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Voon V, Manssuer L, Zhao YJ, Ding Q, Zhao Y, Wang L, Wang T, Huang P, Pan Y, Sun B, Li D. Modeling impulsivity and risk aversion in the subthalamic nucleus with deep brain stimulation. NATURE. MENTAL HEALTH 2024; 2:1084-1095. [PMID: 39263364 PMCID: PMC11383798 DOI: 10.1038/s44220-024-00289-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/24/2024] [Indexed: 09/13/2024]
Abstract
Risk evaluation is ubiquitous in decisions. Deep brain stimulation of the subthalamic nucleus is effective for Parkinson's disease and obsessive-compulsive disorder, and can be associated with impulsivity and hypomania. Subthalamic stimulation has seemingly contrasting effects on impulsivity enhancing conflict-induced impulsivity but decreasing risk taking. Here, using a card gambling task paired with intracranial recordings (n = 25) and within-subject case control acute stimulation (n = 15) of the right subthalamic nucleus, we dissociated objective risk and uncertainty and subjective physiological markers of risk. Acute stimulation decreased risk taking (P = 0.010, Cohen's d = 0.72) and increased subthalamic theta activity (P < 0.001, Cohen's d = 0.72). Critically, stimulation negatively shifted the relationship between subthalamic physiology and a measure of evidence accumulation similar to observations with stimulation-induced conflict processing. This highlights the phenotypic and physiological heterogeneity of impulsivity, yet linking mechanisms underlying stimulation-induced conflict and risk. Finally, stimulation-induced risk seeking implicates the ventral subthalamic nucleus and dissociating anatomical and functional connectivity with the mesial prefrontal cortex. Our findings have implications for conceptualizations of impulsivity, and clinical relevance for neuropsychiatric disorders.
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Affiliation(s)
- Valerie Voon
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Luis Manssuer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Yi-Jie Zhao
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, China
| | - Qiong Ding
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ying Zhao
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Linbin Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China
| | - Tao Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Coutinho PB, Johnson KA, Seritan AL, Galifianakis NB, Coleman R, Wang D, Racine CA, Ostrem JL, Starr PA, de Hemptinne C. Elevated Mood Induced by Subthalamic Nucleus Deep Brain Stimulation: A Video-Recorded Case Report. Tremor Other Hyperkinet Mov (N Y) 2024; 14:37. [PMID: 39005242 PMCID: PMC11243764 DOI: 10.5334/tohm.900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Background Deep brain stimulation (DBS) can be an effective therapy to control motor signs in patients with Parkinson's disease (PD). However, subthalamic nucleus (STN) DBS can induce undesirable psychiatric adverse effects, including elevated mood. Case report We reported a video case of a 73-year-old male implanted with bilateral STN DBS who experienced stimulation-induced elevated mood. A correlation between mood changes and enhanced activation of the ventromedial region in the left STN was observed. Discussion This video case report illustrates STN DBS-induced elevated mood and enhances early symptom recognition for patients and diagnostic awareness for professionals.
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Affiliation(s)
- Patricia B. Coutinho
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kara A. Johnson
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Andreea L. Seritan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas B. Galifianakis
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
| | - Robert Coleman
- Department of Neurology, Corewell Health, Grand Rapids, MI, USA
| | - Doris Wang
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline A. Racine
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jill L. Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
| | - Philip A. Starr
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Coralie de Hemptinne
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
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Wang Y, Yu L, Mao H, Chen X, Hu P, Ge Y, Liu Y, Zhang J, Cheng H. Deep Brain Stimulation Modulates the Visual Pathway to Improve Freezing of Gait in Parkinson's Disease Patients. World Neurosurg 2024; 187:e148-e155. [PMID: 38636635 DOI: 10.1016/j.wneu.2024.04.055] [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: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To investigate the involvement of the visual cortex in improving freezing of gait (FoG) after subthalamic nucleus (STN) deep brain stimulation (DBS) in Parkinson's disease (PD) patients using whole-brain seed-based functional connectivity. METHODS A total of 66 PD patients with FoG who underwent bilateral STN-DBS were included in our study. Patients were divided into a FoG responder group and an FoG nonresponder group according to whether FoG improved 1 year after DBS. We compared the differences in clinical characteristics, brain structural imaging, and seed-based functional connectivity between the 2 groups. The locations of active contacts were further analyzed. RESULTS All PD patients benefited from STN-DBS. No significant differences in the baseline characteristics or brain structures were found between the 2 groups. Seed-based functional connectivity analysis revealed that better connectivity in bilateral primary visual areas was associated with better clinical improvement in FoG (P < 0.05 familywise error corrected). Further analysis revealed that this disparity was associated with the location of the active contacts within the rostral region of the sensorimotor subregion in the FoG responder group, in contrast to the findings in the FoG nonresponder group. CONCLUSIONS This study suggested that DBS in the rostral region of the STN sensorimotor subregion may alleviate FoG by strengthening functional connectivity in primary visual areas, which has significant implications for guiding surgical strategies for FoG in the future.
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Affiliation(s)
- Yi Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Liangchen Yu
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Hongliang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Xianwen Chen
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Panpan Hu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Ge
- Department of Rehabilitation, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China
| | - Yue Liu
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Jiarui Zhang
- First Clinical Medical College, Anhui Medical University, Hefei, P.R. China
| | - Hongwei Cheng
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, P.R. China.
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Willett A, Wylie SA, Bowersock JL, Dawant BM, Rodriguez W, Ugiliweneza B, Neimat JS, van Wouwe NC. Focused stimulation of dorsal versus ventral subthalamic nucleus enhances action-outcome learning in patients with Parkinson's disease. Brain Commun 2024; 6:fcae111. [PMID: 38646144 PMCID: PMC11032193 DOI: 10.1093/braincomms/fcae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 02/01/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective treatment for the clinical motor symptoms of Parkinson's disease, but may alter the ability to learn contingencies between stimuli, actions and outcomes. We investigated how stimulation of the functional subregions in the subthalamic nucleus (motor and cognitive regions) modulates stimulus-action-outcome learning in Parkinson's disease patients. Twelve Parkinson's disease patients with deep brain stimulation of the subthalamic nucleus completed a probabilistic stimulus-action-outcome task while undergoing ventral and dorsal subthalamic nucleus stimulation (within subjects, order counterbalanced). The task orthogonalized action choice and outcome valence, which created four action-outcome learning conditions: action-reward, inhibit-reward, action-punishment avoidance and inhibit-punishment avoidance. We compared the effects of deep brain stimulation on learning rates across these conditions as well as on computed Pavlovian learning biases. Dorsal stimulation was associated with higher overall learning proficiency relative to ventral subthalamic nucleus stimulation. Compared to ventral stimulation, stimulating the dorsal subthalamic nucleus led to a particular advantage in learning to inhibit action to produce desired outcomes (gain reward or avoid punishment) as well as better learning proficiency across all conditions providing reward opportunities. The Pavlovian reward bias was reduced with dorsal relative to ventral subthalamic nucleus stimulation, which was reflected by improved inhibit-reward learning. Our results show that focused stimulation in the dorsal compared to the ventral subthalamic nucleus is relatively more favourable for learning action-outcome contingencies and reduces the Pavlovian bias that could lead to reward-driven behaviour. Considering the effects of deep brain stimulation of the subthalamic nucleus on learning and behaviour could be important when optimizing stimulation parameters to avoid side effects like impulsive reward-driven behaviour.
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Affiliation(s)
- Andrew Willett
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Scott A Wylie
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Jessica L Bowersock
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Benoit M Dawant
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - William Rodriguez
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN 37235, USA
| | - Beatrice Ugiliweneza
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
| | - Nelleke C van Wouwe
- Department of Neurological Surgery, University of Louisville, Louisville, KY 40202, USA
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5
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Melo M, Furlanetti L, Hasegawa H, Mundil N, Ashkan K. Comparison of direct MRI guided versus atlas-based targeting for subthalamic nucleus and globus pallidus deep brain stimulation. Br J Neurosurg 2023; 37:1040-1045. [PMID: 33416411 DOI: 10.1080/02688697.2020.1850641] [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: 11/22/2019] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The subthalamic nucleus (STN) and globus pallidus internus (GPi) targets for deep brain stimulation (DBS) can be defined by atlas coordinates or direct visualisation of the target on MRI. The aim of this study was to evaluate geometric differences between atlas-based targeting and MRI-guided direct targeting. METHODS One-hundred-nine Parkinson's disease or dystonia patients records who underwent DBS surgery between 2005 and 2016 were prospectively reviewed. MRI-guided direct targeting coordinates was used to implant 205 STN and 64 GPi electrodes and compared with atlas-based coordinates. RESULTS The directly targeted coordinates (mean, SD, range) for STN were x: [9.9 ± 1.1 (7.1 - 13.2)], y: [-0.8 ± 1.1 (-4.2 - 2)] and z: [-4.7 ± 0.53 (-5.9 - -3.2)]. The mean value for the STN was 2.1 mm more medial (p < 0.0001), 1.2 mm more anterior (p < 0.0001) and 0.7 mm more ventral (p < 0.0001) than the atlas target. The targeted coordinates for GPi were x: [22.3 ± 2.0 (17.8 - 26.1)], y: [-0.2 ± 2.2 (-4.5 - 3.4)], z: [-4.3 ± 0.8 (-6.2 - -2.3)]. The mean value for the GPi was 2.2 mm (p < 0.001) more posterior and 0.3 mm (p < 0.01) more ventral than the atlas-based coordinates. CONCLUSION MRI-guided targeting may be more accurate than atlas-based targeting due to individual variations in anatomy.
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Affiliation(s)
- Mariane Melo
- Department of Neurosurgery, King's College Hospital, London, UK
| | | | | | - Nilesh Mundil
- Department of Neurosurgery, King's College Hospital, London, UK
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Weerasinghe-Mudiyanselage PD, Kang S, Kim JS, Moon C. Therapeutic Approaches to Non-Motor Symptoms of Parkinson's Disease: A Current Update on Preclinical Evidence. Curr Neuropharmacol 2023; 21:560-577. [PMID: 36200159 PMCID: PMC10207906 DOI: 10.2174/1570159x20666221005090126] [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: 06/19/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/22/2022] Open
Abstract
Despite being classified as a movement disorder, Parkinson's disease (PD) is characterized by a wide range of non-motor symptoms that significantly affect the patients' quality of life. However, clear evidence-based therapy recommendations for non-motor symptoms of PD are uncommon. Animal models of PD have previously been shown to be useful for advancing the knowledge and treatment of motor symptoms. However, these models may provide insight into and assess therapies for non-motor symptoms in PD. This paper highlights non-motor symptoms in preclinical models of PD and the current position regarding preclinical therapeutic approaches for these non-motor symptoms. This information may be relevant for designing future preclinical investigations of therapies for nonmotor symptoms in PD.
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Affiliation(s)
- Poornima D.E. Weerasinghe-Mudiyanselage
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju 61186, South Korea
| | - Sohi Kang
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju 61186, South Korea
| | - Joong-Sun Kim
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju 61186, South Korea
| | - Changjong Moon
- Department of Veterinary Anatomy and Animal Behavior, College of Veterinary Medicine and BK21 FOUR Program, Chonnam National University, Gwangju 61186, South Korea
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7
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Cometa A, Falasconi A, Biasizzo M, Carpaneto J, Horn A, Mazzoni A, Micera S. Clinical neuroscience and neurotechnology: An amazing symbiosis. iScience 2022; 25:105124. [PMID: 36193050 PMCID: PMC9526189 DOI: 10.1016/j.isci.2022.105124] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the last decades, clinical neuroscience found a novel ally in neurotechnologies, devices able to record and stimulate electrical activity in the nervous system. These technologies improved the ability to diagnose and treat neural disorders. Neurotechnologies are concurrently enabling a deeper understanding of healthy and pathological dynamics of the nervous system through stimulation and recordings during brain implants. On the other hand, clinical neurosciences are not only driving neuroengineering toward the most relevant clinical issues, but are also shaping the neurotechnologies thanks to clinical advancements. For instance, understanding the etiology of a disease informs the location of a therapeutic stimulation, but also the way stimulation patterns should be designed to be more effective/naturalistic. Here, we describe cases of fruitful integration such as Deep Brain Stimulation and cortical interfaces to highlight how this symbiosis between clinical neuroscience and neurotechnology is closer to a novel integrated framework than to a simple interdisciplinary interaction.
