroplasticity and point to the involvement of regions within the motor network in mediating this sustained response. Future studies may further characterize the durability of TUS-mediated neuroplasticity and its clinical applications as a neuromodulation strategy for neurological and psychiatric disorders.
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Affiliation(s)
- Nardin Samuel
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Ke Zeng
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Irene E Harmsen
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Mandy Yi Rong Ding
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Ghazaleh Darmani
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Can Sarica
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Brendan Santyr
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Artur Vetkas
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Department of Neurosurgery, Tartu University Hospital, University of Tartu, Estonia
| | - Aditya Pancholi
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Anton Fomenko
- Division of Neurosurgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Milano
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Kazuaki Yamamoto
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Utpal Saha
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Richard Wennberg
- Mitchell Goldhar MEG Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Nathan C Rowland
- Department of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA
| | - Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada; Division of Neurology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
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David FJ, Rivera YM, Entezar TK, Arora R, Drane QH, Munoz MJ, Rosenow JM, Sani SB, Pal GD, Verhagen-Metman L, Corcos DM. Encoding type, medication, and deep brain stimulation differentially affect memory-guided sequential reaching movements in Parkinson's disease. Front Neurol 2022; 13:980935. [PMID: 36324383 PMCID: PMC9618698 DOI: 10.3389/fneur.2022.980935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Memory-guided movements, vital to daily activities, are especially impaired in Parkinson's disease (PD). However, studies examining the effects of how information is encoded in memory and the effects of common treatments of PD, such as medication and subthalamic nucleus deep brain stimulation (STN-DBS), on memory-guided movements are uncommon and their findings are equivocal. We designed two memory-guided sequential reaching tasks, peripheral-vision or proprioception encoded, to investigate the effects of encoding type (peripheral-vision vs. proprioception), medication (on- vs. off-), STN-DBS (on- vs. off-, while off-medication), and compared STN-DBS vs. medication on reaching amplitude, error, and velocity. We collected data from 16 (analyzed n = 7) participants with PD, pre- and post-STN-DBS surgery, and 17 (analyzed n = 14) healthy controls. We had four important findings. First, encoding type differentially affected reaching performance: peripheral-vision reaches were faster and more accurate. Also, encoding type differentially affected reaching deficits in PD compared to healthy controls: peripheral-vision reaches manifested larger deficits in amplitude. Second, the effect of medication depended on encoding type: medication had no effect on amplitude, but reduced error for both encoding types, and increased velocity only during peripheral-vision encoding. Third, the effect of STN-DBS depended on encoding type: STN-DBS increased amplitude for both encoding types, increased error during proprioception encoding, and increased velocity for both encoding types. Fourth, STN-DBS was superior to medication with respect to increasing amplitude and velocity, whereas medication was superior to STN-DBS with respect to reducing error. We discuss our findings in the context of the previous literature and consider mechanisms for the differential effects of medication and STN-DBS.
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Affiliation(s)
- Fabian J. David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yessenia M. Rivera
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Tara K. Entezar
- School of Integrative Biology, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, United States
| | - Rishabh Arora
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Quentin H. Drane
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Miranda J. Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Joshua M. Rosenow
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sepehr B. Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Gian D. Pal
- Department of Neurology, Rutgers University, New Brunswick, NJ, United States
| | - Leonard Verhagen-Metman
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Daniel M. Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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76
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Bove F, Genovese D, Moro E. Developments in the mechanistic understanding and clinical application of deep brain stimulation for Parkinson's disease. Expert Rev Neurother 2022; 22:789-803. [PMID: 36228575 DOI: 10.1080/14737175.2022.2136030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION. Deep brain stimulation (DBS) is a life-changing treatment for patients with Parkinson's disease (PD) and gives the unique opportunity to directly explore how basal ganglia work. Despite the rapid technological innovation of the last years, the untapped potential of DBS is still high. AREAS COVERED. This review summarizes the developments in the mechanistic understanding of DBS and the potential clinical applications of cutting-edge technological advances. Rather than a univocal local mechanism, DBS exerts its therapeutic effects through several multimodal mechanisms and involving both local and network-wide structures, although crucial questions remain unexplained. Nonetheless, new insights in mechanistic understanding of DBS in PD have provided solid bases for advances in preoperative selection phase, prediction of motor and non-motor outcomes, leads placement and postoperative stimulation programming. EXPERT OPINION. DBS has not only strong evidence of clinical effectiveness in PD treatment, but technological advancements are revamping its role of neuromodulation of brain circuits and key to better understanding PD pathophysiology. In the next few years, the worldwide use of new technologies in clinical practice will provide large data to elucidate their role and to expand their applications for PD patients, providing useful insights to personalize DBS treatment and follow-up.
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Affiliation(s)
- Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Genovese
- Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM, U1216, Grenoble, France
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77
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Klostermann F, Wyrobnik M, Boll M, Ehlen F, Tiedt HO. Tracing embodied word production in persons with Parkinson's disease in distinct motor conditions. Sci Rep 2022; 12:16669. [PMID: 36198900 PMCID: PMC9534912 DOI: 10.1038/s41598-022-21106-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 09/22/2022] [Indexed: 11/09/2022] Open
Abstract
Embodied cognition theories posit direct interactions between sensorimotor and mental processing. Various clinical observations have been interpreted in this controversial framework, amongst others, low verb generation in word production tasks performed by persons with Parkinson's disease (PD). If this were the consequence of reduced motor simulation of prevalent action semantics in this word class, reduced PD pathophysiology should result in increased verb production and a general shift of lexical contents towards particular movement-related meanings. 17 persons with PD and bilateral deep brain stimulation (DBS) of the subhtalamic nucleus (STN) and 17 healthy control persons engaged in a semantically unconstrained, phonemic verbal fluency task, the former in both DBS-off and DBS-on states. The analysis referred to the number of words produced, verb use, and the occurrence of different dimensions of movement-related semantics in the lexical output. Persons with PD produced fewer words than controls. In the DBS-off, but not in the DBS-on condition, the proportion of verbs within this reduced output was lower than in controls. Lowered verb production went in parallel with a semantic shift: in persons with PD in the DBS-off, but not the DBS-on condition, the relatedness of produced words to own body-movement was lower than in controls. In persons with PD, DBS induced-changes of the motor condition appear to go along with formal and semantic shifts in word production. The results are compatible with the idea of some impact of motor system states on lexical processing.
