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Yang Y, Zheng C, Chen B, Hernandez NC, Faust PL, Cai Z, Louis ED, Matuskey D. Decreased Synaptic Vesicle Glycoprotein 2A Binding in the Human Postmortem Essential Tremor Cerebellum: Evidence of Reduction in Synaptic Density. CEREBELLUM (LONDON, ENGLAND) 2024; 23:1053-1060. [PMID: 37783917 DOI: 10.1007/s12311-023-01611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Despite being one of the most prevalent neurological diseases, the pathophysiology of essential tremor (ET) is not fully understood. Neuropathological studies have identified numerous degenerative changes in the cerebellum of ET patients, however. These data align with considerable clinical and neurophysiological data linking ET to the cerebellum. While neuroimaging studies have variably shown mild atrophy in the cerebellum, marked atrophy is not a clear feature of the cerebellum in ET and a search for a more suitable neuroimaging signature of neurodegeneration is in order. Postmortem studies in ET have examined different neuropathological alterations in the cerebellum, but as of yet have not focused on measures of generalized synaptic markers. This pilot study focuses on synaptic vesicle glycoprotein 2A (SV2A), a protein expressed in practically all synapses in the brain, as a measure of synaptic density in postmortem ET cases. METHODS The current study utilized autoradiography with the SV2A radioligand [18F]SDM-16 to assess synaptic density in the cerebellar cortex and dentate nucleus in three ET cases and three age-matched controls. RESULTS Using [18F]SDM-16, SV2A was 53% and 46% lower in the cerebellar cortex and dentate nucleus, respectively, in ET cases compared to age-matched controls. CONCLUSION In this pilot study, using in vitro SV2A autoradiography, we have observed significantly lower synaptic density in the cerebellar cortex and dentate nucleus of ET cases. Future research could expand on our sample size and focus on in vivo imaging in ET to explore whether SV2A imaging could serve as a much-needed disease biomarker.
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Affiliation(s)
- Yanghong Yang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Chao Zheng
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Baosheng Chen
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Nora C Hernandez
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - Phyllis L Faust
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons and the New York Presbyterian Hospital, New York, NY, USA
| | - Zhengxin Cai
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA
| | - Elan D Louis
- Department of Neurology, University of Texas Southwestern School of Medicine, Dallas, TX, USA
| | - David Matuskey
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
- Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
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2
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Okelberry T, Lyons KE, Pahwa R. Updates in essential tremor. Parkinsonism Relat Disord 2024; 122:106086. [PMID: 38538475 DOI: 10.1016/j.parkreldis.2024.106086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 05/05/2024]
Abstract
Essential tremor (ET) is one of the most common tremor disorders and can be disabling in its affect on daily activities. There have been major breakthroughs in the treatment of tremor and ET is the subject of important ongoing research. This review will present recent advancements in the epidemiology, genetics, pathophysiology, diagnosis, comorbidities, and imaging of ET. Current and future treatment options in the management of ET will also be reviewed. The need for continued innovation and scientific inquiry to address the unmet needs of persons of ET will be highlighted.
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Affiliation(s)
- Tyler Okelberry
- University of Kansas Medical Center, 3599 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Kelly E Lyons
- University of Kansas Medical Center, 3599 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Rajesh Pahwa
- University of Kansas Medical Center, 3599 Rainbow Blvd, Kansas City, KS, 66160, USA
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Franthal S, Khalil M, Kern D, Gattermeyer L, Buchmann A, Katschnig-Winter P, Kögl M, Demjaha R, Tafrali C, Hofer E, Schmidt R, Schwingenschuh P. Elevated serum neurofilament light chain protein in patients with essential tremor. Eur J Neurol 2024; 31:e16143. [PMID: 37975778 DOI: 10.1111/ene.16143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/17/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND PURPOSE Quantification of neurofilament light chain protein in serum (sNfL) enables the neuro-axonal damage in peripheral blood to be reliably assessed and monitored. There is a long-standing debate whether essential tremor represents a 'benign' tremor syndrome or whether it is linked to neurodegeneration. This study aims to investigate sNfL concentrations in essential tremor compared to healthy controls (cross-sectionally and longitudinally) and to assess whether sNfL is associated with motor and nonmotor markers of disease progression. METHODS Data of patients with essential tremor from our prospective registry on movement disorders (PROMOVE) were retrospectively analysed. Age-, sex- and body-mass-index-matched healthy controls were recruited from an ongoing community-dwelling aging cohort. sNfL was quantified by an ultra-sensitive single molecule array (Simoa). All participants underwent detailed clinical examination at baseline and after approximately 5 years of follow-up. RESULTS Thirty-seven patients with clinically diagnosed essential tremor were included and 37 controls. The essential tremor group showed significantly higher sNfL levels compared to healthy controls at baseline and follow-up. sNfL levels increased over time in both groups, and the slope of sNfL increase was similar in the essential tremor and healthy control groups. Comparing patients with a disease duration under 5 years to those with a longer disease duration, the former group had a significantly greater increase of sNfL over time, which strongly correlated to worsening of tremor and cognition. CONCLUSION Our findings indicate that neurodegeneration, possibly happening at an early disease stage, might play a role in the pathophysiology of essential tremor.
