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Kruithof ES, Klaus J, Schutter DJLG. Cerebellar Asymmetry of Motivational Direction: Anger-Dependent Effects of Cerebellar Transcranial Direct Current Stimulation on Aggression in Healthy Volunteers. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1426-1434. [PMID: 38172315 PMCID: PMC11269334 DOI: 10.1007/s12311-023-01644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
It has recently been theorized that the frontal asymmetry of approach- and avoidance-related motivation is mirrored in the posterolateral cerebellum. Accordingly, left-to-right dominant cerebellar activity is associated with avoidance-related motivation, whereas right-to-left dominant cerebellar activity is associated with approach-related motivation. The aim of this study was to examine the cerebellar asymmetry of motivational direction in approach-related behavior in the context of aggression. In this randomized double-blind sham-controlled crossover study, thirty healthy right-handed adult volunteers received 2 mA active or sham left cathodal-right anodal transcranial direct current stimulation (tDCS) to the cerebellum on two separate occasions while engaging in the Point Subtraction Aggression Paradigm (PSAP) task to measure aggressive behavior. Self-reported state anger was assessed before, halfway and immediately after the task, and heart rate and heart rate variability (HRV) were measured during the task. No main effects of tDCS on aggressive behavior, heart rate and HRV were found. Higher state anger before and during the PSAP task was associated with increased aggressive behavior in the active compared to sham tDCS condition. Aggressive behavior was positively correlated with heart rate during active tDCS, while an inverse association was observed during sham tDCS. Results provide support for the cerebellar asymmetry of motivational direction in approach-related behavior and illustrate the importance of affective state-dependency in tDCS-related effects.
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Affiliation(s)
- Eline S Kruithof
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands.
| | - Jana Klaus
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
| | - Dennis J L G Schutter
- Department of Experimental Psychology, Helmholtz Institute, Utrecht University, Heidelberglaan 1, 3584 CS, Utrecht, The Netherlands
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2
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Wang L, Wang S, Zheng W, Yang B, Yang Y, Chen X, Chen Q, Li X, Hu Y, Du J, Qin W, Lu J, Chen N. Altered Brain Function in Pediatric Patients With Complete Spinal Cord Injury: A Resting-State Functional MRI Study. J Magn Reson Imaging 2024; 60:304-313. [PMID: 37800893 DOI: 10.1002/jmri.29045] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Injury to the spinal cord of children may cause potential brain reorganizations, affecting their rehabilitation. However, the specific functional alterations of children after complete spinal cord injury (CSCI) remain unclear. PURPOSE To explore the specific functional changes in local brain and the relationship with clinical characteristics in pediatric CSCI patients, clarifying the impact of CSCI on brain function in developing children. STUDY TYPE Prospective. SUBJECTS Thirty pediatric CSCI patients (7.83 ± 1.206 years) and 30 age-, gender-matched healthy children as controls (HCs) (8.77 ± 2.079 years). FIELD STRENGTH/SEQUENCE 3.0 T/Resting-state functional MRI (rs-fMRI) using echo-planar-imaging (EPI) sequence. ASSESSMENT Amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), and regional homogeneity (ReHo) were used to characterize regional neural function. STATISTICAL TESTS Two-sample t-tests were used to compare the ALFF, fALFF, ReHo values of the brain between pediatric CSCI and HCs (voxel-level FWE correction, P < 0.05). Spearman correlation analyses were performed to analyze the associations between the ALFF, fALFF, ReHo values in altered regions and the injury duration, sensory motor scores of pediatric CSCI patients (P < 0.05). Then receiver operating characteristic (ROC) analysis was conducted to identify possible sensitive imaging indicators for clinical therapy. RESULTS Compared with HCs, pediatric CSCI showed significantly decreased ALFF in the right postcentral gyrus (S1), orbitofrontal cortex, and left superior temporal gyrus (STG), increased ALFF in bilateral caudate nucleus, thalamus, middle cingulate gyrus, and cerebellar lobules IV-VI, and increased ReHo in left cerebellum Crus II and Brodmann area 21. The ALFF value in the right S1 negatively correlated with the pinprick and light touch sensory scores of pediatric CSCI. When the left STG was used as an imaging biomarker for pediatric CSCI, it achieved the highest area under the curve of 0.989. CONCLUSIONS These findings may provide potential neural mechanisms for sensory motor and cognitive-emotional deficits in children after CSCI. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 5.
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Affiliation(s)
- Ling Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Shengqiang Wang
- Department of Neurosurgery, Aerospace Center Hospital, Beijing, China
| | - Weimin Zheng
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Beining Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Yanhui Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Xin Chen
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuejing Li
- Department of Radiology, China Rehabilitation Research Center, Beijing, China
| | - Yongsheng Hu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jubao Du
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Wen Qin
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
| | - Nan Chen
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, China
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Hoffman LJ, Foley JM, Leong JK, Sullivan-Toole H, Elliott BL, Olson IR. An in vivo Dissection, and Analysis of Socio-Affective Symptoms related to Cerebellum-Midbrain Reward Circuitry in Humans. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.09.29.560239. [PMID: 38798382 PMCID: PMC11118266 DOI: 10.1101/2023.09.29.560239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Emerging research in non-human animals implicates cerebellar projections to the ventral tegmental area (VTA) in appetitive behaviors, but these circuits have not been characterized in humans. Here, we mapped cerebello-VTA white-matter connectivity in humans using probabilistic tractography on diffusion imaging data from the Human Connectome Project. We uncovered the topographical organization of these connections by separately tracking from parcels of cerebellar lobule VI, crus I/II, vermis, paravermis, and cerebrocerebellum. Results revealed that connections from the cerebellum to the VTA predominantly originate in the right hemisphere, interposed nucleus, and paravermal cortex, and terminate mostly ipsilaterally. Paravermal crus I sends the most connections to the VTA compared to other lobules. We discovered a medial-to-lateral gradient of connectivity, such that the medial cerebellum has the highest connectivity with the VTA. Individual differences in microstructure were associated with measures of negative affect and social functioning. By splitting the tracts into quarters, we found that the socio-affective effects were driven by the third quarter of the tract, corresponding to the point at which the fibers leave the deep nuclei. Taken together, we produced detailed maps of cerebello-VTA structural connectivity for the first time in humans and established their relevance for trait differences in socio-affective regulation.
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Affiliation(s)
- Linda J. Hoffman
- Temple University, Department of Psychology and Neuroscience, Philadelphia, PA, USA
| | - Julia M. Foley
- Temple University, Department of Psychology and Neuroscience, Philadelphia, PA, USA
| | - Josiah K. Leong
- University of Arkansas, Department of Psychological Science, Fayetteville, AR, USA
| | - Holly Sullivan-Toole
- Temple University, Department of Psychology and Neuroscience, Philadelphia, PA, USA
| | - Blake L. Elliott
- Temple University, Department of Psychology and Neuroscience, Philadelphia, PA, USA
| | - Ingrid R. Olson
- Temple University, Department of Psychology and Neuroscience, Philadelphia, PA, USA
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4
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Faris P, Pischedda D, Palesi F, D’Angelo E. New clues for the role of cerebellum in schizophrenia and the associated cognitive impairment. Front Cell Neurosci 2024; 18:1386583. [PMID: 38799988 PMCID: PMC11116653 DOI: 10.3389/fncel.2024.1386583] [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: 02/15/2024] [Accepted: 04/26/2024] [Indexed: 05/29/2024] Open
Abstract
Schizophrenia (SZ) is a complex neuropsychiatric disorder associated with severe cognitive dysfunction. Although research has mainly focused on forebrain abnormalities, emerging results support the involvement of the cerebellum in SZ physiopathology, particularly in Cognitive Impairment Associated with SZ (CIAS). Besides its role in motor learning and control, the cerebellum is implicated in cognition and emotion. Recent research suggests that structural and functional changes in the cerebellum are linked to deficits in various cognitive domains including attention, working memory, and decision-making. Moreover, cerebellar dysfunction is related to altered cerebellar circuit activities and connectivity with brain regions associated with cognitive processing. This review delves into the role of the cerebellum in CIAS. We initially consider the major forebrain alterations in CIAS, addressing impairments in neurotransmitter systems, synaptic plasticity, and connectivity. We then focus on recent findings showing that several mechanisms are also altered in the cerebellum and that cerebellar communication with the forebrain is impaired. This evidence implicates the cerebellum as a key component of circuits underpinning CIAS physiopathology. Further studies addressing cerebellar involvement in SZ and CIAS are warranted and might open new perspectives toward understanding the physiopathology and effective treatment of these disorders.
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Affiliation(s)
- Pawan Faris
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Doris Pischedda
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Digital Neuroscience Center, IRCCS Mondino Foundation, Pavia, Italy
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5
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Fong PY, Rothwell JC, Rocchi L. The Past, Current and Future Research in Cerebellar TMS Evoked Responses-A Narrative Review. Brain Sci 2024; 14:432. [PMID: 38790411 PMCID: PMC11118133 DOI: 10.3390/brainsci14050432] [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: 03/22/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/26/2024] Open
Abstract
Transcranial magnetic stimulation coupled with electroencephalography (TMS-EEG) is a novel technique to investigate cortical physiology in health and disease. The cerebellum has recently gained attention as a possible new hotspot in the field of TMS-EEG, with several reports published recently. However, EEG responses obtained by cerebellar stimulation vary considerably across the literature, possibly due to different experimental methods. Compared to conventional TMS-EEG, which involves stimulation of the cortex, cerebellar TMS-EEG presents some technical difficulties, including strong muscle twitches in the neck area and a loud TMS click when double-cone coils are used, resulting in contamination of responses by electromyographic activity and sensory potentials. Understanding technical difficulties and limitations is essential for the development of cerebellar TMS-EEG research. In this review, we summarize findings of cerebellar TMS-EEG studies, highlighting limitations in experimental design and potential issues that can result in discrepancies between experimental outcomes. Lastly, we propose a possible direction for academic and clinical research with cerebellar TMS-EEG.
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Affiliation(s)
- Po-Yu Fong
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
- Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 333, Taiwan
- Medical School, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - John C. Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London WC1N 3BG, UK; (J.C.R.)
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Tur C, Battiston M, Yiannakas MC, Collorone S, Calvi A, Prados F, Kanber B, Grussu F, Ricciardi A, Pajak P, Martinelli D, Schneider T, Ciccarelli O, Samson RS, Wheeler-Kingshott CAG. What contributes to disability in progressive MS? A brain and cervical cord-matched quantitative MRI study. Mult Scler 2024; 30:516-534. [PMID: 38372019 DOI: 10.1177/13524585241229969] [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: 02/20/2024]
Abstract
BACKGROUND We assessed the ability of a brain-and-cord-matched quantitative magnetic resonance imaging (qMRI) protocol to differentiate patients with progressive multiple sclerosis (PMS) from controls, in terms of normal-appearing (NA) tissue abnormalities, and explain disability. METHODS A total of 27 patients and 16 controls were assessed on the Expanded Disability Status Scale (EDSS), 25-foot timed walk (TWT), 9-hole peg (9HPT) and symbol digit modalities (SDMT) tests. All underwent 3T brain and (C2-C3) cord structural imaging and qMRI (relaxometry, quantitative magnetisation transfer, multi-shell diffusion-weighted imaging), using a fast brain-and-cord-matched protocol with brain-and-cord-unified imaging readouts. Lesion and NA-tissue volumes and qMRI metrics reflecting demyelination and axonal loss were obtained. Random forest analyses identified the most relevant volumetric/qMRI measures to clinical outcomes. Confounder-adjusted linear regression estimated the actual MRI-clinical associations. RESULTS Several qMRI/volumetric differences between patients and controls were observed (p < 0.01). Higher NA-deep grey matter quantitative-T1 (EDSS: beta = 7.96, p = 0.006; 9HPT: beta = -0.09, p = 0.004), higher NA-white matter orientation dispersion index (TWT: beta = -3.21, p = 0.005; SDMT: beta = -847.10, p < 0.001), lower whole-cord bound pool fraction (9HPT: beta = 0.79, p = 0.001) and higher NA-cortical grey matter quantitative-T1 (SDMT = -94.31, p < 0.001) emerged as particularly relevant predictors of greater disability. CONCLUSION Fast brain-and-cord-matched qMRI protocols are feasible and identify demyelination - combined with other mechanisms - as key for disability accumulation in PMS.
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Affiliation(s)
- Carmen Tur
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Multiple Sclerosis Centre of Catalonia (Cemcat). Vall d'Hebron Institute of Research. Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Marco Battiston
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Marios C Yiannakas
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Sara Collorone
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Alberto Calvi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, Hospital Clinic, Barcelona, Spain
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
- eHealth Center, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Baris Kanber
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Francesco Grussu
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Radiomics Group, Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Antonio Ricciardi
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Patrizia Pajak
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Daniele Martinelli
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | | | - Olga Ciccarelli
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- NIHR UCLH Biomedical Research Centre, London, UK
| | - Rebecca S Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Claudia Am Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, UCL (University College London) Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy; Brain Connectivity Research Center, IRCCS Mondino Foundation, Pavia, Italy
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Hudgins SN, Curtin A, Tracy J, Ayaz H. Impaired Cortico-Thalamo-Cerebellar Integration Across Schizophrenia, Bipolar II, and Attention Deficit Hyperactivity Disorder Patients Suggests Potential Neural Signatures for Psychiatric Illness. RESEARCH SQUARE 2024:rs.3.rs-4145883. [PMID: 38586053 PMCID: PMC10996788 DOI: 10.21203/rs.3.rs-4145883/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Understanding aberrant functional changes between brain regions has shown promise for characterizing and differentiating the symptoms associated with progressive psychiatric disorders. The functional integration between the thalamus and cerebellum significantly influences learning and memory in cognition. Observed in schizophrenic patients, dysfunction within the corticalthalamocerebellar (CTC) circuitry is linked to challenges in prioritizing, processing, coordinating, and responding to information. This study explored whether abnormal CTC functional network connectivity patterns are present across schizophrenia (SCHZ) patients, bipolar II disorder (BIPOL) patients, and ADHD patients by examining both task- and task-free conditions compared to healthy volunteers (HC). Leveraging fMRI data from 135 participants (39 HC, 27 SCHZ patients, 38 BIPOL patients, and 31 ADHD patients), we analyzed functional network connectivity (FNC) patterns across 115 cortical, thalamic, subcortical, and cerebellar regions of interest (ROIs). Guiding our investigation: First, do the brain regions of the CTC circuit exhibit distinct abnormal patterns at rest in SCHZ, ADHD, and BIPOL? Second, do working memory tasks in these patients engage common regions of the circuit in similar or unique patterns? Consistent with previous findings, our observations revealed FNC patterns constrained in the cerebellar, thalamic, striatal, hippocampal, medial prefrontal and insular cortices across all three psychiatric cohorts when compared to controls in both task and task-free conditions. Post hoc analysis suggested a predominance in schizophrenia and ADHD patients during rest, while the task condition demonstrated effects across all three disorders. Factor-by-covariance GLM MANOVA further specified regions associated with clinical symptoms and trait assessments. Our study provides evidence suggesting that dysfunctional CTC circuitry in both task-free and task-free conditions may be an important broader neural signature of psychiatric illness.
