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Ricci A, Rubino E, Serra GP, Wallén-Mackenzie Å. Concerning neuromodulation as treatment of neurological and neuropsychiatric disorder: Insights gained from selective targeting of the subthalamic nucleus, para-subthalamic nucleus and zona incerta in rodents. Neuropharmacology 2024; 256:110003. [PMID: 38789078 DOI: 10.1016/j.neuropharm.2024.110003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/26/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Neuromodulation such as deep brain stimulation (DBS) is advancing as a clinical intervention in several neurological and neuropsychiatric disorders, including Parkinson's disease, dystonia, tremor, and obsessive-compulsive disorder (OCD) for which DBS is already applied to alleviate severely afflicted individuals of symptoms. Tourette syndrome and drug addiction are two additional disorders for which DBS is in trial or proposed as treatment. However, some major remaining obstacles prevent this intervention from reaching its full therapeutic potential. Side-effects have been reported, and not all DBS-treated individuals are relieved of their symptoms. One major target area for DBS electrodes is the subthalamic nucleus (STN) which plays important roles in motor, affective and associative functions, with impact on for example movement, motivation, impulsivity, compulsivity, as well as both reward and aversion. The multifunctionality of the STN is complex. Decoding the anatomical-functional organization of the STN could enhance strategic targeting in human patients. The STN is located in close proximity to zona incerta (ZI) and the para-subthalamic nucleus (pSTN). Together, the STN, pSTN and ZI form a highly heterogeneous and clinically important brain area. Rodent-based experimental studies, including opto- and chemogenetics as well as viral-genetic tract tracings, provide unique insight into complex neuronal circuitries and their impact on behavior with high spatial and temporal precision. This research field has advanced tremendously over the past few years. Here, we provide an inclusive review of current literature in the pre-clinical research fields centered around STN, pSTN and ZI in laboratory mice and rats; the three highly heterogeneous and enigmatic structures brought together in the context of relevance for treatment strategies. Specific emphasis is placed on methods of manipulation and behavioral impact.
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Affiliation(s)
- Alessia Ricci
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Eleonora Rubino
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Gian Pietro Serra
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Åsa Wallén-Mackenzie
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA.
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2
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Cagle JN, de Araujo T, Johnson KA, Yu J, Fanty L, Sarmento FP, Little S, Okun MS, Wong JK, de Hemptinne C. Chronic intracranial recordings in the globus pallidus reveal circadian rhythms in Parkinson's disease. Nat Commun 2024; 15:4602. [PMID: 38816390 PMCID: PMC11139908 DOI: 10.1038/s41467-024-48732-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 05/10/2024] [Indexed: 06/01/2024] Open
Abstract
Circadian rhythms have been shown in the subthalamic nucleus (STN) in Parkinson's disease (PD), but only a few studies have focused on the globus pallidus internus (GPi). This retrospective study investigates GPi circadian rhythms in a large cohort of subjects with PD (130 recordings from 93 subjects) with GPi activity chronically recorded in their home environment. We found a significant change in GPi activity between daytime and nighttime in most subjects (82.4%), with a reduction in GPi activity at nighttime in 56.2% of recordings and an increase in activity in 26.2%. GPi activity in higher frequency bands ( > 20 Hz) was more likely to decrease at night and in patients taking extended-release levodopa medication. Our results suggest that circadian fluctuations in the GPi vary across individuals and that increased power at night might be due to the reemergence of pathological neural activity. These findings should be considered to ensure successful implementation of adaptive neurostimulation paradigms in the real-world.
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Affiliation(s)
- Jackson N Cagle
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Tiberio de Araujo
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kara A Johnson
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - John Yu
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Lauren Fanty
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Filipe P Sarmento
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Simon Little
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Michael S Okun
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Joshua K Wong
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Coralie de Hemptinne
- Department of Neurology, University of Florida, Gainesville, FL, USA.
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA.
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Bayman E, Chee K, Mendlen M, Denman DJ, Tien RN, Ojemann S, Kramer DR, Thompson JA. Subthalamic nucleus synchronization between beta band local field potential and single-unit activity in Parkinson's disease. Physiol Rep 2024; 12:e16001. [PMID: 38697943 PMCID: PMC11065686 DOI: 10.14814/phy2.16001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/24/2023] [Accepted: 03/26/2024] [Indexed: 05/05/2024] Open
Abstract
Local field potential (LFP) oscillations in the beta band (13-30 Hz) in the subthalamic nucleus (STN) of Parkinson's disease patients have been implicated in disease severity and treatment response. The relationship between single-neuron activity in the STN and regional beta power changes remains unclear. We used spike-triggered average (STA) to assess beta synchronization in STN. Beta power and STA magnitude at the beta frequency range were compared in three conditions: STN versus other subcortical structures, dorsal versus ventral STN, and high versus low beta power STN recordings. Magnitude of STA-LFP was greater within the STN compared to extra-STN structures along the trajectory path, despite no difference in percentage of the total power. Within the STN, there was a higher percent beta power in dorsal compared to ventral STN but no difference in STA-LFP magnitude. Further refining the comparison to high versus low beta peak power recordings inside the STN to evaluate if single-unit activity synchronized more strongly with beta band activity in areas of high beta power resulted in a significantly higher STA magnitude for areas of high beta power. Overall, these results suggest that STN single units strongly synchronize to beta activity, particularly units in areas of high beta power.
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Affiliation(s)
- Eric Bayman
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Keanu Chee
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Madelyn Mendlen
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Daniel J. Denman
- Department of Neurophysiology and BiophysicsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Rex N. Tien
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Steven Ojemann
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Daniel R. Kramer
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - John A. Thompson
- Department of NeurosurgeryUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
- Department of NeurologyUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
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Vinding MC, Waldthaler J, Eriksson A, Manting CL, Ferreira D, Ingvar M, Svenningsson P, Lundqvist D. Oscillatory and non-oscillatory features of the magnetoencephalic sensorimotor rhythm in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:51. [PMID: 38443402 PMCID: PMC10915140 DOI: 10.1038/s41531-024-00669-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/26/2024] [Indexed: 03/07/2024] Open
Abstract
Parkinson's disease (PD) is associated with changes in neural activity in the sensorimotor alpha and beta bands. Using magnetoencephalography (MEG), we investigated the role of spontaneous neuronal activity within the somatosensory cortex in a large cohort of early- to mid-stage PD patients (N = 78) on Parkinsonian medication and age- and sex-matched healthy controls (N = 60) using source reconstructed resting-state MEG. We quantified features of the time series data in terms of oscillatory alpha power and central alpha frequency, beta power and central beta frequency, and 1/f broadband characteristics using power spectral density. Furthermore, we characterised transient oscillatory burst events in the mu-beta band time-domain signals. We examined the relationship between these signal features and the patients' disease state, symptom severity, age, sex, and cortical thickness. PD patients and healthy controls differed on PSD broadband characteristics, with PD patients showing a steeper 1/f exponential slope and higher 1/f offset. PD patients further showed a steeper age-related decrease in the burst rate. Out of all the signal features of the sensorimotor activity, the burst rate was associated with increased severity of bradykinesia, whereas the burst duration was associated with axial symptoms. Our study shows that general non-oscillatory features (broadband 1/f exponent and offset) of the sensorimotor signals are related to disease state and oscillatory burst rate scales with symptom severity in PD.
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Affiliation(s)
- Mikkel C Vinding
- NatMEG, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.
| | - Josefine Waldthaler
- NatMEG, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Section of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Allison Eriksson
- NatMEG, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Cassia Low Manting
- NatMEG, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Cognitive Neuroimaging Centre, Lee Kong Chien School of Medicine, Nanyang Technological University, Singapore, Singapore
- McGovern Institute of Brain Research, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Daniel Ferreira
- Division of Clinical Geriatrics, Center for Alzheimer's Research, Department of Neurobiology, Care Sciences, and Society, Karolinska Institutet, Stockholm, Sweden
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Facultad de Ciencias de la Salud, Universidad Fernando Pessoa Canarias, Las Palmas de Gran, Canaria, España
| | - Martin Ingvar
- NatMEG, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Svenningsson
- Section of Neurology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Lundqvist
- NatMEG, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Bočková M, Lamoš M, Chrastina J, Daniel P, Kupcová S, Říha I, Šmahovská L, Baláž M, Rektor I. Coupling between beta band and high frequency oscillations as a clinically useful biomarker for DBS. NPJ Parkinsons Dis 2024; 10:40. [PMID: 38383550 PMCID: PMC10882016 DOI: 10.1038/s41531-024-00656-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Beta hypersynchrony was recently introduced into clinical practice in Parkinson's disease (PD) to identify the best stimulation contacts and for adaptive deep brain stimulation (aDBS) sensing. However, many other oscillopathies accompany the disease, and beta power sensing may not be optimal for all patients. The aim of this work was to study the potential clinical usefulness of beta power phase-amplitude coupling (PAC) with high frequency oscillations (HFOs). Subthalamic nucleus (STN) local field potentials (LFPs) from externalized DBS electrodes were recorded and analyzed in PD patients (n = 19). Beta power and HFOs were evaluated in a resting-state condition; PAC was then studied and compared with the electrode contact positions, structural connectivity, and medication state. Beta-HFO PAC (mainly in the 200-500 Hz range) was observed in all subjects. PAC was detectable more specifically in the motor part of the STN compared to beta power and HFOs. Moreover, the presence of PAC better corresponds to the stimulation setup based on the clinical effect. PAC is also sensitive to the laterality of symptoms and dopaminergic therapy, where the greater PAC cluster reflects the more affected side and medication "off" state. Coupling between beta power and HFOs is known to be a correlate of the PD "off" state. Beta-HFO PAC seems to be more sensitive than beta power itself and could be more helpful in the selection of the best clinical stimulation contact and probably also as a potential future input signal for aDBS.
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Affiliation(s)
- Martina Bočková
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Martin Lamoš
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Jan Chrastina
- Department of Neurosurgery, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Pavel Daniel
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Silvia Kupcová
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivo Říha
- Department of Neurosurgery, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Lucia Šmahovská
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marek Baláž
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Ivan Rektor
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
- First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic.
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Hill ME, Johnson LA, Wang J, Sanabria DE, Patriat R, Cooper SE, Park MC, Harel N, Vitek JL, Aman JE. Paradoxical Modulation of STN β-Band Activity with Medication Compared to Deep Brain Stimulation. Mov Disord 2024; 39:192-197. [PMID: 37888906 PMCID: PMC10843006 DOI: 10.1002/mds.29634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/20/2023] [Accepted: 10/04/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Excessive subthalamic nucleus (STN) β-band (13-35 Hz) synchronized oscillations has garnered interest as a biomarker for characterizing disease state and developing adaptive stimulation systems for Parkinson's disease (PD). OBJECTIVES To report on a patient with abnormal treatment-responsive modulation in the β-band. METHODS We examined STN local field potentials from an externalized deep brain stimulation (DBS) lead while assessing PD motor signs in four conditions (OFF, MEDS, DBS, and MEDS+DBS). RESULTS The patient presented here exhibited a paradoxical increase in β power following administration of levodopa and pramipexole (MEDS), but an attenuation in β power during DBS and MEDS+DBS despite clinical improvement of 50% or greater under all three therapeutic conditions. CONCLUSIONS This case highlights the need for further study on the role of β oscillations in the pathophysiology of PD and the importance of personalized approaches to the development of β or other biomarker-based DBS closed loop algorithms. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Meghan E. Hill
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Luke A. Johnson
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Jing Wang
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | | | - Rémi Patriat
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Scott E. Cooper
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Michael C. Park
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA
| | - Noam Harel
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Jerrold L. Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Joshua E. Aman
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
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Guehl D, Guillaud E, Langbour N, Doat E, Auzou N, Courtin E, Branchard O, Engelhardt J, Benazzouz A, Eusebio A, Cuny E, Burbaud P. Usefulness of thalamic beta activity for closed-loop therapy in essential tremor. Sci Rep 2023; 13:22332. [PMID: 38102180 PMCID: PMC10724233 DOI: 10.1038/s41598-023-49511-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 12/08/2023] [Indexed: 12/17/2023] Open
Abstract
A partial loss of effectiveness of deep brain stimulation of the ventral intermediate nucleus of the thalamus (VIM) has been reported in some patients with essential tremor (ET), possibly due to habituation to permanent stimulation. This study focused on the evolution of VIM local-field potentials (LFPs) data over time to assess the long-term feasibility of closed-loop therapy based on thalamic activity. We performed recordings of thalamic LFPs in 10 patients with severe ET using the ACTIVA™ PC + S (Medtronic plc.) allowing both recordings and stimulation in the same region. Particular attention was paid to describing the evolution of LFPs over time from 3 to 24 months after surgery when the stimulation was Off. We demonstrated a significant decrease in high-beta LFPs amplitude during movements inducing tremor in comparison to the rest condition 3 months after surgery (1.91 ± 0.89 at rest vs. 1.27 ± 1.37 µV2/Hz during posture/action for N = 8/10 patients; p = 0.010), 12 months after surgery (2.92 ± 1.75 at rest vs. 2.12 ± 1.78 µV2/Hz during posture/action for N = 7/10 patients; p = 0.014) and 24 months after surgery (2.32 ± 0.35 at rest vs 0.75 ± 0.78 µV2/Hz during posture/action for 4/6 patients; p = 0.017). Among the patients who exhibited a significant decrease of high-beta LFP amplitude when stimulation was Off, this phenomenon was observed at least twice during the follow-up. Although the extent of this decrease in high-beta LFPs amplitude during movements inducing tremor may vary over time, this thalamic biomarker of movement could potentially be usable for closed-loop therapy in the long term.
