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Guo S, Li J, Zhang Y, Li Y, Zhuang P. Optimal target localisation and eight-year outcome for subthalamic stimulation in patients with Parkinson's disease. Br J Neurosurg 2020; 35:151-156. [PMID: 32532160 DOI: 10.1080/02688697.2020.1775786] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a useful therapy to improve motor functions and reduce dependence on medication in patients with Parkinson's disease (PD). The purpose of the study is to assess the long-term clinical outcomes of STN-DBS and to determine the optimal placement of electrodes that for the most positive outcomes. METHODS A consecutive series of 42 PD patients were evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS) before and after STN-DBS lead implantation. Postoperatively, patients were evaluated during both the medication 'ON' period (medication suppressed symptoms) and the medication 'OFF' period (when medication failed to suppress symptoms), and the results were compared to the baseline values prior to surgery. Follow-up assessments, focusing on motor functions, were performed 1, 3, 5, and 8 years after the initial implantation surgery. The locations of electrodes were measured and compared against the clinical outcomes. RESULTS STN-DBS remarkably improved the UPDRS-II, -III, and -IV dyskinesia and motor fluctuation scores in the OFF-medication condition when compared to baseline values. In addition, the dose of levodopa needed to elicit an effect declined sharply in the OFF-medication condition. Over time, the axial signs progressively worsened even with continuous stimulation and a levodopa response. The location of electrodes correlated with the most beneficial outcomes was the dorsal STN margin. CONCLUSIONS Our results confirm that overall, stimulation-induced motor improvement is still evident after 8 years. However, the primary best outcome declines with the progressive loss of favourable axial signs.
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Affiliation(s)
- Song Guo
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Jianyu Li
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yuqing Zhang
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Yongjie Li
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
| | - Ping Zhuang
- Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China
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202
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Ozturk M, Telkes I, Jimenez-Shahed J, Viswanathan A, Tarakad A, Kumar S, Sheth SA, Ince NF. Randomized, Double-Blind Assessment of LFP Versus SUA Guidance in STN-DBS Lead Implantation: A Pilot Study. Front Neurosci 2020; 14:611. [PMID: 32655356 PMCID: PMC7325925 DOI: 10.3389/fnins.2020.00611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/18/2020] [Indexed: 11/13/2022] Open
Abstract
Background: The efficacy of deep brain stimulation (DBS) therapy in Parkinson's disease (PD) patients is highly dependent on the precise localization of the target structures such as subthalamic nucleus (STN). Most commonly, microelectrode single unit activity (SUA) recordings are performed to refine the target. This process is heavily experience based and can be technically challenging. Local field potentials (LFPs), representing the activity of a population of neurons, can be obtained from the same microelectrodes used for SUA recordings and allow flexible online processing with less computational complexity due to lower sampling rate requirements. Although LFPs have been shown to contain biomarkers capable of predicting patients' symptoms and differentiating various structures, their use in the localization of the STN in the clinical practice is not prevalent. Methods: Here we present, for the first time, a randomized and double-blinded pilot study with intraoperative online LFP processing in which we compare the clinical benefit from SUA- versus LFP-based implantation. Ten PD patients referred for bilateral STN-DBS were randomly implanted using either SUA or LFP guided targeting in each hemisphere. Although both SUA and LFP were recorded for each STN, the electrophysiologist was blinded to one at a time. Three months postoperatively, the patients were evaluated by a neurologist blinded to the intraoperative recordings to assess the performance of each modality. While SUA-based decisions relied on the visual and auditory inspection of the raw traces, LFP-based decisions were given through an online signal processing and machine learning pipeline. Results: We found a dramatic agreement between LFP- and SUA-based localization (16/20 STNs) providing adequate clinical improvement (51.8% decrease in 3-month contralateral motor assessment scores), with LFP-guided implantation resulting in greater average improvement in the discordant cases (74.9%, n = 3 STNs). The selected tracks were characterized by higher activity in beta (11-32 Hz) and high-frequency (200-400 Hz) bands (p < 0.01) of LFPs and stronger non-linear coupling between these bands (p < 0.05). Conclusion: Our pilot study shows equal or better clinical benefit with LFP-based targeting. Given the robustness of the electrode interface and lower computational cost, more centers can utilize LFP as a strategic feedback modality intraoperatively, in conjunction to the SUA-guided targeting.
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Affiliation(s)
- Musa Ozturk
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
| | - Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Joohi Jimenez-Shahed
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Ashwin Viswanathan
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Arjun Tarakad
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Suneel Kumar
- Department of Neurology, Baylor College of Medicine, Houston, TX, United States
| | - Sameer A. Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, United States
| | - Nuri F. Ince
- Department of Biomedical Engineering, University of Houston, Houston, TX, United States
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203
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Kahan J, Mancini L, Flandin G, White M, Papadaki A, Thornton J, Yousry T, Zrinzo L, Hariz M, Limousin P, Friston K, Foltynie T. Deep brain stimulation has state-dependent effects on motor connectivity in Parkinson's disease. Brain 2020; 142:2417-2431. [PMID: 31219504 DOI: 10.1093/brain/awz164] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/12/2019] [Accepted: 04/18/2019] [Indexed: 12/17/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation is an effective treatment for advanced Parkinson's disease; however, its therapeutic mechanism is unclear. Previous modelling of functional MRI data has suggested that deep brain stimulation has modulatory effects on a number of basal ganglia pathways. This work uses an enhanced data collection protocol to collect rare functional MRI data in patients with subthalamic nucleus deep brain stimulation. Eleven patients with Parkinson's disease and subthalamic nucleus deep brain stimulation underwent functional MRI at rest and during a movement task; once with active deep brain stimulation, and once with deep brain stimulation switched off. Dynamic causal modelling and Bayesian model selection were first used to compare a series of plausible biophysical models of the cortico-basal ganglia circuit that could explain the functional MRI activity at rest in an attempt to reproduce and extend the findings from our previous work. General linear modelling of the movement task functional MRI data revealed deep brain stimulation-associated signal increases in the primary motor and cerebellar cortices. Given the significance of the cerebellum in voluntary movement, we then built a more complete model of the motor system by including cerebellar-basal ganglia interactions, and compared the modulatory effects deep brain stimulation had on different circuit components during the movement task and again using the resting state data. Consistent with previous results from our independent cohort, model comparison found that the rest data were best explained by deep brain stimulation-induced increased (effective) connectivity of the cortico-striatal, thalamo-cortical and direct pathway and reduced coupling of subthalamic nucleus afferent and efferent connections. No changes in cerebellar connectivity were identified at rest. In contrast, during the movement task, there was functional recruitment of subcortical-cerebellar pathways, which were additionally modulated by deep brain stimulation, as well as modulation of local (intrinsic) cortical and cerebellar circuits. This work provides in vivo evidence for the modulatory effects of subthalamic nucleus deep brain stimulation on effective connectivity within the cortico-basal ganglia loops at rest, as well as further modulations in the cortico-cerebellar motor system during voluntary movement. We propose that deep brain stimulation has both behaviour-independent effects on basal ganglia connectivity, as well as behaviour-dependent modulatory effects.
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Affiliation(s)
- Joshua Kahan
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Guillaume Flandin
- The Wellcome Centre for Human Neuroimaging, UCL, London, WC1N 3AR, UK
| | - Mark White
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Anastasia Papadaki
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - John Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, UK.,Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Ludvic Zrinzo
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Marwan Hariz
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Patricia Limousin
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
| | - Karl Friston
- The Wellcome Centre for Human Neuroimaging, UCL, London, WC1N 3AR, UK
| | - Tom Foltynie
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, WC1N 3BG, UK
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204
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Optimal open-loop desynchronization of neural oscillator populations. J Math Biol 2020; 81:25-64. [PMID: 32418056 DOI: 10.1007/s00285-020-01501-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/28/2020] [Indexed: 10/24/2022]
Abstract
Deep brain stimulation (DBS) is an increasingly used medical treatment for various neurological disorders. While its mechanisms are not fully understood, experimental evidence suggests that through application of periodic electrical stimulation DBS may act to desynchronize pathologically synchronized populations of neurons resulting desirable changes to a larger brain circuit. However, the underlying mathematical mechanisms by which periodic stimulation can engender desynchronization in a coupled population of neurons is not well understood. In this work, a reduced phase-amplitude reduction framework is used to characterize the desynchronizing influence of periodic stimulation on a population of coupled oscillators. Subsequently, optimal control theory allows for the design of periodic, open-loop stimuli with the capacity to destabilize completely synchronized solutions while simultaneously stabilizing rotating block solutions. This framework exploits system nonlinearities in order to strategically modify unstable Floquet exponents. In the limit of weak neural coupling, it is shown that this method only requires information about the phase response curves of the individual neurons. The effects of noise and heterogeneity are also considered and numerical results are presented. This framework could ultimately be used to inform the design of more efficient deep brain stimulation waveforms for the treatment of neurological disease.