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Takahashi A, Kitsunai S, Kawana H, Saito N, Yoshihara A, Furukawa K. Physiotherapy management focusing on proprioceptive impairment in a patient with gait and balance impairments following stroke: A case report. Physiother Theory Pract 2024:1-15. [PMID: 38516762 DOI: 10.1080/09593985.2024.2332792] [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: 09/07/2023] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Proprioceptive impairment contributes to gait and balance impairments in patients with stroke. Diagnosis functional impairments and evaluation treatment efficacy require quantitative proprioception assessment. However, proprioception assessment has remained limited to ordinal scale measurement, with a lack of ratio scale measurements. PURPOSE This case report describes a physiotherapy management program focusing on proprioceptive impairment in patients with stroke using quantitative tests such as Threshold to Detect Passive Motion (TDPM) and Joint Position Sense (JPS). CASE DESCRIPTION A63-year-old male patient with an acute pontine lacunar infarction was admitted to our hospital. His muscle strength, selective movement, and trunk activity were preserved. However, the Berg Balance Scale (BBS) and Gait Assessment andIntervention Tool (GAIT) score were 42 and 9 points, observing balance impairment and the buckling knee pattern with hip ataxia during gait. Based on these, TDPM and JPS using image capture were performed. In physiotherapeuticdiagnosis, proprioceptive impairments in the hip and knee joints were the primary functional impairments related to balance and gait. To address these proprioceptive impairments, a 13-day treatment protocol incorporating transcutaneous electrical nerve stimulation (intensity: sensory threshold, frequency: 100 Hz) targeting the quadriceps femoris was performed. OUTCOMES The patient was discharged after achieving independent ambulation and improvement in BBS (56 points) and GAIT (2 points) scores, exceeding the minimum clinically important difference. Recovery of proprioceptive impairment corresponded withimproved balance and gait ability. CONCLUSION Quantitatively evaluating proprioceptive impairments may provide novel rehabilitation for patients with stroke who have proprioceptive impairments and contribute to clinical decision-making.
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Affiliation(s)
- Aisuke Takahashi
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Shun Kitsunai
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Hikaru Kawana
- Department of Medical Rehabilitation, Ohara General Hospital, Fukushima, Japan
| | - Naoshi Saito
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Akioh Yoshihara
- Department of Neurology, Ohara General Hospital, Fukushima, Japan
| | - Katsuhiro Furukawa
- Department of Physical Therapy, Faculty of Health Sciences, Iryo Sosei University, Fukushima, Japan
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9
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Lyu W, Wu Y, Huynh KM, Ahmad S, Yap PT. A multimodal submillimeter MRI atlas of the human cerebellum. Sci Rep 2024; 14:5622. [PMID: 38453991 PMCID: PMC10920891 DOI: 10.1038/s41598-024-55412-y] [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: 11/17/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
The human cerebellum is engaged in a broad array of tasks related to motor coordination, cognition, language, attention, memory, and emotional regulation. A detailed cerebellar atlas can facilitate the investigation of the structural and functional organization of the cerebellum. However, existing cerebellar atlases are typically limited to a single imaging modality with insufficient characterization of tissue properties. Here, we introduce a multifaceted cerebellar atlas based on high-resolution multimodal MRI, facilitating the understanding of the neurodevelopment and neurodegeneration of the cerebellum based on cortical morphology, tissue microstructure, and intra-cerebellar and cerebello-cerebral connectivity.
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Affiliation(s)
- Wenjiao Lyu
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Ye Wu
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Khoi Minh Huynh
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Sahar Ahmad
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA
| | - Pew-Thian Yap
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA.
- Biomedical Research Imaging Center, University of North Carolina, Chapel Hill, NC, USA.
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10
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Sinisalo H, Rissanen I, Kahilakoski OP, Souza VH, Tommila T, Laine M, Nyrhinen M, Ukharova E, Granö I, Soto AM, Matsuda RH, Rantala R, Guidotti R, Kičić D, Lioumis P, Mutanen T, Pizzella V, Marzetti L, Roine T, Stenroos M, Ziemann U, Romani GL, Ilmoniemi RJ. Modulating brain networks in space and time: Multi-locus transcranial magnetic stimulation. Clin Neurophysiol 2024; 158:218-224. [PMID: 38184469 DOI: 10.1016/j.clinph.2023.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/17/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024]
Affiliation(s)
- Heikki Sinisalo
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland.
| | - Ilkka Rissanen
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | | | - Victor H Souza
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki, Aalto University, and Helsinki University Hospital, Helsinki, Finland; Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Timo Tommila
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Mikael Laine
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Mikko Nyrhinen
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland; AMI Centre, Aalto NeuroImaging, Aalto University School of Science, Espoo, Finland
| | - Elena Ukharova
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Ida Granö
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Ana M Soto
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Renan H Matsuda
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland; Department of Physics, Faculty of Philosophy Sciences and Letters of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Robin Rantala
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Roberto Guidotti
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Dubravko Kičić
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Pantelis Lioumis
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland; BioMag Laboratory, HUS Medical Imaging Center, University of Helsinki, Aalto University, and Helsinki University Hospital, Helsinki, Finland
| | - Tuomas Mutanen
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Vittorio Pizzella
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Laura Marzetti
- Department of Neuroscience, Imaging and Clinical Sciences, University G. d'Annunzio of Chieti-Pescara, Chieti, Italy; Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Timo Roine
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Matti Stenroos
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
| | - Ulf Ziemann
- Department of Neurology & Stroke, University of Tübingen, Tübingen, Germany; Hertie-Institute for Clinical Brain Research, Tübingen, Germany
| | - Gian Luca Romani
- Institute for Advanced Biomedical Technologies (ITAB), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Risto J Ilmoniemi
- Department of Neuroscience and Biomedical Engineering, Aalto University, Espoo, Finland
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11
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Magielse N, Heuer K, Toro R, Schutter DJLG, Valk SL. A Comparative Perspective on the Cerebello-Cerebral System and Its Link to Cognition. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1293-1307. [PMID: 36417091 PMCID: PMC10657313 DOI: 10.1007/s12311-022-01495-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
The longstanding idea that the cerebral cortex is the main neural correlate of human cognition can be elaborated by comparative analyses along the vertebrate phylogenetic tree that support the view that the cerebello-cerebral system is suited to support non-motor functions more generally. In humans, diverse accounts have illustrated cerebellar involvement in cognitive functions. Although the neocortex, and its transmodal association cortices such as the prefrontal cortex, have become disproportionately large over primate evolution specifically, human neocortical volume does not appear to be exceptional relative to the variability within primates. Rather, several lines of evidence indicate that the exceptional volumetric increase of the lateral cerebellum in conjunction with its connectivity with the cerebral cortical system may be linked to non-motor functions and mental operation in primates. This idea is supported by diverging cerebello-cerebral adaptations that potentially coevolve with cognitive abilities across other vertebrates such as dolphins, parrots, and elephants. Modular adaptations upon the vertebrate cerebello-cerebral system may thus help better understand the neuroevolutionary trajectory of the primate brain and its relation to cognition in humans. Lateral cerebellar lobules crura I-II and their reciprocal connections to the cerebral cortical association areas appear to have substantially expanded in great apes, and humans. This, along with the notable increase in the ventral portions of the dentate nucleus and a shift to increased relative prefrontal-cerebellar connectivity, suggests that modular cerebellar adaptations support cognitive functions in humans. In sum, we show how comparative neuroscience provides new avenues to broaden our understanding of cerebellar and cerebello-cerebral functions in the context of cognition.
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Affiliation(s)
- Neville Magielse
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Center Jülich, Jülich, Germany
- Otto Hahn Cognitive Neurogenetics Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
- Institute of Systems Neuroscience, Heinrich Heine University, Düsseldorf, Germany
| | - Katja Heuer
- Institute Pasteur, Unité de Neuroanatomie Appliquée et Théorique, Université Paris Cité, Paris, France
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Roberto Toro
- Institute Pasteur, Unité de Neuroanatomie Appliquée et Théorique, Université Paris Cité, Paris, France
| | - Dennis J L G Schutter
- Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, The Netherlands
| | - Sofie L Valk
- Institute of Neuroscience and Medicine (INM-7: Brain and Behaviour), Research Center Jülich, Jülich, Germany.
- Otto Hahn Cognitive Neurogenetics Group, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany.
- Institute of Systems Neuroscience, Heinrich Heine University, Düsseldorf, Germany.
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12
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Magielse N, Toro R, Steigauf V, Abbaspour M, Eickhoff SB, Heuer K, Valk SL. Phylogenetic comparative analysis of the cerebello-cerebral system in 34 species highlights primate-general expansion of cerebellar crura I-II. Commun Biol 2023; 6:1188. [PMID: 37993596 PMCID: PMC10665558 DOI: 10.1038/s42003-023-05553-z] [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: 03/16/2023] [Accepted: 11/07/2023] [Indexed: 11/24/2023] Open
Abstract
The reciprocal connections between the cerebellum and the cerebrum have been suggested to simultaneously play a role in brain size increase and to support a broad array of brain functions in primates. The cerebello-cerebral system has undergone marked functionally relevant reorganization. In particular, the lateral cerebellar lobules crura I-II (the ansiform) have been suggested to be expanded in hominoids. Here, we manually segmented 63 cerebella (34 primate species; 9 infraorders) and 30 ansiforms (13 species; 8 infraorders) to understand how their volumes have evolved over the primate lineage. Together, our analyses support proportional cerebellar-cerebral scaling, whereas ansiforms have expanded faster than the cerebellum and cerebrum. We did not find different scaling between strepsirrhines and haplorhines, nor between apes and non-apes. In sum, our study shows primate-general structural reorganization of the ansiform, relative to the cerebello-cerebral system, which is relevant for specialized brain functions in an evolutionary context.
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Grants
- RT and KH are supported by the French Agence Nationale de la Recherche, projects NeuroWebLab (ANR-19-DATA-0025) and DMOBE (ANR-21-CE45-0016). KH received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement No101033485 (Individual Fellowship). Last, this work was funded in part by Helmholtz Association’s Initiative and Networking Fund under the Helmholtz International Lab grant agreement InterLabs-0015, and the Canada First Research Excellence Fund (CFREF Competition 2, 2015–2016), awarded to the Healthy Brains, Healthy Lives initiative at McGill University, through the Helmholtz International BigBrain Analytics and Learning Laboratory (HIBALL), including NM, SBE, and SLV.
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Affiliation(s)
- Neville Magielse
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Wilhelm-Johnen-Straße, 52428, Jülich, Germany.
- Otto Hahn Cognitive Neurogenetics Group, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1A, 04103, Leipzig, Germany.
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Roberto Toro
- Institut Pasteur, Unité de Neuroanatomie Appliquée et Théorique, Université Paris Cité, 25 rue du Dr. Roux, 75724, Paris, France
| | - Vanessa Steigauf
- Department of Biology, Northern Michigan University, 1401 Presque Isle Ave, MI, 49855, Marquette, USA
| | - Mahta Abbaspour
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Luisenstraße 56, Haus 1, 10117, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Bonhoefferweg 3, 10117, Berlin, Germany
| | - Simon B Eickhoff
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Wilhelm-Johnen-Straße, 52428, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Katja Heuer
- Institut Pasteur, Unité de Neuroanatomie Appliquée et Théorique, Université Paris Cité, 25 rue du Dr. Roux, 75724, Paris, France
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1A, 04103, Leipzig, Germany
| | - Sofie L Valk
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Center Jülich, Wilhelm-Johnen-Straße, 52428, Jülich, Germany.
- Otto Hahn Cognitive Neurogenetics Group, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1A, 04103, Leipzig, Germany.
- Institute of Systems Neuroscience, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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13
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Nishiyama H, Nishiyama N, Zemelman BV. Loss of Purkinje cells in the developing cerebellum strengthens the cerebellothalamic synapses. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.01.564864. [PMID: 37961231 PMCID: PMC10635038 DOI: 10.1101/2023.11.01.564864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
Cerebellar damage early in life often causes long-lasting motor, social, and cognitive impairments, suggesting the roles of the cerebellum in developing a broad spectrum of behaviors. This recent finding has promoted research on how cerebellar damage affects the development of the cerebral cortex, the brain region responsible for higher-order control of all behaviors. However, the cerebral cortex is not directly connected to the cerebellum. The thalamus is the direct postsynaptic target of the cerebellum, sending cerebellar outputs to the cerebral cortex. Despite its crucial position in cerebello-cerebral interaction, thalamic susceptibility to cerebellar damage remains largely unclear. Here, we studied the consequences of early cerebellar perturbation on thalamic development. Whole-cell patch-clamp recordings showed that the synaptic organization of the cerebellothlamic circuit is similar to that of the primary sensory thalamus, in which aberrant sensory activity alters synaptic circuit formation. The hemizygous deletion of the tuberous sclerosis complex-1 ( Tsc1 ) gene in the Purkinje cell-known to cause Purkinje cell hypoactivity and autistic behaviors-did not alter cerebellothalamic synapses or intrinsic membrane properties of thalamic neurons. However, the ablation of Purkinje cells in the developing cerebellum strengthened the cerebellothalamic synapses and enhanced thalamic suprathreshold activities. These results suggest that the cerebellothalamic circuit is resistant to moderate perturbation in the developing cerebellum, such as the reduced firing rate of Purkinje cells, and that autistic behaviors are not necessarily linked to thalamic abnormality. Still, Purkinje cell loss alters the thalamic circuit, suggesting the vulnerability of the thalamus to substantial disturbance in the developing cerebellum.