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Affiliation(s)
- Fabian Klostermann
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany. .,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - Michelle Wyrobnik
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.,Institute of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489, Berlin, Germany
| | - Moritz Boll
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
| | - Felicitas Ehlen
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany.,Department of Psychiatry, Jüdisches Krankenhaus Berlin, Heinz-Galinski-Straße 1, 13347, Berlin, Germany
| | - Hannes Ole Tiedt
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12200, Berlin, Germany
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Liu F, Wu Y, Almarri N, Habibollahi M, Lancashire HT, Bryson B, Greensmith L, Jiang D, Demosthenous A. A Fully Implantable Opto-Electro Closed-Loop Neural Interface for Motor Neuron Disease Studies. IEEE TRANSACTIONS ON BIOMEDICAL CIRCUITS AND SYSTEMS 2022; 16:752-765. [PMID: 36018872 DOI: 10.1109/tbcas.2022.3202026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
This paper presents a fully implantable closed-loop device for use in freely moving rodents to investigate new treatments for motor neuron disease. The 0.18 μm CMOS integrated circuit comprises 4 stimulators, each featuring 16 channels for optical and electrical stimulation using arbitrary current waveforms at frequencies from 1.5 Hz to 50 kHz, and a bandwidth programmable front-end for neural recording. The implant uses a Qi wireless inductive link which can deliver >100 mW power at a maximum distance of 2 cm for a freely moving rodent. A backup rechargeable battery can support 10 mA continuous stimulation currents for 2.5 hours in the absence of an inductive power link. The implant is controlled by a graphic user interface with broad programmable parameters via a Bluetooth low energy bidirectional data telemetry link. The encapsulated implant is 40 mm × 20 mm × 10 mm. Measured results are presented showing the electrical performance of the electronics and the packaging method.
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79
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Steiner LA, Kühn AA, Geiger JR, Alle H, Popovic MR, Kalia SK, Hodaie M, Lozano AM, Hutchison WD, Milosevic L. Persistent synaptic inhibition of the subthalamic nucleus by high frequency stimulation. Brain Stimul 2022; 15:1223-1232. [PMID: 36058524 DOI: 10.1016/j.brs.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 05/10/2022] [Accepted: 08/25/2022] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) provides symptomatic relief in a growing number of neurological indications, but local synaptic dynamics in response to electrical stimulation that may relate to its mechanism of action have not been fully characterized. OBJECTIVE The objectives of this study were to (1) study local synaptic dynamics during high frequency extracellular stimulation of the subthalamic nucleus (STN), and (2) compare STN synaptic dynamics with those of the neighboring substantia nigra pars reticulata (SNr). METHODS Two microelectrodes were advanced into the STN and SNr of patients undergoing DBS surgery for Parkinson's disease (PD). Neuronal firing and evoked field potentials (fEPs) were recorded with one microelectrode during stimulation from an adjacent microelectrode. RESULTS Inhibitory fEPs could be discerned within the STN and their amplitudes predicted bidirectional effects on neuronal firing (p = .013). There were no differences between STN and SNr inhibitory fEP dynamics at low stimulation frequencies (p > .999). However, inhibitory neuronal responses were sustained over time in STN during high frequency stimulation but not in SNr (p < .001) where depression of inhibitory input was coupled with a return of neuronal firing (p = .003). INTERPRETATION Persistent inhibitory input to the STN suggests a local synaptic mechanism for the suppression of subthalamic firing during high frequency stimulation. Moreover, differences in the resiliency versus vulnerability of inhibitory inputs to the STN and SNr suggest a projection source- and frequency-specificity for this mechanism. The feasibility of targeting electrophysiologically-identified neural structures may provide insight into how DBS achieves frequency-specific modulation of neuronal projections.
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Affiliation(s)
- Leon A Steiner
- Krembil Brain Institute, University Health Network, Canada; Department of Neurology, Charité-Universitätsmedizin Berlin, Germany; Berlin Institute of Health (BIH), Germany; Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Germany
| | - Jörg Rp Geiger
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Henrik Alle
- Institute of Neurophysiology, Charité-Universitätsmedizin Berlin, Germany
| | - Milos R Popovic
- KITE Research Institute, University Health Network, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, University Health Network, Canada; KITE Research Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - Mojgan Hodaie
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - Andres M Lozano
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada
| | - William D Hutchison
- Krembil Brain Institute, University Health Network, Canada; Department of Surgery, University of Toronto, Canada; Department of Physiology, University of Toronto, Canada
| | - Luka Milosevic
- Krembil Brain Institute, University Health Network, Canada; KITE Research Institute, University Health Network, Canada; Institute of Biomedical Engineering, University of Toronto, Canada.
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Cortical beta burst dynamics are altered in Parkinson's disease but normalized by deep brain stimulation. Neuroimage 2022; 257:119308. [PMID: 35569783 DOI: 10.1016/j.neuroimage.2022.119308] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/12/2022] [Accepted: 05/10/2022] [Indexed: 11/21/2022] Open
Abstract
Exaggerated subthalamic beta oscillatory activity and increased beta range cortico-subthalamic synchrony have crystallized as the electrophysiological hallmarks of Parkinson's disease. Beta oscillatory activity is not tonic but occurs in 'bursts' of transient amplitude increases. In Parkinson's disease, the characteristics of these bursts are altered especially in the basal ganglia. However, beta oscillatory dynamics at the cortical level and how they compare with healthy brain activity is less well studied. We used magnetoencephalography (MEG) to study sensorimotor cortical beta bursting and its modulation by subthalamic deep brain stimulation in Parkinson's disease patients and age-matched healthy controls. We show that the changes in beta bursting amplitude and duration typical of Parkinson's disease can also be observed in the sensorimotor cortex, and that they are modulated by chronic subthalamic deep brain stimulation, which, in turn, is reflected in improved motor function at the behavioural level. In addition to the changes in individual beta bursts, their timing relative to each other was altered in patients compared to controls: bursts were more clustered in untreated Parkinson's disease, occurring in 'bursts of bursts', and re-burst probability was higher for longer compared to shorter bursts. During active deep brain stimulation, the beta bursting in patients resembled healthy controls' data. In summary, both individual bursts' characteristics and burst patterning are affected in Parkinson's disease, and subthalamic deep brain stimulation normalizes some of these changes to resemble healthy controls' beta bursting activity, suggesting a non-invasive biomarker for patient and treatment follow-up.
