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Thenaisie Y, Lee K, Moerman C, Scafa S, Gálvez A, Pirondini E, Burri M, Ravier J, Puiatti A, Accolla E, Wicki B, Zacharia A, Castro Jiménez M, Bally JF, Courtine G, Bloch J, Moraud EM. Principles of gait encoding in the subthalamic nucleus of people with Parkinson's disease. Sci Transl Med 2022; 14:eabo1800. [PMID: 36070366 DOI: 10.1126/scitranslmed.abo1800] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Disruption of subthalamic nucleus dynamics in Parkinson's disease leads to impairments during walking. Here, we aimed to uncover the principles through which the subthalamic nucleus encodes functional and dysfunctional walking in people with Parkinson's disease. We conceived a neurorobotic platform embedding an isokinetic dynamometric chair that allowed us to deconstruct key components of walking under well-controlled conditions. We exploited this platform in 18 patients with Parkinson's disease to demonstrate that the subthalamic nucleus encodes the initiation, termination, and amplitude of leg muscle activation. We found that the same fundamental principles determine the encoding of leg muscle synergies during standing and walking. We translated this understanding into a machine learning framework that decoded muscle activation, walking states, locomotor vigor, and freezing of gait. These results expose key principles through which subthalamic nucleus dynamics encode walking, opening the possibility to operate neuroprosthetic systems with these signals to improve walking in people with Parkinson's disease.
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Affiliation(s)
- Yohann Thenaisie
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne CH-1011, Switzerland.,NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland
| | - Kyuhwa Lee
- Wyss Center for Bio and Neuroengineering, Geneva CH-1202, Switzerland
| | - Charlotte Moerman
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne CH-1011, Switzerland.,NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland
| | - Stefano Scafa
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne CH-1011, Switzerland.,NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland.,Institute of Digital Technologies for Personalized Healthcare (MeDiTech) , University of Southern Switzerland (SUPSI), Lugano-Viganello CH-6962 Switzerland
| | - Andrea Gálvez
- NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland.,Faculty of Life Sciences, EPFL, NeuroX Institute, Lausanne CH-1015, Switzerland
| | - Elvira Pirondini
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne CH-1011, Switzerland.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh 15213, PA, USA.,Rehabilitation and Neural Engineering Labs, University of Pittsburgh, Pittsburgh 15213, PA, USA
| | - Morgane Burri
- NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland.,Faculty of Life Sciences, EPFL, NeuroX Institute, Lausanne CH-1015, Switzerland
| | - Jimmy Ravier
- NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland.,Faculty of Life Sciences, EPFL, NeuroX Institute, Lausanne CH-1015, Switzerland
| | - Alessandro Puiatti
- Institute of Digital Technologies for Personalized Healthcare (MeDiTech) , University of Southern Switzerland (SUPSI), Lugano-Viganello CH-6962 Switzerland
| | - Ettore Accolla
- Department of Neurology, Hôpital Fribourgeois, Fribourg University, Fribourg CH-1708, Switzerland
| | - Benoit Wicki
- Department of Neurology, Hôpital du Valais, Sion CH-1951, Switzerland
| | - André Zacharia
- Clinique Bernoise, Crans-Montana CH-3963, Switzerland.,Department of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne CH-1011, Switzerland.,Department of Medicine, University of Geneva, Geneva CH-1201, Switzerland
| | - Mayte Castro Jiménez
- Department of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne CH-1011, Switzerland
| | - Julien F Bally
- Department of Neurology, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne CH-1011, Switzerland
| | - Grégoire Courtine
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne CH-1011, Switzerland.,NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland.,Faculty of Life Sciences, EPFL, NeuroX Institute, Lausanne CH-1015, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne CH-1011, Switzerland
| | - Jocelyne Bloch
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne CH-1011, Switzerland.,NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland.,Faculty of Life Sciences, EPFL, NeuroX Institute, Lausanne CH-1015, Switzerland.,Department of Neurosurgery, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne CH-1011, Switzerland
| | - Eduardo Martin Moraud
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne CH-1011, Switzerland.,NeuroRestore, Defitech Centre for Interventional Neurotherapies, CHUV, UNIL, and Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne CH-1011, Switzerland
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Pal G, Mangone G, Hill EJ, Ouyang B, Liu Y, Lythe V, Ehrlich D, Saunders-Pullman R, Shanker V, Bressman S, Alcalay RN, Garcia P, Marder KS, Aasly J, Mouradian MM, Link S, Rosenbaum M, Anderson S, Bernard B, Wilson R, Stebbins G, Nichols WC, Welter ML, Sani S, Afshari M, Verhagen L, de Bie RM, Foltynie T, Hall D, Corvol JC, Goetz CG. Parkinson Disease and Subthalamic Nucleus Deep Brain Stimulation: Cognitive Effects in GBA Mutation Carriers. Ann Neurol 2022; 91:424-435. [PMID: 34984729 PMCID: PMC8857042 DOI: 10.1002/ana.26302] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/01/2022] [Accepted: 01/03/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE This study was undertaken to compare the rate of change in cognition between glucocerebrosidase (GBA) mutation carriers and noncarriers with and without subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson disease. METHODS Clinical and genetic data from 12 datasets were examined. Global cognition was assessed using the Mattis Dementia Rating Scale (MDRS). Subjects were examined for mutations in GBA and categorized as GBA carriers with or without DBS (GBA+DBS+, GBA+DBS-), and noncarriers with or without DBS (GBA-DBS+, GBA-DBS-). GBA mutation carriers were subcategorized according to mutation severity (risk variant, mild, severe). Linear mixed modeling was used to compare rate of change in MDRS scores over time among the groups according to GBA and DBS status and then according to GBA severity and DBS status. RESULTS Data were available for 366 subjects (58 GBA+DBS+, 82 GBA+DBS-, 98 GBA-DBS+, and 128 GBA-DBS- subjects), who were longitudinally followed (range = 36-60 months after surgery). Using the MDRS, GBA+DBS+ subjects declined on average 2.02 points/yr more than GBA-DBS- subjects (95% confidence interval [CI] = -2.35 to -1.69), 1.71 points/yr more than GBA+DBS- subjects (95% CI = -2.14 to -1.28), and 1.49 points/yr more than GBA-DBS+ subjects (95% CI = -1.80 to -1.18). INTERPRETATION Although not randomized, this composite analysis suggests that the combined effects of GBA mutations and STN-DBS negatively impact cognition. We advise that DBS candidates be screened for GBA mutations as part of the presurgical decision-making process. We advise that GBA mutation carriers be counseled regarding potential risks associated with STN-DBS so that alternative options may be considered. ANN NEUROL 2022;91:424-435.
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Affiliation(s)
- Gian Pal
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Graziella Mangone
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Institut du Cerveau – Paris Brain Institute – ICM, Pitié-Salpêtrière Hospital, Department of Neurology, Centre d’Investigation Clinique Neurosciences, Paris, France
| | - Emily J. Hill
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Yuanqing Liu
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Vanessa Lythe
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London, UK
| | - Debra Ehrlich
- Parkinson’s Disease Clinic, Office of the Clinical Director, NIH/NINDS, Bethesda, MD, USA
| | - Rachel Saunders-Pullman
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vicki Shanker
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Susan Bressman
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roy N. Alcalay
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Priscilla Garcia
- Department of Neurology, New York Medical College, Valhalla, NY, USA
| | - Karen S. Marder
- Department of Neurology, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
| | - Jan Aasly
- Department of Neurology, St. Olavs Hospital and Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, 7030, Norway
| | - M. Maral Mouradian
- Department of Neurology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
- Robert Wood Johnson Medical School Institute for Neurological Therapeutics, Rutgers Biomedical and Health Sciences, Piscataway, NJ, USA
| | - Samantha Link
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Marc Rosenbaum
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Sharlet Anderson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bryan Bernard
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Robert Wilson
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Glenn Stebbins
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - William C. Nichols
- Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Marie-Laure Welter
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Institut du Cerveau – Paris Brain Institute – ICM, Pitié-Salpêtrière Hospital, Department of Neurology, Centre d’Investigation Clinique Neurosciences, Paris, France
- Normandie Univ, CHU Rouen, Department of Neurophysiology, Rouen, France
| | - Sepehr Sani
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Mitra Afshari
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Leo Verhagen
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Rob M.A. de Bie
- Amsterdam University Medical Centers, University of Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Tom Foltynie
- Department of Clinical & Movement Neurosciences, UCL Institute of Neurology, London, UK
| | - Deborah Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jean-Christophe Corvol
- Sorbonne Université, Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Institut du Cerveau – Paris Brain Institute – ICM, Pitié-Salpêtrière Hospital, Department of Neurology, Centre d’Investigation Clinique Neurosciences, Paris, France
| | - Christopher G. Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
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Brunet J, Price J, Wurz A, McDonough M, Nantel J. Boxing with Parkinson's Disease: findings from a qualitative study using self-determination theory. Disabil Rehabil 2021; 44:3880-3889. [PMID: 33625954 DOI: 10.1080/09638288.2021.1891465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Adults with Parkinson's disease (PD) experience debilitating symptoms that may be mitigated by boxing. Yet, attrition from boxing programs is problematic. Understanding whether PD-specific boxing programs can enhance motivation to remain physically active is important. This study investigated adults' experiences within a PD-specific boxing program and explored their perspectives on how the program has influenced physical activity motivational processes using a self-determination theory (SDT) lens. Methods: Nine adults with PD who took part in the Boxing 4 Health PD-specific boxing program completed face-to-face, semi-structured interviews. Data were analyzed using a hybrid approach of inductive and deductive thematic analysis. Results: The analysis yielded five themes: (1) I made an informed decision to participate and it feels good, (2) Boxing helps me stay active and keep moving, (3) To keep me going, the boxing program needs to have variety and allow for input, (4) A program that can be adapted to me is important, and (5) The instructor and the group facilitate my continued participation in the program. Conclusion: Providing participants with adapted exercises, varied sessions, and opportunities to provide input in a group-based PD-specific boxing program may be conducive to enhancing motivation for physical activity. Further, SDT may be a useful theoretical framework for developing and evaluating PD-specific programs.IMPLICATIONS FOR REHABILITATIONAdults with Parkinson's disease (PD) have many reasons for not engaging in physical activity, including a lack of motivation.A group-based PD-specific boxing program may be conducive to increasing motivation for physical activity.Professionals should consider: (1) educating adults with PD on the benefits of boxing, (2) offering group-based PD-specific boxing programs that are adaptable, varied, and open to input, and (3) fostering social support and networking opportunities within such programs.
