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di Biase L, Pecoraro PM, Carbone SP, Caminiti ML, Di Lazzaro V. Levodopa-Induced Dyskinesias in Parkinson's Disease: An Overview on Pathophysiology, Clinical Manifestations, Therapy Management Strategies and Future Directions. J Clin Med 2023; 12:4427. [PMID: 37445461 DOI: 10.3390/jcm12134427] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/18/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Since its first introduction, levodopa has become the cornerstone for the treatment of Parkinson's disease and remains the leading therapeutic choice for motor control therapy so far. Unfortunately, the subsequent appearance of abnormal involuntary movements, known as dyskinesias, is a frequent drawback. Despite the deep knowledge of this complication, in terms of clinical phenomenology and the temporal relationship during a levodopa regimen, less is clear about the pathophysiological mechanisms underpinning it. As the disease progresses, specific oscillatory activities of both motor cortical and basal ganglia neurons and variation in levodopa metabolism, in terms of the dopamine receptor stimulation pattern and turnover rate, underlie dyskinesia onset. This review aims to provide a global overview on levodopa-induced dyskinesias, focusing on pathophysiology, clinical manifestations, therapy management strategies and future directions.
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Affiliation(s)
- Lazzaro di Biase
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Brain Innovations Lab, Università Campus Bio-Medico di Roma, Via Álvaro del Portillo, 21, 00128 Rome, Italy
| | - Pasquale Maria Pecoraro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Simona Paola Carbone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Maria Letizia Caminiti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Vincenzo Di Lazzaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy
- Unit of Neurology, Neurophysiology, Neurobiology and Psichiatry, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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2
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Chen R, Berardelli A, Bhattacharya A, Bologna M, Chen KHS, Fasano A, Helmich RC, Hutchison WD, Kamble N, Kühn AA, Macerollo A, Neumann WJ, Pal PK, Paparella G, Suppa A, Udupa K. Clinical neurophysiology of Parkinson's disease and parkinsonism. Clin Neurophysiol Pract 2022; 7:201-227. [PMID: 35899019 PMCID: PMC9309229 DOI: 10.1016/j.cnp.2022.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/11/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023] Open
Abstract
This review is part of the series on the clinical neurophysiology of movement disorders and focuses on Parkinson’s disease and parkinsonism. The pathophysiology of cardinal parkinsonian motor symptoms and myoclonus are reviewed. The recordings from microelectrode and deep brain stimulation electrodes are reported in detail.
This review is part of the series on the clinical neurophysiology of movement disorders. It focuses on Parkinson’s disease and parkinsonism. The topics covered include the pathophysiology of tremor, rigidity and bradykinesia, balance and gait disturbance and myoclonus in Parkinson’s disease. The use of electroencephalography, electromyography, long latency reflexes, cutaneous silent period, studies of cortical excitability with single and paired transcranial magnetic stimulation, studies of plasticity, intraoperative microelectrode recordings and recording of local field potentials from deep brain stimulation, and electrocorticography are also reviewed. In addition to advancing knowledge of pathophysiology, neurophysiological studies can be useful in refining the diagnosis, localization of surgical targets, and help to develop novel therapies for Parkinson’s disease.
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Affiliation(s)
- Robert Chen
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Amitabh Bhattacharya
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Matteo Bologna
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kai-Hsiang Stanley Chen
- Department of Neurology, National Taiwan University Hospital Hsinchu Branch, Hsinchu, Taiwan
| | - Alfonso Fasano
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Division of Neurology, Department of Medicine, University of Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - William D Hutchison
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.,Departments of Surgery and Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Nitish Kamble
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - Andrea A Kühn
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Antonella Macerollo
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, United Kingdom.,The Walton Centre NHS Foundation Trust for Neurology and Neurosurgery, Liverpool, United Kingdom
| | - Wolf-Julian Neumann
- Department of Neurology, Movement Disorder and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Germany
| | - Pramod Kumar Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | | | - Antonio Suppa
- Department of Human Neurosciences, Sapienza University of Rome, Italy.,IRCCS Neuromed Pozzilli (IS), Italy
| | - Kaviraja Udupa
- Department of Neurophysiology National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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3
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Goyal A, Goetz S, Stanslaski S, Oh Y, Rusheen AE, Klassen B, Miller K, Blaha CD, Bennet KE, Lee K. The development of an implantable deep brain stimulation device with simultaneous chronic electrophysiological recording and stimulation in humans. Biosens Bioelectron 2021; 176:112888. [PMID: 33395569 PMCID: PMC7953342 DOI: 10.1016/j.bios.2020.112888] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 01/26/2023]
Abstract
Deep brain stimulation (DBS) is used to treat a wide array of neurologic conditions. However, traditional programming of stimulation parameters relies upon short term subjective observation of patient symptoms and undesired stimulation effects while in the clinic. To gain a more objective measure of the neuronal activity that contributes to patient symptoms and response to treatment, there is a clear need for a fully-implantable DBS system capable of chronically recording patient-specific electrophysiological biomarker signals over time. By providing an objective correlate of a patient's disease and response to treatment, this capability has the potential to improve therapeutic benefit while preventing undesirable side effects. Herein, the engineering and capabilities of the Percept PC, the first FDA-approved, fully-implantable DBS device capable of nearly-simultaneous electrophysiological recordings and stimulation, are discussed. The device's ability to chronically record local field potentials (LFPs) at implanted DBS leads was validated in patients with neurological disorders. Lastly, the electrophysiological activity correlates of clinically relevant patient-reported events are presented. While FDA approved for conditions such as Parkinson's disease, essential tremor, dystonia, obsessive-compulsive disorder, and epilepsy, chronic electrophysiological recordings in humans has broad applications within basic science and clinical practice beyond DBS, offering a wealth of information related to normal and abnormal neurophysiology within distinct brain areas.
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Affiliation(s)
- Abhinav Goyal
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, 55905, USA
| | - Steve Goetz
- Medtronic PLC Brain Modulation, Minneapolis, MN, USA
| | | | - Yoonbae Oh
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA; Department of Biomedical Engineering, Mayo Clinic, Rochester, MN, 55905, USA
| | - Aaron E Rusheen
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, 55905, USA
| | - Bryan Klassen
- Department of Neurology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kai Miller
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Charles D Blaha
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA
| | - Kevin E Bennet
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA; Division of Engineering, Mayo Clinic, Rochester, MN, 55905, USA.
| | - Kendall Lee
- Mayo Clinic Medical Scientist Training Program, Mayo Clinic, Rochester, MN, 55905, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, 55905, USA.
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4
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Fleming JE, Dunn E, Lowery MM. Simulation of Closed-Loop Deep Brain Stimulation Control Schemes for Suppression of Pathological Beta Oscillations in Parkinson's Disease. Front Neurosci 2020; 14:166. [PMID: 32194372 PMCID: PMC7066305 DOI: 10.3389/fnins.2020.00166] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/14/2020] [Indexed: 11/17/2022] Open
Abstract
This study presents a computational model of closed-loop control of deep brain stimulation (DBS) for Parkinson's disease (PD) to investigate clinically viable control schemes for suppressing pathological beta-band activity. Closed-loop DBS for PD has shown promising results in preliminary clinical studies and offers the potential to achieve better control of patient symptoms and side effects with lower power consumption than conventional open-loop DBS. However, extensive testing of algorithms in patients is difficult. The model presented provides a means to explore a range of control algorithms in silico and optimize control parameters before preclinical testing. The model incorporates (i) the extracellular DBS electric field, (ii) antidromic and orthodromic activation of STN afferent fibers, (iii) the LFP detected at non-stimulating contacts on the DBS electrode and (iv) temporal variation of network beta-band activity within the thalamo-cortico-basal ganglia loop. The performance of on-off and dual-threshold controllers for suppressing beta-band activity by modulating the DBS amplitude were first verified, showing levels of beta suppression and reductions in power consumption comparable with previous clinical studies. Proportional (P) and proportional-integral (PI) closed-loop controllers for amplitude and frequency modulation were then investigated. A simple tuning rule was derived for selecting effective PI controller parameters to target long duration beta bursts while respecting clinical constraints that limit the rate of change of stimulation parameters. Of the controllers tested, PI controllers displayed superior performance for regulating network beta-band activity whilst accounting for clinical considerations. Proportional controllers resulted in undesirable rapid fluctuations of the DBS parameters which may exceed clinically tolerable rate limits. Overall, the PI controller for modulating DBS frequency performed best, reducing the mean error by 83% compared to DBS off and the mean power consumed to 25% of that utilized by open-loop DBS. The network model presented captures sufficient physiological detail to act as a surrogate for preclinical testing of closed-loop DBS algorithms using a clinically accessible biomarker, providing a first step for deriving and testing novel, clinically suitable closed-loop DBS controllers.
