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Streng ML, Kottke BW, Wasserman EM, Zecker L, Luong L, Ebner TJ, Krook-Magnuson E. Early and widespread engagement of the cerebellum during hippocampal epileptiform activity Format: Brief Communication. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.05.14.593969. [PMID: 38798649 PMCID: PMC11118491 DOI: 10.1101/2024.05.14.593969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Despite research illustrating the cerebellum may be a critical circuit element in the epilepsies, remarkably little is known about cerebellar engagement during seizures. We therefore implemented a novel method for repeated imaging of the cerebellum in awake, chronically epileptic animals. We found widespread changes in cerebellar calcium signals during behavioral seizures and during hippocampal seizures that remained electrographic only, arguing against cerebellar modulation simply reflecting motor components. Moreover, even brief interictal spikes produced widespread alterations in cerebellar activity. Changes were noted in the anterior and posterior cerebellum, along the midline, and both ipsilaterally and contralaterally to the seizure focus. Remarkably, changes in the cerebellum also occurred prior to any noticeable change in the hippocampal electrographic recordings, suggesting a special relationship between the cerebellum and hippocampal epileptiform activity. Together these results underscore the importance of the cerebellum in epilepsy, warranting a more consistent consideration of the cerebellum when evaluating epilepsy patients.
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Xiao W, Li P, Kong F, Kong J, Pan A, Long L, Yan X, Xiao B, Gong J, Wan L. Unraveling the Neural Circuits: Techniques, Opportunities and Challenges in Epilepsy Research. Cell Mol Neurobiol 2024; 44:27. [PMID: 38443733 PMCID: PMC10914928 DOI: 10.1007/s10571-024-01458-5] [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: 12/25/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024]
Abstract
Epilepsy, a prevalent neurological disorder characterized by high morbidity, frequent recurrence, and potential drug resistance, profoundly affects millions of people globally. Understanding the microscopic mechanisms underlying seizures is crucial for effective epilepsy treatment, and a thorough understanding of the intricate neural circuits underlying epilepsy is vital for the development of targeted therapies and the enhancement of clinical outcomes. This review begins with an exploration of the historical evolution of techniques used in studying neural circuits related to epilepsy. It then provides an extensive overview of diverse techniques employed in this domain, discussing their fundamental principles, strengths, limitations, as well as their application. Additionally, the synthesis of multiple techniques to unveil the complexity of neural circuits is summarized. Finally, this review also presents targeted drug therapies associated with epileptic neural circuits. By providing a critical assessment of methodologies used in the study of epileptic neural circuits, this review seeks to enhance the understanding of these techniques, stimulate innovative approaches for unraveling epilepsy's complexities, and ultimately facilitate improved treatment and clinical translation for epilepsy.
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Affiliation(s)
- Wenjie Xiao
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Peile Li
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Fujiao Kong
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jingyi Kong
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Aihua Pan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xiaoxin Yan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaoe Gong
- Department of Neurology, Hunan Children's Hospital, Changsha, Hunan Province, China.
| | - Lily Wan
- Department of Anatomy and Neurobiology, Central South University Xiangya Medical School, Changsha, Hunan Province, China.
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Streng ML. The bidirectional relationship between the cerebellum and seizure networks: a double-edged sword. Curr Opin Behav Sci 2023; 54:101327. [PMID: 38800711 PMCID: PMC11126210 DOI: 10.1016/j.cobeha.2023.101327] [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] [Indexed: 05/29/2024]
Abstract
Epilepsy is highly prevalent and notoriously pharmacoresistant. New therapeutic interventions are urgently needed, both for preventing the seizures themselves as well as negative outcomes and comorbidities associated with chronic epilepsy. While the cerebellum is not traditionally associated with epilepsy or seizures, research over the past decade has outlined the cerebellum as a brain region that is uniquely suited for both therapeutic needs. This review discusses our current understanding of the cerebellum as a key node within seizure networks, capable of both attenuating seizures in several animal models, and conversely, prone to altered structure and function in chronic epilepsy. Critical next steps are to advance therapeutic modulation of the cerebellum more towards translation, and to provide a more comprehensive characterization of how the cerebellum is impacted by chronic epilepsy, in order to subvert negative outcomes.