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Affiliation(s)
- Jennifer Brunet
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada.,Cancer Therapeutic Program, Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Canada.,Institut du savoir Montfort, Hôpital Montfort, Ottawa, Canada
| | - Jenson Price
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Amanda Wurz
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | | | - Julie Nantel
- Faculty of Health Sciences, School of Human Kinetics, University of Ottawa, Ottawa, Canada
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Abstract
OBJECTIVES To compare long-term survival of Parkinson's disease (PD) patients with deep brain stimulation (DBS) to matched controls, and examine whether DBS was associated with differences in injurious falls, long-term care, and home care. METHODS Using administrative health data (Ontario, Canada), we examined DBS outcomes within a cohort of individuals diagnosed with PD between 1997 and 2012. Patients receiving DBS were matched with non-DBS controls by age, sex, PD diagnosis date, time with PD, and a propensity score. Survival between groups was compared using the log-rank test and marginal Cox proportional hazards regression. Cumulative incidence function curves and marginal subdistribution hazard models were used to assess effects of DBS on falls, long-term care admission, and home care use, with death as a competing risk. RESULTS There were 260 DBS recipients matched with 551 controls. Patients undergoing DBS did not experience a significant survival advantage compared to controls (log-rank test p = 0.50; HR: 0.89, 95% CI: 0.65-1.22). Among patients <65 years of age, DBS recipients had a significantly reduced risk of death (HR: 0.49, 95% CI: 0.28-0.84). Patients receiving DBS were more likely than controls to receive care for falls (HR: 1.56, 95% CI: 1.19-2.05) and home care (HR: 1.59, 95% CI: 1.32-1.90), while long-term care admission was similar between groups. CONCLUSIONS Receiving DBS may increase survival for younger PD patients who undergo DBS. Future studies should examine whether survival benefits may be attributed to effects on PD or the absence of comorbidities that influence mortality.
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Xing Y, Tench C, Wongwandee M, Schwarz ST, Bajaj N, Auer DP. Coordinate based meta-analysis of motor functional imaging in Parkinson's: disease-specific patterns and modulation by dopamine replacement and deep brain stimulation. Brain Imaging Behav 2020; 14:1263-1280. [PMID: 30809759 PMCID: PMC7381438 DOI: 10.1007/s11682-019-00061-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To investigate factors affecting the pattern of motor brain activation reported in people with Parkinson's (PwP), aiming to differentiate disease-specific features from treatment effects. METHODS A co-ordinate-based-meta-analysis (CBMA) of functional motor neuroimaging studies involving patients with Parkinson's (PwP), and healthy controls (HC) identified 126 suitable articles. The experiments were grouped based on subject feature, medication status (onMed/offMed), deep brain stimulation (DBS) status (DBSon/DBSoff) and type of motor initiation. RESULTS HC and PwP shared similar neural networks during upper extremity motor tasks but with differences of reported frequency in mainly bilateral putamen, insula and ipsilateral inferior parietal and precentral gyri. The activation height was significantly reduced in the bilateral putamen, left SMA, left subthalamus nucleus, right thalamus and right midial global pallidum in PwPoffMed (vs. HC), and pre-SMA hypoactivation correlated with disease severity. These changes were not found in patients on dopamine replacement therapy (PwPonMed vs. HC) in line with a restorative function. By contrast, left SMA and primary motor cortex showed hyperactivation in the medicated state (vs. HC) suggesting dopaminergic overcompensation. Deep-brain stimulation (PwP during the high frequency subthalamus nucleus (STN) DBS vs. no stimulation) induced a decrease in left SMA activity and the expected increase in the left subthalamic/thalamic region regardless of hand movement. We further demonstrated a disease related effect of motor intention with only PwPoffMed showing increased activation in the medial frontal lobe in self-initiated studies. CONCLUSION We describe a consistent disease-specific pattern of putaminal hypoactivation during motor tasks that appears reversed by dopamine replacement. Inconsistent reports of altered SMA/pre-SMA activation can be explained by task- and medication-specific variation in intention. Moreover, SMA activity was reduced during STN-DBS, while dopamine-induced hyperactivation of SMA which might underpin hyperdynamic L-dopa related overcompensation.
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Affiliation(s)
- Yue Xing
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2UH, UK.
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
- Radiological Sciences, Sir Peter Mansfield Imaging Centre, NIHR Nottingham BRC, University of Nottingham, Nottingham, NG7 2UH, UK.
| | - Christopher Tench
- Division of Clinical Neurology, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Monton Wongwandee
- Department of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Stefan T Schwarz
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2UH, UK
- Department of Radiology, Cardiff and Vale University Health Board, Cardiff, Wales
| | - Nin Bajaj
- Department of Neurology, Nottingham University Hospitals, Nottingham, NG7 2UH, UK
| | - Dorothee P Auer
- Radiological Sciences, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NG7 2UH, UK.
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG7 2UH, UK.
- Radiological Sciences, Sir Peter Mansfield Imaging Centre, NIHR Nottingham BRC, University of Nottingham, Nottingham, NG7 2UH, UK.
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DePaoli D, Goetz L, Gagnon D, Maranon G, Prud'homme M, Cantin L, Parent M, Côté DC. Intraoperative fiber optic guidance during chronic electrode implantation in deep brain stimulation neurosurgery: proof of concept in primates. J Neurosurg 2020; 132:1810-1819. [PMID: 31151099 DOI: 10.3171/2019.1.jns182600] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/29/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The clinical outcome of deep brain stimulation (DBS) surgery relies heavily on the implantation accuracy of a chronic stimulating electrode into a small target brain region. Most techniques that have been proposed to precisely target these deep brain regions were designed to map intracerebral electrode trajectory prior to chronic electrode placement, sometimes leading to positioning error of the final electrode. This study was designed to create a new intraoperative guidance tool for DBS neurosurgery that can improve target detection during the final implantation of the chronic electrode. METHODS Taking advantage of diffuse reflectance spectroscopy, the authors developed a new surgical tool that senses proximal brain tissue through the tip of the chronic electrode by means of a novel stylet, which provides rigidity to DBS leads and houses fiber optics. RESULTS As a proof of concept, the authors demonstrated the ability of their noninvasive optical guidance technique to precisely locate the border of the subthalamic nucleus during the implantation of commercially available DBS electrodes in anesthetized parkinsonian monkeys. Innovative optical recordings combined to standard microelectrode mapping and detailed postmortem brain examination allowed the authors to confirm the precision of optical target detection. They also show the optical technique's ability to detect, in real time, upcoming blood vessels, reducing the risk of hemorrhage during the chronic lead implantation. CONCLUSIONS The authors present a new optical guidance technique that can detect target brain regions during DBS surgery from within the implanted electrode using a proof of concept in nonhuman primates. The technique discriminates tissue in real time, contributes no additional invasiveness to the procedure by being housed within the electrode, and can provide complementary information to microelectrode mapping during the implantation of the chronic electrode. The technique may also be a powerful tool for providing direct anatomical information in the case of direct implantations wherein microelectrode mapping is not performed.
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Affiliation(s)
- Damon DePaoli
- 1CERVO Brain Research Center, Québec City, Québec, Canada
- 2Center for Optics, Photonics and Lasers (COPL), Physics, Engineering and Optics Department, Université Laval, Québec City, Québec, Canada; and
| | - Laurent Goetz
- 1CERVO Brain Research Center, Québec City, Québec, Canada
| | - Dave Gagnon
- 1CERVO Brain Research Center, Québec City, Québec, Canada
| | | | - Michel Prud'homme
- 3Neurosurgery, CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, Québec City, Québec, Canada
| | - Léo Cantin
- 3Neurosurgery, CHU de Québec-Université Laval, Hôpital de l'Enfant-Jésus, Québec City, Québec, Canada
| | - Martin Parent
- 1CERVO Brain Research Center, Québec City, Québec, Canada
| | - Daniel C Côté
- 1CERVO Brain Research Center, Québec City, Québec, Canada
- 2Center for Optics, Photonics and Lasers (COPL), Physics, Engineering and Optics Department, Université Laval, Québec City, Québec, Canada; and
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7
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Disparities in Deep Brain Stimulation Use for Parkinson's Disease in Ontario, Canada. Can J Neurol Sci 2020; 47:642-655. [PMID: 32329424 DOI: 10.1017/cjn.2020.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine whether sociodemographic characteristics and health care utilization are associated with receiving deep brain stimulation (DBS) surgery for Parkinson's disease (PD) in Ontario, Canada. METHODS Using health administrative data, we identified a cohort of individuals aged 40 years or older diagnosed with incident PD between 1995 and 2009. A case-control study was used to examine whether select factors were associated with DBS for PD. Patients were classified as cases if they underwent DBS surgery at any point 1-year after cohort entry until December 31, 2016. Conditional logistic regression modeling was used to estimate the adjusted odds of DBS surgery for sociodemographic and health care utilization indicators. RESULTS A total of 46,237 individuals with PD were identified, with 543 (1.2%) receiving DBS surgery. Individuals residing in northern Ontario were more likely than southern patients to receive DBS surgery [adjusted odds ratio (AOR) = 2.23, 95% confidence interval (CI) = 1.15-4.34]; however, regional variations were not observed after accounting for medication use among older adults (AOR = 1.04, 95% CI = 0.26-4.21). Patients living in neighborhoods with the highest concentration of visible minorities were less likely to receive DBS surgery compared to patients living in predominantly white neighborhoods (AOR = 0.27, 95% CI = 0.16-0.46). Regular neurologist care and use of multiple PD medications were positively associated with DBS surgery. CONCLUSIONS Variations in use of DBS may reflect differences in access to care, specialist referral pathways, health-seeking behavior, or need for DBS. Future studies are needed to understand drivers of potential disparities in DBS use.
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8
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Cordeiro JG, Diaz A, Davis JK, Di Luca DG, Farooq G, Luca CC, Jagid JR. Safety of Noncontrast Imaging-Guided Deep Brain Stimulation Electrode Placement in Parkinson Disease. World Neurosurg 2019; 134:e1008-e1014. [PMID: 31756502 DOI: 10.1016/j.wneu.2019.11.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 11/12/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is considered standard of care for the treatment of medically refractory Parkinson disease (PD). The placement of brain electrodes is performed using contrast imaging to enhance blood vessel identification during stereotactic planning. We present our experience with a series of patients implanted using noncontrast imaging. METHODS All cases of DBS surgery for PD performed between 2012 and 2018 with noncontrast imaging were retrospectively reviewed. Clinical features, postoperative imaging, and complications were analyzed. RESULTS A total of 287 deep-seated electrodes were implanted in 152 patients. Leads were placed at the subthalamic nucleus and globus pallidus internus in 258 and 29 hemispheres, respectively. We identified 2 cases of intracranial hemorrhage (0.7%). CONCLUSIONS DBS lead placement can be performed without the use of intravenous contrast with a postoperative intracranial hemorrhage rate comparable with other reported series.