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Affiliation(s)
- John E. Fleming
- Neuromuscular Systems Laboratory, UCD School of Electrical & Electronic Engineering, University College Dublin, Dublin, Ireland
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Bouthour W, Béreau M, Kibleur A, Zacharia A, Tomkova Chaoui E, Fleury V, Benis D, Momjian S, Bally J, Lüscher C, Krack P, Burkhard PR. Dyskinesia‐inducing lead contacts optimize outcome of subthalamic stimulation in Parkinson's disease. Mov Disord 2019; 34:1728-1734. [DOI: 10.1002/mds.27853] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 07/25/2019] [Accepted: 08/14/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Walid Bouthour
- Department of Neurology Geneva University Hospital Geneva Switzerland
- Department of Basic Neuroscience University of Geneva Geneva Switzerland
| | - Matthieu Béreau
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Astrid Kibleur
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - André Zacharia
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | | | - Vanessa Fleury
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Damien Benis
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Shahan Momjian
- Department of Neurosurgery Geneva University Hospital Geneva Switzerland
| | - Julien Bally
- Department of Neurology Geneva University Hospital Geneva Switzerland
| | - Christian Lüscher
- Department of Neurology Geneva University Hospital Geneva Switzerland
- Department of Basic Neuroscience University of Geneva Geneva Switzerland
| | - Paul Krack
- Department of Neurology Geneva University Hospital Geneva Switzerland
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6
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Evangelisti S, Pittau F, Testa C, Rizzo G, Gramegna LL, Ferri L, Coito A, Cortelli P, Calandra-Buonaura G, Bisquoli F, Bianchini C, Manners DN, Talozzi L, Tonon C, Lodi R, Tinuper P. L-Dopa Modulation of Brain Connectivity in Parkinson's Disease Patients: A Pilot EEG-fMRI Study. Front Neurosci 2019; 13:611. [PMID: 31258465 PMCID: PMC6587436 DOI: 10.3389/fnins.2019.00611] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/28/2019] [Indexed: 01/08/2023] Open
Abstract
Studies of functional neurosurgery and electroencephalography in Parkinson's disease have demonstrated abnormally synchronous activity between basal ganglia and motor cortex. Functional neuroimaging studies investigated brain dysfunction during motor task or resting state and primarily have shown altered patterns of activation and connectivity for motor areas. L-dopa administration relatively normalized these functional alterations. The aim of this pilot study was to examine the effects of L-dopa administration on functional connectivity in early-stage PD, as revealed by simultaneous recording of functional magnetic resonance imaging (fMRI) and electroencephalographic (EEG) data. Six patients with diagnosis of probable PD underwent EEG-fMRI acquisitions (1.5 T MR scanner and 64-channel cap) before and immediately after the intake of L-dopa. Regions of interest in the primary motor and sensorimotor regions were used for resting state fMRI analysis. From the EEG data, weighted partial directed coherence was computed in the inverse space after the removal of gradient and cardioballistic artifacts. fMRI results showed that the intake of L-dopa increased functional connectivity within the sensorimotor network, and between motor areas and both attention and default mode networks. EEG connectivity among regions of the motor network did not change significantly, while regions of the default mode network showed a strong tendency to increase their outflow toward the rest of the brain. This pilot study provided a first insight into the potentiality of simultaneous EEG-fMRI acquisitions in PD patients, showing for both techniques the analogous direction of increased connectivity after L-dopa intake, mainly involving motor, dorsal attention and default mode networks.
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Affiliation(s)
- Stefania Evangelisti
- Functional MR Unit, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Francesca Pittau
- EEG and Epilepsy Unit, Geneva University Hospitals, Geneva, Switzerland
| | - Claudia Testa
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Giovanni Rizzo
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Laura Ludovica Gramegna
- Functional MR Unit, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Lorenzo Ferri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Ana Coito
- Functional Brain Mapping Lab, Department of Fundamental Neurosciences, University of Geneva, Geneva, Switzerland
| | - Pietro Cortelli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Fabio Bisquoli
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Claudio Bianchini
- Functional MR Unit, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - David Neil Manners
- Functional MR Unit, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Lia Talozzi
- Functional MR Unit, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Caterina Tonon
- Functional MR Unit, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Raffaele Lodi
- Functional MR Unit, Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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7
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Du G, Zhuang P, Hallett M, Zhang YQ, Li JY, Li YJ. Properties of oscillatory neuronal activity in the basal ganglia and thalamus in patients with Parkinson's disease. Transl Neurodegener 2018; 7:17. [PMID: 30065816 PMCID: PMC6062949 DOI: 10.1186/s40035-018-0123-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 07/03/2018] [Indexed: 01/28/2023] Open
Abstract
Background The cardinal features of Parkinson’s disease (PD) are bradykinesia, rigidity and rest tremor. Abnormal activity in the basal ganglia is predicted to underlie the mechanism of motor symptoms. This study aims to characterize properties of oscillatory activity in the basal ganglia and motor thalamus in patients with PD. Methods Twenty-nine patients with PD who underwent bilateral or unilateral electrode implantation for subthalamic nucleus (STN) DBS (n = 11), unilateral pallidotomy (n = 9) and unilateral thalamotomy (n = 9) were studied. Microelectrode recordings in the STN, globus pallidus internus (GPi) and ventral oral posterior/ventral intermediate of thalamus (Vop/Vim) were performed. Electromyography of the contralateral limbs was recorded. Single unit characteristics including interspike intervals were analyzed. Spectral and coherence analyses were assessed. Mean spontaneous firing rate (MSFR) of neurons was calculated. Analysis of variance and X2 test were performed. Results Of 76 STN neurons, 39.5% were 4–6 Hz band oscillatory neurons and 28.9% were β frequency band (βFB) oscillatory neurons. The MSFR was 44.2 ± 7.6 Hz. Of 62 GPi neurons, 37.1% were 4–6 Hz band oscillatory neurons and 27.4% were βFB neurons. The MSFR was 80.9 ± 9.6 Hz. Of 44 Vop neurons, 65.9% were 4–6 Hz band oscillatory neurons and 9% were βFB neurons. The MSFR was 24.4 ± 4.2 Hz. Of 30 Vim oscillatory neurons, 70% were 4–6 Hz band oscillatory neurons and 13.3% were βFB neurons. The MSFR was 30.3 ± 3.6 Hz. Further analysis indicated that proportion of βFB oscillatory neurons in STN and GPi was higher than that of similar neurons in the Vop and Vim (P < 0.05). Conversely, the proportion of 4–6 Hz band oscillatory neurons and tremor related neurons in the Vim and Vop was higher than that of STN and GPi (P < 0.05). The highest MSFR was for GPi oscillatory neurons whereas the lowest MSFR was for Vop oscillatory neurons (P < 0.005). Conclusion The alterations in neuronal activity in basal ganglia play a critical role in generation of parkinsonism. β oscillatory activity is more prominent in basal ganglia than in thalamus suggesting that the activity likely results from dopaminergic depletion. While both basal ganglia and thalamus have tremor activity, the thalamus appears to play a more important role in tremor production, and basal ganglia β oscillatory activity might be the trigger.