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81
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Wang K, Wang J, Zhu Y, Li H, Liu C, Fietkiewicz C, Loparo KA. Adaptive closed-loop control strategy inhibiting pathological basal ganglia oscillations. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2022.103776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Sinclair NC, McDermott HJ, Lee WL, Xu SS, Acevedo N, Begg A, Perera T, Thevathasan W, Bulluss KJ. Electrically evoked and spontaneous neural activity in the subthalamic nucleus under general anesthesia. J Neurosurg 2022; 137:449-458. [PMID: 34891136 DOI: 10.3171/2021.8.jns204225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 08/09/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) surgery is commonly performed with the patient awake to facilitate assessments of electrode positioning. However, awake neurosurgery can be a barrier to patients receiving DBS. Electrode implantation can be performed with the patient under general anesthesia (GA) using intraoperative imaging, although such techniques are not widely available. Electrophysiological features can also aid in the identification of target neural regions and provide functional evidence of electrode placement. Here we assess the presence and positional variation under GA of spontaneous beta and high-frequency oscillation (HFO) activity, and evoked resonant neural activity (ERNA), a novel evoked response localized to the subthalamic nucleus. METHODS ERNA, beta, and HFO were intraoperatively recorded from DBS leads comprising four individual electrodes immediately after bilateral awake implantation into the subthalamic nucleus of 21 patients with Parkinson's disease (42 hemispheres) and after subsequent GA induction deep enough to perform pulse generator implantation. The main anesthetic agent was either propofol (10 patients) or sevoflurane (11 patients). RESULTS GA reduced the amplitude of ERNA, beta, and HFO activity (p < 0.001); however, ERNA amplitudes remained large in comparison to spontaneous local field potentials. Notably, a moderately strong correlation between awake ERNA amplitude and electrode distance to an "ideal" therapeutic target within dorsal STN was preserved under GA (awake: ρ = -0.73, adjusted p value [padj] < 0.001; GA: ρ = -0.69, padj < 0.001). In contrast, correlations were diminished under GA for beta (awake: ρ = -0.45, padj < 0.001; GA: ρ = -0.13, padj = 0.12) and HFO (awake: ρ = -0.69, padj < 0.001; GA: ρ = -0.33, padj < 0.001). The largest ERNA occurred at the same electrode (awake vs GA) for 35/42 hemispheres (83.3%) and corresponded closely to the electrode selected by the clinician for chronic therapy at 12 months (awake ERNA 77.5%, GA ERNA 82.5%). The largest beta amplitude occurred at the same electrode (awake vs GA) for only 17/42 (40.5%) hemispheres and 21/42 (50%) for HFO. The electrode measuring the largest awake beta and HFO amplitudes corresponded to the electrode selected by the clinician for chronic therapy at 12 months in 60% and 70% of hemispheres, respectively. However, this correspondence diminished substantially under GA (beta 20%, HFO 35%). CONCLUSIONS ERNA is a robust electrophysiological signal localized to the dorsal subthalamic nucleus subregion that is largely preserved under GA, indicating it could feasibly guide electrode implantation, either alone or in complementary use with existing methods.
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Affiliation(s)
- Nicholas C Sinclair
- 1Bionics Institute, East Melbourne
- 2Medical Bionics Department, The University of Melbourne, East Melbourne
| | - Hugh J McDermott
- 1Bionics Institute, East Melbourne
- 2Medical Bionics Department, The University of Melbourne, East Melbourne
| | | | - San San Xu
- 1Bionics Institute, East Melbourne
- 3Department of Neurology, Austin Hospital, Heidelberg
| | | | | | - Thushara Perera
- 1Bionics Institute, East Melbourne
- 2Medical Bionics Department, The University of Melbourne, East Melbourne
| | - Wesley Thevathasan
- 1Bionics Institute, East Melbourne
- 3Department of Neurology, Austin Hospital, Heidelberg
- 5Department of Medicine, The University of Melbourne, Parkville
| | - Kristian J Bulluss
- 1Bionics Institute, East Melbourne
- 6Department of Neurosurgery, St. Vincent's and Austin Hospitals, Melbourne; and
- 7Department of Surgery, The University of Melbourne, Heidelberg, Victoria, Australia
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83
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Chen R, Berardelli A, Bhattacharya A, Bologna M, Chen KHS, Fasano A, Helmich RC, Hutchison WD, Kamble N, Kühn AA, Macerollo A, Neumann WJ, Pal PK, Paparella G, Suppa A, Udupa K. Clinical neurophysiology of Parkinson's disease and parkinsonism. Clin Neurophysiol Pract 2022; 7:201-227. [PMID: 35899019 PMCID: PMC9309229 DOI: 10.1016/j.cnp.2022.06.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/11/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023] Open
Abstract
This review is part of the series on the clinical neurophysiology of movement disorders and focuses on Parkinson’s disease and parkinsonism. The pathophysiology of cardinal parkinsonian motor symptoms and myoclonus are reviewed. The recordings from microelectrode and deep brain stimulation electrodes are reported in detail.
This review is part of the series on the clinical neurophysiology of movement disorders. It focuses on Parkinson’s disease and parkinsonism. The topics covered include the pathophysiology of tremor, rigidity and bradykinesia, balance and gait disturbance and myoclonus in Parkinson’s disease. The use of electroencephalography, electromyography, long latency reflexes, cutaneous silent period, studies of cortical excitability with single and paired transcranial magnetic stimulation, studies of plasticity, intraoperative microelectrode recordings and recording of local field potentials from deep brain stimulation, and electrocorticography are also reviewed. In addition to advancing knowledge of pathophysiology, neurophysiological studies can be useful in refining the diagnosis, localization of surgical targets, and help to develop novel therapies for Parkinson’s disease.
