1
|
Fang H, Berman SA, Wang Y, Yang Y. Robust adaptive deep brain stimulation control of in-silico non-stationary Parkinsonian neural oscillatory dynamics. J Neural Eng 2024; 21:036043. [PMID: 38834058 DOI: 10.1088/1741-2552/ad5406] [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: 01/23/2024] [Accepted: 06/04/2024] [Indexed: 06/06/2024]
Abstract
Objective. Closed-loop deep brain stimulation (DBS) is a promising therapy for Parkinson's disease (PD) that works by adjusting DBS patterns in real time from the guidance of feedback neural activity. Current closed-loop DBS mainly uses threshold-crossing on-off controllers or linear time-invariant (LTI) controllers to regulate the basal ganglia (BG) Parkinsonian beta band oscillation power. However, the critical cortex-BG-thalamus network dynamics underlying PD are nonlinear, non-stationary, and noisy, hindering accurate and robust control of Parkinsonian neural oscillatory dynamics.Approach. Here, we develop a new robust adaptive closed-loop DBS method for regulating the Parkinsonian beta oscillatory dynamics of the cortex-BG-thalamus network. We first build an adaptive state-space model to quantify the dynamic, nonlinear, and non-stationary neural activity. We then construct an adaptive estimator to track the nonlinearity and non-stationarity in real time. We next design a robust controller to automatically determine the DBS frequency based on the estimated Parkinsonian neural state while reducing the system's sensitivity to high-frequency noise. We adopt and tune a biophysical cortex-BG-thalamus network model as an in-silico simulation testbed to generate nonlinear and non-stationary Parkinsonian neural dynamics for evaluating DBS methods.Main results. We find that under different nonlinear and non-stationary neural dynamics, our robust adaptive DBS method achieved accurate regulation of the BG Parkinsonian beta band oscillation power with small control error, bias, and deviation. Moreover, the accurate regulation generalizes across different therapeutic targets and consistently outperforms current on-off and LTI DBS methods.Significance. These results have implications for future designs of closed-loop DBS systems to treat PD.
Collapse
Affiliation(s)
- Hao Fang
- MOE Frontier Science Center for Brain Science and Brain-machine Integration, Zhejiang University, Hangzhou 310058, People's Republic of China
- Nanhu Brain-computer Interface Institute, Hangzhou 311100, People's Republic of China
| | - Stephen A Berman
- College of Medicine, University of Central Florida, Orlando, FL 32816, United States of America
| | - Yueming Wang
- Nanhu Brain-computer Interface Institute, Hangzhou 311100, People's Republic of China
- Qiushi Academy for Advanced Studies, Hangzhou 310058, People's Republic of China
- College of Computer Science and Technology, Zhejiang University, Hangzhou 310058, People's Republic of China
- State Key Laboratory of Brain-machine Intelligence, Hangzhou 310058, People's Republic of China
| | - Yuxiao Yang
- MOE Frontier Science Center for Brain Science and Brain-machine Integration, Zhejiang University, Hangzhou 310058, People's Republic of China
- Nanhu Brain-computer Interface Institute, Hangzhou 311100, People's Republic of China
- College of Computer Science and Technology, Zhejiang University, Hangzhou 310058, People's Republic of China
- State Key Laboratory of Brain-machine Intelligence, Hangzhou 310058, People's Republic of China
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Hangzhou 310058, People's Republic of China
- NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University, Hangzhou 310058, People's Republic of China
| |
Collapse
|
2
|
Lundqvist M, Miller EK, Nordmark J, Liljefors J, Herman P. Beta: bursts of cognition. Trends Cogn Sci 2024:S1364-6613(24)00077-9. [PMID: 38658218 DOI: 10.1016/j.tics.2024.03.010] [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: 09/11/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/26/2024]
Abstract
Beta oscillations are linked to the control of goal-directed processing of sensory information and the timing of motor output. Recent evidence demonstrates they are not sustained but organized into intermittent high-power bursts mediating timely functional inhibition. This implies there is a considerable moment-to-moment variation in the neural dynamics supporting cognition. Beta bursts thus offer new opportunities for studying how sensory inputs are selectively processed, reshaped by inhibitory cognitive operations and ultimately result in motor actions. Recent method advances reveal diversity in beta bursts that provide deeper insights into their function and the underlying neural circuit activity motifs. We propose that brain-wide, spatiotemporal patterns of beta bursting reflect various cognitive operations and that their dynamics reveal nonlinear aspects of cortical processing.