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14
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Marchese SM, Palesi F, Nigri A, Bruzzone MG, Pantaleoni C, Gandini Wheeler-Kingshott CAM, D’Arrigo S, D’Angelo E, Cavallari P. Structural and connectivity parameters reveal spared connectivity in young patients with non-progressive compared to slow-progressive cerebellar ataxia. Front Neurol 2023; 14:1279616. [PMID: 37965172 PMCID: PMC10642782 DOI: 10.3389/fneur.2023.1279616] [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: 08/21/2023] [Accepted: 10/12/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Within Pediatric Cerebellar Ataxias (PCAs), patients with non-progressive ataxia (NonP) surprisingly show postural motor behavior comparable to that of healthy controls, differently to slow-progressive ataxia patients (SlowP). This difference may depend on the building of compensatory strategies of the intact areas in NonP brain network. Methods Eleven PCAs patients were recruited: five with NonP and six with SlowP. We assessed volumetric and axonal bundles alterations with a multimodal approach to investigate whether eventual spared connectivity between basal ganglia and cerebellum explains the different postural motor behavior of NonP and SlowP patients. Results Cerebellar lobules were smaller in SlowP patients. NonP patients showed a lower number of streamlines in the cerebello-thalamo-cortical tracts but a generalized higher integrity of white matter tracts connecting the cortex and the basal ganglia with the cerebellum. Discussion This work reveals that the axonal bundles connecting the cerebellum with basal ganglia and cortex demonstrate a higher integrity in NonP patients. This evidence highlights the importance of the cerebellum-basal ganglia connectivity to explain the different postural motor behavior of NonP and SlowP patients and support the possible compensatory role of basal ganglia in patients with stable cerebellar malformation.
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Affiliation(s)
- Silvia Maria Marchese
- Human Physiology Section of the DePT, Università degli Studi di Milano, Milan, Italy
| | - Fulvia Palesi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Digital Neuroscience, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Nigri
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico “Carlo Besta”, Milan, Italy
| | - Chiara Pantaleoni
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Digital Neuroscience, IRCCS Mondino Foundation, Pavia, Italy
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Stefano D’Arrigo
- Department of Pediatric Neuroscience, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan, Italy
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Digital Neuroscience, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Cavallari
- Human Physiology Section of the DePT, Università degli Studi di Milano, Milan, Italy
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15
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Xia Y, Wang M, Zhu Y. The Effect of Cerebellar rTMS on Modulating Motor Dysfunction in Neurological Disorders: a Systematic Review. CEREBELLUM (LONDON, ENGLAND) 2023; 22:954-972. [PMID: 36018543 DOI: 10.1007/s12311-022-01465-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The effectiveness of cerebellar repetitive transcranial magnetic stimulation (rTMS) on motor dysfunction in patients with neurological disorders has received increasing attention because of its potential for neuromodulation. However, studies on the neuromodulatory effects, parameters, and safety of rTMS implementation in the cerebellum to alleviate motor dysfunction are limited. This systematic review aimed to evaluate the effectiveness and safety of cerebellar rTMS treatment for motor dysfunction caused by neurological disorders and to review popular stimulation parameters. Five electronic databases-Medline, Web of Science, Scopus, Cochrane Library, and Embase-were searched for relevant research published from inception to July 2022. All randomized controlled trials (RCTs) that reported the effects of cerebellar rTMS combined with behavioral rating scales on motor dysfunction were eligible for enrollment. Additionally, reference lists of the enrolled studies were manually checked. Among 1156 articles screened, 21 RCTs with 666 subjects were included. rTMS conducted on the cerebellum showed an improvement in stroke (spasticity, balance, and gait), cervical dystonia, Parkinson's disease (tremor), cerebellar ataxia, and essential tremor but not in multiple sclerosis. The 8-shaped coil with a diameter of 70 mm was determined as the most common therapeutic choice. None of the studies reported severe adverse events except mild side effects in three. Therefore, rTMS appears to be a promising and safe technique for the treatment of motor dysfunction, targeting the cerebellum to induce motor behavioral improvement. Further rigorous RCTs, including more samples and longer follow-up periods, are required to precisely explore the effective stimulation parameters and possible mechanisms.
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Affiliation(s)
- Yifei Xia
- School of Kinesiology, Shanghai University of Sport, Yangpu District, No. 200 Hengren Road, Shanghai, China
| | - Mingqi Wang
- School of Kinesiology, Shanghai University of Sport, Yangpu District, No. 200 Hengren Road, Shanghai, China
| | - Yulian Zhu
- School of Kinesiology, Shanghai University of Sport, Yangpu District, No. 200 Hengren Road, Shanghai, China.
- Department of Rehabilitation Medicine, Huashan Hospital, Fudan University, Jing'an District, No. 12 Wulumuqi road, Shanghai, 200040, China.
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16
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Martinie O, Karan P, Traverse E, Mercier C, Descoteaux M, Robert MT. The Challenge of Diffusion Magnetic Resonance Imaging in Cerebral Palsy: A Proposed Method to Identify White Matter Pathways. Brain Sci 2023; 13:1386. [PMID: 37891755 PMCID: PMC10605121 DOI: 10.3390/brainsci13101386] [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: 08/18/2023] [Revised: 09/19/2023] [Accepted: 09/26/2023] [Indexed: 10/29/2023] Open
Abstract
Cerebral palsy (CP), a neuromotor disorder characterized by prenatal brain lesions, leads to white matter alterations and sensorimotor deficits. However, the CP-related diffusion neuroimaging literature lacks rigorous and consensual methodology for preprocessing and analyzing data due to methodological challenges caused by the lesion extent. Advanced methods are available to reconstruct diffusion signals and can update current advances in CP. Our study demonstrates the feasibility of analyzing diffusion CP data using a standardized and open-source pipeline. Eight children with CP (8-12 years old) underwent a single diffusion magnetic resonance imaging (MRI) session on a 3T scanner (Achieva 3.0T (TX), Philips Healthcare Medical Systems, Best, The Netherlands). Exclusion criteria were contraindication to MRI and claustrophobia. Anatomical and diffusion images were acquired. Data were corrected and analyzed using Tractoflow 2.3.0 version, an open-source and robust tool. The tracts were extracted with customized procedures based on existing atlases and freely accessed standardized libraries (ANTs, Scilpy). DTI, CSD, and NODDI metrics were computed for each tract. Despite lesion heterogeneity and size, we successfully reconstructed major pathways, except for a participant with a larger lesion. Our results highlight the feasibility of identifying and quantifying subtle white matter pathways. Ultimately, this will increase our understanding of the clinical symptoms to provide precision medicine and optimize rehabilitation.
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Affiliation(s)
- Ophélie Martinie
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Philippe Karan
- Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (P.K.); (M.D.)
| | - Elodie Traverse
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Catherine Mercier
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
| | - Maxime Descoteaux
- Department of Computer Sciences, Université de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada; (P.K.); (M.D.)
| | - Maxime T. Robert
- Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Québec, QC G1M 2S8, Canada; (O.M.); (E.T.); (C.M.)
- Department of Rehabilitation, Université Laval, Québec, QC G1V 0A6, Canada
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17
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Lorenzi RM, Geminiani A, Zerlaut Y, De Grazia M, Destexhe A, Gandini Wheeler-Kingshott CAM, Palesi F, Casellato C, D'Angelo E. A multi-layer mean-field model of the cerebellum embedding microstructure and population-specific dynamics. PLoS Comput Biol 2023; 19:e1011434. [PMID: 37656758 PMCID: PMC10501640 DOI: 10.1371/journal.pcbi.1011434] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 09/14/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
Mean-field (MF) models are computational formalism used to summarize in a few statistical parameters the salient biophysical properties of an inter-wired neuronal network. Their formalism normally incorporates different types of neurons and synapses along with their topological organization. MFs are crucial to efficiently implement the computational modules of large-scale models of brain function, maintaining the specificity of local cortical microcircuits. While MFs have been generated for the isocortex, they are still missing for other parts of the brain. Here we have designed and simulated a multi-layer MF of the cerebellar microcircuit (including Granule Cells, Golgi Cells, Molecular Layer Interneurons, and Purkinje Cells) and validated it against experimental data and the corresponding spiking neural network (SNN) microcircuit model. The cerebellar MF was built using a system of equations, where properties of neuronal populations and topological parameters are embedded in inter-dependent transfer functions. The model time constant was optimised using local field potentials recorded experimentally from acute mouse cerebellar slices as a template. The MF reproduced the average dynamics of different neuronal populations in response to various input patterns and predicted the modulation of the Purkinje Cells firing depending on cortical plasticity, which drives learning in associative tasks, and the level of feedforward inhibition. The cerebellar MF provides a computationally efficient tool for future investigations of the causal relationship between microscopic neuronal properties and ensemble brain activity in virtual brain models addressing both physiological and pathological conditions.
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Affiliation(s)
| | - Alice Geminiani
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Yann Zerlaut
- Institut du Cerveau-Paris Brain Institute-ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, Paris, France
| | | | | | - Claudia A M Gandini Wheeler-Kingshott
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, UCL, London, United Kingdom
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
| | - Fulvia Palesi
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Claudia Casellato
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - Egidio D'Angelo
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
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18
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Cazzoli D, Kaufmann BC, Rühe H, Geiser N, Vanbellingen T, Nyffeler T. A case study of left visual neglect after right pontine lesion: pathophysiological evidence for the infratentorial involvement in human visual attention. J Neurophysiol 2023; 129:1534-1539. [PMID: 37222432 DOI: 10.1152/jn.00123.2023] [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: 03/22/2023] [Revised: 05/11/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023] Open
Abstract
Hemispatial neglect, the inability to attend to the contralesional side of space, is the most common disturbance of visuospatial attention. Both hemispatial neglect and visuospatial attention are typically associated with extended cortical networks. Nevertheless, recent accounts challenge this so-called corticocentric view and postulate the participation of structures well beyond the telencephalic cortex, in particular advocating the role of the brainstem. However, to the best of our knowledge, hemispatial neglect after a brainstem lesion has not yet been described. We describe, for the first time in a human, the occurrence and remission of contralesional visual hemispatial neglect after a focal lesion in the right pons. Hemispatial neglect was assessed by means of video-oculography during free visual exploration, a very sensitive and established method, and its remission was followed up until 3 wk after stroke. Moreover, by means of a lesion-deficit approach complemented by imaging, we identify a pathophysiological mechanism involving the disconnection of cortico-ponto-cerebellar and/or tecto-cerebellar-tectal pathways passing through the pons. Our findings offer, for the first time in a human, causal, lesion-based support for recent seminal accounts postulating the role of infratentorial structures participating in the activity of cerebral cortical attentional networks mediating attentional processes.NEW & NOTEWORTHY Visuospatial attention and its most common disturbance, hemispatial neglect, are typically associated with extended cortical networks. However, recent accounts challenge this corticocentric view and advocate the role of infratentorial structures. We describe, for the first time in a human, the occurrence of contralesional visual hemispatial neglect after a focal lesion in the right pons. We provide causal, lesion-based evidence for a pathophysiological mechanism involving the disconnection of cortico-ponto-cerebellar and/or tecto-cerebellar-tectal pathways passing through the pons.
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Affiliation(s)
- Dario Cazzoli
- Neurocenter, Luzerner Kantonsspital LUKS, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Psychology, University of Bern, Bern, Switzerland
| | - Brigitte C Kaufmann
- Neurocenter, Luzerner Kantonsspital LUKS, Lucerne, Switzerland
- Sorbonne Université, Institut du Cerveau-Paris Brain Institute (ICM), Inserm, CNRS, Paris, France
| | - Henrik Rühe
- Neurocenter, Luzerner Kantonsspital LUKS, Lucerne, Switzerland
| | - Nora Geiser
- Neurocenter, Luzerner Kantonsspital LUKS, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Tim Vanbellingen
- Neurocenter, Luzerner Kantonsspital LUKS, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Thomas Nyffeler
- Neurocenter, Luzerner Kantonsspital LUKS, Lucerne, Switzerland
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, University Hospital, University of Bern, Bern, Switzerland
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19
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Fong PY, Spampinato D, Michell K, Mancuso M, Brown K, Ibáñez J, Santo AD, Latorre A, Bhatia K, Rothwell JC, Rocchi L. EEG responses induced by cerebellar TMS at rest and during visuomotor adaptation. Neuroimage 2023; 275:120188. [PMID: 37230209 DOI: 10.1016/j.neuroimage.2023.120188] [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: 01/10/2023] [Revised: 05/17/2023] [Accepted: 05/22/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Connections between the cerebellum and the cortex play a critical role in learning and executing complex behaviours. Dual-coil transcranial magnetic stimulation (TMS) can be used non-invasively to probe connectivity changes between the lateral cerebellum and motor cortex (M1) using the motor evoked potential as an outcome measure (cerebellar-brain inhibition, CBI). However, it gives no information about cerebellar connections to other parts of cortex. OBJECTIVES We used electroencephalography (EEG) to investigate whether it was possible to detect activity evoked in any areas of cortex by single-pulse TMS of the cerebellum (cerebellar TMS evoked potentials, cbTEPs). A second experiment tested if these responses were influenced by the performance of a cerebellar-dependent motor learning paradigm. METHODS In the first series of experiments, TMS was applied over either the right or left cerebellar cortex, and scalp EEG was recorded simultaneously. Control conditions that mimicked auditory and somatosensory inputs associated with cerebellar TMS were included to identify responses due to non-cerebellar sensory stimulation. We conducted a follow-up experiment that evaluated whether cbTEPs are behaviourally sensitive by assessing individuals before and after learning a visuomotor reach adaptation task. RESULTS A TMS pulse over the lateral cerebellum evoked EEG responses that could be distinguished from those caused by auditory and sensory artefacts. Significant positive (P80) and negative peaks (N110) over the contralateral frontal cerebral area were identified with a mirrored scalp distribution after left vs. right cerebellar stimulation. The P80 and N110 peaks were replicated in the cerebellar motor learning experiment and changed amplitude at different stages of learning. The change in amplitude of the P80 peak was associated with the degree of learning that individuals retained following adaptation. Due to overlap with sensory responses, the N110 should be interpreted with caution. CONCLUSIONS Cerebral potentials evoked by TMS of the lateral cerebellum provide a neurophysiological probe of cerebellar function that complements the existing CBI method. They may provide novel insight into mechanisms of visuomotor adaptation and other cognitive processes.