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Affiliation(s)
- Andrea Cometa
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Antonio Falasconi
- Friedrich Miescher Institute for Biomedical Research, 4058 Basel, Switzerland
- Biozentrum, University of Basel, 4056 Basel, Switzerland
| | - Marco Biasizzo
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Jacopo Carpaneto
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Andreas Horn
- Center for Brain Circuit Therapeutics Department of Neurology Brigham & Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
- MGH Neurosurgery & Center for Neurotechnology and Neurorecovery (CNTR) at MGH Neurology Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Department of Neurology, 10117 Berlin, Germany
| | - Alberto Mazzoni
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
| | - Silvestro Micera
- The Biorobotics Institute, Scuola Superiore Sant’Anna, 56127 Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127 Pisa, Italy
- Translational Neural Engineering Lab, School of Engineering, École Polytechnique Fèdèrale de Lausanne, 1015 Lausanne, Switzerland
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8
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Prange S, Lin Z, Nourredine M, Danaila T, Laurencin C, Lagha-Boukbiza O, Anheim M, Klinger H, Longato N, Phillipps C, Voirin J, Polo G, Simon E, Mertens P, Rolland AS, Devos D, Metereau E, Tranchant C, Thobois S. Limbic stimulation drives mania in STN-DBS in Parkinson disease: a prospective study. Ann Neurol 2022; 92:411-417. [PMID: 35703252 DOI: 10.1002/ana.26434] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022]
Abstract
In this one-year prospective study, Parkinson's disease (PD) patients with or without mania following STN-DBS were compared to investigate risk and etiological factors, clinical management and consequences. Eighteen (16.2%) out of 111 consecutive PD patients developed mania, of whom 17 were males. No preoperative risk factor was identified. Postoperative mania was related to ventral limbic subthalamic stimulation in 15 (83%) patients, and resolved as stimulation was relocated to the sensorimotor STN, besides discontinuation or reduction of dopamine agonists and use of low-dose clozapine in 12 patients, while motor and nonmotor outcomes were similar. These findings underpin the prominent role of limbic subthalamic stimulation in postoperative mania. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stéphane Prange
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - Zhengyu Lin
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France.,Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Teodor Danaila
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Chloé Laurencin
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Nadine Longato
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clelie Phillipps
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN, Strasbourg University Hospital, Strasbourg, France
| | - Gustavo Polo
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Emile Simon
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Patrick Mertens
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Anne-Sophie Rolland
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - David Devos
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - Elise Metereau
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Stéphane Thobois
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Oullins, France
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9
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Kratter IH, Jorge A, Feyder MT, Whiteman AC, Chang YF, Henry LC, Karp JF, Richardson RM. Depression history modulates effects of subthalamic nucleus topography on neuropsychological outcomes of deep brain stimulation for Parkinson's disease. Transl Psychiatry 2022; 12:213. [PMID: 35624103 PMCID: PMC9142573 DOI: 10.1038/s41398-022-01978-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022] Open
Abstract
Patients with psychiatric symptoms, such as depression, anxiety, and visual hallucinations, may be at increased risk for adverse effects following deep brain stimulation of the subthalamic nucleus for Parkinson's disease, but there have been relatively few studies of associations between locations of chronic stimulation and neuropsychological outcomes. We sought to determine whether psychiatric history modulates associations between stimulation location within the subthalamic nucleus and postoperative affective and cognitive changes. We retrospectively identified 42 patients with Parkinson's disease who received bilateral subthalamic nucleus deep brain stimulation and who completed both pre- and postoperative neuropsychological testing. Active stimulation contacts were localized in MNI space using Lead-DBS software. Linear discriminant analysis identified vectors maximizing variance in postoperative neuropsychological changes, and Pearson's correlations were used to assess for linear relationships. Stimulation location was associated with postoperative change for only 3 of the 18 neuropsychological measures. Variation along the superioinferior (z) axis was most influential. Constraining the analysis to patients with a history of depression revealed 10 measures significantly associated with active contact location, primarily related to location along the anterioposterior (y) axis and with worse outcomes associated with more anterior stimulation. Analysis of patients with a history of anxiety revealed 5 measures with location-associated changes without a predominant axis. History of visual hallucinations was not associated with significant findings. Our results suggest that a history of depression may influence the relationship between active contact location and neuropsychological outcomes following subthalamic nucleus deep brain stimulation. These patients may be more sensitive to off-target (nonmotor) stimulation.
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Affiliation(s)
- Ian H Kratter
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA.
| | - Ahmed Jorge
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael T Feyder
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashley C Whiteman
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yue-Fang Chang
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Luke C Henry
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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10
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Tödt I, Al-Fatly B, Granert O, Kühn AA, Krack P, Rau J, Timmermann L, Schnitzler A, Paschen S, Helmers AK, Hartmann A, Bardinet E, Schuepbach M, Barbe MT, Dembek TA, Fraix V, Kübler D, Brefel-Courbon C, Gharabaghi A, Wojtecki L, Pinsker MO, Thobois S, Damier P, Witjas T, Houeto JL, Schade-Brittinger C, Vidailhet M, Horn A, Deuschl G. The Contribution of Subthalamic Nucleus Deep Brain Stimulation to the Improvement in Motor Functions and Quality of Life. Mov Disord 2022; 37:291-301. [PMID: 35112384 DOI: 10.1002/mds.28952] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Subthalamic nucleus deep brain stimulation (STN-DBS) effectively treats motor symptoms and quality of life (QoL) of advanced and fluctuating early Parkinson's disease. Little is known about the relation between electrode position and changes in symptom control and ultimately QoL. OBJECTIVES The relation between the stimulated part of the STN and clinical outcomes, including the motor score of the Unified Parkinson's Disease Rating Scale (UPDRS) and the quality-of-life questionnaire, was assessed in a subcohort of the EARLYSTIM study. METHODS Sixty-nine patients from the EARLYSTIM cohort who underwent DBS, with a comprehensive clinical characterization before and 24 months after surgery, were included. Intercorrelations of clinical outcome changes, correlation between the affected functional parts of the STN, and changes in clinical outcomes were investigated. We further calculated sweet spots for different clinical parameters. RESULTS Improvements in the UPDRS III and Parkinson's Disease Questionnaire (PDQ-39) correlated positively with the extent of the overlap with the sensorimotor STN. The sweet spots for the UPDRS III (x = 11.6, y = -13.1, z = -6.3) and the PDQ-39 differed (x = 14.8, y = -12.4, z = -4.3) ~3.8 mm. CONCLUSIONS The main influence of DBS on QoL is likely mediated through the sensory-motor basal ganglia loop. The PDQ sweet spot is located in a posteroventral spatial location in the STN territory. For aspects of QoL, however, there was also evidence of improvement through stimulation of the other STN subnuclei. More research is necessary to customize the DBS target to individual symptoms of each patient. © 2022 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Inken Tödt
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Bassam Al-Fatly
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Oliver Granert
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Paul Krack
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Joern Rau
- Coordinating Center for Clinical Trials, Philipps-University, Marburg, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Giessen and Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Department of Neurology, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University Duesseldorf, Duesseldorf, Germany
| | - Steffen Paschen
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
| | - Ann-Kristin Helmers
- Department of Neurosurgery, University Hospital Schleswig Holstein, Kiel, Germany
| | - Andreas Hartmann
- Assistance-Publique Hôpitaux de Paris, Center d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Paris, France.,Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, Paris, France
| | - Eric Bardinet
- Department of Neurology, NS-PARK/F-CRIN, University Hospital of Besançon, Besançon, France.,Center de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle (ICM), Paris, France
| | - Michael Schuepbach
- Department of Neurology, University Hospital Bern and University of Bern, Bern, Switzerland.,Assistance-Publique Hôpitaux de Paris, Center d'Investigation Clinique 9503, Institut du Cerveau et de la Moelle épinière, Paris, France.,Département de Neurologie, Université Pierre et Marie Curie-Paris 6 et INSERM, Paris, France.,Institute of Neurology, Konolfingen, Switzerland
| | - Michael T Barbe
- Department of Neurology, University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Till A Dembek
- Department of Neurology, University of Cologne, Faculty of Medicine, Cologne, Germany
| | - Valerie Fraix
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.,Neurology Department, Grenoble University Hospital, Grenoble, France
| | - Dorothee Kübler
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | | | - Alireza Gharabaghi
- Department of Neurosurgery and Neurotechnology Institute for Neuromodulation and Neurotechnology, University Hospital and University of Tuebingen, Tuebingen, Germany
| | - Lars Wojtecki
- Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist GmbH & Co.KG Academic Teaching Hospital of the Heinrich-Heine-University Düsseldorf Von-Broichhausen-Allee 1, Kempen, Germany
| | - Marcus O Pinsker
- Department of Neurosurgery, University of Freiburg, Freiburg, Germany
| | - Stephane Thobois
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Center Expert Parkinson, Bron, France.,Université Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Sud Charles Mérieux, Oullins, France
| | | | - Tatiana Witjas
- Department of Neurology, Timone University Hospital UMR 7289, CNRS Marseille, Marseille, France
| | - Jean-Luc Houeto
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Center Expert Parkinson, Bron, France
| | | | - Marie Vidailhet
- Department of Neurology, Sorbonne Université, ICM UMR1127, INSERM &1127, CNRS 7225, Salpêtriere University Hospital AP-HP, Paris, France
| | - Andreas Horn
- Department of Neurology, Movement Disorders and Neuromodulation Section, Charité Medicine University of Berlin, Berlin, Germany
| | - Günther Deuschl
- Department of Neurology, University Hospital Schleswig Holstein, Kiel, Germany
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11
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Alonso-Frech F, Fernandez-Garcia C, Gómez-Mayordomo V, Monje MHG, Delgado-Suarez C, Villanueva-Iza C, Catalan-Alonso MJ. Non-motor Adverse Effects Avoided by Directional Stimulation in Parkinson's Disease: A Case Report. Front Neurol 2022; 12:786166. [PMID: 35173666 PMCID: PMC8843015 DOI: 10.3389/fneur.2021.786166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Deep brain stimulation (DBS) is widely used for treatment of advanced, medication-refractory Parkinson's disease (PD). However, a significant proportion of patients may suffer adverse effects; up to 10% will present one or more transient or permanent neurobehavioral events. Patient and Methods In our case study, a 44-year-old woman diagnosed with PD 6 years previously who was suffering from motor fluctuations, dyskinesia, and freezing of gait episodes was submitted for DBS and implanted with directional electrodes. Intraoperative local field potentials (LFPs) were recorded. After surgery, conventional monopolar revision was performed. Preoperative 3T MRI studies and postoperative 3D and X-ray data were integrated using the Guide DTI software application (Brainlab), and diffusion tensor imaging tractography traced from cortical areas to each subthalamic nucleus (STN) using Elements software (Brainlab). Results We observed that left STN stimulation in the ring mode significantly improved motor symptoms, but the patient presented uncontrollable mirthful laughter. Stimulation was then switched to the directional mode; laughter remained when using the more posteromedial contact (3-C+) but not 2-C+ or 4-C+ at the same parameters. Interestingly, LFP recordings showed the highest beta-band activity over contacts 4 and 2, and very scarce beta power over contact 3. The orientation of the directional leads was selected based on the 3D postoperative X-rays. Associative fibers showed the shortest distance to contact number 3. Conclusion Stimulation of the STN can affect motor and associative loops. The use of directional electrodes is a good option to avoid not only undesirable capsular or lemniscal effects, but also limbic/associative events. Oscillatory activity in the beta range that preferentially takes place over the somatomotor STN region and is closely related to motor improvement, provides a reliable guide for optimizing the DBS programming. The importance of the exact location of electrical stimulation to determine the non-motor symptoms such as mood, apathy, attention, and memory, as well as the usefulness of biological markers such as LFP for optimal programming, is discussed in relation to this case.