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Affiliation(s)
- G Du
- 1Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street , Xicheng District, Beijing, 100053 China
| | - P Zhuang
- 1Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street , Xicheng District, Beijing, 100053 China.,3Center of Parkinson's disease, Beijing Institute for Brain Disorders, Beijing, China.,4Key Laboratory of Neurodegenerative Diseases (Capital Medical University), Ministry of Education, Beijing, China
| | - M Hallett
- Human Motor Control Section, Medical Neurology Branch, NINDS, NIH, Bethesda, MD USA
| | - Y-Q Zhang
- 1Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street , Xicheng District, Beijing, 100053 China
| | - J-Y Li
- 1Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street , Xicheng District, Beijing, 100053 China
| | - Y-J Li
- 1Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street , Xicheng District, Beijing, 100053 China
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8
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Ryu HS, Kim MS, You S, Kim MJ, Kim YJ, Kim J, Kim K, Chung SJ. Comparison of Pallidal and Subthalamic Deep Brain Stimulation in Parkinson's Disease: Therapeutic and Adverse Effects. J Mov Disord 2017; 10:80-86. [PMID: 28479586 PMCID: PMC5435836 DOI: 10.14802/jmd.17001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/07/2017] [Accepted: 03/13/2017] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To compare the therapeutic and adverse effects of globus pallidus interna (GPi) and subthalamic nucleus (STN) deep brain stimulation (DBS) for the treatment of advanced Parkinson's disease (PD). METHODS We retrospectively analyzed the clinical data of patients with PD who underwent GPi (n = 14) or STN (n = 28) DBS surgery between April 2002 and May 2014. The subjects were matched for age at surgery and disease duration. The Unified Parkinson's Disease Rating Scale (UPDRS) scores and levodopa equivalent dose (LED) at baseline and 12 months after surgery were used to assess the therapeutic effects of DBS. Adverse effects were also compared between the two groups. RESULTS At 12 months, the mean changes in the UPDRS total and part I-IV scores did not differ significantly between the two groups. However, the subscores for gait disturbance/postural instability and dyskinesia were significantly more improved after GPi DBS than those after STN DBS (p = 0.024 and 0.016, respectively). The LED was significantly more reduced in patients after STN DBS than that after GPi DBS (p = 0.004). Serious adverse effects did not differ between the two groups (p = 0.697). CONCLUSION The patients with PD showed greater improvement in gait disturbance/postural instability and dyskinesia after GPi DBS compared with those after STN DBS, although the patients had a greater reduction in LED after STN DBS. These results may provide useful information for optimal target selection for DBS in PD.
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Affiliation(s)
- Ho-Sung Ryu
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi-Sun Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sooyeoun You
- Department of Neurology, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Mi-Jung Kim
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Young Jin Kim
- Department of Neurology, Best Heals Hospital, Ansan, Korea
| | - Juyeon Kim
- Department of Neurology, Metro Hospital, Anyang, Korea
| | - Kiju Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sun Ju Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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9
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Comparison of oscillatory activity in subthalamic nucleus in Parkinson's disease and dystonia. Neurobiol Dis 2016; 98:100-107. [PMID: 27940307 DOI: 10.1016/j.nbd.2016.12.006] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 11/06/2016] [Accepted: 12/05/2016] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been successfully used to treat both Parkinson's disease (PD) and dystonia. Local field potentials (LFPs) recorded from the STN of PD patients demonstrate prominent beta frequency band activity. It is unclear whether such activity occurs in the STN in dystonia, and, if not, whether dystonia has another distinctive neural population activity in the STN. METHODS Twelve patients with PD, and eight patients with dystonia underwent DBS electrode implantation targeting the STN. Seven dystonia patients were off medication and one was on aripiprazole and clonazepam. LFPs were recorded from the DBS electrodes in PD in the on/off medication states and in dystonia. Power spectra and temporal dynamics measured by the with Lempel-Ziv complexity of the LFPs were compared among these states. RESULTS Normalised power spectra and Lempel-Ziv complexity of subthalamic LFPs differed between dystonia off and PD on/off, and between PD off and on over the low frequency, beta and high gamma bands. Patients with dystonia and off medication had lower beta power but higher low frequency and high gamma power than PD. Spectral power in the low beta frequency (11-20Hz) range was attenuated in medicated PD. CONCLUSION The results suggest that dystonia and PD are characterized by different patterns of oscillatory activities even within the same nucleus, and exaggerated beta activity may relate to hypo-dopaminergic status.
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10
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Shreve LA, Velisar A, Malekmohammadi M, Koop MM, Trager M, Quinn EJ, Hill BC, Blumenfeld Z, Kilbane C, Mantovani A, Henderson JM, Brontë-Stewart H. Subthalamic oscillations and phase amplitude coupling are greater in the more affected hemisphere in Parkinson's disease. Clin Neurophysiol 2016; 128:128-137. [PMID: 27889627 DOI: 10.1016/j.clinph.2016.10.095] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Determine the incidence of resting state oscillations in alpha/beta, high frequency (HFO) bands, and their phase amplitude coupling (PAC) in a large cohort in Parkinson's disease (PD). METHODS Intra-operative local field potentials (LFPs) from subthalamic nucleus (STN) were recorded from 100 PD subjects, data from 74 subjects were included in the analysis. RESULTS Alpha/beta oscillations were evident in >99%, HFO in 87% and PAC in 98% of cases. Alpha/beta oscillations (P<0.01) and PAC were stronger in the more affected (MA) hemisphere (P=0.03). Alpha/beta oscillations were primarily found in 13-20Hz (low beta). Beta and HFO frequencies with the greatest coupling, were positively correlated (P=0.001). Tremor attenuated alpha (P=0.002) and beta band oscillations (P<0.001). CONCLUSIONS STN alpha/beta band oscillations and PAC were evident in ⩾98% cases and were greater in MA hemisphere. Resting tremor attenuated underlying alpha/beta band oscillations. SIGNIFICANCE Beta band LFP power may be used to drive adaptive deep brain stimulation (aDBS), augmented by a kinematic classifier in tremor dominant PD.
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Affiliation(s)
- Lauren A Shreve
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Anca Velisar
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Mahsa Malekmohammadi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Mandy Miller Koop
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Megan Trager
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Emma J Quinn
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Bruce C Hill
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Zack Blumenfeld
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Camilla Kilbane
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | | | - Jaimie M Henderson
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Helen Brontë-Stewart
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Neurosurgery, Stanford University, Stanford, CA, USA.
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11
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Baizabal-Carvallo JF, Alonso-Juarez M. Low-frequency deep brain stimulation for movement disorders. Parkinsonism Relat Disord 2016; 31:14-22. [DOI: 10.1016/j.parkreldis.2016.07.018] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/21/2016] [Accepted: 07/28/2016] [Indexed: 12/24/2022]
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12
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Kühn AA, Volkmann J. Innovations in deep brain stimulation methodology. Mov Disord 2016; 32:11-19. [PMID: 27400763 DOI: 10.1002/mds.26703] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/15/2016] [Accepted: 05/22/2016] [Indexed: 01/15/2023] Open
Abstract
Deep brain stimulation is a powerful clinical method for movement disorders that no longer respond satisfactorily to pharmacological management, but its progress has been hampered by stagnation in technological procedure solutions and device development. Recently, the combined research efforts of bioengineers, neuroscientists, and clinicians have helped to better understand the mechanisms of deep brain stimulation, and solutions for the translational roadblock are emerging. Here, we define the needs for methodological advances in deep brain stimulation from a neurophysiological perspective and describe technological solutions that are currently evaluated for near-term clinical application. © 2016 International Parkinson and Movement Disorder Society.
