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Wang X, Fu S, Yoo K, Wang X, Gan L, Zou T, Gao Q, Han H, Yang Z, Hu X, Chen H, Liu D, Li R. Individualized Structural Perturbations on Normative Brain Connectome Restrict Deep Brain Stimulation Outcomes in Parkinson's Disease. Mov Disord 2024. [PMID: 38894532 DOI: 10.1002/mds.29874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Patients with Parkinson's disease (PD) respond to deep brain stimulation (DBS) variably. However, how brain substrates restrict DBS outcomes remains unclear. OBJECTIVE In this article, we aim to identify prognostic brain signatures for explaining the response variability. METHODS We retrospectively investigated a cohort of patients with PD (n = 141) between 2017 and 2022, and defined DBS outcomes as the improvement ratio of clinical motor scores. We used a deviation index to quantify individual perturbations on a reference structural covariance network acquired with preoperative T1-weighted magnetic resonance imaging. The neurobiological perturbations of patients were represented as z scored indices based on the chronological perturbations measured on a group of normal aging adults. RESULTS After applying stringent statistical tests (z > 2.5) and correcting for false discoveries (P < 0.01), we found that accelerated deviations mainly affected the prefrontal cortex, motor strip, limbic system, and cerebellum in PD. Particularly, a negative network within the accelerated deviations, expressed as "more preoperative deviations, less postoperative improvements," could predict DBS outcomes (mean absolute error = 0.09, R2 = 0.15). Moreover, a fusion of personal brain predictors and medical responses significantly improved traditional evaluations of DBS outcomes. Notably, the most important brain predictor, a pathway connecting the cognitive unit (prefrontal cortex) and motor control unit (cerebellum and motor strip), partially mediates DBS outcomes with the age at surgery. CONCLUSIONS Our findings suggest that individual structural perturbations on the cognitive motor control circuit are critical for modulating DBS outcomes. Interventions toward the circuit have the potential for additional clinical improvements. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Xuyang Wang
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Shiyu Fu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Kwangsun Yoo
- Department of Digital Health, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea
- Data Science Research Institute, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Xiaoyue Wang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lin Gan
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Ting Zou
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Qing Gao
- School of Mathematical Sciences, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Honghao Han
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Zhenzhe Yang
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Xiaofei Hu
- Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Huafu Chen
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Rong Li
- Clinical Hospital of Chengdu Brain Science Institute, School of Life Science and Technology, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
- MOE Key Laboratory for Neuroinformation, High-Field Magnetic Resonance Brain Imaging Key Laboratory of Sichuan Province, University of Electronic Science and Technology of China, Chengdu, People's Republic of China
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Koivu M, Sihvonen AJ, Eerola-Rautio J, Pauls KAM, Resendiz-Nieves J, Vartiainen N, Kivisaari R, Scheperjans F, Pekkonen E. Clinical and Brain Morphometry Predictors of Deep Brain Stimulation Outcome in Parkinson's Disease. Brain Topogr 2024:10.1007/s10548-024-01054-2. [PMID: 38662300 DOI: 10.1007/s10548-024-01054-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Subthalamic deep brain stimulation (STN-DBS) is known to improve motor function in advanced Parkinson's disease (PD) and to enable a reduction of anti-parkinsonian medication. While the levodopa challenge test and disease duration are considered good predictors of STN-DBS outcome, other clinical and neuroanatomical predictors are less established. This study aimed to evaluate, in addition to clinical predictors, the effect of patients' individual brain topography on DBS outcome. The medical records of 35 PD patients were used to analyze DBS outcomes measured with the following scales: Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III) off medication at baseline, and at 6-months during medication off and stimulation on, use of anti-parkinsonian medication (LED), Abnormal Involuntary Movement Scale (AIMS) and Non-Motor Symptoms Questionnaire (NMS-Quest). Furthermore, preoperative brain MRI images were utilized to analyze the brain morphology in relation to STN-DBS outcome. With STN-DBS, a 44% reduction in the UPDRS-III score and a 43% decrease in the LED were observed (p<0.001). Dyskinesia and non-motor symptoms decreased significantly [median reductions of 78,6% (IQR 45,5%) and 18,4% (IQR 32,2%) respectively, p=0.001 - 0.047]. Along with the levodopa challenge test, patients' age correlated with the observed DBS outcome measured as UPDRS-III improvement (ρ= -0.466 - -0.521, p<0.005). Patients with greater LED decline had lower grey matter volumes in left superior medial frontal gyrus, in supplementary motor area and cingulum bilaterally. Additionally, patients with greater UPDRS-III score improvement had lower grey matter volume in similar grey matter areas. These findings remained significant when adjusted for sex, age, baseline LED and UPDRS scores respectively and for total intracranial volume (p=0.0041- 0.001). However, only the LED decrease finding remained significant when the analyses were further controlled for stimulation amplitude. It appears that along with the clinical predictors of STN-DBS outcome, individual patient topographic differences may influence DBS outcome. Clinical Trial Registration Number: NCT06095245, registration date October 23, 2023, retrospectively registered.