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Affiliation(s)
| | - Anthony Diaz
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jenna Kylene Davis
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Daniel Garbin Di Luca
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ghulam Farooq
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Corneliu C Luca
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jonathan Russell Jagid
- Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida, USA.
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9
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Swanson KI, Smith KA, Mirzadeh Z, Ponce FA. Epilepsy, Functional Neurosurgery, and Pain. Oper Neurosurg (Hagerstown) 2019; 17:S209-S228. [PMID: 31099850 DOI: 10.1093/ons/opz075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kyle I Swanson
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kris A Smith
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Zaman Mirzadeh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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10
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Patient Knowledge and Attitudes towards Genetic Testing in Parkinson's Disease Subjects with Deep Brain Stimulation. PARKINSONS DISEASE 2019; 2019:3494609. [PMID: 31143438 PMCID: PMC6501170 DOI: 10.1155/2019/3494609] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/15/2019] [Accepted: 04/01/2019] [Indexed: 11/29/2022]
Abstract
Objectives As genetic testing is becoming more widely commercially available for Parkinson's disease (PD) and may have implications regarding clinical outcomes for deep brain stimulation (DBS) and other therapies, we aimed to determine patient knowledge and attitudes towards genetic testing. Methods A sample of 88 PD subjects with bilateral STN-DBS completed a Genetic Attitudes Questionnaire (GAQ). Knowledge and attitudes towards genetic testing were assessed. Results The mean percent of correct responses regarding genetic testing knowledge was 58.5%. Nearly 90% of subjects were unfamiliar with Genetic Information Nondiscrimination Act (GINA). The most important reasons subjects cited in deciding whether to undergo genetic testing included (1) to be a candidate for clinical trials if positive, (2) to learn that they do not carry a mutation, and (3) because a healthcare provider had recommended it. Individuals who influence decision-making include spouses and children. About 88% of subjects would share results with spouses, children, and siblings. Discussion These results reveal that there is a major knowledge gap regarding genetic testing in PD and the implications of testing results on treatment, work, insurance, and privacy. Also, subjects would mainly seek genetic testing to participate in clinical trials, with spouses and children being the key stakeholders in decision-making.
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11
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Deep Brain Stimulation Rescues Memory and Synaptic Activity in a Rat Model of Global Ischemia. J Neurosci 2019; 39:2430-2440. [PMID: 30696731 DOI: 10.1523/jneurosci.1222-18.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 01/07/2019] [Accepted: 01/11/2019] [Indexed: 12/18/2022] Open
Abstract
Deep brain stimulation (DBS) is remarkably effective in treating Parkinson's disease and is currently under investigation for the treatment of neuropsychiatric disorders including Alzheimer's disease. Until now, DBS has not been examined for its cognitive benefits in the context of hypoxic-ischemic injuries. Here, we investigated the effect of DBS in a rat model of global ischemia (GI) that mimics the neurological consequences occurring after a cardiac arrest. We show that DBS rescues memory deficits induced by GI and produces changes in synaptic activity in the hippocampus. Novel approaches to improve neurological outcomes after stroke are urgently needed; therefore, the present study highlights a possible role for DBS in the treatment of cognitive impairment associated with ischemia.
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12
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Plotkin JL, Goldberg JA. Thinking Outside the Box (and Arrow): Current Themes in Striatal Dysfunction in Movement Disorders. Neuroscientist 2018; 25:359-379. [PMID: 30379121 PMCID: PMC6529282 DOI: 10.1177/1073858418807887] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The basal ganglia are an intricately connected assembly of subcortical nuclei, forming the core of an adaptive network connecting cortical and thalamic circuits. For nearly three decades, researchers and medical practitioners have conceptualized how the basal ganglia circuit works, and how its pathology underlies motor disorders such as Parkinson's and Huntington's diseases, using what is often referred to as the "box-and-arrow model": a circuit diagram showing the broad strokes of basal ganglia connectivity and the pathological increases and decreases in the weights of specific connections that occur in disease. While this model still has great utility and has led to groundbreaking strategies to treat motor disorders, our evolving knowledge of basal ganglia function has made it clear that this classic model has several shortcomings that severely limit its predictive and descriptive abilities. In this review, we will focus on the striatum, the main input nucleus of the basal ganglia. We describe recent advances in our understanding of the rich microcircuitry and plastic capabilities of the striatum, factors not captured by the original box-and-arrow model, and provide examples of how such advances inform our current understanding of the circuit pathologies underlying motor disorders.
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Affiliation(s)
- Joshua L Plotkin
- Department of Neurobiology and Behavior, Stony Brook University School of Medicine, Stony Brook, NY, USA
| | - Joshua A Goldberg
- Department of Medical Neurobiology, The Hebrew University of Jerusalem, Jerusalem, Israel
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13
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Lio G, Thobois S, Ballanger B, Lau B, Boulinguez P. Removing deep brain stimulation artifacts from the electroencephalogram: Issues, recommendations and an open-source toolbox. Clin Neurophysiol 2018; 129:2170-2185. [PMID: 30144660 DOI: 10.1016/j.clinph.2018.07.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 07/23/2018] [Accepted: 07/28/2018] [Indexed: 12/30/2022]
Abstract
A major question for deep brain stimulation (DBS) research is understanding how DBS of one target area modulates activity in different parts of the brain. EEG gives privileged access to brain dynamics, but its use with implanted patients is limited since DBS adds significant high-amplitude electrical artifacts that can completely obscure neural activity measured using EEG. Here, we systematically review and discuss the methods available for removing DBS artifacts. These include simple techniques such as oversampling, antialiasing analog filtering and digital low-pass filtering, which are necessary but typically not sufficient to fully remove DBS artifacts when each is used in isolation. We also cover more advanced methods, including techniques tracking outliers in the frequency-domain, which can be effective, but are rarely used. The reason for that is twofold: First, it requires advanced skills in signal processing since no user friendly tool for removing DBS artifacts is currently available. Second, it involves fine-tuning to avoid over-aggressive filtering. We highlight an open-source toolbox incorporating most artifact removal methods, allowing users to combine different strategies.
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Affiliation(s)
- Guillaume Lio
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, Centre de Neuroscience Cognitive, Bron, France
| | - Stéphane Thobois
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; CNRS, Centre de Neuroscience Cognitive, Bron, France; Hospices civils de Lyon, hôpital neurologique Pierre Wertheimer, Bron, France
| | - Bénédicte Ballanger
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France
| | - Brian Lau
- Sorbonne Universités, UPMC Univ Paris 06, UMR S 1127, CNRS UMR 7225, Institut du Cerveau et de la Moelle épinière, F-75013 Paris, France
| | - Philippe Boulinguez
- Université de Lyon, F-69622 Lyon, France; Université Lyon 1, Villeurbanne, France; INSERM U1028, CNRS UMR5292, Centre de Recherche en Neurosciences de Lyon, Lyon, France.
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14
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Kádár E, Varela EV, Aldavert-Vera L, Huguet G, Morgado-Bernal I, Segura-Torres P. Arc protein expression after unilateral intracranial self-stimulation of the medial forebrain bundle is upregulated in specific nuclei of memory-related areas. BMC Neurosci 2018; 19:48. [PMID: 30089460 PMCID: PMC6083502 DOI: 10.1186/s12868-018-0449-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 07/31/2018] [Indexed: 12/22/2022] Open
Abstract
Background Intracranial Self-Stimulation (ICSS) of the medial forebrain bundle (MFB) is a deep brain stimulation procedure, which has a powerful enhancement effect on explicit and implicit memory. However, the downstream synaptic plasticity events of MFB-ICSS in memory related areas have not been described thoroughly. This study complements previous work studying the effect of MFB-ICSS on the expression of the activity-regulated cytoskeleton-associated (Arc) protein, which has been widely established as a synaptic plasticity marker. We provide new integrated measurements from memory related regions and take possible regional hemispheric differences into consideration. Results Arc protein expression levels were analyzed 4.5 h after MFB-ICSS by immunohistochemistry in the hippocampus, habenula, and memory related amygdalar and thalamic nuclei, in both the ipsilateral and contralateral hemispheres to the stimulating electrode location. MFB-ICSS was performed using the same paradigm which has previously been shown to facilitate memory. Our findings illustrate that MFB-ICSS upregulates the expression of Arc protein in the oriens and radiatum layers of ipsilateral CA1 and contralateral CA3 hippocampal regions; the hilus bilaterally, the lateral amygdala and dorsolateral thalamic areas as well as the central medial thalamic nucleus. In contrast, the central amygdala, mediodorsal and paraventricular thalamic nuclei, and the habenular complex did not show changes in Arc expression after MFB-ICSS. Conclusions Our results expand our knowledge of which specific memory related areas MFB-ICSS activates and, motivates the definition of three functionally separate groups according to their Arc-related synaptic plasticity response: (1) the hippocampus and dorsolateral thalamic area, (2) the central medial thalamic area and (3) the lateral amygdala. Electronic supplementary material The online version of this article (10.1186/s12868-018-0449-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elisabet Kádár
- Departament de Biologia, Universitat de Girona, 17071, Girona, Spain. .,Department of Biology, Sciences Faculty, University of Girona, C/Mª Aurèlia Capmany 40, Camous Montilivi, 17003, Girona, Spain.
| | - Eva Vico Varela
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autónoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.,Douglas Mental Health University Institute, McGill University, Montreal, QC, H4H 1R3, Canada
| | - Laura Aldavert-Vera
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autónoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Gemma Huguet
- Departament de Biologia, Universitat de Girona, 17071, Girona, Spain
| | - Ignacio Morgado-Bernal
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autónoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
| | - Pilar Segura-Torres
- Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Institut de Neurociències, Universitat Autónoma de Barcelona, 08193, Bellaterra, Barcelona, Spain
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15
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Abstract
PURPOSE OF REVIEW This review aims to survey recent trends in electrical forms of neuromodulation, with a specific application to Parkinson's disease (PD). Emerging trends are identified, highlighting synergies in state-of-the-art neuromodulation strategies, with directions for future improvements in stimulation efficacy suggested. RECENT FINDINGS Deep brain stimulation remains the most common and effective form of electrical stimulation for the treatment of PD. Evidence suggests that transcranial direct current stimulation (tDCS) most likely impacts the motor symptoms of the disease, with the most prominent results relating to rehabilitation. However, utility is limited due to its weak effects and high variability, with medication state a key confound for efficacy level. Recent innovations in transcranial alternating current stimulation (tACS) offer new areas for investigation. SUMMARY Our understanding of the mechanistic foundations of electrical current stimulation is advancing and as it does so, trends emerge which steer future clinical trials towards greater efficacy.
