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Mensah-Brown KG, Naylor RM, Graepel S, Brinjikji W. Neuromodulation: What the neurointerventionalist needs to know. Interv Neuroradiol 2024:15910199231224554. [PMID: 38454831 DOI: 10.1177/15910199231224554] [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: 03/09/2024] Open
Abstract
Neuromodulation is the alteration of neural activity in the central, peripheral, or autonomic nervous systems. Consequently, this term lends itself to a variety of organ systems including but not limited to the cardiac, nervous, and even gastrointestinal systems. In this review, we provide a primer on neuromodulation, examining the various technological systems employed and neurological disorders targeted with this technology. Ultimately, we undergo a historical analysis of the field's development, pivotal discoveries and inventions gearing this review to neuro-adjacent subspecialties with a specific focus on neurointerventionalists.
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Affiliation(s)
| | - Ryan M Naylor
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA
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Beckinghausen J, Ortiz-Guzman J, Lin T, Bachman B, Salazar Leon LE, Liu Y, Heck DH, Arenkiel BR, Sillitoe RV. The cerebellum contributes to generalized seizures by altering activity in the ventral posteromedial nucleus. Commun Biol 2023; 6:731. [PMID: 37454228 PMCID: PMC10349834 DOI: 10.1038/s42003-023-05100-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
Thalamo-cortical networks are central to seizures, yet it is unclear how these circuits initiate seizures. We test whether a facial region of the thalamus, the ventral posteromedial nucleus (VPM), is a source of generalized, convulsive motor seizures and if convergent VPM input drives the behavior. To address this question, we devise an in vivo optogenetic mouse model to elicit convulsive motor seizures by driving these inputs and perform single-unit recordings during awake, convulsive seizures to define the local activity of thalamic neurons before, during, and after seizure onset. We find dynamic activity with biphasic properties, raising the possibility that heterogenous activity promotes seizures. Virus tracing identifies cerebellar and cerebral cortical afferents as robust contributors to the seizures. Of these inputs, only microinfusion of lidocaine into the cerebellar nuclei blocks seizure initiation. Our data reveal the VPM as a source of generalized convulsive seizures, with cerebellar input providing critical signals.
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Affiliation(s)
- Jaclyn Beckinghausen
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
| | - Joshua Ortiz-Guzman
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
| | - Tao Lin
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
| | - Benjamin Bachman
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Luis E Salazar Leon
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
| | - Yu Liu
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, 103515 University Dr., Duluth, MN, USA
| | - Detlef H Heck
- Department of Biomedical Sciences, University of Minnesota Medical School, Duluth, 103515 University Dr., Duluth, MN, USA
| | - Benjamin R Arenkiel
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, TX, USA.
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, USA.
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA.
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3
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Beckinghausen J, Donofrio SG, Lin T, Miterko LN, White JJ, Lackey EP, Sillitoe RV. Deep Brain Stimulation of the Interposed Cerebellar Nuclei in a Conditional Genetic Mouse Model with Dystonia. ADVANCES IN NEUROBIOLOGY 2023; 31:93-117. [PMID: 37338698 DOI: 10.1007/978-3-031-26220-3_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Dystonia is a neurological disease that is currently ranked as the third most common motor disorder. Patients exhibit repetitive and sometimes sustained muscle contractions that cause limb and body twisting and abnormal postures that impair movement. Deep brain stimulation (DBS) of the basal ganglia and thalamus can be used to improve motor function when other treatment options fail. Recently, the cerebellum has garnered interest as a DBS target for treating dystonia and other motor disorders. Here, we describe a procedure for targeting DBS electrodes to the interposed cerebellar nuclei to correct motor dysfunction in a mouse model with dystonia. Targeting cerebellar outflow pathways with neuromodulation opens new possibilities for using the expansive connectivity of the cerebellum to treat motor and non-motor diseases.
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Affiliation(s)
- Jaclyn Beckinghausen
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Sarah G Donofrio
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Tao Lin
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Lauren N Miterko
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
| | - Joshua J White
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Elizabeth P Lackey
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA
| | - Roy V Sillitoe
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX, USA.
- Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.
- Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA.
- Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA.
- Development, Disease Models & Therapeutics Graduate Program, Baylor College of Medicine, Houston, TX, USA.
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.
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4
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Possible contribution of cerebellar disinhibition in epilepsy. Epilepsy Behav 2021; 118:107944. [PMID: 33887658 DOI: 10.1016/j.yebeh.2021.107944] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We hypothesize that loss of inhibition from the cerebellum can lead to cortical activation and seizures. BACKGROUND The traditional model for development of seizures purports that the source of seizures is increased electrical activity originating from cerebral cortical neurons. Studies have shown a decrease in inhibition results in a shift of cortical activity to a hyperexcitable state, which may lead to seizures. Interestingly, a 1978 study suggested the term "disorder of disinhibition" as a way to describe epilepsy from studies of chronic cerebellar stimulation. DESIGN/METHODS Cases and experimental studies in which cerebellar lesions have been implicated in the development of seizures were reviewed. Cases in which cerebellar inhibition has been targeted in the treatment of seizures were also included. Twenty-six studies and case reports are presented for this report. RESULTS The cases show cerebellar lesions can lead to cortical epileptiform activity. Purkinje cell loss is linked to the occurrence of seizures in animals. The majority of patients with cerebellar lesions were seizure free after complete resection, while less than half of patients were seizure free after partial resection. Novel treatments using deep-brain stimulation targeting cerebellar structures demonstrated therapeutic benefits for seizures. CONCLUSIONS Although pathophysiology is not well-understood, the cerebellum likely plays an inherent role in inhibiting aberrant cortical epileptogenesis. Cerebellar lesions may cause seizures due to loss of the inhibition of cortical areas or through intrinsic epileptic activity. Treatments enhancing cerebellar stimulation have shown therapeutic benefits in treating seizures, which could potentially provide another avenue for treatment.
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Schreglmann SR, Wang D, Peach RL, Li J, Zhang X, Latorre A, Rhodes E, Panella E, Cassara AM, Boyden ES, Barahona M, Santaniello S, Rothwell J, Bhatia KP, Grossman N. Non-invasive suppression of essential tremor via phase-locked disruption of its temporal coherence. Nat Commun 2021; 12:363. [PMID: 33441542 PMCID: PMC7806740 DOI: 10.1038/s41467-020-20581-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/04/2020] [Indexed: 12/16/2022] Open
Abstract
Aberrant neural oscillations hallmark numerous brain disorders. Here, we first report a method to track the phase of neural oscillations in real-time via endpoint-corrected Hilbert transform (ecHT) that mitigates the characteristic Gibbs distortion. We then used ecHT to show that the aberrant neural oscillation that hallmarks essential tremor (ET) syndrome, the most common adult movement disorder, can be transiently suppressed via transcranial electrical stimulation of the cerebellum phase-locked to the tremor. The tremor suppression is sustained shortly after the end of the stimulation and can be phenomenologically predicted. Finally, we use feature-based statistical-learning and neurophysiological-modelling to show that the suppression of ET is mechanistically attributed to a disruption of the temporal coherence of the aberrant oscillations in the olivocerebellar loop, thus establishing its causal role. The suppression of aberrant neural oscillation via phase-locked driven disruption of temporal coherence may in the future represent a powerful neuromodulatory strategy to treat brain disorders.