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205
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Milosevic L, Scherer M, Cebi I, Guggenberger R, Machetanz K, Naros G, Weiss D, Gharabaghi A. Online Mapping With the Deep Brain Stimulation Lead: A Novel Targeting Tool in Parkinson's Disease. Mov Disord 2020; 35:1574-1586. [PMID: 32424887 DOI: 10.1002/mds.28093] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Beta-frequency oscillations (13-30 Hz) are a subthalamic hallmark in patients with Parkinson's disease, and there is increased interest in their utility as an intraoperative marker. OBJECTIVES The objectives of this study were to assess whether beta activity measured directly from macrocontacts of deep brain stimulation leads could be used (a) as an intraoperative electrophysiological approach for guiding lead placements and (b) for physiologically informed stimulation delivery. METHODS Every millimeter along the surgical trajectory, local field-potential data were collected from each macrocontact, and power spectral densities were calculated and visualized (n = 39 patients). This was done for online intraoperative functional mapping and post hoc statistical analyses using 2 methods: generating distributions of spectral activity along surgical trajectories and direct delineation (presence versus lack) of beta peaks. In a subset of patients, this approach was corroborated by microelectrode recordings. Furthermore, the match rate between beta peaks at the final target position and the clinically determined best stimulation site were assessed. RESULTS Subthalamic recording sites were delineated by both methods of reconstructing functional topographies of spectral activity along surgical trajectories at the group level (P < 0.0001). Beta peaks were detected when any portion of the 1.5 mm macrocontact was within the microelectrode-defined subthalamic border. The highest beta peak at the final implantation site corresponded to the site of active stimulation in 73.3% of hemispheres (P < 0.0001). In 93.3% of hemispheres, active stimulation corresponded to the first-highest or second-highest beta peak. CONCLUSIONS Online measures of beta activity with the deep brain stimulation macroelectrode can be used to inform surgical lead placement and contribute to optimization of stimulation programming procedures. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Luka Milosevic
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
| | - Maximilian Scherer
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
| | - Idil Cebi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany.,Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Robert Guggenberger
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
| | - Kathrin Machetanz
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
| | - Georgios Naros
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
| | - Daniel Weiss
- Centre for Neurology, Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, University Tübingen, Tübingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Tübingen NeuroCampus, University of Tübingen, Tübingen, Germany
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206
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Al‐Ozzi TM, Botero-Posada LF, Lopez Rios AL, Hutchison WD. Single unit and beta oscillatory activities in subthalamic nucleus are modulated during visual choice preference. Eur J Neurosci 2020; 53:2220-2233. [DOI: 10.1111/ejn.14750] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/31/2020] [Accepted: 04/11/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Tameem M. Al‐Ozzi
- Department of Physiology University of Toronto Toronto ON Canada
- Department of Surgery University of Toronto Toronto ON Canada
- Krembil Research Institute Toronto ON Canada
| | - Luis F. Botero-Posada
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
| | - Adriana L. Lopez Rios
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
| | - William D. Hutchison
- Department of Physiology University of Toronto Toronto ON Canada
- Department of Surgery University of Toronto Toronto ON Canada
- Krembil Research Institute Toronto ON Canada
- Hospital Universitario y Centros Especializados de Saint Vicente Fundacion Rionegro/Medellin Colombia
- Division of Neurosurgery Toronto Western Hospital – University Health Network Toronto ON Canada
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207
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The Effects of Long-Term 40-Hz Physioacoustic Vibrations on Motor Impairments in Parkinson's Disease: A Double-Blinded Randomized Control Trial. Healthcare (Basel) 2020; 8:healthcare8020113. [PMID: 32353963 PMCID: PMC7349639 DOI: 10.3390/healthcare8020113] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/22/2020] [Accepted: 04/24/2020] [Indexed: 02/07/2023] Open
Abstract
Recent studies have suggested that vibration therapy may have a positive influence in treating motor symptoms of Parkinson’s disease (PD). However, quantitative evidence of the benefits of vibration utilized inconsistent methods of vibration delivery, and to date there have been no studies showing a long-term benefit of 40 Hz vibration in the PD population. The objective of this study was to demonstrate the efficacy of vibration administered via a physioacoustic therapy method (PAT) on motor symptoms of PD over a longer term, completed as a randomized placebo-controlled trial. Overall motor symptom severity measured by the Unified Parkinson’s Disease Rating Scale III showed significant improvements in the treatment group over 12 weeks. Specifically, all aspects of PD, including tremor, rigidity, bradykinesia, and posture and gait measures improved. To our knowledge, this is the first study to quantitatively assess 40-Hz vibration applied using the PAT method for potential long-term therapeutic effects on motor symptoms of PD.
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208
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Telkes I, Sabourin S, Durphy J, Adam O, Sukul V, Raviv N, Staudt MD, Pilitsis JG. Functional Use of Directional Local Field Potentials in the Subthalamic Nucleus Deep Brain Stimulation. Front Hum Neurosci 2020; 14:145. [PMID: 32410972 PMCID: PMC7198898 DOI: 10.3389/fnhum.2020.00145] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 03/30/2020] [Indexed: 11/13/2022] Open
Abstract
Background Directional deep brain stimulation (DBS) technology aims to address the limitations, such as stimulation-induced side effects, by delivering selective, focal modulation via segmented contacts. However, DBS programming becomes more complex and time-consuming for clinical feasibility. Local field potentials (LFPs) might serve a functional role in guiding clinical programming. Objective In this pilot study, we investigated the spectral dynamics of directional LFPs in subthalamic nucleus (STN) and their relationship to motor symptoms of Parkinson’s disease (PD). Methods We recorded intraoperative STN-LFPs from 8-contact leads (Infinity-6172, Abbott Laboratories, Illinois, United States) in 8 PD patients at rest. Directional LFPs were referenced to their common average and time-frequency analysis was computed using a modified Welch periodogram method. The beta band (13–35 Hz) features were extracted and their correlation to preoperative UPDRS-III scores were assessed. Results Normalized beta power (13–20 Hz) and normalized peak power (13–35 Hz) were found to be higher in anterior direction despite lack of statistical significance (p > 0.05). Results of the Spearman correlation analysis demonstrated positive trends with bradykinesia/rigidity in dorsoanterior direction (r = 0.659, p = 0.087) and with axial scores in the dorsomedial direction (r = 0.812, p = 0.072). Conclusion Given that testing all possible combinations of contact pairs and stimulation parameters is not feasible in a single clinic visit, spatio-spectral LFP dynamics obtained from intraoperative recordings might be used as an initial marker to select optimal contact(s).
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Affiliation(s)
- Ilknur Telkes
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Shelby Sabourin
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States
| | - Jennifer Durphy
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Octavian Adam
- Department of Neurology, Albany Medical Center, Albany, NY, United States
| | - Vishad Sukul
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Nataly Raviv
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Michael D Staudt
- Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
| | - Julie G Pilitsis
- Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany, NY, United States.,Department of Neurosurgery, Albany Medical Center, Albany, NY, United States
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209
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Abstract
PURPOSE OF REVIEW Deep brain stimulation (DBS) is an established but growing treatment option for multiple brain disorders. Over the last decade, electrode placement and their effects were increasingly analyzed with modern-day neuroimaging methods like spatial normalization, fibertracking, or resting-state functional MRI. Similarly, specialized basal ganglia MRI sequences were introduced and imaging at high field strengths has become increasingly popular. RECENT FINDINGS To facilitate the process of precise electrode localizations, specialized software pipelines were introduced. By those means, DBS targets could recently be refined and significant relationships between electrode placement and clinical improvement could be shown. Furthermore, by combining electrode reconstructions with network imaging methods, relationships between electrode connectivity and clinical improvement were investigated. This led to a broad series of imaging-based insights about DBS that are reviewed in the present work. SUMMARY The reviewed literature makes a strong case that brain imaging plays an increasingly important role in DBS targeting and programming. Furthermore, brain imaging will likely help to better understand the mechanism of action of DBS.
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210
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Hasegawa H, Fischer P, Tan H, Pogosyan A, Samuel M, Brown P, Ashkan K. The Effect of Unilateral Subthalamic Nucleus Deep Brain Stimulation on Contralateral Subthalamic Nucleus Local Field Potentials. Neuromodulation 2020; 23:509-514. [PMID: 32281215 DOI: 10.1111/ner.13155] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/05/2020] [Accepted: 03/10/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Unilateral subthalamic nucleus (STN) deep brain stimulation (DBS) for Parkinson's disease (PD) improves ipsilateral symptoms, but how this occurs is not well understood. We investigated whether unilateral STN DBS suppresses contralateral STN beta activity in the local field potential (LFP), since previous research has shown that activity in the beta band can correlate with the severity of contralateral clinical symptoms and is modulated by DBS. MATERIALS AND METHODS We recorded STN LFPs from 14 patients who underwent bilateral STN DBS for PD. Following a baseline recording, unilateral STN stimulation was delivered at therapeutic parameters while LFPs were recorded from the contralateral (unstimulated) STN. RESULTS Unilateral STN DBS suppressed contralateral beta power (p = 0.039, relative suppression = -5.7% ± [SD] 16% when averaging across the highest beta peak channels; p = 0.033, relative suppression = -5.2% ± 13% when averaging across all channels). Unilateral STN DBS produced a 17% ipsilateral (p = 0.016) and 29% contralateral (p = 0.002) improvement in upper limb hemi-body bradykinesia-rigidity (UPDRS-III, items 3.3-3.6). The ipsilateral clinical improvement and the change in contralateral beta power were not significantly correlated. CONCLUSIONS Unilateral STN DBS suppresses contralateral STN beta LFP. This indicates that unilateral STN DBS modulates bilateral basal ganglia networks. It remains unclear whether this mechanism accounts for the ipsilateral motor improvements.
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Affiliation(s)
- Harutomo Hasegawa
- Department of Neurosurgery, King's College Hospital, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Petra Fischer
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Michael Samuel
- Department of Neurosurgery, King's College Hospital, London, UK.,Department of Neurology, King's College Hospital, London, UK
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, UK.,Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College Hospital, London, UK.,Department of Neurology, King's College Hospital, London, UK
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211
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Zhu GY, Zhang RL, Chen YC, Liu YY, Liu DF, Wang SY, Jiang Y, Zhang JG. Characteristics of globus pallidus internus local field potentials in generalized dystonia patients with TWNK mutation. Clin Neurophysiol 2020; 131:1453-1461. [PMID: 32387964 DOI: 10.1016/j.clinph.2020.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/11/2019] [Accepted: 03/07/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE We focused on a rare gene mutation causing dystonia in two siblings who received globus pallidus internus deep brain stimulation (GPi-DBS). The aim was to characterize the relationship between neuronal activity patterns and clinical syndromes. METHODS Whole exome sequencing was applied to identify the TWNK (previous symbol C10orf2) mutation; Two siblings with TWNK mutation presented as generalized dystonia with rigidity and bradykinesia; four other sporadic generalized dystonia patients underwent GPi-DBS and local field potentials (LFPs) were recorded. Oscillatory activities were illustrated with power spectra and temporal dynamics measured by the Lempel-Ziv complexity (LZC). RESULTS Normalized power spectra of GPi LFPs differed between patients with TWNK mutation and dystonia over the low beta bands. Patients with TWNK mutation had higher low beta power (15-27 Hz, unpaired t-test, corrected P < 0.0022) and lower LZC (15-27 Hz, unpaired t-test, P < 0.01) than other patients with generalized dystonia. On the other hand, the TWNK mutation patients showed decreased low frequency and beta oscillation in the GPi after DBS, as well as improved movement performance. CONCLUSION The LFPs were different in TWNK mutation dystonia siblings than other patients with generalized dystonia, which indicate the abnormal LFPs were related to symptoms rather than specific disease. In addition, the inhibited effect on oscillations also provided a potential evidence for DBS treatment on rare movement disorders. SIGNIFICANCE This study could potentially aid in the future development of adaptive DBS via rare disease LFPs comparison.
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Affiliation(s)
- Guan-Yu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Rui-Li Zhang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Ying-Chuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yu-Ye Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - De-Feng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shou-Yan Wang
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence (Fudan University), Ministry of Education, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
| | - Jian-Guo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.
