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Tambirajoo K, Furlanetti L, Hasegawa H, Raslan A, Gimeno H, Lin JP, Selway R, Ashkan K. Deep Brain Stimulation of the Internal Pallidum in Lesch-Nyhan Syndrome: Clinical Outcomes and Connectivity Analysis. Neuromodulation 2020; 24:380-391. [PMID: 32573906 DOI: 10.1111/ner.13217] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Lesch-Nyhan syndrome (LNS) is a rare genetic disorder characterized by a deficiency of hypoxanthine-guanine phosphoribosyltransferase enzyme. It manifests during infancy with compulsive self-mutilation behavior associated with disabling generalized dystonia and dyskinesia. Clinical management of these patients poses an enormous challenge for medical teams and carers. OBJECTIVES We report our experience with bilateral deep brain stimulation (DBS) of the globus pallidus internus (GPi) in the management of this complex disorder. MATERIALS AND METHODS Preoperative and postoperative functional assessment data prospectively collected by a multidisciplinary pediatric complex motor disorders team, including imaging, neuropsychology, and neurophysiology evaluations were analyzed with regards to motor and behavioral control, goal achievement, and patient and caregivers' expectations. RESULTS Four male patients (mean age 13 years) underwent DBS implantation between 2011 and 2018. Three patients received double bilateral DBS electrodes within the posteroventral GPi and the anteromedial GPi, whereas one patient had bilateral electrodes placed in the posteroventral GPi only. Median follow-up was 47.5 months (range 22-98 months). Functional improvement was observed in all patients and discussed in relation to previous reports. Analysis of structural connectivity revealed significant correlation between the involvement of specific cortical regions and clinical outcome. CONCLUSION Combined bilateral stimulation of the anteromedial and posteroventral GPi may be considered as an option for managing refractory dystonia and self-harm behavior in LNS patients. A multidisciplinary team-based approach is essential for patient selection and management, to support children and families, to achieve functional improvement and alleviate the overall disease burden for patients and caregivers.
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Affiliation(s)
- Kantharuby Tambirajoo
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK
| | - Luciano Furlanetti
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK
| | - Ahmed Raslan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK
| | - Hortensia Gimeno
- King's Health Partners Academic Health Sciences Centre, London, UK.,Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jean-Pierre Lin
- King's Health Partners Academic Health Sciences Centre, London, UK.,Complex Motor Disorders Service, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Richard Selway
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital NHS Foundation Trust, London, UK.,King's Health Partners Academic Health Sciences Centre, London, UK
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Horn A, Wenzel G, Irmen F, Huebl J, Li N, Neumann WJ, Krause P, Bohner G, Scheel M, Kühn AA. Deep brain stimulation induced normalization of the human functional connectome in Parkinson's disease. Brain 2020; 142:3129-3143. [PMID: 31412106 DOI: 10.1093/brain/awz239] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/12/2019] [Accepted: 06/09/2019] [Indexed: 12/20/2022] Open
Abstract
Neuroimaging has seen a paradigm shift away from a formal description of local activity patterns towards studying distributed brain networks. The recently defined framework of the 'human connectome' enables global analysis of parts of the brain and their interconnections. Deep brain stimulation (DBS) is an invasive therapy for patients with severe movement disorders aiming to retune abnormal brain network activity by local high frequency stimulation of the basal ganglia. Beyond clinical utility, DBS represents a powerful research platform to study functional connectomics and the modulation of distributed brain networks in the human brain. We acquired resting-state functional MRI in 20 patients with Parkinson's disease with subthalamic DBS switched on and off. An age-matched control cohort of 15 subjects was acquired from an open data repository. DBS lead placement in the subthalamic nucleus was localized using a state-of-the art pipeline that involved brain shift correction, multispectral image registration and use of a precise subcortical atlas. Based on a realistic 3D model of the electrode and surrounding anatomy, the amount of local impact of DBS was estimated using a finite element method approach. On a global level, average connectivity increases and decreases throughout the brain were estimated by contrasting on and off DBS scans on a voxel-wise graph comprising eight thousand nodes. Local impact of DBS on the motor subthalamic nucleus explained half the variance in global connectivity increases within the motor network (R = 0.711, P < 0.001). Moreover, local impact of DBS on the motor subthalamic nucleus could explain the degree to how much voxel-wise average brain connectivity normalized towards healthy controls (R = 0.713, P < 0.001). Finally, a network-based statistics analysis revealed that DBS attenuated specific couplings known to be pathological in Parkinson's disease. Namely, coupling between motor thalamus and motor cortex was increased while striatal coupling with cerebellum, external pallidum and subthalamic nucleus was decreased by DBS. Our results show that resting state functional MRI may be acquired in DBS on and off conditions on clinical MRI hardware and that data are useful to gain additional insight into how DBS modulates the functional connectome of the human brain. We demonstrate that effective DBS increases overall connectivity in the motor network, normalizes the network profile towards healthy controls and specifically strengthens thalamo-cortical connectivity while reducing striatal control over basal ganglia and cerebellar structures.
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Affiliation(s)
- Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany
| | - Gregor Wenzel
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany
| | - Friederike Irmen
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julius Huebl
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany
| | - Ningfei Li
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany.,Department of Neuroradiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Patricia Krause
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany
| | - Georg Bohner
- Department of Neuroradiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Michael Scheel
- Department of Neuroradiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Exzellenzcluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
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53
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Treu S, Strange B, Oxenford S, Neumann WJ, Kühn A, Li N, Horn A. Deep brain stimulation: Imaging on a group level. Neuroimage 2020; 219:117018. [PMID: 32505698 DOI: 10.1016/j.neuroimage.2020.117018] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 05/07/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022] Open
Abstract
Deep Brain Stimulation (DBS) is an established treatment option for movement disorders and is under investigation for treatment in a growing number of other brain diseases. It has been shown that exact electrode placement crucially affects the efficacy of DBS and this should be considered when investigating novel indications or DBS targets. To measure clinical improvement as a function of electrode placement, neuroscientific methodology and specialized software tools are needed. Such tools should have the goal to make electrode placement comparable across patients and DBS centers, and include statistical analysis options to validate and define optimal targets. Moreover, to allow for comparability across different centers, these need to be performed within an algorithmically and anatomically standardized and openly available group space. With the publication of Lead-DBS software in 2014, an open-source tool was introduced that allowed for precise electrode reconstructions based on pre- and postoperative neuroimaging data. Here, we introduce Lead Group, implemented within the Lead-DBS environment and specifically designed to meet aforementioned demands. In the present article, we showcase the various processing streams of Lead Group in a retrospective cohort of 51 patients suffering from Parkinson's disease, who were implanted with DBS electrodes to the subthalamic nucleus (STN). Specifically, we demonstrate various ways to visualize placement of all electrodes in the group and map clinical improvement values to subcortical space. We do so by using active coordinates and volumes of tissue activated, showing converging evidence of an optimal DBS target in the dorsolateral STN. Second, we relate DBS outcome to the impact of each electrode on local structures by measuring overlap of stimulation volumes with the STN. Finally, we explore the software functions for connectomic mapping, which may be used to relate DBS outcomes to connectivity estimates with remote brain areas. The manuscript is accompanied by a walkthrough tutorial which allows users to reproduce all main results presented here. All data and code needed to reproduce results are openly available.
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Affiliation(s)
- Svenja Treu
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, Spain; Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany.
| | - Bryan Strange
- Laboratory for Clinical Neuroscience, Centre for Biomedical Technology, Universidad Politécnica de Madrid, Spain
| | - Simon Oxenford
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Wolf-Julian Neumann
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Andrea Kühn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; Exzellenzcluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ningfei Li
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
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Guo W, Koo BB, Kim JH, Bhadelia RA, Seo DW, Hong SB, Joo EY, Lee S, Lee JI, Cho KR, Shon YM. Defining the optimal target for anterior thalamic deep brain stimulation in patients with drug-refractory epilepsy. J Neurosurg 2020; 134:1054-1063. [PMID: 32384279 DOI: 10.3171/2020.2.jns193226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 02/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The anterior thalamic nucleus (ATN) is a common target for deep brain stimulation (DBS) for the treatment of drug-refractory epilepsy. However, no atlas-based optimal DBS (active contacts) target within the ATN has been definitively identified. The object of this retrospective study was to analyze the relationship between the active contact location and seizure reduction to establish an atlas-based optimal target for ATN DBS. METHODS From among 25 patients who had undergone ATN DBS surgery for drug-resistant epilepsy between 2016 and 2018, those who had follow-up evaluations for more than 1 year were eligible for study inclusion. After an initial stimulation period of 6 months, patients were classified as responsive (≥ 50% median decrease in seizure frequency) or nonresponsive (< 50% median decrease in seizure frequency) to treatment. Stimulation parameters and/or active contact positions were adjusted in nonresponsive patients, and their responsiveness was monitored for at least 1 year. Postoperative CT scans were coregistered nonlinearly with preoperative MR images to determine the center coordinate and atlas-based anatomical localizations of all active contacts in the Montreal Neurological Institute (MNI) 152 space. RESULTS Nineteen patients with drug-resistant epilepsy were followed up for at least a year following bilateral DBS electrode implantation targeting the ATN. Active contacts located more adjacent to the center of gravity of the anterior half of the ATN volume, defined as the anterior center (AC), were associated with greater seizure reduction than those not in this location. Intriguingly, the initially nonresponsive patients could end up with much improved seizure reduction by adjusting the active contacts closer to the AC at the final postoperative follow-up. CONCLUSIONS Patients with stimulation targeting the AC may have a favorable seizure reduction. Moreover, the authors were able to obtain additional good outcomes after electrode repositioning in the initially nonresponsive patients. Purposeful and strategic trajectory planning to target this optimal region may predict favorable outcomes of ATN DBS.