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Affiliation(s)
- Sebastian R Schreglmann
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK
| | - David Wang
- Computer Science and Artificial Intelligence Laboratory, Massachussetts Institute of Technology (MIT), Cambridge, MA, 02139, USA
- NuVu studio Inc, Cambridge, MA, 02139, USA
| | - Robert L Peach
- Department of Mathematics and EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ, UK
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK
| | - Junheng Li
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK
| | - Xu Zhang
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
- CT Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Anna Latorre
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK
| | - Edward Rhodes
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK
| | - Emanuele Panella
- Department of Physics, Imperial College London, London, SW7 2AZ, UK
| | - Antonino M Cassara
- IT'IS Foundation for Research on Information Technologies in Society, 8004, Zurich, Switzerland
| | - Edward S Boyden
- Department of Media Arts and Sciences, MIT, Cambridge, MA, 02139, USA
- McGovern Institute for Brain Research, MIT, Cambridge, MA, 02139, USA
- Howard Hughes Medical Institute, Cambridge, MA, 02142, USA
- Department of Biological Engineering, MIT, Cambridge, MA, 02139, USA
- Department of Brain and Cognitive Sciences, MIT, Cambridge, MA, 02139, USA
- Centre for Neurobiological Engineering, MIT, Cambridge, MA, 02139, USA
- Koch Institute for Integrative Cancer Research, MIT, Cambridge, MA, 02139, USA
| | - Mauricio Barahona
- Department of Mathematics and EPSRC Centre for Mathematics of Precision Healthcare, Imperial College London, London, SW7 2AZ, UK
| | - Sabato Santaniello
- Biomedical Engineering Department, University of Connecticut, Storrs, CT, 06269, USA
- CT Institute for the Brain and Cognitive Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - John Rothwell
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK
| | - Kailash P Bhatia
- Institute of Neurology, Department of Clinical and Movement Neuroscience, Queen Square, University College London (UCL), London, WC1N 3BG, UK.
| | - Nir Grossman
- Department of Brain Sciences, Imperial College London, London, W12 0HS, UK.
- UK Dementia Research Institute (UK DRI) at Imperial College London, London, W12 0NN, UK.
- Department of Media Arts and Sciences, MIT, Cambridge, MA, 02139, USA.
- McGovern Institute for Brain Research, MIT, Cambridge, MA, 02139, USA.
- Centre for Bio-Inspired Technology, Department of Electrical and Electronic Engineering, Imperial College London, London, SW7 2AZ, UK.
- Centre for Neurotechnology, Imperial College London, London, SW7 2AZ, UK.
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6
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Different modalities of invasive neurostimulation for epilepsy. Neurol Sci 2020; 41:3527-3536. [PMID: 32740896 DOI: 10.1007/s10072-020-04614-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/19/2020] [Indexed: 01/12/2023]
Abstract
Epilepsy affects 1% of the general population, about one-third of which is pharmacologically resistant. Uncontrolled seizures are associated with an increased risk of traumatic injury and sudden unexpected death of epilepsy. There is a considerable psychological and financial burden on caregivers of patients with epilepsy, particularly among pediatric patients. Epilepsy surgery, when indicated, is the most promising cure for epilepsy. However, when surgery is contraindicated or refused by the patient, neurostimulation is an alternative palliative approach, albeit with a lower chance of entirely curing patients of seizures. There are many options for neurostimulation. The three most commonly used invasive neurostimulation procedures that consistently show evidence of being safe and efficacious are vagal nerve stimulation, responsive neuro stimulation, or anterior thalamic nucleus deep brain stimulation. The goal of this review is to summarize the current evidence supporting the use of these three techniques, which are approved by most regulatory bodies, and discuss different factors that may enable epilepsy surgeons to choose the most appropriate modality for each patient.
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Brown EG, Bledsoe IO, Luthra NS, Miocinovic S, Starr PA, Ostrem JL. Cerebellar Deep Brain Stimulation for Acquired Hemidystonia. Mov Disord Clin Pract 2020; 7:188-193. [PMID: 32071938 DOI: 10.1002/mdc3.12876] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 02/01/2023] Open
Abstract
Background The cerebellum's role in dystonia is increasingly recognized. Dystonia can be a disabling and refractory condition; deep brain stimulation can help many patients, but it is traditionally less effective in acquired dystonia. New surgical targets would be instrumental in providing treatment options and understanding dystonia further. Objective To evaluate the efficacy of deep brain stimulation of the cerebellum in acquired dystonia. Methods We report our management of a 37-year-old woman with severe left arm and leg dystonia, a complication of an ischemic stroke in childhood. She had already had 2 thalamotomies with only transient benefit. These procedures, in addition to her initial stroke that had damaged the basal ganglia, left traditional deep brain stimulation targets unavailable. Results After implantation of bilateral deep cerebellar nuclei, dystonia improved with a 40% reduction in severity on scales and subjective reports of improved posturing, gait, and pain. This improvement has been maintained for almost 2 years after implantation. Conclusion Cerebellar stimulation has potential for therapeutic benefit in acquired dystonia and should be further explored.
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Affiliation(s)
- Ethan G Brown
- Movement Disorders and Neuromodulation Center, Department of Neurology University of California San Francisco San Francisco California USA
| | - Ian O Bledsoe
- Movement Disorders and Neuromodulation Center, Department of Neurology University of California San Francisco San Francisco California USA
| | - Nijee S Luthra
- Movement Disorders and Neuromodulation Center, Department of Neurology University of California San Francisco San Francisco California USA
| | | | - Philip A Starr
- Department of Neurosurgery University of California San Francisco San Francisco California USA
| | - Jill L Ostrem
- Movement Disorders and Neuromodulation Center, Department of Neurology University of California San Francisco San Francisco California USA
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8
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Sathyanesan A, Zhou J, Scafidi J, Heck DH, Sillitoe RV, Gallo V. Emerging connections between cerebellar development, behaviour and complex brain disorders. Nat Rev Neurosci 2019; 20:298-313. [PMID: 30923348 DOI: 10.1038/s41583-019-0152-2] [Citation(s) in RCA: 154] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The human cerebellum has a protracted developmental timeline compared with the neocortex, expanding the window of vulnerability to neurological disorders. As the cerebellum is critical for motor behaviour, it is not surprising that most neurodevelopmental disorders share motor deficits as a common sequela. However, evidence gathered since the late 1980s suggests that the cerebellum is involved in motor and non-motor function, including cognition and emotion. More recently, evidence indicates that major neurodevelopmental disorders such as intellectual disability, autism spectrum disorder, attention-deficit hyperactivity disorder and Down syndrome have potential links to abnormal cerebellar development. Out of recent findings from clinical and preclinical studies, the concept of the 'cerebellar connectome' has emerged that can be used as a framework to link the role of cerebellar development to human behaviour, disease states and the design of better therapeutic strategies.
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Affiliation(s)
- Aaron Sathyanesan
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, DC, USA.
| | - Joy Zhou
- Department of Pathology and Immunology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA
| | - Joseph Scafidi
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Detlef H Heck
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, Houston, TX, USA.,Department of Neuroscience, Baylor College of Medicine, Houston, TX, USA.,Program in Developmental Biology, Baylor College of Medicine, Houston, TX, USA
| | - Vittorio Gallo
- Center for Neuroscience Research, Children's Research Institute, Children's National Health System, Washington, DC, USA. .,George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
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Miterko LN, Baker KB, Beckinghausen J, Bradnam LV, Cheng MY, Cooperrider J, DeLong MR, Gornati SV, Hallett M, Heck DH, Hoebeek FE, Kouzani AZ, Kuo SH, Louis ED, Machado A, Manto M, McCambridge AB, Nitsche MA, Taib NOB, Popa T, Tanaka M, Timmann D, Steinberg GK, Wang EH, Wichmann T, Xie T, Sillitoe RV. Consensus Paper: Experimental Neurostimulation of the Cerebellum. CEREBELLUM (LONDON, ENGLAND) 2019; 18:1064-1097. [PMID: 31165428 PMCID: PMC6867990 DOI: 10.1007/s12311-019-01041-5] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The cerebellum is best known for its role in controlling motor behaviors. However, recent work supports the view that it also influences non-motor behaviors. The contribution of the cerebellum towards different brain functions is underscored by its involvement in a diverse and increasing number of neurological and neuropsychiatric conditions including ataxia, dystonia, essential tremor, Parkinson's disease (PD), epilepsy, stroke, multiple sclerosis, autism spectrum disorders, dyslexia, attention deficit hyperactivity disorder (ADHD), and schizophrenia. Although there are no cures for these conditions, cerebellar stimulation is quickly gaining attention for symptomatic alleviation, as cerebellar circuitry has arisen as a promising target for invasive and non-invasive neuromodulation. This consensus paper brings together experts from the fields of neurophysiology, neurology, and neurosurgery to discuss recent efforts in using the cerebellum as a therapeutic intervention. We report on the most advanced techniques for manipulating cerebellar circuits in humans and animal models and define key hurdles and questions for moving forward.