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Affiliation(s)
- Dominique Guehl
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France.
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France.
| | - Etienne Guillaud
- Institute of Cognitive and Integrative Neurosciences, Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Nicolas Langbour
- Centre de Recherche en Psychiatrie, CH de la Milétrie, 86000, Poitiers, France
| | - Emilie Doat
- Institute of Cognitive and Integrative Neurosciences, Univ. Bordeaux, CNRS, INCIA, UMR 5287, F-33000, Bordeaux, France
| | - Nicolas Auzou
- Institut des Maladies Neurodégénératives Clinique (IMNc), Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | - Edouard Courtin
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
| | | | | | - Abdelhamid Benazzouz
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpitaux Universitaire de Marseille, Marseille, France
- Institut de Neurosciences de la Timone, UMR 7289, Aix Marseille Univ, CNRS, Marseille, France
| | - Emmanuel Cuny
- Service de Neurochirurgie, CHU de Bordeaux, Bordeaux, France
| | - Pierre Burbaud
- Service de Neurophysiologie Clinique de l'enfant et de l'adulte, Hôpital Pellegrin, Pôle des Neurosciences Cliniques, CHU de Bordeaux, Bordeaux, France
- Institut des Maladies Neurodégénératives, Univ. Bordeaux, CNRS, IMN, UMR 5293, F-33000, Bordeaux, France
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Mirzai N, Polet K, Morisot A, Hesse S, Pesce A, Louchart de la Chapelle S, Iakimova G. Can the Ability to Recognize Facial Emotions in Individuals With Neurodegenerative Disease be Improved? A Systematic Review and Meta-analysis. Cogn Behav Neurol 2023; 36:202-218. [PMID: 37410880 PMCID: PMC10683976 DOI: 10.1097/wnn.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/30/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Facial emotion recognition (FER) is commonly impaired in individuals with neurodegenerative disease (NDD). This impairment has been linked to an increase in behavioral disorders and caregiver burden. OBJECTIVE To identify interventions targeting the improvement of FER ability in individuals with NDD and investigate the magnitude of the efficacy of the interventions. We also wanted to explore the duration of the effects of the intervention and their possible impacts on behavioral and psychological symptoms of dementia and caregiver burden. METHOD We included 15 studies with 604 individuals who had been diagnosed with NDD. The identified interventions were categorized into three types of approach (cognitive, neurostimulation, and pharmacological) as well as a combined approach (neurostimulation with pharmacological). RESULTS The three types of approaches pooled together had a significant large effect size for FER ability improvement (standard mean difference: 1.21, 95% CI = 0.11, 2.31, z = 2.15, P = 0.03). The improvement lasted post intervention, in tandem with a decrease in behavioral disorders and caregiver burden. CONCLUSION A combination of different approaches for FER ability improvement may be beneficial for individuals with NDD and their caregivers.
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Affiliation(s)
- Naz Mirzai
- Clinical Research Unit–Memory Clinic, Princess Grace Hospital, Monaco
- Cote d’Azur University, Laboratory of Clinical, Cognitive and Social Anthropology and Psychology, Nice, France
| | - Kévin Polet
- Clinical Research Unit–Memory Clinic, Princess Grace Hospital, Monaco
| | - Adeline Morisot
- Clinical Research Unit–Memory Clinic, Princess Grace Hospital, Monaco
- Public Health Department, Cote d’Azur University, University Hospital Center of Nice, Nice, France
| | - Solange Hesse
- Clinical Research Unit–Memory Clinic, Princess Grace Hospital, Monaco
| | - Alain Pesce
- Bibliographic Research Association for Neurosciences, Nice, France
| | | | - Galina Iakimova
- Cote d’Azur University, Laboratory of Clinical, Cognitive and Social Anthropology and Psychology, Nice, France
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Wiesman AI, da Silva Castanheira J, Degroot C, Fon EA, Baillet S, Network QP. Adverse and compensatory neurophysiological slowing in Parkinson's disease. Prog Neurobiol 2023; 231:102538. [PMID: 37832713 PMCID: PMC10872886 DOI: 10.1016/j.pneurobio.2023.102538] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/27/2023] [Accepted: 10/09/2023] [Indexed: 10/15/2023]
Abstract
Patients with Parkinson's disease (PD) exhibit multifaceted changes in neurophysiological brain activity, hypothesized to represent a global cortical slowing effect. Using task-free magnetoencephalography and extensive clinical assessments, we found that neurophysiological slowing in PD is differentially associated with motor and non-motor symptoms along a sagittal gradient over the cortical anatomy. In superior parietal regions, neurophysiological slowing reflects an adverse effect and scales with cognitive and motor impairments, while across the inferior frontal cortex, neurophysiological slowing is compatible with a compensatory role. This adverse-to-compensatory gradient is sensitive to individual clinical profiles, such as drug regimens and laterality of symptoms; it is also aligned with the topography of neurotransmitter and transporter systems relevant to PD. We conclude that neurophysiological slowing in patients with PD signals both deleterious and protective mechanisms of the disease, from posterior to anterior regions across the cortex, respectively, with functional and clinical relevance to motor and cognitive symptoms.
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Affiliation(s)
- Alex I Wiesman
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada.
| | | | - Clotilde Degroot
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Edward A Fon
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
| | - Sylvain Baillet
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada.
| | - Quebec Parkinson Network
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Canada
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Cohen SL, Woo Choi J, Toga AW, Pouratian N, Duncan D. Exaggerated High-Beta Oscillations are Associated with Cortical Thinning at the Motor Cortex in Parkinson's Disease. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083533 DOI: 10.1109/embc40787.2023.10341040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Elevated β oscillations (13-35 Hz) are characteristic pathophysiology in Parkinson's Disease (PD). Cortical thinning has also been reported in the disease, however the relationship between these biomarkers of PD has not been established. By comparing electrophysiological measurements with cortical thickness, this study aims to reveal the pathoetiology of disease and symptoms in PD. Preoperative magnetic resonance imaging (MRI) and intraoperative local field potentials (LFPs) were collected from 34 subjects diagnosed with PD. Cortical surfaces were reconstructed from the images, and cortical thickness was extracted from the subregions where the recording electrode was placed in M1. LFPs were preprocessed and cleaned using a semiautomatic artifact detection algorithm, then power spectral densities (PSD) were computed and periodic and aperiodic frequency components were calculated. Nonparametric Spearman rank correlations assessed the relationship between electrophysiological components (i.e. center frequency (CF), power, bandwidth, 1/f exponent, knee), with cortical thickness. According to the CF of each subject's PSD, the cohort was split into two sub-groups: low-β peak (13-20 Hz) and high-β peak (20-35 Hz) groups. There was a significant negative correlation between power and cortical thickness only in the high-β subgroup (r=-0.48, p(corrected)=0.049). This relationship remained significant when correcting for age (r=-0.52,p=0.015), indicating that the effect of age on cortical thinning was not the determining factor. We did not find significant differences between UPDRS-III motor symptom scores for the low-and high-β subgroups. Of note is the dominance of high-β oscillatory power and its relationship with cortical thickness. As suggested by the literature, increased high-β activity during movement may be exaggerated in PD. These findings suggest that the characteristic cortical thinning in PD causes variation in electrical activity, leading to elevated high-β activity.Clinical relevance- This multimodal study provides additional insights on the pathophysiology and its relevance with morphology of Parkinson's Disease.
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Mirzac D, Kreis SL, Luhmann HJ, Gonzalez-Escamilla G, Groppa S. Translating Pathological Brain Activity Primers in Parkinson's Disease Research. RESEARCH (WASHINGTON, D.C.) 2023; 6:0183. [PMID: 37383218 PMCID: PMC10298229 DOI: 10.34133/research.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
Translational experimental approaches that help us better trace Parkinson's disease (PD) pathophysiological mechanisms leading to new therapeutic targets are urgently needed. In this article, we review recent experimental and clinical studies addressing abnormal neuronal activity and pathological network oscillations, as well as their underlying mechanisms and modulation. Our aim is to enhance our knowledge about the progression of Parkinson's disease pathology and the timing of its symptom's manifestation. Here, we present mechanistic insights relevant for the generation of aberrant oscillatory activity within the cortico-basal ganglia circuits. We summarize recent achievements extrapolated from available PD animal models, discuss their advantages and limitations, debate on their differential applicability, and suggest approaches for transferring knowledge on disease pathology into future research and clinical applications.
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Affiliation(s)
- Daniela Mirzac
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Svenja L. Kreis
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Heiko J. Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
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12
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Giannini G, Baldelli L, Leogrande G, Cani I, Mantovani P, Lopane G, Cortelli P, Calandra-Buonaura G, Conti A. Case report: Bilateral double beta peak activity is influenced by stimulation, levodopa concentrations, and motor tasks, in a Parkinson's disease patient on chronic deep brain stimulation. Front Neurol 2023; 14:1163811. [PMID: 37273691 PMCID: PMC10232856 DOI: 10.3389/fneur.2023.1163811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction Subthalamic (STN) local field potentials (LFPs) in the beta band are considered potential biomarkers for closed-loop deep brain stimulation (DBS) in Parkinson's disease (PD). The beta band is further dissected into low-and high-frequency components with somewhat different functions, although their concomitance and association in the single patient is far to be defined. We present a 56-year-old male PD patient undergoing DBS showing a double-beta peak activity on both sides. The aim of the study was to investigate how low-and high-beta peaks were influenced by plasma levodopa (L-dopa) levels, stimulation, and motor performances. Methods A systematic evaluation of raw LFPs, plasma L-dopa levels, and motor tasks was performed in the following four conditions: OFF medications/ON stimulation, OFF medications/OFF stimulation, ON medications/OFF stimulation, and ON medications/ON stimulation. Results The analysis of the LFP spectra suggests the following results: (1) the high-beta peak was suppressed by stimulation, while the low-beta peak showed a partial and not consistent response to stimulation; (2) the high-beta peak is also influenced by plasma L-dopa concentration, showing a progressive amplitude increment concordant with plasma L-dopa levels, while the low-beta peak shows a different behavir; and (3) motor performances seem to impact beta peaks behavior. Conclusion This single exploratory case study illustrates a complex behavior of low-and high-beta peaks in a PD patient, in response to stimulation, L-dopa plasma levels, and motor performances. Our results suggest the importance to investigate patient-specific individual LFP patterns in view of upcoming closed-loop stimulation.
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Affiliation(s)
- Giulia Giannini
- UOC Clinica Neurologica Rete Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Luca Baldelli
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Gaetano Leogrande
- Medtronic EMEA Corporate Technology and Innovation, Maastricht, Netherlands
| | - Ilaria Cani
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Paolo Mantovani
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Giovanna Lopane
- Unit of Rehabilitation Medicine, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Pietro Cortelli
- UOC Clinica Neurologica Rete Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Giovanna Calandra-Buonaura
- UOC Clinica Neurologica Rete Metropolitana NEUROMET, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Alfredo Conti
- Department of Biomedical and NeuroMotor Sciences (DiBiNeM), Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Unit of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
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Wang S, Zhu G, Shi L, Zhang C, Wu B, Yang A, Meng F, Jiang Y, Zhang J. Closed-Loop Adaptive Deep Brain Stimulation in Parkinson's Disease: Procedures to Achieve It and Future Perspectives. JOURNAL OF PARKINSON'S DISEASE 2023:JPD225053. [PMID: 37182899 DOI: 10.3233/jpd-225053] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease with a heavy burden on patients, families, and society. Deep brain stimulation (DBS) can improve the symptoms of PD patients for whom medication is insufficient. However, current open-loop uninterrupted conventional DBS (cDBS) has inherent limitations, such as adverse effects, rapid battery consumption, and a need for frequent parameter adjustment. To overcome these shortcomings, adaptive DBS (aDBS) was proposed to provide responsive optimized stimulation for PD. This topic has attracted scientific interest, and a growing body of preclinical and clinical evidence has shown its benefits. However, both achievements and challenges have emerged in this novel field. To date, only limited reviews comprehensively analyzed the full framework and procedures for aDBS implementation. Herein, we review current preclinical and clinical data on aDBS for PD to discuss the full procedures for its achievement and to provide future perspectives on this treatment.