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Affiliation(s)
| | - Michael Khalil
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Daniela Kern
- Department of Neurology, Medical University of Graz, Graz, Austria
| | | | | | | | - Mariella Kögl
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Rina Demjaha
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Cansu Tafrali
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Edith Hofer
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Reinhold Schmidt
- Department of Neurology, Medical University of Graz, Graz, Austria
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4
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Dynamic functional changes upon thalamotomy in essential tremor depend on baseline brain morphometry. Sci Rep 2024; 14:2605. [PMID: 38297028 PMCID: PMC10831051 DOI: 10.1038/s41598-024-52410-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 01/18/2024] [Indexed: 02/02/2024] Open
Abstract
Patients with drug-resistant essential tremor (ET) may undergo Gamma Knife stereotactic radiosurgical thalamotomy (SRS-T), where the ventro-intermediate nucleus of the thalamus (Vim) is lesioned by focused beams of gamma radiations to induce clinical improvement. Here, we studied SRS-T impacts on left Vim dynamic functional connectivity (dFC, n = 23 ET patients scanned before and 1 year after intervention), and on surface-based morphometric brain features (n = 34 patients, including those from dFC analysis). In matched healthy controls (HCs), three dFC states were extracted from resting-state functional MRI data. In ET patients, state 1 spatial stability increased upon SRS-T (F1,22 = 19.13, p = 0.004). More frequent expression of state 3 over state 1 before SRS-T correlated with greater clinical recovery in a way that depended on the MR signature volume (t6 = 4.6, p = 0.004). Lower pre-intervention spatial variability in state 3 expression also did (t6 = - 4.24, p = 0.005) and interacted with the presence of familial ET so that these patients improved less (t6 = 4.14, p = 0.006). ET morphometric profiles showed significantly lower similarity to HCs in 13 regions upon SRS-T (z ≤ - 3.66, p ≤ 0.022), and a joint analysis revealed that before thalamotomy, morphometric similarity and states 2/3 mean spatial similarity to HCs were anticorrelated, a relationship that disappeared upon SRS-T (z ≥ 4.39, p < 0.001). Our results show that left Vim functional dynamics directly relates to upper limb tremor lowering upon intervention, while morphometry instead has a supporting role in reshaping such dynamics.
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Affiliation(s)
- Thomas A W Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland.
- Department of Radiology, Lausanne University Hospital and University of Lausanne (CHUV-UNIL), 1011, Lausanne, Switzerland.
| | - Dimitri Van De Ville
- Neuro-X Institute, Ecole Polytechnique Fédérale de Lausanne, 1202, Geneva, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, 1202, Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), 1015, Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), 1015, Lausanne, Switzerland
- Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, 1015, Lausanne, Switzerland
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van der Heijden ME, Sillitoe RV. Cerebellar dysfunction in rodent models with dystonia, tremor, and ataxia. DYSTONIA 2023; 2:11515. [PMID: 38105800 PMCID: PMC10722573 DOI: 10.3389/dyst.2023.11515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Dystonia is a movement disorder characterized by involuntary co- or over-contractions of the muscles, which results in abnormal postures and movements. These symptoms arise from the pathophysiology of a brain-wide dystonia network. There is mounting evidence suggesting that the cerebellum is a central node in this network. For example, manipulations that target the cerebellum cause dystonic symptoms in mice, and cerebellar neuromodulation reduces these symptoms. Although numerous findings provide insight into dystonia pathophysiology, they also raise further questions. Namely, how does cerebellar pathophysiology cause the diverse motor abnormalities in dystonia, tremor, and ataxia? Here, we describe recent work in rodents showing that distinct cerebellar circuit abnormalities could define different disorders and we discuss potential mechanisms that determine the behavioral presentation of cerebellar diseases.
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Affiliation(s)
- Meike E. van der Heijden
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, United States
| | - Roy V. Sillitoe
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, United States
- Jan and Dan Duncan Neurological Research Institute at Texas Children’s Hospital, Houston, TX, United States
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, United States
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, United States
- Development, Disease Models & Therapeutics Graduate Program, Baylor College of Medicine, Houston, TX, United States
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Blondiaux F, Lebrun L, Hanseeuw BJ, Crevecoeur F. Impairments of saccadic and reaching adaptation in essential tremor are linked to movement execution. J Neurophysiol 2023; 130:1092-1102. [PMID: 37791388 DOI: 10.1152/jn.00165.2023] [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: 04/25/2023] [Revised: 09/05/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023] Open
Abstract
Essential tremor (ET) is a neurological disorder characterized by involuntary oscillations of the limbs. Previous studies have hypothesized that ET is a cerebellar disorder and reported impairments in motor adaptation. However, recent advances have highlighted that motor adaptation involves several components linked to anticipation and control, all dependent on cerebellum. We studied the contribution of both components in adaptation to better understand the adaptation impairments observed in ET from a behavioral perspective. To address this question, we investigated behavioral markers of adaptation in ET patients (n = 20) and age-matched neurologically intact volunteers (n = 20) in saccadic and upper limb adaptation tasks, probing compensation for target jumps and for velocity-dependent force fields, respectively. We found that both groups adapted their movements to the novel contexts; however, ET patients adapted to a lesser extent compared with neurologically intact volunteers. Importantly, components of the movement linked to anticipation were preserved in the ET group, whereas components linked to movement execution appeared responsible for the adaptation deficit in this group. Altogether, our results suggest that execution deficits may be a specific functional consequence of the alteration of neural pathways associated with ET.NEW & NOTEWORTHY We tested essential tremor patients' adaptation abilities in classical tasks including saccadic adaptation to target jumps and reaching adaptation to force field disturbances. Patients' adaptation was present but impaired in both tasks. Interestingly, the deficits were mainly present during movement execution, whereas the anticipatory components of movements were similar to neurologically intact volunteers. These findings reinforce the hypothesis of a cerebellar origin for essential tremor and detail the motor adaptation impairments previously found in this disorder.