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Affiliation(s)
- Lauren N Miterko
- Department of Pathology and Immunology, Department of Neuroscience, Program in Developmental Biology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, 77030, USA
| | - Kenneth B Baker
- Neurological Institute, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Jaclyn Beckinghausen
- Department of Pathology and Immunology, Department of Neuroscience, Program in Developmental Biology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, 77030, USA
| | - Lynley V Bradnam
- Department of Exercise Science, Faculty of Science, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand
| | - Michelle Y Cheng
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS P352, Stanford, CA, 94305-5487, USA
| | - Jessica Cooperrider
- Neurological Institute, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mahlon R DeLong
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
| | - Simona V Gornati
- Department of Neuroscience, Erasmus Medical Center, 3015 AA, Rotterdam, Netherlands
| | - Mark Hallett
- Human Motor Control Section, NINDS, NIH, Building 10, Room 7D37, 10 Center Dr MSC 1428, Bethesda, MD, 20892-1428, USA
| | - Detlef H Heck
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, 855 Monroe Ave, Memphis, TN, 38163, USA
| | - Freek E Hoebeek
- Department of Neuroscience, Erasmus Medical Center, 3015 AA, Rotterdam, Netherlands
- NIDOD Department, Wilhelmina Children's Hospital, University Medical Center Utrecht Brain Center, Utrecht, Netherlands
| | - Abbas Z Kouzani
- School of Engineering, Deakin University, Geelong, VIC, 3216, Australia
| | - Sheng-Han Kuo
- Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, 10032, USA
| | - Elan D Louis
- Department of Neurology, Yale School of Medicine, Department of Chronic Disease Epidemiology, Yale School of Public Health, Center for Neuroepidemiology and Clinical Research, Yale School of Medicine, Yale University, New Haven, CT, 06520, USA
| | - Andre Machado
- Neurological Institute, Department of Neurosurgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, USA
| | - Mario Manto
- Service de Neurologie, CHU-Charleroi, 6000, Charleroi, Belgium
- Service des Neurosciences, Université de Mons, 7000, Mons, Belgium
| | - Alana B McCambridge
- Graduate School of Health, Physiotherapy, University of Technology Sydney, PO Box 123, Broadway, Sydney, NSW, 2007, Australia
| | - Michael A Nitsche
- Department of Psychology and Neurosiences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | | | - Traian Popa
- Human Motor Control Section, NINDS, NIH, Building 10, Room 7D37, 10 Center Dr MSC 1428, Bethesda, MD, 20892-1428, USA
- Defitech Chair of Clinical Neuroengineering, Center for Neuroprosthetics (CNP) and Brain Mind Institute (BMI), Ecole Polytechnique Federale de Lausanne (EPFL), Sion, Switzerland
| | - Masaki Tanaka
- Department of Physiology, Hokkaido University School of Medicine, Sapporo, 060-8638, Japan
| | - Dagmar Timmann
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gary K Steinberg
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS P352, Stanford, CA, 94305-5487, USA
- R281 Department of Neurosurgery, Stanfod University School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Eric H Wang
- Department of Neurosurgery, Stanford University School of Medicine, 1201 Welch Road, MSLS P352, Stanford, CA, 94305-5487, USA
| | - Thomas Wichmann
- Department of Neurology, Emory University, Atlanta, GA, 30322, USA
- Yerkes National Primate Research Center, Emory University, Atlanta, GA, 30322, USA
| | - Tao Xie
- Department of Neurology, University of Chicago, 5841 S. Maryland Avenue, MC 2030, Chicago, IL, 60637-1470, USA
| | - Roy V Sillitoe
- Department of Pathology and Immunology, Department of Neuroscience, Program in Developmental Biology, Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute of Texas Children's Hospital, 1250 Moursund Street, Suite 1325, Houston, TX, 77030, USA.
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10
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Molinari M, Masciullo M. The Implementation of Predictions During Sequencing. Front Cell Neurosci 2019; 13:439. [PMID: 31649509 PMCID: PMC6794410 DOI: 10.3389/fncel.2019.00439] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 09/17/2019] [Indexed: 12/13/2022] Open
Abstract
Optimal control mechanisms require prediction capabilities. If one cannot predict the consequences of a motor act or behavior, one will continually collide with walls or become a social pariah. "Looking into the future" is thus one of the most important prerequisites for smooth movements and social interactions. To achieve this goal, the brain must constantly predict future events. This principle applies to all domains of information processing, including motor and cognitive control, as well as the development of decision-making skills, theory of mind, and virtually all cognitive processes. Sequencing is suggested to support the predictive capacity of the brain. To recognize that events are related, the brain must discover links among them in the spatiotemporal domain. To achieve this, the brain must often hold one event in working memory and compare it to a second one, and the characteristics of the two must be compared and correctly placed in space and time. Among the different brain structures involved in sequencing, the cerebellum has been proposed to have a central function. We have suggested that the operational mode of the cerebellum is based on "sequence detection" and that this process is crucial for prediction. Patterns of temporally or spatially structured events are conveyed to the cerebellum via the pontine nuclei and compared with actual ones conveyed through the climbing fibers olivary inputs. Through this interaction, data on previously encountered sequences can be obtained and used to generate internal models from which predictions can be made. This mechanism would allow the cerebellum not only to recognize sequences but also to detect sequence violations. Cerebellar pattern detection and prediction would thus be a means to allow feedforward control based on anticipation. We will argue that cerebellar sequencing allows implementation of prediction by setting the correct excitatory levels in defined brain areas to implement the adaptive response for a given pattern of stimuli that embeds sufficient information to be recognized as a previously encountered template. Here, we will discuss results from human and animal studies and correlate them with the present understanding of cerebellar function in cognition and behavior.
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An overview of structurally diversified anticonvulsant agents. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2019; 69:321-344. [PMID: 31259739 DOI: 10.2478/acph-2019-0023] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/15/2018] [Indexed: 01/19/2023]
Abstract
There are several limited approaches to treat epilepsy in hospitals, for example, using medicines, surgery, electrical stimulation and dietary interventions. Despite the availability of all these new and old approaches, seizure is particularly difficult to manage. The quest for new antiepileptic molecules with more specificity and less CNS toxicity continues for medicinal chemists until a new and ideal drug arrives. This review covers new antiseizure molecules of different chemical classes, the exact mode of action of which is still unidentified. Newer agents include sulfonamides, thiadiazoles, semi- and thiosemicarbazones, pyrrolidine-2,5-diones, imidazoles, benzothiazoles and amino acid deriva tives. These new chemical entities can be useful for the design and development of forthcoming antiseizure agents.