Collapse
Affiliation(s)
- Mikael Lundqvist
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden; The Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
| | - Earl K Miller
- The Picower Institute for Learning & Memory, Massachusetts Institute of Technology, Cambridge, MA 02139, USA; Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Jonatan Nordmark
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Johan Liljefors
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden
| | - Pawel Herman
- School of Electrical Engineering and Computer Science, KTH Royal Institute of Technology, Stockholm, Sweden; Digital Futures, KTH Royal Institute of Technology, Stockholm, Sweden
| |
Collapse
|
3
|
Mathiopoulou V, Lofredi R, Feldmann LK, Habets J, Darcy N, Neumann WJ, Faust K, Schneider GH, Kühn AA. Modulation of subthalamic beta oscillations by movement, dopamine, and deep brain stimulation in Parkinson's disease. NPJ Parkinsons Dis 2024; 10:77. [PMID: 38580641 PMCID: PMC10997749 DOI: 10.1038/s41531-024-00693-3] [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: 09/21/2023] [Accepted: 03/21/2024] [Indexed: 04/07/2024] Open
Abstract
Subthalamic beta band activity (13-35 Hz) is known as a real-time correlate of motor symptom severity in Parkinson's disease (PD) and is currently explored as a feedback signal for closed-loop deep brain stimulation (DBS). Here, we investigate the interaction of movement, dopaminergic medication, and deep brain stimulation on subthalamic beta activity in PD patients implanted with sensing-enabled, implantable pulse generators. We recorded subthalamic activity from seven PD patients at rest and during repetitive movements in four conditions: after withdrawal of dopaminergic medication and DBS, with medication only, with DBS only, and with simultaneous medication and DBS. Medication and DBS showed additive effects in improving motor performance. Distinct effects of each therapy were seen in subthalamic recordings, with medication primarily suppressing low beta activity (13-20 Hz) and DBS being associated with a broad decrease in beta band activity (13-35 Hz). Movement suppressed beta band activity compared to rest. This suppression was most prominent when combining medication with DBS and correlated with motor improvement within patients. We conclude that DBS and medication have distinct effects on subthalamic beta activity during both rest and movement, which might explain their additive clinical effects as well as their difference in side-effect profiles. Importantly, subthalamic beta activity significantly correlated with motor symptoms across all conditions, highlighting its validity as a feedback signal for closed-loop DBS.
Collapse
Affiliation(s)
- Varvara Mathiopoulou
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Roxanne Lofredi
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Lucia K Feldmann
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jeroen Habets
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Natasha Darcy
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolf-Julian Neumann
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
- Berlin School of Mind and Brain, Charité Universitätsmedizin Medicine, Berlin, Germany.
- NeuroCure Clinical Research Centre, Charité Universitätsmedizin, Berlin, Germany.
- DZNE, German Center for Degenerative Diseases, Berlin, Germany.
| |
Collapse
|
4
|
Davidson B, Milosevic L, Kondrataviciute L, Kalia LV, Kalia SK. Neuroscience fundamentals relevant to neuromodulation: Neurobiology of deep brain stimulation in Parkinson's disease. Neurotherapeutics 2024; 21:e00348. [PMID: 38579455 PMCID: PMC11000190 DOI: 10.1016/j.neurot.2024.e00348] [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: 11/15/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 04/07/2024] Open
Abstract
Deep Brain Stimulation (DBS) has become a pivotal therapeutic approach for Parkinson's Disease (PD) and various neuropsychiatric conditions, impacting over 200,000 patients. Despite its widespread application, the intricate mechanisms behind DBS remain a subject of ongoing investigation. This article provides an overview of the current knowledge surrounding the local, circuit, and neurobiochemical effects of DBS, focusing on the subthalamic nucleus (STN) as a key target in PD management. The local effects of DBS, once thought to mimic a reversible lesion, now reveal a more nuanced interplay with myelinated axons, neurotransmitter release, and the surrounding microenvironment. Circuit effects illuminate the modulation of oscillatory activities within the basal ganglia and emphasize communication between the STN and the primary motor cortex. Neurobiochemical effects, encompassing changes in dopamine levels and epigenetic modifications, add further complexity to the DBS landscape. Finally, within the context of understanding the mechanisms of DBS in PD, the article highlights the controversial question of whether DBS exerts disease-modifying effects in PD. While preclinical evidence suggests neuroprotective potential, clinical trials such as EARLYSTIM face challenges in assessing long-term disease modification due to enrollment timing and methodology limitations. The discussion underscores the need for robust biomarkers and large-scale prospective trials to conclusively determine DBS's potential as a disease-modifying therapy in PD.
Collapse
Affiliation(s)
- Benjamin Davidson
- Division of Neurosurgery, Department of Surgery, University of Toronto, Canada.
| | - Luka Milosevic
- KITE, Toronto, Canada; CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Laura Kondrataviciute
- CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Canada
| | - Lorraine V Kalia
- CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada; Division of Neurology, Department of Medicine, University of Toronto, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Surgery, University of Toronto, Canada; KITE, Toronto, Canada; CRANIA, Toronto, Canada; Krembil Research Institute, University Health Network Toronto, Canada
| |
Collapse
|
5
|
Liénard JF, Aubin L, Cos I, Girard B. Estimation of the transmission delays in the basal ganglia of the macaque monkey and subsequent predictions about oscillatory activity under dopamine depletion. Eur J Neurosci 2024; 59:1657-1680. [PMID: 38414108 DOI: 10.1111/ejn.16271] [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: 07/20/2023] [Revised: 12/31/2023] [Accepted: 01/21/2024] [Indexed: 02/29/2024]
Abstract
The timescales of the dynamics of a system depend on the combination of the timescales of its components and of its transmission delays between components. Here, we combine experimental stimulation data from 10 studies in macaque monkeys that reveal the timing of excitatory and inhibitory events in the basal ganglia circuit, to estimate its set of transmission delays. In doing so, we reveal possible inconsistencies in the existing data, calling for replications, and we propose two possible sets of transmission delays. We then integrate these delays in a model of the primate basal ganglia that does not rely on direct and indirect pathways' segregation and show that extrastriatal dopaminergic depletion in the external part of the globus pallidus and in the subthalamic nucleus is sufficient to generate β-band oscillations (in the high part, 20-35 Hz, of the band). More specifically, we show that D2 and D5 dopamine receptors in these nuclei play opposing roles in the emergence of these oscillations, thereby explaining how completely deactivating D5 receptors in the subthalamic nucleus can, paradoxically, cancel oscillations.