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Affiliation(s)
| | - Jens Volkmann
- Department of Neurology, University Hospital of Würzburg, Würzburg, Germany
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13
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Movement disorders induced by deep brain stimulation. Parkinsonism Relat Disord 2016; 25:1-9. [DOI: 10.1016/j.parkreldis.2016.01.014] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/24/2022]
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14
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Salvadè A, D'Angelo V, Di Giovanni G, Tinkhauser G, Sancesario G, Städler C, Möller JC, Stefani A, Kaelin-Lang A, Galati S. Distinct roles of cortical and pallidal β and γ frequencies in hemiparkinsonian and dyskinetic rats. Exp Neurol 2016; 275 Pt 1:199-208. [DOI: 10.1016/j.expneurol.2015.11.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 09/21/2015] [Accepted: 11/10/2015] [Indexed: 01/25/2023]
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15
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Blumenfeld Z, Brontë-Stewart H. High Frequency Deep Brain Stimulation and Neural Rhythms in Parkinson's Disease. Neuropsychol Rev 2015; 25:384-97. [PMID: 26608605 DOI: 10.1007/s11065-015-9308-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 01/28/2023]
Abstract
High frequency (HF) deep brain stimulation (DBS) is an established therapy for the treatment of Parkinson's disease (PD). It effectively treats the cardinal motor signs of PD, including tremor, bradykinesia, and rigidity. The most common neural target is the subthalamic nucleus, located within the basal ganglia, the region most acutely affected by PD pathology. Using chronically-implanted DBS electrodes, researchers have been able to record underlying neural rhythms from several nodes in the PD network as well as perturb it using DBS to measure the ensuing neural and behavioral effects, both acutely and over time. In this review, we provide an overview of the PD neural network, focusing on the pathophysiological signals that have been recorded from PD patients as well as the mechanisms underlying the therapeutic benefits of HF DBS. We then discuss evidence for the relationship between specific neural oscillations and symptoms of PD, including the aberrant relationships potentially underlying functional connectivity in PD as well as the use of different frequencies of stimulation to more specifically target certain symptoms. Finally, we briefly describe several current areas of investigation and how the ability to record neural data in ecologically-valid settings may allow researchers to explore the relationship between brain and behavior in an unprecedented manner, culminating in the future automation of neurostimulation therapy for the treatment of a variety of neuropsychiatric diseases.
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Affiliation(s)
- Zack Blumenfeld
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, 94305, USA
| | - Helen Brontë-Stewart
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, 94305, USA.
- Department of Neurosurgery, Stanford University, Stanford, CA, 94305, USA.
- Stanford University School of Medicine, Rm A343, 300 Pasteur Drive, Stanford, CA, 94305, USA.
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16
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Alam M, Sanghera MK, Schwabe K, Lütjens G, Jin X, Song J, von Wrangel C, Stewart RM, Jankovic J, Grossman RG, Darbin O, Krauss JK. Globus pallidus internus neuronal activity: a comparative study of linear and non-linear features in patients with dystonia or Parkinson’s disease. J Neural Transm (Vienna) 2015; 123:231-40. [DOI: 10.1007/s00702-015-1484-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 11/08/2015] [Indexed: 10/22/2022]
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17
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Bastide MF, Meissner WG, Picconi B, Fasano S, Fernagut PO, Feyder M, Francardo V, Alcacer C, Ding Y, Brambilla R, Fisone G, Jon Stoessl A, Bourdenx M, Engeln M, Navailles S, De Deurwaerdère P, Ko WKD, Simola N, Morelli M, Groc L, Rodriguez MC, Gurevich EV, Quik M, Morari M, Mellone M, Gardoni F, Tronci E, Guehl D, Tison F, Crossman AR, Kang UJ, Steece-Collier K, Fox S, Carta M, Angela Cenci M, Bézard E. Pathophysiology of L-dopa-induced motor and non-motor complications in Parkinson's disease. Prog Neurobiol 2015. [PMID: 26209473 DOI: 10.1016/j.pneurobio.2015.07.002] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Involuntary movements, or dyskinesia, represent a debilitating complication of levodopa (L-dopa) therapy for Parkinson's disease (PD). L-dopa-induced dyskinesia (LID) are ultimately experienced by the vast majority of patients. In addition, psychiatric conditions often manifested as compulsive behaviours, are emerging as a serious problem in the management of L-dopa therapy. The present review attempts to provide an overview of our current understanding of dyskinesia and other L-dopa-induced dysfunctions, a field that dramatically evolved in the past twenty years. In view of the extensive literature on LID, there appeared a critical need to re-frame the concepts, to highlight the most suitable models, to review the central nervous system (CNS) circuitry that may be involved, and to propose a pathophysiological framework was timely and necessary. An updated review to clarify our understanding of LID and other L-dopa-related side effects was therefore timely and necessary. This review should help in the development of novel therapeutic strategies aimed at preventing the generation of dyskinetic symptoms.
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Affiliation(s)
- Matthieu F Bastide
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Wassilios G Meissner
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; Department of Neurology, University Hospital Bordeaux, France
| | - Barbara Picconi
- Laboratory of Neurophysiology, Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Stefania Fasano
- Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Pierre-Olivier Fernagut
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Michael Feyder
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Francardo
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Cristina Alcacer
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Yunmin Ding
- Department of Neurology, Columbia University, New York, USA
| | - Riccardo Brambilla
- Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gilberto Fisone
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre and National Parkinson Foundation Centre of Excellence, University of British Columbia, Vancouver, Canada
| | - Mathieu Bourdenx
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Michel Engeln
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Sylvia Navailles
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Philippe De Deurwaerdère
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Wai Kin D Ko
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Nicola Simola
- Department of Biomedical Sciences, Section of Neuropsychopharmacology, Cagliari University, 09124 Cagliari, Italy
| | - Micaela Morelli
- Department of Biomedical Sciences, Section of Neuropsychopharmacology, Cagliari University, 09124 Cagliari, Italy
| | - Laurent Groc
- Univ. de Bordeaux, Institut Interdisciplinaire de neurosciences, UMR 5297, 33000 Bordeaux, France; CNRS, Institut Interdisciplinaire de neurosciences, UMR 5297, 33000 Bordeaux, France
| | - Maria-Cruz Rodriguez
- Department of Neurology, Hospital Universitario Donostia and Neuroscience Unit, Bio Donostia Research Institute, San Sebastian, Spain
| | - Eugenia V Gurevich
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Maryka Quik
- Center for Health Sciences, SRI International, CA 94025, USA
| | - Michele Morari
- Department of Medical Sciences, Section of Pharmacology, University of Ferrara, Ferrara, Italy
| | - Manuela Mellone
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milano, Italy
| | - Fabrizio Gardoni
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milano, Italy
| | - Elisabetta Tronci
- Department of Biomedical Sciences, Physiology Section, Cagliari University, Cagliari, Italy
| | - Dominique Guehl
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - François Tison
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; Department of Neurology, University Hospital Bordeaux, France
| | | | - Un Jung Kang
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Kathy Steece-Collier
- Michigan State University, College of Human Medicine, Department of Translational Science and Molecular Medicine & The Udall Center of Excellence in Parkinson's Disease Research, 333 Bostwick Ave NE, Grand Rapids, MI 49503, USA
| | - Susan Fox
- Morton & Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Toronto, Ontario M4T 2S8, Canada
| | - Manolo Carta
- Department of Biomedical Sciences, Physiology Section, Cagliari University, Cagliari, Italy
| | - M Angela Cenci
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Erwan Bézard
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; Motac Neuroscience Ltd, Manchester, UK.
