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Melo-Thomas L, Schwarting RKW. Paradoxical kinesia may no longer be a paradox waiting for 100 years to be unraveled. Rev Neurosci 2023; 34:775-799. [PMID: 36933238 DOI: 10.1515/revneuro-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 02/10/2023] [Indexed: 03/19/2023]
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder mainly characterized by bradykinesia and akinesia. Interestingly, these motor disabilities can depend on the patient emotional state. Disabled PD patients remain able to produce normal motor responses in the context of urgent or externally driven situations or even when exposed to appetitive cues such as music. To describe this phenomenon Souques coined the term "paradoxical kinesia" a century ago. Since then, the mechanisms underlying paradoxical kinesia are still unknown due to a paucity of valid animal models that replicate this phenomenon. To overcome this limitation, we established two animal models of paradoxical kinesia. Using these models, we investigated the neural mechanisms of paradoxical kinesia, with the results pointing to the inferior colliculus (IC) as a key structure. Intracollicular electrical deep brain stimulation, glutamatergic and GABAergic mechanisms may be involved in the elaboration of paradoxical kinesia. Since paradoxical kinesia might work by activation of some alternative pathway bypassing basal ganglia, we suggest the IC as a candidate to be part of this pathway.
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Affiliation(s)
- Liana Melo-Thomas
- Experimental and Biological Psychology, Behavioral Neuroscience, Faculty of Psychology, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
- Marburg Center for Mind, Brain, and Behavior (MCMBB), Hans-Meerwein-Straße 6, 35032 Marburg, Germany
- Behavioral Neurosciences Institute (INeC), Av. do Café, 2450, Monte Alegre, Ribeirão Preto, 14050-220, São Paulo, Brazil
| | - Rainer K W Schwarting
- Experimental and Biological Psychology, Behavioral Neuroscience, Faculty of Psychology, Philipps-University of Marburg, Gutenbergstraße 18, 35032 Marburg, Germany
- Marburg Center for Mind, Brain, and Behavior (MCMBB), Hans-Meerwein-Straße 6, 35032 Marburg, Germany
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You Z, Wu YY, Wu R, Xu ZX, Wu X, Wang XP. Efforts of subthalamic nucleus deep brain stimulation on cognitive spectrum: From explicit to implicit changes in the patients with Parkinson's disease for 1 year. CNS Neurosci Ther 2020; 26:972-980. [PMID: 32436660 PMCID: PMC7415202 DOI: 10.1111/cns.13392] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 04/20/2020] [Accepted: 04/23/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To evaluate the cognitive function of Chinese patients with Parkinson's disease PD postsubthalamic nucleus deep brain stimulation (STN-DBS). METHODS Cognitive function was assessed by neuropsychological methods in PD patients. Twenty matched healthy persons served as normal controls. t test, analysis of variance, and chi-square analysis were used to compare the difference among the groups. Reliable change index was utilized to analyze the changes in cognition from the individual level. RESULTS (a) Improvement in motor function was significantly better after STN-DBS (P < .01). (b) Notably, the increase error rates of implicit SRTT (serial reaction time task) was significantly higher after STN-DBS as compared with the conservative therapy group (P = .03). (c) The decline of verbal fluency (explicit) was also significantly higher after STN-DBS than that in the medication therapy group (P = .03). (d) In the explicit clock-drawing test, scores had significantly improved after STN-DBS (P = .04). CONCLUSIONS STN-DBS as a neuromodulatory tool in the Chinese PD population not only improves motor symptoms but also cognitive function to a certain extent, such as the decline of executive function and verbal fluency. The explicit cognitive decline was significantly quicker than that in patients on medication therapy. The improvement of visiospatial function was also noted. Implicit memory impairment during the 1-year follow-up period was not observed.
