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Jiang Y, Qi Z, Zhu H, Shen K, Liu R, Fang C, Lou W, Jiang Y, Yuan W, Cao X, Chen L, Zhuang Q. Role of the globus pallidus in motor and non-motor symptoms of Parkinson's disease. Neural Regen Res 2025; 20:1628-1643. [PMID: 38845220 DOI: 10.4103/nrr.nrr-d-23-01660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/21/2024] [Indexed: 08/07/2024] Open
Abstract
The globus pallidus plays a pivotal role in the basal ganglia circuit. Parkinson's disease is characterized by degeneration of dopamine-producing cells in the substantia nigra, which leads to dopamine deficiency in the brain that subsequently manifests as various motor and non-motor symptoms. This review aims to summarize the involvement of the globus pallidus in both motor and non-motor manifestations of Parkinson's disease. The firing activities of parvalbumin neurons in the medial globus pallidus, including both the firing rate and pattern, exhibit strong correlations with the bradykinesia and rigidity associated with Parkinson's disease. Increased beta oscillations, which are highly correlated with bradykinesia and rigidity, are regulated by the lateral globus pallidus. Furthermore, bradykinesia and rigidity are strongly linked to the loss of dopaminergic projections within the cortical-basal ganglia-thalamocortical loop. Resting tremors are attributed to the transmission of pathological signals from the basal ganglia through the motor cortex to the cerebellum-ventral intermediate nucleus circuit. The cortico-striato-pallidal loop is responsible for mediating pallidi-associated sleep disorders. Medication and deep brain stimulation are the primary therapeutic strategies addressing the globus pallidus in Parkinson's disease. Medication is the primary treatment for motor symptoms in the early stages of Parkinson's disease, while deep brain stimulation has been clinically proven to be effective in alleviating symptoms in patients with advanced Parkinson's disease, particularly for the movement disorders caused by levodopa. Deep brain stimulation targeting the globus pallidus internus can improve motor function in patients with tremor-dominant and non-tremor-dominant Parkinson's disease, while deep brain stimulation targeting the globus pallidus externus can alter the temporal pattern of neural activity throughout the basal ganglia-thalamus network. Therefore, the composition of the globus pallidus neurons, the neurotransmitters that act on them, their electrical activity, and the neural circuits they form can guide the search for new multi-target drugs to treat Parkinson's disease in clinical practice. Examining the potential intra-nuclear and neural circuit mechanisms of deep brain stimulation associated with the globus pallidus can facilitate the management of both motor and non-motor symptoms while minimizing the side effects caused by deep brain stimulation.
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Affiliation(s)
- Yimiao Jiang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Zengxin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Brain Science, Fudan University, Shanghai, China
| | - Huixian Zhu
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Kangli Shen
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Ruiqi Liu
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Chenxin Fang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Weiwei Lou
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Yifan Jiang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Wangrui Yuan
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Xin Cao
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Brain Science, Fudan University, Shanghai, China
| | - Qianxing Zhuang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
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Ricci A, Rubino E, Serra GP, Wallén-Mackenzie Å. Concerning neuromodulation as treatment of neurological and neuropsychiatric disorder: Insights gained from selective targeting of the subthalamic nucleus, para-subthalamic nucleus and zona incerta in rodents. Neuropharmacology 2024; 256:110003. [PMID: 38789078 DOI: 10.1016/j.neuropharm.2024.110003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 04/26/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024]
Abstract
Neuromodulation such as deep brain stimulation (DBS) is advancing as a clinical intervention in several neurological and neuropsychiatric disorders, including Parkinson's disease, dystonia, tremor, and obsessive-compulsive disorder (OCD) for which DBS is already applied to alleviate severely afflicted individuals of symptoms. Tourette syndrome and drug addiction are two additional disorders for which DBS is in trial or proposed as treatment. However, some major remaining obstacles prevent this intervention from reaching its full therapeutic potential. Side-effects have been reported, and not all DBS-treated individuals are relieved of their symptoms. One major target area for DBS electrodes is the subthalamic nucleus (STN) which plays important roles in motor, affective and associative functions, with impact on for example movement, motivation, impulsivity, compulsivity, as well as both reward and aversion. The multifunctionality of the STN is complex. Decoding the anatomical-functional organization of the STN could enhance strategic targeting in human patients. The STN is located in close proximity to zona incerta (ZI) and the para-subthalamic nucleus (pSTN). Together, the STN, pSTN and ZI form a highly heterogeneous and clinically important brain area. Rodent-based experimental studies, including opto- and chemogenetics as well as viral-genetic tract tracings, provide unique insight into complex neuronal circuitries and their impact on behavior with high spatial and temporal precision. This research field has advanced tremendously over the past few years. Here, we provide an inclusive review of current literature in the pre-clinical research fields centered around STN, pSTN and ZI in laboratory mice and rats; the three highly heterogeneous and enigmatic structures brought together in the context of relevance for treatment strategies. Specific emphasis is placed on methods of manipulation and behavioral impact.
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Affiliation(s)
- Alessia Ricci
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Eleonora Rubino
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Gian Pietro Serra
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA
| | - Åsa Wallén-Mackenzie
- Uppsala University, Department of Organism Biology, 756 32 Uppsala, Sweden; Aligning Science Across Parkinson's (ASAP) Collaborative Research Network, Chevy Chase, MD 20815, USA.
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3
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Witt K, Levin J, van Eimeren T, Hasan A, Ebersbach G. Diagnostics and treatment of impulse control disorders, psychosis and delirium: systemic review-based recommendations - guideline "Parkinson's disease" of the German Society of Neurology. J Neurol 2024:10.1007/s00415-024-12576-x. [PMID: 39046524 DOI: 10.1007/s00415-024-12576-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 07/05/2024] [Accepted: 07/07/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND AND OBJECTIVE Impulse control disorders (ICD), psychosis and delirium are part of the spectrum of behavioural changes associated with Parkinson's disease (PD). The diagnostic and therapeutic management of these rather complex neuropsychiatric conditions has been updated in the clinical guideline by the German Society of Neurology (DGN). METHODS Recommendations are based on a systematic literature reviews, other relevant guidelines and expert opinion. RESULTS Patients receiving dopamine agonists (DA) therapy should be informed about the symptoms and risks of an ICD and should be routinely screened for ICD symptoms. In the presence of an ICD, DA should be reduced or discontinued and psychotherapeutic treatment may be considered. Non-oral therapies (levodopa/carbidopa intestinal gel infusion or deep brain stimulation) may also be an option for appropriate candidates. Psychosis in PD often has a gradual onset. Cognitive and affective disorders, psychiatric and medical comorbidities as well as polypharmacy are risk factors for a psychosis. Non-pharmacological treatments should be implemented as soon as possible and anti-parkinsonian medications should be adjusted/reduced if feasible. For psychosis associated with PD, quetiapine or clozapine should be used on an as-needed basis and for as short a time as is necessary, with safety monitoring. Delirium in PD may be underdiagnosed due to an overlap with chronic neuropsychiatric features of PD. Although transient by definition, delirium in PD can lead to permanent cognitive decline, motor impairment and increased mortality. Management of delirium includes pharmacological and non-pharmacological interventions. CONCLUSION The updated guideline encompasses the evidence-based diagnostic, non-pharmacological and pharmacological management of ICD, psychosis and delirium in PD.
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Affiliation(s)
- Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Marienstrasse 15, 26121, Oldenburg, Germany.
- University Clinic of Neurology, Evangelical Hospital, Oldenburg, Germany.
- Center of Neurosensory Sciences, University of Oldenburg, Oldenburg, Germany.
| | - Johannes Levin
- Department of Neurology, LMU University Hospital, LMU Munich, Munich, Germany
- German Center for Neurodegenerative Diseases, Site Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | | | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, University of Augsburg, Augsburg, Germany
- DZPG (German Center for Mental Health), Partner Site München/Augsburg, Augsburg, Germany
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Lellis CDA, Herbas MAM, da Silva LJ. Psychiatric disorders after deep brain stimulation of the subthalamic nucleus in Parkinson's disease: a systematic review. EINSTEIN-SAO PAULO 2024; 22:eRW0182. [PMID: 39046070 PMCID: PMC11221831 DOI: 10.31744/einstein_journal/2024rw0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 11/06/2023] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE To evaluate the psychiatric alterations resulting from deep brain stimulation of the subthalamic nucleus in the management of Parkinson's disease. METHODS Articles were searched using three databases: Public/Publisher MEDLINE, Virtual Health Library, and Cochrane Library. RESULTS Eleven studies were included in the analysis. Manic syndrome alone was reported in two of the 11 studies analyzed. Psychosis alone was not reported in any of them, but it was found in association with other psychiatric alterations in two studies, not including manic syndrome. In one case report, hypersexuality was associated with depression and self-alienation. Depressive disorder was the most frequent psychiatric disorder after deep brain stimulation of the subthalamic nucleus, according to five of the reviewed articles, encompassing 26 patients. In four of these articles, depression was associated with other psychiatric disorders, such as psychosis, suicidal ideation, hypersexuality, and anxiety. Hypomanic syndrome was reported in two cases. CONCLUSION More common psychiatric disorders related to the neuroanatomy of the nucleus were observed, probably because of the microlesions caused by the implantation of deep brain stimulation and the regulation of the stimulation of the device. The most common disorders include depression, mania/hypomania, psychosis, anxiety, suicidal ideation, and hypersexuality.
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Affiliation(s)
- Caio de Almeida Lellis
- Escola de Ciências Médicas e da VidaPontifícia Universidade Católica de GoiásGoiâniaGOBrazilEscola de Ciências Médicas e da Vida, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil.
| | - Marco Alejandro Menacho Herbas
- Escola de Ciências Médicas e da VidaPontifícia Universidade Católica de GoiásGoiâniaGOBrazilEscola de Ciências Médicas e da Vida, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil.
| | - Ledismar José da Silva
- Escola de Ciências Médicas e da VidaPontifícia Universidade Católica de GoiásGoiâniaGOBrazilEscola de Ciências Médicas e da Vida, Pontifícia Universidade Católica de Goiás, Goiânia, GO, Brazil.
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Butenko K, Neudorfer C, Dembek TA, Hollunder B, Meyer GM, Li N, Oxenford S, Bahners BH, Al-Fatly B, Lofredi R, Gordon EM, Dosenbach NUF, Ganos C, Hallett M, Starr PA, Ostrem JL, Wu Y, Zhang C, Fox MD, Horn A. Engaging dystonia networks with subthalamic stimulation. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.24.24307896. [PMID: 38903109 PMCID: PMC11188120 DOI: 10.1101/2024.05.24.24307896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2024]
Abstract
Deep brain stimulation is a viable and efficacious treatment option for dystonia. While the internal pallidum serves as the primary target, more recently, stimulation of the subthalamic nucleus (STN) has been investigated. However, optimal targeting within this structure and its complex surroundings have not been studied in depth. Indeed, multiple historical targets that have been used for surgical treatment of dystonia are directly adjacent to the STN. Further, multiple types of dystonia exist, and outcomes are variable, suggesting that not all types would profit maximally from the exact same target. Therefore, a thorough investigation of the neural substrates underlying effects on dystonia symptoms is warranted. Here, we analyze a multi-center cohort of isolated dystonia patients with subthalamic implantations (N = 58) and relate their stimulation sites to improvement of appendicular and cervical symptoms as well as blepharospasm. Stimulation of the ventral oral posterior nucleus of thalamus and surrounding regions was associated with improvement in cervical dystonia, while stimulation of the dorsolateral STN was associated with improvement in limb dystonia and blepharospasm. This dissociation was also evident for structural connectivity, where the cerebellothalamic, corticospinal and pallidosubthalamic tracts were associated with improvement of cervical dystonia, while hyperdirect and subthalamopallidal pathways were associated with alleviation of limb dystonia and blepharospasm. Importantly, a single well-placed electrode may reach the three optimal target sites. On the level of functional networks, improvement of limb dystonia was correlated with connectivity to the corresponding somatotopic regions in primary motor cortex, while alleviation of cervical dystonia was correlated with connectivity to the recently described 'action-mode' network that involves supplementary motor and premotor cortex. Our findings suggest that different types of dystonia symptoms are modulated via distinct networks. Namely, appendicular dystonia and blepharospasm are improved with modulation of the basal ganglia, and, in particular, the subthalamic circuitry, including projections from the primary motor cortex. In contrast, cervical dystonia was more responsive when engaging the cerebello-thalamo-cortical circuit, including direct stimulation of ventral thalamic nuclei. These findings may inform DBS targeting and image-based programming strategies for patient-specific treatment of dystonia.