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Affiliation(s)
- Shu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunkui Zhang
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Bing Wu
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
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14
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Lamoš M, Bočková M, Goldemundová S, Baláž M, Chrastina J, Rektor I. The effect of deep brain stimulation in Parkinson's disease reflected in EEG microstates. NPJ Parkinsons Dis 2023; 9:63. [PMID: 37069159 PMCID: PMC10110608 DOI: 10.1038/s41531-023-00508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023] Open
Abstract
Mechanisms of deep brain stimulation (DBS) on cortical networks were explored mainly by fMRI. Advanced analysis of high-density EEG is a source of additional information and may provide clinically useful biomarkers. The presented study evaluates EEG microstates in Parkinson's disease and the effect of DBS of the subthalamic nucleus (STN). The association between revealed spatiotemporal dynamics of brain networks and changes in oscillatory activity and clinical examination were assessed. Thirty-seven patients with Parkinson's disease treated by STN-DBS underwent two sessions (OFF and ON stimulation conditions) of resting-state EEG. EEG microstates were analyzed in patient recordings and in a matched healthy control dataset. Microstate parameters were then compared across groups and were correlated with clinical and neuropsychological scores. Of the five revealed microstates, two differed between Parkinson's disease patients and healthy controls. Another microstate differed between ON and OFF stimulation conditions in the patient group and restored parameters in the ON stimulation state toward to healthy values. The mean beta power of that microstate was the highest in patients during the OFF stimulation condition and the lowest in healthy controls; sources were localized mainly in the supplementary motor area. Changes in microstate parameters correlated with UPDRS and neuropsychological scores. Disease specific alterations in the spatiotemporal dynamics of large-scale brain networks can be described by EEG microstates. The approach can reveal changes reflecting the effect of DBS on PD motor symptoms as well as changes probably related to non-motor symptoms not influenced by DBS.
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Grants
- NU21-04-00445 Agentura Pro Zdravotnický Výzkum České Republiky (Czech Health Research Council)
- NU21-04-00445 Agentura Pro Zdravotnický Výzkum České Republiky (Czech Health Research Council)
- NU21-04-00445 Agentura Pro Zdravotnický Výzkum České Republiky (Czech Health Research Council)
- NU21-04-00445 Agentura Pro Zdravotnický Výzkum České Republiky (Czech Health Research Council)
- NU21-04-00445 Agentura Pro Zdravotnický Výzkum České Republiky (Czech Health Research Council)
- NU21-04-00445 Agentura Pro Zdravotnický Výzkum České Republiky (Czech Health Research Council)
- LM2018129 Ministerstvo Školství, Mládeže a Tělovýchovy (Ministry of Education, Youth and Sports)
- LM2018129 Ministerstvo Školství, Mládeže a Tělovýchovy (Ministry of Education, Youth and Sports)
- LM2018129 Ministerstvo Školství, Mládeže a Tělovýchovy (Ministry of Education, Youth and Sports)
- LM2018129 Ministerstvo Školství, Mládeže a Tělovýchovy (Ministry of Education, Youth and Sports)
- LM2018129 Ministerstvo Školství, Mládeže a Tělovýchovy (Ministry of Education, Youth and Sports)
- LM2018129 Ministerstvo Školství, Mládeže a Tělovýchovy (Ministry of Education, Youth and Sports)
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Affiliation(s)
- Martin Lamoš
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Martina Bočková
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Movement Disorders Center, First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Sabina Goldemundová
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Marek Baláž
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Movement Disorders Center, First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Jan Chrastina
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic
- Department of Neurosurgery, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic
| | - Ivan Rektor
- Brain and Mind Research Program, Central European Institute of Technology, Masaryk University, Brno, Czech Republic.
- Movement Disorders Center, First Department of Neurology, Masaryk University School of Medicine, St. Anne's Hospital, Brno, Czech Republic.
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Wiest C, Torrecillos F, Pogosyan A, Bange M, Muthuraman M, Groppa S, Hulse N, Hasegawa H, Ashkan K, Baig F, Morgante F, Pereira EA, Mallet N, Magill PJ, Brown P, Sharott A, Tan H. The aperiodic exponent of subthalamic field potentials reflects excitation/inhibition balance in Parkinsonism. eLife 2023; 12:e82467. [PMID: 36810199 PMCID: PMC10005762 DOI: 10.7554/elife.82467] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/22/2023] [Indexed: 02/24/2023] Open
Abstract
Periodic features of neural time-series data, such as local field potentials (LFPs), are often quantified using power spectra. While the aperiodic exponent of spectra is typically disregarded, it is nevertheless modulated in a physiologically relevant manner and was recently hypothesised to reflect excitation/inhibition (E/I) balance in neuronal populations. Here, we used a cross-species in vivo electrophysiological approach to test the E/I hypothesis in the context of experimental and idiopathic Parkinsonism. We demonstrate in dopamine-depleted rats that aperiodic exponents and power at 30-100 Hz in subthalamic nucleus (STN) LFPs reflect defined changes in basal ganglia network activity; higher aperiodic exponents tally with lower levels of STN neuron firing and a balance tipped towards inhibition. Using STN-LFPs recorded from awake Parkinson's patients, we show that higher exponents accompany dopaminergic medication and deep brain stimulation (DBS) of STN, consistent with untreated Parkinson's manifesting as reduced inhibition and hyperactivity of STN. These results suggest that the aperiodic exponent of STN-LFPs in Parkinsonism reflects E/I balance and might be a candidate biomarker for adaptive DBS.
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Affiliation(s)
- Christoph Wiest
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Flavie Torrecillos
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Alek Pogosyan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Manuel Bange
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University MainzMainzGermany
| | - Natasha Hulse
- Department of Neurosurgery, King's College LondonLondonUnited Kingdom
| | - Harutomo Hasegawa
- Department of Neurosurgery, King's College LondonLondonUnited Kingdom
| | - Keyoumars Ashkan
- Department of Neurosurgery, King's College LondonLondonUnited Kingdom
| | - Fahd Baig
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George' s, University of LondonLondonUnited Kingdom
| | - Francesca Morgante
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George' s, University of LondonLondonUnited Kingdom
| | - Erlick A Pereira
- Neurosciences Research Centre, Molecular and Clinical Sciences Institute, St. George' s, University of LondonLondonUnited Kingdom
| | - Nicolas Mallet
- Institut des Maladies Neurodégénératives, CNRS UMR5293, Université de BordeauxBordeauxFrance
| | - Peter J Magill
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Peter Brown
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Andrew Sharott
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of OxfordOxfordUnited Kingdom
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16
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Jergas H, Petry-Schmelzer JN, Dembek TA, Dafsari HS, Visser-Vandewalle V, Fink GR, Baldermann JC, Barbe MT. Brain Morphometry Associated With Response to Levodopa and Deep Brain Stimulation in Parkinson Disease. Neuromodulation 2023; 26:340-347. [PMID: 35219570 DOI: 10.1016/j.neurom.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/21/2021] [Accepted: 01/13/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Whether treatment response in patients with Parkinson disease depends on brain atrophy is insufficiently understood. The goal of this study is to identify specific atrophy patterns associated with response to dopaminergic therapy and deep brain stimulation. MATERIALS AND METHODS In this study, we analyzed the association of gray matter brain atrophy patterns, as identified by voxel-based morphometry, with acute response to levodopa (N = 118) and subthalamic nucleus deep brain stimulation (N = 39). Motor status was measured as a change in points on the Unified Parkinson's Disease Rating Scale III score. Baseline values were obtained before surgery, after cessation of dopaminergic medication for at least 12 hours; response to medication was assessed after administration of a standardized dose of levodopa. Response to deep brain stimulation was measured three months after surgery in the clinical condition after withdrawal of dopaminergic medication. RESULTS Although frontoparietal brain gray matter loss was associated with subpar response to deep brain stimulation, there was no significant link between brain atrophy and response to levodopa. CONCLUSION We conclude that response to deep brain stimulation relies on gray matter integrity; hence, gray matter loss may present a risk factor for poor response to deep brain stimulation and may be considered when making decision regarding clinical practice.
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Affiliation(s)
- Hannah Jergas
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Jan Niklas Petry-Schmelzer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Haidar S Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Functional Neurosurgery and Stereotaxy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine, Forschungszentrum Jülich, Jülich, Germany
| | - Juan Carlos Baldermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael T Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Effects of Contralateral Deep Brain Stimulation and Levodopa on Subthalamic Nucleus Oscillatory Activity and Phase-Amplitude Coupling. Neuromodulation 2023; 26:310-319. [PMID: 36513587 DOI: 10.1016/j.neurom.2022.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/14/2022] [Accepted: 11/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The modulatory effects of medication and deep brain stimulation (DBS) on subthalamic nucleus (STN) neural activity in Parkinson's disease have been widely studied. However, effects on the contralateral side to the stimulated STN, in particular, changes in local field potential (LFP) oscillatory activity and phase-amplitude coupling (PAC), have not yet been reported. OBJECTIVE The aim of this study was to examine changes in STN LFP activity across a range of frequency bands and STN PAC for different combinations of DBS and medication on/off on the side contralateral to the applied stimulation. MATERIALS AND METHODS We examined STN LFPs that were recorded using externalized leads from eight parkinsonian patients during unilateral DBS from the side contralateral to the stimulation. LFP spectral power in alpha (5 to ∼13 Hz), low beta (13 to ∼20 Hz), high beta (20-30 Hz), and high gamma plus high-frequency oscillation (high gamma+HFO) (100-400 Hz) bands were estimated for different combinations of medication and unilateral stimulation (off/on). PAC between beta and high gamma+HFO in the STN LFPs was also investigated. The effect of the condition was examined using linear mixed models. RESULTS PAC in the STN LFP was reduced by DBS when compared to the baseline condition (no medication and stimulation). Medication had no significant effect on PAC. Alpha power decreased with DBS, both alone and when combined with medication. Beta power decreased with DBS, medication, and DBS and medication combined. High gamma+HFO power increased during the application of contralateral DBS and was unaltered by medication. CONCLUSIONS The results provide new insights into the effects of DBS and levodopa on STN LFP PAC and oscillatory activity on the side contralateral to stimulation. These may have important implications in understanding mechanisms underlying motor improvements with DBS, including changes on both contralateral and ipsilateral sides, while suggesting a possible role for contralateral sensing during unilateral DBS.
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18
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Holland MT, Jiao J, Mantovani A, Anderson S, Mitchell KA, Safarpour D, Burchiel KJ. Identifying the therapeutic zone in globus pallidus deep brain stimulation for Parkinson's disease. J Neurosurg 2023; 138:329-336. [PMID: 35901683 DOI: 10.3171/2022.5.jns22152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/19/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The globus pallidus internus (GPI) has been demonstrated to be an effective surgical target for deep brain stimulation (DBS) treatment in patients with medication-refractory Parkinson's disease (PD). The ability of neurosurgeons to define the area of greatest therapeutic benefit within the globus pallidus (GP) may improve clinical outcomes in these patients. The objective of this study was to determine the best DBS therapeutic implantation site within the GP for effective treatment in PD patients. METHODS The authors performed a retrospective review of 56 patients who underwent bilateral GP DBS implantation at their institution during the period from January 2015 to January 2020. Each implanted contact was anatomically localized. Patients were followed for stimulation programming for at least 6 months. The authors reviewed preoperative and 6-month postsurgery clinical outcomes based on data from the Unified Parkinson's Disease Rating Scale Part III (UPDRS III), dyskinesia scores, and levodopa equivalent daily dose (LEDD). RESULTS Of the 112 leads implanted, the therapeutic cathode was most frequently located in the lamina between the GPI external segment (GPIe) and the GP externus (GPE) (n = 40). Other common locations included the GPE (n = 24), the GPIe (n = 15), and the lamina between the GPI internal segment (GPIi) and the GPIe (n = 14). In the majority of patients (73%) a monopolar programming configuration was used. At 6 months postsurgery, UPDRS III off medications (OFF) and on stimulation (ON) scores significantly improved (z = -4.02, p < 0.001), as did postsurgery dyskinesia ON scores (z = -4.08, p < 0.001) and postsurgery LEDD (z = -4.7, p < 0.001). CONCLUSIONS Though the ventral GP (pallidotomy target) has been a commonly used target for GP DBS, a more dorsolateral target may be more effective for neuromodulation strategies. The assessment of therapeutic contact locations performed in this study showed that the lamina between GPI and GPE used in most patients is the optimal central stimulation target. This information should improve preoperative GP targeting.
