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Rajamani N, Friedrich H, Butenko K, Dembek T, Lange F, Navrátil P, Zvarova P, Hollunder B, de Bie RMA, Odekerken VJJ, Volkmann J, Xu X, Ling Z, Yao C, Ritter P, Neumann WJ, Skandalakis GP, Komaitis S, Kalyvas A, Koutsarnakis C, Stranjalis G, Barbe M, Milanese V, Fox MD, Kühn AA, Middlebrooks E, Li N, Reich M, Neudorfer C, Horn A. Deep brain stimulation of symptom-specific networks in Parkinson's disease. Nat Commun 2024; 15:4662. [PMID: 38821913 PMCID: PMC11143329 DOI: 10.1038/s41467-024-48731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/13/2024] [Indexed: 06/02/2024] Open
Abstract
Deep Brain Stimulation can improve tremor, bradykinesia, rigidity, and axial symptoms in patients with Parkinson's disease. Potentially, improving each symptom may require stimulation of different white matter tracts. Here, we study a large cohort of patients (N = 237 from five centers) to identify tracts associated with improvements in each of the four symptom domains. Tremor improvements were associated with stimulation of tracts connected to primary motor cortex and cerebellum. In contrast, axial symptoms are associated with stimulation of tracts connected to the supplementary motor cortex and brainstem. Bradykinesia and rigidity improvements are associated with the stimulation of tracts connected to the supplementary motor and premotor cortices, respectively. We introduce an algorithm that uses these symptom-response tracts to suggest optimal stimulation parameters for DBS based on individual patient's symptom profiles. Application of the algorithm illustrates that our symptom-tract library may bear potential in personalizing stimulation treatment based on the symptoms that are most burdensome in an individual patient.
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Affiliation(s)
- Nanditha Rajamani
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Helen Friedrich
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- University of Würzburg, Faculty of Medicine, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Konstantin Butenko
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Till Dembek
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Florian Lange
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Pavel Navrátil
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Patricia Zvarova
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
| | - Barbara Hollunder
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
- Brain Simulation Section, Department of Neurology, Charité University Medicine Berlin and Berlin Institute of Health, Berlin, 10117, Germany
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Jens Volkmann
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Xin Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhipei Ling
- Department of Neurosurgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan, 572000, China
| | - Chen Yao
- Department of Neurosurgery, The National Key Clinic Specialty, Shenzhen Key Laboratory of Neurosurgery, the First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, 518035, China
| | - Petra Ritter
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
- Brain Simulation Section, Department of Neurology, Charité University Medicine Berlin and Berlin Institute of Health, Berlin, 10117, Germany
- Bernstein center for Computational Neuroscience Berlin, Berlin, 10117, Germany
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Georgios P Skandalakis
- Section of Neurosurgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, 03756, USA
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
| | - Spyridon Komaitis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
- Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aristotelis Kalyvas
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Christos Koutsarnakis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
| | - George Stranjalis
- Department of Neurosurgery, National and Kapodistrian University of Athens Medical School, Evangelismos General Hospital, Athens, Greece
| | - Michael Barbe
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Vanessa Milanese
- Neurosurgical Division, Hospital Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Department of Neurosurgery, Mayo Clinic, Florida, USA
- Movement Disorders and Neuromodulation Unit, DOMMO Clinic, São Paulo, Brazil
| | - Michael D Fox
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, 02114, USA
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Einstein Center Digital Future, Berlin, 10117, Germany
- Brain Simulation Section, Department of Neurology, Charité University Medicine Berlin and Berlin Institute of Health, Berlin, 10117, Germany
| | | | - Ningfei Li
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Martin Reich
