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Parkinson's Disease Symptoms Associated with Developing On-State Axial Symptoms Early after Subthalamic Deep Brain Stimulation. Diagnostics (Basel) 2022; 12:diagnostics12041001. [PMID: 35454049 PMCID: PMC9027591 DOI: 10.3390/diagnostics12041001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/17/2022] Open
Abstract
Background: The relationship between axial symptoms in Parkinson’s disease (PD) and subthalamic deep brain stimulation (STN-DBS) is still unclear. Purpose: We searched for particular clinical characteristics before STN-DBS linked to on-state axial problems after surgery. Methods: We retrospectively analyzed baseline motor, emotional and cognitive features from PD patients with early axial symptoms (within 4 years after STN-DBS) and late axial symptoms (after 4 years). We also considered a group of PD patients without axial symptoms for at least 4 years after surgery. Results: At baseline, early-axial PD patients (n = 28) had a higher on-state Unified Parkinson’s Disease Rating Scale III (15.0 ± 5.6 to 11.6 ± 6.2, p = 0.020), higher axial score (2.4 ± 1.8 to 0.7 ± 1.0, p < 0.001) and worse dopaminergic response (0.62 ± 0.12 to 0.70 ± 0.11, p = 0.005), than non-axial PD patients (n = 51). Early-axial PD patients had short-term recall impairment, not seen in non-axial PD (36.3 ± 7.6 to 40.3 ± 9.3, p = 0.041). These variables were similar between late-axial PD (n = 18) and non-axial PD, but late-axial PD showed worse frontal dysfunction. Conclusions: PD patients with early axial symptoms after DBS may have a significantly worse presurgical motor phenotype, poorer dopaminergic response and memory impairment. This may correspond to a more severe form of PD.
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102
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Fujikawa J, Morigaki R, Yamamoto N, Oda T, Nakanishi H, Izumi Y, Takagi Y. Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials. Front Aging Neurosci 2022; 14:807909. [PMID: 35462692 PMCID: PMC9020378 DOI: 10.3389/fnagi.2022.807909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease. Methods We first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices. Results Our review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark. Conclusion Invasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- *Correspondence: Ryoma Morigaki,
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
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Swinnen BEKS, Buijink AW, Piña-Fuentes D, de Bie RMA, Beudel M. Diving into the Subcortex: The Potential of Chronic Subcortical Sensing for Unravelling Basal Ganglia Function and Optimization of Deep Brain STIMULATION. Neuroimage 2022; 254:119147. [PMID: 35346837 DOI: 10.1016/j.neuroimage.2022.119147] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Subcortical structures are a relative neurophysiological 'terra incognita' owing to their location within the skull. While perioperative subcortical sensing has been performed for more than 20 years, the neurophysiology of the basal ganglia in the home setting has remained almost unexplored. However, with the recent advent of implantable pulse generators (IPG) that are able to record neural activity, the opportunity to chronically record local field potentials (LFPs) directly from electrodes implanted for deep brain stimulation opens up. This allows for a breakthrough of chronic subcortical sensing into fundamental research and clinical practice. In this review an extensive overview of the current state of subcortical sensing is provided. The widespread potential of chronic subcortical sensing for investigational and clinical use is discussed. Finally, status and future perspectives of the most promising application of chronic subcortical sensing -i.e., adaptive deep brain stimulation (aDBS)- are discussed in the context of movement disorders. The development of aDBS based on both chronic subcortical and cortical sensing has the potential to dramatically change clinical practice and the life of patients with movement disorders. However, several barriers still stand in the way of clinical implementation. Advancements regarding IPG and lead technology, physiomarkers, and aDBS algorithms as well as harnessing artificial intelligence, multimodality and sensing in the naturalistic setting are needed to bring aDBS to clinical practice.
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Affiliation(s)
- Bart E K S Swinnen
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland.
| | - Arthur W Buijink
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Dan Piña-Fuentes
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Rob M A de Bie
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
| | - Martijn Beudel
- Department of Neurology and Clinical Neurophysiology, Amsterdam University Medical, Centers, Amsterdam Neuroscience, University of Amsterdam, PO Box 22660, Amsterdam 1100DD, the Netherland
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104
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Bai Y, Diao Y, Gan L, Zhuo Z, Yin Z, Hu T, Cheng D, Xie H, Wu D, Fan H, Zhang Q, Duan Y, Meng F, Liu Y, Jiang Y, Zhang J. Deep Brain Stimulation Modulates Multiple Abnormal Resting-State Network Connectivity in Patients With Parkinson’s Disease. Front Aging Neurosci 2022; 14:794987. [PMID: 35386115 PMCID: PMC8978802 DOI: 10.3389/fnagi.2022.794987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Background Deep brain stimulation (DBS) improves motor and non-motor symptoms in patients with Parkinson’s disease (PD). Researchers mainly investigated the motor networks to reveal DBS mechanisms, with few studies extending to other networks. This study aimed to investigate multi-network modulation patterns using DBS in patients with PD. Methods Twenty-four patients with PD underwent 1.5 T functional MRI (fMRI) scans in both DBS-on and DBS-off states, with twenty-seven age-matched healthy controls (HCs). Default mode, sensorimotor, salience, and left and right frontoparietal networks were identified by using the independent component analysis. Power spectra and functional connectivity of these networks were calculated. In addition, multiregional connectivity was established from 15 selected regions extracted from the abovementioned networks. Comparisons were made among groups. Finally, correlation analyses were performed between the connectivity changes and symptom improvements. Results Compared with HCs, PD-off showed abnormal power spectra and functional connectivity both within and among these networks. Some of the abovementioned abnormalities could be corrected by DBS, including increasing the power spectra in the sensorimotor network and modulating the parts of the ipsilateral functional connectivity in different regions centered in the frontoparietal network. Moreover, the DBS-induced functional connectivity changes were correlated with motor and depression improvements in patients with PD. Conclusion DBS modulated the abnormalities in multi-networks. The functional connectivity alterations were associated with motor and psychiatric improvements in PD. This study lays the foundation for large-scale brain network research on multi-network DBS modulation.
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Affiliation(s)
- Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu Diao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lu Gan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianqi Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dan Cheng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Delong Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Houyou Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yaou Liu,
| | - Yin Jiang
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
- Yin Jiang,
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Beijing Neurosurgical Institute, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Jianguo Zhang,
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105
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Meng FG, Zhang F, Wang F, Li CH, Wang JW, Han CL, Fan SY, Jing SQ, Jin HB, Du L, Liu W, Wang ZF, Yin ZY, Gao DM, Xing YJ, Yang C, Zhang JG. Therapeutic effects of subthalamic nucleus deep brain stimulation on anxiety and depression in Parkinson’s disease patients. JOURNAL OF NEURORESTORATOLOGY 2022. [DOI: 10.26599/jnr.2022.9040004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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106
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Iazourene T, Malloul H, Noureddine RM, Oujagir E, Escoffre JM, Bouakaz A. Ultrasound Neurostimulation in Mice: Impact of Ultrasound Settings and Beam Properties. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1053-1063. [PMID: 35041601 DOI: 10.1109/tuffc.2022.3144335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Ultrasound neurostimulation (USNS) is being investigated as a treatment approach for neuropsychiatric and neurodegenerative disorders. Indeed, unlike the existing methods that use electric or magnetic stimulation, it offers the possibility to modulate brain activity in a noninvasive way, with good spatial specificity and a high penetration capacity. However, there is no consensus yet on ultrasound parameters and beam properties required for efficient neurostimulation. In this context, this preclinical study aimed to elucidate the effect of frequency, peak negative pressure (PNP), pulse duration (PD), and focal spot diameter, on the USNS efficiency. This was done by targeting the motor cortex (M1) of 70 healthy mice and analyzing the elicited motor responses (visually and with electromyography). Also, a further investigation was performed by assessing the corresponding neuronal activity, using c-Fos immunostaining. The results showed that the success rate, a metric that depicts USNS efficacy, increased with PNP in a sigmoidal way, reaching up to 100%. This was verified at different frequencies (0.5, 1, 1.5, and 2.25 MHz) and PDs (53.3, 160, and 320 ms, at 1.5 MHz fixed frequency). Moreover, it was shown that higher PNP values were required to achieve a constant USNS efficacy not only when frequency increased, but also when the focal spot diameter decreased, emphasizing a close link between these acoustic parameters and USNS efficacy. These findings were confirmed with immunohistochemistry (IHC), which showed a strong relationship between neural activation, the applied PNP, and the focal spot diameter.
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107
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Artusi CA, Rinaldi D, Balestrino R, Lopiano L. Deep brain stimulation for atypical parkinsonism: A systematic review on efficacy and safety. Parkinsonism Relat Disord 2022; 96:109-118. [PMID: 35288028 DOI: 10.1016/j.parkreldis.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/14/2022] [Accepted: 03/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Atypical Parkinsonisms (APs) -including progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and dementia with Lewy bodies (DLB)- are neurodegenerative diseases lacking satisfying symptomatic therapies. Deep Brain Stimulation (DBS) is an established neurosurgical option for advanced Parkinson disease (PD). Although DBS effectiveness in PD fed expectations for the treatment of APs, DBS is still not recommended for APs on the basis of expert consensus and lack of clinical trials. OBJECTIVE In this systematic review, we sought to analyze current evidence on the safety and efficacy of DBS in APs, discussing clinical indications, anatomical targets, and ethical issues. METHODS Following the PRISMA guidelines, we systematically searched PubMed for studies reporting the outcome of patients with APs treated with DBS. RESULTS We identified 25 eligible studies for a total of 66 patients with APs treated with DBS: 31 PSP, 22 MSA, 12 DLB, 1 unspecified parkinsonism with tongue tremor. Targeted nuclei were subthalamic nucleus (STN), globus pallidus pars-interna (GPi), pedunculopontine nucleus (PPN), and nucleus basalis of Meynert (nbM). Only 3/25 studies were randomized controlled trials, and most studies showed a high risk of bias. CONCLUSION Taking into account study biases and confounding factors, current evidence does not support the use of DBS in APs. However, some interesting insights arise from the literature, such as the high frequency of cognitive/neurobehavioral issues in MSA patients treated with STN-DBS, the low frequency of complications in trials of nbM-DBS for DLB, and the possible good response of dystonic symptoms in PSP with GPi DBS.
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Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Torino, Italy; Neurology 2 Unit, A.O.U, Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy.
| | - Domiziana Rinaldi
- Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Sapienza University of Rome, Via di Grottarossa, 1035-00189, Rome, Italy
| | - Roberta Balestrino
- Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Via Cherasco 15, 10126, Torino, Italy; Neurology 2 Unit, A.O.U, Città della Salute e della Scienza di Torino, Corso Bramante 88, 10126, Torino, Italy
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108
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Paulk AC, Zelmann R, Crocker B, Widge AS, Dougherty DD, Eskandar EN, Weisholtz DS, Richardson RM, Cosgrove GR, Williams ZM, Cash SS. Local and distant cortical responses to single pulse intracranial stimulation in the human brain are differentially modulated by specific stimulation parameters. Brain Stimul 2022; 15:491-508. [PMID: 35247646 PMCID: PMC8985164 DOI: 10.1016/j.brs.2022.02.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Electrical neuromodulation via direct electrical stimulation (DES) is an increasingly common therapy for a wide variety of neuropsychiatric diseases. Unfortunately, therapeutic efficacy is inconsistent, likely due to our limited understanding of the relationship between the massive stimulation parameter space and brain tissue responses. OBJECTIVE To better understand how different parameters induce varied neural responses, we systematically examined single pulse-induced cortico-cortico evoked potentials (CCEP) as a function of stimulation amplitude, duration, brain region, and whether grey or white matter was stimulated. METHODS We measured voltage peak amplitudes and area under the curve (AUC) of intracranially recorded stimulation responses as a function of distance from the stimulation site, pulse width, current injected, location relative to grey and white matter, and brain region stimulated (N = 52, n = 719 stimulation sites). RESULTS Increasing stimulation pulse width increased responses near the stimulation location. Increasing stimulation amplitude (current) increased both evoked amplitudes and AUC nonlinearly. Locally (<15 mm), stimulation at the boundary between grey and white matter induced larger responses. In contrast, for distant sites (>15 mm), white matter stimulation consistently produced larger responses than stimulation in or near grey matter. The stimulation location-response curves followed different trends for cingulate, lateral frontal, and lateral temporal cortical stimulation. CONCLUSION These results demonstrate that a stronger local response may require stimulation in the grey-white boundary while stimulation in the white matter could be needed for network activation. Thus, stimulation parameters tailored for a specific anatomical-functional outcome may be key to advancing neuromodulatory therapy.
