101
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Lhommée E, Boyer F, Wack M, Pélissier P, Klinger H, Schmitt E, Bichon A, Fraix V, Chabardès S, Mertens P, Castrioto A, Kistner A, Broussolle E, Thobois S, Krack P. Personality, dopamine, and Parkinson's disease: Insights from subthalamic stimulation. Mov Disord 2017. [PMID: 28643887 DOI: 10.1002/mds.27065] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Subthalamic stimulation improves the motor and neuropsychiatric symptoms of Parkinson's disease. However, the impact of this treatment on impulse control and personality is the subject of heavy debate. The objective of this study was to investigate personality changes after subthalamic stimulation. METHODS Using Cloninger's biosocial model, we assessed personality in 73 Parkinson's disease patients before and 12 months after subthalamic stimulation accompanied by a drastic reduction in dopaminergic medication. Changes in psychobehavioral symptoms were measured using a battery of validated clinical scales (apathy, depression, anxiety, hyperemotionality, mania, psychosis, punding, and impulse control behaviors). RESULTS One year after surgery, the harm avoidance personality domain total score increased compared with the baseline (+2.8; 34 patients; P < 0.001), as did 3 of its 4 subdomains: anticipatory worry (+0.7; 10 patients; P = 0.005), shyness (+0.6; 7 patients; P = 0.03), and fatigability (+1.1; 10 patients; P = 0.0014). Evolution of the shyness personality trait correlated with the decrease in dopaminergic medication. Total scores in the other personality domains remained unchanged, except for extravagance, a subdomain of novelty seeking, and persistence, a subdomain of reward dependence, which both decreased following surgery (-0.3; 7 patients; and -0.6; 9 patients; P = 0.03 and P = 0.0019, respectively). Although apathy increased, other psychobehavioral symptoms, including impulse control behaviors and neuropsychiatric nonmotor fluctuations, improved. Depression and anhedonia remained stable. Scores in hypodopaminergia and neuropsychiatric nonmotor OFF correlated with harm avoidance. Scores in hyperdopaminergia and neuropsychiatric nonmotor ON correlated with novelty seeking. CONCLUSIONS When subthalamic stimulation is applied in Parkinson's disease, significant changes in personality traits are observed, which may be related to postoperative tapering of dopaminergic treatment. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Eugénie Lhommée
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - François Boyer
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France
| | - Maxime Wack
- Faculté de Médecine, Université de Lorraine, Vandœuvre-lès-Nancy, France.,Service d'épidémiologie et évaluation cliniques, CHU de Nancy, Vandœuvre-lès-Nancy, France
| | - Pierre Pélissier
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Emmanuelle Schmitt
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Amélie Bichon
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Valérie Fraix
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Stéphan Chabardès
- Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France.,Department of neurosurgery, CHU Grenoble Alpes, Grenoble, France
| | - Patrick Mertens
- Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,Hospices Civils de Lyon, Hôpital Neurologique, Neurochirurgie A, Lyon, France
| | - Anna Castrioto
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Andrea Kistner
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France
| | - Emmanuel Broussolle
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Stéphane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique, Neurologie C, Lyon, France.,Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Université de Lyon 1, Lyon, France.,CNRS, UMR 5229, Centre de Neurosciences Cognitives, Bron, France
| | - Paul Krack
- Movement Disorders Unit, Department of Psychiatry Neurology and Neurological Rehabilitation, CHU Grenoble Alpes, Grenoble, France.,Univ. Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, Grenoble, France.,Inserm, U1216, Grenoble, France.,Present address: Department of Clinical Neuroscience, Hôpitaux Universitaires de Genève, Faculty University of Geneva, Switzerland
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102
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Caspers J, Mathys C, Hoffstaedter F, Südmeyer M, Cieslik EC, Rubbert C, Hartmann CJ, Eickhoff CR, Reetz K, Grefkes C, Michely J, Turowski B, Schnitzler A, Eickhoff SB. Differential Functional Connectivity Alterations of Two Subdivisions within the Right dlPFC in Parkinson's Disease. Front Hum Neurosci 2017; 11:288. [PMID: 28611616 PMCID: PMC5447710 DOI: 10.3389/fnhum.2017.00288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 05/16/2017] [Indexed: 02/02/2023] Open
Abstract
Patients suffering from Parkinson's disease (PD) often show impairments in executive function (EF) like decision-making and action control. The right dorsolateral prefrontal cortex (dlPFC) has been strongly implicated in EF in healthy subjects and has repeatedly been reported to show alterations related to EF impairment in PD. Recently, two key regions for cognitive action control have been identified within the right dlPFC by co-activation based parcellation. While the posterior region is engaged in rather basal EF like stimulus integration and working memory, the anterior region has a more abstract, supervisory function. To investigate whether these functionally distinct subdivisions of right dlPFC are differentially affected in PD, we analyzed resting-state functional connectivity (FC) in 39 PD patients and 44 age- and gender-matched healthy controls. Patients were examined both after at least 12 h withdrawal of dopaminergic drugs (OFF) and under their regular dopaminergic medication (ON). We found that only the posterior right dlPFC subdivision shows FC alterations in PD, while the anterior part remains unaffected. PD-related decreased FC with posterior right dlPFC was found in the bilateral medial posterior parietal cortex (mPPC) and left dorsal premotor region (PMd) in the OFF state. In the medical ON, FC with left PMd normalized, while decoupling with bilateral mPPC remained. Furthermore, we observed increased FC between posterior right dlPFC and the bilateral dorsomedial prefrontal cortex (dmPFC) in PD in the ON state. Our findings point to differential disturbances of right dlPFC connectivity in PD, which relate to its hierarchical organization of EF processing by stronger affecting the functionally basal posterior aspect than the hierarchically higher anterior part.
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Affiliation(s)
- Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University DüsseldorfDüsseldorf, Germany.,Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1, INM-3, INM-11)Jülich, Germany
| | - Christian Mathys
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University DüsseldorfDüsseldorf, Germany
| | - Felix Hoffstaedter
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1, INM-3, INM-11)Jülich, Germany.,Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-UniversityDüsseldorf, Germany
| | - Martin Südmeyer
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-UniversityDüsseldorf, Germany.,Department of Neurology, Medical Faculty, Center for Movement Disorders and Neuromodulation, Heinrich-Heine-UniversityDüsseldorf, Germany
| | - Edna C Cieslik
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1, INM-3, INM-11)Jülich, Germany.,Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-UniversityDüsseldorf, Germany
| | - Christian Rubbert
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University DüsseldorfDüsseldorf, Germany
| | - Christian J Hartmann
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-UniversityDüsseldorf, Germany.,Department of Neurology, Medical Faculty, Center for Movement Disorders and Neuromodulation, Heinrich-Heine-UniversityDüsseldorf, Germany
| | - Claudia R Eickhoff
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1, INM-3, INM-11)Jülich, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen UniversityAachen, Germany
| | - Kathrin Reetz
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1, INM-3, INM-11)Jülich, Germany.,JARA BRAIN and Department of Neurology, RWTH Aachen UniversityAachen, Germany
| | - Christian Grefkes
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1, INM-3, INM-11)Jülich, Germany.,Department of Neurology, University of CologneCologne, Germany
| | - Jochen Michely
- Department of Neurology, University of CologneCologne, Germany
| | - Bernd Turowski
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University DüsseldorfDüsseldorf, Germany
| | - Alfons Schnitzler
- Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-UniversityDüsseldorf, Germany.,Department of Neurology, Medical Faculty, Center for Movement Disorders and Neuromodulation, Heinrich-Heine-UniversityDüsseldorf, Germany
| | - Simon B Eickhoff
- Research Centre Jülich, Institute of Neuroscience and Medicine (INM-1, INM-3, INM-11)Jülich, Germany.,Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine-UniversityDüsseldorf, Germany
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103
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van Wouwe NC, Pallavaram S, Phibbs FT, Martinez-Ramirez D, Neimat JS, Dawant BM, D'Haese PF, Kanoff KE, van den Wildenberg WPM, Okun MS, Wylie SA. Focused stimulation of dorsal subthalamic nucleus improves reactive inhibitory control of action impulses. Neuropsychologia 2017; 99:37-47. [PMID: 28237741 PMCID: PMC5493526 DOI: 10.1016/j.neuropsychologia.2017.02.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/13/2017] [Accepted: 02/22/2017] [Indexed: 01/23/2023]
Abstract
Frontal-basal ganglia circuitry dysfunction caused by Parkinson's disease impairs important executive cognitive processes, such as the ability to inhibit impulsive action tendencies. Subthalamic Nucleus Deep Brain Stimulation in Parkinson's disease improves the reactive inhibition of impulsive actions that interfere with goal-directed behavior. An unresolved question is whether this effect depends on stimulation of a particular Subthalamic Nucleus subregion. The current study aimed to 1) replicate previous findings and additionally investigate the effect of chronic versus acute Subthalamic Nucleus stimulation on inhibitory control in Parkinson's disease patients off dopaminergic medication 2) test whether stimulating Subthalamic Nucleus subregions differentially modulate proactive response control and the proficiency of reactive inhibitory control. In the first experiment, twelve Parkinson's disease patients completed three sessions of the Simon task, Off Deep brain stimulation and medication, on acute Deep Brain Stimulation and on chronic Deep Brain Stimulation. Experiment 2 consisted of 11 Parkinson's disease patients with Subthalamic Nucleus Deep Brain Stimulation (off medication) who completed two testing sessions involving of a Simon task either with stimulation of the dorsal or the ventral contact in the Subthalamic Nucleus. Our findings show that Deep Brain Stimulation improves reactive inhibitory control, regardless of medication and regardless of whether it concerns chronic or acute Subthalamic Nucleus stimulation. More importantly, selective stimulation of dorsal and ventral subregions of the Subthalamic Nucleus indicates that especially the dorsal Subthalamic Nucleus circuitries are crucial for modulating the reactive inhibitory control of motor actions.