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Affiliation(s)
- Konstantin Butenko
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Clemens Neudorfer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Till A Dembek
- Department of Neurology, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Barbara Hollunder
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Garance M Meyer
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ningfei Li
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simón Oxenford
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bahne H Bahners
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
- Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Germany
| | - Bassam Al-Fatly
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Roxanne Lofredi
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Evan M Gordon
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Nico U F Dosenbach
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St Louis, MO, USA
| | - Christos Ganos
- Movement Disorder Clinic, Edmond J. Safra Program in Parkinson's Disease, Division of Neurology, University of Toronto, Toronto Western Hospital, Toronto, ON, Canada
| | - Mark Hallett
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Philip A Starr
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Jill L Ostrem
- Movement Disorders and Neuromodulation Centre, Department of Neurology, University of California, San Francisco, CA, USA
| | - Yiwen Wu
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - ChenCheng Zhang
- Department of Neurosurgery, Rujin Hospital, Shanghai Jiaotong University Schools of Medicine, Shanghai, China
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Scott BM, Eisinger RS, Mara R, Rana AN, Thompson S, Okun MS, Gunduz A, Bowers D. Co-Occurrence of Apathy and Impulse Control Disorders in Parkinson Disease: Variation across Multiple Measures. Arch Clin Neuropsychol 2024:acae036. [PMID: 38704737 DOI: 10.1093/arclin/acae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/21/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
OBJECTIVE To determine if the co-occurrence of apathy and impulse control disorders (ICDs) in Parkinson disease is dependent on instrument selection and assess the concurrent validity of three motivation measures by examining interrelationships between them. METHOD Ninety-seven cognitively normal individuals with idiopathic Parkinson disease (PD) completed the Questionnaire for Impulsive-Compulsive Disorders in Parkinson Disease-Rating Scale (QUIP-RS) and three apathy measures: the Apathy Scale, Lille Apathy Rating Scale, and Item 4 of the Movement Disorder Society-Unified Parkinson Disease Rating Scale. RESULTS Fifty (51.5%) participants were classified as apathetic on at least one measure, and only four individuals (4.3%) obtained clinically elevated scores on all three measures. The co-occurrence of apathy and ICD varied across measures. CONCLUSIONS We observed a co-occurrence of apathy and ICDs in PD patients with each apathy instrument; however, limited concurrent validity exists across measures. This is important for future investigations into shared pathophysiology and the design of future clinical trials aimed at improving the early detection and treatment of these debilitating syndromes.
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Affiliation(s)
- Bonnie M Scott
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Robert S Eisinger
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Roshan Mara
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Amtul-Noor Rana
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA
| | - Sable Thompson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Aysegul Gunduz
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, FL, USA
| | - Dawn Bowers
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
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Jones MB, Gibson L, Gimenez-Zapiola M, Guerra A, Bhatti G, Broadway D, Tea J, Prasad A, Gates R, Hinton E, Jorge RE, Marsh L. Physical Violence and Aggression in Parkinson's Disease: A Systematic Review. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00015-6. [PMID: 38311061 DOI: 10.1016/j.jaclp.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 01/10/2024] [Accepted: 01/28/2024] [Indexed: 02/06/2024]
Abstract
BACKGROUND Physical violence and aggression (PVA), defined as behaviors with the potential to cause bodily injury, are unfortunate risks in the management of all-cause neurodegenerative dementias. While dementia in Parkinson's disease (PD) may not be evident for many years after clinical onset, neuropsychiatric disturbances occur at all stages of the disease. At issue is whether PVA in PD is associated with clinical factors that can be targets for prevention and management in the absence of a prevailing dementia syndrome. OBJECTIVE This systematic review examined the extent to which PVA in PD without dementia is a clinically significant concern and whether it is associated with factors that could warrant proactive management. METHODS A systematic search of 9 electronic databases used MeSH headings and equivalent terms for PD, aggression, and violence. Eligible manuscripts were original articles that were published in peer-reviewed journals and reported on adults with PD in the awake state with PVA as possible outcomes. Extracted data included study design, PD ascertainment methods and characteristics, PVA assessment methods, subject demographics, psychiatric and medical comorbidities, and pertinent results. Inciting and confounding factors were extracted from case reports. Quality assessment tools were applied in accordance with the study design (e.g., observational, qualitative, or case report). RESULTS The search identified 10 manuscripts: 2 observational quantitative studies (total n with PD = 545), 1 qualitative study (n with PD = 20), and 7 case reports (n = 7). The observational studies suggested that PVA is less common than other neuropsychiatric disturbances, but heterogeneous methods and quality concerns prevented further conclusions. In the case reports, all patients were male, and most were early onset. In 6 of the reports, PVA occurred in the context of bilateral subthalamic nucleus deep brain stimulation. CONCLUSIONS PVA, while relatively rare in PD, can be a significant management issue that is associated with select premorbid characteristics and antiparkinsonian motor treatments. As PVA may be under-reported, further understanding of its frequency, causes, risk factors, and outcomes would benefit from its systematic assessment, ideally using self-report and informant-based questionnaires.
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Affiliation(s)
- Melissa B Jones
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX.
| | - Lakeshia Gibson
- University of Mississippi Medical Center, Jackson, MS; Brigham and Women's Hospital, Boston, MA
| | - Malena Gimenez-Zapiola
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Ana Guerra
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Gursimrat Bhatti
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Dakota Broadway
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Juliann Tea
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Aksa Prasad
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX; The University of Texas Rio Grande Valley, Edinburg, TX
| | - Rachel Gates
- Department of Medicine, Baylor College of Medicine, Houston, TX; UCHealth University of Colorado Hospital, Aurora, CO
| | | | - Ricardo E Jorge
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Laura Marsh
- Michael E. DeBakey VA Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX
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8
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Chen X, Zhang Y. A review of the neurotransmitter system associated with cognitive function of the cerebellum in Parkinson's disease. Neural Regen Res 2024; 19:324-330. [PMID: 37488885 PMCID: PMC10503617 DOI: 10.4103/1673-5374.379042] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/30/2023] [Accepted: 05/08/2023] [Indexed: 07/26/2023] Open
Abstract
The dichotomized brain system is a concept that was generalized from the 'dual syndrome hypothesis' to explain the heterogeneity of cognitive impairment, in which anterior and posterior brain systems are independent but partially overlap. The dopaminergic system acts on the anterior brain and is responsible for executive function, working memory, and planning. In contrast, the cholinergic system acts on the posterior brain and is responsible for semantic fluency and visuospatial function. Evidence from dopaminergic/cholinergic imaging or functional neuroimaging has shed significant insight relating to the involvement of the cerebellum in the cognitive process of patients with Parkinson's disease. Previous research has reported evidence that the cerebellum receives both dopaminergic and cholinergic projections. However, whether these two neurotransmitter systems are associated with cognitive function has yet to be fully elucidated. Furthermore, the precise role of the cerebellum in patients with Parkinson's disease and cognitive impairment remains unclear. Therefore, in this review, we summarize the cerebellar dopaminergic and cholinergic projections and their relationships with cognition, as reported by previous studies, and investigated the role of the cerebellum in patients with Parkinson's disease and cognitive impairment, as determined by functional neuroimaging. Our findings will help us to understand the role of the cerebellum in the mechanisms underlying cognitive impairment in Parkinson's disease.
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Affiliation(s)
- Xi Chen
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
- Shantou University Medical College, Shantou, Guangdong Province, China
| | - Yuhu Zhang
- Department of Neurology, Guangdong Neuroscience Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China
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Prasad AA, Wallén-Mackenzie Å. Architecture of the subthalamic nucleus. Commun Biol 2024; 7:78. [PMID: 38200143 PMCID: PMC10782020 DOI: 10.1038/s42003-023-05691-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 12/11/2023] [Indexed: 01/12/2024] Open
Abstract
The subthalamic nucleus (STN) is a major neuromodulation target for the alleviation of neurological and neuropsychiatric symptoms using deep brain stimulation (DBS). STN-DBS is today applied as treatment in Parkinson´s disease, dystonia, essential tremor, and obsessive-compulsive disorder (OCD). STN-DBS also shows promise as a treatment for refractory Tourette syndrome. However, the internal organization of the STN has remained elusive and challenges researchers and clinicians: How can this small brain structure engage in the multitude of functions that renders it a key hub for therapeutic intervention of a variety of brain disorders ranging from motor to affective to cognitive? Based on recent gene expression studies of the STN, a comprehensive view of the anatomical and cellular organization, including revelations of spatio-molecular heterogeneity, is now possible to outline. In this review, we focus attention to the neurobiological architecture of the STN with specific emphasis on molecular patterns discovered within this complex brain area. Studies from human, non-human primate, and rodent brains now reveal anatomically defined distribution of specific molecular markers. Together their spatial patterns indicate a heterogeneous molecular architecture within the STN. Considering the translational capacity of targeting the STN in severe brain disorders, the addition of molecular profiling of the STN will allow for advancement in precision of clinical STN-based interventions.
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Affiliation(s)
- Asheeta A Prasad
- University of Sydney, School of Medical Sciences, Faculty of Medicine and Health, Sydney, NSW, Australia.
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10
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Serra GP, Guillaumin A, Vlcek B, Delgado-Zabalza L, Ricci A, Rubino E, Dumas S, Baufreton J, Georges F, Wallén-Mackenzie Å. A role for the subthalamic nucleus in aversive learning. Cell Rep 2023; 42:113328. [PMID: 37925641 DOI: 10.1016/j.celrep.2023.113328] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/28/2023] [Accepted: 10/08/2023] [Indexed: 11/07/2023] Open
Abstract
The subthalamic nucleus (STN) is critical for behavioral control; its dysregulation consequently correlated with neurological and neuropsychiatric disorders, including Parkinson's disease. Deep brain stimulation (DBS) targeting the STN successfully alleviates parkinsonian motor symptoms. However, low mood and depression are affective side effects. STN is adjoined with para-STN, associated with appetitive and aversive behavior. DBS aimed at STN might unintentionally modulate para-STN, causing aversion. Alternatively, the STN mediates aversion. To investigate causality between STN and aversion, affective behavior is addressed using optogenetics in mice. Selective promoters allow dissociation of STN (e.g., Pitx2) vs. para-STN (Tac1). Acute photostimulation results in aversion via both STN and para-STN. However, only STN stimulation-paired cues cause conditioned avoidance and only STN stimulation interrupts on-going sugar self-administration. Electrophysiological recordings identify post-synaptic responses in pallidal neurons, and selective photostimulation of STN terminals in the ventral pallidum replicates STN-induced aversion. Identifying STN as a source of aversive learning contributes neurobiological underpinnings to emotional affect.
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Affiliation(s)
- Gian Pietro Serra
- Uppsala University, Department of Organism Biology, 752 36 Uppsala, Sweden
| | - Adriane Guillaumin
- Uppsala University, Department of Organism Biology, 752 36 Uppsala, Sweden; University of Bordeaux, CNRS, IMN, UMR 5293, 33000 Bordeaux, France
| | - Bianca Vlcek
- Uppsala University, Department of Organism Biology, 752 36 Uppsala, Sweden
| | | | - Alessia Ricci
- Uppsala University, Department of Organism Biology, 752 36 Uppsala, Sweden
| | - Eleonora Rubino
- Uppsala University, Department of Organism Biology, 752 36 Uppsala, Sweden
| | | | - Jérôme Baufreton
- University of Bordeaux, CNRS, IMN, UMR 5293, 33000 Bordeaux, France
| | - François Georges
- University of Bordeaux, CNRS, IMN, UMR 5293, 33000 Bordeaux, France
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Chen L, Sun J, Gao L, Wang J, Ma J, Xu E, Zhang D, Li L, Wu T. Dysconnectivity of the parafascicular nucleus in Parkinson's disease: A dynamic causal modeling analysis. Neurobiol Dis 2023; 188:106335. [PMID: 37890560 DOI: 10.1016/j.nbd.2023.106335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 10/24/2023] [Accepted: 10/24/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Recent animal model studies have suggested that the parafascicular nucleus has the potential to be an effective deep brain stimulation target for Parkinson's disease. However, our knowledge on the role of the parafascicular nucleus in Parkinson's disease patients remains limited. OBJECTIVE We aimed to investigate the functional alterations of the parafascicular nucleus projections in Parkinson's disease patients. METHODS We enrolled 72 Parkinson's disease patients and 60 healthy controls, then utilized resting-state functional MRI and spectral dynamic causal modeling to explore the effective connectivity of the bilateral parafascicular nucleus to the dorsal putamen, nucleus accumbens, and subthalamic nucleus. The associations between the effective connectivity of the parafascicular nucleus projections and clinical features were measured with Pearson partial correlations. RESULTS Compared with controls, the effective connectivity from the parafascicular nucleus to dorsal putamen was significantly increased, while the connectivity to the nucleus accumbens and subthalamic nucleus was significantly reduced in Parkinson's disease patients. There was a significantly positive correlation between the connectivity of parafascicular nucleus-dorsal putamen projection and motor deficits. The connectivity from the parafascicular nucleus to the subthalamic nucleus was negatively correlated with motor deficits and apathy, while the connectivity from the parafascicular nucleus to the nucleus accumbens was negatively associated with depression. CONCLUSION The present study demonstrates that the parafascicular nucleus-related projections are damaged and associated with clinical symptoms of Parkinson's disease. Our findings provide new insights into the impaired basal ganglia-thalamocortical circuits and give support for the parafascicular nucleus as a potential effective neuromodulating target of the disease.
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Affiliation(s)
- Lili Chen
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Junyan Sun
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Linlin Gao
- Department of General Medicine, Tianjin Union Medical Center, Tianjin, China
| | - Junling Wang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Jinghong Ma
- Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Erhe Xu
- Department of Neurobiology, Beijing Institute of Geriatrics, Xuanwu Hospital of Capital Medical University, Beijing, China
| | - Dongling Zhang
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Liang Li
- Brain Science Center, Beijing Institute of Basic Medical Sciences, China.
| | - Tao Wu
- Center for Movement Disorders, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China.
