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Yun SJ, Lee HS, Kim DH, Im S, Yoo YJ, Kim NY, Lee J, Kim D, Park HY, Yoon MJ, Kim YS, Chang WH, Seo HG. Efficacy of personalized repetitive transcranial magnetic stimulation based on functional reserve to enhance ambulatory function in patients with Parkinson's disease: study protocol for a randomized controlled trial. Trials 2024; 25:543. [PMID: 39152467 PMCID: PMC11328369 DOI: 10.1186/s13063-024-08385-2] [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: 04/28/2024] [Accepted: 08/06/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) is one of the non-invasive brain stimulations that modulate cortical excitability through magnetic pulses. However, the effects of rTMS on Parkinson's disease (PD) have yielded mixed results, influenced by factors including various rTMS stimulation parameters as well as the clinical characteristics of patients with PD. There is no clear evidence regarding which patients should be applied with which parameters of rTMS. The study aims to investigate the efficacy and safety of personalized rTMS in patients with PD, focusing on individual functional reserves to improve ambulatory function. METHODS This is a prospective, exploratory, multi-center, single-blind, parallel-group, randomized controlled trial. Sixty patients with PD will be recruited for this study. This study comprises two sub-studies, each structured as a two-arm trial. Participants are classified into sub-studies based on their functional reserves for ambulatory function, into either the motor or cognitive priority group. The Timed-Up and Go (TUG) test is employed under both single and cognitive dual-task conditions (serial 3 subtraction). The motor dual-task effect, using stride length, and the cognitive dual-task effect, using the correct response rate of subtraction, are calculated. In the motor priority group, high-frequency rTMS targets the primary motor cortex of the lower limb, whereas the cognitive priority group receives rTMS over the left dorsolateral prefrontal cortex. The active comparator for each sub-study is bilateral rTMS of the primary motor cortex of the upper limb. Over 4 weeks, the participants will undergo 10 rTMS sessions, with evaluations conducted pre-intervention, mid-intervention, immediately post-intervention, and at 2-month follow-up. The primary outcome is a change in TUG time between the pre- and immediate post-intervention evaluations. The secondary outcome variables are the TUG under cognitive dual-task conditions, Movement Disorder Society-Unified Parkinson's Disease Rating Scale Part III, New Freezing of Gait Questionnaire, Digit Span, trail-making test, transcranial magnetic stimulation-induced motor-evoked potentials, diffusion tensor imaging, and resting state functional magnetic resonance imaging. DISCUSSION The study will reveal the effect of personalized rTMS based on functional reserve compared to the conventional rTMS approach in PD. Furthermore, the findings of this study may provide empirical evidence for an rTMS protocol tailored to individual functional reserves to enhance ambulatory function in patients with PD. TRIAL REGISTRATION ClinicalTrials.gov NCT06350617. Registered on 5 April 2024.
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Affiliation(s)
- Seo Jung Yun
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Seok Lee
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Kim
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sun Im
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yeun Jie Yoo
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Na Young Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Jungsoo Lee
- Department of Medical IT Convergence Engineering, Kumoh National Institute of Technology, Gumi, Republic of Korea
| | - Donghyeon Kim
- Research Institute, NEUROPHET Inc, Seoul, Republic of Korea
| | - Hae-Yeon Park
- Department of Rehabilitation Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mi-Jeong Yoon
- Department of Rehabilitation Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Seok Kim
- Department of Rehabilitation Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Health Science and Technology, Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Han Gil Seo
- Department of Rehabilitation Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Singh H, Sawal N, Gupta VK, Jha R, Stamm M, Arjun S, Gupta V, Rolston JD. Increased electrode impedance as an indicator for early detection of deep brain stimulation (DBS) hardware Infection: Clinical experience and in vitro study. J Clin Neurosci 2024; 120:76-81. [PMID: 38211444 DOI: 10.1016/j.jocn.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND When deep brain stimulation (DBS) infections are identified, they are often too advanced to treat without complete hardware removal. New objective markers to promptly identify DBS infections are needed. We present a patient with GPi (globus pallidus interna) DBS for dystonia, where the electrode impedance unexpectedly increased 3-months post-operatively, followed by serologic and hematologic markers of inflammation at 6-months, prompting explantation surgery. We recreated these conditions in a laboratory environment to analyze the pattern of changing of electrical impedance across the contacts of a DBS lead following Staphylococcus biofilm formation. METHODS A stainless-steel culture chamber containing 1 % brain heart infusion agar was used. A DBS electrode was dipped in peptone water containing a strain of S. aureus and subsequently introduced into the chamber. The apparatus was incubated at 37 °C for 6 days. Impedance was measured at 24hr intervals. A control experiment without S. Aureus inoculation was used to determine changes in impedance over a period of 6-days. RESULTS The mean monopolar impedance on day-1 was 751.8 ± 23.8 Ω and on day-3 was 1004.8 ± 68.7 Ω, a 33.7 % rise (p = 0.007). A faint biofilm formation could be seen around the DBS lead by day-2 and florid growth by day-3. After addition of the linezolid solution, a 15.9 % decrease in monopolar impedance was observed from day 3-6 (p = 0.003). CONCLUSION This study gives insight into impedance trends following a hardware infection in DBS. Increased impedance outside expected norms may be valuable for early prediction of infection. Furthermore, timely management using antibiotics might reduce the frequency of infection-related explant surgeries.
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Affiliation(s)
- Hargunbir Singh
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Harvard University, Boston, MA, United States.
| | - Nishit Sawal
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Vipin K Gupta
- Department of Neurosurgery, Government Medical College and Hospital, Chandigarh, India
| | - Rohan Jha
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Harvard University, Boston, MA, United States
| | - Michaela Stamm
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Harvard University, Boston, MA, United States
| | - Shivani Arjun
- Department of Medicine, Government Medical College and Hospital, Chandigarh, India
| | - Varsha Gupta
- Department of Microbiology, Government Medical College and Hospital, Chandigarh, India
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, MA, United States; Harvard Medical School, Harvard University, Boston, MA, United States
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Kalhoro A, Hashim ASM. Effectiveness of deep brain stimulation in Parkinson's disease treatment with Single-center experience in Pakistan. Pak J Med Sci 2023; 39:1018-1023. [PMID: 37492334 PMCID: PMC10364257 DOI: 10.12669/pjms.39.4.7680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/03/2023] [Accepted: 04/18/2023] [Indexed: 07/27/2023] Open
Abstract
Objective To assess the effectiveness and accuracy of deep brain stimulation in Parkinsonian Disease (PD). Methods This study was a descriptive prospective study, and patients were treated at Neurospinal and Cancer Care Institute Karachi, from February 1, 2016, to June 30, 2020. We had 21 cases of parkinsonian disease. Inclusion criteria was Idiopathic Parkinson's disease, marked motor fluctuations against the response to dopaminergic therapy, UPDRS-III scores, which is 30 or higher, with a duration of disease of five years or longer, developing dyskinesia while the exclusion criteria was patient with known comorbid or active psychiatric disease. Results Mean age of patient was 64 years. The standard deviation was 1.11697. The male patients' mean, median and mode had a standard deviation of 0.3. For the duration of disease, the mean was 1.4, the median 1 (5-6 years) and mode one. The standard deviation was 0.51177. The primary symptoms' mean was 2.2857, the median was 2.0, and the mode was two (tremor). The mean on medication (age) was 2 (45-49), and the median and mode were the same. Conclusion Deep brain stimulation (DBS) is an effective treatment option for a carefully selected patient. DBS improves tremors, dyskinesias, rigidity, motor fluctuations and bradykinesia. DBS is unlikely to benefit Autonomic dysfunction, cognitive disorders, hypophonia, and postural instability. Although it is an expensive treatment compared to lesioning or gamma knife, it is reversible.
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Affiliation(s)
- Aurangzeb Kalhoro
- Dr. Aurangzeb Kalhoro, F.C.P.S(Neurosurgery), F.A.C.S, M.B.A. Consultant Neurosurgeon, Neuro Spinal and Cancer Care Institute, Karachi, Pakistan
| | - Abdul Sattar M. Hashim
- Prof. Dr. Abdul Sattar M. Hashim, MD, Ph.D. Neurosurgery, Ex. Professor, JPMC, Karachi, Medical Director, Neuro Spinal and Cancer Care Institute, Karachi, Pakistan
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Girges C, Vijiaratnam N, Zrinzo L, Ekanayake J, Foltynie T. Volitional Control of Brain Motor Activity and Its Therapeutic Potential. Neuromodulation 2022; 25:1187-1196. [DOI: 10.1016/j.neurom.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/08/2021] [Accepted: 12/28/2021] [Indexed: 12/01/2022]
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Heiden P, Pieczewski J, Andrade P. Women in Neuromodulation: Innovative Contributions to Stereotactic and Functional Neurosurgery. Front Hum Neurosci 2022; 15:756039. [PMID: 35126071 PMCID: PMC8811476 DOI: 10.3389/fnhum.2021.756039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/06/2021] [Indexed: 11/15/2022] Open
Abstract
Stereotactic neurosurgery emerged in the mid-20th century following the development of a stereotactic frame by Spiegel and Wycis. Historically women were underrepresented in clinical and academic neurosurgery. There is still a significant deficit of female scientists in this field. This article aims to demonstrate the career and scientific work of some of the most important women who contributed to the development of stereotactic and functional neurosurgery. Exceptional women from all over the world, represented in this review, assisted the evolution of modern stereotactic and functional neurosurgery as neurosurgeons, neuropathologists, neurologists, neurophysiologists and occupational therapists. Fortunately, we could conclude that in the last two decades the number of female researchers has increased significantly.
