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Permezel F. Brain MRI-guided focused ultrasound conceptualised as a tool for brain network intervention. J Clin Neurosci 2021; 90:370-379. [PMID: 34275578 DOI: 10.1016/j.jocn.2021.05.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 05/02/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
Magnetic resonance imaging guided high intensity focused ultrasound (HIFU) has emerged as a tool offering incisionless intervention on brain tissue. The low risk and rapid recovery from this procedure, in addition to the ability to assess for clinical benefit and adverse events intraprocedurally, makes it an ideal tool for intervention upon brain networks both for clinical and research applications. This review article proposes that conceptualising brain focused ultrasound as a tool for brain network intervention and adoption of methodology to complement this approach may result in better clinical outcomes, fewer adverse events and may unveil or allow treatment opportunities not otherwise possible. A brief introduction to network neuroscience is discussed before a description of pathological brain networks is provided for a number of conditions for which MRI-guided brain HIFU intervention has been implemented. Essential Tremor is discussed as the most advanced example of MRI-guided brain HIFU intervention adoption along with the issues that present with this treatment modality compared to alternatives. The brain network intervention paradigm is proposed to overcome these issues and a number of examples of implementation of this are discussed. The ability of low intensity MRI guided focussed ultrasound to neuromoduate brain tissue without lesioning is introduced. This tool is discussed with regards to its potential clinical application as well as its potential to further our understanding of network neuroscience via its ability to interrogate brain networks without damaging tissue. Finally, a number of current clinical trials utilising brain focused ultrasound are discussed, along with the additional applications available from the utilisation of low intensity focused ultrasound.
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Affiliation(s)
- Fiona Permezel
- Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Austin Hospital, Victoria, Australia.
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2
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Mahmoudzadeh M, Wallois F, Tir M, Krystkowiak P, Lefranc M. Cortical hemodynamic mapping of subthalamic nucleus deep brain stimulation in Parkinsonian patients, using high-density functional near-infrared spectroscopy. PLoS One 2021; 16:e0245188. [PMID: 33493171 PMCID: PMC7833160 DOI: 10.1371/journal.pone.0245188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/23/2020] [Indexed: 12/02/2022] Open
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) is an effective treatment for idiopathic Parkinson's disease. Despite recent progress, the mechanisms responsible for the technique's effectiveness have yet to be fully elucidated. The purpose of the present study was to gain new insights into the interactions between STN-DBS and cortical network activity. We therefore combined high-resolution functional near-infrared spectroscopy with low-resolution electroencephalography in seven Parkinsonian patients on STN-DBS, and measured cortical haemodynamic changes at rest and during hand movement in the presence and absence of stimulation (the ON-stim and OFF-stim conditions, respectively) in the off-drug condition. The relative changes in oxyhaemoglobin [HbO], deoxyhaemoglobin [HbR], and total haemoglobin [HbT] levels were analyzed continuously. At rest, the [HbO], [HbR], and [HbT] over the bilateral sensorimotor (SM), premotor (PM) and dorsolateral prefrontal (DLPF) cortices decreased steadily throughout the duration of stimulation, relative to the OFF-stim condition. During hand movement in the OFF-stim condition, [HbO] increased and [HbR] decreased concomitantly over the contralateral SM cortex (as a result of neurovascular coupling), and [HbO], [HbR], and [HbT] increased concomitantly in the dorsolateral prefrontal cortex (DLPFC)-suggesting an increase in blood volume in this brain area. During hand movement with STN-DBS, the increase in [HbO] was over the contralateral SM and PM cortices was significantly lower than in the OFF-stim condition, as was the decrease in [HbO] and [HbT] in the DLPFC. Our results indicate that STN-DBS is associated with a reduction in blood volume over the SM, PM and DLPF cortices, regardless of whether or not the patient is performing a task. This particular effect on cortical networks might explain not only STN-DBS's clinical effectiveness but also some of the associated adverse effects.
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Affiliation(s)
| | | | - Mélissa Tir
- Neurosurgery Department, CHU Amiens-Picardie, Amiens, France
| | - Pierre Krystkowiak
- Neurology Department, CHU Amiens-Picardie, Amiens, France
- Laboratory of Functional Neurosciences, University of Picardie Jules Verne, Amiens, France
| | - Michel Lefranc
- Neurosurgery Department, CHU Amiens-Picardie, Amiens, France
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Parkinson’s Disease: Lesions. Stereotact Funct Neurosurg 2020. [DOI: 10.1007/978-3-030-34906-6_19] [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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Muthuraman M, Koirala N, Ciolac D, Pintea B, Glaser M, Groppa S, Tamás G, Groppa S. Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease. Front Neurol 2018; 9:711. [PMID: 30210436 PMCID: PMC6119713 DOI: 10.3389/fneur.2018.00711] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nabin Koirala
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stanislav Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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Saenger VM, Kahan J, Foltynie T, Friston K, Aziz TZ, Green AL, van Hartevelt TJ, Cabral J, Stevner ABA, Fernandes HM, Mancini L, Thornton J, Yousry T, Limousin P, Zrinzo L, Hariz M, Marques P, Sousa N, Kringelbach ML, Deco G. Uncovering the underlying mechanisms and whole-brain dynamics of deep brain stimulation for Parkinson's disease. Sci Rep 2017; 7:9882. [PMID: 28851996 PMCID: PMC5574998 DOI: 10.1038/s41598-017-10003-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 06/28/2017] [Indexed: 12/01/2022] Open
Abstract
Deep brain stimulation (DBS) for Parkinson's disease is a highly effective treatment in controlling otherwise debilitating symptoms. Yet the underlying brain mechanisms are currently not well understood. Whole-brain computational modeling was used to disclose the effects of DBS during resting-state functional Magnetic Resonance Imaging in ten patients with Parkinson's disease. Specifically, we explored the local and global impact that DBS has in creating asynchronous, stable or critical oscillatory conditions using a supercritical bifurcation model. We found that DBS shifts global brain dynamics of patients towards a Healthy regime. This effect was more pronounced in very specific brain areas such as the thalamus, globus pallidus and orbitofrontal regions of the right hemisphere (with the left hemisphere not analyzed given artifacts arising from the electrode lead). Global aspects of integration and synchronization were also rebalanced. Empirically, we found higher communicability and coherence brain measures during DBS-ON compared to DBS-OFF. Finally, using our model as a framework, artificial in silico DBS was applied to find potential alternative target areas for stimulation and whole-brain rebalancing. These results offer important insights into the underlying large-scale effects of DBS as well as in finding novel stimulation targets, which may offer a route to more efficacious treatments.
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Affiliation(s)
- Victor M Saenger
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
| | - Joshua Kahan
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Karl Friston
- Wellcome Trust Centre for Neuroimaging, Institute of Neurology, University College London, London, WC1N 3BG, United Kingdom
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Alexander L Green
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, OX3 9DU, United Kingdom
| | - Tim J van Hartevelt
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Joana Cabral
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
| | - Angus B A Stevner
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Henrique M Fernandes
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark
| | - Laura Mancini
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - John Thornton
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, WC1N 3BG, United Kingdom
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Marwan Hariz
- Sobell Department of Motor Neuroscience & Movement Disorders, UCL Institute of Neurology, London, WC1N 3BG, United Kingdom
| | - Paulo Marques
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga, Portugal
- Clinical Academic Center, 4710-057, Braga, Portugal
| | - Nuno Sousa
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, 4710-057, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, 4710-057, Braga, Portugal
- Clinical Academic Center, 4710-057, Braga, Portugal
| | - Morten L Kringelbach
- Department of Psychiatry, University of Oxford, Oxford, OX3 7JX, United Kingdom.
- Center for Music in the Brain, Aarhus University, Aarhus, 8000, Aarhus C, Denmark.
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Department of Information and Communication Technologies, Universitat Pompeu Fabra, Barcelona, 08018, Spain
- Instituci Catalana de la Recerca i Estudis Avanats (ICREA), Universitat Pompeu Fabra, Barcelona, 08010, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, 04103, Leipzig, Germany
- School of Psychological Sciences, Monash University, Clayton VIC, 3800, Melbourne, Australia
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Novel Mechanisms Underlying Inhibitory and Facilitatory Transcranial Magnetic Stimulation Abnormalities in Parkinson's Disease. Arch Med Res 2013; 44:221-8. [DOI: 10.1016/j.arcmed.2013.03.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 03/05/2013] [Indexed: 12/31/2022]
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Perfusion brain SPECT in assessing motor improvement after deep brain stimulation in Parkinson's disease. Acta Neurochir (Wien) 2013; 155:497-505. [PMID: 23334750 DOI: 10.1007/s00701-012-1610-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 12/27/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND High-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an established therapeutic approach for the management of patients with late-stage idiopathic Parkinson's disease (PD). The aim of the present study was to assess regional cerebral blood flow (rCBF) changes related to motor improvement. METHODS Twenty-one PD patients underwent two rCBF SPECT studies at rest, once preoperatively in the off-meds state and the other postoperatively (at 6 ± 2 months) in the off medication/on stimulation state. Patients were classified according to the UPDRS and H&Y scale. NeuroGam software was used to register, quantify, and compare two sequential brain SPECT studies of the same patient in order to investigate rCBF changes during STN stimulation in comparison with preoperative rCBF. The relationship between rCBF and UPDRS scores was used as a covariate of interest. RESULTS Twenty patients showed clinical improvement during the first months after surgery, resulting in a 44 % reduction of the UPDRS motor score. The administered mean daily levodopa dose significantly decreased from 850 ± 108 mg before surgery to 446 ± 188 mg during the off-meds state (p < 0.001, paired t test). At the 6-month postoperative assessment, we noticed rCBF increases in the pre-supplementary motor area (pre-SMA) and the premotor cortex (PMC) (mean rCBF increase = 10.2 %, p < 0.05), the dorsolateral prefrontal cortex and in associative and limbic territories of the frontal cortex (mean rCBF increase = 8.2 %, p > 0.05). A correlation was detected between the improvement in motor scores and the rCBF increase in the pre-SMA and PMC (r = 0.89, p < 0.001). CONCLUSIONS Our study suggests that STN stimulation leads to improvement in neural activity and rCBF increase in higher-order motor cortical areas.