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Affiliation(s)
- N C van Wouwe
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S Pallavaram
- Department of Engineering, Vanderbilt University, Nashville, TN, USA
| | - F T Phibbs
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - D Martinez-Ramirez
- Department of Neurology, University of Florida Medical Center, Gainesville, Florida, USA
| | - J S Neimat
- Department of Neurosurgery, University of Louisville Medical Center, Louisville, KY, USA
| | - B M Dawant
- Department of Engineering, Vanderbilt University, Nashville, TN, USA
| | - P F D'Haese
- Department of Engineering, Vanderbilt University, Nashville, TN, USA
| | - K E Kanoff
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - W P M van den Wildenberg
- Cognitive Science Center Amsterdam and Psychology Department, University of Amsterdam, Amsterdam, The Netherlands
| | - M S Okun
- Department of Neurology, University of Florida Medical Center, Gainesville, Florida, USA
| | - S A Wylie
- Department of Neurosurgery, University of Louisville Medical Center, Louisville, KY, USA
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104
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Aiello M, Eleopra R, Foroni F, Rinaldo S, Rumiati RI. Weight gain after STN-DBS: The role of reward sensitivity and impulsivity. Cortex 2017; 92:150-161. [PMID: 28494345 DOI: 10.1016/j.cortex.2017.04.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 02/15/2017] [Accepted: 04/08/2017] [Indexed: 12/23/2022]
Abstract
Weight gain has been reported after deep brain stimulation of the subthalamic nucleus (STN-DBS), a widely used treatment for Parkinson's disease (PD). This nucleus has been repeatedly found to be linked both to reward and to inhibitory control, two key aspects in the control of food intake. In this study, we assessed whether weight gain experienced by patients with PD after STN-DBS, might be due to an alteration of reward and inhibitory functions. Eighteen patients with PD were compared to eighteen healthy controls and tested three times: before surgery, in ON medication and after surgery, respectively five days after the implantation in ON medication/OFF stimulation and at least three months after surgery in ON medication/ON stimulation. All participants were assessed for depression (Beck Depression Inventory), anhedonia (Snaith-Hamilton Pleasure Scale) and impulsiveness (Barratt Impulsiveness Scale). They performed a battery of tests assessing food reward sensitivity (Liking, Wanting and Preference) and a food go/no-go task. Results showed that body weight significantly increased after STN-DBS. A few days after surgery, patients were slower and more impulsive in the go/no-go task, showed a higher preference for high calorie (HC) foods and rated foods as less tasty. Months after subthalamic stimulation, the performance on the go/no-go task improved while no differences were observed in reward sensitivity. Interestingly, weight gain resulted greater in patients with higher levels of attentional impulsiveness pre-surgery, higher wanting for low calorie (LC) foods and impulsivity in the go/no-go task in ON medication/ON stimulation. However, only wanting and attentional impulsivity significantly predicted weight change. Furthermore, weight gain resulted associated with the reduction of l-Dopa after surgery and disease's duration. In conclusion, our findings are consistent with the view that weight gain in PD after STN-DBS has a multifactorial nature, which reflects the complex functional organization of the STN.
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Affiliation(s)
| | - Roberto Eleopra
- S.O.C. Neurologia, Azienda Ospedaliero Universitaria "Santa Maria Della Misericordia", Piazzale Santa Maria Della Misericordia, Udine, UD, Italy
| | | | - Sara Rinaldo
- S.O.C. Neurologia, Azienda Ospedaliero Universitaria "Santa Maria Della Misericordia", Piazzale Santa Maria Della Misericordia, Udine, UD, Italy
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105
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Duque J, Greenhouse I, Labruna L, Ivry RB. Physiological Markers of Motor Inhibition during Human Behavior. Trends Neurosci 2017; 40:219-236. [PMID: 28341235 DOI: 10.1016/j.tins.2017.02.006] [Citation(s) in RCA: 147] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/17/2017] [Accepted: 02/21/2017] [Indexed: 01/25/2023]
Abstract
Transcranial magnetic stimulation (TMS) studies in humans have shown that many behaviors engage processes that suppress excitability within the corticospinal tract. Inhibition of the motor output pathway has been extensively studied in the context of action stopping, where a planned movement needs to be abruptly aborted. Recent TMS work has also revealed markers of motor inhibition during the preparation of movement. Here, we review the evidence for motor inhibition during action stopping and action preparation, focusing on studies that have used TMS to monitor changes in the excitability of the corticospinal pathway. We discuss how these physiological results have motivated theoretical models of how the brain selects actions, regulates movement initiation and execution, and switches from one state to another.
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Affiliation(s)
- Julie Duque
- Institute of Neuroscience, Université catholique de Louvain, Brussels, Belgium.
