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Leodori G, Mancuso M, Marchet F, Belvisi D. The Role of the Motor Cortex in the Parkinsonian Tremor Network: Is it Time for an Upgrade? Mov Disord 2024; 39:1084. [PMID: 38924141 DOI: 10.1002/mds.29872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024] Open
Affiliation(s)
- Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Marco Mancuso
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Marchet
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
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Zalyalova ZA, Katunina EA, Pokhabov DV, Munasipova SE, Ermakova MM. [Tremor-dominant form of Parkinson's disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:28-35. [PMID: 38676674 DOI: 10.17116/jnevro202412404128] [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] [Indexed: 04/29/2024]
Abstract
The article is of a review nature and is devoted to tremor, one of the maladaptive and difficult-to-treat symptoms of Parkinson's disease (PD). Along with the classic rest tremor, patients with PD may experience tremor of other modalities: postural tremor, kinetic tremor, which reflects a multimodal mechanism of tremor formation involving multiple neurotransmitter systems. The unpredictable response to therapeutic options, the ambiguous response to levodopa, also reflects the role of multiple underlying pathophysiological processes. Among the drug methods of tremor correction, preference is given to dopamine receptor agonists - due to the spectrum of their pharmaceutical action, high efficiency in relation to all leading motor and a number of non-motor manifestations. The evidence for advanced neurosurgical, non-invasive modalities is mixed, and there are insufficient comparative studies to assess their efficacy in patients with tremor-dominant forms of PD.
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Affiliation(s)
- Z A Zalyalova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
| | - E A Katunina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center for Brain and Neurotechnology, Moscow, Russia
| | - D V Pokhabov
- Center for Innovative Neurology, Extrapyramidal Diseases and Botulinum Therapy, Krasnoyarsk, Russia
- Voino-Yasnevetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
| | - S E Munasipova
- Kazan State Medical University, Kazan, Russia
- Republican Consultative and Diagnostic Center for Extrapyramidal Pathology and Botulinum Therapy, Kazan, Russia
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Deveney CM, Surya JR, Haroon JM, Mahdavi KD, Hoffman KR, Enemuo KC, Jordan KG, Becerra SA, Kuhn T, Bystritsky A, Jordan SE. Transcranial focused ultrasound for the treatment of tremor: A preliminary case series. Brain Stimul 2024; 17:35-38. [PMID: 38128826 DOI: 10.1016/j.brs.2023.12.007] [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: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Essential tremor (ET) can be debilitating. Treatments for ET include beta-blockers and surgical interventions. Low-intensity focused ultrasound (LIFU) may offer an office-based non-invasive alternative. OBJECTIVE This pilot open label clinical trial explores safety, feasibility, and potential efficacy of LIFU in treatment of ET. METHODS We report outcomes from the first 10 participants in this IRB-approved trial of LIFU for treatment of ET. The ventral intermediate nucleus of the thalamus (Vim) was targeted using structural and functional MRI. Participants underwent eight 10-min sessions of LIFU targeting the contralateral (Vim) to the most affected hand. Safety was closely monitored; Global Rating of Change (GRC) and The Essential Tremor Rating Scale (TETRAS) scores were collected. RESULTS No adverse effects were reported. Eight participants reported a GRC ≥2. TETRAS performance subscale demonstrated clinically significant improvement in all participants. CONCLUSION Preliminary findings support LIFU's safety and feasibility. The potential efficacy encourages additional sham-controlled studies.
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Affiliation(s)
- C M Deveney
- The Regenesis Project, Santa Monica, CA, USA.
| | - J R Surya
- The Regenesis Project, Santa Monica, CA, USA
| | - J M Haroon
- The Regenesis Project, Santa Monica, CA, USA
| | - K D Mahdavi
- The Regenesis Project, Santa Monica, CA, USA
| | - K R Hoffman
- The Regenesis Project, Santa Monica, CA, USA
| | - K C Enemuo
- The Regenesis Project, Santa Monica, CA, USA
| | - K G Jordan
- The Regenesis Project, Santa Monica, CA, USA
| | - S A Becerra
- The Regenesis Project, Santa Monica, CA, USA
| | - T Kuhn
- University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, USA
| | - A Bystritsky
- University of California Los Angeles, Department of Psychiatry and Biobehavioral Sciences, USA
| | - S E Jordan
- The Regenesis Project, Santa Monica, CA, USA; University of California Los Angeles, Department of Neurology, USA
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4
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Liu B, Xu J, Feng Z, Hui R, Zhang Y, Liu D, Chang Q, Yu X, Mao Z. One-pass deep brain stimulation of subthalamic nucleus and ventral intermediate nucleus for levodopa-resistant tremor-dominant Parkinson's disease. Front Aging Neurosci 2023; 15:1289183. [PMID: 38187361 PMCID: PMC10768017 DOI: 10.3389/fnagi.2023.1289183] [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: 09/05/2023] [Accepted: 11/29/2023] [Indexed: 01/09/2024] Open
Abstract
Objective Tremor-dominant Parkinson's disease (TD-PD) can be further separated into levodopa-responsive and levodopa-resistant types, the latter being considered to have a different pathogenesis. Previous studies indicated that deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the globus pallidus internus (GPi) individually was not sufficient for tremor control, especially for the levodopa-resistant TD-PD (LRTD-PD). The thalamic ventral intermediate nucleus (VIM) has been regarded as a potent DBS target for different kinds of tremors. Therefore, we focused on the LRTD-PD subgroup and performed one-pass combined DBSs of STN and VIM to treat refractory tremors, aiming to investigate the safety and effectiveness of this one-trajectory dual-target DBS scheme. Methods We retrospectively collected five LRTD-PD patients who underwent a one-pass combined DBS of STN and VIM via a trans-frontal approach. The targeting of VIM was achieved by probabilistic tractography. Changes in severity of symptoms (measured by the Unified Parkinson Disease Rating Scale part III, UPDRS-III), levodopa equivalent daily doses (LEDD), and disease-specific quality of life (measured by the 39-item Parkinson's Disease Questionnaire, PDQ-39) were evaluated. Results Three-dimensional reconstruction of electrodes illustrated that all leads were successfully implanted into predefined positions. The mean improvement rates (%) were 53 ± 6.2 (UPDRS-III), 82.6 ± 11.4 (tremor-related items of UPDRS), and 52.1 ± 11.4 (PDQ-39), respectively, with a mean follow-up of 11.4 months. Conclusion One-pass combined DBS of STN and VIM via the trans-frontal approach is an effective and safe strategy to alleviate symptoms for LRTD-PD patients.
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Affiliation(s)
- Bin Liu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Junpeng Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhebin Feng
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Rui Hui
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yanyang Zhang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Di Liu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Qing Chang
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Xinguang Yu
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Zhiqi Mao
- Department of Neurosurgery, The First Medical Center of Chinese PLA General Hospital, Beijing, China
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5
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Rahimi S, Towhidkhah F, Baghdadi G, Forogh B, Saadat P, Soleimani G, Habibi SA. Modeling of cerebellar transcranial electrical stimulation effects on hand tremor in Parkinson's disease. Front Aging Neurosci 2023; 15:1187157. [PMID: 38020756 PMCID: PMC10679529 DOI: 10.3389/fnagi.2023.1187157] [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: 03/15/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Parkinson's disease (PD) is a neurodegenerative disorder with different motor and neurocognitive symptoms. Tremor is a well-known symptom of this disease. Increasing evidence suggested that the cerebellum may substantially contribute to tremors as a clinical symptom of PD. However, the theoretical foundations behind these observations are not yet fully understood. Methods In this study, a computational model is proposed to consider the role of the cerebellum and to show the effectiveness of cerebellar transcranial alternating current stimulation (tACS) on the rest tremor in participants with PD. The proposed model consists of the cortex, cerebellum, spinal circuit-muscular system (SC-MS), and basal ganglia blocks as the most critical parts of the brain, which are involved in generating rest tremors. The cortex, cerebellum, and SC-MS blocks were modeled using Van der Pol oscillators that interacted through synchronization procedures. Basal ganglia are considered as a regulator of the coupling weights defined between oscillators. In order to evaluate the global behavior of the model, we applied tACS on the cerebellum of fifteen PD patients for 15 min at each patient's peak frequency of their rest tremors. A tri-axial accelerometer recorded rest tremors before, during, and after the tACS. Results and Discussion The simulation of the model provides a suggestion for the possible role of the cerebellum on rest tremors and how cerebellar tACS can affect these tremors. Results of human experiments also showed that the online and offline effects of cerebellar tACS could lead to the reduction of rest tremors significantly by about %76 and %68, respectively. Our findings suggest that the cerebellar tACS could serve as a reliable, therapeutic technique to suppress the PD tremor.
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Affiliation(s)
- Soraya Rahimi
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
- Department of Neuroscience, University of Montreal, Montreal, QC, Canada
| | - Farzad Towhidkhah
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Golnaz Baghdadi
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Bijan Forogh
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Ghazaleh Soleimani
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Seyed Amirhassan Habibi
- Department of Neurology, Hazrat Rasool Hospital, Iran University of Medical Sciences, Tehran, Iran
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6
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Lu H, Wang X, Lou X. Current applications for magnetic resonance-guided focused ultrasound in the treatment of Parkinson's disease. Chin Med J (Engl) 2023; 136:780-787. [PMID: 36914938 PMCID: PMC10150909 DOI: 10.1097/cm9.0000000000002319] [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: 12/22/2022] [Indexed: 03/16/2023] Open
Abstract
ABSTRACT Magnetic resonance-guided focused ultrasound (MRgFUS) is a novel and minimally invasive technology. Since the US Food and Drug Administration approved unilateral ventral intermediate nucleus-MRgFUS for medication-refractory essential tremor in 2016, studies on new indications, such as Parkinson's disease (PD), psychiatric diseases, and brain tumors, have been on the rise, and MRgFUS has become a promising method to treat such neurological diseases. Currently, as the second most common degenerative disease, PD is a research hotspot in the field of MRgFUS. The actions of MRgFUS on the brain range from thermoablation, blood-brain barrier (BBB) opening, to neuromodulation. Intensity is a key determinant of ultrasound actions. Generally, high intensity can be used to precisely thermoablate brain targets, whereas low intensity can be used as molecular therapies to modulate neuronal activity and open the BBB in conjunction with injected microbubbles. Here, we aimed to summarize advances in the application of MRgFUS for the treatment of PD, with a focus on thermal ablation, BBB opening, and neuromodulation, in the hope of informing clinicians of current applications.