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Affiliation(s)
- Petra Heiden
- Department of Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany
- *Correspondence: Petra Heiden
| | - Julia Pieczewski
- Department of Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Pablo Andrade
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine, University of Cologne, Cologne, Germany
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Islam MS, Azim F, Saju H, Zargaran A, Shirzad M, Kamal M, Fatema K, Rehman S, Azad MAM, Ebrahimi-Barough S. Pesticides and Parkinson's disease: Current and future perspective. J Chem Neuroanat 2021; 115:101966. [PMID: 33991619 DOI: 10.1016/j.jchemneu.2021.101966] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 05/08/2021] [Accepted: 05/09/2021] [Indexed: 11/24/2022]
Abstract
Inappropriate use of pesticides has globally exposed mankind to a number of health hazards. Still their production is rising at the rate of 11 % annually and, has already exceeded more than 5 million tons in 2000 (FAO 2017). Plenty of available data reveals that pesticides exposures through agricultural use and food-preservative residue consumption may lead to neurodegenerative disorders like Parkinson's and Alzheimer's diseases. Parkinson's disease (PD) is a progressive motor impairment and a neurodegenerative disorder, considered as the leading source of motor disability. Pesticides strongly inhibit mitochondrial Complex-I, causing mitochondrial dysfunction and death of dopaminergic neurons in the substantia nigra (SN), thus leading to pathophysiologic implications of PD. Current medical treatment strategies, including pharmacotherapeutics and supportive therapies can only provide symptomatic relief. While complementary and alternative medicines including traditional medicine or acupuncture are considered as beneficial ways of treatment with significant clinical effect. Medically non-responding cases can be treated by surgical means, 'Deep Brain Stimulation'. Cell therapy is also an emerging and promising technology for disease modeling and drug development in PD. Their main aim is to replace and/or support the lost and dying dopaminergic neurons in the SN. Recently I/II clinical phase trial (Japan) have used dopaminergic progenitors generated from induced pluripotent stem (iPS) cells which can unveil a successful cell therapy to treat PD symptoms efficiently. This review focuses on PD caused by pesticides use, current treatment modalities, and ongoing research updates. Since PD is not a cell-autonomous disease rather caused by multiple factors, a combinatorial therapeutic approach may address not only the motor-related symptoms but also non-motor cognitive-behavioral issues.
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Affiliation(s)
- Md Shahidul Islam
- Dept. of Tissue Engineering and Applied Cell Sciences, Tehran University of Medical Sciences, Iran.
| | - Fazli Azim
- Dept. of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Iran; IHITC: Isolation Hospital & Infection Treatment Centre, Islamabad, Pakistan.
| | - Hedaeytullah Saju
- School of Persian Medicine (Traditional Medicine), Tehran University of Medical Science, Tehran, Iran.
| | - Arman Zargaran
- School of Persian Medicine (Traditional Medicine), Tehran University of Medical Science, Tehran, Iran.
| | - Meysam Shirzad
- School of Persian Medicine (Traditional Medicine), Tehran University of Medical Science, Tehran, Iran.
| | - Mostofa Kamal
- Shaheed Suhrawardi Medical College & Hospital, Dhaka, Bangladesh.
| | - Kaniz Fatema
- National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh.
| | - Sumbul Rehman
- Faculty of Unani Medicine, Department of Ilmul Advia (Unani Pharmacology), Aligarh Muslim University, India.
| | - M A Momith Azad
- Dept of Research & Product Development (Natural Medicine), The IBN SINA Pharma Ltd, Bangladesh.
| | - Somayeh Ebrahimi-Barough
- Dept. of Tissue Engineering and Applied Cell Sciences, Tehran University of Medical Sciences, Iran.
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Peralta M, Baxter JSH, Khan AR, Haegelen C, Jannin P. Striatal shape alteration as a staging biomarker for Parkinson's Disease. Neuroimage Clin 2020; 27:102272. [PMID: 32473544 PMCID: PMC7260673 DOI: 10.1016/j.nicl.2020.102272] [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] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/13/2022]
Abstract
Parkinson's Disease provokes alterations of subcortical deep gray matter, leading to subtle changes in the shape of several subcortical structures even before the manifestation of motor and non-motor clinical symptoms. We used an automated registration and segmentation pipeline to measure this structural alteration in one early and one advanced Parkinson's Disease (PD) cohorts, one prodromal stage cohort and one healthy control cohort. These structural alterations are then passed to a machine learning pipeline to classify these populations. Our workflow is able to distinguish different stages of PD based solely on shape analysis of the bilateral caudate nucleus and putamen, with balanced accuracies in the range of 59% to 85%. Furthermore, we compared the significance of each of these subcortical structure, compared the performances of different classifiers on this task, thus quantifying the informativeness of striatal shape alteration as a staging bio-marker for PD.
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Affiliation(s)
- Maxime Peralta
- INSERM, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - John S H Baxter
- INSERM, LTSI - UMR 1099, University of Rennes, Rennes, France
| | - Ali R Khan
- Imaging Research Laboratories, Robarts Research institute, Western University, London, Canada
| | - Claire Haegelen
- INSERM, LTSI - UMR 1099, University of Rennes, Rennes, France; CHU Rennes, Rennes, France
| | - Pierre Jannin
- INSERM, LTSI - UMR 1099, University of Rennes, Rennes, France.
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Modeling and simulation of deep brain stimulation electrodes with various active contacts. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s42600-020-00060-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Sandström L, Blomstedt P, Karlsson F, Hartelius L. The Effects of Deep Brain Stimulation on Speech Intelligibility in Persons With Essential Tremor. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2020; 63:456-471. [PMID: 32091953 DOI: 10.1044/2019_jslhr-19-00014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose The aim of this study was to investigate how deep brain stimulation (DBS) of the caudal zona incerta (cZi) affects speech intelligibility in persons with essential tremor. Method Thirty-five participants were evaluated: off stimulation, on chronic stimulation optimized to alleviate tremor, and during unilateral stimulation at increasing amplitude levels. At each stimulation condition, the participants read 10 unique nonsense sentences from the Swedish Test of Intelligibility. Two listeners, blinded to stimulation condition, transcribed all recorded sentences orthographically in a randomized procedure. A mean speech intelligibility score for each patient and stimulation condition was computed, and comparisons were made between scores off and on stimulation. Results Chronic cZi-DBS had no significant effect on speech intelligibility, and there was no difference in outcome between bilateral and unilateral treatments. During unilateral stimulation at increasing amplitudes, nine participants demonstrated deteriorating speech intelligibility. These nine participants were on average older and had more superior contacts activated during the evaluation compared with the participants without deterioration. Conclusions Chronic cZi-DBS, optimized for tremor suppression, does not generally affect speech intelligibility in persons with essential tremor. Furthermore, speech intelligibility may be preserved in many individuals, even when stimulated at high amplitudes. Adverse effects of high-amplitude unilateral stimulation observed in this study were associated with stimulation originating from a more superior location, as well as with the participants' age. These results, highlighting age and stimulation location as contributing to speech intelligibility outcomes, were, however, based on a limited number of individuals experiencing adverse effects with high-amplitude stimulation and should, therefore, be interpreted with caution.
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Affiliation(s)
- Linda Sandström
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, Sweden
| | - Patric Blomstedt
- Division of Clinical Neuroscience, Department of Clinical Sciences, Umeå University, Sweden
| | - Fredrik Karlsson
- Division of Speech and Language Pathology, Department of Clinical Sciences, Umeå University, Sweden
| | - Lena Hartelius
- Division of Speech and Language Pathology, Department of Health and Rehabilitation, Sahlgrenska Academy at the University of Gothenburg, Sweden
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Iarkov A, Barreto GE, Grizzell JA, Echeverria V. Strategies for the Treatment of Parkinson's Disease: Beyond Dopamine. Front Aging Neurosci 2020; 12:4. [PMID: 32076403 PMCID: PMC7006457 DOI: 10.3389/fnagi.2020.00004] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) is the second-leading cause of dementia and is characterized by a progressive loss of dopaminergic neurons in the substantia nigra alongside the presence of intraneuronal α-synuclein-positive inclusions. Therapies to date have been directed to the restoration of the dopaminergic system, and the prevention of dopaminergic neuronal cell death in the midbrain. This review discusses the physiological mechanisms involved in PD as well as new and prospective therapies for the disease. The current data suggest that prevention or early treatment of PD may be the most effective therapeutic strategy. New advances in the understanding of the underlying mechanisms of PD predict the development of more personalized and integral therapies in the years to come. Thus, the development of more reliable biomarkers at asymptomatic stages of the disease, and the use of genetic profiling of patients will surely permit a more effective treatment of PD.
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Affiliation(s)
- Alexandre Iarkov
- Laboratorio de Neurobiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile
| | - George E Barreto
- Department of Biological Sciences, University of Limerick, Limerick, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
| | - J Alex Grizzell
- Department of Psychology and Neuroscience, Center for Neuroscience, University of Colorado, Boulder, CO, United States
| | - Valentina Echeverria
- Laboratorio de Neurobiología, Facultad de Ciencias de la Salud, Universidad San Sebastián, Concepción, Chile.,Research & Development Service, Bay Pines VA Healthcare System, Bay Pines, FL, United States
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Nagao KJ, Patel NJ. From medications to surgery: advances in the treatment of motor complications in Parkinson's disease. Drugs Context 2019; 8:212592. [PMID: 31516532 PMCID: PMC6727789 DOI: 10.7573/dic.212592] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 11/21/2022] Open
Abstract
Motor complications are responsible for the large burden of disability and poor quality of life in Parkinson’s disease (PD). The pulsatile nature of stimulation with oral dopaminergic therapies due to relatively short pharmacokinetic profiles and dysfunctional gastrointestinal absorption have been attributed to the development of PD motor complications. In this review, we will provide an overview of the pharmacologic and surgical therapies currently available and under investigation for the treatment of motor fluctuations and dyskinesia.