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18
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Welter ML, Grabli D, Karachi C, Jodoin N, Fernandez-Vidal S, Brun Y, Navarro S, Rogers A, Cornu P, Pidoux B, Yelnik J, Roze E, Bardinet E, Vidailhet M. Pallidal activity in myoclonus dystonia correlates with motor signs. Mov Disord 2015; 30:992-6. [PMID: 25880339 DOI: 10.1002/mds.26244] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 03/18/2015] [Accepted: 03/21/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Myoclonus-dystonia related to epsilon-sarcoglycan gene mutations is characterized by myoclonic jerks and mild to moderate dystonia. The role of basal ganglia dysfunction in the pathogenesis is unknown. METHODS Pallidal neuronal activity was recorded in six myoclonus-dystonia and six primary generalized dystonia patients operated on for internal globus pallidus deep brain stimulation. RESULTS In myoclonus-dystonia patients compared with primary-dystonia patients, internal pallidum neurons showed higher burst frequency, lower mean burst, and pause durations. External pallidum neurons showed higher mean pause frequency. Oscillatory activity was present in 33% and 35% of internal pallidum neurons in myoclonus-dystonia and primary-dystonia patients, respectively, predominantly in the theta frequency band (3-8 Hz). In myoclonus-dystonia patients with more severe myoclonus, internal pallidum neurons exhibited a higher bursting activity with high intraburst frequency and lower oscillatory activity frequency. CONCLUSIONS Myoclonus-dystonia appears to be related to specific changes in internal pallidum activity, leading to disruption in striato-pallido-thalamo-cortical circuits. © 2015 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Marie-Laure Welter
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Grabli
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Carine Karachi
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Nicolas Jodoin
- Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Service de Neurologie, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Sara Fernandez-Vidal
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Centre de Neuroimagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Yohann Brun
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France
| | - Soledad Navarro
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alister Rogers
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Philippe Cornu
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Bernard Pidoux
- Service de Neurochirurgie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérôme Yelnik
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Roze
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Eric Bardinet
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Centre de Neuroimagerie de Recherche (CENIR), Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marie Vidailhet
- Université Pierre et Marie Curie-Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle épiniere (CRICM), UMR-S975, Paris, France.,Inserm, U1127, Paris, France.,CNRS, UMR 7225, Paris, France.,Centre d'Investigation Clinique Pitié Neurosciences (Inserm CIC-1422), Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France.,Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
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19
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Bour LJ, Lourens MAJ, Verhagen R, de Bie RMA, van den Munckhof P, Schuurman PR, Contarino MF. Directional Recording of Subthalamic Spectral Power Densities in Parkinson's Disease and the Effect of Steering Deep Brain Stimulation. Brain Stimul 2015; 8:730-41. [PMID: 25753176 DOI: 10.1016/j.brs.2015.02.002] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 02/03/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND A new 32-contacts deep brain stimulation (DBS) lead, capable of directionally steering stimulation, was tested intraoperatively. OBJECTIVE The aim of this pilot study was to perform recordings from the multidirectional contacts and to investigate the effect of directional current steering on the local field potentials (LFPs). METHODS In eight patients with Parkinson's disease, after standard microelectrode recording and clinical testing, the new lead was temporarily implanted. The 32-channel LFP recordings were measured simultaneously at different depths and directions before and after directional stimulation. RESULTS The spatial distribution of LFPs power spectral densities across the contact array at baseline marked the borders of the subthalamic nucleus (STN) with a significant increase in beta power and with a mean accuracy of approximately 0.6 mm in four patients.The power in the 18.5-30 Hz frequency band varied across different directions in all patients. In the three cases that showed improvement of rigidity, this was higher when current was steered toward the direction with the highest LFP power in the beta band. Subthalamic LFPs in six patients showed a differential frequency-dependent suppression/enhancement of the oscillatory activity in the 10-45 Hz frequency band after four different 'steering' modes as compared to ring mode, suggesting a higher specificity. CONCLUSIONS Through a new 32-contact DBS lead it is possible to record simultaneous subthalamic LFPs at different depths and directions, providing confirmation of adequate lead placement and multidirectional spatial-temporal information potentially related to pathological subthalamic electrical activity and to the effect of stimulation. Although further research is needed, this may improve the efficiency of steering stimulation.
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Affiliation(s)
- L J Bour
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, the Netherlands.
| | - M A J Lourens
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - R Verhagen
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - R M A de Bie
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, the Netherlands
| | - P van den Munckhof
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, the Netherlands
| | - P R Schuurman
- Department of Neurosurgery, Academic Medical Center, University of Amsterdam, the Netherlands
| | - M F Contarino
- Department of Neurology and Clinical Neurophysiology, Academic Medical Center, University of Amsterdam, the Netherlands; Department of Neurology, Haga Teaching Hospital, the Hague, the Netherlands.
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20
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Cook RJ, Jones L, Fracchia G, Anderson N, Miu J, Meagher LJ, Silburn PA, Silberstein P. Globus pallidus internus deep brain stimulation as rescue therapy for refractory dyskinesias following effective subthalamic nucleus stimulation. Stereotact Funct Neurosurg 2015; 93:25-9. [PMID: 25613902 DOI: 10.1159/000365223] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/13/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) at the subthalamic nucleus (STN) or globus pallidus internus (GPi) can effectively treat the motor symptoms of Parkinson's disease, but dual implantation is rare. We report the first cases of additional GPi stimulation as rescue therapy for disabling dyskinesias following successful STN stimulation. METHODS Two patients, initially treated with bilateral STN DBS, underwent subsequent bilateral GPi DBS after the development of refractory dyskinesias within 1 and 6 years of STN surgery. Patients were evaluated with the Unified Parkinson's Disease Rating Scale (UPDRS) before and after surgeries for STN and GPi DBS. RESULTS GPi DBS effectively suppressed dyskinesias in these patients and improved their quality of life, as demonstrated by their videos and UPDRS scores. CONCLUSIONS Additional bilateral GPi DBS may be considered in the rare instance of patients who develop refractory dyskinesias early or late after bilateral STN DBS.
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Affiliation(s)
- Raymond J Cook
- Sydney DBS, North Shore Private Hospital, St. Leonards, N.S.W., Australia
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Thompson JA, Lanctin D, Ince NF, Abosch A. Clinical implications of local field potentials for understanding and treating movement disorders. Stereotact Funct Neurosurg 2014; 92:251-63. [PMID: 25170784 DOI: 10.1159/000364913] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 05/30/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) for the treatment of movement disorders has provided researchers with an opportunity to record electrical oscillatory activity from electrodes implanted in deep brain structures. Extracellular activity recorded from a population of neurons, termed local field potentials (LFPs), has shed light on the pathophysiology of movement disorders and holds the potential to lead to refinement in existing treatments. OBJECTIVE This paper reviews the clinical significance of LFPs recorded from macroelectrodes implanted in basal ganglia and thalamic targets for the treatment of Parkinson's disease, essential tremor and dystonia. METHODS Neural population dynamics and subthreshold events, which are undetectable by single-unit recordings, can be examined with frequency band analysis of LFPs (frequency range: 1-250 Hz). RESULTS Of clinical relevance, reliable correlations between motor symptoms and components of the LFP power spectrum suggest that LFPs may serve as a biomarker for movement disorders. In particular, Parkinson's rigidity has been shown to correlate with the power of beta oscillations (13-30 Hz), and essential tremor coheres with oscillations of 8-27 Hz. Furthermore, evidence indicates that the optimal contacts for DBS programming can be predicted from the anatomic location of beta and gamma bands (48-200 Hz). CONCLUSION LFP analysis has implications for improved electrode targeting and the development of a real-time, individualized, 'closed-loop' stimulation system.
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Affiliation(s)
- John A Thompson
- Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colo., USA
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22
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Kishore A, Popa T. Cerebellum in levodopa-induced dyskinesias: the unusual suspect in the motor network. Front Neurol 2014; 5:157. [PMID: 25183959 PMCID: PMC4135237 DOI: 10.3389/fneur.2014.00157] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/05/2014] [Indexed: 12/12/2022] Open
Abstract
The exact mechanisms that generate levodopa-induced dyskinesias (LID) during chronic levodopa therapy for Parkinson’s disease (PD) are not yet fully established. The most widely accepted theories incriminate the non-physiological synthesis, release and reuptake of dopamine generated by exogenously administered levodopa in the striatum, and the aberrant plasticity in the cortico-striatal loops. However, normal motor performance requires the correct recruitment of motor maps. This depends on a high level of synergy within the primary motor cortex (M1) as well as between M1 and other cortical and subcortical areas, for which dopamine is necessary. The plastic mechanisms within M1, which are crucial for the maintenance of this synergy, are disrupted both during “OFF” and dyskinetic states in PD. When tested without levodopa, dyskinetic patients show loss of treatment benefits on long-term potentiation and long-term depression-like plasticity of the intracortical circuits. When tested with the regular pulsatile levodopa doses, they show further impairment of the M1 plasticity, such as inability to depotentiate an already facilitated synapse and paradoxical facilitation in response to afferent input aimed at synaptic inhibition. Dyskinetic patients have also severe impairment of the associative, sensorimotor plasticity of M1 attributed to deficient cerebellar modulation of sensory afferents to M1. Here, we review the anatomical and functional studies, including the recently described bidirectional connections between the cerebellum and the basal ganglia that support a key role of the cerebellum in the generation of LID. This model stipulates that aberrant neuronal synchrony in PD with LID may propagate from the subthalamic nucleus to the cerebellum and “lock” the cerebellar cortex in a hyperactive state. This could affect critical cerebellar functions such as the dynamic and discrete modulation of M1 plasticity and the matching of motor commands with sensory information from the environment during motor performance. We propose that in dyskinesias, M1 neurons have lost the ability to depotentiate an activated synapse when exposed to acute pulsatile, non-physiological, dopaminergic surges and become abnormally receptive to unfiltered, aberrant, and non-salient afferent inputs from the environment. The motor program selection in response to such non-salient and behaviorally irrelevant afferent inputs would be abnormal and involuntary. The motor responses are worsened by the lack of normal subcortico–cortical inputs from cerebellum and basal ganglia, because of the aberrant plasticity at their own synapses. Artificial cerebellar stimulation might help re-establish the cerebellar and basal ganglia control over the non-salient inputs to the motor areas during synaptic dopaminergic surges.