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Affiliation(s)
- Wendy Guo
- 1Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Bang-Bon Koo
- 1Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, Massachusetts
| | - Jae-Hun Kim
- 2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Rafeeque A Bhadelia
- 3Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Dae-Won Seo
- 4Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Seung Bong Hong
- 4Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Eun Yeon Joo
- 4Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul
| | - Seunghoon Lee
- 5Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Jung-Il Lee
- 5Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Kyung Rae Cho
- 5Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul; and
| | - Young-Min Shon
- 4Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul.,6Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea
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55
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Avecillas-Chasin JM, Honey CR. Modulation of Nigrofugal and Pallidofugal Pathways in Deep Brain Stimulation for Parkinson Disease. Neurosurgery 2020; 86:E387-E397. [PMID: 31832650 DOI: 10.1093/neuros/nyz544] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 10/13/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is a well-established surgical therapy for patients with Parkinson disease (PD). OBJECTIVE To define the role of adjacent white matter stimulation in the effectiveness of STN-DBS. METHODS We retrospectively evaluated 43 patients with PD who received bilateral STN-DBS. The volumes of activated tissue were analyzed to obtain significant stimulation clusters predictive of 4 clinical outcomes: improvements in bradykinesia, rigidity, tremor, and reduction of dopaminergic medication. Tractography of the nigrofugal and pallidofugal pathways was performed. The significant clusters were used to calculate the involvement of the nigrofugal and pallidofugal pathways and the STN. RESULTS The clusters predictive of rigidity and tremor improvement were dorsal to the STN with most of the clusters outside of the STN. These clusters preferentially involved the pallidofugal pathways. The cluster predictive of bradykinesia improvement was located in the central part of the STN with an extension outside of the STN. The cluster predictive of dopaminergic medication reduction was located ventrolateral and caudal to the STN. These clusters preferentially involved the nigrofugal pathways. CONCLUSION Improvements in rigidity and tremor mainly involved the pallidofugal pathways dorsal to the STN. Improvement in bradykinesia mainly involved the central part of the STN and the nigrofugal pathways ventrolateral to the STN. Maximal reduction in dopaminergic medication following STN-DBS was associated with an exclusive involvement of the nigrofugal pathways.
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Affiliation(s)
| | - Christopher R Honey
- Department of Surgery, Division of Neurosurgery, University of British Columbia, Vancouver, Canada
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56
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Steffen JK, Reker P, Mennicken FK, Dembek TA, Dafsari HS, Fink GR, Visser‐Vandewalle V, Barbe MT. Bipolar Directional Deep Brain Stimulation in Essential and Parkinsonian Tremor. Neuromodulation 2020; 23:543-549. [DOI: 10.1111/ner.13109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/30/2019] [Accepted: 01/08/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Julia K. Steffen
- Faculty of Medicine and University Hospital Cologne, Department of Neurology University of Cologne Cologne, Germany
| | - Paul Reker
- Faculty of Medicine and University Hospital Cologne, Department of Neurology University of Cologne Cologne, Germany
| | - Fiona K. Mennicken
- Faculty of Medicine and University Hospital Cologne, Department of Neurology University of Cologne Cologne, Germany
| | - Till A. Dembek
- Faculty of Medicine and University Hospital Cologne, Department of Neurology University of Cologne Cologne, Germany
| | - Haidar S. Dafsari
- Faculty of Medicine and University Hospital Cologne, Department of Neurology University of Cologne Cologne, Germany
| | - Gereon R. Fink
- Faculty of Medicine and University Hospital Cologne, Department of Neurology University of Cologne Cologne, Germany
- Cognitive Neuroscience Institute of Neuroscience and Medicine (INM‐3), Research Center Jülich Jülich, Germany
| | - Veerle Visser‐Vandewalle
- Faculty of Medicine and University Hospital Cologne, Department of Stereotactic and Functional Neurosurgery University of Cologne Cologne, Germany
| | - Michael T. Barbe
- Faculty of Medicine and University Hospital Cologne, Department of Neurology University of Cologne Cologne, Germany
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57
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Middlebrooks EH, Grewal SS, Stead M, Lundstrom BN, Worrell GA, Van Gompel JJ. Differences in functional connectivity profiles as a predictor of response to anterior thalamic nucleus deep brain stimulation for epilepsy: a hypothesis for the mechanism of action and a potential biomarker for outcomes. Neurosurg Focus 2019; 45:E7. [PMID: 30064322 DOI: 10.3171/2018.5.focus18151] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a promising therapy for refractory epilepsy. Unfortunately, the variability in outcomes from ANT DBS is not fully understood. In this pilot study, the authors assess potential differences in functional connectivity related to the volume of tissue activated (VTA) in ANT DBS responders and nonresponders as a means for better understanding the mechanism of action and potentially improving DBS targeting. METHODS This retrospective analysis consisted of 6 patients who underwent ANT DBS for refractory epilepsy. Patients were classified as responders (n = 3) if their seizure frequency decreased by at least 50%. The DBS electrodes were localized postoperatively and VTAs were computationally generated based on DBS programming settings. VTAs were used as seed points for resting-state functional MRI connectivity analysis performed using a control dataset. Differences in cortical connectivity to the VTA were assessed between the responder and nonresponder groups. RESULTS The ANT DBS responders showed greater positive connectivity with the default mode network compared to nonresponders, including the posterior cingulate cortex, medial prefrontal cortex, inferior parietal lobule, and precuneus. Interestingly, there was also a consistent anticorrelation with the hippocampus seen in responders that was not present in nonresponders. CONCLUSIONS Based on their pilot study, the authors observed that successful ANT DBS in patients with epilepsy produces increased connectivity in the default mode network, which the authors hypothesize increases the threshold for seizure propagation. Additionally, an inhibitory effect on the hippocampus mediated through increased hippocampal γ-aminobutyric acid (GABA) concentration may contribute to seizure suppression. Future studies are planned to confirm these findings.
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Affiliation(s)
- Erik H Middlebrooks
- Departments of1Radiology and.,2Neurosurgery, Mayo Clinic, Jacksonville, Florida; and
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58
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Directional DBS leads show large deviations from their intended implantation orientation. Parkinsonism Relat Disord 2019; 67:117-121. [DOI: 10.1016/j.parkreldis.2019.08.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 08/25/2019] [Accepted: 08/27/2019] [Indexed: 11/18/2022]
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Dembek TA, Roediger J, Horn A, Reker P, Oehrn C, Dafsari HS, Li N, Kühn AA, Fink GR, Visser‐Vandewalle V, Barbe MT, Timmermann L. Probabilistic sweet spots predict motor outcome for deep brain stimulation in Parkinson disease. Ann Neurol 2019; 86:527-538. [DOI: 10.1002/ana.25567] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 07/07/2019] [Accepted: 07/28/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Till A. Dembek
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
- Department of Stereotactic and Functional Neurosurgery, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Jan Roediger
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department for NeurologyCharité–University Medicine Berlin Berlin Germany
| | - Paul Reker
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Carina Oehrn
- Cognitive Neuroscience, Institute of Neuroscience and MedicineJülich Research Center Jülich Germany
| | - Haidar S. Dafsari
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Ningfei Li
- Movement Disorders and Neuromodulation Unit, Department for NeurologyCharité–University Medicine Berlin Berlin Germany
| | - Andrea A. Kühn
- Movement Disorders and Neuromodulation Unit, Department for NeurologyCharité–University Medicine Berlin Berlin Germany
| | - Gereon R. Fink
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
- Cognitive Neuroscience, Institute of Neuroscience and MedicineJülich Research Center Jülich Germany
| | - Veerle Visser‐Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Michael T. Barbe
- Department of Neurology, Faculty of MedicineUniversity of Cologne Cologne Germany
| | - Lars Timmermann
- Department of NeurologyUniversity Hospital of Marburg and Gießen Marburg Germany
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60
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Wang YC, Grewal SS, Middlebrooks EH, Worrell GA, Stead M, Lundstrom BN, Britton JW, Wu MH, Van Gompel JJ. Targeting analysis of a novel parietal approach for deep brain stimulation of the anterior nucleus of the thalamus for epilepsy. Epilepsy Res 2019; 153:1-6. [PMID: 30913474 DOI: 10.1016/j.eplepsyres.2019.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/02/2019] [Accepted: 03/18/2019] [Indexed: 01/08/2023]
Abstract
PURPOSE Deep brain stimulation (DBS) of the anterior nucleus of the thalamus (ANT) is a promising treatment for refractory epilepsy; however, it remains challenging to successfully target the ANT. The results of Medtronic Registry for Epilepsy (MORE) supported a frontal transventricular(TV) compared to frontal extraventricular (EV) lead trajectory for ANT DBS may have better coverage of the ANT. Here we report the safety and targeting efficacy of a novel, posterior parietal extraventricular (PEV) approach to the ANT. METHODS We conducted a retrospective analysis of ten patients who underwent bilateral ANT DBS (20 total trajectories) for medically-refractory epilepsy. Similar targeting methodology as the MORE trial was used, and the DBS Intrinsic Template Atlas (DISTAL) was utilized for ANT localization and contact position relative to ANT. Clinical data were assessed for DBS targeting efficacy and surgical complications. RESULTS The demonstrated PEV trajectory showed a successful ANT targeting rate of 90% bilaterally. Two or more contacts within ANT were presented in 75% of all leads. Mean contact number in ANT was 2.2+ 1.2. There were no intracranial hemorrhages, cerebrospinal fluid leakage, or permanent neurologic deficits. CONCLUSION In this small series, the novel PEV for ANT DBS is feasible with good targeting accuracy and potential safety advantages. The high accuracy of the PEV trajectory suggests that it is a reasonable alternative trajectory for ANT DBS. Larger studies will be needed to assess this trajectory on clinical outcome of DBS treatment to epilepsy.
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Affiliation(s)
- Yu-Chi Wang
- Department of Neurosurgery, Chang Gung Memorial Hospital in Linkou, Chang Gung University, Taiwan; Program of Biomedical Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan
| | | | - Erik H Middlebrooks
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA; Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Matt Stead
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Min-Hsien Wu
- Program of Biomedical Engineering, Graduate Institute of Biomedical Engineering, Chang Gung University, Taiwan
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Horn A, Li N, Dembek TA, Kappel A, Boulay C, Ewert S, Tietze A, Husch A, Perera T, Neumann WJ, Reisert M, Si H, Oostenveld R, Rorden C, Yeh FC, Fang Q, Herrington TM, Vorwerk J, Kühn AA. Lead-DBS v2: Towards a comprehensive pipeline for deep brain stimulation imaging. Neuroimage 2019; 184:293-316. [PMID: 30179717 PMCID: PMC6286150 DOI: 10.1016/j.neuroimage.2018.08.068] [Citation(s) in RCA: 436] [Impact Index Per Article: 87.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 01/09/2023] Open
Abstract
Deep brain stimulation (DBS) is a highly efficacious treatment option for movement disorders and a growing number of other indications are investigated in clinical trials. To ensure optimal treatment outcome, exact electrode placement is required. Moreover, to analyze the relationship between electrode location and clinical results, a precise reconstruction of electrode placement is required, posing specific challenges to the field of neuroimaging. Since 2014 the open source toolbox Lead-DBS is available, which aims at facilitating this process. The tool has since become a popular platform for DBS imaging. With support of a broad community of researchers worldwide, methods have been continuously updated and complemented by new tools for tasks such as multispectral nonlinear registration, structural/functional connectivity analyses, brain shift correction, reconstruction of microelectrode recordings and orientation detection of segmented DBS leads. The rapid development and emergence of these methods in DBS data analysis require us to revisit and revise the pipelines introduced in the original methods publication. Here we demonstrate the updated DBS and connectome pipelines of Lead-DBS using a single patient example with state-of-the-art high-field imaging as well as a retrospective cohort of patients scanned in a typical clinical setting at 1.5T. Imaging data of the 3T example patient is co-registered using five algorithms and nonlinearly warped into template space using ten approaches for comparative purposes. After reconstruction of DBS electrodes (which is possible using three methods and a specific refinement tool), the volume of tissue activated is calculated for two DBS settings using four distinct models and various parameters. Finally, four whole-brain tractography algorithms are applied to the patient's preoperative diffusion MRI data and structural as well as functional connectivity between the stimulation volume and other brain areas are estimated using a total of eight approaches and datasets. In addition, we demonstrate impact of selected preprocessing strategies on the retrospective sample of 51 PD patients. We compare the amount of variance in clinical improvement that can be explained by the computer model depending on the preprocessing method of choice. This work represents a multi-institutional collaborative effort to develop a comprehensive, open source pipeline for DBS imaging and connectomics, which has already empowered several studies, and may facilitate a variety of future studies in the field.