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Affiliation(s)
- Florence Blondiaux
- Institute for Information and Communication Technologies, Electronics and Applied Mathematics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
| | - Louisien Lebrun
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Neurology Department, Saint-Luc University Hospital, Brussels, Belgium
| | - Bernard J Hanseeuw
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
- Neurology Department, Saint-Luc University Hospital, Brussels, Belgium
- Gordon Center for Medical Imaging, Radiology Department, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Louvain Aging Brain Lab, Walloon Excellence in Life Sciences and Biotechnology (WELBIO), UCLouvain, Brussels, Belgium
| | - Frédéric Crevecoeur
- Institute for Information and Communication Technologies, Electronics and Applied Mathematics, UCLouvain, Louvain-la-Neuve, Belgium
- Institute of Neuroscience, UCLouvain, Brussels, Belgium
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7
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Herzog R, Bolte C, Radecke JO, von Möller K, Lencer R, Tzvi E, Münchau A, Bäumer T, Weissbach A. Neuronavigated Cerebellar 50 Hz tACS: Attenuation of Stimulation Effects by Motor Sequence Learning. Biomedicines 2023; 11:2218. [PMID: 37626715 PMCID: PMC10452137 DOI: 10.3390/biomedicines11082218] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Cerebellar transcranial alternating current stimulation (tACS) is an emerging non-invasive technique that induces electric fields to modulate cerebellar function. Although the effect of cortical tACS seems to be state-dependent, the impact of concurrent motor activation and the duration of stimulation on the effects of cerebellar tACS has not yet been examined. In our study, 20 healthy subjects received neuronavigated 50 Hz cerebellar tACS for 40 s or 20 min, each during performance using a motor sequence learning task (MSL) and at rest. We measured the motor evoked potential (MEP) before and at two time points after tACS application to assess corticospinal excitability. Additionally, we investigated the online effect of tACS on MSL. Individual electric field simulations were computed to evaluate the distribution of electric fields, showing a focal electric field in the right cerebellar hemisphere with the highest intensities in lobe VIIb, VIII and IX. Corticospinal excitability was only increased after tACS was applied for 40 s or 20 min at rest, and motor activation during tACS (MSL) cancelled this effect. In addition, performance was better (shorter reaction times) for the learned sequences after 20 min of tACS, indicating more pronounced learning under 20 min of tACS compared to tACS applied only in the first 40 s.
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Affiliation(s)
- Rebecca Herzog
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of Neurology, University Hospital Schleswig Holstein, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Christina Bolte
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Jan-Ole Radecke
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Kathinka von Möller
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Rebekka Lencer
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
- Department of Psychiatry and Psychotherapy, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Elinor Tzvi
- Department of Neurology, Leipzig University, Liebigstraße 20, 04103 Leipzig, Germany
- Syte Institute, Hohe Bleichen 8, 20354 Hamburg, Germany
| | - Alexander Münchau
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Tobias Bäumer
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Anne Weissbach
- Institute of Systems Motor Science, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany; (R.H.); (C.B.)
- Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
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Fanning A, Kuo SH. Clinical Heterogeneity of Essential Tremor: Understanding Neural Substrates of Action Tremor Subtypes. CEREBELLUM (LONDON, ENGLAND) 2023:10.1007/s12311-023-01551-3. [PMID: 37022657 PMCID: PMC10556200 DOI: 10.1007/s12311-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/21/2023] [Indexed: 04/07/2023]
Abstract
Essential tremor (ET) is a common movement disorder affecting millions of people. Studies of ET patients and perturbations in animal models have provided a foundation for the neural networks involved in its pathophysiology. However, ET encompasses a wide variability of phenotypic expression, and this may be the consequence of dysfunction in distinct subcircuits in the brain. The cerebello-thalamo-cortical circuit is a common substrate for the multiple subtypes of action tremor. Within the cerebellum, three sets of cerebellar cortex-deep cerebellar nuclei connections are important for tremor. The lateral hemispheres and dentate nuclei may be involved in intention, postural and isometric tremor. The intermediate zone and interposed nuclei could be involved in intention tremor. The vermis and fastigial nuclei could be involved in head and proximal upper extremity tremor. Studying distinct cerebellar circuitry will provide important framework for understanding the clinical heterogeneity of ET.