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Brand G, Bontempi C, Jacquot L. Impact of deep brain stimulation (DBS) on olfaction in Parkinson's disease: Clinical features and functional hypotheses. Rev Neurol (Paris) 2023; 179:947-954. [PMID: 37301657 DOI: 10.1016/j.neurol.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/17/2022] [Accepted: 12/22/2022] [Indexed: 06/12/2023]
Abstract
Deep brain stimulation (DBS) is a surgical therapy typically applied in Parkinson's disease (PD). The efficacity of DBS on the control of motor symptoms in PD is well grounded while the efficacity on non-motor symptoms is more controversial, especially on olfactory disorders (ODs). The present review shows that DBS does not improve hyposmia but can affect positively identification/discrimination scores in PD. The functional hypotheses suggest complex mechanisms in terms of cerebral connectivity and neurogenesis process which could act indirectly on the olfactory bulb and olfactory pathways related to specific cognitive olfactory tasks. The functional hypotheses also suggest complex mechanisms of cholinergic neurotransmitter interactions involved in these pathways. Finally, the impact of DBS on general cognitive functions in PD could also be beneficial to identification/discrimination tasks in PD.
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Affiliation(s)
- G Brand
- Neuroscience Laboratory, University of Franche-Comte, Besançon, France.
| | - C Bontempi
- Neuroscience Laboratory, University of Franche-Comte, Besançon, France
| | - L Jacquot
- Neuroscience Laboratory, University of Franche-Comte, Besançon, France
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Diao Y, Hu T, Xie H, Fan H, Meng F, Yang A, Bai Y, Zhang J. Premature drug reduction after subthalamic nucleus deep brain stimulation leading to worse depression in patients with Parkinson's disease. Front Neurol 2023; 14:1270746. [PMID: 37928164 PMCID: PMC10620523 DOI: 10.3389/fneur.2023.1270746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023] Open
Abstract
Background Reduction of medication in Parkinson's disease (PD) following subthalamic nucleus deep brain stimulation (STN-DBS) has been recognized, but the optimal timing for medication adjustments remains unclear, posing challenges in postoperative patient management. Objective This study aimed to provide evidence for the timing of medication reduction post-DBS using propensity score matching (PSM). Methods In this study, initial programming and observation sessions were conducted over 1 week for patients 4-6 weeks postoperatively. Patients were subsequently categorized into medication reduction or non-reduction groups based on their dyskinesia evaluation using the 4.2-item score from the MDS-UPDRS-IV. PSM was employed to maintain baseline comparability. Short-term motor and neuropsychiatric symptom assessments for both groups were conducted 3-6 months postoperatively. Results A total of 123 PD patients were included. Baseline balance in motor and non-motor scores was achieved between the two groups based on PSM. Short-term efficacy revealed a significant reduction in depression scores within the non-reduction group compared to baseline (P < 0.001) and a significant reduction compared to the reduction group (P = 0.037). No significant differences were observed in UPDRS-III and HAMA scores between the two groups. Within-group analysis showed improvements in motor symptoms, depression, anxiety, and subdomains in the non-reduction group, while the reduction group exhibited improvements only in motor symptoms. Conclusion This study provides evidence for the timing of medication reduction following DBS. Our findings suggest that early maintenance of medication stability is more favorable for improving neuropsychiatric symptoms.
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Affiliation(s)
- Yu Diao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianqi Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Houyou Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
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Ricciardi L, Apps M, Little S. Uncovering the neurophysiology of mood, motivation and behavioral symptoms in Parkinson's disease through intracranial recordings. NPJ Parkinsons Dis 2023; 9:136. [PMID: 37735477 PMCID: PMC10514046 DOI: 10.1038/s41531-023-00567-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 08/07/2023] [Indexed: 09/23/2023] Open
Abstract
Neuropsychiatric mood and motivation symptoms (depression, anxiety, apathy, impulse control disorders) in Parkinson's disease (PD) are highly disabling, difficult to treat and exacerbated by current medications and deep brain stimulation therapies. High-resolution intracranial recording techniques have the potential to undercover the network dysfunction and cognitive processes that drive these symptoms, towards a principled re-tuning of circuits. We highlight intracranial recording as a valuable tool for mapping and desegregating neural networks and their contribution to mood, motivation and behavioral symptoms, via the ability to dissect multiplexed overlapping spatial and temporal neural components. This technique can be powerfully combined with behavioral paradigms and emerging computational techniques to model underlying latent behavioral states. We review the literature of intracranial recording studies investigating mood, motivation and behavioral symptomatology with reference to 1) emotional processing, 2) executive control 3) subjective valuation (reward & cost evaluation) 4) motor control and 5) learning and updating. This reveals associations between different frequency specific network activities and underlying cognitive processes of reward decision making and action control. If validated, these signals represent potential computational biomarkers of motivational and behavioural states and could lead to principled therapy development for mood, motivation and behavioral symptoms in PD.
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Affiliation(s)
- Lucia Ricciardi
- Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK.
| | - Matthew Apps
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Simon Little
- Movement Disorders and Neuromodulation Centre, University of California San Francisco, San Francisco, CA, USA
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Wang L, Li J, Pan Y, Huang P, Li D, Voon V. Subacute alpha frequency (10Hz) subthalamic stimulation for emotional processing in Parkinson's disease. Brain Stimul 2023; 16:1223-1231. [PMID: 37567462 DOI: 10.1016/j.brs.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/21/2023] [Accepted: 08/07/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Psychiatric comorbidities are common in Parkinson's disease (PD) and may change with high-frequency stimulation targeting the subthalamic nucleus. Numerous accounts indicate subthalamic alpha-frequency oscillation is implicated in emotional processing. While intermittent alpha-frequency (10Hz) stimulation induces positive emotional effects, with more ventromedial contacts inducing larger effects, little is known about the subacute effect of ventral 10Hz subthalamic stimulation on emotional processing. OBJECTIVE/HYPOTHESIS To evaluate the subacute effect of 10Hz stimulation at bilateral ventral subthalamic nucleus on emotional processing in PD patients using an affective task, compared to that of clinical-frequency stimulation and off-stimulation. METHODS Twenty PD patients with bilateral subthalamic deep brain stimulation for more than six months were tested with the affective task under three stimulation conditions (10Hz, 130Hz, and off-stimulation) in a double-blinded randomized design. RESULTS While 130Hz stimulation reduced arousal ratings in all patients, 10Hz stimulation increased arousal selectively in patients with higher depression scores. Furthermore, 10Hz stimulation induced a positive shift in valence rating to negative emotional stimuli in patients with lower apathy scores, and 130Hz stimulation led to more positive valence to emotional stimuli in the patients with higher apathy scores. Notably, we found correlational relationships between stimulation site and affective rating: arousal ratings increase with stimulation from anterior to posterior site, and positive valence ratings increase with stimulation from dorsal to ventral site of the ventral subthalamic nucleus. CONCLUSIONS Our findings highlight the distinctive role of 10Hz stimulation on subjective emotional experience and unveil the spatial organization of the stimulation effect.
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Affiliation(s)
- Linbin Wang
- Institute of Science and Technology for Brain-Inspired Intelligence (ISTBI), Fudan University, Shanghai, China; Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Li
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Yixin Pan
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Huang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Valerie Voon
- Institute of Science and Technology for Brain-Inspired Intelligence (ISTBI), Fudan University, Shanghai, China; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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16
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Steinhardt J, Lokowandt L, Rasche D, Koch A, Tronnier V, Münte TF, Meyhöfer SM, Wilms B, Brüggemann N. Mechanisms and consequences of weight gain after deep brain stimulation of the subthalamic nucleus in patients with Parkinson's disease. Sci Rep 2023; 13:14202. [PMID: 37648732 PMCID: PMC10468527 DOI: 10.1038/s41598-023-40316-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
Body weight gain in combination with metabolic alterations has been observed after deep brain stimulation (DBS) of subthalamic nucleus (STN) in patients with Parkinson's disease (PD), which potentially counteracts the positive effects of motor improvement. We aimed to identify stimulation-dependent effects on motor activities, body weight, body composition, energy metabolism, and metabolic blood parameters and to determine if these alterations are associated with the local impact of DBS on different STN parcellations. We assessed 14 PD patients who underwent STN DBS (PD-DBS) before as well as 6- and 12-months post-surgery. For control purposes, 18 PD patients under best medical treatment (PD-CON) and 25 healthy controls (H-CON) were also enrolled. Wrist actigraphy, body composition, hormones, and energy expenditure measurements were applied. Electrode placement in the STN was localized, and the local impact of STN DBS was estimated. We found that STN DBS improved motor function by ~ 40% (DBS ON, Med ON). Weight and fat mass increased by ~ 3 kg and ~ 3% in PD-DBS (all P ≤ 0.005). fT3 (P = 0.001) and insulin levels (P = 0.048) increased solely in PD-DBS, whereas growth hormone levels (P = 0.001), daily physical activity, and VO2 during walking were decreased in PD-DBS (all P ≤ 0.002). DBS of the limbic part of the STN was associated with changes in weight and body composition, sedentary activity, insulin levels (all P ≤ 0.040; all r ≥ 0.56), and inversely related to HOMA-IR (P = 0.033; r = - 0.62). Daily physical activity is decreased after STN DBS, which can contribute to weight gain and an unfavorable metabolic profile. We recommend actigraphy devices to provide feedback on daily activities to achieve pre-defined activity goals.
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Affiliation(s)
- Julia Steinhardt
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Laura Lokowandt
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Dirk Rasche
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Andreas Koch
- Section Maritime Medicine, Naval Medical Institute, Kiel, Germany
| | - Volker Tronnier
- Department of Neurosurgery, University of Lübeck, Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
| | - Sebastian M Meyhöfer
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Britta Wilms
- Institute of Endocrinology and Diabetes, University of Lübeck, Lübeck, Germany
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany
- Section Maritime Medicine, Naval Medical Institute, Kiel, Germany
| | - Norbert Brüggemann
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- Center of Brain, Behavior and Metabolism, University of Lübeck, Lübeck, Germany.
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Zuk P, Sanchez CE, Kostick-Quenet K, Muñoz KA, Kalwani L, Lavingia R, Torgerson L, Sierra-Mercado D, Robinson JO, Pereira S, Outram S, Koenig BA, McGuire AL, Lázaro-Muñoz G. Researcher Views on Changes in Personality, Mood, and Behavior in Next-Generation Deep Brain Stimulation. AJOB Neurosci 2023; 14:287-299. [PMID: 35435795 PMCID: PMC9639000 DOI: 10.1080/21507740.2022.2048724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The literature on deep brain stimulation (DBS) and adaptive DBS (aDBS) raises concerns that these technologies may affect personality, mood, and behavior. We conducted semi-structured interviews with researchers (n = 23) involved in developing next-generation DBS systems, exploring their perspectives on ethics and policy topics including whether DBS/aDBS can cause such changes. The majority of researchers reported being aware of personality, mood, or behavioral (PMB) changes in recipients of DBS/aDBS. Researchers offered varying estimates of the frequency of PMB changes. A smaller majority reported changes in personality specifically. Some expressed reservations about the scientific status of the term 'personality,' while others used it freely. Most researchers discussed negative PMB changes, but a majority said that DBS/aDBS can also result in positive changes. Several researchers viewed positive PMB changes as part of the therapeutic goal in psychiatric applications of DBS/aDBS. Finally, several discussed potential causes of PMB changes other than the device itself.
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18
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Gencer GYG, Erdem NŞ, Ipek L, Özkaynak SS, Uçar T. Caregiver Burden and Quality of Life of Caregivers for Patients with Parkinson's Disease Treated with Deep Brain Stimulation. Ann Indian Acad Neurol 2023; 26:530-536. [PMID: 37970306 PMCID: PMC10645263 DOI: 10.4103/aian.aian_210_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/18/2023] [Accepted: 06/17/2023] [Indexed: 11/17/2023] Open
Abstract
Objective This study aimed to identify caregiver burden (CB) and contributing factors to CB for Parkinson's disease (PD) patients under Subthalamic Nucleus Deep Brain Stimulation (STN-DBS) treatment, and investigation the factors, affecting the caregivers' quality of life (QoL). Methods Twenty-four PD patients under STN-DBS treatment and their caregivers participated in this study. Unified Parkinson's Disease Rating Scale (UPDRS) was applied for the clinical assessment of the patients. Beck Depression Inventory-II (BDI), Hospital Anxiety and Depression Scale (HADS), and Minnesota Impulse Control Disorders Interview (MIDI) were used to screen for neuropsychiatric symptoms of the patients. CB was evaluated with the Caregivers Burden Inventory (CBI) and the Burden Scale for Family Caregivers (BSFC-s). The health-related QoL of caregivers was assessed with the Short Form Survey-36 (SF-36). Results Mean total CBI and BSFC-s scores of caregivers were 32.53 ± 19.71 and 11.66 ± 8.86, respectively. Nineteen caregivers defined moderate or severe caregiver burden according to BSFC-s. Both CBI and BSFC-s scores were significantly associated with UPDRS-part-1 scores, but not with the age and gender of both the patients and their caregivers, disease duration, PDQ39, BDI, HADS, LARS scores, and scores of patients for other UPDRS parts. The presence of impulse control behaviors (ICBs) significantly increased the total CBI score and total BSFC-s (P < 0.01). The caregivers' total and all domain scores of SF-36 were significantly affected by higher CBI and BSFC-s scores. Conclusions The CB of the patients under STN-DBS treatment was severe. Non-motor symptoms, particularly impulsivity, significantly increased CB and worsened the caregivers' mental and physical health.