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Affiliation(s)
- M L Streng
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
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Keever KM, Li Y, Womble PD, Sullens DG, Otazu GH, Lugo JN, Ramos RL. Neocortical and cerebellar malformations affect flurothyl-induced seizures in female C57BL/6J mice. Front Neurosci 2023; 17:1271744. [PMID: 38027492 PMCID: PMC10651747 DOI: 10.3389/fnins.2023.1271744] [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: 08/03/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Brain malformations cause cognitive disability and seizures in both human and animal models. Highly laminated structures such as the neocortex and cerebellum are vulnerable to malformation, affecting lamination and neuronal connectivity as well as causing heterotopia. The objective of the present study was to determine if sporadic neocortical and/or cerebellar malformations in C57BL/6J mice are correlated with reduced seizure threshold. The inhaled chemi-convulsant flurothyl was used to induce generalized, tonic-clonic seizures in male and female C57BL/6J mice, and the time to seizure onset was recorded as a functional correlate of brain excitability changes. Following seizures, mice were euthanized, and brains were extracted for histology. Cryosections of the neocortex and cerebellar vermis were stained and examined for the presence of molecular layer heterotopia as previously described in C57BL/6J mice. Over 60% of mice had neocortical and/or cerebellar heterotopia. No sex differences were observed in the prevalence of malformations. Significantly reduced seizure onset time was observed dependent on sex and the type of malformation present. These results raise important questions regarding the presence of malformations in C57BL/6J mice used in the study of brain development, epilepsy, and many other diseases of the nervous system.
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Affiliation(s)
- Katherine M. Keever
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Ying Li
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Paige D. Womble
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - D. Gregory Sullens
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Gonzalo H. Otazu
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
| | - Joaquin N. Lugo
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, United States
| | - Raddy L. Ramos
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, United States
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Remore LG, Rifi Z, Nariai H, Eliashiv DS, Fallah A, Edmonds BD, Matsumoto JH, Salamon N, Tolossa M, Wei W, Locatelli M, Tsolaki EC, Bari AA. Structural connections of the centromedian nucleus of thalamus and their relevance for neuromodulation in generalized drug-resistant epilepsy: insight from a tractography study. Ther Adv Neurol Disord 2023; 16:17562864231202064. [PMID: 37822361 PMCID: PMC10563482 DOI: 10.1177/17562864231202064] [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: 05/03/2023] [Accepted: 09/01/2023] [Indexed: 10/13/2023] Open
Abstract
Background Epilepsy is a widespread neurologic disorder and almost one-third of patients suffer from drug-resistant epilepsy (DRE). Neuromodulation targeting the centromediannucleus of the thalamus (CM) has been showing promising results for patients with generalized DRE who are not surgical candidates. Recently, the effect of CM- deep brain stimulation (DBS) in DRE patients was investigated in the Electrical Stimulation of Thalamus for Epilepsy of Lennox-Gastaut phenotype (ESTEL) trial, a monocentric randomized-controlled study. The same authors described a 'cold-spot' and a 'sweet-spot', which are defined as the volume of stimulation in the thalamus yielding the least and the best clinical response, respectively. However, it remains unclear which structural connections may contribute to the anti-seizure effect of the stimulation. Objective We investigated the differences in structural connectivity among CM, the sweet-spot and the cold-spot. Furthermore, we tried to validate our results in a cohort of DRE patients who underwent CM-DBS or CM-RNS (responsive neurostimulation). We hypothesized that the sweet-spot would share similar structural connectivity with responder patients. Methods By using the software FMRIB Software Library (FSL), probabilistic tractography was performed on 100 subjects from the Human Connectome Project to calculate the probability of connectivity of the whole CM, the sweet-spot and the cold-spot to 45 cortical and subcortical areas. Results among the three seeds were compared with multivariate analysis of variance (MANOVA). Similarly, the structural connectivity of volumes of tissue activated (VTAs) from eight DRE patients was investigated. Patients were divided into responders and non-responders based on the degree of reduction in seizure frequency, and the mean probabilities of connectivity were similarly compared between the two groups. Results The sweet-spot demonstrated a significantly higher probability of connectivity (p < 0.001) with the precentral gyrus, superior frontal gyrus, and the cerebellum than the whole CM and the cold-spot. Responder patients displayed a higher probability of connectivity with both ipsilateral (p = 0.011) and contralateral cerebellum (p = 0.04) than the non-responders. Conclusion Cerebellar connections seem to contribute to the beneficial effects of CM-neuromodulation in patients with drug-resistant generalized epilepsy.
