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Alare K, Abioye E, Saydo B. Gerstmann Syndrome: What is the Possible Role of Deep Brain Stimulation? Neurocrit Care 2024:10.1007/s12028-024-02013-2. [PMID: 38914905 DOI: 10.1007/s12028-024-02013-2] [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: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 06/26/2024]
Abstract
Gerstmann syndrome, characterized by a tetrad of symptoms, which are agraphia, acalculia, left-right disorientation, and finger agnosia, presents challenges in both understanding its pathophysiology and establishing effective treatment modalities. Neuroanatomical studies have highlighted the involvement of the dominant parietal lobe, particularly the inferior parietal lobule, in the development of Gerstmann syndrome. Although current treatment options are largely supportive, recent research suggests a potential role for deep brain stimulation (DBS) in managing this condition. DBS, known for its efficacy in various neurological disorders, has been hypothesized to modulate neuronal pathways associated with Gerstmann syndrome. However, clinical evidence supporting DBS in Gerstmann syndrome remains scarce, posing challenges in patient selection and ethical considerations. Future research should prioritize investigating the efficacy and safety of DBS in Gerstmann syndrome to improve patient outcomes and quality of life.
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Affiliation(s)
- Kehinde Alare
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria.
| | - Elishama Abioye
- Department of Medicine, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Biam Saydo
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
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2
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Moscovich M, Aquino CHD, Marinho MM, Barcelos LB, Felício AC, Halverson M, Hamani C, Ferraz HB, Munhoz RP. Fundamentals of deep brain stimulation for Parkinson's disease in clinical practice: part 2. ARQUIVOS DE NEURO-PSIQUIATRIA 2024; 82:1-9. [PMID: 38653486 PMCID: PMC11039109 DOI: 10.1055/s-0044-1786037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/30/2023] [Indexed: 04/25/2024]
Abstract
The field of neuromodulation has evolved significantly over the past decade. Developments include novel indications and innovations of hardware, software, and stimulation techniques leading to an expansion in scope and role of these techniques as powerful therapeutic interventions. In this review, which is the second part of an effort to document and integrate the basic fundamentals and recent successful developments in the field, we will focus on classic paradigms for electrode placement as well as new exploratory targets, mechanisms of neuromodulation using this technique and new developments, including focused ultrasound driven ablative procedures.
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Affiliation(s)
- Mariana Moscovich
- Christian-Albrechts University, Department of Neurology, Kiel, Germany.
| | - Camila Henriques de Aquino
- University of Calgary, Cumming School of Medicine, Department of Clinical Neurosciences, Calgary, AB, Canada.
- University of Calgary, Hotchkiss Brain Institute, Calgary, AB, Canada.
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | - Murilo Martinez Marinho
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | - Lorena Broseghini Barcelos
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
| | | | - Matthew Halverson
- University of Utah, Department of Neurology, Salt Lake City, Utah, United States.
| | - Clement Hamani
- University of Toronto, Sunnybrook Hospital, Toronto, ON, Canada.
| | - Henrique Ballalai Ferraz
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
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3
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Harris AR, Grayden DB, John SE. Electrochemistry in a Two- or Three-Electrode Configuration to Understand Monopolar or Bipolar Configurations of Platinum Bionic Implants. MICROMACHINES 2023; 14:722. [PMID: 37420955 DOI: 10.3390/mi14040722] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 07/09/2023]
Abstract
Electrodes are used in vivo for chemical sensing, electrophysiological recording, and stimulation of tissue. The electrode configuration used in vivo is often optimised for a specific anatomy and biological or clinical outcomes, not electrochemical performance. Electrode materials and geometries are constrained by biostability and biocompatibility issues and may be required to function clinically for decades. We performed benchtop electrochemistry, with changes in reference electrode, smaller counter-electrode sizes, and three- or two-electrode configurations. We detail the effects different electrode configurations have on typical electroanalytical techniques used on implanted electrodes. Changes in reference electrode required correction by application of an offset potential. In a two-electrode configuration with similar working and reference/counter-electrode sizes, the electrochemical response was dictated by the rate-limiting charge transfer step at either electrode. This could invalidate calibration curves, standard analytical methods, and equations, and prevent use of commercial simulation software. We provide methods for determining if an electrode configuration is affecting the in vivo electrochemical response. We recommend sufficient details be provided in experimental sections on electronics, electrode configuration, and their calibration to justify results and discussion. In conclusion, the experimental limitations of performing in vivo electrochemistry may dictate what types of measurements and analyses are possible, such as obtaining relative rather than absolute measurements.
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Affiliation(s)
- Alexander R Harris
- Department of Biomedical Engineering, University of Melbourne, Melbourne 3010, Australia
| | - David B Grayden
- Department of Biomedical Engineering, University of Melbourne, Melbourne 3010, Australia
- Graeme Clark Institute, University of Melbourne, Melbourne 3010, Australia
| | - Sam E John
- Department of Biomedical Engineering, University of Melbourne, Melbourne 3010, Australia
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4
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Monosov IE, Ogasawara T, Haber SN, Heimel JA, Ahmadlou M. The zona incerta in control of novelty seeking and investigation across species. Curr Opin Neurobiol 2022; 77:102650. [PMID: 36399897 DOI: 10.1016/j.conb.2022.102650] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 10/02/2022] [Accepted: 10/06/2022] [Indexed: 11/17/2022]
Abstract
Many organisms rely on a capacity to rapidly replicate, disperse, and evolve when faced with uncertainty and novelty. But mammals do not evolve and replicate quickly. They rely on a sophisticated nervous system to generate predictions and select responses when confronted with these challenges. An important component of their behavioral repertoire is the adaptive context-dependent seeking or avoiding of perceptually novel objects, even when their values have not yet been learned. Here, we outline recent cross-species breakthroughs that shed light on how the zona incerta (ZI), a relatively evolutionarily conserved brain area, supports novelty-seeking and novelty-related investigations. We then conjecture how the architecture of the ZI's anatomical connectivity - the wide-ranging top-down cortical inputs to the ZI, and its specifically strong outputs to both the brainstem action controllers and to brain areas involved in action value learning - place the ZI in a unique role at the intersection of cognitive control and learning.
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Affiliation(s)
- Ilya E Monosov
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA.
| | - Takaya Ogasawara
- Department of Neuroscience, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Suzanne N Haber
- Department of Pharmacology and Physiology, University of Rochester School of Medicine & Dentistry, Rochester, NY, 14642, USA; Department of Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA
| | - J Alexander Heimel
- Circuits Structure and Function Group, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA, Amsterdam, the Netherlands
| | - Mehran Ahmadlou
- Circuits Structure and Function Group, Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA, Amsterdam, the Netherlands; Sainsbury Wellcome Centre for Neural Circuits and Behaviour, University College London, 25 Howland St., W1T4JG London, UK
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Savas A, Bayatli E, Eroglu U, Akbostanci MC. Combined Unilateral Radiofrequency Lesioning of the Motor Thalamus, Field of Forel, and Zona Incerta: A Series of Cases With Dystonia. Neurosurgery 2022; 90:313-321. [PMID: 35049526 DOI: 10.1227/neu.0000000000001819] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/03/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Dystonia is a group of disorders characterized by involuntary slow repetitive twisting movements and/or abnormal posture. Surgical options such as neuromodulation through deep brain stimulation and neuroablative procedures are available for patients who do not respond to conservative treatment. OBJECTIVE To present our series of patients with dystonia who were treated with stereotactic combined unilateral radiofrequency lesioning of the motor thalamus, field of Forel, and zona incerta. METHODS Medical records of 50 patients with dystonia who were treated with unilateral combined lesions were reviewed. Outcomes of the surgical procedure were evaluated using the Burke-Fahn-Marsden Dystonia Rating Scale (with movement and disability subscales) and Unified Parkinson's Disease Rating Scale-tremor items. RESULTS Based on the symptoms, patients were categorized as having generalized dystonia (34%), hemidystonia (30%), and dystonic tremor (DT) (36%). Primary/idiopathic dystonia, primary genetic/hereditary dystonia, and secondary dystonia accounted for 16%, 4%, and 80% of patients, respectively. The mean follow-up duration was 156.2 ± 88.9 mo. The overall improvement in the Burke-Fahn-Marsden Dystonia Rating Scale scores (movement and disability, respectively) was 57.8% and 36.4% in generalized dystonia, 60.0% and 45.8% in hemidystonia, and 65.6% and 56.8% in DT. Patients with DT showed an 83.3% improvement in mean Unified Parkinson's Disease Rating Scale tremor score. Patients with cerebral palsy showed mean improvements of 66.7% in movement scores and 50.8% in disability scores. No mortality or major morbidity was observed postoperatively. CONCLUSION Stereotactic radiofrequency unilateral combined thalamotomy, campotomy, and zona incerta lesions may be an effective surgical alternative for patients with dystonia, especially those with secondary dystonia resistant to deep brain stimulation.