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Clemens Neudorfer
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, 02114, USA
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, 02114, USA
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, 02114, USA
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Fontana HJ, Mazzucco J, Lescano S. The anterior perforated substance (APS) revisited: Commented anatomical and imagenological views. Brain Behav 2023; 13:e3029. [PMID: 38010896 PMCID: PMC10726791 DOI: 10.1002/brb3.3029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/10/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Since 2002, when we published our article about the anterior perforated substance (APS), the knowledge about the region has grown enormously. OBJECTIVE To make a better description of the anatomy of the zone with new dissection material added to the previous, to sustain the anatomical analysis of the MRI employing the SPACE sequence, interacting with our imagenology colleagues. Especially, we aim to identify and topographically localize by MRI the principal structures in APS-substantia innominata (SI). METHOD The presentation follows various steps: (1) location and boundaries of the zone and its neighboring areas; (2) schematic description of the region with simple outlines; (3) cursory revision of the SI and its three systems; (4) serial images of the dissections of the zone and its vessels, illustrated and completed when possible, by MRI images of a voluntary experimental subject (ES). RESULTS With this method, we could expose most of the structures of the region anatomically and imagenologically. DISCUSSION The zone can be approached for dissection with magnification and the habitual microsurgical instruments with satisfactory results. We think that fibers in this region should be followed by other anatomical methods in addition to tractography. The principal structures of ventral striopallidum and extended amygdala (EA) can be identified with the SPACE sequence. The amygdala and the basal ganglion of Meynert (BGM) are easily confused because of their similar signal. Anatomical clues can orient the clinician about the different clusters of the BGM in MRI. CONCLUSIONS The dissection requires a previous knowledge of the zone and a good amount of patience. The APS is a little space where concentrate essential vessels for the telencephalon, "en passage" or perforating, and neural structures of relevant functional import. From anatomical and MRI points of view, both neural and vascular structures follow a harmonious and topographically describable plan. The SPACE MRI sequence has proved to be a useful tool for identifying different structures in this area as the striatopallidal and EA. Anatomical knowledge of the fibers helps in the search of clusters of the basal ganglion.
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Affiliation(s)
| | - Juan Mazzucco
- Instituto ARGUS de Diagnóstico por ImágenesBuenos AiresArgentina
| | - Sebastián Lescano
- ARGUS Diagnóstico por Imágenes CNS imagenologistBuenos AiresArgentina
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Melo M, Furlanetti L, Hasegawa H, Mundil N, Ashkan K. Comparison of direct MRI guided versus atlas-based targeting for subthalamic nucleus and globus pallidus deep brain stimulation. Br J Neurosurg 2023; 37:1040-1045. [PMID: 33416411 DOI: 10.1080/02688697.2020.1850641] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The subthalamic nucleus (STN) and globus pallidus internus (GPi) targets for deep brain stimulation (DBS) can be defined by atlas coordinates or direct visualisation of the target on MRI. The aim of this study was to evaluate geometric differences between atlas-based targeting and MRI-guided direct targeting. METHODS One-hundred-nine Parkinson's disease or dystonia patients records who underwent DBS surgery between 2005 and 2016 were prospectively reviewed. MRI-guided direct targeting coordinates was used to implant 205 STN and 64 GPi electrodes and compared with atlas-based coordinates. RESULTS The directly targeted coordinates (mean, SD, range) for STN were x: [9.9 ± 1.1 (7.1 - 13.2)], y: [-0.8 ± 1.1 (-4.2 - 2)] and z: [-4.7 ± 0.53 (-5.9 - -3.2)]. The mean value for the STN was 2.1 mm more medial (p < 0.0001), 1.2 mm more anterior (p < 0.0001) and 0.7 mm more ventral (p < 0.0001) than the atlas target. The targeted coordinates for GPi were x: [22.3 ± 2.0 (17.8 - 26.1)], y: [-0.2 ± 2.2 (-4.5 - 3.4)], z: [-4.3 ± 0.8 (-6.2 - -2.3)]. The mean value for the GPi was 2.2 mm (p < 0.001) more posterior and 0.3 mm (p < 0.01) more ventral than the atlas-based coordinates. CONCLUSION MRI-guided targeting may be more accurate than atlas-based targeting due to individual variations in anatomy.