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Affiliation(s)
- Luigi G. Remore
- Surgical Neuromodulation and Brain Mapping Laboratory, ULCA
- Department of Neurosurgery, 300 Stein Plaza, Los Angeles, CA 90095, USA
- University of Milan ‘La Statale’, Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ziad Rifi
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Hiroki Nariai
- Division of Pediatric Neurology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Dawn S. Eliashiv
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA
| | - Aria Fallah
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
- Division of Pediatric Neurology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Benjamin D. Edmonds
- Division of Pediatric Neurology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Joyce H. Matsumoto
- Division of Pediatric Neurology, Department of Pediatrics, University of California Los Angeles, Los Angeles, CA, USA
| | - Noriko Salamon
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Radiology, University of California Los Angeles, Los Angeles, CA, USA
| | - Meskerem Tolossa
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Wexin Wei
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Marco Locatelli
- University of Milan ‘La Statale’, Milan, Italy
- Department of Neurosurgery, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- ‘Aldo Ravelli’ Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
| | - Evangelia C. Tsolaki
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Ausaf A. Bari
- Department of Neurosurgery, University of California Los Angeles, Los Angeles, CA, USA
- Geffen School of Medicine David California Los Angeles University of Angeles Los CA, USA
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Schaper FLWVJ, Nordberg J, Cohen AL, Lin C, Hsu J, Horn A, Ferguson MA, Siddiqi SH, Drew W, Soussand L, Winkler AM, Simó M, Bruna J, Rheims S, Guenot M, Bucci M, Nummenmaa L, Staals J, Colon AJ, Ackermans L, Bubrick EJ, Peters JM, Wu O, Rost NS, Grafman J, Blumenfeld H, Temel Y, Rouhl RPW, Joutsa J, Fox MD. Mapping Lesion-Related Epilepsy to a Human Brain Network. JAMA Neurol 2023; 80:891-902. [PMID: 37399040 PMCID: PMC10318550 DOI: 10.1001/jamaneurol.2023.1988] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/03/2023] [Indexed: 07/04/2023]
Abstract
Importance It remains unclear why lesions in some locations cause epilepsy while others do not. Identifying the brain regions or networks associated with epilepsy by mapping these lesions could inform prognosis and guide interventions. Objective To assess whether lesion locations associated with epilepsy map to specific brain regions and networks. Design, Setting, and Participants This case-control study used lesion location and lesion network mapping to identify the brain regions and networks associated with epilepsy in a discovery data set of patients with poststroke epilepsy and control patients with stroke. Patients with stroke lesions and epilepsy (n = 76) or no epilepsy (n = 625) were included. Generalizability to other lesion types was assessed using 4 independent cohorts as validation data sets. The total numbers of patients across all datasets (both discovery and validation datasets) were 347 with epilepsy and 1126 without. Therapeutic relevance was assessed using deep brain stimulation sites that improve seizure control. Data were analyzed from September 2018 through December 2022. All shared patient data were analyzed and included; no patients were excluded. Main Outcomes and Measures Epilepsy or no epilepsy. Results Lesion locations from 76 patients with poststroke epilepsy (39 [51%] male; mean [SD] age, 61.0 [14.6] years; mean [SD] follow-up, 6.7 [2.0] years) and 625 control patients with stroke (366 [59%] male; mean [SD] age, 62.0 [14.1] years; follow-up range, 3-12 months) were included in the discovery data set. Lesions associated with epilepsy occurred in multiple heterogenous locations spanning different lobes and vascular territories. However, these same lesion locations were part of a specific brain network defined by functional connectivity to the basal ganglia and cerebellum. Findings were validated in 4 independent cohorts including 772 patients with brain lesions (271 [35%] with epilepsy; 515 [67%] male; median [IQR] age, 60 [50-70] years; follow-up range, 3-35 years). Lesion connectivity to this brain network was associated with increased risk of epilepsy after stroke (odds ratio [OR], 2.82; 95% CI, 2.02-4.10; P < .001) and across different lesion types (OR, 2.85; 95% CI, 2.23-3.69; P < .001). Deep brain stimulation site connectivity to this same network was associated with improved seizure control (r, 0.63; P < .001) in 30 patients with drug-resistant epilepsy (21 [70%] male; median [IQR] age, 39 [32-46] years; median [IQR] follow-up, 24 [16-30] months). Conclusions and Relevance The findings in this study indicate that lesion-related epilepsy mapped to a human brain network, which could help identify patients at risk of epilepsy after a brain lesion and guide brain stimulation therapies.