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Affiliation(s)
- Ali Savas
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Eyup Bayatli
- Department of Neurosurgery, Ankara University, Ankara, Turkey
| | - Umit Eroglu
- Department of Neurosurgery, Ankara University, Ankara, Turkey
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Voice handicap Index in Parkinson's patients: Subthalamic versus globus pallidus deep brain stimulation. J Clin Neurosci 2022; 98:83-88. [PMID: 35151061 DOI: 10.1016/j.jocn.2022.01.029] [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: 11/20/2020] [Revised: 11/22/2021] [Accepted: 01/22/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE Subthalamic nucleus (STN) and globus pallidus interna (GPI) are the two most common sites for deep brain stimulation (DBS) in people with Parkinson's disease (PWP). Voice impairments are a common symptom of Parkinson's disease and information about voice outcomes with DBS is limited. Most studies in speech-language pathology have focused on STN-DBS and few have examined the effects of GPI-DBS. This was an initial effort to examine the impact of DBS location on Vocal Handicap Index (VHI) scores, which assess the impact of a voice disorder on an individual. METHOD Twenty-four gender-matched PWP (12 STN-DBS and 12 GPI-DBS) completed the VHI post-DBS implantation. Two-tailed independent samples t-tests were used to compare each VHI scale score (physical, functional, emotional, total) and patient factors between the two groups. RESULTS No significant differences in total or subscale VHI scores were identified between the two DBS groups. A trend toward greater impairment in PWP with GPI-DBS was noted. An association between higher VHI scores and DBS settings was found. CONCLUSIONS Studies directly comparing speech outcomes for different DBS targets are lacking. The current findings provide new insights concerning voice outcomes following DBS by adding to the limited literature directly comparing speech outcomes in multiple DBS targets. Limitations and directions for future research are discussed.
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Harris A. Understanding Charge Transfer on the Clinically Used Conical Utah Electrode Array: Charge Storage Capacity, Electrochemical Impedance Spectroscopy and Effective Electrode Area. J Neural Eng 2021; 18. [PMID: 33401255 DOI: 10.1088/1741-2552/abd897] [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: 07/23/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The Utah electrode is used for pre/clinical studies on neural recording and stimulation. Anecdotal and empirical reports on their performance have been made, resulting in variable testing methods. An in depth investigation was performed to understand the electrochemical behaviour and charge transfer mechanisms occurring on these clinically important electrodes. APPROACH Platinum and iridium electrodes were assessed by cyclic voltammetry and electrochemical impedance spectroscopy. The effective electrode area was measured by reduction of Ru(NH3)63+. MAIN RESULTS Pristine Utah electrodes have little to no oxide present and the surface roughness is very low. Pristine iridium electrodes pass charge through capacitance and oxide formation. Hydride and anion adsorption occurs on the platinum electrode. Anodic current oxidises both metal surfaces, altering the charge transfer mechanisms at the electrode-solution interface. The charge storage capacity depends on measurement technique and electrode structure, providing no information on charge transfer mechanisms. Electrode oxidation increases pseudocapacitance, reducing impedance. Charge transfer was non-homogeneous, most likely due to the electrode geometry enhancing charge density at the electrode tip and base. Oxidation of the electrode surface enhanced charge transfer inhomogeneity. The effective electrode area could be measured by reduction of Ru(NH3)63+ and calculated with a finite cone geometry. SIGNIFICANCE Increasing electrode pseudocapacitance, demonstrated by metal oxidation, reduces impedance. Increasing electrode capacitance offers a potential route to reducing thermal noise and increasing signal-to-noise ratio of neural recording. The effective electrode area of conical electrodes can be measured. The charge density of the conical electrode was greater than expected on a planar disc electrode, indicating modification of electrode geometry can increase an electrodes safe charge injection capacity. In vivo electrochemical measurements often don't include sufficient details to understand the electrode behaviour. Electrode oxidation most likely accounts for a significant amount of variation in previously published Utah electrode impedance data.
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Affiliation(s)
- Alex Harris
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Aikenhead Centre for Medical Discovery, Melbourne, Victoria, 3065, AUSTRALIA
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Bardon J, Kurcova S, Chudackova M, Otruba P, Krahulik D, Nevrly M, Kanovsky P, Zapletalova J, Valosek J, Hlustik P, Vastik M, Vecerkova M, Hvizdosova L, Mensikova K, Kurca E, Sivak S. Deep brain stimulation electrode position impact on parkinsonian non-motor symptoms. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 166:57-62. [PMID: 33883752 DOI: 10.5507/bp.2020.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/17/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In this study we evaluated the impact of location of deep brain stimulation electrode active contact in different parts of the subthalamic nucleus on improvement of non-motor symptoms in patients with Parkinson's disease. METHODS The subthalamic nucleus was divided into two (dorsolateral/ventromedial) and three (dorsolateral, medial, ventromedial) parts. 37 deep brain stimulation electrodes were divided according to their active contact location. Correlation between change in non-motor symptoms before and one and four months after deep brain stimulation electrode implantation and the location of active contact was made. RESULTS In dividing the subthalamic nucleus into three parts, no electrode active contact was placed ventromedially, 28 active contacts were located in the medial part and 9 contacts were placed dorsolaterally. After one and four months, no significant difference was found between medial and dorsolateral positions. In the division of the subthalamic nucleus into two parts, 13 contacts were located in the ventromedial part and 24 contacts were placed in the dorsolateral part. After one month, significantly greater improvement in the Non-motor Symptoms Scale for Parkinson's disease (P=0.045) was found on dorsolateral left-sided stimulation, but no significant differences between the ventromedial and dorsolateral positions were found on the right side. CONCLUSION This study demonstrated the relationship between improvement of non-motor symptoms and the side (hemisphere, left/right) of the deep brain stimulation electrode active contact, rather than its precise location within specific parts of the subthalamic nucleus in patients treated for advanced Parkinson's disease.