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Affiliation(s)
| | - Nazan Şimşek Erdem
- Department of Neurology, Private Termessos Hospital, Konyaaltı/Antalya, Turkey
| | - Lutfiye Ipek
- Department of Gerontology Faculty of Health Sciences, Akdeniz University, Konyaaltı/Antalya, Turkey
| | | | - Tanju Uçar
- Department of Neurosurgery, Akdeniz University Hospital, Konyaaltı/Antalya, Turkey
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Eraifej J, Cabral J, Fernandes HM, Kahan J, He S, Mancini L, Thornton J, White M, Yousry T, Zrinzo L, Akram H, Limousin P, Foltynie T, Aziz TZ, Deco G, Kringelbach M, Green AL. Modulation of limbic resting-state networks by subthalamic nucleus deep brain stimulation. Netw Neurosci 2023; 7:478-495. [PMID: 37397890 PMCID: PMC10312264 DOI: 10.1162/netn_a_00297] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/29/2022] [Indexed: 09/03/2023] Open
Abstract
Beyond the established effects of subthalamic nucleus deep brain stimulation (STN-DBS) in reducing motor symptoms in Parkinson's disease, recent evidence has highlighted the effect on non-motor symptoms. However, the impact of STN-DBS on disseminated networks remains unclear. This study aimed to perform a quantitative evaluation of network-specific modulation induced by STN-DBS using Leading Eigenvector Dynamics Analysis (LEiDA). We calculated the occupancy of resting-state networks (RSNs) in functional MRI data from 10 patients with Parkinson's disease implanted with STN-DBS and statistically compared between ON and OFF conditions. STN-DBS was found to specifically modulate the occupancy of networks overlapping with limbic RSNs. STN-DBS significantly increased the occupancy of an orbitofrontal limbic subsystem with respect to both DBS OFF (p = 0.0057) and 49 age-matched healthy controls (p = 0.0033). Occupancy of a diffuse limbic RSN was increased with STN-DBS OFF when compared with healthy controls (p = 0.021), but not when STN-DBS was ON, which indicates rebalancing of this network. These results highlight the modulatory effect of STN-DBS on components of the limbic system, particularly within the orbitofrontal cortex, a structure associated with reward processing. These results reinforce the value of quantitative biomarkers of RSN activity in evaluating the disseminated impact of brain stimulation techniques and the personalization of therapeutic strategies.
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Affiliation(s)
- John Eraifej
- Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Joana Cabral
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, United Kingdom
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrique M. Fernandes
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Joshua Kahan
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Shenghong He
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Laura Mancini
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - John Thornton
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - Mark White
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - Tarek Yousry
- Neuroradiological Academic Unit, Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, United Kingdom
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, UCLH NHS Foundation Trust, London, United Kingdom
| | - Ludvic Zrinzo
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Harith Akram
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Patricia Limousin
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Tom Foltynie
- Sobell Department for Motor Neurosciences and Movement Disorders, UCL Institute of Neurology, London, United Kingdom
| | - Tipu Z. Aziz
- Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Gustavo Deco
- Center for Brain and Cognition, Computational Neuroscience Group, Universitat Pompeu Fabra, Barcelona, Spain
- Institució Catalana de la Recerca i Estudis Avançats, Barcelona, Spain
- Department of Neuropsychology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Morten Kringelbach
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, United Kingdom
- Center for Music in the Brain, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Alexander L. Green
- Oxford Functional Neurosurgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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20
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Bronte-Stewart H, Merola A. Hope vs. Hype: Closed loop technology will provide more meaningful improvement vs. directional leads in deep brain stimulation. Parkinsonism Relat Disord 2023:105452. [PMID: 37355400 DOI: 10.1016/j.parkreldis.2023.105452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/26/2023]
Affiliation(s)
- Helen Bronte-Stewart
- Department of Neurology and Neurological Sciences, Stanford Comprehensive Movement Disorders Center, United States.
| | - Aristide Merola
- Center for Parkinson's Disease and Related Movement Disorders, Wexner Medical Center, The Ohio State University, Columbus, United States.
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21
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Schüller T, Kohl S, Dembek T, Tittgemeyer M, Huys D, Visser-Vandewalle V, Li N, Wehmeyer L, Barbe M, Kuhn J, Baldermann JC. Internal Capsule/Nucleus Accumbens Deep Brain Stimulation Increases Impulsive Decision Making in Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:281-289. [PMID: 36739254 DOI: 10.1016/j.bpsc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/22/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Deep brain stimulation of the anterior limb of the internal capsule (ALIC)/nucleus accumbens is an effective treatment in patients with obsessive-compulsive disorder but may increase impulsive behavior. We aimed to investigate how active stimulation alters subdomains of impulsive decision making and whether respective effects depend on the location of stimulation sites. METHODS We assessed 15 participants with obsessive-compulsive disorder performing the Cambridge Gambling Task during active and inactive ALIC/nucleus accumbens deep brain stimulation. Specifically, we determined stimulation-induced changes in risk adjustment and delay aversion. To characterize underlying neural pathways, we computed probabilistic stimulation maps and applied fiber filtering based on normative structural connectivity data to identify "hot" and "cold" spots/fibers related to changes in impulsive decision making. RESULTS Active stimulation significantly reduced risk adjustment while increasing delay aversion, both implying increased impulsive decision making. Changes in risk adjustment were robustly associated with stimulation sites located in the central ALIC and fibers connecting the thalamus and subthalamic nucleus with the medial and lateral prefrontal cortex. Both hot spots and fibers for changes in risk adjustment were robust to leave-one-out cross-validation. Changes in delay aversion were similarly associated with central ALIC stimulation, but validation hereof was nonsignificant. CONCLUSIONS Our findings provide experimental evidence that ALIC/nucleus accumbens stimulation increases impulsive decision making in obsessive-compulsive disorder. We show that changes in risk adjustment depend on the location of stimulation volumes and affected fiber bundles. The relationship between impulsive decision making and long-term clinical outcomes requires further investigation.
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Affiliation(s)
- Thomas Schüller
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Sina Kohl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till Dembek
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Tittgemeyer
- Max-Planck-Institute for Metabolism Research, Cologne, Germany; Cologne Cluster of Excellence in Cellular Stress and Aging associated Disease (CECAD), Cologne, Germany
| | - Daniel Huys
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Psychiatry and Psychotherapy III, LVR Hospital Bonn, Bonn, Germany
| | | | - Ningfei Li
- Movement Disorders and Neuromodulation Unit, Department for Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Laura Wehmeyer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jens Kuhn
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Psychiatry, Psychotherapy, and Psychosomatics, Johanniter Hospital Oberhausen, Oberhausen, Germany
| | - Juan Carlos Baldermann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
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22
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Dissociable behavioural signatures of co-existing impulsivity and apathy in decision-making. Sci Rep 2022; 12:21476. [PMID: 36509827 PMCID: PMC9744918 DOI: 10.1038/s41598-022-25882-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Apathy and impulsivity are expressed in a wide range of neuropsychiatric disorders, and, to a less severe extent, in healthy people too. Although traditionally considered to be opposite extremes of a single motivational spectrum, recent epidemiological questionnaire-based data suggest that both traits can in fact co-exist within the same individual. Here, we sought to investigate the relationship between these constructs in healthy people within a controlled task environment that examines the ability to make a decision under temporal uncertainty and measures the vigour of the response. Sixty participants performed a new version of the Traffic Light Task and completed self-report questionnaire measures of apathy and impulsivity. The task required individuals to make rapid decision-making for time-sensitive reward by squeezing a hand-held dynamometer as quickly as possible after a predictable event occurred (a traffic light turning green). Although apathy and impulsivity were positively correlated in questionnaire assessments, the two traits were associated with distinct behavioural signatures on the task. Impulsivity was expressed as an inflexible tendency to generate rapid anticipatory responses, regardless of cost-benefit information. Apathy, on the other hand, was associated with a blunted effect of reward on response vigour. These findings reveal how apathy and impulsivity are related to distinct dimensions of goal-directed behaviour, explaining how these traits might co-exist in the same individuals.
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23
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Lamy F, Lagha-Boukbiza O, Wirth T, Philipps C, Longato N, Gebus O, Montaut S, Mengin A, Voirin J, Proust F, Tuzin N, Anheim M, Tranchant C. Early hyperdopaminergic state following sub-thalamic nucleus deep brain stimulation in Parkinson disease. Rev Neurol (Paris) 2022; 178:896-906. [PMID: 36153257 DOI: 10.1016/j.neurol.2022.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/26/2022] [Accepted: 07/17/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Hyperdopaminergic state (HS), especially impulse control behaviors (ICBs), are not rare in Parkinson's disease (PD). Controversial data regarding HS prevalence one year following sub-thalamic nucleus deep brain stimulation (STN-DBS) are reported. OBJECTIVE Our objectives were to describe early postoperative HS (PoOHS) including ICBs, hypomania and psychotic symptoms during the first 3 months following STN-DBS (V1) and their prognosis at 1 year (V2). METHODS This descriptive study included 24 PD patients treated successively with bilateral STN-DBS between 2017 and 2019. The primary endpoint was prevalence of PoOHS at V1 according to the Ardouin Scale of Behaviour in Parkinson's Disease. RESULTS Prior to STN-DBS (V0), 25% patients had HS (only ICBs) whereas at V1 (during the 3 first months), 10 patients (41.7%) had one or several HS (P=0.22) (de novo in 29.2%): 7 (29.2%) ICBs, 4 (16.7%) hypomanic mood, 1 (4.7%) psychotic symptoms. At V2, all V0 and V1 HS had disappeared, while 1 patient (4.2%) presented de novo HS (P<0.01). No correlation was found between the occurrence of PoOHS at V1 and any V0 data. Higher levodopa equivalent dose of dopamine agonists at V1 was correlated with ICB at V1 (P=0.04). CONCLUSION We found that early PoOHS are frequent in PD after STN-DBS, mostly de novo, with ICBs and hypomania being the most frequent. Despite a good prognosis of PoOHS at one year, our work emphasizes the importance of both a cautious adjustment of dopamine agonist doses and a close non-motor monitoring pre- and post-STN-DBS in PD.
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Affiliation(s)
- F Lamy
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France; Département de neurologie fonctionnelle et d'épileptologie, hospices civils de Lyon, université de Lyon, Lyon, France
| | - O Lagha-Boukbiza
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - T Wirth
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - C Philipps
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - N Longato
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - O Gebus
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - S Montaut
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - A Mengin
- Clinique psychiatrique, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, Strasbourg cedex, France
| | - J Voirin
- Service de neurochirurgie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - F Proust
- Service de neurochirurgie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France
| | - N Tuzin
- Département de santé publique, hôpitaux universitaires de Strasbourg, Strasbourg, France
| | - M Anheim
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France; Inserm-U964/CNRS-UMR7104, institut de génétique et de biologie moléculaire et cellulaire (IGBMC), université de Strasbourg, Illkirch, France; Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, Strasbourg, France
| | - C Tranchant
- Service de neurologie, département de neurologie, hôpitaux universitaires de Strasbourg, hôpital de Hautepierre, 1, avenue Molière, 67200 Strasbourg cedex, France; Inserm-U964/CNRS-UMR7104, institut de génétique et de biologie moléculaire et cellulaire (IGBMC), université de Strasbourg, Illkirch, France; Fédération de médecine translationnelle de Strasbourg (FMTS), université de Strasbourg, Strasbourg, France.
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24
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Askari A, Greif TR, Lam J, Maher AC, Persad CC, Patil PG. Decline of verbal fluency with lateral superior frontal gyrus penetration in subthalamic nucleus deep brain stimulation for Parkinson disease. J Neurosurg 2022; 137:729-734. [PMID: 35090137 DOI: 10.3171/2021.11.jns211528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/22/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Verbal fluency (VF) decline is a well-recognized adverse cognitive outcome following subthalamic nucleus deep brain stimulation (STN DBS) in patients with Parkinson disease (PD). The mechanisms underlying VF decline, whether from stimulation, lesioning, or both, remain unclear. This study aims to investigate the unique effects of DBS lead trajectory on VF beyond previously reported effects of active contact location. METHODS The study population included 56 patients with idiopathic PD who underwent bilateral STN DBS. Phonemic and semantic VF scores were compared pre- and postoperatively. Features of the electrode trajectory were measured on postoperative imaging, including distance from the falx cerebri, distance from the superior frontal sulcus, and caudate nucleus penetration. The authors used t-tests, Pearson's correlation, and multiple linear regression analyses to examine the relationship between VF change and demographic, disease, and electrode trajectory variables. RESULTS The laterality of entry within the left superior frontal gyrus (SFG) predicted greater phonemic VF decline (sr2 = 0.28, p < 0.001) after controlling for active contact location. VF change did not differ by the presence of caudate nucleus penetration in either hemisphere (p > 0.05). CONCLUSIONS Lateral penetration of the SFG in the left hemisphere is associated with worsening phonemic VF and has greater explanatory power than active contact location. This may be explained by lesioning of the lateral SFG-Broca area pathway, which is implicated in language function.