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Affiliation(s)
- Mariane Melo
- Department of Neurosurgery, King's College Hospital, London, UK
| | | | | | - Nilesh Mundil
- Department of Neurosurgery, King's College Hospital, London, UK
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Oxenford S, Roediger J, Neudorfer C, Milosevic L, Güttler C, Spindler P, Vajkoczy P, Neumann WJ, Kühn A, Horn A. Lead-OR: A multimodal platform for deep brain stimulation surgery. eLife 2022; 11:e72929. [PMID: 35594135 PMCID: PMC9177150 DOI: 10.7554/elife.72929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 05/19/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deep brain stimulation (DBS) electrode implant trajectories are stereotactically defined using preoperative neuroimaging. To validate the correct trajectory, microelectrode recordings (MERs) or local field potential recordings can be used to extend neuroanatomical information (defined by MRI) with neurophysiological activity patterns recorded from micro- and macroelectrodes probing the surgical target site. Currently, these two sources of information (imaging vs. electrophysiology) are analyzed separately, while means to fuse both data streams have not been introduced. Methods Here, we present a tool that integrates resources from stereotactic planning, neuroimaging, MER, and high-resolution atlas data to create a real-time visualization of the implant trajectory. We validate the tool based on a retrospective cohort of DBS patients (N = 52) offline and present single-use cases of the real-time platform. Results We establish an open-source software tool for multimodal data visualization and analysis during DBS surgery. We show a general correspondence between features derived from neuroimaging and electrophysiological recordings and present examples that demonstrate the functionality of the tool. Conclusions This novel software platform for multimodal data visualization and analysis bears translational potential to improve accuracy of DBS surgery. The toolbox is made openly available and is extendable to integrate with additional software packages. Funding Deutsche Forschungsgesellschaft (410169619, 424778381), Deutsches Zentrum für Luft- und Raumfahrt (DynaSti), National Institutes of Health (2R01 MH113929), and Foundation for OCD Research (FFOR).
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Affiliation(s)
- Simón Oxenford
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
| | - Jan Roediger
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
- Charité — Universitätsmedizin Berlin, Einstein Center for Neurosciences BerlinBerlinGermany
| | - Clemens Neudorfer
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
- Center for Brain Circuit Therapeutics Department of Neurology, Brigham & Women’s Hospital, Harvard Medical SchoolBostonUnited States
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
| | - Luka Milosevic
- Institute of Biomedical Engineering, University of TorontoTorontoCanada
- Krembil Brain Institute, University Health NetworkTorontoCanada
| | - Christopher Güttler
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
| | - Philipp Spindler
- Department of Neurosurgery, Charité — Universitätsmedizin BerlinBerlinGermany
| | - Peter Vajkoczy
- Department of Neurosurgery, Charité — Universitätsmedizin BerlinBerlinGermany
| | - Wolf-Julian Neumann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
| | - Andrea Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité — Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu BerlinBerlinGermany
- Center for Brain Circuit Therapeutics Department of Neurology, Brigham & Women’s Hospital, Harvard Medical SchoolBostonUnited States
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical SchoolBostonUnited States
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Boyne P, DiFrancesco M, Awosika OO, Williamson B, Vannest J. Mapping the human corticoreticular pathway with multimodal delineation of the gigantocellular reticular nucleus and high-resolution diffusion tractography. J Neurol Sci 2022; 434:120091. [PMID: 34979371 PMCID: PMC8957549 DOI: 10.1016/j.jns.2021.120091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 11/17/2021] [Accepted: 12/10/2021] [Indexed: 11/29/2022]
Abstract
The corticoreticular pathway (CRP) is a major motor tract that transmits cortical input to the reticular formation motor nuclei and may be an important mediator of motor recovery after central nervous system damage. However, its cortical origins, trajectory and laterality are incompletely understood in humans. This study aimed to map the human CRP and generate an average CRP template in standard MRI space. Following recently established guidelines, we manually delineated the primary reticular formation motor nucleus (gigantocellular reticular nucleus [GRN]) using several group-mean MRI contrasts from the Human Connectome Project (HCP). CRP tractography was then performed with HCP diffusion-weighted MRI data (N = 1065) by selecting diffusion streamlines that reached both the cortex and GRN. Corticospinal tract (CST) tractography was also performed for comparison. Results suggest that the human CRP has widespread origins, which overlap with the CST across most of the motor cortex and include additional exclusive inputs from the medial and anterior prefrontal cortices. The estimated CRP projected through the anterior and posterior limbs of the internal capsule before partially decussating in the midbrain tegmentum and converging bilaterally on the pontomedullary reticular formation. Thus, the CRP trajectory appears to partially overlap the CST, while being more distributed and anteromedial to the CST in the cerebrum before moving posterior to the CST in the brainstem. These findings have important implications for neurophysiologic testing, cortical stimulation and movement recovery after brain lesions. We expect that our GRN and tract maps will also facilitate future CRP research.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USA.