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Affiliation(s)
- Fernando Alonso-Frech
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- *Correspondence: Fernando Alonso-Frech
| | - Carla Fernandez-Garcia
- Department of Neurosurgery, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Carla Fernandez-Garcia
| | - Victor Gómez-Mayordomo
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Mariana H. G. Monje
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Clara Villanueva-Iza
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Maria Jose Catalan-Alonso
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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12
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Abstract
Mania, the diagnostic hallmark of bipolar disorder, is an episodic disturbance of mood, sleep, behavior, and perception. Improved understanding of the neurobiology of mania is expected to allow for novel avenues to address current challenges in its diagnosis and treatment. Previous research focusing on the impairment of functional neuronal circuits and brain networks has resulted in heterogenous findings, possibly due to a focus on bipolar disorder and its several phases, rather than on the unique context of mania. Here we present a comprehensive overview of the evidence regarding the functional neuroanatomy of mania. Our interpretation of the best available evidence is consistent with a convergent model of lateralized circuit dysfunction in mania, with hypoactivity of the ventral prefrontal cortex in the right hemisphere, and hyperactivity of the amygdala, basal ganglia, and anterior cingulate cortex in the left hemisphere of the brain. Clarification of dysfunctional neuroanatomic substrates of mania may contribute not only to improve understanding of the neurobiology of bipolar disorder overall, but also highlights potential avenues for new circuit-based therapeutic approaches in the treatment of mania.
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Affiliation(s)
- Gonçalo Cotovio
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
- NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal
- Departamento de Psiquiatria e Saúde Mental, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Research and Clinical Centre, Champalimaud Foundation, Lisbon, Portugal.
- NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.
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13
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Chen Y, Zhu G, Liu Y, Liu D, Yuan T, Zhang X, Jiang Y, Du T, Zhang J. Predict initial subthalamic nucleus stimulation outcome in Parkinson's disease with brain morphology. CNS Neurosci Ther 2022; 28:667-676. [PMID: 35049150 PMCID: PMC8981473 DOI: 10.1111/cns.13797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 11/06/2021] [Accepted: 11/07/2021] [Indexed: 12/12/2022] Open
Abstract
AIM Subthalamic nucleus deep brain stimulation (STN-DBS) has been reported to be effective in treating motor symptoms in Parkinson's disease (PD), which may be attributed to changes in the brain network. However, the association between brain morphology and initial STN-DBS efficacy, as well as the performance of prediction using neuroimaging, has not been well illustrated. Therefore, we aim to investigate these issues. METHODS In the present study, 94 PD patients underwent bilateral STN-DBS, and the initial stimulation efficacy was evaluated. Brain morphology was examined by magnetic resonance imaging (MRI). The volume of tissue activated in the motor STN was measured with MRI and computed tomography. The prediction of stimulation efficacy was achieved with a support vector machine, using brain morphology and other features, after feature selection and hyperparameter optimization. RESULTS A higher stimulation efficacy was correlated with a thicker right precentral cortex. No association with subcortical gray or white matter volumes was observed. These morphological features could estimate the individual stimulation response with an r value of 0.5678, an R2 of 0.3224, and an average error of 11.4%. The permutation test suggested these predictions were not based on chance. CONCLUSION Our results indicate that changes in morphology are associated with the initial stimulation motor response and could be used to predict individual initial stimulation-related motor responses.
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Affiliation(s)
- Yingchuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuye Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Defeng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Tingting Du
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China
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14
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Bokulić E, Medenica T, Knezović V, Štajduhar A, Almahariq F, Baković M, Judaš M, Sedmak G. The Stereological Analysis and Spatial Distribution of Neurons in the Human Subthalamic Nucleus. Front Neuroanat 2022; 15:749390. [PMID: 34970124 PMCID: PMC8712451 DOI: 10.3389/fnana.2021.749390] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
The subthalamic nucleus (STN) is a small, ovoid structure, and an important site of deep brain stimulation (DBS) for the treatment of Parkinson’s disease. Although the STN is a clinically important structure, there are many unresolved issues with regard to it. These issues are especially related to the anatomical subdivision, neuronal phenotype, neuronal composition, and spatial distribution. In this study, we have examined the expression pattern of 8 neuronal markers [nNOS, NeuN, parvalbumin (PV), calbindin (CB), calretinin (CR), FOXP2, NKX2.1, and PAX6] in the adult human STN. All of the examined markers, except CB, were present in the STN. To determine the neuronal density, we have performed stereological analysis on Nissl-stained and immunohistochemical slides of positive markers. The stereology data were also used to develop a three-dimensional map of the spatial distribution of neurons within the STN. The nNOS population exhibited the largest neuronal density. The estimated total number of nNOS STN neurons is 281,308 ± 38,967 (± 13.85%). The STN neuronal subpopulations can be divided into two groups: one with a neuronal density of approximately 3,300 neurons/mm3 and the other with a neuronal density of approximately 2,200 neurons/mm3. The largest density of STN neurons was observed along the ventromedial border of the STN and the density gradually decreased toward the dorsolateral border. In this study, we have demonstrated the presence of 7 neuronal markers in the STN, three of which were not previously described in the human STN. The human STN is a collection of diverse, intermixed neuronal subpopulations, and our data, as far as the cytoarchitectonics is concerned, did not support the tripartite STN subdivision.
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Affiliation(s)
- Ema Bokulić
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Tila Medenica
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Vinka Knezović
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Andrija Štajduhar
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,School of Public Health "Andrija Štampar," University of Zagreb School of Medicine, Zagreb, Croatia
| | - Fadi Almahariq
- Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia.,Department of Neurosurgery, Clinical Hospital "Dubrava," Zagreb, Croatia
| | - Marija Baković
- Department of Forensic Medicine, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Miloš Judaš
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
| | - Goran Sedmak
- Croatian Institute for Brain Research, University of Zagreb School of Medicine, Zagreb, Croatia.,Centre of Excellence for Basic, Clinical and Translational Neuroscience, Zagreb, Croatia
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15
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Chen Y, Zu J, Zhang W, Xu C, Cui G, Cui C, Xiao Q. Comparative Analysis of Acute Levodopa Challenge Test and the Outcomes of Deep Brain Stimulation in Parkinson's Disease. J Neurol Surg A Cent Eur Neurosurg 2021; 83:535-539. [PMID: 34897613 DOI: 10.1055/s-0041-1739226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND We study the correlation between the preoperative levodopa challenge test and the efficacy of deep brain stimulation (DBS) surgery in Parkinson's disease (PD). METHODS Fifty patients with PD who underwent DBS treatment in our hospital from October 2016 to October 2017 were enrolled in this study. Using the Unified Parkinson Disease Rating Scale-III (UPDRS-III) as an indicator, we analyzed the improvement in motor symptoms on the levodopa challenge test and by DBS surgery. We also discussed the correlation between the effects of the levodopa challenge test and DBS surgery. RESULTS There was no correlation between the results of the levodopa challenge test and DBS surgery. There was a linear correlation between muscle rigidity and bradykinesia, whereas the linear correlation between other symptoms was weak. CONCLUSION The levodopa challenge test can be used as a screening tool for patients undergoing DBS surgery, and can predict the degree of improvement in muscle rigidity and bradykinesia surgery. However, the prediction of the degree of improvement of total motor symptoms is poor.
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Affiliation(s)
- Yusheng Chen
- Department of Neurology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jie Zu
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wei Zhang
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chuanying Xu
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Guiyun Cui
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Chenchen Cui
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Qihua Xiao
- Parkinson Disease Center, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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16
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Effect of deep brain stimulation on impulse control behaviors of Parkinson’s disease patients: A systematic review and meta-analysis. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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17
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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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18
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Mosley PE, Robinson K, Dissanayaka NN, Coyne T, Silburn P, Marsh R, Pye D. A Pilot Trial of Cognitive Behavioral Therapy for Caregivers After Deep Brain Stimulation for Parkinson's Disease. J Geriatr Psychiatry Neurol 2021; 34:454-465. [PMID: 32400266 DOI: 10.1177/0891988720924720] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Subthalamic deep brain stimulation for Parkinson's disease may not ameliorate burden among caregivers. An 8-session, manualized program of cognitive-behavioral therapy (CBT) was delivered to a pilot sample of 10 caregivers (6 females, mean age: 60, age range: 34-79). Primary outcome measures were caregiver burden (Zarit Burden Interview) and caregiver quality of life (Parkinson's Disease Questionnaire-Carer). Secondary outcome measures comprised ratings of depression and anxiety in the caregiver, in addition to relationship quality. Caregiver burden (t = 2.91 P = .017) and caregiver anxiety (t = 2.82 P = .020) symptoms were significantly reduced at completion of the program, and these benefits were maintained 3 months later. Caregiver quality of life had significantly improved by the end of the intervention (t = 3.02 P = .015), but this effect was not sustained after 3 months. The longitudinal influence of participation in the program on caregiver burden was confirmed in a linear, mixed-effects model, χ2 (3) = 15.1, P = .0017). The intervention was well received by participants, and qualitative feedback was obtained. These results indicate that caregiver burden is modifiable in this cohort with a short course of CBT, that benefits are maintained after termination of the program, and that psychological treatment is acceptable to participants. Larger, controlled trials are justified.
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Affiliation(s)
- Philip E Mosley
- Systems Neuroscience Group, 56362QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,171919Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Faculty of Medicine, 171919University of Queensland, Herston, Queensland, Australia
| | - Katherine Robinson
- Systems Neuroscience Group, 56362QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, University of Queensland, Herston, Queensland, Australia.,310748School of Psychology, St Lucia, University of Queensland, Brisbane, Australia.,Department of Neurology, 3883Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Terry Coyne
- 171919Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Brizbrain and Spine, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Peter Silburn
- Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,171919Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | - Rodney Marsh
- Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,Department of Psychiatry, 3883Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | - Deidre Pye
- 310748School of Psychology, St Lucia, University of Queensland, Brisbane, Australia
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19
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Sobesky L, Goede L, Odekerken VJJ, Wang Q, Li N, Neudorfer C, Rajamani N, Al-Fatly B, Reich M, Volkmann J, de Bie RMA, Kühn AA, Horn A. Subthalamic and pallidal deep brain stimulation: are we modulating the same network? Brain 2021; 145:251-262. [PMID: 34453827 DOI: 10.1093/brain/awab258] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/05/2021] [Accepted: 06/21/2021] [Indexed: 11/14/2022] Open
Abstract
The subthalamic nucleus and internal pallidum are main target sites for deep brain stimulation in Parkinson's disease. Multiple trials that investigated subthalamic versus pallidal stimulation were unable to settle on a definitive optimal target between the two. One reason could be that the effect is mediated via a common functional network. To test this hypothesis, we calculated connectivity profiles seeding from deep brain stimulation electrodes in 94 patients that underwent subthalamic and 28 patients with pallidal treatment based on a normative connectome atlas calculated from 1,000 healthy subjects. In each cohort, we calculated connectivity profiles that were associated with optimal clinical improvements. The two maps showed striking similarity and were able to cross-predict outcomes in the respective other cohort (R = 0.37 at p < 0.001; R = 0.34 at p = 0.032). Next, we calculated an agreement map which retained regions common to both target sites. Crucially, this map was able to explain an additional amount of variance in clinical improvements of either cohort when compared to the maps calculated on the two cohorts alone. Finally, we tested profiles and predictive utility of connectivity maps calculated from different motor symptom subscores with a specific focus on bradykinesia and rigidity. While our study is based on retrospective data and indirect connectivity metrics, it may deliver empirical data to support the hypothesis of a largely overlapping network associated with effective deep brain stimulation in Parkinson's disease irrespective of the specific target.
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Affiliation(s)
- Leon Sobesky
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Lukas Goede
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Vincent J J Odekerken
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Qiang Wang
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Ningfei Li
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Clemens Neudorfer
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Nanditha Rajamani
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Bassam Al-Fatly
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Martin Reich
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Clinic of Würzburg, Josef-Schneider-Str. 11, 97080 Würzburg, Germany
| | - Rob M A de Bie
- Department of Neurology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Andrea A Kühn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Andreas Horn
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
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20
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Lo Buono V, Lucà Trombetta M, Palmeri R, Bonanno L, Cartella E, Di Lorenzo G, Bramanti P, Marino S, Corallo F. Subthalamic nucleus deep brain stimulation and impulsivity in Parkinson's disease: a descriptive review. Acta Neurol Belg 2021; 121:837-847. [PMID: 33961279 PMCID: PMC8349322 DOI: 10.1007/s13760-021-01684-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
Standard treatment of Parkinson’s disease involves the dopaminergic medications. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an important neurosurgical intervention often used as alternative treatment to drug therapy; however, it can be associated with increase of impulsive behaviors. This descriptive review focused on studies investigating the correlation between Deep brain stimulation of the subthalamic nucleus and impulsivity in Parkinson’s disease patients, arguing, the action’s mechanism and the specific role of the subthalamic nucleus. We searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 106 studies, only 15 met the search criteria. Parkinson’s Disease patients with and without Deep Brain Stimulation were compared with healthy controls, through 16 different tasks that assessed some aspects of impulsivity. Both Deep brain stimulation of the subthalamic nucleus and medication were associated with impulsive behavior and influenced decision-making processes. Moreover, findings demonstrated that: Impulse Control Disorders (ICDs) occurred soon after surgery, while, in pharmacological treatment, they appeared mainly after the initiation of treatment or the increase in dosage, especially with dopamine agonists. The subthalamic nucleus plays a part in the fronto-striato-thalamic-cortical loops mediating motor, cognitive, and emotional functions: this could explain the role of the Deep Brain Stimulation in behavior modulation in Parkinson’s Disease patients. Indeed, increase impulsivity has been reported also after deep brain stimulation of the subthalamic nucleus independently by dopaminergic medication status.