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Dietz N, Neimat J. Neuromodulation: Deep Brain Stimulation for Treatment of Dystonia. Neurosurg Clin N Am 2019; 30:161-168. [PMID: 30898268 DOI: 10.1016/j.nec.2018.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dystonia is a heterogeneous, hyperkinetic movement disorder with sustained or intermittent abnormal postures, hyperkinetic muscle contractions, or repetitive movements. Classification of dystonia involves 2 axes: axis I and axis II, defining relevant clinical features and etiology, respectively. Medical therapy varies based on subtype and includes intramuscular botulinum toxin injections and oral anticholinergic pharmaceuticals. Deep brain stimulation became widely incorporated in 1999 after several landmark studies and has been effectively used in targets of the thalamus, pallidum, and subthalamic nucleus. New insights into pathophysiology of dystonia and genetic analysis continue to guide surgical technique toward ever-effective treatment.
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Affiliation(s)
- Nicholas Dietz
- Department of Neurosurgery, University of Louisville, School of Medicine, 200 Abraham Flexner Highway, Louisville, KY 40202, USA
| | - Joseph Neimat
- Department of Neurosurgery, University of Louisville, School of Medicine, 200 Abraham Flexner Highway, Louisville, KY 40202, USA.
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Shakkottai VG, Batla A, Bhatia K, Dauer WT, Dresel C, Niethammer M, Eidelberg D, Raike RS, Smith Y, Jinnah HA, Hess EJ, Meunier S, Hallett M, Fremont R, Khodakhah K, LeDoux MS, Popa T, Gallea C, Lehericy S, Bostan AC, Strick PL. Current Opinions and Areas of Consensus on the Role of the Cerebellum in Dystonia. THE CEREBELLUM 2017; 16:577-594. [PMID: 27734238 DOI: 10.1007/s12311-016-0825-6] [Citation(s) in RCA: 163] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A role for the cerebellum in causing ataxia, a disorder characterized by uncoordinated movement, is widely accepted. Recent work has suggested that alterations in activity, connectivity, and structure of the cerebellum are also associated with dystonia, a neurological disorder characterized by abnormal and sustained muscle contractions often leading to abnormal maintained postures. In this manuscript, the authors discuss their views on how the cerebellum may play a role in dystonia. The following topics are discussed: The relationships between neuronal/network dysfunctions and motor abnormalities in rodent models of dystonia. Data about brain structure, cerebellar metabolism, cerebellar connections, and noninvasive cerebellar stimulation that support (or not) a role for the cerebellum in human dystonia. Connections between the cerebellum and motor cortical and sub-cortical structures that could support a role for the cerebellum in dystonia. Overall points of consensus include: Neuronal dysfunction originating in the cerebellum can drive dystonic movements in rodent model systems. Imaging and neurophysiological studies in humans suggest that the cerebellum plays a role in the pathophysiology of dystonia, but do not provide conclusive evidence that the cerebellum is the primary or sole neuroanatomical site of origin.
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Affiliation(s)
- Vikram G Shakkottai
- Department of Neurology, University of Michigan, Room 4009, BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA. .,Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, 48109-2200, USA.
| | - Amit Batla
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - Kailash Bhatia
- Sobell Department of Motor Neuroscience and Movement Disorders, University College London, London, UK
| | - William T Dauer
- Department of Neurology, University of Michigan, Room 4009, BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA.,Department of Cell and Developmental Biology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Christian Dresel
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Martin Niethammer
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - David Eidelberg
- Center for Neurosciences, The Feinstein Institute for Medical Research, Manhasset, NY, USA
| | - Robert S Raike
- Global Research Organization, Medtronic Inc. Neuromodulation, Minneapolis, MN, USA
| | - Yoland Smith
- Yerkes National Primate Center and Department of Neurology, Emory University, Atlanta, GA, USA
| | - H A Jinnah
- Department of Neurology, Human Genetics and Pediatrics, Emory University, Atlanta, GA, USA
| | - Ellen J Hess
- Departments of Pharmacology and Neurology, Emory University, Atlanta, GA, USA
| | - Sabine Meunier
- Institut du Cerveau et de la Moelle épinière (ICM), Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR, S 1127, Paris, France.,Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Mark Hallett
- Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke, Bethesda, MD, USA
| | - Rachel Fremont
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Department of Psychiatry and Behavioral Sciences, and The Saul R. Korey Department of Neurology, Albert Einstein College of Medicine, New York, NY, USA
| | - Mark S LeDoux
- Departments of Neurology, and Anatomy and Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Traian Popa
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Cécile Gallea
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France.,Centre de NeuroImagerie de Recherche - CENIR, ICM, F-75013, Paris, France
| | - Stéphane Lehericy
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, F-75013, Paris, France
| | - Andreea C Bostan
- Systems Neuroscience Institute and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA
| | - Peter L Strick
- Systems Neuroscience Institute and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, USA.,Department of Neurobiology, University of Pittsburgh Brain Institute, University of Pittsburgh, Pittsburgh, PA, USA
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Tewari A, Fremont R, Khodakhah K. It's not just the basal ganglia: Cerebellum as a target for dystonia therapeutics. Mov Disord 2017; 32:1537-1545. [PMID: 28843013 DOI: 10.1002/mds.27123] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/26/2017] [Accepted: 06/27/2017] [Indexed: 01/01/2023] Open
Abstract
Dystonia is a common movement disorder that devastates the lives of many patients, but the etiology of this disorder remains poorly understood. Dystonia has traditionally been considered a disorder of the basal ganglia. However, growing evidence suggests that the cerebellum may be involved in certain types of dystonia, raising several questions. Can different types of dystonia be classified as either a basal ganglia disorder or a cerebellar disorder? Is dystonia a network disorder that involves the cerebellum and basal ganglia? If dystonia is a network disorder, how can we target treatments to alleviate symptoms in patients? A recent study by Chen et al, using the pharmacological mouse model of rapid-onset dystonia parkinsonism, has provided some insight into these important questions. They showed that the cerebellum can directly modulate basal ganglia activity through a short latency cerebello-thalamo-basal ganglia pathway. Further, this article and others have provided evidence that in some cases, aberrant cerebello-basal ganglia communication can be involved in dystonia. In this review we examine the evidence for the involvement of the cerebellum and cerebello-basal ganglia interactions in dystonia. We conclude that there is ample evidence to suggest that the cerebellum plays a role in some dystonias, including the early-onset primary torsion dystonia DYT1 and that further studies examining the role of this brain region and its interaction with the basal ganglia in dystonia are warranted. © 2017 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Ambika Tewari
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rachel Fremont
- Columbia University Medical Center, Department of Psychiatry, New York, New York, USA
| | - Kamran Khodakhah
- Dominick P. Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, New York, USA
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Hudson VE, Elniel A, Ughratdar I, Zebian B, Selway R, Lin JP. A comparative historical and demographic study of the neuromodulation management techniques of deep brain stimulation for dystonia and cochlear implantation for sensorineural deafness in children. Eur J Paediatr Neurol 2017; 21:122-135. [PMID: 27562095 DOI: 10.1016/j.ejpn.2016.07.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 07/15/2016] [Accepted: 07/20/2016] [Indexed: 12/19/2022]
Abstract
UNLABELLED Cochlear implants for sensorineural deafness in children is one of the most successful neuromodulation techniques known to relieve early chronic neurodisability, improving activity and participation. In 2012 there were 324,000 recipients of cochlear implants globally. AIM To compare cochlear implant (CI) neuromodulation with deep brain stimulation (DBS) for dystonia in childhood and explore relations between age and duration of symptoms at implantation and outcome. METHODS Comparison of published annual UK CI figures for 1985-2009 with a retrospective cohort of the first 9 years of DBS for dystonia in children at a single-site Functional Neurosurgery unit from 2006 to 14. RESULTS From 2006 to 14, DBS neuromodulation of childhood dystonia increased by a factor of 3.8 to a total of 126 cases over the first 9 years, similar to the growth in cochlear implants which increased by a factor of 4.1 over a similar period in the 1980s rising to 527 children in 2009. The CI saw a dramatic shift in practice from implantation at >5 years of age at the start of the programme towards earlier implantation by the mid-1990s. Best language results were seen for implantation <5 years of age and duration of cochlear neuromodulation >4 years, hence implantation <1 year of age, indicating that severely deaf, pre-lingual children could benefit from cochlear neuromodulation if implanted early. Similar to initial CI use, the majority of children receiving DBS for dystonia in the first 9 years were 5-15 years of age, when the proportion of life lived with dystonia exceeds 90% thus limiting benefits. CONCLUSION Early DBS neuromodulation for acquired motor disorders should be explored to maximise the benefits of dystonia reduction in a period of maximal developmental plasticity before the onset of disability. Learning from cochlear implantation, DBS can become an accepted management option in children under the age of 5 years who have a reduced proportion of life lived with dystonia, and not viewed as a last resort reserved for only the most severe cases where benefits may be at their most limited.