| | - Mark DiFrancesco
- Department of Radiology and Pediatric Neuroimaging Research Consortium, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, USA
| | - Oluwole O Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Brady Williamson
- Department of Radiology, College of Medicine, University of Cincinnati, Cincinnati, OH 45267, USA
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH 45267, USA
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Hollunder B, Rajamani N, Siddiqi SH, Finke C, Kühn AA, Mayberg HS, Fox MD, Neudorfer C, Horn A. Toward personalized medicine in connectomic deep brain stimulation. Prog Neurobiol 2022; 210:102211. [PMID: 34958874 DOI: 10.1016/j.pneurobio.2021.102211] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
At the group-level, deep brain stimulation leads to significant therapeutic benefit in a multitude of neurological and neuropsychiatric disorders. At the single-patient level, however, symptoms may sometimes persist despite "optimal" electrode placement at established treatment coordinates. This may be partly explained by limitations of disease-centric strategies that are unable to account for heterogeneous phenotypes and comorbidities observed in clinical practice. Instead, tailoring electrode placement and programming to individual patients' symptom profiles may increase the fraction of top-responding patients. Here, we propose a three-step, circuit-based framework with the aim of developing patient-specific treatment targets that address the unique symptom constellation prevalent in each patient. First, we describe how a symptom network target library could be established by mapping beneficial or undesirable DBS effects to distinct circuits based on (retrospective) group-level data. Second, we suggest ways of matching the resulting symptom networks to circuits defined in the individual patient (template matching). Third, we introduce network blending as a strategy to calculate optimal stimulation targets and parameters by selecting and weighting a set of symptom-specific networks based on the symptom profile and subjective priorities of the individual patient. We integrate the approach with published literature and conclude by discussing limitations and future challenges.
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Affiliation(s)
- Barbara Hollunder
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Nanditha Rajamani
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
| | - Clemens Neudorfer
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Schurr R, Mezer AA. The glial framework reveals white matter fiber architecture in human and primate brains. Science 2021; 374:762-767. [PMID: 34618596 DOI: 10.1126/science.abj7960] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
[Figure: see text].
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Affiliation(s)
- Roey Schurr
- Edmond and Lily Safra Center for Brain Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Aviv A Mezer
- Edmond and Lily Safra Center for Brain Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
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8
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Vedam-Mai V, Deisseroth K, Giordano J, Lazaro-Munoz G, Chiong W, Suthana N, Langevin JP, Gill J, Goodman W, Provenza NR, Halpern CH, Shivacharan RS, Cunningham TN, Sheth SA, Pouratian N, Scangos KW, Mayberg HS, Horn A, Johnson KA, Butson CR, Gilron R, de Hemptinne C, Wilt R, Yaroshinsky M, Little S, Starr P, Worrell G, Shirvalkar P, Chang E, Volkmann J, Muthuraman M, Groppa S, Kühn AA, Li L, Johnson M, Otto KJ, Raike R, Goetz S, Wu C, Silburn P, Cheeran B, Pathak YJ, Malekmohammadi M, Gunduz A, Wong JK, Cernera S, Wagle Shukla A, Ramirez-Zamora A, Deeb W, Patterson A, Foote KD, Okun MS. Proceedings of the Eighth Annual Deep Brain Stimulation Think Tank: Advances in Optogenetics, Ethical Issues Affecting DBS Research, Neuromodulatory Approaches for Depression, Adaptive Neurostimulation, and Emerging DBS Technologies. Front Hum Neurosci 2021; 15:644593. [PMID: 33953663 PMCID: PMC8092047 DOI: 10.3389/fnhum.2021.644593] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/10/2021] [Indexed: 12/20/2022] Open
Abstract
We estimate that 208,000 deep brain stimulation (DBS) devices have been implanted to address neurological and neuropsychiatric disorders worldwide. DBS Think Tank presenters pooled data and determined that DBS expanded in its scope and has been applied to multiple brain disorders in an effort to modulate neural circuitry. The DBS Think Tank was founded in 2012 providing a space where clinicians, engineers, researchers from industry and academia discuss current and emerging DBS technologies and logistical and ethical issues facing the field. The emphasis is on cutting edge research and collaboration aimed to advance the DBS field. The Eighth Annual DBS Think Tank was held virtually on September 1 and 2, 2020 (Zoom Video Communications) due to restrictions related to the COVID-19 pandemic. The meeting focused on advances in: (1) optogenetics as a tool for comprehending neurobiology of diseases and on optogenetically-inspired DBS, (2) cutting edge of emerging DBS technologies, (3) ethical issues affecting DBS research and access to care, (4) neuromodulatory approaches for depression, (5) advancing novel hardware, software and imaging methodologies, (6) use of neurophysiological signals in adaptive neurostimulation, and (7) use of more advanced technologies to improve DBS clinical outcomes. There were 178 attendees who participated in a DBS Think Tank survey, which revealed the expansion of DBS into several indications such as obesity, post-traumatic stress disorder, addiction and Alzheimer’s disease. This proceedings summarizes the advances discussed at the Eighth Annual DBS Think Tank.