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Affiliation(s)
- Haoxuan Lu
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
| | - Xiaoyu Wang
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
- School of Medicine, Nankai University, Tianjin 300071, China
| | - Xin Lou
- Department of Radiology, Chinese PLA General Hospital/Chinese PLA Medical School, Beijing 100853, China
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Abusrair AH, Elsekaily W, Bohlega S. Tremor in Parkinson's Disease: From Pathophysiology to Advanced Therapies. Tremor Other Hyperkinet Mov (N Y) 2022; 12:29. [PMID: 36211804 PMCID: PMC9504742 DOI: 10.5334/tohm.712] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background Tremor is one of the most prevalent symptoms in Parkinson's Disease (PD). The progression and management of tremor in PD can be challenging, as response to dopaminergic agents might be relatively poor, particularly in patients with tremor-dominant PD compared to the akinetic/rigid subtype. In this review, we aim to highlight recent advances in the underlying pathogenesis and treatment modalities for tremor in PD. Methods A structured literature search through Embase was conducted using the terms "Parkinson's Disease" AND "tremor" OR "etiology" OR "management" OR "drug resistance" OR "therapy" OR "rehabilitation" OR "surgery." After initial screening, eligible articles were selected with a focus on published literature in the last 10 years. Discussion The underlying pathophysiology of tremor in PD remains complex and incompletely understood. Neurodegeneration of dopaminergic neurons in the retrorubral area, in addition to high-power neural oscillations in the cerebello-thalamo-cortical circuit and the basal ganglia, play a major role. Levodopa is the first-line therapeutic option for all motor symptoms, including tremor. The addition of dopamine agonists or anticholinergics can lead to further tremor reduction. Botulinum toxin injection is an effective alternative for patients with pharmacological-resistant tremor who are not seeking advanced therapies. Deep brain stimulation is the most well-established advanced therapy owing to its long-term efficacy, reversibility, and effectiveness in other motor symptoms and fluctuations. Magnetic resonance-guided focused ultrasound is a promising modality, which has the advantage of being incisionless. Cortical and peripheral electrical stimulation are non-invasive innovatory techniques that have demonstrated good efficacy in suppressing intractable tremor.
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Affiliation(s)
- Ali H. Abusrair
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Neurology, Department of Internal Medicine, Qatif Health Network, Qatif, Saudi Arabia
| | - Walaa Elsekaily
- College of Medicine, AlFaisal University, Riyadh, Saudi Arabia
| | - Saeed Bohlega
- Movement Disorders Program, Neurosciences Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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8
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Silkis IG. Hypothetical Mechanism of Resting Tremor in Parkinson’s Disease. NEUROCHEM J+ 2022. [DOI: 10.1134/s1819712422010111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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9
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Chan PY, Ripin ZM, Halim SA, Arifin WN, Yahya AS, Eow GB, Tan K, Hor JY, Wong CK. Motion characteristics of subclinical tremors in Parkinson's disease and normal subjects. Sci Rep 2022; 12:4021. [PMID: 35256707 PMCID: PMC8901710 DOI: 10.1038/s41598-022-07957-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/28/2022] [Indexed: 11/16/2022] Open
Abstract
The characteristics of the Parkinson’s disease tremor reported previously are not applicable to the full spectrum of severity. The characteristics of high- and low-amplitude tremors differ in signal regularity and frequency dispersion, a phenomenon that indicates characterisation should be studied separately based on the severity. The subclinical tremor of Parkinson’s disease is close to physiological tremor in terms of amplitude and frequency, and their distinctive features are still undetermined. We aimed to determine joint motion characteristics that are unique to subclinical Parkinson’s disease tremors. The tremors were characterised by four hand–arm motions based on displacement and peak frequencies. The rest and postural tremors of 63 patients with Parkinson’s disease and 62 normal subjects were measured with inertial sensors. The baseline was established from normal tremors, and the joint motions were compared within and between the two subject groups. Displacement analysis showed that pronation–supination and wrist abduction–adduction are the most and least predominant tremor motions for both Parkinson’s disease and normal tremors, respectively. However, the subclinical Parkinson’s disease tremor has significant greater amplitude and peak frequency in specific predominant motions compared with the normal tremor. The flexion–extension of normal postural tremor increases in frequency from the proximal to distal segment, a phenomenon that is explainable by mechanical oscillation. This characteristic is also observed in patients with Parkinson’s disease but with amplification in wrist and elbow joints. The contributed distinctive characteristics of subclinical tremors provide clues on the physiological manifestation that is a result of the neuromuscular mechanism of Parkinson’s disease.
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Affiliation(s)
- Ping Yi Chan
- School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 47500, Subang Jaya, Selangor, Malaysia.
| | - Zaidi Mohd Ripin
- School of Mechanical Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, Malaysia
| | - Sanihah Abdul Halim
- Department of Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Wan Nor Arifin
- Biostatistics and Research Methodology Unit, School of Medical Sciences, Health Campus, Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Shukri Yahya
- School of Civil Engineering, Universiti Sains Malaysia, Engineering Campus, Nibong Tebal, Penang, Malaysia
| | - Gaik Bee Eow
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
| | - Kenny Tan
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
| | - Jyh Yung Hor
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
| | - Chee Keong Wong
- Department of Neurology, Penang General Hospital, Georgetown, Penang, Malaysia
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Stanziano M, Golfrè Andreasi N, Messina G, Rinaldo S, Palermo S, Verri M, Demichelis G, Medina JP, Ghielmetti F, Bonvegna S, Nigri A, Frazzetta G, D'Incerti L, Tringali G, DiMeco F, Eleopra R, Bruzzone MG. Resting State Functional Connectivity Signatures of MRgFUS Vim Thalamotomy in Parkinson's Disease: A Preliminary Study. Front Neurol 2022; 12:786734. [PMID: 35095731 PMCID: PMC8791196 DOI: 10.3389/fneur.2021.786734] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/02/2021] [Indexed: 12/03/2022] Open
Abstract
Magnetic Resonance-guided high-intensity Focused Ultrasound (MRgFUS) of the thalamic ventral intermediate nucleus (Vim) for tremor has increasingly gained interest as a new non-invasive alternative to standard neurosurgery. Resting state functional connectivity (rs-FC) correlates of MRgFUS have not been extensively investigated yet. A region of interest (ROI)-to-ROI rs-FC MRI “connectomic” analysis focusing on brain regions relevant for tremor was conducted on 15 tremor-dominant patients with Parkinson's disease who underwent MRgFUS. We tested whether rs-FC between tremor-related areas was modulated by MRgFUS at 1 and 3 months post-operatively, and whether such changes correlated with individual clinical outcomes assessed by the MDS-UPDRS-III sub items for tremor. Significant increase in FC was detected within bilateral primary motor (M1) cortices, as well as between bilateral M1 and crossed primary somatosensory cortices, and also between pallidum and the dentate nucleus of the untreated hemisphere. Correlation between disease duration and FC increase at 3 months was found between the putamen of both cerebral hemispheres and the Lobe VI of both cerebellar hemispheres, as well as between the Lobe VI of untreated cerebellar hemisphere with bilateral supplementary motor area (SMA). Drop-points value of MDS-UPDRS at 3 months correlated with post-treatment decrease in FC, between the anterior cingulate cortex and bilateral SMA, as well as between the Lobe VI of treated cerebellar hemisphere and the interpositus nucleus of untreated cerebellum. Tremor improvement at 3 months, expressed as percentage of intra-subject MDS-UPDRS changes, correlated with FC decrease between bilateral occipital fusiform gyrus and crossed Lobe VI and Vermis VI. Good responders (≥50% of baseline tremor improvement) showed reduced FC between bilateral SMA, between the interpositus nucleus of untreated cerebellum and the Lobe VI of treated cerebellum, as well as between the untreated SMA and the contralateral putamen. Good responders were characterized at baseline by crossed hypoconnectivity between bilateral putamen and M1, as well as between the putamen of the treated hemisphere and the contralateral SMA. We conclude that MRgFUS can effectively modulate brain FC within the tremor network. Such changes are associated with clinical outcome. The shifting mode of integration among the constituents of this network is, therefore, susceptible to external redirection despite the chronic nature of PD.
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Affiliation(s)
- Mario Stanziano
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Neurosciences Department "Rita Levi Montalcini, " University of Turin, Turin, Italy
| | - Nico Golfrè Andreasi
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giuseppe Messina
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Rinaldo
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Sara Palermo
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,European Innovation Partnership on Active and Healthy Ageing, Brussels, Belgium
| | - Mattia Verri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Greta Demichelis
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jean Paul Medina
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Ghielmetti
- Health Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Salvatore Bonvegna
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Anna Nigri
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | | | - Ludovico D'Incerti
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Tringali
- Functional Neurosurgery Unit, Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco DiMeco
- Neurosurgery Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy.,Pathophysiology and Transplantation Department, University of Milan, Milan, Italy.,Neurological Surgery Department, Johns Hopkins Medical School, Baltimore, MD, United States
| | - Roberto Eleopra
- Parkinson and Movement Disorders Unit, Clinical Neurosciences Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
| | - Maria Grazia Bruzzone
- Neuroradiology Unit, Diagnostic and Technology Department, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Neurologico Carlo Besta, Milan, Italy
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11
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Is essential tremor a degenerative disorder or an electric disorder? Degenerative disorder. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 163:65-101. [PMID: 35750370 PMCID: PMC9846862 DOI: 10.1016/bs.irn.2022.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Essential tremor (ET) is a highly prevalent neurologic disease and is the most common of the many tremor disorders. ET is a progressive condition with marked clinical heterogeneity, associated with a spectrum of both motor and non-motor features. However, its disease mechanisms remain poorly understood. Much debate has centered on whether ET should be considered a degenerative disorder, with underlying pathological changes in brain causing progressive disease manifestations, or an electric disorder, with overactivity of intrinsically oscillatory motor networks that occur without underlying structural brain abnormalities. Converging data from clinical, neuroimaging and pathological studies in ET now provide considerable evidence for the neurodegenerative hypothesis. A major turning point in this debate is that rigorous tissue-based studies have recently identified a series of structural changes in the ET cerebellum. Most of these pathological changes are centered on the Purkinje cell and connected neuronal populations, which can result in partial loss of Purkinje cells and circuitry reorganizations that would disturb cerebellar function. There is significant overlap in clinical and pathological features of ET with other disorders of cerebellar degeneration, and an increased risk of developing other degenerative diseases in ET. The combined implication of these studies is that ET could be degenerative. The evidence in support of the degenerative hypothesis is presented.
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12
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Wu C, Ferreira F, Fox M, Harel N, Hattangadi-Gluth J, Horn A, Jbabdi S, Kahan J, Oswal A, Sheth SA, Tie Y, Vakharia V, Zrinzo L, Akram H. Clinical applications of magnetic resonance imaging based functional and structural connectivity. Neuroimage 2021; 244:118649. [PMID: 34648960 DOI: 10.1016/j.neuroimage.2021.118649] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 09/24/2021] [Accepted: 10/10/2021] [Indexed: 12/23/2022] Open
Abstract
Advances in computational neuroimaging techniques have expanded the armamentarium of imaging tools available for clinical applications in clinical neuroscience. Non-invasive, in vivo brain MRI structural and functional network mapping has been used to identify therapeutic targets, define eloquent brain regions to preserve, and gain insight into pathological processes and treatments as well as prognostic biomarkers. These tools have the real potential to inform patient-specific treatment strategies. Nevertheless, a realistic appraisal of clinical utility is needed that balances the growing excitement and interest in the field with important limitations associated with these techniques. Quality of the raw data, minutiae of the processing methodology, and the statistical models applied can all impact on the results and their interpretation. A lack of standardization in data acquisition and processing has also resulted in issues with reproducibility. This limitation has had a direct impact on the reliability of these tools and ultimately, confidence in their clinical use. Advances in MRI technology and computational power as well as automation and standardization of processing methods, including machine learning approaches, may help address some of these issues and make these tools more reliable in clinical use. In this review, we will highlight the current clinical uses of MRI connectomics in the diagnosis and treatment of neurological disorders; balancing emerging applications and technologies with limitations of connectivity analytic approaches to present an encompassing and appropriate perspective.