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Affiliation(s)
| | | | | | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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21
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Lin Z, Zhang C, Li D, Sun B. Lateralized effects of deep brain stimulation in Parkinson's disease: evidence and controversies. NPJ Parkinsons Dis 2021; 7:64. [PMID: 34294724 PMCID: PMC8298477 DOI: 10.1038/s41531-021-00209-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 07/01/2021] [Indexed: 02/06/2023] Open
Abstract
The bilateral effects of deep brain stimulation (DBS) on motor and non-motor symptoms of Parkinson's disease (PD) have been extensively studied and reviewed. However, the unilateral effects-in particular, the potential lateralized effects of left- versus right-sided DBS-have not been adequately recognized or studied. Here we summarized the current evidence and controversies in the literature regarding the lateralized effects of DBS on motor and non-motor outcomes in PD patients. Publications in English language before February 2021 were obtained from the PubMed database and included if they directly compared the effects of unilateral versus contralateral side DBS on motor or non-motor outcomes in PD. The current literature is overall of low-quality and is biased by various confounders. Researchers have investigated mainly PD patients receiving subthalamic nucleus (STN) DBS while the potential lateralized effects of globus pallidus interna (GPi) DBS have not been adequately studied. Evidence suggests potential lateralized effects of STN DBS on axial motor symptoms and deleterious effects of left-sided DBS on language-related functions, in particular, the verbal fluency, in PD. The lateralized DBS effects on appendicular motor symptoms as well as other neurocognitive and neuropsychiatric domains remain inconclusive. Future studies should control for varying methodological approaches as well as clinical and DBS management heterogeneities, including symptom laterality, stimulation parameters, location of active contacts, and lead trajectories. This would contribute to improved treatment strategies such as personalized target selection, surgical planning, and postoperative management that ultimately benefit patients.
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Affiliation(s)
- Zhengyu Lin
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chencheng Zhang
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.511008.dShanghai Research Center for Brain Science and Brain-Inspired Intelligence, Shanghai, China
| | - Dianyou Li
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- grid.412277.50000 0004 1760 6738Department of Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China ,grid.16821.3c0000 0004 0368 8293Institute of Clinical Neuroscience, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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22
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de Roquemaurel A, Wirth T, Vijiaratnam N, Ferreira F, Zrinzo L, Akram H, Foltynie T, Limousin P. Stimulation Sweet Spot in Subthalamic Deep Brain Stimulation - Myth or Reality? A Critical Review of Literature. Stereotact Funct Neurosurg 2021; 99:425-442. [PMID: 34120117 DOI: 10.1159/000516098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION While deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been extensively used for more than 20 years in Parkinson's disease (PD), the optimal area of stimulation to relieve motor symptoms remains elusive. OBJECTIVE We aimed at localizing the sweet spot within the subthalamic region by performing a systematic review of the literature. METHOD PubMed database was searched for published studies exploring optimal stimulation location for STN DBS in PD, published between 2000 and 2019. A standardized assessment procedure based on methodological features was applied to select high-quality publications. Studies conducted more than 3 months after the DBS procedure, employing lateralized scores and/or stimulation condition, and reporting the volume of tissue activated or the position of the stimulating contact within the subthalamic region were considered in the final analysis. RESULTS Out of 439 references, 24 were finally retained, including 21 studies based on contact location and 3 studies based on volume of tissue activated (VTA). Most studies (all VTA-based studies and 13 of the 21 contact-based studies) suggest the superior-lateral STN and the adjacent white matter as the optimal sites for stimulation. Remaining contact-based studies were either inconclusive (5/21), favoured the caudal zona incerta (1/21), or suggested a better outcome of STN stimulation than adjacent white matter stimulation (2/21). CONCLUSION Using a standardized methodological approach, our review supports the presence of a sweet spot located within the supero-lateral STN and extending to the adjacent white matter.
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Affiliation(s)
- Alexis de Roquemaurel
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Thomas Wirth
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom.,Neurology department, Strasbourg University Hospital, Strasbourg, France.,INSERM-U964/CNRS-UMR7104/University of Strasbourg, Illkirch-Graffenstaden, France
| | - Nirosen Vijiaratnam
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Francisca Ferreira
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Ludvic Zrinzo
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Harith Akram
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Thomas Foltynie
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Patricia Limousin
- Unit of Functional Neurosurgery, Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology and the National Hospital for Neurology and Neurosurgery, London, United Kingdom
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23
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Hug K. Bringing Advanced Therapies for Parkinson's Disease to the Clinic: An Analysis of Ethical Issues. JOURNAL OF PARKINSONS DISEASE 2021; 11:S147-S155. [PMID: 34092655 PMCID: PMC8543290 DOI: 10.3233/jpd-212639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Advanced therapies for Parkinson’s disease (PD) constitute a broad range of treatments, each presenting specific ethical challenges. Some of these therapies are established and in clinical use, like device-aided therapies, and others, based on advanced therapeutic medicinal products (ATMPs), are still in early stage of clinical trials. This paper focuses on some common ethical issues arising in these two categories of advanced therapies, especially challenges arising when advanced therapies are proposed to PD patients in the form of advanced care, under a clinical trial, or, in case of ATMPs, under the “hospital exemption” rule. The ethical issues covered here relate mainly to ensuring informed consent in these different contexts, to the stakeholder role of patient’s non-professional caretakers, such as family, and to patient safety in treatments under “hospital exemption”. To illustrate the points discussed in connection with “hospital exemption” rule, the example of the EU has been chosen. This paper does not claim completeness of ethical issues raised by bringing advanced therapies for PD to the clinic, but rather presents examples of ethical challenges in this context.
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Affiliation(s)
- Kristina Hug
- Department of Clinical Sciences, Medical Ethics, Faculty of Medicine, Lund University, Lund, Sweden
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24
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Tian H, Zhang B, Yu Y, Zhen X, Zhang L, Yuan Y, Wang L. Electrophysiological signatures predict clinical outcomes after deep brain stimulation of the globus pallidus internus in Meige syndrome. Brain Stimul 2021; 14:685-692. [PMID: 33848676 DOI: 10.1016/j.brs.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 02/24/2021] [Accepted: 04/01/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Deep brain stimulation (DBS) of the globus pallidus internus (GPi) has been shown to be a safe and effective alternative therapy for ameliorating medically refractory primary Meige syndrome. However, the associations between DBS target position and surrounding electrophysiological properties as well as patients' clinical outcomes remains largely unknown. In a large number of patients, we investigated electrophysiological features around stimulation targets and explored their roles in predicting clinical outcomes following bilateral GPi-DBS. METHODS The locations of DBS active contacts along the long axis of the GPi in a standard space were calculated and compared among three groups with different clinical outcomes. The firing rates of individual neurons within the GPi were calculated for each patient and compared across the three groups. RESULTS Compared with the bad group (poor clinical outcome), active contacts in the good group (good clinical outcome) and the best group (best clinical outcome) were located in the more posterior GPi. The average firing rates in the good and best groups were significantly higher than in the bad group, and this difference was pronounced within the ventral GPi. For the bad group, the average firing rates were significantly lower in the ventral than in the dorsal GPi. CONCLUSIONS This study suggests that DBS of the posterior GPi may produce better clinical outcomes during primary Meige syndrome treatment and that higher GPi neuronal activity, particularly within the ventral part, can be used as a biomarker to guide DBS electrode implantation during surgery.
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Affiliation(s)
- Hong Tian
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Bo Zhang
- Key Laboratory of Brain Science, Zunyi Medical University, Zunyi, China; Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China; The Brain Cognition and Brain Disease Institute, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yanbing Yu
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China.
| | - Xueke Zhen
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Li Zhang
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Yue Yuan
- Department of Neurosurgery, China-Japan Friendship Hospital, Beijing, China
| | - Liang Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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25
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Kardous R, Joly H, Giordana B, Stefanini L, Mulliez A, Giordana C, Lemaire JJ, Fontaine D. Functional and dysfunctional impulsivities changes after subthalamic nucleus-deep brain stimulation in Parkinson disease. Neurochirurgie 2021; 67:420-426. [PMID: 33845115 DOI: 10.1016/j.neuchi.2021.03.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/04/2021] [Accepted: 03/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We investigated changes of impulsivity after deep brain stimulation (DBS) of the subthalamic nucleus (STN) in Parkinson's disease (PD) patients, distinguishing functional from dysfunctional impulsivity and their contributing factors. METHODS Data of 33 PD patients treated by STN-DBS were studied before and 6 months after surgery: motor impairment, medication (dose and dopaminergic agonists), cognition, mood and occurrence of impulse control disorders. Impulsivity was assessed by the Dickman Impulsivity Inventory, which distinguishes functional impulsivity (FI), reflecting the potential for reasoning and rapid action when the situation requires it, and dysfunctional impulsivity (DI), reflecting the lack of prior reasoning, even when the situation demands it. The location of DBS leads was studied on postoperative MRI using a deformable histological atlas and by compartmentalization of the STN. RESULTS After STN-DBS, DI was significantly increased (mean pre- and postoperative DI scores 1.9±1.6 and 3.5±2.4, P<0.001) although FI was not modified (mean pre- and postoperative FI scores 6.2±2.7 and 5.8±2.6). Factors associated with a DI score's increase≥2 (multivariable logistic regression model) were: low preoperative Frontal Assessment Battery score and location of the left active contact in the ventral part of the STN. CONCLUSION Our study suggests that STN-DBS may have a different impact on both dimensions of impulsivity, worsening pathological impulsivity without altering physiological impulsivity. The increase in dysfunctional impulsivity may be favoured by the location of the electrode in the ventral part of the STN.
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Affiliation(s)
- R Kardous
- Department of Psychiatry, Université Côte d'Azur, CHU de Nice, Nice, France; Centre d'acceuil Psychiatrique, Université Côte d'Azur, CHU de Nice, Nice, France
| | - H Joly
- Department of Neurology, CRC SEP, UR2CA, URRIS, Université Côte d'Azur, CHU de Nice, Hôpital Pasteur 2, 30, avenue de la voie Romaine, 06000 Nice, France.
| | - B Giordana
- Department of Psychiatry, Université Côte d'Azur, CHU de Nice, Nice, France
| | - L Stefanini
- Department of Psychiatry, Université Côte d'Azur, CHU de Nice, Nice, France
| | - A Mulliez
- Unité de Biostatistiques (DRCI), CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - C Giordana
- Department of Neurology, Université Côte d'Azur, CHU de Nice, Nice, France
| | - J-J Lemaire
- CNRS, SIGMA Clermont, Institut Pascal, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - D Fontaine
- Department of Neurosurgery, Université Côte d'Azur, CHU de Nice, Nice, France
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26
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Mosley PE, Windels F, Morris J, Coyne T, Marsh R, Giorni A, Mohan A, Sachdev P, O’Leary E, Boschen M, Sah P, Silburn PA. A randomised, double-blind, sham-controlled trial of deep brain stimulation of the bed nucleus of the stria terminalis for treatment-resistant obsessive-compulsive disorder. Transl Psychiatry 2021; 11:190. [PMID: 33782383 PMCID: PMC8007749 DOI: 10.1038/s41398-021-01307-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/19/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation (DBS) is a promising treatment for severe, treatment-resistant obsessive-compulsive disorder (OCD). Here, nine participants (four females, mean age 47.9 ± 10.7 years) were implanted with DBS electrodes bilaterally in the bed nucleus of the stria terminalis (BNST). Following a one-month postoperative recovery phase, participants entered a three-month randomised, double-blind, sham-controlled phase before a twelve-month period of open-label stimulation incorporating a course of cognitive behavioural therapy (CBT). The primary outcome measure was OCD symptoms as rated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS). In the blinded phase, there was a significant benefit of active stimulation over sham (p = 0.025, mean difference 4.9 points). After the open phase, the mean reduction in YBOCS was 16.6 ± 1.9 points (χ2 (11) = 39.8, p = 3.8 × 10-5), with seven participants classified as responders. CBT resulted in an additive YBOCS reduction of 4.8 ± 3.9 points (p = 0.011). There were two serious adverse events related to the DBS device, the most severe of which was an infection during the open phase necessitating device explantation. There were no serious psychiatric adverse events related to stimulation. An analysis of the structural connectivity of each participant's individualised stimulation field isolated right-hemispheric fibres associated with YBOCS reduction. These included subcortical tracts incorporating the amygdala, hippocampus and stria terminalis, in addition to cortical regions in the ventrolateral and ventromedial prefrontal cortex, parahippocampal, parietal and extrastriate visual cortex. In conclusion, this study provides further evidence supporting the efficacy and tolerability of DBS in the region of the BNST for individuals with otherwise treatment-refractory OCD and identifies a connectivity fingerprint associated with clinical benefit.