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Affiliation(s)
- John-Stuart Brittain
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT UK
| | - Hayriye Cagnan
- Institute of Neurology, University College London, London, UK
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16
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Duncan RP, Van Dillen LR, Garbutt JM, Earhart GM, Perlmutter JS. Physical therapy and deep brain stimulation in Parkinson's Disease: protocol for a pilot randomized controlled trial. Pilot Feasibility Stud 2018; 4:54. [PMID: 29484198 PMCID: PMC5822622 DOI: 10.1186/s40814-018-0243-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 02/02/2018] [Indexed: 01/28/2023] Open
Abstract
Background Subthalamic nucleus deep brain stimulation (STN-DBS) reduces tremor, muscle stiffness, and bradykinesia in people with Parkinson’s Disease (PD). Walking speed, known to be reduced in PD, typically improves after surgery; however, other important aspects of gait may not improve. Furthermore, balance may worsen and falls may increase after STN-DBS. Thus, interventions to improve balance and gait could reduce morbidity and improve quality of life following STN-DBS. Physical therapy (PT) effectively improves balance and gait in people with PD, but studies on the effects of PT have not been extended to those treated with STN-DBS. As such, the efficacy, safety, and feasibility of PT in this population remain to be determined. The purpose of this pilot study is to address these unmet needs. We hypothesize that PT designed to target balance and gait impairment will be effective, safe, and feasible in this population. Methods/design Participants with PD treated with STN-DBS will be randomly assigned to either a PT or control group. Participants assigned to PT will complete an 8-week, twice-weekly PT program consisting of exercises designed to improve balance and gait. Control group participants will receive the current standard of care following STN-DBS, which does not include prescription of PT. The primary aim is to assess preliminary efficacy of PT on balance (Balance Evaluation Systems Test). A secondary aim is to assess efficacy of PT on gait (GAITRite instrumented walkway). Participants will be assessed OFF medication/OFF stimulation and ON medication/ON stimulation at baseline and at 8 and 12 weeks after baseline. Adverse events will be measured over the duration of the study, and adherence to PT will be measured to determine feasibility. Discussion To our knowledge, this will be the first study to explore the preliminary efficacy, safety, and feasibility of PT for individuals with PD with STN-DBS. If the study suggests potential efficacy, then this would justify larger trials to test effectiveness and safety of PT for those with PD with STN-DBS. Trial registration NCT03181282 (clinicaltrials.gov). Registered on 7 June 2017. Electronic supplementary material The online version of this article (10.1186/s40814-018-0243-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ryan P Duncan
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,2Department of Neurology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Linda R Van Dillen
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,3Department of Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Jane M Garbutt
- 4Department of Medicine, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,5Department of Pediatrics, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Gammon M Earhart
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,2Department of Neurology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,6Department of Neuroscience, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
| | - Joel S Perlmutter
- 1Program in Physical Therapy, Washington University School of Medicine in Saint Louis, Campus Box 8502, 4444 Forest Park Blvd, St. Louis, MO 63108 USA.,2Department of Neurology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,6Department of Neuroscience, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,7Department of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO USA.,8Program in Occupational Therapy, Washington University School of Medicine in Saint Louis, St. Louis, MO USA
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17
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Southwell DG, Rutkowski MJ, San Luciano M, Racine C, Ostrem J, Starr PA, Larson PS. Before and after the veterans affairs cooperative program 468 study: Deep brain stimulator target selection for treatment of Parkinson's disease. Parkinsonism Relat Disord 2017; 48:40-44. [PMID: 29249683 DOI: 10.1016/j.parkreldis.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 11/21/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The Veterans Affairs Cooperative Study Program 468 study (CSP 468) produced significant findings regarding deep brain stimulation (DBS) target selection for Parkinson's Disease (PD) treatment, yet its impact on clinical practices has not been described. Here we assess how CSP 468 influenced target selection at a high-volume movement disorders treatment center. METHODS We compared DBS target site selection between 4-year periods that immediately preceded and followed CSP 468 publication. Additionally, we examined how baseline clinical features influenced target selection following CSP 468. RESULTS The STN was the predominant site of DBS implantation before and after CSP 468 publication (93.2% of cases, and 60.4%, respectively), but GPi targeting increased significantly following CSP 468 publication (from 5.3% to 37.4%; p < .001). Patients who underwent GPi stimulation following CSP 468 exhibited worse indices of depression (p < .001), less responsiveness to medications (p < .05), and a trend towards worse pre-operative cognitive performance (p = .06). In multi-variate analysis, advanced patient age and depression were independent predictors of GPi targeting (p < .01). CONCLUSIONS Key findings of CSP 468 were reflected in our target selection of DBS for Parkinson's Disease. Following CSP 468, GPi targeting increased, and it was selected for patients with poorer cognitive and mood indices.
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Affiliation(s)
- Derek G Southwell
- Department of Neurological Surgery, University of California, San Francisco, USA.
| | - Martin J Rutkowski
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Marta San Luciano
- Department of Neurology, University of California, San Francisco, USA
| | - Caroline Racine
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Jill Ostrem
- Department of Neurology, University of California, San Francisco, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, USA
| | - Paul S Larson
- Department of Neurological Surgery, University of California, San Francisco, USA
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18
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Xia F, Yiu A, Stone SSD, Oh S, Lozano AM, Josselyn SA, Frankland PW. Entorhinal Cortical Deep Brain Stimulation Rescues Memory Deficits in Both Young and Old Mice Genetically Engineered to Model Alzheimer's Disease. Neuropsychopharmacology 2017; 42:2493-2503. [PMID: 28540926 PMCID: PMC5686482 DOI: 10.1038/npp.2017.100] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 05/16/2017] [Accepted: 05/18/2017] [Indexed: 12/20/2022]
Abstract
Alzheimer's disease (AD) is a neurodegenerative disorder characterized by progressive cognitive decline. Deep brain stimulation (DBS) has been used to treat a variety of brain disorders and shows promise in alleviating cognitive symptoms in some AD patients (Laxton et al, 2010). We previously showed that DBS of the entorhinal cortex (EC) enhances spatial memory formation in normal (wild-type) mice (Stone et al, 2011). Here we tested the effects of EC-DBS on the progressive cognitive deficits in a genetically-based mouse model of AD. TgCRND8 (Tg) transgenic mice express human amyloid precursor protein harboring the Swedish and Indiana familial AD mutations. These mice exhibit age-related increases in Aβ production, plaque deposition, as well as contextual fear and spatial memory impairments. Here, we found EC stimulation in young mice (6 weeks old) rescued the early contextual fear and spatial memory deficits and decreased subsequent plaque load in Tg mice. Moreover, stimulation in older mice (6 months old) was also sufficient to rescue the memory deficits in Tg mice. The memory enhancement induced by DBS emerged gradually (over the course of weeks) and was both persistent and specific to hippocampal-based memories. These results provide further support for the development of novel therapeutics aimed to resolve the cognitive decline and memory impairment in AD using DBS of hippocampal afferents.
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Affiliation(s)
- Frances Xia
- Department of Physiology, University of Toronto, Toronto, ON, Canada,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Adelaide Yiu
- Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Scellig S D Stone
- Harvard Medical School, Boston, MA, USA,Department of Neurosurgery, Boston Children's Hospital, Boston, MA, USA
| | - Soojin Oh
- Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada,Toronto Western Research Institute, Krembil Discovery Tower, University Health Network, Toronto, ON, Canada
| | - Sheena A Josselyn
- Department of Physiology, University of Toronto, Toronto, ON, Canada,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada,Department of Psychology, University of Toronto, Toronto, ON, Canada,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada,Program in Neurosciences and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada, Tel: +(416) 813-7654, E-mail: or
| | - Paul W Frankland
- Department of Physiology, University of Toronto, Toronto, ON, Canada,Program in Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada,Department of Psychology, University of Toronto, Toronto, ON, Canada,Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada,Program in Neurosciences and Mental Health, Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada, Tel: +(416) 813-7654, E-mail: or
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19
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Sidtis D, Sidtis JJ. Subcortical Effects on Voice and Fluency in Dysarthria: Observations from Subthalamic Nucleus Stimulation. JOURNAL OF ALZHEIMER'S DISEASE & PARKINSONISM 2017; 7:392. [PMID: 29456879 PMCID: PMC5814133 DOI: 10.4172/2161-0460.1000392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Parkinson's disease (PD), caused by basal ganglia dysfunction, is associated with motor disturbances including dysarthria. Stimulation of the subthalamic nucleus, a preferred treatment targeting basal ganglia function, improves features of the motor disorder, but has uncertain effects on speech.We studied speech during contrasting stimulation states to reveal subcortical effects on voice and articulation. Measures were made on selected samples of spontaneous and repeated speech. METHODS Persons with Parkinson's disease (PWP) who had undergone bilateral deep brain stimulation of the subthalamic nucleus (DBS-STN) provided spontaneous speech samples and then repeated portions of their monologue both on and off stimulation. Excerpts were presented in a listening protocol probing intelligibility. Also analysed were a continuous phrase repetition task and a second spontaneous speech sample. Fundamental frequency (F0), harmonic-to-noise ratio (HNR), jitter, shimmer and fluency were measured in these three speech samples performed with DBS stimulation on and off. RESULTS During subcortical stimulation, spontaneous excerpts were less intelligible than repeated excerpts. F0 and HNR were higher and shimmer was decreased in repetition and stimulation. Articulatory dysfluencies were increased for spontaneous speech and during stimulation in all three speech samples. CONCLUSION Deep brain stimulation disrupts fluency and improves voice in spontaneous speech, reflecting an inverse influence of subcortical systems on articulatory posturing and laryngeal mechanisms. Better voice and less dysfluency in repetition may occur because an external model reduces the speech planning burden, as seen for gait and arm reach. These orthogonal results for fluency versus phonatory competence may account for ambivalent reports from dysarthric speakers and reveal the complexity of subcortical control of motor speech.