| | - Ian Greenhouse
- Department of Psychology, University of California, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Ludovica Labruna
- Department of Psychology, University of California, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
| | - Richard B Ivry
- Department of Psychology, University of California, Berkeley, CA, USA; Helen Wills Neuroscience Institute, University of California, Berkeley, CA, USA
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106
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Maier F, Lewis CJ, Eggers C, Kühn AA, Krug H, Volkmann J, Kirsch AD, Wojtecki L, Schnitzler A, Deuschl G, Krauss JK, Woopen C, Timmermann L. Development and validation of the deep brain stimulation impairment scale (DBS-IS). Parkinsonism Relat Disord 2017; 36:69-75. [DOI: 10.1016/j.parkreldis.2017.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 12/05/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
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107
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Impulse control disorders and levodopa-induced dyskinesias in Parkinson's disease: an update. Lancet Neurol 2017; 16:238-250. [DOI: 10.1016/s1474-4422(17)30004-2] [Citation(s) in RCA: 234] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/28/2016] [Accepted: 01/06/2017] [Indexed: 02/03/2023]
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108
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Krack P, Martinez-Fernandez R, del Alamo M, Obeso JA. Current applications and limitations of surgical treatments for movement disorders. Mov Disord 2017; 32:36-52. [DOI: 10.1002/mds.26890] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 11/10/2016] [Accepted: 11/13/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Paul Krack
- Neurology Division, Department of Clinical Neurosciences; University Hospital of Geneva; Geneva Switzerland
| | | | - Marta del Alamo
- CINAC-Hospital Universitario HM Puerta del Sur; CEU-San Pablo University; Madrid Spain
- Neurosurgery Department; Hospital Universitario Ramon y Cajal; Madrid Spain
| | - Jose A. Obeso
- CINAC-Hospital Universitario HM Puerta del Sur; CEU-San Pablo University; Madrid Spain
- Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas; Madrid Spain
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109
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Atherton JF, McIver EL, Mullen MR, Wokosin DL, Surmeier DJ, Bevan MD. Early dysfunction and progressive degeneration of the subthalamic nucleus in mouse models of Huntington's disease. eLife 2016; 5. [PMID: 27995895 PMCID: PMC5199195 DOI: 10.7554/elife.21616] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023] Open
Abstract
The subthalamic nucleus (STN) is an element of cortico-basal ganglia-thalamo-cortical circuitry critical for action suppression. In Huntington's disease (HD) action suppression is impaired, resembling the effects of STN lesioning or inactivation. To explore this potential linkage, the STN was studied in BAC transgenic and Q175 knock-in mouse models of HD. At <2 and 6 months of age autonomous STN activity was impaired due to activation of KATP channels. STN neurons exhibited prolonged NMDA receptor-mediated synaptic currents, caused by a deficit in glutamate uptake, and elevated mitochondrial oxidant stress, which was ameliorated by NMDA receptor antagonism. STN activity was rescued by NMDA receptor antagonism or the break down of hydrogen peroxide. At 12 months of age approximately 30% of STN neurons had been lost, as in HD. Together, these data argue that dysfunction within the STN is an early feature of HD that may contribute to its expression and course. DOI:http://dx.doi.org/10.7554/eLife.21616.001
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Affiliation(s)
- Jeremy F Atherton
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - Eileen L McIver
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - Matthew Rm Mullen
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - David L Wokosin
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - D James Surmeier
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, United States
| | - Mark D Bevan
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, United States
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110
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Wessel JR, Ghahremani A, Udupa K, Saha U, Kalia SK, Hodaie M, Lozano AM, Aron AR, Chen R. Stop-related subthalamic beta activity indexes global motor suppression in Parkinson's disease. Mov Disord 2016; 31:1846-1853. [PMID: 27474845 PMCID: PMC5154922 DOI: 10.1002/mds.26732] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Rapid action stopping leads to global motor suppression. This is shown by studies using transcranial magnetic stimulation to measure corticospinal excitability of task-unrelated effectors (e.g., from the hand during speech stopping). We hypothesize that this global suppression relates to the STN of the basal ganglia. Several STN local field potential studies in PD patients have shown increased ß-band power during successful stopping. OBJECTIVES Here, we aimed to test whether this STN ß-band activity indexes global motor suppression measured by transcranial magnetic stimulation. METHODS We studied 9 medicated PD patients (age, 47-67 years; mean, 55.8; 3 female) who were implanted with STN-DBS electrodes. Participants performed a vocal stop-signal task (i.e., they had to occasionally stop a vocal response) while we simultaneously recorded local field potentials from right STN and delivered transcranial magnetic stimulation to primary motor cortex to measure corticospinal excitability from a task-unrelated hand muscle (first dorsal interosseous). RESULTS Replicating previous results, STN ß-band power was increased (P < 0.005) and corticospinal excitability was reduced (P = 0.024; global motor suppression) during successful stopping. As hypothesized, global motor suppression was greater for successful stop trials with higher STN ß-power (median split: P = 0.043), which was further evident in a negative correlation between single-trial STN ß-power and corticospinal excitability (mean, r = -0.176; P = 0.011). CONCLUSION These findings link stopping-related global motor suppression to STN ß-band activity through simultaneous recordings of STN and corticospinal excitability. The results support models of basal ganglia function that propose the STN has broad motor suppressive effects. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Jan R. Wessel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52242, USA
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
- Department of Psychology, University of California San Diego, La Jolla, CA 92093, USA
| | - Ayda Ghahremani
- Toronto Western Research Institute, Toronto, ON, CA
- Institute of Medical Science, University of Toronto, Toronto, ON, CA
| | - Kaviraja Udupa
- Toronto Western Research Institute, Toronto, ON, CA
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, CA
| | - Utpal Saha
- Toronto Western Research Institute, Toronto, ON, CA
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, CA
| | - Suneil K. Kalia
- Toronto Western Research Institute, Toronto, ON, CA
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, CA
| | - Mojgan Hodaie
- Toronto Western Research Institute, Toronto, ON, CA
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, CA
| | - Andres M. Lozano
- Toronto Western Research Institute, Toronto, ON, CA
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, CA
| | - Adam R. Aron
- Department of Psychology, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert Chen
- Toronto Western Research Institute, Toronto, ON, CA
- Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, CA
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111
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Georgiades MJ, Gilat M, Ehgoetz Martens KA, Walton CC, Bissett PG, Shine JM, Lewis SJ. Investigating motor initiation and inhibition deficits in patients with Parkinson’s disease and freezing of gait using a virtual reality paradigm. Neuroscience 2016; 337:153-162. [DOI: 10.1016/j.neuroscience.2016.09.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/05/2016] [Accepted: 09/11/2016] [Indexed: 10/21/2022]
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112
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Houvenaghel JF, Duprez J, Argaud S, Naudet F, Dondaine T, Robert GH, Drapier S, Haegelen C, Jannin P, Drapier D, Vérin M, Sauleau P. Influence of subthalamic deep-brain stimulation on cognitive action control in incentive context. Neuropsychologia 2016; 91:519-530. [PMID: 27664297 DOI: 10.1016/j.neuropsychologia.2016.09.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 08/23/2016] [Accepted: 09/20/2016] [Indexed: 01/24/2023]
Abstract
Subthalamic nucleus deep-brain stimulation (STN-DBS) is an effective treatment in Parkinson's disease (PD), but can have cognitive side effects, such as increasing the difficulty of producing appropriate responses when a habitual but inappropriate responses represent strong alternatives. STN-DBS also appears to modulate representations of incentives such as monetary rewards. Furthermore, conflict resolution can be modulated by incentive context. We therefore used a rewarded Simon Task to assess the influence of promised rewards on cognitive action control in 50 patients with PD, half of whom were being treated with STN-DBS. Results were analyzed according to the activation-suppression model. We showed that STN-DBS (i) favored the expression of motor impulsivity, as measured with the Barratt Impulsiveness Scale, (ii) facilitated the expression of incentive actions as observed with a greater increase in speed according to promised reward in patients with versus without DBS and (iii) may increase impulsive action selection in an incentive context. In addition, analysis of subgroups of implanted patients suggested that those who exhibited the most impulsive action selection had the least severe disease. This may indicate that patients with less marked disease are more at risk of developing impulsivity postoperatively. Finally, in these patients, incentive context increased the difficulty of resolving conflict situations. As a whole, the current study revealed that in patients with PD, STN-DBS affects the cognitive processes involved in conflict resolution, reward processing and the influence of promised rewards on conflict resolution.