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Affiliation(s)
- V E Hudson
- Guys', King's and St Thomas' School of Medical Education, United Kingdom.
| | - A Elniel
- Guys', King's and St Thomas' School of Medical Education, United Kingdom
| | | | - B Zebian
- King's College Hospital, United Kingdom
| | - R Selway
- King's College Hospital, United Kingdom
| | - J P Lin
- Evelina London Children's Hospital, United Kingdom.
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16
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Securing a future for responsible neuromodulation in children: The importance of maintaining a broad clinical gaze. Eur J Paediatr Neurol 2017; 21:49-55. [PMID: 27257018 PMCID: PMC5282397 DOI: 10.1016/j.ejpn.2016.04.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 04/27/2016] [Indexed: 12/30/2022]
Abstract
AIM This perspective paper provides an overview of several key tensions and challenges within the social context of neuromodulation, and it suggests a means of securing the future of paediatric neuromodulation in light of these. RESULTS Tensions and challenges relate to: the considerable clinical and economic need for new therapies to manage neurological diseases; significant commercial involvement in the field; funding pressures; public perceptions (particularly unrealistic expectations); and the emerging Responsible Research and Innovation initiative. This paper argues that managing these challenges and tensions requires that clinicians working within the field adopt what could be called a broad clinical gaze. This paper will define the broad clinical gaze, and it will propose several ways in which a broad clinical gaze can be - and indeed is being - operationalised in recent advances in neuromodulation in children. These include the use of multidisciplinary and interdisciplinary clinical team structures, the adoption of clinical assessment tools that capture day-to-day functionality, and the use of patient registries. CONCLUSION By adopting a broad clinical gaze, clinicians and investigators can ensure that the field as a whole can responsibly and ethically deliver on its significant clinical potential.
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Fremont R, Tewari A, Khodakhah K. Aberrant Purkinje cell activity is the cause of dystonia in a shRNA-based mouse model of Rapid Onset Dystonia-Parkinsonism. Neurobiol Dis 2015; 82:200-212. [PMID: 26093171 DOI: 10.1016/j.nbd.2015.06.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/19/2022] Open
Abstract
Loss-of-function mutations in the α3 isoform of the sodium pump are responsible for Rapid Onset Dystonia-Parkinsonism (RDP). A pharmacologic model of RDP replicates the most salient features of RDP, and implicates both the cerebellum and basal ganglia in the disorder; dystonia is associated with aberrant cerebellar output, and the parkinsonism-like features are attributable to the basal ganglia. The pharmacologic agent used to generate the model, ouabain, is selective for sodium pumps. However, close to the infusion sites in vivo it likely affects all sodium pump isoforms. Therefore, it remains to be established whether selective loss of α3-containing sodium pumps replicates the pharmacologic model. Moreover, while the pharmacologic model suggested that aberrant firing of Purkinje cells was the main cause of abnormal cerebellar output, it did not allow the scrutiny of this hypothesis. To address these questions RNA interference using small hairpin RNAs (shRNAs) delivered via adeno-associated viruses (AAV) was used to specifically knockdown α3-containing sodium pumps in different regions of the adult mouse brain. Knockdown of the α3-containing sodium pumps mimicked both the behavioral and electrophysiological changes seen in the pharmacologic model of RDP, recapitulating key aspects of the human disorder. Further, we found that knockdown of the α3 isoform altered the intrinsic pacemaking of Purkinje cells, but not the neurons of the deep cerebellar nuclei. Therefore, acute knockdown of proteins associated with inherited dystonias may be a good strategy for developing phenotypic genetic mouse models where traditional transgenic models have failed to produce symptomatic mice.
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Affiliation(s)
- Rachel Fremont
- Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Ambika Tewari
- Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA
| | - Kamran Khodakhah
- Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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A history of deep brain stimulation: Technological innovation and the role of clinical assessment tools. SOCIAL STUDIES OF SCIENCE 2013; 43. [PMCID: PMC3785222 DOI: 10.1177/0306312713483678] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Deep brain stimulation involves using a pacemaker-like device to deliver constant electrical stimulation to problematic areas within the brain. It has been used to treat over 40,000 people with Parkinson’s disease and essential tremor worldwide and is currently undergoing clinical trials as a treatment for depression and obsessive–compulsive disorder. This article will provide an historical account of deep brain stimulation in order to illustrate the plurality of interests involved in the development and stabilization of deep brain stimulation technology. Using Latour’s notion of immutable mobiles, this article will illustrate the importance of clinical assessment tools in shaping technological development in the era of medical device regulation. Given that such tools can serve commercial and professional interests, this article suggests that it is necessary to scrutinise their application in research contexts to ensure that they capture clinical changes that are meaningful for patients and their families. This is particularly important in relation to potentially ethically problematic therapies such as deep brain stimulation for psychiatric disorders.
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Schmahmann JD. Dysmetria of thought: clinical consequences of cerebellar dysfunction on cognition and affect. Trends Cogn Sci 2013; 2:362-71. [PMID: 21227233 DOI: 10.1016/s1364-6613(98)01218-2] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cognitive and emotional changes might be prominent or even principal manifestations of cerebellar lesions. This realization supports evidence suggesting that the cerebellum is an important part of a set of distributed neural circuits that subserve higher-order processing. Early anecdotal clinical accounts described aberrant mental or intellectual functions in the setting of cerebellar atrophy. Later systematic analyses showed that the cerebellum is able to influence autonomic, vasomotor, and emotional behaviors, and further studies revealed neuropsychological deficits in patients with degenerative diseases. Current descriptions of behavioral changes in adults and children with acquired cerebellar lesions bring the debate about the cerebellar role in neural function within the realm of clinically relevant cognitive neuroscience. The activation of focal cerebellar regions by cognitive tasks on functional neuroimaging studies, and morphologic abnormalities of cerebellum in psychiatric diseases such as autism and schizophrenia further support this view. Anatomical substrates have been elucidated that could support a cerebellar role in cognition and emotion. Our concept of `dysmetria of thought' draws an analogy with the motor system to describe and explain the impairments of higher-order behavior that result when the distributed neural circuits subserving cognitive operations are deprived of cerebellar modulation.