Collapse
Affiliation(s)
- Jean F Liénard
- Sorbonne Université, CNRS, Institut des Systèmes Intelligents et de Robotique (ISIR), Paris, France
| | - Lise Aubin
- Sorbonne Université, CNRS, Institut des Systèmes Intelligents et de Robotique (ISIR), Paris, France
| | - Ignasi Cos
- Sorbonne Université, CNRS, Institut des Systèmes Intelligents et de Robotique (ISIR), Paris, France
- Facultat de Matemàtiques i Informàtica, Universitat de Barcelona, Barcelona, Spain
- Serra-Hunter Fellow Program, Barcelona, Spain
| | - Benoît Girard
- Sorbonne Université, CNRS, Institut des Systèmes Intelligents et de Robotique (ISIR), Paris, France
| |
Collapse
|
6
|
Cavallo A, Neumann WJ. Dopaminergic reinforcement in the motor system: Implications for Parkinson's disease and deep brain stimulation. Eur J Neurosci 2024; 59:457-472. [PMID: 38178558 DOI: 10.1111/ejn.16222] [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: 09/19/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 01/06/2024]
Abstract
Millions of people suffer from dopamine-related disorders spanning disturbances in movement, cognition and emotion. These changes are often attributed to changes in striatal dopamine function. Thus, understanding how dopamine signalling in the striatum and basal ganglia shapes human behaviour is fundamental to advancing the treatment of affected patients. Dopaminergic neurons innervate large-scale brain networks, and accordingly, many different roles for dopamine signals have been proposed, such as invigoration of movement and tracking of reward contingencies. The canonical circuit architecture of cortico-striatal loops sparks the question, of whether dopamine signals in the basal ganglia serve an overarching computational principle. Such a holistic understanding of dopamine functioning could provide new insights into symptom generation in psychiatry to neurology. Here, we review the perspective that dopamine could bidirectionally control neural population dynamics, increasing or decreasing their strength and likelihood to reoccur in the future, a process previously termed neural reinforcement. We outline how the basal ganglia pathways could drive strengthening and weakening of circuit dynamics and discuss the implication of this hypothesis on the understanding of motor signs of Parkinson's disease (PD), the most frequent dopaminergic disorder. We propose that loss of dopamine in PD may lead to a pathological brain state where repetition of neural activity leads to weakening and instability, possibly explanatory for the fact that movement in PD deteriorates with repetition. Finally, we speculate on how therapeutic interventions such as deep brain stimulation may be able to reinstate reinforcement signals and thereby improve treatment strategies for PD in the future.
Collapse
Affiliation(s)
- Alessia Cavallo
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
7
|
Neumann WJ. Cortical brain signals improve decoding of movement and tremor for clinical brain computer interfaces. Clin Neurophysiol 2024; 157:143-145. [PMID: 38097414 DOI: 10.1016/j.clinph.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Chariteplatz 1, 10117 Berlin, Berlin, Germany.
| |
Collapse
|
8
|
Pardo-Valencia J, Fernández-García C, Alonso-Frech F, Foffani G. Oscillatory vs. non-oscillatory subthalamic beta activity in Parkinson's disease. J Physiol 2024; 602:373-395. [PMID: 38084073 DOI: 10.1113/jp284768] [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: 04/02/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
Parkinson's disease is characterized by exaggerated beta activity (13-35 Hz) in cortico-basal ganglia motor loops. Beta activity includes both periodic fluctuations (i.e. oscillatory activity) and aperiodic fluctuations reflecting spiking activity and excitation/inhibition balance (i.e. non-oscillatory activity). However, the relative contribution, dopamine dependency and clinical correlations of oscillatory vs. non-oscillatory beta activity remain unclear. We recorded, modelled and analysed subthalamic local field potentials in parkinsonian patients at rest while off or on medication. Autoregressive modelling with additive 1/f noise clarified the relationships between measures of beta activity in the time domain (i.e. amplitude and duration of beta bursts) or in the frequency domain (i.e. power and sharpness of the spectral peak) and oscillatory vs. non-oscillatory activity: burst duration and spectral sharpness are specifically sensitive to oscillatory activity, whereas burst amplitude and spectral power are ambiguously sensitive to both oscillatory and non-oscillatory activity. Our experimental data confirmed the model predictions and assumptions. We subsequently analysed the effect of levodopa, obtaining strong-to-extreme Bayesian evidence that oscillatory beta activity is reduced in patients on vs. off medication, with moderate evidence for absence of modulation of the non-oscillatory component. Finally, specifically the oscillatory component of beta activity correlated with the rate of motor progression of the disease. Methodologically, these results provide an integrative understanding of beta-based biomarkers relevant for adaptive deep brain stimulation. Biologically, they suggest that primarily the oscillatory component of subthalamic beta activity is dopamine dependent and may play a role not only in the pathophysiology but also in the progression of Parkinson's disease. KEY POINTS: Beta activity in Parkinson's disease includes both true periodic fluctuations (i.e. oscillatory activity) and aperiodic fluctuations reflecting spiking activity and synaptic balance (i.e. non-oscillatory activity). The relative contribution, dopamine dependency and clinical correlations of oscillatory vs. non-oscillatory beta activity remain unclear. Burst duration and spectral sharpness are specifically sensitive to oscillatory activity, while burst amplitude and spectral power are ambiguously sensitive to both oscillatory and non-oscillatory activity. Only the oscillatory component of subthalamic beta activity is dopamine-dependent. Stronger beta oscillatory activity correlates with faster motor progression of the disease.