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Affiliation(s)
- Asha Kishore
- Department of Neurology, Comprehensive Care Centre for Movement Disorders, Sree Chitra Tirunal Institute for Medical Sciences and Technology , Kerala , India
| | - Traian Popa
- Centre de Neuroimagerie de Recherche (CENIR), Institut du Cerveau et de la Moelleepiniere (ICM) , Paris , France
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Comparative characterization of single cell activity in the globus pallidus internus of patients with dystonia or Tourette syndrome. J Neural Transm (Vienna) 2014; 122:687-99. [DOI: 10.1007/s00702-014-1277-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/15/2014] [Indexed: 10/25/2022]
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Heinrichs-Graham E, Kurz MJ, Becker KM, Santamaria PM, Gendelman HE, Wilson TW. Hypersynchrony despite pathologically reduced beta oscillations in patients with Parkinson's disease: a pharmaco-magnetoencephalography study. J Neurophysiol 2014; 112:1739-47. [PMID: 25008416 DOI: 10.1152/jn.00383.2014] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) is a progressive debilitating neurodegenerative disorder clinically manifest by motor, posture and gait abnormalities. Human neurophysiological studies recording local field potentials within the subthalamic nucleus and scalp-based electroencephalography have shown pathological beta synchrony throughout the basal ganglia-thalamic-cortical motor network in PD. Notably, suppression of this pathological beta synchrony by dopamine replacement therapy or deep-brain stimulation has been associated with improved motor function. However, due to the invasive nature of these studies, it remains unknown whether this "pathological beta" is actually stronger than that observed in healthy demographically matched controls. We used magnetoencephalography to investigate neuronal synchrony and oscillatory amplitude in the beta range and lower frequencies during the resting state in patients with PD and a matched group of patients without neurological disease. Patients with PD were studied both in the practically defined drug "OFF" state, and after administration of dopamine replacements. We found that beta oscillatory amplitude was reduced bilaterally in the primary motor regions of unmedicated patients with PD compared with controls. Administration of dopaminergic medications significantly increased beta oscillatory activity, thus having a normalizing effect. Interestingly, we also found significantly stronger beta synchrony (i.e., hypersynchrony) between the primary motor regions in unmedicated patients with PD compared with controls, and that medication reduced this coupling which is in agreement with the intraoperative studies. These results are consistent with the known functionality of the basal ganglia-thalamic-cortical motor circuit and the likely consequences of beta hypersynchrony in the subthalamic nucleus of patients with PD.
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Affiliation(s)
- Elizabeth Heinrichs-Graham
- Department of Psychology, University of Nebraska, Omaha, Nebraska; Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska
| | - Max J Kurz
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska; Department of Physical Therapy, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska
| | - Katherine M Becker
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Howard E Gendelman
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska; and
| | - Tony W Wilson
- Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, Nebraska; Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center, Omaha, Nebraska; and Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska
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Oyama G, Maling N, Avila-Thompson A, Zeilman PR, Foote KD, Malaty IA, Rodriguez RL, Okun MS. Rescue GPi-DBS for a Stroke-associated Hemiballism in a Patient with STN-DBS. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2014; 4. [PMID: 24587970 PMCID: PMC3918512 DOI: 10.7916/d8xp72wf] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Accepted: 12/23/2013] [Indexed: 01/24/2023]
Abstract
Background Hemiballism/hemichorea commonly occurs as a result of a lesion in the subthalamic region. Case Report A 38-year-old male with Parkinson’s disease developed intractable hemiballism in his left extremities due to a small lesion that was located adjacent to the right deep brain stimulation (DBS) lead, 10 months after bilateral subthalamic nucleus (STN)-DBS placement. He underwent a right globus pallidus internus (GPi)-DBS lead implantation. GPi-DBS satisfactorily addressed his hemiballism. Discussion This case offered a unique look at basal ganglia physiology in human hemiballism. GPi-DBS is a reasonable therapeutic option for the treatment of medication refractory hemiballism in the setting of Parkinson’s disease.
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Affiliation(s)
- Genko Oyama
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Nicholas Maling
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Amanda Avila-Thompson
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Pam R Zeilman
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Kelly D Foote
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Irene A Malaty
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Ramon L Rodriguez
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
| | - Michael S Okun
- Departments of Neurology and Neurosurgery, Center for Movement Disorders & Neurorestoration, University of Florida, Gainesville, Florida, United States of America
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Alam M, Capelle HH, Schwabe K, Krauss J. Effect of Deep Brain Stimulation on Levodopa-Induced Dyskinesias and Striatal Oscillatory Local Field Potentials in a Rat Model of Parkinson's Disease. Brain Stimul 2014; 7:13-20. [PMID: 24126192 DOI: 10.1016/j.brs.2013.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 08/31/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022] Open
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Mazzone P, Stocchi F, Galati S, Insola A, Altibrandi MG, Modugno N, Tropepi D, Brusa L, Stefani A. Bilateral Implantation of Centromedian-Parafascicularis Complex and GPi: A New Combination of Unconventional Targets for Deep Brain Stimulation in Severe Parkinson Disease. Neuromodulation 2013; 9:221-8. [PMID: 22151710 DOI: 10.1111/j.1525-1403.2006.00063.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives. Traditional deep brain stimulation (DBS) at the subthalamic nucleus (STN) has proved to be efficacious on core Parkinsonian symptoms. However, very disabling l-dopa-induced abnormal involuntary movements (AIMs) and axial signs are slightly affected, suggesting that we target less conventional targets. Our candidates for DBS were the globus pallidus internus (GPi) plus the intralaminar thalamic complex (Pf or CM), given its extensive functional links with basal ganglia nuclei. Materials and Methods. The routine utilization of our innovative stereotactic apparatus allows us to implant, at the same time, both the CM-Pf complex together with the GPi in six Parkinson disease patients. Both intraoperative and postoperative neurophysiologic assessments helped us recognize functional subregions while optimizing implantation of electrodes. Unified Parkinson disease rating scale (UPDRS) motor scores, AIMs, and freezing were carefully blindly evaluated for each condition. Results. A significant amelioration of UPDRS scores was achieved by simultaneous activation of both targets. CM-Pf activation was only slightly effective in reducing rigidity and akinesia, but more efficacious on freezing. Not surprisingly, AIMs were peculiarly decreased by the activation of the permanent electro-catheter in the posteroventral GPi. Conclusions. These findings confirm that, in selected patients, it is conceivable to target structures other than the conventional STN in order to maximize clinical benefit.