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Affiliation(s)
| | - Taylor R Greif
- 2Department of Psychiatry-Neuropsychology Section, University of Michigan, Ann Arbor, Michigan
| | | | - Amanda C Maher
- 2Department of Psychiatry-Neuropsychology Section, University of Michigan, Ann Arbor, Michigan
| | - Carol C Persad
- 2Department of Psychiatry-Neuropsychology Section, University of Michigan, Ann Arbor, Michigan
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25
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Chu C, He N, Zeljic K, Zhang Z, Wang J, Li J, Liu Y, Zhang Y, Sun B, Li D, Yan F, Zhang C, Liu C. Subthalamic and pallidal stimulation in Parkinson's disease induce distinct brain topological reconstruction. Neuroimage 2022; 255:119196. [PMID: 35413446 DOI: 10.1016/j.neuroimage.2022.119196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 10/18/2022] Open
Abstract
The subthalamic nucleus (STN) and globus pallidus internus (GPi) are the two most common and effective target brain areas for deep brain stimulation (DBS) treatment of advanced Parkinson's disease. Although DBS has been shown to restore functional neural circuits of this disorder, the changes in topological organization associated with active DBS of each target remain unknown. To investigate this, we acquired resting-state functional magnetic resonance imaging (fMRI) data from 34 medication-free patients with Parkinson's disease that had DBS electrodes implanted in either the subthalamic nucleus or internal globus pallidus (n = 17 each), in both ON and OFF DBS states. Sixteen age-matched healthy individuals were used as a control group. We evaluated the regional information processing capacity and transmission efficiency of brain networks with and without stimulation, and recorded how stimulation restructured the brain network topology of patients with Parkinson's disease. For both targets, the variation of local efficiency in motor brain regions was significantly correlated (p < 0.05) with improvement rate of the Uniform Parkinson's Disease Rating Scale-III scores, with comparable improvements in motor function for the two targets. However, non-motor brain regions showed changes in topological organization during active stimulation that were target-specific. Namely, targeting the STN decreased the information transmission of association, limbic and paralimbic regions, including the inferior frontal gyrus angle, insula, temporal pole, superior occipital gyri, and posterior cingulate, as evidenced by the simultaneous decrease of clustering coefficient and local efficiency. GPi-DBS had a similar effect on the caudate and lenticular nuclei, but enhanced information transmission in the cingulate gyrus. These effects were not present in the DBS-OFF state for GPi-DBS, but persisted for STN-DBS. Our results demonstrate that DBS to the STN and GPi induce distinct brain network topology reconstruction patterns, providing innovative theoretical evidence for deciphering the mechanism through which DBS affects disparate targets in the human brain.
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Affiliation(s)
- Chunguang Chu
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Naying He
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Kristina Zeljic
- School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Zhen Zhang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Jiang Wang
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China
| | - Jun Li
- School of Information Science and Technology, Shanghai Tech University, Shanghai, China
| | - Yu Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Youmin Zhang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bomin Sun
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Neuroscience Center, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dianyou Li
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Neuroscience Center, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Chencheng Zhang
- Department of Neurosurgery, Center for Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Clinical Neuroscience Center, Ruijin Hospital LuWan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Center for Brain Science and Brain-Inspired Technology, Shanghai, China.
| | - Chen Liu
- School of Electrical and Information Engineering, Tianjin University, Tianjin, China.
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26
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Kratter IH, Jorge A, Feyder MT, Whiteman AC, Chang YF, Henry LC, Karp JF, Richardson RM. Depression history modulates effects of subthalamic nucleus topography on neuropsychological outcomes of deep brain stimulation for Parkinson's disease. Transl Psychiatry 2022; 12:213. [PMID: 35624103 PMCID: PMC9142573 DOI: 10.1038/s41398-022-01978-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 05/10/2022] [Accepted: 05/17/2022] [Indexed: 11/09/2022] Open
Abstract
Patients with psychiatric symptoms, such as depression, anxiety, and visual hallucinations, may be at increased risk for adverse effects following deep brain stimulation of the subthalamic nucleus for Parkinson's disease, but there have been relatively few studies of associations between locations of chronic stimulation and neuropsychological outcomes. We sought to determine whether psychiatric history modulates associations between stimulation location within the subthalamic nucleus and postoperative affective and cognitive changes. We retrospectively identified 42 patients with Parkinson's disease who received bilateral subthalamic nucleus deep brain stimulation and who completed both pre- and postoperative neuropsychological testing. Active stimulation contacts were localized in MNI space using Lead-DBS software. Linear discriminant analysis identified vectors maximizing variance in postoperative neuropsychological changes, and Pearson's correlations were used to assess for linear relationships. Stimulation location was associated with postoperative change for only 3 of the 18 neuropsychological measures. Variation along the superioinferior (z) axis was most influential. Constraining the analysis to patients with a history of depression revealed 10 measures significantly associated with active contact location, primarily related to location along the anterioposterior (y) axis and with worse outcomes associated with more anterior stimulation. Analysis of patients with a history of anxiety revealed 5 measures with location-associated changes without a predominant axis. History of visual hallucinations was not associated with significant findings. Our results suggest that a history of depression may influence the relationship between active contact location and neuropsychological outcomes following subthalamic nucleus deep brain stimulation. These patients may be more sensitive to off-target (nonmotor) stimulation.
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Affiliation(s)
- Ian H Kratter
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA, 94305, USA.
| | - Ahmed Jorge
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Michael T Feyder
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ashley C Whiteman
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Yue-Fang Chang
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Luke C Henry
- Brain Modulation Laboratory, Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jordan F Karp
- Department of Psychiatry, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - R Mark Richardson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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27
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Reich MM, Hsu J, Ferguson M, Schaper FLWVJ, Joutsa J, Roothans J, Nickl RC, Frankemolle-Gilbert A, Alberts J, Volkmann J, Fox MD. A brain network for deep brain stimulation induced cognitive decline in Parkinson's disease. Brain 2022; 145:1410-1421. [PMID: 35037938 PMCID: PMC9129093 DOI: 10.1093/brain/awac012] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 11/15/2021] [Accepted: 12/19/2021] [Indexed: 11/22/2022] Open
Abstract
Deep brain stimulation is an effective treatment for Parkinson's disease but can be complicated by side-effects such as cognitive decline. There is often a delay before this side-effect is apparent and the mechanism is unknown, making it difficult to identify patients at risk or select appropriate deep brain stimulation settings. Here, we test whether connectivity between the stimulation site and other brain regions is associated with cognitive decline following deep brain stimulation. First, we studied a unique patient cohort with cognitive decline following subthalamic deep brain stimulation for Parkinson's disease (n = 10) where reprogramming relieved the side-effect without loss of motor benefit. Using resting state functional connectivity data from a large normative cohort (n = 1000), we computed connectivity between each stimulation site and the subiculum, an a priori brain region functionally connected to brain lesions causing memory impairment. Connectivity between deep brain stimulation sites and this same subiculum region was significantly associated with deep brain stimulation induced cognitive decline (P < 0.02). We next performed a data-driven analysis to identify connections most associated with deep brain stimulation induced cognitive decline. Deep brain stimulation sites causing cognitive decline (versus those that did not) were more connected to the anterior cingulate, caudate nucleus, hippocampus, and cognitive regions of the cerebellum (PFWE < 0.05). The spatial topography of this deep brain stimulation-based circuit for cognitive decline aligned with an a priori lesion-based circuit for memory impairment (P = 0.017). To begin translating these results into a clinical tool that might be used for deep brain stimulation programming, we generated a 'heat map' in which the intensity of each voxel reflects the connectivity to our cognitive decline circuit. We then validated this heat map using an independent dataset of Parkinson's disease patients in which cognitive performance was measured following subthalamic deep brain stimulation (n = 33). Intersection of deep brain stimulation sites with our heat map was correlated with changes in the Mattis dementia rating scale 1 year after lead implantation (r = 0.39; P = 0.028). Finally, to illustrate how this heat map might be used in clinical practice, we present a case that was flagged as 'high risk' for cognitive decline based on intersection of the patient's deep brain stimulation site with our heat map. This patient had indeed experienced cognitive decline and our heat map was used to select alternative deep brain stimulation parameters. At 14 days follow-up the patient's cognition improved without loss of motor benefit. These results lend insight into the mechanism of deep brain stimulation induced cognitive decline and suggest that connectivity-based heat maps may help identify patients at risk and who might benefit from deep brain stimulation reprogramming.
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Affiliation(s)
- Martin M. Reich
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | - Joey Hsu
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Ferguson
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham & Women’s Hospital, Boston, MA, USA
| | - Frederic L. W. V. J. Schaper
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham & Women’s Hospital, Boston, MA, USA
| | - Juho Joutsa
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Turku Brain and Mind Center, Clinical Neurosciences, University of Turku, Turku, Finland
- Turku PET Centre, Neurocenter, Turku University Hospital, Turku, Finland
| | - Jonas Roothans
- Department of Neurology, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | - Robert C. Nickl
- Department of Neurosurgery, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | | | - Jay Alberts
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH, USA
| | - Jens Volkmann
- Department of Neurology, University Hospital and Julius-Maximilians-University, Wuerzburg, Germany
| | - Michael D. Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation and Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Center for Brain Circuit Therapeutics, Department of Neurology, Psychiatry, and Radiology, Brigham & Women’s Hospital, Boston, MA, USA
- Martinos Center for Biomedical Imaging and Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Hollunder B, Rajamani N, Siddiqi SH, Finke C, Kühn AA, Mayberg HS, Fox MD, Neudorfer C, Horn A. Toward personalized medicine in connectomic deep brain stimulation. Prog Neurobiol 2022; 210:102211. [PMID: 34958874 DOI: 10.1016/j.pneurobio.2021.102211] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
At the group-level, deep brain stimulation leads to significant therapeutic benefit in a multitude of neurological and neuropsychiatric disorders. At the single-patient level, however, symptoms may sometimes persist despite "optimal" electrode placement at established treatment coordinates. This may be partly explained by limitations of disease-centric strategies that are unable to account for heterogeneous phenotypes and comorbidities observed in clinical practice. Instead, tailoring electrode placement and programming to individual patients' symptom profiles may increase the fraction of top-responding patients. Here, we propose a three-step, circuit-based framework with the aim of developing patient-specific treatment targets that address the unique symptom constellation prevalent in each patient. First, we describe how a symptom network target library could be established by mapping beneficial or undesirable DBS effects to distinct circuits based on (retrospective) group-level data. Second, we suggest ways of matching the resulting symptom networks to circuits defined in the individual patient (template matching). Third, we introduce network blending as a strategy to calculate optimal stimulation targets and parameters by selecting and weighting a set of symptom-specific networks based on the symptom profile and subjective priorities of the individual patient. We integrate the approach with published literature and conclude by discussing limitations and future challenges.
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Affiliation(s)
- Barbara Hollunder
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Nanditha Rajamani
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Shan H Siddiqi
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; NeuroCure Cluster of Excellence, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Helen S Mayberg
- Nash Family Center for Advanced Circuit Therapeutics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D Fox
- Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA
| | - Clemens Neudorfer
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Brigham & Women's Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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29
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Martinez Marinho M, Broseghini Barcelos L, Hyczy de Siqueira Tosin M, Candeias da Silva C, Borges V, Ballalai Ferraz H, Silva Centeno R. Effect of bilateral deep brain stimulation on the subthalamic nucleus on patients with Parkinson's disease: An observational and non-blinded study. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Eisinger RS, Cagle JN, Alcantara JD, Opri E, Cernera S, Le A, Torres Ponce EM, Lanese J, Nelson B, Lopes J, Hundley C, Ravy T, Wu SS, Foote KD, Okun MS, Gunduz A. Distinct Roles of the Human Subthalamic Nucleus and Dorsal Pallidum in Parkinson's Disease Impulsivity. Biol Psychiatry 2022; 91:370-379. [PMID: 33993998 PMCID: PMC8419208 DOI: 10.1016/j.biopsych.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/02/2022]
Abstract
BACKGROUND Impulsivity and impulse control disorders are common in Parkinson's disease and lead to increased morbidity and reduced quality of life. Impulsivity is thought to arise from aberrant reward processing and inhibitory control, but it is unclear why deep brain stimulation of either the subthalamic nucleus (STN) or globus pallidus internus (GPi) affects levels of impulsivity. Our aim was to assess the role of the STN and GPi in impulsivity using invasive local field potential (LFP) recordings from deep brain stimulation electrodes. METHODS We measured LFPs during a simple rewarding Go/NoGo paradigm in 39 female and male human patients with Parkinson's disease manifesting variable amounts of impulsivity who were undergoing unilateral deep brain stimulation of either the STN (18 nuclei) or GPi (28 nuclei). We identified reward-specific LFP event-related potentials and correlated them to impulsivity severity. RESULTS LFPs in both structures modulated during reward-specific Go and NoGo stimulus evaluation, reward feedback, and loss feedback. Motor and limbic functions were anatomically separable in the GPi but not in the STN. Across participants, LFP reward processing responses in the STN and GPi uniquely depended on the severity of impulsivity. CONCLUSIONS This study establishes LFP correlates of impulsivity within the STN and GPi regions. We propose a model for basal ganglia reward processing that includes the bottom-up role of the GPi in reward salience and the top-down role of the STN in cognitive control.
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Affiliation(s)
- Robert S Eisinger
- Department of Neuroscience, University of Florida, Gainesville, Florida.
| | - Jackson N Cagle
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Jose D Alcantara
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Enrico Opri
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Stephanie Cernera
- J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
| | - Anh Le
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | | | - Joseph Lanese
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Brawn Nelson
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Janine Lopes
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | | | - Tasmeah Ravy
- Department of Neuroscience, University of Florida, Gainesville, Florida
| | - Samuel S Wu
- Department of Biostatistics, University of Florida, Gainesville, Florida
| | - Kelly D Foote
- Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - Michael S Okun
- Department of Neuroscience, University of Florida, Gainesville, Florida; Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida; Department of Neurosurgery, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, Florida; J. Crayton Pruitt Department of Biomedical Engineering, University of Florida, Gainesville, Florida
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31
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Caregiver Burden in Partners of Parkinsonian Patients with Deep Brain Stimulation. Brain Sci 2022; 12:brainsci12020238. [PMID: 35204001 PMCID: PMC8870343 DOI: 10.3390/brainsci12020238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 01/12/2023] Open
Abstract
In Parkinson’s disease (PD) patients, the progressive nature of the disease and the variability of disabling motor and non-motor symptoms contribute to the growing caregiver burden of PD partners and conflicts in their relationships. Deep brain stimulation (DBS) improves PD symptoms and patients’ quality of life but necessitates an intensified therapy optimization after DBS surgery. This review illuminates caregiver burden in the context of DBS, framing both pre- and postoperative aspects. We aim to provide an overview of perioperative factors influencing caregiver burden and wish to stimulate further recognition of caregiver burden of PD patients with DBS.