Collapse
Affiliation(s)
- Jesús Pardo-Valencia
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Carla Fernández-García
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
| | - Fernando Alonso-Frech
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Department of Neurology, San Carlos Research Health Intitute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Guglielmo Foffani
- HM CINAC (Centro Integral de Neurociencias Abarca Campal), Hospital Universitario HM Puerta del Sur, HM Hospitales, Madrid, Spain
- Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- Instituto de Salud Carlos III, CIBERNED, Madrid, Spain
| |
Collapse
|
9
|
Hoy CW, de Hemptinne C, Wang SS, Harmer CJ, Apps MAJ, Husain M, Starr PA, Little S. Beta and theta oscillations track effort and previous reward in human basal ganglia and prefrontal cortex during decision making. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.05.570285. [PMID: 38106063 PMCID: PMC10723308 DOI: 10.1101/2023.12.05.570285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Choosing whether to exert effort to obtain rewards is fundamental to human motivated behavior. However, the neural dynamics underlying the evaluation of reward and effort in humans is poorly understood. Here, we investigate this with chronic intracranial recordings from prefrontal cortex (PFC) and basal ganglia (BG; subthalamic nuclei and globus pallidus) in people with Parkinson's disease performing a decision-making task with offers that varied in levels of reward and physical effort required. This revealed dissociable neural signatures of reward and effort, with BG beta (12-20 Hz) oscillations tracking subjective effort on a single trial basis and PFC theta (4-7 Hz) signaling previous trial reward. Stimulation of PFC increased overall acceptance of offers in addition to increasing the impact of reward on choices. This work uncovers oscillatory mechanisms that guide fundamental decisions to exert effort for reward across BG and PFC, as well as supporting a causal role of PFC for such choices.
Collapse
Affiliation(s)
- Colin W. Hoy
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Coralie de Hemptinne
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
- Department of Neurology, University of Florida, Gainesville, FL, USA
| | - Sarah S. Wang
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | | | - Mathew A. J. Apps
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Institute for Mental Health, School of Psychology, University of Birmingham, Birmingham, UK
| | - Masud Husain
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Philip A. Starr
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Simon Little
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
10
|
He S, Baig F, Merla A, Torrecillos F, Perera A, Wiest C, Debarros J, Benjaber M, Hart MG, Ricciardi L, Morgante F, Hasegawa H, Samuel M, Edwards M, Denison T, Pogosyan A, Ashkan K, Pereira E, Tan H. Beta-triggered adaptive deep brain stimulation during reaching movement in Parkinson's disease. Brain 2023; 146:5015-5030. [PMID: 37433037 PMCID: PMC10690014 DOI: 10.1093/brain/awad233] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/30/2023] [Accepted: 06/28/2023] [Indexed: 07/13/2023] Open
Abstract
Subthalamic nucleus (STN) beta-triggered adaptive deep brain stimulation (ADBS) has been shown to provide clinical improvement comparable to conventional continuous DBS (CDBS) with less energy delivered to the brain and less stimulation induced side effects. However, several questions remain unanswered. First, there is a normal physiological reduction of STN beta band power just prior to and during voluntary movement. ADBS systems will therefore reduce or cease stimulation during movement in people with Parkinson's disease and could therefore compromise motor performance compared to CDBS. Second, beta power was smoothed and estimated over a time period of 400 ms in most previous ADBS studies, but a shorter smoothing period could have the advantage of being more sensitive to changes in beta power, which could enhance motor performance. In this study, we addressed these two questions by evaluating the effectiveness of STN beta-triggered ADBS using a standard 400 ms and a shorter 200 ms smoothing window during reaching movements. Results from 13 people with Parkinson's disease showed that reducing the smoothing window for quantifying beta did lead to shortened beta burst durations by increasing the number of beta bursts shorter than 200 ms and more frequent switching on/off of the stimulator but had no behavioural effects. Both ADBS and CDBS improved motor performance to an equivalent extent compared to no DBS. Secondary analysis revealed that there were independent effects of a decrease in beta power and an increase in gamma power in predicting faster movement speed, while a decrease in beta event related desynchronization (ERD) predicted quicker movement initiation. CDBS suppressed both beta and gamma more than ADBS, whereas beta ERD was reduced to a similar level during CDBS and ADBS compared with no DBS, which together explained the achieved similar performance improvement in reaching movements during CDBS and ADBS. In addition, ADBS significantly improved tremor compared with no DBS but was not as effective as CDBS. These results suggest that STN beta-triggered ADBS is effective in improving motor performance during reaching movements in people with Parkinson's disease, and that shortening of the smoothing window does not result in any additional behavioural benefit. When developing ADBS systems for Parkinson's disease, it might not be necessary to track very fast beta dynamics; combining beta, gamma, and information from motor decoding might be more beneficial with additional biomarkers needed for optimal treatment of tremor.