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Affiliation(s)
- Alexander Fanning
- Department of Neurology, Columbia University, New York, NY, 10032, USA
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA
| | - Sheng-Han Kuo
- Department of Neurology, Columbia University, New York, NY, 10032, USA.
- Initiative for Columbia Ataxia and Tremor, Columbia University, New York, NY, 10032, USA.
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Zhang Y, Huang P, Wang X, Xu Q, Liu Y, Jin Z, Li Y, Cheng Z, Tang R, Chen S, He N, Yan F, Haacke EM. Visualizing the deep cerebellar nuclei using quantitative susceptibility mapping: An application in healthy controls, Parkinson's disease patients and essential tremor patients. Hum Brain Mapp 2023; 44:1810-1824. [PMID: 36502376 PMCID: PMC9921226 DOI: 10.1002/hbm.26178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 10/20/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022] Open
Abstract
The visualization and identification of the deep cerebellar nuclei (DCN) (dentate [DN], interposed [IN] and fastigial nuclei [FN]) are particularly challenging. We aimed to visualize the DCN using quantitative susceptibility mapping (QSM), predict the contrast differences between QSM and T2* weighted imaging, and compare the DCN volume and susceptibility in movement disorder populations and healthy controls (HCs). Seventy-one Parkinson's disease (PD) patients, 39 essential tremor patients, and 80 HCs were enrolled. The PD patients were subdivided into tremor dominant (TD) and postural instability/gait difficulty (PIGD) groups. A 3D strategically acquired gradient echo MR imaging protocol was used for each subject to obtain the QSM data. Regions of interest were drawn manually on the QSM data to calculate the volume and susceptibility. Correlation analysis between the susceptibility and either age or volume was performed and the intergroup differences of the volume and magnetic susceptibility in all the DCN structures were evaluated. For the most part, all the DCN structures were clearly visualized on the QSM data. The susceptibility increased as a function of volume for both the HC group and disease groups in the DN and IN (p < .001) but not the FN (p = .74). Only the volume of the FN in the TD-PD group was higher than that in the HCs (p = .012), otherwise, the volume and susceptibility among these four groups did not differ significantly. In conclusion, QSM provides clear visualization of the DCN structures. The results for the volume and susceptibility of the DCN can be used as baseline references in future studies of movement disorders.
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Affiliation(s)
- Youmin Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pei Huang
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinhui Wang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiuyun Xu
- Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA
| | - Yu Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhijia Jin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zenghui Cheng
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rongbiao Tang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengdi Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - E Mark Haacke
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Department of Biomedical Engineering, Wayne State University, Detroit, Michigan, USA.,Department of Radiology, Wayne State University, Detroit, Michigan, USA
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10
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Locus coeruleus degeneration and cerebellar gray matter changes in essential tremor. J Neurol 2023; 270:780-787. [PMID: 36194299 DOI: 10.1007/s00415-022-11409-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND The pathophysiology of essential tremor (ET) is not fully understood, and studies suggest pathological changes mainly occur in the cerebellum and locus coeruleus (LC). METHODS Fifty-three ET patients, including 30 patients with head tremor (h-ET), 23 patients without head tremor (nh-ET), 71 age and education matched healthy controls (HCs) were enrolled. All participants underwent Neuromelanin-sensitive magnetic resonance imaging (NM-MRI) and T1 scans on a 3-Tesla MR system. Next, we assessed the relationship between the contrast-to-noise ratio of LC (CNRLC) and the score of The Essential Tremor Rating Assessment Scale (TETRAS) and cerebellum gray matter (GM) volume. RESULTS Significant difference of CNRLC was found between ET and HC groups. The CNRLC of ET groups is lower than the HC group (p = 0.031). Subgroup analysis showed that the CNRLC in nh-ET was significantly lower than HCs (p = 0.016). Compared to HCs, h-ETs showed marked atrophy in the cerebellum: the vermis IV-V and lobule VI (GRF corrected, p < 0.05). A significant negative correlation was found between CNRLC and the vermis lobule IV-V in h-ETs (r = - 0.651, p < 0.001). No significant correlation was found between CNRLC and TETRAS scores. CONCLUSION The LC and the cerebellum might both involve in the pathophysiology of ET. LC evaluation using NM-MRI might be an effective tool for us to explore the pathophysiology of ET further.