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Affiliation(s)
- Jean-François Houvenaghel
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurology, Rennes University Hospital, Rennes, France.
| | - Joan Duprez
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
| | - Soizic Argaud
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; "Neuroscience of Emotion and Affective Dynamics" Laboratory, Department of Psychology and Educational Sciences/Swiss Center for Affective Sciences, Campus Biotech, University of Geneva, Geneva, Switzerland
| | - Florian Naudet
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Clinical Investigation Center (INSERM 0203), Department of Pharmacology, Rennes University Hospital, Rennes, France; Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Thibaut Dondaine
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France
| | - Gabriel Hadrien Robert
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Sophie Drapier
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurology, Rennes University Hospital, Rennes, France
| | - Claire Haegelen
- Department of Neurosurgery, Rennes University Hospital, Rennes, France; "MediCIS" laboratory (UMR 1099 LTSI), INSERM/University of Rennes, Rennes, France
| | - Pierre Jannin
- "MediCIS" laboratory (UMR 1099 LTSI), INSERM/University of Rennes, Rennes, France
| | - Dominique Drapier
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Psychiatry, Rennes University Hospital, Rennes, France
| | - Marc Vérin
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurology, Rennes University Hospital, Rennes, France
| | - Paul Sauleau
- "Behavior and Basal Ganglia" Research Unit (EA 4712), University of Rennes 1, Rennes, France; Department of Neurophysiology, Rennes University Hospital, Rennes, France
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Tiedt HO, Ehlen F, Krugel LK, Horn A, Kühn AA, Klostermann F. Subcortical roles in lexical task processing: Inferences from thalamic and subthalamic event-related potentials. Hum Brain Mapp 2016; 38:370-383. [PMID: 27647660 DOI: 10.1002/hbm.23366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 07/27/2016] [Accepted: 08/24/2016] [Indexed: 02/04/2023] Open
Abstract
Subcortical functions for language capacities are poorly defined, but may be investigated in the context of deep brain stimulation. Here, we studied event-related potentials recorded from electrodes in the subthalamic nucleus (STN) and the thalamic ventral intermediate nucleus (VIM) together with surface-EEG. Participants completed a lexical decision task (LDT), which required the differentiation of acoustically presented words from pseudo-words by button press. Target stimuli were preceded by prime-words. In recordings from VIM, a slow potential shift apparent at the lower electrode contacts persisted during target stimulus presentation (equally for words and pseudo-words). In contrast, recordings from STN electrodes showed a short local activation on prime-words but not target-stimuli. In both depth-recording regions, further components related to contralateral motor responses to target words were evident. On scalp level, mid-central activations on (pseudo)lexical stimuli were obtained, in line with the expression of N400 potentials. The prolonged activity recorded from VIM, exclusively accompanying the relevant LDT phase, is in line with the idea of thalamic "selective engagement" for supporting the realization of the behavioral focus demanded by the task. In contrast, the phasic prime related activity rather indicates "procedural" STN functions, for example, for trial sequencing or readiness inhibition of prepared target reactions. Hum Brain Mapp 38:370-383, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Hannes O Tiedt
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, Berlin, 12003, Germany
| | - Felicitas Ehlen
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, Berlin, 12003, Germany
| | - Lea K Krugel
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, Berlin, 12003, Germany
| | - Andreas Horn
- Department of Neurology, Motor Neuroscience Group, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, Berlin, 13353, Germany.,Laboratory for Brain Network Imaging and Modulation, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, Massachusetts, 02215
| | - Andrea A Kühn
- Department of Neurology, Motor Neuroscience Group, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum (CVK), Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, Berlin, 10099, Germany
| | - Fabian Klostermann
- Department of Neurology, Motor and Cognition Group, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Hindenburgdamm 30, Berlin, 12003, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Unter den Linden 6, Berlin, 10099, Germany
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114
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Ineichen C, Baumann-Vogel H, Christen M. Deep Brain Stimulation: In Search of Reliable Instruments for Assessing Complex Personality-Related Changes. Brain Sci 2016; 6:E40. [PMID: 27618110 PMCID: PMC5039469 DOI: 10.3390/brainsci6030040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/23/2016] [Accepted: 09/01/2016] [Indexed: 12/16/2022] Open
Abstract
During the last 25 years, more than 100,000 patients have been treated with Deep Brain Stimulation (DBS). While human clinical and animal preclinical research has shed light on the complex brain-signaling disturbances that underpin e.g., Parkinson's disease (PD), less information is available when it comes to complex psychosocial changes following DBS interventions. In this contribution, we propose to more thoroughly investigate complex personality-related changes following deep brain stimulation through refined and reliable instruments in order to help patients and their relatives in the post-surgery phase. By pursuing this goal, we first outline the clinical importance DBS has attained followed by discussing problematic and undesired non-motor problems that accompany some DBS interventions. After providing a brief definition of complex changes, we move on by outlining the measurement problem complex changes relating to non-motor symptoms currently are associated with. The latter circumstance substantiates the need for refined instruments that are able to validly assess personality-related changes. After providing a brief paragraph with regard to conceptions of personality, we argue that the latter is significantly influenced by certain competencies which themselves currently play only a tangential role in the clinical DBS-discourse. Increasing awareness of the latter circumstance is crucial in the context of DBS because it could illuminate a link between competencies and the emergence of personality-related changes, such as new-onset impulse control disorders that have relevance for patients and their relatives. Finally, we elaborate on the field of application of instruments that are able to measure personality-related changes.
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Affiliation(s)
- Christian Ineichen
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich 8006, Switzerland.
| | - Heide Baumann-Vogel
- Department of Neurology, University Hospital Zurich, Frauenklinikstrasse 26, Zurich 8091, Switzerland.
| | - Markus Christen
- Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich 8006, Switzerland.
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Deffains M, Iskhakova L, Katabi S, Haber SN, Israel Z, Bergman H. Subthalamic, not striatal, activity correlates with basal ganglia downstream activity in normal and parkinsonian monkeys. eLife 2016; 5. [PMID: 27552049 PMCID: PMC5030093 DOI: 10.7554/elife.16443] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/22/2016] [Indexed: 02/02/2023] Open
Abstract
The striatum and the subthalamic nucleus (STN) constitute the input stage of the basal ganglia (BG) network and together innervate BG downstream structures using GABA and glutamate, respectively. Comparison of the neuronal activity in BG input and downstream structures reveals that subthalamic, not striatal, activity fluctuations correlate with modulations in the increase/decrease discharge balance of BG downstream neurons during temporal discounting classical condition task. After induction of parkinsonism with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), abnormal low beta (8-15 Hz) spiking and local field potential (LFP) oscillations resonate across the BG network. Nevertheless, LFP beta oscillations entrain spiking activity of STN, striatal cholinergic interneurons and BG downstream structures, but do not entrain spiking activity of striatal projection neurons. Our results highlight the pivotal role of STN divergent projections in BG physiology and pathophysiology and may explain why STN is such an effective site for invasive treatment of advanced Parkinson's disease and other BG-related disorders. DOI:http://dx.doi.org/10.7554/eLife.16443.001 The symptoms of Parkinson’s disease include tremor and slow movement, as well as loss of balance, depression and problems with sleep and memory. The death of neurons in a region of the brain called the substantia nigra pars compacta is one of the major hallmarks of Parkinson’s disease. These neurons produce a chemical called dopamine, and their death reduces dopamine levels in another area of the brain called the striatum. This structure is one of five brain regions known collectively as the basal ganglia, which form a circuit that helps to control movement. The most effective treatment currently available for advanced Parkinson’s disease entails lowering electrodes deep into the brain in order to shut down the activity of part of the basal ganglia. However, the target is not the striatum; instead it is a structure called the subthalamic nucleus. The striatum and the subthalamic nucleus are the two input regions of the basal ganglia: each sends signals to the other three structures downstream. So why does targeting the subthalamic nucleus, but not the striatum, reduce the symptoms of Parkinson’s disease? To shed some light on this issue, Deffains et al. recorded the activity of neurons in the basal ganglia before and after injecting two monkeys with a drug called MPTP. Related to heroin, MPTP produces symptoms in animals that resemble those of Parkinson’s disease. Before the injections, spontaneous fluctuations in the activity of the subthalamic nucleus produced matching changes in the activity of the three downstream basal ganglia structures. Fluctuations in the activity of the striatum, by contrast, had no such effect. Moreover, injecting the monkeys with MPTP caused the basal ganglia to fire in an abnormal highly synchronized rhythm, similar to that seen in Parkinson’s disease. Crucially, the subthalamic nucleus contributed to this abnormal rhythm, whereas the striatum did not. The results presented by Deffains et al. provide a concrete explanation for why inactivating the subthalamic nucleus, but not the striatum, reduces the symptoms of Parkinson’s disease. Further research is now needed to explore how the striatum controls the activity of downstream regions of the basal ganglia, both in healthy people and in those with Parkinson's disease. DOI:http://dx.doi.org/10.7554/eLife.16443.002