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Affiliation(s)
- Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - William D Hutchison
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Departments of Surgery and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Andrea A Kühn
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Antonella Macerollo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.,The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kaviraja Udupa
- Department of Neurophysiology National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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84
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Schor JS, Gonzalez Montalvo I, Spratt PWE, Brakaj RJ, Stansil JA, Twedell EL, Bender KJ, Nelson AB. Therapeutic deep brain stimulation disrupts movement-related subthalamic nucleus activity in Parkinsonian mice. eLife 2022; 11:75253. [PMID: 35786442 PMCID: PMC9342952 DOI: 10.7554/elife.75253] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/01/2022] [Indexed: 12/02/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation (STN DBS) relieves many motor symptoms of Parkinson’s disease (PD), but its underlying therapeutic mechanisms remain unclear. Since its advent, three major theories have been proposed: (1) DBS inhibits the STN and basal ganglia output; (2) DBS antidromically activates motor cortex; and (3) DBS disrupts firing dynamics within the STN. Previously, stimulation-related electrical artifacts limited mechanistic investigations using electrophysiology. We used electrical artifact-free GCaMP fiber photometry to investigate activity in basal ganglia nuclei during STN DBS in parkinsonian mice. To test whether the observed changes in activity were sufficient to relieve motor symptoms, we then combined electrophysiological recording with targeted optical DBS protocols. Our findings suggest that STN DBS exerts its therapeutic effect through the disruption of movement-related STN activity, rather than inhibition or antidromic activation. These results provide insight into optimizing PD treatments and establish an approach for investigating DBS in other neuropsychiatric conditions.
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Affiliation(s)
- Jonathan S Schor
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | | | - Perry W E Spratt
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | - Rea J Brakaj
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Jasmine A Stansil
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Emily L Twedell
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
| | - Kevin J Bender
- Department of Neurology, University of California, San Francisco, San Francisco, United States
| | - Alexandra B Nelson
- Neuroscience Program, University of California, San Francisco, San Francisco, United States
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85
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Jin L, Zhang C, Shi W, Yeh CH. A Novel Framework in Quantifying Oscillatory Coupling to Gait Disturbance in Parkinson's Disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:263-266. [PMID: 36086225 DOI: 10.1109/embc48229.2022.9871963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Phase-amplitude coupling (PAC) based on the uniform phase empirical mode decomposition (UPEMD) is proposed to improve the accuracy of PAC assessment. The framework is applied to investigate the mechanism and improvement measure of gait disturbance for Parkinson's disease (PD). Hβ modulation is suppressed at the time of contralateral heel strikes and rebounds when the contralateral foot rests on the ground and the ipsilateral foot is raised. Prominent PACs exist between δ and Lβ/Hβ activities. Auditory cue improves the gait; meanwhile, it enhances the Hβ modulation, and suppresses the δ-Lβ/Hβ PACs, which may rebound toward the before-cue stage afterward. Our findings suggest the proposed UPEMD-PAC is a useful framework in quantifying PAC with pre-determined frequencies, whereas the δ-Lβ/Hβ PACs in the subthalamic nucleus serve as potential biomarkers for gait disturbance in PD. Clinical Relevance- This manifests the efficacy of auditory cues on gait disturbance. The proposed framework may be useful in diagnosing the severity of motor impairment.
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86
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Mitchell KT, Schmidt SL, Cooney JW, Grill WM, Peters J, Rahimpour S, Lee HJ, Jung SH, Mantri S, Scott B, Lad SP, Turner DA. Initial Clinical Outcome With Bilateral, Dual-Target Deep Brain Stimulation Trial in Parkinson Disease Using Summit RC + S. Neurosurgery 2022; 91:132-138. [PMID: 35383660 PMCID: PMC9514741 DOI: 10.1227/neu.0000000000001957] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 01/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective therapy in advanced Parkinson disease (PD). Although both subthalamic nucleus (STN) and globus pallidus (GP) DBS show equivalent efficacy in PD, combined stimulation may demonstrate synergism. OBJECTIVE To evaluate the clinical benefit of stimulating a combination of STN and GP DBS leads and to demonstrate biomarker discovery for adaptive DBS therapy in an observational study. METHODS We performed a pilot trial (n = 3) of implanting bilateral STN and GP DBS leads, connected to a bidirectional implantable pulse generator (Medtronic Summit RC + S; NCT03815656, IDE No. G180280). Initial 1-year outcome in 3 patients included Unified PD Rating Scale on and off medications, medication dosage, Hauser diary, and recorded beta frequency spectral power. RESULTS Combined DBS improved PD symptom control, allowing >80% levodopa medication reduction. There was a greater decrease in off-medication motor Unified PD Rating Scale with multiple electrodes activated (mean difference from off stimulation off medications -18.2, range -25.5 to -12.5) than either STN (-12.8, range -20.5 to 0) or GP alone (-9, range -11.5 to -4.5). Combined DBS resulted in a greater reduction of beta oscillations in STN in 5/6 hemispheres than either site alone. Adverse events occurred in 2 patients, including a small cortical hemorrhage and seizure at 24 hours postoperatively, which resolved spontaneously, and extension wire scarring requiring revision at 2 months postoperatively. CONCLUSION Patients with PD preferred combined DBS stimulation in this preliminary cohort. Future studies will address efficacy of adaptive DBS as we further define biomarkers and control policy.