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Affiliation(s)
- Angelique C Paulk
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Rina Zelmann
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Britni Crocker
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA; Harvard-MIT Health Sciences and Technology, Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Alik S Widge
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - Darin D Dougherty
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA, 02129, USA
| | - Emad N Eskandar
- Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Daniel S Weisholtz
- Department of Neurology, Brigham and Women's Hospital, Boston, MA, 02114, USA
| | - R Mark Richardson
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, 02114, USA
| | - Ziv M Williams
- Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA
| | - Sydney S Cash
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114, USA; Center for Neurotechnology and Neurorecovery, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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109
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Meng L, Jin M, Zhu X, Ming D. Peripherical Electrical Stimulation for Parkinsonian Tremor: A Systematic Review. Front Aging Neurosci 2022; 14:795454. [PMID: 35197841 PMCID: PMC8859162 DOI: 10.3389/fnagi.2022.795454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinsonian tremor is one of the most common motor disorders in patients with Parkinson's disease (PD). Compared to oral medications and brain surgery, electrical stimulation approaches have emerged as effective and non-invasive methods for tremor reduction. The pathophysiology, detection and interventions of tremors have been introduced, however, a systematic review of peripherical electrical stimulation approaches, methodologies, experimental design and clinical outcomes for PD tremor suppression is still missing. Therefore, in this paper, we summarized recent studies on electrical stimulation for tremor suppression in PD patients and discussed stimulation protocols and effectiveness of different types of electrical stimulation approaches in detail. Twenty out of 528 papers published from 2010 to 2021 July were reviewed. The results show that electrical stimulation is an efficient intervention for tremor suppression. The methods fall into three main categories according to the mechanisms: namely functional electrical stimulation (FES), sensory electrical stimulation (SES) and transcutaneous electrical nerve stimulation (TENS). The outcomes of tremor suppression were varied due to various stimulation approaches, electrode locations and stimulation parameters. The FES method performed the best in tremor attenuation where the efficiency depends mainly by the control strategy and accuracy of tremor detection. However, the mechanism underlying tremor suppression with SES and TENS, is not well-known. Current electrical stimulation approaches may only work for a number of patients. The potential mechanism of tremor suppression still needs to be further explored.
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Affiliation(s)
- Lin Meng
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Mengyue Jin
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Xiaodong Zhu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
- Xiaodong Zhu
| | - Dong Ming
- Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
- Department of Biomedical Engineering, Tianjin University, Tianjin, China
- *Correspondence: Dong Ming
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110
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Frank A, Bendig J, Schniewind I, Polanski WH, Sobottka SB, Reichmann H, Akgün K, Ziemssen T, Klingelhoefer L, Falkenburger BH. Serum neurofilament indicates that DBS surgery can cause neuronal damage whereas stimulation itself does not. Sci Rep 2022; 12:1446. [PMID: 35087088 PMCID: PMC8795190 DOI: 10.1038/s41598-022-05117-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 12/30/2021] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) is a potent symptomatic therapy for Parkinson’s disease, but it is debated whether it causes or prevents neurodegeneration. We used serum neurofilament light chain (NFL) as a reporter for neuronal damage and found no difference between 92 patients with chronic STN-DBS and 57 patients on best medical treatment. Serum NFL transiently increased after DBS surgery whereas the initiation of STN stimulation did not affect NFL levels, suggesting that DBS surgery can be associated with neuronal damage whereas stimulation itself is not.
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Affiliation(s)
- Anika Frank
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany.,German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany
| | - Jonas Bendig
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Iñaki Schniewind
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Witold H Polanski
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Stephan B Sobottka
- Department of Neurosurgery, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Katja Akgün
- Department of Neurology, Center of Clinical Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Tjalf Ziemssen
- Department of Neurology, Center of Clinical Neuroscience, Technische Universität Dresden, Dresden, Germany
| | - Lisa Klingelhoefer
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Björn H Falkenburger
- Department of Neurology, University Hospital Carl Gustav Carus, Dresden, Germany. .,German Center for Neurodegenerative Diseases (DZNE), Dresden, Germany. .,Department of Neurology, Technische Universität Dresden, University Hospital Carl Gustav Carus, Dresden, Germany.
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111
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Spivak NM, Sanguinetti JL, Monti MM. Focusing in on the Future of Focused Ultrasound as a Translational Tool. Brain Sci 2022; 12:brainsci12020158. [PMID: 35203922 PMCID: PMC8870102 DOI: 10.3390/brainsci12020158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/22/2022] [Indexed: 12/22/2022] Open
Abstract
This article summarizes the field of focused ultrasound for use in neuromodulation and discusses different ways of targeting, delivering, and validating focused ultrasound. A discussion is focused on parameter space and different ongoing theories of ultrasonic neuromodulation. Current and future applications of the technique are discussed.
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Affiliation(s)
- Norman M. Spivak
- UCLA—Caltech Medical Scientist Training Program, David Geffen School of Medicine, Los Angeles, CA 90095, USA
- Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA;
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
- Correspondence:
| | - Joseph L. Sanguinetti
- Department of Psychology, University of Arizona, Tucson, AZ 85721, USA;
- Department of Psychology, University of New Mexico, Albuquerque, NM 87131, USA
| | - Martin M. Monti
- Department of Neurosurgery, University of California, Los Angeles, CA 90095, USA;
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA
- Department of Psychology, University of California, Los Angeles, CA 90095, USA
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112
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Hernandez CM, Hernandez AR, Hoffman JM, King PH, McMahon LL, Buford TW, Carter C, Bizon JL, Burke SN. A Neuroscience Primer for Integrating Geroscience With the Neurobiology of Aging. J Gerontol A Biol Sci Med Sci 2022; 77:e19-e33. [PMID: 34623396 PMCID: PMC8751809 DOI: 10.1093/gerona/glab301] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 11/13/2022] Open
Abstract
Neuroscience has a rich history of studies focusing on neurobiology of aging. However, much of the aging studies in neuroscience occur outside of the gerosciences. The goal of this primer is 2-fold: first, to briefly highlight some of the history of aging neurobiology and second, to introduce to geroscientists the broad spectrum of methodological approaches neuroscientists use to study the neurobiology of aging. This primer is accompanied by a corresponding geroscience primer, as well as a perspective on the current challenges and triumphs of the current divide across these 2 fields. This series of manuscripts is intended to foster enhanced collaborations between neuroscientists and geroscientists with the intent of strengthening the field of cognitive aging through inclusion of parameters from both areas of expertise.
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Affiliation(s)
- Caesar M Hernandez
- Department of Cellular, Development, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Abigail R Hernandez
- Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jessica M Hoffman
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter H King
- Department of Cellular, Development, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Neurology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Birmingham Veterans Affairs Medical Center, Birmingham, Alabama, USA
| | - Lori L McMahon
- Department of Cellular, Development, and Integrative Biology, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Nathan Shock Center for the Basic Biology of Aging, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Integrative Center for Aging Research, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Thomas W Buford
- Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Nathan Shock Center for the Basic Biology of Aging, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,UAB Integrative Center for Aging Research, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Geriatric Research Education and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama, USA
| | - Christy Carter
- Evelyn F. McKnight Brain Institute, The University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jennifer L Bizon
- Department of Neuroscience, Center for Cognitive Aging and Memory, and the McKnight Brain Institute, The University of Florida, College of Medicine, Gainesville, Florida, USA
| | - Sara N Burke
- Department of Neuroscience, Center for Cognitive Aging and Memory, and the McKnight Brain Institute, The University of Florida, College of Medicine, Gainesville, Florida, USA
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Marceglia S, Conti C, Svanidze O, Foffani G, Lozano AM, Moro E, Volkmann J, Arlotti M, Rossi L, Priori A. Double-blind cross-over pilot trial protocol to evaluate the safety and preliminary efficacy of long-term adaptive deep brain stimulation in patients with Parkinson's disease. BMJ Open 2022; 12:e049955. [PMID: 34980610 PMCID: PMC8724732 DOI: 10.1136/bmjopen-2021-049955] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION After several years of brain-sensing technology development and proof-of-concept studies, adaptive deep brain stimulation (aDBS) is ready to better treat Parkinson's disease (PD) using aDBS-capable implantable pulse generators (IPGs). New aDBS devices are capable of continuous sensing of neuronal activity from the subthalamic nucleus (STN) and contemporaneous stimulation automatically adapted to match the patient's clinical state estimated from the analysis of STN activity using proprietary algorithms. Specific studies are necessary to assess superiority of aDBS vs conventional DBS (cDBS) therapy. This protocol describes an original innovative multicentre international study aimed to assess safety and efficacy of aDBS vs cDBS using a new generation of DBS IPG in PD (AlphaDBS system by Newronika SpA, Milan, Italy). METHODS The study involves six investigational sites (in Italy, Poland and The Netherlands). The primary objective will be to evaluate the safety and tolerability of the AlphaDBS System, when used in cDBS and aDBS mode. Secondary objective will be to evaluate the potential efficacy of aDBS. After eligibility screening, 15 patients with PD already implanted with DBS systems and in need of battery replacement will be randomised to enter a two-phase protocol, including a 'short-term follow-up' (2 days experimental sessions during hospitalisation, 1 day per each mode) and a 'long-term follow-up' (1 month at home, 15 days per each mode). ETHICS AND DISSEMINATION The trial was approved as premarket study by the Italian, Polish, and Dutch Competent Authorities: Bioethics Committee at National Oncology Institute of Maria Skłodowska-Curie-National Research Institute in Warsaw; Comitato Etico Milano Area 2; Comitato Etico IRCCS Istituto Neurologico C. Besta; Comitato Etico interaziendale AOUC Città della Salute e della Scienza-AO Ordine Mauriziano di Torino-ASL Città di Torino; De Medisch Ethisch Toetsingscommissie van Maastricht UMC. The study started enrolling patients in January 2021. TRIAL REGISTRATION NUMBER NCT04681534.
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Affiliation(s)
- Sara Marceglia
- Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste, Trieste, Italy
- UO Neurofisiopatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Guglielmo Foffani
- Fundación del Hospital Nacional de Parapléjicos para la Investigación y la Integración, Toledo, Spain
- CINAC, Hospital Universitario HM Puerta del Sur, Universidad CEU-San Pablo, Móstoles, Madrid, Spain
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Elena Moro
- Grenoble Institute of Neurosciences, INSERM U1216, University Grenoble Alpes, Grenoble, France
| | - Jens Volkmann
- Department of Neurology, University of Wurzburg, Würzburg, Germany
| | | | | | - Alberto Priori
- ASST Santi Paolo e Carlo, Milano, Italy
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Milan, Italy
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114
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Murray SB, Strober M, Tadayonnejad R, Bari AA, Feusner JD. Neurosurgery and neuromodulation for anorexia nervosa in the 21st century: a systematic review of treatment outcomes. Eat Disord 2022; 30:26-53. [PMID: 32991247 PMCID: PMC8386186 DOI: 10.1080/10640266.2020.1790270] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
As current psychosocial and pharmacological interventions show limited efficacy in the treatment of anorexia nervosa (AN), interest in the potential value of neurosurgical intervention and neuromodulation in managing severe and enduring illness has grown. We conducted a systematic review of 20 trials of neurosurgical and neuromodulatory treatments for AN, including neurosurgical ablation, deep brain stimulation (DBS), repetitive transcranial magnetic stimulation (rTMS), and transcranial direct current stimulation (tDCS). Overall, there is evidence to support the role of stereotactic ablation and DBS in the treatment of AN. In contrast, results for rTMS and tDCS have been modest and generally more mixed. Neurosurgical treatment may offer important new avenues for the treatment of AN. Additional randomized clinical trials with comparable patient populations will be needed, in which change in affective, cognitive, and perceptual symptom phenomena, and interrogation of targeted circuits, pre- and post-intervention, are carefully documented.
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Affiliation(s)
- Stuart B Murray
- Department of Psychiatry and the Behavioral Sciences, University of Southern California, Los Angeles, California, USA
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Reza Tadayonnejad
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
| | - Ausaf A Bari
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, USA
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Vasan A, Orosco J, Magaram U, Duque M, Weiss C, Tufail Y, Chalasani SH, Friend J. Ultrasound Mediated Cellular Deflection Results in Cellular Depolarization. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2022; 9:e2101950. [PMID: 34747144 PMCID: PMC8805560 DOI: 10.1002/advs.202101950] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/16/2021] [Indexed: 05/29/2023]
Abstract
Ultrasound has been used to manipulate cells in both humans and animal models. While intramembrane cavitation and lipid clustering have been suggested as likely mechanisms, they lack experimental evidence. Here, high-speed digital holographic microscopy (kiloHertz order) is used to visualize the cellular membrane dynamics. It is shown that neuronal and fibroblast membranes deflect about 150 nm upon ultrasound stimulation. Next, a biomechanical model that predicts changes in membrane voltage after ultrasound exposure is developed. Finally, the model predictions are validated using whole-cell patch clamp electrophysiology on primary neurons. Collectively, it is shown that ultrasound stimulation directly defects the neuronal membrane leading to a change in membrane voltage and subsequent depolarization. The model is consistent with existing data and provides a mechanism for both ultrasound-evoked neurostimulation and sonogenetic control.