Collapse
Affiliation(s)
- Shenghong He
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Fahd Baig
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Anca Merla
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Flavie Torrecillos
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Andrea Perera
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Christoph Wiest
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Jean Debarros
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Moaad Benjaber
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Michael G Hart
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Lucia Ricciardi
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Francesca Morgante
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Harutomo Hasegawa
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Michael Samuel
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London, SE5 9RS, UK
| | - Mark Edwards
- Department of Clinical and Basic Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London WC2R 2LS, UK
| | - Timothy Denison
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Alek Pogosyan
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| | - Keyoumars Ashkan
- Department of Neurosurgery, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Erlick Pereira
- Neurosciences Research Centre, St George’s, University of London & St George’s University Hospitals NHS Foundation Trust, Institute of Molecular and Clinical Sciences, Cranmer Terrace, London SW17 0QT, UK
| | - Huiling Tan
- MRC Brain Network Dynamics Unit, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
| |
Collapse
|
11
|
Busch JL, Kaplan J, Bahners BH, Roediger J, Faust K, Schneider GH, Florin E, Schnitzler A, Krause P, Kühn AA. Local Field Potentials Predict Motor Performance in Deep Brain Stimulation for Parkinson's Disease. Mov Disord 2023; 38:2185-2196. [PMID: 37823518 DOI: 10.1002/mds.29626] [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: 05/05/2023] [Revised: 08/16/2023] [Accepted: 09/19/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) is an effective treatment option for patients with Parkinson's disease (PD). However, clinical programming remains challenging with segmented electrodes. OBJECTIVE Using novel sensing-enabled neurostimulators, we investigated local field potentials (LFPs) and their modulation by DBS to assess whether electrophysiological biomarkers may facilitate clinical programming in chronically implanted patients. METHODS Sixteen patients (31 hemispheres) with PD implanted with segmented electrodes in the subthalamic nucleus and a sensing-enabled neurostimulator were included in this study. Recordings were conducted 3 months after DBS surgery following overnight withdrawal of dopaminergic medication. LFPs were acquired while stimulation was turned OFF and during a monopolar review of both directional and ring contacts. Directional beta power and stimulation-induced beta power suppression were computed. Motor performance, as assessed by a pronation-supination task, clinical programming and electrode placement were correlated to directional beta power and stimulation-induced beta power suppression. RESULTS Better motor performance was associated with stronger beta power suppression at higher stimulation amplitudes. Across directional contacts, differences in directional beta power and the extent of stimulation-induced beta power suppression predicted motor performance. However, within individual hemispheres, beta power suppression was superior to directional beta power in selecting the contact with the best motor performance. Contacts clinically activated for chronic stimulation were associated with stronger beta power suppression than non-activated contacts. CONCLUSIONS Our results suggest that stimulation-induced β power suppression is superior to directional β power in selecting the clinically most effective contact. In sum, electrophysiological biomarkers may guide programming of directional DBS systems in PD patients. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Johannes L Busch
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Junior Clinician Scientist Program, Berlin, Germany
| | - Jonathan Kaplan
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bahne H Bahners
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Jan Roediger
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katharina Faust
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Esther Florin
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Alfons Schnitzler
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Patricia Krause
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Berlin, Germany
| |
Collapse
|
12
|
Neumann WJ, Steiner LA, Milosevic L. Neurophysiological mechanisms of deep brain stimulation across spatiotemporal resolutions. Brain 2023; 146:4456-4468. [PMID: 37450573 PMCID: PMC10629774 DOI: 10.1093/brain/awad239] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/04/2023] [Accepted: 06/28/2023] [Indexed: 07/18/2023] Open
Abstract
Deep brain stimulation is a neuromodulatory treatment for managing the symptoms of Parkinson's disease and other neurological and psychiatric disorders. Electrodes are chronically implanted in disease-relevant brain regions and pulsatile electrical stimulation delivery is intended to restore neurocircuit function. However, the widespread interest in the application and expansion of this clinical therapy has preceded an overarching understanding of the neurocircuit alterations invoked by deep brain stimulation. Over the years, various forms of neurophysiological evidence have emerged which demonstrate changes to brain activity across spatiotemporal resolutions; from single neuron, to local field potential, to brain-wide cortical network effects. Though fruitful, such studies have often led to debate about a singular putative mechanism. In this Update we aim to produce an integrative account of complementary instead of mutually exclusive neurophysiological effects to derive a generalizable concept of the mechanisms of deep brain stimulation. In particular, we offer a critical review of the most common historical competing theories, an updated discussion on recent literature from animal and human neurophysiological studies, and a synthesis of synaptic and network effects of deep brain stimulation across scales of observation, including micro-, meso- and macroscale circuit alterations.
Collapse
Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
| | - Leon A Steiner
- Movement Disorder and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin 10117, Germany
- Department of Clinical and Computational Neuroscience, Krembil Brain Institute, University Health Network, Toronto M5T 1M8, Canada
| | - Luka Milosevic
- Department of Clinical and Computational Neuroscience, Krembil Brain Institute, University Health Network, Toronto M5T 1M8, Canada
- Institute of Biomedical Engineering, Institute of Medical Sciences, and CRANIA Neuromodulation Institute, University of Toronto, Toronto M5S 3G9, Canada
| |
Collapse
|
13
|
Sil T, Hanafi I, Eldebakey H, Palmisano C, Volkmann J, Muthuraman M, Reich MM, Peach R. Wavelet-Based Bracketing, Time-Frequency Beta Burst Detection: New Insights in Parkinson's Disease. Neurotherapeutics 2023; 20:1767-1778. [PMID: 37819489 PMCID: PMC10684463 DOI: 10.1007/s13311-023-01447-4] [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] [Accepted: 09/25/2023] [Indexed: 10/13/2023] Open
Abstract
Studies have shown that beta band activity is not tonically elevated but comprises exaggerated phasic bursts of varying durations and magnitudes, for Parkinson's disease (PD) patients. Current methods for detecting beta bursts target a single frequency peak in beta band, potentially ignoring bursts in the wider beta band. In this study, we propose a new robust framework for beta burst identification across wide frequency ranges. Chronic local field potential at-rest recordings were obtained from seven PD patients implanted with Medtronic SenSight™ deep brain stimulation (DBS) electrodes. The proposed method uses wavelet decomposition to compute the time-frequency spectrum and identifies bursts spanning multiple frequency bins by thresholding, offering an additional burst measure, ∆f, that captures the width of a burst in the frequency domain. Analysis included calculating burst duration, magnitude, and ∆f and evaluating the distribution and likelihood of bursts between the low beta (13-20 Hz) and high beta (21-35 Hz). Finally, the results of the analysis were correlated to motor impairment (MDS-UPDRS III) med off scores. We found that low beta bursts with longer durations and larger width in the frequency domain (∆f) were positively correlated, while high beta bursts with longer durations and larger ∆f were negatively correlated with motor impairment. The proposed method, finding clear differences between bursting behavior in high and low beta bands, has clearly demonstrated the importance of considering wide frequency bands for beta burst behavior with implications for closed-loop DBS paradigms.