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Affiliation(s)
- Philip E. Mosley
- grid.1049.c0000 0001 2294 1395Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, QLD Australia ,Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, QLD Australia ,grid.1003.20000 0000 9320 7537Queensland Brain Institute, University of Queensland, St Lucia, QLD Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Herston, QLD Australia
| | - François Windels
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, University of Queensland, St Lucia, QLD Australia
| | - John Morris
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, University of Queensland, St Lucia, QLD Australia
| | - Terry Coyne
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, University of Queensland, St Lucia, QLD Australia ,grid.417021.10000 0004 0627 7561Brizbrain and Spine, the Wesley Hospital, Auchenflower, QLD Australia
| | - Rodney Marsh
- Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, QLD Australia ,grid.1003.20000 0000 9320 7537Faculty of Medicine, University of Queensland, Herston, QLD Australia
| | - Andrea Giorni
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, University of Queensland, St Lucia, QLD Australia
| | - Adith Mohan
- grid.1005.40000 0004 4902 0432Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW Australia ,grid.415193.bNeuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW Australia
| | - Perminder Sachdev
- grid.1005.40000 0004 4902 0432Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, NSW Australia ,grid.415193.bNeuropsychiatric Institute, The Prince of Wales Hospital, Randwick, NSW Australia
| | | | - Mark Boschen
- grid.1022.10000 0004 0437 5432School of Applied Psychology, Griffith University, Gold Coast, QLD Australia
| | - Pankaj Sah
- grid.1003.20000 0000 9320 7537Queensland Brain Institute, University of Queensland, St Lucia, QLD Australia ,grid.263817.9Joint Center for Neuroscience and Neural Engineering, and Department of Biology, Southern University of Science and Technology, Shenzhen, Guangdong Province P. R. China
| | - Peter A. Silburn
- Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, QLD Australia ,grid.1003.20000 0000 9320 7537Queensland Brain Institute, University of Queensland, St Lucia, QLD Australia
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27
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van den Wildenberg WPM, van Wouwe NC, Ridderinkhof KR, Neimat JS, Elias WJ, Bashore TR, Wylie SA. Deep-brain stimulation of the subthalamic nucleus improves overriding motor actions in Parkinson's disease. Behav Brain Res 2021; 402:113124. [PMID: 33422595 DOI: 10.1016/j.bbr.2021.113124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 01/04/2021] [Accepted: 01/04/2021] [Indexed: 11/17/2022]
Abstract
Findings from previous research using the classic stop-signal task indicate that the subthalamic nucleus (STN) plays an important role in the ability to inhibit motor actions. Here we extend these findings using a stop-change task that requires voluntary action override to stop an ongoing motor response and change to an alternative response. Sixteen patients diagnosed with Parkinson's disease (PD) and 16 healthy control participants (HC) performed the stop-change task. PD patients completed the task when deep-brain stimulation (DBS) of the STN was turned on and when it was turned off. Behavioral results indicated that going, stopping, and changing latencies were shortened significantly among PD patients during STN DBS, the former two reductions replicating findings from previous DBS studies using the classic stop-signal task. The shortened go latencies observed among PD patients fell within the control range. In contrast, stopping latencies among PD patients, although reduced significantly, continued to be significantly longer than those of the HC. Like go latencies, stop-change latencies were reduced sufficiently among PD patients for them to fall within the control range, a novel finding. In conclusion, STN DBS produced a general, but differential, improvement in the ability of PD patients to override motor actions. Going, stopping, and stop-change latencies were all shortened, but only going and stop-change latencies were normalized.
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Affiliation(s)
- Wery P M van den Wildenberg
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, the Netherlands.
| | | | - K Richard Ridderinkhof
- Department of Psychology, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, the Netherlands
| | - Joseph S Neimat
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
| | - W Jeffrey Elias
- Department of Neurosurgery, University of Virginia Health Systems, Charlottesville, VA, USA
| | - Theodore R Bashore
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA; School of Psychological Sciences, University of Northern Colorado, Greeley, CO, USA
| | - Scott A Wylie
- Department of Neurosurgery, University of Louisville, Louisville, KY, USA
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Mosley PE, Akram H. Neuropsychiatric effects of subthalamic deep brain stimulation. THE HUMAN HYPOTHALAMUS - MIDDLE AND POSTERIOR REGION 2021; 180:417-431. [DOI: 10.1016/b978-0-12-820107-7.00026-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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Mosley PE, Paliwal S, Robinson K, Coyne T, Silburn P, Tittgemeyer M, Stephan KE, Perry A, Breakspear M. The structural connectivity of subthalamic deep brain stimulation correlates with impulsivity in Parkinson's disease. Brain 2020; 143:2235-2254. [PMID: 32568370 DOI: 10.1093/brain/awaa148] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
Subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease treats motor symptoms and improves quality of life, but can be complicated by adverse neuropsychiatric side-effects, including impulsivity. Several clinically important questions remain unclear: can 'at-risk' patients be identified prior to DBS; do neuropsychiatric symptoms relate to the distribution of the stimulation field; and which brain networks are responsible for the evolution of these symptoms? Using a comprehensive neuropsychiatric battery and a virtual casino to assess impulsive behaviour in a naturalistic fashion, 55 patients with Parkinson's disease (19 females, mean age 62, mean Hoehn and Yahr stage 2.6) were assessed prior to STN-DBS and 3 months postoperatively. Reward evaluation and response inhibition networks were reconstructed with probabilistic tractography using the participant-specific subthalamic volume of activated tissue as a seed. We found that greater connectivity of the stimulation site with these frontostriatal networks was related to greater postoperative impulsiveness and disinhibition as assessed by the neuropsychiatric instruments. Larger bet sizes in the virtual casino postoperatively were associated with greater connectivity of the stimulation site with right and left orbitofrontal cortex, right ventromedial prefrontal cortex and left ventral striatum. For all assessments, the baseline connectivity of reward evaluation and response inhibition networks prior to STN-DBS was not associated with postoperative impulsivity; rather, these relationships were only observed when the stimulation field was incorporated. This suggests that the site and distribution of stimulation is a more important determinant of postoperative neuropsychiatric outcomes than preoperative brain structure and that stimulation acts to mediate impulsivity through differential recruitment of frontostriatal networks. Notably, a distinction could be made amongst participants with clinically-significant, harmful changes in mood and behaviour attributable to DBS, based upon an analysis of connectivity and its relationship with gambling behaviour. Additional analyses suggested that this distinction may be mediated by the differential involvement of fibres connecting ventromedial subthalamic nucleus and orbitofrontal cortex. These findings identify a mechanistic substrate of neuropsychiatric impairment after STN-DBS and suggest that tractography could be used to predict the incidence of adverse neuropsychiatric effects. Clinically, these results highlight the importance of accurate electrode placement and careful stimulation titration in the prevention of neuropsychiatric side-effects after STN-DBS.
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Affiliation(s)
- Philip E Mosley
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Saee Paliwal
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland
| | - Katherine Robinson
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Brizbrain and Spine, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Peter Silburn
- Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | | | - Klaas E Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland.,Max Planck Institute for Metabolism Research, Cologne, Germany.,Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Alistair Perry
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany.,Centre for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Michael Breakspear
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Brain and Mind Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, NSW, Australia
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Elias GJB, Boutet A, Joel SE, Germann J, Gwun D, Neudorfer C, Gramer RM, Algarni M, Paramanandam V, Prasad S, Beyn ME, Horn A, Madhavan R, Ranjan M, Lozano CS, Kühn AA, Ashe J, Kucharczyk W, Munhoz RP, Giacobbe P, Kennedy SH, Woodside DB, Kalia SK, Fasano A, Hodaie M, Lozano AM. Probabilistic Mapping of Deep Brain Stimulation: Insights from 15 Years of Therapy. Ann Neurol 2020; 89:426-443. [PMID: 33252146 DOI: 10.1002/ana.25975] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022]
Abstract
Deep brain stimulation (DBS) depends on precise delivery of electrical current to target tissues. However, the specific brain structures responsible for best outcome are still debated. We applied probabilistic stimulation mapping to a retrospective, multidisorder DBS dataset assembled over 15 years at our institution (ntotal = 482 patients; nParkinson disease = 303; ndystonia = 64; ntremor = 39; ntreatment-resistant depression/anorexia nervosa = 76) to identify the neuroanatomical substrates of optimal clinical response. Using high-resolution structural magnetic resonance imaging and activation volume modeling, probabilistic stimulation maps (PSMs) that delineated areas of above-mean and below-mean response for each patient cohort were generated and defined in terms of their relationships with surrounding anatomical structures. Our results show that overlap between PSMs and individual patients' activation volumes can serve as a guide to predict clinical outcomes, but that this is not the sole determinant of response. In the future, individualized models that incorporate advancements in mapping techniques with patient-specific clinical variables will likely contribute to the optimization of DBS target selection and improved outcomes for patients. ANN NEUROL 2021;89:426-443.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | | | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Dave Gwun
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Robert M Gramer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Musleh Algarni
- Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
| | - Vijayashankar Paramanandam
- Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
| | - Sreeram Prasad
- Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
| | - Michelle E Beyn
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department for Neurology, Charité-Universitätsmedizin, Berlin, Germany
| | | | - Manish Ranjan
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Christopher S Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department for Neurology, Charité-Universitätsmedizin, Berlin, Germany
| | - Jeff Ashe
- GE Global Research, Toronto, Ontario, Canada
| | - Walter Kucharczyk
- Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sidney H Kennedy
- Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - D Blake Woodside
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Alfonso Fasano
- Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Clinic, University Health Network, Toronto, Ontario, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, University of Toronto, Toronto, Ontario, Canada
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Mandali A, Manssuer L, Zhao Y, Zhang C, Wang L, Ding Q, Pan Y, Li D, Sun B, Voon V. Acute Time-Locked Alpha Frequency Subthalamic Stimulation Reduces Negative Emotional Bias in Parkinson's Disease. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2020; 6:568-578. [PMID: 33622656 DOI: 10.1016/j.bpsc.2020.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/08/2020] [Accepted: 12/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Emotional processing is a core cognitive process cutting across neuropsychiatric disorders. Understanding the neurophysiological features underlying depressive symptoms and their sensitivity to modulation is critical to modifying emotional bias. The subthalamic nucleus (STN), targeted in Parkinson's disease, shows a late alpha desynchronization to affective stimuli. We targeted this alpha desynchronization using a novel stimulation protocol asking if brief alpha (10 Hz) frequency stimulation time-locked to unpleasant imagery might influence subjective emotion. METHODS A total of 27 patients with Parkinson's disease were recruited. The first study tested patients (n = 16) on affective stimuli with STN local field potential recordings assessed bilaterally without stimulation. In the second study, patients (n = 24) were tested on two affective tasks comparing negative and neutral stimuli paired with acute right-STN stimulation, with one of the negative conditions stimulated briefly for 1 second at either 130 Hz or 10 Hz. The subjects rated valence and arousal of negative and neutral stimuli. RESULTS We confirmed greater alpha desynchronization in both negative and positive affect relative to neutral in the right STN. Using acute stimulation of the right STN, we show a critical interaction effect between ratings, stimulation, and frequency; alpha frequency stimulation increased the subjective pleasantness of negative imagery, particularly with ventromedial contacts. Higher depression scores were associated with a positive bias to 10-Hz but not 130-Hz stimulation. CONCLUSIONS We highlight the potential of brief alpha frequency subthalamic stimulation to reduce negative emotional bias. This finding provides mechanistic insights underlying subjective emotional valence and has implications for the management of depression using neuromodulation.