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Affiliation(s)
- Aditya Vasan
- Medically Advanced Devices LaboratoryDepartment of Mechanical and Aerospace EngineeringJacobs School of Engineering and Department of SurgerySchool of MedicineUniversity of California San DiegoLa JollaCA92093USA
| | - Jeremy Orosco
- Medically Advanced Devices LaboratoryDepartment of Mechanical and Aerospace EngineeringJacobs School of Engineering and Department of SurgerySchool of MedicineUniversity of California San DiegoLa JollaCA92093USA
| | - Uri Magaram
- Molecular Neurobiology LaboratoryThe Salk Institute for Biological StudiesLa JollaCA92037USA
| | - Marc Duque
- Molecular Neurobiology LaboratoryThe Salk Institute for Biological StudiesLa JollaCA92037USA
| | - Connor Weiss
- Molecular Neurobiology LaboratoryThe Salk Institute for Biological StudiesLa JollaCA92037USA
| | - Yusuf Tufail
- Molecular Neurobiology LaboratoryThe Salk Institute for Biological StudiesLa JollaCA92037USA
| | - Sreekanth H Chalasani
- Molecular Neurobiology LaboratoryThe Salk Institute for Biological StudiesLa JollaCA92037USA
| | - James Friend
- Medically Advanced Devices LaboratoryDepartment of Mechanical and Aerospace EngineeringJacobs School of Engineering and Department of SurgerySchool of MedicineUniversity of California San DiegoLa JollaCA92093USA
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Devignes Q, Daoudi S, Viard R, Lopes R, Betrouni N, Kuchcinski G, Rolland AS, Moreau C, Defebvre L, Bardinet E, Bonnet M, Brefel-Courbon C, Delmaire C, El Mountassir F, Fluchère F, Fradet A, Giordana C, Hainque E, Houvenaghel JF, Jarraya B, Klinger H, Maltête D, Marques A, Meyer M, Rascol O, Rouaud T, Tir M, Wirth T, Corvol JC, Devos D, Dujardin K. Heterogeneity of PD-MCI in Candidates to Subthalamic Deep Brain Stimulation: Associated Cortical and Subcortical Modifications. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1507-1526. [PMID: 35599498 DOI: 10.3233/jpd-223232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Parkinson's disease mild cognitive impairment (PD-MCI) is frequent and heterogenous. There is no consensus about its influence on subthalamic deep brain stimulation (STN-DBS) outcomes. OBJECTIVE To determine the prevalence of PD-MCI and its subtypes in candidates to STN-DBS. Secondarily, we sought to identify MRI structural markers associated with cognitive impairment in these subgroups. METHODS Baseline data from the French multicentric PREDISTIM cohort were used. Candidates to STN-DBS were classified according to their cognitive performance in normal cognition (PD-NC) or PD-MCI. The latter included frontostriatal (PD-FS) and posterior cortical (PD-PC) subtypes. Between-group comparisons were performed on demographical and clinical variables as well as on T1-weighted MRI sequences at the cortical and subcortical levels. RESULTS 320 patients were included: 167 (52%) PD-NC and 153 (48%) PD-MCI patients. The latter group included 123 (80%) PD-FS and 30 (20%) PD-PC patients. There was no between-group difference regarding demographic and clinical variables. PD-PC patients had significantly lower global efficiency than PD-FS patients and significantly worse performance on visuospatial functions, episodic memory, and language. Compared to PD-NC, PD-MCI patients had cortical thinning and radiomic-based changes in the left caudate nucleus and hippocampus. There were no significant differences between the PD-MCI subtypes. CONCLUSION Among the candidates to STN-DBS, a significant proportion has PD-MCI which is associated with cortical and subcortical alterations. Some PD-MCI patients have posterior cortical deficits, a subtype known to be at higher risk of dementia.
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Affiliation(s)
- Quentin Devignes
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France
| | - Sami Daoudi
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France
| | - Romain Viard
- Univ. Lille, CNRS, Inserm, US 41 - UMS 2014 - PLBS, CHU Lille, Lille Pasteur Institute, Lille, France
| | - Renaud Lopes
- Univ. Lille, CNRS, Inserm, US 41 - UMS 2014 - PLBS, CHU Lille, Lille Pasteur Institute, Lille, France
| | - Nacim Betrouni
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France
| | - Gregory Kuchcinski
- Univ. Lille, CNRS, Inserm, US 41 - UMS 2014 - PLBS, CHU Lille, Lille Pasteur Institute, Lille, France
| | - Anne-Sophie Rolland
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Lille, France
| | - Caroline Moreau
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France
| | - Luc Defebvre
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France
| | - Eric Bardinet
- Institut du Cerveau (ICM), Centre de Neuro-Imagerie de Recherche (CENIR), UMR S 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Marie Bonnet
- Centre Expert Parkinson, NS-Park/F-CRIN, Centre Mémoire de Ressources et de Recherche, IMNc, Hôpital Pellegrin, CHU de Bordeaux, France
| | - Christine Brefel-Courbon
- Service de Neurologie B8, Centre Expert Parkinson, NS-Park/F-CRIN, Hôpital Pierre Paul Riquet, CHU Purpan, Toulouse, France
| | - Christine Delmaire
- Department of Radiology, NS-Park/F-CRIN, Hôpital Fondation A de Rothschild, Paris, France
| | - Fouzia El Mountassir
- Université Paris-Saclay, CEA, CNRS, Baobab, Neurospin, Gif-sur-Yvette, France and Institut du Cerveau (ICM), UMR S 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
| | - Frédérique Fluchère
- Department of Neurology, NS-Park/F-CRIN, Assistance Publique - Hôpitaux de Marseille (APHM), Timone University Hospital and Institut de Neurosciences de la Timone, Marseille, France
| | - Anne Fradet
- Neurology Department, NS-Park/F-CRIN, University Hospital of Poitiers and INSERM, University of Poitiers, Centre d'Investigation Clinique CIC 1402, Poitiers, France
| | - Caroline Giordana
- Department of Neurology, NS-Park/F-CRIN, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Elodie Hainque
- Sorbonne Université, Paris Brain Institute - ICM, NS-Park/F-CRIN, Assistance publique Hôpitaux de Paris, Inserm, CRNS, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | | | - Béchir Jarraya
- Neuroscience Pole, NS-Park/F-CRIN, Hôpital Foch, Suresnes, University of Versailles Paris-Saclay, INSERM-CEA NeuroSpin, Saclay, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, NS-Park/F-CRIN, Lyon, France
| | - David Maltête
- Department of Neurology, NS-Park/F-CRIN, Rouen University Hospital and University of Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Mont-Saint-Aignan, France
| | - Ana Marques
- Université Clermont Auvergne, CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN, Clermont-Ferrand, France
| | - Mylène Meyer
- Neurology department, NS-Park/F-CRIN, Central Hospital, CHRU-Nancy, Nancy, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neuroscience, NS-Park/F-CRIN, Toulouse University Hospital, Toulouse, France
| | - Tiphaine Rouaud
- Department of Neurology, Centre Expert Parkinson, NS-Park/F-CRIN, CHU Nantes, Nantes, France
| | - Melissa Tir
- Department of Neurology, NS-PARK/FCRIN, Amiens University Hospital, Amiens, France
| | - Thomas Wirth
- Service de Neurologie, NS-Park/F-CRIN, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute - ICM, NS-Park/F-CRIN, Assistance publique Hôpitaux de Paris, Inserm, CRNS, Hôpital Pitié-Salpêtrière, Department of Neurology, Paris, France
| | - David Devos
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Lille, France
| | - Kathy Dujardin
- Univ. Lille, Inserm, Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN, Lille, France
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Badihian N, Jackson LM, Klassen BT, Hassan A, Low PA, Singer W, Coon EA. The Effects of Deep Brain Stimulation in Patients with Multiple System Atrophy. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2595-2600. [PMID: 36442207 PMCID: PMC10077954 DOI: 10.3233/jpd-223504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The course of patients with multiple system atrophy (MSA) who undergo deep brain stimulation (DBS) is unclear. In a retrospective review of 1,496 patients with MSA evaluated at our institutions from 1998-2021, 12 patients underwent DBS; 9 had a diagnosis of Parkinson's disease at the time of surgery. Nine patients reported initial improvement in at least one symptom and 7 experienced overall worsening following DBS. All patients had at least one red flag sign or symptom suggesting atypical parkinsonism prior to surgery. Considering overall poor outcomes of DBS in MSA, we recommend careful consideration of red flags in patient selection.
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Affiliation(s)
- Negin Badihian
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Anhar Hassan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Phillip A Low
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
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Tarnaud T, Joseph W, Schoeters R, Martens L, Tanghe E. Improved alpha-beta power reduction via combined electrical and ultrasonic stimulation in a parkinsonian cortex-basal ganglia-thalamus computational model. J Neural Eng 2021; 18. [PMID: 34874304 DOI: 10.1088/1741-2552/ac3f6d] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/02/2021] [Indexed: 11/11/2022]
Abstract
Objective. To investigate computationally the interaction of combined electrical and ultrasonic modulation of isolated neurons and of the parkinsonian cortex-basal ganglia-thalamus loop.Approach. Continuous-wave or pulsed electrical and ultrasonic neuromodulation is applied to isolated Otsuka plateau-potential generating subthalamic nucleus (STN) and Pospischil regular, fast and low-threshold spiking cortical cells in a temporally alternating or simultaneous manner. Similar combinations of electrical/ultrasonic waveforms are applied to a parkinsonian biophysical cortex-basal ganglia-thalamus neuronal network. Ultrasound-neuron interaction is modelled respectively for isolated neurons and the neuronal network with the NICE and SONIC implementations of the bilayer sonophore underlying mechanism. Reduction inα-βspectral energy is used as a proxy to express improvement in Parkinson's disease by insonication and electrostimulation.Main results. Simultaneous electro-acoustic stimulation achieves a given level of neuronal activity at lower intensities compared to the separate stimulation modalities. Conversely, temporally alternating stimulation with50 Hzelectrical and ultrasound pulses is capable of eliciting100 HzSTN firing rates. Furthermore, combination of ultrasound with hyperpolarizing currents can alter cortical cell relative spiking regimes. In the parkinsonian neuronal network, continuous-wave and pulsed ultrasound reduce pathological oscillations by different mechanisms. High-frequency pulsed separated electrical and ultrasonic deep brain stimulation (DBS) reduce pathologicalα-βpower by entraining STN-neurons. In contrast, continuous-wave ultrasound reduces pathological oscillations by silencing the STN. Compared to the separated stimulation modalities, temporally simultaneous or alternating electro-acoustic stimulation can achieve higher reductions inα-βpower for the same safety contraints on electrical/ultrasonic intensity.Significance. Focused ultrasound has the potential of becoming a non-invasive alternative of conventional DBS for the treatment of Parkinson's disease. Here, we elaborate on proposed benefits of combined electro-acoustic stimulation in terms of improved dynamic range, efficiency, spatial resolution, and neuronal selectivity.
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Affiliation(s)
- Thomas Tarnaud
- Department of Information Technology (INTEC-WAVES/IMEC), Ghent University/IMEC, Technologiepark 126Zwijnaarde, 9052, Belgium
| | - Wout Joseph
- Department of Information Technology (INTEC-WAVES/IMEC), Ghent University/IMEC, Technologiepark 126Zwijnaarde, 9052, Belgium
| | - Ruben Schoeters
- Department of Information Technology (INTEC-WAVES/IMEC), Ghent University/IMEC, Technologiepark 126Zwijnaarde, 9052, Belgium
| | - Luc Martens
- Department of Information Technology (INTEC-WAVES/IMEC), Ghent University/IMEC, Technologiepark 126Zwijnaarde, 9052, Belgium
| | - Emmeric Tanghe
- Department of Information Technology (INTEC-WAVES/IMEC), Ghent University/IMEC, Technologiepark 126Zwijnaarde, 9052, Belgium
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Cabrera LY, Young Han C, Ostendorf T, Jimenez-Shahed J, Sarva H. Neurologists' Attitudes Toward Use and Timing of Deep Brain Stimulation. Neurol Clin Pract 2021; 11:506-516. [PMID: 34992957 PMCID: PMC8723941 DOI: 10.1212/cpj.0000000000001098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We sought to explore current perspectives and attitudes of general neurologists and movement disorder specialists toward deep brain stimulation (DBS) for Parkinson disease (PD), focusing on perspectives on its earlier use in the clinical course of the disease. METHODS We designed a 30-question online survey comprised of Likert-type, multiple choice, and rank-order questions, which was distributed to 932 neurologist members of the American Academy of Neurology. We analyzed clinicians' sociodemographic information, treatment patterns used for patients with PD, reasons for and against patient referral for DBS, and general attitudes toward DBS. Data were analyzed using descriptive and inferential statistics. RESULTS We received 164/930 completed surveys (completion rate of 18%). Overall, most respondents agreed that DBS was more useful after the appearance of motor complications and that DBS utilization offered better management of PD than medication alone. However, respondents were divided on issues like minimum duration of disease needed to consider DBS as a treatment option and timing of DBS referral relative to disease progression. Specifically, differences between movement disorder specialists and general neurologists were seen in medication management of symptoms and dyskinesia. CONCLUSIONS There remains a lack of consensus on several aspects of DBS, including medical management before offering DBS and the appropriate timing of its consideration for patients. Given the effect of such lack of consensus on patients' outcomes and recent evidence on positive DBS results, it is essential to update DBS professional guidelines with a focus on medical management and the timely use of DBS.