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Affiliation(s)
- Vinata Vedam-Mai
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Karl Deisseroth
- Department of Bioengineering, Stanford University, Stanford, CA, United States.,Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - James Giordano
- Department of Neurology and Neuroethics Studies Program, Georgetown University Medical Center, Washington, DC, United States
| | - Gabriel Lazaro-Munoz
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States
| | - Winston Chiong
- Weill Institute for Neurosciences, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Nanthia Suthana
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Bioengineering, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jean-Philippe Langevin
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States.,Neurosurgery Service, Department of Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Jay Gill
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Wayne Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Nicole R Provenza
- School of Engineering, Brown University, Providence, RI, United States
| | - Casey H Halpern
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Rajat S Shivacharan
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Tricia N Cunningham
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, United States
| | - Sameer A Sheth
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Nader Pouratian
- Department of Neurosurgery, David Geffen School of Medicine and Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States
| | - Katherine W Scangos
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, United States
| | - Helen S Mayberg
- Department of Neurology and Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Kara A Johnson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Christopher R Butson
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States.,Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT, United States
| | - Ro'ee Gilron
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Robert Wilt
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Maria Yaroshinsky
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Simon Little
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Philip Starr
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Greg Worrell
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Prasad Shirvalkar
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States.,Department of Anesthesiology (Pain Management) and Neurology, University of California, San Francisco, San Francisco, CA, United States
| | - Edward Chang
- Department of Neurological Surgery, Kavli Institute for Fundamental Neuroscience, University of California, San Francisco, San Francisco, CA, United States
| | - Jens Volkmann
- Neurologischen Klinik Universitätsklinikum Würzburg, Würzburg, Germany
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, Focus Program Translational Neuroscience, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Luming Li
- National Engineering Laboratory for Neuromodulation, School of Aerospace Engineering, Tsinghua University, Beijing, China
| | - Matthew Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Kevin J Otto
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Robert Raike
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic, Minneapolis, MN, United States
| | - Steve Goetz
- Restorative Therapies Group Implantables, Research and Core Technology, Medtronic, Minneapolis, MN, United States
| | - Chengyuan Wu
- Department of Neurological Surgery, Thomas Jefferson University Hospitals, Philadelphia, PA, United States
| | - Peter Silburn
- Asia Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Binith Cheeran
- Neuromodulation Division, Abbott, Plano, TX, United States
| | - Yagna J Pathak
- Neuromodulation Division, Abbott, Plano, TX, United States
| | | | - Aysegul Gunduz
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Joshua K Wong
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Stephanie Cernera
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States.,J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
| | - Aparna Wagle Shukla
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Wissam Deeb
- Department of Neurology, University of Massachusetts, Worchester, MA, United States
| | - Addie Patterson
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Kelly D Foote
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Michael S Okun
- Norman Fixel Institute for Neurological Diseases and the Program for Movement Disorders and Neurorestoration, Department of Neurology, University of Florida, Gainesville, FL, United States
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9
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De Barros A, Arribarat G, Lotterie JA, Dominguez G, Chaynes P, Péran P. Iron distribution in the lentiform nucleus: A post-mortem MRI and histology study. Brain Struct Funct 2021; 226:351-364. [PMID: 33389044 DOI: 10.1007/s00429-020-02175-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 11/09/2020] [Indexed: 01/19/2023]