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Affiliation(s)
- Paolo Mazzone
- Unità Operativa di Neurochirurgia Funzionale e Stereotassica, Ospedale CTO, Roma, Italy; Institute of Neurology, IRCCS Neuromed, Pozzilli, Isernia, Italy; Clinica Neurologica, Università di Roma Tor Vergata, Roma, Italy; Unità Operativa di Neurologia, Ospedale S. Eugenio, ASL RMC, Roma, Italy; I.R.C.C.S. Fondazione S. Lucia, Roma, Italy
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Priori A, Foffani G, Rossi L, Marceglia S. Adaptive deep brain stimulation (aDBS) controlled by local field potential oscillations. Exp Neurol 2013; 245:77-86. [DOI: 10.1016/j.expneurol.2012.09.013] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/27/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
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Little S, Brown P. What brain signals are suitable for feedback control of deep brain stimulation in Parkinson's disease? Ann N Y Acad Sci 2012; 1265:9-24. [PMID: 22830645 PMCID: PMC3495297 DOI: 10.1111/j.1749-6632.2012.06650.x] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Feedback control of deep brain stimulation (DBS) in Parkinson's disease has great potential to improve efficacy, reduce side effects, and decrease the cost of treatment. In this, the timing and intensity of stimulation are titrated according to biomarkers that capture current clinical state. Stimulation may be at standard high frequency or intelligently patterned to directly modify specific pathological rhythms. The search for and validation of appropriate feedback signals are therefore crucial. Signals recorded from the DBS electrode currently appear to be the most promising source of feedback. In particular, beta-frequency band oscillations in the local field potential recorded at the stimulation target may capture variation in bradykinesia and rigidity across patients, but this remains to be confirmed within patients. Biomarkers that reliably reflect other impairments, such as tremor, also need to be established. Finally, whether brain signals are causally important needs to be established before stimulation can be specifically patterned rather than delivered at empirically defined high frequency.
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Affiliation(s)
- Simon Little
- Nuffield Departments of Clinical Neurosciences, University of Oxford, United Kingdom
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30
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Oscillatory activity in the globus pallidus internus: Comparison between Parkinson’s disease and dystonia. Clin Neurophysiol 2012; 123:358-68. [DOI: 10.1016/j.clinph.2011.07.029] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 06/30/2011] [Accepted: 07/04/2011] [Indexed: 11/22/2022]
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31
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Szabó N, Kincses ZT, Toldi J, Vécsei L. Altered tryptophan metabolism in Parkinson's disease: A possible novel therapeutic approach. J Neurol Sci 2011; 310:256-60. [DOI: 10.1016/j.jns.2011.07.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Revised: 07/13/2011] [Accepted: 07/14/2011] [Indexed: 02/06/2023]
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Wichmann T, Dostrovsky JO. Pathological basal ganglia activity in movement disorders. Neuroscience 2011; 198:232-44. [PMID: 21723919 DOI: 10.1016/j.neuroscience.2011.06.048] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 06/13/2011] [Accepted: 06/14/2011] [Indexed: 11/16/2022]
Abstract
Our understanding of the pathophysiology of movement disorders and associated changes in basal ganglia activities has significantly changed during the last few decades. This process began with the development of detailed anatomical models of the basal ganglia, followed by studies of basal ganglia activity patterns in animal models of common movement disorders and electrophysiological recordings in movement disorder patients undergoing functional neurosurgical procedures. These investigations first resulted in an appreciation of global activity changes in the basal ganglia in parkinsonism and other disorders, and later in the detailed description of pathological basal ganglia activity patterns, specifically burst patterns and oscillatory synchronous discharge of basal ganglia neurons. In this review, we critically summarize our current knowledge of the pathological discharge patterns of basal ganglia neurons in Parkinson's disease, dystonia, and dyskinesias.
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Affiliation(s)
- T Wichmann
- Yerkes National Primate Research Center, Emory University, Atlanta, GA 30329, USA.
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33
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Hauptmann C, Tass PA. Restoration of segregated, physiological neuronal connectivity by desynchronizing stimulation. J Neural Eng 2010; 7:056008. [DOI: 10.1088/1741-2560/7/5/056008] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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34
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Tass P, Smirnov D, Karavaev A, Barnikol U, Barnikol T, Adamchic I, Hauptmann C, Pawelcyzk N, Maarouf M, Sturm V, Freund HJ, Bezruchko B. The causal relationship between subcortical local field potential oscillations and Parkinsonian resting tremor. J Neural Eng 2010; 7:16009. [DOI: 10.1088/1741-2560/7/1/016009] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Reck C, Florin E, Wojtecki L, Groiss S, Voges J, Sturm V, Schnitzler A, Timmermann L. Differential distribution of coherence between beta-band subthalamic oscillations and forearm muscles in Parkinson’s disease during isometric contraction. Clin Neurophysiol 2009; 120:1601-9. [DOI: 10.1016/j.clinph.2009.05.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2009] [Revised: 04/24/2009] [Accepted: 05/20/2009] [Indexed: 11/24/2022]
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36
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Frequency-specific effects of stimulation of the subthalamic area in treated Parkinson's disease patients. Neuroreport 2009; 20:975-8. [DOI: 10.1097/wnr.0b013e32832d2456] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kühn AA, Brücke C, Schneider GH, Trottenberg T, Kivi A, Kupsch A, Capelle HH, Krauss JK, Brown P. Increased beta activity in dystonia patients after drug-induced dopamine deficiency. Exp Neurol 2008; 214:140-3. [DOI: 10.1016/j.expneurol.2008.07.023] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Revised: 07/22/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
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38
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Subthalamic local field potential oscillations during ongoing deep brain stimulation in Parkinson's disease. Brain Res Bull 2008; 76:512-21. [DOI: 10.1016/j.brainresbull.2008.01.023] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2007] [Revised: 01/18/2008] [Accepted: 01/19/2008] [Indexed: 11/17/2022]
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Starr PA, Kang GA, Heath S, Shimamoto S, Turner RS. Pallidal neuronal discharge in Huntington's disease: support for selective loss of striatal cells originating the indirect pathway. Exp Neurol 2008; 211:227-33. [PMID: 18342309 PMCID: PMC3673313 DOI: 10.1016/j.expneurol.2008.01.023] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2007] [Revised: 01/24/2008] [Accepted: 01/27/2008] [Indexed: 10/22/2022]
Abstract
Chorea is the predominant motor manifestation in the early symptomatic phase of adult onset Huntington's disease (HD). Pathologically, this stage is marked by differential loss of striatal neurons contributing to the indirect pathway. This pattern of neuronal loss predicts decreased neuronal firing rates in GPi and increased firing rates in GPe, the opposite of the changes in firing rate known to occur in Parkinson's disease (PD). We present single-unit discharge characteristics (33 neurons) observed in an awake patient with HD (41 CAG repeats) undergoing microelectrode guided surgery for pallidal deep brain stimulation. Pallidal single-unit activity at "rest" and during voluntary movement was discriminated off line by principal component analysis and evaluated with respect to discharge rate, bursting, and oscillatory activity in the 0-200 Hz range. 24 GPi and 9 GPe units were studied, and compared with 132 GPi and 50 GPe units from 14 patients with PD. The mean (+/-SEM) spontaneous discharge rate for HD was 58+/-4 for GPi and 73+/-5 for GPe. This contrasted with discharge rates in PD of 95+/-2 for GPi and 57+/-3 for GPe. HD GPi units showed more bursting than PD GPi units but much less oscillatory activity in the 2-35 Hz frequency range at rest. These findings are consistent with selective early loss of striatal cells originating the indirect pathway.
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Affiliation(s)
- Philip A Starr
- Department of Neurosurgery, University of California, San Francisco, San Francisco CA 94143, USA.
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40
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Marceglia S, Bianchi AM, Baselli G, Foffani G, Cogiamanian F, Modugno N, Mrakic-Sposta S, Priori A, Cerutti S. Interaction between rhythms in the human basal ganglia: application of bispectral analysis to local field potentials. IEEE Trans Neural Syst Rehabil Eng 2008; 15:483-92. [PMID: 18198705 DOI: 10.1109/tnsre.2007.907893] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The application of deep brain stimulation (DBS) for the treatment of Parkinson's disease offered a direct "insight" into the human electrical activity in subcortical structures. The analysis of the oscillatory activity [local field potentials (LFPs)] disclosed the importance of rhythms and of interactions between rhythms in the human basal ganglia information processing. The aim of this study was to investigate the existence of possible nonlinear interactions between LFP rhythms characterizing the output structure of the basal ganglia, the globus pallidus internus, by means of bispectral analysis. The results of this study disclosed that the rhythms expressed in the globus pallidus internus of the untreated parkinsonian patient are not independent and, in particular, the low-beta (13-20 Hz) band generates harmonics that are included in the high-beta (20-35 Hz) band. Conversely, in the dystonic globus pallidus, as well as in the parkinsonian globus pallidus after dopaminergic medication (i.e., in the more "normal" condition), the rhythms are substantially independent and characterized by a strong activity in the low-frequency band that generates a second harmonic (4-14 Hz), mostly included in the same band. The interactions between rhythms in the human globus pallidus are therefore different in different pathologies and in different patient's states. The interpretation of these interactions is likely critical for fully understanding the role of LFP rhythms in the pathophysiology of human basal ganglia.