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Affiliation(s)
- Laura Yenisa Cabrera
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Catherine Young Han
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Tasha Ostendorf
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Joohi Jimenez-Shahed
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
| | - Harini Sarva
- Center for Ethics and Humanities in the Life Sciences (LYC), Department of Translational Neuroscience, Michigan State University, East Lansing, current affiliation: Center for Neural Engineering, Department of Engineering Science and Mechanics, Rock Ethics Institutes, Pennsylvania State University; Weill Cornell Medicine (CYH), New York; American Academy of Neurology (TO), Minneapolis, MN; Bonnie and Tom Strauss Movement Disorders Center (JJ-S), Icahn School of Medicine at Mount Sinai, New York; and Parkinson's Disease and Movement Disorders Institute (HS), Department of Neurology, Weill Cornell Medicine, New York
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Vion-Bailly J, Suarez-Castellanos IM, Chapelon JY, Carpentier A, N'Djin WA. Neurostimulation success rate of repetitive-pulse focused ultrasound in an in vivo giant axon model: An acoustic parametric study. Med Phys 2021; 49:682-701. [PMID: 34796512 DOI: 10.1002/mp.15358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE Focused ultrasound (FUS) is a promising tool to develop new modalities of therapeutic neurostimulation. The ability of FUS to stimulate the nervous system, in a noninvasive and spatiotemporally precise manner, has been demonstrated in animals and human subjects, but the underlying biomechanisms are not fully understood yet. The objective of the present study was to investigate the bioeffects involved in the generation of trains of action potentials (APs) by repetitive-pulse FUS stimuli in a simple invertebrate neural model. METHODS The respective influences of different acoustic parameters on the neurostimulation success rate (NSR), defined as the rate of FUS stimuli capable of evoking at least one AP, were explored using the system of afferent nerves and giant fibers of Lumbricus terrestris as neural model. Each parameter was studied independently by administering random FUS sequences while keeping all but one FUS parameter constant. The NSR was evaluated as a function of (i) the spatial-average pulse-average intensity (Isapa ); (ii) the pulse duration (PD); (iii) the pulse repetition frequency (PRF); iv) the number of cycles per pulse (Ncycles ); (v) two ultrasound frequencies, f0 = 1.1 MHz and f3 = 3.3 MHz, corresponding to the fundamental and third-harmonic resonant frequencies of the FUS transducer, respectively (spherical, radius of curvature: 50 mm); and (vi) levels of emerging stable cavitation and inertial cavitation. RESULTS The NSR associated to 1.1 MHz repetitive-pulse FUS stimuli was found to increase as a function of increasing Isapa , PD, PRF, and Ncycles . When evaluating each parameter at f = 1.1 MHz, it was observed that NSRs close to 100% were achieved when sufficiently elevating their respective values. When computing the NSR as a function of the spatial-average, temporal-average intensity (Isata ), defined as the product of PRF, PD, and Isapa , a significant elevation of the NSR from 0% to close to 100% was measured by increasing Isata from values approximate to 4 W/cm2 to values higher than 12 W/cm2 . No clear and consistent trend was observed in trials aimed at exploring the effects of different levels of stable and inertial acoustic cavitation on the NSR. Finally, the feasibility of inducing neural responses with 3.3 MHz repetitive-pulse FUS stimuli was also demonstrated with NSRs reaching up to 60%, in the range of FUS parameters studied. CONCLUSION The time-averaged value of the radiation force per unit volume of tissue is proportional to the acoustic intensity. As a result, the observations from this study suggest that the neural structure responding to the stimulus is sensitive to the mean radiation force carried by the FUS sequence, regardless of the combination of FUS parameters giving rise to such force. The results from this study further revealed the existence of a minimal activation threshold with regard to Isapa .
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Affiliation(s)
- Jérémy Vion-Bailly
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | | | - Jean-Yves Chapelon
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
| | - Alexandre Carpentier
- AP-HP, Neurosurgery department, Pitié-Salpêtrière Hospital, Paris, France.,Sorbonne University, GRC23, Interface Neuro Machine Team, Sorbonne University, Paris, France
| | - W Apoutou N'Djin
- LabTAU, INSERM, Centre Léon Bérard, Université Lyon 1, Univ Lyon, F-69003, Lyon, France
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121
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Levodopa Challenge Test Predicts STN-DBS Outcomes in Various Parkinson's Disease Motor Subtypes: A More Accurate Judgment. Neural Plast 2021; 2021:4762027. [PMID: 34721568 PMCID: PMC8553443 DOI: 10.1155/2021/4762027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 12/03/2022] Open
Abstract
Background The relationship between the levodopa challenge test (LDCT) and postoperative subthalamic nucleus-deep brain stimulation (STN-DBS) benefits is controversial in patients with Parkinson's disease (PD). We aim to evaluate the value of total levodopa response (TLR) and symptom levodopa response (SLR) in predicting postoperative improvement in different PD motor subtypes. Methods Studies were split into a training set (147 patients) and a validation set (304 patients). We retrospectively collected data from 147 patients who received the Unified Parkinson's Disease Rating Scale- (UPDRS-) III and the Parkinson's Disease Questionnaire- (PDQ-) 39 evaluation. Patients were classified into tremor-dominant (TD), akinetic-rigid-dominant (AR), and mixed (MX) groups. Clinically important difference (CID) was employed to dichotomize DBS effects. For patients in each subtype group from the training set, we used the correlation and receiver operator characteristic (ROC) curve analyses to explore the strength of their relations. Areas under the curve (AUCs) were calculated and compared through the DeLong test. Results developed from the training set were applied into the validation set to predict postoperative improvement in different PD motor subtypes. Results In the validation cohort, TLR significantly correlated with postoperative motor (p < 0.001) and quality of life (QOL) (p < 0.001) improvement in the MX group. The AUC between TLR and UPDRS-III (TU) is 0.800. The AUC between TLR and PDQ-39 (TP) is 0.770. An associated criterion in both TU and TP is around 50%. In the AR group, strong correlation was only found in SLR and PDQ-39 (SP) (p < 0.001). And the AUC of SP is significantly larger than that in TLR and PDQ-39 (TP) (p = 0.034). An associated criterion in SP is around 37%. No significant correlation was found in the TD group. Conclusions We provide a more accurate judgment for LDCT. TLR strongly correlated with postoperative UPDRS-III and PDQ-39 improvement in MX patients. A TLR > 50% may indicate a higher possibility of clinically meaningful benefits from STN-DBS comparing to medication only. SLR can well predict QOL improvement in AR patients. Similarly, a SLR > 37% may indicate a higher possibility of clinically significant benefits from STN-DBS. LDCT provides limited information for TD patients.
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Bremm RP, Berthold C, Krüger R, Koch KP, Gonçalves J, Hertel F. Therapeutic maps for a sensor-based evaluation of deep brain stimulation programming. BIOMED ENG-BIOMED TE 2021; 66:603-611. [PMID: 34727584 DOI: 10.1515/bmt-2020-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/01/2021] [Indexed: 11/15/2022]
Abstract
Programming in deep brain stimulation (DBS) is a labour-intensive process for treating advanced motor symptoms. Specifically for patients with medication-refractory tremor in multiple sclerosis (MS). Wearable sensors are able to detect some manifestations of pathological signs, such as intention tremor in MS. However, methods are needed to visualise the response of tremor to DBS parameter changes in a clinical setting while patients perform the motor task finger-to-nose. To this end, we attended DBS programming sessions of a MS patient and intention tremor was effectively quantified by acceleration amplitude and frequency. A new method is introduced which results in the generation of therapeutic maps for a systematic review of the programming procedure in DBS. The maps visualise the combination of tremor acceleration power, clinical rating scores, total electrical energy delivered to the brain and possible side effects. Therapeutic maps have not yet been employed and could lead to a certain degree of standardisation for more objective decisions about DBS settings. The maps provide a base for future research on visualisation tools to assist physicians who frequently encounter patients for DBS therapy.
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Affiliation(s)
- Rene Peter Bremm
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg (City), Luxembourg
- Interventional Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Christophe Berthold
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg (City), Luxembourg
| | - Rejko Krüger
- Translational Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Klaus Peter Koch
- Department of Electrical Engineering, Trier University of Applied Sciences, Trier, Germany
| | - Jorge Gonçalves
- Systems Control, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Frank Hertel
- National Department of Neurosurgery, Centre Hospitalier de Luxembourg, Luxembourg (City), Luxembourg
- Interventional Neuroscience, Luxembourg Centre for Systems Biomedicine, University of Luxembourg, Esch-sur-Alzette, Luxembourg
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123
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A Systematic Review of Neurofeedback for the Management of Motor Symptoms in Parkinson's Disease. Brain Sci 2021; 11:brainsci11101292. [PMID: 34679358 PMCID: PMC8534214 DOI: 10.3390/brainsci11101292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Neurofeedback has been proposed as a treatment for Parkinson’s disease (PD) motor symptoms by changing the neural network activity directly linked with movement. However, the effectiveness of neurofeedback as a treatment for PD motor symptoms is unclear. Aim: To systematically review the literature to identify the effects of neurofeedback in people with idiopathic PD; as defined by measurement of brain activity; motor function; and performance. Design: A systematic review. Included Sources and Articles: PubMed; MEDLINE; Cinhal; PsychoInfo; Prospero; Cochrane; ClinicalTrials.gov; EMBASE; Web of Science; PEDro; OpenGrey; Conference Paper Index; Google Scholar; and eThos; searched using the Population-Intervention-Comparison-Outcome (PICO) framework. Primary studies with the following designs were included: randomized controlled trials (RCTs), non-RCTs; quasi-experimental; pre/post studies; and case studies. Results: This review included 11 studies out of 6197 studies that were identified from the literature search. Neuroimaging methods used were fMRI; scalp EEG; surface brain EEG; and deep brain EEG; where 10–15 Hz and the supplementary motor area were the most commonly targeted signatures for EEG and fMRI, respectively. Success rates for changing one’s brain activity ranged from 47% to 100%; however, both sample sizes and success criteria differed considerably between studies. While six studies included a clinical outcome; a lack of consistent assessments prevented a reliable conclusion on neurofeedback’s effectiveness. Narratively, fMRI neurofeedback has the greatest potential to improve PD motor symptoms. Two main limitations were found in the studies that contributed to the lack of a confident conclusion: (1) insufficient clinical information and perspectives (e.g., no reporting of adverse events), and (2) limitations in numerical data reporting (e.g., lack of explicit statistics) that prevented a meta-analysis. Conclusions: While fMRI neurofeedback was narratively the most effective treatment; the omission of clinical outcome measures in studies using other neurofeedback approaches limits comparison. Therefore, no single neurofeedback type can currently be identified as an optimal treatment for PD motor symptoms. This systematic review highlights the need to improve the inclusion of clinical information and more robust reporting of numerical data in future work. Neurofeedback appears to hold great potential as a treatment for PD motor symptoms. However, this field is still in its infancy and needs high quality RCTs to establish its effectiveness. Review Registration: PROSPERO (ID: CRD42020191097)
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Visanji NP, Ghani M, Yu E, Kakhki EG, Sato C, Moreno D, Naranian T, Poon YY, Abdollahi M, Naghibzadeh M, Rajalingam R, Lozano AM, Kalia SK, Hodaie M, Cohn M, Statucka M, Boutet A, Elias GJB, Germann J, Munhoz R, Lang AE, Gan-Or Z, Rogaeva E, Fasano A. Axial Impairment Following Deep Brain Stimulation in Parkinson's Disease: A Surgicogenomic Approach. JOURNAL OF PARKINSONS DISEASE 2021; 12:117-128. [PMID: 34602499 PMCID: PMC8842751 DOI: 10.3233/jpd-212730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Postoperative outcome following deep brain stimulation (DBS) of the subthalamic nucleus is variable, particularly with respect to axial motor improvement. We hypothesized a genetic underpinning to the response to surgical intervention, termed “surgicogenomics”. Objective: We aimed to identify genetic variants associated with clinical heterogeneity in DBS outcome of Parkinson’s disease (PD) patients that could then be applied clinically to target selection leading to improved surgical outcome. Methods: Retrospective clinical data was extracted from 150 patient’s charts. Each individual was genotyped using the genome-wide NeuroX array tailored to study neurologic diseases. Genetic data were clustered based on surgical outcome assessed by comparing pre- and post-operative scores of levodopa equivalent daily dose and axial impairment at one and five years post-surgery. Allele frequencies were compared between patients with excellent vs. moderate/poor outcomes grouped using a priori defined cut-offs. We analyzed common variants, burden of rare coding variants, and PD polygenic risk score. Results: NeuroX identified 2,917 polymorphic markers at 113 genes mapped to known PD loci. The gene-burden analyses of 202 rare nonsynonymous variants suggested a nominal association of axial impairment with 14 genes (most consistent with CRHR1, IP6K2, and PRSS3). The strongest association with surgical outcome was detected between a reduction in levodopa equivalent daily dose and common variations tagging two linkage disequilibrium blocks with SH3GL2. Conclusion: Once validated in independent populations, our findings may be implemented to improve patient selection for DBS in PD.
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Affiliation(s)
- Naomi P Visanji
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric Yu
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada.,The Department of Human Genetics, McGill University, Montreal, Quebec, Canada
| | - Erfan Ghani Kakhki
- DisorDATA Analytics, Ottawa, ON, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Christine Sato
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Danielle Moreno
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada
| | - Taline Naranian
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Yu-Yan Poon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Maryam Abdollahi
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Maryam Naghibzadeh
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Rajasumi Rajalingam
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Mojgan Hodaie
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Melanie Cohn
- Krembil Brain Institute, Toronto, Ontario, Canada
| | | | - Alexandre Boutet
- Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Jürgen Germann
- Department of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Renato Munhoz
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Ziv Gan-Or
- The Neuro (Montreal Neurological Institute-Hospital), McGill University, Montreal, Quebec, Canada.,The Department of Human Genetics, McGill University, Montreal, Quebec, Canada.,The Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Ekaterina Rogaeva
- Tanz Centre for Research in Neurodegenerative Diseases, University of Toronto, Toronto, ON, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
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Lipp MM, Hickey AJ, Langer R, LeWitt PA. A technology evaluation of CVT-301 (Inbrija): an inhalable therapy for treatment of Parkinson's disease. Expert Opin Drug Deliv 2021; 18:1559-1569. [PMID: 34311641 DOI: 10.1080/17425247.2021.1960820] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: The most widely used pharmacological treatment for Parkinson's disease is levodopa, the precursor for dopamine formation in the brain. Over time, the effectiveness of levodopa declines, and patients experience motor fluctuations, or OFF periods. A levodopa formulation administered via a capsule-based oral inhaler provides a new delivery mechanism for levodopa that provides rapid relief of OFF periods.Areas covered: CVT-301 is a dry powder formulation designed to supply levodopa to the systemic circulation via pulmonary absorption. The technology, pharmacokinetics, efficacy, and safety data of this formulation are presented.Expert opinion: Oral inhalation is a novel method of administration for levodopa that bypasses the gastrointestinal tract, allowing levodopa to enter the systemic circulation rapidly and more reliably than oral medications. Gastrointestinal dysfunction, a common feature of Parkinson's disease, can lead to impaired absorption of oral medications. Pulmonary delivery rapidly elevates levodopa plasma concentrations to provide relief of OFF periods for patients receiving oral levodopa.