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Affiliation(s)
- ZhiFei You
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
| | - Yi-Ying Wu
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Rong Wu
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Zhi-Xiang Xu
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China
| | - Xi Wu
- Department of Neurosurgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Xiao-Ping Wang
- Department of Neurology, Shanghai General Hospital of Nanjing Medical University, Shanghai, China.,Department of Neurology, Shanghai TongRen Hospital, Shanghai Jiao-Tong University School of Medicine, Shanghai, China
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Liu C, Wang J, Deng B, Wei X, Yu H, Li H, Fietkiewicz C, Loparo KA. Closed-Loop Control of Tremor-Predominant Parkinsonian State Based on Parameter Estimation. IEEE Trans Neural Syst Rehabil Eng 2016; 24:1109-1121. [PMID: 26955042 DOI: 10.1109/tnsre.2016.2535358] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A significant feature of Parkinson's disease (PD) is the inability of the thalamus to respond faithfully to sensorimotor information from the cerebral cortex. This may be the result of abnormal oscillations in the basal ganglia (BG). Deep brain stimulation (DBS) is regarded as an effective method to modulate these pathological brain rhythmic activities. However, the selection of DBS parameters is challenging because the mechanism is not well understood. This work proposes the design of a closed-loop control strategy to automatically adjust the parameters of a DBS waveform based on a computational model. By estimating the synaptic input from BG to the thalamic neuron model as feedback variable, we designed and compared various control algorithms to counteract the effects of pathological oscillatory inputs. We then obtained optimal DBS parameters to modulate the tremor-predominant Parkinsonian state. We showed that even a simple proportional controller provides higher fidelity of thalamic relay of sensorimotor information and lower energy expenditure, as compared with classical open-loop DBS. Integral action further enhances DBS performance. Additionally, a positive bias voltage further improves the relay ability of the thalamus with decreased stimulation energy expenditure. These findings were conducive to the development of a more effective DBS to further improve the treatment of the PD.
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Boller JK, Barbe MT, Pauls KAM, Reck C, Brand M, Maier F, Fink GR, Timmermann L, Kalbe E. Decision-making under risk is improved by both dopaminergic medication and subthalamic stimulation in Parkinson's disease. Exp Neurol 2014; 254:70-7. [PMID: 24444545 DOI: 10.1016/j.expneurol.2014.01.005] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/07/2014] [Indexed: 10/25/2022]
Abstract
Inconsistent findings regarding the effects of dopaminergic medication (MED) and deep brain stimulation (DBS) of the subthalamic nucleus (STN) on decision making processes and impulsivity in Parkinson's disease (PD) patients have been reported. This study investigated the influence of MED and STN-DBS on decision-making under risk. Eighteen non-demented PD patients, treated with both MED and STN-DBS (64.3±10.2years, UPDRS III MED off, DBS off 45.5±17.1) were tested with the Game of Dice Task (GDT) which probes decision-making under risk during four conditions: MED on/DBS on, MED on/DBS off, MED off/DBS on, and MED off/DBS off. Task performance across conditions was compared analyzing two GDT-parameters: (i) the "net score" indicating advantageous decisions, and (ii) the patient's ability to use negative feedback. Significantly higher GDT net scores were observed in Med on in contrast to Med off conditions as well as in DBS on versus DBS off conditions. However, no effect of therapy for the patient's ability to make use of negative feedback could be detected. The data suggest a positive influence of both MED and STN-DBS on making decisions under risk in PD patients, an effect which seems to be mediated by mechanisms other than the use of negative feedback.
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Affiliation(s)
- Jana K Boller
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Institute of Neurosciences and Medicine (INM-3), Cognitive Neurology Section, Research Centre Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany.
| | - K Amande M Pauls
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Christiane Reck
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Matthias Brand
- General Psychology: Cognition, Faculty of Engineering, University of Duisburg-Essen, Campus Duisburg, Forsthausweg 2, 47048 Duisburg, Germany; Erwin L. Hahn Institute for Magnetic Resonance Imaging, Ahrendahls Wiese 199, 45141 Essen, Germany.
| | - Franziska Maier
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Institute of Neurosciences and Medicine (INM-3), Cognitive Neurology Section, Research Centre Jülich, Wilhelm-Johnen-Strasse, 52428 Jülich, Germany.
| | - Lars Timmermann
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany.
| | - Elke Kalbe
- Department of Neurology, University of Cologne, Kerpener Strasse 62, 50937 Cologne, Germany; Institute of Gerontology & Center for Neuropsychological Diagnostics and Intervention (CeNDI), University of Vechta, Driverstrasse 22, 49377 Vechta, Germany.