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Affiliation(s)
- Chengyuan Wu
- Department of Neurological Surgery, Vickie and Jack Farber Institute for Neuroscience, Thomas Jefferson University, 909 Walnut Street, Third Floor, Philadelphia, PA 19107, USA; Jefferson Integrated Magnetic Resonance Imaging Center, Department of Radiology, Thomas Jefferson University, 909 Walnut Street, First Floor, Philadelphia, PA 19107, USA.
| | - Francisca Ferreira
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Michael Fox
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Noam Harel
- Center for Magnetic Resonance Research, University of Minnesota, 2021 Sixth Street S.E., Minneapolis, MN 55455, USA.
| | - Jona Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, Center for Precision Radiation Medicine, University of California, San Diego, 3855 Health Sciences Drive, La Jolla, CA 92037, USA.
| | - Andreas Horn
- Neurology Department, Movement Disorders and Neuromodulation Section, Charité - University Medicine Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
| | - Saad Jbabdi
- Wellcome Centre for Integrative Neuroimaging, Centre for Functional MRI of the Brain, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford OX3 9DU, UK.
| | - Joshua Kahan
- Department of Neurology, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065, USA.
| | - Ashwini Oswal
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Mansfield Rd, Oxford OX1 3TH, UK.
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, 7200 Cambridge, Ninth Floor, Houston, TX 77030, USA.
| | - Yanmei Tie
- Center for Brain Circuit Therapeutics, Departments of Neurology, Psychiatry, Radiology, and Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA; Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Boston, MA 02115, USA.
| | - Vejay Vakharia
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK.
| | - Ludvic Zrinzo
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
| | - Harith Akram
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, 33 Queen Square, London WC1N 3BG, UK; Unit of Functional Neurosurgery, UCL Queen Square Institute of Neurology, 33 Queen Square, London WC1N 3BG, UK.
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13
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Yang J, Guo Q, Zou X, Wang M, Wen Y, Chen X, Weng X, Xu F. Correlation between head tremble and the severity of Parkinson's disease. CNS Neurosci Ther 2021; 28:218-225. [PMID: 34758102 PMCID: PMC8739048 DOI: 10.1111/cns.13753] [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: 07/21/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Parkinson's (PD) is a common degenerative disease of the central nervous system. It affects more than 6 million individuals worldwide. The typical clinical manifestations include static tremor, slow movement, and unstable posture. However, the correlation between head tremor and the severity of PD remains unclear. Methods In the current study, 18 patients and 18 healthy subjects were recruited to undergo a phonation test. Noldus facereader 7.0 software was used to analyze the range of head trembling between the two groups. Results The data revealed that patients with PD had significant differences in the x‐, y‐, and z‐axis of head movement with respect to the specific pronunciation syllables compared with the normal group. Moreover, the head movement of the patients with PD was positively correlated with the severity of the disease in the single, double, and multiple syllable tests. In the phonetic test, the head displacement of patients with PD was significantly greater than that of healthy individuals, and the displacement range was positively correlated with the severity of the disease. Conclusion These pieces of evidence suggested that the measurement of head displacement assists the early diagnosis and severity of the disease.
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Affiliation(s)
- Jingsheng Yang
- Department of Public Health, Chengdu Medical College, Sichuan, China
| | - Quanhao Guo
- MOEMIL Laboratory, School of Optoelectronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China
| | - Xianwei Zou
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Meng Wang
- Department of Public Health, Chengdu Medical College, Sichuan, China
| | - Yanxia Wen
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Xiaqing Chen
- Department of Neurology, First Affiliated Hospital of Chengdu Medical College, Sichuan, China
| | - Xiechuan Weng
- Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Fan Xu
- Department of Public Health, Chengdu Medical College, Sichuan, China
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Ferreira F, Akram H, Ashburner J, Zrinzo L, Zhang H, Lambert C. Ventralis intermedius nucleus anatomical variability assessment by MRI structural connectivity. Neuroimage 2021; 238:118231. [PMID: 34089871 PMCID: PMC8960999 DOI: 10.1016/j.neuroimage.2021.118231] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 05/14/2021] [Accepted: 06/01/2021] [Indexed: 12/11/2022] Open
Abstract
The ventralis intermedius nucleus (Vim) is centrally placed in the dentato-thalamo-cortical pathway (DTCp) and is a key surgical target in the treatment of severe medically refractory tremor. It is not visible on conventional MRI sequences; consequently, stereotactic targeting currently relies on atlas-based coordinates. This fails to capture individual anatomical variability, which may lead to poor long-term clinical efficacy. Probabilistic tractography, combined with known anatomical connectivity, enables localisation of thalamic nuclei at an individual subject level. There are, however, a number of confounds associated with this technique that may influence results. Here we focused on an established method, using probabilistic tractography to reconstruct the DTCp, to identify the connectivity-defined Vim (cd-Vim) in vivo. Using 100 healthy individuals from the Human Connectome Project, our aim was to quantify cd-Vim variability across this population, measure the discrepancy with atlas-defined Vim (ad-Vim), and assess the influence of potential methodological confounds. We found no significant effect of any of the confounds. The mean cd-Vim coordinate was located within 1.88 mm (left) and 2.12 mm (right) of the average midpoint and 3.98 mm (left) and 5.41 mm (right) from the ad-Vim coordinates. cd-Vim location was more variable on the right, which reflects hemispheric asymmetries in the probabilistic DTC reconstructed. The method was reproducible, with no significant cd-Vim location differences in a separate test-retest cohort. The superior cerebellar peduncle was identified as a potential source of artificial variance. This work demonstrates significant individual anatomical variability of the cd-Vim that atlas-based coordinate targeting fails to capture. This variability was not related to any methodological confound tested. Lateralisation of cerebellar functions, such as speech, may contribute to the observed asymmetry. Tractography-based methods seem sensitive to individual anatomical variability that is missed by conventional neurosurgical targeting; these findings may form the basis for translational tools to improve efficacy and reduce side-effects of thalamic surgery for tremor.
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Affiliation(s)
- Francisca Ferreira
- EPSRC Centre for Doctoral Training in Intelligent, Integrated Imaging in Healthcare (i4health), University College London, Gower Street, London WC1E 6BT, United Kingdom; Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, Queen Square, WC1N 3BG London, United Kingdom; Wellcome Centre for Human Neuroimaging, 12 Queen Square, London WC1N 3AR, United Kingdom.
| | - Harith Akram
- Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, Queen Square, WC1N 3BG London, United Kingdom
| | - John Ashburner
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, London WC1N 3AR, United Kingdom
| | - Ludvic Zrinzo
- Functional Neurosurgery Unit, Department of Clinical and Motor Neurosciences, UCL Institute of Neurology, Queen Square, WC1N 3BG London, United Kingdom
| | - Hui Zhang
- EPSRC Centre for Doctoral Training in Intelligent, Integrated Imaging in Healthcare (i4health), University College London, Gower Street, London WC1E 6BT, United Kingdom; Department of Computer Science and Centre for Medical Image Computing, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Christian Lambert
- Wellcome Centre for Human Neuroimaging, 12 Queen Square, London WC1N 3AR, United Kingdom
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15
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Permezel F. Brain MRI-guided focused ultrasound conceptualised as a tool for brain network intervention. J Clin Neurosci 2021; 90:370-379. [PMID: 34275578 DOI: 10.1016/j.jocn.2021.05.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 05/02/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
Magnetic resonance imaging guided high intensity focused ultrasound (HIFU) has emerged as a tool offering incisionless intervention on brain tissue. The low risk and rapid recovery from this procedure, in addition to the ability to assess for clinical benefit and adverse events intraprocedurally, makes it an ideal tool for intervention upon brain networks both for clinical and research applications. This review article proposes that conceptualising brain focused ultrasound as a tool for brain network intervention and adoption of methodology to complement this approach may result in better clinical outcomes, fewer adverse events and may unveil or allow treatment opportunities not otherwise possible. A brief introduction to network neuroscience is discussed before a description of pathological brain networks is provided for a number of conditions for which MRI-guided brain HIFU intervention has been implemented. Essential Tremor is discussed as the most advanced example of MRI-guided brain HIFU intervention adoption along with the issues that present with this treatment modality compared to alternatives. The brain network intervention paradigm is proposed to overcome these issues and a number of examples of implementation of this are discussed. The ability of low intensity MRI guided focussed ultrasound to neuromoduate brain tissue without lesioning is introduced. This tool is discussed with regards to its potential clinical application as well as its potential to further our understanding of network neuroscience via its ability to interrogate brain networks without damaging tissue. Finally, a number of current clinical trials utilising brain focused ultrasound are discussed, along with the additional applications available from the utilisation of low intensity focused ultrasound.
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Affiliation(s)
- Fiona Permezel
- Austin Hospital, Heidelberg, Victoria, Australia; The University of Melbourne, Parkville, Victoria, Australia; The Florey Institute of Neuroscience and Mental Health, Austin Hospital, Victoria, Australia.