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Dhawan V, Tang CC, Ma Y, Spetsieris P, Eidelberg D. Abnormal network topographies and changes in global activity: absence of a causal relationship. Neuroimage 2012; 63:1827-32. [PMID: 22951259 PMCID: PMC3474325 DOI: 10.1016/j.neuroimage.2012.08.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/13/2012] [Accepted: 08/15/2012] [Indexed: 10/28/2022] Open
Abstract
Changes in regional brain activity can be observed following global normalization procedures to reduce variability in the data. In particular, spurious regional differences may appear when scans from patients with low global activity are compared to those from healthy subjects. It has thus been suggested that the consistent increases in subcortical activity that characterize the abnormal Parkinson's disease-related metabolic covariance pattern (PDRP) are artifacts of global normalization, and that similar topographies can be identified in scans from healthy subjects with varying global activity. To address this issue, we examined the effects of experimental reductions in global metabolic activity on PDRP expression. Ten healthy subjects underwent ¹⁸F-fluorodeoxyglucose PET in wakefulness and following sleep induction. In all subjects, the global metabolic rate (GMR) declined with sleep (mean -34%, range: -17 to -56%), exceeding the test-retest differences of the measure (p<0.001). By contrast, sleep-wake differences in PDRP expression did not differ from test-retest differences, and did not correlate (R²=0.04) with concurrent declines in global metabolic activity. Indeed, despite significant GMR reductions in sleep, PDRP values remained within the normal range. Likewise, voxel weights on the principal component patterns resulting from combined analysis of the sleep and wake scans did not correlate (R²<0.07) with the corresponding regional loadings on the PDRP topography. In aggregate, the data demonstrate that abnormal PDRP expression is not induced by reductions in global activity. Moreover, significant declines in GMR are not associated with the appearance of PDRP-like spatial topographies.
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Affiliation(s)
- Vijay Dhawan
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Chris C. Tang
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Yilong Ma
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - Phoebe Spetsieris
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, 350 Community Drive, Manhasset, NY 11030, USA
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Abstract
Actions are goal-directed behaviours that usually involve movem ent. There is evidence that intentional self-generated actions (willed actions) are controlled differently from routine, stereotyped actions that are externally triggered by environmental stimuli. We review evidence from investigations using positron emission tomography (PET), recordings of movement-related cortical potentials (MRCPs) or transcranial magnetic stimulation (TMS), and conclude that willed actions are controlled by a network of frontal cortical (dorsolateral prefrontal cortex, supplementary motor area, anterior cingulate) and subcortical (thalamus and basal ganglia) areas. We also consider evidence suggesting that some of the cognitive and motor deficits of patients with frontal lesions, Parkinson's disease, or schizophrenia as well as apathy and abulia and rarer phenomena such as primary obsessional slowness can be considered as reflecting im pairment of willed actions. We propose that the concept of a willed action system based on the frontostriatal circuits provides a useful framework for integrating the cognitive, motor, and motivational deficits found in these disorders. Problems remaining to be resolved include: identification of the component processes of willed actions; the specific and differential role played by each of the frontal cortical and subcortical areas in the control of willed actions; the specific mechanisms of impairm ent of willed actions in Parkinson's disease, schizophrenia, and frontal damage; and the precise role of the neurotransmitter dopamine in the willed action system.
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10
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Wichmann T, Delong MR. Anatomy and physiology of the basal ganglia: relevance to Parkinson's disease and related disorders. HANDBOOK OF CLINICAL NEUROLOGY 2012; 83:1-18. [PMID: 18808908 DOI: 10.1016/s0072-9752(07)83001-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Thomas Wichmann
- Department of Neurology, and; Yerkes National Primate Center, Emory University, Atlanta, GA, USA
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11
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Leon-Sarmiento FE, Rizzo-Sierra CV, Bayona EA, Bayona-Prieto J, Bara-Jimenez W. WITHDRAWN: Mechanisms Underlying Inhibitory and Facilitatory Transcranial Magnetic Stimulation Abnormalities in a Large Sample of Patients with Parkinson's Disease. Arch Med Res 2012:S0188-4409(12)00158-0. [PMID: 22721866 DOI: 10.1016/j.arcmed.2012.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/24/2012] [Indexed: 10/28/2022]
Abstract
This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Fidias E Leon-Sarmiento
- Smell and Taste Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Department of Otorhinolaryngology: Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Unit of Parkinson and Movement Disorders, Mediciencias Research Group, Universidad Nacional/Ramon and Cajal Panamerican Health Foundation, Bogota, Colombia
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12
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Skidmore FM, Yang M, Baxter L, von Deneen KM, Collingwood J, He G, White K, Korenkevych D, Savenkov A, Heilman KM, Gold M, Liu Y. Reliability analysis of the resting state can sensitively and specifically identify the presence of Parkinson disease. Neuroimage 2011; 75:249-261. [PMID: 21924367 DOI: 10.1016/j.neuroimage.2011.06.056] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 06/21/2011] [Accepted: 06/22/2011] [Indexed: 11/29/2022] Open
Abstract
Parkinson disease (PD) is characterized by a number of motor and behavioral abnormalities that could be considered deficits of a "no task" or "resting" state, including resting motor findings and defects in emerging from a resting state (e.g., resting tremor, elevated resting tone, abulia, akinesia, apathy). PET imaging, and recently, the MRI technique of continuous arterial spin labeling (CASL) have shown evidence of changes in metabolic patterns in individuals with PD. The purpose of this study was to learn if the presence of PD could be "predicted" based on resting fluctuations of the BOLD signal. Participants were 15 healthy controls, 14 subjects with PD, and 1 subject who presented as a control but later developed PD. The amplitude of the low frequency fluctuation (ALFF) was used as an index of brain activity level in the resting state. Participants with PD using this index showed a reliable decrease in activity in a number of regions, including the supplementary motor cortex, the mesial prefrontal cortex, the right middle frontal gyrus, and the left cerebellum (lobule VII/VIII) as well as increased activity in the right cerebellum (lobule IV/V). Using a cross validation approach we term "Reliability Mapping of Regional Differences" (RMRD) to analyze our sample, we were able to reliably distinguish participants with PD from controls with 92% sensitivity and 87% specificity. Our "pre-diagnostic" subject segregated in our analysis with the PD group. These results suggest that resting fMRI should be considered for development as a biomarker and analytical tool for evaluation of PD.
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Affiliation(s)
- F M Skidmore
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA; Department of Psychiatry, University of Florida, Gainesville, FL, USA.
| | - M Yang
- Department of Statistics, University of Florida, Gainesville, FL, USA
| | - L Baxter
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - K M von Deneen
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - J Collingwood
- Department of Engineering, Warwick University, Warwick, UK
| | - G He
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA; Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - K White
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - D Korenkevych
- Department of Systems and Industrial Engineering, University of Florida, Gainesville, FL, USA
| | - A Savenkov
- Department of Statistics, University of Florida, Gainesville, FL, USA
| | - K M Heilman
- North Florida/South Georgia Veterans Health System, Gainesville, FL, USA; Department of Neurology, University of Florida, Gainesville, FL, USA
| | - M Gold
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Y Liu
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
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Hermes D, Miller KJ, Vansteensel MJ, Aarnoutse EJ, Leijten FSS, Ramsey NF. Neurophysiologic correlates of fMRI in human motor cortex. Hum Brain Mapp 2011; 33:1689-99. [PMID: 21692146 DOI: 10.1002/hbm.21314] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 12/03/2010] [Accepted: 03/07/2011] [Indexed: 11/12/2022] Open
Abstract
The neurophysiological underpinnings of functional magnetic resonance imaging (fMRI) are not well understood. To understand the relationship between the fMRI blood oxygen level dependent (BOLD) signal and neurophysiology across large areas of cortex, we compared task related BOLD change during simple finger movement to brain surface electric potentials measured on a similar spatial scale using electrocorticography (ECoG). We found that spectral power increases in high frequencies (65-95 Hz), which have been related to local neuronal activity, colocalized with spatially focal BOLD peaks on primary sensorimotor areas. Independent of high frequencies, decreases in low frequency rhythms (<30 Hz), thought to reflect an aspect of cortical-subcortical interaction, colocalized with weaker BOLD signal increase. A spatial regression analysis showed that there was a direct correlation between the amplitude of the task induced BOLD change on different areas of primary sensorimotor cortex and the amplitude of the high frequency change. Low frequency change explained an additional, different part of the spatial BOLD variance. Together, these spectral power changes explained a significant 36% of the spatial variance in the BOLD signal change (R(2) = 0.36). These results suggest that BOLD signal change is largely induced by two separate neurophysiological mechanisms, one being spatially focal neuronal processing and the other spatially distributed low frequency rhythms.