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Affiliation(s)
- Frederic L. W. V. J. Schaper
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Janne Nordberg
- Turku Brain and Mind Center, Department of Clinical Neurophysiology, Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
| | - Alexander L. Cohen
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Computational Radiology Laboratory, Department of Radiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher Lin
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Joey Hsu
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Andreas Horn
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Michael A. Ferguson
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Shan H. Siddiqi
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - William Drew
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Louis Soussand
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Anderson M. Winkler
- National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
- Department of Human Genetics, University of Texas Rio Grande Valley, Brownsville
| | - Marta Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge - Institut Català d’Oncologia (IDIBELL), L’Hospitalet del Llobregat, Barcelona, Spain
| | - Jordi Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge - Institut Català d’Oncologia (IDIBELL), L’Hospitalet del Llobregat, Barcelona, Spain
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology, Lyon Neurosciences Research Center, Hospices Civils de Lyon and University of Lyon, Lyon, France
- Institut national de la santé et de la recherche médicale, Lyon, France
| | - Marc Guenot
- Institut national de la santé et de la recherche médicale, Lyon, France
- Department of Functional Neurosurgery, Hospices Civils de Lyon and University of Lyon, Lyon, France
| | - Marco Bucci
- Turku PET Centre, University of Turku and Åbo Akademi University, Turku, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Lauri Nummenmaa
- Turku PET Centre, University of Turku and Åbo Akademi University, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
| | - Julie Staals
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Albert J. Colon
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center, Heeze & Maastricht, the Netherlands
- Department of Epileptology, Centre Hospitalier Universitaire Martinique, Fort-de-France, France
| | - Linda Ackermans
- Department of Neurosurgery and School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Ellen J. Bubrick
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Jurriaan M. Peters
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Ona Wu
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Natalia S. Rost
- Harvard Medical School, Harvard University, Boston, Massachusetts
- J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jordan Grafman
- Cognitive Neuroscience Laboratory, Think + Speak Lab, Shirley Ryan Ability Lab, Chicago, Illinois
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Hal Blumenfeld
- Departments of Neurology, Neuroscience and Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Yasin Temel
- Department of Neurosurgery and School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Rob P. W. Rouhl
- Department of Neurology and School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, the Netherlands
- Academic Center for Epileptology Kempenhaeghe/Maastricht University Medical Center, Heeze & Maastricht, the Netherlands
| | - Juho Joutsa
- Turku Brain and Mind Center, Department of Clinical Neurophysiology, Clinical Neurosciences, Turku University Hospital and University of Turku, Turku, Finland
- Turku PET Centre, University of Turku and Åbo Akademi University, Turku, Finland
| | - Michael D. Fox
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry and Radiology, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Harvard University, Boston, Massachusetts
- Athinoula A Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Spampinato DA, Casula EP, Koch G. The Cerebellum and the Motor Cortex: Multiple Networks Controlling Multiple Aspects of Behavior. Neuroscientist 2023:10738584231189435. [PMID: 37649430 DOI: 10.1177/10738584231189435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
The cerebellum and its thalamic projections to the primary motor cortex (M1) are well known to play an essential role in executing daily actions. Anatomic investigations in animals and postmortem humans have established the reciprocal connections between these regions; however, how these pathways can shape cortical activity in behavioral contexts and help promote recovery in neuropathological conditions remains not well understood. The present review aims to provide a comprehensive description of these pathways in animals and humans and discuss how novel noninvasive brain stimulation (NIBS) methods can be used to gain a deeper understanding of the cerebellar-M1 connections. In the first section, we focus on recent animal literature that details how information sent from the cerebellum and thalamus is integrated into an broad network of cortical motor neurons. We then discuss how NIBS approaches in humans can be used to reliably assess the connectivity between the cerebellum and M1. Moreover, we provide the latest perspectives on using advanced NIBS approaches to investigate and modulate multiple cerebellar-cortical networks involved in movement behavior and plasticity. Finally, we discuss how these emerging methods have been used in translation research to produce long-lasting modifications of cerebellar-thalamic-M1 to restore cortical activity and motor function in neurologic patients.