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Affiliation(s)
- Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany.
| | - Ningfei Li
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Till A Dembek
- Department of Neurology, University Hospital of Cologne, Germany
| | - Ari Kappel
- Wayne State University, Department of Neurosurgery, Detroit, Michigan, USA
| | | | - Siobhan Ewert
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité - University Medicine Berlin, Germany
| | - Andreas Husch
- University of Luxembourg, Luxembourg Centre for Systems Biomedicine, Interventional Neuroscience Group, Belvaux, Luxembourg
| | - Thushara Perera
- Bionics Institute, East Melbourne, Victoria, Australia; Department of Medical Bionics, University of Melbourne, Parkville, Victoria, Australia
| | - Wolf-Julian Neumann
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany; Institute of Neuroradiology, Charité - University Medicine Berlin, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Faculty of Medicine, University Freiburg, Germany
| | - Hang Si
- Numerical Mathematics and Scientific Computing, Weierstrass Institute for Applied Analysis and Stochastics (WIAS), Germany
| | - Robert Oostenveld
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, NL, Netherlands; NatMEG, Karolinska Institutet, Stockholm, SE, Sweden
| | - Christopher Rorden
- McCausland Center for Brain Imaging, University of South Carolina, Columbia, SC, USA
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh PA, USA
| | - Qianqian Fang
- Department of Bioengineering, Northeastern University, Boston, USA
| | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Vorwerk
- Scientific Computing & Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Andrea A Kühn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
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Ewert S, Horn A, Finkel F, Li N, Kühn AA, Herrington TM. Optimization and comparative evaluation of nonlinear deformation algorithms for atlas-based segmentation of DBS target nuclei. Neuroimage 2018; 184:586-598. [PMID: 30267856 DOI: 10.1016/j.neuroimage.2018.09.061] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 08/16/2018] [Accepted: 09/21/2018] [Indexed: 12/23/2022] Open
Abstract
Nonlinear registration of individual brain MRI scans to standard brain templates is common practice in neuroimaging and multiple registration algorithms have been developed and refined over the last 20 years. However, little has been done to quantitatively compare the available algorithms and much of that work has exclusively focused on cortical structures given their importance in the fMRI literature. In contrast, for clinical applications such as functional neurosurgery and deep brain stimulation (DBS), proper alignment of subcortical structures between template and individual space is important. This allows for atlas-based segmentations of anatomical DBS targets such as the subthalamic nucleus (STN) and internal pallidum (GPi). Here, we systematically evaluated the performance of six modern and established algorithms on subcortical normalization and segmentation results by calculating over 11,000 nonlinear warps in over 100 subjects. For each algorithm, we evaluated its performance using T1-or T2-weighted acquisitions alone or a combination of T1-, T2-and PD-weighted acquisitions in parallel. Furthermore, we present optimized parameters for the best performing algorithms. We tested each algorithm on two datasets, a state-of-the-art MRI cohort of young subjects and a cohort of subjects age- and MR-quality-matched to a typical DBS Parkinson's Disease cohort. Our final pipeline is able to segment DBS targets with precision comparable to manual expert segmentations in both cohorts. Although the present study focuses on the two prominent DBS targets, STN and GPi, these methods may extend to other small subcortical structures like thalamic nuclei or the nucleus accumbens.
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Affiliation(s)
- Siobhan Ewert
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany
| | - Francisca Finkel
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Program in Behavioral Neuroscience, Northeastern University, Boston, MA, USA
| | - Ningfei Li
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany; Institute of Software Engineering and Theoretical Computer Science, Neural Information Processing Group, Technische Universität Berlin, Germany
| | - Andrea A Kühn
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorders and Neuromodulation Unit, Berlin, Germany
| | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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van Wijk BCM, Pogosyan A, Hariz MI, Akram H, Foltynie T, Limousin P, Horn A, Ewert S, Brown P, Litvak V. Localization of beta and high-frequency oscillations within the subthalamic nucleus region. NEUROIMAGE-CLINICAL 2017; 16:175-183. [PMID: 28794978 PMCID: PMC5540829 DOI: 10.1016/j.nicl.2017.07.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/05/2017] [Accepted: 07/22/2017] [Indexed: 12/01/2022]
Abstract
Parkinsonian bradykinesia and rigidity are typically associated with excessive beta band oscillations in the subthalamic nucleus. Recently another spectral peak has been identified that might be implicated in the pathophysiology of the disease: high-frequency oscillations (HFO) within the 150–400 Hz range. Beta-HFO phase-amplitude coupling (PAC) has been found to correlate with severity of motor impairment. However, the neuronal origin of HFO and its usefulness as a potential target for deep brain stimulation remain to be established. For example, it is unclear whether HFO arise from the same neural populations as beta oscillations. We intraoperatively recorded local field potentials from the subthalamic nucleus while advancing DBS electrodes in 2 mm steps from 4 mm above the surgical target point until 2 mm below, resulting in 4 recording sites. Data from 26 nuclei from 14 patients were analysed. For each trajectory, we identified the recording site with the largest spectral peak in the beta range (13–30 Hz), and the largest peak in the HFO range separately. In addition, we identified the recording site with the largest beta-HFO PAC. Recording sites with largest beta power and largest HFO power coincided in 50% of cases. In the other 50%, HFO was more likely to be detected at a more superior recording site in the target area. PAC followed more closely the site with largest HFO (45%) than beta power (27%). HFO are likely to arise from spatially close, but slightly more superior neural populations than beta oscillations. Further work is necessary to determine whether the different activities can help fine-tune deep brain stimulation targeting. LFPs were recorded from multiple sites within and around the subthalamic nucleus. Sites with largest beta and high-frequency oscillations (HFO) were identified. HFO were located slightly more superior than beta oscillations. Phase-amplitude coupling more closely followed the site with largest HFO. This work hints at different neural generators for beta and HFO.
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Affiliation(s)
- B C M van Wijk
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
| | - A Pogosyan
- Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - M I Hariz
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.,Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - H Akram
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom.,Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - T Foltynie
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - P Limousin
- Unit of Functional Neurosurgery, Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - A Horn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Berenson-Allen Center for Non-Invasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - S Ewert
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - P Brown
- Nuffield Department of Clinical Neuroscience, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom.,Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom
| | - V Litvak
- Wellcome Trust Centre for Neuroimaging, UCL Institute of Neurology, London, United Kingdom
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Münte TF, Marco-Pallares J, Bolat S, Heldmann M, Lütjens G, Nager W, Müller-Vahl K, Krauss JK. The human globus pallidus internus is sensitive to rewards – Evidence from intracerebral recordings. Brain Stimul 2017; 10:657-663. [DOI: 10.1016/j.brs.2017.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 12/18/2016] [Accepted: 01/07/2017] [Indexed: 10/20/2022] Open
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Horn A, Kühn AA, Merkl A, Shih L, Alterman R, Fox M. Probabilistic conversion of neurosurgical DBS electrode coordinates into MNI space. Neuroimage 2017; 150:395-404. [PMID: 28163141 DOI: 10.1016/j.neuroimage.2017.02.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 02/01/2017] [Accepted: 02/02/2017] [Indexed: 10/20/2022] Open
Abstract
In neurosurgical literature, findings such as deep brain stimulation (DBS) electrode positions are conventionally reported in relation to the anterior and posterior commissures of the individual patient (AC/PC coordinates). However, the neuroimaging literature including neuroanatomical atlases, activation patterns, and brain connectivity maps has converged on a different population-based standard (MNI coordinates). Ideally, one could relate these two literatures by directly transforming MRIs from neurosurgical patients into MNI space. However obtaining these patient MRIs can prove difficult or impossible, especially for older studies or those with hundreds of patients. Here, we introduce a methodology for mapping an AC/PC coordinate (such as a DBS electrode position) to MNI space without the need for MRI scans from the patients themselves. We validate our approach using a cohort of DBS patients in which MRIs are available, and test whether several variations on our approach provide added benefit. We then use our approach to convert previously reported DBS electrode coordinates from eight different neurological and psychiatric diseases into MNI space. Finally, we demonstrate the value of such a conversion using the DBS target for essential tremor as an example, relating the site of the active DBS contact to different MNI atlases as well as anatomical and functional connectomes in MNI space.
