1
|
Reese R, Kriesen T, Kersten M, Löhle M, Cantré D, Freiman TM, Storch A, Walter U. Combining ultrasound and microelectrode recordings for postoperative localization of subthalamic electrodes in Parkinson's disease. Clin Neurophysiol 2023; 156:196-206. [PMID: 37972531 DOI: 10.1016/j.clinph.2023.11.001] [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: 07/21/2023] [Revised: 10/10/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess transcranial sonography (TCS) as stand-alone tool and in combination with microelectrode recordings (MER) as a method for the postoperative localization of deep brain stimulation (DBS) electrodes in the subthalamic nucleus (STN). METHODS Individual dorsal and ventral boundaries of STN (n = 12) were determined on intraoperative MER. Postoperatively, a standardized TCS protocol was applied to measure medio-lateral, anterior-posterior and rostro-caudal electrode position using visualized reference structures (midline, substantia nigra). TCS and combined TCS-MER data were validated using fusion-imaging and clinical outcome data. RESULTS Test-retest reliability of standard TCS measures of electrode position was excellent. Computed tomography and TCS measures of distance between distal electrode contact and midline agreed well (Pearson correlation; r = 0.86; p < 0.001). Comparing our "gold standard" of rostro-caudal electrode localization relative to STN boundaries, i.e. combining MRI-based stereotaxy and MER data, with the combination of TCS and MER data, the measures differed by 0.32 ± 0.87 (range, -1.35 to 1.25) mm. Combined TCS-MER data identified the clinically preferred electrode contacts for STN-DBS with high accuracy (Coheńs kappa, 0.86). CONCLUSIONS Combined TCS-MER data allow for exact localization of STN-DBS electrodes. SIGNIFICANCE Our method provides a new option for monitoring of STN-DBS electrode location and guidance of DBS programming in Parkinson's disease.
Collapse
Affiliation(s)
- René Reese
- Department of Neurology, Rostock University Medical Center, Rostock, Germany.
| | - Thomas Kriesen
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Maxi Kersten
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany
| | - Matthias Löhle
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany
| | - Daniel Cantré
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Thomas M Freiman
- Department of Neurosurgery, Rostock University Medical Center, Rostock, Germany
| | - Alexander Storch
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany
| | - Uwe Walter
- Department of Neurology, Rostock University Medical Center, Rostock, Germany; Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany; German Center for Neurodegenerative Diseases (DZNE) Rostock / Greifswald, Rostock, Germany.
| |
Collapse
|
2
|
Weersink JB, Gefferie SR, van Laar T, Maurits NM, de Jong BM. Pre-Movement Cortico-Muscular Dynamics Underlying Improved Parkinson Gait Initiation after Instructed Arm Swing. JOURNAL OF PARKINSON'S DISEASE 2020; 10:1675-1693. [PMID: 32773398 PMCID: PMC7683047 DOI: 10.3233/jpd-202112] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/12/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND The supplementary motor area (SMA) is implicated in both motor initiation and stereotypic multi-limb movements such as walking with arm swing. Gait in Parkinson's disease exhibits starting difficulties and reduced arm swing, consistent with reduced SMA activity. OBJECTIVE We tested whether enhanced arm swing could improve Parkinson gait initiation and assessed whether increased SMA activity during preparation might facilitate such improvement. METHODS Effects of instructed arm swing on cortical activity, muscle activity and kinematics were assessed by ambulant EEG, EMG, accelerometers and video in 17 Parkinson patients and 19 controls. At baseline, all participants repeatedly started walking after a simple auditory cue. Next, patients started walking at this cue, which now meant starting with enhanced arm swing. EEG changes over the putative SMA and leg motor cortex were assessed by event related spectral perturbation (ERSP) analysis of recordings at Fz and Cz. RESULTS Over the putative SMA location (Fz), natural PD gait initiation showed enhanced alpha/theta synchronization around the auditory cue, and reduced alpha/beta desynchronization during gait preparation and movement onset, compared to controls. Leg muscle activity in patients was reduced during preparation and movement onset, while the latter was delayed compared to controls. When starting with enhanced arm swing, these group differences virtually disappeared. CONCLUSION Instructed arm swing improves Parkinson gait initiation. ERSP normalization around the cue indicates that the attributed information may serve as a semi-internal cue, recruiting an internalized motor program to overcome initiation difficulties.