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Affiliation(s)
- Po-Yu Fong
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Division of Movement Disorders, Department of Neurology and Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Medical School, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Danny Spampinato
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Non-invasive Brain Stimulation Unit, IRCCS Santa Lucia Foundation, Via Ardeatina 306/354, 00142, Rome, Italy
| | - Kevin Michell
- UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Katlyn Brown
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Jaime Ibáñez
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; BSICoS group, I3A Institute, University of Zaragoza, IIS Aragón, Zaragoza, Spain; Department of Bioengineering, Imperial College, London, UK
| | - Alessandro Di Santo
- NEuroMuscular Omnicentre (NEMO), Serena Onlus, AOS Monaldi, Naples, Italy; Unit of Neurology, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - Anna Latorre
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Kailash Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - John C Rothwell
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Lorenzo Rocchi
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK; Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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20
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Monteverdi A, Di Domenico D, D'Angelo E, Mapelli L. Anisotropy and Frequency Dependence of Signal Propagation in the Cerebellar Circuit Revealed by High-Density Multielectrode Array Recordings. Biomedicines 2023; 11:biomedicines11051475. [PMID: 37239146 DOI: 10.3390/biomedicines11051475] [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: 03/24/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
The cerebellum is one of the most connected structures of the central nervous system and receives inputs over an extended frequency range. Nevertheless, the frequency dependence of cerebellar cortical processing remains elusive. In this work, we characterized cerebellar cortex responsiveness to mossy fibers activation at different frequencies and reconstructed the spread of activity in the sagittal and coronal planes of acute mouse cerebellar slices using a high-throughput high-density multielectrode array (HD-MEA). The enhanced spatiotemporal resolution of HD-MEA revealed the frequency dependence and spatial anisotropy of cerebellar activation. Mossy fiber inputs reached the Purkinje cell layer even at the lowest frequencies, but the efficiency of transmission increased at higher frequencies. These properties, which are likely to descend from the topographic organization of local inhibition, intrinsic electroresponsiveness, and short-term synaptic plasticity, are critical elements that have to be taken into consideration to define the computational properties of the cerebellar cortex and its pathological alterations.
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Affiliation(s)
- Anita Monteverdi
- Brain Connectivity Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Danila Di Domenico
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Egidio D'Angelo
- Brain Connectivity Center, IRCCS Mondino Foundation, 27100 Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Lisa Mapelli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
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21
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Ciapponi C, Li Y, Osorio Becerra DA, Rodarie D, Casellato C, Mapelli L, D’Angelo E. Variations on the theme: focus on cerebellum and emotional processing. Front Syst Neurosci 2023; 17:1185752. [PMID: 37234065 PMCID: PMC10206087 DOI: 10.3389/fnsys.2023.1185752] [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: 03/13/2023] [Accepted: 04/18/2023] [Indexed: 05/27/2023] Open
Abstract
The cerebellum operates exploiting a complex modular organization and a unified computational algorithm adapted to different behavioral contexts. Recent observations suggest that the cerebellum is involved not just in motor but also in emotional and cognitive processing. It is therefore critical to identify the specific regional connectivity and microcircuit properties of the emotional cerebellum. Recent studies are highlighting the differential regional localization of genes, molecules, and synaptic mechanisms and microcircuit wiring. However, the impact of these regional differences is not fully understood and will require experimental investigation and computational modeling. This review focuses on the cellular and circuit underpinnings of the cerebellar role in emotion. And since emotion involves an integration of cognitive, somatomotor, and autonomic activity, we elaborate on the tradeoff between segregation and distribution of these three main functions in the cerebellum.
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Affiliation(s)
- Camilla Ciapponi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Yuhe Li
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Dimitri Rodarie
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Centro Ricerche Enrico Fermi, Rome, Italy
| | - Claudia Casellato
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Lisa Mapelli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Egidio D’Angelo
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Brain Connectivity Center, IRCCS Mondino Foundation, Pavia, Italy
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22
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Coll L, Pareto D, Carbonell-Mirabent P, Cobo-Calvo Á, Arrambide G, Vidal-Jordana Á, Comabella M, Castilló J, Rodríguez-Acevedo B, Zabalza A, Galán I, Midaglia L, Nos C, Salerno A, Auger C, Alberich M, Río J, Sastre-Garriga J, Oliver A, Montalban X, Rovira À, Tintoré M, Lladó X, Tur C. Deciphering multiple sclerosis disability with deep learning attention maps on clinical MRI. Neuroimage Clin 2023; 38:103376. [PMID: 36940621 PMCID: PMC10034138 DOI: 10.1016/j.nicl.2023.103376] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
The application of convolutional neural networks (CNNs) to MRI data has emerged as a promising approach to achieving unprecedented levels of accuracy when predicting the course of neurological conditions, including multiple sclerosis, by means of extracting image features not detectable through conventional methods. Additionally, the study of CNN-derived attention maps, which indicate the most relevant anatomical features for CNN-based decisions, has the potential to uncover key disease mechanisms leading to disability accumulation. From a cohort of patients prospectively followed up after a first demyelinating attack, we selected those with T1-weighted and T2-FLAIR brain MRI sequences available for image analysis and a clinical assessment performed within the following six months (N = 319). Patients were divided into two groups according to expanded disability status scale (EDSS) score: ≥3.0 and < 3.0. A 3D-CNN model predicted the class using whole-brain MRI scans as input. A comparison with a logistic regression (LR) model using volumetric measurements as explanatory variables and a validation of the CNN model on an independent dataset with similar characteristics (N = 440) were also performed. The layer-wise relevance propagation method was used to obtain individual attention maps. The CNN model achieved a mean accuracy of 79% and proved to be superior to the equivalent LR-model (77%). Additionally, the model was successfully validated in the independent external cohort without any re-training (accuracy = 71%). Attention-map analyses revealed the predominant role of frontotemporal cortex and cerebellum for CNN decisions, suggesting that the mechanisms leading to disability accrual exceed the mere presence of brain lesions or atrophy and probably involve how damage is distributed in the central nervous system.
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Affiliation(s)
- Llucia Coll
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ángela Vidal-Jordana
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Breogán Rodríguez-Acevedo
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Nos
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Annalaura Salerno
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manel Alberich
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jordi Río
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Arnau Oliver
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Xavier Montalban
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology (IDI), Vall d'Hebron University Hospital, Spain, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Lladó
- Research institute of Computer Vision and Robotics, University of Girona, Girona, Spain
| | - Carmen Tur
- Multiple Sclerosis Centre of Catalonia (Cemcat), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain.
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23
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Chen Z, He C, Zhang P, Cai X, Huang W, Chen X, Xu M, Wang L, Zhang Y. Abnormal cerebellum connectivity patterns related to motor subtypes of Parkinson's disease. J Neural Transm (Vienna) 2023; 130:549-560. [PMID: 36859555 PMCID: PMC10050038 DOI: 10.1007/s00702-023-02606-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 02/14/2023] [Indexed: 03/03/2023]
Abstract
Cerebellar dysfunction may substantially contribute to the clinical symptoms of Parkinson's disease (PD). The role of cerebellar subregions in tremors and gait disturbances in PD remains unknown. To investigate alterations in cerebellar subregion volumes and functional connectivity (FC), as well as FC between the dentate nucleus (DN) and ventral lateral posterior nucleus (VLp) of the thalamus, which are potentially involved in different PD motor subtypes. We conducted morphometric and resting-state functional connectivity analyses in various cerebellar subregions in 22 tremor-dominant (TD)-PD and 35 postural instability gait difficulty dominant (PIGD)-PD patients and 38 sex- and age-matched healthy controls (HCs). The volume and FC alterations in various cerebellar subregions and the neural correlates of these changes with the clinical severity scores were investigated. The PIGD-PD group showed greater FC between the right motor cerebellum (CBMm) and left postcentral gyrus than the HC group, and a higher FC was associated with less severe PIGD symptoms. In contrast, the TD-PD group had decreased FC between the right DN and left VLp compared with the PIGD-PD and HC groups, and lower FC was associated with worse TD symptoms. Furthermore, the PIGD-PD group had higher FC between the left DN and left inferior temporal gyrus than the TD-PD group. Morphometric analysis revealed that the TD-PD group showed a significantly higher volume of left CBMm than the HC group. Our findings point to differential alteration patterns in cerebellar subregions and offer a new perspective on the pathophysiology of motor subtypes of PD.
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Affiliation(s)
- Zhenzhen Chen
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China.,Department of Neurology, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.,Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Chentao He
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China.,Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Piao Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China.,Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xin Cai
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
| | - Wenlin Huang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
| | - Xi Chen
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China
| | - Mingze Xu
- Center for MRI Research, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, 100190, China
| | - Lijuan Wang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China.,Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, No. 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, China. .,Guangzhou Key Laboratory of Diagnosis and Treatment for Neurodegenerative Diseases, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China. .,Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
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24
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Van Malderen S, Hehl M, Verstraelen S, Swinnen SP, Cuypers K. Dual-site TMS as a tool to probe effective interactions within the motor network: a review. Rev Neurosci 2023; 34:129-221. [PMID: 36065080 DOI: 10.1515/revneuro-2022-0020] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/02/2022] [Indexed: 02/07/2023]
Abstract
Dual-site transcranial magnetic stimulation (ds-TMS) is well suited to investigate the causal effect of distant brain regions on the primary motor cortex, both at rest and during motor performance and learning. However, given the broad set of stimulation parameters, clarity about which parameters are most effective for identifying particular interactions is lacking. Here, evidence describing inter- and intra-hemispheric interactions during rest and in the context of motor tasks is reviewed. Our aims are threefold: (1) provide a detailed overview of ds-TMS literature regarding inter- and intra-hemispheric connectivity; (2) describe the applicability and contributions of these interactions to motor control, and; (3) discuss the practical implications and future directions. Of the 3659 studies screened, 109 were included and discussed. Overall, there is remarkable variability in the experimental context for assessing ds-TMS interactions, as well as in the use and reporting of stimulation parameters, hindering a quantitative comparison of results across studies. Further studies examining ds-TMS interactions in a systematic manner, and in which all critical parameters are carefully reported, are needed.
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Affiliation(s)
- Shanti Van Malderen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Melina Hehl
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stefanie Verstraelen
- Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
| | - Stephan P Swinnen
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,KU Leuven, Leuven Brain Institute (LBI), Leuven, Belgium
| | - Koen Cuypers
- Department of Movement Sciences, Movement Control & Neuroplasticity Research Group, Group Biomedical Sciences, KU Leuven, Heverlee 3001, Belgium.,Neuroplasticity and Movement Control Research Group, Rehabilitation Research Institute (REVAL), Hasselt University, Diepenbeek 3590, Belgium
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25
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Schmitt JE, DeBevits JJ, Roalf DR, Ruparel K, Gallagher RS, Gur RC, Alexander-Bloch A, Eom TY, Alam S, Steinberg J, Akers W, Khairy K, Crowley TB, Emanuel B, Zakharenko SS, McDonald-McGinn DM, Gur RE. A Comprehensive Analysis of Cerebellar Volumes in the 22q11.2 Deletion Syndrome. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:79-90. [PMID: 34848384 PMCID: PMC9162086 DOI: 10.1016/j.bpsc.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The presence of a 22q11.2 microdeletion (22q11.2 deletion syndrome [22q11DS]) ranks among the greatest known genetic risk factors for the development of psychotic disorders. There is emerging evidence that the cerebellum is important in the pathophysiology of psychosis. However, there is currently limited information on cerebellar neuroanatomy in 22q11DS specifically. METHODS High-resolution 3T magnetic resonance imaging was acquired in 79 individuals with 22q11DS and 70 typically developing control subjects (N = 149). Lobar and lobule-level cerebellar volumes were estimated using validated automated segmentation algorithms, and subsequently group differences were compared. Hierarchical clustering, principal component analysis, and graph theoretical models were used to explore intercerebellar relationships. Cerebrocerebellar structural connectivity with cortical thickness was examined via linear regression models. RESULTS Individuals with 22q11DS had, on average, 17.3% smaller total cerebellar volumes relative to typically developing subjects (p < .0001). The lobules of the superior posterior cerebellum (e.g., VII and VIII) were particularly affected in 22q11DS. However, all cerebellar lobules were significantly smaller, even after adjusting for total brain volumes (all cerebellar lobules p < .0002). The superior posterior lobule was disproportionately associated with cortical thickness in the frontal lobes and cingulate cortex, brain regions known be affected in 22q11DS. Exploratory analyses suggested that the superior posterior lobule, particularly Crus I, may be associated with psychotic symptoms in 22q11DS. CONCLUSIONS The cerebellum is a critical but understudied component of the 22q11DS neuroendophenotype.