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Affiliation(s)
| | | | - Monika Chudackova
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Pavel Otruba
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - David Krahulik
- Department of Neurosurgery, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Martin Nevrly
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Petr Kanovsky
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jana Zapletalova
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Jan Valosek
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Department of Biomedical Engineering, University Hospital Olomouc, Czech Republic
| | - Petr Hlustik
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Miroslav Vastik
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Marketa Vecerkova
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Lenka Hvizdosova
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Katerina Mensikova
- Department of Neurology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Egon Kurca
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovak Republic
| | - Stefan Sivak
- Department of Neurology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital Martin, Martin, Slovak Republic
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Selective distant electrostimulation by synchronized bipolar nanosecond pulses. Sci Rep 2019; 9:13116. [PMID: 31511591 PMCID: PMC6739416 DOI: 10.1038/s41598-019-49664-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 08/22/2019] [Indexed: 02/07/2023] Open
Abstract
A unique aspect of electrostimulation (ES) with nanosecond electric pulses (nsEP) is the inhibition of effects when the polarity is reversed. This bipolar cancellation feature makes bipolar nsEP less efficient at biostimulation than unipolar nsEP. We propose to minimize stimulation near pulse-delivering electrodes by applying bipolar nsEP, whereas the superposition of two phase-shifted bipolar nsEP from two independent sources yields a biologically-effective unipolar pulse remotely. This is accomplished by electrical compensation of all nsEP phases except the first one, resulting in the restoration of stimulation efficiency due to cancellation of bipolar cancellation (CANCAN-ES). We experimentally proved the CANCAN-ES paradigm by measuring YO-PRO-1 dye uptake in CHO-K1 cells which were permeabilized by multiphasic nsEP (600 ns per phase) from two generators; these nsEP were synchronized either to overlap into a unipolar pulse remotely from electrodes (CANCAN), or not to overlap (control). Enhancement of YO-PRO-1 entry due to CANCAN was observed in all sets of experiments and reached ~3-fold in the center of the gap between electrodes, exactly where the unipolar pulse was formed, and equaled the degree of bipolar cancellation. CANCAN-ES is promising for non-invasive deep tissue stimulation, either alone or combined with other remote stimulation techniques to improve targeting.
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Smith ES, Porterfield JE, Kannan RM. Leveraging the interplay of nanotechnology and neuroscience: Designing new avenues for treating central nervous system disorders. Adv Drug Deliv Rev 2019; 148:181-203. [PMID: 30844410 PMCID: PMC7043366 DOI: 10.1016/j.addr.2019.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/21/2019] [Accepted: 02/28/2019] [Indexed: 12/12/2022]
Abstract
Nanotechnology has the potential to open many novel diagnostic and treatment avenues for disorders of the central nervous system (CNS). In this review, we discuss recent developments in the applications of nanotechnology in CNS therapies, diagnosis and biology. Novel approaches for the diagnosis and treatment of neuroinflammation, brain dysfunction, psychiatric conditions, brain cancer, and nerve injury provide insights into the potential of nanomedicine. We also highlight nanotechnology-enabled neuroscience techniques such as electrophysiology and intracellular sampling to improve our understanding of the brain and its components. With nanotechnology integrally involved in the advancement of basic neuroscience and the development of novel treatments, combined diagnostic and therapeutic applications have begun to emerge. Nanotheranostics for the brain, able to achieve single-cell resolution, will hasten the rate in which we can diagnose, monitor, and treat diseases. Taken together, the recent advances highlighted in this review demonstrate the prospect for significant improvements to clinical diagnosis and treatment of a vast array of neurological diseases. However, it is apparent that a strong dialogue between the nanoscience and neuroscience communities will be critical for the development of successful nanotherapeutics that move to the clinic, benefit patients, and address unmet needs in CNS disorders.
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Affiliation(s)
- Elizabeth S Smith
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua E Porterfield
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Rangaramanujam M Kannan
- Center for Nanomedicine, Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA; Department of Chemical and Biomolecular Engineering, Johns Hopkins University, Baltimore, MD 21218, USA; Hugo W. Moser Research Institute at Kennedy Krieger, Inc., Baltimore, MD 21205, USA; Kennedy Krieger Institute, Johns Hopkins University for Cerebral Palsy Research Excellence, Baltimore, MD 21218, USA.
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Harris AR, Newbold C, Carter P, Cowan R, Wallace GG. Using Chronopotentiometry to Better Characterize the Charge Injection Mechanisms of Platinum Electrodes Used in Bionic Devices. Front Neurosci 2019; 13:380. [PMID: 31118879 PMCID: PMC6508053 DOI: 10.3389/fnins.2019.00380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
The safe charge injection capacity and charge density of neural stimulating electrodes is based on empirical evidence obtained from stimulating feline cortices. Stimulation induced tissue damage may be caused by electrochemical or biological mechanisms. Separating these mechanisms requires greater understanding of charge transfer at the electrode-tissue interface. Clinical devices typically use a biphasic waveform with controlled current. Therefore, the charge injection mechanism and charge injection capacity of platinum was assessed on a commercial potentiostat by chronopotentiometry (controlled current stimulation). Platinum is a non-ideal electrode, charge injection by chronopotentiometry can be passed via capacitive and Faradaic mechanisms. Electrodes were tested under a variety of conditions to assess the impact on charge injection capacity. The change in electrode potential (charge injection capacity) was affected by applied charge density, pulse length, pulse polarity, electrode size, polishing method, electrolyte composition, and oxygen concentration. The safe charge injection capacity and charge density could be increased by changing the electrode-solution composition and stimulation parameters. However, certain conditions (e.g., acid polished electrodes) allowed the electrode to exceed the water electrolysis potential despite the stimulation protocol being deemed safe according to the Shannon plot. Multiple current pulses led to a shift or ratcheting in electrode potential due to changes in the electrode-solution composition. An accurate measure of safe charge injection capacity and charge density of an implantable electrode can only be obtained from suitable conditions (an appropriately degassed electrolyte and clinically relevant electrode structure). Cyclic voltammetric measurement of charge storage capacity can be performed on implantable electrodes, but will not provide information on electrode stability to multiple chronopotentiometric pulses. In contrast, chronopotentiometry will provide details on electrode stability, but the minimum time resolution of typical commercial potentiostats (ms range) is greater than used in a clinical stimulator (μs range) so that extrapolation to short stimulation pulses is required. Finally, an impedance test is typically used to assess clinical electrode performance. The impedance test is also based on a biphasic chronopotentiometic waveform where the measured potential is used to calculate an impedance value. Here it is shown that the measured potential is a function of many parameters (solution composition, electrode area, and surface composition). Subsequently, impedance test results allow electrode comparison and to indicate electrode failure, but use of Ohm's law to calculate an impedance value is not valid.
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Affiliation(s)
- Alexander R. Harris
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, University of Wollongong, Wollongong, NSW, Australia
- The HEARing CRC, University of Melbourne, Melbourne, VIC, Australia
| | - Carrie Newbold
- The HEARing CRC, University of Melbourne, Melbourne, VIC, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - Paul Carter
- Cochlear, Ltd., Macquarie University, Sydney, NSW, Australia
| | - Robert Cowan
- The HEARing CRC, University of Melbourne, Melbourne, VIC, Australia
- Department of Audiology and Speech Pathology, University of Melbourne, Melbourne, VIC, Australia
| | - Gordon G. Wallace
- ARC Centre of Excellence for Electromaterials Science, Intelligent Polymer Research Institute, University of Wollongong, Wollongong, NSW, Australia
- The HEARing CRC, University of Melbourne, Melbourne, VIC, Australia
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Mao Z, Ling Z, Pan L, Xu X, Cui Z, Liang S, Yu X. Comparison of Efficacy of Deep Brain Stimulation of Different Targets in Parkinson's Disease: A Network Meta-Analysis. Front Aging Neurosci 2019; 11:23. [PMID: 30853908 PMCID: PMC6395396 DOI: 10.3389/fnagi.2019.00023] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Deep brain stimulation (DBS) is considered an effective treatment option for Parkinson's disease (PD). Several studies have demonstrated the efficacy of neurostimulation in patients with advanced PD. The subthalamic nucleus (STN), the internal globus pallidus (GPi), ventral intermediate nucleus (Vim), and pedunculopontine nucleus (PPN) are reportedly effective DBS targets for control of Parkinsonian tremors. However, there is no consensus on the ideal target for DBS in patients with Parkinson's disease. Only a few studies have directly compared the efficacy of DBS of the Vim, STN, and GPi. Therefore, we searched PubMed, Embase, Cochrane Library, and other databases for observational studies, extracted data on unified Parkinson's disease rating scale (UPDRS) scores and performed a comprehensive network meta-analysis of different strategies of DBS and compared the efficiency of DBS at different targets. Methods: Forest plot was used to examine the overall efficiency of DBS; cumulative probability value was used to rank the strategies under examination. A node-splitting model was employed to assess consistency of reported outcomes inconsistency. A total of 16 studies which focused on UPDRS improvement were included in the network meta-analysis. Results: By comparing the overall efficiency associated with each target, we confirmed the efficacy of DBS therapy in PD. Our findings revealed similar efficacy of DBS targeted at GPi and STN in the on-medication phase [GPi-3.9 (95% CI -7.0 to -0.96); STN-3.1 (-5.9 to -0.38)]; however, in the off-medication phase, Vim-targeted DBS was associated with better improvement in UPDRS scores and could be a choice as a DBS target for tremor-dominant Parkinsonism. Conclusions: Our findings will help improve clinical application of DBS.