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Wilson D. Stabilization of Weakly Unstable Fixed Points as a Common Dynamical Mechanism of High-Frequency Electrical Stimulation. Sci Rep 2020; 10:5922. [PMID: 32246051 PMCID: PMC7125125 DOI: 10.1038/s41598-020-62839-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/19/2020] [Indexed: 11/09/2022] Open
Abstract
While high-frequency electrical stimulation often used to treat various biological diseases, it is generally difficult to understand its dynamical mechanisms of action. In this work, high-frequency electrical stimulation is considered in the context of neurological and cardiological systems. Despite inherent differences between these systems, results from both theory and computational modeling suggest identical dynamical mechanisms responsible for desirable qualitative changes in behavior in response to high-frequency stimuli. Specifically, desynchronization observed in a population of periodically firing neurons and reversible conduction block that occurs in cardiomyocytes both result from bifurcations engendered by stimulation that modifies the stability of unstable fixed points. Using a reduced order phase-amplitude modeling framework, this phenomenon is described in detail from a theoretical perspective. Results are consistent with and provide additional insight for previously published experimental observations. Also, it is found that sinusoidal input is energy-optimal for modifying the stability of weakly unstable fixed points using periodic stimulation.
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Affiliation(s)
- Dan Wilson
- Department of Electrical Engineering and Computer Science, University of Tennessee, Knoxville, TN, 37996, USA.
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213
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Belardinelli P, Azodi-Avval R, Ortiz E, Naros G, Grimm F, Weiss D, Gharabaghi A. Intraoperative localization of spatially and spectrally distinct resting-state networks in Parkinson's disease. J Neurosurg 2020; 132:1234-1242. [PMID: 30835693 DOI: 10.3171/2018.11.jns181684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for symptomatic Parkinson's disease (PD); the clinical benefit may not only mirror modulation of local STN activity but also reflect consecutive network effects on cortical oscillatory activity. Moreover, STN-DBS selectively suppresses spatially and spectrally distinct patterns of synchronous oscillatory activity within cortical-subcortical loops. These STN-cortical circuits have been described in PD patients using magnetoencephalography after surgery. This network information, however, is currently not available during surgery to inform the implantation strategy.The authors recorded spontaneous brain activity in 3 awake patients with PD (mean age 67 ± 14 years; mean disease duration 13 ± 7 years) during implantation of DBS electrodes into the STN after overnight withdrawal of dopaminergic medication. Intraoperative propofol was discontinued at least 30 minutes prior to the electrophysiological recordings. The authors used a novel approach for performing simultaneous recordings of STN local field potentials (LFPs) and multichannel electroencephalography (EEG) at rest. Coherent oscillations between LFP and EEG sensors were computed, and subsequent dynamic imaging of coherent sources was performed.The authors identified coherent activity in the upper beta range (21-35 Hz) between the STN and the ipsilateral mesial (pre)motor area. Coherence in the theta range (4-6 Hz) was detected in the ipsilateral prefrontal area.These findings demonstrate the feasibility of detecting frequency-specific and spatially distinct synchronization between the STN and cortex during DBS surgery. Mapping the STN with this technique may disentangle different functional loops relevant for refined targeting during DBS implantation.
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Affiliation(s)
- Paolo Belardinelli
- 1Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience
- 2Department of Neurology and Stroke, and Hertie Institute for Clinical Brain Research; and
| | - Ramin Azodi-Avval
- 1Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience
| | - Erick Ortiz
- 1Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience
| | - Georgios Naros
- 1Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience
| | - Florian Grimm
- 1Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience
| | - Daniel Weiss
- 3Department for Neurodegenerative Diseases, and Hertie Institute for Clinical Brain Research, and German Centre of Neurodegenerative Diseases (DZNE), Eberhard Karls University Tübingen, Germany
| | - Alireza Gharabaghi
- 1Division of Functional and Restorative Neurosurgery, and Centre for Integrative Neuroscience
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214
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Little S, Brown P. Debugging Adaptive Deep Brain Stimulation for Parkinson's Disease. Mov Disord 2020; 35:555-561. [PMID: 32039501 PMCID: PMC7166127 DOI: 10.1002/mds.27996] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 12/20/2022] Open
Abstract
Deep brain stimulation (DBS) is a successful treatment for patients with Parkinson's disease. In adaptive DBS, stimulation is titrated according to feedback about clinical state and underlying pathophysiology. This contrasts with conventional stimulation, which is fixed and continuous. In acute trials, adaptive stimulation matches the efficacy of conventional stimulation while delivering about half the electrical energy. The latter means potentially fewer side-effects. The next step is to determine the long-term efficacy, efficiency, and side-effect profile of adaptive stimulation, and chronic trials are currently being considered by the medical devices industry. However, there are several different approaches to adaptive DBS, and several possible limitations have been highlighted. Here we review the findings to date to ascertain how and who to stimulate in chronic trials designed to establish the long-term utility of adaptive DBS. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Simon Little
- Department of Movement Disorders and Neuromodulation, University of California San Francisco, San Francisco, California, USA
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit at the University of Oxford, Oxford, United Kingdom
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215
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Basal ganglia oscillations as biomarkers for targeting circuit dysfunction in Parkinson's disease. PROGRESS IN BRAIN RESEARCH 2020; 252:525-557. [PMID: 32247374 DOI: 10.1016/bs.pbr.2020.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Oscillations are a naturally occurring phenomenon in highly interconnected dynamical systems. However, it is thought that excessive synchronized oscillations in brain circuits can be detrimental for many brain functions by disrupting neuronal information processing. Because synchronized basal ganglia oscillations are a hallmark of Parkinson's disease (PD), it has been suggested that aberrant rhythmic activity associated with symptoms of the disease could be used as a physiological biomarker to guide pharmacological and electrical neuromodulatory interventions. We here briefly review the various manifestations of basal ganglia oscillations observed in human subjects and in animal models of PD. In this context, we also review the evidence supporting a pathophysiological role of different oscillations for the suppression of voluntary movements as well as for the induction of excessive motor activity. In light of these findings, it is discussed how oscillations could be used to guide a more precise targeting of dysfunctional circuits to obtain improved symptomatic treatment of PD.
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216
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Fleming JE, Dunn E, Lowery MM. Simulation of Closed-Loop Deep Brain Stimulation Control Schemes for Suppression of Pathological Beta Oscillations in Parkinson's Disease. Front Neurosci 2020; 14:166. [PMID: 32194372 PMCID: PMC7066305 DOI: 10.3389/fnins.2020.00166] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
This study presents a computational model of closed-loop control of deep brain stimulation (DBS) for Parkinson's disease (PD) to investigate clinically viable control schemes for suppressing pathological beta-band activity. Closed-loop DBS for PD has shown promising results in preliminary clinical studies and offers the potential to achieve better control of patient symptoms and side effects with lower power consumption than conventional open-loop DBS. However, extensive testing of algorithms in patients is difficult. The model presented provides a means to explore a range of control algorithms in silico and optimize control parameters before preclinical testing. The model incorporates (i) the extracellular DBS electric field, (ii) antidromic and orthodromic activation of STN afferent fibers, (iii) the LFP detected at non-stimulating contacts on the DBS electrode and (iv) temporal variation of network beta-band activity within the thalamo-cortico-basal ganglia loop. The performance of on-off and dual-threshold controllers for suppressing beta-band activity by modulating the DBS amplitude were first verified, showing levels of beta suppression and reductions in power consumption comparable with previous clinical studies. Proportional (P) and proportional-integral (PI) closed-loop controllers for amplitude and frequency modulation were then investigated. A simple tuning rule was derived for selecting effective PI controller parameters to target long duration beta bursts while respecting clinical constraints that limit the rate of change of stimulation parameters. Of the controllers tested, PI controllers displayed superior performance for regulating network beta-band activity whilst accounting for clinical considerations. Proportional controllers resulted in undesirable rapid fluctuations of the DBS parameters which may exceed clinically tolerable rate limits. Overall, the PI controller for modulating DBS frequency performed best, reducing the mean error by 83% compared to DBS off and the mean power consumed to 25% of that utilized by open-loop DBS. The network model presented captures sufficient physiological detail to act as a surrogate for preclinical testing of closed-loop DBS algorithms using a clinically accessible biomarker, providing a first step for deriving and testing novel, clinically suitable closed-loop DBS controllers.
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Affiliation(s)
- John E. Fleming
- Neuromuscular Systems Laboratory, UCD School of Electrical & Electronic Engineering, University College Dublin, Dublin, Ireland
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217
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Thevathasan W, Sinclair NC, Bulluss KJ, McDermott HJ. Tailoring Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease Using Evoked Resonant Neural Activity. Front Hum Neurosci 2020; 14:71. [PMID: 32180711 PMCID: PMC7059818 DOI: 10.3389/fnhum.2020.00071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/18/2020] [Indexed: 01/15/2023] Open
Affiliation(s)
- Wesley Thevathasan
- Bionics Institute, East Melbourne, VIC, Australia
- Department of Neurology, The Royal Melbourne and Austin Hospitals, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicholas C. Sinclair
- Bionics Institute, East Melbourne, VIC, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, VIC, Australia
| | - Kristian J. Bulluss
- Bionics Institute, East Melbourne, VIC, Australia
- Department of Neurosurgery, St Vincent's and Austin Hospitals, Melbourne, VIC, Australia
- Department of Surgery, The University of Melbourne, Melbourne, VIC, Australia
| | - Hugh J. McDermott
- Bionics Institute, East Melbourne, VIC, Australia
- Medical Bionics Department, The University of Melbourne, East Melbourne, VIC, Australia
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218
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Parkinsonian Beta Dynamics during Rest and Movement in the Dorsal Pallidum and Subthalamic Nucleus. J Neurosci 2020; 40:2859-2867. [PMID: 32107277 DOI: 10.1523/jneurosci.2113-19.2020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 11/21/2022] Open
Abstract
In Parkinson's disease (PD), pathologically high levels of beta activity (12-30 Hz) reflect specific symptomatology and normalize with pharmacological or surgical intervention. Although beta characterization in the subthalamic nucleus (STN) of PD patients undergoing deep brain stimulation (DBS) has now been translated into adaptive DBS paradigms, a limited number of studies have characterized beta power in the globus pallidus internus (GPi), an equally effective DBS target. Our objective was to compare beta power in the STN and GPi during rest and movement in people with PD undergoing DBS. Thirty-seven human female and male participants completed a simple behavioral experiment consisting of periods of rest and button presses, leading to local field potential recordings from 19 (15 participants) STN and 26 (22 participants) GPi nuclei. We examined overall beta power as well as beta time-domain dynamics (i.e., beta bursts). We found higher beta power during rest and movement in the GPi, which also had more beta desynchronization during movement. Beta power was positively associated with bradykinesia and rigidity severity; however, these clinical associations were present only in the GPi cohort. With regards to beta dynamics, bursts were similar in duration and frequency in the GPi and STN, but GPi bursts were stronger and correlated to bradykinesia-rigidity severity. Beta dynamics therefore differ across basal ganglia nuclei. Relative to the STN, beta power in the GPi may be readily detected, modulates more with movement, and relates more to clinical impairment. Together, this could point to the GPi as a potentially effective target for beta-based adaptive DBS.SIGNIFICANCE STATEMENT It is known that subthalamic nucleus (STN) beta activity is linked to symptom severity in Parkinson's disease (PD), but few studies have characterized beta activity in the globus pallidus internus (GPi), another effective target for deep brain stimulation (DBS). We compared beta power in the STN and GPi during rest and movement in 37 people with PD undergoing DBS. We found that beta dynamics differed across basal ganglia nuclei. Our results show that, relative to the STN, beta power in the GPi may be readily detected, modulates more with movement, and relates more to clinical impairment. Together, this could point to the GPi as a potentially effective target for beta-based adaptive DBS.