Abstract
Iron plays an important role in many neurobiological processes, especially in the basal ganglia, the brain structures with the highest concentration. Composed of the pallidum and putamen, the lentiform nucleus plays a key role in the basal ganglia circuitry. With MRI advances, iron-based sequences such as R2* and quantitative susceptibility mapping (QSM) are now available for detecting and quantifying iron in different brain structures. Since their validation using classic iron detection techniques (histology or physical techniques), these sequences have attracted growing clinical attention, especially in the field of extrapyramidal syndromes that particularly affect the basal nuclei. Accurate mapping of iron in these nuclei and their connections is needed to gain a better understanding of this specific anatomy, before considering its involvement in the physiopathological processes. We performed R2* and QSM along with Perls histology, to gain new insights into the distribution of iron in the lentiform nucleus and its surrounding structures, based on four specimens obtained from voluntary donors. We found that iron is preferentially distributed in the anterior part of the globus pallidus externus and the posterior part of the putamen. The lateral wall of the putamen is iron-poor, compared with the lateral medullary lamina and intraputaminal fibers. The relevance of perivascular iron concentration, along with pallido- and putaminofugal iron-rich fibers, is discussed.
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Affiliation(s)
- Amaury De Barros
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France. .,Department of Anatomy, Toulouse Faculty of Medicine, Toulouse federal University, Toulouse, France. .,Neuroscience (Neurosurgery) Center, Toulouse University Hospital, Toulouse, France.
| | - Germain Arribarat
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France
| | - Jean Albert Lotterie
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France.,Neuroscience (Neurosurgery) Center, Toulouse University Hospital, Toulouse, France
| | - Gaelle Dominguez
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France.,Neuropathology Unit, University Pathology Laboratory, Toulouse University Hospital-University of Toulouse III-Paul Sabatier, Toulouse, France
| | - Patrick Chaynes
- Department of Anatomy, Toulouse Faculty of Medicine, Toulouse federal University, Toulouse, France.,Neuroscience (Neurosurgery) Center, Toulouse University Hospital, Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center (ToNIC), University of Toulouse Paul Sabatier-INSERM, CHU Purpan, Pavillon Baudot, Place du Dr Baylac, 31024, Toulouse, Cedex 3, France
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10
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Guridi J, Gonzalez-Quarante LH. Revisiting Forel Field Surgery. World Neurosurg 2020; 147:11-22. [PMID: 33276174 DOI: 10.1016/j.wneu.2020.11.143] [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: 07/16/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Lesioning the Forel field or the subthalamic region is considered a possible treatment for tremoric patients with Parkinson disease, essential tremor, and other diseases. This surgical treatment was performed in the 1960s to 1970s and was an alternative to thalamotomy. Recently, there has been increasing interest in the reappraisal of stimulating and/or lesioning these targets, partly as a result of innovations in imaging and noninvasive ablative technologies, such as magnetic resonance-guided focused ultrasonography. OBJECTIVE We wanted to perform a thorough review of the subthalamic region, both from an anatomic and a surgical standpoint, to offer a comprehensive and updated analysis of the techniques and results reported for patients with tremor treated with different techniques. METHODS We performed a systematic review of the literature, gathering articles that included patients who underwent ablative or stimulation surgical techniques, targeting the pallidothalamic pathways (pallidothalamic tractotomy), cerebellothalamic pathway (cerebellothalamic tractotomy), or subthalamic area. RESULTS Pallidothalamic tractotomy consists of a reduced area that includes pallidofugal pathways. It may be considered an interesting target, given the benefit/risk ratio and the clinical effect, which, compared with pallidotomy, involves a lower risk of injury or involvement of vital structures such as the internal capsule or optic tract. Cerebellothalamic tractotomy and/or posterior subthalamic area are other alternative targets to thalamic stimulation or ablative surgery. CONCLUSIONS Based on the significant breakthrough that magnetic resonance-guided focused ultrasonography has meant in the neurosurgical world, some classic targets such as the pallidothalamic tract, Forel field, and posterior subthalamic area may be reconsidered as surgical alternatives for patients with movement disorders.