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Affiliation(s)
- Zhiqi Mao
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhipei Ling
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Longsheng Pan
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xin Xu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Zhiqiang Cui
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Shuli Liang
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, Chinese PLA General Hospital, Beijing, China
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13
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Ten Brinke TR, Odekerken VJJ, van Laar T, van Dijk JMC, Dijk JM, van den Munckhof P, Schuurman PR, de Bie RMA. Substituting the Target After Unsatisfactory Outcome of Deep Brain Stimulation in Advanced Parkinson's Disease: Cases From the NSTAPS Trial and Systematic Review of the Literature. Neuromodulation 2018; 21:527-531. [PMID: 29164735 DOI: 10.1111/ner.12732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the globus pallidus pars interna (GPi) and the subthalamic nucleus (STN) are established treatment option in Parkinson's disease (PD). If DBS does not provide the desired effect, re-operation to the alternative target is a treatment option, but data on the effect of re-operation are scarce. OBJECTIVES The objective of this study is to evaluate the clinical effect of re-operation the alternative target after failure of initial STN or GPi DBS for Parkinson's disease. MATERIALS AND METHODS We descriptively analyzed the baseline characteristics, the effect of initial surgery and re-operation of eight NSTAPS (Netherlands SubThalamic and Pallidal Stimulation) patients and six previously published cases that underwent re-operation to a different target. RESULTS In the NSTAPS cohort, two of the eight patients showed more than 30% improvement of off-drug motor symptoms after re-operation. The initial DBS leads of these patients were off target. In the cases from the literature, 30% off-drug motor improvement was seen in all three patients re-operated from GPi to STN and none of the three patients re-operated from STN to GPi. Only one of the three cases from the literature where any improvement was seen with the operation had a confirmed on target lead location after the first surgery, while the other two patients did not undergo post-operative imaging after the first surgery. CONCLUSIONS Re-operation to a different target due to lack of effect appears to have a limited chance of leading to objective improvement if the leads were correctly placed during initial surgery.
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Affiliation(s)
- Timo R Ten Brinke
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Teus van Laar
- Department of Neurology, University Medical Center, Groningen, The Netherlands
| | - J Marc C van Dijk
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Neurosurgery, University Medical Center, Groningen, The Netherlands
| | - Joke M Dijk
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | | | - P Rick Schuurman
- Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Rob M A de Bie
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
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Falconer RA, Rogers SL, Shenai M. Using Directional Deep Brain Stimulation to Co-activate the Subthalamic Nucleus and Zona Incerta for Overlapping Essential Tremor/Parkinson's Disease Symptoms. Front Neurol 2018; 9:544. [PMID: 30026728 PMCID: PMC6041971 DOI: 10.3389/fneur.2018.00544] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 06/18/2018] [Indexed: 12/02/2022] Open
Abstract
This index case report describes a novel programming approach that utilizes the 8-contact directional Deep Brain Stimulation (DBS) lead to effectively control the akinesia, rigidity and tremor of Parkinson's Disease (PD), as well as a severe kinetic tremor of Essential Tremor (ET), in a patient with overlapping symptoms of both PD and ET. Through utilizing a bipolar directional montage on a single segmented contact, symptom control was attained via likely co-activation of the Subthalamic Nucleus (STN) and the adjacent Zona Incerta (ZI). The patient is a 67-year-old professional guitarist with a long-standing diagnosis of ET manifesting with bilateral kinetic tremor, who then developed right lateralizing symptoms indicative of PD. After optimal medical management did not confer sufficient control, he underwent left-sided unilateral DBS targeting the STN. Both intraoperatively and post-operatively, omnidirectional, and directional electrode review resulted in significant akinesia, rigidity, and as well as resting tremor control but failed to sufficiently improve the kinetic tremor. As electrode 2B was shown to be the most efficacious with the largest therapeutic window, a bipolar directional montage on a single segmented contact was tried with the idea of possibly further extending the axial asymmetry of the directional stimulation toward the adjacent ZI to impact the kinetic tremor. This montage resulted in full kinetic and resting tremor control as well as akinesia and rigidity response [2B cathode (–), 2A anode (+), 2C anode (+) (1.4 mA, rate 160 Hz, pulse width 60 μs)]. At 6 months post initial programming, no montage changes have been made, and the patient has experienced a reduction in Motor UPDRS scores from 23 to 3 (evaluated off medication), full resolution of kinetic tremor and normalization of handwriting, as well as significant reduction in his medication requirements. This patient's response to a single segment bipolar directional montage, and lack of response from monopolar directional stimulation in the same area, does suggest the possibility of further axial asymmetric tissue activation and thus co-activation of both the dorsal STN and adjacent ZI. Further modeling and study are warranted.
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Affiliation(s)
- Ramsey A Falconer
- Inova Parkinson's and Movement Disorders Center, Falls Church, VA, United States
| | - Sean L Rogers
- Inova Parkinson's and Movement Disorders Center, Falls Church, VA, United States
| | - Mahesh Shenai
- Inova Parkinson's and Movement Disorders Center, Falls Church, VA, United States
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15
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Rodriguez-Rojas R, Carballo-Barreda M, Alvarez L, Guridi J, Pavon N, Garcia-Maeso I, Mací As R, Rodriguez-Oroz MC, Obeso JA. Subthalamotomy for Parkinson's disease: clinical outcome and topography of lesions. J Neurol Neurosurg Psychiatry 2018; 89:572-578. [PMID: 29222224 DOI: 10.1136/jnnp-2017-316241] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/18/2017] [Accepted: 11/20/2017] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Subthalamotomy is an effective alternative for the treatment of Parkinson's disease (PD). However, uncertainty about the optimal target location and the possibility of inducing haemichorea-ballism have limited its application. We assessed the correlation between the topography of radiofrequency-based lesions of the subthalamic nucleus (STN) with motor improvement and the emergence of haemichorea-ballism. METHODS Sixty-four patients with PD treated with subthalamotomy were evaluated preoperatively and postoperatively using the Unified Parkinson's Disease Rating Scale motor score (UPDRSm), MRI and tractography. Patients were classified according to the degree of clinical motor improvement and dyskinesia scale. Lesions were segmented on MRI and averaged in a standard space. We examined the relationship between the extent of lesion-induced disruption of fibres surrounding the STN and the development of haemichorea-ballism. RESULTS Maximum antiparkinsonian effect was obtained with lesions located within the dorsolateral motor region of the STN as compared with those centre-placed in the dorsal border of the STN and the zona incerta (71.3%, 53.5% and 20.8% UPDRSm reduction, respectively). However, lesions that extended dorsally beyond the STN showed lower probability of causing haemichorea-ballism than those placed entirely within the nucleus. Tractography findings indicate that interruption of pallidothalamic fibres probably determines a low probability of haemichorea-ballism postoperatively. CONCLUSIONS The topography of the lesion is a major factor in the antiparkinsonian effect of subthalamotomy in patients with PD. Lesions involving the motor STN and pallidothalamic fibres induced significant motor improvement and were associated with a low incidence of haemichorea-ballism.