Collapse
Affiliation(s)
- Tanmoy Sil
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Ibrahem Hanafi
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Hazem Eldebakey
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Chiara Palmisano
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Jens Volkmann
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Muthuraman Muthuraman
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany.
| | - Martin M Reich
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Robert Peach
- Department of Neurology, University Hospital Würzburg (UKW), Josef-Schneider-Str. 11, 97080, Würzburg, Germany
- Department of Brain Sciences, Imperial College London, London, UK
| |
Collapse
|
14
|
Merk T, Köhler R, Peterson V, Lyra L, Vanhoecke J, Chikermane M, Binns T, Li N, Walton A, Bush A, Sisterson N, Busch J, Lofredi R, Habets J, Huebl J, Zhu G, Yin Z, Zhao B, Merkl A, Bajbouj M, Krause P, Faust K, Schneider GH, Horn A, Zhang J, Kühn A, Richardson RM, Neumann WJ. Invasive neurophysiology and whole brain connectomics for neural decoding in patients with brain implants. RESEARCH SQUARE 2023:rs.3.rs-3212709. [PMID: 37790428 PMCID: PMC10543023 DOI: 10.21203/rs.3.rs-3212709/v1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Brain computer interfaces (BCI) provide unprecedented spatiotemporal precision that will enable significant expansion in how numerous brain disorders are treated. Decoding dynamic patient states from brain signals with machine learning is required to leverage this precision, but a standardized framework for identifying and advancing novel clinical BCI approaches does not exist. Here, we developed a platform that integrates brain signal decoding with connectomics and demonstrate its utility across 123 hours of invasively recorded brain data from 73 neurosurgical patients treated for movement disorders, depression and epilepsy. First, we introduce connectomics-informed movement decoders that generalize across cohorts with Parkinson's disease and epilepsy from the US, Europe and China. Next, we reveal network targets for emotion decoding in left prefrontal and cingulate circuits in DBS patients with major depression. Finally, we showcase opportunities to improve seizure detection in responsive neurostimulation for epilepsy. Our platform provides rapid, high-accuracy decoding for precision medicine approaches that can dynamically adapt neuromodulation therapies in response to the individual needs of patients.
Collapse
|
15
|
Mirzac D, Kreis SL, Luhmann HJ, Gonzalez-Escamilla G, Groppa S. Translating Pathological Brain Activity Primers in Parkinson's Disease Research. RESEARCH (WASHINGTON, D.C.) 2023; 6:0183. [PMID: 37383218 PMCID: PMC10298229 DOI: 10.34133/research.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/02/2023] [Indexed: 06/30/2023]
Abstract
Translational experimental approaches that help us better trace Parkinson's disease (PD) pathophysiological mechanisms leading to new therapeutic targets are urgently needed. In this article, we review recent experimental and clinical studies addressing abnormal neuronal activity and pathological network oscillations, as well as their underlying mechanisms and modulation. Our aim is to enhance our knowledge about the progression of Parkinson's disease pathology and the timing of its symptom's manifestation. Here, we present mechanistic insights relevant for the generation of aberrant oscillatory activity within the cortico-basal ganglia circuits. We summarize recent achievements extrapolated from available PD animal models, discuss their advantages and limitations, debate on their differential applicability, and suggest approaches for transferring knowledge on disease pathology into future research and clinical applications.
Collapse
Affiliation(s)
- Daniela Mirzac
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Svenja L. Kreis
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Heiko J. Luhmann
- Institute of Physiology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Gabriel Gonzalez-Escamilla
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience, Rhine Main Neuroscience Network, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
| |
Collapse
|
16
|
Torrecillos F, He S, Kühn AA, Tan H. Average power and burst analysis revealed complementary information on drug-related changes of motor performance in Parkinson's disease. NPJ Parkinsons Dis 2023; 9:93. [PMID: 37328511 PMCID: PMC10275865 DOI: 10.1038/s41531-023-00540-x] [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: 09/16/2022] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
In patients with Parkinson's disease (PD), suppression of beta and increase in gamma oscillations in the subthalamic nucleus (STN) have been associated with both levodopa treatment and motor functions. Recent results suggest that modulation of the temporal dynamics of theses oscillations (bursting activity) might contain more information about pathological states and behaviour than their average power. Here we directly compared the information provided by power and burst analyses about the drug-related changes in STN activities and their impact on motor performance within PD patients. STN local field potential (LFP) signals were recorded from externalized patients performing self-paced movements ON and OFF levodopa. When normalised across medication states, both power and burst analyses showed an increase in low-beta oscillations in the dopamine-depleted state during rest. When normalised within-medication state, both analyses revealed that levodopa increased movement-related modulation in the alpha and low-gamma bands, with higher gamma activity around movement predicting faster reaches. Finally, burst analyses helped to reveal opposite drug-related changes in low- and high-beta frequency bands, and identified additional within-patient relationships between high-beta bursting and movement performance. Our findings suggest that although power and burst analyses share a lot in common they also provide complementary information on how STN-LFP activity is associated with motor performance, and how levodopa treatment may modify these relationships in a way that helps explain drug-related changes in motor performance. Different ways of normalisation in the power analysis can reveal different information. Similarly, the burst analysis is sensitive to how the threshold is defined - either for separate medication conditions separately, or across pooled conditions. In addition, the burst interpretation has far-reaching implications about the nature of neural oscillations - whether the oscillations happen as isolated burst-events or are they sustained phenomena with dynamic amplitude variations? This can be different for different frequency bands, and different for different medication states even for the same frequency band.