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Affiliation(s)
- J D Schmahmann
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
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Oyegbile TO, Bayless K, Dabbs K, Jones J, Rutecki P, Pierson R, Seidenberg M, Hermann B. The nature and extent of cerebellar atrophy in chronic temporal lobe epilepsy. Epilepsia 2011; 52:698-706. [PMID: 21269292 DOI: 10.1111/j.1528-1167.2010.02937.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Research indicates that patients with chronic temporal lobe epilepsy (TLE) exhibit cerebellar atrophy compared to healthy controls, but the degree to which specific regions of the cerebellum are affected remains unclear. The purpose of this study was to characterize the extent and lateralization of atrophy in individual cerebellar lobes and subregions in unilateral TLE using advanced quantitative magnetic resonance imaging (MRI) techniques. METHODS Study participants were 46 persons with TLE and 31 age- and gender- matched healthy controls. All participants underwent high-resolution MRI with manual tracing of the cerebellum yielding gray and white matter volumes of the right and left anterior lobes, superior posterior lobes, inferior posterior lobes, and corpus medullare. The degree to which asymmetric versus generalized abnormalities was evident in unilateral chronic TLE was determined and related to selected clinical seizure features (age of onset, duration of disorder). KEY FINDINGS There were no lateralized abnormalities in cerebellar gray matter or white matter in patients with right or left TLE (all p's > 0.2). Compared with controls, unilateral TLE was associated with significant bilateral reductions in the superior (p = 0.032) and inferior (p = 0.023) posterior lobes, whereas volume was significantly increased in the anterior lobes (p = 0.002), especially in patients with early onset TLE, and not significantly different in the corpus medullare (p = 0.71). Total superior cerebellar tissue volumes were reduced in association with increasing duration of epilepsy. SIGNIFICANCE Patients with unilateral TLE exhibit a pattern of bilateral cerebellar pathology characterized by atrophy of the superior and inferior posterior lobes, hypertrophy of the anterior lobe, and no effect on the corpus medullare. Cross-sectional analyses show that specific aspects of cerebellar pathology are associated with neurodevelopmental (anterior lobe) or chronicity-related (superior posterior lobe) features of the disorder.
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Affiliation(s)
- Temitayo O Oyegbile
- Department of Neurology, New York Presbyterian Hospital, New York, New York, USA
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Skarpaas TL, Morrell MJ. Intracranial stimulation therapy for epilepsy. Neurotherapeutics 2009; 6:238-43. [PMID: 19332315 PMCID: PMC5084199 DOI: 10.1016/j.nurt.2009.01.022] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 01/23/2009] [Indexed: 11/17/2022] Open
Abstract
Epilepsy is a common chronic neurological disorder effecting 1 to 2% of the population. Despite advances in anti-epileptic drug therapy, epilepsy surgery, and vagus nerve stimulation, approximately 30% of patients continue to have seizures. Intracranial stimulation is currently under investigation as an adjunctive treatment to anti-epileptic medications in adults with medically intractable epilepsy. Several different approaches are now being investigated. Specifically, acute and long-term clinical studies have delivered stimulation either to inhibitory regions outside the seizure focus or directly to the seizure focus. These studies have demonstrated the safety of intracranial stimulation and proof of principle in epilepsy patients. In addition to the different locations tested, clinical studies have also used different temporal patterns of stimulation. The majority of studies have used open-loop or scheduled stimulation, in which, stimulation is delivered on a fixed schedule and is independent of electrographic activity. In contrast, a number of recent investigations have demonstrated the feasibility of closed-loop or responsive stimulation, which is stimulation that is contingent upon the detection of epileptiform activity. This chapter will review the acute and long-term clinical studies of intracranial stimulation, including focal, and nonfocal, and open-loop and responsive stimulation. We will also discuss the optimization and safety of therapeutic parameters used in neurostimulation for epilepsy.
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Affiliation(s)
| | - Martha J. Morrell
- NeuroPace, Inc., 94043 Mountain View, California
- grid.240952.80000000087342732Department of Neurology, Stanford University Medical Center, 94043 Stanford, California
- grid.168010.e0000000419368956NeuroPace, Inc., Stanford University, 1375 Shorebird Way, 94043 Mountain View, CA
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Lefaucheur JP. Principles of therapeutic use of transcranial and epidural cortical stimulation. Clin Neurophysiol 2008; 119:2179-84. [DOI: 10.1016/j.clinph.2008.07.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Revised: 06/28/2008] [Accepted: 07/02/2008] [Indexed: 11/28/2022]
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Cooper IS. Clinical, physiological and philosophical implications of innovative brain surgery in humans. CIBA FOUNDATION SYMPOSIUM 2008:255-65. [PMID: 317646 DOI: 10.1002/9780470720523.ch14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Abnormal states of motor behaviour can be reversed by interruption of facilitating mechanisms and augmentation of inhibitory mechanisms. Similarly, psychological and emotional behaviours which were abnormal due to disinhibition, such as screaming, repetitive speech and aggressive violent behaviour, have been favourably affected from a clinical and sociological standpoint. The mechanisms of the facilitatory and inhibitory systems which modulate motor behaviour also modify psychological and emotional behaviour. The findings of our studies in experimental neurosurgery may help to provide new insights into mechanisms of mental capacity and behaviour.
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Gwinn RP, Spencer DD. Fighting fire with fire: brain stimulation for the treatment of epilepsy. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.cnr.2004.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Upton A. Vagal stimulation for intractable seizures. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2002; 497:233-9. [PMID: 11993736 DOI: 10.1007/978-1-4615-1335-3_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Vagal stimulation has recently been approved for use in North America. Dr. Upton discusses the findings of a study conducted at the McMaster Medical Centre.
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Benabid AL, Minotti L, Koudsié A, de Saint Martin A, Hirsch E. Antiepileptic effect of high-frequency stimulation of the subthalamic nucleus (corpus luysi) in a case of medically intractable epilepsy caused by focal dysplasia: a 30-month follow-up: technical case report. Neurosurgery 2002; 50:1385-91; discussion 1391-2. [PMID: 12015863 DOI: 10.1097/00006123-200206000-00037] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2001] [Accepted: 01/31/2002] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE AND IMPORTANCE Currently, some forms of epilepsy are resistant to both pharmacological and surgical interventions. As a result, there is a need for new therapeutic strategies. Because the nigral system modulates neuronal excitability in animal models of epilepsy, we considered therapeutic high-frequency stimulation of the subthalamic nucleus (STN). We were encouraged by the known relationship between the STN and the nigral system, as well as by our experience with high-frequency stimulation of the STN in Parkinsonian patients. CLINICAL PRESENTATION A 5-year-old girl with pharmacologically resistant, inoperable epilepsy caused by focal centroparietal dysplasia underwent implantation with a permanent electrode in the left STN and was chronically stimulated. To date, we have followed up this patient for 30 months postoperatively. TECHNIQUE High-frequency stimulation of the STN induced a significant voltage-dependent reduction (by 80%) in the number and severity of seizures. In addition, consistent improvement in both motor and cognitive functions was noted as a result of reduced postictal states. The effect was more prominent for seizures occurring in clusters (89% reduction) and during the day (88% reduction) than for those that occurred during sleep (53% reduction). CONCLUSION This is the first report of epilepsy control using chronic high-frequency stimulation of the STN. Preliminary observations in three other operated patients (at 2, 12, and 18 mo) confirm these data. We think that high-frequency stimulation of the STN may hold significant future potential as a treatment for epilepsy, similar to its established role in the treatment of Parkinson's disease. This finding opens completely new experimental and therapeutic avenues for the treatment of surgically and medically intractable epilepsy.
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Affiliation(s)
- Alim Louis Benabid
- Department of Neurosurgery, University Hospital of Grenoble, and INSERM Research Unit U318, Grenoble, France.