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Affiliation(s)
- Dora Hermes
- Section Brain Function and Plasticity, Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Dorsolateral prefrontal cortex: a possible target for modulating dyskinesias in Parkinson's disease by repetitive transcranial magnetic stimulation. Int J Biomed Imaging 2010; 2008:372125. [PMID: 18274665 PMCID: PMC2233877 DOI: 10.1155/2008/372125] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 10/02/2007] [Indexed: 12/04/2022] Open
Abstract
We studied whether five sessions of 10 Hz repetitive transcranial magnetic stimulation (rTMS treatment) applied over the dorsolateral prefrontal cortex (DLPFC) or the primary motor cortex (MC) in advanced Parkinson's disease (PD) patients would have any effect on L-dopa-induced dyskinesias and cortical excitability. We aimed at a randomised, controlled study. Single-pulse transcranial magnetic stimulation (TMS), paired-pulse transcranial magnetic stimulation, and the Unified Parkinson's Disease Rating Scale (UPDRS parts III and IV) were performed prior to, immediately after, and one week after an appropriate rTMS treatment. Stimulation of the left DLPFC induced a significant motor cortex depression and a trend towards the improvement of L-dopa-induced dyskinesias.
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Wang J, Ma Y, Huang Z, Sun B, Guan Y, Zuo C. Modulation of metabolic brain function by bilateral subthalamic nucleus stimulation in the treatment of Parkinson’s disease. J Neurol 2009; 257:72-8. [PMID: 19662326 DOI: 10.1007/s00415-009-5267-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2008] [Revised: 05/11/2009] [Accepted: 07/13/2009] [Indexed: 10/20/2022]
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16
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Activity propagation in an avian basal ganglia-thalamocortical circuit essential for vocal learning. J Neurosci 2009; 29:4782-93. [PMID: 19369547 DOI: 10.1523/jneurosci.4903-08.2009] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In mammalian basal ganglia-thalamocortical circuits, GABAergic pallidal neurons are thought to "gate" or modulate excitation in thalamus with their strong inhibitory inputs and thus signal to cortex by pausing and permitting thalamic neurons to fire in response to excitatory drive. In contrast, in a homologous circuit specialized for vocal learning in songbirds, evidence suggests that pallidal neurons signal by eliciting postinhibitory rebound spikes in thalamus, which could occur even without any excitatory drive to thalamic neurons. To test whether songbird pallidal neurons can also communicate with thalamus by gating excitatory drive, as well as by postinhibitory rebound, we examined the activity of thalamic relay neurons in response to acute inactivation of the basal ganglia structure Area X; Area X contains the pallidal neurons that project to thalamus. Although inactivation of Area X should eliminate rebound-mediated spiking in thalamus, this manipulation tonically increased the firing rate of thalamic relay neurons, providing evidence that songbird pallidal neurons can gate tonic thalamic excitatory drive. We also found that the increased thalamic activity was fed forward to its target in the avian equivalent of cortex, which includes neurons that project to the vocal premotor area. These data raise the possibility that basal ganglia circuits can signal to cortex through thalamus both by generating postinhibitory rebound and by gating excitatory drive and may switch between these modes depending on the statistics of pallidal firing. Moreover, these findings provide insight into the strikingly different disruptive effects of basal ganglia and cortical lesions on songbird vocal learning.
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Abstract
This short review focuses on practical, present day, clinical application of FDG PET, a technology available to practicing neurologists for managing their patients. Indications in the disease states of dementia, neuro-oncology, epilepsy, parkinsonism, and other less common settings are reviewed. Many third-party payers currently make reimbursements based on these indications. By measuring an aspect of brain function, PET provides information that often is unobtainable from other sources, thus facilitating more rationale and cost-effective management, which can only benefit the patient, the referring physician, and the health care system as a whole.
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Affiliation(s)
- Robert S Miletich
- Department of Nuclear Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, NY 14214, USA.
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18
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Abstract
The major part of the brain's energy budget ( approximately 60%-80%) is devoted to its communication activities. While inhibition is critical to brain function, relatively little attention has been paid to its metabolic costs. Understanding how inhibitory interneurons contribute to brain energy consumption (brain work) is not only of interest in understanding a fundamental aspect of brain function but also in understanding functional brain imaging techniques which rely on measurements related to blood flow and metabolism. Herein we examine issues relevant to an assessment of the work performed by inhibitory interneurons in the service of brain function.
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Affiliation(s)
- György Buzsáki
- Center for Molecular and Behavioral Neuroscience, Rutgers, The State University of New Jersey, Newark, NJ 07102, USA.
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Cilia R, Marotta G, Landi A, Isaias IU, Vergani F, Benti R, Sganzerla E, Gerundini P, Pezzoli G, Antonini A. Cerebral activity modulation by extradural motor cortex stimulation in Parkinson's disease: a perfusion SPECT study. Eur J Neurol 2007; 15:22-8. [PMID: 18042244 DOI: 10.1111/j.1468-1331.2007.01993.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Extradural motor cortex stimulation (EMCS) has been proposed as alternative to deep brain stimulation (DBS) in the treatment of Parkinson's disease (PD). Its mechanisms of action are still unclear. Neuroimaging evidenced motor cortical dysfunction in PD that can be reversed by therapy. We performed left hemisphere EMCS surgery in six advanced PD patients fulfilling CAPSIT criteria for DBS with the exception of age >70 years. After 6 months, we measured regional cerebral blood flow (rCBF) at rest with SPECT and Tc-99m cysteinate dimer bicisate off-medication with stimulator off and on. Clinical assessment included Unified Parkinson's Disease Rating Scale part II and III, Abnormal Involuntary Movement Scale and mean dopaminergic medication dosage. We used statistical parametric mapping for imaging data analysis. Clinically we observed no mean changes in motor scales, although blinded evaluation revealed some benefit in individual patients. We found significant rCBF decrements in the pre-central gyrus, pre-motor cortex and caudate nucleus bilaterally, left prefrontal areas and right thalamus. Perfusion increments were found in cerebellum bilaterally. EMCS determined significant modulation of neuronal activity within the cortico-basal ganglia-thalamo-cortical motor loop in our cohort of advanced PD patients. However, these effects were paralleled by mild and variable clinical efficacy.
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Affiliation(s)
- R Cilia
- Parkinson Institute, Istituti Clinici di Perfezionamento, Milan, Italy, and Department of Neurology, University of Milan-Biocca, San Gerardo Hospital, Monza, Italy.
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20
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Modulation of metabolic brain networks after subthalamic gene therapy for Parkinson's disease. Proc Natl Acad Sci U S A 2007; 104:19559-64. [PMID: 18042721 DOI: 10.1073/pnas.0706006104] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Parkinson's disease (PD) is characterized by elevated expression of an abnormal metabolic brain network that is reduced by clinically effective treatment. We used fluorodeoxyglucose (FDG) positron emission tomography (PET) to determine the basis for motor improvement in 12 PD patients receiving unilateral subthalamic nucleus (STN) infusion of an adenoassociated virus vector expressing glutamic acid decarboxylase (AAV-GAD). After gene therapy, we observed significant reductions in thalamic metabolism on the operated side as well as concurrent metabolic increases in ipsilateral motor and premotor cortical regions. Abnormal elevations in the activity of metabolic networks associated with motor and cognitive functioning in PD patients were evident at baseline. The activity of the motor-related network declined after surgery and persisted at 1 year. These network changes correlated with improved clinical disability ratings. By contrast, the activity of the cognition-related network did not change after gene transfer. This suggests that modulation of abnormal network activity underlies the clinical outcome observed after unilateral STN AAV-GAD gene therapy. Network biomarkers may be used as physiological assays in early-phase trials of experimental therapies for PD and other neurodegenerative disease.