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16
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Orso B, Arnaldi D, Girtler N, Brugnolo A, Doglione E, Mattioli P, Biassoni E, Fancellu R, Massa F, Bauckneht M, Chiola S, Morbelli S, Nobili F, Pardini M. Dopaminergic and Serotonergic Degeneration and Cortical [ 18 F]Fluorodeoxyglucose Positron Emission Tomography in De Novo Parkinson's Disease. Mov Disord 2021; 36:2293-2302. [PMID: 34021923 DOI: 10.1002/mds.28654] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/28/2021] [Accepted: 05/02/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Degeneration of the nigrostriatal dopaminergic (DA) and the raphe-thalamic serotonergic (SE) systems is among the earliest changes observed in Parkinson's disease (PD). The consequences of those changes on brain metabolism, especially regarding their impact on the cortex, are poorly understood. OBJECTIVES Using multi-tracer molecular imaging, we assessed in a cohort of drug-naive PD patients the association between cortical metabolism and DA and SE system deafferentation of either striatum or thalamus, and we explored whether this association was mediated by either striatum or thalamus metabolism. METHODS We recruited 96 drug-naive PD patients (aged 71.9 ± 7.5 years) who underwent [123 I]ioflupane single-photon emission computed tomography ([123 I]FP-CIT-SPECT) and brain [18 F]fluorodeoxyglucose positron emission tomography ([18 F]FDG-PET). We used a voxel-wise analysis of [18 F]FDG-PET images to correlate regional metabolism with striatal DA and thalamic SE innervation as assessed using [123 I]FP-CIT-SPECT. RESULTS We found that [123 I]FP-CIT specific to nondisplaceable binding ratio (SBR) and glucose metabolism positively correlated with one another in the deep gray matter (thalamus: P = 0.001, r = 0.541; caudate P = 0.001, r = 0.331; putamen P = 0.001, r = 0.423). We then observed a direct correlation between temporoparietal metabolism and caudate DA innervation, as well as a direct correlation between prefrontal metabolism and thalamus SE innervation. The effect of caudate [123 I]FP-CIT SBR values on temporoparietal metabolism was mediated by caudate metabolic values (percentage mediated: 89%, P-value = 0.008), and the effect of thalamus [123 I]FP-CIT SBR values on prefrontal metabolism was fully mediated by thalamus metabolic values (P < 0.001). CONCLUSIONS These data suggest that the impact of deep gray matter monoaminergic deafferentation on cortical function is mediated by striatal and thalamic metabolism in drug-naive PD. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Beatrice Orso
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - Nicola Girtler
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - Andrea Brugnolo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | | | - Pietro Mattioli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Erica Biassoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Federico Massa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Matteo Bauckneht
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy.,Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Silvia Chiola
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy.,Humanitas Clinical and Research Center-IRCCS, Rozzano, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy.,Department of Health Science (DISSAL), University of Genoa, Genoa, Italy
| | - Flavio Nobili
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - Matteo Pardini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
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Huang CS, Wang GH, Chuang HH, Chuang AY, Yeh JY, Lai YC, Yang YC. Conveyance of cortical pacing for parkinsonian tremor-like hyperkinetic behavior by subthalamic dysrhythmia. Cell Rep 2021; 35:109007. [PMID: 33882305 DOI: 10.1016/j.celrep.2021.109007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 12/01/2020] [Accepted: 03/25/2021] [Indexed: 10/21/2022] Open
Abstract
Parkinson's disease is characterized by both hypokinetic and hyperkinetic symptoms. While increased subthalamic burst discharges have a direct causal relationship with the hypokinetic manifestations (e.g., rigidity and bradykinesia), the origin of the hyperkinetic symptoms (e.g., resting tremor and propulsive gait) has remained obscure. Neuronal burst discharges are presumed to be autonomous or less responsive to synaptic input, thereby interrupting the information flow. We, however, demonstrate that subthalamic burst discharges are dependent on cortical glutamatergic synaptic input, which is enhanced by A-type K+ channel inhibition. Excessive top-down-triggered subthalamic burst discharges then drive highly correlative activities bottom-up in the motor cortices and skeletal muscles. This leads to hyperkinetic behaviors such as tremors, which are effectively ameliorated by inhibition of cortico-subthalamic AMPAergic synaptic transmission. We conclude that subthalamic burst discharges play an imperative role in cortico-subcortical information relay, and they critically contribute to the pathogenesis of both hypokinetic and hyperkinetic parkinsonian symptoms.
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Affiliation(s)
- Chen-Syuan Huang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Guan-Hsun Wang
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; School of Medicine, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Medical Education, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Hsiang-Hao Chuang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ai-Yu Chuang
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Jui-Yu Yeh
- Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yi-Chen Lai
- Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ya-Chin Yang
- Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Department of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Neuroscience Research Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan.
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18
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Liu J, Shuai G, Fang W, Zhu Y, Chen H, Wang Y, Li Q, Han Y, Zou D, Cheng O. Altered regional homogeneity and connectivity in cerebellum and visual-motor relevant cortex in Parkinson's disease with rapid eye movement sleep behavior disorder. Sleep Med 2021; 82:125-133. [PMID: 33915428 DOI: 10.1016/j.sleep.2021.03.041] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/16/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Rapid eye movement sleep behavior disorder (RBD) frequently occurs in Parkinson's disease (PD), however, the exact pathophysiological mechanism underlying its occurrence is not clear. In this study, we explored whether there is abnormal spontaneous neuronal activities and connectivity maps in some brain areas under resting-state in PD patients with RBD. METHODS We recruited 38 PD patients (19 PD with RBD and 19 PD without RBD), and 20 age- and gender-matched normal controls. We used resting-state functional magnetic resonance imaging (RS-fMRI) to analyze regional homogeneity (ReHo) and functional connectivity (FC), and further to reveal the neuronal activity in all subjects. RESULTS Compared with the PD without RBD patients, the PD with RBD patients showed a significant increase in regional homogeneity in the left cerebellum, the right middle occipital region and the left middle temporal region, and decreased regional homogeneity in the left middle frontal region. The REM sleep behavioral disorders questionnaire scores were significantly positively correlated with the ReHo values of the left cerebellum. The functional connectivity analysis in which the four regions described above were used as regions of interest revealed increased functional activity between the left cerebellum and bilateral occipital regions, bilateral temporal regions and bilateral supplementary motor area. CONCLUSION The pathophysiological mechanism of PD with RBD may be related to abnormal spontaneous neuronal activity patterns with strong synchronization of cerebellar and visual-motor relevant cortex, and the increased connectivity of the cerebellum with the occipital and motor regions.
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Affiliation(s)
- Jinjing Liu
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Guangying Shuai
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Weidong Fang
- Department of Radiology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yingcheng Zhu
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Huiyue Chen
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yuchan Wang
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Qun Li
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Yu Han
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Dezhi Zou
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China
| | - Oumei Cheng
- Department of Neurology, the First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China.
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Boonstra JT, Michielse S, Temel Y, Hoogland G, Jahanshahi A. Neuroimaging Detectable Differences between Parkinson's Disease Motor Subtypes: A Systematic Review. Mov Disord Clin Pract 2021; 8:175-192. [PMID: 33553487 PMCID: PMC7853198 DOI: 10.1002/mdc3.13107] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 09/10/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The neuroanatomical substrates of Parkinson's disease (PD) with tremor-dominance (TD) and those with non-tremor dominance (nTD), postural instability and gait difficulty (PIGD), and akinetic-rigid (AR) are not fully differentiated. A better understanding of symptom specific pathoanatomical markers of PD subtypes may result in earlier diagnosis and more tailored treatment. Here, we aim to give an overview of the neuroimaging literature that compared PD motor subtypes. METHODS A systematic literature review on neuroimaging studies of PD subtypes was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms submitted to the PubMed database included: "Parkinson's disease", "MRI" and "motor subtypes" (TD, nTD, PIGD, AR). The results are first discussed from macro to micro level of organization (i.e., (1) structural; (2) functional; and (3) molecular) and then by applied imaging methodology. FINDINGS Several neuroimaging methods including diffusion imaging and positron emission tomography (PET) distinguish specific PD motor subtypes well, although findings are mixed. Furthermore, our review demonstrates that nTD-PD patients have more severe neuroalterations compared to TD-PD patients. More specifically, nTD-PD patients have deficits within striato-thalamo-cortical (STC) circuitry and other thalamocortical projections related to cognitive and sensorimotor function, while TD-PD patients tend to have greater cerebello-thalamo-cortical (CTC) circuitry dysfunction. CONCLUSIONS Based on the literature, STC and CTC circuitry deficits seem to be the key features of PD and the subtypes. Future research should make greater use of multimodal neuroimaging and techniques that have higher sensitivity in delineating subcortical structures involved in motor diseases.
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Affiliation(s)
- Jackson Tyler Boonstra
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Stijn Michielse
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Yasin Temel
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Govert Hoogland
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
| | - Ali Jahanshahi
- Department of Neurosurgery, School for Mental Health and Neuroscience (MHeNS)Maastricht University Medical CenterMaastrichtThe Netherlands
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20
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Berlot R, Rothwell JC, Bhatia KP, Kojović M. Variability of Movement Disorders: The Influence of Sensation, Action, Cognition, and Emotions. Mov Disord 2020; 36:581-593. [PMID: 33332680 DOI: 10.1002/mds.28415] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 11/02/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
Patients with movement disorders experience fluctuations unrelated to disease progression or treatment. Extrinsic factors that contribute to the variable expression of movement disorders are environment related. They influence the expression of movement disorders through sensory-motor interactions and include somatosensory, visual, and auditory stimuli. Examples of somatosensory effects are stimulus sensitivity of myoclonus on touch and sensory amelioration in dystonia but also some less-appreciated effects on parkinsonian tremor and gait. Changes in visual input may affect practically all types of movement disorders, either by loss of its compensatory role or by disease-related alterations in the pathways subserving visuomotor integration. The interaction between auditory input and motor function is reflected in simple protective reflexes and in complex behaviors such as singing or dancing. Various expressions range from the effect of music on parkinsonian bradykinesia to tics. Changes in body position affect muscle tone and may result in marked fluctuations of rigidity or may affect dystonic manifestations. Factors intrinsic to the patient are related to their voluntary activity and cognitive, motivational, and emotional states. Depending on the situation or disease, they may improve or worsen movement disorders. We discuss various factors that can influence the phenotypic variability of movement disorders, highlighting the potential mechanisms underlying these manifestations. We also describe how motor fluctuations can be provoked during the clinical assessment to help reach the diagnosis and appreciated to understand complaints that seem discrepant with objective findings. We summarize advice and interventions based on the variability of movement disorders that may improve patients' functioning in everyday life. © 2020 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Rok Berlot
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - John C Rothwell
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Kailash P Bhatia
- Department of Clinical and Motor Neuroscience, UCL Institute of Neurology, Queen Square, London, United Kingdom
| | - Maja Kojović
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Wang S, Zhang Y, Lei J, Guo S. Investigation of sensorimotor dysfunction in Parkinson disease by resting-state fMRI. Neurosci Lett 2020; 742:135512. [PMID: 33221477 DOI: 10.1016/j.neulet.2020.135512] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE Functional MRI has played a fundamental role in Parkinson's disease(PD) study. In this paper, we performed an independent component analysis (ICA) based on functional networks to reveal the intricate variations on the morphology and functional properties of brain. Our analysis aims at discovering the differences between PD patients with sensorimotor function impairment and normal controls(NC), thus helping to understand the coordination neurological function degeneration in PD objectively. METHOD We investigated the blood oxygen level dependent(BOLD) functional MRI obtained at a 3.0 T MRI scanner. 30 PD patients and 28 NC subjects underwent the scan in resting state. The signals of sensory and motor coordinative control areas in the sensorimotor, insula and cerebellum networks acquired by ICA(Independent Component Analysis)were applied to analyze the functional alterations. Specifically, intra-network analysis was performed with signals in local networks, and inter-network analysis was conducted by functional network connectivity (FNC) with signals across different networks. Two sample T test was carried out to detect the significant (p < 0.05, FDR p < 0.05) functional abnormality in PD patients. CONCLUSION We identified an obvious increase in bilateral posterior insula, but decrease in bilateral cerebellum hemisphere, supplementary motor area(SMA) and precentral gyrus paracentral lobule of left postcentral gyrus. Besides, we found a significantly increased connection between independent component (IC) 13 which was located in right postcentral gyrus and cerebellum. Decreased connections were detected between sensory and motor cortex in sensorimotor network and between cerebellum and insula network by FNC analysis in PD patients as well. DISCUSSION Parkinson's disease derives from the degeneration of the dopaminergic neurons in substantia nigra, and results in decreased secretion of inhibitory neurotransmitter. The significant differences between PD and NC groups in our research maybe explain the clinical manifestations of prominent bradykinesia and multiple extrapyramidal symptoms.