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Affiliation(s)
- Marshall T Holland
- 1Department of Neurological Surgery, University of Alabama at Birmingham, Alabama; and
| | | | - Alessandra Mantovani
- 3Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Katherine A Mitchell
- 3Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
| | | | - Kim J Burchiel
- 3Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
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19
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Verma AK, Yu Y, Acosta-Lenis SF, Havel T, Sanabria DE, Molnar GF, MacKinnon CD, Howell MJ, Vitek JL, Johnson LA. Parkinsonian daytime sleep-wake classification using deep brain stimulation lead recordings. Neurobiol Dis 2023; 176:105963. [PMID: 36521781 PMCID: PMC9869648 DOI: 10.1016/j.nbd.2022.105963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/01/2022] [Accepted: 12/10/2022] [Indexed: 12/14/2022] Open
Abstract
Excessive daytime sleepiness is a recognized non-motor symptom that adversely impacts the quality of life of people with Parkinson's disease (PD), yet effective treatment options remain limited. Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective treatment for PD motor signs. Reliable daytime sleep-wake classification using local field potentials (LFPs) recorded from DBS leads implanted in STN can inform the development of closed-loop DBS approaches for prompt detection and disruption of sleep-related neural oscillations. We performed STN DBS lead recordings in three nonhuman primates rendered parkinsonian by administrating neurotoxin 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP). Reference sleep-wake states were determined on a second-by-second basis by video monitoring of eyes (eyes-open, wake and eyes-closed, sleep). The spectral power in delta (1-4 Hz), theta (4-8 Hz), low-beta (8-20 Hz), high-beta (20-35 Hz), gamma (35-90 Hz), and high-frequency (200-400 Hz) bands were extracted from each wake and sleep epochs for training (70% data) and testing (30% data) a support vector machines classifier for each subject independently. The spectral features yielded reasonable daytime sleep-wake classification (sensitivity: 90.68 ± 1.28; specificity: 88.16 ± 1.08; accuracy: 89.42 ± 0.68; positive predictive value; 88.70 ± 0.89, n = 3). Our findings support the plausibility of monitoring daytime sleep-wake states using DBS lead recordings. These results could have future clinical implications in informing the development of closed-loop DBS approaches for automatic detection and disruption of sleep-related neural oscillations in people with PD to promote wakefulness.
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Affiliation(s)
- Ajay K Verma
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Ying Yu
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Sergio F Acosta-Lenis
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Tyler Havel
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | | | - Gregory F Molnar
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Colum D MacKinnon
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Michael J Howell
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, United States of America
| | - Luke A Johnson
- Department of Neurology, University of Minnesota, Minneapolis, United States of America.
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20
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Fujikawa J, Morigaki R, Yamamoto N, Nakanishi H, Oda T, Izumi Y, Takagi Y. Diagnosis and Treatment of Tremor in Parkinson's Disease Using Mechanical Devices. LIFE (BASEL, SWITZERLAND) 2022; 13:life13010078. [PMID: 36676025 PMCID: PMC9863142 DOI: 10.3390/life13010078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/09/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Parkinsonian tremors are sometimes confused with essential tremors or other conditions. Recently, researchers conducted several studies on tremor evaluation using wearable sensors and devices, which may support accurate diagnosis. Mechanical devices are also commonly used to treat tremors and have been actively researched and developed. Here, we aimed to review recent progress and the efficacy of the devices related to Parkinsonian tremors. METHODS The PubMed and Scopus databases were searched for articles. We searched for "Parkinson disease" and "tremor" and "device". RESULTS Eighty-six articles were selected by our systematic approach. Many studies demonstrated that the diagnosis and evaluation of tremors in patients with PD can be done accurately by machine learning algorithms. Mechanical devices for tremor suppression include deep brain stimulation (DBS), electrical muscle stimulation, and orthosis. In recent years, adaptive DBS and optimization of stimulation parameters have been studied to further improve treatment efficacy. CONCLUSIONS Due to developments using state-of-the-art techniques, effectiveness in diagnosing and evaluating tremor and suppressing it using these devices is satisfactorily high in many studies. However, other than DBS, no devices are in practical use. To acquire high-level evidence, large-scale studies and randomized controlled trials are needed for these devices.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
- Parkinson’s Disease and Dystonia Research Center, Tokushima University Hospital, 2-50-1 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
- Correspondence: ; Tel.: +81-88-633-7149
| | - Nobuaki Yamamoto
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
- Beauty Life Corporation, 2 Kiba-Cho, Minato-Ku, Nagoya 455-0021, Aichi, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
| | - Yuishin Izumi
- Parkinson’s Disease and Dystonia Research Center, Tokushima University Hospital, 2-50-1 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, 3-18-15 Kuramoto-Cho, Tokushima-Shi 770-8503, Tokushima, Japan
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21
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Peter J, Ferraioli F, Mathew D, George S, Chan C, Alalade T, Salcedo SA, Saed S, Tatti E, Quartarone A, Ghilardi MF. Movement-related beta ERD and ERS abnormalities in neuropsychiatric disorders. Front Neurosci 2022; 16:1045715. [PMID: 36507340 PMCID: PMC9726921 DOI: 10.3389/fnins.2022.1045715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/31/2022] [Indexed: 11/24/2022] Open
Abstract
Movement-related oscillations in the beta range (from 13 to 30 Hz) have been observed over sensorimotor areas with power decrease (i.e., event-related desynchronization, ERD) during motor planning and execution followed by an increase (i.e., event-related synchronization, ERS) after the movement's end. These phenomena occur during active, passive, imaged, and observed movements. Several electrophysiology studies have used beta ERD and ERS as functional indices of sensorimotor integrity, primarily in diseases affecting the motor system. Recent literature also highlights other characteristics of beta ERD and ERS, implying their role in processes not strictly related to motor function. Here we review studies about movement-related ERD and ERS in diseases characterized by motor dysfunction, including Parkinson's disease, dystonia, stroke, amyotrophic lateral sclerosis, cerebral palsy, and multiple sclerosis. We also review changes of beta ERD and ERS reported in physiological aging, Alzheimer's disease, and schizophrenia, three conditions without overt motor symptoms. The review of these works shows that ERD and ERS abnormalities are present across the spectrum of the examined pathologies as well as development and aging. They further suggest that cognition and movement are tightly related processes that may share common mechanisms regulated by beta modulation. Future studies with a multimodal approach are warranted to understand not only the specific topographical dynamics of movement-related beta modulation but also the general meaning of beta frequency changes occurring in relation to movement and cognitive processes at large. Such an approach will provide the foundation to devise and implement novel therapeutic approaches to neuropsychiatric disorders.
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Affiliation(s)
- Jaime Peter
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Francesca Ferraioli
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Dave Mathew
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shaina George
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Cameron Chan
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Tomisin Alalade
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Sheilla A. Salcedo
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Shannon Saed
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States
| | - Elisa Tatti
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,*Correspondence: Elisa Tatti,
| | - Angelo Quartarone
- IRCCS Centro Neurolesi Bonino Pulejo-Piemonte, Messina, Italy,Angelo Quartarone,
| | - M. Felice Ghilardi
- Department of Molecular, Cellular and Biomedical Sciences, CUNY School of Medicine, New York, NY, United States,M. Felice Ghilardi,
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22
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Lin HC, Wu YH, Huang CW, Ker MD. Verification of the beta oscillations in the subthalamic nucleus of the MPTP-induced parkinsonian minipig model. Brain Res 2022; 1798:148165. [DOI: 10.1016/j.brainres.2022.148165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/03/2022] [Accepted: 11/10/2022] [Indexed: 11/14/2022]
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23
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Prenassi M, Borellini L, Bocci T, Scola E, Barbieri S, Priori A, Ferrucci R, Cogiamanian F, Locatelli M, Rampini P, Vergari M, Pastore S, Datola B, Marceglia S. Peri-lead edema and local field potential correlation in post-surgery subthalamic nucleus deep brain stimulation patients. Front Hum Neurosci 2022; 16:950434. [PMID: 36158622 PMCID: PMC9495298 DOI: 10.3389/fnhum.2022.950434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
Implanting deep brain stimulation (DBS) electrodes in patients with Parkinson’s disease often results in the appearance of a non-infectious, delayed-onset edema that disappears over time. However, the time window between the DBS electrode and DBS stimulating device implant is often used to record local field potentials (LFPs) which are used both to better understand basal ganglia pathophysiology and to improve DBS therapy. In this work, we investigated whether the presence of post-surgery edema correlates with the quality of LFP recordings in eight patients with advanced Parkinson’s disease implanted with subthalamic DBS electrodes. The magnetic resonance scans of the brain after 8.5 ± 1.5 days from the implantation surgery were segmented and the peri-electrode edema volume was calculated for both brain hemispheres. We found a correlation (ρ = −0.81, p < 0.0218, Spearman’s correlation coefficient) between left side local field potentials of the low beta band (11–20 Hz) and the edema volume of the same side. No other significant differences between the hemispheres were found. Despite the limited sample size, our results suggest that the effect on LFPs may be related to the edema localization, thus indicating a mechanism involving brain networks instead of a simple change in the electrode-tissue interface.
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Affiliation(s)
- Marco Prenassi
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Engineering and Architecture, Università degli Studi di Trieste, Trieste, Italy
- *Correspondence: Marco Prenassi
| | - Linda Borellini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Tommaso Bocci
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy
| | - Elisa Scola
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Neuroradiology Unit, Department of Radiology, Careggi University Hospital, Florence, Italy
| | - Sergio Barbieri
- Department of Engineering and Architecture, Università degli Studi di Trieste, Trieste, Italy
| | - Alberto Priori
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy
| | - Roberta Ferrucci
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy
| | | | - Marco Locatelli
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- “Aldo Ravelli” Research Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, University of Milan Medical School, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Paolo Rampini
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Maurizio Vergari
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Stefano Pastore
- Department of Engineering and Architecture, Università degli Studi di Trieste, Trieste, Italy
| | - Bianca Datola
- Department of Engineering and Architecture, Università degli Studi di Trieste, Trieste, Italy
| | - Sara Marceglia
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Engineering and Architecture, Università degli Studi di Trieste, Trieste, Italy
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24
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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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25
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Legarda SB, Michas-Martin PA, McDermott D. Managing Intractable Symptoms of Parkinson's Disease: A Nonsurgical Approach Employing Infralow Frequency Neuromodulation. Front Hum Neurosci 2022; 16:894781. [PMID: 35880105 PMCID: PMC9308006 DOI: 10.3389/fnhum.2022.894781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
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26
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Dopamine depletion can be predicted by the aperiodic component of subthalamic local field potentials. Neurobiol Dis 2022; 168:105692. [DOI: 10.1016/j.nbd.2022.105692] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 03/06/2022] [Accepted: 03/11/2022] [Indexed: 12/19/2022] Open
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27
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Alavi SM, Mirzaei A, Valizadeh A, Ebrahimpour R. Excitatory deep brain stimulation quenches beta oscillations arising in a computational model of the subthalamo-pallidal loop. Sci Rep 2022; 12:7845. [PMID: 35552409 PMCID: PMC9098470 DOI: 10.1038/s41598-022-10084-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/21/2022] [Indexed: 11/30/2022] Open
Abstract
Parkinson’s disease (PD) is associated with abnormal \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β band oscillations (13–30 Hz) in the cortico-basal ganglia circuits. Abnormally increased striato-pallidal inhibition and strengthening the synaptic coupling between subthalamic nucleus (STN) and globus pallidus externa (GPe), due to the loss of dopamine, are considered as the potential sources of \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations in the basal ganglia. Deep brain stimulation (DBS) of the basal ganglia subregions is known as a way to reduce the pathological \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations and motor deficits related to PD. Despite the success of the DBS, its underlying mechanism is poorly understood and, there is controversy about the inhibitory or excitatory role of the DBS in the literature. Here, we utilized a computational network model of basal ganglia which consists of STN, GPe, globus pallidus interna, and thalamic neuronal population. This model can reproduce healthy and pathological \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations similar to what has been observed in experimental studies. Using this model, we investigated the effect of DBS to understand whether its effect is excitatory or inhibitory. Our results show that the excitatory DBS is able to quench the pathological synchrony and \documentclass[12pt]{minimal}
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\begin{document}$$\beta$$\end{document}β oscillations, while, applying inhibitory DBS failed to quench the PD signs. In light of simulation results, we conclude that the effect of the DBS on its target is excitatory.