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21
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Kaplitt MG, Feigin A, Tang C, Fitzsimons HL, Mattis P, Lawlor PA, Bland RJ, Young D, Strybing K, Eidelberg D, During MJ. Safety and tolerability of gene therapy with an adeno-associated virus (AAV) borne GAD gene for Parkinson's disease: an open label, phase I trial. Lancet 2007; 369:2097-105. [PMID: 17586305 DOI: 10.1016/s0140-6736(07)60982-9] [Citation(s) in RCA: 744] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Dopaminergic neuronal loss in Parkinson's disease leads to changes in the circuitry of the basal ganglia, such as decreased inhibitory GABAergic input to the subthalamic nucleus. We aimed to measure the safety, tolerability, and potential efficacy of transfer of glutamic acid decarboxylase (GAD) gene with adeno-associated virus (AAV) into the subthalamic nucleus of patients with Parkinson's disease. METHODS We did an open label, safety and tolerability trial of unilateral subthalamic viral vector (AAV-GAD) injection in 11 men and 1 woman with Parkinson's disease (mean age 58.2, SD=5.7 years). Four patients received low-dose, four medium-dose, and four high-dose AAV-GAD at New York Presbyterian Hospital. Inclusion criteria consisted of Hoehn and Yahr stage 3 or greater, motor fluctuations with substantial off time, and age 70 years or less. Patients were assessed clinically both off and on medication at baseline and after 1, 3, 6, and 12 months at North Shore Hospital. Efficacy measures included the Unified Parkinson's Disease Rating Scale (UPDRS), scales of activities of daily living (ADL), neuropsychological testing, and PET imaging with 18F-fluorodeoxyglucose. The trial is registered with the ClinicalTrials.gov registry, number NCT00195143. FINDINGS All patients who enrolled had surgery, and there were no dropouts or patients lost to follow-up. There were no adverse events related to gene therapy. Significant improvements in motor UPDRS scores (p=0.0015), predominantly on the side of the body that was contralateral to surgery, were seen 3 months after gene therapy and persisted up to 12 months. PET scans revealed a substantial reduction in thalamic metabolism that was restricted to the treated hemisphere, and a correlation between clinical motor scores and brain metabolism in the supplementary motor area. INTERPRETATION AAV-GAD gene therapy of the subthalamic nucleus is safe and well tolerated by patients with advanced Parkinson's disease, suggesting that in-vivo gene therapy in the adult brain might be safe for various neurodegenerative diseases.
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Affiliation(s)
- Michael G Kaplitt
- Department of Neurological Surgery, Weill Medical College of Cornell University, New York, NY, USA
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22
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Emborg ME, Carbon M, Holden JE, During MJ, Ma Y, Tang C, Moirano J, Fitzsimons H, Roitberg BZ, Tuccar E, Roberts A, Kaplitt MG, Eidelberg D. Subthalamic glutamic acid decarboxylase gene therapy: changes in motor function and cortical metabolism. J Cereb Blood Flow Metab 2007; 27:501-9. [PMID: 16835631 DOI: 10.1038/sj.jcbfm.9600364] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Parkinson's disease (PD) is associated with increased excitatory activity within the subthalamic nucleus (STN). We sought to inhibit STN output in hemiparkinsonian macaques by transfection with adeno-associated virus (AAV) containing the gene for glutamic acid decarboxylase (GAD). In total, 13 macaques were rendered hemiparkinsonian by right intracarotid 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine injection. Seven animals were injected with AAV-GAD into the right STN, and six received an AAV gene for green fluorescent protein (GFP). Videotaped motor ratings were performed in a masked fashion on a weekly basis over a 55-week period. At 56 weeks, the animals were scanned with (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Histological examination was performed at the end of the study. No adverse events were observed after STN gene therapy. We found that the clinical rating scores for the two treatment groups had different patterns of change over time (group x time interaction, P<0.001). On FDG PET, the GAD animals exhibited an increase in glucose utilization in the right motor cortex relative to GFP controls (P<0.001). Metabolism in this region correlated with clinical ratings at end point (P<0.01). Histology confirmed GAD expression in treated animals. These findings suggest that STN AAV-GAD is well tolerated and potentially effective in a primate model of PD. The changes in motor cortical glucose utilization observed after gene therapy are consistent with the modulation of metabolic brain networks associated with this disorder.
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Affiliation(s)
- Marina E Emborg
- Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI, USA
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23
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Brooks DJ. Imaging Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2007; 83:245-263. [PMID: 18808917 DOI: 10.1016/s0072-9752(07)83010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Liu Y, Postupna N, Falkenberg J, Anderson ME. High frequency deep brain stimulation: what are the therapeutic mechanisms? Neurosci Biobehav Rev 2006; 32:343-51. [PMID: 17187859 DOI: 10.1016/j.neubiorev.2006.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2005] [Revised: 08/15/2006] [Accepted: 10/22/2006] [Indexed: 01/25/2023]
Abstract
High frequency deep brain stimulation (HFS) used to treat the symptoms of Parkinson's disease (PD) was first assumed to act by reducing an excessive tonic GABAergic inhibitory output from the internal globus pallidus (GPi). Stimulation in GPi might produce this directly by mechanisms such as depolarization block or activation of presynaptic inhibitory fibers, and the same mechanisms evoked by HFS in the subthalamic nucleus (STN) could reduce the excitatory action of STN on GPi neurons. Although somatic recordings from neurons near the stimulation site may appear to support this potential mechanism, the action downstream from the site of stimulation often is not consistent with this interpretation. A more parsimonious explanation for the similar effects of HFS in STN or GPi and a lesion of either of these structures is that both HFS and pallidotomy interrupt an abnormal pattern of firing in cortico-basal ganglia-thalamocortical loops that is responsible for the symptoms of PD.
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Affiliation(s)
- Ying Liu
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington 98195, USA
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25
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Asanuma K, Tang C, Ma Y, Dhawan V, Mattis P, Edwards C, Kaplitt MG, Feigin A, Eidelberg D. Network modulation in the treatment of Parkinson's disease. Brain 2006; 129:2667-78. [PMID: 16844713 PMCID: PMC4459513 DOI: 10.1093/brain/awl162] [Citation(s) in RCA: 263] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
It has been proposed that deep brain stimulation (DBS) of the subthalamic nucleus (STN DBS) and dopaminergic therapy ameliorate the symptoms of Parkinson's disease through similar functional mechanisms. We examined this notion using PET to compare the metabolic effects of these treatment approaches. Nine Parkinson's disease patients (age 61.7 +/- 11.1 years) were scanned ON and OFF STN stimulation and nine others (age 60.0 +/- 9.3 years) were scanned ON and OFF an individual titrated intravenous levodopa infusion. The two treatment groups were matched for baseline disease severity as well as clinical response to therapy. Similarities and differences in the effects of treatment on regional metabolism were assessed using statistical parametric mapping (SPM). In addition, we used network analysis to assess the effect of therapy on the expression of an abnormal Parkinson's disease-related spatial covariance pattern (PDRP). We found that both STN DBS and levodopa therapy were associated with significant (P < 0.001) metabolic reductions in the putamen/globus pallidus, sensorimotor cortex and cerebellar vermis, as well as increases in the precuneus (BA 7). The metabolic effects of the two interventions differed in the STN and medial prefrontal cortex, with relative increases with stimulation in the former structure and decreases in the latter. Network quantification disclosed reductions in PDRP activity with both interventions, which correlated with clinical improvement (P < 0.05). The degree of network modulation by therapy did not differ significantly for the two treatment approaches (P > 0.6). These findings support the results of previous imaging studies indicating that effective symptomatic therapies for Parkinson's disease involve a common mechanism. The modulation of pathological brain networks is a critical feature of the treatment response in parkinsonism.
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Affiliation(s)
- Kotaro Asanuma
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
| | - Chengke Tang
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
| | - Yilong Ma
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
| | - Vijay Dhawan
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
| | - Paul Mattis
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
| | - Christine Edwards
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
| | | | - Andrew Feigin
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
| | - David Eidelberg
- Center for Neurosciences, Feinstein Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY
- Department of Neurology, North Shore University Hospital and New York University School of Medicine, NY, USA
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26
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Trošt M, Su S, Su P, Yen RF, Tseng HM, Barnes A, Ma Y, Eidelberg D. Network modulation by the subthalamic nucleus in the treatment of Parkinson's disease. Neuroimage 2006; 31:301-7. [PMID: 16466936 PMCID: PMC4454374 DOI: 10.1016/j.neuroimage.2005.12.024] [Citation(s) in RCA: 121] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 11/25/2005] [Accepted: 12/07/2005] [Indexed: 10/25/2022] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN DBS) has become an accepted tool for the treatment of Parkinson's disease (PD). Although the precise mechanism of action of this intervention is unknown, its effectiveness has been attributed to the modulation of pathological network activity. We examined this notion using positron emission tomography (PET) to quantify stimulation-induced changes in the expression of a PD-related covariance pattern (PDRP) of regional metabolism. These metabolic changes were also compared with those observed in a similar cohort of patients undergoing STN lesioning. We found that PDRP activity declined significantly (P < 0.02) with STN stimulation. The degree of network modulation with DBS did not differ from that measured following lesioning (P = 0.58). Statistical parametric mapping (SPM) revealed that metabolic reductions in the internal globus pallidus (GPi) and caudal midbrain were common to both STN interventions (P < 0.01), although declines in GPi were more pronounced with lesion. By contrast, elevations in posterior parietal metabolism were common to the two procedures, albeit more pronounced with stimulation. These findings indicate that suppression of abnormal network activity is a feature of both STN stimulation and lesioning. Nonetheless, these two interventions may differ metabolically at a regional level.