Collapse
Affiliation(s)
- Flavie Torrecillos
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Shenghong He
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Andrea A Kühn
- Department of Neurology, Charitè, Universitätsmedizin, Berlin, Germany
| | - Huiling Tan
- Medical Research Council Brain Network Dynamics Unit, University of Oxford, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| |
Collapse
|
17
|
Radcliffe EM, Baumgartner AJ, Kern DS, Al Borno M, Ojemann S, Kramer DR, Thompson JA. Oscillatory beta dynamics inform biomarker-driven treatment optimization for Parkinson's disease. J Neurophysiol 2023; 129:1492-1504. [PMID: 37198135 DOI: 10.1152/jn.00055.2023] [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: 02/03/2023] [Revised: 04/23/2023] [Accepted: 05/17/2023] [Indexed: 05/19/2023] Open
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder characterized by loss of dopaminergic neurons and dysregulation of the basal ganglia. Cardinal motor symptoms include bradykinesia, rigidity, and tremor. Deep brain stimulation (DBS) of select subcortical nuclei is standard of care for medication-refractory PD. Conventional open-loop DBS delivers continuous stimulation with fixed parameters that do not account for a patient's dynamic activity state or medication cycle. In comparison, closed-loop DBS, or adaptive DBS (aDBS), adjusts stimulation based on biomarker feedback that correlates with clinical state. Recent work has identified several neurophysiological biomarkers in local field potential recordings from PD patients, the most promising of which are 1) elevated beta (∼13-30 Hz) power in the subthalamic nucleus (STN), 2) increased beta synchrony throughout basal ganglia-thalamocortical circuits, notably observed as coupling between the STN beta phase and cortical broadband gamma (∼50-200 Hz) amplitude, and 3) prolonged beta bursts in the STN and cortex. In this review, we highlight relevant frequency and time domain features of STN beta measured in PD patients and summarize how spectral beta power, oscillatory beta synchrony, phase-amplitude coupling, and temporal beta bursting inform PD pathology, neurosurgical targeting, and DBS therapy. We then review how STN beta dynamics inform predictive, biomarker-driven aDBS approaches for optimizing PD treatment. We therefore provide clinically useful and actionable insight that can be applied toward aDBS implementation for PD.
Collapse
Affiliation(s)
- Erin M Radcliffe
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Alexander J Baumgartner
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Drew S Kern
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Mazen Al Borno
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Computer Science and Engineering, University of Colorado Denver, Denver, Colorado, United States
| | - Steven Ojemann
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - Daniel R Kramer
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| | - John A Thompson
- Department of Neurosurgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Bioengineering, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States
| |
Collapse
|
18
|
Matar E, Bhatia K. Dystonia and Parkinson's disease: Do they have a shared biology? INTERNATIONAL REVIEW OF NEUROBIOLOGY 2023; 169:347-411. [PMID: 37482398 DOI: 10.1016/bs.irn.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Parkinsonism and dystonia co-occur across many movement disorders and are most encountered in the setting of Parkinson's disease. Here we aim to explore the shared neurobiological underpinnings of dystonia and parkinsonism through the clinical lens of the conditions in which these movement disorders can be seen together. Foregrounding the discussion, we briefly review the circuits of the motor system and the neuroanatomical and neurophysiological aspects of motor control and highlight their relevance to the proposed pathophysiology of parkinsonism and dystonia. Insight into shared biology is then sought from dystonia occurring in PD and other forms of parkinsonism including those disorders in which both can be co-expressed simultaneously. We organize these within a biological schema along with important questions to be addressed in this space.
Collapse
Affiliation(s)
- Elie Matar
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom; Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
| | - Kailash Bhatia
- UCL Queen Square Institute of Neurology Department of Clinical and Movement Neurosciences, Queen Square, London, United Kingdom
| |
Collapse
|
19
|
Wang S, Zhu G, Shi L, Zhang C, Wu B, Yang A, Meng F, Jiang Y, Zhang J. Closed-Loop Adaptive Deep Brain Stimulation in Parkinson's Disease: Procedures to Achieve It and Future Perspectives. JOURNAL OF PARKINSON'S DISEASE 2023:JPD225053. [PMID: 37182899 DOI: 10.3233/jpd-225053] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Parkinson's disease (PD) is a neurodegenerative disease with a heavy burden on patients, families, and society. Deep brain stimulation (DBS) can improve the symptoms of PD patients for whom medication is insufficient. However, current open-loop uninterrupted conventional DBS (cDBS) has inherent limitations, such as adverse effects, rapid battery consumption, and a need for frequent parameter adjustment. To overcome these shortcomings, adaptive DBS (aDBS) was proposed to provide responsive optimized stimulation for PD. This topic has attracted scientific interest, and a growing body of preclinical and clinical evidence has shown its benefits. However, both achievements and challenges have emerged in this novel field. To date, only limited reviews comprehensively analyzed the full framework and procedures for aDBS implementation. Herein, we review current preclinical and clinical data on aDBS for PD to discuss the full procedures for its achievement and to provide future perspectives on this treatment.