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Affiliation(s)
- Seyed Mojtaba Alavi
- Faculty of Computer Engineering, Shahid Rajaee Teacher Training University, Tehran, Iran.,School of Cognitive Sciences (SCS), Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | | | - Alireza Valizadeh
- Department of Physics, Institute for Advance Studies in Basic Sciences (IASBS), Zanjan, Iran.,School of Biological Sciences, Institute for Research in Fundamental Sciences (IPM), Tehran, Iran
| | - Reza Ebrahimpour
- Faculty of Computer Engineering, Shahid Rajaee Teacher Training University, Tehran, Iran. .,School of Cognitive Sciences (SCS), Institute for Research in Fundamental Sciences (IPM), Tehran, Iran.
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28
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Hirschmann J, Steina A, Vesper J, Florin E, Schnitzler A. Neuronal oscillations predict deep brain stimulation outcome in Parkinson's disease. Brain Stimul 2022; 15:792-802. [PMID: 35568311 DOI: 10.1016/j.brs.2022.05.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Neuronal oscillations are linked to symptoms of Parkinson's disease. This relation can be exploited for optimizing deep brain stimulation (DBS), e.g. by informing a device or human about the optimal location, time and intensity of stimulation. Whether oscillations predict individual DBS outcome is not clear so far. OBJECTIVE To predict motor symptom improvement from subthalamic power and subthalamo-cortical coherence. METHODS We applied machine learning techniques to simultaneously recorded magnetoencephalography and local field potential data from 36 patients with Parkinson's disease. Gradient-boosted tree learning was applied in combination with feature importance analysis to generate and understand out-of-sample predictions. RESULTS A few features sufficed for making accurate predictions. A model operating on five coherence features, for example, achieved correlations of r > 0.8 between actual and predicted outcomes. Coherence comprised more information in less features than subthalamic power, although in general their information content was comparable. Both signals predicted akinesia/rigidity reduction best. The most important local feature was subthalamic high-beta power (20-35 Hz). The most important connectivity features were subthalamo-parietal coherence in the very high frequency band (>200 Hz) and subthalamo-parietal coherence in low-gamma band (36-60 Hz). Successful prediction was not due to the model inferring distance to target or symptom severity from neuronal oscillations. CONCLUSION This study demonstrates for the first time that neuronal oscillations are predictive of DBS outcome. Coherence between subthalamic and parietal oscillations are particularly informative. These results highlight the clinical relevance of inter-areal synchrony in basal ganglia-cortex loops and might facilitate further improvements of DBS in the future.
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Affiliation(s)
- Jan Hirschmann
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, 40225, Düsseldorf, Germany.
| | - Alexandra Steina
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, 40225, Düsseldorf, Germany
| | - Jan Vesper
- Functional Neurosurgery and Stereotaxy, Department of Neurosurgery, Medical Faculty, Heinrich Heine University, 40225, Düsseldorf, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, 40225, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University, 40225, Düsseldorf, Germany; Center for Movement Disorders and Neuromodulation, Department of Neurology, Medical Faculty, Heinrich Heine University, 40225, Düsseldorf, Germany
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29
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Cassar IR, Grill WM. The cortical evoked potential corresponds with deep brain stimulation efficacy in rats. J Neurophysiol 2022; 127:1253-1268. [PMID: 35389751 PMCID: PMC9054265 DOI: 10.1152/jn.00353.2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 03/28/2022] [Accepted: 04/02/2022] [Indexed: 01/21/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) antidromically activates the motor cortex (M1), and this cortical activation appears to play a role in the treatment of hypokinetic motor behaviors (Gradinaru V, Mogri M, Thompson KR, Henderson JM, Deisseroth K. Science 324: 354-359, 2009; Yu C, Cassar IR, Sambangi J, Grill WM. J Neurosci 40: 4323-4334, 2020). The synchronous antidromic activation takes the form of a short-latency cortical evoked potential (cEP) in electrocorticography (ECoG) recordings of M1. We assessed the utility of the cEP as a biomarker for STN DBS in unilateral 6-hydroxydopamine-lesioned female Sprague Dawley rats, with stimulating electrodes implanted in the STN and the ECoG recorded above M1. We quantified the correlations of the cEP magnitude and latency with changes in motor behavior from DBS and compared them to the correlation between motor behaviors and several commonly used spectral-based biomarkers. The cEP features correlated strongly with motor behaviors and were highly consistent across animals, whereas the spectral biomarkers correlated weakly with motor behaviors and were highly variable across animals. The cEP may thus be a useful biomarker for assessing the therapeutic efficacy of DBS parameters, as its features strongly correlate with motor behavior, it is consistent across time and subjects, it can be recorded under anesthesia, and it is simple to quantify with a large signal-to-noise ratio, enabling rapid, real-time evaluation. Additionally, our work provides further evidence that antidromic cortical activation mediates changes in motor behavior from STN DBS and that the dependence of DBS efficacy on stimulation frequency may be related to antidromic spike failure.NEW & NOTEWORTHY We characterize a new potential biomarker for deep brain stimulation (DBS), the cortical evoked potential (cEP), and demonstrate that it exhibits a robust correlation with motor behaviors as a function of stimulation frequency. The cEP may thus be a useful clinical biomarker for changes in motor behavior. This work also provides insight into the cortical mechanisms of DBS, suggesting that motor behaviors are strongly affected by the rate of antidromic spike failure during DBS.
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Affiliation(s)
- Isaac R Cassar
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
- Department of Electrical and Computer Engineering, Duke University, Durham, North Carolina
- Department of Neurobiology, Duke University, Durham, North Carolina
- Department of Neurosurgery, Duke University, Durham, North Carolina
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30
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Toward therapeutic electrophysiology: beta-band suppression as a biomarker in chronic local field potential recordings. NPJ Parkinsons Dis 2022; 8:44. [PMID: 35440571 PMCID: PMC9018912 DOI: 10.1038/s41531-022-00301-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 03/04/2022] [Indexed: 11/08/2022] Open
Abstract
Adaptive deep brain stimulation (aDBS) is a promising concept for feedback-based neurostimulation, with the potential of clinical implementation with the sensing-enabled Percept neurostimulator. We aim to characterize chronic electrophysiological activity during stimulation and to validate beta-band activity as a biomarker for bradykinesia. Subthalamic activity was recorded during stepwise stimulation amplitude increase OFF medication in 10 Parkinson's patients during rest and finger tapping. Offline analysis of wavelet-transformed beta-band activity and assessment of inter-variable relationships in linear mixed effects models were implemented. There was a stepwise suppression of low-beta activity with increasing stimulation intensity (p = 0.002). Low-beta power was negatively correlated with movement speed and predictive for velocity improvements (p < 0.001), stimulation amplitude for beta suppression (p < 0.001). Here, we characterize beta-band modulation as a chronic biomarker for motor performance. Our investigations support the use of electrophysiology in therapy optimization, providing evidence for the use of biomarker analysis for clinical aDBS.
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31
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Sanmartino F, Cruz-Gómez ÁJ, Rashid-López R, Lozano-Soto E, López-Sosa F, Zuazo A, Riqué-Dormido J, Espinosa-Rosso R, González-Rosa JJ. Subthalamic Beta Activity in Parkinson's Disease May Be Linked to Dorsal Striatum Gray Matter Volume and Prefrontal Cortical Thickness: A Pilot Study. Front Neurol 2022; 13:799696. [PMID: 35401426 PMCID: PMC8985754 DOI: 10.3389/fneur.2022.799696] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Excessive oscillations at beta frequencies (13–35 Hz) in the subthalamic nucleus (STN) represent a pathophysiological hallmark of Parkinson's disease (PD), which correlates well with parkinsonian symptoms and is reduced in response to standard disease treatments. However, the association of disease-specific regional gray matter (GM) atrophy or cortical thickness (CT) with the presence of STN beta oscillatory activity has been poorly investigated but is of relevance given the potential of these variables for extracting information about PD pathophysiology. This exploratory study investigated the involvement of regional GM volume and CT in the basal ganglia-cortical network and its potential association with the presence of STN beta oscillatory activity in PD. Methods We acquired preoperative GM densities on T1-weighted magnetic resonance imaging scans and we carried out regional estimation of GM volume and CT. LFP activities from the STN were recorded post-operatively in 7 cognitively preserved PD patients off dopaminergic medication undergoing deep-brain stimulation surgery. Oscillatory beta power was determined by power spectral density of 4-min resting state STN LFP activity. Spearman partial correlations and regression analysis were used to screen the presence of STN beta power for their relationship with GM volume and CT measurements. Results After controlling for the effects of age, educational level, and disease duration, and after correcting for multiple testing, enhanced STN beta power showed significant and negative correlations between, first, volume of the right putamen and left caudate nucleus, and second, smaller CT in frontal regions involving the left rostral middle frontal gyrus (MFG) and left medial orbitofrontal gyrus. A lower volume in the right putamen and a lower CT in the left MFG demonstrated the strongest associations with increased STN beta power. Conclusions These tentative results seem to suggest that STN LFP beta frequencies may be mainly linked to different but ongoing parallel neurodegenerative processes, on the one hand, to GM volume reduction in dorsal striatum, and on the other hand, to CT reduction of prefrontal-“associative” regions. These findings could further delineate the brain structural interactions underpinning the exaggerated STN beta activity commonly observed in PD patients.
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Affiliation(s)
- Florencia Sanmartino
- Department of Psychology, University of Cadiz, Cádiz, Spain.,Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain
| | - Álvaro J Cruz-Gómez
- Department of Psychology, University of Cadiz, Cádiz, Spain.,Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain
| | - Raúl Rashid-López
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain.,Department of Neurology, Puerta del Mar University Hospital, Cádiz, Spain
| | - Elena Lozano-Soto
- Department of Psychology, University of Cadiz, Cádiz, Spain.,Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain
| | - Fernando López-Sosa
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain
| | - Amaya Zuazo
- Department of Radiodiagnostic and Medical Imaging, Puerta del Mar University Hospital, Cádiz, Spain
| | - Jesús Riqué-Dormido
- Department of Neurosurgery, Puerta del Mar University Hospital, Cádiz, Spain
| | - Raúl Espinosa-Rosso
- Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain.,Department of Neurology, Puerta del Mar University Hospital, Cádiz, Spain.,Department of Neurology, Jerez de la Frontera University Hospital, Jerez de la Frontera, Spain
| | - Javier J González-Rosa
- Department of Psychology, University of Cadiz, Cádiz, Spain.,Psychophysiology and Neuroimaging Group, Institute of Biomedical Research Cadiz (INiBICA), Cádiz, Spain
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32
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Fernández-García C, Monje MH, Gómez-Mayordomo V, Foffani G, Herranz R, Catalán MJ, González-Hidalgo M, Matias-Guiu J, Alonso-Frech F. Long-term directional deep brain stimulation: Monopolar review vs. local field potential guided programming. Brain Stimul 2022; 15:727-736. [DOI: 10.1016/j.brs.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 01/16/2022] [Accepted: 04/20/2022] [Indexed: 11/02/2022] Open
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Fujikawa J, Morigaki R, Yamamoto N, Oda T, Nakanishi H, Izumi Y, Takagi Y. Therapeutic Devices for Motor Symptoms in Parkinson’s Disease: Current Progress and a Systematic Review of Recent Randomized Controlled Trials. Front Aging Neurosci 2022; 14:807909. [PMID: 35462692 PMCID: PMC9020378 DOI: 10.3389/fnagi.2022.807909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/14/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pharmacotherapy is the first-line treatment option for Parkinson’s disease, and levodopa is considered the most effective drug for managing motor symptoms. However, side effects such as motor fluctuation and dyskinesia have been associated with levodopa treatment. For these conditions, alternative therapies, including invasive and non-invasive medical devices, may be helpful. This review sheds light on current progress in the development of devices to alleviate motor symptoms in Parkinson’s disease. Methods We first conducted a narrative literature review to obtain an overview of current invasive and non-invasive medical devices and thereafter performed a systematic review of recent randomized controlled trials (RCTs) of these devices. Results Our review revealed different characteristics of each device and their effectiveness for motor symptoms. Although invasive medical devices are usually highly effective, surgical procedures can be burdensome for patients and have serious side effects. In contrast, non-pharmacological/non-surgical devices have fewer complications. RCTs of non-invasive devices, especially non-invasive brain stimulation and mechanical peripheral stimulation devices, have proven effectiveness on motor symptoms. Nearly no non-invasive devices have yet received Food and Drug Administration certification or a CE mark. Conclusion Invasive and non-invasive medical devices have unique characteristics, and several RCTs have been conducted for each device. Invasive devices are more effective, while non-invasive devices are less effective and have lower hurdles and risks. It is important to understand the characteristics of each device and capitalize on these.