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Affiliation(s)
- Jorge Guridi
- Department of Neurosurgery, Clínica Universidad de Navarra, Navarra University, Pamplona, Spain
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11
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Horn A, Fox MD. Opportunities of connectomic neuromodulation. Neuroimage 2020; 221:117180. [PMID: 32702488 PMCID: PMC7847552 DOI: 10.1016/j.neuroimage.2020.117180] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 06/12/2020] [Accepted: 07/16/2020] [Indexed: 12/14/2022] Open
Abstract
The process of altering neural activity - neuromodulation - has long been used to treat patients with brain disorders and answer scientific questions. Deep brain stimulation in particular has provided clinical benefit to over 150,000 patients. However, our understanding of how neuromodulation impacts the brain is evolving. Instead of focusing on the local impact at the stimulation site itself, we are considering the remote impact on brain regions connected to the stimulation site. Brain connectivity information derived from advanced magnetic resonance imaging data can be used to identify these connections and better understand clinical and behavioral effects of neuromodulation. In this article, we review studies combining neuromodulation and brain connectomics, highlighting opportunities where this approach may prove particularly valuable. We focus on deep brain stimulation, but show that the same principles can be applied to other forms of neuromodulation, such as transcranial magnetic stimulation and MRI-guided focused ultrasound. We outline future perspectives and provide testable hypotheses for future work.
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Affiliation(s)
- Andreas Horn
- Neurology Department, Movement Disorders and Neuromodulation Sectio Charité - University Medicine Berlin,, Charitéplatz 1, D-10117 Berlin, Germany.
| | - Michael D Fox
- Berenson-Allen Center for Non-invasive Brain Stimulation, Department of Neurology, Harvard Medical School and Beth Israel Deaconess Medical Center, United States; Martinos Center for Biomedical Imaging, Departments of Neurology and Radiology, Harvard Medical School and Massachusetts General Hospital, United States; Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, and Radiology, Harvard Medical School and Brigham and Women's Hospital, United States.
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12
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The ansa subthalamica as a substrate for DBS-induced manic symptoms. Brain Stimul 2020; 13:1399-1401. [DOI: 10.1016/j.brs.2020.07.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/21/2020] [Accepted: 07/23/2020] [Indexed: 12/30/2022] Open
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13
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Middlebrooks EH, Domingo RA, Vivas-Buitrago T, Okromelidze L, Tsuboi T, Wong JK, Eisinger RS, Almeida L, Burns MR, Horn A, Uitti RJ, Wharen RE, Holanda VM, Grewal SS. Neuroimaging Advances in Deep Brain Stimulation: Review of Indications, Anatomy, and Brain Connectomics. AJNR Am J Neuroradiol 2020; 41:1558-1568. [PMID: 32816768 DOI: 10.3174/ajnr.a6693] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/03/2020] [Indexed: 12/18/2022]
Abstract
Deep brain stimulation is an established therapy for multiple brain disorders, with rapidly expanding potential indications. Neuroimaging has advanced the field of deep brain stimulation through improvements in delineation of anatomy, and, more recently, application of brain connectomics. Older lesion-derived, localizationist theories of these conditions have evolved to newer, network-based "circuitopathies," aided by the ability to directly assess these brain circuits in vivo through the use of advanced neuroimaging techniques, such as diffusion tractography and fMRI. In this review, we use a combination of ultra-high-field MR imaging and diffusion tractography to highlight relevant anatomy for the currently approved indications for deep brain stimulation in the United States: essential tremor, Parkinson disease, drug-resistant epilepsy, dystonia, and obsessive-compulsive disorder. We also review the literature regarding the use of fMRI and diffusion tractography in understanding the role of deep brain stimulation in these disorders, as well as their potential use in both surgical targeting and device programming.