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Affiliation(s)
- Andreas Horn
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Charité - University Medicine Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Germany.
| | - Andrea A Kühn
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Germany
| | - Angela Merkl
- Charité - University Medicine Berlin, Department of Neurology, Movement Disorder and Neuromodulation Unit, Germany
| | - Ludy Shih
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Ron Alterman
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Beth Israel Deaconess Medical Center, Neurosurgery Department, Harvard Medical School, Boston, MA 02215
| | - Michael Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, USA
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Park SC, Lee CS, Kim SM, Choi EJ, Lee JK. Comparison of the Stereotactic Accuracies of Function-Guided Deep Brain Stimulation, Calculated Using Multitrack Target Locations Geometrically Inferred from Three-Dimensional Trajectory Rotations, and of Magnetic Resonance Imaging-Guided Deep Brain Stimulation and Outcomes. World Neurosurg 2017; 98:734-749.e7. [DOI: 10.1016/j.wneu.2016.11.046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 11/08/2016] [Accepted: 11/10/2016] [Indexed: 12/26/2022]
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Ehlen F, Vonberg I, Tiedt HO, Horn A, Fromm O, Kühn AA, Klostermann F. Thalamic deep brain stimulation decelerates automatic lexical activation. Brain Cogn 2016; 111:34-43. [PMID: 27816778 DOI: 10.1016/j.bandc.2016.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 09/23/2016] [Accepted: 10/05/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Deep Brain Stimulation (DBS) of the thalamic ventral intermediate nucleus (VIM) is a therapeutic option for patients with essential tremor. Despite a generally low risk of side effects, declines in verbal fluency (VF) have previously been reported. OBJECTIVES We aimed to specify effects of VIM-DBS on major cognitive operations needed for VF task performance, represented by clusters and switches. Clusters are word production spurts, thought to arise from automatic activation of associated information pertaining to a given lexical field. Switches are slow word-to-word transitions, presumed to indicate controlled operations for stepping from one lexical field to another. PATIENTS & METHODS Thirteen essential tremor patients with VIM-DBS performed verbal fluency tasks in their VIM-DBS ON and OFF conditions. Clusters and switches were formally defined by mathematical criteria. All results were compared to those of fifteen healthy control subjects, and significant OFF-ON-change scores were correlated to stimulation parameters. RESULTS Patients produced fewer words than healthy controls. DBS ON compared to DBS OFF aggravated this deficit by prolonging the intervals between words within clusters, whereas switches remained unaffected. This stimulation effect correlated with more anterior electrode positions. CONCLUSION VIM-DBS seems to influence word output dynamics during verbal fluency tasks on the level of word clustering. This suggests a perturbation of automatic lexical co-activation by thalamic stimulation, particularly if delivered relatively anteriorly. The findings are discussed in the context of the hypothesized role of the thalamus in lexical processing.
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Affiliation(s)
- Felicitas Ehlen
- Charité - Universitätsmedizin Berlin, Department of Neurology, Motor and Cognition Group, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12000 Berlin, Germany
| | - Isabelle Vonberg
- Charité - Universitätsmedizin Berlin, Department of Neurology, Motor and Cognition Group, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12000 Berlin, Germany
| | - Hannes O Tiedt
- Charité - Universitätsmedizin Berlin, Department of Neurology, Motor and Cognition Group, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12000 Berlin, Germany
| | - Andreas Horn
- Charité - Universitätsmedizin Berlin, Department of Neurology, Motor Neuroscience Group, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, 13353 Berlin, Germany; Laboratory for Brain Network Imaging and Modulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ortwin Fromm
- Charité - Universitätsmedizin Berlin, Department of Neurology, Motor and Cognition Group, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12000 Berlin, Germany
| | - Andrea A Kühn
- Charité - Universitätsmedizin Berlin, Department of Neurology, Motor Neuroscience Group, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, 13353 Berlin, Germany
| | - Fabian Klostermann
- Charité - Universitätsmedizin Berlin, Department of Neurology, Motor and Cognition Group, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, 12000 Berlin, Germany.
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Deep Brain Stimulation of the Subthalamic Nucleus Improves Lexical Switching in Parkinsons Disease Patients. PLoS One 2016; 11:e0161404. [PMID: 27575379 PMCID: PMC5004923 DOI: 10.1371/journal.pone.0161404] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/04/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Reduced verbal fluency (VF) has been reported in patients with Parkinson’s disease (PD), especially those treated by Deep Brain Stimulation of the subthalamic nucleus (STN DBS). To delineate the nature of this dysfunction we aimed at identifying the particular VF-related operations modified by STN DBS. Method Eleven PD patients performed VF tasks in their STN DBS ON and OFF condition. To differentiate VF-components modulated by the stimulation, a temporal cluster analysis was performed, separating production spurts (i.e., ‘clusters’ as correlates of automatic activation spread within lexical fields) from slower cluster transitions (i.e., ‘switches’ reflecting set-shifting towards new lexical fields). The results were compared to those of eleven healthy control subjects. Results PD patients produced significantly more switches accompanied by shorter switch times in the STN DBS ON compared to the STN DBS OFF condition. The number of clusters and time intervals between words within clusters were not affected by the treatment state. Although switch behavior in patients with DBS ON improved, their task performance was still lower compared to that of healthy controls. Discussion Beyond impacting on motor symptoms, STN DBS seems to influence the dynamics of cognitive procedures. Specifically, the results are in line with basal ganglia roles for cognitive switching, in the particular case of VF, from prevailing lexical concepts to new ones.
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69
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Fazio P, Schain M, Varnäs K, Halldin C, Farde L, Varrone A. Mapping the distribution of serotonin transporter in the human brainstem with high-resolution PET: Validation using postmortem autoradiography data. Neuroimage 2016; 133:313-320. [DOI: 10.1016/j.neuroimage.2016.03.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/28/2022] Open
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Schönecker T, Gruber D, Kivi A, Müller B, Lobsien E, Schneider GH, Kühn AA, Hoffmann KT, Kupsch AR. Postoperative MRI localisation of electrodes and clinical efficacy of pallidal deep brain stimulation in cervical dystonia. J Neurol Neurosurg Psychiatry 2015; 86:833-9. [PMID: 25253870 DOI: 10.1136/jnnp-2014-308159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 08/28/2014] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Pallidal deep brain stimulation (DBS) has been shown to be effective in cervical dystonia (CD) with an improvement of about 50-60% in the Toronto Western Spasmodic Torticollis Rating (TWSTR) Scale. However, predictive factors for the efficacy of DBS in CD are missing with the anatomical location of the electrodes being one of the most important potential predictive factors. METHODS In the present blinded observational study we correlated the anatomical localisation of DBS contacts with the relative clinical improvement (CI %) in the TWSTR as achieved by DBS at different pallidal contacts in 20 patients with CD. Localisations of DBS contacts were derived from postoperative MRI-data following anatomical normalisation into the standard Montreal Neurological Institute stereotactic space. The CIs following 76 bilateral test stimulations of 24 h were mapped to stereotactic coordinates of the corresponding bilateral 152 active contacts and were allocated to low CI (<30%; n=74), intermediate CI (≥30%; <60%; n=52) or high CI (≥60%; n=26). RESULTS Euclidean distances between contacts and the centroid differed between the three clusters (p<0.001) indicating different anatomical variances between clusters. The Euclidean distances between contacts and the centroid of the cluster with high CIs correlated with the individual level of CIs (r=-0.61; p<0.0001). This relationship was best fitted with an exponential regression curve (r(2)=0.41). DISCUSSION Our data show that the clinical effect of pallidal DBS on CD displays an exponential decay over anatomical distance from an optimised target localisation within a subregion of the internal pallidum. The results will allow a comparison of future DBS studies with postoperative MRI by verifying optimised (for instance pallidal) targeting in DBS-treated patients.
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Affiliation(s)
- Thomas Schönecker
- Department of Neurology, Charité, University Medicine Berlin, Germany Klinikum Bremeraven, Germany
| | - Doreen Gruber
- Department of Neurology, Charité, University Medicine Berlin, Germany Movement Disorder Clinic Beelitz Heilstätten, Germany
| | - Anatol Kivi
- Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Vivantes Clinic Berlin Spandau, Germany
| | - Bianca Müller
- Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Vivantes Clinic Berlin Spandau, Germany
| | - Elmar Lobsien
- Department of Neurology, Charité, University Medicine Berlin, Germany Department of Neurology, Helios Clinic, Erfurt, Germany
| | | | - Andrea A Kühn
- Department of Neurology, Charité, University Medicine Berlin, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University of Leipzig, Germany Department of Neuroradiology, Charité, University Medicine, Berlin, Germany
| | - Andreas R Kupsch
- Department of Neurology, Charité, University Medicine Berlin, Germany Departments of Neurology and Stereotactic Neurosurgery, Magdeburg, Germany
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Schroll H, Horn A, Gröschel C, Brücke C, Lütjens G, Schneider GH, Krauss JK, Kühn AA, Hamker FH. Differential contributions of the globus pallidus and ventral thalamus to stimulus-response learning in humans. Neuroimage 2015. [PMID: 26220740 DOI: 10.1016/j.neuroimage.2015.07.061] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The ability to learn associations between stimuli, responses and rewards is a prerequisite for survival. Models of reinforcement learning suggest that the striatum, a basal ganglia input nucleus, vitally contributes to these learning processes. Our recently presented computational model predicts, first, that not only the striatum, but also the globus pallidus contributes to the learning (i.e., exploration) of stimulus-response associations based on rewards. Secondly, it predicts that the stable execution (i.e., exploitation) of well-learned associations involves further learning in the thalamus. To test these predictions, we postoperatively recorded local field potentials (LFPs) from patients that had undergone surgery for deep brain stimulation to treat severe movement disorders. Macroelectrodes were placed either in the globus pallidus or in the ventral thalamus. During recordings, patients performed a reward-based stimulus-response learning task that comprised periods of exploration and exploitation. We analyzed correlations between patients' LFP amplitudes and model-based estimates of their reward expectations and reward prediction errors. In line with our first prediction, pallidal LFP amplitudes during the presentation of rewards and reward omissions correlated with patients' reward prediction errors, suggesting pallidal access to reward-based teaching signals. Unexpectedly, the same was true for the thalamus. In further support of this prediction, pallidal LFP amplitudes during stimulus presentation correlated with patients' reward expectations during phases of low reward certainty - suggesting pallidal participation in the learning of stimulus-response associations. In line with our second prediction, correlations between thalamic stimulus-related LFP amplitudes and patients' reward expectations were significant within phases of already high reward certainty, suggesting thalamic participation in exploitation.
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Affiliation(s)
- Henning Schroll
- Neurology, Charité - Universitätsmedizin Berlin, 13353 Berlin, Germany; Bernstein Center for Computational Neuroscience, Charité - Universitätsmedizin Berlin, 10115 Berlin, Germany; Psychology, Humboldt Universität zu Berlin, 10099 Berlin, Germany; Computer Science, Chemnitz University of Technology, Chemnitz 09111, Germany.
| | - Andreas Horn
- Neurology, Charité - Universitätsmedizin Berlin, 13353 Berlin, Germany
| | | | - Christof Brücke
- Neurology, Charité - Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Götz Lütjens
- Neurosurgery, Medical University Hanover, 30625 Hanover, Germany
| | | | - Joachim K Krauss
- Neurosurgery, Medical University Hanover, 30625 Hanover, Germany
| | - Andrea A Kühn
- Neurology, Charité - Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Fred H Hamker
- Bernstein Center for Computational Neuroscience, Charité - Universitätsmedizin Berlin, 10115 Berlin, Germany; Computer Science, Chemnitz University of Technology, Chemnitz 09111, Germany.