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Affiliation(s)
- J Eric Schmitt
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania; Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - John J DeBevits
- Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Roalf
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Kosha Ruparel
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - R Sean Gallagher
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Aaron Alexander-Bloch
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Tae-Yeon Eom
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shahinur Alam
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeffrey Steinberg
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Walter Akers
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Khaled Khairy
- Center for In Vivo Imaging and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - T Blaine Crowley
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beverly Emanuel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stanislav S Zakharenko
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Donna M McDonald-McGinn
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania; Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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26
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Gassmann L, Gordon PC, Ziemann U. Assessing effective connectivity of the cerebellum with cerebral cortex using TMS-EEG. Brain Stimul 2022; 15:1354-1369. [PMID: 36180039 DOI: 10.1016/j.brs.2022.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/25/2022] [Accepted: 09/25/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The cerebellum provides important input to the cerebral cortex but its assessment is difficult. Cerebellar brain inhibition tested by paired-coil transcranial magnetic stimulation (TMS) is limited to the motor cortex. Here we sought to measure responses to cerebellar TMS (cbTMS) throughout the cerebral cortex using electroencephalography (EEG). METHODS Single-pulse TMS was applied with an induced upward current to the right cerebellar hemisphere in 46 healthy volunteers while recording EEG. Multiple control conditions, including TMS of right occipital cortex, cbTMS with induced downward current, and a sham condition modified specifically for cbTMS were tested to provide evidence for the specificity of the EEG responses evoked by cbTMS with an upward induced current. RESULTS Distinct EEG response components could be specifically attributed to cbTMS, namely a left-hemispheric prefrontal positive deflection 25 ms after cbTMS, and a subsequent left-hemispheric parietal negative deflection peaking at 45 ms. In the time-frequency-response analysis, cbTMS induced a left-hemispheric prefrontal power increase in the high-beta frequency band. These responses were not seen in the control and sham conditions. CONCLUSIONS The EEG responses observed in this highly controlled experimental design may cautiously be attributed to reflect specific signatures of the activation of the cerebello-dentato-thalamo-cortical pathway by cbTMS. Therefore, these responses may provide biomarkers for assessing the integrity of this pathway, a proposition that will need further testing in clinical populations.
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Affiliation(s)
- Lukas Gassmann
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Pedro Caldana Gordon
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology & Stroke, University of Tübingen, Germany; Hertie Institute for Clinical Brain Research, University of Tübingen, Germany.
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27
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In vivo probabilistic atlas of white matter tracts of the human subthalamic area combining track density imaging and optimized diffusion tractography. Brain Struct Funct 2022; 227:2647-2665. [PMID: 36114861 PMCID: PMC9618529 DOI: 10.1007/s00429-022-02561-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/29/2022] [Indexed: 11/18/2022]
Abstract
The human subthalamic area is a region of high anatomical complexity, tightly packed with tiny fiber bundles. Some of them, including the pallidothalamic, cerebello-thalamic, and mammillothalamic tracts, are relevant targets in functional neurosurgery for various brain diseases. Diffusion-weighted imaging-based tractography has been suggested as a useful tool to map white matter pathways in the human brain in vivo and non-invasively, though the reconstruction of these specific fiber bundles is challenging due to their small dimensions and complex anatomy. To the best of our knowledge, a population-based, in vivo probabilistic atlas of subthalamic white matter tracts is still missing. In the present work, we devised an optimized tractography protocol for reproducible reconstruction of the tracts of subthalamic area in a large data sample from the Human Connectome Project repository. First, we leveraged the super-resolution properties and high anatomical detail provided by short tracks track-density imaging (stTDI) to identify the white matter bundles of the subthalamic area on a group-level template. Tracts identification on the stTDI template was also aided by visualization of histological sections of human specimens. Then, we employed this anatomical information to drive tractography at the subject-level, optimizing tracking parameters to maximize between-subject and within-subject similarities as well as anatomical accuracy. Finally, we gathered subject level tracts reconstructed with optimized tractography into a large-scale, normative population atlas. We suggest that this atlas could be useful in both clinical anatomy and functional neurosurgery settings, to improve our understanding of the complex morphology of this important brain region.
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28
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Yang W, Ge M, Zhu K, Chen J, Yang P, Cai Y, Peng X, Wang J, Sun H, Ji Y, Zhao F, Zhang H. Male Predisposition in Cerebellar Mutism Syndrome: a Cohort Study. CEREBELLUM (LONDON, ENGLAND) 2022:10.1007/s12311-022-01449-6. [PMID: 35870083 DOI: 10.1007/s12311-022-01449-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to explore the association between sex and cerebellar mutism syndrome and to examine other potential risk factors. This ambispective cohort study examined 218 pediatric patients (132 boys) with a posterior fossa tumor who underwent tumor resection from July 2013 to March 2021. The patients' demographics and tumor characteristics were examined and statistically analyzed to explore the associations among the variables. Multivariable and subgroup analyses were conducted to validate the independent risk factors for cerebellar mutism syndrome (CMS). The male and female patients did not differ significantly in terms of age, tumor size, tumor location, tumor consistency, VP shunt placement before resection, extent of resection, or surgeon, as well as with respect to the presence of hydrocephalus or paraventricular edema. The overall incidence of CMS was 32.6%. The incidence of CMS was significantly higher in male patients than that in female patients (41.7% vs. 18.6%; P = 0.001). In the multivariable analysis, male sex (adjusted odds ratio [OR], 3.27; P = 0.001), solid tumor consistency (adjusted OR, 5.61; P = 0.001), midline location (adjusted OR, 3.78; P = 0.004), and hydrocephalus (adjusted OR, 2.56; P = 0.047) were independent risk factors for the CMS. Chi-square analysis revealed that solid tumor consistency and midline location were associated with medulloblastoma (P < 0.001). Male patients had a higher risk of developing CMS after a posterior fossa tumor resection. Midline location, solid tumor consistency, and hydrocephalus were independent risk factors for CMS.
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Affiliation(s)
- Wei Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Ming Ge
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China.
| | - Kaiyi Zhu
- Department of Neonatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Jiashu Chen
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Ping Yang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Yingjie Cai
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - XiaoJiao Peng
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Jia Wang
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Hailang Sun
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Yuanqi Ji
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Fengmao Zhao
- Department of Neurosurgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishilu, West District, Beijing, 100045, China
| | - Hong Zhang
- Department of Imaging Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
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Grillo M, Geminiani A, Alessandro C, D'Angelo E, Pedrocchi A, Casellato C. Bayesian Integration in a Spiking Neural System for Sensorimotor Control. Neural Comput 2022; 34:1893-1914. [PMID: 35896162 DOI: 10.1162/neco_a_01525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 04/30/2022] [Indexed: 11/04/2022]
Abstract
The brain continuously estimates the state of body and environment, with specific regions that are thought to act as Bayesian estimator, optimally integrating noisy and delayed sensory feedback with sensory predictions generated by the cerebellum. In control theory, Bayesian estimators are usually implemented using high-level representations. In this work, we designed a new spike-based computational model of a Bayesian estimator. The state estimator receives spiking activity from two neural populations encoding the sensory feedback and the cerebellar prediction, and it continuously computes the spike variability within each population as a reliability index of the signal these populations encode. The state estimator output encodes the current state estimate. We simulated a reaching task at different stages of cerebellar learning. The activity of the sensory feedback neurons encoded a noisy version of the trajectory after actual movement, with an almost constant intrapopulation spiking variability. Conversely, the activity of the cerebellar output neurons depended on the phase of the learning process. Before learning, they fired at their baseline not encoding any relevant information, and the variability was set to be higher than that of the sensory feedback (more reliable, albeit delayed). When learning was complete, their activity encoded the trajectory before the actual execution, providing an accurate sensory prediction; in this case, the variability was set to be lower than that of the sensory feedback. The state estimator model optimally integrated the neural activities of the afferent populations, so that the output state estimate was primarily driven by sensory feedback in prelearning and by the cerebellar prediction in postlearning. It was able to deal even with more complex scenarios, for example, by shifting the dominant source during the movement execution if information availability suddenly changed. The proposed tool will be a critical block within integrated spiking, brain-inspired control systems for simulations of sensorimotor tasks.
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Affiliation(s)
- Massimo Grillo
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Alice Geminiani
- Department of Brain and Behavioral Sciences, University of Pavia 27100, Italy
| | - Cristiano Alessandro
- Department of Brain and Behavioral Sciences, University of Pavia 27100, Italy.,School of Medicine and Surgery/Sport and Exercise Science, University of Milano-Bicocca, 20126 Milan, Italy
| | - Egidio D'Angelo
- Department of Brain and Behavioral Sciences, University of Pavia 27100, Italy.,Brain Connectivity Center, IRCCS Mondino Foundation, Pavia 27100, Italy
| | - Alessandra Pedrocchi
- Nearlab, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133, Milan, Italy
| | - Claudia Casellato
- Department of Brain and Behavioral Sciences, University of Pavia 27100, Italy
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Wang W, Zhang X, Bai X, Zhang Y, Yuan Z, Tang H, Li Z, Hu Z, Zhang Y, Yu X, Sui B, Wang Y. Gamma-aminobutyric acid and glutamate/glutamine levels in the dentate nucleus and periaqueductal gray with episodic and chronic migraine: a proton magnetic resonance spectroscopy study. J Headache Pain 2022; 23:83. [PMID: 35840907 PMCID: PMC9287958 DOI: 10.1186/s10194-022-01452-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background The pathogenesis of migraine chronification remains unclear. Functional and structural magnetic resonance imaging studies have shown impaired functional and structural alterations in the brains of patients with chronic migraine. The cerebellum and periaqueductal gray (PAG) play pivotal roles in the neural circuits of pain conduction and analgesia in migraine. However, few neurotransmitter metabolism studies of these migraine-associated regions have been performed. To explore the pathogenesis of migraine chronification, we measured gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels in the dentate nucleus (DN) and PAG of patients with episodic and chronic migraine and healthy subjects. Methods Using the MEGA-PRESS sequence and a 3-Tesla magnetic resonance scanner (Signa Premier; GE Healthcare, Chicago, IL, USA), we obtained DN and PAG metabolite concentrations from patients with episodic migraine (n = 25), those with chronic migraine (n = 24), and age-matched and sex-matched healthy subjects (n = 16). Patients with chronic migraine were further divided into those with (n = 12) and without (n = 12) medication overuse headache. All scans were performed at the Beijing Tiantan Hospital, Capital Medical University. Results We found that patients with chronic migraine had significantly lower levels of GABA/water (p = 0.011) and GABA/creatine (Cr) (p = 0.026) in the DN and higher levels of Glx/water (p = 0.049) in the PAG than healthy controls. In all patients with migraine, higher GABA levels in the PAG were significantly associated with poorer sleep quality (GABA/water: r = 0.515, p = 0.017, n = 21; GABA/Cr: r = 0.522, p = 0.015, n = 21). Additionally, a lower Glx/Cr ratio in the DN may be associated with more severe migraine disability (r = -0.425, p = 0.055, n = 20), and lower GABA/water (r = -0.424, p = 0.062, n = 20) and Glx/Water (r = -0.452, p = 0.045, n = 20) may be associated with poorer sleep quality. Conclusions Neurochemical levels in the DN and PAG may provide evidence of the pathological mechanisms of migraine chronification. Correlations between migraine characteristics and neurochemical levels revealed the pathological mechanisms of the relevant characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01452-6.
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Affiliation(s)
- Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe East Road, Zhengzhou, Henan Province, 450000, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhiye Li
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhangxuan Hu
- GE Healthcare, No.1 Tongji Nan Road, Beijing Economic Technological Development Area, Beijing, 100070, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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Noseda R. Cerebro-Cerebellar Networks in Migraine Symptoms and Headache. FRONTIERS IN PAIN RESEARCH 2022; 3:940923. [PMID: 35910262 PMCID: PMC9326053 DOI: 10.3389/fpain.2022.940923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
The cerebellum is associated with the biology of migraine in a variety of ways. Clinically, symptoms such as fatigue, motor weakness, vertigo, dizziness, difficulty concentrating and finding words, nausea, and visual disturbances are common in different types of migraine. The neural basis of these symptoms is complex, not completely known, and likely involve activation of both specific and shared circuits throughout the brain. Posterior circulation stroke, or neurosurgical removal of posterior fossa tumors, as well as anatomical tract tracing in animals, provided the first insights to theorize about cerebellar functions. Nowadays, with the addition of functional imaging, much progress has been done on cerebellar structure and function in health and disease, and, as a consequence, the theories refined. Accordingly, the cerebellum may be useful but not necessary for the execution of motor, sensory or cognitive tasks, but, rather, would participate as an efficiency facilitator of neurologic functions by improving speed and skill in performance of tasks produced by the cerebral area to which it is reciprocally connected. At the subcortical level, critical regions in these processes are the basal ganglia and thalamic nuclei. Altogether, a modulatory role of the cerebellum over multiple brain regions appears compelling, mainly by considering the complexity of its reciprocal connections to common neural networks involved in motor, vestibular, cognitive, affective, sensory, and autonomic processing—all functions affected at different phases and degrees across the migraine spectrum. Despite the many associations between cerebellum and migraine, it is not known whether this structure contributes to migraine initiation, symptoms generation or headache. Specific cerebellar dysfunction via genetically driven excitatory/inhibitory imbalances, oligemia and/or increased risk to white matter lesions has been proposed as a critical contributor to migraine pathogenesis. Therefore, given that neural projections and functions of many brainstem, midbrain and forebrain areas are shared between the cerebellum and migraine trigeminovascular pathways, this review will provide a synopsis on cerebellar structure and function, its role in trigeminal pain, and an updated overview of relevant clinical and preclinical literature on the potential role of cerebellar networks in migraine pathophysiology.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Rodrigo Noseda
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32
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Goldman DA, Sankar A, Colic L, Villa L, Kim JA, Pittman B, Constable RT, Scheinost D, Blumberg HP. A graph theory-based whole brain approach to assess mood state differences in adolescents and young adults with bipolar disorder. Bipolar Disord 2022; 24:412-423. [PMID: 34665907 PMCID: PMC9016085 DOI: 10.1111/bdi.13144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 09/21/2021] [Accepted: 10/14/2021] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Identifying hubs of brain dysfunction in adolescents and young adults with Bipolar I Disorder (BDAYA ) could provide targets for early detection, prevention, and treatment. Previous neuroimaging studies across mood states of BDAYA are scarce and often examined limited brain regions potentially prohibiting detection of other important regions. We used a data-driven whole-brain Intrinsic Connectivity Distribution (ICD) approach to investigate dysconnectivity hubs across mood states in BDAYA . METHODS Functional magnetic resonance imaging whole-brain ICD data were investigated for differences across four groups: BDAYA -depressed (n = 22), BDAYA -euthymic (n = 45), BDAYA -elevated (n = 24), and healthy controls (HC, n = 111). Clusters of ICD differences were assessed for regional dysconnectivity and mood symptom relationships. Analyses were also performed for BDAYA overall (vs. HC) ICD differences persisting across mood states. RESULTS ICD was higher in the BDAYA- depressed group than other groups in bilateral ventral/rostral/dorsal prefrontal cortex (PFC) and right lenticular nucleus (LN) (pcorrected <0.05). In BDAYA -depressed, functional connectivity (FC) was increased between these regions with their contralateral homologues and PFC-medial temporal FC was more negative (p < 0.005). PFC-related findings correlated with depression scores (p < 0.05). The overall BDAYA group showed ICD increases in more ventral left PFC and right cerebellum, present across euthymia and acute mood states. CONCLUSIONS This ICD approach supports a PFC hub of inter- and intra-hemispheric frontotemporal dysconnectivity in BDAYA with potential trait features and disturbances of higher magnitude during depression. Hubs were also revealed in LN and cerebellum, less common foci of BD research. The hubs are potential targets for early interventions to detect, prevent, and treat BD.