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Affiliation(s)
- Sara Marceglia
- Dipartimento di Scienze Neurologiche, Università di Milano, Fondazione IRCCS Ospedale Maggiore, Policlinico, Mangiagalli e Regina Elena, Milan, Italy.
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41
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Birdno MJ, Grill WM. Mechanisms of deep brain stimulation in movement disorders as revealed by changes in stimulus frequency. Neurotherapeutics 2008; 5:14-25. [PMID: 18164480 PMCID: PMC2200868 DOI: 10.1016/j.nurt.2007.10.067] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Deep brain stimulation (DBS) is an established treatment for symptoms in movement disorders and is under investigation for symptom management in persons with psychiatric disorders and epilepsy. Nevertheless, there remains disagreement regarding the physiological mechanisms responsible for the actions of DBS, and this lack of understanding impedes both the design of DBS systems for treating novel diseases and the effective tuning of current DBS systems. Currently available data indicate that effective DBS overrides pathological bursts, low frequency oscillations, synchronization, and disrupted firing patterns present in movement disorders, and replaces them with more regularized firing. Although it is likely that the specific mechanism(s) by which DBS exerts its effects varies between diseases and target nuclei, the overriding of pathological activity appears to be ubiquitous. This review provides an overview of changes in motor symptoms with changes in DBS frequency and highlights parallels between the changes in motor symptoms and the changes in cellular activity that appear to underlie the motor symptoms.
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Affiliation(s)
- Merrill J. Birdno
- grid.26009.3d0000000419367961Department of Biomedical Engineering, Duke University, Hudson Hall, Room 136, Box 90281, 27708-0281 Durham, NC
| | - Warren M. Grill
- grid.26009.3d0000000419367961Department of Biomedical Engineering, Duke University, Hudson Hall, Room 136, Box 90281, 27708-0281 Durham, NC
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42
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Brown P, Eusebio A. Paradoxes of functional neurosurgery: Clues from basal ganglia recordings. Mov Disord 2007; 23:12-20; quiz 158. [DOI: 10.1002/mds.21796] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Androulidakis AG, Doyle LMF, Yarrow K, Litvak V, Gilbertson TP, Brown P. Anticipatory changes in beta synchrony in the human corticospinal system and associated improvements in task performance. Eur J Neurosci 2007; 25:3758-65. [PMID: 17610595 DOI: 10.1111/j.1460-9568.2007.05620.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Synchronized oscillatory activity in the beta frequency band (13-30 Hz) can be detected in the cerebral motor cortex of healthy humans in the form of corticomuscular coherence. Elevated beta activity is associated with impaired processing of new movements and with more efficient postural or tonic contraction. Accordingly, beta activity is suppressed prior to voluntary movements, rebounding thereafter in the face of peripheral afferance. However, it remains to be established whether synchronized activity in the beta band can be up-regulated in a task-appropriate way independently of confounding changes in sensory afferance. Here we show that there is a systematic and prospective increase in beta synchrony prior to an expected postural challenge. This up-regulation of beta synchrony is associated with improved behavioural performance. We instructed nine healthy subjects to perform a reaction-time movement of the index finger in response to an imperative visual cue or to resist a stretch to the finger in the same direction. These events were preceded by congruent and less common incongruent warning cues. Beta synchrony was temporally increased when subjects were warned of an impending stretch and decreased following a warning cue signalling a forthcoming reaction-time task. Finger positions were less successfully maintained in the face of stretches and reaction times were longer when warning cues were incongruent. The results suggest that the beta state is modulated in a task-relevant way with accompanying behavioural consequences.
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Affiliation(s)
- Alexandros G Androulidakis
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, WC1N 3BG, UK
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44
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Abstract
The external segment of the pallidum (GP(e)) is a relatively large nucleus located caudomedial to the neostriatum (Str). The GP(e) receives major inputs from two major basal ganglia input nuclei, the Str and the subthalamic nucleus (STN), and sends its output to many basal ganglia nuclei including the STN, the Str, the internal pallidal segment (GP(i)), and the substantia nigra (SN). Thus, the GPe can be placed at the center of the basal ganglia connection diagram (Fig. 1(A)). From the viewpoint that emphasizes the direct and indirect pathways of the basal ganglia, the GP(e) is a component of the indirect pathway that relays Str inputs to the STN. The indirect pathway can be traced in Fig. 1(A), although it comprises only a part of multiple indirect pathways. This chapter begins with a brief description of the anatomical organization of the GP(e) followed by physiological and pharmacological characterizations of GABAergic responses in the GP(e).
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Affiliation(s)
- Hitoshi Kita
- Department of Anatomy and Neurobiology, The University of Tennessee Memphis, 855 Monroe Avenue, Memphis, TN 38163, USA.
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45
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Morgante F, Espay AJ, Gunraj C, Lang AE, Chen R. Motor cortex plasticity in Parkinson's disease and levodopa-induced dyskinesias. Brain 2006; 129:1059-69. [PMID: 16476674 DOI: 10.1093/brain/awl031] [Citation(s) in RCA: 249] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Experimental models of Parkinson's disease have demonstrated abnormal synaptic plasticity in the corticostriatal system, possibly related to the development of levodopa-induced dyskinesias (LID). We tested the hypothesis that LID in Parkinson's disease is associated with aberrant plasticity in the human motor cortex (M1). We employed the paired associative stimulation (PAS) protocol, an experimental intervention involving transcranial magnetic stimulation (TMS) and median nerve stimulation capable of producing long-term potentiation (LTP) like changes in the sensorimotor system in humans. We studied the more affected side of 16 moderately affected patients with Parkinson's disease (9 dyskinetic, 7 non-dyskinetic) and the dominant side of 9 age-matched healthy controls. Motor-evoked potential (MEP) amplitudes and cortical silent period (CSP) duration were measured at baseline before PAS and for up to 60 min (T0, T30 and T60) after PAS in abductor pollicis brevis (APB) and abductor digiti minimi (ADM) muscles. PAS significantly increased MEP size in controls (+74.8% of baseline at T30) but not in patients off medication (T30: +0.07% of baseline in the non-dyskinetic, +27% in the dyskinetic group). Levodopa restored the potentiation of MEP amplitudes by PAS in the non-dyskinetic group (T30: +64.9% of baseline MEP) but not in the dyskinetic group (T30: -9.2% of baseline). PAS prolonged CSP duration in controls. There was a trend towards prolongation of CSP in the non-dyskinetic group off medications but not in the dyskinetic group. Levodopa did not restore CSP prolongation by PAS in the dyskinetic group. Our findings suggest that LTP-like plasticity is deficient in Parkinson's disease off medications and is restored by levodopa in non-dyskinetic but not in dyskinetic patients. Abnormal synaptic plasticity in the motor cortex may play a role in the development of LID.
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Affiliation(s)
- Francesca Morgante
- Division of Neurology and Toronto Western Research Institute, University Health Network, University of Toronto, Toronto, Ontario, Canada
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46
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Abstract
Recordings in humans as a result of functional neurosurgery have revealed a tendency for basal ganglia neurons to oscillate and synchronise their activity, giving rise to a rhythmic population activity, manifest as oscillatory local field potentials. The most important activity is synchronised oscillation in the beta band (13-30 Hz), which has been picked up at various sites within the basal ganglia-cortical loop in PD. Dopaminergic medication and movement suppress this activity, with the timing and degree of suppression closely correlating with behavioural performance. Accordingly synchronisation in the beta band has been hypothesised to be essentially antikinetic in nature and pathophysiologically relevant to bradykinesia.
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Affiliation(s)
- P Brown
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, London, United Kingdom.
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