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Affiliation(s)
- Kyle T. Mitchell
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Stephen L. Schmidt
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Jeffrey W. Cooney
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Warren M. Grill
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
| | - Jennifer Peters
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Shervin Rahimpour
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Neurosurgery, Clinical Neuroscience Center, University of Utah, Salt Lake City, Utah, USA;
| | - Hui-Jie Lee
- Duke University CTSI Biostatistics, Epidemiology and Research Design, Durham, North Carolina, USA
| | - Sin-Ho Jung
- Duke University CTSI Biostatistics, Epidemiology and Research Design, Durham, North Carolina, USA
| | - Sneha Mantri
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Burton Scott
- Department of Neurology, Duke University Medical Center, Durham, North Carolina, USA
| | - Shivanand P. Lad
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Dennis A. Turner
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Neurobiology, Duke University Medical Center, Durham, North Carolina, USA
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87
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Dale J, Schmidt SL, Mitchell K, Turner DA, Grill WM. Evoked potentials generated by deep brain stimulation for Parkinson's disease. Brain Stimul 2022; 15:1040-1047. [DOI: 10.1016/j.brs.2022.07.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/18/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022] Open
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88
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Stanslaski SR, Case MA, Giftakis JE, Raike RS, Stypulkowski PH. Long Term Performance of a Bi-Directional Neural Interface for Deep Brain Stimulation and Recording. Front Hum Neurosci 2022; 16:916627. [PMID: 35754768 PMCID: PMC9218069 DOI: 10.3389/fnhum.2022.916627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022] Open
Abstract
Background: In prior reports, we described the design and initial performance of a fully implantable, bi-directional neural interface system for use in deep brain and other neurostimulation applications. Here we provide an update on the chronic, long-term neural sensing performance of the system using traditional 4-contact leads and extend those results to include directional 8-contact leads. Methods: Seven ovine subjects were implanted with deep brain stimulation (DBS) leads at different nodes within the Circuit of Papez: four with unilateral leads in the anterior nucleus of the thalamus and hippocampus; two with bilateral fornix leads, and one with bilateral hippocampal leads. The leads were connected to either an Activa PC+S® (Medtronic) or Percept PC°ledR (Medtronic) deep brain stimulation and recording device. Spontaneous local field potentials (LFPs), evoked potentials (EPs), LFP response to stimulation, and electrode impedances were monitored chronically for periods of up to five years in these subjects. Results: The morphology, amplitude, and latencies of chronic hippocampal EPs evoked by thalamic stimulation remained stable over the duration of the study. Similarly, LFPs showed consistent spectral peaks with expected variation in absolute magnitude dependent upon behavioral state and other factors, but no systematic degradation of signal quality over time. Electrode impedances remained within expected ranges with little variation following an initial stabilization period. Coupled neural activity between the two nodes within the Papez circuit could be observed in synchronized recordings up to 5 years post-implant. The magnitude of passive LFP power recorded from directional electrode segments was indicative of the contacts that produced the greatest stimulation-induced changes in LFP power within the Papez network. Conclusion: The implanted device performed as designed, providing the ability to chronically stimulate and record neural activity within this network for up to 5 years of follow-up.
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89
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Lee LHN, Huang CS, Wang RW, Lai HJ, Chung CC, Yang YC, Kuo CC. Deep brain stimulation rectifies the noisy cortex and irresponsive subthalamus to improve parkinsonian locomotor activities. NPJ Parkinsons Dis 2022; 8:77. [PMID: 35725730 PMCID: PMC9209473 DOI: 10.1038/s41531-022-00343-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
The success of deep brain stimulation (DBS) therapy indicates that Parkinson's disease is a brain rhythm disorder. However, the manifestations of the erroneous rhythms corrected by DBS remain to be established. We found that augmentation of α rhythms and α coherence between the motor cortex (MC) and the subthalamic nucleus (STN) is characteristically prokinetic and is decreased in parkinsonian rats. In multi-unit recordings, movement is normally associated with increased changes in spatiotemporal activities rather than overall spike rates in MC. In parkinsonian rats, MC shows higher spike rates at rest but less spatiotemporal activity changes upon movement, and STN burst discharges are more prevalent, longer lasting, and less responsive to MC inputs. DBS at STN rectifies the foregoing pathological MC-STN oscillations and consequently locomotor deficits, yet overstimulation may cause behavioral restlessness. These results indicate that delicate electrophysiological considerations at both cortical and subcortical levels should be exercised for optimal DBS therapy.
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Affiliation(s)
- Lan-Hsin Nancy Lee
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Neurology, Fu Jen Catholic University Hospital, New Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chen-Syuan Huang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ren-Wei Wang
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hsing-Jung Lai
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.,National Taiwan University Hospital, Jin-Shan Branch, New Taipei, Taiwan
| | - Chih-Ching Chung
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chin Yang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,Department of Psychiatry, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.
| | - Chung-Chin Kuo
- Department of Physiology, National Taiwan University College of Medicine, Taipei, Taiwan. .,Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
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90
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Darcy N, Lofredi R, Al-Fatly B, Neumann WJ, Hübl J, Brücke C, Krause P, Schneider GH, Kühn A. Spectral and spatial distribution of subthalamic beta peak activity in Parkinson's disease patients. Exp Neurol 2022; 356:114150. [PMID: 35732220 DOI: 10.1016/j.expneurol.2022.114150] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/27/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
Current efforts to optimize subthalamic deep brain stimulation in Parkinson's disease patients aim to harness local oscillatory activity in the beta frequency range (13-35 Hz) as a feedback-signal for demand-based adaptive stimulation paradigms. A high prevalence of beta peak activity is prerequisite for this approach to become routine clinical practice. In a large dataset of postoperative rest recordings from 106 patients we quantified occurrence and identified determinants of spectral peaks in the alpha, low and high beta bands. At least one peak in beta band occurred in 92% of patients and 84% of hemispheres off medication, irrespective of demographic parameters, clinical subtype or motor symptom severity. Distance to previously described clinical sweet spot was significantly related both to beta peak occurrence and to spectral power (rho -0.21, p 0.006), particularly in the high beta band. Electrophysiological landscapes of our cohort's dataset in normalised space showed divergent heatmaps for alpha and beta but found similar regions for low and high beta frequency bands. We discuss potential ramifications for clinicians' programming decisions. In summary, this report provides robust evidence that spectral peaks in beta frequency range can be detected in the vast majority of Parkinsonian subthalamic nuclei, increasing confidence in the broad applicability of beta-guided deep brain stimulation.
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Affiliation(s)
- Natasha Darcy
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
| | - Roxanne Lofredi
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany
| | - Bassam Al-Fatly
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany
| | - Julius Hübl
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christof Brücke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Patricia Krause
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany; NeuroCure, Exzellenzcluster, Charité - Universitätsmedizin Berlin, Berlin, Germany; DZNE, German center for neurodegenerative diseases, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Germany
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91
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Rauschenberger L, Güttler C, Volkmann J, Kühn AA, Ip CW, Lofredi R. A translational perspective on pathophysiological changes of oscillatory activity in dystonia and parkinsonism. Exp Neurol 2022; 355:114140. [PMID: 35690132 DOI: 10.1016/j.expneurol.2022.114140] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 05/14/2022] [Accepted: 06/03/2022] [Indexed: 11/19/2022]
Abstract
Intracerebral recordings from movement disorders patients undergoing deep brain stimulation have allowed the identification of pathophysiological patterns in oscillatory activity that correlate with symptom severity. Changes in oscillatory synchrony occur within and across brain areas, matching the classification of movement disorders as network disorders. However, the underlying mechanisms of oscillatory changes are difficult to assess in patients, as experimental interventions are technically limited and ethically problematic. This is why animal models play an important role in neurophysiological research of movement disorders. In this review, we highlight the contributions of translational research to the mechanistic understanding of pathological changes in oscillatory activity, with a focus on parkinsonism and dystonia, while addressing the limitations of current findings and proposing possible future directions.