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Affiliation(s)
- Diana Sidtis
- Department of Communicative Disorders, New York University, New York 10012, USA
- Brain and Behaviour Laboratory, Geriatrics Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York 10962, USA
| | - John J Sidtis
- Brain and Behaviour Laboratory, Geriatrics Division, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York 10962, USA
- Department of Psychiatry, NYU Langone Medical Center, New York 10016, USA
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20
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Ahsan SF, Luo H, Zhang J, Kim E, Xu Y. An animal model of deep brain stimulation for treating tinnitus: A proof of concept study. Laryngoscope 2017; 128:1213-1222. [PMID: 28925013 DOI: 10.1002/lary.26876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/21/2017] [Accepted: 08/01/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This proof-of-concept study aimed to demonstrate therapeutic effects of deep brain stimulation (DBS) on noise-induced tinnitus. STUDY DESIGN Experimental animal study. METHODS After Institutional Animal Care and Use Committee approval, nine adult rats were implanted in the caudate nucleus with custom-made electrode array. The rats were exposed to noise to induce tinnitus. Auditory brainstem response was performed to evaluate hearing threshold changes. Noise-induced tinnitus and its suppression by DBS were evaluated using the gap-detection acoustic startle reflex behavioral paradigm and electrophysiological evaluation of modulatory effects on neural correlates of tinnitus. Various stimulation parameters were used to determine the most effective ones in affecting behavioral changes, along with corresponding neural activity in the caudate nucleus. The correlation between the caudate nucleus and auditory cortex also was determined. Analysis of variance with Bonferroni correction was performed to examine DBS-induced effects on behavioral evidence of tinnitus. RESULTS Bursting activity, a neural marker of tinnitus, was noted to decrease compared to baseline in tinnitus (+) animals. After stimulation, spontaneous and bursting activity increased in the tinnitus (+) animals but decreased in the tinnitus (-) animals. Behavioral data suggested suppression of tinnitus after DBS. These effects lasted up to 5 days. To our knowledge, this is the first development of an animal model to test deep brain stimulation of the caudate region for the treatment of tinnitus. CONCLUSIONS Deep brain stimulation of the caudate nucleus can modulate tinnitus in a rat model of tinnitus. LEVEL OF EVIDENCE NA. Laryngoscope, 128:1213-1222, 2018.
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Affiliation(s)
- Syed F Ahsan
- Otology/Neurotology, Department of Otolaryngology/Head and Neck Surgery, Kaiser Permanente-Orange County, Anaheim, California
| | - Hao Luo
- Department of Otolaryngology/Head and Neck Surgery, Wayne State University, Detroit, Michigan, U.S.A
| | - Jinsheng Zhang
- Department of Otolaryngology/Head and Neck Surgery, Wayne State University, Detroit, Michigan, U.S.A.,Department of Communication Sciences and Disorders, Wayne State University, Detroit, Michigan, U.S.A
| | - Eric Kim
- Department of Engineering, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Yong Xu
- Department of Engineering, Wayne State University School of Medicine, Detroit, Michigan, U.S.A
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21
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Alloway KD, Smith JB, Mowery TM, Watson GDR. Sensory Processing in the Dorsolateral Striatum: The Contribution of Thalamostriatal Pathways. Front Syst Neurosci 2017; 11:53. [PMID: 28790899 PMCID: PMC5524679 DOI: 10.3389/fnsys.2017.00053] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 07/07/2017] [Indexed: 01/24/2023] Open
Abstract
The dorsal striatum has two functionally-defined subdivisions: a dorsomedial striatum (DMS) region involved in mediating goal-directed behaviors that require conscious effort, and a dorsolateral striatum (DLS) region involved in the execution of habitual behaviors in a familiar sensory context. Consistent with its presumed role in forming stimulus-response (S-R) associations, neurons in DLS receive massive inputs from sensorimotor cortex and are responsive to both active and passive sensory stimulation. While several studies have established that corticostriatal inputs contribute to the stimulus-induced responses observed in the DLS, there is growing awareness that the thalamus has a significant role in conveying sensory-related information to DLS and other parts of the striatum. The thalamostriatal projections to DLS originate mainly from the caudal intralaminar region, which contains the parafascicular (Pf) nucleus, and from higher-order thalamic nuclei such as the medial part of the posterior (POm) nucleus. Based on recent findings, we hypothesize that the thalamostriatal projections from these two regions exert opposing influences on the expression of behavioral habits. This article reviews the subcortical circuits that regulate the transmission of sensory information through these thalamostriatal projection systems, and describes the evidence that indicates these circuits could be manipulated to ameliorate the symptoms of Parkinson's disease (PD) and related neurological disorders.
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Affiliation(s)
- Kevin D. Alloway
- Neural and Behavioral Sciences, Center for Neural Engineering, Pennsylvania State UniversityUniversity Park, PA, United States
| | - Jared B. Smith
- Molecular Neurobiology Laboratory, The Salk Institute for Biological StudiesLa Jolla, CA, United States
| | - Todd M. Mowery
- Center for Neural Science, New York UniversityNew York, NY, United States
| | - Glenn D. R. Watson
- Department of Psychology and Neuroscience, Duke UniversityDurham, NC, United States
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High frequency stimulation of afferent fibers generates asynchronous firing in the downstream neurons in hippocampus through partial block of axonal conduction. Brain Res 2017; 1661:67-78. [PMID: 28213155 DOI: 10.1016/j.brainres.2017.02.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/25/2017] [Accepted: 02/10/2017] [Indexed: 01/30/2023]
Abstract
Deep brain stimulation (DBS) is effective for treating neurological disorders in clinic. However, the therapeutic mechanisms of high-frequency stimulation (HFS) of DBS have not yet been elucidated. Previous studies have suggested that HFS-induced changes in axon conduction could have important contributions to the DBS effects and desiderate further studies. To investigate the effects of prolonged HFS of afferent axons on the firing of downstream neurons, HFS trains of 100 and 200Hz were applied on the Schaffer collaterals of the hippocampal CA1 region in anaesthetized rats. Single unit activity of putative pyramidal cells and interneurons in the downstream region was analyzed during the late periods of prolonged HFS when the axonal conduction was blocked. The results show that the firing rates of both pyramidal cells and interneurons increased rather than decreased during the period of axon block. However, the firing rates were far smaller than the stimulation frequency of HFS. In addition, the firing pattern of pyramidal cells changed from typical bursts during baseline recordings into regular single spikes during HFS periods. Furthermore, the HFS produced asynchronous firing in the downstream neurons in contrast to the synchronous firing induced by single pulses. Presumably, the HFS-induced block of axonal conduction was not complete. During the period of partial block, individual axons could recover intermittently and independently, and drive the downstream neurons to fire in an asynchronous pattern. This axonal mechanism of HFS provides a novel explanation for how DBS could replace an original pattern of neuronal activity by a HFS-modulated asynchronous firing in the target region thereby generating the therapeutic effects of DBS.
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Chen T, Mirzadeh Z, Chapple K, Lambert M, Ponce FA. Complication rates, lengths of stay, and readmission rates in "awake" and "asleep" deep brain simulation. J Neurosurg 2016; 127:360-369. [PMID: 27662532 DOI: 10.3171/2016.6.jns152946] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE As the number of deep brain stimulation (DBS) procedures performed under general anesthesia ("asleep" DBS) increases, it is more important to assess the rates of adverse events, inpatient lengths of stay (LOS), and 30-day readmission rates in patients undergoing these procedures compared with those in patients undergoing traditional "awake" DBS without general anesthesia. METHODS All patients in an institutional database who had undergone awake or asleep DBS procedures performed by a single surgeon between August 2011 and August 2014 were reviewed. Adverse events, inpatient LOS, and 30-day readmissions were analyzed. RESULTS A total of 490 electrodes were placed in 284 patients, of whom 126 (44.4%) underwent awake surgery and 158 (55.6%) underwent asleep surgery. The most frequent overall complication for the cohort was postoperative mental status change (13 patients [4.6%]), followed by hemorrhage (4 patients [1.4%]), seizure (4 patients [1.4%]), and hardware-related infection (3 patients [1.1%]). Mean LOS for all 284 patients was 1.19 ± 1.29 days (awake: 1.06 ± 0.46 days; asleep: 1.30 ± 1.67 days; p = 0.08). Overall, the 30-day readmission rate was 1.4% (1 awake patient, 3 asleep patients). There were no significant differences in complications, LOS, and 30-day readmissions between awake and asleep groups. CONCLUSIONS Both awake and asleep DBS can be performed safely with low complication rates. The authors found no significant differences between the 2 procedure groups in adverse events, inpatient LOS, and 30-day readmission rates.
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Affiliation(s)
- Tsinsue Chen
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Zaman Mirzadeh
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Kristina Chapple
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Margaret Lambert
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Francisco A Ponce
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
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Smith KA, Pahwa R, Lyons KE, Nazzaro JM. Deep brain stimulation for Parkinson's disease: current status and future outlook. Neurodegener Dis Manag 2016; 6:299-317. [DOI: 10.2217/nmt-2016-0012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Parkinson's disease is a neurodegenerative condition secondary to loss of dopaminergic neurons in the substantia nigra pars compacta. Surgical therapy serves as an adjunct when unwanted medication side effects become apparent or additional therapy is needed. Deep brain stimulation emerged into the forefront in the 1990s. Studies have demonstrated improvement in all of the cardinal parkinsonian signs with stimulation. Frameless and ‘mini-frame’ stereotactic systems, improved MRI for anatomic visualization, and intraoperative MRI-guided placement are a few of the surgical advances in deep brain stimulation. Other advances include rechargeable pulse generators, voltage- or current-based stimulation, and enhanced abilities to ‘steer’ stimulation. Work is ongoing investigating closed-loop ‘smart’ stimulation in which stimulation is predicated on neuronal feedback.
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Affiliation(s)
- Kyle A Smith
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 3021, Kansas City, KS 66160, USA
| | - Rajesh Pahwa
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Kelly E Lyons
- Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jules M Nazzaro
- Department of Neurosurgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Mailstop 3021, Kansas City, KS 66160, USA
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Pal GD, Hall D, Ouyang B, Phelps J, Alcalay R, Pauciulo MW, Nichols WC, Clark L, Mejia-Santana H, Blasucci L, Goetz CG, Comella C, Colcher A, Gan-Or Z, Rouleau GA, Marder K. Genetic and Clinical Predictors of Deep Brain Stimulation in Young-Onset Parkinson's Disease. Mov Disord Clin Pract 2016; 3:465-471. [PMID: 27709117 DOI: 10.1002/mdc3.12309] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE In a cohort of patients with young-onset Parkinson's disease (PD), the authors assessed (1) the prevalence of genetic mutations in those who enrolled in deep brain stimulation (DBS) programs compared with those who did not enroll DBS programs and (2) specific genetic and clinical predictors of DBS enrollment. METHODS Subjects were participants from 3 sites (Columbia University, Rush University, and the University of Pennsylvania) in the Consortium on Risk for Early Onset Parkinson's Disease (CORE-PD) who had an age at onset < 51 years. The analyses presented here focus on glucocerebrosidase (GBA), leucine-rich repeat kinase 2 (LRRK2), and parkin (PRKN) mutation carriers. Mutation carrier status, demographic data, and disease characteristics in individuals who did and did not enroll in DBS were analyzed. The association between mutation status and DBS placement was assessed in logistic regression models. RESULTS Patients who had PD with either GBA, LRRK2, or PRKN mutations were more common in the DBS group (n = 99) compared with the non-DBS group (n = 684; 26.5% vs. 16.8%, respectively; P = 0.02). In a multivariate logistic regression model, GBA mutation status (odds ratio, 2.1; 95% confidence interval, 1.0-4.3; P = 0.05) was associated with DBS surgery enrollment. However, when dyskinesia was included in the multivariate logistic regression model, dyskinesia had a strong association with DBS placement (odds ratio, 3.8; 95% confidence interval, 1.9-7.3; P < 0.0001), whereas the association between GBA mutation status and DBS placement did not persist (P = 0.25). CONCLUSIONS DBS populations are enriched with genetic mutation carriers. The effect of genetic mutation carriers on DBS outcomes warrants further exploration.