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Influence of deep brain stimulation of the subthalamic nucleus on cognitive function in patients with Parkinson's disease. Neurosci Bull 2013; 30:153-61. [PMID: 24338433 DOI: 10.1007/s12264-013-1389-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 04/05/2013] [Indexed: 10/25/2022] Open
Abstract
Deep brain stimulation (DBS) is an effective technique for treating Parkinson's disease (PD) in the middle and advanced stages. The subthalamic nucleus (STN) is the most common target for clinical treatment using DBS. While STN-DBS can significantly improve motor symptoms in PD patients, adverse cognitive effects have also been reported. The specific effects of STN-DBS on cognitive function and the related mechanisms remain unclear. Thus, it is imperative to identify the influence of STN-DBS on cognition and investigate the potential mechanisms to provide a clearer view of the various cognitive sequelae in PD patients. For this review, a literature search was performed using the following inclusion criteria: (1) at least 10 patients followed for a mean of at least 6 months after surgery since the year 2006; (2) pre- and postoperative cognitive data using at least one standardized neuropsychological scale; and (3) adequate reporting of study results using means and standard deviations. Of ∼170 clinical studies identified, 25 cohort studies (including 15 self-controlled studies, nine intergroup controlled studies, and one multi-center, randomized control experiment) and one meta-analysis were eligible for inclusion. The results suggest that the precise mechanism of the changes in cognitive function after STN-DBS remains obscure, but STN-DBS certainly has effects on cognition. In particular, a progressive decrease in verbal fluency after STN-DBS is consistently reported and although executive function is unchanged in the intermediate stage postoperatively, it tends to decline in the early and later stages. However, these changes do not affect the improvements in quality of life. STN-DBS seems to be safe with respect to cognitive effects in carefully-selected patients during a follow-up period from 6 months to 9 years.
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Shimo Y, Natori S, Oyama G, Nakajima M, Ishii H, Arai H, Hattori N. Subthalamic deep brain stimulation for a Parkinson's disease patient with duplication of SNCA. Neuromodulation 2013; 17:102-3. [PMID: 23441980 DOI: 10.1111/ner.12034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/07/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Yasushi Shimo
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
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Mondillon L, Mermillod M, Musca SC, Rieu I, Vidal T, Chambres P, Auxiette C, Dalens H, Marie Coulangeon L, Jalenques I, Lemaire JJ, Ulla M, Derost P, Marques A, Durif F. The combined effect of subthalamic nuclei deep brain stimulation and L-dopa increases emotion recognition in Parkinson's disease. Neuropsychologia 2012; 50:2869-2879. [PMID: 22944002 DOI: 10.1016/j.neuropsychologia.2012.08.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 07/17/2012] [Accepted: 08/19/2012] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation of the subthalamic nucleus (DBS) is a widely used surgical technique to suppress motor symptoms in Parkinson's disease (PD), and as such improves patients' quality of life. However, DBS may produce emotional disorders such as a reduced ability to recognize emotional facial expressions (EFE). Previous studies have not considered the fact that DBS and l-dopa medication can have differential, common, or complementary consequences on EFE processing. A thorough way of investigating the effect of DBS and l-dopa medication in greater detail is to compare patients' performances after surgery, with the two therapies either being administered ('on') or not administered ('off'). We therefore used a four-condition (l-dopa 'on'/DBS 'on', l-dopa 'on'/DBS 'off', l-dopa 'off'/DBS 'on', and l-dopa 'off'/DBS 'off') EFE recognition paradigm and compared implanted PD patients to healthy controls. The results confirmed those of previous studies, yielding a significant impairment in the detection of some facial expressions relative to controls. Disgust recognition was impaired when patients were 'off' l-dopa and 'on' DBS, and fear recognition impaired when 'off' of both therapies. More interestingly, the combined effect of both DBS and l-dopa administration seems much more beneficial for EFE recognition than the separate administration of each individual therapy. We discuss the implications of these findings in the light of the inverted U curve function that describes the differential effects of dopamine level on the right orbitofrontal cortex (OFC). We propose that, while l-dopa could "overdose" in dopamine the ventral stream of the OFC, DBS would compensate for this over-activation by decreasing OFC activity, thereby restoring the necessary OFC-amygdala interaction. Another finding is that, when collapsing over all treatment conditions, PD patients recognized more neutral faces than the matched controls, a result that concurs with embodiment theories.
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Affiliation(s)
- Laurie Mondillon
- LAPSCO (UMR 6024), Blaise Pascal University, Clermont-Ferrand 63000, France.