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Wang Q, Aljassar M, Bhagwat N, Zeighami Y, Evans AC, Dagher A, Pike GB, Sadikot AF, Poline JB. Reproducibility of cerebellar involvement as quantified by consensus structural MRI biomarkers in advanced essential tremor. Sci Rep 2023; 13:581. [PMID: 36631461 PMCID: PMC9834264 DOI: 10.1038/s41598-022-25306-y] [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: 09/07/2021] [Accepted: 11/28/2022] [Indexed: 01/13/2023] Open
Abstract
Essential tremor (ET) is the most prevalent movement disorder with poorly understood etiology. Some neuroimaging studies report cerebellar involvement whereas others do not. This discrepancy may stem from underpowered studies, differences in statistical modeling or variation in magnetic resonance imaging (MRI) acquisition and processing. To resolve this, we investigated the cerebellar structural differences using a local advanced ET dataset augmented by matched controls from PPMI and ADNI. We tested the hypothesis of cerebellar involvement using three neuroimaging biomarkers: VBM, gray/white matter volumetry and lobular volumetry. Furthermore, we assessed the impacts of statistical models and segmentation pipelines on results. Results indicate that the detected cerebellar structural changes vary with methodology. Significant reduction of right cerebellar gray matter and increase of the left cerebellar white matter were the only two biomarkers consistently identified by multiple methods. Results also show substantial volumetric overestimation from SUIT-based segmentation-partially explaining previous literature discrepancies. This study suggests that current estimation of cerebellar involvement in ET may be overemphasized in MRI studies and highlights the importance of methods sensitivity analysis on results interpretation. ET datasets with large sample size and replication studies are required to improve our understanding of regional specificity of cerebellum involvement in ET. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on 21 March 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.6084/m9.figshare.19697776 .
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Affiliation(s)
- Qing Wang
- grid.14709.3b0000 0004 1936 8649Neuro Data Science - ORIGAMI Laboratory, McConnell Brain Imaging Centre, The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - Meshal Aljassar
- grid.14709.3b0000 0004 1936 8649Department of Neurology and Neurosurgery, McConnell Brain Imaging Centre (BIC), The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - Nikhil Bhagwat
- grid.14709.3b0000 0004 1936 8649Neuro Data Science - ORIGAMI Laboratory, McConnell Brain Imaging Centre, The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - Yashar Zeighami
- grid.14709.3b0000 0004 1936 8649Ludmer Centre for Neuroinformatics and Mental Health, McConnell Brain Imaging Centre (BIC), The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - Alan C. Evans
- grid.14709.3b0000 0004 1936 8649Ludmer Centre for Neuroinformatics and Mental Health, McConnell Brain Imaging Centre (BIC), The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - Alain Dagher
- grid.14709.3b0000 0004 1936 8649Ludmer Centre for Neuroinformatics and Mental Health, McConnell Brain Imaging Centre (BIC), The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - G. Bruce Pike
- grid.22072.350000 0004 1936 7697Department of Radiology, Cumming School of Medicine, Hotchkiss Brain Institute (HBI), University of Calgary, Calgary, QC Canada
| | - Abbas F. Sadikot
- grid.14709.3b0000 0004 1936 8649Department of Neurology and Neurosurgery, McConnell Brain Imaging Centre (BIC), The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC Canada
| | - Jean-Baptiste Poline
- Neuro Data Science - ORIGAMI Laboratory, McConnell Brain Imaging Centre, The Neuro (Montreal Neurological Institute-Hospital), Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
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12
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Exploring the heterogeneous morphometric data in essential tremor with probabilistic modelling. Neuroimage Clin 2023; 37:103283. [PMID: 36516728 PMCID: PMC9755240 DOI: 10.1016/j.nicl.2022.103283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/14/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
Essential tremor (ET) is a prevalent movement disorder characterized by marked clinical heterogeneity. Here, we explored the morphometric underpinnings of this cross-subject variability on a cohort of 34 patients with right-dominant drug-resistant ET and 29 matched healthy controls (HCs). For each brain region, group-wise morphometric data was modelled by a multivariate Gaussian to account for morphometric features' (co)variance. No group differences were found in terms of mean values, highlighting the limits of more basic group comparison approaches. Variance in surface area was higher in ET in the left lingual and caudal anterior cingulate cortices, while variance in mean curvature was lower in the right superior temporal cortex and pars triangularis, left supramarginal gyrus and bilateral paracentral gyrus. Heterogeneity further extended to the right putamen, for which a mixture of two Gaussians fitted the ET data better than a single one. Partial Least Squares analysis revealed the rich clinical relevance of the ET population's heterogeneity: first, increased head tremor and longer symptoms' duration were accompanied by broadly lower cortical gyrification. Second, more severe upper limb tremor and impairments in daily life activities characterized the patients whose morphometric profiles were more atypical compared to the average ET population, irrespective of the exact nature of the alterations. Our results provide candidate morphometric substrates for two different types of clinical variability in ET. They also demonstrate the importance of relying on analytical approaches that can efficiently handle multivariate data and enable to test more sophisticated hypotheses regarding its organization.