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Affiliation(s)
- Rafael Rodriguez-Rojas
- HM CINAC, Hospital Universitario HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,CIBERNED, Institute Carlos III, Madrid, Spain
| | - Maylen Carballo-Barreda
- Brain Images Processing Group and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
| | - Lazaro Alvarez
- Brain Images Processing Group and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
| | - Jorge Guridi
- Service of Neurosurgery, Clinica Universidad de Navarra, Pamplona, Spain
| | - Nancy Pavon
- Brain Images Processing Group and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
| | - Ivan Garcia-Maeso
- Brain Images Processing Group and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
| | - Raul Mací As
- Brain Images Processing Group and Movement Disorder Unit, International Center for Neurological Restoration, Havana, Cuba
| | - Maria C Rodriguez-Oroz
- CIBERNED, Institute Carlos III, Madrid, Spain.,BioDonostia Health Research Institute, Basque Center on Cognition Brain and Language, San Sebastian, Guipuzcoa, Spain
| | - Jose Angel Obeso
- HM CINAC, Hospital Universitario HM Puerta del Sur, CEU-San Pablo University, Madrid, Spain.,CIBERNED, Institute Carlos III, Madrid, Spain
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16
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Southwell DG, Rutkowski MJ, San Luciano M, Racine C, Ostrem J, Starr PA, Larson PS. Before and after the veterans affairs cooperative program 468 study: Deep brain stimulator target selection for treatment of Parkinson's disease. Parkinsonism Relat Disord 2017; 48:40-44. [PMID: 29249683 DOI: 10.1016/j.parkreldis.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Veterans Affairs Cooperative Study Program 468 study (CSP 468) produced significant findings regarding deep brain stimulation (DBS) target selection for Parkinson's Disease (PD) treatment, yet its impact on clinical practices has not been described. Here we assess how CSP 468 influenced target selection at a high-volume movement disorders treatment center. METHODS We compared DBS target site selection between 4-year periods that immediately preceded and followed CSP 468 publication. Additionally, we examined how baseline clinical features influenced target selection following CSP 468. RESULTS The STN was the predominant site of DBS implantation before and after CSP 468 publication (93.2% of cases, and 60.4%, respectively), but GPi targeting increased significantly following CSP 468 publication (from 5.3% to 37.4%; p < .001). Patients who underwent GPi stimulation following CSP 468 exhibited worse indices of depression (p < .001), less responsiveness to medications (p < .05), and a trend towards worse pre-operative cognitive performance (p = .06). In multi-variate analysis, advanced patient age and depression were independent predictors of GPi targeting (p < .01). CONCLUSIONS Key findings of CSP 468 were reflected in our target selection of DBS for Parkinson's Disease. Following CSP 468, GPi targeting increased, and it was selected for patients with poorer cognitive and mood indices.
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Affiliation(s)
- Derek G Southwell
- Department of Neurological Surgery, University of California, San Francisco, USA.
| | - Martin J Rutkowski
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, USA
| | - Caroline Racine
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Jill Ostrem
- Department of Neurology, University of California, San Francisco, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, USA
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Watson GDR, Alloway KD. Opposing collicular influences on the parafascicular (Pf) and posteromedial (POm) thalamic nuclei: relationship to POm-induced inhibition in the substantia nigra pars reticulata (SNR). Brain Struct Funct 2017; 223:535-543. [DOI: 10.1007/s00429-017-1534-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 09/27/2017] [Indexed: 10/18/2022]
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18
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Fiechter M, Nowacki A, Oertel MF, Fichtner J, Debove I, Lachenmayer ML, Wiest R, Bassetti CL, Raabe A, Kaelin-Lang A, Schüpbach MW, Pollo C. Deep Brain Stimulation for Tremor: Is There a Common Structure? Stereotact Funct Neurosurg 2017; 95:243-250. [DOI: 10.1159/000478270] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Accepted: 06/08/2017] [Indexed: 12/19/2022]
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19
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Alloway KD, Smith JB, Mowery TM, Watson GDR. Sensory Processing in the Dorsolateral Striatum: The Contribution of Thalamostriatal Pathways. Front Syst Neurosci 2017; 11:53. [PMID: 28790899 PMCID: PMC5524679 DOI: 10.3389/fnsys.2017.00053] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/07/2017] [Indexed: 01/24/2023] Open
Abstract
The dorsal striatum has two functionally-defined subdivisions: a dorsomedial striatum (DMS) region involved in mediating goal-directed behaviors that require conscious effort, and a dorsolateral striatum (DLS) region involved in the execution of habitual behaviors in a familiar sensory context. Consistent with its presumed role in forming stimulus-response (S-R) associations, neurons in DLS receive massive inputs from sensorimotor cortex and are responsive to both active and passive sensory stimulation. While several studies have established that corticostriatal inputs contribute to the stimulus-induced responses observed in the DLS, there is growing awareness that the thalamus has a significant role in conveying sensory-related information to DLS and other parts of the striatum. The thalamostriatal projections to DLS originate mainly from the caudal intralaminar region, which contains the parafascicular (Pf) nucleus, and from higher-order thalamic nuclei such as the medial part of the posterior (POm) nucleus. Based on recent findings, we hypothesize that the thalamostriatal projections from these two regions exert opposing influences on the expression of behavioral habits. This article reviews the subcortical circuits that regulate the transmission of sensory information through these thalamostriatal projection systems, and describes the evidence that indicates these circuits could be manipulated to ameliorate the symptoms of Parkinson's disease (PD) and related neurological disorders.
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Affiliation(s)
- Kevin D. Alloway
- Neural and Behavioral Sciences, Center for Neural Engineering, Pennsylvania State UniversityUniversity Park, PA, United States
| | - Jared B. Smith
- Molecular Neurobiology Laboratory, The Salk Institute for Biological StudiesLa Jolla, CA, United States
| | - Todd M. Mowery
- Center for Neural Science, New York UniversityNew York, NY, United States
| | - Glenn D. R. Watson
- Department of Psychology and Neuroscience, Duke UniversityDurham, NC, United States
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20
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Affiliation(s)
- Kejia Hu
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
- MGH-HMS Center for Nervous System Repair, Harvard Medical School, Boston, MA, USA
| | - Ziev B. Moses
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Wendong Xu
- Department of Hand Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Ziv Williams
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- MGH-HMS Center for Nervous System Repair, Harvard Medical School, Boston, MA, USA
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21
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Akkhawattanangkul Y, Maiti P, Xue Y, Aryal D, Wetsel WC, Hamilton D, Fowler SC, McDonald MP. Targeted deletion of GD3 synthase protects against MPTP-induced neurodegeneration. GENES BRAIN AND BEHAVIOR 2017; 16:522-536. [PMID: 28239983 DOI: 10.1111/gbb.12377] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 02/20/2017] [Accepted: 02/21/2017] [Indexed: 01/07/2023]
Abstract
Parkinson's disease is a debilitating neurodegenerative condition for which there is no cure. Converging evidence implicates gangliosides in the pathogenesis of several neurodegenerative diseases, suggesting a potential new class of therapeutic targets. We have shown that interventions that simultaneously increase the neuroprotective GM1 ganglioside and decrease the pro-apoptotic GD3 ganglioside - such as inhibition of GD3 synthase (GD3S) or administration of sialidase - are neuroprotective in vitro and in a number of preclinical models. In this study, we investigated the effects of GD3S deletion on parkinsonism induced by 1-methyl-4phenyl-1,2,3,6-tetrahydropyridine (MPTP). MPTP was administered to GD3S-/- mice or controls using a subchronic regimen consisting of three series of low-dose injections (11 mg/kg/day × 5 days each, 3 weeks apart), and motor function was assessed after each. The typical battery of tests used to assess parkinsonism failed to detect deficits in MPTP-treated mice. More sensitive measures - such as the force-plate actimeter and treadmill gait parameters - detected subtle effects of MPTP, some of which were absent in mice lacking GD3S. In wild-type mice, MPTP destroyed 53% of the tyrosine-hydroxylase (TH)-positive neurons in the substantia nigra pars compacta (SNc) and reduced striatal dopamine 60.7%. In contrast, lesion size was only 22.5% in GD3S-/- mice and striatal dopamine was reduced by 37.2%. Stereological counts of Nissl-positive SNc neurons that did not express TH suggest that neuroprotection was complete but TH expression was suppressed in some cells. These results show that inhibition of GD3S has neuroprotective properties in the MPTP model and may warrant further investigation as a therapeutic target.