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Affiliation(s)
- Alekhya Mandali
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Luis Manssuer
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
| | - Yijie Zhao
- Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai, China; Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Fudan University, Ministry of Education, Shanghai, China
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Linbin Wang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiong Ding
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Valerie Voon
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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32
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Bazin PL, Alkemade A, Mulder MJ, Henry AG, Forstmann BU. Multi-contrast anatomical subcortical structures parcellation. eLife 2020; 9:59430. [PMID: 33325368 PMCID: PMC7771958 DOI: 10.7554/elife.59430] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023] Open
Abstract
The human subcortex is comprised of more than 450 individual nuclei which lie deep in the brain. Due to their small size and close proximity, up until now only 7% have been depicted in standard MRI atlases. Thus, the human subcortex can largely be considered as terra incognita. Here, we present a new open-source parcellation algorithm to automatically map the subcortex. The new algorithm has been tested on 17 prominent subcortical structures based on a large quantitative MRI dataset at 7 Tesla. It has been carefully validated against expert human raters and previous methods, and can easily be extended to other subcortical structures and applied to any quantitative MRI dataset. In sum, we hope this novel parcellation algorithm will facilitate functional and structural neuroimaging research into small subcortical nuclei and help to chart terra incognita.
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Affiliation(s)
- Pierre-Louis Bazin
- Integrative Model-based Cognitive Neuroscience research unit, University of Amsterdam, Amsterdam, Netherlands.,Max-Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Anneke Alkemade
- Integrative Model-based Cognitive Neuroscience research unit, University of Amsterdam, Amsterdam, Netherlands
| | - Martijn J Mulder
- Integrative Model-based Cognitive Neuroscience research unit, University of Amsterdam, Amsterdam, Netherlands.,Psychology Department, Utrecht University, Utrecht, Netherlands
| | - Amanda G Henry
- Faculty of Archaeology, Leiden University, Leiden, Netherlands
| | - Birte U Forstmann
- Integrative Model-based Cognitive Neuroscience research unit, University of Amsterdam, Amsterdam, Netherlands
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33
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Mosley PE, Robinson K, Coyne T, Silburn P, Barker MS, Breakspear M, Robinson GA, Perry A. Subthalamic deep brain stimulation identifies frontal networks supporting initiation, inhibition and strategy use in Parkinson's disease. Neuroimage 2020; 223:117352. [DOI: 10.1016/j.neuroimage.2020.117352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/22/2020] [Accepted: 09/04/2020] [Indexed: 12/13/2022] Open
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Santin MDN, Voulleminot P, Vrillon A, Hainque E, Béreau M, Lagha‐Boukbiza O, Wirth T, Montaut S, Bardinet E, Kyheng M, Rolland A, Voirin J, Drapier S, Durif F, Eusebio A, Giordana C, Auzou N, Houeto J, Hubsch C, Jarraya B, Laurencin C, Maltete D, Meyer M, Rascol O, Rouaud T, Tir M, Moreau C, Corvol J, Proust F, Grabli D, Devos D, Tranchant C, Anheim M. Impact of Subthalamic Deep Brain Stimulation on Impulse Control Disorders in Parkinson's Disease: A Prospective Study. Mov Disord 2020; 36:750-757. [DOI: 10.1002/mds.28320] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/02/2020] [Accepted: 09/10/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Paul Voulleminot
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Agathe Vrillon
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
| | - Elodie Hainque
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
- Sorbonne Universités, Assistance Publique ‐ Hôpitaux de Paris (APHP), Inserm, CNRS, Institut du Cerveau et de la Moelle (ICM) Paris France
| | - Matthieu Béreau
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Besançon Besançon France
| | - Ouhaid Lagha‐Boukbiza
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Thomas Wirth
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Solveig Montaut
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Eric Bardinet
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Besançon Besançon France
- Centre de Neuroimagerie de Recherche, Institut du Cerveau et de la Moelle (ICM) Paris France
| | - Maeva Kyheng
- Department of Clinical Research Lille University Hospital Lille France
| | - Anne‐Sophie Rolland
- Department of Medical Pharmacology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, Inserm, UMR‐S1172 Lille France
| | - Jimmy Voirin
- Department of Neurosurgery, NS‐PARK/F‐CRIN Strasbourg University Hospital Strasbourg France
| | - Sophie Drapier
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Rennes Rennes France
| | - Franck Durif
- Department of Neurology NS‐PARK/F‐CRIN, CHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Alexandre Eusebio
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Marseille (APHM), Timone University Hospital and Institut de Neurosciences de la Timone Marseille France
| | - Caroline Giordana
- Department of Neurology NS‐PARK/F‐CRIN, Centre Hospitalier Universitaire de Nice Nice France
| | - Nicolas Auzou
- Institute of Neurodegenerative Disorders NS‐PARK/F‐CRIN, University Hospital of Bordeaux Bordeaux France
| | - Jean‐Luc Houeto
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Poitiers Poitiers France
| | - Cécile Hubsch
- Department of Neurology NS‐PARK/F‐CRIN, Fondation Ophtalmologique Adolphe de Rothschild Paris France
| | - Béchir Jarraya
- Neuroscience Pole NS‐PARK/F‐CRIN, Hôpital Foch, Suresnes, University of Versailles Paris‐Saclay, INSERM‐CEA NeuroSpin Saclay France
| | - Chloé Laurencin
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Lyon Lyon France
| | - David Maltete
- Department of Neurology NS‐PARK/F‐CRIN, Rouen University Hospital and University of Rouen, France; INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication Mont‐Saint‐Aignan France
| | - Mylène Meyer
- Department of Neurology NS‐PARK/F‐CRIN, University Hospital of Nancy Nancy France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neuroscience NS‐Park/F‐CRIN, Toulouse University Hospital Toulouse France
| | - Tiphaine Rouaud
- Department of Neurology NS‐PARK/F‐CRIN, Nantes University Hospital Nantes France
| | - Mélissa Tir
- Department of Neurology NS‐PARK/FCRIN, Amiens University Hospital Amiens France
| | - Caroline Moreau
- Department of Neurology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, INSERM, UMR‐S1172 Lille France
| | - Jean‐Christophe Corvol
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
- Sorbonne Universités, Assistance Publique ‐ Hôpitaux de Paris (APHP), Inserm, CNRS, Institut du Cerveau et de la Moelle (ICM) Paris France
| | - François Proust
- Department of Neurosurgery, NS‐PARK/F‐CRIN Strasbourg University Hospital Strasbourg France
| | - David Grabli
- Department of Neurology NS‐PARK/F‐CRIN, Assistance Publique ‐ Hôpitaux de Paris (APHP), Pitié‐Salpêtrière Hospital Paris France
| | - David Devos
- Department of Medical Pharmacology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, Inserm, UMR‐S1172 Lille France
- Department of Neurology University Hospital, NS‐PARK/F‐CRIN, University of Lille, Lille Neuroscience & Cognition, INSERM, UMR‐S1172 Lille France
| | - Christine Tranchant
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
| | - Mathieu Anheim
- Department of Neurology NS‐PARK/F‐CRIN, Strasbourg University Hospital, Fédération de Médecine Translationnelle de Médecine de Strasbourg Strasbourg France
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Dietrich AD, Koeppen JA, Buhmann C, Pötter-Nerger M, Pinnschmidt HO, Oehlwein C, Oehlwein M, Mittmann K, Gerloff C, Engel AK, Westphal M, Schaper M, Hamel W, Moll CKE, Gulberti A. Sex Disparities in the Self-Evaluation of Subthalamic Deep Brain Stimulation Effects on Mood and Personality in Parkinson's Disease Patients. Front Neurol 2020; 11:776. [PMID: 32849228 PMCID: PMC7412792 DOI: 10.3389/fneur.2020.00776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/24/2020] [Indexed: 01/08/2023] Open
Abstract
Changes in personality are one of the main concerns Parkinson's disease (PD) patients raise when facing the decision to undergo neurosurgery for deep brain stimulation (DBS) of the subthalamic nucleus (STN). While clinical instruments for monitoring functional changes following DBS surgery are well-established in the daily therapeutic routine, personality issues are far less systematically encompassed. Moreover, while sex disparities in the outcomes of STN-DBS therapy have been reported, little is known about the different effects that DBS treatment may have on mood and personality traits in female and male patients. To this aim, the effect of STN-DBS on personality traits was assessed in 46 PD patients (12 women and 34 men) by means of the Freiburg Personality Inventory. The Becks Depression Inventory (BDI-I) and the Parkinson's Disease Questionnaire were used to evaluate patients' level of depression and quality of life (QoL). Patients completed the questionnaires a few days before, within the first year, and 2 years after surgery. The 12 personality traits defined by the FPI-R questionnaire did not change significantly after STN-DBS surgery (p = 0.198). Women declared higher depression scores through all study stages (p = 0.009), but also showed a stronger QoL amelioration after surgery than male patients (p = 0.022). The BDI-I scores of female patients clearly correlated with their levodopa equivalent daily dose (LEDD; r = 0.621, p = 0.008). Remarkably, in both male and female patients, higher pre-operative LEDDs were related to worse post-operative QoL scores (p = 0.034). These results mitigate the concerns about systematic personality changes due to STN-DBS treatment in PD patients and encourage an early DBS approach, before severe levodopa-induced sequelae may irreparably compromise the patients' QoL. In the future, more focus should lie on sex-related effects, since female patients seem to profit more than male patients from STN-DBS, in terms of reduced depressive symptoms associated with a reduction of the LEDD and amelioration of QoL. These aspects may help to redress the sex imbalance in PD patients treated with DBS, given that women are still strongly under-represented.
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Affiliation(s)
- Amelie D Dietrich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Johannes A Koeppen
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Buhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Pötter-Nerger
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany
| | - Marita Oehlwein
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany
| | - Katrin Mittmann
- Neurological Outpatient Clinic for Parkinson's Disease and Deep Brain Stimulation, Gera, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas K Engel
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Miriam Schaper
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Hamel
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian K E Moll
- Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessandro Gulberti
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurophysiology and Pathophysiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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36
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Lo Buono V, Palmeri R, Stroscio G, Corallo F, Di Lorenzo G, Sorbera C, Ciurleo R, Cimino V, Bramanti P, Marino S, Bonanno L. The effect on deep brain stimulation of subthalamic nucleus and dopaminergic treatment in Parkinson disease. Medicine (Baltimore) 2020; 99:e21578. [PMID: 32769905 PMCID: PMC7593015 DOI: 10.1097/md.0000000000021578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Impulsivity is a frequent non-motor symptom in Parkinson disease (PD). It comprises psycho-behavioral alterations that negatively impact quality of life. Dopaminergic treatments underpin many impulsive controls disorders however, side effects, such as increased impulsivity, are described also after neurosurgical procedure of deep brain stimulation (DBS). We investigated the effect of deep brain stimulation on psycho-behavioral alterations and quality of life (QoL) in PD patients, analyzing, also, the role of dopaminergic therapies.Twenty idiopathic PD patients with and 20 idiopathic PD patients without DBS were included in the study. All patient underwent to neuropsychological assessment for a screening of executive functions, impulsivity, anxiety and depressive symptoms and QoL.Differences were found between DBS and no DBS groups and in term of dopaminergic therapies. The comparison between 2 groups showed a greater motor and attentional impulsivity in DBS patients. Moreover, this impulsivity worse QoL and interpersonal relationships. The combination of Levodopa and dopamine agonists exerted a great impact on impulsivity behavior.The emergence of postoperative impulsivity seems to be a neurostimulator phenomenon related to the computational role of the subthalamic nucleus in modulation of behavior.