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Merkl A, Neumann WJ, Huebl J, Aust S, Horn A, Krauss JK, Dziobek I, Kuhn J, Schneider GH, Bajbouj M, Kühn AA. Modulation of Beta-Band Activity in the Subgenual Anterior Cingulate Cortex during Emotional Empathy in Treatment-Resistant Depression. Cereb Cortex 2015; 26:2626-38. [PMID: 25994959 DOI: 10.1093/cercor/bhv100] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Deep brain stimulation (DBS) is a promising approach in treatment-resistant depression (TRD). TRD is associated with problems in interpersonal relationships, which might be linked to impaired empathy. Here, we investigate the influence of DBS in the subgenual anterior cingulate cortex (sgACC) on empathy in patients with TRD and explore the pattern of oscillatory sgACC activity during performance of the multifaceted empathy test. We recorded local field potential activity directly from sgACC via DBS electrodes in patients. Based on previous behavioral findings, we expected disrupted empathy networks. Patients showed increased empathic involvement ratings toward negative stimuli as compared with healthy subjects that were significantly reduced after 6 months of DBS. Stimulus-related oscillatory activity pattern revealed a broad desynchronization in the beta (14-35 Hz) band that was significantly larger during patients' reported emotional empathy for negative stimuli than when patients reported to have no empathy. Beta desynchronization for empathic involvement correlated with self-reported severity of depression. Our results indicate a "negativity bias" in patients that can be reduced by DBS. Moreover, direct recordings show activation of the sgACC area during emotional processing and propose that changes in beta-band oscillatory activity in the sgACC might index empathic involvement of negative emotion in TRD.
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Affiliation(s)
- Angela Merkl
- Department of Neurology Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | | | | | - Sabine Aust
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | | | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Germany
| | | | - Jens Kuhn
- Centre of Psychiatry, Medical School Cologne, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | - Andrea A Kühn
- Department of Neurology Berlin School of Mind and Brain NeuroCure, Charité, University Medicine Berlin, Berlin, Germany
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Abstract
OPINION STATEMENT Dystonia is a movement disorder caused by diverse etiologies. Its treatment in children is particularly challenging due to the complexity of the development of the nervous system from birth to young adulthood. The treatment options of childhood dystonia include several oral pharmaceutical agents, botulinum toxin injections, and deep brain stimulation (DBS) therapy. The choice of drug therapy relies on the suspected etiology of the dystonia and the adverse effect profile of the drugs. Dystonic syndromes with known etiologies may require specific interventions, but most dystonias are treated by trying serially a handful of medications starting with those with the best risk/benefit profile. In conjunction to drug therapy, botulinum toxin injections may be used to target a problematic group dystonic muscles. The maximal botulinum toxin dose is limited by the weight of the child, therefore limiting the number of the muscles amenable to such treatment. When drugs and botulinum toxin injections fail to control the child's disabling dystonia, DBS therapy may be offered as a last remedy. Delivering optimal DBS therapy to children with dystonia requires a multidisciplinary team of experienced pediatric neurosurgeons, neurologists, and nurses to select adequate candidates, perform this delicate stereotactic procedure, and optimize DBS delivery. Even in the best hands, the response of childhood dystonia to DBS therapy varies greatly. Future therapy of childhood dystonia will parallel the advancement of knowledge of the pathophysiology of dystonic syndromes and the development of clinical and research tools for their study.
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Affiliation(s)
- Samer D Tabbal
- Department of Neurology, American University of Beirut, Riad El-Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon,
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Lead-DBS: a toolbox for deep brain stimulation electrode localizations and visualizations. Neuroimage 2014; 107:127-135. [PMID: 25498389 DOI: 10.1016/j.neuroimage.2014.12.002] [Citation(s) in RCA: 414] [Impact Index Per Article: 41.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/30/2014] [Accepted: 12/01/2014] [Indexed: 12/20/2022] Open
Abstract
To determine placement of electrodes after deep brain stimulation (DBS) surgery, a novel toolbox that facilitates both reconstruction of the lead electrode trajectory and the contact placement is introduced. Using the toolbox, electrode placement can be reconstructed and visualized based on the electrode-induced artifacts on post-operative magnetic resonance (MR) or computed tomography (CT) images. Correct electrode placement is essential for efficacious treatment with DBS. Post-operative knowledge about the placement of DBS electrode contacts and trajectories is a promising tool for clinical evaluation of DBS effects and adverse effects. It may help clinicians in identifying the best stimulation contacts based on anatomical target areas and may even shorten test stimulation protocols in the future. Fifty patients that underwent DBS surgery were analyzed in this study. After normalizing the post-operative MR/CT volumes into standard Montreal Neurological Institute (MNI)-stereotactic space, electrode leads (n=104) were detected by a novel algorithm that iteratively thresholds each axial slice and isolates the centroids of the electrode artifacts within the MR/CT-images (MR only n=32, CT only n=10, MR and CT n=8). Two patients received four, the others received two quadripolar DBS leads bilaterally, summing up to a total of 120 lead localizations. In a second reconstruction step, electrode contacts along the lead trajectories were reconstructed by using templates of electrode tips that had been manually created beforehand. Reconstructions that were made by the algorithm were finally compared to manual surveys of contact localizations. The algorithm was able to robustly accomplish lead reconstructions in an automated manner in 98% of electrodes and contact reconstructions in 69% of electrodes. Using additional subsequent manual refinement of the reconstructed contact positions, 118 of 120 electrode lead and contact reconstructions could be localized using the toolbox. Taken together, the toolbox presented here allows for a precise and fast reconstruction of DBS contacts by proposing a semi-automated procedure. Reconstruction results can be directly exported to two- and three-dimensional views that show the relationship between DBS contacts and anatomical target regions. The toolbox is made available to the public in form of an open-source MATLAB repository.
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Siegert S, Herrojo Ruiz M, Brücke C, Huebl J, Schneider GH, Ullsperger M, Kühn AA. Error signals in the subthalamic nucleus are related to post-error slowing in patients with Parkinson's disease. Cortex 2014; 60:103-20. [DOI: 10.1016/j.cortex.2013.12.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/30/2013] [Accepted: 12/13/2013] [Indexed: 10/25/2022]
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Krugel LK, Ehlen F, Tiedt HO, Kühn AA, Klostermann F. Differential impact of thalamic versus subthalamic deep brain stimulation on lexical processing. Neuropsychologia 2014; 63:175-84. [DOI: 10.1016/j.neuropsychologia.2014.08.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 01/01/2023]
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Barow E, Neumann WJ, Brücke C, Huebl J, Horn A, Brown P, Krauss JK, Schneider GH, Kühn AA. Deep brain stimulation suppresses pallidal low frequency activity in patients with phasic dystonic movements. ACTA ACUST UNITED AC 2014; 137:3012-3024. [PMID: 25212852 DOI: 10.1093/brain/awu258] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Deep brain stimulation of the globus pallidus internus alleviates involuntary movements in patients with dystonia. However, the mechanism is still not entirely understood. One hypothesis is that deep brain stimulation suppresses abnormally enhanced synchronized oscillatory activity within the motor cortico-basal ganglia network. Here, we explore deep brain stimulation-induced modulation of pathological low frequency (4-12 Hz) pallidal activity that has been described in local field potential recordings in patients with dystonia. Therefore, local field potentials were recorded from 16 hemispheres in 12 patients undergoing deep brain stimulation for severe dystonia using a specially designed amplifier allowing simultaneous high frequency stimulation at therapeutic parameter settings and local field potential recordings. For coherence analysis electroencephalographic activity (EEG) over motor areas and electromyographic activity (EMG) from affected neck muscles were recorded before and immediately after cessation of high frequency stimulation. High frequency stimulation led to a significant reduction of mean power in the 4-12 Hz band by 24.8 ± 7.0% in patients with predominantly phasic dystonia. A significant decrease of coherence between cortical EEG and pallidal local field potential activity in the 4-12 Hz range was revealed for the time period of 30 s after switching off high frequency stimulation. Coherence between EMG activity and pallidal activity was mainly found in patients with phasic dystonic movements where it was suppressed after high frequency stimulation. Our findings suggest that high frequency stimulation may suppress pathologically enhanced low frequency activity in patients with phasic dystonia. These dystonic features are the quickest to respond to high frequency stimulation and may thus directly relate to modulation of pathological basal ganglia activity, whereas improvement in tonic features may depend on long-term plastic changes within the motor network.
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Affiliation(s)
- Ewgenia Barow
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Christof Brücke
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Julius Huebl
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Medical University Hannover, MHH, Hannover, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Campus Virchow Klinikum, Charité-University Medicine Berlin, Berlin, Germany
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Hohlefeld FU, Huchzermeyer C, Huebl J, Schneider GH, Brücke C, Schönecker T, Kühn AA, Curio G, Nikulin VV. Interhemispheric functional interactions between the subthalamic nuclei of patients with Parkinson's disease. Eur J Neurosci 2014; 40:3273-83. [PMID: 25195608 DOI: 10.1111/ejn.12686] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/04/2014] [Accepted: 07/09/2014] [Indexed: 02/01/2023]
Abstract
Parkinson's disease (PD) is characterized by widespread neural interactions in cortico-basal-ganglia networks primarily in beta oscillations (approx. 10-30 Hz), as suggested by previous findings of levodopa-modulated interhemispheric coherence between the bilateral subthalamic nuclei (STN) in local field potential recordings (LFPs). However, due to confounding effects of volume conduction the existence of 'genuine' interhemispheric subcortical coherence remains an open question. To address this issue we utilized the imaginary part of coherency (iCOH) which, in contrast to the standard coherence, is not susceptible to volume conduction. LFPs were recorded from eight patients with PD during wakeful rest before and after levodopa administration. We demonstrated genuine coherence between the bilateral STN in both 10-20 and 21-30 Hz oscillations, as revealed by a non-zero iCOH. Crucially, increased iCOH in 10-20 Hz oscillations positively correlated with the worsening of motor symptoms in the OFF medication condition across patients, which was not the case for standard coherence. Furthermore, across patients iCOH was increased after levodopa administration in 21-30 Hz oscillations. These results suggest a functional distinction between low and high beta oscillations in STN-LFP in line with previous studies. Furthermore, the observed functional coupling between the bilateral STN might contribute to the understanding of bilateral effects of unilateral deep brain stimulation. In conclusion, the present results imply a significant contribution of time-delayed neural interactions to interhemispheric coherence, and the clinical relevance of long-distance neural interactions between bilateral STN for motor symptoms in PD.