Collapse
Affiliation(s)
- Joyce B. Weersink
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Silvano R. Gefferie
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Teus van Laar
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Natasha M. Maurits
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Bauke M. de Jong
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Ramirez Pasos UE, Steigerwald F, Reich MM, Matthies C, Volkmann J, Reese R. Levodopa Modulates Functional Connectivity in the Upper Beta Band Between Subthalamic Nucleus and Muscle Activity in Tonic and Phasic Motor Activity Patterns in Parkinson's Disease. Front Hum Neurosci 2019; 13:223. [PMID: 31312129 PMCID: PMC6614179 DOI: 10.3389/fnhum.2019.00223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 06/18/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: Striatal dopamine depletion disrupts basal ganglia function and causes Parkinson's disease (PD). The pathophysiology of the dopamine-dependent relationship between basal ganglia signaling and motor control, however, is not fully understood. We obtained simultaneous recordings of local field potentials (LFPs) from the subthalamic nucleus (STN) and electromyograms (EMGs) in patients with PD to investigate the impact of dopaminergic state and movement on long-range beta functional connectivity between basal ganglia and lower motor neurons. Methods: Eight PD patients were investigated 3 months after implantation of a deep brain stimulation (DBS)-system capable of recording LFPs via chronically-implanted leads (Medtronic, ACTIVA PC+S®). We analyzed STN spectral power and its coherence with EMG in the context of two different movement paradigms (tonic wrist extension vs. alternating wrist extension and flexion) and the effect of levodopa (L-Dopa) intake using an unbiased data-driven approach to determine regions of interest (ROI). Results: Two ROIs capturing prominent coherence within a grand average coherogram were identified. A trend of a dopamine effect was observed for the first ROI (50-150 ms after movement start) with higher STN-EMG coherence in medicated patients. Concerning the second ROI (300-500 ms after movement start), an interaction effect of L-Dopa medication and movement task was observed with higher coherence in the isometric contraction task compared to alternating movements in the medication ON state, a pattern which was reversed in L-Dopa OFF. Discussion: L-Dopa medication may normalize functional connectivity between remote structures of the motor system with increased upper beta coherence reflecting a physiological restriction of the amount of information conveyed between remote structures. This may be necessary to maintain simple movements like isometric contraction. Our study adds dynamic properties to the complex interplay between STN spectral beta power and the nucleus' functional connectivity to remote structures of the motor system as a function of movement and dopaminergic state. This may help to identify markers of neuronal activity relevant for more individualized programming of DBS therapy.
Collapse
Affiliation(s)
| | - Frank Steigerwald
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin M Reich
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Cordula Matthies
- Department of Neurosurgery, University Hospital Würzburg, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - René Reese
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany.,Department of Neurology, University of Rostock, Rostock, Germany
| |
Collapse
|
4
|
Alho EJL, Alho ATDL, Grinberg L, Amaro E, Dos Santos GAB, da Silva RE, Neves RC, Alegro M, Coelho DB, Teixeira MJ, Fonoff ET, Heinsen H. High thickness histological sections as alternative to study the three-dimensional microscopic human sub-cortical neuroanatomy. Brain Struct Funct 2018; 223:1121-1132. [PMID: 29094303 PMCID: PMC5899898 DOI: 10.1007/s00429-017-1548-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
Abstract
Stereotaxy is based on the precise image-guided spatial localization of targets within the human brain. Even with the recent advances in MRI technology, histological examination renders different (and complementary) information of the nervous tissue. Although several maps have been selected as a basis for correlating imaging results with the anatomical locations of sub-cortical structures, technical limitations interfere in a point-to-point correlation between imaging and anatomy due to the lack of precise correction for post-mortem tissue deformations caused by tissue fixation and processing. We present an alternative method to parcellate human brain cytoarchitectural regions, minimizing deformations caused by post-mortem and tissue-processing artifacts and enhancing segmentation by means of modified high thickness histological techniques and registration with MRI of the same specimen and into MNI space (ICBM152). A three-dimensional (3D) histological atlas of the human thalamus, basal ganglia, and basal forebrain cholinergic system is displayed. Structure's segmentations were performed in high-resolution dark-field and light-field microscopy. Bidimensional non-linear registration of the histological slices was followed by 3D registration with in situ MRI of the same subject. Manual and automated registration procedures were adopted and compared. To evaluate the quality of the registration procedures, Dice similarity coefficient and normalized weighted spectral distance were calculated and the results indicate good overlap between registered volumes and a small shape difference between them in both manual and automated registration methods. High thickness high-resolution histological slices in combination with registration to in situ MRI of the same subject provide an effective alternative method to study nuclear boundaries in the human brain, enhancing segmentation and demanding less resources and time for tissue processing than traditional methods.