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32
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Shlobin NA, Rosenow JM. Ethical Considerations in the Implantation of Neuromodulatory Devices. Neuromodulation 2022; 25:222-231. [PMID: 35125141 DOI: 10.1111/ner.13357] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/26/2020] [Accepted: 12/21/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Neuromodulatory devices are increasingly used by neurosurgeons to manage a variety of chronic conditions. Given their potential benefits, it is imperative to create clear ethical guidelines for the use of these devices. We present a tiered ethical framework for neurosurgeon recommendations for the use of neuromodulatory devices. MATERIALS AND METHODS We conducted a literature review to identify factors neurosurgeons should consider when choosing to offer a neuromodulatory device to a patient. RESULTS Neurosurgeons must weigh reductions in debilitating symptoms, improved functionality, and preserved quality of life against risks for intraoperative complications and adverse events due to stimulation or the device itself. Neurosurgeons must also evaluate whether patients and families will maintain responsibility for the management of neuromodulatory devices. Consideration of these factors should occur on an axis of resource allocation, ranging from provision of neuromodulatory devices to those with greatest potential benefit in resource-limited settings to provision of neuromodulatory devices to all patients with indications in contexts without resource limitations. Neurosurgeons must also take action to promote device effectiveness throughout the duration of care. CONCLUSIONS Weighing risks and benefits of providing neuromodulatory devices and assessing ability to remain responsible for the devices on the level of the individual patient indicate which patients are most likely to achieve benefit from these devices. Consideration of these factors on an axis of resource allocation will allow for optimal provision of neuromodulatory devices to patients in settings of varied resources. Neurosurgeons play a primary role in promoting the effectiveness of these devices.
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Affiliation(s)
- Nathan A Shlobin
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.
| | - Joshua M Rosenow
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL, USA
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33
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A nigra-subthalamic circuit is involved in acute and chronic pain states. Pain 2022; 163:1952-1966. [PMID: 35082251 DOI: 10.1097/j.pain.0000000000002588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 01/18/2022] [Indexed: 11/25/2022]
Abstract
ABSTRACT The basal ganglia modulate somatosensory pain pathways but it is unclear whether a common circuit exists to mitigate hyperalgesia in pain states induced by peripheral nociceptive stimuli. As a key output nucleus of the basal ganglia, the substantia nigra pars reticulata (SNr) may be a candidate for this role. To test this possibility, we optogenetically modulated SNr GABAergic neurons and examined pain thresholds in freely behaving male mice in inflammatory and neuropathic pain states as well as comorbid depression in chronic pain. We observed that stimulation of either SNr GABAergic neurons or their projections to the subthalamic nucleus (STN) significantly alleviated nociceptive responses in all pain states on the contralateral side and comorbid depression in chronic pain, and that this analgesic effect was eliminated when SNr-STN GABAergic projection was blocked. However, SNr modulation did not affect baseline pain thresholds. We also found that SNr-STN GABAergic projection was attenuated in pain states, resulting in disinhibition of STN neurons. Thus, impairment of the SNr-STN GABAergic circuit may be a common pathophysiology for the maintenance of hyperalgesia in both inflammatory and neuropathic pain states and the comorbid depression in chronic pain; compensating this circuit has potential to effectively treat related pain conditions.
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34
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Favier M, Carcenac C, Savasta M, Carnicella S. Dopamine D3 Receptors: A Potential Target to Treat Motivational Deficits in Parkinson's Disease. Curr Top Behav Neurosci 2022; 60:109-132. [PMID: 35469394 DOI: 10.1007/7854_2022_316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Parkinson's disease (PD), which is traditionally viewed as a motor disorder involving the degeneration of dopaminergic (DA) neurons, has recently been identified as a quintessential neuropsychiatric condition. Indeed, a plethora of non-motor symptoms may occur in PD, including apathy. Apathy can be defined as a lack of motivation or a deficit of goal-directed behaviors and results in a pathological decrease of self-initiated voluntary behavior. Apathy in PD appears to fluctuate with the DA state of the patients, suggesting a critical role of DA neurotransmission in the pathophysiology of this neuropsychiatric syndrome. Using a lesion-based approach, we developed a rodent model which exhibits specific alteration in the preparatory component of motivational processes, reminiscent to apathy in PD. We found a selective decrease of DA D3 receptors (D3R) expression in the dorsal striatum of lesioned rats. Next, we showed that inhibition of D3R neurotransmission in non-lesioned animals was sufficient to reproduce the motivational deficit observed in our model. Interestingly, we also found that pharmacologically targeting D3R efficiently reversed the motivational deficit induced by the lesion. Our findings, among other recent data, suggest a critical role of D3R in parkinsonian apathy and highlight this receptor as a promising target for treating motivational deficits.
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Affiliation(s)
- Mathieu Favier
- Douglas Mental Health University Institute, McGill University, Verdun, QC, Canada
| | - Carole Carcenac
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Marc Savasta
- Inserm, Délégation régionale Provence-Alpes-Côte d'Azur et Corse, Marseille CEDEX 09, France
| | - Sebastien Carnicella
- Inserm, U1216, Univ. Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France.
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35
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Seritan AL, Spiegel LL, Weinstein JL, Racine CA, Brown EG, Volz M, de Hemptinne C, Starr PA, Ostrem JL. Elevated Mood States in Patients With Parkinson's Disease Treated With Deep Brain Stimulation: Diagnosis and Management Strategies. J Neuropsychiatry Clin Neurosci 2021; 33:314-320. [PMID: 34213980 DOI: 10.1176/appi.neuropsych.20080205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Deep brain stimulation (DBS) is an effective surgical treatment for patients with Parkinson's disease (PD). DBS therapy, particularly with the subthalamic nucleus (STN) target, has been linked to rare psychiatric complications, including depression, impulsivity, irritability, and suicidality. Stimulation-induced elevated mood states can also occur. These episodes rarely meet DSM-5 criteria for mania or hypomania. METHODS The investigators conducted a chart review of 82 patients with PD treated with DBS. RESULTS Nine (11%) patients developed stimulation-induced elevated mood. Five illustrative cases are described (all males with STN DBS; mean age=62.2 years [SD=10.5], mean PD duration=8.6 years [SD=1.6]). Elevated mood states occurred during or shortly after programming changes, when more ventral contacts were used (typically in monopolar mode) and lasted minutes to months. Four patients experienced elevated mood at low amplitudes (1.0 V/1.0 mA); all had psychiatric risk factors (history of impulse-control disorder, dopamine dysregulation syndrome, substance use disorder, and/or bipolar diathesis) that likely contributed to mood destabilization. CONCLUSIONS Preoperative DBS evaluations should include a thorough assessment of psychiatric risk factors. The term "stimulation-induced elevated mood states" is proposed to describe episodes of elevated, expansive, or irritable mood and psychomotor agitation that occur during or shortly after DBS programming changes and may be associated with increased goal-directed activity, impulsivity, grandiosity, pressured speech, flight of ideas, or decreased need for sleep and may persist beyond stimulation adjustments. This clinical phenomenon should be considered for inclusion in the bipolar disorder category in future DSM revisions, allowing for increased recognition and appropriate management.
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Affiliation(s)
- Andreea L Seritan
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Lauren L Spiegel
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Jessica L Weinstein
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Caroline A Racine
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Ethan G Brown
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Monica Volz
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Coralie de Hemptinne
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Philip A Starr
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
| | - Jill L Ostrem
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Seritan); Weill Institute for Neurosciences, University of California, San Francisco (Seritan, Spiegel, Racine, Brown, Volz, Starr, Ostrem); Department of Neurology, University of California, San Francisco (Spiegel, Brown, Volz, Ostrem); Kaiser Permanente Group, Roseville, Calif. (Weinstein); Department of Neurological Surgery, University of California, San Francisco (Racine, Starr); and the Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville (de Hemptinne)
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Chrabaszcz A, Wang D, Lipski W, Bush A, Crammond D, Shaiman S, Dickey M, Holt L, Turner R, Fiez J, Richardson R. Simultaneously recorded subthalamic and cortical LFPs reveal different lexicality effects during reading aloud. JOURNAL OF NEUROLINGUISTICS 2021; 60:101019. [PMID: 34305315 PMCID: PMC8294107 DOI: 10.1016/j.jneuroling.2021.101019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Many language functions are traditionally assigned to cortical brain areas, leaving the contributions of subcortical structures to language processing largely unspecified. The present study examines a potential role of the subthalamic nucleus (STN) in lexical processing, specifically, reading aloud of words (e.g., 'fate') and pseudowords (e.g., 'fape'). We recorded local field potentials simultaneously from the STN and the cortex (precentral, postcentral, and superior temporal gyri) of 13 people with Parkinson's disease undergoing awake deep brain stimulation and compared STN's lexicality-related neural activity with that of the cortex. Both STN and cortical activity demonstrated significant task-related modulations, but the lexicality effects were different in the two brain structures. In the STN, an increase in gamma band activity (31-70 Hz) was present in pseudoword trials compared to word trials during subjects' spoken response. In the cortex, a greater decrease in beta band activity (12-30 Hz) was observed for pseudowords in the precentral gyrus. Additionally, 11 individual cortical sites showed lexicality effects with varying temporal and topographic characteristics in the alpha and beta frequency bands. These findings suggest that the STN and the sampled cortical regions are involved differently in the processing of lexical distinctions.
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Affiliation(s)
- A. Chrabaszcz
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA, 15213
| | - D. Wang
- School of Medicine, Tsinghua University, Beijing, China, 100084
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
| | - W.J. Lipski
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
| | - A. Bush
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA, 02114
- Harvard Medical School, Boston, USA, 02115
| | - D.J. Crammond
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
| | - S. Shaiman
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, USA, 15213
| | - M.W. Dickey
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, USA, 15213
| | - L.L. Holt
- Department of Psychology, Carnegie Mellon University, Pittsburgh, USA, 15213
| | - R.S. Turner
- Department of Neurobiology, University of Pittsburgh School of Medicine, Pittsburgh, USA, 15213
- University of Pittsburgh Brain Institute, Pittsburgh, USA, 15213
| | - J.A. Fiez
- Department of Psychology, University of Pittsburgh, Pittsburgh, USA, 15213
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, USA, 15213
- University of Pittsburgh Brain Institute, Pittsburgh, USA, 15213
| | - R.M. Richardson
- Brain Modulation Lab, Department of Neurosurgery, Massachusetts General Hospital, Boston, USA, 02114
- Harvard Medical School, Boston, USA, 02115
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37
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Schedlich-Teufer C, Jost ST, Krack P, Witt K, Weintraub D, Baldermann JC, Sommerauer M, Amstutz D, van Eimeren T, Dafsari HS, Kalbe E, Visser-Vandewalle V, Fink GR, Kessler J, Barbe MT. Assessment of Affective-Behavioral States in Parkinson's Disease Patients: Towards a New Screening Tool. JOURNAL OF PARKINSONS DISEASE 2021; 11:1417-1430. [PMID: 33967055 DOI: 10.3233/jpd-202375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Assessment of affective-behavioral states in patients with Parkinson's disease (PD) undergoing deep brain stimulation (DBS) is essential. OBJECTIVE To analyze well-established questionnaires as a pilot-study with the long term aim to develop a screening tool evaluating affective-behavioral dysfunction, including depression, anxiety, apathy, mania, and impulse control disorders, in PD patients screened for DBS. METHODS Two hundred ninety-seven inpatients with PD underwent standardized neuropsychiatric testing including German versions of Beck Depression Inventory-II, Hospital Anxiety and Depression Scale, Apathy Evaluation Scale, Self-Report Manic Inventory, and Questionnaire for Impulsive-Compulsive Disorders in PD-Rating Scale, to assess appropriateness for DBS. Statistical item reduction was based on exploratory factor analysis, Cronbach's alpha, item-total correlations, item difficulty, and inter-item correlations. Confirmatory factor analysis was conducted to assess factorial validity. An expert rating was performed to identify clinically relevant items in the context of PD and DBS, to maintain content validity. We compared the shortened subscales with the original questionnaires using correlations. To determine cutoff points, receiver operating characteristics analysis was performed. RESULTS The items of the initial questionnaires were reduced from 129 to 38 items. Results of confirmatory factor analyses supported the validity of the shortened pool. It demonstrated high internal consistency (Cronbach's alpha = 0.72-0.83 across subscales), and the individual subscales were correlated with the corresponding original scales (rs = 0.84-0.95). Sensitivities and specificities exceeded 0.7. CONCLUSION The shortened item pool, including 38 items, provides a good basis for the development of a screening tool, capturing affective-behavioral symptoms in PD patients before DBS implantation. Confirmation of the validity of such a screening tool in an independent sample of PD patients is warranted.