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Affiliation(s)
- Joji Fujikawa
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Ryoma Morigaki
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- *Correspondence: Ryoma Morigaki,
| | - Nobuaki Yamamoto
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Teruo Oda
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Hiroshi Nakanishi
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yuishin Izumi
- Department of Neurology, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
| | - Yasushi Takagi
- Department of Advanced Brain Research, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
- Department of Neurosurgery, Institute of Biomedical Sciences, Graduate School of Medicine, Tokushima University, Tokushima, Japan
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34
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Klostermann F, Ehlen F, Tiedt HO. Effects of thalamic and basal ganglia deep brain stimulation on language-related functions - Conceptual and clinical considerations. Eur J Paediatr Neurol 2022; 37:75-81. [PMID: 35149269 DOI: 10.1016/j.ejpn.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 10/19/2022]
Abstract
Deep Brain Stimulation (DBS) is a therapy for various neurological movement disorders. It acts predominantly on motor symptoms, but may unfold a number of mostly subtle cognitive effects. In this regard, reports on particular language-related DBS sequels are comparably frequent, but difficult to overlook, given the heterogeneity of targeted structures in the brain, treated diseases, assessment methods and results reported. Accordingly, available knowledge was organized with respect to important aspects, such as the main DBS loci and surgical versus neuromodulatory therapy actions. Current views of biolinguistic underpinnings of the reviewed data, their clinical relevance and potential implications are discussed.
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Affiliation(s)
- Fabian Klostermann
- Charité - University Medicine Berlin, Clinic for Neurology, Campus Benjamin Franklin, Germany; Berlin School of Mind and Brain, Germany.
| | - Felicitas Ehlen
- Jewish Hospital Berlin, Clinic for Psychiatry and Psychotherapy, Germany
| | - Hannes Ole Tiedt
- Charité - University Medicine Berlin, Clinic for Neurology, Campus Benjamin Franklin, Germany
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35
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Karekal A, Miocinovic S, Swann NC. Novel approaches for quantifying beta synchrony in Parkinson's disease. Exp Brain Res 2022; 240:991-1004. [PMID: 35099592 DOI: 10.1007/s00221-022-06308-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
Abstract
Despite the clinical and financial burden of Parkinson's disease (PD), there is no standardized, reliable biomarker to diagnose and track PD progression. Instead, PD is primarily assessed using subjective clinical rating scales and patient self-report. Such approaches can be imprecise, hindering diagnosis and disease monitoring. An objective biomarker would be beneficial for clinical care, refining diagnosis, and treatment. Due to widespread electrophysiological abnormalities both within and between brain structures in PD, development of electrophysiologic biomarkers may be feasible. Basal ganglia recordings acquired with neurosurgical approaches have revealed elevated power in the beta frequency range (13-30 Hz) in PD, suggesting that beta power could be a putative PD biomarker. However, there are limitations to the use of beta power as a biomarker. Recent advances in analytic approaches have led to novel methods to quantify oscillatory synchrony in the beta frequency range. Here we describe some of these novel approaches in the context of PD and explore how they may serve as electrophysiological biomarkers. These novel signatures include (1) interactions between beta phase and broadband (> 50 Hz, "gamma") amplitude (i.e., phase amplitude coupling, PAC), (2) asymmetries in waveform shape, (3) beta coherence, and (4) beta "bursts." Development of a robust, reliable, and readily accessible electrophysiologic biomarker would represent a major step towards more precise and personalized care in PD.
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Affiliation(s)
- Apoorva Karekal
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
| | | | - Nicole C Swann
- Department of Human Physiology, University of Oregon, Eugene, OR, USA.
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36
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Pozzi NG, Isaias IU. Adaptive deep brain stimulation: Retuning Parkinson's disease. HANDBOOK OF CLINICAL NEUROLOGY 2022; 184:273-284. [PMID: 35034741 DOI: 10.1016/b978-0-12-819410-2.00015-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A brain-machine interface represents a promising therapeutic avenue for the treatment of many neurologic conditions. Deep brain stimulation (DBS) is an invasive, neuro-modulatory tool that can improve different neurologic disorders by delivering electric stimulation to selected brain areas. DBS is particularly successful in advanced Parkinson's disease (PD), where it allows sustained improvement of motor symptoms. However, this approach is still poorly standardized, with variable clinical outcomes. To achieve an optimal therapeutic effect, novel adaptive DBS (aDBS) systems are being developed. These devices operate by adapting stimulation parameters in response to an input signal that can represent symptoms, motor activity, or other behavioral features. Emerging evidence suggests greater efficacy with fewer adverse effects during aDBS compared with conventional DBS. We address this topic by discussing the basics principles of aDBS, reviewing current evidence, and tackling the many challenges posed by aDBS for PD.
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Affiliation(s)
- Nicoló G Pozzi
- Department of Neurology, University Hospital Würzburg and Julius Maximilian University Würzburg, Würzburg, Germany
| | - Ioannis U Isaias
- Department of Neurology, University Hospital Würzburg and Julius Maximilian University Würzburg, Würzburg, Germany.
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37
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Arlotti M, Colombo M, Bonfanti A, Mandat T, Lanotte MM, Pirola E, Borellini L, Rampini P, Eleopra R, Rinaldo S, Romito L, Janssen MLF, Priori A, Marceglia S. A New Implantable Closed-Loop Clinical Neural Interface: First Application in Parkinson's Disease. Front Neurosci 2021; 15:763235. [PMID: 34949982 PMCID: PMC8689059 DOI: 10.3389/fnins.2021.763235] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Deep brain stimulation (DBS) is used for the treatment of movement disorders, including Parkinson’s disease, dystonia, and essential tremor, and has shown clinical benefits in other brain disorders. A natural path for the improvement of this technique is to continuously observe the stimulation effects on patient symptoms and neurophysiological markers. This requires the evolution of conventional deep brain stimulators to bidirectional interfaces, able to record, process, store, and wirelessly communicate neural signals in a robust and reliable fashion. Here, we present the architecture, design, and first use of an implantable stimulation and sensing interface (AlphaDBSR System) characterized by artifact-free recording and distributed data management protocols. Its application in three patients with Parkinson’s disease (clinical trial n. NCT04681534) is shown as a proof of functioning of a clinically viable implanted brain-computer interface (BCI) for adaptive DBS. Reliable artifact free-recordings, and chronic long-term data and neural signal management are in place.
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Affiliation(s)
| | | | - Andrea Bonfanti
- Newronika SpA, Milan, Italy.,Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Tomasz Mandat
- Narodowy Instytut Onkologii im. Marii Skłodowskiej-Curie, Warsaw, Poland
| | - Michele Maria Lanotte
- Department of Neuroscience, University of Torino, Torino, Italy.,AOU Città della Salute e della Scienza, Molinette Hospital, Turin, Italy
| | - Elena Pirola
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Linda Borellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Rampini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Eleopra
- Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Sara Rinaldo
- Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Luigi Romito
- Movement Disorders Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Marcus L F Janssen
- Department of Neurology and Clinical Neurophysiology, Maastricht University Medical Center, Maastricht, Netherlands.,Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alberto Priori
- Department of Health Sciences, Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, University of Milan, Milan, Italy
| | - Sara Marceglia
- Dipartimento di Ingegneria e Architettura, Università degli Studi di Trieste, Trieste, Italy
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38
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Tai CH. Subthalamic burst firing: A pathophysiological target in Parkinson's disease. Neurosci Biobehav Rev 2021; 132:410-419. [PMID: 34856222 DOI: 10.1016/j.neubiorev.2021.11.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/16/2021] [Accepted: 11/28/2021] [Indexed: 11/27/2022]
Abstract
Understanding the pathophysiological mechanism of Parkinson's disease (PD) in the subthalamic nucleus (STN) has become a critical issue since deep brain stimulation (DBS) in this region has been proven as an effective treatment for this disease. The STN possesses a special ability to switch from the spike to the burst firing mode in response to dopamine deficiency in parkinsonism, and this STN burst is considered an electrophysiological signature of the cortico-basal ganglia circuit in the brains of PD patients. This review focuses on the role of STN burst firing in the pathophysiology of PD and during DBS. Here, we review existing literature on how STN bursts originate and the specific factors affecting their formation; how STN burst firing causes motor symptoms in PD and how interventions can rescue these symptoms. Finally, the similarities and differences between the two electrophysiological hallmarks of PD, STN burst firing and beta-oscillation, are discussed. STN burst firing should be considered as a pathophysiological target in PD during treatment with DBS.
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Affiliation(s)
- Chun-Hwei Tai
- Department of Neurology, National Taiwan University Hospital, No. 7, Jhongshan South Road, 100225, Taipei, Taiwan.
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39
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Marceglia S, Guidetti M, Harmsen IE, Loh A, Meoni S, Foffani G, Lozano AM, Volkmann J, Moro E, Priori A. Deep brain stimulation: is it time to change gears by closing the loop? J Neural Eng 2021; 18. [PMID: 34678794 DOI: 10.1088/1741-2552/ac3267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/22/2021] [Indexed: 11/12/2022]
Abstract
Objective.Adaptive deep brain stimulation (aDBS) is a form of invasive stimulation that was conceived to overcome the technical limitations of traditional DBS, which delivers continuous stimulation of the target structure without considering patients' symptoms or status in real-time. Instead, aDBS delivers on-demand, contingency-based stimulation. So far, aDBS has been tested in several neurological conditions, and will be soon extensively studied to translate it into clinical practice. However, an exhaustive description of technical aspects is still missing.Approach.in this topical review, we summarize the knowledge about the current (and future) aDBS approach and control algorithms to deliver the stimulation, as reference for a deeper undestending of aDBS model.Main results.We discuss the conceptual and functional model of aDBS, which is based on the sensing module (that assesses the feedback variable), the control module (which interpretes the variable and elaborates the new stimulation parameters), and the stimulation module (that controls the delivery of stimulation), considering both the historical perspective and the state-of-the-art of available biomarkers.Significance.aDBS modulates neuronal circuits based on clinically relevant biofeedback signals in real-time. First developed in the mid-2000s, many groups have worked on improving closed-loop DBS technology. The field is now at a point in conducting large-scale randomized clinical trials to translate aDBS into clinical practice. As we move towards implanting brain-computer interfaces in patients, it will be important to understand the technical aspects of aDBS.
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Affiliation(s)
- Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, 34127 Trieste, Italy
| | - Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy.,Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
| | - Irene E Harmsen
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Sara Meoni
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy.,Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM U1216, University Grenoble Alpes, Grenoble, France
| | - Guglielmo Foffani
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain.,Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Jens Volkmann
- Department of Neurology, University of Wurzburg, Wurzburg, Germany
| | - Elena Moro
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM U1216, University Grenoble Alpes, Grenoble, France
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, 20142 Milan, Italy.,ASST Santi Paolo e Carlo, 20142 Milan, Italy
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40
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David FJ, Munoz MJ, Shils JL, Pauciulo MW, Hale PT, Nichols WC, Afshari M, Sani S, Verhagen Metman L, Corcos DM, Pal GD. Subthalamic Peak Beta Ratio Is Asymmetric in Glucocerebrosidase Mutation Carriers With Parkinson's Disease: A Pilot Study. Front Neurol 2021; 12:723476. [PMID: 34659089 PMCID: PMC8514636 DOI: 10.3389/fneur.2021.723476] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/24/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction: Up to 27% of individuals undergoing subthalamic nucleus deep brain stimulation (STN-DBS) have a genetic form of Parkinson's disease (PD). Glucocerebrosidase (GBA) mutation carriers, compared to sporadic PD, present with a more aggressive disease, less asymmetry, and fare worse on cognitive outcomes with STN-DBS. Evaluating STN intra-operative local field potentials provide the opportunity to assess and compare symmetry between GBA and non-GBA mutation carriers with PD; thus, providing insight into genotype and STN physiology, and eligibility for and programming of STN-DBS. The purpose of this pilot study was to test differences in left and right STN resting state beta power in non-GBA and GBA mutation carriers with PD. Materials and Methods: STN (left and right) resting state local field potentials were recorded intraoperatively from 4 GBA and 5 non-GBA patients with PD while off medication. Peak beta power expressed as a ratio to total beta power (peak beta ratio) was compared between STN hemispheres and groups while co-varying for age, age of disease onset, and disease severity. Results: Peak beta ratio was significantly different between the left and the right STN for the GBA group (p < 0.01) but not the non-GBA group (p = 0.56) after co-varying for age, age of disease onset, and disease severity. Discussion: Peak beta ratio in GBA mutation carriers was more asymmetric compared with non-mutation carriers and this corresponded with the degree of clinical asymmetry as measured by rating scales. This finding suggests that GBA mutation carriers have a physiologic signature that is distinct from that found in sporadic PD.