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Affiliation(s)
- E H Middlebrooks
- From the Departments of Radiology (E.H.M., L.O.) .,Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | - R A Domingo
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | | | | | - T Tsuboi
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida.,Department of Neurology (T.T., J.K.W., R.S.E., L.A., M.R.B.), Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - J K Wong
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - R S Eisinger
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - L Almeida
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - M R Burns
- and Neurology (R.J.U.), Mayo Clinic, Jacksonville, Florida
| | - A Horn
- Department of Neurology (T.T.), Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - R J Uitti
- Department for Neurology (A.H.), Charité, University Medicine Berlin, Berlin, Germany
| | - R E Wharen
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
| | - V M Holanda
- Center of Neurology and Neurosurgery Associates (V.M.H.), BP-A Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - S S Grewal
- Neurosurgery (E.H.M., R.A.D., T.V.-B., R.E.W., S.S.G.)
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14
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Bertino S, Basile GA, Bramanti A, Anastasi GP, Quartarone A, Milardi D, Cacciola A. Spatially coherent and topographically organized pathways of the human globus pallidus. Hum Brain Mapp 2020; 41:4641-4661. [PMID: 32757349 PMCID: PMC7555102 DOI: 10.1002/hbm.25147] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/29/2020] [Accepted: 07/12/2020] [Indexed: 12/18/2022] Open
Abstract
Internal and external segments of globus pallidus (GP) exert different functions in basal ganglia circuitry, despite their main connectional systems share the same topographical organization, delineating limbic, associative, and sensorimotor territories. The identification of internal GP sensorimotor territory has therapeutic implications in functional neurosurgery settings. This study is aimed at assessing the spatial coherence of striatopallidal, subthalamopallidal, and pallidothalamic pathways by using tractography‐derived connectivity‐based parcellation (CBP) on high quality diffusion MRI data of 100 unrelated healthy subjects from the Human Connectome Project. A two‐stage hypothesis‐driven CBP approach has been carried out on the internal and external GP. Dice coefficient between functionally homologous pairs of pallidal maps has been computed. In addition, reproducibility of parcellation according to different pathways of interest has been investigated, as well as spatial relations between connectivity maps and existing optimal stimulation points for dystonic patients. The spatial organization of connectivity clusters revealed anterior limbic, intermediate associative and posterior sensorimotor maps within both internal and external GP. Dice coefficients showed high degree of coherence between functionally similar maps derived from the different bundles of interest. Sensorimotor maps derived from the subthalamopallidal pathway resulted to be the nearest to known optimal pallidal stimulation sites for dystonic patients. Our findings suggest that functionally homologous afferent and efferent connections may share similar spatial territory within the GP and that subcortical pallidal connectional systems may have distinct implications in the treatment of movement disorders.
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Affiliation(s)
- Salvatore Bertino
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Gianpaolo Antonio Basile
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | | | - Giuseppe Pio Anastasi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Angelo Quartarone
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
| | - Demetrio Milardi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.,IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Alberto Cacciola
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, Messina, Italy
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15
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Emmi A, Antonini A, Macchi V, Porzionato A, De Caro R. Anatomy and Connectivity of the Subthalamic Nucleus in Humans and Non-human Primates. Front Neuroanat 2020; 14:13. [PMID: 32390807 PMCID: PMC7189217 DOI: 10.3389/fnana.2020.00013] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 03/13/2020] [Indexed: 02/02/2023] Open
Abstract
The Subthalamic Nucleus (STh) is an oval-shaped diencephalic structure located ventrally to the thalamus, playing a fundamental role in the circuitry of the basal ganglia. In addition to being involved in the pathophysiology of several neurodegenerative disorders, such as Huntington’s and Parkinson’s disease, the STh is one of the target nuclei for deep brain stimulation. However, most of the anatomical evidence available derives from non-human primate studies. In this review, we will present the topographical and morphological organization of the nucleus and its connections to structurally and functionally related regions of the basal ganglia circuitry. We will also highlight the importance of additional research in humans focused on validating STh connectivity, cytoarchitectural organization, and its functional subdivision.
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Affiliation(s)
- Aron Emmi
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Angelo Antonini
- Parkinson and Movement Disorders Unit, Neurology Clinic, Department of Neuroscience, University of Padua, Padua, Italy
| | - Veronica Macchi
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Andrea Porzionato
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
| | - Raffaele De Caro
- Institute of Human Anatomy, Department of Neuroscience, University of Padua, Padua, Italy
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