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219
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Abstract
Surgery in Parkinson disease is effective for a select group of patients when optimal medical management is not sufficient. Functional neurosurgery can be used as either a salvage therapy in patients with disabling symptoms or to maintain quality of life and independence before progression to severe disability in high-functioning patients. With recent technological advancements in imaging and targeting as well as novel neuromodulation paradigms, there are numerous options for targeted brain lesions and deep brain stimulation. Surgical decision making and postoperative management in Parkinson disease therefore often requires a multidisciplinary team effort with neurology, neurosurgery, neuropsychology, and psychiatry.
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Affiliation(s)
- Kyle T Mitchell
- Duke University Movement Disorders Center, DUMC 3333, 932 Morreene Road, Durham, NC 27705, USA.
| | - Jill L Ostrem
- UCSF Movement Disorders and Neuromodulation Center, 1635 Divisadero Street Suite 520, Box 1838, San Francisco, CA 94115, USA
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220
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Gault JM, Thompson JA, Maharajh K, Hosokawa P, Stevens KE, Olincy A, Liedtke EI, Ojemann A, Ojemann S, Abosch A. Striatal and Thalamic Auditory Response During Deep Brain Stimulation for Essential Tremor: Implications for Psychosis. Neuromodulation 2020; 23:478-488. [PMID: 32022409 DOI: 10.1111/ner.13101] [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: 05/15/2019] [Revised: 12/04/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The P50, a positive auditory-evoked potential occurring 50 msec after an auditory click, has been characterized extensively with electroencephalography (EEG) to detect aberrant auditory electrophysiology in disorders like schizophrenia (SZ) where 61-74% have an auditory gating deficit. The P50 response occurs in primary auditory cortex and several thalamocortical regions. In rodents, the gated P50 response has been identified in the reticular thalamic nucleus (RT)-a deep brain structure traversed during deep brain stimulation (DBS) targeting of the ventral intermediate nucleus (VIM) of the thalamus to treat essential tremor (ET) allowing for interspecies comparison. The goal was to utilize the unique opportunity provided by DBS surgery for ET to map the P50 response in multiple deep brain structures in order to determine the utility of intraoperative P50 detection for facilitating DBS targeting of auditory responsive subterritories. MATERIALS AND METHODS We developed a method to assess P50 response intraoperatively with local field potentials (LFP) using microelectrode recording during routine clinical electrophysiologic mapping for awake DBS surgery in seven ET patients. Recording sites were mapped into a common stereotactic space. RESULTS Forty significant P50 responses of 155 recordings mapped to the ventral thalamus, RT and CN head/body interface at similar rates of 22.7-26.7%. P50 response exhibited anatomic specificity based on distinct positions of centroids of positive and negative responses within brain regions and the fact that P50 response was not identified in the recordings from either the internal capsule or the dorsal thalamus. CONCLUSIONS Detection of P50 response intraoperatively may guide DBS targeting RT and subterritories within CN head/body interface-DBS targets with the potential to treat psychosis and shown to modulate schizophrenia-like aberrancies in mouse models.
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Affiliation(s)
- Judith M Gault
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Keeran Maharajh
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Patrick Hosokawa
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Karen E Stevens
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Ann Olincy
- Department of Psychiatry, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Erin I Liedtke
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Alex Ojemann
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Aviva Abosch
- Department of Neurosurgery, University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA.,Department of Neurology, University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
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221
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Darbin O, Hatanaka N, Takara S, Kaneko M, Chiken S, Naritoku D, Martino A, Nambu A. Local field potential dynamics in the primate cortex in relation to parkinsonism reveled by machine learning: A comparison between the primary motor cortex and the supplementary area. Neurosci Res 2020; 156:66-79. [PMID: 31991205 DOI: 10.1016/j.neures.2020.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 11/09/2019] [Accepted: 11/29/2019] [Indexed: 12/20/2022]
Abstract
The present study compares the cortical local field potentials (LFPs) in the primary motor cortex (M1) and the supplementary motor area (SMA) of non-human primates rendered Parkinsonian with administration of dopaminergic neurotoxin, 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine. The dynamic of the LFPs was investigated under several mathematical frameworks and machine learning was used to discriminate the recordings based on these features between healthy, parkinsonian with off-medication and parkinsonian with on-medication states. The importance of each feature in the discrimination process was further investigated. The dynamic of the LFPs in M1 and SMA was affected regarding its variability (time domain analysis), oscillatory activities (frequency domain analysis) and complex patterns (non-linear domain analysis). Machine learning algorithms achieved accuracy near 0.90 for comparisons between conditions. The TreeBagger algorithm provided best accuracy. The relative importance of these features differed with the cortical location, condition and treatment. Overall, the most important features included beta oscillation, fractal dimension, gamma oscillation, entropy and asymmetry of amplitude fluctuation. The importance of features in discriminating between normal and pathological states, and on- or off-medication states depends on the pair-comparison and it is region-specific. These findings are discussed regarding the refinement of current models for movement disorders and the development of on-demand therapies.
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Affiliation(s)
- Olivier Darbin
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan; Department of Neurology, University South Alabama, 307 University Blvd, Mobile, AL 36688, USA.
| | - Nobuhiko Hatanaka
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan; Department of Physiological Sciences, SOKENDAI (Graduate University for Advanced Studies), Okazaki, Aichi 444-8585, Japan
| | - Sayuki Takara
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan; Department of Physiological Sciences, SOKENDAI (Graduate University for Advanced Studies), Okazaki, Aichi 444-8585, Japan
| | - Masaya Kaneko
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan; Department of Physiological Sciences, SOKENDAI (Graduate University for Advanced Studies), Okazaki, Aichi 444-8585, Japan
| | - Satomi Chiken
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan; Department of Physiological Sciences, SOKENDAI (Graduate University for Advanced Studies), Okazaki, Aichi 444-8585, Japan
| | - Dean Naritoku
- Department of Neurology, University South Alabama, 307 University Blvd, Mobile, AL 36688, USA
| | - Anthony Martino
- Department of Neurosurgery, University South Alabama, 307 University Blvd., Mobile, AL 36688, USA
| | - Atsushi Nambu
- Division of System Neurophysiology, National Institute for Physiological Sciences, Okazaki, Aichi 444-8585, Japan; Department of Physiological Sciences, SOKENDAI (Graduate University for Advanced Studies), Okazaki, Aichi 444-8585, Japan
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Abstract
The clinical use of deep brain stimulation (DBS) is among the most important advances in the clinical neurosciences in the past two decades. As a surgical tool, DBS can directly measure pathological brain activity and can deliver adjustable stimulation for therapeutic effect in neurological and psychiatric disorders correlated with dysfunctional circuitry. The development of DBS has opened new opportunities to access and interrogate malfunctioning brain circuits and to test the therapeutic potential of regulating the output of these circuits in a broad range of disorders. Despite the success and rapid adoption of DBS, crucial questions remain, including which brain areas should be targeted and in which patients. This Review considers how DBS has facilitated advances in our understanding of how circuit malfunction can lead to brain disorders and outlines the key unmet challenges and future directions in the DBS field. Determining the next steps in DBS science will help to define the future role of this technology in the development of novel therapeutics for the most challenging disorders affecting the human brain.
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223
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Fleming JE, Lowery MM. Changes in Neuronal Entropy in a Network Model of the Cortico-Basal Ganglia during Deep Brain Stimulation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5172-5175. [PMID: 31947023 DOI: 10.1109/embc.2019.8857440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Neuronal entropy changes are observed in the basal ganglia circuit in Parkinson's disease (PD). These changes are observed in both single unit recordings from globus pallidus (GP) neurons and in local field potential (LFP) recordings from the subthalamic nucleus (STN). These changes are hypothesized as representing changes in the information coding capacity of the network, with PD resulting in a reduction in the coding capacity of the basal ganglia network. Entropy changes in the LFP and in single unit recordings are investigated in a detailed physiological model of the cortico-basal ganglia network during STN deep brain stimulation (DBS). The model incorporates extracellular stimulation of STN afferent fibers, with both orthodromic and antidromic activation, and simulation of the LFP detected at a differential recording electrode. LFP sample entropy and beta-band oscillation power were found to be altered following the application of DBS. The ring pattern entropy of GP neurons in the network were observed to decrease during high frequency stimulation and increase during low frequency stimulation. Simulation results were consistent with experimentally reported changes in neuronal entropy during DBS.
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224
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Toth R, Holt AB, Benjaber M, Sharott A, Denison T. Frequency and Phase Synchronization in Distributed (Implantable-Transcutaneous) Neural Interfaces. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3831-3834. [PMID: 31946709 DOI: 10.1109/embc.2019.8857895] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Synchronized oscillations are a ubiquitous feature of neuronal circuits and can modulate online information transfer and plasticity between brain areas. The disruption of these oscillatory processes is associated with the symptoms of several brain disorders. While conventional therapeutic high-frequency deep brain stimulation can perturb neuronal oscillations, manipulating the timing of oscillatory activity between areas more precisely could provide a more efficient and effective method of modulating these activities. Here we describe a prototype circuit for synchronizing the clocks between an active implantable and an external sensing and stimulation system that could be used to achieve this goal. Our specific focus is on synchronizing the systems for paired-associative stimulation. The ability to repetitively drive two brain regions with a fixed latency has specific implications for neural plasticity. Furthermore, the general concept can be applied for many potential applications involving distributed neural interfaces.