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Affiliation(s)
- Maija Koivu
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland.
| | - Aleksi J Sihvonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
- Cognitive Brain Research Unit, Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Johanna Eerola-Rautio
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
| | - K Amande M Pauls
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
| | | | - Nuutti Vartiainen
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Riku Kivisaari
- Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Filip Scheperjans
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
| | - Eero Pekkonen
- Department of Neurology, Helsinki University Hospital and Department of Clinical Neurosciences (Neurology), University of Helsinki, Finland, Helsinki, Finland
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Hermann MG, Schröter N, Rau A, Reisert M, Jarc N, Rijntjes M, Hosp JA, Reinacher PC, Jost WH, Urbach H, Weiller C, Coenen VA, Sajonz BEA. The connection of motor improvement after deep brain stimulation in Parkinson's disease and microstructural integrity of the substantia nigra and subthalamic nucleus. Neuroimage Clin 2024; 42:103607. [PMID: 38643635 PMCID: PMC11046219 DOI: 10.1016/j.nicl.2024.103607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Nigrostriatal microstructural integrity has been suggested as a biomarker for levodopa response in Parkinson's disease (PD), which is a strong predictor for motor response to deep brain stimulation (DBS) of the subthalamic nucleus (STN). This study aimed to explore the impact of microstructural integrity of the substantia nigra (SN), STN, and putamen on motor response to STN-DBS using diffusion microstructure imaging. METHODS Data was collected from 23 PD patients (mean age 63 ± 7, 6 females) who underwent STN-DBS, had preoperative 3 T diffusion magnetic resonance imaging including multishell diffusion-weighted MRI with b-values of 1000 and 2000 s/mm2 and records of motor improvement available. RESULTS The association between a poorer DBS-response and increased free interstitial fluid showed notable effect sizes (rho > |0.4|) in SN and STN, but not in putamen. However, this did not reach significance after Bonferroni correction and controlling for sex and age. CONCLUSION Microstructural integrity of SN and STN are potential biomarkers for the prediction of therapy efficacy following STN-DBS, but further studies are required to confirm these associations.