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van Wijk BCM, Alkemade A, Forstmann BU. Functional segregation and integration within the human subthalamic nucleus from a micro- and meso-level perspective. Cortex 2020; 131:103-113. [PMID: 32823130 DOI: 10.1016/j.cortex.2020.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/20/2020] [Accepted: 07/06/2020] [Indexed: 12/25/2022]
Abstract
The subthalamic nucleus (STN) is a core basal ganglia structure involved in the control of motor, cognitive, motivational and affective functions. The (challenged) tripartite subdivision hypothesis places these functions into distinct sensorimotor, cognitive/associative, and limbic subregions based on the topography of cortical projections. To a large extent, this hypothesis is used to motivate the choice of target coordinates for implantation of deep brain stimulation electrodes for treatment of neurological and psychiatric disorders. Yet, the parallel organization of basal ganglia circuits has been known to allow considerable cross-talk, which might contribute to the occurrence of neuropsychiatric side effects when stimulating the dorsolateral, putative sensorimotor, part of the STN for treatment of Parkinson's disease. Any functional segregation within the STN is expected to be reflected both at micro-level microscopy and meso-level neural population activity. As such, we review the current empirical evidence from anterograde tracing and immunocytochemistry studies and from local field potential recordings for delineating the STN into distinct subregions. The spatial distribution of immunoreactivity presents as a combination of gradients, and although neural activity in distinct frequency bands appears spatially clustered, there is substantial overlap in peak locations. We argue that regional specialization without sharply defined borders is likely most representative of the STN's functional organization.
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Affiliation(s)
- Bernadette C M van Wijk
- Integrative Model-based Cognitive Neuroscience Research Unit, Department of Psychology, University of Amsterdam, the Netherlands.
| | - Anneke Alkemade
- Integrative Model-based Cognitive Neuroscience Research Unit, Department of Psychology, University of Amsterdam, the Netherlands
| | - Birte U Forstmann
- Integrative Model-based Cognitive Neuroscience Research Unit, Department of Psychology, University of Amsterdam, the Netherlands
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38
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Spatio-molecular domains identified in the mouse subthalamic nucleus and neighboring glutamatergic and GABAergic brain structures. Commun Biol 2020; 3:338. [PMID: 32620779 PMCID: PMC7334224 DOI: 10.1038/s42003-020-1028-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/20/2020] [Indexed: 01/07/2023] Open
Abstract
The subthalamic nucleus (STN) is crucial for normal motor, limbic and associative function. STN dysregulation is correlated with several brain disorders, including Parkinsonʼs disease and obsessive compulsive disorder (OCD), for which high-frequency stimulation of the STN is increasing as therapy. However, clinical progress is hampered by poor knowledge of the anatomical–functional organization of the STN. Today, experimental mouse genetics provides outstanding capacity for functional decoding, provided selective promoters are available. Here, we implemented single-nuclei RNA sequencing (snRNASeq) of the mouse STN followed through with histological analysis of 16 candidate genes of interest. Our results demonstrate that the mouse STN is composed of at least four spatio-molecularly defined domains, each distinguished by defined sets of promoter activities. Further, molecular profiles dissociate the STN from the adjoining para-STN (PSTN) and neighboring structures of the hypothalamus, mammillary nuclei and zona incerta. Enhanced knowledge of STN´s internal organization should prove useful towards genetics-based functional decoding of this clinically relevant brain structure. Wallén-Mackenzie et al. investigate anatomical–functional organization of the subthalamic nucleus in mice, using single-nuclei RNA sequencing followed by histological analysis. They identify four domains distinguished by defined sets of promoter activities, providing a valuable resource for functional decoding of the subthalamic nucleus.
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Haagensen BN, Herz DM, Meder D, Madsen KH, Løkkegaard A, Siebner HR. Linking brain activity during sequential gambling to impulse control in Parkinson's disease. NEUROIMAGE-CLINICAL 2020; 27:102330. [PMID: 32688307 PMCID: PMC7369593 DOI: 10.1016/j.nicl.2020.102330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/27/2020] [Accepted: 05/29/2020] [Indexed: 12/29/2022]
Abstract
Dopaminergic treatment may impair the ability to suppress impulsive behaviours in patients with Parkinson's disease, triggering impulse control disorders. It is unclear how dopaminergic medication affects the neural networks that contribute to withholding inappropriate actions. To address this question, we mapped task-related brain activity with whole-brain functional magnetic resonance imaging at 3 Tesla in 26 patients with Parkinson's disease. Patients performed a sequential gambling task while being ON and OFF their regular dopaminergic treatment. During a gambling round, patients repeatedly decided between the option to continue with gambling and accumulate more monetary reward under increasing risk or the option to bank the current balance and start a new round. 13 patients had an impulse control disorder (ICD + group). These patients did not differ in risk-taking attitude during sequential gambling from 13 patients without impulse control disorder (ICD - group), but they displayed differences in gambling-related activity in cortico-subcortical brain areas supporting inhibitory control. First, the ICD + group showed reduced "continue-to-gamble" activity in right inferior frontal gyrus and subthalamic nucleus. Second, the individual risk-attitude scaled positively with "continue-to-gamble" activity in right subthalamic nucleus and striatum in the ICD - group only. Third, ICD + patients differed in their functional neural responses to dopaminergic treatment from ICD - patients: dopaminergic therapy reduced functional connectivity between inferior frontal gyrus and subthalamic nucleus during "continue-to-gamble" decisions and attenuated striatal responses towards accumulating reward and risk. Together, the medication-independent (trait) and medication-related (state) differences in neural activity may set a permissive stage for the emergence of impulse control disorders during dopamine replacement therapy in Parkinson's disease.
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Affiliation(s)
- Brian N Haagensen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Damian M Herz
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Kristoffer H Madsen
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Annemette Løkkegaard
- Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Hartwig R Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark; Department of Neurology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Copenhagen, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Petry-Schmelzer JN, Krause M, Dembek TA, Horn A, Evans J, Ashkan K, Rizos A, Silverdale M, Schumacher W, Sack C, Loehrer PA, Fink GR, Fonoff ET, Martinez-Martin P, Antonini A, Barbe MT, Visser-Vandewalle V, Ray-Chaudhuri K, Timmermann L, Dafsari HS. Non-motor outcomes depend on location of neurostimulation in Parkinson's disease. Brain 2020; 142:3592-3604. [PMID: 31553039 DOI: 10.1093/brain/awz285] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 01/29/2023] Open
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective and established therapy for patients with advanced Parkinson's disease improving quality of life, motor symptoms and non-motor symptoms. However, there is a considerable degree of interindividual variability for these outcomes, likely due to variability in electrode placement and stimulation settings. Here, we present probabilistic mapping data from a prospective, open-label, multicentre, international study to investigate the influence of the location of subthalamic nucleus deep brain stimulation on non-motor symptoms in patients with Parkinson's disease. A total of 91 Parkinson's disease patients undergoing bilateral deep brain stimulation of the subthalamic nucleus were included, and we investigated NMSScale, NMSQuestionnaire, Scales for Outcomes in Parkinson's disease-motor examination, -activities of daily living, and -motor complications, and Parkinson's disease Questionnaire-8 preoperatively and at 6-month follow-up after surgery. Leads were localized in standard space using the Lead-DBS toolbox and individual volumes of tissue activated were calculated based on clinical stimulation settings. Probabilistic stimulation maps and non-parametric permutation statistics were applied to identify voxels with significant above or below average improvement for each scale and analysed using the DISTAL atlas. All outcomes improved significantly at follow-up. Significant spatial distribution patterns of neurostimulation were observed for NMSScale total score and its mood/apathy and attention/memory domains. For both domains, voxels associated with below average improvement were mainly located dorsal to the subthalamic nucleus. In contrast, above average improvement for mood/apathy was observed in the ventral border region of the subthalamic nucleus and in its sensorimotor subregion and for attention/memory in the associative subregion. A trend was observed for NMSScale sleep domain showing voxels with above average improvement located ventral to the subthalamic nucleus. Our study provides evidence that the interindividual variability of mood/apathy, attention/memory, and sleep outcomes after subthalamic nucleus deep brain stimulation depends on the location of neurostimulation. This study highlights the importance of holistic assessments of motor and non-motor aspects of Parkinson's disease to tailor surgical targeting and stimulation parameter settings to patients' personal profiles.
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Affiliation(s)
- Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Max Krause
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Till A Dembek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Andreas Horn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal Foundation Thrust, Greater Manchester, UK
| | - Keyoumars Ashkan
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Rizos
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal Foundation Thrust, Greater Manchester, UK
| | - Wibke Schumacher
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Carolin Sack
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany
| | - K Ray-Chaudhuri
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK.,The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Lars Timmermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
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Irmen F, Horn A, Mosley P, Perry A, Petry-Schmelzer JN, Dafsari HS, Barbe M, Visser-Vandewalle V, Schneider GH, Li N, Kübler D, Wenzel G, Kühn AA. Left Prefrontal Connectivity Links Subthalamic Stimulation with Depressive Symptoms. Ann Neurol 2020; 87:962-975. [PMID: 32239535 DOI: 10.1002/ana.25734] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) not only stimulates focal target structures but also affects distributed brain networks. The impact this network modulation has on non-motor DBS effects is not well-characterized. By focusing on the affective domain, we systematically investigate the impact of electrode placement and associated structural connectivity on changes in depressive symptoms following STN-DBS, which have been reported to improve, worsen, or remain unchanged. METHODS Depressive symptoms before and after STN-DBS surgery were documented in 116 patients with PD from 3 DBS centers (Berlin, Queensland, and Cologne). Based on individual electrode reconstructions, the volumes of tissue activated (VTAs) were estimated and combined with normative connectome data to identify structural connections passing through VTAs. Berlin and Queensland cohorts formed a training and cross-validation dataset used to identify structural connectivity explaining change in depressive symptoms. The Cologne data served as the test-set for which depressive symptom change was predicted. RESULTS Structural connectivity was linked to depressive symptom change under STN-DBS. An optimal connectivity map trained on the Berlin cohort could predict changes in depressive symptoms in Queensland patients and vice versa. Furthermore, the joint training-set map predicted changes in depressive symptoms in the independent test-set. Worsening of depressive symptoms was associated with left prefrontal connectivity. INTERPRETATION Fibers connecting the electrode with left prefrontal areas were associated with worsening of depressive symptoms. Our results suggest that for the left STN-DBS lead, placement impacting fibers to left prefrontal areas should be avoided to maximize improvement of depressive symptoms. ANN NEUROL 2020;87:962-975.
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Affiliation(s)
- Friederike Irmen
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Biological Psychology and Cognitive Neuroscience, Freie Universität Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philip Mosley
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Australia.,Queensland Brain Institute, University of Queensland, St. Lucia, Australia
| | - Alistair Perry
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Max Planck Institute for Human Development, Berlin, Germany.,Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Jan Niklas Petry-Schmelzer
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Haidar S Dafsari
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Michael Barbe
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ningfei Li
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dorothee Kübler
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gregor Wenzel
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
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Mosley PE, Paliwal S, Robinson K, Coyne T, Silburn P, Tittgemeyer M, Stephan KE, Breakspear M, Perry A. The structural connectivity of discrete networks underlies impulsivity and gambling in Parkinson’s disease. Brain 2019; 142:3917-3935. [DOI: 10.1093/brain/awz327] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 07/25/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022] Open
Abstract
See O’Callaghan (doi:10.1093/brain/awz349) for a scientific commentary on this article.
Mosley et al. examine impulsivity and naturalistic gambling behaviours in patients with Parkinson’s disease. They link within-patient differences to the structural connectivity of networks subserving reward evaluation and response inhibition, and reveal pivotal roles for the ventral striatum and subthalamic nucleus within these networks.