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Affiliation(s)
- Danielle A Goldman
- Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT 06511,Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511
| | - Anjali Sankar
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Neurology and Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lejla Colic
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany
| | - Luca Villa
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Psychiatry, University of Oxford, UK
| | - Jihoon A Kim
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511
| | - Brian Pittman
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511
| | - R Todd Constable
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06511
| | - Dustin Scheinost
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06511
| | - Hilary P Blumberg
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT 06511,Child Study Center, Yale University School of Medicine, New Haven, CT 06511
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Toescu SM, Bruckert L, Jabarkheel R, Yecies D, Zhang M, Clark CA, Mankad K, Aquilina K, Grant GA, Feldman HM, Travis KE, Yeom KW. Spatiotemporal changes in along-tract profilometry of cerebellar peduncles in cerebellar mutism syndrome. Neuroimage Clin 2022; 35:103000. [PMID: 35370121 PMCID: PMC9421471 DOI: 10.1016/j.nicl.2022.103000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/16/2022] [Accepted: 03/28/2022] [Indexed: 10/29/2022]
Abstract
Cerebellar mutism syndrome, characterised by mutism, emotional lability and cerebellar motor signs, occurs in up to 39% of children following resection of medulloblastoma, the most common malignant posterior fossa tumour of childhood. Its pathophysiology remains unclear, but prior studies have implicated damage to the superior cerebellar peduncles. In this study, the objective was to conduct high-resolution spatial profilometry of the cerebellar peduncles and identify anatomic biomarkers of cerebellar mutism syndrome. In this retrospective study, twenty-eight children with medulloblastoma (mean age 8.8 ± 3.8 years) underwent diffusion MRI at four timepoints over one year. Forty-nine healthy children (9.0 ± 4.2 years), scanned at a single timepoint, served as age- and sex-matched controls. Automated Fibre Quantification was used to segment cerebellar peduncles and compute fractional anisotropy (FA) at 30 nodes along each tract. Thirteen patients developed cerebellar mutism syndrome. FA was significantly lower in the distal third of the left superior cerebellar peduncle pre-operatively in all patients compared to controls (FA in proximal third 0.228, middle and distal thirds 0.270, p = 0.01, Cohen's d = 0.927). Pre-operative differences in FA did not predict cerebellar mutism syndrome. However, post-operative reductions in FA were highly specific to the distal left superior cerebellar peduncle, and were most pronounced in children with cerebellar mutism syndrome compared to those without at the 1-4 month follow up (0.325 vs 0.512, p = 0.042, d = 1.36) and at the 1-year follow up (0.342, vs 0.484, p = 0.038, d = 1.12). High spatial resolution cerebellar profilometry indicated a site-specific alteration of the distal segment of the superior cerebellar peduncle seen in cerebellar mutism syndrome which may have important surgical implications in the treatment of these devastating tumours of childhood.
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Affiliation(s)
- Sebastian M Toescu
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA; Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA; Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK; Department of Neurosurgery, Great Ormond Street Hospital, London WC1N 3JH, UK.
| | - Lisa Bruckert
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Rashad Jabarkheel
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Derek Yecies
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Michael Zhang
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Christopher A Clark
- Developmental Imaging and Biophysics Section, UCL-GOS Institute of Child Health, 30 Guilford St, London WC1N 1EH, UK
| | - Kshitij Mankad
- Department of Radiology, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Kristian Aquilina
- Department of Neurosurgery, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Gerald A Grant
- Department of Neurosurgery, Lucille Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Heidi M Feldman
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Katherine E Travis
- Division of Developmental-Behavioural Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Kristen W Yeom
- Department of Radiology, Lucile Packard Children's Hospital, Stanford University School of Medicine, Stanford, CA 94305, USA
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Wang Y, Lu Y, Du M, Hussein NM, Li L, Wang Y, Mao C, Chen T, Chen F, Liu X, Yan Z, Fu Y. Altered Spontaneous Brain Activity in Left-Behind Children: A Resting-State Functional MRI Study. Front Neurol 2022; 13:834458. [PMID: 35422754 PMCID: PMC9002172 DOI: 10.3389/fneur.2022.834458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Parental migration has been associated with a higher risk of cognitive and behavioral abnormalities in left-behind children (LBC). This study aimed to explore the spontaneous brain activity in LBC and reveal the mechanisms underlying behavioral and cognitive abnormalities. Methods Involved LBC (n = 36) and non-LBC (n = 22) underwent resting-state functional MRI (fMRI) examination and cognitive and behavioral assessment. The fMRI-based amplitude of low-frequency fluctuation (ALFF) and fractional ALFF (fALFF) were assessed to analyze the spontaneous brain activity pattern. The relationships among abnormal spontaneous brain activity, behavioral and cognitive deficits and altered family environment were assessed by partial correlation analysis. Results Compared with non-LBC, LBC exhibited increased amplitude of low-frequency fluctuations in the right lingual gyrus (LING), while a decreased ALFF was observed in the bilateral insula and right orbital part of the middle frontal gyrus (ORBmid) (two-tailed voxel-level p < 0.01 and cluster-level p <0.05, Gaussian Random Field (GRF) correction). The fALFF in LBC were significantly increased in the left cerebellum 9 (Cbe9) and right cerebellum Crus2 (CbeCru2), while it decreased in the right hippocampus and left superior temporal gyrus (STG) (two-tailed voxel-level p < 0.01 and cluster-level p < 0.05, GRF correction). The ALFF and fALFF values in abnormal brain regions were found to be correlated with the learning ability, except for the right insula, while the fALFF values of the left STG were positively correlated with the full-scale IQ scores (p < 0.05). Moreover, the ALFF and fALFF values in all abnormal brain regions correlated with the education level of caregivers (p < 0.05). Conclusions Our study provided empirical evidence that the lack of direct parental care during early childhood could affect brain function development involving cognition, behavior, and emotion. Our findings emphasized that intellectual and emotional cares are essential for LBC.
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Affiliation(s)
- Yu Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yi Lu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meimei Du
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Nimo Mohamed Hussein
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lan Li
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yu Wang
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chuanwan Mao
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Tao Chen
- Department of Radiology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Fangfang Chen
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaozheng Liu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- China-USA Neuroimaging Research Institute, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhihan Yan
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- Zhihan Yan
| | - Yuchuan Fu
- Department of Radiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Yuchuan Fu
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35
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Lipp I, Mole JP, Subramanian L, Linden DEJ, Metzler-Baddeley C. Investigating the Anatomy and Microstructure of the Dentato-rubro-thalamic and Subthalamo-ponto-cerebellar Tracts in Parkinson's Disease. Front Neurol 2022; 13:793693. [PMID: 35401393 PMCID: PMC8987292 DOI: 10.3389/fneur.2022.793693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022] Open
Abstract
Cerebellar-thalamic connections play a central role in deep brain stimulation-based treatment of tremor syndromes. Here, we used diffusion Magnetic Resonance Imaging (MRI) tractography to delineate the main cerebellar peduncles as well as two main white matter tracts that connect the cerebellum with the thalamus, the dentato-rubro-thalamic tract (DRTT) and the subthalamo-ponto-cerebellar tract (SPCT). We first developed a reconstruction protocol in young healthy adults with high-resolution diffusion imaging data and then demonstrate feasibility of transferring this protocol to clinical studies using standard diffusion MRI data from a cohort of patients with Parkinson's disease (PD) and their matched healthy controls. The tracts obtained closely corresponded to the previously described anatomical pathways and features of the DRTT and the SPCT. Second, we investigated the microstructure of these tracts with fractional anisotropy (FA), radial diffusivity (RD), and hindrance modulated orientational anisotropy (HMOA) in patients with PD and healthy controls. By reducing dimensionality of both the microstructural metrics and the investigated cerebellar and cerebellar-thalamic tracts using principal component analyses, we found global differences between patients with PD and controls, suggestive of higher fractional anisotropy, lower radial diffusivity, and higher hindrance modulated orientational anisotropy in patients. However, separate analyses for each of the tracts did not yield any significant differences. Our findings contribute to the characterization of the distinct anatomical connections between the cerebellum and the diencephalon. Microstructural differences between patients and controls in the cerebellar pathways suggest involvement of these structures in PD, complementing previous functional and diffusion imaging studies.
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Affiliation(s)
- Ilona Lipp
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Jilu Princy Mole
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Leena Subramanian
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - David E. J. Linden
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Division of Psychological Medicine and Clinical Neurosciences (DPMCN), School of Medicine, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
- School for Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Claudia Metzler-Baddeley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, United Kingdom
- Neuroscience and Mental Health Research Institute, Cardiff University, Cardiff, United Kingdom
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36
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Regional Alteration within the Cerebellum and the Reorganization of the Cerebrocerebellar System following Poststroke Aphasia. Neural Plast 2022; 2022:3481423. [PMID: 35360259 PMCID: PMC8964230 DOI: 10.1155/2022/3481423] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/24/2022] [Indexed: 12/26/2022] Open
Abstract
Recently, an increasing number of studies have highlighted the role of the cerebellum in language processing. However, the role of neural reorganization within the cerebellum as well as within the cerebrocerebellar system caused by poststroke aphasia remains unknown. To solve this problem, in the present study, we investigated regional alterations of the cerebellum as well as the functional reorganization of the cerebrocerebellar circuit by combining structural and resting-state functional magnetic resonance imaging (fMRI) techniques. Twenty patients diagnosed with aphasia following left-hemispheric stroke and 20 age-matched healthy controls (HCs) were recruited in this study. The Western Aphasia Battery (WAB) test was used to assess the participants' language ability. Gray matter volume, spontaneous brain activity, functional connectivity, and effective connectivity were examined in each participant. We discovered that gray matter volumes in right cerebellar lobule VI and right Crus I were significantly lower in the patient group, and the brain activity within these regions was significantly correlated with WAB scores. We also discovered decreased functional connectivity within the crossed cerebrocerebellar circuit, which was significantly correlated with WAB scores. Moreover, altered information flow between the cerebellum and the contralateral cerebrum was found. Together, our findings provide evidence for regional alterations within the cerebellum and the reorganization of the cerebrocerebellar system following poststroke aphasia and highlight the important role of the cerebellum in language processing within aphasic individuals after stroke.
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Thalamic and Cerebellar Regional Involvement across the ALS-FTD Spectrum and the Effect of C9orf72. Brain Sci 2022; 12:brainsci12030336. [PMID: 35326292 PMCID: PMC8945983 DOI: 10.3390/brainsci12030336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/23/2022] [Accepted: 02/27/2022] [Indexed: 02/01/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) and frontotemporal dementia (FTD) are part of the same disease spectrum. While thalamic−cerebellar degeneration has been observed in C9orf72 expansion carriers, the exact subregions involved across the clinical phenotypes of the ALS−FTD spectrum remain unclear. Using MRIs from 58 bvFTD, 41 ALS−FTD and 52 ALS patients compared to 57 controls, we aimed to delineate thalamic and cerebellar subregional changes across the ALS−FTD spectrum and to contrast these profiles between cases with and without C9orf72 expansions. Thalamic involvement was evident across all ALS−FTD clinical phenotypes, with the laterodorsal nucleus commonly affected across all groups (values below the 2.5th control percentile). The mediodorsal nucleus was disproportionately affected in bvFTD and ALS−FTD but not in ALS. Cerebellar changes were only observed in bvFTD and ALS−FTD predominantly in the superior−posterior region. Comparison of genetic versus sporadic cases revealed significantly lower volumes exclusively in the pulvinar in C9orf72 expansion carriers compared to non-carriers, irrespective of clinical syndrome. Overall, bvFTD showed significant correlations between thalamic subregions, level of cognitive dysfunction and severity of behavioural symptoms. Notably, strong associations were evident between mediodorsal nucleus atrophy and severity of behavioural changes in C9orf72-bvFTD (r = −0.9, p < 0.0005). Our findings reveal distinct thalamic and cerebellar atrophy profiles across the ALS−FTD spectrum, with differential impacts on behaviour and cognition, and point to a unique contribution of C9orf72 expansions in the clinical profiles of these patients.