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8
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Lindquist BE, Timbie C, Voskobiynyk Y, Paz JT. Thalamocortical circuits in generalized epilepsy: Pathophysiologic mechanisms and therapeutic targets. Neurobiol Dis 2023; 181:106094. [PMID: 36990364 PMCID: PMC10192143 DOI: 10.1016/j.nbd.2023.106094] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/02/2023] [Accepted: 03/19/2023] [Indexed: 03/29/2023] Open
Abstract
Generalized epilepsy affects 24 million people globally; at least 25% of cases remain medically refractory. The thalamus, with widespread connections throughout the brain, plays a critical role in generalized epilepsy. The intrinsic properties of thalamic neurons and the synaptic connections between populations of neurons in the nucleus reticularis thalami and thalamocortical relay nuclei help generate different firing patterns that influence brain states. In particular, transitions from tonic firing to highly synchronized burst firing mode in thalamic neurons can cause seizures that rapidly generalize and cause altered awareness and unconsciousness. Here, we review the most recent advances in our understanding of how thalamic activity is regulated and discuss the gaps in our understanding of the mechanisms of generalized epilepsy syndromes. Elucidating the role of the thalamus in generalized epilepsy syndromes may lead to new opportunities to better treat pharmaco-resistant generalized epilepsy by thalamic modulation and dietary therapy.
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Affiliation(s)
- Britta E Lindquist
- UCSF Department of Neurology, Division of Neurocritical Care, United States of America; UCSF Department of Neurology, Division of Pediatric Epilepsy, United States of America; UCSF Department of Neurology, United States of America
| | - Clare Timbie
- Gladstone Institute of Neurological Disease, United States of America; UCSF Department of Neurology, Division of Pediatric Epilepsy, United States of America; UCSF Department of Neurology, United States of America
| | - Yuliya Voskobiynyk
- Gladstone Institute of Neurological Disease, United States of America; UCSF Department of Neurology, United States of America
| | - Jeanne T Paz
- Gladstone Institute of Neurological Disease, United States of America; UCSF Department of Neurology, United States of America; Kavli Institute for Fundamental Neuroscience, UCSF, United States of America.
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9
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Streng ML, Froula JM, Krook-Magnuson E. The cerebellum's understated role and influences in the epilepsies. Neurobiol Dis 2023; 183:106160. [PMID: 37209926 DOI: 10.1016/j.nbd.2023.106160] [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: 02/28/2023] [Revised: 05/03/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
Approximately 1 in 26 people will develop epilepsy in their lifetime, but current treatment options leave as many as half of all epilepsy patients with uncontrolled seizures. In addition to the burden of the seizures themselves, chronic epilepsy can be associated with cognitive deficits, structural changes, and devastating negative outcomes such as sudden unexpected death in epilepsy (SUDEP). Thus, major challenges in epilepsy research surround the need to both develop new therapeutic targets for intervention as well as shed light on the mechanisms by which chronic epilepsy can lead to comorbidities and negative outcomes. Despite not being traditionally associated with epilepsy or seizures, the cerebellum has emerged as not only a brain region that can serve as an important target for seizure control, but one that may also be profoundly impacted by chronic epilepsy. Here, we discuss targeting the cerebellum for potential therapeutic intervention and discuss pathway insights gained from recent optogenetic studies. We then review observations of cerebellar alterations during seizures and in chronic epilepsy, as well as the potential for the cerebellum to be a seizure focus. Cerebellar alterations in epilepsy may be critical to patient outcomes, highlighting the need for a more comprehensive understanding and appreciation of the cerebellum in the epilepsies.
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Affiliation(s)
- Martha L Streng
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA.