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Affiliation(s)
- Maja Trošt
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA
- Department of Neurology, University Medical Centre, Ljubljana, Slovenia
| | - Sherwin Su
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA
| | - Philip Su
- Departments of Neurology, Neurosurgery, and Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ruoh-Fang Yen
- Departments of Neurology, Neurosurgery, and Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ham-Min Tseng
- Departments of Neurology, Neurosurgery, and Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Anna Barnes
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA
| | - Yilong Ma
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA
- Departments of Neurology and Medicine, New York University School of Medicine, New York, NY 10016, USA
| | - David Eidelberg
- Center for Neurosciences, Institute for Medical Research, North Shore-Long Island Jewish Health System, Manhasset, NY 11030, USA
- Departments of Neurology and Medicine, New York University School of Medicine, New York, NY 10016, USA
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Abstract
In this review, we discuss the role of neuroimaging in assessing treatment options for movement disorders, particularly Parkinson's disease (PD). Imaging methods to assess dopaminergic function have recently been applied in trials of potential neuroprotective agents. Other imaging methods using regional metabolism and/or cerebral perfusion have been recently introduced to quantify the modulation of network activity as an objective marker of the treatment response. Both imaging strategies have provided novel insights into the mechanisms underlying a variety of pharmacological and stereotaxic surgical treatment strategies for PD and other movement disorders.
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Affiliation(s)
- Thomas Eckert
- Department of Neurology II and Psychiatry, University of Magdeburg, Germany
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28
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Newberg AB, Alavi A. The role of PET imaging in the management of patients with central nervous system disorders. Radiol Clin North Am 2005; 43:49-65. [PMID: 15693647 DOI: 10.1016/j.rcl.2004.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PET will continue to play a critical role in both clinical and research applications with regard to CNS disorders. PET is useful in the initial diagnosis of patients presenting with CNS symptoms and can help clinicians determine the best course of therapy. PET studies can also be useful for studying the response to therapy. From the research perspective, the various neurotransmitter and other molecular tracers currently available or in development will provide substantial information about pathophysiologic process in the brain. As such applications become more widely tested, their introduction into the clinical arena will further advance the use of PET imaging in the evaluation and management of CNS disorders.
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Affiliation(s)
- Andrew B Newberg
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, 110 Donner Building, Philadelphia, PA 19104, USA.
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29
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Scarmeas N, Habeck CG, Zarahn E, Anderson KE, Park A, Hilton J, Pelton GH, Tabert MH, Honig LS, Moeller JR, Devanand DP, Stern Y. Covariance PET patterns in early Alzheimer's disease and subjects with cognitive impairment but no dementia: utility in group discrimination and correlations with functional performance. Neuroimage 2004; 23:35-45. [PMID: 15325350 PMCID: PMC3026571 DOI: 10.1016/j.neuroimage.2004.04.032] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2003] [Revised: 03/20/2004] [Accepted: 04/28/2004] [Indexed: 10/26/2022] Open
Abstract
Although multivariate analytic techniques might identify diagnostic patterns that are not captured by univariate methods, they have rarely been used to study the neural correlates of Alzheimer's disease (AD) or cognitive impairment. Nonquantitative H2(15)O PET scans were acquired during rest in 17 probable AD subjects selected for mild severity [mean-modified Mini Mental Status Examination (mMMS) 46/57; SD 5.1], 16 control subjects (mMMS 54; SD 2.5) and 23 subjects with minimal to mild cognitive impairment but no dementia (mMMS 53; SD 2.8). Expert clinical reading had low success in discriminating AD and controls. There were no significant mean flow differences among groups in traditional univariate SPM Noxel-wise analyses or region of interest (ROI) analyses. A covariance pattern was identified whose mean expression was significantly higher in the AD as compared to controls (P = 0.03; sensitivity 76-94%; specificity 63-81%). Sites of increased concomitant flow included insula, cuneus, pulvinar, lingual, fusiform, superior occipital and parahippocampal gyri, whereas decreased concomitant flow was found in cingulate, inferior parietal lobule, middle and inferior frontal, supramarginal and precentral gyri. The covariance analysis-derived pattern was then prospectively applied to the cognitively impaired subjects: as compared to subjects with Clinical Dementia Rating (CDR) = 0, subjects with CDR = 0.5 had significantly higher mean covariance pattern expression (P = 0.009). Expression of this pattern correlated inversely with Selective Reminding Test total recall (r = -0.401, P = 0.002), delayed recall (r = -0.351, P = 0.008) and mMMS scores (r = -0.401, P = 0.002) in all three groups combined. We conclude that patients with AD may differentially express resting cerebral blood flow covariance patterns even at very early disease stages. Significant alterations in expression of resting flow covariance patterns occur even for subjects with cognitive impairment. Expression of covariance patterns correlates with cognitive and functional performance measures, holding promise for meaningful associations with underlying biopathological processes.
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Affiliation(s)
- Nikolaos Scarmeas
- Cognitive Neuroscience Division of the Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA.
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30
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Zgaljardic DJ, Feigin A. Neuroimaging of Parkinson's disease and atypical parkinsonism. Curr Neurol Neurosci Rep 2004; 4:284-9. [PMID: 15217542 DOI: 10.1007/s11910-004-0053-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The basal ganglia and its associated circuitry can be assessed with a variety of neuroimaging methods that can provide information regarding specific neurotransmitter systems, the functional activity of brain regions, and the structural integrity of these regions. In Parkinson's disease (PD) and related atypical parkinsonian syndromes (APS), these imaging methods may be useful for many reasons, including aiding in differential diagnosis and measuring the efficacy of new therapies. This paper reviews recent developments in the application of neuroimaging to the assessment of PD and related APS.
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Affiliation(s)
- Dennis J Zgaljardic
- Center for Neurosciences, North Shore-Long Island Jewish Research Institute, 350 Community Drive, Manhasset, NY 11030, USA.
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31
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Zonenshayn M, Sterio D, Kelly PJ, Rezai AR, Beric A. Location of the active contact within the subthalamic nucleus (STN) in the treatment of idiopathic Parkinson's disease. ACTA ACUST UNITED AC 2004; 62:216-25; discussion 225-6. [PMID: 15336862 DOI: 10.1016/j.surneu.2003.09.039] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2003] [Accepted: 09/22/2003] [Indexed: 11/21/2022]
Abstract
BACKGROUND Chronic electrical stimulation of the subthalamic nucleus (STN) has been shown to be safe and effective in the treatment of medically refractory idiopathic Parkinson's disease. The clinically most relevant location of stimulation within the physiologically defined STN has not been confirmed. We reviewed the locations of active electrical contacts in 33 patients who underwent simultaneous bilateral STN deep brain stimulator (DBS) implantation. METHODS The location of the microelectrode-defined dorsal STN border was compared to the location of the center of the active contact(s) employed in achieving optimal clinical results 6 to 18 months postoperatively. Furthermore, the location of this optimal contact was determined with respect to each individual patient's midcommissural point. Bilateral monopolar stimulation was employed in 30 patients using quadripolar DBS electrodes. RESULTS After a minimum follow-up period of 6 months, the motor subscores (UPDRS Part III) in the postoperative on-stimulation/off-medication state were 64 +/- 18% (mean +/- SD) improved as compared to the preoperative off-medication state (p < 0.01). Additionally, an improvement of 53 +/- 38% was noted when comparing the postoperative on-stimulation/on-medication state to the preoperative on-medication state (p < 0.01). On average, the center of the optimal contact was 13.3 mm lateral, 0.5 mm posterior, 0.1 mm inferior to the mid-commissural point and was 0.1 +/- 2.1 mm dorsal to the physiologically defined dorsal STN border. CONCLUSIONS While the achieved clinical results are comparable to those published in the literature, it appears that monopolar electrical stimulation at the anterior dorsolateral border of the STN yields optimal clinical results. Further studies are crucial in determining the precise mechanism of various modes of DBS in an effort to maximize clinical outcome.
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Affiliation(s)
- Martin Zonenshayn
- New York University Center for Functional and Restorative Neurosurgery, New York, New York, USA
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Breit S, Schulz JB, Benabid AL. Deep brain stimulation. Cell Tissue Res 2004; 318:275-88. [PMID: 15322914 DOI: 10.1007/s00441-004-0936-0] [Citation(s) in RCA: 144] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2004] [Accepted: 06/01/2004] [Indexed: 01/11/2023]
Abstract
During the last decade deep brain stimulation (DBS) has become a routine method for the treatment of advanced Parkinson's disease (PD), leading to striking improvements in motor function and quality of life of PD patients. It is associated with minimal morbidity. The rationale of targeting specific structures within basal ganglia such as the subthalamic nucleus (STN) or the internal segment of the globus pallidus (GPi) is strongly supported by the current knowledge of the basal ganglia pathophysiology, which is derived from extensive experimental work and which provides the theoretical basis for surgical therapy in PD. In particular, the STN has advanced to the worldwide most used target for DBS in the treatment of PD, due to the marked improvement of all cardinal symptoms of the disease. Moreover on-period dyskinesias are reduced in parallel with a marked reduction of the equivalent daily levodopa dose following STN-DBS. The success of the therapy largely depends on the selection of the appropriate candidate patients and on the precise implantation of the stimulation electrode, which necessitates careful imaging-based pre-targeting and extensive electrophysiological exploration of the target area. Despite the clinical success of the therapy, the fundamental mechanisms of high-frequency stimulation are still not fully elucidated. There is a large amount of evidence from experimental and clinical data that stimulation frequency represents a key factor with respect to clinical effect of DBS. Interestingly, high-frequency stimulation mimics the functional effects of ablation in various brain structures. The main hypotheses for the mechanism of high-frequency stimulation are: (1) depolarization blocking of neuronal transmission through inactivation of voltage dependent ion-channels, (2) jamming of information by imposing an efferent stimulation-driven high-frequency pattern, (3) synaptic inhibition by stimulation of inhibitory afferents to the target nucleus, (4) synaptic failure by stimulation-induced neurotransmitter depletion. As the hyperactivity of the STN is considered a functional hallmark of PD and as there is experimental evidence for STN-mediated glutamatergic excitotoxicity on neurons of the substantia nigra pars compacta (SNc), STN-DBS might reduce glutamatergic drive, leading to neuroprotection. Further studies will be needed to elucidate if STN-DBS indeed provides a slow-down of disease progression.