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225
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Schneider L, Seeger V, Timmermann L, Florin E. Electrophysiological resting state networks of predominantly akinetic-rigid Parkinson patients: Effects of dopamine therapy. NEUROIMAGE-CLINICAL 2020; 25:102147. [PMID: 31954989 PMCID: PMC6965744 DOI: 10.1016/j.nicl.2019.102147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/21/2019] [Accepted: 12/21/2019] [Indexed: 11/25/2022]
Abstract
Analysis of whole-brain frequency-specific resting state networks with EEG. Comparison of dopamine medication ON and OFF state in Parkinson patients. Parkinson patients show distinct frequency-specific network alterations. Motor network at beta frequencies is re-instated after dopamine medication.
Parkinson's disease (PD) causes both motor and non-motor symptoms, which can partially be reversed by dopamine therapy. These symptoms as well as the effect of dopamine may be explained by distinct alterations in whole-brain architecture. We used functional connectivity (FC) and in particular resting state network (RSN) analysis to identify such whole-brain alterations in a frequency-specific manner. In addition, we hypothesized that standard dopaminergic medication would have a normalizing effect on these whole brain alterations. We recorded resting-state EEGs of 19 PD patients in the medical OFF and ON states, and of 12 healthy age-matched controls. The PD patients were either of akinetic-rigid or mixed subtype. We extracted RSNs with independent component analysis in the source space for five frequency bands. Within the sensorimotor network (SMN) the supplementary motor area (SMA) showed decreased FC in the OFF state compared to healthy controls. This finding was reversed after dopamine administration. Furthermore, in the OFF state no stable SMN beta component could be identified. The default mode network showed alterations due to PD independent of the medication state. The visual network was altered in the OFF state, and reinstated to a pattern similar to healthy controls by medication. In conclusion, PD causes distinct RSN alterations, which are partly reversed after levodopa administration. The changes within the SMN are of particular interest, because they broaden the pathophysiological understanding of PD. Our results identify the SMA as a central network hub affected in PD and a crucial effector of dopamine therapy.
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Affiliation(s)
- Lukas Schneider
- Department of Neurology, University Hospital Cologne, Kerpener Strasse 62, 50937 Köln, Germany
| | - Valentin Seeger
- Department of Neurology, University Hospital Cologne, Kerpener Strasse 62, 50937 Köln, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Kerpener Strasse 62, 50937 Köln, Germany; Department of Neurology, University Hospital Marburg, Baldingerstrasse, 35043 Marburg, Germany
| | - Esther Florin
- Department of Neurology, University Hospital Cologne, Kerpener Strasse 62, 50937 Köln, Germany; Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Universitätsstr. 1, 40225 Düsseldorf, Germany.
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226
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The Cumulative Effect of Transient Synchrony States on Motor Performance in Parkinson's Disease. J Neurosci 2020; 40:1571-1580. [PMID: 31919131 PMCID: PMC7044725 DOI: 10.1523/jneurosci.1975-19.2019] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/16/2019] [Accepted: 12/18/2019] [Indexed: 01/19/2023] Open
Abstract
Bursts of beta frequency band activity in the basal ganglia of patients with Parkinson's disease (PD) are associated with impaired motor performance. Here we test in human adults whether small variations in the timing of movement relative to beta bursts have a critical effect on movement velocity and whether the cumulative effects of multiple beta bursts, both locally and across networks, matter. Bursts of beta frequency band activity in the basal ganglia of patients with Parkinson's disease (PD) are associated with impaired motor performance. Here we test in human adults whether small variations in the timing of movement relative to beta bursts have a critical effect on movement velocity and whether the cumulative effects of multiple beta bursts, both locally and across networks, matter. We recorded local field potentials from the subthalamic nucleus (STN) in 15 PD patients of both genders OFF-medication, during temporary lead externalization after deep brain stimulation surgery. Beta bursts were defined as periods exceeding the 75th percentile amplitude threshold. Subjects performed a visual cued joystick reaching task, with the visual cue being triggered in real time with different temporal relationships to bursts of STN beta activity. The velocity of actions made in response to cues prospectively triggered by STN beta bursts was slower than when responses were not time-locked to recent beta bursts. Importantly, slow movements were those that followed multiple bursts close to each other within a trial. In contrast, small differences in the delay between the last burst and movement onset had no significant impact on velocity. Moreover, when the overlap of bursts between the two STN was high, slowing was more pronounced. Our findings suggest that the cumulative, but recent, history of beta bursting, both locally and across basal ganglia networks, may impact on motor performance. SIGNIFICANCE STATEMENT Bursts of beta frequency band activity in the basal ganglia are associated with slowing of voluntary movement in patients with Parkinson's disease. We show that slow movements are those that follow multiple bursts close to each other and bursts that are coupled across regions. These results suggest that the cumulative, but recent, history of beta bursting, both locally and across basal ganglia networks, impacts on motor performance in this condition. The manipulation of burst dynamics may be a means of selectively improving motor impairment.
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Baaske MK, Kramer ER, Meka DP, Engler G, Engel AK, Moll CKE. Parkin deficiency perturbs striatal circuit dynamics. Neurobiol Dis 2020; 137:104737. [PMID: 31923460 DOI: 10.1016/j.nbd.2020.104737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/16/2019] [Accepted: 01/05/2020] [Indexed: 01/09/2023] Open
Abstract
Loss-of-function mutations in the parkin-encoding PARK2 gene are a frequent cause of young-onset, autosomal recessive Parkinson's disease (PD). Parkin knockout mice have no nigro-striatal neuronal loss but exhibit abnormalities of striatal dopamine transmission and cortico-striatal synaptic function. How these predegenerative changes observed in vitro affect neural dynamics at the intact circuit level, however, remains hitherto elusive. Here, we recorded from motor cortex, striatum and globus pallidus (GP) of anesthetized parkin-deficient mice to assess cortex-basal ganglia circuit dynamics and to dissect cell type-specific functional connectivity in the presymptomatic phase of genetic PD. While ongoing activity of presumed striatal spiny projection neurons and their downstream counterparts in the GP was not different from controls, parkin deficiency had a differential impact on striatal interneurons: In parkin-mutant mice, tonically active neurons displayed elevated activity levels. Baseline firing rates of transgenic striatal fast spiking interneurons (FSI), on the contrary, were reduced and the correlational structure of the FSI microcircuitry was disrupted. The entire transgenic striatal microcircuit showed enhanced and phase-shifted phase coupling to slow (1-3 Hz) cortical population oscillations. Unexpectedly, local field potentials recorded from striatum and GP of parkin-mutant mice robustly displayed amplified beta oscillations (~22 Hz), phase-coupled to cortex. Parkin deficiency selectively increased spike-field coupling of FSIs to beta oscillations. Our findings suggest that loss of parkin function leads to amplifications of synchronized cortico-striatal oscillations and an intrastriatal reconfiguration of interneuronal circuits. This presymptomatic disarrangement of dynamic functional connectivity may precede nigro-striatal neurodegeneration and predispose to imbalance of striatal outflow accompanying symptomatic PD.
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Affiliation(s)
- Magdalena K Baaske
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; Institute of Neurogenetics, University of Lübeck, 23562 Lübeck, Germany; Department of Neurology, University of Lübeck, 23538 Lübeck, Germany.
| | - Edgar R Kramer
- Center of Molecular Neurobiology, 20251 Hamburg, Germany; Institute of Translational and Stratified Medicine, University of Plymouth, Plymouth PL6 8BU, UK
| | | | - Gerhard Engler
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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229
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Local Field Potentials and ECoG. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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230
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From bed to bench side: Reverse translation to optimize neuromodulation for mood disorders. Proc Natl Acad Sci U S A 2019; 116:26288-26296. [PMID: 31871143 DOI: 10.1073/pnas.1902287116] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The advent of neuroimaging has provided foundational insights into the neural basis of psychiatric conditions, such as major depression. Across countless studies, dysfunction has been localized to distinct parts of the limbic system. Specific knowledge about affected locations has led to the development of circuit modulation therapies to correct dysfunction, notably deep brain stimulation (DBS). This and other emerging neuromodulation approaches have shown great promise, but their refinement has been slow and fundamental questions about their mechanisms of action remain. Here, we argue that their continued development requires reverse translation to animal models with close homology to humans, namely, nonhuman primates. With a particular focus on DBS approaches for depression, we highlight the parts of the brain that have been targeted by neuromodulation in humans, their efficacy, and why nonhuman primates are the most suitable model in which to conduct their refinement. We finish by highlighting key gaps in our knowledge that need to be filled to allow more rapid progress toward effective therapies in patients for whom all other treatment attempts have failed.
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231
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Prokic EJ, Stanford IM, Woodhall GL, Williams AC, Hall SD. Bradykinesia Is Driven by Cumulative Beta Power During Continuous Movement and Alleviated by Gabaergic Modulation in Parkinson's Disease. Front Neurol 2019; 10:1298. [PMID: 31920922 PMCID: PMC6933612 DOI: 10.3389/fneur.2019.01298] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/25/2019] [Indexed: 01/22/2023] Open
Abstract
Spontaneous and "event-related" motor cortex oscillations in the beta (15-30 Hz) frequency range are well-established phenomena. However, the precise functional significance of these features is uncertain. An understanding of the specific function is of importance for the treatment of Parkinson's disease (PD), where attenuation of augmented beta throughout the motor network coincides with functional improvement. Previous research using a discrete movement task identified normalization of elevated spontaneous beta and postmovement beta rebound following GABAergic modulation. Here, we explore the effects of the gamma-aminobutyric acid type A modulator, zolpidem, on beta power during the performance of serial movement in 17 (15M, 2F; mean age, 66 ± 6.3 years) PD patients, using a repeated-measures, double-blinded, randomized, placebo-control design. Motor symptoms were monitored before and after treatment, using time-based Unified Parkinson's Disease Rating Scale measurements and beta oscillations in primary motor cortex (M1) were measured during a serial-movement task, using magnetoencephalography. We demonstrate that a cumulative increase in M1 beta power during a 10-s tapping trial is reduced following zolpidem, but not placebo, which is accompanied by an improvement in movement speed and efficacy. This work provides a clear mechanism for the generation of abnormally elevated beta power in PD and demonstrates that perimovement beta accumulation drives the slowing, and impaired initiation, of movement. These findings further indicate a role for GABAergic modulation in bradykinesia in PD, which merits further exploration as a therapeutic target.