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Affiliation(s)
- Marco G Hermann
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Schröter
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nadja Jarc
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | | | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Deep Brain Stimulation, University of Freiburg, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
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Verlaat L, Rijks N, Dilai J, Admiraal M, Beudel M, de Bie RM, van der Zwaag W, Schuurman R, van den Munckhof P, Bot M. 7-Tesla Magnetic Resonance Imaging Scanning in Deep Brain Stimulation for Parkinson's Disease: Improving Visualization of the Dorsolateral Subthalamic Nucleus. Mov Disord Clin Pract 2024; 11:373-380. [PMID: 38385792 PMCID: PMC10982587 DOI: 10.1002/mdc3.13982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/14/2023] [Accepted: 01/05/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Identifying the dorsolateral subthalamic nucleus (STN) for deep brain stimulation (DBS) in Parkinson's disease (PD) can be challenging due to the size and double-oblique orientation. Since 2015 we implemented 7-Tesla T2 weighted magnetic resonance imaging (7 T T2) for improving visualization and targeting of the dorsolateral STN. We describe the changes in surgical planning and outcome since implementation of 7 T T2 for DBS in PD. METHODS By comparing two cohorts of STN DBS patients in different time periods we evaluated the influence of 7 T T2 on STN target planning, the number of microelectrode recording (MER) trajectories, length of STN activity and the postoperative motor (UPDRS) improvement. RESULTS From February 2007 to January 2014, 1.5 and 3-Tesla T2 guided STN DBS with 3 MER channels was performed in 76 PD patients. Average length of recorded STN activity in the definite electrode trajectory was 3.9 ± 1.5 mm. From January 2015 to January 2022 7 T T2 and MER-guided STN DBS was performed in 182 PD patients. Average length of recorded STN activity in the definite electrode trajectory was 5.1 ± 1.3 mm and used MER channels decreased from 3 to 1. Average UPDRS improvement was comparable. CONCLUSION Implementation of 7 T T2 for STN DBS enabled a refinement in targeting. Combining classical DBS targeting with dorsolateral STN alignment may be used to determine the optimal trajectory. The improvement in dorsolateral STN visualization can be used for further target refinements, for example adding probabilistic subthalamic connectivity, to enhance clinical outcome of STN DBS.
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Affiliation(s)
- Lisa Verlaat
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Niels Rijks
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - José Dilai
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Marjolein Admiraal
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Martijn Beudel
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Rob M.A. de Bie
- Department of Neurology and Clinical NeurophysiologyUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Wietske van der Zwaag
- Spinoza Centre for Neuroimaging, Royal Netherlands Academy of Arts and SciencesAmsterdamthe Netherlands
| | - Rick Schuurman
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Pepijn van den Munckhof
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
| | - Maarten Bot
- Department of NeurosurgeryUniversity Medical Centers, Academic Medical CenterAmsterdamthe Netherlands
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Zalyalova ZA, Katunina EA, Pokhabov DV, Munasipova SE, Ermakova MM. [Tremor-dominant form of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:28-35. [PMID: 38676674 DOI: 10.17116/jnevro202412404128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2024]
Abstract
The article is of a review nature and is devoted to tremor, one of the maladaptive and difficult-to-treat symptoms of Parkinson's disease (PD). Along with the classic rest tremor, patients with PD may experience tremor of other modalities: postural tremor, kinetic tremor, which reflects a multimodal mechanism of tremor formation involving multiple neurotransmitter systems. The unpredictable response to therapeutic options, the ambiguous response to levodopa, also reflects the role of multiple underlying pathophysiological processes. Among the drug methods of tremor correction, preference is given to dopamine receptor agonists - due to the spectrum of their pharmaceutical action, high efficiency in relation to all leading motor and a number of non-motor manifestations. The evidence for advanced neurosurgical, non-invasive modalities is mixed, and there are insufficient comparative studies to assess their efficacy in patients with tremor-dominant forms of PD.