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Affiliation(s)
- Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Miranda J Munoz
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Jay L Shils
- Department of Anesthesiology, Rush University Medical Center, Chicago, IL, United States
| | - Michael W Pauciulo
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Philip T Hale
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - William C Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Mitra Afshari
- Department of Neurological Science, Rush University Medical Center, Chicago, IL, United States
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, United States
| | - Leo Verhagen Metman
- Department of Neurological Science, Rush University Medical Center, Chicago, IL, United States
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL, United States
| | - Gian D Pal
- Department of Neurological Science, Rush University Medical Center, Chicago, IL, United States.,Department of Neurology, Rutgers University, New Brunswick, NJ, United States
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Eight-hours conventional versus adaptive deep brain stimulation of the subthalamic nucleus in Parkinson's disease. NPJ PARKINSONS DISEASE 2021; 7:88. [PMID: 34584095 PMCID: PMC8478873 DOI: 10.1038/s41531-021-00229-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/23/2021] [Indexed: 12/04/2022]
Abstract
This study compares the effects on motor symptoms between conventional deep brain stimulation (cDBS) and closed-loop adaptive deep brain stimulation (aDBS) in patients with Parkinson’s Disease. The aDBS stimulation is controlled by the power in the beta band (12–35 Hz) of local field potentials recorded directly by subthalamic nucleus electrodes. Eight subjects were assessed in two 8-h stimulation sessions (first day, cDBS; second day, aDBS) with regular levodopa intake and during normal daily activities. The Unified Parkinson’s Disease Rating Scale (UPDRS) part III scores, the Rush scale for dyskinesias, and the total electrical energy delivered to the tissues per second (TEEDs) were significantly lower in the aDBS session (relative UPDRS mean, cDBS: 0.46 ± 0.05, aDBS: 0.33 ± 0.04, p = 0.015; UPDRS part III rigidity subset mean, cDBS: 2.9143 ± 0.6551 and aDBS: 2.1429 ± 0.5010, p = 0.034; UPDRS part III standard deviation cDBS: 2.95, aDBS: 2.68; p = 0.047; Rush scale, cDBS 2.79 ± 0.39 versus aDBS 1.57 ± 0.23, p = 0.037; cDBS TEEDs mean: 28.75 ± 3.36 µj s−1, aDBS TEEDs mean: 16.47 ± 3.33, p = 0.032 Wilcoxon’s sign rank test). This work further supports the safety and effectiveness of aDBS stimulation compared to cDBS in a daily session, both in terms of motor performance and TEED to the patient.
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Zokaei N, Quinn AJ, Hu MT, Husain M, van Ede F, Nobre AC. Reduced cortico-muscular beta coupling in Parkinson's disease predicts motor impairment. Brain Commun 2021; 3:fcab179. [PMID: 34514395 PMCID: PMC8421699 DOI: 10.1093/braincomms/fcab179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 05/15/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022] Open
Abstract
Long-range communication through the motor system is thought to be facilitated by phase coupling between neural activity in the 15–30 Hz beta range. During periods of sustained muscle contraction (grip), such coupling is manifest between motor cortex and the contralateral forearm muscles—measured as the cortico-muscular coherence. We examined alterations in cortico-muscular coherence in individuals with Parkinson’s disease, while equating grip strength between individuals with Parkinson’s disease (off their medication) and healthy control participants. We show a marked reduction in beta cortico-muscular coherence in the Parkinson’s disease group, even though the grip strength was comparable between the two groups. Moreover, the reduced cortico-muscular coherence was related to motor symptoms, so that individuals with lower cortico-muscular coherence also displayed worse motor symptoms. These findings highlight the cortico-muscular coherence as a simple, effective and clinically relevant neural marker of Parkinson’s disease pathology, with the potential to aid monitoring of disease progression and the efficacy of novel treatments for Parkinson’s disease.
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Affiliation(s)
- Nahid Zokaei
- Oxford Centre for Human Brain Activity (OHBA), Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Andrew J Quinn
- Oxford Centre for Human Brain Activity (OHBA), Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Michele T Hu
- Department of Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford OX2 6GG, UK
| | - Freek van Ede
- Oxford Centre for Human Brain Activity (OHBA), Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
| | - Anna Christina Nobre
- Oxford Centre for Human Brain Activity (OHBA), Wellcome Centre for Integrative Neuroimaging, Department of Psychiatry, University of Oxford, Oxford OX3 7JX, UK
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43
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Alanazi FI, Al-Ozzi TM, Kalia SK, Hodaie M, Lozano AM, Cohn M, Hutchison WD. Neurophysiological responses of globus pallidus internus during the auditory oddball task in Parkinson's disease. Neurobiol Dis 2021; 159:105490. [PMID: 34461266 DOI: 10.1016/j.nbd.2021.105490] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/21/2021] [Accepted: 08/25/2021] [Indexed: 11/28/2022] Open
Abstract
Parkinson's disease can be associated with significant cognitive impairment that may lead to dementia. Deep brain stimulation (DBS) of the subthalamic nucleus is an effective therapy for motor symptoms but is associated with cognitive decline. DBS of globus pallidus internus (GPi) poses less risk of cognitive decline so may be the preferred target. A research priority is to identify biomarkers of cognitive decline in this population, but efforts are hampered by a lack of understanding of the role of the different basal ganglia nuclei, such as the globus pallidus, in cognitive processing. During deep brain stimulation (DBS) surgery, we monitored single units, beta oscillatory LFP activity as well as event related potentials (ERPs) from the globus pallidus internus (GPi) of 16 Parkinson's disease patients, while they performed an auditory attention task. We used an auditory oddball task, during which one standard tone is presented at regular intervals and a second deviant tone is presented with a low probability that the subject is requested to count and report at the end of the task. All forms of neuronal activity studied were selective modulated by the attended tones. Of 62 neurons studied, the majority (51 or 82%) responded selectively to the deviant tone. Beta oscillatory activity showed an overall desynchronization during both types of attended tones interspersed by bursts of beta activity giving rise to peaks at a latency of around 200 ms after tone onset. cognitive ERPs recorded in GPi were selective to the attended tone and the right-side cERP was larger than the left side. The averages of trials showing a difference in beta oscillatory activity between deviant and standard also had a significant difference in cERP amplitude. In one block of trials, the random occurrence of 3 deviant tones in short succession silenced the activity of the GPi neuron being recorded. Trial blocks where a clear difference in LFP beta was seen were twice as likely to yield a correct tone count (25 vs 11). The data demonstrate strong modulation of GPi neuronal activity during the auditory oddball task. Overall, this study demonstrates an involvement of GPi in processing of non-motor cognitive tasks such as working memory and attention, and suggests that direct effects of DBS in non-motor GPi may contribute to cognitive changes observed post-operatively.
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Affiliation(s)
- Frhan I Alanazi
- Department of Physiology, University of Toronto, Canada; Krembil Research Institute, Toronto, Canada
| | - Tameem M Al-Ozzi
- Department of Physiology, University of Toronto, Canada; Krembil Research Institute, Toronto, Canada
| | - Suneil K Kalia
- Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada
| | - Mojgan Hodaie
- Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada
| | - Andres M Lozano
- Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada
| | - Melanie Cohn
- Krembil Research Institute, Toronto, Canada; Department of Psychology, University of Toronto, Canada
| | - William D Hutchison
- Department of Physiology, University of Toronto, Canada; Department of Surgery, University of Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital - University Health Network, Canada; Krembil Research Institute, Toronto, Canada.
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Priori A, Maiorana N, Dini M, Guidetti M, Marceglia S, Ferrucci R. Adaptive deep brain stimulation (aDBS). INTERNATIONAL REVIEW OF NEUROBIOLOGY 2021; 159:111-127. [PMID: 34446243 DOI: 10.1016/bs.irn.2021.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Deep brain stimulation is an established technique for the treatment of movement disorders related to neurodegenerative diseases such as Parkinson's disease (PD) and essential tremor (ET). Its application seems also feasible for the treatment of neuropsychiatric disorders such as treatment resistant depression (TRD) and Tourette's syndrome (TS). In a typical deep brain stimulation system, the amount of current delivered to the patients is constant and regulated by the physician. Conversely, an adaptive deep brain stimulation system (aDBS) is a closed loop system that adjusts the stimulation parameters according to biomarkers which reflect the patient's clinical state. In this chapter, we examined the main issues related to aDBS systems, which are both clinical and technological in nature. From a clinical point of view, we have reported the major findings related to symptoms management using aDBS and principal findings in animal models, showing that the implementation of closed loop adaptive deep brain stimulation can ameliorate symptom management in neurodegenerative disorders. From the technological point of view, we reported the major advances related to aDBS system design and implementation, such as noise filtering methods, biomarkers recording and processing to adjust pulse delivery. To date, aDBS systems represent a major evolution in brain stimulation, further developments are needed to maximize the efficacy of this technique and to expand its use in a wide range of neuropsychiatric disorders.
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Affiliation(s)
- Alberto Priori
- Department of Health Science, Aldo Ravelli Center, University of Milan, Milan, Italy.
| | - Natale Maiorana
- Department of Health Science, Aldo Ravelli Center, University of Milan, Milan, Italy
| | - Michelangelo Dini
- Department of Health Science, Aldo Ravelli Center, University of Milan, Milan, Italy
| | - Matteo Guidetti
- Department of Health Science, Aldo Ravelli Center, University of Milan, Milan, Italy
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Roberta Ferrucci
- Department of Health Science, Aldo Ravelli Center, University of Milan, Milan, Italy
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45
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Guidetti M, Marceglia S, Loh A, Harmsen IE, Meoni S, Foffani G, Lozano AM, Moro E, Volkmann J, Priori A. Clinical perspectives of adaptive deep brain stimulation. Brain Stimul 2021; 14:1238-1247. [PMID: 34371211 DOI: 10.1016/j.brs.2021.07.063] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/01/2021] [Accepted: 07/31/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The application of stimulators implanted directly over deep brain structures (i.e., deep brain stimulation, DBS) was developed in the late 1980s and has since become a mainstream option to treat several neurological conditions. Conventional DBS involves the continuous stimulation of the target structure, which is an approach that cannot adapt to patients' changing symptoms or functional status in real-time. At the beginning of 2000, a more sophisticated form of stimulation was conceived to overcome these limitations. Adaptive deep brain stimulation (aDBS) employs on-demand, contingency-based stimulation to stimulate only when needed. So far, aDBS has been tested in several pathological conditions in animal and human models. OBJECTIVE To review the current findings obtained from application of aDBS to animal and human models that highlights effects on motor, cognitive and psychiatric behaviors. FINDINGS while aDBS has shown promising results in the treatment of Parkinson's disease and essential tremor, the possibility of its use in less common DBS indications, such as cognitive and psychiatric disorders (Alzheimer's disease, obsessive-compulsive disorder, post-traumatic stress disorder) is still challenging. CONCLUSIONS While aDBS seems to be effective to treat movement disorders (Parkinson's disease and essential tremor), its role in cognitive and psychiatric disorders is to be determined, although neurophysiological assumptions are promising.
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Affiliation(s)
- Matteo Guidetti
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì, 8, 20142, Milan, Italy; Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci, 32, 20133, Milan, Italy.
| | - Sara Marceglia
- Department of Engineering and Architecture, University of Trieste, 34127, Trieste, Italy.
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Irene E Harmsen
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Sara Meoni
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì, 8, 20142, Milan, Italy; Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France; Grenoble Institute of Neurosciences, INSERM U1216, University Grenoble Alpes, Grenoble, France.
| | - Guglielmo Foffani
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain; Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain.
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada.
| | - Elena Moro
- Movement Disorders Unit, Division of Neurology, CHU Grenoble Alpes, Grenoble, France; Grenoble Institute of Neurosciences, INSERM U1216, University Grenoble Alpes, Grenoble, France.
| | - Jens Volkmann
- Department of Neurology, University of Wurzburg, Germany.
| | - Alberto Priori
- Aldo Ravelli Research Center for Neurotechnology and Experimental Neurotherapeutics, Department of Health Sciences, University of Milan, Via Antonio di Rudinì, 8, 20142, Milan, Italy; ASST Santi Paolo e Carlo, Milan, Italy.