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Affiliation(s)
- Lisa Rauschenberger
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Christopher Güttler
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany; NeuroCure, Exzellenzcluster, Charité-Universitätsmedizin Berlin, Berlin, Germany; DZNE, German Center for Neurodegenerative Diseases, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Chi Wang Ip
- Department of Neurology, University Hospital of Würzburg, Josef-Schneider-Straße 11, 97080 Würzburg, Germany
| | - Roxanne Lofredi
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
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92
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Fim Neto A, de Luccas JB, Bianqueti BL, da Silva LR, Almeida TP, Takahata AK, Teixeira MJ, Figueiredo EG, Nasuto SJ, Rocha MSG, Soriano DC, Godinho F. Subthalamic low beta bursts differ in Parkinson's disease phenotypes. Clin Neurophysiol 2022; 140:45-58. [PMID: 35728405 DOI: 10.1016/j.clinph.2022.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Parkinson's disease (PD) patients may be categorized into tremor-dominant (TD) and postural-instability and gait disorder (PIGD) motor phenotypes, but the dynamical aspects of subthalamic nucleus local field potentials (STN-LFP) and the neural correlates of this phenotypical classification remain unclear. METHODS 35 STN-LFP (20 PIGD and 15 TD) were investigated through continuous wavelet transform and machine-learning-based methods. The beta oscillation - the main band associated with motor impairment in PD - dynamics was characterized through beta burst parameters across phenotypes and burst intervals under specific proposed criteria for optimal burst threshold definition. RESULTS Low-frequency (13-22 Hz) beta burst probability was the best predictor for PD phenotypes (75% accuracy). PIGD patients presented higher average burst duration (p = 0.018), while TD patients exhibited higher burst probability (p = 0.014). Categorization into shorter and longer than 400 ms bursts led to significant interaction between burst length categories and the phenotypes (p < 0.050) as revealed by mixed-effects models. Long burst durations and short bursts probability positively correlated, respectively, with rigidity-bradykinesia (p = 0.029) and tremor (p = 0.038) scores. CONCLUSIONS Subthalamic low-frequency beta bursts differed between TD and PIGD phenotypes and correlated with motor symptoms. SIGNIFICANCE These findings improve the PD phenotypes' electrophysiological characterization and may define new criteria for adaptive deep brain stimulation.
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Affiliation(s)
- Arnaldo Fim Neto
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of ABC, São Bernardo do Campo, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil; Department of Cosmic Rays and Chronology, Institute of Physics, University of Campinas, Campinas, Brazil.
| | - Julia Baldi de Luccas
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of ABC, São Bernardo do Campo, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Bruno Leonardo Bianqueti
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of ABC, São Bernardo do Campo, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Luiz Ricardo da Silva
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of ABC, São Bernardo do Campo, Brazil
| | - Tiago Paggi Almeida
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - André Kazuo Takahata
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of ABC, São Bernardo do Campo, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | | | | | | | | | - Diogo Coutinho Soriano
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of ABC, São Bernardo do Campo, Brazil; Brazilian Institute of Neuroscience and Neurotechnology, Campinas, São Paulo, Brazil
| | - Fabio Godinho
- Center for Engineering, Modeling and Applied Social Sciences, Federal University of ABC, São Bernardo do Campo, Brazil; Department of Functional Neurosurgery, Santa Marcelina Hospital, São Paulo, São Paulo, Brazil; Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, Medical School, University of São Paulo, São Paulo, São Paulo, Brazil
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93
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Kumar G, Asthana P, Yung WH, Kwan KM, Tin C, Ma CHE. Deep Brain Stimulation of the Interposed Nucleus Reverses Motor Deficits and Stimulates Production of Anti-inflammatory Cytokines in Ataxia Mice. Mol Neurobiol 2022; 59:4578-4592. [PMID: 35581519 DOI: 10.1007/s12035-022-02872-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/05/2022] [Indexed: 11/24/2022]
Abstract
Cerebellum is one of the major targets of autoimmunity and cerebellar damage that leads to ataxia characterized by the loss of fine motor coordination and balance, with no treatment available. Deep brain stimulation (DBS) could be a promising treatment for ataxia but has not been extensively investigated. Here, our study aims to investigate the use of interposed nucleus of deep cerebellar nuclei (IN-DCN) for ataxia. We first characterized ataxia-related motor symptom of a Purkinje cell (PC)-specific LIM homeobox (Lhx)1 and Lhx5 conditional double knockout mice by motor coordination tests, and spontaneous electromyogram (EMG) recording. To validate IN-DCN as a target for DBS, in vivo local field potential (LFP) multielectrode array recording of IN-DCN revealed abnormal LFP amplitude surges in PCs. By synchronizing the EMG and IN-DCN recordings (neurospike and LFP) with high-speed video recordings, ataxia mice showed poorly coordinated movements associated with low EMG amplitude and aberrant IN-DCN neural firing. To optimize IN-DCN-DBS for ataxia, we tested DBS parameters from low (30 Hz) to high stimulation frequency (130 or 150 Hz), and systematically varied pulse width values (60 or 80 µs) to maximize motor symptom control in ataxia mice. The optimal IN-DCN-DBS parameter reversed motor deficits in ataxia mice as detected by animal behavioral tests and EMG recording. Mechanistically, cytokine array analysis revealed that anti-inflammatory cytokines such as interleukin (IL)-13 and IL-4 were upregulated after IN-DCN-DBS, which play key roles in neural excitability. As such, we show that IN-DCN-DBS is a promising treatment for ataxia and possibly other movement disorders alike.