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Affiliation(s)
| | | | - Robert Langer
- Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Peter A LeWitt
- Department of Neurology, Henry Ford Hospital and Wayne State University School of Medicine, West Bloomfield, MI, USA
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126
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Zhang M, Rodrigues A, Zhou Q, Li G. Focused ultrasound: growth potential and future directions in neurosurgery. J Neurooncol 2021; 156:23-32. [PMID: 34410576 DOI: 10.1007/s11060-021-03820-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/31/2021] [Indexed: 12/18/2022]
Abstract
Over the past two decades, vast improvements in focused ultrasound (FUS) technology have made the therapy an exciting addition to the neurosurgical armamentarium. In this time period, FUS has gained US Food and Drug Administration (FDA) approval for the treatment of two neurological disorders, and ongoing efforts seek to expand the lesion profile that is amenable to ultrasonic intervention. In the following review, we highlight future applications for FUS therapy and compare its potential role against established technologies, including deep brain stimulation and stereotactic radiosurgery. Particular attention is paid to tissue ablation, blood-brain-barrier opening, and gene therapy. We also address technical and infrastructural challenges involved with FUS use and summarize the hurdles that must be overcome before FUS becomes widely accepted in the neurosurgical community.
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Affiliation(s)
- Michael Zhang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA. .,Center for Academic Medicine, Neurosurgery, Stanford University School of Medicine, MC 5327, 453 Quarry Road, Palo Alto, CA, 94304, USA.
| | - Adrian Rodrigues
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Quan Zhou
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA.,Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Gordon Li
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, USA
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127
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Alterman RL, Schulder M. Letter: Randomized Trial of Unilateral Focused Ultrasound Subthalamotomy for Parkinson Disease. Neurosurgery 2021; 89:E95-E96. [PMID: 33913497 DOI: 10.1093/neuros/nyab140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ron L Alterman
- Beth Israel Deaconess Medical Center Boston, Massachusetts, USA
| | - Michael Schulder
- Zucker School of Medicine at Hofstra/Northwell Manhasset, New York, USA
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128
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Duffley G, Lutz BJ, Szabo A, Wright A, Hess CW, Ramirez-Zamora A, Zeilman P, Chiu S, Foote KD, Okun MS, Butson CR. Home Health Management of Parkinson Disease Deep Brain Stimulation: A Randomized Clinical Trial. JAMA Neurol 2021; 78:972-981. [PMID: 34180949 DOI: 10.1001/jamaneurol.2021.1910] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance The travel required to receive deep brain stimulation (DBS) programming causes substantial burden on patients and limits who can access DBS therapy. Objective To evaluate the efficacy of home health DBS postoperative management in an effort to reduce travel burden and improve access. Design, Settings, and Participants This open-label randomized clinical trial was conducted at University of Florida Health from November 2017 to April 2020. Eligible participants had a diagnosis of Parkinson disease (PD) and were scheduled to receive DBS independently of the study. Consenting participants were randomized 1:1 to receive either standard of care or home health postoperative DBS management for 6 months after surgery. Primary caregivers, usually spouses, were also enrolled to assess caregiver strain. Interventions The home health postoperative management was conducted by a home health nurse who chose DBS settings with the aid of the iPad-based Mobile Application for PD DBS system. Prior to the study, the home health nurse had no experience providing DBS care. Main Outcomes and Measures The primary outcome was the number of times each patient traveled to the movement disorders clinic during the study period. Secondary outcomes included changes from baseline on the Unified Parkinson's Disease Rating Scale part III. Results Approximately 75 patients per year were scheduled for DBS. Of the patients who met inclusion criteria over the entire study duration, 45 either declined or were excluded for various reasons. Of the 44 patients enrolled, 19 of 21 randomized patients receiving the standard of care (mean [SD] age, 64.1 [10.0] years; 11 men) and 23 of 23 randomized patients receiving home health who underwent a minimum of 1 postoperative management visit (mean [SD] age, 65.0 [10.9] years; 13 men) were included in analysis. The primary outcome revealed that patients randomized to home health had significantly fewer clinic visits than the patients in the standard of care arm (mean [SD], 0.4 [0.8] visits vs 4.8 [0.4] visits; P < .001). We found no significant differences between the groups in the secondary outcomes measuring the efficacy of DBS. No adverse events occurred in association with the study procedure or devices. Conclusions and Relevance This study provides evidence supporting the safety and feasibility of postoperative home health DBS management. Trial Registration ClinicalTrials.gov Identifier: NCT02474459.
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Affiliation(s)
- Gordon Duffley
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City.,Department of Biomedical Engineering, University of Utah, Salt Lake City
| | - Barbara J Lutz
- School of Nursing, University of North Carolina-Wilmington, Wilmington
| | - Aniko Szabo
- Division of Biostatistics, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee
| | - Adrienne Wright
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Christopher W Hess
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Pamela Zeilman
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Shannon Chiu
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville
| | - Christopher R Butson
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City.,Department of Biomedical Engineering, University of Utah, Salt Lake City.,Norman Fixel Institute for Neurological Diseases, Program for Movement Disorders and Neurorestoration, Departments of Neurology and Neurosurgery, University of Florida, Gainesville.,Departments of Neurology, Neurosurgery, and Psychiatry, University of Utah, Salt Lake City
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129
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Ozawa A, Kori H. Feedback-induced desynchronization and oscillation quenching in a population of globally coupled oscillators. Phys Rev E 2021; 103:062217. [PMID: 34271639 DOI: 10.1103/physreve.103.062217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/20/2021] [Indexed: 11/07/2022]
Abstract
Motivated from a wide range of applications, various methods to control synchronization in coupled oscillators have been proposed. Previous studies have demonstrated that global feedback typically induces three macroscopic behaviors: synchronization, desynchronization, and oscillation quenching. However, analyzing all of these transitions within a single theoretical framework is difficult, and thus the feedback effect is only partially understood in each framework. Herein, we analyze a model of globally coupled phase oscillators exposed to global feedback, which shows all of the typical macroscopic dynamical states. Analytical tractability of the model enables us to obtain detailed phase diagrams where transitions and bistabilities between different macroscopic states are identified. Additionally, we propose strategies to steer the oscillators into targeted states with minimal feedback strength. Our study provides a useful overview of the effect of global feedback and is expected to serve as a benchmark when more sophisticated feedback needs to be designed.
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Affiliation(s)
- Ayumi Ozawa
- Department of Complexity Science and Engineering, The University of Tokyo, Chiba 277-8561, Japan
| | - Hiroshi Kori
- Department of Complexity Science and Engineering, The University of Tokyo, Chiba 277-8561, Japan
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130
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Vos SH, Kessels RPC, Vinke RS, Esselink RAJ, Piai V. The Effect of Deep Brain Stimulation of the Subthalamic Nucleus on Language Function in Parkinson's Disease: A Systematic Review. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:2794-2810. [PMID: 34157249 DOI: 10.1044/2021_jslhr-20-00515] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Purpose This systematic review focuses on the effect of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) on language function in Parkinson's disease (PD). It fills an important gap in recent reviews by considering other language tasks in addition to verbal fluency. Method We critically and systematically reviewed the literature on studies that investigated the effect of bilateral STN-DBS on language function in PD. All studies included a matched PD control group who were on best medical treatment, with language testing at similar baseline and follow-up intervals as the DBS PD group. Results Thirteen identified studies included a form of a verbal fluency task, seven studies included picture naming, and only two studies included more language-oriented tasks. We found that verbal fluency was negatively affected after DBS, whereas picture naming was unaffected. Studies investigating individual change patterns using reliable change indices showed that individual variability is larger for picture naming than for verbal fluency. Conclusions Verbal fluency is the most frequently investigated aspect of language function. Our analysis showed a pattern of decline in verbal fluency across multiple studies after STN-DBS, whereas picture naming was unaffected. Data on more language-oriented tests in a large DBS sample and best medical treatment control group are sparse. The investigation of language function in PD after DBS requires sensitive language tests (with and without time pressure) and experimental designs as used in the studies reviewed here. Reliable change index statistics are a promising tool for investigating individual differences in performance after DBS. Supplemental Material https://doi.org/10.23641/asha.14794458.
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Affiliation(s)
- Sandra H Vos
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Roy P C Kessels
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
| | - R Saman Vinke
- Department of Neurosurgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Rianne A J Esselink
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Vitória Piai
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, the Netherlands
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Wei X, Zhang H, Gong B, Chang S, Lu M, Yi G, Zhang Z, Deng B, Wang J. An Embedded Multi-Core Real-Time Simulation Platform of Basal Ganglia for Deep Brain Stimulation. IEEE Trans Neural Syst Rehabil Eng 2021; 29:1328-1340. [PMID: 34232884 DOI: 10.1109/tnsre.2021.3095316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Closed-loop deep brain stimulation (DBS) paradigm is gaining tremendous favor due to its potential capability of further and more efficient improvements in neurological diseases. Preclinical validation of closed-loop controller is quite necessary in order to minimize injury risks of clinical trials to patients, which can greatly benefit from real-time computational models and thus potentially reduce research and development costs and time. Here we developed an embedded multi-core real-time simulation platform (EMC-RTP) for a biological-faithful computational network model of basal ganglia (BG). The single neuron model is implemented in a highly real-time manner using a reasonable simplification. A modular mapping architecture with hierarchical routing organization was constructed to mimic the pathological neural activities of BG observed in parkinsonian conditions. A closed-loop simulation testbed for DBS validation was then set up using a host computer as the DBS controller. The availability of EMC-RTP and the testbed system was validated by comparing the performance of open-loop and proportional-integral (PI) controllers. Our experimental results showed that the proposed EMC-RTP reproduces abnormal beta bursts of BG in parkinsonian conditions while meets requirements of both real-time and computational accuracy as well. Closed-loop DBS experiments using the EMC-RTP suggested that the platform could perform reasonable output under different kinds of DBS strategies, indicating the usability of the platform.
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Pearce P, Bulluss K, Xu SS, Kim B, Milicevic M, Perera T, Thevathasan W. How accurately are subthalamic nucleus electrodes implanted relative to the ideal stimulation location for Parkinson's disease? PLoS One 2021; 16:e0254504. [PMID: 34264988 PMCID: PMC8282046 DOI: 10.1371/journal.pone.0254504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/27/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The efficacy of subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) depends on how closely electrodes are implanted relative to an individual's ideal stimulation location. Yet, previous studies have assessed how closely electrodes are implanted relative to the planned location, after homogenizing data to a reference. Thus here, we measured how accurately electrodes are implanted relative to an ideal, dorsal STN stimulation location, assessed on each individual's native imaging. This measure captures not only the technical error of stereotactic implantation but also constraints imposed by planning a suitable trajectory. METHODS This cross-sectional study assessed 226 electrodes in 113 consecutive PD patients implanted with bilateral STN-DBS by experienced clinicians utilizing awake, microelectrode guided, surgery. The error (Euclidean distance) between the actual electrode trajectory versus a nominated ideal, dorsal STN stimulation location was determined in each hemisphere on native imaging and predictive factors sought. RESULTS The median electrode location error was 1.62 mm (IQR = 1.23 mm). This error exceeded 3 mm in 28/226 electrodes (12.4%). Location error did not differ between hemispheres implanted first or second, suggesting brain shift was minimised. Location error did not differ between electrodes positioned with (48/226), or without, a preceding microelectrode trajectory shift (suggesting such shifts were beneficial). There was no relationship between location error and case order, arguing against a learning effect. DISCUSSION/CONCLUSION The proximity of STN-DBS electrodes to a nominated ideal, dorsal STN, stimulation location is highly variable, even when implanted by experienced clinicians with brain shift minimized, and without evidence of a learning effect. Using this measure, we found that assessments on awake patients (microelectrode recordings and clinical examination) likely yielded beneficial intraoperative decisions to improve positioning. In many patients the error is likely to have reduced therapeutic efficacy. More accurate methods to implant STN-DBS electrodes relative to the ideal stimulation location are needed.