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46
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Prenassi M, Arlotti M, Borellini L, Bocci T, Cogiamanian F, Locatelli M, Rampini P, Barbieri S, Priori A, Marceglia S. The Relationship Between Electrical Energy Delivered by Deep Brain Stimulation and Levodopa-Induced Dyskinesias in Parkinson's Disease: A Retrospective Preliminary Analysis. Front Neurol 2021; 12:643841. [PMID: 34135846 PMCID: PMC8200487 DOI: 10.3389/fneur.2021.643841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Adaptive Deep Brain Stimulation (aDBS) is now considered as a new feasible and effective paradigm to deliver DBS to patients with Parkinson's disease (PD) in such a way that not only stimulation is personalized and finely tuned to the instantaneous patient's state, but also motor improvement is obtained with a lower amount of energy transferred to the tissue. Amplitude-controlled aDBS was shown to significantly decrease the amplitude-driven total electrical energy delivered to the tissue (aTEED), an objective measure of the amount of energy transferred by DBS amplitude to the patient's brain. However, there is no direct evidence of a relationship between aTEED and the occurrence of DBS-related adverse events in humans. Objective: In this work, we investigated the correlation of aTEED with the occurrence of levodopa-induced dyskinesias pooling all the data available from our previous experiments using aDBS and cDBS. Methods: We retrospectively analyzed data coming from 19 patients with PD undergoing surgery for STN-DBS electrode positioning and participating to experiments involving cDBS and aDBS delivery. Patients were all studied some days after the surgery (acute setting). The aTEED and dyskinesia assessments (Rush Dyskinesia Rating Scale, RDRS) considered in the Med ON-Stim ON condition. Results: We confirmed both that aTEED values and RDRS were significantly lower in the aDBS than in cDBS sessions (aTEED mean value, cDBS: 0.0278 ± 0.0011 j, vs. aDBS: 0.0071 ± 0.0003 j, p < 0.0001 Wilcoxon's rank sum; normalized RDRS mean score, cDBS: 0.66 ± 0.017 vs. aDBS: 0.45 ± 0.01, p = 0.025, Wilcoxon's rank sum test). In addition, we found a direct significant correlation between aTEED and RDRS (ρ = 0.44, p = 0.0032, Spearman's correlation). Conclusions: Our results provide a first piece of evidence that aTEED is correlated to the amount of levodopa-induced dyskinesias in patients with PD undergoing STN-DBS, thus supporting the role of aDBS as feasible and safe alternative to cDBS.
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Affiliation(s)
- Marco Prenassi
- Dipartimento di Ingegneria e Architettura, Università Degli Studi di Trieste, Trieste, Italy
| | | | - Linda Borellini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Tommaso Bocci
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Filippo Cogiamanian
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Marco Locatelli
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy.,"Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy.,Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
| | - Paolo Rampini
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sergio Barbieri
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Priori
- "Aldo Ravelli" Research Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan Medical School, Milan, Italy
| | - Sara Marceglia
- Dipartimento di Ingegneria e Architettura, Università Degli Studi di Trieste, Trieste, Italy.,Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca'Granda Ospedale Maggiore Policlinico, Milan, Italy
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47
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Sand D, Rappel P, Marmor O, Bick AS, Arkadir D, Lu BL, Bergman H, Israel Z, Eitan R. Machine learning-based personalized subthalamic biomarkers predict ON-OFF levodopa states in Parkinson patients. J Neural Eng 2021; 18. [PMID: 33906182 DOI: 10.1088/1741-2552/abfc1d] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/27/2021] [Indexed: 01/20/2023]
Abstract
Objective.Adaptive deep brain stimulation (aDBS) based on subthalamic nucleus (STN) electrophysiology has recently been proposed to improve clinical outcomes of DBS for Parkinson's disease (PD) patients. Many current models for aDBS are based on one or two electrophysiological features of STN activity, such as beta or gamma activity. Although these models have shown interesting results, we hypothesized that an aDBS model that includes many STN activity parameters will yield better clinical results. The objective of this study was to investigate the most appropriate STN neurophysiological biomarkers, detectable over long periods of time, that can predict OFF and ON levodopa states in PD patients.Approach.Long-term local field potentials (LFPs) were recorded from eight STNs (four PD patients) during 92 recording sessions (44 OFF and 48 ON levodopa states), over a period of 3-12 months. Electrophysiological analysis included the power of frequency bands, band power ratio and burst features. A total of 140 engineered features was extracted for 20 040 epochs (each epoch lasting 5 s). Based on these engineered features, machine learning (ML) models classified LFPs as OFF vs ON levodopa states.Main results.Beta and gamma band activity alone poorly predicts OFF vs ON levodopa states, with an accuracy of 0.66 and 0.64, respectively. Group ML analysis slightly improved prediction rates, but personalized ML analysis, based on individualized engineered electrophysiological features, were markedly better, predicting OFF vs ON levodopa states with an accuracy of 0.8 for support vector machine learning models.Significance.We showed that individual patients have unique sets of STN neurophysiological biomarkers that can be detected over long periods of time. ML models revealed that personally classified engineered features most accurately predict OFF vs ON levodopa states. Future development of aDBS for PD patients might include personalized ML algorithms.
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Affiliation(s)
- Daniel Sand
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Pnina Rappel
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Odeya Marmor
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel
| | - Atira S Bick
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Arkadir
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bao-Liang Lu
- Center for Brain-like Computing and Machine Intelligence, Department of Computer Science and Engineering, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Hagai Bergman
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Edmond and Lily Safra Center for Brain Research, The Hebrew University, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Zvi Israel
- The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Functional Neurosurgery Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Renana Eitan
- Department of Medical Neurobiology (Physiology), Institute of Medical Research-Israel-Canada, The Hebrew University-Hadassah Medical School, Jerusalem, Israel.,The Brain Division, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.,Jerusalem Mental Health Center, Hebrew University-Hadassah Medical School, Jerusalem, Israel.,Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
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48
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Brazhnik E, Novikov N, McCoy AJ, Ilieva NM, Ghraib MW, Walters JR. Early decreases in cortical mid-gamma peaks coincide with the onset of motor deficits and precede exaggerated beta build-up in rat models for Parkinson's disease. Neurobiol Dis 2021; 155:105393. [PMID: 34000417 DOI: 10.1016/j.nbd.2021.105393] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 04/27/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022] Open
Abstract
Evidence suggests that exaggerated beta range local field potentials (LFP) in basal ganglia-thalamocortical circuits constitute an important biomarker for feedback for deep brain stimulation in Parkinson's disease patients, although the role of this phenomenon in triggering parkinsonian motor symptoms remains unclear. A useful model for probing the causal role of motor circuit LFP synchronization in motor dysfunction is the unilateral dopamine cell-lesioned rat, which shows dramatic motor deficits walking contralaterally to the lesion but can walk steadily ipsilaterally on a circular treadmill. Within hours after 6-OHDA injection, rats show marked deficits in ipsilateral walking with early loss of significant motor cortex (MCx) LFP peaks in the mid-gamma 41-45 Hz range in the lesioned hemisphere; both effects were reversed by dopamine agonist administration. Increases in MCx and substantia nigra pars reticulata (SNpr) coherence and LFP power in the 29-40 Hz range emerged more gradually over 7 days, although without further progression of walking deficits. Twice-daily chronic dopamine antagonist treatment induced rapid onset of catalepsy and also reduced MCx 41-45 Hz LFP activity at 1 h, with increases in MCx and SNpr 29-40 Hz power/coherence emerging over 7 days, as assessed during periods of walking before the morning treatments. Thus, increases in high beta power in these parkinsonian models emerge gradually and are not linearly correlated with motor deficits. Earlier changes in cortical circuits, reflected in the rapid decreases in MCx LFP mid-gamma LFP activity, may contribute to evolving plasticity supporting increased beta range synchronized activity in basal ganglia-thalamocortical circuits after loss of dopamine receptor stimulation.
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Affiliation(s)
- Elena Brazhnik
- Neurophysiological Pharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-3702, United States of America
| | - Nikolay Novikov
- Neurophysiological Pharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-3702, United States of America
| | - Alex J McCoy
- Neurophysiological Pharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-3702, United States of America
| | - Neda M Ilieva
- Neurophysiological Pharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-3702, United States of America
| | - Marian W Ghraib
- Neurophysiological Pharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-3702, United States of America
| | - Judith R Walters
- Neurophysiological Pharmacology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892-3702, United States of America.
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49
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Yin Z, Zhu G, Zhao B, Bai Y, Jiang Y, Neumann WJ, Kühn AA, Zhang J. Local field potentials in Parkinson's disease: A frequency-based review. Neurobiol Dis 2021; 155:105372. [PMID: 33932557 DOI: 10.1016/j.nbd.2021.105372] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/25/2021] [Accepted: 04/26/2021] [Indexed: 12/19/2022] Open
Abstract
Deep brain stimulation (DBS) surgery offers a unique opportunity to record local field potentials (LFPs), the electrophysiological population activity of neurons surrounding the depth electrode in the target area. With direct access to the subcortical activity, LFP research has provided valuable insight into disease mechanisms and cognitive processes and inspired the advent of adaptive DBS for Parkinson's disease (PD). A frequency-based framework is usually employed to interpret the implications of LFP signatures in LFP studies on PD. This approach standardizes the methodology, simplifies the interpretation of LFP patterns, and makes the results comparable across studies. Importantly, previous works have found that activity patterns do not represent disease-specific activity but rather symptom-specific or task-specific neuronal signatures that relate to the current motor, cognitive or emotional state of the patient and the underlying disease. In the present review, we aim to highlight distinguishing features of frequency-specific activities, mainly within the motor domain, recorded from DBS electrodes in patients with PD. Associations of the commonly reported frequency bands (delta, theta, alpha, beta, gamma, and high-frequency oscillations) to motor signs are discussed with respect to band-related phenomena such as individual tremor and high/low beta frequency activity, as well as dynamic transients of beta bursts. We provide an overview on how electrophysiology research in DBS patients has revealed and will continuously reveal new information about pathophysiology, symptoms, and behavior, e.g., when combining deep LFP and surface electrocorticography recordings.
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Affiliation(s)
- Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Yin Jiang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charite´ Campus Mitte, Charite´ - University Medicine Berlin, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charite´ Campus Mitte, Charite´ - University Medicine Berlin, Berlin, Germany; Berlin School of Mind and Brain, Charité - Universitätsmedizin Berlin, Unter den Linden 6, 10099 Berlin, Germany; NeuroCure, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Key Laboratory of Neurostimulation, Beijing, China.
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Belova EM, Semenova U, Gamaleya AA, Tomskiy AA, Sedov A. Is there a single beta oscillation band interfering with movement in Parkinson's disease? Eur J Neurosci 2021; 54:4381-4391. [PMID: 33905150 DOI: 10.1111/ejn.15257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 11/29/2022]
Abstract
Beta oscillations in basal ganglia are considered to contribute to motor dysfunction in Parkinson's disease (PD). However, there is a high variety in frequency borders for beta oscillations between studies, which complicates the comparison and interpretation of results. Here we aimed to study the homogeneity of oscillations in the broad "beta" range (8-30 Hz) and their implication to motor functioning in PD. For this purpose, we recorded local field potentials (LFP) in the subthalamic nucleus (STN) during 34 deep brain stimulation surgeries. We identified spectral features of LFP recordings in the range 8-30 Hz to search for candidate sub-regions of stable oscillations and assessed their association with clinical scores on the contralateral side of the body and sensitivity to motor tests. Lower frequency oscillations (8-16 Hz) had a significant positive association with bradykinesia score. During voluntary movements, we observed a significant increase in LFP power in the 12-16 Hz range and a decrease in the 18-26 Hz range. We may conclude that the 8-30 Hz oscillation range includes oscillations with different functional features-sensitivity and responsiveness to movement, and clinical symptoms, which should be taken into account in further studies of beta oscillations association with PD pathophysiology. These data assume the coexistence of several frequency domains within beta range that are modulated in different ways under dopaminergic regulation and motor processing in human STN.
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Affiliation(s)
- Elena M Belova
- Laboratory of Human Cell Neurophysiology, Semenov Institute of Chemical Physics RAS, Moscow, Russia
| | - Ulia Semenova
- Laboratory of Human Cell Neurophysiology, Semenov Institute of Chemical Physics RAS, Moscow, Russia
| | - Anna A Gamaleya
- Scientific Advisory Department, Federal State Autonomous Institution, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexey A Tomskiy
- Group of functional neurosurgery, Federal State Autonomous Institution, N. N. Burdenko National Medical Research Center of Neurosurgery, Moscow, Russia
| | - Alexey Sedov
- Laboratory of Human Cell Neurophysiology, Semenov Institute of Chemical Physics RAS, Moscow Institute of Physics and Technology, Moscow, Russia
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