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Benabid AL, Minotti L, Koudsié A, de Saint Martin A, Hirsch E. Antiepileptic Effect of High-frequency Stimulation of the Subthalamic Nucleus (Corpus Luysi) in a Case of Medically Intractable Epilepsy Caused by Focal Dysplasia: A 30-month Follow-up: Technical Case Report. Neurosurgery 2002. [DOI: 10.1227/00006123-200206000-00037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Hornyak M, Rovit RL, Simon AS, Couldwell WT. Irving S. Cooper and the early surgical management of movement disorders. Video history. Neurosurg Focus 2001; 11:E6. [PMID: 16602679 DOI: 10.3171/foc.2001.11.2.7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Irving S. Cooper was a pioneer in the field of functional neurosurgery. During his very productive and controversial career, he proposed the surgical treatment of Parkinson disease (PD) by ligating the anterior choroidal artery to control tremor and rigidity. Subsequently, he developed seminal techniques for chemopallidectomy and cryothalamectomy for PD. He also attempted to use electrical stimulation of the cerebellum or the thalamus to treat spasticity. Cooper continued his work on brain stimulation until his death in 1985. He made video recordings of nearly all of his patients during his tenure (1977-1985) at New York Medical College. Cooper's clinical video recordings were reviewed, and selected footage was compiled into a video history of Cooper's surgical management of various movement disorders. Included are pre-, post-, and some intraoperative recordings that Cooper made to document his treatment of patients with PD, tremor, Wilson disease, cerebral palsy, chorea, dystonia musculorum deformans, and some rarer entities.
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Affiliation(s)
- M Hornyak
- Department of Neurosurgery, New York Medical College, Valhalla, New York 10595, USA
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Abstract
Many neurosurgical procedures have been designed for or applied to the treatment of spasticity arising from different disorders, including cerebral palsy; traumatic, ischemic, or hypoxic brain injury, multiple sclerosis, and spinal cord injury. Neurosurgical procedures are primarily aimed at reducing spasticity by interrupting the stretch reflex at various sites along the spinal reflex arc or attempting to increase the centrally mediated inhibitory influence on the pool of motor neurons in the anterior horn. Surgical interventions for spasticity can be classified into peripheral ablative procedures, such as rhizotomy or peripheral neurectomy, and central ablative procedures, such as cordectomy, myelotomy, or stereotactic procedures. Non-ablative procedures include peripheral nerve or motor point blocks, the implantation of cerebellar or spinal stimulators, and the implantation of subdural catheters for infusion of pharmacologic agents to increase inhibitory activity. Several proposed mechanisms for spasticity are reviewed so that the rationale for the various surgical interventions for spasticity described may be better understood.
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Affiliation(s)
- M D Smyth
- Department of Neurological Surgery, Room M-779, Box 0112, University of California San Francisco, 505 Parnassus Avenue, San Francisco, California 94143-0112, USA.
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Das K, Benzil DL, Rovit RL, Murali R, Couldwell WT. Irving S. Cooper (1922-1985): a pioneer in functional neurosurgery. J Neurosurg 1998; 89:865-73. [PMID: 9817430 DOI: 10.3171/jns.1998.89.5.0865] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Irving S. Cooper (1922-1985), the son of a salesman, worked his way through high school, college, and medical school to become one of the pioneers in functional neurosurgery. He developed several novel techniques for the surgical management of Parkinson's disease and other crippling movement disorders. A keen interest in the physiology of movement disorders was kindled by his doctoral research and continued during his neurosurgical training. He began to apply this knowledge to surgical practice in 1952 when he began his faculty career as Assistant Professor of Surgery at New York University. At the time, surgical treatment of parkinsonian tremor focused on various techniques used to interrupt the pyramidal tract. During a subtemporal approach for a cerebral pedunculotomy, he inadvertently injured and, subsequently, was forced to occlude the anterior choroidal artery. Much to Cooper's surprise, following emergence from anesthesia the patient's tremor and rigidity were abolished without any residual hemiparesis. This serendipitous observation, together with Meyer's earlier work on the role of the basal ganglia in motor control, helped focus surgical efforts on targets within the basal ganglia and, subsequently, within the thalamus to alleviate the movement disorders associated with Parkinson's disease. While at New York University, Cooper developed chemopallidectomy and, later at St. Barnabas Hospital in the Bronx (1954-1977), he used cryothalamectomy as a surgical technique for primary control of tremor in patients with Parkinson's disease. Cooper authored many original papers on surgical techniques and several textbooks on the lives of patients afflicted with Parkinson's disease and other crippling movement disorders. Although considered controversial, this fascinating and complex neurosurgeon made significant contributions to this field.
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Affiliation(s)
- K Das
- Department of Neurological Surgery, New York Medical College, Valhalla 10595, USA
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Russo-Neustadt A, Zomorodian TJ, Cotman CW. Preserved cerebellar tyrosine hydroxylase-immunoreactive neuronal fibers in a behaviorally aggressive subgroup of Alzheimer's disease patients. Neuroscience 1998; 87:55-61. [PMID: 9722141 DOI: 10.1016/s0306-4522(98)00134-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aggression is a very problematic behavioral symptom affecting a significant proportion of Alzheimer's disease patients. Previous work in our laboratory has shown that a subgroup of Alzheimer's patients displaying aggressive behaviors had a markedly higher level of alpha2-adrenergic receptors in the cerebellar cortex (approaching or exceeding those of controls), compared to Alzheimer's patients with similar cognitive impairments, but no history of aggressive behaviors. This study has sought to assess whether noradrenergic neuronal inputs to the cerebellum reflect similar changes in this Alzheimer's subgroup. Cerebellar cortex from non-aggressive Alzheimer's subjects showed a markedly lower level of tyrosine hydroxylase-positive neuronal fibers than normal controls (approximately 75% decreased), visualized by immunohistochemistry. Cerebellar cortex from the aggressive Alzheimer's subgroup, on the other hand, had a tyrosine hydroxylase fiber concentration not significantly different than controls. These results suggest that there is a relative preservation of inhibitory noradrenergic neuronal input to the cerebellar cortex in this aggressive subgroup of Alzheimer's disease patients. Much evidence exists that the cerebellum assists in behavioral control. The possibility that this lack of noradrenergic decline in the cerebellum could lead to a system imbalance and result in a selective behavioral disturbance is discussed.
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Affiliation(s)
- A Russo-Neustadt
- Institute for Brain Aging and Dementia, University of California, Irvine 92697-4540, USA
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Pringle SD, Dunn FG, Tweddel AC, Martin W, Macfarlane PW, McKillop JH, Lorimer AR, Cobbe SM. Symptomatic and silent myocardial ischaemia in hypertensive patients with left ventricular hypertrophy. BRITISH HEART JOURNAL 1992; 67:377-82. [PMID: 1389717 PMCID: PMC1024858 DOI: 10.1136/hrt.67.5.377] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the prevalence of symptomatic and silent myocardial ischaemia in patients with hypertensive left ventricular hypertrophy. DESIGN Cross sectional study. SETTING University department of medical cardiology. PATIENTS 90 patients (68 men and 22 women; mean age 57 (range 25 to 79)) with left ventricular hypertrophy due to essential hypertension. INTERVENTIONS 48 hour ambulatory ST segment monitoring (all patients), exercise electrocardiography (n = 79), stress thallium scintigraphy (n = 80), coronary arteriography (n = 35). RESULTS 43 patients had at least one episode of ST segment depression on ambulatory electrocardiographic monitoring. The median number of episodes was 16 (range 1 to 84) with a median duration of 8.6 (range 2 to 17) min. Over 90% of these episodes were clinically silent. 26 patients had positive exercise electrocardiography and 48 patients had reversible thallium perfusion defects despite chest pain during exercise in only five patients. 18 of the 35 patients who had coronary arteriography had important coronary artery disease. Seven of these patients gave no history of chest pain. CONCLUSIONS Symptomatic and silent myocardial ischaemia are common in hypertensive patients with left ventricular hypertrophy, even in the absence of epicardial coronary artery disease.