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Affiliation(s)
- Shuaiwen Wang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China.
| | - Yanli Zhang
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China
| | - Junqiang Lei
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China
| | - Shunlin Guo
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, Gansu, 730000, China; Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, Gansu, 730000, China; Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, Gansu, 730000, China
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22
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Kelley CR, Kauffman JL. Optimal Control Perspective on Parkinson's Disease: Increased Delay Between State Estimator and Controller Produces Tremor. IEEE Trans Neural Syst Rehabil Eng 2020; 28:2144-2152. [PMID: 32822299 DOI: 10.1109/tnsre.2020.3018626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Parkinson's disease produces tremor in a large subset of patients despite generally inhibiting movement. The pathophysiology of parkinsonian tremor is unclear, leading to uncertainty in how and why treatments reduce tremor with varying effectiveness. Models for parkinsonian tremor attempt to explain the underlying principles of tremor generation in the central nervous system, often focusing on neural activity of specific substructures. In contrast, control system approaches to modeling the human motor system provide qualitative results that help inform conclusions from clinical studies. This article uses an optimal control approach to investigate the hypothesis that an increased delay in the central nervous system-unaccounted by delay compensation mechanisms-produces parkinsonian tremor. This hypothesis is motivated by the excessive inhibition projected from the basal ganglia to the thalamus in Parkinson's disease. The thalamus relays signals from the cerebellum to the primary motor cortex: previous mapping of optimal control components indicates this prospective delay exists between the estimator (cerebellum) and controller (primary motor cortex). Simulations demonstrate realistic tremor in a neuromuscular model of the wrist. In addition, changes to effort sensitivity in the optimal controller may account for some clinical features of parkinsonian tremor, including the characteristics of re-emergent tremor and the time-varying amplitude and frequency of tremor. Contextualization of the optimal control model with physiological models and clinical observations provides insight into the potential role of the basal ganglia and cerebello-thalamo-cortical circuit and how treatments like dopaminergic medications and deep brain stimulation reduce tremor.
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Patel M, Nilsson MH, Rehncrona S, Tjernström F, Magnusson M, Johansson R, Fransson PA. Effects of Deep Brain Stimulation on Postural Control in Parkinson's Disease. Comput Biol Med 2020; 122:103828. [DOI: 10.1016/j.compbiomed.2020.103828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/30/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
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24
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SHAH VRUTANGKUMARV, GOYAL SACHIN, PALANTHANDALAM-MADAPUSI HARISHJ. COMPARISON OF THEORIES OF REST TREMOR MECHANISM IN PARKINSON’S DISEASE: CENTRAL OSCILLATOR (SOURCE-TRIGGERED OSCILLATIONS) AND FEEDBACK-INDUCED INSTABILITY IN THE SENSORIMOTOR LOOP (SELF-SUSTAINED OSCILLATIONS). J MECH MED BIOL 2020. [DOI: 10.1142/s0219519419500751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Rest tremor is one of the most common and disabling symptoms of Parkinson’s disease (PD). The exact neural origin of rest tremor is still not clearly understood. Understanding the origin of rest tremor is important as it may aid in optimizing existing treatment strategies such as Deep Brain Stimulation or in developing new treatment strategies for rest tremor reduction. There are broadly two theories that are gaining prominence for rest tremor generation in PD. The first theory is the central oscillator theory that states that the rest tremor is triggered by an oscillatory source in the brain. The second theory is the feedback-induced instability theory that states that the rest tremor arises out of a feedback-induced instability in the sensorimotor loop. This paper analyzes validity of the two theories based on established clinical observations of Parkinsonian rest tremor by using representative simulation examples. Finally, based on our analysis, we propose two test-worthy experiments for further validation.
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Affiliation(s)
- VRUTANGKUMAR V. SHAH
- Balance Disorder Lab, Department of Neurology, Oregon Health and Science University, OR 97239, USA
- SysIDEA Lab, Mechanical Engineering, Indian Institute of Technology Gandhinagar, Gandhinagar, GJ-382355, India
| | - SACHIN GOYAL
- Department of Mechanical Engineering, Health Science Research Institute, University of California, Merced, CA-95343, USA
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25
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Fransson PA, Nilsson MH, Niehorster DC, Nyström M, Rehncrona S, Tjernström F, Magnusson M, Johansson R, Patel M. Exploring the effects of deep brain stimulation and vision on tremor in Parkinson's disease - benefits from objective methods. J Neuroeng Rehabil 2020; 17:56. [PMID: 32334622 PMCID: PMC7183594 DOI: 10.1186/s12984-020-00677-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Tremor is a cardinal symptom of Parkinson’s disease (PD) that may cause severe disability. As such, objective methods to determine the exact characteristics of the tremor may improve the evaluation of therapy. This methodology study aims to validate the utility of two objective technical methods of recording Parkinsonian tremor and evaluate their ability to determine the effects of Deep Brain Stimulation (DBS) of the subthalamic nucleus and of vision. Methods We studied 10 patients with idiopathic PD, who were responsive to L-Dopa and had more than 1 year use of bilateral subthalamic nucleus stimulation. The patients did not have to display visible tremor to be included in the study. Tremor was recorded with two objective methods, a force platform and a 3 dimensional (3D) motion capture system that tracked movements in four key proximal sections of the body (knee, hip, shoulder and head). They were assessed after an overnight withdrawal of anti-PD medications with DBS ON and OFF and with eyes open and closed during unperturbed and perturbed stance with randomized calf vibration, using a randomized test order design. Results Tremor was detected with the Unified Parkinson’s Disease Rating Scale (UPDRS) in 6 of 10 patients but only distally (hands and feet) with DBS OFF. With the force platform and the 3D motion capture system, tremor was detected in 6 of 10 and 7 of 10 patients respectively, mostly in DBS OFF but also with DBS ON in some patients. The 3D motion capture system revealed that more than one body section was usually affected by tremor and that the tremor amplitude was non-uniform, but the frequency almost identical, across sites. DBS reduced tremor amplitude non-uniformly across the body. Visual input mostly reduced tremor amplitude with DBS ON. Conclusions Technical recording methods offer objective and sensitive detection of tremor that provide detailed characteristics such as peak amplitude, frequency and distribution pattern, and thus, provide information that can guide the optimization of treatments. Both methods detected the effects of DBS and visual input but the 3D motion system was more versatile in that it could detail the presence and properties of tremor at individual body sections.
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Affiliation(s)
| | - Maria H Nilsson
- Department of Health Sciences, Lund University, S-221 85, Lund, Sweden.,Memory Clinic, Skåne University Hospital, S-212 24, Malmö, Sweden.,Clinical Memory Research Unit, Faculty of Medicine, Lund University, S-221 85, Lund, Sweden
| | - Diederick C Niehorster
- Lund University Humanities Lab, Lund University, S-221 00, Lund, Sweden.,Department of Psychology, Lund University, S-221 00, Lund, Sweden.,Lund University Cognitive Science, Lund University, S-221 00, Lund, Sweden
| | - Marcus Nyström
- Lund University Humanities Lab, Lund University, S-221 00, Lund, Sweden
| | - Stig Rehncrona
- Department of Neurosurgery, Lund University, S-221 85, Lund, Sweden
| | - Fredrik Tjernström
- Department of Clinical Sciences, Lund University, S-221 85, Lund, Sweden
| | - Måns Magnusson
- Department of Clinical Sciences, Lund University, S-221 85, Lund, Sweden
| | - Rolf Johansson
- Department of Automatic Control, Lund University, S-221 00, Lund, Sweden
| | - Mitesh Patel
- Division of Brain Sciences, Imperial College London, London, W6 8RF, UK.,Faculty of Science and Engineering, University of Wolverhampton, Wolverhampton, WV1 1LZ, UK
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26
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Misra S, Islam N, Pal R. Long-Term Alleviation of Parkinsonian Resting Tremor Using Wireless Optogenetic Nanonetworks. IEEE Trans Nanobioscience 2020; 19:403-409. [PMID: 32167904 DOI: 10.1109/tnb.2020.2979781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Resting tremor is one of the major symptoms of Parkinson's disease, which causes havoc in motor functions of the body, has its genesis in communication impairments in the subthalamic nucleus of the basal ganglia. The modern sophisticated surgical treatments, including electrical deep brain stimulation do not yield satisfactory results due to their inability to provide long-term cure and minimize side effects, such as discomfort and increased infection rates. In this work, we propose a novel system based on the emerging communication technology of wireless optogenetic networks of neural dusts to provide a long-term solution for the alleviation of resting tremor. Interfaced with neural dusts, each of the subthalamic nucleus neurons can be controlled and stimulated by the ultrasonic waves which are transmitted from a single/multiple subdural transducer(s) that are placed in the dura mater of the brain. Moreover, in order to address the challenging tasks of charging and addressing each of the neural dusts, we propose a protocol, named as Single Time Instant addressing Protocol, which outperforms the state-of-the-art parallel charging protocol. The basic idea of our protocol is that it selects most frequently occurring spike patterns in a single time instant and assigns the pattern with an ultrasonic frequency. With the improved efficiency of Single Time Instant addressing Protocol validated with empirical datasets, the proposed system is expected to revolutionize the way of treatment of parkinsonian resting tremor.
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27
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Goubault E, Nguyen HP, Bogard S, Blanchet PJ, Bézard E, Vincent C, Langlois M, Duval C. Cardinal Motor Features of Parkinson's Disease Coexist with Peak-Dose Choreic-Type Drug-Induced Dyskinesia. JOURNAL OF PARKINSONS DISEASE 2019; 8:323-331. [PMID: 29843253 PMCID: PMC6027941 DOI: 10.3233/jpd-181312] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Clinical and anecdotal observations propose that patients with Parkinson’s disease (PD) may show drug-induced dyskinesia (DID) concomitantly with cardinal motor features. However, the extent of the concomitant presence of DID and cardinal features remains to be determined. Objectives: This cross-sectional study measured peak-dose choreic-type DID in a quantitative manner in patients diagnosed with PD, and determined whether symptoms such as tremor, bradykinesia, rigidity, postural instability or freezing of gait (FoG) were still detectable in these patients. Methods: 89 patients diagnosed with PD were recruited and assessed using a combination of quantitative measures using inertial measurement units to capture DID, tremor, bradykinesia, and FoG. Clinical evaluations were also used to assess rigidity and postural instability. Motor symptoms of PD were assessed 3 times during the testing period, and a series of activities of daily living were repeated twice, in between clinical tests, during which the level of DID was quantified. Peak-dose was identified as the period during which patients had the highest levels of DID. Levels of tremor, rigidity, bradykinesia, postural instability, and FoG were used to determine the percentage of patients showing these motor symptoms simultaneously with DID. Results: 72.4% of patients tested presented with measurable DID during the experiment. Rest, postural and kinetic tremor (12.7% , 38.1% , and 15.9% respectively), bradykinesia (28.6% ), rigidity (55.6% ), postural instability (71.4% ) and FoG (9.5% ) were detected simultaneously with DID. Conclusions: PD symptomatology remains present in patients showing peak-dose choreic-type DID, illustrating the challenge facing physicians when trying to avoid dyskinesia while attempting to alleviate motor symptoms.