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Affiliation(s)
- Patrick Pearce
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Kristian Bulluss
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
- Department of Neurosurgery, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Surgery, The University of Melbourne, Parkville, Victoria, Australia
| | - San San Xu
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
- Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
| | - Boaz Kim
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurosurgery, St Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia
| | | | - Thushara Perera
- Bionics Institute, East Melbourne, Victoria, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, Victoria, Australia
| | - Wesley Thevathasan
- Bionics Institute, East Melbourne, Victoria, Australia
- Department of Neurology, Austin Hospital, Heidelberg, Victoria, Australia
- Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Yu N, Liang S, Lu J, Shu Z, Li H, Yu Y, Wu J, Han J. Quantified assessment of deep brain stimulation on Parkinson's patients with task fNIRS measurements and functional connectivity analysis: a pilot study. Chin Neurosurg J 2021; 7:34. [PMID: 34225815 PMCID: PMC8256573 DOI: 10.1186/s41016-021-00251-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 05/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Deep brain stimulation (DBS) has proved effective for Parkinson’s disease (PD), but the identification of stimulation parameters relies on doctors’ subjective judgment on patient behavior. Methods Five PD patients performed 10-meter walking tasks under different brain stimulation frequencies. During walking tests, a wearable functional near-infrared spectroscopy (fNIRS) system was used to measure the concentration change of oxygenated hemoglobin (△HbO2) in prefrontal cortex, parietal lobe and occipital lobe. Brain functional connectivity and global efficiency were calculated to quantify the brain activities. Results We discovered that both the global and regional brain efficiency of all patients varied with stimulation parameters, and the DBS pattern enabling the highest brain efficiency was optimal for each patient, in accordance with the clinical assessments and DBS treatment decision made by the doctors. Conclusions Task fNIRS assessments and brain functional connectivity analysis promise a quantified and objective solution for patient-specific optimization of DBS treatment. Trial registration Name: Accurate treatment under the multidisciplinary cooperative diagnosis and treatment model of Parkinson’s disease. Registration number is ChiCTR1900022715. Date of registration is April 23, 2019.
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Affiliation(s)
- Ningbo Yu
- College of Artificial Intelligence, Nankai University, Tianjin, China.,Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
| | - Siquan Liang
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Jiewei Lu
- College of Artificial Intelligence, Nankai University, Tianjin, China.,Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
| | - Zhilin Shu
- College of Artificial Intelligence, Nankai University, Tianjin, China.,Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China
| | - Haitao Li
- Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
| | - Yang Yu
- Department of Neurorehabilitation, Tianjin Huanhu Hospital, Tianjin, China
| | - Jialing Wu
- Department of Neurorehabilitation, Tianjin Huanhu Hospital, Tianjin, China. .,Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China. .,Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, China.
| | - Jianda Han
- College of Artificial Intelligence, Nankai University, Tianjin, China. .,Tianjin Key Laboratory of Intelligent Robotics, Nankai University, Tianjin, China.
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Nemade D, Subramanian T, Shivkumar V. An Update on Medical and Surgical Treatments of Parkinson's Disease. Aging Dis 2021; 12:1021-1035. [PMID: 34221546 PMCID: PMC8219497 DOI: 10.14336/ad.2020.1225] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/25/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) is characterized by degeneration of dopaminergic neurons in the substantia nigra pars compacta and other neuronal populations. The worldwide prevalence of PD is over 7 million and has been increasing more rapidly than many other neurodegenerative disorders. PD symptoms can be broadly divided into motor (slowness, stiffness, tremor) and non-motor symptoms (such as depression, dementia, psychosis, orthostatic hypotension). Patients can also have prodromal symptoms of rapid eye movement sleep behavior disorder, hyposmia, and constipation. The diagnosis of PD is mainly clinical, but dopamine transporter single-photon emission computed tomography can improve the accuracy of the diagnosis. Dopamine based therapies are used for the treatment of motor symptoms. Non-motor symptoms are treated with other medications such as selective serotonin reuptake inhibitors (depression/anxiety), acetylcholinesterase inhibitors (dementia), and atypical antipsychotics (psychosis). Patients with motor fluctuations or uncontrolled tremor, benefit from deep brain stimulation. Levodopa-carbidopa intestinal gel is an alternative to deep brain stimulation for uncontrolled motor fluctuations. Rehabilitative therapies such as physical, occupational, and speech therapy are important during all stages of the disease. Management of PD is complex but there have been significant advancements in the treatment of motor and non-motor symptoms over the past few years. This review discusses the updates in the medical and surgical management of PD.
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Affiliation(s)
- Dipali Nemade
- 1Department of Neurology, Marshall University School of Medicine, Huntington, WV 25701, USA
| | - Thyagarajan Subramanian
- 2Department of Neurology and Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, USA
| | - Vikram Shivkumar
- 1Department of Neurology, Marshall University School of Medicine, Huntington, WV 25701, USA
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Dorszewska J, Kowalska M, Prendecki M, Piekut T, Kozłowska J, Kozubski W. Oxidative stress factors in Parkinson's disease. Neural Regen Res 2021; 16:1383-1391. [PMID: 33318422 PMCID: PMC8284265 DOI: 10.4103/1673-5374.300980] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/24/2020] [Accepted: 10/21/2020] [Indexed: 01/01/2023] Open
Abstract
Parkinson's disease (PD) is the second most common cause of neurodegeneration. Over the last two decades, various hypotheses have been proposed to explain the etiology of PD. Among these is the oxidant-antioxidant theory, which asserts that local and systemic oxidative damage triggered by reactive oxygen species and other free radicals may promote dopaminergic neuron degeneration. Excessive reactive oxygen species formation, one of the underlying causes of pathology in the course of PD has been evidenced by various studies showing that oxidized macromolecules including lipids, proteins, and nucleic acids accumulate in brain tissues of PD patients. DNA oxidation may produce various lesions in the course of PD. Mutations incurred as a result of DNA oxidation may further enhance reactive oxygen species production in the brains of PD patients, exacerbating neuronal loss due to defects in the mitochondrial electron transport chain, antioxidant depletion, and exposure to toxic oxidized dopamine. The protein products of SNCA, PRKN, PINK1, DJ1, and LRRK2 genes are associated with disrupted oxidoreductive homeostasis in PD. SNCA is the first gene linked with familial PD and is currently known to be affected by six mutations correlated with the disorder: A53T, A30P, E46K, G51D, H50Q and A53E. PRKN encodes Parkin, an E3 ubiquitin ligase which mediates the proteasome degradation of redundant and disordered proteins such as glycosylated α-synuclein. Over 100 mutations have been found among the 12 exons of PRKN. PINK1, a mitochondrial kinase highly expressed in the brain, may undergo loss of function mutations which constitute approximately 1-8% of early onset PD cases. More than 50 PD-promoting mutations have been found in PINK1. Mutations in DJ-1, a neuroprotective protein, are a rare cause of early onset PD and constitute only 1% of cases. Around 20 mutations have been found in DJ1 among PD patients thus far. Mutations in the LRRK2 gene are the most common known cause of familial autosomal dominant PD and sporadic PD. Treatment of PD patients, especially in the advanced stages of the disease, is very difficult. The first step in managing progressive PD is to optimize dopaminergic therapy by increasing the doses of dopamine agonists and L-dopa. The next step is the introduction of advanced therapies, such as deep brain stimulation. Genetic factors may influence the response to L-dopa and deep brain stimulation therapy and the regulation of oxidative stress. Consequently, research into minimally invasive surgical interventions, as well as therapies that target the underlying etiology of PD is warranted.
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Affiliation(s)
- Jolanta Dorszewska
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Kowalska
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Prendecki
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Thomas Piekut
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Joanna Kozłowska
- Laboratory of Neurobiology, Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Wojciech Kozubski
- Chair and Department of Neurology, Poznan University of Medical Sciences, Poznan, Poland
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Arumugham SS, Srinivas D, Narayanaswamy JC, Jaisoorya TS, Kashyap H, Domenech P, Palfi S, Mallet L, Venkatasubramanian G, Reddy YJ. Identification of biomarkers that predict response to subthalamic nucleus deep brain stimulation in resistant obsessive-compulsive disorder: protocol for an open-label follow-up study. BMJ Open 2021; 11:e047492. [PMID: 34158304 PMCID: PMC8220486 DOI: 10.1136/bmjopen-2020-047492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Deep brain stimulation (DBS) of bilateral anteromedial subthalamic nucleus (amSTN) has been found to be helpful in a subset of patients with severe, chronic and treatment-refractory obsessive-compulsive disorder (OCD). Biomarkers may aid in patient selection and optimisation of this invasive treatment. In this trial, we intend to evaluate neurocognitive function related to STN and related biosignatures as potential biomarkers for STN DBS in OCD. METHODS AND ANALYSIS Twenty-four subjects with treatment-refractory OCD will undergo open-label STN DBS. Structural/functional imaging, electrophysiological recording and neurocognitive assessment would be performed at baseline. The subjects would undergo a structured clinical assessment for 12 months postsurgery. A group of 24 healthy volunteers and 24 subjects with treatment-refractory OCD who receive treatment as usual would be recruited for comparison of biomarkers and treatment response, respectively. Baseline biomarkers would be evaluated as predictors of clinical response. Neuroadaptive changes would be studied through a reassessment of neurocognitive functioning, imaging and electrophysiological activity post DBS. ETHICS AND DISSEMINATION The protocol has been approved by the National Institute of Mental Health and Neurosciences Ethics Committee. The study findings will be disseminated through peer-reviewed scientific journals and scientific meetings.
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Affiliation(s)
- Shyam Sundar Arumugham
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Dwarakanath Srinivas
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - T S Jaisoorya
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Himani Kashyap
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Philippe Domenech
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Stéphane Palfi
- Univ Paris-Est Créteil, DMU CARE - Département Médical-Universitaire de Chirurgie et Anesthésie réanimation, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d'Addictologie, Hôpitaux Universitaires Henri Mondor, Creteil, France
- Univ of Paris 12 UPEC, Faculté de médecine, INSERM U955, Creteil, France
| | - Luc Mallet
- Institut du Cerveau, ICM, Inserm U 1127, CNRS UMR 7225, Sorbonne Université, Paris, France
- Department of Mental Health and Psychiatry, University of Geneva, Geneva, Switzerland
| | - Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Yc Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Xu SS, Malpas CB, Bulluss KJ, McDermott HJ, Kalincik T, Thevathasan W. Lesser-Known Aspects of Deep Brain Stimulation for Parkinson's Disease: Programming Sessions, Hardware Surgeries, Residential Care Admissions, and Deaths. Neuromodulation 2021; 25:836-845. [PMID: 34114293 DOI: 10.1111/ner.13466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The long-term treatment burden, duration of community living, and survival of patients with Parkinson's disease (PD) after deep brain stimulation (DBS) implantation are unclear. This study aims to determine the frequency of programming, repeat hardware surgeries (of the intracranial electrode, implantable pulse generator [IPG], and extension-cable), and the timings of residential care and death in patients with PD treated with DBS. MATERIALS AND METHODS In this cross-sectional, population-based study, individual-level data were collected from the Australian government covering a 15-year period (2002-2016) on 1849 patients with PD followed from DBS implantation. RESULTS The mean DBS implantation age was 62.6 years and mean follow-up 5.0 years. Mean annual programming rates were 6.9 in the first year and 2.8 in subsequent years. 51.4% of patients required repeat hardware surgery. 11.3% of patients had repeat intracranial electrode surgery (including an overall 1.1% of patients who were completely explanted). 47.6% of patients had repeat IPG/extension-cable surgery including for presumed battery depletion. 6.2% of patients had early repeat IPG/extension-cable surgery (within one year of any previous such surgery). Thirty-day postoperative mortality was 0.3% after initial DBS implantation and 0.6% after any repeat hardware surgery. 25.3% of patients were admitted into residential care and 17.4% died. The median interval to residential care and death was 10.2 years and 11.4 years, respectively. Age more than 65 years was associated with fewer repeat hardware surgeries for presumed complications (any repeat surgery of electrodes, extension-cables, and early IPG surgery) and greater rates of residential care admission and death. CONCLUSIONS Data from a large cohort of patients with PD treated with DBS found that the median life span after surgery is ten years. Repeat hardware surgery, including of the intracranial electrodes, is common. These findings support development of technologies to reduce therapy burden such as enhanced surgical navigation, hardware miniaturization, and improved battery efficiency.
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Affiliation(s)
- San San Xu
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Medical Bionics, The University of Melbourne, East Melbourne, VIC, Australia.,Department of Neurology, Austin Hospital, Heidelberg, VIC, Australia
| | - Charles B Malpas
- CORe, Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC, Australia.,MS Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Kristian J Bulluss
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Neurosurgery, St Vincent's Hospital Melbourne, Fitzroy, and Department of Neurosurgery, Austin Hospital, Heidelberg, VIC, Australia
| | - Hugh J McDermott
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Medical Bionics, The University of Melbourne, East Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,MS Centre, Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Wesley Thevathasan
- Bionics Institute, East Melbourne, VIC, Australia.,Department of Neurology, Austin Hospital, Heidelberg, VIC, Australia.,Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.,Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
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Correlates of deep brain stimulation consensus conference decision to treat primary dystonia. Clin Neurol Neurosurg 2021; 207:106747. [PMID: 34237680 DOI: 10.1016/j.clineuro.2021.106747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 12/03/2020] [Accepted: 05/24/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective treatment for motor disturbance in people with primary dystonia (PWD). Numerous factors are considered by an interdisciplinary consensus conference before deciding candidacy for DBS surgery (e.g., demographic, medical, cognitive, and behavioral factors). However, little is known about which of these factors are associated with PWD DBS surgery consensus conference decisions. OBJECTIVE Our goal was to examine whether pre-operative demographic, medical, and cognitive/behavioral variables are associated DBS consensus conference decisions in patients with dystonia. METHODS Thirty-two PWD completed comprehensive presurgery workup included neurological and neuropsychological exams, and neuroimaging in consideration for DBS surgery. An interdisciplinary conference committee either recommended or did not recommend DBS surgery based upon these data. Demographic and medical data (e.g., dystonia disease characteristics, medical comorbidities, medications) were also collected. We also examined impact from cardiovascular disease factors, using a Revised Cardiac Risk Index. PWD were grouped based on DBS conference decision (eligible: n = 21, ineligible: n = 11) and compared across demographic, medical, and cognitive/behavioral variables. RESULTS Across clinical variables, PWD who were deemed ineligible for DBS surgery had a higher Revised Cardiac Risk Index. PWD who were classified as ineligible displayed lower global cognitive functioning, working memory, phonemic fluency, memory retrieval, and cognitive flexibility. CONCLUSIONS Consensus decision making regarding DBS surgery eligibility involves a multifactorial process. We found that deficits in executive functioning were associated with the DBS consensus committee decision. We also observed elevated cardiac risk among these individuals, likely reflecting the relation between vascular health and cognition. Implications, and clinical and scientific applications of these findings are discussed.