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Affiliation(s)
- Gian D Pal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Deborah Hall
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Jessica Phelps
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Roy Alcalay
- Department of Neurology and the Taub Institute, Columbia University Medical Center, New York, NY, USA
| | - Michael W Pauciulo
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - William C Nichols
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Lorraine Clark
- Department of Pathology and Cell Biology and the Taub Institute, Columbia University Medical Center, NY, New York, USA
| | - Helen Mejia-Santana
- Department of Neurology and the Taub Institute, Columbia University Medical Center, New York, NY, USA
| | - Lucia Blasucci
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Christopher G Goetz
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Cynthia Comella
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Amy Colcher
- PRKNson's Disease and Movement Disorders Center, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Ziv Gan-Or
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Guy A Rouleau
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada; The Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada
| | - Karen Marder
- Department of Neurology and the Taub Institute, Columbia University Medical Center, New York, NY, USA
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Duval C, Daneault JF, Hutchison WD, Sadikot AF. A brain network model explaining tremor in Parkinson's disease. Neurobiol Dis 2016; 85:49-59. [DOI: 10.1016/j.nbd.2015.10.009] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022] Open
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Lentz L, Zhao Y, Kelly MT, Schindeldecker W, Goetz S, Nelson DE, Raike RS. Motor behaviors in the sheep evoked by electrical stimulation of the subthalamic nucleus. Exp Neurol 2015; 273:69-82. [DOI: 10.1016/j.expneurol.2015.07.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/22/2015] [Accepted: 07/25/2015] [Indexed: 12/25/2022]
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Menegas W, Bergan JF, Ogawa SK, Isogai Y, Umadevi Venkataraju K, Osten P, Uchida N, Watabe-Uchida M. Dopamine neurons projecting to the posterior striatum form an anatomically distinct subclass. eLife 2015; 4:e10032. [PMID: 26322384 PMCID: PMC4598831 DOI: 10.7554/elife.10032] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Accepted: 08/28/2015] [Indexed: 12/18/2022] Open
Abstract
Combining rabies-virus tracing, optical clearing (CLARITY), and whole-brain light-sheet imaging, we mapped the monosynaptic inputs to midbrain dopamine neurons projecting to different targets (different parts of the striatum, cortex, amygdala, etc) in mice. We found that most populations of dopamine neurons receive a similar set of inputs rather than forming strong reciprocal connections with their target areas. A common feature among most populations of dopamine neurons was the existence of dense ‘clusters’ of inputs within the ventral striatum. However, we found that dopamine neurons projecting to the posterior striatum were outliers, receiving relatively few inputs from the ventral striatum and instead receiving more inputs from the globus pallidus, subthalamic nucleus, and zona incerta. These results lay a foundation for understanding the input/output structure of the midbrain dopamine circuit and demonstrate that dopamine neurons projecting to the posterior striatum constitute a unique class of dopamine neurons regulated by different inputs. DOI:http://dx.doi.org/10.7554/eLife.10032.001 Most neurons send their messages to recipient neurons by releasing a substance called a ‘neurotransmitter’ that binds to receptors on the target cell. The sites of this type of signal transmission are called synapses. Some small populations of neurons modulate the activity of hundreds or thousands of these synapses all across the brain by releasing ‘neuromodulators’ that affect how they work. These neuromodulators are essential because they broadcast information that is likely to be useful to many brain regions, like a ‘news channel’ for the brain. One important neuromodulator in the mammalian brain is dopamine, which contributes to motivation, learning, and the control of movement. Clusters of cells deep in the brain release dopamine, and people with Parkinson's disease gradually lose these cells. This makes it increasingly difficult for their brains to produce the correct amount of dopamine, and results in symptoms such as tremors and stiff muscles. Individual dopamine neurons typically send information to a single part of the brain. This suggests that dopamine neurons with different targets might have different roles. To explore this possibility, Menegas et al. classified dopamine neurons in the mouse brain into eight types based on the areas to which they project, and then mapped which neurons send input signals to each type. These inputs are likely to shape the activity of each type (that is, their ‘message’ to the rest of the brain). The mapping revealed that most dopamine neurons do not receive substantial input from the area to which they project (i.e., they do not form ‘closed loops’). Instead, most of their input comes from a common set of brain regions, including a particularly large number of inputs from the ventral striatum. However, Menegas et al. found one exception. Dopamine neurons that target part of the brain called the posterior striatum receive relatively little input from the ventral striatum. Their input comes instead from a set of other brain structures, and in particular from a region called the subthalamic nucleus. Electrical stimulation of the subthalamic nucleus can help to relieve the symptoms of Parkinson's disease. Therefore, the results presented by Menegas et al. suggest that this population of dopamine neurons might be particularly relevant to Parkinson's disease and that focusing future studies on them could ultimately be beneficial for patients. DOI:http://dx.doi.org/10.7554/eLife.10032.002
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Affiliation(s)
- William Menegas
- Center for Brain Science, Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | - Joseph F Bergan
- Center for Brain Science, Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | - Sachie K Ogawa
- Center for Brain Science, Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | - Yoh Isogai
- Center for Brain Science, Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | | | - Pavel Osten
- Cold Spring Harbor Laboratory, Cold Spring Harbor, United States
| | - Naoshige Uchida
- Center for Brain Science, Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
| | - Mitsuko Watabe-Uchida
- Center for Brain Science, Department of Molecular and Cellular Biology, Harvard University, Cambridge, United States
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Gondard E, Chau HN, Mann A, Tierney TS, Hamani C, Kalia SK, Lozano AM. Rapid Modulation of Protein Expression in the Rat Hippocampus Following Deep Brain Stimulation of the Fornix. Brain Stimul 2015; 8:1058-64. [PMID: 26321354 DOI: 10.1016/j.brs.2015.07.044] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/24/2015] [Accepted: 07/29/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The forniceal area is currently being evaluated as a target for deep brain stimulation (DBS) to improve cognitive function in patients with Alzheimer's disease. The molecular changes at downstream targets within the stimulated circuit are unknown. OBJECTIVE To analyze the modulation of hippocampal protein expression following 1 h of fornix DBS in the rat. METHODS Animals underwent bilateral forniceal DBS for 1 h and sacrificed at different time-points after the initiation of the stimulation (1 h, 2.5 h, 5 h, 25 h). Bilateral hippocampi were isolated for western blot analyses. RESULTS Forniceal DBS led to a dramatic elevation of cFos post-stimulation, suggesting that forniceal DBS activates the hippocampus. There was also a significant increase in candidate proteins including several trophic factors, such as brain derived neurotrophic factor (BDNF) and vascular endothelial growth factor (VEGF) but not glial cell-derived neurotrophic factor (GDNF). There was in addition, increased expression of the synaptic markers growth associated protein 43 (GAP-43), synaptophysin and α-synuclein. No changes were observed at the studied time-points in Alzheimer's-related proteins including amyloid precursor protein (APP), tau, phosphorylated tau (ptau), or selected chaperone proteins (HSP40, HSP70 and CHIP). CONCLUSIONS Forniceal DBS triggers hippocampal activity and rapidly modulate the expression of neurotrophic factors and markers of synaptic plasticity known to play key roles in memory processing. The clinical effects of DBS of the fornix may, in part, be mediated by producing changes in the expression of these proteins.
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Affiliation(s)
- Elise Gondard
- Toronto Western Research Institute, Krembil Discovery Tower, University Health Network, 60 Leonard Street, Toronto, ON, M5T 2S8, Canada
| | - Hien N Chau
- Toronto Western Research Institute, Krembil Discovery Tower, University Health Network, 60 Leonard Street, Toronto, ON, M5T 2S8, Canada
| | - Amandeep Mann
- Toronto Western Research Institute, Krembil Discovery Tower, University Health Network, 60 Leonard Street, Toronto, ON, M5T 2S8, Canada
| | - Travis S Tierney
- Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Clement Hamani
- Research Imaging Centre, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 250 College Street, Toronto, ON, M5T 1R8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Suneil K Kalia
- Toronto Western Research Institute, Krembil Discovery Tower, University Health Network, 60 Leonard Street, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada
| | - Andres M Lozano
- Toronto Western Research Institute, Krembil Discovery Tower, University Health Network, 60 Leonard Street, Toronto, ON, M5T 2S8, Canada; Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada.
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Veerakumar A, Berton O. Cellular mechanisms of deep brain stimulation: activity-dependent focal circuit reprogramming? Curr Opin Behav Sci 2015; 4:48-55. [PMID: 26719852 DOI: 10.1016/j.cobeha.2015.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Deep brain stimulation (DBS) is a well-established treatment modality for movement disorders. As more behavioral disorders are becoming understood as specific disruptions in neural circuitry, the therapeutic realm of DBS is broadening to encompass a wider range of domains, including disorders of compulsion, affect, and memory, but current understanding of the cellular mechanisms of DBS remains limited. We review progress made during the last decade focusing in particular on how recent methods for targeted circuit manipulations, imaging and reconstruction are fostering preclinical and translational advances that improve our neurobiological understanding of DBS's action in psychiatric disorders.