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Affiliation(s)
- Etienne Goubault
- Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, Québec, Canada.,Centre de Recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Hung P Nguyen
- Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, Québec, Canada.,Centre de Recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Sarah Bogard
- Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, Québec, Canada.,Centre de Recherche de l'Institut universitaire de gériatrie de Montréal, Montréal, Québec, Canada
| | - Pierre J Blanchet
- Département de stomatologie, Faculté de médecine dentaire, Université de Montréal, Montréal, QC, Canada.,Département de médecine, CHU Montréal, Montréal, QC, Canada
| | - Erwan Bézard
- Université de Bordeaux, Institut des Maladies Neurodégénératives, F-33000 Bordeaux, France.,Centre National de la Recherche Scientifique Unité Mixte de Recherche 5293, Institut des Maladies Neurodégénératives, F-33000 Bordeaux, France
| | - Claude Vincent
- Département de réadaptation, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Mélanie Langlois
- Département de médecine, Faculté de médecine, Université Laval, Québec, Québec, Canada
| | - Christian Duval
- Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, Québec, Canada.,Département des Sciences de l'activité physique, Université du Québec à Montréal, Montréal, Québec, Canada
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28
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Increased functional connectivity of thalamic subdivisions in patients with Parkinson's disease. PLoS One 2019; 14:e0222002. [PMID: 31483847 PMCID: PMC6726201 DOI: 10.1371/journal.pone.0222002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 08/20/2019] [Indexed: 01/09/2023] Open
Abstract
Parkinson’s disease (PD) affects 2–3% of the population over the age of 65 with loss of dopaminergic neurons in the substantia nigra impacting the functioning of basal ganglia-thalamocortical circuits. The precise role played by the thalamus is unknown, despite its critical role in the functioning of the cerebral cortex, and the abnormal neuronal activity of the structure in PD. Our objective was to more clearly elucidate how functional connectivity and morphology of the thalamus are impacted in PD (n = 32) compared to Controls (n = 20). To investigate functional connectivity of the thalamus we subdivided the structure into two important regions-of-interest, the first with putative connections to the motor cortices and the second with putative connections to prefrontal cortices. We then investigated potential differences in the size and shape of the thalamus in PD, and how morphology and functional connectivity relate to clinical variables. Our data demonstrate that PD is associated with increases in functional connectivity between motor subdivisions of the thalamus and the supplementary motor area, and between prefrontal thalamic subdivisions and nuclei of the basal ganglia, anterior and dorsolateral prefrontal cortices, as well as the anterior and paracingulate gyri. These results suggest that PD is associated with increased functional connectivity of subdivisions of the thalamus which may be indicative alterations to basal ganglia-thalamocortical circuitry.
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29
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Milosevic L, Kalia SK, Hodaie M, Lozano AM, Popovic MR, Hutchison WD. Physiological mechanisms of thalamic ventral intermediate nucleus stimulation for tremor suppression. Brain 2019; 141:2142-2155. [PMID: 29878147 PMCID: PMC6022553 DOI: 10.1093/brain/awy139] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/05/2018] [Indexed: 11/12/2022] Open
Abstract
Ventral intermediate thalamic deep brain stimulation is a standard therapy for the treatment of medically refractory essential tremor and tremor-dominant Parkinson's disease. Despite the therapeutic benefits, the mechanisms of action are varied and complex, and the pathophysiology and genesis of tremor remain unsubstantiated. This intraoperative study investigated the effects of high frequency microstimulation on both neuronal firing and tremor suppression simultaneously. In each of nine essential tremor and two Parkinson's disease patients who underwent stereotactic neurosurgery, two closely spaced (600 µm) microelectrodes were advanced into the ventral intermediate nucleus. One microelectrode recorded action potential firing while the adjacent electrode delivered stimulation trains at 100 Hz and 200 Hz (2-5 s, 100 µA, 150 µs). A triaxial accelerometer was used to measure postural tremor of the contralateral hand. At 200 Hz, stimulation led to 68 ± 8% (P < 0.001) inhibition of neuronal firing and a 53 ± 5% (P < 0.001) reduction in tremor, while 100 Hz reduced firing by 26 ± 12% (not significant) with a 17 ± 6% (P < 0.05) tremor reduction. The degree of cell inhibition and tremor suppression were significantly correlated (P < 0.001). We also found that the most ventroposterior stimulation sites, closest to the border of the ventral caudal nucleus, had the best effect on tremor. Finally, prior to the inhibition of neuronal firing, microstimulation caused a transient driving of neuronal activity at stimulus onset (61% of sites), which gave rise to a tremor phase reset (73% of these sites). This was likely due to activation of the excitatory glutamatergic cortical and cerebellar afferents to the ventral intermediate nucleus. Temporal characteristics of the driving responses (duration, number of spikes, and onset latency) significantly differed between 100 Hz and 200 Hz stimulation trains. The subsequent inhibition of neuronal activity was likely due to synaptic fatigue. Thalamic neuronal inhibition seems necessary for tremor reduction and may function in effect as a thalamic filter to uncouple thalamo-cortical from cortico-spinal reflex loops. Additionally, our findings shed light on the gating properties of the ventral intermediate nucleus within the cerebello-thalamo-cortical tremor network, provide insight for the optimization of deep brain stimulation technologies, and may inform controlled clinical studies for assessing optimal target locations for the treatment of tremor.
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Affiliation(s)
- Luka Milosevic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Suneil K Kalia
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, Canada.,Krembil Research Institute, Toronto, Canada
| | - Mojgan Hodaie
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, Canada.,Krembil Research Institute, Toronto, Canada
| | - Andres M Lozano
- Department of Surgery, University of Toronto, Toronto, Canada.,Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, Canada.,Krembil Research Institute, Toronto, Canada
| | - Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Canada.,Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - William D Hutchison
- Department of Surgery, University of Toronto, Toronto, Canada.,Krembil Research Institute, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Canada
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30
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Blakemore RL, MacAskill MR, Myall DJ, Anderson TJ. Volitional Suppression of Parkinsonian Resting Tremor. Mov Disord Clin Pract 2019; 6:470-478. [PMID: 31392248 PMCID: PMC6660237 DOI: 10.1002/mdc3.12801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/25/2019] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We have observed in the clinic that a number of patients with Parkinson's disease (PD) can suppress their tremor at will for brief periods, by conscious mental processes. To our knowledge, the ability to consciously diminish one's resting tremor has not yet been reported nor assessed quantitatively. OBJECTIVE To provide the first detailed systematic investigation of the phenomenon of voluntary tremor suppression in PD. METHODS We examined changes in tremor characteristics during voluntary tremor suppression in 37 PD patients (on medication) presenting with rest tremor in their upper limb. We measured tremor oscillations with a triaxis accelerometer on the index finger of the most-affected hand (n = 27). With surface electromyography (EMG), we measured changes in neuromuscular activity of the forearm flexor digitorum superficialis and extensor digitorum muscles (n = 15). Participants completed four 1-minute trials, consisting of alternating consecutive 30-second periods of resting tremor and 30-second periods of attempted tremor suppression. RESULTS Bayesian multilevel modeling revealed that attempted voluntary tremor suppression did indeed reduce tremor amplitude (peak power) of the acceleration signal and increased tremor frequency of the acceleration and EMG signals. Relative EMG power in the 3- to 8-Hz tremor band was also smaller. Tremor suppression was not by enhanced voluntary contraction of the relevant muscle pairs. CONCLUSIONS We present novel empirical evidence that PD resting tremor can be suppressed by an act of will, as evidenced by significant modulation of key neurophysiological tremor characteristics. These data highlight that it is possible to exert significant conscious control over parkinsonian resting tremor.
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Affiliation(s)
- Rebekah L. Blakemore
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | - Michael R. MacAskill
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
| | | | - Tim J. Anderson
- New Zealand Brain Research InstituteChristchurchNew Zealand
- Department of MedicineUniversity of OtagoChristchurchNew Zealand
- Department of NeurologyChristchurch HospitalChristchurchNew Zealand
- Brain Research New Zealand Rangahau Roro Aotearoa Centre of Research ExcellenceChristchurchNew Zealand
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31
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Naros G, Grimm F, Weiss D, Gharabaghi A. Directional communication during movement execution interferes with tremor in Parkinson's disease. Mov Disord 2019; 33:251-261. [PMID: 29427344 DOI: 10.1002/mds.27221] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 08/15/2017] [Accepted: 09/08/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Both the cerebello-thalamo-cortical circuit and the basal ganglia/cortical motor loop have been postulated to be generators of tremor in PD. The recent suggestion that the basal ganglia trigger tremor episodes and the cerebello-thalamo-cortical circuitry modulates tremor amplitude combines both competing hypotheses. However, the role of the STN in tremor generation and the impact of proprioceptive feedback on tremor suppression during voluntary movements have not been considered in this model yet. OBJECTIVES The objective of this study was to evaluate the role of the STN and proprioceptive feedback in PD tremor generation during movement execution. METHODS Local-field potentials of the STN as well as electromyographical and electroencephalographical rhythms were recorded in tremor-dominant and nontremor PD patients while performing voluntary movements of the contralateral hand during DBS surgery. Effective connectivity between these electrophysiological signals were analyzed and compared to electromyographical tremor activity. RESULTS There was an intensified information flow between the STN and the muscle in the tremor frequencies (5-8 Hz) for tremor-dominant, in comparison to nontremor, patients. In both subtypes, active movement was associated with an increase of afferent interaction between the muscle and the cortex in the β- and γ-frequencies. The γ-frequency (30-40 Hz) of this communication between muscle and cortex correlated inversely with electromyographical tremor activity. CONCLUSIONS Our results indicate an involvement of the STN in propagation of tremor-related activity to the muscle. Furthermore, we provide evidence that increased proprioceptive information flow during voluntary movement interferes with central tremor generation. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Georgios Naros
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Florian Grimm
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Daniel Weiss
- Department for Neurodegenerative Diseases and Hertie Institute for Clinical Brain Research, and German Centre of Neurodegenerative Diseases (DZNE), Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Alireza Gharabaghi
- Division of Functional and Restorative Neurosurgery, Department of Neurosurgery, and Centre for Integrative Neuroscience, Eberhard Karls University Tuebingen, Tuebingen, Germany
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32
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Hartmann CJ, Fliegen S, Groiss SJ, Wojtecki L, Schnitzler A. An update on best practice of deep brain stimulation in Parkinson's disease. Ther Adv Neurol Disord 2019; 12:1756286419838096. [PMID: 30944587 PMCID: PMC6440024 DOI: 10.1177/1756286419838096] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 02/01/2019] [Indexed: 11/16/2022] Open
Abstract
During the last 30 years, deep brain stimulation (DBS) has evolved into the clinical standard of care as a highly effective treatment for advanced Parkinson’s disease. Careful patient selection, an individualized anatomical target localization and meticulous evaluation of stimulation parameters for chronic DBS are crucial requirements to achieve optimal results. Current hardware-related advances allow for a more focused, individualized stimulation and hence may help to achieve optimal clinical results. However, current advances also increase the degrees of freedom for DBS programming and therefore challenge the skills of healthcare providers. This review gives an overview of the clinical effects of DBS, the criteria for patient, target, and device selection, and finally, offers strategies for a structured programming approach.