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Affiliation(s)
- Thomas A W Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; Department of Radiology, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland.
| | - Dimitri Van De Ville
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, 1202 Geneva, Switzerland; Department of Radiology and Medical Informatics, University of Geneva, 1202 Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005 Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005 Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, 13005 Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), 1015 Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois, 1011 Lausanne, Switzerland; University of Lausanne (UNIL), Faculty of Biology and Medicine (FBM), 1015 Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne, 1015 Lausanne, Switzerland
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13
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Upper Limb Function but Not Proprioception is Impaired in Essential Tremor: A Between-Groups Study and Causal Mediation Analysis. Tremor Other Hyperkinet Mov (N Y) 2023; 13:1. [PMID: 36644368 PMCID: PMC9818046 DOI: 10.5334/tohm.731] [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: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 01/04/2023] Open
Abstract
Background Essential tremor (ET) is characterized by abnormal oscillatory muscle activity and cerebellar involvement, factors that can lead to proprioceptive deficits, especially in active tasks. The present study aimed to quantify the severity of proprioceptive deficits in people with ET and estimate how these contribute to functional impairments. Methods Upper limb sensory, proprioceptive and motor function was assessed inindividuals with ET (n = 20) and healthy individuals (n = 22). To measure proprioceptive ability, participants discriminated the width of grasped objects and the weight of objects liftedwith the wrist extensors. Causal mediation analysis was used to estimate the extentthat impairments in upper limb function in ET was mediated by proprioceptive ability. Results Participants with ET had impaired upper limb function in all outcomes, and had greater postural and kinetic tremor. There were no differences between groups in proprioceptive discrimination of width (between-group mean difference [95% CI]: 0.32 mm [-0.23 to 0.87 mm]) or weight (-1.12 g [-7.31 to 5.07 g]). Causal mediation analysis showed the effect of ET on upper limb function was not mediated by proprioceptive ability. Conclusions Upper limb function but not proprioception was impaired in ET. The effect of ET on motor function was not mediated by proprioception. These results indicate that the central nervous system of people with ET is able to accommodate mild to moderate tremor in active proprioceptive tasks that rely primarily on afferent signals from muscle spindles.
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14
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Morphometric features of drug-resistant essential tremor and recovery after stereotactic radiosurgical thalamotomy. Netw Neurosci 2022; 6:850-869. [PMID: 36605417 PMCID: PMC9810368 DOI: 10.1162/netn_a_00253] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/02/2022] [Indexed: 01/09/2023] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Its neural underpinnings remain unclear. Here, we quantified structural covariance between cortical thickness (CT), surface area (SA), and mean curvature (MC) estimates in patients with ET before and 1 year after ventro-intermediate nucleus stereotactic radiosurgical thalamotomy, and contrasted the observed patterns with those from matched healthy controls. For SA, complex rearrangements within a network of motion-related brain areas characterized patients with ET. This was complemented by MC alterations revolving around the left middle temporal cortex and the disappearance of positive-valued covariance across both modalities in the right fusiform gyrus. Recovery following thalamotomy involved MC readjustments in frontal brain centers, the amygdala, and the insula, capturing nonmotor characteristics of the disease. The appearance of negative-valued CT covariance between the left parahippocampal gyrus and hippocampus was another recovery mechanism involving high-level visual areas. This was complemented by the appearance of negative-valued CT/MC covariance, and positive-valued SA/MC covariance, in the right inferior temporal cortex and bilateral fusiform gyrus. Our results demonstrate that different morphometric properties provide complementary information to understand ET, and that their statistical cross-dependences are also valuable. They pinpoint several anatomical features of the disease and highlight routes of recovery following thalamotomy.
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Affiliation(s)
- Thomas A. W. Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Connectomics Laboratory, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,* Corresponding Author:
| | - Dimitri Van De Ville
- Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland,Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland,Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland,Signal Processing Laboratory (LTS 5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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15
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Bolton TAW, Van De Ville D, Régis J, Witjas T, Girard N, Levivier M, Tuleasca C. Graph Theoretical Analysis of Structural Covariance Reveals the Relevance of Visuospatial and Attentional Areas in Essential Tremor Recovery After Stereotactic Radiosurgical Thalamotomy. Front Aging Neurosci 2022; 14:873605. [PMID: 35677202 PMCID: PMC9168220 DOI: 10.3389/fnagi.2022.873605] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Essential tremor (ET) is the most common movement disorder. Its pathophysiology is only partially understood. Here, we leveraged graph theoretical analysis on structural covariance patterns quantified from morphometric estimates for cortical thickness, surface area, and mean curvature in patients with ET before and one year after (to account for delayed clinical effect) ventro-intermediate nucleus (Vim) stereotactic radiosurgical thalamotomy. We further contrasted the observed patterns with those from matched healthy controls (HCs). Significant group differences at the level of individual morphometric properties were specific to mean curvature and the post-/pre-thalamotomy contrast, evidencing brain plasticity at the level of the targeted left thalamus, and of low-level visual, high-level visuospatial and attentional areas implicated in the dorsal visual stream. The introduction of cross-correlational analysis across pairs of morphometric properties strengthened the presence of dorsal visual stream readjustments following thalamotomy, as cortical thickness in the right lingual gyrus, bilateral rostral middle frontal gyrus, and left pre-central gyrus was interrelated with mean curvature in the rest of the brain. Overall, our results position mean curvature as the most relevant morphometric feature to understand brain plasticity in drug-resistant ET patients following Vim thalamotomy. They also highlight the importance of examining not only individual features, but also their interactions, to gain insight into the routes of recovery following intervention.