Collapse
Affiliation(s)
- Eduardo Joaquim Lopes Alho
- Morphological Brain Research Unit, Department of Psychiatry, University of Würzburg, Würzburg, Germany.
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil.
- Department of Radiology, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 01060-970, Brazil.
- , Rua Pamplona, 1585, Apto 53, São Paulo, 01405-002, Brazil.
| | - Ana Tereza Di Lorenzo Alho
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
- Department of Radiology, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 01060-970, Brazil
| | - Lea Grinberg
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
- Sandler Neurosciences Center, Memory and Aging Center, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Edson Amaro
- Department of Radiology, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 01060-970, Brazil
| | - Gláucia Aparecida Bento Dos Santos
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
- Department of Radiology, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 01060-970, Brazil
| | - Rafael Emídio da Silva
- Department of Radiology, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 01060-970, Brazil
| | - Ricardo Caires Neves
- Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil
| | - Maryana Alegro
- Department of Radiology, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 01060-970, Brazil
- Sandler Neurosciences Center, Memory and Aging Center, Department of Neurology, University of California at San Francisco, San Francisco, CA, USA
| | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Erich Talamoni Fonoff
- Division of Functional Neurosurgery, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Helmut Heinsen
- Morphological Brain Research Unit, Department of Psychiatry, University of Würzburg, Würzburg, Germany
- Department of Radiology, University of São Paulo Medical School, Rua Dr. Ovidio Pires de Campos, 785, São Paulo, 01060-970, Brazil
| |
Collapse
|
5
|
Ebert M, Hauptmann C, Tass PA. Coordinated reset stimulation in a large-scale model of the STN-GPe circuit. Front Comput Neurosci 2014; 8:154. [PMID: 25505882 PMCID: PMC4245901 DOI: 10.3389/fncom.2014.00154] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 11/05/2014] [Indexed: 11/15/2022] Open
Abstract
Synchronization of populations of neurons is a hallmark of several brain diseases. Coordinated reset (CR) stimulation is a model-based stimulation technique which specifically counteracts abnormal synchrony by desynchronization. Electrical CR stimulation, e.g., for the treatment of Parkinson's disease (PD), is administered via depth electrodes. In order to get a deeper understanding of this technique, we extended the top-down approach of previous studies and constructed a large-scale computational model of the respective brain areas. Furthermore, we took into account the spatial anatomical properties of the simulated brain structures and incorporated a detailed numerical representation of 2 · 104 simulated neurons. We simulated the subthalamic nucleus (STN) and the globus pallidus externus (GPe). Connections within the STN were governed by spike-timing dependent plasticity (STDP). In this way, we modeled the physiological and pathological activity of the considered brain structures. In particular, we investigated how plasticity could be exploited and how the model could be shifted from strongly synchronized (pathological) activity to strongly desynchronized (healthy) activity of the neuronal populations via CR stimulation of the STN neurons. Furthermore, we investigated the impact of specific stimulation parameters especially the electrode position on the stimulation outcome. Our model provides a step forward toward a biophysically realistic model of the brain areas relevant to the emergence of pathological neuronal activity in PD. Furthermore, our model constitutes a test bench for the optimization of both stimulation parameters and novel electrode geometries for efficient CR stimulation.
Collapse
Affiliation(s)
- Martin Ebert
- Institute of Neuroscience and Medicine - Neuromodulation, Juelich Research Center GmbH Juelich, Germany ; Department of Physics, Institute of Nuclear Physics, University of Cologne Cologne, Germany
| | - Christian Hauptmann
- Institute of Neuroscience and Medicine - Neuromodulation, Juelich Research Center GmbH Juelich, Germany
| | - Peter A Tass
- Institute of Neuroscience and Medicine - Neuromodulation, Juelich Research Center GmbH Juelich, Germany ; Department of Neurosurgery, Stanford University Stanford, CA, USA ; Department of Neuromodulation, University of Cologne Cologne, Germany
| |
Collapse
|