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Affiliation(s)
- Z A Zalyalova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
| | - E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center for Brain and Neurotechnology, Moscow, Russia
| | - D V Pokhabov
- Center for Innovative Neurology, Extrapyramidal Diseases and Botulinum Therapy, Krasnoyarsk, Russia
- Voino-Yasnevetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S E Munasipova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
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Kroneberg D, Al-Fatly B, Morkos C, Steiner LA, Schneider GH, Kühn A. Kinematic Effects of Combined Subthalamic and Dorsolateral Nigral Deep Brain Stimulation in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:269-282. [PMID: 38363617 PMCID: PMC10977420 DOI: 10.3233/jpd-230181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/17/2024]
Abstract
Background Additional stimulation of the substantia nigra (SNr) has been proposed to target axial symptoms and gait impairment in patients with Parkinson's disease (PD). Objective This study aimed to characterize effects of combined deep brain stimulation (DBS) of the subthalamic nucleus (STN) and SNr on gait performance in PD and to map stimulation sites within the SNr. Methods In a double-blinded crossover design, 10 patients with PD and gait impairment underwent clinical examination and kinematic assessment with STN DBS, combined STN+SNr DBS and OFF DBS 30 minutes after reprogramming. To confirm stimulation within the SNr, electrodes, active contacts, and stimulation volumes were modeled in a common space and overlap with atlases of SNr was computed. Results Overlap of stimulation volumes with dorsolateral SNr was confirmed for all patients. UPDRS III, scoring of freezing during turning and transitioning, stride length, stride velocity, and range of motion of shank, knee, arm, and trunk as well as peak velocities during turning and transitions and turn duration were improved with STN DBS compared to OFF. On cohort level, no further improvement was observed with combined STN+SNr DBS but additive improvement of spatiotemporal gait parameters was observed in individual subjects. Conclusions Combined high frequency DBS of the STN and dorsolateral SNr did not consistently result in additional short-term kinematic or clinical benefit compared to STN DBS. Stimulation intervals, frequency, and patient selection for target symptoms as well as target region within the SNr need further refinement in future trials.
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Affiliation(s)
- Daniel Kroneberg
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bassam Al-Fatly
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Cornelia Morkos
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leon Amadeus Steiner
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité – Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A. Kühn
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charite - Universitatsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Charité – Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Lench DH, Doolittle JD, Ramakrishnan V, Rowland N, Revuelta GJ. Subthalamic functional connectivity associated with freezing of gait dopa-response. Parkinsonism Relat Disord 2024; 118:105952. [PMID: 38101024 PMCID: PMC10872230 DOI: 10.1016/j.parkreldis.2023.105952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023]
Abstract
INTRODUCTION Freezing of gait (FOG) is a prevalent and debilitating feature of Parkinson's Disease (PD). The subthalamic nucleus (STN) is a center for controlled locomotion and a common DBS target. The objective of this study was to identify STN circuitry associated with FOG response to dopaminergic medication. In this study, we compare BOLD functional connectivity of the subthalamic nucleus (STN) in participants with and without dopa-responsive FOG. METHODS 55 PD participants either with FOG (n = 38) or without FOG (n = 17) were recruited. Among FOG participants 22 were dopa-responsive and 16 were dopa-unresponsive. STN whole-brain connectivity was performed using CONN toolbox. The relationship between the degree of self-reported FOG dopa-response and STN connectivity was evaluated using partial correlations corrected for age, disease duration, and levodopa equivalent daily dose. RESULTS Right STN connectivity with the cerebellar locomotor region and the temporal/occipital cortex was greater in the dopa-responsive FOG group (voxel threshold p < 0.01, FWE corrected p < 0.05). Left STN connectivity with the occipital cortex was greater in the dopa-responsive FOG group and connectivity with the postcentral gyrus was greater in the dopa-unresponsive FOG group. Strength of connectivity to these regions correlated with l-dopa induced improvement in UPDRS Item-14 (FOG), but not UPDRS Part-III (overall motor score). DISCUSSION We demonstrate that dopa-unresponsive FOG is associated with changes in BOLD functional connectivity between the STN and locomotor as well as sensory processing regions. This finding supports the conceptual framework that effective treatment for freezing of gait likely requires the engagement of both locomotor and sensory brain regions.