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Affiliation(s)
- Kanae Jennifer Nagao
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan, USA
| | - Neepa J Patel
- Department of Neurology, Henry Ford Health System, West Bloomfield, Michigan, USA
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Rahmani M, Benabdeljlil M, Bellakhdar F, Faris MEA, Jiddane M, Bayad KE, Boutbib F, Razine R, Gana R, Hassani MRE, Fatemi NE, Fikri M, Sanhaji S, Tassine H, Balrhiti IEA, Hadri SE, Kettani NEC, Abbadi NE, Amor M, Moussaoui A, Semlali A, Aidi S, Benhaddou EHA, Benomar A, Bouhouche A, Yahyaoui M, Khamlichi AE, Ouahabi AE, Maaqili RE, Tibar H, Arkha Y, Melhaoui A, Benazzouz A, Regragui W. Deep Brain Stimulation in Moroccan Patients With Parkinson's Disease: The Experience of Neurology Department of Rabat. Front Neurol 2018; 9:532. [PMID: 30108543 PMCID: PMC6080137 DOI: 10.3389/fneur.2018.00532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 06/14/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is known as a therapy of choice of advanced Parkinson's disease. The present study aimed to assess the beneficial and side effects of STN DBS in Moroccan Parkinsonian patients. Material and Methods: Thirty five patients underwent bilateral STN DBS from 2008 to 2016 in the Rabat University Hospital. Patients were assessed preoperatively and followed up for 6 to 12 months using the Unified Parkinson's Disease Rating Scale in four conditions (stimulation OFF and ON and medication OFF and ON), the levodopa-equivalent daily dose (LEDD), dyskinesia and fluctuation scores and PDQ39 scale for quality of life (QOL). Postoperative side effects were also recorded. Results: The mean age at disease onset was 42.31 ± 7.29 years [28-58] and the mean age at surgery was 54.66 ± 8.51 years [34-70]. The median disease duration was 11.95 ± 4.28 years [5-22]. Sixty-three percentage of patients were male. 11.4% of patients were tremor dominant while 45.71 showed akinetic-rigid form and 42.90 were classified as mixed phenotype. The LEDD before surgery was 1200 mg/day [800-1500]. All patients had motor fluctuations whereas non-motor fluctuations were present in 61.80% of cases. STN DBS decreased the LEDD by 51.72%, as the mean LEDD post-surgery was 450 [188-800]. The UPDRS-III was improved by 52.27%, dyskinesia score by 66.70% and motor fluctuations by 50%, whereas QOL improved by 27.12%. Post-operative side effects were hypophonia (2 cases), infection (3 cases), and pneumocephalus (2 cases). Conclusion: Our results showed that STN DBS is an effective treatment in Moroccan Parkinsonian patients leading to a major improvement of the most disabling symptoms (dyskinesia, motor fluctuation) and a better QOL.
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Affiliation(s)
- Mounia Rahmani
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Maria Benabdeljlil
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Fouad Bellakhdar
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Mustapha El Alaoui Faris
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Mohamed Jiddane
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Khalil El Bayad
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Fatima Boutbib
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Rachid Razine
- Laboratory of Biostatistics, Clinical Research and Epidemiology, Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - Rachid Gana
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Moulay R El Hassani
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Nizar El Fatemi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Meryem Fikri
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Siham Sanhaji
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Hennou Tassine
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Imane El Alaoui Balrhiti
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Souad El Hadri
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Najwa Ech-Cherif Kettani
- Department of Neuroradiology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Najia El Abbadi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Mourad Amor
- Department of Anesthesia and Intensive Care, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdelmjid Moussaoui
- Department of Anesthesia and Intensive Care, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Afifa Semlali
- Department of Surgical Intensive Care, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Saadia Aidi
- Research Team in Neurology and Neurogenetics, Department of Neurology A and Neuropsychology, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - El Hachmia Ait Benhaddou
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Ali Benomar
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Ahmed Bouhouche
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Mohamed Yahyaoui
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdeslam El Khamlichi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdessamad El Ouahabi
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Rachid El Maaqili
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Hôpital Ibn Sina, University Mohammed V, Rabat, Morocco
| | - Houyam Tibar
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Yasser Arkha
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Adyl Melhaoui
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, Centre de Rehabilitation et de Neurosciences, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
| | - Abdelhamid Benazzouz
- Centre National de la Recherche Scientifique, Institut des Maladies Neurodégénératives, Univ. de Bordeaux UMR 5293, Bordeaux, France
| | - Wafa Regragui
- Research Team in Neurology and Neurogenetics, Department of Neurology B and Neurogenetics, Faculty of Medicine and Pharmacy, Hôpital des Spécialités ONO, University Mohammed V, Rabat, Morocco
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13
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Foley JA, Foltynie T, Limousin P, Cipolotti L. Standardised Neuropsychological Assessment for the Selection of Patients Undergoing DBS for Parkinson's Disease. PARKINSON'S DISEASE 2018; 2018:4328371. [PMID: 29971141 PMCID: PMC6009029 DOI: 10.1155/2018/4328371] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/23/2018] [Accepted: 04/30/2018] [Indexed: 11/17/2022]
Abstract
DBS is an increasingly offered advanced treatment for Parkinson's disease (PD). Neuropsychological assessment is considered to be an important part of the screening for selection of candidates for this treatment. However, no standardised screening procedure currently exists. In this study, we examined the use of our standardised neuropsychological assessment for the evaluation of surgical candidates and to identify risk factors for subsequent decline in cognition and mood. A total of 40 patients were assessed before and after DBS. Evaluation of mood and case notes review was also undertaken. Before DBS, patients with PD demonstrated frequent impairments in intellectual functioning, memory, attention, and executive function, as well as high rates of mood disorder. Post-DBS, there was a general decline in verbal fluency only, and in one patient, we documented an immediate and irreversible global cognitive decline, which was associated with older age and more encompassing cognitive deficits at baseline. Case note review revealed that a high proportion of patients developed mood disorder, which was associated with higher levels of depression at baseline and greater reduction in levodopa medication. We conclude that our neuropsychological assessment is suitable for the screening of candidates and can identify baseline risk factors, which requires careful consideration before and after surgery.
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Affiliation(s)
- Jennifer A. Foley
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Tom Foltynie
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Patricia Limousin
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Neurology, Queen Square, London, UK
| | - Lisa Cipolotti
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Dipartimento di Scienze Psicologiche, Pedagogiche e della Formazione, Università degli Studi di Palermo, Palermo, Italy
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14
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Iqbal M, Rehan M, Hong KS. Robust Adaptive Synchronization of Ring Configured Uncertain Chaotic FitzHugh-Nagumo Neurons under Direction-Dependent Coupling. Front Neurorobot 2018. [PMID: 29535622 PMCID: PMC5834533 DOI: 10.3389/fnbot.2018.00006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This paper exploits the dynamical modeling, behavior analysis, and synchronization of a network of four different FitzHugh–Nagumo (FHN) neurons with unknown parameters linked in a ring configuration under direction-dependent coupling. The main purpose is to investigate a robust adaptive control law for the synchronization of uncertain and perturbed neurons, communicating in a medium of bidirectional coupling. The neurons are assumed to be different and interconnected in a ring structure. The strength of the gap junctions is taken to be different for each link in the network, owing to the inter-neuronal coupling medium properties. Robust adaptive control mechanism based on Lyapunov stability analysis is employed and theoretical criteria are derived to realize the synchronization of the network of four FHN neurons in a ring form with unknown parameters under direction-dependent coupling and disturbances. The proposed scheme for synchronization of dissimilar neurons, under external electrical stimuli, coupled in a ring communication topology, having all parameters unknown, and subject to directional coupling medium and perturbations, is addressed for the first time as per our knowledge. To demonstrate the efficacy of the proposed strategy, simulation results are provided.
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Affiliation(s)
- Muhammad Iqbal
- Department of Computer and Information Sciences, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad, Pakistan
| | - Muhammad Rehan
- Department of Electrical Engineering, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad, Pakistan
| | - Keum-Shik Hong
- Department of Cogno-Mechatronics Engineering, School of Mechanical Engineering, Pusan National University, Busan, South Korea
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15
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Ghahremani A, Wessel JR, Udupa K, Neagu B, Zhuang P, Saha U, Kalia SK, Hodaie M, Lozano AM, Aron AR, Chen R. Stopping and slowing manual and spoken responses: Similar oscillatory signatures recorded from the subthalamic nucleus. BRAIN AND LANGUAGE 2018; 176:1-10. [PMID: 29125966 DOI: 10.1016/j.bandl.2017.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 06/07/2023]
Abstract
Response control in the forms of stopping and slowing responses is thought to be implemented by a frontal-subcortical network, which includes the subthalamic nucleus (STN). For manual control, stopping is linked to STN beta (13-30 Hz) and slowing responses are linked to lower frequencies (<12 Hz). Whether similar STN oscillatory activities are associated with the control of spoken responses is not clear. We studied 16 patients with STN LFP recordings during manual and vocal stop signal tasks in two experiments. We found increased beta activities for stopping spoken responses, similar to manual stopping. However, unlike manual stopping, stopping spoken responses elicited a right-lateralized beta power increase, which may be related to previously reported hyperactivity of right-sided motor control regions in stuttering. We additionally studied STN power changes associated with slowing responses in the same stop-signal tasks by comparing slower vs. faster go trials. Now, rather than beta, there was an alpha power increase after Go cues, which remained elevated only in slower Go trials in both the vocal and manual tasks. These data show that different types of response control are generalizable across effectors and relate to different frequencies recorded from the STN.