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Affiliation(s)
- Sorin Breit
- Department of General Neurology, Hertie Institute for Clinical Brain Research, Center of Neurology, University of Tübingen, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany.
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Hilker R, Voges J, Weisenbach S, Kalbe E, Burghaus L, Ghaemi M, Lehrke R, Koulousakis A, Herholz K, Sturm V, Heiss WD. Subthalamic nucleus stimulation restores glucose metabolism in associative and limbic cortices and in cerebellum: evidence from a FDG-PET study in advanced Parkinson's disease. J Cereb Blood Flow Metab 2004; 24:7-16. [PMID: 14688612 DOI: 10.1097/01.wcb.0000092831.44769.09] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) is a highly effective surgical treatment in patients with advanced Parkinson's disease (PD). Because the STN has been shown to represent an important relay station not only in motor basal ganglia circuits, the modification of brain areas also involved in non-motor functioning can be expected by this intervention. To determine the impact of STN-DBS upon the regional cerebral metabolic rate of glucose (rCMRGlc), we performed positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) in eight patients with advanced PD before surgery as well as in the DBS on- and off-conditions 4 months after electrode implantation and in ten age-matched healthy controls. Before surgery, PD patients showed widespread bilateral reductions of cortical rCMRGlc versus controls but a hypermetabolic state in the left rostral cerebellum. In the STN-DBS on-condition, clusters of significantly increased rCMRGlc were found in both lower thalami reaching down to the midbrain area and remote from the stimulation site in the right frontal cortex, temporal cortex, and parietal cortex, whereas rCMRGlc significantly decreased in the left rostral cerebellum. Therefore, STN-DBS was found to suppress cerebellar hypermetabolism and to partly restore physiologic glucose consumption in limbic and associative projection territories of the basal ganglia. These data suggest an activating effect of DBS upon its target structures and confirm a central role of the STN in motor as well as associative, limbic, and cerebellar basal ganglia circuits.
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Affiliation(s)
- Ruediger Hilker
- Departments of Neurology and dagger Stereotaxy and Functional Neurosurgery, University Hospital, Cologne, Germany
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Brownell AL, Canales K, Chen YI, Jenkins BG, Owen C, Livni E, Yu M, Cicchetti F, Sanchez-Pernaute R, Isacson O. Mapping of brain function after MPTP-induced neurotoxicity in a primate Parkinson's disease model. Neuroimage 2003; 20:1064-75. [PMID: 14568476 DOI: 10.1016/s1053-8119(03)00348-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2002] [Revised: 06/01/2003] [Accepted: 06/03/2003] [Indexed: 01/28/2023] Open
Abstract
Neurophysiological studies of the brain in normal and Parkinson's disease (PD) patients have indicated intricate connections for basal ganglia-induced control of signaling into the motor cortex. To investigate if similar mechanisms are controlling function in the primate brain (Macaca fascicularis) after MPTP-induced neurotoxicity, we conducted PET studies of cerebral blood flow, oxygen and glucose metabolism, dopamine transporter, and D2 receptor function. Our observations after MPTP-induced dopamine terminal degeneration of the caudate and putamen revealed increased blood flow (15%) in the globus pallidus (GP), while blood flow was moderately decreased (15-25%) in the caudate, putamen, and thalamus and 40 % in the primary motor cortex (PMC). Oxygen extraction fraction was moderately increased (10-20%) in other brain areas but the thalamus, where no change was observable. Oxygen metabolism was increased in the GP and SMA (supplementary motor area including premotor cortex, Fig. 3) by a range of 20-40% and decreased in the putamen and caudate and in the PMC. Glucose metabolism was decreased in the caudate, putamen, thalamus, and PMC (range 35-50%) and enhanced in the GP by 15%. No change was observed in the SMA. In the parkinsonian primate, [(11)C]CFT (2beta-carbomethoxy-3beta-(4-fluorophenyltropane) dopamine transporter binding was significantly decreased in the putamen and caudate (range 60-65%). [(11)C]Raclopride binding of dopamine D(2) receptors did not show any significant changes. These experimental results obtained in primate studies of striato-thalamo-cortico circuitry show a similar trend as hypothetized in Parkinson's disease-type degeneration.
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Affiliation(s)
- Anna Liisa Brownell
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA.
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Trost M, Su PC, Barnes A, Su SL, Yen RF, Tseng HM, Ma Y, Eidelberg D. Evolving metabolic changes during the first postoperative year after subthalamotomy. J Neurosurg 2003; 99:872-8. [PMID: 14609167 DOI: 10.3171/jns.2003.99.5.0872] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Short-term benefit from unilateral subthalamotomy for advanced Parkinson disease (PD) is associated with metabolic alterations in key targets of subthalamic nucleus (STN) and globus pallidus (GP) output. In this study positron emission tomography (PET) scanning was used to assess these changes and their relation to long-term benefits of subthalamotomy. METHODS To determine whether the early postoperative changes persisted at longer-term follow up, the authors assessed six patients with advanced PD by using [18F]fluorodeoxyglucose-PET at 3 and 12 months postsurgery. The authors compared each of the postoperative images with baseline studies, and assessed interval changes between the short- and long-term follow-up scans. Clinical improvement at 3 and 12 months was associated with sustained metabolic decreases in the midbrain GP internus (GPi), thalamus, and pons of the lesioned side (p < 0.01). The activity of a PD-related multiregional brain network, which correlated with bradykinesia and rigidity, was reduced at both postoperative time points (p < 0.05). Comparisons of 3- and 12-month images revealed a relative metabolic increase in the GP externus (GPe) (p < 0.001), which was associated with worsening gait, postural stability, and tremor at long-term follow up. CONCLUSIONS These findings indicate that subthalamotomy may have differential effects on each of the functional pathways that mediate parkinsonian symptomatology. Sustained relief of akinesia and rigidity is associated with suppression of a pathological network involving the GPi and its output. In contrast, the recurrence of tremor may relate to changes in the function of an STN-GPe oscillatory network.
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Affiliation(s)
- Maja Trost
- Center for Neurosciences, North Shore-Long Island Jewish Research Institute, Manhasset, USA
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O'Sullivan JD, Maruff P, Tyler P, Peppard RF, McNeill P, Currie J. Unilateral pallidotomy for Parkinson's disease disrupts ocular fixation. J Clin Neurosci 2003; 10:181-5. [PMID: 12637045 DOI: 10.1016/s0967-5868(02)00125-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Although some motor functions of the basal ganglia have been well studied, the oculomotor functions are not well established. We studied eye movements in patients with Parkinson's disease (PD) undergoing pallidotomy to assess the role of the globus pallidus interna (GPi) in oculomotor control. Horizontal visually guided, gap and predictive saccades as well as ocular fixation were studied in patients with advanced PD before and 1 month after unilateral pallidotomy, and in healthy controls on two occasions 1 month apart. There was no difference in saccadic latency or accuracy, the number of saccadic anticipations or the ability to generate predictive saccades between the two assessments for either patients or controls. The number and amplitude of square wave jerks during ocular fixation however increased significantly in patients after pallidotomy. The results imply altered function of frontal or prefrontal cortical regions involved in ocular fixation resulting from a disruption to inhibitory pallidal influences on thalamocortical projections. The posteroventral GPi however appears not to be involved in externally controlled or predictive saccadic function.
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Affiliation(s)
- John D O'Sullivan
- Department of Clinical Neuroscience, St Vincent's Hospital, Fitzroy, 3065 Victoria, Australia.