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38
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Metoki A, Wang Y, Olson IR. The Social Cerebellum: A Large-Scale Investigation of Functional and Structural Specificity and Connectivity. Cereb Cortex 2022; 32:987-1003. [PMID: 34428293 PMCID: PMC8890001 DOI: 10.1093/cercor/bhab260] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
The cerebellum has been traditionally disregarded in relation to nonmotor functions, but recent findings indicate it may be involved in language, affective processing, and social functions. Mentalizing, or Theory of Mind (ToM), is the ability to infer mental states of others and this skill relies on a distributed network of brain regions. Here, we leveraged large-scale multimodal neuroimaging data to elucidate the structural and functional role of the cerebellum in mentalizing. We used functional activations to determine whether the cerebellum has a domain-general or domain-specific functional role, and effective connectivity and probabilistic tractography to map the cerebello-cerebral mentalizing network. We found that the cerebellum is organized in a domain-specific way and that there is a left cerebellar effective and structural lateralization, with more and stronger effective connections from the left cerebellar hemisphere to the right cerebral mentalizing areas, and greater cerebello-thalamo-cortical and cortico-ponto-cerebellar streamline counts from and to the left cerebellum. Our study provides novel insights to the network organization of the cerebellum, an overlooked brain structure, and mentalizing, one of humans' most essential abilities to navigate the social world.
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Affiliation(s)
- Athanasia Metoki
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
- Department of Neurology,Washington University in St. Louis, St. Louis, MO 63108, USA
| | - Yin Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, and IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, 100875, China
| | - Ingrid R Olson
- Department of Psychology, Temple University, Philadelphia, PA 19122, USA
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De Benedictis A, Rossi-Espagnet MC, de Palma L, Carai A, Marras CE. Networking of the Human Cerebellum: From Anatomo-Functional Development to Neurosurgical Implications. Front Neurol 2022; 13:806298. [PMID: 35185765 PMCID: PMC8854219 DOI: 10.3389/fneur.2022.806298] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
In the past, the cerebellum was considered to be substantially involved in sensory-motor coordination. However, a growing number of neuroanatomical, neuroimaging, clinical and lesion studies have now provided converging evidence on the implication of the cerebellum in a variety of cognitive, affective, social, and behavioral processes as well. These findings suggest a complex anatomo-functional organization of the cerebellum, involving a dense network of cortical territories and reciprocal connections with many supra-tentorial association areas. The final architecture of cerebellar networks results from a complex, highly protracted, and continuous development from childhood to adulthood, leading to integration between short-distance connections and long-range extra-cerebellar circuits. In this review, we summarize the current evidence on the anatomo-functional organization of the cerebellar connectome. We will focus on the maturation process of afferent and efferent neuronal circuitry, and the involvement of these networks in different aspects of neurocognitive processing. The final section will be devoted to identifying possible implications of this knowledge in neurosurgical practice, especially in the case of posterior fossa tumor resection, and to discuss reliable strategies to improve the quality of approaches while reducing postsurgical morbidity.
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Affiliation(s)
- Alessandro De Benedictis
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
- *Correspondence: Alessandro De Benedictis
| | - Maria Camilla Rossi-Espagnet
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Luca de Palma
- Neurology Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Andrea Carai
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Carlo Efisio Marras
- Neurosurgery Unit, Department of Neurosciences, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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40
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Microsurgical anatomy and surgical exposure of the cerebellar peduncles. Neurosurg Rev 2022; 45:2095-2117. [PMID: 34997381 DOI: 10.1007/s10143-021-01701-3] [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: 07/18/2021] [Revised: 11/04/2021] [Accepted: 11/22/2021] [Indexed: 10/19/2022]
Abstract
A better understanding of the surgical anatomy of the cerebellar peduncles in different surgical approaches and their relationship with other neural structures are delineated through cadaveric dissections. We aimed to revisit the surgical anatomy of the cerebellar peduncles to describe their courses along the brain stem and the cerebellum and revise their segmental classification in surgical areas exposed through different approaches. Stepwise fiber microdissection was performed along the cerebellar tentorial and suboccipital surfaces. Multiple surgical approaches in each of the cerebellar peduncles were compared in eight silicone-injected cadaveric whole heads to evaluate the peduncular exposure areas. From a neurosurgical point of view, the middle cerebellar peduncle (MCP) was divided into a proximal cisternal and a distal intracerebellar segments; the inferior cerebellar peduncle (ICP) into a ventricular segment followed by a posterior curve and a subsequent intracerebellar segment; the superior cerebellar peduncle (SCP) into an initial congregated, an intermediate intraventricular, and a distal intramesencephalic segment. Retrosigmoid and anterior petrosectomy approaches exposed the junction of the MCP segments; telovelar, supratonsillar, and lateral ICP approaches each reached different segments of ICP; paramedian supracerebellar infratentorial, suboccipital transtentorial, and combined posterior transpetrosal approaches displayed the predecussation SCP within the cerbellomesencephalic fissure, whereas the telovelar approach revealed the intraventricular SCP within the superolateral recess of the fourth ventricle. Better understanding of the microsurgical anatomy of the cerebellar peduncles in various surgical approaches and their exposure limits constitute the most critical aspect for the prevention of surgical morbidity during surgery in and around the pons and the upper medulla. Our findings help in evaluating radiological data and planning an operative procedure for cerebellar peduncles.
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41
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Finegan E, Siah WF, Li Hi Shing S, Chipika RH, Hardiman O, Bede P. Cerebellar degeneration in primary lateral sclerosis: an under-recognized facet of PLS. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:542-553. [PMID: 34991421 DOI: 10.1080/21678421.2021.2023188] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
While primary lateral sclerosis (PLS) has traditionally been regarded as a pure upper motor neuron disorder, recent clinical, neuroimaging and postmortem studies have confirmed significant extra-motor involvement. Sporadic reports have indicated that in addition to the motor cortex and corticospinal tracts, the cerebellum may also be affected in PLS. Cerebellar manifestations are difficult to ascertain in PLS as the clinical picture is dominated by widespread upper motor neuron signs. The likely contribution of cerebellar dysfunction to gait disturbance, falls, pseudobulbar affect and dysarthria may be overlooked in the context of progressive spasticity. The objective of this study is the comprehensive characterization of cerebellar gray and white matter degeneration in PLS using multiparametric quantitative neuroimaging methods to systematically evaluate each cerebellar lobule and peduncle. Forty-two patients with PLS and 117 demographically-matched healthy controls were enrolled in a prospective MRI study. Complementary volumetric and voxelwise analyses revealed focal cerebellar alterations instead of global cerebellar atrophy. Bilateral gray matter volume reductions were observed in lobules III, IV and VIIb. Significant diffusivity alterations within the superior cerebellar peduncle indicate disruption of the main cerebellar outflow tracts. These findings suggest that the considerable intra-cerebellar disease-burden is coupled with concomitant cerebro-cerebellar connectivity disruptions. While cerebellar dysfunction is challenging to demonstrate clinically, cerebellar pathology is likely to be a significant contributor to disability in PLS.
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Affiliation(s)
- Eoin Finegan
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - We Fong Siah
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Stacey Li Hi Shing
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Rangariroyashe H Chipika
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Orla Hardiman
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - Peter Bede
- Computational Neuroimaging Group, Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, St James's Hospital Dublin, Dublin, Ireland
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Chen KT, Ho TY, Siow TY, Yeh YC, Huang SY. OUP accepted manuscript. Cereb Cortex Commun 2022; 3:tgac008. [PMID: 35281215 PMCID: PMC8914218 DOI: 10.1093/texcom/tgac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Ko-Ting Chen
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
- Neuroscience Research Center, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Tsung-Ying Ho
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan 333, Taiwan
| | - Tiing-Yee Siow
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Yu-Chiang Yeh
- Department of Neurosurgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 333, Taiwan
| | - Sheng-Yao Huang
- Corresponding author: Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
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43
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van Niftrik CHB, Visser TF, Sebök M, Muscas G, El Amki M, Serra C, Regli L, Wegener S, Fierstra J. Delayed cerebral atrophy after cerebellar stroke: topographical relation and clinical impact. Brain Commun 2021; 3:fcab279. [PMID: 34877537 PMCID: PMC8643502 DOI: 10.1093/braincomms/fcab279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 08/15/2021] [Accepted: 09/29/2021] [Indexed: 11/17/2022] Open
Abstract
Remote dysconnectivity following cerebellar ischaemic stroke may have a negative impact on supratentorial brain tissue. Since the cerebellum is connected to the individual cerebral lobes via contralateral tracts, cerebellar lesion topography might determine the distribution of contralateral supratentorial brain tissue changes. We investigated (i) the occurrence of delayed cerebral atrophy after cerebellar ischaemic stroke and its relationship to infarct volume; (ii) whether cerebellar stroke topography determines supratentorial atrophy location; and (iii) how cortical atrophy after cerebellar stroke impacts clinical outcome. We performed longitudinal volumetric MRI analysis of patients with isolated cerebellar stroke from the Swiss Stroke Registry database. Stroke location and volume were determined at baseline MRI. Delayed cerebral atrophy was measured as supratentorial cortical volumetric change at follow-up, in contralateral target as compared to ipsilateral reference-areas. In patients with bilateral stroke, both hemispheres were analysed separately. We obtained maps of how cerebellar lesion topography, determines the probability of delayed atrophy per distinct cerebral lobe. Clinical performance was measured with the National Institutes of Health Stroke Scale and modified Rankin Scale. In 29 patients (age 58 ± 18; 9 females; median follow-up: 6.2 months), with 36 datasets (7 patients with bilateral cerebellar stroke), delayed cerebral atrophy occurred in 28 (78%) datasets. A multivariable generalized linear model for a Poisson distribution showed that infarct volume (milliliter) in bilateral stroke patients was positively associated with the number of atrophic target areas (Rate ratio = 1.08; P = 0.01). Lobe-specific cerebral atrophy related to distinct topographical cerebellar stroke patterns. By ordinal logistic regression (shift analysis), more atrophic areas predicted higher 3-month mRS scores in patients with low baseline scores (baseline score 3–5: Odds ratio = 1.34; P = 0.02; baseline score 0–2: OR = 0.71; P = 0.19). Our results indicate that (i) isolated cerebellar ischaemic stroke commonly results in delayed cerebral atrophy and stroke volume determines the severity of cerebral atrophy in patients with bilateral stroke; (ii) cerebellar stroke topography affects the location of delayed cerebral atrophy; and (iii) delayed cerebral atrophy negatively impacts clinical outcome.
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Affiliation(s)
- Christiaan H B van Niftrik
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Thomas F Visser
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, UMC Utrecht, 3584 CX Utrecht, The Netherlands
| | - Martina Sebök
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Giovanni Muscas
- Department of Neurosurgery, Careggi Hospital and University of Florence, 50134 Florence, Italy
| | - Mohamad El Amki
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Carlo Serra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Luca Regli
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Susanne Wegener
- Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
| | - Jorn Fierstra
- Department of Neurosurgery, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland
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44
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van Gool R, Tucker-Bartley A, Yang E, Todd N, Guenther F, Goodlett B, Al-Hertani W, Bodamer OA, Upadhyay J. Targeting neurological abnormalities in lysosomal storage diseases. Trends Pharmacol Sci 2021; 43:495-509. [PMID: 34844772 DOI: 10.1016/j.tips.2021.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 01/07/2023]
Abstract
Central nervous system (CNS) abnormalities and corresponding neurological and psychiatric symptoms are frequently observed in lysosomal storage disorders (LSDs). The genetic background of individual LSDs is indeed unique to each illness. However, resulting defective lysosomal function within the CNS can transition normal cellular processes (i.e., autophagy) into aberrant mechanisms, facilitating overlapping downstream consequences including neurocircuitry dysfunction, neurodegeneration as well as sensory, motor, cognitive, and psychological symptoms. Here, the neurological and biobehavioral phenotypes of major classes of LSDs are discussed alongside therapeutic strategies in development that aim to tackle neuropathology among other disease elements. Finally, focused ultrasound blood-brain barrier opening is proposed to enhance therapeutic delivery thereby overcoming the key hurdle of central distribution of disease modifying therapies in LSDs.
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Affiliation(s)
- Raquel van Gool
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Faculty of Psychology and Neuroscience, Section Neuropsychology & Psychopharmacology, Maastricht University, Maastricht, The Netherlands
| | - Anthony Tucker-Bartley
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Massachusetts General Hospital, Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Edward Yang
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nicholas Todd
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Frank Guenther
- Department of Speech, Language and Hearing Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - Benjamin Goodlett
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Walla Al-Hertani
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Olaf A Bodamer
- Division of Genetics and Genomics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, USA.
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45
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Lorca-Puls DL, Gajardo-Vidal A, Oberhuber M, Prejawa S, Hope TMH, Leff AP, Green DW, Price CJ. Brain regions that support accurate speech production after damage to Broca's area. Brain Commun 2021; 3:fcab230. [PMID: 34671727 PMCID: PMC8523882 DOI: 10.1093/braincomms/fcab230] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
Broca’s area in the posterior half of the left inferior frontal gyrus has traditionally been considered an important node in the speech production network. Nevertheless, recovery of speech production has been reported, to different degrees, within a few months of damage to Broca’s area. Importantly, contemporary evidence suggests that, within Broca’s area, its posterior part (i.e. pars opercularis) plays a more prominent role in speech production than its anterior part (i.e. pars triangularis). In this study, we therefore investigated the brain activation patterns that underlie accurate speech production following stroke damage to the opercular part of Broca’s area. By combining functional MRI and 13 tasks that place varying demands on speech production, brain activation was compared in (i) seven patients of interest with damage to the opercular part of Broca’s area; (ii) 55 neurologically intact controls; and (iii) 28 patient controls with left-hemisphere damage that spared Broca’s area. When producing accurate overt speech responses, the patients with damage to the left pars opercularis activated a substantial portion of the normal bilaterally distributed system. Within this system, there was a lesion-site-dependent effect in a specific part of the right cerebellar Crus I where activation was significantly higher in the patients with damage to the left pars opercularis compared to both neurologically intact and patient controls. In addition, activation in the right pars opercularis was significantly higher in the patients with damage to the left pars opercularis relative to neurologically intact controls but not patient controls (after adjusting for differences in lesion size). By further examining how right Crus I and right pars opercularis responded across a range of conditions in the neurologically intact controls, we suggest that these regions play distinct roles in domain-general cognitive control. Finally, we show that enhanced activation in the right pars opercularis cannot be explained by release from an inhibitory relationship with the left pars opercularis (i.e. dis-inhibition) because right pars opercularis activation was positively related to left pars opercularis activation in neurologically intact controls. Our findings motivate and guide future studies to investigate (i) how exactly right Crus I and right pars opercularis support accurate speech production after damage to the opercular part of Broca’s area and (ii) whether non-invasive neurostimulation to one or both of these regions boosts speech production recovery after damage to the opercular part of Broca’s area.