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Affiliation(s)
- Marc Deffains
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Liliya Iskhakova
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Sciences, The Hebrew University, Jerusalem, Israel
| | - Shiran Katabi
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester School of Medicine, Rochester, United States
| | - Zvi Israel
- Department of Neurosurgery, Hadassah University Hospital, Jerusalem, Israel
| | - Hagai Bergman
- Department of Medical Neurobiology, Institute of Medical Research Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel
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Wang J, Nebeck S, Muralidharan A, Johnson MD, Vitek JL, Baker KB. Coordinated Reset Deep Brain Stimulation of Subthalamic Nucleus Produces Long-Lasting, Dose-Dependent Motor Improvements in the 1-Methyl-4-phenyl-1,2,3,6-tetrahydropyridine Non-Human Primate Model of Parkinsonism. Brain Stimul 2016; 9:609-17. [PMID: 27151601 DOI: 10.1016/j.brs.2016.03.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 02/25/2016] [Accepted: 03/18/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Novel deep brain stimulation (DBS) paradigms are being explored in an effort to further optimize therapeutic outcome for patients with Parkinson's disease (PD). One approach, termed 'Coordinated Reset' (CR) DBS, was developed to target pathological oscillatory network activity. with desynchronizing effects and associated therapeutic benefit hypothesized to endure beyond cessation of stimulus delivery. OBJECTIVE To characterize the acute and carry-over effects of low-intensity CR DBS versus traditional DBS (tDBS) in the region of the subthalamic nucleus (STN). METHODS A within-subject, block treatment design involving the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) non-human primate model of parkinsonism was used. Each treatment block consisted of five days of daily DBS delivery followed by a one week minimum post-treatment observation window. Motor behavior was quantified using a modified rating scale for both animals combined with an objective, upper-extremity reach task in one animal. RESULTS Both animals demonstrated significant motor improvements during acute tDBS; however, within-session and post-treatment carry-over was limited. Acute motor improvements were also observed in response to low-intensity CR DBS; however, both within- and between-session therapeutic carry-over enhanced progressively following each daily treatment. Moreover, in contrast to tDBS, five consecutive days of CR DBS treatment yielded carry-over benefits that persisted for up to two weeks without additional intervention. Notably, the magnitude and time-course of CR DBS' effects on each animal varied with daily dose-duration, pointing to possible interaction effects involving baseline parkinsonian severity. CONCLUSION Our results support the therapeutic promise of CR DBS for PD, including its potential to induce carryover while reducing both side effect risk and hardware power consumption.
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Affiliation(s)
- Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Shane Nebeck
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | | | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kenneth B Baker
- Department of Neuroscience, Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195, USA.
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Tan ZG, Zhou Q, Huang T, Jiang Y. Efficacies of globus pallidus stimulation and subthalamic nucleus stimulation for advanced Parkinson's disease: a meta-analysis of randomized controlled trials. Clin Interv Aging 2016; 11:777-86. [PMID: 27382262 PMCID: PMC4922790 DOI: 10.2147/cia.s105505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Deep brain stimulation (DBS) is the surgical procedure for patients with advanced Parkinson's disease. Globus pallidus internus (GPi) and subthalamic nucleus (STN) are the most targeted locations for the procedure. To investigate the variable efficiencies for the two different locations, we conducted a meta-analysis to compare both stimulation sites. MATERIALS AND METHODS A systematic search was performed in PubMed, Embase, and the Cochrane Library databases. Randomized controlled trials comparing the efficacies of GPi and STN DBS were included. Clinical outcomes of motor function, nonmotor function, and quality of life (QOL) were collected for the meta-analysis. RESULTS Ten eligible trials with 1,034 patients were included in the analysis. Unified Parkinson's disease rating scale III (UPDRS-III) scores were collected at 6, 12, and 24 months postsurgery separately to assess the motor function of the patients. A statistically significant effect in favor of the GPi DBS was obtained in the off-medication/on-stimulation phase of UPDRS-III at 12 months (mean difference [MD] =6.87, 95% confidence interval [95% CI]: 3.00-10.74, P=0.57, I (2)=0%). However, GPi DBS showed an opposite result at 24 months (MD =-2.46, 95% CI: -4.91 to -0.02, P=0.05, I (2)=0%). In the on-medication/on-stimulation phase, GPi DBS obtained a worse outcome compared with STN DBS (MD =-2.90, 95% CI: -5.71 to -0.09, P=0.05, I (2)=0%). Compared with STN DBS, increased dosage of levodopa equivalent doses was needed in GPi DBS (standardized MD =0.60, 95% CI: 0.46-0.74, P<0.00001, I (2)=24%). Meanwhile, Beck Depression Inventory II scores demonstrated that STN has a better performance (standardized MD =-0.31, 95% CI: -0.51 to -0.12, P=0.002, I (2)=0%). As for neurocognitive phase postsurgery, GPi DBS showed better performance in three of the nine tests, especially in verbal fluency. Use of GPi DBS was associated with a greater effect in eight of the nine subscales of QOL. CONCLUSION GPi and STN DBS significantly improve advanced Parkinson's patients' symptoms, functionality, and QOL. Variable therapeutic efficiencies were observed in both procedures, GPi and STN DBS. GPi DBS allowed greater recovery of verbal fluency and provided greater relief of depression symptoms. Better QOL was also obtained using GPi DBS. Meanwhile, GPi DBS was also associated with increased dosage of levodopa equivalent doses. The question regarding which target is superior remained open for discussion. An understanding of the target selection still depends on individual symptoms, neurocognitive/mood status, therapeutic goals of DBS (eg, levodopa reduction), and surgical expertise.
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Affiliation(s)
- Zhi-Gang Tan
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Qian Zhou
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Tao Huang
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Yugang Jiang
- Department of Neurosurgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
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Zeitler M, Tass PA. Anti-kindling Induced by Two-Stage Coordinated Reset Stimulation with Weak Onset Intensity. Front Comput Neurosci 2016; 10:44. [PMID: 27242500 PMCID: PMC4868855 DOI: 10.3389/fncom.2016.00044] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022] Open
Abstract
Abnormal neuronal synchrony plays an important role in a number of brain diseases. To specifically counteract abnormal neuronal synchrony by desynchronization, Coordinated Reset (CR) stimulation, a spatiotemporally patterned stimulation technique, was designed with computational means. In neuronal networks with spike timing–dependent plasticity CR stimulation causes a decrease of synaptic weights and finally anti-kindling, i.e., unlearning of abnormally strong synaptic connectivity and abnormal neuronal synchrony. Long-lasting desynchronizing aftereffects of CR stimulation have been verified in pre-clinical and clinical proof of concept studies. In general, for different neuromodulation approaches, both invasive and non-invasive, it is desirable to enable effective stimulation at reduced stimulation intensities, thereby avoiding side effects. For the first time, we here present a two-stage CR stimulation protocol, where two qualitatively different types of CR stimulation are delivered one after another, and the first stage comes at a particularly weak stimulation intensity. Numerical simulations show that a two-stage CR stimulation can induce the same degree of anti-kindling as a single-stage CR stimulation with intermediate stimulation intensity. This stimulation approach might be clinically beneficial in patients suffering from brain diseases characterized by abnormal neuronal synchrony where a first treatment stage should be performed at particularly weak stimulation intensities in order to avoid side effects. This might, e.g., be relevant in the context of acoustic CR stimulation in tinnitus patients with hyperacusis or in the case of electrical deep brain CR stimulation with sub-optimally positioned leads or side effects caused by stimulation of the target itself. We discuss how to apply our method in first in man and proof of concept studies.