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Affiliation(s)
- Philip E Mosley
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
- Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Saee Paliwal
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland
| | - Katherine Robinson
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
- Brizbrain and Spine, the Wesley Hospital, Auchenflower, Queensland, Australia
| | - Peter Silburn
- Neurosciences Queensland, St Andrew’s War Memorial Hospital, Spring Hill, Queensland, Australia
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | | | - Klaas E Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Michael Breakspear
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Alistair Perry
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany
- Centre for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
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Vissani M, Cordella R, Micera S, Eleopra R, Romito LM, Mazzoni A. Spatio-temporal structure of single neuron subthalamic activity identifies DBS target for anesthetized Tourette syndrome patients. J Neural Eng 2019; 16:066011. [PMID: 31370042 DOI: 10.1088/1741-2552/ab37b4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Deep brain stimulation (DBS) of basal ganglia effectively tackles motor symptoms of movement disorders such as Tourette syndrome (TS). The precise location of target stimulation site determines the range of clinical outcome in DBS patients, and the occurrence of side-effects of DBS. DBS implant procedures currently localize stimulation target relying on a combination of pre-surgical imaging, standardized brain atlases and on-the-spot clinical tests. Here we show that temporal structure of single unit activity in subthalamic nucleus (STN) of patients affected by pure TS can contribute to identify the optimal target location of DBS. APPROACH Neural activity was recorded at different depths within STN with microelectrodes during DBS implant surgery. Depth specific neural features were extracted and correlated with the optimal depth for tic control. MAIN RESULTS We describe for the first time temporal spike patterns of single neurons from sensorimotor STN of anesthetized TS patients. A large fraction of units (31.2%) displayed intense bursting in the delta band (<4 Hz). The highest firing irregularity and hence the higher density of bursting units (42%) were found at the optimal spot for tic control. Discharge patterns irregularity and dominant oscillations frequency (but not firing rate) carried significant information on optimal target. SIGNIFICANCE We found single unit activity features in the STN of TS patients reliably associated to optimal DBS target site for tic control. In future works measures of firing irregularity could be integrated with current target localization methods leading to a more effective and safer DBS for TS patients.
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Affiliation(s)
- Matteo Vissani
- The Biorobotics Institute, Scuola Superiore Sant'Anna, 56025 Pisa, Italy
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Subjective estimates of uncertainty during gambling and impulsivity after subthalamic deep brain stimulation for Parkinson's disease. Sci Rep 2019; 9:14795. [PMID: 31616015 PMCID: PMC6794275 DOI: 10.1038/s41598-019-51164-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/25/2019] [Indexed: 01/08/2023] Open
Abstract
Subthalamic deep brain stimulation (DBS) for Parkinson’s disease (PD) may modulate chronometric and instrumental aspects of choice behaviour, including motor inhibition, decisional slowing, and value sensitivity. However, it is not well known whether subthalamic DBS affects more complex aspects of decision-making, such as the influence of subjective estimates of uncertainty on choices. In this study, 38 participants with PD played a virtual casino prior to subthalamic DBS (whilst ‘on’ medication) and again, 3-months postoperatively (whilst ‘on’ stimulation). At the group level, there was a small but statistically significant decrease in impulsivity postoperatively, as quantified by the Barratt Impulsiveness Scale (BIS). The gambling behaviour of participants (bet increases, slot machine switches and double or nothing gambles) was associated with this self-reported measure of impulsivity. However, there was a large variance in outcome amongst participants, and we were interested in whether individual differences in subjective estimates of uncertainty (specifically, volatility) were related to differences in pre- and postoperative impulsivity. To examine these individual differences, we fit a computational model (the Hierarchical Gaussian Filter, HGF), to choices made during slot machine game play as well as a simpler reinforcement learning model based on the Rescorla-Wagner formalism. The HGF was superior in accounting for the behaviour of our participants, suggesting that participants incorporated beliefs about environmental uncertainty when updating their beliefs about gambling outcome and translating these beliefs into action. A specific aspect of subjective uncertainty, the participant’s estimate of the tendency of the slot machine’s winning probability to change (volatility), increased subsequent to DBS. Additionally, the decision temperature of the response model decreased post-operatively, implying greater stochasticity in the belief-to-choice mapping of participants. Model parameter estimates were significantly associated with impulsivity; specifically, increased uncertainty was related to increased postoperative impulsivity. Moreover, changes in these parameter estimates were significantly associated with the maximum post-operative change in impulsivity over a six month follow up period. Our findings suggest that impulsivity in PD patients may be influenced by subjective estimates of uncertainty (environmental volatility) and implicate a role for the subthalamic nucleus in the modulation of outcome certainty. Furthermore, our work outlines a possible approach to characterising those persons who become more impulsive after subthalamic DBS, an intervention in which non-motor outcomes can be highly variable.
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Changes in Personality Associated with Deep Brain Stimulation: a Qualitative Evaluation of Clinician Perspectives. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09419-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Berardelli I, Belvisi D, Pasquini M, Fabbrini A, Petrini F, Fabbrini G. Treatment of psychiatric disturbances in hypokinetic movement disorders. Expert Rev Neurother 2019; 19:965-981. [PMID: 31241368 DOI: 10.1080/14737175.2019.1636648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: We reviewed studies that assessed the treatment of psychiatric disturbances in Parkinson's disease and atypical parkinsonisms. Neuropsychiatric disturbances in these conditions are frequent and have a profound impact on quality of life of patients and of their caregivers. It is therefore important to be familiar with the appropriate pharmacological and non-pharmacological interventions for treating these disorders. Areas covered: The authors searched for papers in English in Pubmed using the following keywords: Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, depression, apathy, anxiety, fatigue, sleep disorders, obsessive compulsive disorders, psychosis, hallucinations, delusions, impulse control disorders. Expert opinion: In Parkinson's disease, depression may benefit from the optimization of dopaminergic therapy, from the use of antidepressants acting on both the serotoninergic and noradrenergic pathways and from cognitive behavioral therapy. Psychosis in Parkinson's disease may improve with the use of clozapine; the serotonin inverse agonist pimavanserin has been shown to be effective. Treatment of impulse control disorders is primarily based on the removal of dopamine agonists. No controlled studies have investigated the treatment of neuropsychiatric disorders in multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. Acethylcholinesterase inhibitors may be used to treat hallucinations in Lewy body dementia.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | | | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Federica Petrini
- Department of Neurosciences and Mental Health, Azienda Universitaria Policlinico Umberto I° , Rome , Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed , Pozzilli , Italy.,Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
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Mosley PE, Robinson K, Coyne T, Silburn P, Breakspear M, Carter A. ‘Woe Betides Anybody Who Tries to Turn me Down.’ A Qualitative Analysis of Neuropsychiatric Symptoms Following Subthalamic Deep Brain Stimulation for Parkinson’s Disease. NEUROETHICS-NETH 2019. [DOI: 10.1007/s12152-019-09410-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Horn A, Li N, Dembek TA, Kappel A, Boulay C, Ewert S, Tietze A, Husch A, Perera T, Neumann WJ, Reisert M, Si H, Oostenveld R, Rorden C, Yeh FC, Fang Q, Herrington TM, Vorwerk J, Kühn AA. Lead-DBS v2: Towards a comprehensive pipeline for deep brain stimulation imaging. Neuroimage 2019; 184:293-316. [PMID: 30179717 PMCID: PMC6286150 DOI: 10.1016/j.neuroimage.2018.08.068] [Citation(s) in RCA: 451] [Impact Index Per Article: 90.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/13/2018] [Accepted: 08/28/2018] [Indexed: 01/09/2023] Open
Abstract
Deep brain stimulation (DBS) is a highly efficacious treatment option for movement disorders and a growing number of other indications are investigated in clinical trials. To ensure optimal treatment outcome, exact electrode placement is required. Moreover, to analyze the relationship between electrode location and clinical results, a precise reconstruction of electrode placement is required, posing specific challenges to the field of neuroimaging. Since 2014 the open source toolbox Lead-DBS is available, which aims at facilitating this process. The tool has since become a popular platform for DBS imaging. With support of a broad community of researchers worldwide, methods have been continuously updated and complemented by new tools for tasks such as multispectral nonlinear registration, structural/functional connectivity analyses, brain shift correction, reconstruction of microelectrode recordings and orientation detection of segmented DBS leads. The rapid development and emergence of these methods in DBS data analysis require us to revisit and revise the pipelines introduced in the original methods publication. Here we demonstrate the updated DBS and connectome pipelines of Lead-DBS using a single patient example with state-of-the-art high-field imaging as well as a retrospective cohort of patients scanned in a typical clinical setting at 1.5T. Imaging data of the 3T example patient is co-registered using five algorithms and nonlinearly warped into template space using ten approaches for comparative purposes. After reconstruction of DBS electrodes (which is possible using three methods and a specific refinement tool), the volume of tissue activated is calculated for two DBS settings using four distinct models and various parameters. Finally, four whole-brain tractography algorithms are applied to the patient's preoperative diffusion MRI data and structural as well as functional connectivity between the stimulation volume and other brain areas are estimated using a total of eight approaches and datasets. In addition, we demonstrate impact of selected preprocessing strategies on the retrospective sample of 51 PD patients. We compare the amount of variance in clinical improvement that can be explained by the computer model depending on the preprocessing method of choice. This work represents a multi-institutional collaborative effort to develop a comprehensive, open source pipeline for DBS imaging and connectomics, which has already empowered several studies, and may facilitate a variety of future studies in the field.
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Affiliation(s)
- Andreas Horn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany.
| | - Ningfei Li
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Till A Dembek
- Department of Neurology, University Hospital of Cologne, Germany
| | - Ari Kappel
- Wayne State University, Department of Neurosurgery, Detroit, Michigan, USA
| | | | - Siobhan Ewert
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité - University Medicine Berlin, Germany
| | - Andreas Husch
- University of Luxembourg, Luxembourg Centre for Systems Biomedicine, Interventional Neuroscience Group, Belvaux, Luxembourg
| | - Thushara Perera
- Bionics Institute, East Melbourne, Victoria, Australia; Department of Medical Bionics, University of Melbourne, Parkville, Victoria, Australia
| | - Wolf-Julian Neumann
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany; Institute of Neuroradiology, Charité - University Medicine Berlin, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Faculty of Medicine, University Freiburg, Germany
| | - Hang Si
- Numerical Mathematics and Scientific Computing, Weierstrass Institute for Applied Analysis and Stochastics (WIAS), Germany
| | - Robert Oostenveld
- Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, NL, Netherlands; NatMEG, Karolinska Institutet, Stockholm, SE, Sweden
| | - Christopher Rorden
- McCausland Center for Brain Imaging, University of South Carolina, Columbia, SC, USA
| | - Fang-Cheng Yeh
- Department of Neurological Surgery, University of Pittsburgh PA, USA
| | - Qianqian Fang
- Department of Bioengineering, Northeastern University, Boston, USA
| | - Todd M Herrington
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Johannes Vorwerk
- Scientific Computing & Imaging (SCI) Institute, University of Utah, Salt Lake City, USA
| | - Andrea A Kühn
- Movement Disorders & Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Germany
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Irmen F, Horn A, Meder D, Neumann WJ, Plettig P, Schneider GH, Siebner HR, Kühn AA. Sensorimotor subthalamic stimulation restores risk-reward trade-off in Parkinson's disease. Mov Disord 2018; 34:366-376. [PMID: 30485537 DOI: 10.1002/mds.27576] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/26/2018] [Accepted: 10/11/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND STN-DBS effectively treats motor symptoms of advanced PD. Nonmotor cognitive symptoms, such as impaired impulse control or decision making, may either improve or worsen with DBS. A potential mediating factor of DBS-induced modulation of cognition is the electrode position within the STN with regard to functional subareas of parallel motor, cognitive, and affective basal ganglia loops. However, to date, the volume of tissue activated and weighted stimulation of STN motor versus nonmotor territories are yet to be linked to differential DBS effects on cognition. OBJECTIVES We aim to investigate whether STN-DBS influences risk-reward trade-off decisions and analyze its dependency on electrode placement. METHODS Seventeen PD patients ON and OFF STN-DBS and 17 age-matched healthy controls conducted a sequential decision-making task with escalating risk and reward. We computed the effect of STN-DBS on risk-reward trade-off decisions, localized patients' bilateral electrodes, and analyzed the predictive value of volume of tissue activated in STN motor and nonmotor territories on behavioral change. RESULTS We found that STN-DBS not only improves PD motor symptoms, but also normalizes overly risk-averse decision behavior in PD. Intersubject variance in electrode location could explain this behavioral change. Specifically, if STN-DBS activated preferentially STN motor territory, patients' risk-reward trade-off decisions more resembled those of healthy controls. CONCLUSIONS Our findings support the notion of convergence of different functional circuits within the STN and imply a positive effect of well-placed STN-DBS on nonmotor cognitive functioning in PD. © 2018 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Friederike Irmen
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Biological Psychology and Cognitive Neuroscience, Freie Universität Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Meder
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Wolf-Julian Neumann
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Philip Plettig
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hartwig Roman Siebner
- Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.,Department of Neurology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
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