| | - Jessica M Froula
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
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10
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Gray MM, Naik A, Ebner TJ, Carter RE. Altered brain state during episodic dystonia in tottering mice decouples primary motor cortex from limb kinematics. DYSTONIA 2023; 2:10974. [PMID: 37800168 PMCID: PMC10554815 DOI: 10.3389/dyst.2023.10974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Episodic Ataxia Type 2 (EA2) is a rare neurological disorder caused by a mutation in the CACNA1A gene, encoding the P/Q-type voltage-gated Ca2+ channel important for neurotransmitter release. Patients with this channelopathy exhibit both cerebellar and cerebral pathologies, suggesting the condition affects both regions. The tottering (tg/tg) mouse is the most commonly used EA2 model due to an orthologous mutation in the cacna1a gene. The tg/tg mouse has three prominent behavioral phenotypes: a dramatic episodic dystonia; absence seizures with generalized spike and wave discharges (GSWDs); and mild ataxia. We previously observed a novel brain state, transient low-frequency oscillations (LFOs) in the cerebellum and cerebral cortex under anesthesia. In this study, we examine the relationships among the dystonic attack, GSWDs, and LFOs in the cerebral cortex. Previous studies characterized LFOs in the motor cortex of anesthetized tg/tg mice using flavoprotein autofluorescence imaging testing the hypothesis that LFOs provide a mechanism for the paroxysmal dystonia. We sought to obtain a more direct understanding of motor cortex (M1) activity during the dystonic episodes. Using two-photon Ca2+ imaging to investigate neuronal activity in M1 before, during, and after the dystonic attack, we show that there is not a significant change in the activity of M1 neurons from baseline through the attack. We also conducted simultaneous, multi-electrode recordings to further understand how M1 cellular activity and local field potentials change throughout the progression of the dystonic attack. Neither putative pyramidal nor inhibitory interneuron firing rate changed during the dystonic attack. However, we did observe a near complete loss of GSWDs during the dystonic attack in M1. Finally, using spike triggered averaging to align simultaneously recorded limb kinematics to the peak Ca2+ response, and vice versa, revealed a reduction in the spike triggered average during the dystonic episodes. Both the loss of GSWDs and the reduction in the coupling suggest that, during the dystonic attack, M1 is effectively decoupled from other structures. Overall, these results indicate that the attack is not initiated or controlled in M1, but elsewhere in the motor circuitry. The findings also highlight that LFOs, GSWDs, and dystonic attacks represent three brain states in tg/tg mice.
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Affiliation(s)
- Madelyn M Gray
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Anant Naik
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Timothy J Ebner
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
| | - Russell E Carter
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
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11
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Stieve BJ, Richner TJ, Krook-Magnuson C, Netoff TI, Krook-Magnuson E. Optimization of closed-loop electrical stimulation enables robust cerebellar-directed seizure control. Brain 2023; 146:91-108. [PMID: 35136942 DOI: 10.1093/brain/awac051] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/17/2021] [Accepted: 01/11/2022] [Indexed: 01/11/2023] Open
Abstract
Additional treatment options for temporal lobe epilepsy are needed, and potential interventions targeting the cerebellum are of interest. Previous animal work has shown strong inhibition of hippocampal seizures through on-demand optogenetic manipulation of the cerebellum. However, decades of work examining electrical stimulation-a more immediately translatable approach-targeting the cerebellum has produced very mixed results. We were therefore interested in exploring the impact that stimulation parameters may have on seizure outcomes. Using a mouse model of temporal lobe epilepsy, we conducted on-demand electrical stimulation of the cerebellar cortex, and varied stimulation charge, frequency and pulse width, resulting in over 1000 different potential combinations of settings. To explore this parameter space in an efficient, data-driven, manner, we utilized Bayesian optimization with Gaussian process regression, implemented in MATLAB with an Expected Improvement Plus acquisition function. We examined three different fitting conditions and two different electrode orientations. Following the optimization process, we conducted additional on-demand experiments to test the effectiveness of selected settings. Regardless of experimental setup, we found that Bayesian optimization allowed identification of effective intervention settings. Additionally, generally similar optimal settings were identified across animals, suggesting that personalized optimization may not always be necessary. While optimal settings were effective, stimulation with settings predicted from the Gaussian process regression to be ineffective failed to provide seizure control. Taken together, our results provide a blueprint for exploration of a large parameter space for seizure control and illustrate that robust inhibition of seizures can be achieved with electrical stimulation of the cerebellum, but only if the correct stimulation parameters are used.