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Affiliation(s)
- Charlotte Schedlich-Teufer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Theresa Jost
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Paul Krack
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Karsten Witt
- Department of Neurology, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany.,Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
| | - Daniel Weintraub
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA
| | - Juan Carlos Baldermann
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Sommerauer
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Deborah Amstutz
- Department of Neurology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Thilo van Eimeren
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany
| | - Haidar Salimi Dafsari
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Department of Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gereon Rudolf Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Josef Kessler
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Thomas Barbe
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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38
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Lo Buono V, Lucà Trombetta M, Palmeri R, Bonanno L, Cartella E, Di Lorenzo G, Bramanti P, Marino S, Corallo F. Subthalamic nucleus deep brain stimulation and impulsivity in Parkinson's disease: a descriptive review. Acta Neurol Belg 2021; 121:837-847. [PMID: 33961279 PMCID: PMC8349322 DOI: 10.1007/s13760-021-01684-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
Standard treatment of Parkinson’s disease involves the dopaminergic medications. Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an important neurosurgical intervention often used as alternative treatment to drug therapy; however, it can be associated with increase of impulsive behaviors. This descriptive review focused on studies investigating the correlation between Deep brain stimulation of the subthalamic nucleus and impulsivity in Parkinson’s disease patients, arguing, the action’s mechanism and the specific role of the subthalamic nucleus. We searched on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From initial 106 studies, only 15 met the search criteria. Parkinson’s Disease patients with and without Deep Brain Stimulation were compared with healthy controls, through 16 different tasks that assessed some aspects of impulsivity. Both Deep brain stimulation of the subthalamic nucleus and medication were associated with impulsive behavior and influenced decision-making processes. Moreover, findings demonstrated that: Impulse Control Disorders (ICDs) occurred soon after surgery, while, in pharmacological treatment, they appeared mainly after the initiation of treatment or the increase in dosage, especially with dopamine agonists. The subthalamic nucleus plays a part in the fronto-striato-thalamic-cortical loops mediating motor, cognitive, and emotional functions: this could explain the role of the Deep Brain Stimulation in behavior modulation in Parkinson’s Disease patients. Indeed, increase impulsivity has been reported also after deep brain stimulation of the subthalamic nucleus independently by dopaminergic medication status.
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Affiliation(s)
| | | | | | - Lilla Bonanno
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | | | | | | | - Silvia Marino
- IRCCS Centro Neurolesi Bonino Pulejo, Messina, Italy
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39
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Cuvillier C, Bayard S. Apathy and executive functioning among non-demented community-dwelling elderly individuals in an everyday environment: the mediating effect of impulsivity. Psychogeriatrics 2021; 21:636-649. [PMID: 34060188 DOI: 10.1111/psyg.12725] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 04/17/2021] [Accepted: 05/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Apathy is common in normal ageing and widely recognized as a predictor of cognitive decline, especially in executive functions. Much less characterized than apathy in the elderly is impulsivity, which increases with ageing. It is also frequently described in comorbidity with apathy in various clinical populations, in whom it is associated with poorer executive functioning. In the present study, by capitalizing on a multidimensional approach, we explore the mediating role of facets of impulsivity on the bidirectional relationships between apathy dimensions and executive functioning in non-demented community-dwelling elderly individuals in daily life. METHODS A sample of non-demented community-dwelling older adults (n = 101) completed self-rated questionnaires. Apathy was measured by the Apathy Evaluation Scale; impulsivity was examined through the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency (UPPS-P) Impulsive Behaviour Scale; and executive functioning in daily life was assessed by the Behaviour Rating Inventory of Executive Function-Adult (BRIEF-A). Two models positing mediation were tested using conditional process modelling. RESULTS Hierarchical regressions controlling for depressive symptoms indicated that the cognitive apathy dimension was associated with the UPPS-P facets sensation seeking, lack of perseverance, and premeditation. Among the UPPS-P facets, lack of perseverance and negative urgency were found to contribute significantly to BRIEF-A Metacognitive index variance. Finally, in both models, lack of perseverance was found to totally mediate the relationship between cognitive apathy and the BRIEF-A Metacognitive index. CONCLUSIONS These preliminary findings suggest that, in normal ageing, apathy may share an overlap with impulsivity, contradicting the notion they represent opposite ends of a single behavioural spectrum. Our results argue for bidirectional relationship between a specific apathy dimension (i.e. cognitive apathy) and executive functioning. Moreover, they shed new light on the underlying psychological process implicated (i.e. lack of perseverance) among older adults without dementia and represent an interesting prospect for psychological interventions.
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Affiliation(s)
- Cécilia Cuvillier
- Univ Paul Valéry Montpellier 3, Univ Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Sophie Bayard
- Univ Paul Valéry Montpellier 3, Univ Montpellier, EPSYLON EA 4556, Montpellier, France
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40
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Pierce JE, Péron J. The basal ganglia and the cerebellum in human emotion. Soc Cogn Affect Neurosci 2021; 15:599-613. [PMID: 32507876 PMCID: PMC7328022 DOI: 10.1093/scan/nsaa076] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 04/03/2020] [Accepted: 06/02/2020] [Indexed: 12/26/2022] Open
Abstract
The basal ganglia (BG) and the cerebellum historically have been relegated to a functional role in producing or modulating motor output. Recent research, however, has emphasized the importance of these subcortical structures in multiple functional domains, including affective processes such as emotion recognition, subjective feeling elicitation and reward valuation. The pathways through the thalamus that connect the BG and cerebellum directly to each other and with extensive regions of the cortex provide a structural basis for their combined influence on limbic function. By regulating cortical oscillations to guide learning and strengthening rewarded behaviors or thought patterns to achieve a desired goal state, these regions can shape the way an individual processes emotional stimuli. This review will discuss the basic structure and function of the BG and cerebellum and propose an updated view of their functional role in human affective processing.
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Affiliation(s)
- Jordan E Pierce
- Clinical and Experimental Neuropsychology Laboratory, University of Geneva, 1205 Geneva, Switzerland
| | - Julie Péron
- Clinical and Experimental Neuropsychology Laboratory, University of Geneva, 1205 Geneva, Switzerland.,Neuropsychology Unit, Neurology Department, University Hospitals of Geneva, 1205 Geneva, Switzerland
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41
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Fauser M, Ricken M, Markert F, Weis N, Schmitt O, Gimsa J, Winter C, Badstübner-Meeske K, Storch A. Subthalamic nucleus deep brain stimulation induces sustained neurorestoration in the mesolimbic dopaminergic system in a Parkinson's disease model. Neurobiol Dis 2021; 156:105404. [PMID: 34044146 DOI: 10.1016/j.nbd.2021.105404] [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] [Received: 01/06/2021] [Revised: 05/03/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established therapeutic principle in Parkinson's disease, but the underlying mechanisms, particularly mediating non-motor actions, remain largely enigmatic. OBJECTIVE/HYPOTHESIS The delayed onset of neuropsychiatric actions in conjunction with first experimental evidence that STN-DBS causes disease-modifying effects prompted our investigation on how cellular plasticity in midbrain dopaminergic systems is affected by STN-DBS. METHODS We applied unilateral or bilateral STN-DBS in two independent cohorts of 6-hydroxydopamine hemiparkinsonian rats four to eight weeks after dopaminergic lesioning to allow for the development of a stable dopaminergic dysfunction prior to DBS electrode implantation. RESULTS After 5 weeks of STN-DBS, stimulated animals had significantly more TH+ dopaminergic neurons and fibres in both the nigrostriatal and the mesolimbic systems compared to sham controls with large effect sizes of gHedges = 1.9-3.4. DBS of the entopeduncular nucleus as the homologue of the human Globus pallidus internus did not alter the dopaminergic systems. STN-DBS effects on mesolimbic dopaminergic neurons were largely confirmed in an independent animal cohort with unilateral STN stimulation for 6 weeks or for 3 weeks followed by a 3 weeks washout period. The latter subgroup even demonstrated persistent mesolimbic dopaminergic plasticity after washout. Pilot behavioural testing showed that augmentative dopaminergic effects on the mesolimbic system by STN-DBS might translate into improvement of sensorimotor neglect. CONCLUSIONS Our data support sustained neurorestorative effects of STN-DBS not only in the nigrostriatal but also in the mesolimbic system as a potential factor mediating long-latency neuropsychiatric effects of STN-DBS in Parkinson's disease.
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Affiliation(s)
- Mareike Fauser
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Manuel Ricken
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Franz Markert
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Nikolai Weis
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany
| | - Oliver Schmitt
- Department of Anatomy, University of Rostock, Gertrudenstraße 9, 18057 Rostock, Germany
| | - Jan Gimsa
- Department of Biophysics, University of Rostock, Gertrudenstraße 11A, 18057 Rostock, Germany
| | - Christine Winter
- Department of Psychiatry and Psychotherapy, Charité University Medicine Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | | | - Alexander Storch
- Department of Neurology, University of Rostock, Gehlsheimer Straße 20, 18147 Rostock, Germany; German Centre for Neurodegenerative Diseases (DZNE) Rostock/Greifswald, Gehlsheimer Straße 20, 18147 Rostock, Germany.
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42
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Lofredi R, Auernig GC, Irmen F, Nieweler J, Neumann WJ, Horn A, Schneider GH, Kühn AA. Subthalamic stimulation impairs stopping of ongoing movements. Brain 2021; 144:44-52. [PMID: 33253351 DOI: 10.1093/brain/awaa341] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 01/27/2023] Open
Abstract
The subthalamic nucleus is part of a global stopping network that also includes the presupplementary motor area and inferior frontal gyrus of the right hemisphere. In Parkinson's disease, subthalamic deep brain stimulation improves movement initiation and velocity, but its effect on stopping of ongoing movement is unknown. Here, we examine the relation between movement stopping and connectivity of stimulation volumes to the stopping network. Stop and go times were collected in 17 patients with Parkinson's disease on and off subthalamic stimulation during visually cued initiation and termination of continuous, rotational movements. Deep brain stimulation contacts were localized; the stimulation volume computed and connectivity profiles estimated using an openly available, normative structural connectome. Subthalamic stimulation significantly increased stop times, which correlated with the connectivity of the stimulation volume to presupplementary motor area and inferior frontal gyrus of the right hemisphere. The robustness of this finding was validated using three separate analysis streams: voxel-wise whole-brain connectivity, region of interest connectivity and a tract-centred method. Our study sheds light on the role of the fronto-subthalamic inhibitory triangle in stopping of ongoing movements and may inspire circuit based adaptive stimulation strategies for control of stopping impairment, possibly reflected in stimulation-induced dyskinesia.
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Affiliation(s)
- Roxanne Lofredi
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Georg Cem Auernig
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friederike Irmen
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Johanna Nieweler
- Department of Neurology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Bernstein Center for Computational Neuroscience, Humboldt-Universität, Berlin, Germany.,NeuroCure, Exzellenzcluster, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZNE, German center for neurodegenerative diseases, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
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43
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Hirano S. Clinical implications for dopaminergic and functional neuroimage research in cognitive symptoms of Parkinson's disease. Mol Med 2021; 27:40. [PMID: 33858320 PMCID: PMC8048076 DOI: 10.1186/s10020-021-00301-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 04/06/2021] [Indexed: 12/12/2022] Open
Abstract
Evidence from dopaminergic image and cerebral blood flow/metabolism images have shed light on symptomatology of cognitive aspects in brain physiology of healthy human as well as patients with Parkinson's disease. Cognitive impairment in Parkinson's disease is characterized by executive, visuospatial, attentional disturbances. Dopaminergic system includes triadic parallel pathways. The mesostriatal pathway consist of posterolateral putamen and motor areas, the mesocortical pathway of dorsal caudate nucleus and dorsolateral prefrontal cortex, and the mesolimbic pathway of ventral striatum, anterior cingulate cortex. The mesocortical pathway is responsible for the executive function which may change by administration of dopaminergic medication. The mesolimbic pathway is associated with motivation and reward prediction which may result in depression or apathy when dopamine level was suboptimal, impulse control disorder and punding when dopamine was over the optimal level. Abnormal brain metabolism/perfusion related to cognitive impairment in Parkinson's disease are relatively reduced activity located in frontal and parietal association areas and relatively increased activity in the cerebellum. In the anterior brain, the mesocortical pathway, is responsible for verbal memory and executive function, which originates with caudate dopaminergic system and account for mild cognitive impairment of Parkinson's disease. The posterior brain system which includes the parietal, temporal, and occipital cortices, is responsible for the memory and visuospatial function, and related to cholinergic dysfunction and possibly glucocerebrosidase gene variants, relating to dementia in Parkinson's disease. The role of cerebellum in Parkinson's disease remains unclear but emerging evidence suggests that it may relate to the sequencing detection and affective symptoms. The dual syndrome hypothesis is helpful for understanding the mechanism of cognitive impairment in Parkinson's disease and optimal symptom management.
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Affiliation(s)
- Shigeki Hirano
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan.