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Affiliation(s)
- Thomas A. W. Bolton
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Connectomics Laboratory, Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Dimitri Van De Ville
- Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jean Régis
- Stereotactic and Functional Neurosurgery Service and Gamma Knife Unit, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Tatiana Witjas
- Neurology Department, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Nadine Girard
- Department of Diagnostic and Interventional Neuroradiology, Centre de Résonance Magnétique Biologique et Médicale, Assistance Publique-Hôpitaux de Marseille, Centre Hospitalier Universitaire de la Timone, Marseille, France
| | - Marc Levivier
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Constantin Tuleasca
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
- Signal Processing Laboratory (LTS5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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16
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Acute Cerebellar Inflammation and Related Ataxia: Mechanisms and Pathophysiology. Brain Sci 2022; 12:brainsci12030367. [PMID: 35326323 PMCID: PMC8946185 DOI: 10.3390/brainsci12030367] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 12/11/2022] Open
Abstract
The cerebellum governs motor coordination and motor learning. Infection with external microorganisms, such as viruses, bacteria, and fungi, induces the release and production of inflammatory mediators, which drive acute cerebellar inflammation. The clinical observation of acute cerebellitis is associated with the emergence of cerebellar ataxia. In our animal model of the acute inflammation of the cerebellar cortex, animals did not show any ataxia but hyperexcitability in the cerebellar cortex and depression-like behaviors. In contrast, animal models with neurodegeneration of the cerebellar Purkinje cells and hypoexcitability of the neurons show cerebellar ataxia. The suppression of the Ca2+-activated K+ channels in vivo is associated with a type of ataxia. Therefore, there is a gap in our interpretation between the very early phase of cerebellar inflammation and the emergence of cerebellar ataxia. In this review, we discuss the hypothesized scenario concerning the emergence of cerebellar ataxia. First, compared with genetically induced cerebellar ataxias, we introduce infection and inflammation in the cerebellum via aberrant immunity and glial responses. Especially, we focus on infections with cytomegalovirus, influenza virus, dengue virus, and SARS-CoV-2, potential relevance to mitochondrial DNA, and autoimmunity in infection. Second, we review neurophysiological modulation (intrinsic excitability, excitatory, and inhibitory synaptic transmission) by inflammatory mediators and aberrant immunity. Next, we discuss the cerebellar circuit dysfunction (presumably, via maintaining the homeostatic property). Lastly, we propose the mechanism of the cerebellar ataxia and possible treatments for the ataxia in the cerebellar inflammation.
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17
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Reclassification of patients with tremor syndrome and comparisons of essential tremor and essential tremor-plus patients. J Neurol 2022; 269:3653-3662. [DOI: 10.1007/s00415-022-10985-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/17/2022] [Accepted: 01/19/2022] [Indexed: 12/20/2022]
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18
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Lenka A, Pandey S. Essential Tremor: Five New Things. Neurol Clin Pract 2021; 12:183-186. [PMID: 35747894 PMCID: PMC9208407 DOI: 10.1212/cpj.0000000000001145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/19/2021] [Indexed: 11/15/2022]
Abstract
ABSTRACTPurpose of the review:To highlight five new things in the research and clinical aspects of essential tremor (ET).Recent findings:The introduction of a new definition of ET and a new category “ET plus” were the major themes of the recent consensus statement. This new change demands a change in the approach to the clinical diagnosis of ET and related diseases. From the pathogenesis standpoint, the cerebellar neurodegenerative model seems to have numerous evidence in its favor compared to the olivary model which has largely fallen out of favor. From the standpoint of therapeutics, magnetic resonance-guided focused ultrasound (MRgFUS) thalamotomy has enriched the therapeutic armamentarium.Summary:There has been considerable progress in the field of ET. We discuss five new things in this article which include- (i) new definition (ii) ET plus (iii) approach to the diagnosis of ET, (iv) cerebellar degeneration, and (v) MRgFUS thalamotomy.
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Affiliation(s)
- Abhishek Lenka
- MedStar Georgetown University Hospital (AL), Washington, DC; and G.B. Pant Institute of Postgraduate Medical Education and Research (SP), New Delhi, India
| | - Sanjay Pandey
- MedStar Georgetown University Hospital (AL), Washington, DC; and G.B. Pant Institute of Postgraduate Medical Education and Research (SP), New Delhi, India
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19
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Fra̧czek TM, Ferleger BI, Brown TE, Thompson MC, Haddock AJ, Houston BC, Ojemann JG, Ko AL, Herron JA, Chizeck HJ. Closing the Loop With Cortical Sensing: The Development of Adaptive Deep Brain Stimulation for Essential Tremor Using the Activa PC+S. Front Neurosci 2021; 15:749705. [PMID: 34955714 PMCID: PMC8695120 DOI: 10.3389/fnins.2021.749705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022] Open
Abstract
Deep Brain Stimulation (DBS) is an important tool in the treatment of pharmacologically resistant neurological movement disorders such as essential tremor (ET) and Parkinson's disease (PD). However, the open-loop design of current systems may be holding back the true potential of invasive neuromodulation. In the last decade we have seen an explosion of activity in the use of feedback to "close the loop" on neuromodulation in the form of adaptive DBS (aDBS) systems that can respond to the patient's therapeutic needs. In this paper we summarize the accomplishments of a 5-year study at the University of Washington in the use of neural feedback from an electrocorticography strip placed over the sensorimotor cortex. We document our progress from an initial proof of hardware all the way to a fully implanted adaptive stimulation system that leverages machine-learning approaches to simplify the programming process. In certain cases, our systems out-performed current open-loop approaches in both power consumption and symptom suppression. Throughout this effort, we collaborated with neuroethicists to capture patient experiences and take them into account whilst developing ethical aDBS approaches. Based on our results we identify several key areas for future work. "Graded" aDBS will allow the system to smoothly tune the stimulation level to symptom severity, and frequent automatic calibration of the algorithm will allow aDBS to adapt to the time-varying dynamics of the disease without additional input from a clinician. Additionally, robust computational models of the pathophysiology of ET will allow stimulation to be optimized to the nuances of an individual patient's symptoms. We also outline the unique advantages of using cortical electrodes for control and the remaining hardware limitations that need to be overcome to facilitate further development in this field. Over the course of this study we have verified the potential of fully-implanted, cortically driven aDBS as a feasibly translatable treatment for pharmacologically resistant ET.