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Affiliation(s)
- Y Akkhawattanangkul
- Department of Comparative Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - P Maiti
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Y Xue
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - D Aryal
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Department of Cell Biology, Duke University Medical Center, Durham, NC, USA.,Department of Neurobiology, Duke University Medical Center, Durham, NC, USA
| | - W C Wetsel
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.,Department of Cell Biology, Duke University Medical Center, Durham, NC, USA.,Department of Neurobiology, Duke University Medical Center, Durham, NC, USA
| | - D Hamilton
- Department of Comparative Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - S C Fowler
- Department of Pharmacology & Toxicology, University of Kansas, Lawrence, KS, USA
| | - M P McDonald
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Anatomy & Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
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22
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Schneider J, Novak D, Jech R. Optimization of Parkinson Disease treatment combining anti-Parkinson drugs and deep brain stimulation using patient diaries. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:3444-7. [PMID: 26737033 DOI: 10.1109/embc.2015.7319133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The number of patients suffering from Parkinson's disease is increasing rapidly due to population aging. While traditional medications-based palliative therapy is successful in early stages, deep brain stimulation (DBS) may be used as an alternative treatment in later stages. After DBS implantation, the therapy typically consists of electrical stimulation and reduced medication. In order to provide good clinical outcome, a balance has to be found between medication and stimulation parameters, this is usually done as follows: First, Unified Parkinson's Disease Rating Scale (UPDRS) scoring is performed, second patients are supposed to fill subjective diaries during a specific period. This study shows that these diaries are useful as therapy progression indicator. Feel scores based on diaries and sleep time were examined with respect to DBS stimulation and medication. The results confirmed the positive effect of both therapy components--stimulation as well as medication--on patient feel scores. Furthermore, a positive correlation was observed between stimulation energy and sleep duration.
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23
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Hartmann A. Deep brain stimulation in Gilles de la Tourette syndrome: killing several birds with one stone? F1000Res 2016; 5:2255. [PMID: 27746910 PMCID: PMC5040147 DOI: 10.12688/f1000research.9521.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2016] [Indexed: 12/02/2022] Open
Abstract
In patients with severe, treatment-refractory Gilles de la Tourette syndrome (GTS), deep brain stimulation (DBS) of various targets has been increasingly explored over the past 15 years. The multiplicity of surgical targets is intriguing and may be partly due to the complexity of GTS, specifically the various and frequent associated psychiatric comorbidities in this disorder. Thus, the target choice may not only be aimed at reducing tics but also comorbidities. While this approach is laudable, it also carries the risk to increase confounding factors in DBS trials and patient evaluation. Moreover, I question whether DBS should really be expected to alleviate multiple symptoms at a time. Rather, I argue that tic reduction should remain our primary objective in severe GTS patients and that this intervention may subsequently allow an improved psychotherapeutic and/or pharmacological treatment of comorbidities. Thus, I consider DBS in GTS not as a single solution for all our patients’ ailments but as a stepping stone to improved holistic care made possible by tic reduction.
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Affiliation(s)
- Andreas Hartmann
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, Paris, France; Assistance Publique-Hôpitaux de Paris, Department of Neurology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France; French Reference Centre for Gilles de la Tourette Syndrome, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Abstract
AbstractDuring the “DBS Canada Day” symposium held in Toronto July 4-5, 2014, the scientific committee invited experts to discuss three main questions on target selection for deep brain stimulation (DBS) of patients with Parkinson’s disease (PD). First, is the subthalamic nucleus (STN) or the globus pallidus internus (GPi) the ideal target? In summary, both targets are equally effective in improving the motor symptoms of PD. STN allows a greater medications reduction, while GPi exerts a direct antidyskinetic effect. Second, are there further potential targets? Ventral intermediate nucleus DBS has significant long-term benefit for tremor control but insufficiently addresses other motor features of PD. DBS in the posterior subthalamic area also reduces tremor. The pedunculopontine nucleus remains an investigational target. Third, should DBS for PD be performed unilaterally, bilaterally or staged? Unilateral STN DBS can be proposed to asymmetric patients. There is no evidence that a staged bilateral approach reduces the incidence of DBS-related adverse events.
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25
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Altered neuronal activity in the pedunculopontine nucleus: An electrophysiological study in a rat model of Parkinson's disease. Behav Brain Res 2016; 305:57-64. [PMID: 26924016 DOI: 10.1016/j.bbr.2016.02.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 02/19/2016] [Accepted: 02/23/2016] [Indexed: 01/31/2023]
Abstract
The pedunculopontine nucleus (PPN) is a new deep brain stimulation target for treating Parkinson's disease (PD). But the alterations of the PPN electrophysiological activities in PD are still debated. To investigate these potential alterations, extracellular single unit and local field potential (LFP) activities in the PPN were recorded in unilateral hemispheric 6-hydroxydopamine (6-OHDA) lesioned rats and in control rats, respectively. The spike activity results revealed two types of neurons (Type I and Type II) with distinct electrophysiological characteristics in the PPN. Both types of neurons had increased firing rate and changed firing pattern in lesioned rats when compared to control rats. Specifically, Type II neurons showed an increased firing rate when the rat state was switched from rest to locomotion. The LFP results demonstrated that lesioned rats had lower LFP power at 0.7-12Hz and higher power at 12-30Hz than did control animals in either resting or locomotor state. These findings provide a better understanding of the effects of 6-OHDA lesion on neuronal activities in the PPN and also provide a proof of the link between this structure and locomotion, which contributes to better understanding the mechanisms of the PPN functioning in the pathophysiology of PD.
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Oswal A, Jha A, Neal S, Reid A, Bradbury D, Aston P, Limousin P, Foltynie T, Zrinzo L, Brown P, Litvak V. Analysis of simultaneous MEG and intracranial LFP recordings during Deep Brain Stimulation: a protocol and experimental validation. J Neurosci Methods 2015; 261:29-46. [PMID: 26698227 PMCID: PMC4758829 DOI: 10.1016/j.jneumeth.2015.11.029] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 11/30/2015] [Indexed: 11/17/2022]
Abstract
Setup for MEG and intracranial recordings during Deep Brain Stimulation is described. Phantom experiment showed correct recovery of oscillatory sources despite artefacts. The method is applied to real data from a patient with Parkinson's Disease. Cortico-subthalamic coherence profiles on and off stimulation were comparable.