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Affiliation(s)
- Christian J Hartmann
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Sabine Fliegen
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Stefan J Groiss
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Lars Wojtecki
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Alfons Schnitzler
- Department of Neurology/Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Zeng Q, Guan X, Guo T, Law Yan Lun JCF, Zhou C, Luo X, Shen Z, Huang P, Zhang M, Cheng G. The Ventral Intermediate Nucleus Differently Modulates Subtype-Related Networks in Parkinson's Disease. Front Neurosci 2019; 13:202. [PMID: 30914916 PMCID: PMC6421280 DOI: 10.3389/fnins.2019.00202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 02/20/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Posture instability gait difficulty-dominant (PIGD) and tremor-dominant (TD) are two subtypes of Parkinson's disease (PD). The thalamus is involved in the neural circuits of both subtypes. However, which subregion of the thalamus has an influence on the PD subtypes remains unclear. Objective: To explore the core subregion of the thalamus showing a significant influence on the PD subtypes and its directional interaction between the PD subtypes. Methods: A total of 79 PD patients (43 TD and 36 PIGD) and 31 normal controls (NC) were enrolled, and the gray matter volume and perfusion characteristics in the thalamus were compared between the three groups. The subregion of the thalamus with significantly different perfusion and volume among three groups was used as the seed of a Granger causality analysis (GCA) to compare the causal connectivity between different subtypes. Results: Perfusion with an increased gradient among the three groups (TD > PIGD > NC) in the bilateral ventral intermediate nucleus (Vim) was observed, which was positively correlated with the clinical tremor scores. The GCA revealed that TD patients had enhanced causal connectivity from the bilateral Vim to the bilateral paracentral gyrus, M1 and the cerebellum compared with the NC group, while the PIGD subtype revealed an increased causal connectivity from the bilateral Vim to the bilateral premotor cortex (preM) and putamen. Additionally, there were positive correlations between the tremor scores and a causal connectivity from the Vim to the cerebellum. The connectivity from the right Vim to the right preM and the right putamen was positively correlated with the PIGD scores. Conclusion: This multilevel analysis showed that the Vim had a significant influence on the PD subtypes and that it differentially mediated the TD and PIGD-related causal connectivity pattern in PD.
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Affiliation(s)
- Qiaoling Zeng
- Department of Medical Imaging, Peking University Shenzhen Hospital, Shenzhen, China
| | - Xiaojun Guan
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Tao Guo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jason C F Law Yan Lun
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Cheng Zhou
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiao Luo
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhujing Shen
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Peiyu Huang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Guanxun Cheng
- Department of Medical Imaging, Peking University Shenzhen Hospital, Shenzhen, China
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Li W, Qiao L, Zhang L, Wang Z, Shen D. Functional Brain Network Estimation With Time Series Self-Scrubbing. IEEE J Biomed Health Inform 2019; 23:2494-2504. [PMID: 30668484 DOI: 10.1109/jbhi.2019.2893880] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Functional brain network (FBN) is becoming an increasingly important measurement for exploring cerebral mechanisms and mining informative biomarkers that assist diagnosis of some neurodegenerative disorders. Despite its effectiveness to discover valuable hidden patterns in the human brain, the estimated FBNs are often heavily influenced by the quality of the observed data (e.g., blood oxygen level dependent signal series). In practice, a preprocessing pipeline is usually employed for improving data quality. With this in mind, some data points (volumes or time course in the time series) are still not clean enough, due to artifacts including spurious resting-state processes (head movement, mind-wandering). Therefore, not all volumes in the fMRI time series can contribute to the subsequent FBN estimation. To address this issue, we propose a novel FBN estimation method by introducing a latent variable as an indicator of the data quality, and develop an alternating optimization algorithm for jointly scrubbing the data and estimating FBN simultaneously. To further illustrate the effectiveness of the proposed method, we conduct experiments on two public datasets to identify subjects with mild cognitive impairment from normal controls based on the estimated FBNs, and achieve improved accuracies than the baseline methods.
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35
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Muthuraman M, Koirala N, Ciolac D, Pintea B, Glaser M, Groppa S, Tamás G, Groppa S. Deep Brain Stimulation and L-DOPA Therapy: Concepts of Action and Clinical Applications in Parkinson's Disease. Front Neurol 2018; 9:711. [PMID: 30210436 PMCID: PMC6119713 DOI: 10.3389/fneur.2018.00711] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/06/2018] [Indexed: 12/15/2022] Open
Abstract
L-DOPA is still the most effective pharmacological therapy for the treatment of motor symptoms in Parkinson's disease (PD) almost four decades after it was first used. Deep brain stimulation (DBS) is a safe and highly effective treatment option in patients with PD. Even though a clear understanding of the mechanisms of both treatment methods is yet to be obtained, the combination of both treatments is the most effective standard evidenced-based therapy to date. Recent studies have demonstrated that DBS is a therapy option even in the early course of the disease, when first complications arise despite a rigorous adjustment of the pharmacological treatment. The unique feature of this therapeutic approach is the ability to preferentially modulate specific brain networks through the choice of stimulation site. The clinical effects have been unequivocally confirmed in recent studies; however, the impact of DBS and the supplementary effect of L-DOPA on the neuronal network are not yet fully understood. In this review, we present emerging data on the presumable mechanisms of DBS in patients with PD and discuss the pathophysiological similarities and differences in the effects of DBS in comparison to dopaminergic medication. Targeted, selective modulation of brain networks by DBS and pharmacodynamic effects of L-DOPA therapy on the central nervous system are presented. Moreover, we outline the perioperative algorithms for PD patients before and directly after the implantation of DBS electrodes and strategies for the reduction of side effects and optimization of motor and non-motor symptoms.
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Affiliation(s)
- Muthuraman Muthuraman
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Nabin Koirala
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Bogdan Pintea
- Department of Neurosurgery, University Hospital of Bonn, Bonn, Germany
| | - Martin Glaser
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Stanislav Groppa
- Department of Neurology, Institute of Emergency Medicine, Chisinau, Moldova.,Laboratory of Neurobiology and Medical Genetics, Nicolae Testemiţanu State University of Medicine and Pharmacy, Chisinau, Moldova
| | - Gertrúd Tamás
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing Unit, Department of Neurology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
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36
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Abstract
PURPOSE OF REVIEW This review aims to survey recent trends in electrical forms of neuromodulation, with a specific application to Parkinson's disease (PD). Emerging trends are identified, highlighting synergies in state-of-the-art neuromodulation strategies, with directions for future improvements in stimulation efficacy suggested. RECENT FINDINGS Deep brain stimulation remains the most common and effective form of electrical stimulation for the treatment of PD. Evidence suggests that transcranial direct current stimulation (tDCS) most likely impacts the motor symptoms of the disease, with the most prominent results relating to rehabilitation. However, utility is limited due to its weak effects and high variability, with medication state a key confound for efficacy level. Recent innovations in transcranial alternating current stimulation (tACS) offer new areas for investigation. SUMMARY Our understanding of the mechanistic foundations of electrical current stimulation is advancing and as it does so, trends emerge which steer future clinical trials towards greater efficacy.
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Affiliation(s)
- John-Stuart Brittain
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Hayriye Cagnan
- Institute of Neurology, University College London, London, UK
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37
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Benito-León J, Serrano JI, Louis ED, Holobar A, Romero JP, Povalej-Bržan P, Bermejo-Pareja F, Del Castillo MD, Posada IJ, Rocon E. Tremor severity in Parkinson's disease and cortical changes of areas controlling movement sequencing: A preliminary study. J Neurosci Res 2018; 96:1341-1352. [PMID: 29660812 DOI: 10.1002/jnr.24248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/24/2018] [Accepted: 03/26/2018] [Indexed: 11/07/2022]
Abstract
There remains much to learn about the changes in cortical anatomy that are associated with tremor severity in Parkinson's disease (PD). For this reason, we used a combination of structural neuroimaging to measure cortical thickness and neurophysiological studies to analyze whether PD tremor was associated with cortex integrity. Magnetic resonance imaging and neurophysiological assessment were performed in 13 nondemented PD patients (9 women, 69.2%) with a clearly tremor-dominant phenotype. Cortical reconstruction and volumetric segmentation were performed with the Freesurfer image analysis software. Assessment of tremor was performed by means of high-density surface electromyography (hdEMG) and inertial measurement units (IMUs). Individual motor unit discharge patterns were identified from surface hdEMG and tremor metrics quantifying motor unit synchronization from IMUs. Increased motor unit synchronization (i.e., more severe tremor) was associated with cortical changes (i.e., atrophy) in wide-spread cortical areas, including caudal middle frontal regions bilaterally (dorsal premotor cortices), left inferior parietal lobe (posterior parietal cortex), left lateral orbitofrontal cortex, cingulate cortex bilaterally, left posterior and transverse temporal cortex, and left occipital lobe, as well as reduced left middle temporal volume. Given that the majority of these areas are involved in controlling movement sequencing, our results support Albert's classic hypothesis that PD tremor may be the result of an involuntary activation of a program of motor behavior used in the genesis of rapid voluntary alternating movements.
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Affiliation(s)
- Julián Benito-León
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain
- Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - J Ignacio Serrano
- Neural and Cognitive Engineering group, Centre for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Spain
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
- Yale School of Medicine and Yale School of Public Health, Center for Neuroepidemiology and Clinical Neurological Research, New Haven, Connecticut, USA
| | - Ales Holobar
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
| | - Juan P Romero
- Faculty of Biosanitary Sciences, Francisco de Vitoria University, Pozuelo de Alarcón, Madrid, Spain
- Brain Damage Service, Hospital Beata Maria Ana, Madrid, Spain
| | - P Povalej-Bržan
- Faculty of Electrical Engineering and Computer Science, University of Maribor, Maribor, Slovenia
- Faculty of Health Sciences, Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Félix Bermejo-Pareja
- Center of Biomedical Network Research on Neurodegenerative Diseases (CIBERNED), Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
- Clinical Research Unit, University Hospital 12 de Octubre, Madrid, Spain
| | - M Dolores Del Castillo
- Neural and Cognitive Engineering group, Centre for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Spain
| | - Ignacio J Posada
- Department of Neurology, University Hospital 12 de Octubre, Madrid, Spain
- Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Eduardo Rocon
- Neural and Cognitive Engineering group, Centre for Automation and Robotics (CAR) CSIC-UPM, Arganda del Rey, Spain
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Nahimi A, Sommerauer M, Kinnerup MB, Østergaard K, Wintherdahl M, Jacobsen J, Schacht A, Johnsen B, Damholdt MF, Borghammer P, Gjedde A. Noradrenergic Deficits in Parkinson Disease Imaged with 11C-MeNER. J Nucl Med 2017; 59:659-664. [DOI: 10.2967/jnumed.117.190975] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 07/18/2017] [Indexed: 01/08/2023] Open
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Lozano AM, Hutchison WD, Kalia SK. What Have We Learned About Movement Disorders from Functional Neurosurgery? Annu Rev Neurosci 2017; 40:453-477. [DOI: 10.1146/annurev-neuro-070815-013906] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Andres M. Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - William D. Hutchison
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario M5T 2S8, Canada;, ,
- Krembil Research Institute, Toronto Western Hospital, Toronto, Ontario M5T 2S8, Canada
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40
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Dirkx MF, den Ouden HEM, Aarts E, Timmer MHM, Bloem BR, Toni I, Helmich RC. Dopamine controls Parkinson's tremor by inhibiting the cerebellar thalamus. Brain 2017; 140:721-734. [PMID: 28073788 DOI: 10.1093/brain/aww331] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 11/14/2016] [Indexed: 11/14/2022] Open
Abstract
Parkinson's resting tremor is related to altered cerebral activity in the basal ganglia and the cerebello-thalamo-cortical circuit. Although Parkinson's disease is characterized by dopamine depletion in the basal ganglia, the dopaminergic basis of resting tremor remains unclear: dopaminergic medication reduces tremor in some patients, but many patients have a dopamine-resistant tremor. Using pharmacological functional magnetic resonance imaging, we test how a dopaminergic intervention influences the cerebral circuit involved in Parkinson's tremor. From a sample of 40 patients with Parkinson's disease, we selected 15 patients with a clearly tremor-dominant phenotype. We compared tremor-related activity and effective connectivity (using combined electromyography-functional magnetic resonance imaging) on two occasions: ON and OFF dopaminergic medication. Building on a recently developed cerebral model of Parkinson's tremor, we tested the effect of dopamine on cerebral activity associated with the onset of tremor episodes (in the basal ganglia) and with tremor amplitude (in the cerebello-thalamo-cortical circuit). Dopaminergic medication reduced clinical resting tremor scores (mean 28%, range -12 to 68%). Furthermore, dopaminergic medication reduced tremor onset-related activity in the globus pallidus and tremor amplitude-related activity in the thalamic ventral intermediate nucleus. Network analyses using dynamic causal modelling showed that dopamine directly increased self-inhibition of the ventral intermediate nucleus, rather than indirectly influencing the cerebello-thalamo-cortical circuit through the basal ganglia. Crucially, the magnitude of thalamic self-inhibition predicted the clinical dopamine response of tremor. Dopamine reduces resting tremor by potentiating inhibitory mechanisms in a cerebellar nucleus of the thalamus (ventral intermediate nucleus). This suggests that altered dopaminergic projections to the cerebello-thalamo-cortical circuit have a role in Parkinson's tremor.aww331media15307619934001.