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Affiliation(s)
- Ayda Ghahremani
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Krembil Research Institute, Toronto, ON, Canada
| | - Jan R Wessel
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA 52245, USA; Department of Neurology, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
| | | | | | - Ping Zhuang
- Beijing Institute of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Key Laboratory for Neurodegenerative Diseases of Ministry of Education, China
| | - Utpal Saha
- Krembil Research Institute, Toronto, ON, Canada
| | - Suneil K Kalia
- Krembil Research Institute, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Mojgan Hodaie
- Krembil Research Institute, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Andres M Lozano
- Krembil Research Institute, Toronto, ON, Canada; Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Adam R Aron
- Department of Psychology, University of California San Diego, La Jolla, CA 92093, USA
| | - Robert Chen
- Krembil Research Institute, Toronto, ON, Canada; Division of Neurology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
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16
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Pham T, Bronstein JM. Neuropsychological outcomes from deep brain stimulation-stimulation versus micro-lesion. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:217. [PMID: 28603732 DOI: 10.21037/atm.2017.02.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tammy Pham
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeff M Bronstein
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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17
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Iqbal M, Rehan M, Hong KS. Modeling of inter-neuronal coupling medium and its impact on neuronal synchronization. PLoS One 2017; 12:e0176986. [PMID: 28486505 PMCID: PMC5423630 DOI: 10.1371/journal.pone.0176986] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/20/2017] [Indexed: 11/18/2022] Open
Abstract
In this paper, modeling of the coupling medium between two neurons, the effects of the model parameters on the synchronization of those neurons, and compensation of coupling strength deficiency in synchronization are studied. Our study exploits the inter-neuronal coupling medium and investigates its intrinsic properties in order to get insight into neuronal-information transmittance and, there from, brain-information processing. A novel electrical model of the coupling medium that represents a well-known RLC circuit attributable to the coupling medium’s intrinsic resistive, inductive, and capacitive properties is derived. Surprisingly, the integration of such properties reveals the existence of a natural three-term control strategy, referred to in the literature as the proportional integral derivative (PID) controller, which can be responsible for synchronization between two neurons. Consequently, brain-information processing can rely on a large number of PID controllers based on the coupling medium properties responsible for the coherent behavior of neurons in a neural network. Herein, the effects of the coupling model (or natural PID controller) parameters are studied and, further, a supervisory mechanism is proposed that follows a learning and adaptation policy based on the particle swarm optimization algorithm for compensation of the coupling strength deficiency.
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Affiliation(s)
- Muhammad Iqbal
- Department of Computer and Information Sciences, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad, Pakistan
| | - Muhammad Rehan
- Department of Electrical Engineering, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad, Pakistan
- * E-mail:
| | - Keum-Shik Hong
- Department of Cogno-Mechatronics Engineering and School of Mechanical Engineering, Pusan National University, Geumjeong-gu, Busan, Republic of Korea
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18
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Meta-Analysis of the Relationship between Deep Brain Stimulation in Patients with Parkinson's Disease and Performance in Evaluation Tests for Executive Brain Functions. PARKINSONS DISEASE 2017; 2017:9641392. [PMID: 28280646 PMCID: PMC5320384 DOI: 10.1155/2017/9641392] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/11/2016] [Indexed: 01/04/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative condition, which compromises the motor functions and causes the alteration of some executive brain functions. The presence of changes in cognitive symptoms in PD could be due to the procedure of deep brain stimulation (DBS). We searched in several databases for studies that compared performance in executive function tests before and after the DBS procedure in PE and then performed a meta-analysis. After the initial search, there were 15 articles that specifically evaluated the functions of verbal fluency, working memory, cognitive flexibility, abstract thinking, and inhibition. It was found that there were differences in the evaluation of the cognitive functions in terms of the protocols, which generated heterogeneity in the results of the meta-analysis. Likewise, a tendency to diminish functions like verbal fluency and inhibition was found, being this consistent with similar studies. In the other functions evaluated, no difference was found between pre- and postsurgery scores. Monitoring of this type of function is recommended after the procedure.
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Calice da Silva C, Azevedo BN, Machado DC, Zimmer ER, Martins LAM, da Costa JC. Dissociation between dopaminergic response and motor behavior following intrastriatal, but not intravenous, transplant of bone marrow mononuclear stem cells in a mouse model of Parkinson's disease. Behav Brain Res 2017; 324:30-40. [PMID: 28167338 DOI: 10.1016/j.bbr.2017.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Revised: 01/29/2017] [Accepted: 02/02/2017] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is characterized by the progressive loss of dopaminergic neurons from the substantia nigra, a process that leads to a dopamine deficiency in the striatum. This deficiency is responsible for the development of motor symptoms, including resting tremor, bradykinesia, rigidity and postural instability. Based on the observation of substantial neuronal death, alternatives to Parkinson's disease treatment have been studied, including cell-based therapies. The present study aimed to assess the therapeutic potential of intravenous and intrastriatal transplant of bone marrow mononuclear cells in a mouse model of Parkinson's disease. Animals underwent stereotaxic surgery and received an injection of 6-hydroxydopamine into their medial forebrain bundle. Three weeks later, mice were injected with bone marrow mononuclear cells or saline through the caudal vein or directly into their right striatum. Motor function was assessed using the rotarod and apomorphine-induced rotation tests. Our results showed that intrastriatal bone marrow mononuclear cells, but not intravenous, have a short-term therapeutic effect on dopaminergic response in this mice model of parkinsonism assessed by the apomorphine-induced rotation test. This phenomenon was not identified on the rotarod test, showing dissociation between dopaminergic response and motor behavior. Further experiments are needed to elucidate the precise mechanisms involved in these effects.
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Affiliation(s)
- Caroline Calice da Silva
- Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, 90619-900, Brazil; Laboratory of Neurosciences and Cellular Signaling, Institute of Biomedical Research and Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, 90619-900, Brazil
| | - Bárbara Nunes Azevedo
- Laboratory of Neurosciences and Cellular Signaling, Institute of Biomedical Research and Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, 90619-900, Brazil
| | - Denise Cantarelli Machado
- Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, 90619-900, Brazil; Laboratory of Molecular and Cellular Biology, Institute of Biomedical Research, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, 90619-900, Brazil
| | - Eduardo R Zimmer
- Department of Biochemistry, Institute of Basic Health Sciences (ICBS), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-003, Brazil
| | - Leo Anderson Meira Martins
- Department of Biochemistry, Institute of Basic Health Sciences (ICBS), Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, 90035-003, Brazil
| | - Jaderson Costa da Costa
- Postgraduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, 90619-900, Brazil; Laboratory of Neurosciences and Cellular Signaling, Institute of Biomedical Research and Brain Institute of Rio Grande do Sul (BraIns), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, 90619-900, Brazil.
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20
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Neumaier F, Paterno M, Alpdogan S, Tevoufouet EE, Schneider T, Hescheler J, Albanna W. Surgical Approaches in Psychiatry: A Survey of the World Literature on Psychosurgery. World Neurosurg 2017; 97:603-634.e8. [DOI: 10.1016/j.wneu.2016.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/29/2016] [Accepted: 10/01/2016] [Indexed: 12/11/2022]
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21
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Zwirner J, Möbius D, Bechmann I, Arendt T, Hoffmann KT, Jäger C, Lobsien D, Möbius R, Planitzer U, Winkler D, Morawski M, Hammer N. Subthalamic nucleus volumes are highly consistent but decrease age-dependently-a combined magnetic resonance imaging and stereology approach in humans. Hum Brain Mapp 2016; 38:909-922. [PMID: 27726278 DOI: 10.1002/hbm.23427] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Revised: 09/08/2016] [Accepted: 09/26/2016] [Indexed: 01/03/2023] Open
Abstract
The subthalamic nucleus (STN) is a main target structure of deep brain stimulation (DBS) in idiopathic Parkinson's disease. Nevertheless, there is an ongoing discussion regarding human STN volumes and neuron count, which could potentially have an impact on STN-DBS. Moreover, a suspected functional subdivision forms the basis of the tripartite hypothesis, which has not yet been morphologically substantiated. In this study, it was aimed to investigate the human STN by means of combined magnetic resonance imaging (MRI) and stereology. STN volumes were obtained from 14 individuals (ranging from 65 to 96 years, 25 hemispheres) in 3 T MRI and in luxol-stained histology slices. Neuron number and cell densities were investigated stereologically over the entire STN and in pre-defined subregions in anti-human neuronal protein HuC/D-stained slices. STN volumes measured with MRI were smaller than in stereology but appeared to be highly consistent, measuring on average 99 ± 6 mm3 (MRI) and 132 ± 20 mm3 (stereology). The neuron count was 431,088 ± 72,172. Both STN volumes and cell count decreased age-dependently. Neuron density was different for the dorsal, medial and ventral subregion with significantly higher values ventrally than dorsally. Small variations in STN volumes in both MRI and stereology contradict previous findings of large variations in STN size. Age-dependent decreases in STN volumes and neuron numbers might influence the efficacy of STN-DBS in a geriatric population. Though the study is limited in sample size, site-dependent differences for the STN subregions form a morphological basis for the tripartite theory. Hum Brain Mapp 38:909-922, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Johann Zwirner
- Faculty of Medicine, Institute of Anatomy University of Leipzig, Leipzig, Germany
| | - Dustin Möbius
- Faculty of Medicine, Institute of Anatomy University of Leipzig, Leipzig, Germany
| | - Ingo Bechmann
- Faculty of Medicine, Institute of Anatomy University of Leipzig, Leipzig, Germany
| | - Thomas Arendt
- Paul-Flechsig-Institute for Brain Research University of Leipzig, Leipzig, Germany
| | - Karl-Titus Hoffmann
- Department of Neuroradiology, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Carsten Jäger
- Paul-Flechsig-Institute for Brain Research University of Leipzig, Leipzig, Germany
| | - Donald Lobsien
- Department of Neuroradiology, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Robert Möbius
- Faculty of Medicine, Institute of Anatomy University of Leipzig, Leipzig, Germany
| | - Uwe Planitzer
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Dirk Winkler
- Department of Neurosurgery, University Clinic of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - Markus Morawski
- Paul-Flechsig-Institute for Brain Research University of Leipzig, Leipzig, Germany
| | - Niels Hammer
- Faculty of Medicine, Institute of Anatomy University of Leipzig, Leipzig, Germany.,Department of Anatomy, University of Otago, Dunedin, New Zealand
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22
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Sousa SCP, Almeida J, Cavaleiro Miranda P, Salvador R, Silvestre J, Simões H, Crespo P. Optimization of multiple coils immersed in a conducting liquid for half-hemisphere or whole-brain deep transcranial magnetic stimulation: a simulation study. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2014:538-41. [PMID: 25570015 DOI: 10.1109/embc.2014.6943647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transcranial magnetic stimulation (TMS) was proposed in 1985. Nevertheless, its wider use in the treatment of several neurologic diseases has been hindered by its inability to stimulate deep-brain regions. This is mainly due to the physical limiting effect arising from the presence of surface discontinuities, particularly between the scalp and air. Here, we present the optimization of a system of large multiple coils for whole-brain and half-hemisphere deep TMS, termed orthogonal configuration. COMSOL(®)-based simulations show that the system is capable of reaching the very center of a spherical brain phantom with 58% induction relative to surface maximum. Such penetration capability surpasses to the best of our knowledge that of existing state of the art TMS systems. This induction capability strongly relies on the immersion of the stimulating coils and part of the head of the patient in a conducting liquid (e.g. simple saline solution). We show the impact of the presence of this surrounding conducting liquid by comparing the performance of our system with and without such liquid. In addition, we also compare the performance of the proposed coil with that of a circular coil, a figure-eight coil, and the H-coil. Finally, in addition to its whole-brain stimulation capability (e.g. potentially useful for prophylaxis of epileptic patients) the system is also able to stimulate mainly one brain hemisphere, which may be useful in stroke rehabilitation, among other applications.