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Affiliation(s)
- Avin Veerakumar
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
| | - Olivier Berton
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania
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Thompson DM, Koppes AN, Hardy JG, Schmidt CE. Electrical stimuli in the central nervous system microenvironment. Annu Rev Biomed Eng 2015; 16:397-430. [PMID: 25014787 DOI: 10.1146/annurev-bioeng-121813-120655] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Electrical stimulation to manipulate the central nervous system (CNS) has been applied as early as the 1750s to produce visual sensations of light. Deep brain stimulation (DBS), cochlear implants, visual prosthetics, and functional electrical stimulation (FES) are being applied in the clinic to treat a wide array of neurological diseases, disorders, and injuries. This review describes the history of electrical stimulation of the CNS microenvironment; recent advances in electrical stimulation of the CNS, including DBS to treat essential tremor, Parkinson's disease, and depression; FES for the treatment of spinal cord injuries; and alternative electrical devices to restore vision and hearing via neuroprosthetics (retinal and cochlear implants). It also discusses the role of electrical cues during development and following injury and, importantly, manipulation of these endogenous cues to support regeneration of neural tissue.
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Affiliation(s)
- Deanna M Thompson
- Department of Biomedical Engineering and Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York 12180;
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Fraix V, Castrioto A, Moro E, Krack P. Trattamento chirurgico della malattia di Parkinson. Neurologia 2015. [DOI: 10.1016/s1634-7072(14)69825-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
The next several decades will see an exponential rise in the number of patients with disorders of memory and cognition, and of Alzheimer's disease in particular. Impending demographic shifts, an absence of effective treatments, and the significant burden these conditions place on patients, caregivers, and society, mean there is an urgent need to develop novel therapies. Deep brain stimulation (DBS) is a neurosurgical procedure that is a standard-of-care for many patients with treatment-refractory Parkinson's disease, dystonia, and essential tremor. DBS has proven to be an effective means of modulating activity in disrupted motor circuitry, and has shown promise as a modulator of other dysfunctional circuits, including for mood and anxiety disorders. The deficits in Alzheimer's disease and other disorders of memory and cognition are also beginning to be thought of as arising from dysfunction in neural circuits. Such dysfunction may be amenable to modulation using focal brain stimulation. A global experience is now emerging for the use of DBS for these conditions, targeting key nodes in the memory circuit, including the fornix and nucleus basalis of Meynert. Such work holds promise as a novel therapeutic approach for one of medicine's most urgent priorities.
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Affiliation(s)
- Tejas Sankar
- />Division of Neurosurgery, Walter C. MacKenzie Health Sciences Centre, University of Alberta, 8440-112 Street, Edmonton, Alberta T6G 2B7 Canada
| | - Nir Lipsman
- />Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. WW 4-447, Toronto, Ontario M5T 2S8 Canada
| | - Andres M. Lozano
- />Division of Neurosurgery, Toronto Western Hospital, 399 Bathurst St. WW 4-447, Toronto, Ontario M5T 2S8 Canada
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Lukins TR, Tisch S, Jonker B. The latest evidence on target selection in deep brain stimulation for Parkinson’s disease. J Clin Neurosci 2014; 21:22-7. [PMID: 24210797 DOI: 10.1016/j.jocn.2013.05.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
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Jourdain VA, Schechtmann G. Health Economics and Surgical Treatment for Parkinson's Disease in a World Perspective: Results from an International Survey. Stereotact Funct Neurosurg 2014; 92:71-9. [DOI: 10.1159/000355215] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/22/2013] [Indexed: 11/19/2022]
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Dopamine-dependent compensation maintains motor behavior in mice with developmental ablation of dopaminergic neurons. J Neurosci 2013; 33:17095-107. [PMID: 24155314 DOI: 10.1523/jneurosci.0890-13.2013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The loss of dopaminergic neurons in the substantia nigra pars compacta (SNc) and consequent depletion of striatal dopamine are known to underlie the motor deficits observed in Parkinson's disease (PD). Adaptive changes in dopaminergic terminals and in postsynaptic striatal neurons can compensate for significant losses of striatal dopamine, resulting in preservation of motor behavior. In addition, compensatory changes independent of striatal dopamine have been proposed based on PD therapies that modulate nondopaminergic circuits within the basal ganglia. We used a genetic strategy to selectively destroy dopaminergic neurons in mice during development to determine the necessity of these neurons for the maintenance of normal motor behavior in adult and aged mice. We find that loss of 90% of SNc dopaminergic neurons and consequent depletion of >95% of striatal dopamine does not result in changes in motor behavior in young-adult or aged mice as evaluated by an extensive array of motor behavior tests. Treatment of aged mutant mice with the dopamine receptor antagonist haloperidol precipitated motor behavior deficits in aged mutant mice, indicating that <5% of striatal dopamine is sufficient to maintain motor function in these mice. We also found that mutant mice exhibit an exaggerated response to l-DOPA compared with control mice, suggesting that preservation of motor function involves sensitization of striatal dopamine receptors. Our results indicate that congenital loss of dopaminergic neurons induces remarkable adaptions in the nigrostriatal system where limited amounts of dopamine in the dorsal striatum can maintain normal motor function.
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Franzini A, Cordella R, Rizzi M, Marras CE, Messina G, Zorzi G, Caldiroli D. Deep brain stimulation in critical care conditions. J Neural Transm (Vienna) 2013; 121:391-8. [PMID: 24292857 DOI: 10.1007/s00702-013-1122-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 11/15/2013] [Indexed: 11/26/2022]
Abstract
Some neurological conditions require admission to an intensive care unit (ICU) where deep sedation and mechanical ventilation are administered to improve the patient's condition. Nevertheless, these treatments are not always helpful in disease control. At this stage, deep brain stimulation (DBS) could become a viable alternative in the treatment of critical neurological conditions with long-lasting clinical benefit. The value of deep brain stimulation has been investigated in the treatment of patients who had undergone surgical electrode implants as an emergency procedure to treat acute life-threatening conditions requiring admission to neurological ICU (NICU). A before-and-after perspective study was examined of seven patients who were treated with DBS for status dystonicus (SD) and post-stroke severe hemiballismus. Bilateral globus pallidus internus (GPi) DBS was performed in five SD patients and unilateral ventralis oralis anterior and posterior (Voa/Vop) nucleus of the thalamus DBS in two post-stroke hemiballismus patients. Bilateral GPi-DBS allowed SD resolution in a time lapse varying from 1 week to 3 months. No clear improvements compared to the baseline clinical condition were observed. Unilateral Voa/Vop-DBS intervention controlled hemiballismus after 10 h, and the patient was discharged in 2 days. The other patient was transferred from the NICU to the neurosurgery ward after 13 days. No surgical complications were observed in any of the above procedures. Neurostimulation procedures could represent a valuable choice in critical care conditions, when involuntary movements are continuous, life-threatening and refractory to intensive care procedures. DBS is feasible, safe and effective in selected cases.
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Affiliation(s)
- Angelo Franzini
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico "C. Besta", Via Celoria 11, 20133, Milan, Italy
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Cognitive factors modulate activity within the human subthalamic nucleus during voluntary movement in Parkinson's disease. J Neurosci 2013; 33:15815-26. [PMID: 24089489 DOI: 10.1523/jneurosci.1790-13.2013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Movement is accompanied by changes in the degree to which neurons in corticobasal ganglia loops synchronize their activity within discrete frequency ranges. Although two principal frequency bands--beta (15-30 Hz) and gamma (60-90 Hz)--have been implicated in motor control, the precise functional correlates of their activities remain unclear. Local field potential (LFP) recordings in humans with Parkinson's disease undergoing surgery for deep brain stimulation to the subthalamic nucleus (STN) indicate that spectral changes both anticipate movement and occur perimovement. The extent to which such changes are modulated by cognitive factors involved in making a correct response seems critical in characterizing the functional associations of these oscillations. Accordingly, by recording LFP activity from the STN in parkinsonian patients, we demonstrate that perimovement beta and gamma reactivity is modulated by task complexity in a dopamine-dependent manner, despite the dynamics of the movement remaining unchanged. In contrast, spectral changes occurring in anticipation of future movement were limited to the beta band and, although modulated by dopaminergic therapy, were not modulated by task complexity. Our findings suggest two dopamine-dependent processes indexed by spectral changes in the STN: (1) an anticipatory activity reflected in the beta band that signals the likelihood of future action but does not proactively change with the cognitive demands of the potential response, and (2) perimovement activity that involves reciprocal beta and gamma band changes and is not exclusively related to explicit motor processing. Rather perimovement activity can also vary with, and may reflect, the cognitive complexity of the task.
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Ethics of the electrified mind: defining issues and perspectives on the principled use of brain stimulation in medical research and clinical care. Brain Topogr 2013; 27:33-45. [PMID: 23733209 DOI: 10.1007/s10548-013-0296-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 05/15/2013] [Indexed: 12/19/2022]
Abstract
In recent years, non-pharmacologic approaches to modifying human neural activity have gained increasing attention. One of these approaches is brain stimulation, which involves either the direct application of electrical current to structures in the nervous system or the indirect application of current by means of electromagnetic induction. Interventions that manipulate the brain have generally been regarded as having both the potential to alleviate devastating brain-related conditions and the capacity to create unforeseen and unwanted consequences. Hence, although brain stimulation techniques offer considerable benefits to society, they also raise a number of ethical concerns. In this paper we will address various dilemmas related to brain stimulation in the context of clinical practice and biomedical research. We will survey current work involving deep brain stimulation, transcranial magnetic stimulation and transcranial direct current stimulation. We will reflect upon relevant similarities and differences between them, and consider some potentially problematic issues that may arise within the framework of established principles of medical ethics: nonmaleficence and beneficence, autonomy, and justice.
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Daneault JF, Carignan B, Sadikot AF, Panisset M, Duval C. Drug-induced dyskinesia in Parkinson's disease. Should success in clinical management be a function of improvement of motor repertoire rather than amplitude of dyskinesia? BMC Med 2013; 11:76. [PMID: 23514355 PMCID: PMC3751666 DOI: 10.1186/1741-7015-11-76] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 03/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dyskinesia, a major complication in the treatment of Parkinson's disease (PD), can require prolonged monitoring and complex medical management. DISCUSSION The current paper proposes a new way to view the management of dyskinesia in an integrated fashion. We suggest that dyskinesia be considered as a factor in a signal-to-noise ratio (SNR) equation where the signal is the voluntary movement and the noise is PD symptomatology, including dyskinesia. The goal of clinicians should be to ensure a high SNR in order to maintain or enhance the motor repertoire of patients. To understand why such an approach would be beneficial, we first review mechanisms of dyskinesia, as well as their impact on the quality of life of patients and on the health-care system. Theoretical and practical bases for the SNR approach are then discussed. SUMMARY Clinicians should not only consider the level of motor symptomatology when assessing the efficacy of their treatment strategy, but also breadth of the motor repertoire available to patients.