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Affiliation(s)
- Gajendra Kumar
- Department of Neuroscience, City University of Hong Kong, Tat Chee Avenue, Hong Kong SAR, China
| | - Pallavi Asthana
- Department of Neuroscience, City University of Hong Kong, Tat Chee Avenue, Hong Kong SAR, China
| | - Wing Ho Yung
- School of Biomedical Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Kin Ming Kwan
- School of Life Sciences, Center for Cell and Developmental Biology and State Key Laboratory of Agrobiotechnology, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Chung Tin
- Department of Biomedical Engineering, City University of Hong Kong, Tat Chee Avenue, Hong Kong, SAR, China
| | - Chi Him Eddie Ma
- Department of Neuroscience, City University of Hong Kong, Tat Chee Avenue, Hong Kong SAR, China.
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94
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Neumann WJ, Köhler RM, Kühn AA. A practical guide to invasive neurophysiology in patients with deep brain stimulation. Clin Neurophysiol 2022; 140:171-180. [PMID: 35659821 DOI: 10.1016/j.clinph.2022.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 11/03/2022]
Abstract
Deep brain stimulation (DBS) offers the unique opportunity to record human neural population activity as multiunit activity and local field potentials (LFP) directly from the target area in the depth of the brain. This has led to important discoveries through characterization of pathological activity patterns and identification of motor and cognitive correlates of basal ganglia function in patients with movement disorders. These findings have been covered extensively in a large body of literature, but the technical aspects of microelectrode and LFP recordings in DBS patients are rarely reported. This review summarizes the experience from invasive neurophysiology experiments in over 500 DBS cases in the last 20 years in a single centre. It introduces the basics of intraoperative microelectrode recordings, discusses the neurophysiological and technical aspects of LFP signals and gives and outlook on current and next-generation developments - from sensing enabled implantable devices to combined electrocorticography and LFP recordings during adaptive DBS.
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Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Richard M Köhler
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Chariteplatz 1, 10117 Berlin, Germany.
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95
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Korsun O, Renvall H, Nurminen J, Mäkelä JP, Pekkonen E. Modulation of sensory cortical activity by deep brain stimulation in advanced Parkinson's Disease. Eur J Neurosci 2022; 56:3979-3990. [PMID: 35560964 PMCID: PMC9544049 DOI: 10.1111/ejn.15692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
Despite optimal oral drug treatment, about 90% of patients with Parkinson's disease develop motor fluctuation and dyskinesia within 5-10 years from the diagnosis. Moreover, the patients show non-motor symptoms in different sensory domains. Bilateral deep brain stimulation applied to the subthalamic nucleus is considered the most effective treatment in advanced Parkinson's disease and it has been suggested to affect sensorimotor modulation and relate to motor improvement in patients. However, observations on the relationship between sensorimotor activity and clinical improvement have remained sparse. Here we studied the somatosensory evoked magnetic fields in thirteen right-handed patients with advanced Parkinson's disease before and 7 months after stimulator implantation. Somatosensory processing was addressed with magnetoencephalography during alternated median nerve stimulation at both wrists. The strengths and the latencies of the ~60-ms responses at the contralateral primary somatosensory cortices were highly variable but detectable and reliably localized in all patients. The response strengths did not differ between preoperative and postoperative DBSON measurements. The change in the response strength between pre- and postoperative condition in the dominant left hemisphere of our right-handed patients correlated with the alleviation of their motor symptoms (p = 0.04). However, the result did not survive correction for multiple comparisons. Magnetoencephalography appears an effective tool to explore non-motor effects in patients with Parkinson's disease, and it may help in understanding the neurophysiological basis of deep brain stimulation. However, the high interindividual variability in the somatosensory responses and poor tolerability of DBSOFF condition warrants larger patient groups and measurements also in non-medicated patients.
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Affiliation(s)
- Olesia Korsun
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, School of Science, Espoo, Finland
| | - Hanna Renvall
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland.,Department of Neuroscience and Biomedical Engineering, Aalto University, School of Science, Espoo, Finland
| | - Jussi Nurminen
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland.,Motion Analysis Laboratory, Children's Hospital, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Jyrki P Mäkelä
- Biomag Laboratory, HUS Medical Imaging Center, Helsinki University Hospital, Helsinki University, and Aalto University School of Science, Helsinki, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Helsinki, Finland
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96
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Alavi SM, Mirzaei A, Valizadeh A, Ebrahimpour R. Excitatory deep brain stimulation quenches beta oscillations arising in a computational model of the subthalamo-pallidal loop. Sci Rep 2022; 12:7845. [PMID: 35552409 PMCID: PMC9098470 DOI: 10.1038/s41598-022-10084-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinson’s disease (PD) is associated with abnormal \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β band oscillations (13–30 Hz) in the cortico-basal ganglia circuits. Abnormally increased striato-pallidal inhibition and strengthening the synaptic coupling between subthalamic nucleus (STN) and globus pallidus externa (GPe), due to the loss of dopamine, are considered as the potential sources of \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations in the basal ganglia. Deep brain stimulation (DBS) of the basal ganglia subregions is known as a way to reduce the pathological \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations and motor deficits related to PD. Despite the success of the DBS, its underlying mechanism is poorly understood and, there is controversy about the inhibitory or excitatory role of the DBS in the literature. Here, we utilized a computational network model of basal ganglia which consists of STN, GPe, globus pallidus interna, and thalamic neuronal population. This model can reproduce healthy and pathological \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations similar to what has been observed in experimental studies. Using this model, we investigated the effect of DBS to understand whether its effect is excitatory or inhibitory. Our results show that the excitatory DBS is able to quench the pathological synchrony and \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations, while, applying inhibitory DBS failed to quench the PD signs. In light of simulation results, we conclude that the effect of the DBS on its target is excitatory.