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Affiliation(s)
- F U Hohlefeld
- Neurophysics Group, Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Berlin, Germany
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Herrojo Ruiz M, Rusconi M, Brücke C, Haynes JD, Schönecker T, Kühn AA. Encoding of sequence boundaries in the subthalamic nucleus of patients with Parkinson's disease. ACTA ACUST UNITED AC 2014; 137:2715-30. [PMID: 25031238 DOI: 10.1093/brain/awu191] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Sequential behaviour is widespread not only in humans but also in animals, ranging in different degrees of complexity from locomotion to birdsong or music performance. The capacity to learn new motor sequences relies on the integrity of basal ganglia-cortical loops. In Parkinson's disease the execution of habitual action sequences as well as the acquisition of novel sequences is impaired partly due to a deficiency in being able to generate internal cues to trigger movement sequences. In addition, patients suffering from Parkinson's disease have difficulty initiating or terminating a self-paced sequence of actions. Direct recordings from the basal ganglia in these patients show an increased level of beta (14-30 Hz) band oscillatory activity associated with impairment in movement initiation. In this framework, the current study aims to evaluate in patients with Parkinson's disease the neuronal activity in the subthalamic nucleus related to the encoding of sequence boundaries during the explicit learning of sensorimotor sequences. We recorded local field potential activity from the subthalamic nucleus of 12 patients who underwent deep brain stimulation for the treatment of advanced Parkinson's disease, while the patients in their usual medicated state practiced sequences of finger movements on a digital piano with corresponding auditory feedback. Our results demonstrate that variability in performance during an early phase of sequence acquisition correlates across patients with changes in the pattern of subthalamic beta-band oscillations; specifically, an anticipatory suppression of beta-band activity at sequence boundaries is linked to better performance. By contrast, a more compromised performance is related to attenuation of beta-band activity before within-sequence elements. Moreover, multivariate pattern classification analysis reveals that differential information about boundaries and within-sequence elements can be decoded at least 100 ms before the keystroke from the amplitude of oscillations of subthalamic nucleus activity across different frequency bands, not just from the beta-band. Additional analysis was performed to assess the strength of how much the putative signal encoding class of ordinal position (boundaries, within-sequence elements) is reflected in each frequency band. This analysis demonstrates that suppression of power in the beta-band contains the most class-related information, whereas enhancement of gamma band (31-100 Hz) activity is the second main contributor to the encoding. Our findings support the hypothesis that subthalamic nucleus-mediated gating of salient boundary elements during sequence encoding may be a prerequisite for the adequate acquisition of action sequences and the transition to habitual behaviour.
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Affiliation(s)
- María Herrojo Ruiz
- 1 Department of Neurology, Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marco Rusconi
- 2 Bernstein Centre for Computational Neuroscience Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christof Brücke
- 1 Department of Neurology, Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - John-Dylan Haynes
- 2 Bernstein Centre for Computational Neuroscience Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany 3 Berlin Centre for Advanced Neuroimaging, Charité-Universitätsmedizin Berlin, Berlin, Germany 4 Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany 5 Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany 6 Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Thomas Schönecker
- 1 Department of Neurology, Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- 1 Department of Neurology, Campus Virchow, Charité-Universitätsmedizin Berlin, Berlin, Germany 4 Berlin School of Mind and Brain, Humboldt Universität zu Berlin, Berlin, Germany 5 Excellence Cluster NeuroCure, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Ehlen F, Schoenecker T, Kühn AA, Klostermann F. Differential effects of deep brain stimulation on verbal fluency. BRAIN AND LANGUAGE 2014; 134:23-33. [PMID: 24815947 DOI: 10.1016/j.bandl.2014.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 03/31/2014] [Accepted: 04/07/2014] [Indexed: 06/03/2023]
Abstract
We aimed at gaining insights into principles of subcortical lexical processing. Therefore, effects of deep brain stimulation (DBS) in different target structures on verbal fluency (VF) were tested. VF was assessed with active vs. inactivated DBS in 13 and 14 patients with DBS in the vicinity of the thalamic ventral intermediate nucleus (VIM) and, respectively, of the subthalamic nucleus (STN). Results were correlated to electrode localizations in postoperative MRI, and compared to those of 12 age-matched healthy controls. Patients' VF performance was generally below normal. However, while activation of DBS in the vicinity of VIM provoked marked VF decline, it induced subtle phonemic VF enhancement in the vicinity of STN. The effects correlated with electrode localizations in left hemispheric stimulation sites. The results show distinct dependencies of VF on DBS in the vicinity of VIM vs. STN. Particular risks for deterioration occur in patients with relatively ventromedial thalamic electrodes.
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Affiliation(s)
- Felicitas Ehlen
- Charité, University Medicine Berlin, Dept. of Neurology, Motor and Cognition Group, Campus Benjamin Franklin, Germany.
| | - Thomas Schoenecker
- Charité, University Medicine Berlin, Dept. of Neurology, Motor Neuroscience Group, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Andrea A Kühn
- Charité, University Medicine Berlin, Dept. of Neurology, Motor Neuroscience Group, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany.
| | - Fabian Klostermann
- Charité, University Medicine Berlin, Dept. of Neurology, Motor and Cognition Group, Campus Benjamin Franklin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099 Berlin, Germany.
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81
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Accolla EA, Dukart J, Helms G, Weiskopf N, Kherif F, Lutti A, Chowdhury R, Hetzer S, Haynes JD, Kühn AA, Draganski B. Brain tissue properties differentiate between motor and limbic basal ganglia circuits. Hum Brain Mapp 2014; 35:5083-92. [PMID: 24777915 PMCID: PMC4282398 DOI: 10.1002/hbm.22533] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/10/2014] [Accepted: 04/08/2014] [Indexed: 12/24/2022] Open
Abstract
Despite advances in understanding basic organizational principles of the human basal ganglia, accurate in vivo assessment of their anatomical properties is essential to improve early diagnosis in disorders with corticosubcortical pathology and optimize target planning in deep brain stimulation. Main goal of this study was the detailed topological characterization of limbic, associative, and motor subdivisions of the subthalamic nucleus (STN) in relation to corresponding corticosubcortical circuits. To this aim, we used magnetic resonance imaging and investigated independently anatomical connectivity via white matter tracts next to brain tissue properties. On the basis of probabilistic diffusion tractography we identified STN subregions with predominantly motor, associative, and limbic connectivity. We then computed for each of the nonoverlapping STN subregions the covariance between local brain tissue properties and the rest of the brain using high‐resolution maps of magnetization transfer (MT) saturation and longitudinal (R1) and transverse relaxation rate (R2*). The demonstrated spatial distribution pattern of covariance between brain tissue properties linked to myelin (R1 and MT) and iron (R2*) content clearly segregates between motor and limbic basal ganglia circuits. We interpret the demonstrated covariance pattern as evidence for shared tissue properties within a functional circuit, which is closely linked to its function. Our findings open new possibilities for investigation of changes in the established covariance pattern aiming at accurate diagnosis of basal ganglia disorders and prediction of treatment outcome. Hum Brain Mapp 35:5083–5092, 2014. © 2014 The Authors. Human Brain Mapping Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ettore A Accolla
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany; LREN, Département des Neurosciences Cliniques, CHUV, Université de Lausanne, Lausanne, Switzerland; Berlin Center for Advanced Neuroimaging, Charité Universitätsmedizin, Berlin, Germany
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82
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Quadruple deep brain stimulation in Huntington's disease, targeting pallidum and subthalamic nucleus: case report and review of the literature. J Neural Transm (Vienna) 2014; 121:1303-12. [PMID: 24699718 DOI: 10.1007/s00702-014-1201-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
Deep brain stimulation (DBS) represents an established treatment option in a growing number of movement disorders. Recent case reports suggest beneficial effect of globus pallidus internus (GPi)-DBS in selected patients suffering from Huntington's disease with marked disabling chorea. We present a 41-year-old man with genetically confirmed HD following quadruple GPi- and subthalamic nucleus (STN)-DBS. Motor function was assessed by Abnormal Involuntary Movement Scale (AIMS) and by Unified Huntington Disease Rating Scale (UHDRS) presurgery and postsurgery for up to 4 years. Furthermore, cognitive, neuropsychiatric state and quality of life (QoL) including life satisfaction (QLS) were annually evaluated. Chorea assessed by AIMS and UHDRS subscores improved by 52 and 55 %, 45 and 60 %, 35 and 45 % and 55-66 % at 1-4 years, respectively, compared to presurgical state following GPi-STN-DBS. During these time periods bradykinesia did not increase following separate STN- and combined GPi-STN-DBS compared to presurgical state. Mood, QoL and QLS were ameliorated. However, dysexecutive symptoms increased at 4 years postsurgery. The present case report suggests that bilateral GPi- and STN-DBS may represent a new treatment avenue in selected HD patients. Clinically, GPi-DBS attenuated chorea and was associated with a larger effect-adverse effect window compared to STN-DBS. However, GPi-DBS-induced bradykinesia may emerge as one main limitation of GPi-DBS in HD. Thus, quadruple GPi-STN-DBS may be indicated, if separate GPi-DBS does not result in sufficient control of motor symptoms. Future controlled studies need to confirm if the present anecdotal observation of additive beneficial effects of GPi- and STN-DBS in a HD patient with severe generalized chorea and relatively intact cognitive and affective functions indeed represents a new therapeutic option.
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Huebl J, Spitzer B, Brücke C, Schönecker T, Kupsch A, Alesch F, Schneider GH, Kühn AA. Oscillatory subthalamic nucleus activity is modulated by dopamine during emotional processing in Parkinson's disease. Cortex 2014; 60:69-81. [PMID: 24713195 DOI: 10.1016/j.cortex.2014.02.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/09/2014] [Accepted: 02/12/2014] [Indexed: 11/19/2022]
Abstract
Dopaminergic denervation in Parkinson's disease (PD) leads to motor deficits but also depression, lack of motivation and apathy. These symptoms can be reversed by dopaminergic treatment, which may even lead to an increased hedonic tone in some patients with PD. Here, we tested the effects of dopamine on emotional processing as indexed by changes in local field potential (LFP) activity of the subthalamic nucleus (STN) in 28 PD patients undergoing deep brain stimulation. LFP activity from the STN was recorded after the administration of levodopa (ON group) or after overnight withdrawal of medication (OFF group) during presentation of an emotional picture-viewing task. Neutral and emotionally arousing pleasant and unpleasant stimuli were chosen from the International Affective Picture System. We found a double dissociation of the alpha band response depending on dopamine state and stimulus valence: dopamine enhanced the processing of pleasant stimuli, while activation during unpleasant stimuli was reduced, as indexed by the degree of desynchronization in the alpha frequency band. This pattern was reversed in the OFF state and more pronounced in the subgroup of non-depressed PD patients. Further, we found an early gamma band increase with unpleasant stimuli that occurred when ON but not OFF medication and was correlated with stimulus arousal. The late STN alpha band decrease is thought to represent active processing of sensory information. Our findings support the idea that dopamine enhances approach-related processes during late stimulus evaluation in PD. The early gamma band response may represent local encoding of increased attention, which varies as a function of stimulus arousal.