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Affiliation(s)
- Magteld Zeitler
- Research Center Jülich, Institute of Neuroscience and Medicine, Neuromodulation (INM-7) Jülich, Germany
| | - Peter A Tass
- Research Center Jülich, Institute of Neuroscience and Medicine, Neuromodulation (INM-7)Jülich, Germany; Department of Neurosurgery, Stanford UniversityStanford, CA, USA; Department of Neuromodulation, University of CologneCologne, Germany
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Piron C, Kase D, Topalidou M, Goillandeau M, Orignac H, N'Guyen TH, Rougier N, Boraud T. The globus pallidus pars interna in goal-oriented and routine behaviors: Resolving a long-standing paradox. Mov Disord 2016; 31:1146-54. [PMID: 26900137 DOI: 10.1002/mds.26542] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/18/2015] [Accepted: 12/23/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is an apparent contradiction between experimental data showing that the basal ganglia are involved in goal-oriented and routine behaviors and clinical observations. Lesion or disruption by deep brain stimulation of the globus pallidus interna has been used for various therapeutic purposes ranging from the improvement of dystonia to the treatment of Tourette's syndrome. None of these approaches has reported any severe impairment in goal-oriented or automatic movement. METHOD To solve this conundrum, we trained 2 monkeys to perform a variant of a 2-armed bandit-task (with different reward contingencies). In the latter we alternated blocks of trials with choices between familiar rewarded targets that elicit routine behavior and blocks with novel pairs of targets that require an intentional learning process. RESULTS Bilateral inactivation of the globus pallidus interna, by injection of muscimol, prevents animals from learning new contingencies while performance remains intact, although slower for the familiar stimuli. We replicate in silico these data by adding lateral competition and Hebbian learning in the cortical layer of the theoretical model of the cortex-basal ganglia loop that provided the framework of our experimental approach. CONCLUSION The basal ganglia play a critical role in the deliberative process that underlies learning but are not necessary for the expression of routine movements. Our approach predicts that after pallidotomy or during stimulation, patients should have difficulty with complex decision-making processes or learning new goal-oriented behaviors. © 2016 Movement Disorder Society.
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Affiliation(s)
- Camille Piron
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France.,CNRS, French-Israeli Neuroscience Lab, Bordeaux, France
| | - Daisuke Kase
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France.,CNRS, French-Israeli Neuroscience Lab, Bordeaux, France
| | - Meropi Topalidou
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France.,INRIA, Bordeaux Sud-Ouest, Talence, France.,University of Bordeaux, UMR 5800, LABRI, IPB, Talence, France.,CNRS, UMR 5800, LABRI, IPB, Talence, France
| | - Michel Goillandeau
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France
| | - Hugues Orignac
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France
| | - Tho-Haï N'Guyen
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France
| | - Nicolas Rougier
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France.,INRIA, Bordeaux Sud-Ouest, Talence, France.,University of Bordeaux, UMR 5800, LABRI, IPB, Talence, France.,CNRS, UMR 5800, LABRI, IPB, Talence, France
| | - Thomas Boraud
- University of Bordeaux, UMR 5293, IMN, Bordeaux, France.,CNRS, UMR 5293, IMN, Bordeaux, France.,CNRS, French-Israeli Neuroscience Lab, Bordeaux, France.,CHU de Bordeaux, IMN Clinique, Bordeaux, France
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Subthalamic nucleus deep brain stimulation induces impulsive action when patients with Parkinson's disease act under speed pressure. Exp Brain Res 2016; 234:1837-1848. [PMID: 26892884 PMCID: PMC4893074 DOI: 10.1007/s00221-016-4577-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 01/28/2016] [Indexed: 12/19/2022]
Abstract
The subthalamic nucleus (STN) is proposed to modulate response thresholds and speed–accuracy trade-offs. In situations of conflict, the STN is considered to raise response thresholds, allowing time for the accumulation of information to occur before a response is selected. Conversely, speed pressure is thought to reduce the activity of the STN and lower response thresholds, resulting in fast, errorful responses. In Parkinson’s disease (PD), subthalamic nucleus deep brain stimulation (STN-DBS) reduces the activity of the nucleus and improves motor symptoms. We predicted that the combined effects of STN stimulation and speed pressure would lower STN activity and lead to fast, errorful responses, hence resulting in impulsive action. We used the motion discrimination ‘moving-dots’ task to assess speed–accuracy trade-offs, under both speed and accuracy instructions. We assessed 12 patients with PD and bilateral STN-DBS and 12 age-matched healthy controls. Participants completed the task twice, and the patients completed it once with STN-DBS on and once with STN-DBS off, with order counterbalanced. We found that STN stimulation was associated with significantly faster reaction times but more errors under speed instructions. Application of the drift diffusion model showed that stimulation resulted in lower response thresholds when acting under speed pressure. These findings support the involvement of the STN in the modulation of speed–accuracy trade-offs and establish for the first time that speed pressure alone, even in the absence of conflict, can result in STN stimulation inducing impulsive action in PD.
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Georgiev D, Dirnberger G, Wilkinson L, Limousin P, Jahanshahi M. In Parkinson's disease on a probabilistic Go/NoGo task deep brain stimulation of the subthalamic nucleus only interferes with withholding of the most prepotent responses. Exp Brain Res 2016; 234:1133-43. [PMID: 26758720 PMCID: PMC4785203 DOI: 10.1007/s00221-015-4531-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 12/12/2015] [Indexed: 01/31/2023]
Abstract
The evidence on the impact of subthalamic nucleus deep brain stimulation (STN-DBS) on action restraint on Go/NoGO reaction time (RT) tasks in Parkinson’s disease (PD) is inconsistent; with some studies reporting no effect and others finding that STN stimulation interferes with withholding of responses and results in more commission errors relative to STN-DBS off. We used a task in which the probability of Go stimuli varied from 100 % (simple RT task) to 80, 50 and 20 % (probabilistic Go/NoGo RT task), thus altering the prepotency of the response and the difficulty in withholding it on NoGo trials. Twenty PD patients with STN-DBS, ten unoperated PD patients and ten healthy controls participated in the study. All participants were tested twice; the order of on versus off stimulation for STN-DBS PD patients was counterbalanced. Both STN-DBS and unoperated PD patients were tested on medication. The results indicated that STN-DBS selectively decreased discriminability when the response was most prepotent (high—80 %, as compared to low Go probability trials—50 and 20 %). Movement times were faster with STN stimulation than with DBS off across different Go probability levels. There was neither an overall nor a selective effect of STN-DBS on RTs depending on the level of Go probability. Furthermore, compared to healthy controls, both STN-DBS and unoperated PD patients were more prone to making anticipatory errors; which was not influenced by STN stimulation. The results provide evidence for ‘load-dependent’ effects of STN stimulation on action restraint as a function of the prepotency of the Go response.
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Affiliation(s)
- Dejan Georgiev
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, 33 Queen Square, London, WC1N 3BG, UK
| | - Georg Dirnberger
- Department of Clinical Neuroscience, Danube University, Dr.-Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Leonora Wilkinson
- Behavioural Neurology Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Centre Dr., MSC 1440, Bethesda, MD, 20892-1440, USA
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, 33 Queen Square, London, WC1N 3BG, UK
| | - Marjan Jahanshahi
- Sobell Department of Motor Neuroscience and Movement Disorders, UCL Institute of Neurology, 33 Queen Square, London, WC1N 3BG, UK.