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Affiliation(s)
- Seyed Mojtaba Alavi
- Faculty of Computer Engineering, Shahid Rajaee Teacher Training University, Tehran, Iran.,School of Cognitive Sciences (SCS), Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | | | - Alireza Valizadeh
- Department of Physics, Institute for Advance Studies in Basic Sciences (IASBS), Zanjan, Iran.,School of Biological Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Reza Ebrahimpour
- Faculty of Computer Engineering, Shahid Rajaee Teacher Training University, Tehran, Iran. .,School of Cognitive Sciences (SCS), Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
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97
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Adam EM, Brown EN, Kopell N, McCarthy MM. Deep brain stimulation in the subthalamic nucleus for Parkinson's disease can restore dynamics of striatal networks. Proc Natl Acad Sci U S A 2022; 119:e2120808119. [PMID: 35500112 PMCID: PMC9171607 DOI: 10.1073/pnas.2120808119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is highly effective in alleviating movement disability in patients with Parkinson’s disease (PD). However, its therapeutic mechanism of action is unknown. The healthy striatum exhibits rich dynamics resulting from an interaction of beta, gamma, and theta oscillations. These rhythms are essential to selection and execution of motor programs, and their loss or exaggeration due to dopamine (DA) depletion in PD is a major source of behavioral deficits. Restoring the natural rhythms may then be instrumental in the therapeutic action of DBS. We develop a biophysical networked model of a BG pathway to study how abnormal beta oscillations can emerge throughout the BG in PD and how DBS can restore normal beta, gamma, and theta striatal rhythms. Our model incorporates STN projections to the striatum, long known but understudied, found to preferentially target fast-spiking interneurons (FSI). We find that DBS in STN can normalize striatal medium spiny neuron activity by recruiting FSI dynamics and restoring the inhibitory potency of FSIs observed in normal conditions. We also find that DBS allows the reexpression of gamma and theta rhythms, thought to be dependent on high DA levels and thus lost in PD, through cortical noise control. Our study highlights that DBS effects can go beyond regularizing BG output dynamics to restoring normal internal BG dynamics and the ability to regulate them. It also suggests how gamma and theta oscillations can be leveraged to supplement DBS treatment and enhance its effectiveness.
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Affiliation(s)
- Elie M. Adam
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
| | - Emery N. Brown
- Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, MA 02114
| | - Nancy Kopell
- Department of Mathematics and Statistics, Boston University, Boston, MA 02215
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98
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Meier JM, Perdikis D, Blickensdörfer A, Stefanovski L, Liu Q, Maith O, Dinkelbach HÜ, Baladron J, Hamker FH, Ritter P. Virtual deep brain stimulation: Multiscale co-simulation of a spiking basal ganglia model and a whole-brain mean-field model with the virtual brain. Exp Neurol 2022; 354:114111. [DOI: 10.1016/j.expneurol.2022.114111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 04/04/2022] [Accepted: 05/05/2022] [Indexed: 11/04/2022]
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99
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Merk T, Peterson V, Köhler R, Haufe S, Richardson RM, Neumann WJ. Machine learning based brain signal decoding for intelligent adaptive deep brain stimulation. Exp Neurol 2022; 351:113993. [PMID: 35104499 PMCID: PMC10521329 DOI: 10.1016/j.expneurol.2022.113993] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/18/2021] [Accepted: 01/22/2022] [Indexed: 12/30/2022]
Abstract
Sensing enabled implantable devices and next-generation neurotechnology allow real-time adjustments of invasive neuromodulation. The identification of symptom and disease-specific biomarkers in invasive brain signal recordings has inspired the idea of demand dependent adaptive deep brain stimulation (aDBS). Expanding the clinical utility of aDBS with machine learning may hold the potential for the next breakthrough in the therapeutic success of clinical brain computer interfaces. To this end, sophisticated machine learning algorithms optimized for decoding of brain states from neural time-series must be developed. To support this venture, this review summarizes the current state of machine learning studies for invasive neurophysiology. After a brief introduction to the machine learning terminology, the transformation of brain recordings into meaningful features for decoding of symptoms and behavior is described. Commonly used machine learning models are explained and analyzed from the perspective of utility for aDBS. This is followed by a critical review on good practices for training and testing to ensure conceptual and practical generalizability for real-time adaptation in clinical settings. Finally, first studies combining machine learning with aDBS are highlighted. This review takes a glimpse into the promising future of intelligent adaptive DBS (iDBS) and concludes by identifying four key ingredients on the road for successful clinical adoption: i) multidisciplinary research teams, ii) publicly available datasets, iii) open-source algorithmic solutions and iv) strong world-wide research collaborations.
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Affiliation(s)
- Timon Merk
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Victoria Peterson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Richard Köhler
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - Stefan Haufe
- Berlin Center for Advanced Neuroimaging (BCAN), Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Chariteplatz 1, 10117 Berlin, Germany.
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100
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Jin L, Shi W, Zhang C, Yeh CH. Frequency Nesting Interactions in the Subthalamic Nucleus Correlate With the Step Phases for Parkinson’s Disease. Front Physiol 2022; 13:890753. [PMID: 35574448 PMCID: PMC9100409 DOI: 10.3389/fphys.2022.890753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
Gait disturbance in Parkinson’s disease (PD) can be ameliorated by sound stimulation. Given that excessive β synchronization in basal ganglia is linked to motor impairment in PD, whether the frequency nesting interactions are associated with the gait problem is far from clear. To this end, the masking phase-amplitude coupling (PAC) method was proposed to overcome the trade-off between intrinsic nonlinearity/non-stationarity and demand for predetermined frequencies, normally extracted by the filter. In this study, we analyzed LFPs recorded from 13 patients (one female) with PD during stepping with bilateral deep brain electrodes implanted in the subthalamic nucleus (STN). We found that not only high-frequency oscillation (100–300 Hz) was modulated by β (13–30 Hz) but also β and γ amplitude were modulated by their low-frequency components in δ/θ/α and δ/θ/α/β bands. These PAC values were suppressed by sound stimulation, along with an improvement in gait. We also showed that gait-related high-β (Hβ) modulation in the STN was sensitive to auditory cues, and Hβ gait-phase modulation increased with a metronome. Meanwhile, phase-locking values (PLVs) across all frequencies were significantly suppressed around contralateral heel strikes, manifesting the contralateral step as a critical gait phase in gait initiation for PD. Only the PLVs around contralateral steps were sensitive to auditory cues. Our results support masking PAC as an effective method in exploring frequency nesting interactions in LFPs and reveal the linkages between sound stimulation and couplings related to gait phases in the STN. These findings raise the possibility that nesting interactions in the STN work as feasible biomarkers in alleviating gait disorders.
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Affiliation(s)
- Luyao Jin
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Wenbin Shi
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Chuting Zhang
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
| | - Chien-Hung Yeh
- School of Information and Electronics, Beijing Institute of Technology, Beijing, China
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- *Correspondence: Chien-Hung Yeh,
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