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Affiliation(s)
- Julius Huebl
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Bernhard Spitzer
- Dahlem Institute for Neuroimaging of Emotion, Free University Berlin, Berlin, Germany
| | - Christof Brücke
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Thomas Schönecker
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Andreas Kupsch
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - François Alesch
- Neurosurgical Department of the Vienna General Hospital, Vienna, Austria
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany; Berlin School of Mind and Brain, Charité - University Medicine Berlin, Berlin, Germany; NeuroCure, Charité - University Medicine Berlin, Berlin, Germany.
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Intact lexicon running slowly--prolonged response latencies in patients with subthalamic DBS and verbal fluency deficits. PLoS One 2013; 8:e79247. [PMID: 24236114 PMCID: PMC3827350 DOI: 10.1371/journal.pone.0079247] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/20/2013] [Indexed: 12/02/2022] Open
Abstract
Background Verbal Fluency is reduced in patients with Parkinson’s disease, particularly if treated with deep brain stimulation. This deficit could arise from general factors, such as reduced working speed or from dysfunctions in specific lexical domains. Objective To test whether DBS-associated Verbal Fluency deficits are accompanied by changed dynamics of word processing. Methods 21 Parkinson’s disease patients with and 26 without deep brain stimulation of the subthalamic nucleus as well as 19 healthy controls participated in the study. They engaged in Verbal Fluency and (primed) Lexical Decision Tasks, testing phonemic and semantic word production and processing time. Most patients performed the experiments twice, ON and OFF stimulation or, respectively, dopaminergic drugs. Results Patients generally produced abnormally few words in the Verbal Fluency Task. This deficit was more severe in patients with deep brain stimulation who additionally showed prolonged response latencies in the Lexical Decision Task. Slowing was independent of semantic and phonemic word priming. No significant changes of performance accuracy were obtained. The results were independent from the treatment ON or OFF conditions. Conclusion Low word production in patients with deep brain stimulation was accompanied by prolonged latencies for lexical decisions. No indication was found that the latter slowing was due to specific lexical dysfunctions, so that it probably reflects a general reduction of cognitive working speed, also evident on the level of Verbal Fluency. The described abnormalities seem to reflect subtle sequelae of the surgical procedure for deep brain stimulation rather than of the proper neurostimulation.
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Merkl A, Schneider GH, Schönecker T, Aust S, Kühl KP, Kupsch A, Kühn AA, Bajbouj M. Antidepressant effects after short-term and chronic stimulation of the subgenual cingulate gyrus in treatment-resistant depression. Exp Neurol 2013; 249:160-8. [DOI: 10.1016/j.expneurol.2013.08.017] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Revised: 08/22/2013] [Accepted: 08/27/2013] [Indexed: 01/19/2023]
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Sarnthein J, Péus D, Baumann-Vogel H, Baumann CR, Sürücü O. Stimulation sites in the subthalamic nucleus projected onto a mean 3-D atlas of the thalamus and basal ganglia. Acta Neurochir (Wien) 2013; 155:1655-60. [PMID: 23728503 DOI: 10.1007/s00701-013-1780-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/16/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND In patients with severe forms of Parkinson's disease (PD), deep brain stimulation (DBS) commonly targets the subthalamic nucleus (STN). Recently, the mean 3-D Morel-Atlas of the basal ganglia and the thalamus was introduced. It combines information contained in histological data from ten post-mortem brains. We were interested whether the Morel-Atlas is applicable for the visualization of stimulation sites. METHODS In a consecutive PD patient series, we documented preoperative MRI planning, intraoperative target adjustment based on electrophysiological and neurological testing, and perioperative CT target reconstruction. The localization of the DBS electrodes and the optimal stimulation sites were projected onto the Morel-Atlas. RESULTS We included 20 patients (median age 62 years). The active contact had mean coordinates Xlat = ±12.1 mm, Yap = -1.8 mm, Zvert = -3.2 mm. There was a significant difference between the initially planned site and the coordinates of the postoperative active contact site (median 2.2 mm). The stimulation site was, on average, more anterior and more dorsal. The electrode contact used for optimal stimulation was found within the STN of the atlas in 38/40 (95 %) of implantations. CONCLUSIONS The cluster of stimulation sites in individual patients-as deduced from preoperative MR, intraoperative electrophysiology and neurological testing-showed a high degree of congruence with the atlas. The mean 3D Morel Atlas is thus a useful tool for postoperative target visualization. This represents the first clinical evaluation of the recently created atlas.
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Affiliation(s)
- Johannes Sarnthein
- Klinik für Neurochirurgie, UniversitätsSpital Zürich, Frauenklinikstrasse 10, 8091, Zürich, Switzerland.
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87
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Hohlefeld FU, Huchzermeyer C, Huebl J, Schneider GH, Nolte G, Brücke C, Schönecker T, Kühn AA, Curio G, Nikulin VV. Functional and effective connectivity in subthalamic local field potential recordings of patients with Parkinson's disease. Neuroscience 2013; 250:320-32. [PMID: 23876322 DOI: 10.1016/j.neuroscience.2013.07.028] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 06/24/2013] [Accepted: 07/11/2013] [Indexed: 01/16/2023]
Abstract
In Parkinson's disease (PD) levodopa-associated changes in the power and long-range temporal correlations of beta oscillations have been demonstrated, yet the presence and modulation of genuine connectivity in local field potentials (LFP) recorded from the subthalamic nucleus (STN) remains an open question. The present study investigated LFP recorded bilaterally from the STN at wakeful rest in ten patients with PD after overnight withdrawal of levodopa (OFF) and after a single dose levodopa administration (ON). We utilized connectivity measures being insensitive to volume conduction (functional connectivity: non-zero imaginary part of coherency; effective connectivity: phase-slope index). We demonstrated the presence of neuronal interactions in the frequency range of 10-30 Hz in STN-LFP without a preferential directionality of interactions between different contacts along the electrode tracks. While the direction of neuronal interactions per se was preserved after levodopa administration, functional connectivity and the ventral-dorsal information flow were modulated by medication. The OFF-ON differences in functional connectivity were correlated with the levodopa-induced improvement in clinical Unified Parkinson's Disease Rating Scale scores. We hypothesize that regional neuronal interactions, as reflected in STN-LFP connectivity, might represent a basis for the intra-nuclear spatial specificity of deep brain stimulation. Moreover, our results suggest the potential use of volume conduction-insensitive measures of connectivity in STN-LFP as a marker of clinical motor symptoms in PD.
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Affiliation(s)
- F U Hohlefeld
- Neurophysics Group, Department of Neurology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.
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Herrojo Ruiz M, Brücke C, Nikulin VV, Schneider GH, Kühn AA. Beta-band amplitude oscillations in the human internal globus pallidus support the encoding of sequence boundaries during initial sensorimotor sequence learning. Neuroimage 2013; 85 Pt 2:779-93. [PMID: 23711534 DOI: 10.1016/j.neuroimage.2013.05.085] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/14/2013] [Accepted: 05/19/2013] [Indexed: 11/17/2022] Open
Abstract
Sequential behavior characterizes both simple everyday tasks, such as getting dressed, and complex skills, such as music performance. The basal ganglia (BG) play an important role in the learning of motor sequences. To study the contribution of the human BG to the initial encoding of sequence boundaries, we recorded local field potentials in the sensorimotor area of the internal globus pallidus (GPi) during the early acquisition of sensorimotor sequences in patients undergoing deep brain stimulation for dystonia. We demonstrated an anticipatory modulation of pallidal beta-band neuronal oscillations that was specific to sequence boundaries, as compared to within-sequence elements, and independent of both the movement parameters and the initiation/termination of ongoing movement. The modulation at sequence boundaries emerged with training, in parallel with skill learning, and correlated with the degree of long-range temporal correlations (LRTC) in the dynamics of ongoing beta-band amplitude oscillations. The implication is that LRTC of beta-band oscillations in the sensorimotor GPi might facilitate the emergence of beta power modulations by the sequence boundaries in parallel with sequence learning. Taken together, the results reveal the oscillatory mechanisms in the human BG that contribute at an initial learning phase to the hierarchical organization of sequential behavior as reflected in the formation of boundary-delimited representations of action sequences.
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Affiliation(s)
- María Herrojo Ruiz
- Department of Neurology, Campus Virchow, Charité-University Medicine Berlin, Berlin 13353, Germany.
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89
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Brücke C, Bock A, Huebl J, Krauss JK, Schönecker T, Schneider GH, Brown P, Kühn AA. Thalamic gamma oscillations correlate with reaction time in a Go/noGo task in patients with essential tremor. Neuroimage 2013; 75:36-45. [PMID: 23466935 DOI: 10.1016/j.neuroimage.2013.02.038] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 01/23/2013] [Accepted: 02/14/2013] [Indexed: 10/27/2022] Open
Abstract
Intracerebral recordings of neuronal activity in patients undergoing deep brain stimulation have revealed characteristic movement-related desynchronization at frequencies <30 Hz and increased activity in the gamma band (~30-100 Hz) in the basal ganglia and thalamus. Thalamic gamma activity is also found during arousal. Here, we explore oscillatory gamma band activity recorded from the ventralis intermedius nucleus of the thalamus during motor performance in a Go/noGo task in 10 patients with essential tremor after implantation of deep brain stimulation electrodes. We show that movement-related gamma activity is lateralized to the nucleus contralateral to the moved side similar to previous findings in the globus pallidus internus and the subthalamic nucleus. The onset of contralateral gamma band synchronization following imperative Go cues is positively correlated with reaction time. Remarkably, baseline levels of gamma activity shortly before the Go cue correlated with the reaction times. Here, faster responses occurred in patients with higher levels of pre-cue gamma activity. Our findings support the role of gamma activity as a physiological prokinetic activity in the motor system. Moreover, we suggest that subtle fluctuations in pre-cue gamma band activity may have an impact on task performance and may index arousal-related states.