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Affiliation(s)
- Bethany J Stieve
- Graduate Program in Neuroscience, University of Minnesota, Minneapolis 55455, USA
| | - Thomas J Richner
- Department of Biomedical Engineering, University of Minnesota, Minneapolis 55455, USA.,Department of Neuroscience, University of Minnesota, Minneapolis 55455, USA
| | | | - Theoden I Netoff
- Graduate Program in Neuroscience, University of Minnesota, Minneapolis 55455, USA.,Department of Biomedical Engineering, University of Minnesota, Minneapolis 55455, USA
| | - Esther Krook-Magnuson
- Graduate Program in Neuroscience, University of Minnesota, Minneapolis 55455, USA.,Department of Neuroscience, University of Minnesota, Minneapolis 55455, USA
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12
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Ma L, Liu G, Zhang P, Wang J, Huang W, Jiang Y, Zheng Y, Han N, Zhang Z, Zhang J. Altered Cerebro-Cerebellar Effective Connectivity in New-Onset Juvenile Myoclonic Epilepsy. Brain Sci 2022; 12:brainsci12121658. [PMID: 36552118 PMCID: PMC9775154 DOI: 10.3390/brainsci12121658] [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: 11/03/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022] Open
Abstract
(1) Objective: Resting-state fMRI studies have indicated that juvenile myoclonic epilepsy (JME) could cause widespread functional connectivity disruptions between the cerebrum and cerebellum. However, the directed influences or effective connectivities (ECs) between these brain regions are poorly understood. In the current study, we aimed to evaluate the ECs between the cerebrum and cerebellum in patients with new-onset JME. (2) Methods: Thirty-four new-onset JME patients and thirty-four age-, sex-, and education-matched healthy controls (HCs) were included in this study. We compared the degree centrality (DC) between the two groups to identify intergroup differences in whole-brain functional connectivity. Then, we used a Granger causality analysis (GCA) to explore JME-caused changes in EC between cerebrum regions and cerebellum regions. Furthermore, we applied a correlation analysis to identify associations between aberrant EC and disease severity in patients with JME. (3) Results: Compared to HCs, patients with JME showed significantly increased DC in the left cerebellum posterior lobe (CePL.L), the right inferior temporal gyrus (ITG.R) and the right superior frontal gyrus (SFG.R), and decreased DC in the left inferior frontal gyrus (IFG.L) and the left superior temporal gyrus (STG.L). The patients also showed unidirectionally increased ECs from cerebellum regions to the cerebrum regions, including from the CePL.L to the right precuneus (PreCU.R), from the left cerebellum anterior lobe (CeAL.L) to the ITG.R, from the right cerebellum posterior lobe (CePL.R) to the IFG.L, and from the left inferior semi-lunar lobule of the cerebellum (CeISL.L) to the SFG.R. Additionally, the EC from the CeISL.L to the SFG.R was negatively correlated with the disease severity. (4) Conclusions: JME patients showed unidirectional EC disruptions from the cerebellum to the cerebrum, and the negative correlation between EC and disease severity provides a new perspective for understanding the cerebro-cerebellar neural circuit mechanisms in JME.
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Affiliation(s)
- Laiyang Ma
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Guangyao Liu
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Pengfei Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Jun Wang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Wenjing Huang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Yanli Jiang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Yu Zheng
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Na Han
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Second Clinical School, Lanzhou University, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
| | - Zhe Zhang
- School of Physics, Hangzhou Normal University, Hangzhou 311121, China
- Institute of Brain Science, Hangzhou Normal University, Hangzhou 311121, China
- Correspondence: (Z.Z.); (J.Z.); Tel.: +86-0571-28861955 (Z.Z.); +86-0931-8942090 (J.Z.)
| | - Jing Zhang
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China
- Correspondence: (Z.Z.); (J.Z.); Tel.: +86-0571-28861955 (Z.Z.); +86-0931-8942090 (J.Z.)
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Schwitalla JC, Pakusch J, Mücher B, Brückner A, Depke DA, Fenzl T, De Zeeuw CI, Kros L, Hoebeek FE, Mark MD. Controlling absence seizures from the cerebellar nuclei via activation of the G q signaling pathway. Cell Mol Life Sci 2022; 79:197. [PMID: 35305155 PMCID: PMC8934336 DOI: 10.1007/s00018-022-04221-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
Absence seizures (ASs) are characterized by pathological electrographic oscillations in the cerebral cortex and thalamus, which are called spike-and-wave discharges (SWDs). Subcortical structures, such as the cerebellum, may well contribute to the emergence of ASs, but the cellular and molecular underpinnings remain poorly understood. Here we show that the genetic ablation of P/Q-type calcium channels in cerebellar granule cells (quirky) or Purkinje cells (purky) leads to recurrent SWDs with the purky model showing the more severe phenotype. The quirky mouse model showed irregular action potential firing of their cerebellar nuclei (CN) neurons as well as rhythmic firing during the wave of their SWDs. The purky model also showed irregular CN firing, in addition to a reduced firing rate and rhythmicity during the spike of the SWDs. In both models, the incidence of SWDs could be decreased by increasing CN activity via activation of the Gq-coupled designer receptor exclusively activated by designer drugs (DREADDs) or via that of the Gq-coupled metabotropic glutamate receptor 1. In contrast, the incidence of SWDs was increased by decreasing CN activity via activation of the inhibitory Gi/o-coupled DREADD. Finally, disrupting CN rhythmic firing with a closed-loop channelrhodopsin-2 stimulation protocol confirmed that ongoing SWDs can be ceased by activating CN neurons. Together, our data highlight that P/Q-type calcium channels in cerebellar granule cells and Purkinje cells can be relevant for epileptogenesis, that Gq-coupled activation of CN neurons can exert anti-epileptic effects and that precisely timed activation of the CN can be used to stop ongoing SWDs.