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Affiliation(s)
- Emma J. Prokic
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
- Department of Biosciences, University of Helsinki, Helsinki, Finland
| | - Ian M. Stanford
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Gavin L. Woodhall
- School of Life and Health Sciences, Aston University, Birmingham, United Kingdom
| | - Adrian C. Williams
- Queen Elizabeth Hospital, University Hospital Birmingham, Birmingham, United Kingdom
| | - Stephen D. Hall
- Brain Research and Imaging Centre, University of Plymouth, Plymouth, United Kingdom
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232
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Koelman LA, Lowery MM. Beta-Band Resonance and Intrinsic Oscillations in a Biophysically Detailed Model of the Subthalamic Nucleus-Globus Pallidus Network. Front Comput Neurosci 2019; 13:77. [PMID: 31749692 PMCID: PMC6848887 DOI: 10.3389/fncom.2019.00077] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/17/2019] [Indexed: 12/29/2022] Open
Abstract
Increased beta-band oscillatory activity in the basal ganglia network is associated with Parkinsonian motor symptoms and is suppressed with medication and deep brain stimulation (DBS). The origins of the beta-band oscillations, however, remains unclear with both intrinsic oscillations arising within the subthalamic nucleus (STN)-external globus pallidus (GPe) network and exogenous beta-activity, originating outside the network, proposed as potential sources of the pathological activity. The aim of this study was to explore the relative contribution of autonomous oscillations and exogenous oscillatory inputs in the generation of pathological oscillatory activity in a biophysically detailed model of the parkinsonian STN-GPe network. The network model accounts for the integration of synaptic currents and their interaction with intrinsic membrane currents in dendritic structures within the STN and GPe. The model was used to investigate the development of beta-band synchrony and bursting within the STN-GPe network by changing the balance of excitation and inhibition in both nuclei, and by adding exogenous oscillatory inputs with varying phase relationships through the hyperdirect cortico-subthalamic and indirect striato-pallidal pathways. The model showed an intrinsic susceptibility to beta-band oscillations that was manifest in weak autonomously generated oscillations within the STN-GPe network and in selective amplification of exogenous beta-band synaptic inputs near the network's endogenous oscillation frequency. The frequency at which this resonance peak occurred was determined by the net level of excitatory drive to the network. Intrinsic or endogenously generated oscillations were too weak to support a pacemaker role for the STN-GPe network, however, they were considerably amplified by sparse cortical beta inputs and were further amplified by striatal beta inputs that promoted anti-phase firing of the cortex and GPe, resulting in maximum transient inhibition of STN neurons. The model elucidates a mechanism of cortical patterning of the STN-GPe network through feedback inhibition whereby intrinsic susceptibility to beta-band oscillations can lead to phase locked spiking under parkinsonian conditions. These results point to resonance of endogenous oscillations with exogenous patterning of the STN-GPe network as a mechanism of pathological synchronization, and a role for the pallido-striatal feedback loop in amplifying beta oscillations.
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Affiliation(s)
- Lucas A. Koelman
- Neuromuscular Systems Laboratory, School of Electrical and Electronic Engineering, University College Dublin, Dublin, Ireland
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Leta V, Jenner P, Chaudhuri KR, Antonini A. Can therapeutic strategies prevent and manage dyskinesia in Parkinson’s disease? An update. Expert Opin Drug Saf 2019; 18:1203-1218. [DOI: 10.1080/14740338.2019.1681966] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Valentina Leta
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
| | - Peter Jenner
- Neurodegenerative Diseases Research Group, School of Cancer and Pharmaceutical Sciences, Faculty of Life Science and Medicine, King’s College London, London, UK
| | - K. Ray Chaudhuri
- King’s College London, Department of Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- Parkinson’s Foundation Centre of Excellence, King’s College Hospital, London, UK
| | - Angelo Antonini
- Department of Neuroscience, University of Padova, Padua, Italy
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234
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Beta Frequency Oscillations in the Subthalamic Nucleus Are Not Sufficient for the Development of Symptoms of Parkinsonian Bradykinesia/Akinesia in Rats. eNeuro 2019; 6:ENEURO.0089-19.2019. [PMID: 31540998 PMCID: PMC6817717 DOI: 10.1523/eneuro.0089-19.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/30/2019] [Accepted: 09/11/2019] [Indexed: 11/21/2022] Open
Abstract
Substantial correlative evidence links the synchronized, oscillatory patterns of neural activity that emerge in Parkinson's disease (PD) in the beta (β) frequency range (13-30 Hz) with bradykinesia in PD. However, conflicting evidence exists, and whether these changes in neural activity are causal of motor symptoms in PD remains unclear. We tested the hypothesis that the synchronized β oscillations that emerge in PD are causal of symptoms of bradykinesia/akinesia. We designed patterns of stimulation that mimicked the temporal characteristics of single unit β bursting activity seen in PD animals and humans. We applied these β-patterned stimulation patterns along with continuous low-frequency and high-frequency controls to the subthalamic nucleus (STN) of intact and 6-OHDA-lesioned female Long-Evans and Sprague-Dawley rats. β-Patterned paradigms were superior to low-frequency controls at induction of β power in downstream substantia nigra reticulata (SNr) neurons and in ipsilateral motor cortex. However, we did not detect deleterious effects on motor performance across a wide battery of validated behavioral tasks. Our results suggest that β frequency oscillations (BFOs) may not be sufficient for the generation of bradykinesia/akinesia in PD.
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235
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Schmidt R, Herrojo Ruiz M, Kilavik BE, Lundqvist M, Starr PA, Aron AR. Beta Oscillations in Working Memory, Executive Control of Movement and Thought, and Sensorimotor Function. J Neurosci 2019; 39:8231-8238. [PMID: 31619492 PMCID: PMC6794925 DOI: 10.1523/jneurosci.1163-19.2019] [Citation(s) in RCA: 126] [Impact Index Per Article: 25.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022] Open
Abstract
Beta oscillations (∼13 to 30 Hz) have been observed during many perceptual, cognitive, and motor processes in a plethora of brain recording studies. Although the function of beta oscillations (hereafter "beta" for short) is unlikely to be explained by any single monolithic description, we here discuss several convergent findings. In prefrontal cortex (PFC), increased beta appears at the end of a trial when working memory information needs to be erased. A similar "clear-out" function might apply during the stopping of action and the stopping of long-term memory retrieval (stopping thoughts), where increased prefrontal beta is also observed. A different apparent role for beta in PFC occurs during the delay period of working memory tasks: it might serve to maintain the current contents and/or to prevent interference from distraction. We confront the challenge of relating these observations to the large literature on beta recorded from sensorimotor cortex. Potentially, the clear-out of working memory in PFC has its counterpart in the postmovement clear-out of the motor plan in sensorimotor cortex. However, recent studies support alternative interpretations. In addition, we flag emerging research on different frequencies of beta and the relationship between beta and single-neuron spiking. We also discuss where beta might be generated: basal ganglia, cortex, or both. We end by considering the clinical implications for adaptive deep-brain stimulation.
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Affiliation(s)
- Robert Schmidt
- Department of Psychology, University of Sheffield, Sheffield, S1 2LT, UK,
| | - Maria Herrojo Ruiz
- Department of Psychology, Goldsmiths University of London, London, SE14 6NW, UK
- Center for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Moscow 101000, Russian Federation
| | - Bjørg E Kilavik
- Institut de Neurosciences de la Timone, Aix-Marseille Université, Marseille, 13005, France
| | - Mikael Lundqvist
- Department of Brain and Cognitive Sciences, The Picower Institute for Learning and Memory, Massachusetts Institute of Technology, Cambridge, MA 02139-4307
| | - Philip A Starr
- Department of Neurosurgery, University of California San Francisco, San Francisco, CA 94143, and
| | - Adam R Aron
- Department of Psychology, University of California San Diego La Jolla, CA 92093
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236
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Macerollo A, Limousin P, Korlipara P, Foltynie T, Edwards MJ, Kilner J. Dopaminergic Modulation of Sensory Attenuation in Parkinson's Disease: Is There an Underlying Modulation of Beta Power? Front Neurol 2019; 10:1001. [PMID: 31620072 PMCID: PMC6759719 DOI: 10.3389/fneur.2019.01001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 09/02/2019] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Pathological high amplitude of beta oscillations is thought as the underlying mechanism of motor symptoms in Parkinson's disease (PD), in particular with regard to bradykinesia. In addition, abnormality in a neurophysiological phenomenon labeled sensory attenuation has been found in patients with PD. The current study explored the hypothesis that the abnormal sensory attenuation has a causal link with the typical abnormality in beta oscillations in PD. Methods: The study tested sixteen right-handed patients with a diagnosis of PD and 22 healthy participants, which were matched by age and gender. Somatosensory evoked potentials were elicited through electrical stimulation of the median nerve at the wrist. Electrical activity was recorded at the scalp using a 128 channels EEG. Somatosensory evoked potentials were recorded in 2 conditions: at rest and at the onset of a voluntary movement, which was a self-paced abduction movement of the right thumb. Results: Healthy participants showed a reduction of the N20-P25 amplitude at the onset of the right thumb abduction compared to the rest condition (P < 0.05). When patients were OFF medication, they showed mild reduction of the N20-P25 component at movement onset (P < 0.05). On the contrary, they did show greater attenuation of the N20-P25 component at the onset of movement compared to the rest condition when ON medication (P < 0.05). There was no significant evidence of a link between the degree of sensory attenuation and the change in beta oscillations in our cohort of patients. Conclusion: These results confirmed a significant link between dopaminergic modulation and sensory attenuation. However, the sensory attenuation and beta oscillations were found as two independent phenomena.
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Affiliation(s)
- Antonella Macerollo
- The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom.,School of Psychology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom.,National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Institute of Neurology, University College of London, London, United Kingdom
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Institute of Neurology, University College of London, London, United Kingdom
| | - Prasad Korlipara
- National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Tom Foltynie
- National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Institute of Neurology, University College of London, London, United Kingdom
| | - Mark J Edwards
- Department of Neurology, St George's University of London, London, United Kingdom
| | - James Kilner
- Institute of Neurology, University College of London, London, United Kingdom
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237
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Wilhelm RA, Miller MW, Gable PA. Neural and Attentional Correlates of Intrinsic Motivation Resulting from Social Performance Expectancy. Neuroscience 2019; 416:137-146. [PMID: 31369789 DOI: 10.1016/j.neuroscience.2019.07.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/12/2019] [Accepted: 07/22/2019] [Indexed: 11/28/2022]
Abstract
Some models of motivation distinguish between intrinsic and extrinsic motivation. While past work has examined the neural and cognitive correlates of extrinsic motivation, research on intrinsic motivation has relied primarily on behavioral measures of performance and learning. In particular, no past work has examined the neural and cognitive correlates of social performance expectancy, which is linked to intrinsic motivation. The current study manipulated expectancy of difficult (vs. easy) trials on a cued flanker task and assessed attentional scope and performance. EEG was used to examine motor-action preparation as measured by suppression of beta band activity over the motor cortex and feedback processing as measured by the Reward Positivity (RewP). Results revealed expectancy of difficult (vs. easy) trials narrowed attentional scope, reduced beta activity over the motor cortex, and enhanced RewP amplitudes to win feedback. These findings suggest that enhancing intrinsic motivation through expectancies of positive social comparison engages similar neural and cognitive correlates as extrinsic motivators high in motivational intensity.