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122
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Houeto JL, Magnard R, Dalley JW, Belin D, Carnicella S. Trait Impulsivity and Anhedonia: Two Gateways for the Development of Impulse Control Disorders in Parkinson's Disease? Front Psychiatry 2016; 7:91. [PMID: 27303314 PMCID: PMC4884740 DOI: 10.3389/fpsyt.2016.00091] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 05/17/2016] [Indexed: 12/03/2022] Open
Abstract
Apathy and impulsivity are two major comorbid syndromes of Parkinson's disease (PD) that may represent two extremes of a behavioral spectrum modulated by dopamine-dependent processes. PD is characterized by a progressive loss of dopaminergic neurons in the substantia nigra pars compacta to which are attributed the cardinal motor symptoms of the disorder. Dopamine replacement therapy (DRT), used widely to treat these motor symptoms, is often associated with deficits in hedonic processing and motivation, including apathy and depression, as well as impulse control disorders (ICDs). ICDs comprise pathological gambling, hypersexuality, compulsive shopping, binge eating, compulsive overuse of dopaminergic medication, and punding. More frequently observed in males with early onset PD, ICDs are associated not only with comorbid affective symptoms, such as depression and anxiety, but also with behavioral traits, such as novelty seeking and impulsivity, as well as with personal or familial history of alcohol use. This constellation of associated risk factors highlights the importance of inter-individual differences in the vulnerability to develop comorbid psychiatric disorders in PD patients. Additionally, withdrawal from DRT in patients with ICDs frequently unmasks a severe apathetic state, suggesting that apathy and ICDs may be caused by overlapping neurobiological mechanisms within the cortico-striato-thalamo-cortical networks. We suggest that altered hedonic and impulse control processes represent distinct prodromal substrates for the development of these psychiatric symptoms, the etiopathogenic mechanisms of which remain unknown. Specifically, we argue that deficits in hedonic and motivational states and impulse control are mediated by overlapping, yet dissociable, neural mechanisms that differentially interact with DRT to promote the emergence of ICDs in vulnerable individuals. Thus, we provide a novel heuristic framework for basic and clinical research to better define and treat comorbid ICDs in PD.
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Affiliation(s)
- Jean-Luc Houeto
- Service de Neurologie, CIC-INSERM 1402, CHU de Poitiers, Université de Poitiers , Poitiers , France
| | - Robin Magnard
- INSERM U1216, Grenoble Institut des Neurosciences (GIN), University Grenoble Alpes , Grenoble , France
| | - Jeffrey W Dalley
- Department of Psychology, University of Cambridge, Cambridge, UK; Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - David Belin
- Department of Pharmacology, University of Cambridge , Cambridge , UK
| | - Sebastien Carnicella
- INSERM U1216, Grenoble Institut des Neurosciences (GIN), University Grenoble Alpes , Grenoble , France
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123
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Albares M, Lio G, Boulinguez P. Tracking markers of response inhibition in electroencephalographic data: why should we and how can we go beyond the N2 component? Rev Neurosci 2015; 26:461-78. [PMID: 25915079 DOI: 10.1515/revneuro-2014-0078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 03/08/2015] [Indexed: 11/15/2022]
Abstract
Response inhibition is a pivotal component of executive control, which is especially difficult to assess. Indeed, it is a substantial challenge to gauge brain-behavior relationships because this function is precisely intended to suppress overt measurable behaviors. A further complication is that no single neuroimaging method has been found that can disentangle the accurate time-course of concurrent excitatory and inhibitory mechanisms. Here, we argue that this objective can be achieved with electroencephalography (EEG) on some conditions. Based on a systematic review, we emphasize that the standard event-related potential N2 (N200) is not an appropriate marker of prepotent response inhibition. We provide guidelines for assessing the cortical brain dynamics of response inhibition with EEG. This includes the combined use of inseparable data processing steps (source separation, source localization, and single-trial and time-frequency analyses) as well as the amendment of the classical experimental designs to enable the recording of different kinds of electrophysiological activity predicted by different models of response inhibition. We conclude with an illustration based on recent findings of how fruitful this approach can be.
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124
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A fronto–striato–subthalamic–pallidal network for goal-directed and habitual inhibition. Nat Rev Neurosci 2015; 16:719-32. [DOI: 10.1038/nrn4038] [Citation(s) in RCA: 352] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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125
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Cognition and Depression Following Deep Brain Stimulation of the Subthalamic Nucleus and Globus Pallidus Pars Internus in Parkinson’s Disease: A Meta-Analysis. Neuropsychol Rev 2015; 25:439-54. [DOI: 10.1007/s11065-015-9302-0] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 10/05/2015] [Indexed: 01/19/2023]
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126
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Subthalamic nucleus activity in the awake hemiparkinsonian rat: relationships with motor and cognitive networks. J Neurosci 2015; 35:6918-30. [PMID: 25926466 DOI: 10.1523/jneurosci.0587-15.2015] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Oscillatory activity in both beta and gamma ranges has been recorded in the subthalamic nucleus (STN) of Parkinson's disease (PD) patients and linked to motor function, with beta activity considered antikinetic, and gamma activity, prokinetic. However, the extent to which nonmotor networks contribute to this activity is unclear. This study uses hemiparkinsonian rats performing a treadmill walking task to compare synchronized STN local field potential (LFP) activity with activity in motor cortex (MCx) and medial prefrontal cortex (mPFC), areas involved in motor and cognitive processes, respectively. Data show increases in STN and MCx 29-36 Hz LFP spectral power and coherence after dopamine depletion, which are reduced by apomorphine and levodopa treatments. In contrast, recordings from mPFC 3 weeks after dopamine depletion failed to show peaks in 29-36 Hz LFP power. However, mPFC and STN both showed peaks in the 45-55 Hz frequency range in LFP power and coherence during walking before and 21 days after dopamine depletion. Interestingly, power in this low gamma range was transiently reduced in both mPFC and STN after dopamine depletion but recovered by day 21. In contrast to the 45-55 Hz activity, the amplitude of the exaggerated 29-36 Hz rhythm in the STN was modulated by paw movement. Furthermore, as in PD patients, after dopamine treatment a third band (high gamma) emerged in the lesioned hemisphere. The results suggest that STN integrates activity from both motor and cognitive networks in a manner that varies with frequency, behavioral state, and the integrity of the dopamine system.
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127
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Hu S, Ide JS, Zhang S, Li CSR. Anticipating conflict: Neural correlates of a Bayesian belief and its motor consequence. Neuroimage 2015; 119:286-95. [PMID: 26095091 DOI: 10.1016/j.neuroimage.2015.06.032] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/02/2015] [Accepted: 06/10/2015] [Indexed: 02/05/2023] Open
Abstract
Previous studies have examined the neural correlates of proactive control using a variety of behavioral paradigms; however, the neural network relating the control process to its behavioral consequence remains unclear. Here, we applied a dynamic Bayesian model to a large fMRI data set of the stop signal task to address this issue. By estimating the probability of the stop signal - p(Stop) - trial by trial, we showed that higher p(Stop) is associated with prolonged go trial reaction time (RT), indicating proactive control of motor response. In modeling fMRI signals at trial and target onsets, we distinguished activities of proactive control, prediction error, and RT slowing. We showed that the anterior pre-supplementary motor area (pre-SMA) responds specifically to increased stop signal likelihood, and its activity is correlated with activations of the posterior pre-SMA and bilateral anterior insula during prolonged response times. This directional link is also supported by Granger causality analysis. Furthermore, proactive control, prediction error, and time-on-task are each mapped to distinct areas in the medial prefrontal cortex. Together, these findings dissect regional functions of the medial prefrontal cortex in cognitive control and provide system level evidence associating conflict anticipation with its motor consequence.
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Affiliation(s)
- Sien Hu
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA.
| | - Jaime S Ide
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Sheng Zhang
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA
| | - Chiang-Shan R Li
- Department of Psychiatry, Yale University, New Haven, CT 06519, USA; Department of Neurobiology, Yale University, New Haven, CT 06520, USA; Interdepartmental Neuroscience Program, Yale University, New Haven, CT 06520, USA.