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Affiliation(s)
| | - Johanna Pakusch
- Department of Behavioral Neuroscience, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Brix Mücher
- Department of Zoology and Neurobiology, Ruhr-University Bochum, 44801, Bochum, Germany
| | - Alexander Brückner
- Institute of Physiology I, Medical Faculty, University of Bonn, 53127, Bonn, Germany
| | - Dominic Alexej Depke
- European Institute of Molecular Imaging, University of Münster, 48149, Münster, Germany
| | - Thomas Fenzl
- Department of Anesthesiology and Intensive Care, TUM School of Medicine, Technical University of Munich, 81675, Munich, Germany
| | - Chris I De Zeeuw
- Department of Neuroscience, Erasmus MC, 3015 AA, Rotterdam, The Netherlands.,Netherlands Institute for Neuroscience, Royal Dutch Academy for Arts and Sciences, 1105, BA, Amsterdam, The Netherlands
| | - Lieke Kros
- Department of Neuroscience, Erasmus MC, 3015 AA, Rotterdam, The Netherlands
| | - Freek E Hoebeek
- Department for Developmental Origins of Disease, Wilhelmina Children's Hospital and Brain Center, University Medical Center Utrecht, 3584 EA, Utrecht, The Netherlands
| | - Melanie D Mark
- Department of Behavioral Neuroscience, Ruhr-University Bochum, 44801, Bochum, Germany.
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Rondi-Reig L. The cerebellum on the epilepsy frontline. Trends Neurosci 2022; 45:337-338. [DOI: 10.1016/j.tins.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 01/24/2023]
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Distinct Fastigial Output Channels and Their Impact on Temporal Lobe Seizures. J Neurosci 2021; 41:10091-10107. [PMID: 34716233 DOI: 10.1523/jneurosci.0683-21.2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/07/2021] [Accepted: 10/22/2021] [Indexed: 01/07/2023] Open
Abstract
Despite being canonically considered a motor control structure, the cerebellum is increasingly recognized for important roles in processes beyond this traditional framework, including seizure suppression. Excitatory fastigial neurons project to a large number of downstream targets, and it is unclear whether this broad targeting underlies seizure suppression, or whether a specific output may be sufficient. To address this question, we used the intrahippocampal kainic acid mouse model of temporal lobe epilepsy, male and female animals, and a dual-virus approach to selectively label and manipulate fastigial outputs. We examined fastigial neurons projecting to the superior colliculus, medullary reticular formation, and central lateral nucleus of the thalamus, and found that these comprise largely nonoverlapping populations of neurons that send collaterals to unique sets of additional, somewhat overlapping, thalamic and brainstem regions. We found that neither optogenetic stimulation of superior colliculus nor reticular formation output channels attenuated hippocampal seizures. In contrast, on-demand stimulation of fastigial neurons targeting the central lateral nucleus robustly inhibited seizures. Our results indicate that fastigial control of hippocampal seizures does not require simultaneous modulation of many fastigial output channels. Rather, selective modulation of the fastigial output channel to the central lateral thalamus, specifically, is sufficient for seizure control. More broadly, our data highlight the concept of specific cerebellar output channels, whereby discrete cerebellar nucleus neurons project to specific aggregates of downstream targets, with important consequences for therapeutic interventions.SIGNIFICANCE STATEMENT The cerebellum has an emerging relationship with nonmotor systems and may represent a powerful target for therapeutic intervention in temporal lobe epilepsy. We find, as previously reported, that fastigial neurons project to numerous brain regions via largely segregated output channels, and that projection targets cannot be predicted simply by somatic locations within the nucleus. We further find that on-demand optogenetic excitation of fastigial neurons projecting to the central lateral nucleus of the thalamus-but not fastigial neurons projecting to the reticular formation, superior colliculus, or ventral lateral thalamus-is sufficient to attenuate hippocampal seizures.
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