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Affiliation(s)
- Daniel H. Lench
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | - Jade D. Doolittle
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
| | | | - Nathan Rowland
- Department of Neurosurgery, Medical University of South Carlina, Charleston, SC, USA
- MUSC Institute for Neuroscience Discovery (MIND), Medical University of South Carolina, Charleston, SC 29425, USA
| | - Gonzalo J. Revuelta
- Department of Neurology, Medical University of South Carlina, Charleston, SC, USA
- Ralph H. Johnson VA Medical Center, Charleston, SC, USA
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Wirth T, Ferreira F, Vijiaratnam N, Girges C, Pakzad A, de Roquemaurel A, Sinani O, Hyam J, Hariz M, Zrinzo L, Akram H, Limousin P, Foltynie T. Parkinson's Disease Tremor Differentially Responds to Levodopa and Subthalamic Stimulation. Mov Disord Clin Pract 2023; 10:1639-1649. [PMID: 37982119 PMCID: PMC10654834 DOI: 10.1002/mdc3.13876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 11/21/2023] Open
Abstract
Background Tremor in Parkinson's disease (PD) has an inconsistent response to levodopa and subthalamic deep brain stimulation (STN-DBS). Objectives To identify predictive factors of PD tremor responsiveness to levodopa and STN-DBS. Material and Methods PD patients with upper limb tremor who underwent STN-DBS were included. The levodopa responsiveness of tremor (overall, postural, and rest sub-components), was assessed using the relevant Unified Parkinson's Disease Rating Scale-III items performed during the preoperative assessment. Post-surgical outcomes were similarly assessed ON and OFF stimulation. A score for the rest/postural tremor ratio was used to determine the influence of rest and postural tremor severity on STN-DBS outcome. Factors predictive of tremor responsiveness were determined using multiple linear regression modeling. Volume of tissue activated measurement coupled to voxel-based analysis was performed to identify anatomical clusters associated with motor symptoms improvement. Results One hundred and sixty five patients were included in this study. Male gender was negatively correlated with tremor responsiveness to levodopa, whereas the ratio of rest/postural tremor was positively correlated with both levodopa responsiveness and STN-DBS tremor outcome. Clusters corresponding to improvement of tremor were in the subthalamic nucleus, the zona incerta and the thalamus, whereas clusters corresponding to improvement for akinesia and rigidity were located within the subthalamic nucleus. Conclusion More severe postural tremor and less severe rest tremor were associated with both poorer levodopa and STN-DBS response. The different locations of clusters associated with best correction of tremor and other parkinsonian features suggest that STN-DBS effect on PD symptoms is underpinned by the modulation of different networks.
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Affiliation(s)
- Thomas Wirth
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Neurology DepartmentStrasbourg University HospitalStrasbourgFrance
- Institute of Genetics and Cellular and Molecular BiologyINSERM‐U964, CNRS‐UMR7104, University of StrasbourgStrasbourgFrance
- Strasbourg Translational Medicine FederationUniversity of StrasbourgStrasbourgFrance
| | - Francisca Ferreira
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Wellcome Centre for Human NeuroimagingLondonUnited Kingdom
| | - Nirosen Vijiaratnam
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Christine Girges
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Ashkan Pakzad
- EPSRC Centre for Doctoral Training i4healthUniversity College LondonLondonUnited Kingdom
| | - Alexis de Roquemaurel
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Olga Sinani
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Jonathan Hyam
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Marwan Hariz
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
- Department of Clinical Science, NeuroscienceUmeå UniversityUmeåSweden
| | - Ludvic Zrinzo
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Harith Akram
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Patricia Limousin
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
| | - Thomas Foltynie
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology and the National Hospital for Neurology and NeurosurgeryLondonUnited Kingdom
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9