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Affiliation(s)
- Ricardo A Wilhelm
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, United States.
| | | | - Philip A Gable
- Department of Psychology, The University of Alabama, Box 870348, Tuscaloosa, AL 35487-0348, United States.
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238
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Nagao KJ, Patel NJ. From medications to surgery: advances in the treatment of motor complications in Parkinson's disease. Drugs Context 2019; 8:212592. [PMID: 31516532 PMCID: PMC6727789 DOI: 10.7573/dic.212592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/21/2022] Open
Abstract
Motor complications are responsible for the large burden of disability and poor quality of life in Parkinson’s disease (PD). The pulsatile nature of stimulation with oral dopaminergic therapies due to relatively short pharmacokinetic profiles and dysfunctional gastrointestinal absorption have been attributed to the development of PD motor complications. In this review, we will provide an overview of the pharmacologic and surgical therapies currently available and under investigation for the treatment of motor fluctuations and dyskinesia.
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Affiliation(s)
- Kanae Jennifer Nagao
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan, USA
| | - Neepa J Patel
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan, USA
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239
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Sinclair NC, Fallon JB, Bulluss KJ, Thevathasan W, McDermott HJ. On the neural basis of deep brain stimulation evoked resonant activity. Biomed Phys Eng Express 2019. [DOI: 10.1088/2057-1976/ab366e] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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240
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Stefani A, Grandi LC, Galati S. Deep brain stimulation of the pedunculopontine nucleus modulates subthalamic pathological oscillations. Neurobiol Dis 2019; 128:49-52. [DOI: 10.1016/j.nbd.2018.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 10/29/2018] [Accepted: 11/09/2018] [Indexed: 01/24/2023] Open
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241
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Ozturk M, Abosch A, Francis D, Wu J, Jimenez‐Shahed J, Ince NF. Distinct Subthalamic Coupling in the ON State Describes Motor Performance in Parkinson's Disease. Mov Disord 2019; 35:91-100. [DOI: 10.1002/mds.27800] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 04/20/2019] [Accepted: 06/27/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Musa Ozturk
- Department of Biomedical Engineering University of Houston Houston Texas USA
| | - Aviva Abosch
- Department of Neurosurgery University of Colorado Aurora Colorado USA
| | - David Francis
- Department of Psychology University of Houston Houston Texas USA
| | - Jianping Wu
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic Minneapolis Minnesota USA
| | | | - Nuri F. Ince
- Department of Biomedical Engineering University of Houston Houston Texas USA
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Temporal evolution of beta bursts in the parkinsonian cortical and basal ganglia network. Proc Natl Acad Sci U S A 2019; 116:16095-16104. [PMID: 31341079 PMCID: PMC6690030 DOI: 10.1073/pnas.1819975116] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Prevalence and temporal dynamics of transient oscillations in the beta frequency band (15 to 35 Hz), referred to as β bursts, are correlated with motor performance. Disturbance of these activities is a candidate mechanism for motor impairment in Parkinson’s disease (PD), where the excessively long bursts correlate with symptom severity and are reduced by pharmacological and surgical treatments. Here we describe the changes in action potential firing that take place across multiple nodes of the cortical and basal ganglia circuit as these transient oscillations evolve. These analyses provide fresh insights into the network dynamics of β bursts that can guide novel strategies to interfere with their generation and maintenance in PD. Beta frequency oscillations (15 to 35 Hz) in cortical and basal ganglia circuits become abnormally synchronized in Parkinson’s disease (PD). How excessive beta oscillations emerge in these circuits is unclear. We addressed this issue by defining the firing properties of basal ganglia neurons around the emergence of cortical beta bursts (β bursts), transient (50 to 350 ms) increases in the beta amplitude of cortical signals. In PD patients, the phase locking of background spiking activity in the subthalamic nucleus (STN) to frontal electroencephalograms preceded the onset and followed the temporal profile of cortical β bursts, with conditions of synchronization consistent within and across bursts. Neuronal ensemble recordings in multiple basal ganglia structures of parkinsonian rats revealed that these dynamics were recapitulated in STN, but also in external globus pallidus and striatum. The onset of consistent phase-locking conditions was preceded by abrupt phase slips between cortical and basal ganglia ensemble signals. Single-unit recordings demonstrated that ensemble-level properties of synchronization were not underlain by changes in firing rate but, rather, by the timing of action potentials in relation to cortical oscillation phase. Notably, the preferred angle of phase-locked action potential firing in each basal ganglia structure was shifted during burst initiation, then maintained stable phase relations during the burst. Subthalamic, pallidal, and striatal neurons engaged and disengaged with cortical β bursts to different extents and timings. The temporal evolution of cortical and basal ganglia synchronization is cell type-selective, which could be key for the generation/ maintenance of excessive beta oscillations in parkinsonism.
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243
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Adaptive delivery of continuous and delayed feedback deep brain stimulation - a computational study. Sci Rep 2019; 9:10585. [PMID: 31332226 PMCID: PMC6646395 DOI: 10.1038/s41598-019-47036-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/09/2019] [Indexed: 12/15/2022] Open
Abstract
Adaptive deep brain stimulation (aDBS) is a closed-loop method, where high-frequency DBS is turned on and off according to a feedback signal, whereas conventional high-frequency DBS (cDBS) is delivered permanently. Using a computational model of subthalamic nucleus and external globus pallidus, we extend the concept of adaptive stimulation by adaptively controlling not only continuous, but also demand-controlled stimulation. Apart from aDBS and cDBS, we consider continuous pulsatile linear delayed feedback stimulation (cpLDF), specifically designed to induce desynchronization. Additionally, we combine adaptive on-off delivery with continuous delayed feedback modulation by introducing adaptive pulsatile linear delayed feedback stimulation (apLDF), where cpLDF is turned on and off using pre-defined amplitude thresholds. By varying the stimulation parameters of cDBS, aDBS, cpLDF, and apLDF we obtain optimal parameter ranges. We reveal a simple relation between the thresholds of the local field potential (LFP) for aDBS and apLDF, the extent of the stimulation-induced desynchronization, and the integral stimulation time required. We find that aDBS and apLDF can be more efficient in suppressing abnormal synchronization than continuous simulation. However, apLDF still remains more efficient and also causes a stronger reduction of the LFP beta burst length. Hence, adaptive on-off delivery may further improve the intrinsically demand-controlled pLDF.
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Deep brain stimulation for Parkinson's disease modulates high-frequency evoked and spontaneous neural activity. Neurobiol Dis 2019; 130:104522. [PMID: 31276793 DOI: 10.1016/j.nbd.2019.104522] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/11/2019] [Accepted: 07/01/2019] [Indexed: 01/23/2023] Open
Abstract
Deep brain stimulation is an established therapy for Parkinson's disease; however, its effectiveness is hindered by limited understanding of therapeutic mechanisms and the lack of a robust feedback signal for tailoring stimulation. We recently reported that subthalamic nucleus deep brain stimulation evokes a neural response resembling a decaying high-frequency (200-500 Hz) oscillation that typically has a duration of at least 10 ms and is localizable to the dorsal sub-region. As the morphology of this response suggests a propensity for the underlying neural circuitry to oscillate at a particular frequency, we have named it evoked resonant neural activity. Here, we determine whether this evoked activity is modulated by therapeutic stimulation - a critical attribute of a feedback signal. Furthermore, we investigated whether any related changes occurred in spontaneous local field potentials. Evoked and spontaneous neural activity was intraoperatively recorded from 19 subthalamic nuclei in patients with Parkinson's disease. Recordings were obtained before therapeutic stimulation and during 130 Hz stimulation at increasing amplitudes (0.67-3.38 mA), 'washout' of therapeutic effects, and non-therapeutic 20 Hz stimulation. Therapeutic efficacy was assessed using clinical bradykinesia and rigidity scores. The frequency and amplitude of evoked resonant neural activity varied with the level of 130 Hz stimulation (p < .001). This modulation coincided with improvement in bradykinesia and rigidity (p < .001), and correlated with spontaneous beta band suppression (p < .001). Evoked neural activity occupied a similar frequency band to spontaneous high-frequency oscillations (200-400 Hz), both of which decreased to around twice the 130 Hz stimulation rate. Non-therapeutic stimulation at 20 Hz evoked, but did not modulate, resonant activity. These results indicate that therapeutic deep brain stimulation alters the frequency of evoked and spontaneous oscillations recorded in the subthalamic nucleus that are likely generated by loops within the cortico-basal ganglia-thalamo-cortical network. Evoked resonant neural activity therefore has potential as a tool for providing insight into brain network function and has key attributes of a dynamic feedback signal for optimizing therapy.
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Halje P, Brys I, Mariman JJ, da Cunha C, Fuentes R, Petersson P. Oscillations in cortico-basal ganglia circuits: implications for Parkinson’s disease and other neurologic and psychiatric conditions. J Neurophysiol 2019; 122:203-231. [DOI: 10.1152/jn.00590.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cortico-basal ganglia circuits are thought to play a crucial role in the selection and control of motor behaviors and have also been implicated in the processing of motivational content and in higher cognitive functions. During the last two decades, electrophysiological recordings in basal ganglia circuits have shown that several disease conditions are associated with specific changes in the temporal patterns of neuronal activity. In particular, synchronized oscillations have been a frequent finding suggesting that excessive synchronization of neuronal activity may be a pathophysiological mechanism involved in a wide range of neurologic and psychiatric conditions. We here review the experimental support for this hypothesis primarily in relation to Parkinson’s disease but also in relation to dystonia, essential tremor, epilepsy, and psychosis/schizophrenia.