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23
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Su F, Wang J, Deng B, Wei XL, Chen YY, Liu C, Li HY. Adaptive control of Parkinson's state based on a nonlinear computational model with unknown parameters. Int J Neural Syst 2015; 25:1450030. [PMID: 25338775 DOI: 10.1142/s0129065714500300] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective here is to explore the use of adaptive input-output feedback linearization method to achieve an improved deep brain stimulation (DBS) algorithm for closed-loop control of Parkinson's state. The control law is based on a highly nonlinear computational model of Parkinson's disease (PD) with unknown parameters. The restoration of thalamic relay reliability is formulated as the desired outcome of the adaptive control methodology, and the DBS waveform is the control input. The control input is adjusted in real time according to estimates of unknown parameters as well as the feedback signal. Simulation results show that the proposed adaptive control algorithm succeeds in restoring the relay reliability of the thalamus, and at the same time achieves accurate estimation of unknown parameters. Our findings point to the potential value of adaptive control approach that could be used to regulate DBS waveform in more effective treatment of PD.
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Affiliation(s)
- Fei Su
- School of Electrical and Automation Engineering, Tianjin University, Tianjin 300072, China
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24
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Li H, Lei X, Yan T, Li H, Huang B, Li L, Xu L, Liu L, Chen N, Lü L, Ma Y, Xu L, Li J, Wang Z, Zhang B, Hu X. The temporary and accumulated effects of transcranial direct current stimulation for the treatment of advanced Parkinson's disease monkeys. Sci Rep 2015. [PMID: 26220760 PMCID: PMC4518219 DOI: 10.1038/srep12178] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Transcranial direct current stimulation (tDCS) is a useful noninvasive technique of cortical brain stimulation for the treatment of neurological disorders. Clinical research has demonstrated tDCS with anodal stimulation of primary motor cortex (M1) in Parkinson’s disease (PD) patients significantly improved their motor function. However, few studies have been focused on the optimization of parameters which contributed significantly to the treatment effects of tDCS and exploration of the underline neuronal mechanisms. Here, we used different stimulation parameters of anodal tDCS on M1 for the treatment of aged advanced PD monkeys induced with 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine (MPTP) administration, and then analyzed the temporary and accumulated effects of tDCS treatment. The results indicated anodal tDCS on M1 very significantly improved motor ability temporarily; importantly, the treatment effects of anodal tDCS on M1 were quantitatively correlated to the accumulated stimulation instead of the stimuli intensity or duration respectively. In addition, c-fos staining showed tDCS treatment effects activated the neurons both in M1 and substantia nigra (SN). Therefore, we propose that long time and continue anodal tDCS on M1 is a better strategy to improve the motor symptoms of PD than individual manipulation of stimuli intensity or duration.
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Affiliation(s)
- Hao Li
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Xiaoguang Lei
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Ting Yan
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Hongwei Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Baihui Huang
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Ling Li
- Medical imaging department, Kunming general hospital of PLA, Kunming, Yunnan, 650032, China
| | - Liqi Xu
- Medical imaging department, Kunming general hospital of PLA, Kunming, Yunnan, 650032, China
| | - Li Liu
- Medical imaging department, Kunming general hospital of PLA, Kunming, Yunnan, 650032, China
| | - Nanhui Chen
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Longbao Lü
- Kunming Primate Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Yuanye Ma
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] Kunming Primate Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Lin Xu
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] CAS Center for Excellence in Brain Science, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Jiali Li
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Zhengbo Wang
- Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
| | - Baorong Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China
| | - Xintian Hu
- 1] Key Laboratory of Animal Models and Human Disease Mechanisms of Chinese Academy of Sciences &Yunnan Province, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China [2] CAS Center for Excellence in Brain Science, Chinese Academy of Sciences, Shanghai, 200031, China [3] Kunming Primate Research Center, Kunming Institute of Zoology, Chinese Academy of Sciences, Kunming, Yunnan, 650223, China
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Lei X, Huang B, Li H, Jiang H, Hu X, Zhang B. Drift in centrality of different brain regions in an anatomical neural network with Parkinson’s disease: A view from complex network analysis. Neuroscience 2015; 299:107-24. [DOI: 10.1016/j.neuroscience.2015.04.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/12/2015] [Accepted: 04/22/2015] [Indexed: 10/23/2022]
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Lee JY, Khaing ZZ, Siegel JJ, Schmidt CE. Surface modification of neural electrodes with pyrrole-hyaluronic acid conjugate to attenuate reactive astrogliosis in vivo. RSC Adv 2015; 5:39228-39231. [PMID: 35528963 PMCID: PMC9075707 DOI: 10.1039/c5ra03294f] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
Surface of neural probes were electrochemically modified with a non-cell adhesive and biocompatible conjugate, pyrrole-hyaluronic acid (PyHA), to reduce reactive astrogliosis. Poly(PyHA)-modified wire electrodes were implanted into rat motor cortices for three weeks and were found to markedly reduce the expression of glial fibrillary acidic protein compared to uncoated electrodes.
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Affiliation(s)
- J Y Lee
- Department of Chemical Engineering, The University of Texas at Austin, Austin, TX, USA
- School of Materials Science and Engineering, Gwangju Institute of Science and Engineering, Gwangju, South Korea
| | - Z Z Khaing
- Department of Biomedical Engineering, The University of Florida at Gainesville, Gainesville, FL, USA
| | - J J Siegel
- Center for Learning and Memory, The University of Texas at Austin, Austin, TX, USA
| | - C E Schmidt
- Department of Chemical Engineering, The University of Texas at Austin, Austin, TX, USA
- Department of Biomedical Engineering, The University of Florida at Gainesville, Gainesville, FL, USA
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27
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Paffi A, Camera F, Apollonio F, d'Inzeo G, Liberti M. Numerical characterization of intraoperative and chronic electrodes in deep brain stimulation. Front Comput Neurosci 2015; 9:2. [PMID: 25745397 PMCID: PMC4333814 DOI: 10.3389/fncom.2015.00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022] Open
Abstract
An intraoperative electrode (microelectrode) is used in the deep brain stimulation (DBS) technique to pinpoint the brain target and to choose the best parameters for the electrical stimulus. However, when the intraoperative electrode is replaced with the chronic one (macroelectrode), the observed effects do not always coincide with predictions. To investigate the causes of such discrepancies, a 3D model of the basal ganglia has been considered and realistic models of both intraoperative and chronic electrodes have been developed and numerically solved. Results of simulations of the electric potential (V) and the activating function (AF) along neuronal fibers show that the different geometries and sizes of the two electrodes do not change the distributions and polarities of these functions, but rather the amplitudes. This effect is similar to the one produced by the presence of different tissue layers (edema or glial tissue) in the peri-electrode space. Conversely, an inaccurate positioning of the chronic electrode with respect to the intraoperative one (electric centers not coincident) may induce a completely different electric stimulation in some groups of fibers.