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Affiliation(s)
- S D Pringle
- University Department of Medical Cardiology, Royal Infirmary, Glasgow
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Hershler C, Upton AR, Debruin H, Burcea I, King RN, Zoghaib C. Effects of chronic cerebellar stimulation (CCS) setting on the gait and speech of a spastic cerebral palsy adult. Pacing Clin Electrophysiol 1989; 12:861-9. [PMID: 2471175 DOI: 10.1111/j.1540-8159.1989.tb01911.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A single (N = 1) spastic cerebral palsy adult who had experienced Chronic Cerebellar Stimulation (CCS) for 9 years without any change in the stimulator settings was assessed at six different stimulator settings. These voltage settings varied from 0 volts to 40 volts and frequencies of stimulation from 0 to 200 Hz. Stimulation was with bipolar rectangular pulses with less than 0.2 C/mm2 charge per phase. Responses measured at each setting were quantitative gait, speech, and somatosensory evoked potential measurements. Additional clinical assessments were done by a neurologist and speech therapist. Alteration in stimulator settings occurred 1 week apart to allow for stabilization and all assessments were completed in the same sequence each day. None of the individual stimulator settings were known to any of the assessors or to the patient. The results showed consistently that the patient's gait and speech were poorest when the stimulator was switched off completely. Switching on the stimulator caused improved function according to all assessments. There was consistent improvement in gait and speech when the rate of the cerebellar stimuli was high (for voltages between 0 and 40 V). Changing the voltage (within the range 0 to 40 V), while keeping the frequency of stimulation constant, did not appear to have as much effect. This preliminary evaluation suggests that the technique of CCS is safe and can improve function in a measurable manner.
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Affiliation(s)
- C Hershler
- G.F. Strong Rehabilitation Centre, Vancouver, B.C
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Upton AR, Amin I, Garnett S, Springman M, Nahmias C, Cooper IS. Evoked metabolic responses in the limbic-striate system produced by stimulation of anterior thalamic nucleus in man. Pacing Clin Electrophysiol 1987; 10:217-25. [PMID: 2436182 DOI: 10.1111/j.1540-8159.1987.tb05952.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Six human subjects (5 male, 1 female, age 23.7 + 5.7 years) with incapacitating partial seizure disorders intractable to medical therapy have been treated by ongoing pulsed electrical stimulation of anterior nucleus of the thalamus. Four of the six patients have demonstrated statistically significant clinical control of the seizure disorder. One patient (D.L.) has been seizure-free for the last two years. In two of these six patients, it was possible to study not only electrophysiological activity of the brain, but also regional cerebral glucose metabolism by the (18F) 2-fluoro-2-deoxy-D-glucose method, blood cortisol levels, and blood levels of valproic acid, diphenylhydantoin, and carbamazepine. Significant changes were seen during periods of stimulation compared with control periods without stimulation. These results imply that stimulation of the principal thalamic relay nucleus of the limbic system causes clinical, behavioral, cerebral metabolic, electroencephalographic, endocrinologic, and pharmacokinetic responses.
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Zuccarello M, Sawaya R, Lukin R, deCourten-Myers G. Spontaneous cerebellar hematoma associated with chronic cerebellar stimulation. Case report. J Neurosurg 1986; 65:860-2. [PMID: 3490550 DOI: 10.3171/jns.1986.65.6.0860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A 24-year-old man developed a spontaneous cerebellar hematoma 5 years after the implantation of cerebellar electrodes. No vascular malformations were found either intraoperatively or radiographically. The histopathological findings of the cerebellar tissue obtained at biopsy from the region surrounding the electrodes support the hypothesis of a causal relationship between the spontaneous cerebellar hemorrhage and chronic cerebellar stimulation.
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Cooper IS, Upton AR. Therapeutic implications of modulation of metabolism and functional activity of cerebral cortex by chronic stimulation of cerebellum and thalamus. Biol Psychiatry 1985; 20:811-3. [PMID: 3873965 DOI: 10.1016/0006-3223(85)90164-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Wright GD, Weller RO. Biopsy and post-mortem findings in a patient receiving cerebellar stimulation for epilepsy. J Neurol Neurosurg Psychiatry 1983; 46:266-73. [PMID: 6405013 PMCID: PMC1027335 DOI: 10.1136/jnnp.46.3.266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Cerebellar stimulating equipment was implanted in a 24-year-old male with severe epilepsy. He received continuous alternating stimulation for at least two months, intermittent bilateral stimulation on demand for at least two months and numerous short bursts of stimulation during preliminary testing and calibration of the apparatus. The patient died during a prolonged grand mal seizure 16 months after implantation and this paper reports the findings at necropsy. A special study was made of the degree of tissue damage in the cerebellar hemispheres resulting from implantation of the electrodes and subsequent cerebellar stimulation. There was deep grooving of the upper aspect of the cerebellum under the electrodes but only a minor degree of neuronal loss and gliosis was observed in the underlying cortex. Purkinje cell populations in the cerebellum at necropsy were similar to those in a biopsy specimen taken 16 months previously during implantation. The electrodes were covered with a thick layer of fibrous tissue but they were not adherent to the cerebellar surface. Thus, the main significant findings in the present case were the very slight structural damage to the cerebellum in contact with the electrodes and the intense fibrosis around the electrodes themselves. These features are discussed in relation to the efficacy of long-term cerebellar stimulation.
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Haines DE. Zones in the cerebellar cortex. Their organization and potential relevance to cerebellar stimulation. J Neurosurg 1981; 55:254-64. [PMID: 7252549 DOI: 10.3171/jns.1981.55.2.0254] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The organization of zones in the cerebellar cortex, as reflected by the arrangement of cortical efferent and afferent fibers, was reviewed with special emphasis on the anterior lobe. There is conclusive evidence for the existence of at least six, and possibly as many as nine, ipsilateral rostrocaudally oriented cortical zones, each having specific afferent and efferent connections. The topography afferent and efferent fibers of the cerebellar cortex and/or the spatial arrangement of cortical zones have not been given appropriate attention in both experimental and clinical studies dealing with focal electrical stimulation of the cerebellum. It is suggested that inattention to the relationships between electrode placement and zones in the cerebellar cortex may be partially responsible for the sometimes capricious results during and/or subsequent cerebellar cortical stimulation.
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Cooper IS, Upton AR, Rappaport ZH, Amin I. Correlation of clinical and physiological effects of cerebellar stimulation. ACTA NEUROCHIRURGICA. SUPPLEMENTUM 1980; 30:339-44. [PMID: 6970509 DOI: 10.1007/978-3-7091-8592-6_41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The value of clinical assessment of patients undergoing chronic cerebellar stimulation (CCS) is limited by lack of objective measures but neurophysiological tests can be used to "biocalibrate" the stimulator and may be used to predict effects of CCS. Eighty-seven patients undergoing CCS have been assessed clinically and neurophysiologically over the last 4 years. Somatosensory evoked responses were significantly ( p less than 0.05) reduced in amplitude in 35 patients, cortical somatosensory evoked responses in 44 patients and one or both responses were reduced in 55 patients. There were no clinical or physiological changes in 16 patients. Evoked responses showed significant changes in only 3 patients who did not show clinical improvement. The mean voltage settings were 5.2 volts and most patients were stimulated at 200 herz. These results indicate that significant changes in those somatosensory evoked potentials are a good indication of clinical benefits from CCS but clinical improvement may occur in the absence of any acute effect on evoked responses.
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