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44
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Petitet P, Scholl J, Attaallah B, Drew D, Manohar S, Husain M. The relationship between apathy and impulsivity in large population samples. Sci Rep 2021; 11:4830. [PMID: 33649399 PMCID: PMC7921138 DOI: 10.1038/s41598-021-84364-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 01/29/2021] [Indexed: 12/22/2022] Open
Abstract
Apathy and impulsivity are debilitating conditions associated with many neuropsychiatric conditions, and expressed to variable degrees in healthy people. While some theories suggest that they lie at different ends of a continuum, others suggest their possible co-existence. Surprisingly little is known, however, about their empirical association in the general population. Here, gathering data from six large studies (\documentclass[12pt]{minimal}
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\begin{document}$$n = 3755$$\end{document}n=3755), we investigated the relationship between measures of apathy and impulsivity in young adults. The questionnaires included commonly used self-assessment tools—Apathy Evaluation Scale, Barratt Impulsiveness Scale (BIS-11) and UPPS-P Scale—as well as a more recent addition, the Apathy Motivation Index (AMI). Remarkably, across datasets and assessment tools, global measures of apathy and impulsivity correlated positively. However, analysis of sub-scale scores revealed a more complex relationship. Although most dimensions correlated positively with one another, there were two important exceptions revealed using the AMI scale. Social apathy was mostly negatively correlated with impulsive behaviour, and emotional apathy was orthogonal to all other sub-domains. These results suggest that at a global level, apathy and impulsivity do not exist at distinct ends of a continuum. Instead, paradoxically, they most often co-exist in young adults. Processes underlying social and emotional apathy, however, appear to be different and dissociable from behavioural apathy and impulsivity.
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Affiliation(s)
- Pierre Petitet
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK.
| | - Jacqueline Scholl
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK
| | - Bahaaeddin Attaallah
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Daniel Drew
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Sanjay Manohar
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, OX1 3PH, UK.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DU, UK
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45
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Carey G, Görmezoğlu M, de Jong JJ, Hofman PA, Backes WH, Dujardin K, Leentjens AF. Neuroimaging of Anxiety in Parkinson's Disease: A Systematic Review. Mov Disord 2021; 36:327-339. [PMID: 33289195 PMCID: PMC7984351 DOI: 10.1002/mds.28404] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/02/2020] [Accepted: 10/26/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The aim of this systematic review was (1) to identify the brain regions involved in anxiety in Parkinson's disease (PD) based on neuroimaging studies and (2) to interpret the findings against the background of dysfunction of the fear circuit and limbic cortico-striato-thalamocortical circuit. METHODS Studies assessing anxiety symptoms in PD patients and studies using magnetic resonance imaging, positron emission tomography, or single-photon emission computed tomography were included. RESULTS The severity of anxiety was associated with changes in the fear circuit and the cortico-striato-thalamocortical limbic circuit. In the fear circuit, a reduced gray-matter volume of the amygdala and the anterior cingulate cortex (ACC); an increased functional connectivity (FC) between the amygdala and orbitofrontal cortex (OFC) and hippocampus and between the striatum and the medial prefrontal cortex (PFC), temporal cortex, and insula; and a reduced FC between the lateral PFC and the OFC, hippocampus, and amygdala were reported. In the cortico-striato-thalamocortical limbic circuit, a reduced FC between the striatum and ACC; a reduced dopaminergic and noradrenergic activity in striatum, thalamus, and locus coeruleus; and a reduced serotoninergic activity in the thalamus were reported. CONCLUSION To conclude, anxiety is associated with structural and functional changes in both the hypothesized fear and the limbic cortico-striato-thalamocortical circuits. These circuits overlap and may well constitute parts of a more extensive pathway, of which different parts play different roles in anxiety. The neuropathology of PD may affect these circuits in different ways, explaining the high prevalence of anxiety in PD and also the associated cognitive, motor, and psychiatric symptoms. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Guillaume Carey
- School for Mental Health and Neurosciences (MHeNS)Maastricht UniversityMaastrichtthe Netherlands
- Université de Lille, Inserm, CHU Lille, Lille Neurosciences and CognitionLilleFrance
| | - Meltem Görmezoğlu
- Department of PsychiatryMaastricht University Medical CenterMaastrichtthe Netherlands
- Department of Psychiatry, Ondokuz Mayis University HospitalOndokuz Mayıs UniversitySamsunTurkey
| | - Joost J.A. de Jong
- School for Mental Health and Neurosciences (MHeNS)Maastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Paul A.M. Hofman
- School for Mental Health and Neurosciences (MHeNS)Maastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Walter H. Backes
- School for Mental Health and Neurosciences (MHeNS)Maastricht UniversityMaastrichtthe Netherlands
- Department of Radiology and Nuclear MedicineMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Kathy Dujardin
- Université de Lille, Inserm, CHU Lille, Lille Neurosciences and CognitionLilleFrance
| | - Albert F.G. Leentjens
- School for Mental Health and Neurosciences (MHeNS)Maastricht UniversityMaastrichtthe Netherlands
- Department of PsychiatryMaastricht University Medical CenterMaastrichtthe Netherlands
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46
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The rostro-caudal gradient in the prefrontal cortex and its modulation by subthalamic deep brain stimulation in Parkinson's disease. Sci Rep 2021; 11:2138. [PMID: 33483554 PMCID: PMC7822958 DOI: 10.1038/s41598-021-81535-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/28/2020] [Indexed: 11/08/2022] Open
Abstract
Deep brain stimulation of the subthalamic nucleus (STN-DBS) alleviates motor symptoms in Parkinson’s disease (PD) but also affects the prefrontal cortex (PFC), potentially leading to cognitive side effects. The present study tested alterations within the rostro-caudal hierarchy of neural processing in the PFC induced by STN-DBS in PD. Granger-causality analyses of fast functional near-infrared spectroscopy (fNIRS) measurements were used to infer directed functional connectivity from intrinsic PFC activity in 24 PD patients treated with STN-DBS. Functional connectivity was assessed ON stimulation, in steady-state OFF stimulation and immediately after the stimulator was switched ON again. Results revealed that STN-DBS significantly enhanced the rostro-caudal hierarchical organization of the PFC in patients who had undergone implantation early in the course of the disease, whereas it attenuated the rostro-caudal hierarchy in late-implanted patients. Most crucially, this systematic network effect of STN-DBS was reproducible in the second ON stimulation measurement. Supplemental analyses demonstrated the significance of prefrontal networks for cognitive functions in patients and matched healthy controls. These findings show that the modulation of prefrontal functional networks by STN-DBS is dependent on the disease duration before DBS implantation and suggest a neurophysiological mechanism underlying the side effects on prefrontally-guided cognitive functions observed under STN-DBS.
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47
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Mosley PE, Akram H. Neuropsychiatric effects of subthalamic deep brain stimulation. THE HUMAN HYPOTHALAMUS - MIDDLE AND POSTERIOR REGION 2021; 180:417-431. [DOI: 10.1016/b978-0-12-820107-7.00026-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
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48
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Mosley PE, Paliwal S, Robinson K, Coyne T, Silburn P, Tittgemeyer M, Stephan KE, Perry A, Breakspear M. The structural connectivity of subthalamic deep brain stimulation correlates with impulsivity in Parkinson's disease. Brain 2020; 143:2235-2254. [PMID: 32568370 DOI: 10.1093/brain/awaa148] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/19/2020] [Accepted: 03/20/2020] [Indexed: 12/13/2022] Open
Abstract
Subthalamic deep brain stimulation (STN-DBS) for Parkinson's disease treats motor symptoms and improves quality of life, but can be complicated by adverse neuropsychiatric side-effects, including impulsivity. Several clinically important questions remain unclear: can 'at-risk' patients be identified prior to DBS; do neuropsychiatric symptoms relate to the distribution of the stimulation field; and which brain networks are responsible for the evolution of these symptoms? Using a comprehensive neuropsychiatric battery and a virtual casino to assess impulsive behaviour in a naturalistic fashion, 55 patients with Parkinson's disease (19 females, mean age 62, mean Hoehn and Yahr stage 2.6) were assessed prior to STN-DBS and 3 months postoperatively. Reward evaluation and response inhibition networks were reconstructed with probabilistic tractography using the participant-specific subthalamic volume of activated tissue as a seed. We found that greater connectivity of the stimulation site with these frontostriatal networks was related to greater postoperative impulsiveness and disinhibition as assessed by the neuropsychiatric instruments. Larger bet sizes in the virtual casino postoperatively were associated with greater connectivity of the stimulation site with right and left orbitofrontal cortex, right ventromedial prefrontal cortex and left ventral striatum. For all assessments, the baseline connectivity of reward evaluation and response inhibition networks prior to STN-DBS was not associated with postoperative impulsivity; rather, these relationships were only observed when the stimulation field was incorporated. This suggests that the site and distribution of stimulation is a more important determinant of postoperative neuropsychiatric outcomes than preoperative brain structure and that stimulation acts to mediate impulsivity through differential recruitment of frontostriatal networks. Notably, a distinction could be made amongst participants with clinically-significant, harmful changes in mood and behaviour attributable to DBS, based upon an analysis of connectivity and its relationship with gambling behaviour. Additional analyses suggested that this distinction may be mediated by the differential involvement of fibres connecting ventromedial subthalamic nucleus and orbitofrontal cortex. These findings identify a mechanistic substrate of neuropsychiatric impairment after STN-DBS and suggest that tractography could be used to predict the incidence of adverse neuropsychiatric effects. Clinically, these results highlight the importance of accurate electrode placement and careful stimulation titration in the prevention of neuropsychiatric side-effects after STN-DBS.
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Affiliation(s)
- Philip E Mosley
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Faculty of Medicine, University of Queensland, Herston, Queensland, Australia
| | - Saee Paliwal
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland
| | - Katherine Robinson
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Terry Coyne
- Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia.,Brizbrain and Spine, The Wesley Hospital, Auchenflower, Queensland, Australia
| | - Peter Silburn
- Neurosciences Queensland, St Andrew's War Memorial Hospital, Spring Hill, Queensland, Australia.,Queensland Brain Institute, University of Queensland, St Lucia, Queensland, Australia
| | | | - Klaas E Stephan
- Translational Neuromodeling Unit (TNU), Institute for Biomedical Engineering, University of Zürich and Swiss Federal Institute of Technology (ETH Zürich), Zürich, Switzerland.,Max Planck Institute for Metabolism Research, Cologne, Germany.,Wellcome Centre for Human Neuroimaging, University College London, London, UK
| | - Alistair Perry
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Berlin, Germany.,Centre for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Michael Breakspear
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia.,Brain and Mind Priority Research Centre, Hunter Medical Research Institute, University of Newcastle, NSW, Australia
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Tang W, He X, Feng L, Liu D, Yang Z, Zhang J, Xiao B, Yang Z. The Role of Hippocampal Neurogenesis in ANT-DBS for LiCl-Pilocarpine-Induced Epileptic Rats. Stereotact Funct Neurosurg 2020; 99:55-64. [PMID: 33302280 DOI: 10.1159/000509314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 06/10/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Abnormal neurogenesis in the hippocampus after status epilepticus (SE) has been suggested as a key pathogeny of temporal lobe epilepsy. This study aimed to investigate the effect of deep brain stimulation of the anterior thalamic nucleus (ANT-DBS) on hippocampal neurogenesis in LiCl-pilocarpine-induced epileptic rats and to analyze its relationship with postoperative spontaneous recurrent seizures (SRS) and anxiety. METHOD SE was induced by a systemic LiCl-pilocarpine injection in adult male rats. Rats in the DBS group underwent ANT-DBS immediately after successful SE induction. SRS was only recorded during the chronic stage. An elevated plus maze was used to evaluate the level of anxiety in rats 7, 28, and 60 days after SE onset. After the elevated plus-maze experiment, rats were sacrificed under anesthesia in order to evaluate hippocampal neurogenesis. Doublecortin (DCX) was used as a marker for neurogenesis. RESULTS During the chronic stage, SRS in rats in the DBS group were significantly decreased. The level of anxiety was increased significantly in rats in the DBS group 28 days after SE, while no significant differences in anxiety levels were found 7 and 60 days after SE. The number of DCX-positive cells in the hippocampus was significantly increased 7 days after SE and was significantly decreased 60 days after SE in all rats in which SE was induced. However, the number of DCX-positive cells in the DBS group was significantly lower than that in the other groups 28 days after SE. CONCLUSIONS ANT-DBS may suppress SRS and increase the postoperative anxiety of epileptic rats by influencing hippocampal neurogenesis.
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Affiliation(s)
- Weiting Tang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Xinghui He
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China,
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Dingyang Liu
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhuanyi Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
| | - Junmei Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiquan Yang
- Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha, China
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Dinter E, Saridaki T, Diederichs L, Reichmann H, Falkenburger BH. Parkinson's disease and translational research. Transl Neurodegener 2020; 9:43. [PMID: 33256849 PMCID: PMC7708097 DOI: 10.1186/s40035-020-00223-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
Parkinson’s disease (PD) is diagnosed when patients exhibit bradykinesia with tremor and/or rigidity, and when these symptoms respond to dopaminergic medications. Yet in the last years there was a greater recognition of additional aspects of the disease including non-motor symptoms and prodromal states with associated pathology in various regions of the nervous system. In this review we discuss current concepts of two major alterations found during the course of the disease: cytoplasmic aggregates of the protein α-synuclein and the degeneration of dopaminergic neurons. We provide an overview of new approaches in this field based on current concepts and latest literature. In many areas, translational research on PD has advanced the understanding of the disease but there is still a need for more effective therapeutic options based on the insights into the basic biological phenomena.
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Affiliation(s)
- Elisabeth Dinter
- Department of Neurology, Technische Universität Dresden, Dresden, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Dresden, Germany
| | | | | | - Heinz Reichmann
- Department of Neurology, Technische Universität Dresden, Dresden, Germany
| | - Björn H Falkenburger
- Department of Neurology, Technische Universität Dresden, Dresden, Germany. .,Deutsches Zentrum für Neurodegenerative Erkrankungen, Dresden, Germany. .,Department of Neurology, RWTH University Aachen, Aachen, Germany.
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