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Affiliation(s)
- Jean-François Daneault
- Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 3801 University Street, Montreal, Quebec H3A 2B4, Canada
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Multimodal imaging and image analysis techniques for neuromodulation. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2012. [PMID: 23206685 DOI: 10.1016/b978-0-12-404706-8.00012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
Functional neurosurgical procedures used to treat the debilitating motor symptoms of Parkinson's disease and that target small subcortical structures have typically relied on semi-qualitative manual approaches that rely upon the establishing qualitative between volumetric imaging data and print atlases. This chapter reviews many new high -precision and -accuracy techniques that can be used for the full automated localization of these targets. These techniques rely on the a priori development of neuroanatomical atlases derived from magnetic resonance imaging data, high-resolution identification of subcortical structures from histology, and spatially localized data bases of intra-operative recordings and successful surgical outcomes. Other novel structural and functional MRI techniques that allow for the direct visualization of thalamic sub nuclei are also reviewed.
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Falowski S, Ghods AJ, Bakay RAE. Displacement of a deep brain stimulator lead during placement of an additional ipsilateral lead. Neuromodulation 2012; 16:41-4; discussion 44-5. [PMID: 22947046 DOI: 10.1111/j.1525-1403.2012.00500.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The use of Deep Brain Stimulation (DBS) has been increasing. It follows the premise of neuromodulation in that it is reversible, as compared to previous lesioning procedures. MATERIALS AND METHODS Complications with DBS are inherently low and range from short-term complications during surgery such as hemorrhage to long-term complications that include lead fractures and infection. Over time, the authors have experienced indications for additional lead placements or change in position of the lead on the ipsilateral side. There is the inherent possibility of direct contact between leads or the microelectrode. This can lead to malpositioning, displacement of a lead placed previously, and malfunctioning. RESULT We report a case in which a lead placed previously becomes displaced during microelectrode recording on the ipsilateral side. CONCLUSION This scenario was corrected and had no clinical or functional complication. Placement of an additional ipsilateral DBS lead can be a safe and effective treatment option.
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Affiliation(s)
- Steven Falowski
- Department of Neurosurgery, Rush University Medical College, Chicago, IL 60612, USA.
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Schiff ND. Moving toward a generalizable application of central thalamic deep brain stimulation for support of forebrain arousal regulation in the severely injured brain. Ann N Y Acad Sci 2012; 1265:56-68. [PMID: 22834729 DOI: 10.1111/j.1749-6632.2012.06712.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review considers the challenges ahead for developing a generalizable strategy for the use of central thalamic deep brain stimulation (CT/DBS) to support arousal regulation mechanisms in the severely injured brain. Historical efforts to apply CT/DBS to patients with severe brain injuries and a proof-of-concept result from a single-subject study are discussed. Circuit and cellular mechanisms underlying the recovery of consciousness are considered for their relevance to the application of CT/DBS, to improve consciousness and cognition in nonprogressive brain injuries. Finally, directions for development, and testing of generalizable criteria for CT/DBS are suggested, which aim to identify neuronal substrates and behavioral profiles that may optimally benefit from support of arousal regulation mechanisms.
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Affiliation(s)
- Nicholas D Schiff
- Department of Neurology and Neuroscience, Weill Cornell Medical College, New York, USA.
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Schiff ND. Dissecting DBS Dynamics through quantitative behavioral assessments and statistical modeling: A commentary on Cooper et al. 2011. Exp Neurol 2012; 233:747-8. [DOI: 10.1016/j.expneurol.2011.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 11/18/2011] [Indexed: 11/28/2022]
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Stimulation of entorhinal cortex promotes adult neurogenesis and facilitates spatial memory. J Neurosci 2011; 31:13469-84. [PMID: 21940440 DOI: 10.1523/jneurosci.3100-11.2011] [Citation(s) in RCA: 290] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Deep brain stimulation (DBS) is an established therapeutic modality for the treatment of movement disorders and an emerging therapeutic approach for the treatment of disorders of mood and thought. For example, recently we have shown that DBS of the fornix may ameliorate cognitive decline associated with dementia. However, like other applications of DBS, the mechanisms mediating these clinical effects are unknown. As DBS modulates neurophysiological activity in targeted brain regions, DBS might influence cognitive function via activity-dependent regulation of hippocampal neurogenesis. Using stimulation parameters analogous to clinical high-frequency DBS, here we addressed this question in mice. We found that acute stimulation of the entorhinal cortex (EC) transiently promoted proliferation in the dentate gyrus (DG). Cells generated as a consequence of stimulation differentiated into neurons, survived for at least several weeks, and acquired normal dentate granule cell (DGC) morphology. Importantly, stimulation-induced promotion of neurogenesis was limited to the DG and not associated with changes in apoptotic cell death. Using immunohistochemical approaches, we found that, once sufficiently mature, these stimulation-induced neurons integrated into hippocampal circuits supporting water-maze memory. Finally, formation of water-maze memory was facilitated 6 weeks (but not 1 week) after bilateral stimulation of the EC. The delay-dependent nature of these effects matches the maturation-dependent integration of adult-generated DGCs into dentate circuits supporting water-maze memory. Furthermore, because the beneficial effects of EC stimulation were prevented by blocking neurogenesis, this suggests a causal relationship between stimulation-induced promotion of adult neurogenesis and enhanced spatial memory.
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Optetrode: a multichannel readout for optogenetic control in freely moving mice. Nat Neurosci 2011; 15:163-70. [PMID: 22138641 DOI: 10.1038/nn.2992] [Citation(s) in RCA: 243] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 10/24/2011] [Indexed: 12/12/2022]
Abstract
Recent advances in optogenetics have improved the precision with which defined circuit elements can be controlled optically in freely moving mammals; in particular, recombinase-dependent opsin viruses, used with a growing pool of transgenic mice expressing recombinases, allow manipulation of specific cell types. However, although optogenetic control has allowed neural circuits to be manipulated in increasingly powerful ways, combining optogenetic stimulation with simultaneous multichannel electrophysiological readout of isolated units in freely moving mice remains a challenge. We designed and validated the optetrode, a device that allows for colocalized multi-tetrode electrophysiological recording and optical stimulation in freely moving mice. Optetrode manufacture employs a unique optical fiber-centric coaxial design approach that yields a lightweight (2 g), compact and robust device that is suitable for behaving mice. This low-cost device is easy to construct (2.5 h to build without specialized equipment). We found that the drive design produced stable high-quality recordings and continued to do so for at least 6 weeks following implantation. We validated the optetrode by quantifying, for the first time, the response of cells in the medial prefrontal cortex to local optical excitation and inhibition, probing multiple different genetically defined classes of cells in the mouse during open field exploration.
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Jenkinson N, Brown P. New insights into the relationship between dopamine, beta oscillations and motor function. Trends Neurosci 2011; 34:611-8. [DOI: 10.1016/j.tins.2011.09.003] [Citation(s) in RCA: 357] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 09/19/2011] [Accepted: 09/23/2011] [Indexed: 01/11/2023]
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Nantel J, McDonald JC, Bronte-Stewart H. Effect of medication and STN-DBS on postural control in subjects with Parkinson's disease. Parkinsonism Relat Disord 2011; 18:285-9. [PMID: 22130147 DOI: 10.1016/j.parkreldis.2011.11.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 10/31/2011] [Accepted: 11/04/2011] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To assess the effect of disease severity, dopaminergic medication (med) and STN-DBS on postural stability in Parkinson's disease (PD). METHODS Postural sway in quiet stance, and the Unified Parkinson's Disease Rating Scale (motor) (UPDRS III) were evaluated in 129 subjects in the off-med state. A subgroup of 28 subjects was studied on-med and after STN-DBS. Postural sway was measured using center of pressure (CoP) root mean square displacement (RMS(CoP)) and mean velocity (V(CoP)) in the anterior-posterior (AP) and medial-lateral (ML) directions. RESULTS All CoP parameters were larger in moderate/advanced subjects vs controls (P < 0.001) and early subjects. Only RMS(CoP)ML was larger in early subjects vs controls (P < 0.05). Med, DBS and DBS + med decreased UPDRS III compared to off-med (P < 0.001). RMS(CoP)ML and V(CoP)ML were larger on-med vs off-med and vs DBS (P < 0.001). Compared to controls and PD subjects with normal CoP sway off-med, med increased all CoP parameters (P < 0.01) but DBS returned V(CoP)ML to normal values. For 'abnormal' PD subjects, STN-DBS improved the excessive V(CoP) in ML compared to off and on-med pre-DBS (P < 0.05). CONCLUSIONS Postural sway in quiet stance increased with disease severity. Only ML CoP displacement was abnormal in early stage PD, and this may be a compensatory mechanism. Medication increased ML postural sway. In 'normal' PD subjects, STN-DBS reversed medication induced postural instability. Subjects with abnormal balance in quiet stance did not benefit from medication or DBS, except for improvement in ML CoP velocity from DBS. This may serve to reduce postural instability and falling.
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Affiliation(s)
- Julie Nantel
- Department of Neurology and Neurological Sciences, Rm A343, 300 Pasteur Drive, Stanford University School of Medicine, Stanford, CA 94303, USA.
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Iravani MM, Jenner P. Mechanisms underlying the onset and expression of levodopa-induced dyskinesia and their pharmacological manipulation. J Neural Transm (Vienna) 2011; 118:1661-90. [DOI: 10.1007/s00702-011-0698-2] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Accepted: 08/06/2011] [Indexed: 12/18/2022]
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Zold CL, Kasanetz F, Pomata PE, Belluscio MA, Escande MV, Galinanes GL, Riquelme LA, Murer MG. Striatal gating through up states and oscillations in the basal ganglia: Implications for Parkinson's disease. ACTA ACUST UNITED AC 2011; 106:40-6. [PMID: 21767642 DOI: 10.1016/j.jphysparis.2011.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 06/24/2011] [Indexed: 11/25/2022]
Abstract
Up states are a hallmark of striatal physiology. Spontaneous activity in the thalamo-cortical network drives robust plateau depolarizations in the medium spiny projection neurons of the striatum. Medium spiny neuron firing is only possible during up states and is very tightly regulated by dopamine and NMDA receptors. In a rat model of Parkinson's disease the medium spiny neurons projecting to the globus pallidus (indirect pathway) show more depolarized up states and increased firing. This is translated into abnormal patterns of synchronization between the globus pallidus and frontal cortex, which are believed to underlie the symptoms of Parkinson's disease. Here we review our work in the field and propose a mechanism through which the lack of D2 receptor stimulation in the striatum allows the establishment of fixed routes of information flow in the cortico-striato-pallidal network.
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Affiliation(s)
- Camila L Zold
- Neural Circuit Physiology Lab., Systems Neuroscience Group, Department of Physiology and Biophysics, University of Buenos Aires School of Medicine, 2155 Paraguay St., Buenos Aires 1121, Argentina.
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