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Gironell A, Rodríguez-Fornells A, Kulisevsky J, Pascual B, Barbanoj M, Otermin P. Motor circuitry re-organization after pallidotomy in Parkinson disease: a neurophysiological study of the bereitschaftspotential, contingent negative variation, and N30. J Clin Neurophysiol 2002; 19:553-61. [PMID: 12488787 DOI: 10.1097/00004691-200212000-00009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of the study was to evaluate the reorganization changes in the motor circuitry of the basal ganglia following unilateral posteroventral pallidotomy in Parkinson disease (PD) patients using neurophysiological paradigms. Eight advanced PD patients received a neurophysiological battery 2 months prior and 6 months after unilateral pallidotomy. Examinations were all performed in the practically defined "off" situation. Bereitschaftspotential (BP) and N30 were recorded for each hand alternately. Contingent negative variation (CNV) was obtained using a visual Go/no-Go paradigm. ANOVAs (electrode position; surgery) were applied for BP and CNV results. N30 data were analyzed using Wilcoxon matched-pair tests. A significant increase in amplitude of the late component (NS') of the BP was evidenced with patient performing with the hand contralateral to pallidotomy. No significant amplitude differences were found in CNV after surgery in any lead, or in any of the time windows tested. A trend toward significance was observed corresponding to a postsurgical numerical increase in amplitude of the N30 peak in the hand contralateral to pallidotomy. These results suggest that neurophysiological changes after pallidotomy are mainly in the last stages of movement preparation and execution.
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Affiliation(s)
- A Gironell
- Servei de Neurologia, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Catalonia, Spain.
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Tröster AI, Woods SP, Fields JA, Hanisch C, Beatty WW. Declines in switching underlie verbal fluency changes after unilateral pallidal surgery in Parkinson's disease. Brain Cogn 2002; 50:207-17. [PMID: 12464190 DOI: 10.1016/s0278-2626(02)00504-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Declines in verbal fluency are consistently reported in patients with Parkinson's disease (PD) after pallidal surgery. In the present study, the clustering and switching components of semantic or category fluency (oral naming of items obtainable in supermarkets) were examined at baseline and four months after unilateral deep brain stimulation or pallidotomy in 45 patients with PD (30 left, 15 right pallidal surgery). Post-operative declines were observed for supermarket fluency total score and switching, but not for average cluster size. These findings support the proposal that semantic fluency decrements after pallidal surgery reflect a disruption of frontal-basal ganglia circuits mediating efficient shifting between semantic categories, or perhaps efficient access to categories, rather than a degradation of semantic stores.
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Affiliation(s)
- Alexander I Tröster
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA.
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Feigin A, Antonini A, Fukuda M, De Notaris R, Benti R, Pezzoli G, Mentis MJ, Moeller JR, Eidelberg D. Tc-99m ethylene cysteinate dimer SPECT in the differential diagnosis of parkinsonism. Mov Disord 2002; 17:1265-70. [PMID: 12465066 DOI: 10.1002/mds.10270] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Positron emission tomography (PET) and network analysis have been used to identify a reproducible pattern of regional metabolic covariation that is associated with idiopathic Parkinson's disease (PD). The activity of this PD-related pattern can be quantified in individual subjects and used to discriminate PD patients from atypical parkinsonians. Because PET is not commonly available, we sought to determine whether similar discrimination could be achieved using more routine single photon emission computed tomography (SPECT) perfusion methods. Twenty-three subjects with PD (age, 63 +/- 9 years), 22 subjects with multiple system atrophy (MSA; age, 64 +/- 7 years), and 20 age-matched healthy controls (age, 62 +/- 13 years) underwent SPECT imaging of regional cerebral perfusion with Tc-99m ethylene cysteinate dimer (ECD). Using network analysis, we determined whether a PD-related pattern existed in the SPECT data, and whether its expression discriminated PD from MSA patients. Additionally, we compared the accuracy of group discrimination achieved by this pattern with that of the PET-derived PD-related pattern applied to the SPECT data. Network analysis of the SPECT data identified a significant pattern characterized by relative increases in cerebellar, lentiform, and thalamic perfusion covarying with decrements in the frontal operculum and in the medial temporal cortex. Subject scores for this pattern discriminated PD patients from controls (P < 0.01) and from MSA patients (P < 0.03). Subject scores for the PET-derived PD-related pattern computed in the individual SPECT scans more accurately distinguished PD patients from controls (P < 0.005) and from MSA patients (P = 0.0002). A significant PD-related covariance pattern can be identified in SPECT perfusion data. Moreover, the disease related pattern identified previously with PET can be applied to individual SPECT perfusion scans to provide group discrimination between PD patients, healthy controls, and individuals with MSA. Because of significant individual subject overlap between groups, however, the clinical utility of this method in the differential diagnosis of Parkinsonism remains uncertain.
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Affiliation(s)
- Andrew Feigin
- Center for Neuroscience, North Shore University Hospital, Manhasset, New York and New York University School of Medicine, New York, New York, USA.
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The Metabolic Substrates of Bradykinesia and Tremor in Uncomplicated Parkinson's Disease. Neuroimage 2002. [DOI: 10.1006/nimg.2002.1245] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Carbon M, Eidelberg D. Modulation of regional brain function by deep brain stimulation: studies with positron emission tomography. Curr Opin Neurol 2002; 15:451-5. [PMID: 12151842 DOI: 10.1097/00019052-200208000-00008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fukuda M, Ghilardi MF, Carbon M, Dhawan V, Ma Y, Feigin A, Mentis MJ, Ghez C, Eidelberg D. Pallidal stimulation for parkinsonism: improved brain activation during sequence learning. Ann Neurol 2002; 52:144-52. [PMID: 12210783 DOI: 10.1002/ana.10261] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We used (15)O-labeled water and positron emission tomography to assess the effect of deep brain stimulation of the internal globus pallidus on motor sequence learning in Parkinson's disease. Seven right-handed patients were scanned on and off stimulation while they were performing a motor sequence learning task and a kinematically matched motor execution reference task. The scans were performed after a 12-hour medication washout. Stimulation parameters were adjusted for maximal motor improvement; experimental task parameters were held constant across stimulation conditions. Internal globus pallidus stimulation improved motor ratings by 37% (p < 0.01). During the sequence learning task, stimulation improved performance as measured by several correct anticipatory movements (p < 0.01) and by verbal report (p < 0.001). Concurrent positron emission tomography imaging during learning demonstrated significant (p < 0.01) increases in brain activation with stimulation in the left dorsolateral prefrontal cortex, bilaterally in premotor cortex, and in posterior parietal and occipital association areas. Stimulation did not affect the activity of these regions during the performance of the motor execution reference task. These findings suggest that internal globus pallidus deep brain stimulation can enhance the activity of prefrontal cortico-striato-pallidothalamic loops and related transcortical pathways. Improved sequence learning with stimulation may be directly related to these functional changes.
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Affiliation(s)
- Masafumi Fukuda
- Center for Neurosciences, North Shore-Long Island Jewish Research Institute, Manhasset, NY 11030, USA
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Feigin A, Ghilardi MF, Fukuda M, Mentis MJ, Dhawan V, Barnes A, Ghez CP, Eidelberg D. Effects of levodopa infusion on motor activation responses in Parkinson's disease. Neurology 2002; 59:220-6. [PMID: 12136061 DOI: 10.1212/wnl.59.2.220] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Clinical improvement with levodopa therapy for PD is associated with specific regional changes in cerebral glucose metabolism. However, it is unknown how these effects of treatment in the resting state relate to alterations in brain function that occur during movement. In this study, the authors used PET to assess the effects of levodopa on motor activation responses and determined how these changes related to on-line recordings of movement speed and accuracy. METHODS Seven right-handed PD patients were scanned with H(2)15O/PET while performing a predictable paced sequence of reaching movements and while observing the same screen displays and tones. PET studies were performed during "on" and "off" states with an individually titrated constant rate levodopa infusion; movements were kinematically controlled across treatment conditions. RESULTS Levodopa improved "off" state UPDRS motor ratings (34%; p < 0.006) and movement time (18%; p = 0.001). Spatial errors worsened during levodopa infusion (24%; p = 0.02). Concurrent regional cerebral blood flow (rCBF) recordings revealed significant enhancement of motor activation responses in the posterior putamen bilaterally (p < 0.001), left ventral thalamus (p < 0.002), and pons (p < 0.005). Movement time improvement with treatment correlated with rCBF increases in the left globus pallidus and left ventral thalamus (p < 0.01). By contrast, the increase in spatial errors correlated with rCBF increases in the cerebellar vermis (p < 0.01). CONCLUSION These results suggest that levodopa infusion may improve aspects of motor performance while worsening others. Different components of the motor cortico-striato-pallido-thalamo-cortical loop and related pathways may underlie motor improvement and adverse motoric effects of levodopa therapy for PD.
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Affiliation(s)
- A Feigin
- Center for Neurosciences, North Shore-LIJ Research Institute, Manhasset, NY 11030, USA.
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Enhanced synchrony among primary motor cortex neurons in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine primate model of Parkinson's disease. J Neurosci 2002. [PMID: 12040070 DOI: 10.1523/jneurosci.22-11-04639.2002] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Primary motor cortex (MI) neurons discharge vigorously during voluntary movement. A cardinal symptom of Parkinson's disease (PD) is poverty of movement (akinesia). Current models of PD thus hypothesize that increased inhibitory pallidal output reduces firing rates in frontal cortex, including MI, resulting in akinesia and muscle rigidity. We recorded the simultaneous spontaneous discharge of several neurons in the arm-related area of MI of two monkeys and in the globus pallidus (GP) of one of the two. Accelerometers were fastened to the forelimbs to detect movement, and surface electromyograms were recorded from the contralateral arm of one monkey. The recordings were conducted before and after systemic treatment with 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), rendering the animals severely akinetic and rigid with little or no tremor. The mean spontaneous MI rates during periods of immobility (four to five spikes/sec) did not change after MPTP; however, in this parkinsonian state, MI neurons discharged in long bursts (sometimes >2 sec long). These bursts were synchronized across many cells but failed to elicit detectable movement, indicating that even robust synchronous MI discharge need not result in movement. These synchronized population bursts were absent from the GP and were on a larger timescale than oscillatory synchrony found in the GP of tremulous MPTP primates, suggesting that MI parkinsonian synchrony arises independently of basal ganglia dynamics. After MPTP, MI neurons responded more vigorously and with less specificity to passive limb movement. Abnormal MI firing patterns and synchronization, rather than reduced firing rates, may underlie PD akinesia and persistent muscle rigidity.