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Lench DH, Turner TH, McLeod C, Boger HA, Lovera L, Heidelberg L, Elm J, Phan A, Badran BW, Hinson VK. Multi-session transcutaneous auricular vagus nerve stimulation for Parkinson's disease: evaluating feasibility, safety, and preliminary efficacy. Front Neurol 2023; 14:1210103. [PMID: 37554394 PMCID: PMC10406445 DOI: 10.3389/fneur.2023.1210103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/03/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND In pre-clinical animal models of Parkinson's disease (PD), vagus nerve stimulation (VNS) can rescue motor deficits and protect susceptible neuronal populations. Transcutaneous auricular vagus nerve stimulation (taVNS) has emerged as a non-invasive alternative to traditional invasive cervical VNS. This is the first report summarizing the safety, feasibility, and preliminary efficacy of repeated sessions of taVNS in participants with PD. OBJECTIVES To evaluate the feasibility, safety, and possible efficacy of taVNS for motor and non-motor symptoms in mild to moderate PD. METHODS This is a double-blind, sham controlled RCT (NCT04157621) of taVNS in 30 subjects with mild to moderate PD without cognitive impairment. Participants received 10, 1-h taVNS sessions (25 Hz, 200% of sensory threshold, 500 μs pulse width, 60 s on and 30 s off) over a 2-week period. Primary outcome measures were feasibility and safety of the intervention; secondary outcomes included the MDS-UPDRS, cognitive function and self-reported symptom improvement. RESULTS taVNS treatment was feasible, however, daily in-office visits were reported as being burdensome for participants. While five participants in the taVNS group and three in the sham group self-reported one or more minor adverse events, no major adverse events occurred. There were no group differences on blood pressure and heart rate throughout the intervention. There were no group differences in MDS-UPDRS scores or self-reported measures. Although global cognitive scores remained stable across groups, there was a reduction in verbal fluency within the taVNS group. CONCLUSIONS taVNS was safe, and well-tolerated in PD participants. Future studies of taVNS for PD should explore at-home stimulation devices and optimize stimulation parameters to reduce variability and maximize engagement of neural targets.
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Affiliation(s)
- Daniel H. Lench
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Travis H. Turner
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Colin McLeod
- Department of Neurology, Augusta University Medical Center, Augusta, GA, United States
| | - Heather A. Boger
- Department of Neurosciences, Medical University of South Carolina, Charleston, SC, United States
| | - Lilia Lovera
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Lisa Heidelberg
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
| | - Jordan Elm
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Anh Phan
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, United States
| | - Bashar W. Badran
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC, United States
| | - Vanessa K. Hinson
- Department of Neurology, Medical University of South Carolina, Charleston, SC, United States
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10
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Geraedts VJ, van Vugt JPP, Marinus J, Kuiper R, Middelkoop HAM, Zutt R, van der Gaag NA, Hoffmann CFE, Dorresteijn LDA, van Hilten JJ, Contarino MF. Predicting Motor Outcome and Quality of Life After Subthalamic Deep Brain Stimulation for Parkinson's Disease: The Role of Standard Screening Measures and Wearable-Data. JOURNAL OF PARKINSON'S DISEASE 2023:JPD225101. [PMID: 37182900 DOI: 10.3233/jpd-225101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND Standardized screening for subthalamic deep brain stimulation (STN DBS) in Parkinson's disease (PD) patients is crucial to determine eligibility, but its utility to predict postoperative outcomes in eligible patients is inconclusive. It is unknown whether wearable data can contribute to this aim. OBJECTIVE To evaluate the utility of universal components incorporated in the DBS screening, complemented by a wearable sensor, to predict motor outcomes and Quality of life (QoL) one year after STN DBS surgery. METHODS Consecutive patients were included in the OPTIMIST cohort study from two DBS centers. Standardized assessments included a preoperative Levodopa Challenge Test (LCT), and questionnaires on QoL and non-motor symptoms including cognition, psychiatric symptoms, impulsiveness, autonomic symptoms, and sleeping problems. Moreover, an ambulatory wearable sensor (Parkinson Kinetigraph (PKG)) was used. Postoperative assessments were similar and also included a Stimulation Challenge Test to determine DBS effects on motor function. RESULTS Eighty-three patients were included (median (interquartile range) age 63 (56-68) years, 36% female). Med-OFF (Stim-OFF) motor severity deteriorated indicating disease progression, but patients significantly improved in terms of Med-ON (Stim-ON) motor function, motor fluctuations, QoL, and most non-motor domains. Motor outcomes were not predicted by preoperative tests, including covariates of either LCT or PKG. Postoperative QoL was predicted by better preoperative QoL, lower age, and more preoperative impulsiveness scores in multivariate models. CONCLUSION Data from the DBS screening including wearable data do not predict postoperative motor outcome at one year. Post-DBS QoL appears primarily driven by non-motor symptoms, rather than by motor improvement.