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Zheng Y, Xia P, Dong L, Tian L, Tian C. Development and review of a sub-millimeter-sized cell-scale micro-magnetic stimulation device. Biomed Phys Eng Express 2021; 7. [PMID: 34020437 DOI: 10.1088/2057-1976/ac0409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/21/2021] [Indexed: 11/12/2022]
Abstract
The development of modern micro-processing technology has led to the design and production of sub-millimeter-sized coils. A novel type of micro-magnetic stimulation (μMS) regulatory technology has widely been researched in recent years. This technology has several advantages, including small size, no contact between tissues and the metal coil, and high spatial resolution. Considering some problems with theμMS control technology in practical applications, different kinds ofμMS devices have been developed, including anin vitrosingle-pointμMS device, anin vivoimplantable single-pointμMs device, a discrete-arrayμMS device, and anin vivoimplantable-arrayμMs device. Given the problems that currently exist in the design and implementation of this device, such as the key problems of structural design, implantation method, experimental safety, and reliability of the device, we review the development process in detail. We also discuss the precise targeting advantage of this device, which is likely to be of great significance for wide-ranging applications of magnetic stimulation technology.
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Affiliation(s)
- Yu Zheng
- School of Life Sciences, Tiangong university, Tianjin 300387, People's Republic of China
| | - Pei Xia
- School of Life Sciences, Tiangong university, Tianjin 300387, People's Republic of China
| | - Lei Dong
- State Key Laboratory of Precision Measurement Technology and Instruments, Tianjin University, Tianjin 300072, People's Republic of China
| | - Lei Tian
- School of Life Sciences, Tiangong university, Tianjin 300387, People's Republic of China
| | - Chunxiao Tian
- School of Life Sciences, Tiangong university, Tianjin 300387, People's Republic of China
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Bhave G, Chen JC, Singer A, Sharma A, Robinson JT. Distributed sensor and actuator networks for closed-loop bioelectronic medicine. MATERIALS TODAY (KIDLINGTON, ENGLAND) 2021; 46:125-135. [PMID: 34366697 PMCID: PMC8336425 DOI: 10.1016/j.mattod.2020.12.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Designing implantable bioelectronic systems that continuously monitor physiological functions and simultaneously provide personalized therapeutic solutions for patients remains a persistent challenge across many applications ranging from neural systems to bioelectronic organs. Closed-loop systems typically consist of three functional blocks, namely, sensors, signal processors and actuators. An effective system, that can provide the necessary therapeutics, tailored to individual physiological factors requires a distributed network of sensors and actuators. While significant progress has been made, closed-loop systems still face many challenges before they can truly be considered as long-term solutions for many diseases. In this review, we consider three important criteria where materials play a critical role to enable implantable closed-loop systems: Specificity, Biocompatibility and Connectivity. We look at the progress made in each of these fields with respect to a specific application and outline the challenges in creating bioelectronic technologies for the future.
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Muacevic A, Adler JR, Novakovic E, Huynh H, Jones K, Gendreau JL, Mammis A, Abraham ME. Characterizing Complications of Deep Brain Stimulation Devices for the Treatment of Parkinsonian Symptoms Without Tremor: A Federal MAUDE Database Analysis. Cureus 2021; 13:e15539. [PMID: 34277165 PMCID: PMC8269991 DOI: 10.7759/cureus.15539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 01/09/2023] Open
Abstract
Introduction Deep brain stimulation (DBS) is a modality of treatment for medication refractory Parkinson's disease (PD) in patients with debilitating motor symptoms. While potentially life-changing for individuals with Parkinson's disease, characterization of adverse events for these DBS devices have not yet been systematically organized. Therefore, the goal of this study was to characterize reported complications of DBS devices reported to the Food & Drug Administration over the last 10 years. Methods The Manufacturer and User Facility Device Experience (MAUDE) database was utilized to retrieve entries reported under "Stimulator, Electrical, Implanted, For Parkinsonian Symptoms" between July 31, 2010 and August 1, 2020. After removing duplicate entries, each unique adverse event reported was sorted into complication categories based on the entries' provided narrative description. A final tabulation of complications was generated. Results The search query revealed 221 unique adverse events. The most common DBS devices were the Vercise Gevia, Vercise Cartesia and Vercise PC produced by Boston Scientific (Brian Walker, Boston Scientific, Marlborough, MA, USA). The most commonly reported complications were infection (16.2%) follow by lead migrations (8.6%). Other common causes of complications were circuit-related impedance (6.5%), cerebral bleeds (6.3%), device failure (6.3%) and device-related trauma (4.5%). Over a third (40%) of all devices reported with adverse events required returning to the operating room for explant or revision. Conclusion The most common complications of DBS systems are infections followed by lead migrations. Further research is needed to minimize infection rates associated with DBS systems and to reduce intrinsic device malfunctions for patients in the future.
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Affiliation(s)
| | | | - Ena Novakovic
- Neurological Surgery, Mercer University School of Medicine, Savannah, USA
| | - Huey Huynh
- Neurological Surgery, Mercer University School of Medicine, Macon, USA
| | - Keri Jones
- Graduate Medical Education, Eisenhower Army Medical Center, Augusta, USA
| | | | - Antonios Mammis
- Neurological Surgery, New York University School of Medicine, New York, USA
| | - Mickey E Abraham
- Neurological Surgery, University of California San Diego, San Diego, USA
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142
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Prenassi M, Arlotti M, Borellini L, Bocci T, Cogiamanian F, Locatelli M, Rampini P, Barbieri S, Priori A, Marceglia S. The Relationship Between Electrical Energy Delivered by Deep Brain Stimulation and Levodopa-Induced Dyskinesias in Parkinson's Disease: A Retrospective Preliminary Analysis. Front Neurol 2021; 12:643841. [PMID: 34135846 PMCID: PMC8200487 DOI: 10.3389/fneur.2021.643841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adaptive Deep Brain Stimulation (aDBS) is now considered as a new feasible and effective paradigm to deliver DBS to patients with Parkinson's disease (PD) in such a way that not only stimulation is personalized and finely tuned to the instantaneous patient's state, but also motor improvement is obtained with a lower amount of energy transferred to the tissue. Amplitude-controlled aDBS was shown to significantly decrease the amplitude-driven total electrical energy delivered to the tissue (aTEED), an objective measure of the amount of energy transferred by DBS amplitude to the patient's brain. However, there is no direct evidence of a relationship between aTEED and the occurrence of DBS-related adverse events in humans. Objective: In this work, we investigated the correlation of aTEED with the occurrence of levodopa-induced dyskinesias pooling all the data available from our previous experiments using aDBS and cDBS. Methods: We retrospectively analyzed data coming from 19 patients with PD undergoing surgery for STN-DBS electrode positioning and participating to experiments involving cDBS and aDBS delivery. Patients were all studied some days after the surgery (acute setting). The aTEED and dyskinesia assessments (Rush Dyskinesia Rating Scale, RDRS) considered in the Med ON-Stim ON condition. Results: We confirmed both that aTEED values and RDRS were significantly lower in the aDBS than in cDBS sessions (aTEED mean value, cDBS: 0.0278 ± 0.0011 j, vs. aDBS: 0.0071 ± 0.0003 j, p < 0.0001 Wilcoxon's rank sum; normalized RDRS mean score, cDBS: 0.66 ± 0.017 vs. aDBS: 0.45 ± 0.01, p = 0.025, Wilcoxon's rank sum test). In addition, we found a direct significant correlation between aTEED and RDRS (ρ = 0.44, p = 0.0032, Spearman's correlation). Conclusions: Our results provide a first piece of evidence that aTEED is correlated to the amount of levodopa-induced dyskinesias in patients with PD undergoing STN-DBS, thus supporting the role of aDBS as feasible and safe alternative to cDBS.
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Affiliation(s)
- Marco Prenassi
- Dipartimento di Ingegneria e Architettura, Università Degli Studi di Trieste, Trieste, Italy
| | | | - Linda Borellini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Filippo Cogiamanian
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Locatelli
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Paolo Rampini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sergio Barbieri
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Sara Marceglia
- Dipartimento di Ingegneria e Architettura, Università Degli Studi di Trieste, Trieste, Italy.,Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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143
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Li H, Wang H, Zhang L, Wang M, Li Y. Dl-3-n-Butylphthalide Alleviates Behavioral and Cognitive Symptoms Via Modulating Mitochondrial Dynamics in the A53T-α-Synuclein Mouse Model of Parkinson's Disease. Front Neurosci 2021; 15:647266. [PMID: 34121985 PMCID: PMC8193045 DOI: 10.3389/fnins.2021.647266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/26/2021] [Indexed: 01/23/2023] Open
Abstract
Background Aggregation and neurotoxicity of the presynaptic protein α-synuclein and the progressive loss of nigral dopaminergic neurons are believed to be the key hallmarks of Parkinson’s disease (PD). A53T mutant α-synuclein causes early onset PD and more severe manifestations. A growing body of evidence shows that misfolding or deposition of α-synuclein is linked to the maintenance of mitochondrial dynamics, which has been proven to play an important role in the pathogenesis of PD. It has been observed that Dl-3-n-butylphthalide (NBP) may be safe and effective in improving the non-tremor-dominant PD. However, the potential mechanism remains unclear. This study aimed to investigate whether NBP could decrease the loss of dopaminergic neurons and α-synuclein deposition and explore its possible neuroprotective mechanisms. Methods A total of 20 twelve-month-old human A53T α-synuclein transgenic mice and 10 matched adult C57BL/6 mice were included in the study; 10 adult C57BL/6 mice were selected as the control group and administered with saline (0.2 ml daily for 14 days); 20 human A53T α-synuclein transgenic mice were randomly divided into A53T group (treated in the same manner as in the control group) and A53T + NBP group (treated with NBP 0.2 ml daily for 14 days). Several markers of mitochondrial fission and fusion and mitophagy were determined, and the behavioral, olfactory, and cognitive symptoms were assessed as well. Results In the present study, it was observed that the A53T-α-synuclein PD mice exhibited anxiety-like behavioral disturbance, impairment of coordination ability, memory deficits, and olfactory dysfunction, loss of dopaminergic neurons, and α-synuclein accumulation. Meanwhile, the mitofusin 1 expression was significantly decreased, and the mitochondrial number and dynamin-related protein 1, Parkin, and LC3 levels were increased. The detected levels of all markers were reversed by NBP treatment, and the mitochondrial morphology was partially recovered. Conclusion In the present study, a valuable neuropharmacological role of NBP has been established in the A53T-α-synuclein PD mouse model. Possible neuroprotective mechanisms might be that NBP is involved in the maintenance of mitochondrial dynamics including mitochondrial fission and fusion and clearance of damaged mitochondria. It is essential to perform further experiments to shed light on the precise mechanisms of NBP on mitochondrial homeostasis.
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Affiliation(s)
- Huiying Li
- Department of Neurology, Beijing Aerospace General Hospital, Beijing, China
| | - Hongquan Wang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing, China
| | - Ling Zhang
- Key Laboratory of Human Disease Comparative Medicine, Chinese Ministry of Health, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
| | - Manshi Wang
- Key Laboratory of Human Disease Comparative Medicine, Chinese Ministry of Health, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China
| | - Yanfeng Li
- Key Laboratory of Human Disease Comparative Medicine, Chinese Ministry of Health, Institute of Laboratory Animal Science, Chinese Academy of Medical Sciences, Beijing, China.,Key Laboratory of Human Diseases Animal Models, State Administration of Traditional Chinese Medicine, Peking Union Medicine College, Beijing, China.,Department of Neurology, Peking Union Medical College Hospital, Beijing, China
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144
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Sidtis JJ, Sidtis DVL, Dhawan V, Tagliati M, Eidelberg D. Stimulation of the Subthalamic Nucleus Changes Cortical-Subcortical Blood Flow Patterns During Speech: A Positron Emission Tomography Study. Front Neurol 2021; 12:684596. [PMID: 34122323 PMCID: PMC8187801 DOI: 10.3389/fneur.2021.684596] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for Parkinson's disease (PD) but can have an adverse effect on speech. In normal speakers and in those with spinocerebellar ataxia, an inverse relationship between regional cerebral blood flow (rCBF) in the left inferior frontal (IFG) region and the right caudate (CAU) is associated with speech rate. This pattern was examined to determine if it was present in PD, and if so, whether it was altered by STN-DBS. Methods: Positron Emission Tomography (PET) measured rCBF during speech in individuals with PD not treated with STN-DBS (n = 7), and those treated with bilateral STN-DBS (n = 7). Previously reported results from non-PD control subjects (n = 16) were reported for comparison. The possible relationships between speech rate during scanning and data from the left and right IFG and CAU head regions were investigated using a step-wise multiple linear regression to identify brain regions that interacted to predict speech rate. Results: The multiple linear regression analysis replicated previously reported predictive coefficients for speech rate involving the left IFG and right CAU regions. However, the relationships between these predictive coefficients and speech rates were abnormal in both PD groups. In PD who had not received STN-DBS, the right CAU coefficient decreased normally with increasing speech rate but the left IFG coefficient abnormally decreased. With STN-DBS, this pattern was partially normalized with the addition of a left IFG coefficient that increased with speech rate, as in normal controls, but the abnormal left IFG decreasing coefficient observed in PD remained. The magnitudes of both cortical predictive coefficients but not the CAU coefficient were exaggerated with STN-DBS. Conclusions: STN-DBS partially corrects the abnormal relationships between rCBF and speech rate found in PD by introducing a left IFG subregion that increases with speech rate, but the conflicting left IFG subregion response remained. Conflicting IFG responses may account for some of the speech problems observed after STN-DBS. Cortical and subcortical regions may be differentially affected by STN-DBS.