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Affiliation(s)
- Alessandra Paffi
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome Rome, Italy
| | - Francesca Camera
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome Rome, Italy
| | - Francesca Apollonio
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome Rome, Italy
| | - Guglielmo d'Inzeo
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome Rome, Italy
| | - Micaela Liberti
- Department of Information Engineering, Electronics and Telecommunications (DIET), Sapienza University of Rome Rome, Italy
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28
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The prefrontal cortex achieves inhibitory control by facilitating subcortical motor pathway connectivity. J Neurosci 2015; 35:786-94. [PMID: 25589771 PMCID: PMC4293423 DOI: 10.1523/jneurosci.3093-13.2015] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Communication between the prefrontal cortex and subcortical nuclei underpins the control and inhibition of behavior. However, the interactions in such pathways remain controversial. Using a stop-signal response inhibition task and functional imaging with analysis of effective connectivity, we show that the lateral prefrontal cortex influences the strength of communication between regions in the frontostriatal motor system. We compared 20 generative models that represented alternative interactions between the inferior frontal gyrus, presupplementary motor area (preSMA), subthalamic nucleus (STN), and primary motor cortex during response inhibition. Bayesian model selection revealed that during successful response inhibition, the inferior frontal gyrus modulates an excitatory influence of the preSMA on the STN, thereby amplifying the downstream polysynaptic inhibition from the STN to the motor cortex. Critically, the strength of the interaction between preSMA and STN, and the degree of modulation by the inferior frontal gyrus, predicted individual differences in participants' stopping performance (stop-signal reaction time). We then used diffusion-weighted imaging with tractography to assess white matter structure in the pathways connecting these three regions. The mean diffusivity in tracts between preSMA and the STN, and between the inferior frontal gyrus and STN, also predicted individual differences in stopping efficiency. Finally, we found that white matter structure in the tract between preSMA and STN correlated with effective connectivity of the same pathway, providing important cross-modal validation of the effective connectivity measures. Together, the results demonstrate the network dynamics and modulatory role of the prefrontal cortex that underpin individual differences in inhibitory control.
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30
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Plantinga BR, Temel Y, Roebroeck A, Uludağ K, Ivanov D, Kuijf ML, Ter Haar Romenij BM. Ultra-high field magnetic resonance imaging of the basal ganglia and related structures. Front Hum Neurosci 2014; 8:876. [PMID: 25414656 PMCID: PMC4220687 DOI: 10.3389/fnhum.2014.00876] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/10/2014] [Indexed: 12/13/2022] Open
Abstract
Deep brain stimulation is a treatment for Parkinson's disease and other related disorders, involving the surgical placement of electrodes in the deeply situated basal ganglia or thalamic structures. Good clinical outcome requires accurate targeting. However, due to limited visibility of the target structures on routine clinical MR images, direct targeting of structures can be challenging. Non-clinical MR scanners with ultra-high magnetic field (7T or higher) have the potential to improve the quality of these images. This technology report provides an overview of the current possibilities of visualizing deep brain stimulation targets and their related structures with the aid of ultra-high field MRI. Reviewed studies showed improved resolution, contrast- and signal-to-noise ratios at ultra-high field. Sequences sensitive to magnetic susceptibility such as T2* and susceptibility weighted imaging and their maps in general showed the best visualization of target structures, including a separation between the subthalamic nucleus and the substantia nigra, the lamina pallidi medialis and lamina pallidi incompleta within the globus pallidus and substructures of the thalamus, including the ventral intermediate nucleus (Vim). This shows that the visibility, identification, and even subdivision of the small deep brain stimulation targets benefit from increased field strength. Although ultra-high field MR imaging is associated with increased risk of geometrical distortions, it has been shown that these distortions can be avoided or corrected to the extent where the effects are limited. The availability of ultra-high field MR scanners for humans seems to provide opportunities for a more accurate targeting for deep brain stimulation in patients with Parkinson's disease and related disorders.
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Affiliation(s)
- Birgit R Plantinga
- Biomedical Image Analysis, Eindhoven University of Technology Eindhoven, Netherlands ; Department of Neuroscience, Maastricht University Maastricht, Netherlands
| | - Yasin Temel
- Department of Neuroscience, Maastricht University Maastricht, Netherlands ; Department of Neurology, Maastricht University Medical Center Maastricht, Netherlands
| | - Alard Roebroeck
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Kâmil Uludağ
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Dimo Ivanov
- Department of Neurosurgery, Maastricht University Medical Center Maastricht, Netherlands
| | - Mark L Kuijf
- Department of Cognitive Neuroscience, Maastricht University Maastricht, Netherlands
| | - Bart M Ter Haar Romenij
- Biomedical Image Analysis, Eindhoven University of Technology Eindhoven, Netherlands ; Department of Biomedical and Information Engineering, Northeastern University Shenyang, China
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31
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To move or not to move: Subthalamic deep brain stimulation effects on implicit motor simulation. Brain Res 2014; 1574:14-25. [DOI: 10.1016/j.brainres.2014.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 05/13/2014] [Accepted: 06/06/2014] [Indexed: 11/23/2022]
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32
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Synchronization of coupled different chaotic FitzHugh-Nagumo neurons with unknown parameters under communication-direction-dependent coupling. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2014; 2014:367173. [PMID: 25101140 PMCID: PMC4101220 DOI: 10.1155/2014/367173] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/24/2014] [Accepted: 05/28/2014] [Indexed: 12/04/2022]
Abstract
This paper investigates the chaotic behavior and synchronization of two different coupled chaotic FitzHugh-Nagumo (FHN) neurons with unknown parameters under external electrical stimulation (EES). The coupled FHN neurons of different parameters admit unidirectional and bidirectional gap junctions in the medium between them. Dynamical properties, such as the increase in synchronization error as a consequence of the deviation of neuronal parameters for unlike neurons, the effect of difference in coupling strengths caused by the unidirectional gap junctions, and the impact of large time-delay due to separation of neurons, are studied in exploring the behavior of the coupled system. A novel integral-based nonlinear adaptive control scheme, to cope with the infeasibility of the recovery variable, for synchronization of two coupled delayed chaotic FHN neurons of different and unknown parameters under uncertain EES is derived. Further, to guarantee robust synchronization of different neurons against disturbances, the proposed control methodology is modified to achieve the uniformly ultimately bounded synchronization. The parametric estimation errors can be reduced by selecting suitable control parameters. The effectiveness of the proposed control scheme is illustrated via numerical simulations.
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33
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Sui L, Huang S, Peng B, Ren J, Tian F, Wang Y. Deep brain stimulation of the amygdala alleviates fear conditioning-induced alterations in synaptic plasticity in the cortical–amygdala pathway and fear memory. J Neural Transm (Vienna) 2014; 121:773-82. [DOI: 10.1007/s00702-014-1183-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 02/21/2014] [Indexed: 11/28/2022]
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34
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A numerical study to compare stimulations by intraoperative microelectrodes and chronic macroelectrodes in the DBS technique. BIOMED RESEARCH INTERNATIONAL 2013; 2013:262739. [PMID: 24222899 PMCID: PMC3814092 DOI: 10.1155/2013/262739] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/29/2013] [Indexed: 11/30/2022]
Abstract
Deep brain stimulation is a clinical technique for the treatment of parkinson's disease based on the electric stimulation, through an implanted electrode, of specific basal ganglia in the brain. To identify the correct target of stimulation and to choose the optimal parameters for the stimulating signal, intraoperative microelectrodes are generally used. However, when they are replaced with the chronic macroelectrode, the effect of the stimulation is often very different. Here, we used numerical simulations to predict the stimulation of neuronal fibers induced by microelectrodes and macroelectrodes placed in different positions with respect to each other. Results indicate that comparable stimulations can be obtained if the chronic macroelectrode is correctly positioned with the same electric center of the intraoperative microelectrode. Otherwise, some groups of fibers may experience a completely different electric stimulation.
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Abstract
The subthalamic nucleus (STh) is a small subcortical structure which is involved in regulating motor as well as cognitive functions. Due to its small size and close proximity to other small subcortical structures, it has been a challenge to localize and visualize it using magnetic resonance imaging (MRI). Currently there are several standard atlases available that are used to localize the STh in functional MRI studies and clinical procedures such as deep brain stimulation (DBS). DBS is an increasingly common neurosurgical procedure that has been successfully used to alleviate motor symptoms present in Parkinson's disease. However, current atlases are based on low sample sizes and restricted age ranges (Schaltenbrand and Wahren, 1977), and hence the use of these atlases effectively ignores the substantial structural brain changes that are associated with aging. In the present study, ultra-high field 7 tesla (T) magnetic resonance imaging (MRI) in humans was used to visualize and segment the STh in young, middle-aged, and elderly participants. The resulting probabilistic atlas maps for all age groups show that the STh shifts in the lateral direction with increasing age. In sum, the results of the present study suggest that age has to be taken into account in atlases for the optimal localization of the STh in healthy and diseased brains.
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36
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Amano S, Roemmich RT, Skinner JW, Hass CJ. Ambulation and Parkinson Disease. Phys Med Rehabil Clin N Am 2013; 24:371-92. [DOI: 10.1016/j.pmr.2012.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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37
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Rehan M, Hong KS. Modeling and automatic feedback control of tremor: adaptive estimation of deep brain stimulation. PLoS One 2013; 8:e62888. [PMID: 23638163 PMCID: PMC3634768 DOI: 10.1371/journal.pone.0062888] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Accepted: 03/26/2013] [Indexed: 11/18/2022] Open
Abstract
This paper discusses modeling and automatic feedback control of (postural and rest) tremor for adaptive-control-methodology-based estimation of deep brain stimulation (DBS) parameters. The simplest linear oscillator-based tremor model, between stimulation amplitude and tremor, is investigated by utilizing input-output knowledge. Further, a nonlinear generalization of the oscillator-based tremor model, useful for derivation of a control strategy involving incorporation of parametric-bound knowledge, is provided. Using the Lyapunov method, a robust adaptive output feedback control law, based on measurement of the tremor signal from the fingers of a patient, is formulated to estimate the stimulation amplitude required to control the tremor. By means of the proposed control strategy, an algorithm is developed for estimation of DBS parameters such as amplitude, frequency and pulse width, which provides a framework for development of an automatic clinical device for control of motor symptoms. The DBS parameter estimation results for the proposed control scheme are verified through numerical simulations.