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Affiliation(s)
- Victor J Geraedts
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Johan Marinus
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Roy Kuiper
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Huub A M Middelkoop
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rodi Zutt
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
| | - Niels A van der Gaag
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
- Department of Neurosurgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Carel F E Hoffmann
- Department of Neurosurgery, HAGA Teaching Hospital, Den Haag, the Netherlands
| | | | - Jacobus J van Hilten
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Maria Fiorella Contarino
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Neurology, HAGA Teaching Hospital, Den Haag, the Netherlands
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11
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Hwang YS, Jo S, Lee SH, Kim N, Kim MS, Jeon SR, Chung SJ. Long-term motor outcomes of deep brain stimulation of the globus pallidus interna in Parkinson's disease patients: Five-year follow-up. J Neurol Sci 2023; 444:120484. [PMID: 36463584 DOI: 10.1016/j.jns.2022.120484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 07/26/2022] [Accepted: 10/25/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of globus pallidus interna (GPi) is an established treatment for advanced Parkinson's disease (PD). However, in contrast to subthalamic nucleus (STN)-DBS, long-term outcomes of GPi-DBS have rarely been studied. OBJECTIVE We investigated the long-term motor outcomes in PD patients at 5 years after GPi-DBS. METHODS We retrospectively analyzed the clinical data for PD patients who underwent GPi-DBS. Longitudinal changes of UPDRS scores from baseline to 5 years after surgery were assessed. RESULTS Forty PD patients with a mean age of 59.5 ± 7.9 years at DBS surgery (mean duration of PD: 11.4 ± 3.4 years) were included at baseline and 25 patients were included in 5-year evaluation after DBS. Compared to baseline, sub-scores for tremor, levodopa-induced dyskinesia (LID), and motor fluctuation indicated improved states up to 5 years after surgery (p < 0.001). However, UPDRS Part 3 total score and sub-score for postural instability and gait disturbance (PIGD) gradually worsened over time until 5 years after surgery (p > 0.017 after Bonferroni correction). In a logistic regression model, only preoperative levodopa response was associated with the long-term benefits on UPDRS Part 3 total score and PIGD sub-score (OR = 1.20; 95% CI = 1.04-1.39; p = 0.015 and OR = 4.99; 95% CI = 1.39-17.89; p = 0.014, respectively). CONCLUSIONS GPi-DBS provides long-term beneficial effects against tremor, motor fluctuation and LID, but PIGD symptoms gradually worsen. This selective long-term benefit has implications for the optimal application of DBS in PD patients.
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Affiliation(s)
- Yun Su Hwang
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea; Department of Neurology, Jeonbuk National University Medical School and Hospital, Jeonju, South Korea; Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, South Korea
| | - Sungyang Jo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seung Hyun Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Nayoung Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi-Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Ryong Jeon
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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12
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Shen D, Cao L, Ling Y, Li D, Ren K, Shi W, Chen Z, Zhou H, Liu J. Bilateral globus pallidus interna deep brain stimulation in Parkinson's disease: Therapeutic effects and motor outcomes prediction in a short-term follow up. Front Hum Neurosci 2023; 16:1023917. [PMID: 36699962 PMCID: PMC9868647 DOI: 10.3389/fnhum.2022.1023917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Objective We aimed to compare the motor effect of bilateral globus pallidus interna (GPi) deep brain stimulation (DBS) on motor subtypes of Parkinson's disease (PD) patients and identify preoperative predictive factors of short-term motor outcome. Methods We retrospectively investigated bilateral GPi DBS clinical outcomes in 55 PD patients in 1 year follow up. Motor outcome was measured by the Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part III before and 1 year after surgery. Clinical outcomes were compared among different motor subtypes. Preoperative predictors of motor outcome were assessed by performing univariate and multivariate linear regression and logistic regression analyses. Results At 1 year following implantation, GPi DBS significantly improved the off-medication MDS-UPDRS III scores in all motor subtype cohorts, with prominent improvement in tremor. No significant difference of postoperative motor symptoms changes was found except greater tremor improvement achieved in both the tremor-dominant (TD) and indeterminate (IND) patients compared to the postural instability and gait difficulty (PIGD) patients. High percentage of PIGD patients were weak responders to DBS. Better levodopa responsiveness and more severe tremor predicted greater overall improvement of motor function in the entire cohort. Similarly, both levodopa responsiveness and tremor improvement were confirmed as predictors for motor improvement in PIGD patients. Conclusion Bilateral GPi DBS could effectively improve motor outcomes in PD patients regardless of motor subtypes. Both TD and IND patients obtained larger tremor improvement. The intensity of levodopa responsiveness and the severity of tremor could serve as predictors of motor improvement 1 year after GPi DBS.