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Affiliation(s)
- Michiel F Dirkx
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6500 HB Nijmegen, The Netherlands.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Parkinson Centre Nijmegen (ParC), 6500 HB Nijmegen, The Netherlands
| | - Hanneke E M den Ouden
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6500 HB Nijmegen, The Netherlands
| | - Esther Aarts
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6500 HB Nijmegen, The Netherlands
| | - Monique H M Timmer
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6500 HB Nijmegen, The Netherlands.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Parkinson Centre Nijmegen (ParC), 6500 HB Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Parkinson Centre Nijmegen (ParC), 6500 HB Nijmegen, The Netherlands
| | - Ivan Toni
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6500 HB Nijmegen, The Netherlands
| | - Rick C Helmich
- Donders Institute for Brain, Cognition and Behavior, Radboud University, 6500 HB Nijmegen, The Netherlands.,Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology and Parkinson Centre Nijmegen (ParC), 6500 HB Nijmegen, The Netherlands
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41
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Kaski D, Bronstein AM. Ocular Tremor in Parkinson's Disease: Discussion, Debate, and Controversy. Front Neurol 2017; 8:134. [PMID: 28484420 PMCID: PMC5401892 DOI: 10.3389/fneur.2017.00134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/21/2017] [Indexed: 11/13/2022] Open
Abstract
The identification of ocular tremor in a small cohort of patients with Parkinson’s disease (PD) had lay somewhat dormant until the recent report of a pervasive ocular tremor as a universal finding in a large PD cohort that was, however, generally absent from a cohort of age-matched healthy subjects. The reported tremor had frequency characteristics similar to those of PD limb tremor, but the amplitude and frequency of the tremor did not correlate with clinical tremor ratings. Much controversy ensued as to the origin of such a tremor, and specifically as to whether a pervasive ocular tremor was a fundamental feature of PD, or rather a compensatory eye oscillation secondary to a transmitted head tremor, and thus a measure of a normal vestibulo-ocular reflex. In this mini review, we summarize some of the evidence for and against the case for a pervasive ocular tremor in PD and suggest future experiments that may help resolve these conflicting opinions.
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Affiliation(s)
- Diego Kaski
- Division of Brain Sciences, Department of Neuro-Otology, Imperial College London, London, UK.,Department of Neuro-Otology, University College London, National Hospital for Neurology and Neurosurgery, London, UK
| | - Adolfo M Bronstein
- Division of Brain Sciences, Department of Neuro-Otology, Imperial College London, London, UK.,Department of Neuro-Otology, University College London, National Hospital for Neurology and Neurosurgery, London, UK
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Gu Q, Cao H, Xuan M, Luo W, Guan X, Xu J, Huang P, Zhang M, Xu X. Increased thalamic centrality and putamen-thalamic connectivity in patients with parkinsonian resting tremor. Brain Behav 2017; 7:e00601. [PMID: 28127519 PMCID: PMC5256184 DOI: 10.1002/brb3.601] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 09/27/2016] [Accepted: 09/27/2016] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Evidence has indicated a strong association between hyperactivity in the cerebello-thalamo-motor cortical loop and resting tremor in Parkinson's disease (PD). Within this loop, the thalamus serves as a central hub based on its structural centrality in the generation of resting tremor. To study whether this thalamic abnormality leads to an alteration at the whole-brain level, our study investigated the role of the thalamus in patients with parkinsonian resting tremor in a large-scale brain network context. METHODS Forty-one patients with PD (22 with resting tremor, TP and 19 without resting tremor, NTP) and 45 healthy controls (HC) were included in this resting-state functional MRI study. Graph theory-based network analysis was performed to examine the centrality measures of bilateral thalami across the three groups. To further provide evidence to the central role of the thalamus in parkinsonian resting tremor, the seed-based functional connectivity analysis was then used to quantify the functional interactions between the basal ganglia and the thalamus. RESULTS Compared with the HC group, patients with the TP group exhibited increased degree centrality (p < .04), betweenness centrality (p < .01), and participation coefficient (p < .01) in the bilateral thalami. Two of these alterations (degree centrality and participation coefficient) were significantly correlated with tremor severity, especially in the left hemisphere (p < .02). The modular analysis showed that the TP group had more intermodular connections between the thalamus and the regions within the cerebello-thalamo-motor cortical loop. Furthermore, the data revealed significantly enhanced functional connectivity between the putamen and the thalamus in the TP group (p = .027 corrected for family-wise error). CONCLUSIONS These findings suggest increased thalamic centrality as a potential tremor-specific imaging measure for PD, and provide evidence for the altered putamen-thalamic interaction in patients with resting tremor.
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Affiliation(s)
- Quanquan Gu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Hengyi Cao
- Department of Psychiatry and PsychotherapyCentral Institute of Mental HealthUniversity of Heidelberg Medical Faculty MannheimMannheimGermany
| | - Min Xuan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Wei Luo
- Department of NeurologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaojun Guan
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Jingjing Xu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Peiyu Huang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Minming Zhang
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
| | - Xiaojun Xu
- Department of RadiologyThe Second Affiliated HospitalZhejiang University School of MedicineHangzhouChina
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Shreve LA, Velisar A, Malekmohammadi M, Koop MM, Trager M, Quinn EJ, Hill BC, Blumenfeld Z, Kilbane C, Mantovani A, Henderson JM, Brontë-Stewart H. Subthalamic oscillations and phase amplitude coupling are greater in the more affected hemisphere in Parkinson's disease. Clin Neurophysiol 2016; 128:128-137. [PMID: 27889627 DOI: 10.1016/j.clinph.2016.10.095] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 10/27/2016] [Accepted: 10/29/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Determine the incidence of resting state oscillations in alpha/beta, high frequency (HFO) bands, and their phase amplitude coupling (PAC) in a large cohort in Parkinson's disease (PD). METHODS Intra-operative local field potentials (LFPs) from subthalamic nucleus (STN) were recorded from 100 PD subjects, data from 74 subjects were included in the analysis. RESULTS Alpha/beta oscillations were evident in >99%, HFO in 87% and PAC in 98% of cases. Alpha/beta oscillations (P<0.01) and PAC were stronger in the more affected (MA) hemisphere (P=0.03). Alpha/beta oscillations were primarily found in 13-20Hz (low beta). Beta and HFO frequencies with the greatest coupling, were positively correlated (P=0.001). Tremor attenuated alpha (P=0.002) and beta band oscillations (P<0.001). CONCLUSIONS STN alpha/beta band oscillations and PAC were evident in ⩾98% cases and were greater in MA hemisphere. Resting tremor attenuated underlying alpha/beta band oscillations. SIGNIFICANCE Beta band LFP power may be used to drive adaptive deep brain stimulation (aDBS), augmented by a kinematic classifier in tremor dominant PD.
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Affiliation(s)
- Lauren A Shreve
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Anca Velisar
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Mahsa Malekmohammadi
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Mandy Miller Koop
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Megan Trager
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Emma J Quinn
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Bruce C Hill
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Zack Blumenfeld
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Camilla Kilbane
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | | | - Jaimie M Henderson
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Neurosurgery, Stanford University, Stanford, CA, USA
| | - Helen Brontë-Stewart
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA; Department of Neurosurgery, Stanford University, Stanford, CA, USA.
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Altered Activation in Cerebellum Contralateral to Unilateral Thalamotomy May Mediate Tremor Suppression in Parkinson's Disease: A Short-Term Regional Homogeneity fMRI Study. PLoS One 2016; 11:e0157562. [PMID: 27310133 PMCID: PMC4910974 DOI: 10.1371/journal.pone.0157562] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 06/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ventral intermediate nucleus thalamotomy is an effective treatment for Parkinson's disease tremor. However, its mechanism is still unclear. PURPOSE We used resting-state fMRI to investigate short-term ReHo changes after unilateral thalamotomy in tremor-dominant PD, and to speculate about its possible mechanism on tremor suppression. METHODS 26 patients and 31 healthy subjects (HS) were recruited. Patients were divided into two groups according to right- (rPD) and left-side (lPD) thalamotomy. Tremor was assessed using the 7-item scale from the Unified Parkinson's disease rating scale motor score (mUPDRS). Patients were scanned using resting state fMRI after 12h withdrawal of medication, both preoperatively (PDpre) and 7- day postoperatively (PDpost), whereas healthy subjects were scanned once. The regions associated with tremor and altered ReHo due to thalamic ablation were examined. RESULTS The impact of unilateral VIM thalamotomy was characterized in the frontal, parietal, temporal regions, basal ganglia, thalamus, and cerebellum. Compared with PDpre, significantly reduced ReHo was found in the left cerebellum in patients with rPDpost, and slightly decreased ReHo in the cerebellum vermis in patients with lPDpost, which was significantly higher than HS. We demonstrated a positive correlation between the ReHo values in the cerebellum (in rPD, peak coordinate [-12, -54, -21], R = 0.64, P = 0.0025, and peak coordinate [-9, -54, -18], R = 0.71, P = 0.0025; in lPD, peak coordinate [3, -45, -15], R = 0.71, P = 0.004) in the pre-surgical condition, changes of ReHo induced by thalamotomy (in rPD, R = 0.63, P = 0.021, R = 0.6, P = 0.009; in lPD, R = 0.58, P = 0.028) and tremor scores contralateral to the surgical side, respectively. CONCLUSION The specific area that may be associated with PD tremor and altered ReHo due to thalamic ablation is the cerebellum. The neural basis underlying thalamotomy is complex; cerebellum involvement is far beyond cerebello-thalamic tract breakage.
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