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Affiliation(s)
- Muhammad Rehan
- Department of Electrical Engineering, Pakistan Institute of Engineering and Applied Sciences (PIEAS), Islamabad, Pakistan.
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38
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Liu HG, Ma Y, Zhang K, Ge M, Meng FG, Feng T, Wan XH, Guo Y, Wang RZ, Yang AC, Hu WH, Guo JZ, Zhang JG. Subthalamic Deep Brain Stimulation With a New Device in Parkinson's Disease: An Open-Label Trial. Neuromodulation 2013; 16:212-8; discussion 218. [DOI: 10.1111/ner.12050] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 01/14/2013] [Accepted: 02/07/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Huan-guang Liu
- Department of Neurology and Neurosurgery; Beijing Tiantan Hospital; Capital Medical University; Beijing; China
| | - Yu Ma
- Beijing Neurosurgical Institute; Capital Medical University; Beijing; China
| | - Kai Zhang
- Department of Neurology and Neurosurgery; Beijing Tiantan Hospital; Capital Medical University; Beijing; China
| | - Ming Ge
- Department of Neurology and Neurosurgery; Beijing Tiantan Hospital; Capital Medical University; Beijing; China
| | - Fan-gang Meng
- Beijing Neurosurgical Institute; Capital Medical University; Beijing; China
| | - Tao Feng
- Department of Neurology and Neurosurgery; Beijing Tiantan Hospital; Capital Medical University; Beijing; China
| | - Xin-hua Wan
- Peking Union Medical College Hospital; Beijing; China
| | - Yi Guo
- Peking Union Medical College Hospital; Beijing; China
| | - Ren-zhi Wang
- Peking Union Medical College Hospital; Beijing; China
| | - An-chao Yang
- Department of Neurology and Neurosurgery; Beijing Tiantan Hospital; Capital Medical University; Beijing; China
| | - Wen-han Hu
- Beijing Neurosurgical Institute; Capital Medical University; Beijing; China
| | - Jin-zu Guo
- Peking Union Medical College Hospital; Beijing; China
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39
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40
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Favre E, Ballanger B, Thobois S, Broussolle E, Boulinguez P. Deep brain stimulation of the subthalamic nucleus, but not dopaminergic medication, improves proactive inhibitory control of movement initiation in Parkinson's disease. Neurotherapeutics 2013; 10:154-67. [PMID: 23184315 PMCID: PMC3557357 DOI: 10.1007/s13311-012-0166-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Slowness in movement initiation is a cardinal feature of Parkinson's disease (PD) that is still poorly understood and unsuccessfully alleviated by standard therapies. Here, we raise this major clinical issue within the framework of a novel theoretical model that allows a better understanding of the basic mechanisms involved in movement initiation. This model assumes that movement triggering is inhibited by default to prevent automatic responses to unpredictable events. We investigated to which extent the top-down control necessary to release this locking state before initiating actions is impaired in PD and restored by standard therapies. We used a cue-target reaction time task to test both the ability to initiate fast responses to targets and the ability to refrain from reacting to cues. Fourteen patients with dopaminergic (DA) medication and 11 with subthalamic nucleus (STN) stimulation were tested on and off treatment, and compared with 14 healthy controls. We found evidence that patients withdrawn from treatment have trouble voluntarily releasing proactive inhibitory control; while DA medication broadly reduces movement initiation latency, it does not reinstate a normal pattern of movement initiation; and stimulation of the STN specifically re-establishes the efficiency of the top-down control of proactive inhibition. These results suggest that movement initiation disorders that resist DA medication are due to executive, not motor, dysfunctions. This conclusion is discussed with regard to the role the STN may play as an interface between non-DA executive and DA motor systems in cortico-basal ganglia loops.
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Affiliation(s)
- Emilie Favre
- />Université de Lyon, 69622 Lyon, France
- />Université Lyon 1, Villeurbanne, France
- />CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- />Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Bénédicte Ballanger
- />Université de Lyon, 69622 Lyon, France
- />Université Lyon 1, Villeurbanne, France
- />CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
| | - Stéphane Thobois
- />Université de Lyon, 69622 Lyon, France
- />Université Lyon 1, Villeurbanne, France
- />CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- />Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Emmanuel Broussolle
- />Université de Lyon, 69622 Lyon, France
- />Université Lyon 1, Villeurbanne, France
- />CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
- />Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Philippe Boulinguez
- />Université de Lyon, 69622 Lyon, France
- />Université Lyon 1, Villeurbanne, France
- />CNRS, UMR5229, Centre de Neuroscience Cognitive, Bron, France
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41
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Robust synchronization of delayed chaotic FitzHugh-Nagumo neurons under external electrical stimulation. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2012. [PMID: 23197990 PMCID: PMC3502803 DOI: 10.1155/2012/230980] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Synchronization of chaotic neurons under external electrical stimulation (EES) is studied in order to understand information processing in the brain and to improve the methodologies employed in the treatment of cognitive diseases. This paper investigates the dynamics of uncertain coupled chaotic delayed FitzHugh-Nagumo (FHN) neurons under EES for incorporated parametric variations. A global nonlinear control law for synchronization of delayed neurons with known parameters is developed. Based on local and global Lipschitz conditions, knowledge of the bounds on the neuronal states, the Lyapunov-Krasovskii functional, and the L(2) gain reduction, a less conservative local robust nonlinear control law is formulated to address the problem of robust asymptotic synchronization of delayed FHN neurons under parametric uncertainties. The proposed local control law guarantees both robust stability and robust performance and provides the L(2) bound for uncertainty rejection in the synchronization error dynamics. Separate conditions for single-input and multiple-input control schemes for synchronization of a wide class of FHN systems are provided. The results of the proposed techniques are verified through numerical simulations.
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42
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Subthalamic local field potentials after seven-year deep brain stimulation in Parkinson's disease. Exp Neurol 2012; 237:312-7. [DOI: 10.1016/j.expneurol.2012.06.012] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/11/2012] [Accepted: 06/16/2012] [Indexed: 11/21/2022]
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Abstract
Movement disorders are neurological conditions affecting speed, fluency, quality, and ease of movement. Deep brain stimulation (DBS) is used to treat advanced Parkinson's disease, essential tremor, and dystonia. Possible target sites for DBS include the ventral intermediate nucleus of the thalamus, the globus pallidus internus, and the subthalamic nucleus. High-frequency DBS leads to a kind of functional deafferentation of the stimulated structure and to the modulation of cortical activity. This has a profound effect on the efficiency of movement. Indications for the use of DBS include the need to improve function, reduce medication dependency, and avoid ablative neurosurgery. Appropriate patient selection is critical for success. The implantation technique is briefly described. Programming stimulation parameters are performed via telemetry. The adverse effects of DBS are discussed. The future should see the development of “closed-loop” systems. Its use has promoted interdisciplinary team work and provided an improved understanding of the complex neurocircuitry associated with these disorders. DBS is a highly effective, safe, and reversible surgical treatment for advanced Parkinson's disease, tremor, and dystonia. It is a useful therapeutic option in carefully selected patients that significantly improves motor symptoms, functional status, and quality of life.
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Schmidt EF, Warner-Schmidt JL, Otopalik BG, Pickett SB, Greengard P, Heintz N. Identification of the cortical neurons that mediate antidepressant responses. Cell 2012; 149:1152-63. [PMID: 22632977 DOI: 10.1016/j.cell.2012.03.038] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Revised: 01/17/2012] [Accepted: 03/07/2012] [Indexed: 12/15/2022]
Abstract
Our understanding of current treatments for depression, and the development of more specific therapies, is limited by the complexity of the circuits controlling mood and the distributed actions of antidepressants. Although the therapeutic efficacy of serotonin-specific reuptake inhibitors (SSRIs) is correlated with increases in cortical activity, the cell types crucial for their action remain unknown. Here we employ bacTRAP translational profiling to show that layer 5 corticostriatal pyramidal cells expressing p11 (S100a10) are strongly and specifically responsive to chronic antidepressant treatment. This response requires p11 and includes the specific induction of Htr4 expression. Cortex-specific deletion of p11 abolishes behavioral responses to SSRIs, but does not lead to increased depression-like behaviors. Our data identify corticostriatal projection neurons as critical for the response to antidepressants, and suggest that the regulation of serotonergic tone in this single cell type plays a pivotal role in antidepressant therapy.
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Affiliation(s)
- Eric F Schmidt
- Laboratory of Molecular Biology, Howard Hughes Medical Institute, The Rockefeller University, 1230 York Ave., New York, NY 10065, USA
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45
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Cholinergic interneurons in the nucleus accumbens regulate depression-like behavior. Proc Natl Acad Sci U S A 2012; 109:11360-5. [PMID: 22733786 DOI: 10.1073/pnas.1209293109] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A large number of studies have demonstrated that the nucleus accumbens (NAC) is a critical site in the neuronal circuits controlling reward responses, motivation, and mood, but the neuronal cell type(s) underlying these processes are not yet known. Identification of the neuronal cell types that regulate depression-like states will guide us in understanding the biological basis of mood and its regulation by diseases like major depressive disorder. Taking advantage of recent findings demonstrating that the serotonin receptor chaperone, p11, is an important molecular regulator of depression-like states, here we identify cholinergic interneurons (CINs) as a primary site of action for p11 in the NAC. Depression-like behavior is observed in mice after decrease of p11 levels in NAC CINs. This phenotype is recapitulated by silencing neuronal transmission in these cells, demonstrating that accumbal cholinergic neuronal activity regulates depression-like behaviors and suggesting that accumbal CIN activity is crucial for the regulation of mood and motivation.