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128
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Hughes LE, Rittman T, Regenthal R, Robbins TW, Rowe JB. Improving response inhibition systems in frontotemporal dementia with citalopram. Brain 2015; 138:1961-75. [PMID: 26001387 PMCID: PMC5412666 DOI: 10.1093/brain/awv133] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 03/18/2015] [Indexed: 01/16/2023] Open
Abstract
Disinhibition is a cardinal feature of the behavioural variant of frontotemporal dementia, presenting as impulsive and impetuous behaviours that are often difficult to manage. The options for symptomatic treatments are limited, but a potential target for therapy is the restoration of serotonergic function, which is both deficient in behavioural variant frontotemporal dementia and closely associated with inhibitory control. Based on preclinical studies and psychopharmacological interventions in other disorders, we predicted that inhibition would be associated with the right inferior frontal gyrus and dependent on serotonin. Using magnetoencephalography and electroencephalography of a Go-NoGo paradigm, we investigated the neural basis of behavioural disinhibition in behavioural variant frontotemporal dementia and the effect of selective serotonin reuptake inhibition on the neural systems for response inhibition. In a randomized double-blinded placebo-controlled crossover design study, 12 patients received either a single 30 mg dose of citalopram or placebo. Twenty age-matched healthy controls underwent the same magnetoencephalography/electroencephalography protocol on one session without citalopram, providing normative data for this task. In the control group, successful NoGo trials evoked two established indices of successful response inhibition: the NoGo-N2 and NoGo-P3. Both of these components were significantly attenuated by behavioural variant frontotemporal dementia. Cortical sources associated with successful inhibition in control subjects were identified in the right inferior frontal gyrus and anterior temporal lobe, which have been strongly associated with behavioural inhibition in imaging and lesion studies. These sources were impaired by behavioural variant frontotemporal dementia. Critically, citalopram enhanced the NoGo-P3 signal in patients, relative to placebo treatment, and increased the evoked response in the right inferior frontal gyrus. Voxel-based morphometry confirmed significant atrophy of inferior frontal gyrus, alongside insular, orbitofrontal and temporal cortex in our patient cohort. Together, these data suggest that the dysfunctional prefrontal cortical systems underlying response inhibition deficits in behavioural variant frontotemporal dementia can be partially restored by increasing serotonergic neurotransmission. The results support a translational neuroscience approach to impulsive neurological disorders and indicate the potential for symptomatic treatment of behavioural variant frontotemporal dementia including serotonergic strategies to improve disinhibition.media-1vid110.1093/brain/awv133_video_abstractawv133_video_abstract.
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Affiliation(s)
- Laura E Hughes
- 1 Department of Clinical Neurosciences, University of Cambridge, UK 2 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK
| | - Timothy Rittman
- 1 Department of Clinical Neurosciences, University of Cambridge, UK
| | - Ralf Regenthal
- 3 Division of Clinical Pharmacology, Department of Pharmacology and Toxicology, University of Leipzig, Germany
| | - Trevor W Robbins
- 4 Department of Psychology, University of Cambridge, Cambridge, UK 5 Behavioural and Clinical Neuroscience Institute, Cambridge, UK
| | - James B Rowe
- 1 Department of Clinical Neurosciences, University of Cambridge, UK 2 Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK 5 Behavioural and Clinical Neuroscience Institute, Cambridge, UK
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129
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Merkl A, Neumann WJ, Huebl J, Aust S, Horn A, Krauss JK, Dziobek I, Kuhn J, Schneider GH, Bajbouj M, Kühn AA. Modulation of Beta-Band Activity in the Subgenual Anterior Cingulate Cortex during Emotional Empathy in Treatment-Resistant Depression. Cereb Cortex 2015; 26:2626-38. [PMID: 25994959 DOI: 10.1093/cercor/bhv100] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Deep brain stimulation (DBS) is a promising approach in treatment-resistant depression (TRD). TRD is associated with problems in interpersonal relationships, which might be linked to impaired empathy. Here, we investigate the influence of DBS in the subgenual anterior cingulate cortex (sgACC) on empathy in patients with TRD and explore the pattern of oscillatory sgACC activity during performance of the multifaceted empathy test. We recorded local field potential activity directly from sgACC via DBS electrodes in patients. Based on previous behavioral findings, we expected disrupted empathy networks. Patients showed increased empathic involvement ratings toward negative stimuli as compared with healthy subjects that were significantly reduced after 6 months of DBS. Stimulus-related oscillatory activity pattern revealed a broad desynchronization in the beta (14-35 Hz) band that was significantly larger during patients' reported emotional empathy for negative stimuli than when patients reported to have no empathy. Beta desynchronization for empathic involvement correlated with self-reported severity of depression. Our results indicate a "negativity bias" in patients that can be reduced by DBS. Moreover, direct recordings show activation of the sgACC area during emotional processing and propose that changes in beta-band oscillatory activity in the sgACC might index empathic involvement of negative emotion in TRD.
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Affiliation(s)
- Angela Merkl
- Department of Neurology Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | | | | | - Sabine Aust
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | | | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Germany
| | | | - Jens Kuhn
- Centre of Psychiatry, Medical School Cologne, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité, University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Malek Bajbouj
- Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin
| | - Andrea A Kühn
- Department of Neurology Berlin School of Mind and Brain NeuroCure, Charité, University Medicine Berlin, Berlin, Germany
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130
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In Parkinson's disease pallidal deep brain stimulation speeds up response initiation but has no effect on reactive inhibition. J Neurol 2015; 262:1741-50. [PMID: 25963101 DOI: 10.1007/s00415-015-7768-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 04/16/2015] [Accepted: 04/17/2015] [Indexed: 12/27/2022]
Abstract
The fronto-striatal circuits are considered to mediate inhibitory control over action. The aim of this study was to investigate the contribution of the internal segment of the pallidum (GPi), one of the final output pathways from the basal ganglia to the cortex, in inhibition. We examined the effect of deep brain stimulation (DBS) of the GPi (GPi-DBS) in patients with Parkinson's disease who performed a conditional stop signal task, with DBS on and off. Modulation of GPi activity was associated with significantly faster Go reaction times with DBS on than off, but stop signal reaction times were not altered. Application of the drift diffusion model indicated that GPi-DBS was associated with significantly lower response thresholds compared to GPi-DBS off. However, the drift rate was significantly lower than healthy controls with both GPi-DBS on and off. These results suggest that the GPi plays a crucial role in the 'Go' pathway, perhaps facilitating reaching the required threshold to initiate actions. However, GPi-DBS does not alter the functioning of the indirect 'NoGo' pathway, and other basal ganglia nuclei, such as the STN, may play a greater role in reactive response inhibition and conflict resolution.
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131
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Zimnik AJ, Nora GJ, Desmurget M, Turner RS. Movement-related discharge in the macaque globus pallidus during high-frequency stimulation of the subthalamic nucleus. J Neurosci 2015; 35:3978-89. [PMID: 25740526 PMCID: PMC4348192 DOI: 10.1523/jneurosci.4899-14.2015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/21/2015] [Accepted: 01/23/2015] [Indexed: 12/21/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN-DBS) has largely replaced ablative therapies for Parkinson's disease. Because of the similar efficacies of the two treatments, it has been proposed that DBS acts by creating an "informational lesion," whereby pathologic neuronal firing patterns are replaced by low-entropy, stimulus-entrained firing patterns. The informational lesion hypothesis, in its current form, states that DBS blocks the transmission of all information from the basal ganglia, including both pathologic firing patterns and normal, task-related modulations in activity. We tested this prediction in two healthy rhesus macaques by recording single-unit spiking activity from the globus pallidus (232 neurons) while the animals completed choice reaction time reaching movements with and without STN-DBS. Despite strong effects of DBS on the activity of most pallidal cells, reach-related modulations in firing rate were equally prevalent in the DBS-on and DBS-off states. This remained true even when the analysis was restricted to cells affected significantly by DBS. In addition, the overall form and timing of perimovement modulations in firing rate were preserved between DBS-on and DBS-off states in the majority of neurons (66%). Active movement and DBS had largely additive effects on the firing rate of most neurons, indicating an orthogonal relationship in which both inputs contribute independently to the overall firing rate of pallidal neurons. These findings suggest that STN-DBS does not act as an indiscriminate informational lesion but rather as a filter that permits task-related modulations in activity while, presumably, eliminating the pathological firing associated with parkinsonism.
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Affiliation(s)
- Andrew J Zimnik
- Department of Neurobiology, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, and
| | - Gerald J Nora
- Department of Neurobiology, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, and
| | - Michel Desmurget
- Centre for Cognitive Neuroscience, UMR5229, CNRS, 67 Boulevard Pinel 69500 Bron, France
| | - Robert S Turner
- Department of Neurobiology, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, and
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