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Affiliation(s)
- Christof Brücke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Antje Bock
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Julius Huebl
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Germany
| | - Thomas Schönecker
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany
| | | | - Peter Brown
- Nuffield Department of Clinical Neurology, University Oxford, UK
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
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90
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Herrojo Ruiz M, Huebl J, Schönecker T, Kupsch A, Yarrow K, Krauss JK, Schneider GH, Kühn AA. Involvement of human internal globus pallidus in the early modulation of cortical error-related activity. ACTA ACUST UNITED AC 2013; 24:1502-17. [PMID: 23349222 DOI: 10.1093/cercor/bht002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The detection and assessment of errors are a prerequisite to adapt behavior and improve future performance. Error monitoring is afforded by the interplay between cortical and subcortical neural systems. Ample evidence has pointed to a specific cortical error-related evoked potential, the error-related negativity (ERN), during the detection and evaluation of response errors. Recent models of reinforcement learning implicate the basal ganglia (BG) in early error detection following the learning of stimulus-response associations and in the modulation of the cortical ERN. To investigate the influence of the human BG motor output activity on the cortical ERN during response errors, we recorded local field potentials from the sensorimotor area of the internal globus pallidus and scalp electroencephalogram representing activity from the posterior medial frontal cortex in patients with idiopathic dystonia (hands not affected) during a flanker task. In error trials, a specific pallidal error-related potential arose 60 ms prior to the cortical ERN. The error-related changes in pallidal activity-characterized by theta oscillations-were predictive of the cortical error-related activity as assessed by Granger causality analysis. Our findings show an early modulation of error-related activity in the human pallidum, suggesting that pallidal output influences the cortex at an early stage of error detection.
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Affiliation(s)
- María Herrojo Ruiz
- Department of Neurology, Charité-University Medicine Berlin, Berlin, Germany
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91
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Hohlefeld FU, Huebl J, Huchzermeyer C, Schneider GH, Schönecker T, Kühn AA, Curio G, Nikulin VV. Long-range temporal correlations in the subthalamic nucleus of patients with Parkinson's disease. Eur J Neurosci 2013; 36:2812-21. [PMID: 22985199 DOI: 10.1111/j.1460-9568.2012.08198.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neuronal activity in the subthalamic nucleus (STN) of patients with Parkinson's disease (PD) is characterised by excessive neuronal synchronization, particularly in the beta frequency range. However, less is known about the temporal dynamics of neuronal oscillations in PD. In this respect long-range temporal correlations (LRTC) are of special interest as they quantify the neuronal dynamics on different timescales and have been shown to be relevant for optimal information processing in the brain. While the presence of LRTC has been demonstrated in cortical data, their existence in deep brain structures remains an open question. We investigated (i) whether LRTC are present in local field potentials (LFP) recorded bilaterally from the STN at wakeful rest in ten patients with PD after overnight withdrawal of levodopa (OFF) and (ii) whether LRTC can be modulated by levodopa treatment (ON). Detrended fluctuation analysis was utilised in order to quantify the temporal dynamics in the amplitude fluctuations of LFP oscillations. We demonstrated for the first time the presence of LRTC (extending up to 50 s) in the STN. Importantly, the ON state was characterised by significantly stronger LRTC than the OFF state, both in beta (13-35 Hz) and high-frequency (> 200 Hz) oscillations. The existence of LRTC in subcortical structures such as STN provides further evidence for their ubiquitous nature in the brain. The weaker LRTC in the OFF state might indicate limited information processing in the dopamine-depleted basal ganglia. The present results implicate LRTC as a potential biomarker of pathological neuronal processes in PD.
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Affiliation(s)
- F U Hohlefeld
- Neurophysics Group, Department of Neurology, Charité- Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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92
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Abstract
Neuronal synchronization in the gamma (γ) band is considered important for information processing through functional integration of neuronal assemblies across different brain areas. Movement-related γ synchronization occurs in the human basal ganglia where it is centered at ~70 Hz and more pronounced contralateral to the moved hand. However, its functional significance in motor performance is not yet well understood. Here, we assessed whether event-related γ synchronization (ERS) recorded from the globus pallidus internus in patients undergoing deep brain stimulation for medically intractable primary focal and segmental dystonia might code specific motor parameters. Pallidal local field potentials were recorded in 22 patients during performance of a choice-reaction-time task. Movement amplitude of the forearm pronation-supination movements was parametrically modulated with an angular degree of 30°, 60°, and 90°. Only patients with limbs not affected by dystonia were tested. A broad contralateral γ band (35-105 Hz) ERS occurred at movement onset with a maximum reached at peak velocity of the movement. The pallidal oscillatory γ activity correlated with movement parameters: the larger and faster the movement, the stronger was the synchronization in the γ band. In contrast, the event-related decrease in beta band activity was similar for all movements. Gamma band activity did not change with movement direction and did not occur during passive movements. The stepwise increase of γ activity with movement size and velocity suggests a role of neuronal synchronization in this frequency range in basal ganglia control of the scaling of ongoing movements.
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93
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Kupsch A, Tagliati M, Vidailhet M, Aziz T, Krack P, Moro E, Krauss JK. Early postoperative management of DBS in dystonia: programming, response to stimulation, adverse events, medication changes, evaluations, and troubleshooting. Mov Disord 2011; 26 Suppl 1:S37-53. [PMID: 21692111 DOI: 10.1002/mds.23624] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Early postoperative management in deep brain stimulation-treated patients with dystonia differs from that of patients with essential tremor and Parkinson's disease, mainly due to the usually delayed effects of deep brain stimulation and the heterogenous clinical manifestation and etiologies of dystonia. The present chapter summarizes the available data about and concentrates on practical clinical aspects of early postoperative management in deep brain stimulation-treated patients with dystonia.
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Affiliation(s)
- Andreas Kupsch
- Division of Neurology, Charité, Campus Virchow, Berlin, Germany.
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94
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Reese R, Gruber D, Schoenecker T, Bäzner H, Blahak C, Capelle HH, Falk D, Herzog J, Pinsker MO, Schneider GH, Schrader C, Deuschl G, Mehdorn HM, Kupsch A, Volkmann J, Krauss JK. Long-term clinical outcome in meige syndrome treated with internal pallidum deep brain stimulation. Mov Disord 2011; 26:691-8. [PMID: 21312284 DOI: 10.1002/mds.23549] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 10/19/2010] [Accepted: 11/01/2010] [Indexed: 11/06/2022] Open
Abstract
Deep brain stimulation of the globus pallidus internus (GPi DBS) is effective in the treatment of primary segmental and generalized dystonia. Although limb, neck, or truncal dystonia are markedly improved, orofacial dystonia is ameliorated to a lesser extent. Nevertheless, several case reports and small cohort studies have described favorable short-term results of GPi DBS in patients with severe Meige syndrome. Here, we extend this preliminary experience by reporting long-term outcome in a multicenter case series, following 12 patients (6 women, 6 men) with Meige syndrome for up to 78 months after bilateral GPi DBS. We retrospectively assessed dystonia severity based on preoperative and postoperative video documentation. Mean age of patients at surgery was 64.5 ± 4.4 years, and mean disease duration 8.3 ± 4.4 years. Dystonia severity as assessed by the Burke-Fahn-Marsden Dystonia Rating Scale showed a mean improvement of 45% at short-term follow-up (4.4 ± 1.5 months; P < 0.001) and of 53% at long-term follow-up (38.8 ± 21.7 months; P < 0.001). Subscores for eyes were improved by 38% (P = 0.004) and 47% (P < 0.001), for mouth by 50% (P < 0.001) and 56% (P < 0.001), and for speech/swallowing by 44% (P = 0.058) and 64% (P = 0.004). Mean improvements were 25% (P = 0.006) and 38% (P < 0.001) on the Blepharospasm Movement Scale and 44% (P < 0.001) and 49% (P < 0.001) on the Abnormal Involuntary Movement Scale. This series, which is the first to demonstrate a long-term follow-up in a large number of patients, shows that GPi DBS is a safe and highly effective therapy for Meige syndrome. The benefit is preserved for up to 6 years.
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Affiliation(s)
- René Reese
- Department of Neurosurgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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95
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Gruber D, Kühn AA, Schoenecker T, Kivi A, Trottenberg T, Hoffmann KT, Gharabaghi A, Kopp UA, Schneider GH, Klein C, Asmus F, Kupsch A. Pallidal and thalamic deep brain stimulation in myoclonus-dystonia. Mov Disord 2010; 25:1733-43. [PMID: 20623686 DOI: 10.1002/mds.23312] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Deep brain stimulation (DBS) of the internal globus pallidus (GPi) and ventral intermediate thalamic nucleus (VIM) are established treatment options in primary dystonia and tremor syndromes and have been reported anecdotally to be efficacious in myoclonus-dystonia (MD). We investigated short- and long-term effects on motor function, cognition, affective state, and quality of life (QoL) of GPi- and VIM-DBS in MD. Ten MD-patients (nine epsilon-sarcoglycan-mutation-positive) were evaluated pre- and post-surgically following continuous bilateral GPi- and VIM-DBS at four time points: presurgical, 6, 12, and as a last follow-up at a mean of 62.3 months postsurgically, and in OFF-, GPi-, VIM-, and GPi-VIM-DBS conditions by validated motor [unified myoclonus rating scale (UMRS), TSUI Score, Burke-Fahn-Marsden dystonia rating scale (BFMDRS)], cognitive, affective, and QoL-scores. MD-symptoms significantly improved at 6 months post-surgery (UMRS: 61.5%, TSUI Score: 36.5%, BFMDRS: 47.3%). Beneficial effects were sustained at long-term evaluation post-surgery (UMRS: 65.5%, TSUI Score: 35.1%, BFMDRS: 48.2%). QoL was significantly ameliorated; affective status and cognition remained unchanged postsurgically irrespective of the stimulation conditions. No serious long-lasting stimulation-related adverse events (AEs) were observed. Both GPi- and VIM-DBS offer equally effective and safe treatment options for MD. With respect to fewer adverse, stimulation-induced events of GPi-DBS in comparison with VIM-DBS, GPi-DBS seems to be preferable. Combined GPi-VIM-DBS can be useful in cases of incapaciting myoclonus, refractory to GPi-DBS alone.
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Affiliation(s)
- Doreen Gruber
- Departments of Neurology, University Medicine Berlin, Berlin, Germany
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