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Affiliation(s)
- John J Sidtis
- Brain and Behavior Laboratory, Geriatrics Department, Nathan Kline Institute, Orangeburg, NY, United States.,Department of Psychiatry, School of Medicine, New York University Langone, New York, NY, United States
| | - Diana Van Lancker Sidtis
- Brain and Behavior Laboratory, Geriatrics Department, Nathan Kline Institute, Orangeburg, NY, United States.,Department of Communicative Disorders and Sciences, New York University Steinhardt School, New York, NY, United States
| | - Vijay Dhawan
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, United States
| | - Michele Tagliati
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, United States
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145
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Over L, Brüggemann N, Lohmann K. Therapies for Genetic Forms of Parkinson's Disease: Systematic Literature Review. J Neuromuscul Dis 2021; 8:341-356. [PMID: 33459660 PMCID: PMC8203229 DOI: 10.3233/jnd-200598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Parkinson’s disease (PD) is a disabling neurological condition characterized by the loss of dopaminergic neurons. Currently, the treatment for PD is symptomatic and compensates for the endogenous loss of dopamine production. In cases where the pharmacological therapy is only partly beneficial or results in major wearing-off complications, surgical interventions such as deep brain stimulation may be an alternative treatment. The disease cause often remains unknown, but in some patients, a monogenic cause can be identified. Mutations in at least six genes, LRRK2, SNCA, and VPS35 (dominant forms) or Parkin/PRKN, PINK1, and DJ1/PARK7 (recessive forms) have been unequivocally linked to PD pathogenesis. We here systematically screened 8,576 publications on these monogenic PD forms. We identified 2,226 mutation carriers from 456 papers. Levodopa was the most widely applied treatment; only 34 patients were indicated to be untreated at the time of reporting. Notably, detailed treatment data was rarely mentioned including response quantification (good, moderate, minimal) in 951 and/or dose in 293 patients only. Based on available data, levodopa showed an overall good outcome, especially in LRRK2, VPS35, Parkin, and PINK1 mutation carriers (“good” response in 94.6–100%). Side effects of levodopa therapy were reported in ∼15–40%of levodopa-treated patients across genes with dyskinesias as the most frequent one. Non-levodopa medication was indicated to be administered to <200 patients with mainly good outcome. Only a few reports were available on outcomes of brain surgery. Here, most mutation carriers showed a good response. Importantly, none of the available treatments is harmful to one genetic form but effective in another one. In the light of different medication schemes, the progressive nature of PD, and side effects, an improvement of therapeutic options for PD is warranted including a treatabolome database to guide clinicians in treatment decisions. Further, novel disease-cause-modifying drugs are needed.
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Affiliation(s)
- Laura Over
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
| | - Norbert Brüggemann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Katja Lohmann
- Institute of Neurogenetics, University of Lübeck, Lübeck, Germany
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146
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Direct visualization of deep brain stimulation targets in patients with Parkinson's disease via 3-T quantitative susceptibility mapping. Acta Neurochir (Wien) 2021; 163:1335-1345. [PMID: 33576911 DOI: 10.1007/s00701-021-04715-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/11/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND The direct visualization of brain nuclei on magnetic resonance (MR) images is important for target localization during deep brain stimulation (DBS) in patients with Parkinson's disease (PD). We demonstrated the superiority of 3-T high-resolution submillimeter voxel size quantitative susceptibility mapping (QSM) for delineating the subthalamic nucleus (STN) and the globus pallidus internus (GPi). METHODS Preoperative 3-T QSM and T2 weighted (T2w) images were obtained from ten patients with PD. Qualitative visualization scores were analyzed by two neurosurgeons on both images using a 4-point and 5-point scale, respectively. Images were also compared with regard to contrast-to-noise ratios (CNRs) and edge detection power for the STN and GPi. The Wilcoxon rank-sum test and the signed-rank test were used to compare measurements between the two images. RESULTS Visualization scores for the STN and GPi, the mean CNR of the STN relative to the zona incerta (ZI) and the substantia nigra, and the mean CNR of the GPi relative to the internal capsule (IC) and the globus pallidum externum, were significantly higher on QSM images than on T2w images (P < 0.01). The edge detection powers of the STN-ZI and GPi-IC on QSM were significantly larger (by 2.6- and 3.8-fold, respectively) than those on T2w images (P < 0.01). QSM detected asymmetry of the STN in two patients. CONCLUSIONS QSM images provided improved delineation ability for the STN and GPi when compared to T2w images. Our findings are important for patients with PD who undergo DBS surgery, particularly those with asymmetric bilateral nuclei.
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147
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Artusi CA, Romagnolo A, Imbalzano G, Montanaro E, Zibetti M, Rizzone MG, Lopiano L. Deep brain stimulation outcomes in the malignant end of Parkinson's disease spectrum. Parkinsonism Relat Disord 2021; 86:5-9. [PMID: 33812276 DOI: 10.1016/j.parkreldis.2021.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Heterogeneity of Parkinson's Disease (PD) phenotype may influence deep brain stimulation (DBS) outcome. However, DBS response in the malignant end of the PD spectrum has been poorly investigated. OBJECTIVE To evaluate and compare DBS outcomes in malignant and benign PD patients, defined according to motor and non-motor symptom presentation at the presurgical selection. METHODS We categorized a cohort of 154 parkinsonian patients fulfilling criteria for subthalamic nucleus (STN)-DBS into malignant, benign, and intermediate subtypes, according to a recently validated clinical PD classification. DBS efficacy on daily living independence (Schwab and England -S&E-score ≥70%), motor symptoms, and motor fluctuations (Unified Parkinson's Disease Rating Scale -UPDRS- part-III and -IV, and Ambulatory Capacity Measure) were compared between malignant and benign patients, using corrected binary logistic regressions and repeated measure general linear model. RESULTS One year after surgery, the probability of losing daily life independence was 16-fold higher in malignant patients, even after adjusting for age at PD onset, PD duration, and percentage of motor improvement after STN-DBS (OR: 16.233; p: 0.035). Conversely, malignant and benign patients showed a similar extent of improvement after STN-DBS (p > 0.05) in motor symptoms, motor fluctuations, and ambulatory capacity, both in medication-ON and medication-OFF conditions. CONCLUSION DBS candidates in the malignant end of the PD spectrum may profit from a similar improvement of motor symptoms and fluctuations after STN-DBS when compared to benign PD. However, patients of the malignant group have a lower probability of maintaining independence in daily life early after surgery.
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Affiliation(s)
- Carlo Alberto Artusi
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy.
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Gabriele Imbalzano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Elisa Montanaro
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Maurizio Zibetti
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Mario Giorgio Rizzone
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
| | - Leonardo Lopiano
- Department of Neuroscience "Rita Levi Montalcini", University of Torino, Torino, Italy; Neurology 2 Unit, A.O.U. Città Della Salute e Della Scienza di Torino, Corso Bramante 88, 10124, Torino, Italy
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148
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Rodriguez-Zurrunero R, Araujo A, Lowery MM. Methods for Lowering the Power Consumption of OS-Based Adaptive Deep Brain Stimulation Controllers. SENSORS (BASEL, SWITZERLAND) 2021; 21:2349. [PMID: 33800544 PMCID: PMC8036781 DOI: 10.3390/s21072349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/11/2021] [Accepted: 03/24/2021] [Indexed: 12/16/2022]
Abstract
The identification of a new generation of adaptive strategies for deep brain stimulation (DBS) will require the development of mixed hardware-software systems for testing and implementing such controllers clinically. Towards this aim, introducing an operating system (OS) that provides high-level features (multitasking, hardware abstraction, and dynamic operation) as the core element of adaptive deep brain stimulation (aDBS) controllers could expand the capabilities and development speed of new control strategies. However, such software frameworks also introduce substantial power consumption overhead that could render this solution unfeasible for implantable devices. To address this, in this work four techniques to reduce this overhead are proposed and evaluated: a tick-less idle operation mode, reduced and dynamic sampling, buffered read mode, and duty cycling. A dual threshold adaptive deep brain stimulation algorithm for suppressing pathological oscillatory neural activity was implemented along with the proposed energy saving techniques on an energy-efficient OS, YetiOS, running on a STM32L476RE microcontroller. The system was then tested using an emulation environment coupled to a mean field model of the parkinsonian basal ganglia to simulate local field potential (LFPs) which acted as a biomarker for the controller. The OS-based controller alone introduced a power consumption overhead of 10.03 mW for a sampling rate of 1 kHz. This was reduced to 12 μW by applying the proposed tick-less idle mode, dynamic sampling, buffered read and duty cycling techniques. The OS-based controller using the proposed methods can facilitate rapid and flexible testing and implementation of new control methods. Furthermore, the approach has the potential to become a central element in future implantable devices to enable energy-efficient implementation of a wide range of control algorithms across different neurological conditions and hardware platforms.
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Affiliation(s)
| | - Alvaro Araujo
- B105 Electronic Systems Lab. ETSI Telecomunicación, Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Madeleine M. Lowery
- School of Electrical, Electronical and Communications Engineering, University College Dublin, Belfield, Dublin 4, Ireland;
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149
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Howell B, Isbaine F, Willie JT, Opri E, Gross RE, De Hemptinne C, Starr PA, McIntyre CC, Miocinovic S. Image-based biophysical modeling predicts cortical potentials evoked with subthalamic deep brain stimulation. Brain Stimul 2021; 14:549-563. [PMID: 33757931 DOI: 10.1016/j.brs.2021.03.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 02/19/2021] [Accepted: 03/14/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Subthalamic deep brain stimulation (DBS) is an effective surgical treatment for Parkinson's disease and continues to advance technologically with an enormous parameter space. As such, in-silico DBS modeling systems have become common tools for research and development, but their underlying methods have yet to be standardized and validated. OBJECTIVE Evaluate the accuracy of patient-specific estimates of neural pathway activations in the subthalamic region against intracranial, cortical evoked potential (EP) recordings. METHODS Pathway activations were modeled in eleven patients using the latest advances in connectomic modeling of subthalamic DBS, focusing on the hyperdirect pathway (HDP) and corticospinal/bulbar tract (CSBT) for their relevance in human research studies. Correlations between pathway activations and respective EP amplitudes were quantified. RESULTS Good model performance required accurate lead localization and image fusions, as well as appropriate selection of fiber diameter in the biophysical model. While optimal model parameters varied across patients, good performance could be achieved using a global set of parameters that explained 60% and 73% of electrophysiologic activations of CSBT and HDP, respectively. Moreover, restricted models fit to only EP amplitudes of eight standard (monopolar and bipolar) electrode configurations were able to extrapolate variation in EP amplitudes across other directional electrode configurations and stimulation parameters, with no significant reduction in model performance across the cohort. CONCLUSIONS Our findings demonstrate that connectomic models of DBS with sufficient anatomical and electrical details can predict recruitment dynamics of white matter. These results will help to define connectomic modeling standards for preoperative surgical targeting and postoperative patient programming applications.
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Affiliation(s)
- Bryan Howell
- Department of Biomedical Engineering, Case Western Reserve University, USA
| | | | - Jon T Willie
- Department of Neurosurgery, Emory University, USA
| | - Enrico Opri
- Department of Neurology, Emory University, USA
| | | | | | - Philip A Starr
- Department of Neurological Surgery, University of California San Francisco, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University, USA
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150
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Effect of Intraoperative Computed Tomography in Microelectrode Recording during Frameless Stereotactic Deep Brain Stimulation for Parkinson Disease. World Neurosurg 2021; 154:e1-e6. [PMID: 33722720 DOI: 10.1016/j.wneu.2021.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Microelectrode recording (MER)-guided deep brain stimulation (DBS) remains the standard electrophysiological procedure to place the DBS lead at the optimal target. When single-track MER or test stimulation yields suboptimal results, trajectory adjustments are needed. Intraoperative computed tomography (iCT) can be useful to visualize the microelectrode and verify possible adjustments. The aim of this study was to evaluate the effect of iCT in MER during frameless stereotactic DBS for Parkinson disease (PD). METHODS We retrospectively collected 28 PD patients, of whom 19 received iCT and 9 did not, and measured intracranial volume, cerebral volume, cerebrospinal fluid volume, and pneumocephalus volume. Euclidean distance was assessed according to merged preoperative brain CT and magnetic resonance imaging and postoperative brain CT. RESULTS Fifty-six hemispheres in the 28 patients were analyzed for MER tracks. The patients who received iCT had a significantly lower mean number of MER tracks (1.6 vs. 2.6, P = 0.013) and lower mean Euclidean distance (2.2 mm vs. 2.7 mm, P = 0.033) compared with those who did not receive iCT. Although there was a trend of a decrease in pneumocephalus using intraoperative imaging, there was no significant difference in surgical time. CONCLUSIONS iCT can reduce the number of MER tracks and increase surgical accuracy. Further studies are warranted to investigate whether iCT can reduce surgical complications and improve surgical outcomes.
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