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Affiliation(s)
- Tomasz M. Fra̧czek
- Neuroscience Program, University of Washington, Seattle, WA, United States
| | - Benjamin I. Ferleger
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Timothy E. Brown
- Department of Philosophy, University of Washington, Seattle, WA, United States
| | - Margaret C. Thompson
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Andrew J. Haddock
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
| | - Brady C. Houston
- Neuroscience Program, University of Washington, Seattle, WA, United States
| | - Jeffrey G. Ojemann
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Andrew L. Ko
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Jeffrey A. Herron
- Department of Neurological Surgery, University of Washington, Seattle, WA, United States
| | - Howard J. Chizeck
- Department of Electrical and Computer Engineering, University of Washington, Seattle, WA, United States
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20
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Nagao S, Hirai H, Kano M, Yuzaki M. Masao Ito-A Visionary Neuroscientist with a Passion for the Cerebellum. Neuroscience 2021; 462:1-3. [PMID: 33892899 DOI: 10.1016/j.neuroscience.2021.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Soichi Nagao
- Laboratory for Integrative Brain Function, Nozomi Hospital, Saitama 362-0806, Japan; Laboratory for Memory Neuroscience, Tokyo Metropolitan Institute for Gerontology, Tokyo 173-0015, Japan
| | - Hirokazu Hirai
- Department of Neurophysiology & Neural Repair, Gunma University Graduate School of Medicine, Gunma 371-8511, Japan
| | - Masanobu Kano
- Depertment of Neurophysiology, Graduate School of Medicine, The University of Tokyo, Tokyo 113-0033, Japan; International Research Center for Neurointelligence (IRCN), The University of Tokyo Institutes for Advanced Study (UTIAS), The University of Tokyo, Tokyo 113-0033, Japan
| | - Michisuke Yuzaki
- Department of Neurophysiology, Keio University School of Medicine, Tokyo 160-8582, Japan
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21
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Segawa K, Blumenthal Y, Yamawaki Y, Ohtsuki G. A Destruction Model of the Vascular and Lymphatic Systems in the Emergence of Psychiatric Symptoms. BIOLOGY 2021; 10:34. [PMID: 33419067 PMCID: PMC7825436 DOI: 10.3390/biology10010034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/24/2020] [Accepted: 12/31/2020] [Indexed: 01/02/2023]
Abstract
The lymphatic system is important for antigen presentation and immune surveillance. The lymphatic system in the brain was originally introduced by Giovanni Mascagni in 1787, while the rediscovery of it by Jonathan Kipnis and Kari Kustaa Alitalo now opens the door for a new interpretation of neurological diseases and therapeutic applications. The glymphatic system for the exchanges of cerebrospinal fluid (CSF) and interstitial fluid (ISF) is associated with the blood-brain barrier (BBB), which is involved in the maintenance of immune privilege and homeostasis in the brain. Recent notions from studies of postmortem brains and clinical studies of neurodegenerative diseases, infection, and cerebral hemorrhage, implied that the breakdown of those barrier systems and infiltration of activated immune cells disrupt the function of both neurons and glia in the parenchyma (e.g., modulation of neurophysiological properties and maturation of myelination), which causes the abnormality in the functional connectivity of the entire brain network. Due to the vulnerability, such dysfunction may occur in developing brains as well as in senile or neurodegenerative diseases and may raise the risk of emergence of psychosis symptoms. Here, we introduce this hypothesis with a series of studies and cellular mechanisms.
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Affiliation(s)
- Kohei Segawa
- Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8397, Japan; (K.S.); (Y.Y.)
| | - Yukari Blumenthal
- Urology Department at Cambridge University Hospitals, NHS Foundation Trust, Addenbrooke’s Hospital, Hills Road Cambridge, Cambridge CB2 0QQ, UK;
| | - Yuki Yamawaki
- Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8397, Japan; (K.S.); (Y.Y.)
| | - Gen Ohtsuki
- Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8397, Japan; (K.S.); (Y.Y.)
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