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Jahanshahi M, Rowe J, Saleem T, Brown RG, Limousin-Dowsey P, Rothwell JC, Thomas DGT, Quinn NP. Striatal contribution to cognition: working memory and executive function in Parkinson's disease before and after unilateral posteroventral pallidotomy. J Cogn Neurosci 2002; 14:298-310. [PMID: 11970793 DOI: 10.1162/089892902317236911] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The basal ganglia are intimately connected to the frontal cortex via five fronto-striatal circuits. While the role of the frontal cortex in cognition has been extensively studied, the contribution of the basal ganglia to cognition has remained less clear. In Parkinson's disease, posteroventral pallidotomy (PVP) involves surgical lesioning of the internal section of the globus pallidus (GPi, the final output pathway from the basal ganglia) to relieve the motor symptoms of the disorder. PVP in Parkinson's disease provides a unique opportunity to investigate the impact of disruption of striatal outflow to the frontal cortex on cognition. We assessed executive function and working memory after withdrawal of medication in 13 patients with Parkinson's disease before and 3 months after unilateral PVP compared to 12 age- and IQ-matched normals assessed twice with an interval of 3 months. The tests used were: Wisconsin Card Sorting (WCST), Self-Ordered Random Number Sequences, Missing Digit Test, Paced Visual Serial Addition Test (PVSAT), and Visual Conditional Associative Learning Test (VCALT). After PVP, the patients performed significantly better on the Self-Ordered Random Number Sequences and the WCST, an improvement that was also observed in the normals across the two assessment and is therefore likely to reflect practice effects. Relative to the normals, the patients showed significant differential change following PVP on the Missing Digit Test and PVSAT, on which they performed worse after compared to before surgery, while the controls performed better on the second assessment. For the patients, performance on the VCALT also indicated deterioration after PVP, but the changes approached significance. The side of PVP had no effect on the results. The pattern of change observed 3 months after PVP was maintained at 15-month follow-up. The results suggest that striatal outflow to the frontal cortex may be essential for those aspects of executive function that showed deterioration after PVP.
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Affiliation(s)
- M Jahanshahi
- Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, UK.
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Sterio D, Zonenshayn M, Mogilner AY, Rezai AR, Kiprovski K, Kelly PJ, Beric A. Neurophysiological Refinement of Subthalamic Nucleus Targeting. Neurosurgery 2002. [DOI: 10.1227/00006123-200201000-00012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Sterio D, Zonenshayn M, Mogilner AY, Rezai AR, Kiprovski K, Kelly PJ, Beric A. Neurophysiological refinement of subthalamic nucleus targeting. Neurosurgery 2002; 50:58-67; discussion 67-9. [PMID: 11844235 DOI: 10.1097/00006123-200201000-00012] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2001] [Accepted: 08/16/2001] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Advances in image-guided stereotactic surgery, microelectrode recording techniques, and stimulation technology have been the driving forces behind a resurgence in the use of functional neurosurgery for the treatment of movement disorders. Despite the dramatic effects of deep brain stimulation (DBS) techniques in ameliorating the symptoms of Parkinson's disease, many critical questions related to the targeting, effects, and mechanisms of action of DBS remain unanswered. In this report, we describe the methods used to localize the subthalamic nucleus (STN) and we present the characteristics of encountered cells. METHODS Twenty-six patients with idiopathic Parkinson's disease underwent simultaneous, bilateral, microelectrode-refined, DBS electrode implantation into the STN. Direct and indirect magnetic resonance imaging-based anatomic targeting was used. Cellular activity was analyzed for various neurophysiological parameters, including firing rates and interspike intervals. Physiological targeting confirmation was obtained by performing macrostimulation through the final DBS electrode. RESULTS The average microelectrode recording time for each trajectory was 20 minutes, with a mean of 5.2 trajectories/patient. Typical trajectories passed through the anterior thalamus, zona incerta/fields of Forel, STN, and substantia nigra-pars reticulata. Each structure exhibited a characteristic firing pattern. In particular, recordings from the STN exhibited an increase in background activity and an irregular firing pattern, with a mean rate of 47 Hz. The mean cell density was 5.6 cells/mm, with an average maximal trajectory length of 5.3 mm. Macrostimulation via the DBS electrode yielded mean sensory and motor thresholds of 4.2 and 5.7 V, respectively. CONCLUSION The principal objectives of microelectrode recording refinement of anatomic targeting are precise identification of the borders of the STN and thus determination of its maximal length. Microelectrode recording also allows identification of the longest and most lateral segment of the STN, which is our preferred target for STN DBS electrode implantation. Macrostimulation via the final DBS electrode is then used primarily to establish the side effect profile for postoperative stimulation. Microelectrode recording is a helpful targeting adjunct that will continue to facilitate our understanding of basal ganglion physiological features.
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Affiliation(s)
- Djordje Sterio
- Department of Neurosurgery, New York University School of Medicine, 301 East 17th Street, New York, NY 10003, USA
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Su PC, Tseng HM, Liou HH. Postural asymmetries following unilateral subthalomotomy for advanced Parkinson's disease. Mov Disord 2002; 17:191-4. [PMID: 11835462 DOI: 10.1002/mds.1269] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Two cases of postural asymmetries following unilateral stereotaxic subthalamotomy were observed with head and body tilting to the side contralateral to the STN lesion, which corrected itself completely or partially with levodopa treatment. After subsequent contralateral STN surgery, the postural asymmetry disappeared in both patients. Possible mechanism is discussed.
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Affiliation(s)
- Philip C Su
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
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Jech R, Urgosík D, Tintera J, Nebuzelský A, Krásenský J, Liscák R, Roth J, Růzicka E. Functional magnetic resonance imaging during deep brain stimulation: a pilot study in four patients with Parkinson's disease. Mov Disord 2001; 16:1126-32. [PMID: 11748747 DOI: 10.1002/mds.1217] [Citation(s) in RCA: 136] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Functional magnetic resonance imaging (fMRI) was performed in patients with Parkinson's disease during deep brain stimulation of the subthalamic nucleus (three patients) and during deep brain stimulation of the ventral intermedius nucleus of the thalamus (one patient). All showed an increase in blood oxygenation level-dependent signal in the subcortical regions ipsilateral to the stimulated nucleus. This effect cannot be simply explained by a mechanism of depolarization blockade; rather, it is caused by overstimulation of the target nucleus, resulting in the suppression of its spontaneous activity. We confirm that fMRI during deep brain stimulation is a safe method with considerable potential for elucidating the functional connectivity of the stimulated nuclei.
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Affiliation(s)
- R Jech
- Movement Disorders Center, Department of Neurology, 1st Medical Faculty, Charles University, Prague, Czech Republic.
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Abstract
With the advent of new methods of network analysis, we have utilized metabolic data acquired through positron emission tomography (PET) to identify disease-related patterns of functional pathology in the movement disorders. In Parkinson's disease (PD), we have used [(18)F]-fluorodeoxyglucose (FDG)/PET to identify a disease-related regional metabolic covariance pattern characterized by lentiform and thalamic hypermetabolism associated with regional metabolic decrements in the lateral premotor cortex, the supplementary motor area, the dorsolateral prefrontal cortex, and the parieto-occipital association regions. The expression of this network is modulated in a predictable fashion by levodopa therapy and by stereotaxic interventions for PD.We have extended this network analytical approach from studies of glucose metabolism in the resting state to dynamic studies of brain activation during motor performance. These PET studies utilized [(15)O]-water (H(2) (15)O) to measure cerebral blood flow activation responses during the execution of simple and complex motor tasks. In addition to the modulation of abnormal resting metabolic networks, effective PD therapy can enhance brain activation responses during motor execution, with specific regional associations with improvements in timing and spatial accuracy.This approach is also useful in identifying specific brain networks mediating the learning of sequential information. We have found that the normal relationship between brain networks and learning performance are altered in the earliest stages of PD with a functional shift from striatal to cortical processing. Brain activation PET studies during therapeutic interventions for PD demonstrate how normal brain-behavior relationships can be restored with successful therapy. Thus, functional brain imaging with network analysis can provide insights into the mechanistic basis of basal ganglia disorders and their treatment.
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Affiliation(s)
- M Fukuda
- Department of Neurology and Neurosurgery, New York University School of Medicine, Functional Brain Imaging Laboratory, North Shore-LIJ Research Institute, Manhasset, NY, USA
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