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Affiliation(s)
- Diego L Lorca-Puls
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Andrea Gajardo-Vidal
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | | | - Marion Oberhuber
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Susan Prejawa
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Thomas M H Hope
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
| | - Alexander P Leff
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - David W Green
- Department of Experimental Psychology, University College London, London, UK
| | - Cathy J Price
- Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, London, UK
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46
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Palesi F, Ferrante M, Gaviraghi M, Misiti A, Savini G, Lascialfari A, D'Angelo E, Gandini Wheeler‐Kingshott CAM. Motor and higher-order functions topography of the human dentate nuclei identified with tractography and clustering methods. Hum Brain Mapp 2021; 42:4348-4361. [PMID: 34087040 PMCID: PMC8356999 DOI: 10.1002/hbm.25551] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/11/2021] [Accepted: 05/17/2021] [Indexed: 01/29/2023] Open
Abstract
Deep gray matter nuclei are the synaptic relays, responsible to route signals between specific brain areas. Dentate nuclei (DNs) represent the main output channel of the cerebellum and yet are often unexplored especially in humans. We developed a multimodal MRI approach to identify DNs topography on the basis of their connectivity as well as their microstructural features. Based on results, we defined DN parcellations deputed to motor and to higher-order functions in humans in vivo. Whole-brain probabilistic tractography was performed on 25 healthy subjects from the Human Connectome Project to infer DN parcellations based on their connectivity with either the cerebral or the cerebellar cortex, in turn. A third DN atlas was created inputting microstructural diffusion-derived metrics in an unsupervised fuzzy c-means classification algorithm. All analyses were performed in native space, with probability atlas maps generated in standard space. Cerebellar lobule-specific connectivity identified one motor parcellation, accounting for about 30% of the DN volume, and two non-motor parcellations, one cognitive and one sensory, which occupied the remaining volume. The other two approaches provided overlapping results in terms of geometrical distribution with those identified with cerebellar lobule-specific connectivity, although with some differences in volumes. A gender effect was observed with respect to motor areas and higher-order function representations. This is the first study that indicates that more than half of the DN volumes is involved in non-motor functions and that connectivity-based and microstructure-based atlases provide complementary information. These results represent a step-ahead for the interpretation of pathological conditions involving cerebro-cerebellar circuits.
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Affiliation(s)
- Fulvia Palesi
- Department of Brain and Behavioral SciencesUniversity of PaviaPavia
| | | | - Marta Gaviraghi
- Department of Electrical, Computer, and Biomedical EngineeringUniversity of PaviaPaviaItaly
| | - Anastasia Misiti
- Department of Electrical, Computer, and Biomedical EngineeringUniversity of PaviaPaviaItaly
| | - Giovanni Savini
- Department of NeuroradiologyIRCCS Humanitas Research HospitalMilanItaly
| | | | - Egidio D'Angelo
- Department of Brain and Behavioral SciencesUniversity of PaviaPavia
- Brain Connectivity CenterIRCCS Mondino FoundationPavia
| | - Claudia A. M. Gandini Wheeler‐Kingshott
- Department of Brain and Behavioral SciencesUniversity of PaviaPavia
- Brain Connectivity CenterIRCCS Mondino FoundationPavia
- NMR Research Unit, Queen Square MS Centre, Department of NeuroinflammationUCL Queen Square Institute of NeurologyLondon
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Ferreira F, Akram H, Ashburner J, Zrinzo L, Zhang H, Lambert C. Ventralis intermedius nucleus anatomical variability assessment by MRI structural connectivity. Neuroimage 2021; 238:118231. [PMID: 34089871 PMCID: PMC8960999 DOI: 10.1016/j.neuroimage.2021.118231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 12/11/2022] Open
Abstract
The ventralis intermedius nucleus (Vim) is centrally placed in the dentato-thalamo-cortical pathway (DTCp) and is a key surgical target in the treatment of severe medically refractory tremor. It is not visible on conventional MRI sequences; consequently, stereotactic targeting currently relies on atlas-based coordinates. This fails to capture individual anatomical variability, which may lead to poor long-term clinical efficacy. Probabilistic tractography, combined with known anatomical connectivity, enables localisation of thalamic nuclei at an individual subject level. There are, however, a number of confounds associated with this technique that may influence results. Here we focused on an established method, using probabilistic tractography to reconstruct the DTCp, to identify the connectivity-defined Vim (cd-Vim) in vivo. Using 100 healthy individuals from the Human Connectome Project, our aim was to quantify cd-Vim variability across this population, measure the discrepancy with atlas-defined Vim (ad-Vim), and assess the influence of potential methodological confounds. We found no significant effect of any of the confounds. The mean cd-Vim coordinate was located within 1.88 mm (left) and 2.12 mm (right) of the average midpoint and 3.98 mm (left) and 5.41 mm (right) from the ad-Vim coordinates. cd-Vim location was more variable on the right, which reflects hemispheric asymmetries in the probabilistic DTC reconstructed. The method was reproducible, with no significant cd-Vim location differences in a separate test-retest cohort. The superior cerebellar peduncle was identified as a potential source of artificial variance. This work demonstrates significant individual anatomical variability of the cd-Vim that atlas-based coordinate targeting fails to capture. This variability was not related to any methodological confound tested. Lateralisation of cerebellar functions, such as speech, may contribute to the observed asymmetry. Tractography-based methods seem sensitive to individual anatomical variability that is missed by conventional neurosurgical targeting; these findings may form the basis for translational tools to improve efficacy and reduce side-effects of thalamic surgery for tremor.
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Affiliation(s)
- Francisca Ferreira
- EPSRC Centre for Doctoral Training in Intelligent, Integrated Imaging in Healthcare (i4health), University College London, Gower Street, London WC1E 6BT, United Kingdom; Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, Queen Square, WC1N 3BG London, United Kingdom; Wellcome Centre for Human Neuroimaging, 12 Queen Square, London WC1N 3AR, United Kingdom.
| | - Harith Akram
- Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, Queen Square, WC1N 3BG London, United Kingdom
| | - John Ashburner
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, London WC1N 3AR, United Kingdom
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, Queen Square, WC1N 3BG London, United Kingdom
| | - Hui Zhang
- EPSRC Centre for Doctoral Training in Intelligent, Integrated Imaging in Healthcare (i4health), University College London, Gower Street, London WC1E 6BT, United Kingdom; Department of Computer Science and Centre for Medical Image Computing, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Christian Lambert
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, London WC1N 3AR, United Kingdom
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Bocchetta M, Malpetti M, Todd EG, Rowe JB, Rohrer JD. Looking beneath the surface: the importance of subcortical structures in frontotemporal dementia. Brain Commun 2021; 3:fcab158. [PMID: 34458729 PMCID: PMC8390477 DOI: 10.1093/braincomms/fcab158] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 12/15/2022] Open
Abstract
Whilst initial anatomical studies of frontotemporal dementia focussed on cortical involvement, the relevance of subcortical structures to the pathophysiology of frontotemporal dementia has been increasingly recognized over recent years. Key structures affected include the caudate, putamen, nucleus accumbens, and globus pallidus within the basal ganglia, the hippocampus and amygdala within the medial temporal lobe, the basal forebrain, and the diencephalon structures of the thalamus, hypothalamus and habenula. At the most posterior aspect of the brain, focal involvement of brainstem and cerebellum has recently also been shown in certain subtypes of frontotemporal dementia. Many of the neuroimaging studies on subcortical structures in frontotemporal dementia have been performed in clinically defined sporadic cases. However, investigations of genetically- and pathologically-confirmed forms of frontotemporal dementia are increasingly common and provide molecular specificity to the changes observed. Furthermore, detailed analyses of sub-nuclei and subregions within each subcortical structure are being added to the literature, allowing refinement of the patterns of subcortical involvement. This review focuses on the existing literature on structural imaging and neuropathological studies of subcortical anatomy across the spectrum of frontotemporal dementia, along with investigations of brain–behaviour correlates that examine the cognitive sequelae of specific subcortical involvement: it aims to ‘look beneath the surface’ and summarize the patterns of subcortical involvement have been described in frontotemporal dementia.
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Affiliation(s)
- Martina Bocchetta
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Maura Malpetti
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK
| | - Emily G Todd
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - James B Rowe
- Department of Clinical Neurosciences and Cambridge University Hospitals NHS Trust, University of Cambridge, Cambridge, UK.,Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
| | - Jonathan D Rohrer
- Dementia Research Centre, Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, University College London, London, UK
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Bertino S, Basile GA, Bramanti A, Ciurleo R, Tisano A, Anastasi GP, Milardi D, Cacciola A. Ventral intermediate nucleus structural connectivity-derived segmentation: anatomical reliability and variability. Neuroimage 2021; 243:118519. [PMID: 34461233 DOI: 10.1016/j.neuroimage.2021.118519] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/24/2021] [Accepted: 08/25/2021] [Indexed: 12/30/2022] Open
Abstract
The Ventral intermediate nucleus (Vim) of thalamus is the most targeted structure for the treatment of drug-refractory tremors. Since methodological differences across existing studies are remarkable and no gold-standard pipeline is available, in this study, we tested different parcellation pipelines for tractography-derived putative Vim identification. Thalamic parcellation was performed on a high quality, multi-shell dataset and a downsampled, clinical-like dataset using two different diffusion signal modeling techniques and two different voxel classification criteria, thus implementing a total of four parcellation pipelines. The most reliable pipeline in terms of inter-subject variability has been picked and parcels putatively corresponding to motor thalamic nuclei have been selected by calculating similarity with a histology-based mask of Vim. Then, spatial relations with optimal stimulation points for the treatment of essential tremor have been quantified. Finally, effect of data quality and parcellation pipelines on a volumetric index of connectivity clusters has been assessed. We found that the pipeline characterized by higher-order signal modeling and threshold-based voxel classification criteria was the most reliable in terms of inter-subject variability regardless data quality. The maps putatively corresponding to Vim were those derived by precentral and dentate nucleus-thalamic connectivity. However, tractography-derived functional targets showed remarkable differences in shape and sizes when compared to a ground truth model based on histochemical staining on seriate sections of human brain. Thalamic voxels connected to contralateral dentate nucleus resulted to be the closest to literature-derived stimulation points for essential tremor but at the same time showing the most remarkable inter-subject variability. Finally, the volume of connectivity parcels resulted to be significantly influenced by data quality and parcellation pipelines. Hence, caution is warranted when performing thalamic connectivity-based segmentation for stereotactic targeting.
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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
| | | | | | - Adriana Tisano
- Department of Clinical and Experimental Medicine, 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
| | - Demetrio Milardi
- Brain Mapping Lab, Department of Biomedical, Dental Sciences and Morphological and Functional Images, University of Messina, 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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Surgent O, Dean DC, Alexander AL, Dadalko OI, Guerrero-Gonzalez J, Taylor D, Skaletski E, Travers BG. Neurobiological and behavioural outcomes of biofeedback-based training in autism: a randomized controlled trial. Brain Commun 2021; 3:fcab112. [PMID: 34250479 PMCID: PMC8254423 DOI: 10.1093/braincomms/fcab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/26/2021] [Accepted: 04/28/2021] [Indexed: 11/13/2022] Open
Abstract
The human brain has demonstrated the power to structurally change as a result of movement-based interventions. However, it is unclear whether these structural brain changes differ in autistic individuals compared to non-autistic individuals. The purpose of the present study was to pilot a randomized controlled trial to investigate brain, balance, autism symptom severity and daily living skill changes that result from a biofeedback-based balance intervention in autistic adolescents (13-17 years old). Thirty-four autistic participants and 28 age-matched non-autistic participants underwent diagnostic testing and pre-training assessment (neuroimaging, cognitive, autism symptom severity and motor assessments) and were then randomly assigned to 6 weeks of a balance-training intervention or a sedentary-control condition. After the 6 weeks, neuroimaging, symptom severity and motor assessments were repeated. Results found that both the autistic and non-autistic participants demonstrated similar and significant increases in balance times with training. Furthermore, individuals in the balance-training condition showed significantly greater improvements in postural sway and reductions in autism symptom severity compared to individuals in the control condition. Daily living scores did not change with training, nor did we observe hypothesized changes to the microstructural properties of the corticospinal tract. However, follow-up voxel-based analyses found a wide range of balance-related structures that showed changes across the brain. Many of these brain changes were specific to the autistic participants compared to the non-autistic participants, suggesting distinct structural neuroplasticity in response to balance training in autistic participants. Altogether, these findings suggest that biofeedback-based balance training may target postural stability challenges, reduce core autism symptoms and influence neurobiological change. Future research is encouraged to examine the superior cerebellar peduncle in response to balance training and symptom severity changes in autistic individuals, as the current study produced overlapping findings in this brain region.
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Affiliation(s)
- Olivia Surgent
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
- Neuroscience Training Program, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Douglas C Dean
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
- Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, USA
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Andrew L Alexander
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA
- Psychiatry, University of Wisconsin-Madison, Madison, WI 53719, USA
| | - Olga I Dadalko
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Jose Guerrero-Gonzalez
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
- Medical Physics, University of Wisconsin-Madison, Madison, WI 53705, USA
| | - Desiree Taylor
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
- Occupational Therapy Program in Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Emily Skaletski
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
- Occupational Therapy Program in Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA
| | - Brittany G Travers
- Waisman Center, University of Wisconsin-Madison, Madison, WI 53705, USA
- Occupational Therapy Program in Kinesiology, University of Wisconsin-Madison, Madison, WI 53706, USA
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