Background Deep Brain Stimulation (DBS) is an effective treatment for several neurological and psychiatric disorders. In order to gain insights into the therapeutic mechanisms of DBS and to advance future therapies a better understanding of the effects of DBS on large-scale brain networks is required. New method In this paper, we describe an experimental protocol and analysis pipeline for simultaneously performing DBS and intracranial local field potential (LFP) recordings at a target brain region during concurrent magnetoencephalography (MEG) measurement. Firstly we describe a phantom setup that allowed us to precisely characterise the MEG artefacts that occurred during DBS at clinical settings. Results Using the phantom recordings we demonstrate that with MEG beamforming it is possible to recover oscillatory activity synchronised to a reference channel, despite the presence of high amplitude artefacts evoked by DBS. Finally, we highlight the applicability of these methods by illustrating in a single patient with Parkinson's disease (PD), that changes in cortical-subthalamic nucleus coupling can be induced by DBS. Comparison with existing approaches To our knowledge this paper provides the first technical description of a recording and analysis pipeline for combining simultaneous cortical recordings using MEG, with intracranial LFP recordings of a target brain nucleus during DBS.
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Affiliation(s)
- Ashwini Oswal
- Wellcome Trust Centre for Neuroimaging, 12 Queen Square, London, UK; Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Ashwani Jha
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
| | - Spencer Neal
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
| | - Alphonso Reid
- Wellcome Trust Centre for Neuroimaging, 12 Queen Square, London, UK
| | - David Bradbury
- Wellcome Trust Centre for Neuroimaging, 12 Queen Square, London, UK
| | - Peter Aston
- Wellcome Trust Centre for Neuroimaging, 12 Queen Square, London, UK
| | - Patricia Limousin
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
| | - Ludvic Zrinzo
- Sobell Department of Motor Neuroscience and Movement Disorders, Institute of Neurology, Queen Square, London, UK
| | - Peter Brown
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Vladimir Litvak
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
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27
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De Jesus S, Almeida L, Peng-Chen Z, Okun MS, Hess CW. Novel targets and stimulation paradigms for deep brain stimulation. Expert Rev Neurother 2015; 15:1067-80. [DOI: 10.1586/14737175.2015.1083421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Shenai MB, Romeo A, Walker HC, Guthrie S, Watts RL, Guthrie BL. Spatial topographies of unilateral subthalamic nucleus deep brain stimulation efficacy for ipsilateral, contralateral, midline, and total Parkinson disease motor symptoms. Neurosurgery 2015; 11 Suppl 2:80-8; discussion 88. [PMID: 25599197 DOI: 10.1227/neu.0000000000000613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation is a successful intervention for medically refractory Parkinson disease, although its efficacy depends on optimal electrode placement. Even though the predominant effect is observed contralaterally, modest improvements in ipsilateral and midline symptoms are also observed. OBJECTIVE To elucidate the role of contact location of unilateral deep brain stimulation on contralateral, ipsilateral, and axial subscores of Parkinson disease motor symptoms. METHODS Eighty-six patients receiving first deep brain stimulation STN electrode placements were identified, yielding 73 patients with 3-month follow-up. Total preoperative and postoperative Unified Parkinson Disease Rating Scale Part III scores were obtained and divided into contralateral, ipsilateral, and midline subscores. Contact location was determined on immediate postoperative magnetic resonance imaging. A 3-dimensional ordinary "kriging" algorithm generated spatial interpolations for total, ipsilateral, contralateral, and midline symptom categories. Interpolative reconstructions were performed in the axial planes (z = -0.5, -1.0, -1.5, -3.5, -4.5, -6.0) and a sagittal plane (x = 12.0). Interpolation error and significance were quantified by use of a cross-validation technique and quantile-quantile analysis. RESULTS There was an overall reduction in Unified Parkinson Disease Rating Scale Part III symptoms: total = 37.0 ± 24.11% (P < .05), ipsilateral = 15.9 ± 51.8%, contralateral = 56.2 ± 26.8% (P < .05), and midline = 26.5 ± 34.7%. Kriging interpolation was performed and cross-validated with quantile-quantile analysis with high correlation (R2 > 0.92) and demonstrated regions of efficacy for each symptom category. Contralateral symptoms demonstrated broad regions of efficacy across the peri-STN area. The ipsilateral and midline regions of efficacy were constrained and located along the dorsal STN and caudal zona incerta. CONCLUSION We provide evidence for a unique functional topographic window in which contralateral, ipsilateral, and midline structures may achieve the best efficacy. Although there are overlapping regions, laterality demonstrates distinct topographies. Surgical optimization should target the intersection of optimal regions for these symptom categories.
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Affiliation(s)
- Mahesh B Shenai
- *Department of Neuroscience, Inova Health System, Falls Church, Virginia, ‡Department of Neurosurgery, and §Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama
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Bastide MF, Meissner WG, Picconi B, Fasano S, Fernagut PO, Feyder M, Francardo V, Alcacer C, Ding Y, Brambilla R, Fisone G, Jon Stoessl A, Bourdenx M, Engeln M, Navailles S, De Deurwaerdère P, Ko WKD, Simola N, Morelli M, Groc L, Rodriguez MC, Gurevich EV, Quik M, Morari M, Mellone M, Gardoni F, Tronci E, Guehl D, Tison F, Crossman AR, Kang UJ, Steece-Collier K, Fox S, Carta M, Angela Cenci M, Bézard E. Pathophysiology of L-dopa-induced motor and non-motor complications in Parkinson's disease. Prog Neurobiol 2015. [PMID: 26209473 DOI: 10.1016/j.pneurobio.2015.07.002] [Citation(s) in RCA: 334] [Impact Index Per Article: 37.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Involuntary movements, or dyskinesia, represent a debilitating complication of levodopa (L-dopa) therapy for Parkinson's disease (PD). L-dopa-induced dyskinesia (LID) are ultimately experienced by the vast majority of patients. In addition, psychiatric conditions often manifested as compulsive behaviours, are emerging as a serious problem in the management of L-dopa therapy. The present review attempts to provide an overview of our current understanding of dyskinesia and other L-dopa-induced dysfunctions, a field that dramatically evolved in the past twenty years. In view of the extensive literature on LID, there appeared a critical need to re-frame the concepts, to highlight the most suitable models, to review the central nervous system (CNS) circuitry that may be involved, and to propose a pathophysiological framework was timely and necessary. An updated review to clarify our understanding of LID and other L-dopa-related side effects was therefore timely and necessary. This review should help in the development of novel therapeutic strategies aimed at preventing the generation of dyskinetic symptoms.