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Affiliation(s)
- Dingding Shen
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Linghao Cao
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yun Ling
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Dianyou Li
- Department of Neurosurgery, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kang Ren
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Weikun Shi
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China
| | - Zhonglue Chen
- Gyenno Science Co., Ltd., Shenzhen, China,HUST-GYENNO CNS Intelligent Digital Medicine Technology Center, Wuhan, China,Zhonglue Chen,
| | - Haiyan Zhou
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Haiyan Zhou,
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China,*Correspondence: Jun Liu,
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13
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Caulfield ME, Manfredsson FP, Steece-Collier K. The Role of Striatal Cav1.3 Calcium Channels in Therapeutics for Parkinson's Disease. Handb Exp Pharmacol 2023; 279:107-137. [PMID: 36592226 DOI: 10.1007/164_2022_629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Parkinson's disease (PD) is a relentlessly progressive neurodegenerative disorder with typical motor symptoms that include rigidity, tremor, and akinesia/bradykinesia, in addition to a host of non-motor symptoms. Motor symptoms are caused by progressive and selective degeneration of dopamine (DA) neurons in the SN pars compacta (SNpc) and the accompanying loss of striatal DA innervation from these neurons. With the exception of monogenic forms of PD, the etiology of idiopathic PD remains unknown. While there are a number of symptomatic treatment options available to individuals with PD, these therapies do not work uniformly well in all patients, and eventually most are plagued with waning efficacy and significant side-effect liability with disease progression. The incidence of PD increases with aging, and as such the expected burden of this disease will continue to escalate as our aging population increases (Dorsey et al. Neurology 68:384-386, 2007). The daunting personal and socioeconomic burden has pressed scientists and clinicians to find improved symptomatic treatment options devoid side-effect liability and meaningful disease-modifying therapies. Federal and private sources have supported clinical investigations over the past two-plus decades; however, no trial has yet been successful in finding an effective therapy to slow progression of PD, and there is currently just one FDA approved drug to treat the antiparkinsonian side-effect known as levodopa-induced dyskinesia (LID) that impacts approximately 90% of all individuals with PD. In this review, we present biological rationale and experimental evidence on the potential therapeutic role of the L-type voltage-gated Cav1.3 calcium (Ca2+) channels in two distinct brain regions, with two distinct mechanisms of action, in impacting the lives of individuals with PD. Our primary emphasis will be on the role of Cav1.3 channels in the striatum and the compelling evidence of their involvement in LID side-effect liability. We also briefly discuss the role of these same Ca2+ channels in the SNpc and the longstanding interest in Cav1.3 in this brain region in halting or delaying progression of PD.
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Affiliation(s)
- Margaret E Caulfield
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Fredric P Manfredsson
- Parkinson's Disease Research Unit, Department of Translational Neuroscience, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Kathy Steece-Collier
- Department of Translational Neuroscience, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA.
- Hauenstein Neuroscience Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA.
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