| | - Martial Mermillod
- LAPSCO (UMR 6024), Blaise Pascal University, Clermont-Ferrand 63000, France; Institut Universitaire de France, Paris 75005, France
| | - Serban C Musca
- CRPCC (EA 1285), European University of Brittany, Rennes 35000, France
| | - Isabelle Rieu
- Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France; UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France
| | - Tiphaine Vidal
- Neurology Department, Resource and Research Memory Center (CMRR), CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France
| | - Patrick Chambres
- LAPSCO (UMR 6024), Blaise Pascal University, Clermont-Ferrand 63000, France
| | - Catherine Auxiette
- Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France
| | - Hélène Dalens
- Ophtalmology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France
| | | | - Isabelle Jalenques
- UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France; Psychiatry A Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France
| | - Jean-Jacques Lemaire
- UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France; Neurosurgery Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France
| | - Miguel Ulla
- Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France
| | - Philippe Derost
- Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France
| | - Ana Marques
- Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France; UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France
| | - Franck Durif
- Neurology Department, CHU Clermont-Ferrand, Clermont-Ferrand F-63001, France; UFR Medecine, University of Clermont 1, Clermont-Ferrand F-63009, France
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Phillips L, Litcofsky KA, Pelster M, Gelfand M, Ullman MT, Charles PD. Subthalamic nucleus deep brain stimulation impacts language in early Parkinson's disease. PLoS One 2012; 7:e42829. [PMID: 22880117 PMCID: PMC3413674 DOI: 10.1371/journal.pone.0042829] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 07/13/2012] [Indexed: 11/25/2022] Open
Abstract
Although deep brain stimulation (DBS) of the basal ganglia improves motor outcomes in Parkinson's disease (PD), its effects on cognition, including language, remain unclear. This study examined the impact of subthalamic nucleus (STN) DBS on two fundamental capacities of language, grammatical and lexical functions. These functions were tested with the production of regular and irregular past-tenses, which contrast aspects of grammatical (regulars) and lexical (irregulars) processing while controlling for multiple potentially confounding factors. Aspects of the motor system were tested by contrasting the naming of manipulated (motor) and non-manipulated (non-motor) objects. Performance was compared between healthy controls and early-stage PD patients treated with either DBS/medications or medications alone. Patients were assessed on and off treatment, with controls following a parallel testing schedule. STN-DBS improved naming of manipulated (motor) but not non-manipulated (non-motor) objects, as compared to both controls and patients with just medications, who did not differ from each other across assessment sessions. In contrast, STN-DBS led to worse performance at regulars (grammar) but not irregulars (lexicon), as compared to the other two subject groups, who again did not differ. The results suggest that STN-DBS negatively impacts language in early PD, but may be specific in depressing aspects of grammatical and not lexical processing. The finding that STN-DBS affects both motor and grammar (but not lexical) functions strengthens the view that both depend on basal ganglia circuitry, although the mechanisms for its differential impact on the two (improved motor, impaired grammar) remain to be elucidated.
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Affiliation(s)
- Lara Phillips
- Department of Neurology, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail: (LP); (MU); (PDC)
| | - Kaitlyn A. Litcofsky
- Brain and Language Lab, Department of Neuroscience, Georgetown University, Washington, District of Columbia, United States of America
- Department of Psychology, Center for Language Science, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Michael Pelster
- Department of Neurology, Vanderbilt University, Nashville, Tennessee, United States of America
| | - Matthew Gelfand
- Brain and Language Lab, Department of Neuroscience, Georgetown University, Washington, District of Columbia, United States of America
| | - Michael T. Ullman
- Brain and Language Lab, Department of Neuroscience, Georgetown University, Washington, District of Columbia, United States of America
- * E-mail: (LP); (MU); (PDC)
| | - P. David Charles
- Department of Neurology, Vanderbilt University, Nashville, Tennessee, United States of America
- * E-mail: (LP); (MU); (PDC)
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Hofmann L, Ebert M, Tass PA, Hauptmann C. Modified pulse shapes for effective neural stimulation. FRONTIERS IN NEUROENGINEERING 2011; 4:9. [PMID: 22007167 PMCID: PMC3181430 DOI: 10.3389/fneng.2011.00009] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 08/09/2011] [Indexed: 11/16/2022]
Abstract
The electrical stimulation of neuronal structures is used as a treatment for many neurological disorders, e.g., for the treatment of Parkinson’s disease via deep brain stimulation (DBS). To reduce side effects, to avoid tissue or electrode damage, and to increase battery lifetimes, an effective but gentle electrical stimulation is of prime importance. We studied different modified pulse shapes for application in DBS with respect to their efficiency to initiate neuronal activity. Numerical simulations of two mathematical neuron models were performed to investigate the effectiveness of different modified pulse shapes. According to our results, the pulse shapes considered showed a considerably increased efficiency in terms of both activation and entrainment of neural activity. We found that the introduction of a gap with a specific and optimized duration in a biphasic pulse and the reversal of the standard pulse phase order yielded stimulation protocols that could increase the efficiency and therefore reduce the energy consumption of stimulation. The improvements were achieved by simple modifications of existing stimulation techniques. The modification of the pulse shapes resulted in an improvement of up to 50% for both the activation of resting neurons and the entrainment of bursting neurons.
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Affiliation(s)
- Lorenz Hofmann
- Forschungszentrum Jülich GmbH, Institute of Neuroscience and Medicine - Neuromodulation (INM-7), Forschungszentrum Jülich Jülich, Germany
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