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Affiliation(s)
- Matthieu F Bastide
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Wassilios G Meissner
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; Department of Neurology, University Hospital Bordeaux, France
| | - Barbara Picconi
- Laboratory of Neurophysiology, Fondazione Santa Lucia, IRCCS, Rome, Italy
| | - Stefania Fasano
- Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Pierre-Olivier Fernagut
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Michael Feyder
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Francardo
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Cristina Alcacer
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Yunmin Ding
- Department of Neurology, Columbia University, New York, USA
| | - Riccardo Brambilla
- Division of Neuroscience, Institute of Experimental Neurology, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Gilberto Fisone
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - A Jon Stoessl
- Pacific Parkinson's Research Centre and National Parkinson Foundation Centre of Excellence, University of British Columbia, Vancouver, Canada
| | - Mathieu Bourdenx
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Michel Engeln
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Sylvia Navailles
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Philippe De Deurwaerdère
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Wai Kin D Ko
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - Nicola Simola
- Department of Biomedical Sciences, Section of Neuropsychopharmacology, Cagliari University, 09124 Cagliari, Italy
| | - Micaela Morelli
- Department of Biomedical Sciences, Section of Neuropsychopharmacology, Cagliari University, 09124 Cagliari, Italy
| | - Laurent Groc
- Univ. de Bordeaux, Institut Interdisciplinaire de neurosciences, UMR 5297, 33000 Bordeaux, France; CNRS, Institut Interdisciplinaire de neurosciences, UMR 5297, 33000 Bordeaux, France
| | - Maria-Cruz Rodriguez
- Department of Neurology, Hospital Universitario Donostia and Neuroscience Unit, Bio Donostia Research Institute, San Sebastian, Spain
| | - Eugenia V Gurevich
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Maryka Quik
- Center for Health Sciences, SRI International, CA 94025, USA
| | - Michele Morari
- Department of Medical Sciences, Section of Pharmacology, University of Ferrara, Ferrara, Italy
| | - Manuela Mellone
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milano, Italy
| | - Fabrizio Gardoni
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, 20133 Milano, Italy
| | - Elisabetta Tronci
- Department of Biomedical Sciences, Physiology Section, Cagliari University, Cagliari, Italy
| | - Dominique Guehl
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France
| | - François Tison
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; Department of Neurology, University Hospital Bordeaux, France
| | | | - Un Jung Kang
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Kathy Steece-Collier
- Michigan State University, College of Human Medicine, Department of Translational Science and Molecular Medicine & The Udall Center of Excellence in Parkinson's Disease Research, 333 Bostwick Ave NE, Grand Rapids, MI 49503, USA
| | - Susan Fox
- Morton & Gloria Shulman Movement Disorders Center, Toronto Western Hospital, Toronto, Ontario M4T 2S8, Canada
| | - Manolo Carta
- Department of Biomedical Sciences, Physiology Section, Cagliari University, Cagliari, Italy
| | - M Angela Cenci
- Basal Ganglia Pathophysiology Unit, Department of Experimental Medical Science, Lund University, Lund, Sweden
| | - Erwan Bézard
- Univ. de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; CNRS, Institut des Maladies Neurodégénératives, UMR 5293, 33000 Bordeaux, France; Motac Neuroscience Ltd, Manchester, UK.
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Low-frequency stimulation of the pedunculopontine nucleus affects gait and the neurotransmitter level in the ventrolateral thalamic nucleus in 6-OHDA Parkinsonian rats. Neurosci Lett 2015; 600:62-8. [PMID: 26054938 DOI: 10.1016/j.neulet.2015.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 05/24/2015] [Accepted: 06/03/2015] [Indexed: 12/11/2022]
Abstract
The pedunculopontine nucleus (PPN) is connected to spinal, cerebellar and cerebral motor control structures and can be activated with external electrodes. Intrinsic cholinergic neuronal degeneration in the PPN is associated with postural instabilities and gait disturbances (PIGD) in advanced Parkinson's disease (PD). Clinical studies have demonstrated that PPN stimulation may improve PIGD. We investigated this claim and the underlying mechanisms using the 6-hydroxydopamine (6-OHDA) hemilesion model of PD. In this study, gait-related parameters, including the base of support (BOS), stride length, and maximum contact area, were analyzed via CatWalk gait analysis following PPN-low frequency stimulation (LFS) of rats with unilateral 6-OHDA lesions. Additionally, neurotransmitter concentrations in the ventrolateral thalamic nucleus (VL) were measured by microdialysis and liquid chromatography-mass spectrometry (LC-MS). Our data revealed that unilateral 6-OHDA lesions of the medial forebrain bundle (MFB) induced significant gait deficits. PPN-LFS significantly improved the BOS (hindlimb) and maximum contact area (impaired forelimb) scores, whereas no other gait parameters were significantly affected. Unilateral 6-OHDA MFB lesions significantly decreased acetylcholine (ACh) and moderately decreased noradrenaline (NA) concentrations in the VL. PPN-LFS mildly reversed the ACh loss in the VL in the lesioned rats but did not alter the NA levels. Taken together, our data indicate that PPN-LFS is useful for treating gait deficits of PD and that these effects are probably mediated by a rebalancing of ACh levels in the PPN-VL pathway. Thus, our findings provide possible insight into the mechanisms underlying PIGD in PD.
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Security and privacy issues in implantable medical devices: A comprehensive survey. J Biomed Inform 2015; 55:272-89. [DOI: 10.1016/j.jbi.2015.04.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 03/19/2015] [Accepted: 04/17/2015] [Indexed: 11/24/2022]
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Poortvliet PC, Silburn PA, Coyne TJ, Chenery HJ. Deep brain stimulation for Parkinson disease in Australia: current scientific and clinical status. Intern Med J 2015; 45:134-9. [DOI: 10.1111/imj.12656] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- P. C. Poortvliet
- Asia-Pacific Centre for Neuromodulation; Centre for Clinical Research; The University of Queensland; Brisbane Queensland Australia
- Centre for Sensorimotor Performance; School of Human Movement and Nutrition Sciences; The University of Queensland; Brisbane Queensland Australia
| | - P. A. Silburn
- Asia-Pacific Centre for Neuromodulation; Centre for Clinical Research; The University of Queensland; Brisbane Queensland Australia
| | - T. J. Coyne
- Asia-Pacific Centre for Neuromodulation; Centre for Clinical Research; The University of Queensland; Brisbane Queensland Australia
| | - H. J. Chenery
- Asia-Pacific Centre for Neuromodulation; Centre for Clinical Research; The University of Queensland; Brisbane Queensland Australia
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Abstract
Deep brain stimulation (DBS) is an implanted electrical device that modulates specific targets in the brain resulting in symptomatic improvement in a particular neurologic disease, most commonly a movement disorder. It is preferred over previously used lesioning procedures due to its reversibility, adjustability, and ability to be used bilaterally with a good safety profile. Risks of DBS include intracranial bleeding, infection, malposition, and hardware issues, such migration, disconnection, or malfunction, but the risk of each of these complications is low--generally ≤ 5% at experienced, large-volume centers. It has been used widely in essential tremor, Parkinson's disease, and dystonia when medical treatment becomes ineffective, intolerable owing to side effects, or causes motor complications. Brain targets implanted include the thalamus (most commonly for essential tremor), subthalamic nucleus (most commonly for Parkinson's disease), and globus pallidus (Parkinson's disease and dystonia), although new targets are currently being explored. Future developments include brain electrodes that can steer current directionally and systems capable of "closed loop" stimulation, with systems that can record and interpret regional brain activity and modify stimulation parameters in a clinically meaningful way. New, image-guided implantation techniques may have advantages over traditional DBS surgery.
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Affiliation(s)
- Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, CA, 94143-0112, USA,
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A movable microelectrode array for chronic basal ganglia single-unit electrocorticogram co-recording in freely behaving rats. Neurol Sci 2014; 35:1429-39. [PMID: 24838541 DOI: 10.1007/s10072-014-1775-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
The basal ganglia-cortical circuits are important for information process to brain function. However, chronic recording of single-unit activities in the basal ganglia nucleus has not yet been well established. We present a movable bundled microwire array for chronic subthalamic nucleus (STN) single-unit electrocorticogram co-recording. The electrode assembly contains a screw-advanced microdrive and a microwire array. The array consists of a steel guide tube, five recording wires and one referenced wire which form the shape of a guiding hand, and one screw electrode for cortico-recording. The electrode can acquire stable cortex oscillation-driven STN firing units in rats under different behaving conditions for 8 weeks. We achieved satisfying signal-to-noise ratio, portions of cells retaining viability, and spike waveform similarities across the recording sections. Using this method, we investigated neural correlations of the basal ganglia-cortical circuits in different behaving conditions. This method will become a powerful tool for multi-region recording to study normal statements or movement disorders.
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