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Affiliation(s)
- Pär Halje
- Group for Integrative Neurophysiology and Neurotechnology, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Ivani Brys
- Federal University of Vale do São Francisco, Petrolina, Brazil
| | - Juan J. Mariman
- Research and Development Direction, Universidad Tecnológica de Chile, Inacap, Santiago, Chile
- Department of Physical Therapy, Faculty of Medicine, Universidad de Chile, Santiago, Chile
- Department of Physical Therapy, Faculty of Arts and Physical Education, Universidad Metropolitana de Ciencias de la Educación, Santiago, Chile
| | - Claudio da Cunha
- Laboratório de Fisiologia e Farmacologia do Sistema Nervoso Central, Programas de Pós-Graduação em Farmacologia e Bioquímica, Universidade Federal do Paraná, Curitiba, Brazil
| | - Romulo Fuentes
- Department of Neurocience, Faculty of Medicine, Universidad de Chile, Santiago, Chile
| | - Per Petersson
- Group for Integrative Neurophysiology and Neurotechnology, Department of Experimental Medical Science, Lund University, Lund, Sweden
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
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246
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Lofredi R, Tan H, Neumann WJ, Yeh CH, Schneider GH, Kühn AA, Brown P. Beta bursts during continuous movements accompany the velocity decrement in Parkinson's disease patients. Neurobiol Dis 2019; 127:462-471. [PMID: 30898668 PMCID: PMC6520224 DOI: 10.1016/j.nbd.2019.03.013] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 02/27/2019] [Accepted: 03/14/2019] [Indexed: 11/18/2022] Open
Abstract
Bradykinesia is reported to correlate with subthalamic beta power (13-35 Hz) recorded at rest in Parkinson's disease (PD). Pilot studies suggest adaptive deep brain stimulation triggered by amplitude threshold crossings of beta activity defined at rest is effective. This is puzzling, given that beta is suppressed during repetitive movements when bradykinesia becomes apparent. Recently, increased beta power in PD has been linked to beta bursts. Here we investigate whether beta bursts also occur during repetitive movements and relate to progressive decrement in movement velocity. Therefore, subthalamic local field potentials were recorded in 12 PD patients off medication while performing 30s blocks of rotatory movements alternating with rest periods. Bursts were defined separately for the low (13-20 Hz) and high (20-35 Hz) beta band using thresholds defined at rest. As expected, velocity significantly decreased within movement blocks. Despite the sustained suppression of both beta sub-bands, bursts could still be detected during movement. Beta bursts were reduced in amplitude, duration and rate during movement with beta rate correlating best with beta power. A mixed-effects linear model revealed that percentage time spent in beta bursts predicted velocity decreases better than averaged power. This correlation was specific for the low beta band. Our results link beta bursts during movement to bradykinesia. This helps explain how beta activity may contribute to bradykinetic movement decrement even though mean beta power is reduced during movement. Moreover, our findings help explain the effectiveness of adaptive DBS triggered off beta bursts, even though these may be defined with respect to beta levels at rest.
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Affiliation(s)
- Roxanne Lofredi
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK; Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), 10178 Berlin, Germany
| | - Huiling Tan
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Wolf-Julian Neumann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Chien-Hung Yeh
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK.
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247
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Characteristics of Waveform Shape in Parkinson's Disease Detected with Scalp Electroencephalography. eNeuro 2019; 6:ENEURO.0151-19.2019. [PMID: 31110135 PMCID: PMC6553574 DOI: 10.1523/eneuro.0151-19.2019] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/28/2019] [Indexed: 11/21/2022] Open
Abstract
Neural activity in the β frequency range (13-30 Hz) is excessively synchronized in Parkinson's disease (PD). Previous work using invasive intracranial recordings and non-invasive scalp electroencephalography (EEG) has shown that correlations between β phase and broad-band γ (>50 Hz) amplitude [i.e., phase amplitude coupling (PAC)] are elevated in PD, perhaps a reflection of this synchrony. Recently, it has also been shown, in invasive human recordings, that non-sinusoidal features of β oscillation shape also characterize PD. Here, we show that these features of β waveform shape also distinguish PD patients on and off medication using non-invasive recordings in a dataset of 15 PD patients with resting scalp EEG. Specifically, β oscillations over sensorimotor electrodes in PD patients off medication had greater sharpness asymmetry and steepness asymmetry than on medication (sign rank, p < 0.02, corrected). We also showed that β oscillations over sensorimotor cortex most often had a canonical shape, and that using this prototypical shape as an inclusion criteria increased the effect size of our findings. Together, our findings suggest that novel ways of measuring β synchrony that incorporate waveform shape could improve detection of PD pathophysiology in non-invasive recordings. Moreover, they motivate the consideration of waveform shape in future EEG studies.
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248
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Naros G, Grimm F, Weiss D, Gharabaghi A. Directional communication during movement execution interferes with tremor in Parkinson's disease. Mov Disord 2019; 33:251-261. [PMID: 29427344 DOI: 10.1002/mds.27221] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/15/2017] [Accepted: 09/08/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Both the cerebello-thalamo-cortical circuit and the basal ganglia/cortical motor loop have been postulated to be generators of tremor in PD. The recent suggestion that the basal ganglia trigger tremor episodes and the cerebello-thalamo-cortical circuitry modulates tremor amplitude combines both competing hypotheses. However, the role of the STN in tremor generation and the impact of proprioceptive feedback on tremor suppression during voluntary movements have not been considered in this model yet. OBJECTIVES The objective of this study was to evaluate the role of the STN and proprioceptive feedback in PD tremor generation during movement execution. METHODS Local-field potentials of the STN as well as electromyographical and electroencephalographical rhythms were recorded in tremor-dominant and nontremor PD patients while performing voluntary movements of the contralateral hand during DBS surgery. Effective connectivity between these electrophysiological signals were analyzed and compared to electromyographical tremor activity. RESULTS There was an intensified information flow between the STN and the muscle in the tremor frequencies (5-8 Hz) for tremor-dominant, in comparison to nontremor, patients. In both subtypes, active movement was associated with an increase of afferent interaction between the muscle and the cortex in the β- and γ-frequencies. The γ-frequency (30-40 Hz) of this communication between muscle and cortex correlated inversely with electromyographical tremor activity. CONCLUSIONS Our results indicate an involvement of the STN in propagation of tremor-related activity to the muscle. Furthermore, we provide evidence that increased proprioceptive information flow during voluntary movement interferes with central tremor generation. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Georgios Naros
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Florian Grimm
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Weiss
- Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, and German Centre of Neurodegenerative Diseases (DZNE), Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Tuebingen, Germany
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249
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Miller AM, Miocinovic S, Swann NC, Rajagopalan SS, Darevsky DM, Gilron R, de Hemptinne C, Ostrem JL, Starr PA. Effect of levodopa on electroencephalographic biomarkers of the parkinsonian state. J Neurophysiol 2019; 122:290-299. [PMID: 31066605 DOI: 10.1152/jn.00141.2019] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to evaluate proposed electroencephalographic (EEG) biomarkers of Parkinson's disease (PD) and test their correlation with motor impairment in a new, well-characterized cohort of PD patients and controls. Sixty-four-channel EEG was recorded from 14 patients with rigid-akinetic PD with minimal tremor and from 14 age-matched healthy controls at rest and during voluntary movement. Patients were tested off and on medication during a single session. Recordings were analyzed for phase-amplitude coupling over sensorimotor cortex and for pairwise coherence from all electrode pairs in the recording montage (distributed coherence). Phase-amplitude coupling and distributed coherence were found to be elevated Off compared with On levodopa, and their reduction was correlated with motor improvement. In the Off medication state, phase-amplitude coupling was greater in sensorimotor contacts contralateral to the most affected body part and reduced by voluntary movement. We conclude that phase-amplitude coupling and distributed coherence are cortical biomarkers of the parkinsonian state that are detectable noninvasively and may be useful as objective aids for management of dopaminergic therapy. Several analytic methods may be used for noninvasive measurement of abnormal brain synchronization in PD. Calculation of phase-amplitude coupling requires only a single electrode over motor cortex. NEW & NOTEWORTHY Several EEG biomarkers of the parkinsonian state have been proposed that are related to abnormal cortical synchronization. We report several new findings in this study: correlations of EEG markers of synchronization with specific motor signs of Parkinson's disease (PD), and demonstration that one of the EEG markers, phase-amplitude coupling, is more elevated over the more clinically affected brain hemisphere. These findings underscore the potential utility of scalp EEG for objective, noninvasive monitoring of medication state in PD.
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Affiliation(s)
- Andrew M Miller
- Department of Neurological Surgery, University of California , San Francisco, California.,School of Medicine, University of Kansas , Kansas City, Kansas
| | | | - Nicole C Swann
- Department of Human Physiology, University of Oregon , Eugene, Oregon
| | - Sheila S Rajagopalan
- Department of Neurological Surgery, University of California , San Francisco, California
| | - David M Darevsky
- Department of Neurological Surgery, University of California , San Francisco, California.,Graduate Program in Neuroscience, University of California , San Francisco, California
| | - Ro'ee Gilron
- Department of Neurological Surgery, University of California , San Francisco, California
| | - Coralie de Hemptinne
- Department of Neurological Surgery, University of California , San Francisco, California
| | - Jill L Ostrem
- Department of Neurology, University of California , San Francisco, California.,Parkinson's Disease Research, Education and Clinical Center at the San Francisco Veteran's Affairs Medical Center , San Francisco, California
| | - Philip A Starr
- Department of Neurological Surgery, University of California , San Francisco, California.,Parkinson's Disease Research, Education and Clinical Center at the San Francisco Veteran's Affairs Medical Center , San Francisco, California.,Graduate Program in Neuroscience, University of California , San Francisco, California
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250
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Analysis of Movement-Related Beta Oscillations in the Off-Medication State During Subthalamic Nucleus Deep Brain Stimulation Surgery. J Clin Neurophysiol 2019; 36:67-73. [PMID: 30418266 DOI: 10.1097/wnp.0000000000000521] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Local field potential recordings from deep brain stimulation (DBS) leads provide insight into the pathophysiology of Parkinson disease (PD). We recorded local field potential activity from DBS leads within the subthalamic nucleus in patients with PD undergoing DBS surgery to identify reproducible pathophysiological signatures of the disease. METHODS Local field potentials were recorded in 11 hemispheres from patients with PD undergoing subthalamic nucleus-DBS. Bipolar recordings were performed off medication for 2 minutes at rest and another 2 minutes with continuous repetitive opening-closing of the contralateral hand. Spectral analysis and bicoherence were performed and compared between the two testing conditions. RESULTS In all hemispheres, predominance of the beta band frequency (13-30 Hz) was observed at rest and during movement. Beta peak energy was significantly (P < 0.05) increased during movement compared with rest in 6 of 10 hemispheres. Significant beta bicoherence was observed at rest and during movement in 5 of 10 hemispheres. The most robust local field potential recordings were observed at the DBS contact(s) independently chosen for programming in 9 of the 10 hemispheres. CONCLUSIONS In patients with PD, beta activity that increases with repetitive movement may be a signature of the "off" medication state. These findings provide new data on beta oscillatory activity during the Parkinsonian "off" state that may help further define the local field potential signatures of PD.
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