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Blomstedt P, Fytagoridis A, Åström M, Linder J, Forsgren L, Hariz MI. Unilateral caudal zona incerta deep brain stimulation for Parkinsonian tremor. Parkinsonism Relat Disord 2012; 18:1062-6. [PMID: 22709794 DOI: 10.1016/j.parkreldis.2012.05.024] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 04/30/2012] [Accepted: 05/23/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The subthalamic nucleus is currently the target of choice in deep brain stimulation (DBS) for Parkinson's disease (PD), while thalamic DBS is used in some cases of tremor-dominant PD. Recently, a number of studies have presented promising results from DBS in the posterior subthalamic area, including the caudal zona incerta (cZi). The aim of the current study was to evaluate cZi DBS in tremor-dominant Parkinson's disease. METHODS 14 patients with predominately unilateral tremor-dominant PD and insufficient relief from pharmacologic therapy were included and evaluated according to the motor part of the Unified Parkinson Disease Rating Scale (UPDRS). The mean age was 65 ± 6.1 years and the disease duration 7 ± 5.7 years. Thirteen patients were operated on with unilateral cZi DBS and 1 patient with a bilateral staged procedure. Five patients had non-L-dopa responsive symptoms. The patients were evaluated on/off medication before surgery and on/off medication and stimulation after a minimum of 12 months after surgery. RESULTS At the follow-up after a mean of 18.1 months stimulation in the off-medication state improved the contralateral UPDRS III score by 47.7%. Contralateral tremor, rigidity, and bradykinesia were improved by 82.2%, 34.3%, and 26.7%, respectively. Stimulation alone abolished tremor at rest in 10 (66.7%) and action tremor in 8 (53.3%) of the patients. CONCLUSION Unilateral cZi DBS seems to be safe and effective for patients with severe Parkinsonian tremor. The effects on rigidity and bradykinesia were, however, not as profound as in previous reports of DBS in this area.
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Affiliation(s)
- Patric Blomstedt
- Department of Pharmacology and Clinical Neuroscience, Division of Neurosurgery, Umeå University, Umeå, Sweden.
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Lettieri C, Rinaldo S, Devigili G, Pauletto G, Verriello L, Budai R, Fadiga L, Oliynyk A, Mondani M, D'Auria S, Skrap M, Eleopra R. Deep brain stimulation: Subthalamic nucleus electrophysiological activity in awake and anesthetized patients. Clin Neurophysiol 2012; 123:2406-13. [PMID: 22683113 DOI: 10.1016/j.clinph.2012.04.027] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 04/15/2012] [Accepted: 04/17/2012] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate changes in subthalamic nucleus (STN) neuronal activity in Parkinson's disease (PD) patients during deep brain stimulation (DBS) surgery under general anesthesia, and to compare these data with those recorded in the same subjects during previous surgery under local anesthesia. METHODS Five patients with advanced PD, who had previously undergone bilateral STN-DBS under local anesthesia, underwent re-implantation under general anesthesia (with an anesthetic protocol based on the intravenous infusion of remifentanyl and ketamine) owing to surgical device complications. The microelectrode recording (MER) data obtained were analyzed by an off-line spike-sorting software. Neurophysiological data (number of spikes detected, mean firing rate, pause index and burst index) obtained under local and general anesthesia were then evaluated and compared by means of statistical analysis. RESULTS We found no statistically significant difference between the first and second surgical procedures in any of the neurophysiological parameters analyzed. CONCLUSIONS Bilateral STN-DBS for advanced PD with MER guidance is possible and reliable under a ketamine-based anesthetic protocol. SIGNIFICANCE General anesthesia can be proposed for those patients who do not accept an "awake surgery" for clinical reasons, such as excessive fear, poor cooperation or severe "off"-medication effects.
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Affiliation(s)
- Christian Lettieri
- Neurology Unit, University-Hospital S. Maria della Misericordia, Udine, Italy.
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Muniz AMS, Nadal J, Lyons KE, Pahwa R, Liu W. Long-term evaluation of gait initiation in six Parkinson's disease patients with bilateral subthalamic stimulation. Gait Posture 2012; 35:452-7. [PMID: 22154114 DOI: 10.1016/j.gaitpost.2011.11.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 09/09/2011] [Accepted: 11/03/2011] [Indexed: 02/02/2023]
Abstract
Defined as the transient state between standing and walking, gait initiation is negatively affected in Parkinson's disease (PD), which often results in significant disability. Although deep brain stimulation (DBS) is the most common surgical procedure for PD, the long-term effects of DBS on gait initiation are not well studied. The present study evaluated the long-term effects of subthalamic nucleus (STN) DBS on the preparation phase of gait initiation using principal component (PC) analysis. Six patients with PD who had undergone STN DBS and 24 healthy control subjects were evaluated. PD subjects were assessed 11.3±10.3 (P1) and 78.9±10.6 (P2) months after surgery. PD subjects were tested with STN DBS in two conditions: without medication and with medication. PC analysis was applied separately for the vertical, anterior-posterior and medial-lateral components of ground reaction force (GRF) recorded during gait initiation. Three PC scores were chosen by the scree test for each GRF component and all these PC scores were used for calculating a standard distance between healthy controls and PD subjects. The Friedman test showed a significant difference in standard distance among conditions (P=0.004), with the post-hoc test recognizing differences among P1 conditions and P2 medication-on condition. The eigenvector loading factors pointed to major differences between PD conditions surrounding the maximum amplitude of vertical and anterior-posterior GRF. For the studied sample, all distances increased in the follow-up evaluation (P2) with and without medications, indicating a worsening in gait initiation after seven years.
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Affiliation(s)
- A M S Muniz
- Department of Post-graduation, Physical Education Collage of Brazilian Army, Rio de Janeiro, RJ, Brazil.
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Franzini A, Cordella R, Messina G, Marras CE, Romito LM, Albanese A, Rizzi M, Nardocci N, Zorzi G, Zekaj E, Villani F, Leone M, Gambini O, Broggi G. Targeting the brain: considerations in 332 consecutive patients treated by deep brain stimulation (DBS) for severe neurological diseases. Neurol Sci 2012; 33:1285-303. [PMID: 22271259 DOI: 10.1007/s10072-012-0937-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Accepted: 12/23/2011] [Indexed: 11/28/2022]
Abstract
Deep brain stimulation (DBS) extends the treatment of some severe neurological diseases beyond pharmacological and conservative therapy. Our experience extends the field of DBS beyond the treatment of Parkinson disease and dystonia, including several other diseases such as cluster headache and disruptive behavior. Since 1993, at the Istituto Nazionale Neurologico "Carlo Besta" in Milan, 580 deep brain electrodes were implanted in 332 patients. The DBS targets include Stn, GPi, Voa, Vop, Vim, CM-pf, pHyp, cZi, Nacc, IC, PPN, and Brodmann areas 24 and 25. Three hundred patients are still available for follow-up and therapeutic considerations. DBS gave a new therapeutic chance to these patients affected by severe neurological diseases and in some cases controlled life-threatening pathological conditions, which would otherwise result in the death of the patient such as in status dystonicus, status epilepticus and post-stroke hemiballismus. The balance of DBS in severe neurological disease is strongly positive even if further investigations and studies are needed to search for new applications and refine the selection criteria for the actual indications.
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Affiliation(s)
- Angelo Franzini
- Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133, Milan, Italy
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Schiefer TK, Matsumoto JY, Lee KH. Moving forward: advances in the treatment of movement disorders with deep brain stimulation. Front Integr Neurosci 2011; 5:69. [PMID: 22084629 PMCID: PMC3211039 DOI: 10.3389/fnint.2011.00069] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/07/2011] [Indexed: 11/13/2022] Open
Abstract
The modern era of stereotactic and functional neurosurgery has ushered in state of the art technologies for the treatment of movement disorders, particularly Parkinson's disease (PD), tremor, and dystonia. After years of experience with various surgical therapies, the eventual shortcomings of both medical and surgical treatments, and several serendipitous discoveries, deep brain stimulation (DBS) has risen to the forefront as a highly effective, safe, and reversible treatment for these conditions. Idiopathic advanced PD can be treated with thalamic, globus pallidus internus (GPi), or subthalamic nucleus (STN) DBS. Thalamic DBS primarily relieves tremor while GPi and STN DBS alleviate a wide range of Parkinsonian symptoms. Thalamic DBS is also used in the treatment of other types of tremor, particularly essential tremor, with excellent results. Both primary and various types of secondary dystonia can be treated very effectively with GPi DBS. The variety of anatomical targets for these movement disorders is indicative of the network-level dysfunction mediating these movement disturbances. Despite an increasing understanding of the clinical benefits of DBS, little is known about how DBS can create such wide sweeping neuromodulatory effects. The key to improving this therapeutic modality and discovering new ways to treat these and other neurologic conditions lies in better understanding the intricacies of DBS. Here we review the history and pertinent clinical data for DBS treatment of PD, tremor, and dystonia. While multiple regions of the brain have been targeted for DBS in the treatment of these movement disorders, this review article focuses on those that are most commonly used in current clinical practice. Our search criteria for PubMed included combinations of the following terms: DBS, neuromodulation, movement disorders, PD, tremor, dystonia, and history. Dates were not restricted.
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Affiliation(s)
| | | | - Kendall H. Lee
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA
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