Collapse
Affiliation(s)
- Shu Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Chunkui Zhang
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Bing Wu
- Center of Cognition and Brain Science, Beijing Institute of Basic Medical Sciences, Beijing, China
| | - Anchao Yang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fangang Meng
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Yin Jiang
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
| |
Collapse
|
20
|
Neumann WJ, Horn A, Kühn AA. Insights and opportunities for deep brain stimulation as a brain circuit intervention. Trends Neurosci 2023; 46:472-487. [PMID: 37105806 DOI: 10.1016/j.tins.2023.03.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/29/2023]
Abstract
Deep brain stimulation (DBS) is an effective treatment and has provided unique insights into the dynamic circuit architecture of brain disorders. This Review illustrates our current understanding of the pathophysiology of movement disorders and their underlying brain circuits that are modulated with DBS. It proposes principles of pathological network synchronization patterns like beta activity (13-35 Hz) in Parkinson's disease. We describe alterations from microscale including local synaptic activity via modulation of mesoscale hypersynchronization to changes in whole-brain macroscale connectivity. Finally, an outlook on advances for clinical innovations in next-generation neurotechnology is provided: from preoperative connectomic targeting to feedback controlled closed-loop adaptive DBS as individualized network-specific brain circuit interventions.
Collapse
Affiliation(s)
- Wolf-Julian Neumann
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt Universität zu Berlin, Berlin, Germany
| | - Andreas Horn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt Universität zu Berlin, Berlin, Germany; Center for Brain Circuit Therapeutics, Department of Neurology, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA; MGH Neurosurgery & Center for Neurotechnology and Neurorecovery at MGH Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrea A Kühn
- Movement Disorders and Neuromodulation Unit, Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center for Neurosciences Berlin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Bernstein Center for Computational Neuroscience, Humboldt Universität zu Berlin, Berlin, Germany; NeuroCure Clinical Research Centre, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany; DZNE, German Center for Degenerative Diseases, Berlin, Germany.
| |
Collapse
|
21
|
Morelli N, Summers RLS. Association of subthalamic beta frequency sub-bands to symptom severity in patients with Parkinson's disease: A systematic review. Parkinsonism Relat Disord 2023; 110:105364. [PMID: 36997437 DOI: 10.1016/j.parkreldis.2023.105364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE Local field potentials (LFP), specifically beta (13-30Hz) frequency measures, have been found to be associated with motor dysfunction in people with Parkinson's disease (PwPD). A consensus on beta subband (low- and high-beta) relationships to clinical state or therapy response has yet to be determined. The objective of this review is to synthesize literature reporting the association of low- and high-beta characteristics to clinical ratings of motor symptoms in PwPD. METHODS A systematic search of existing literature was completed using EMBASE. Articles which collected subthalamic nucleus (STN) LFPs using macroelectrodes in PwPD, analyzed low- (13-20 Hz) and high-beta (21-35 Hz) bands, collected UPDRS-III, and reported correlational strength or predictive capacity of LFPs to UPDRS-III scores. RESULTS The initial search yielded 234 articles, with 11 articles achieving inclusion. Beta measures included power spectral density, peak characteristics, and burst characteristics. High-beta was a significant predictor of UPDRS-III responses to therapy in 5 (100%) articles. Low-beta was significantly associated with UPDRS-III total score in 3 (60%) articles. Low- and high-beta associations to UPDRS-III subscores were mixed. CONCLUSION This systematic review reinforces previous reports that beta band oscillatory measures demonstrate a consistent relationship to Parkinsonian motor symptoms and ability to predict motor response to therapy. Specifically, high-beta, demonstrated a consistent ability to predict UPDRS-III responses to common PD therapies, while low-beta measures were associated with general Parkinsonian symptom severity. Continued research is needed to determine which beta subband demonstrates the greatest association to motor symptom subtypes and potentially offers clinical utility toward LFP-guided DBS programming and adaptive DBS.
Collapse
|
22
|
Lofredi R, Scheller U, Mindermann A, Feldmann LK, Krauss JK, Saryyeva A, Schneider GH, Kühn AA. Pallidal Beta Activity Is Linked to Stimulation-Induced Slowness in Dystonia. Mov Disord 2023. [PMID: 36807626 DOI: 10.1002/mds.29347] [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: 09/08/2022] [Accepted: 01/30/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND Pallidal deep brain stimulation (DBS) effectively alleviates symptoms in dystonia patients, but may induce movement slowness as a side-effect. In Parkinson's disease, hypokinetic symptoms have been associated with increased beta oscillations (13-30 Hz). We hypothesize that this pattern is symptom-specific, thus accompanying DBS-induced slowness in dystonia. METHODS In 6 dystonia patients, pallidal rest recordings with a sensing-enabled DBS device were performed and tapping speed was assessed using marker-less pose estimation over 5 time points following cessation of DBS. RESULTS After cessation of pallidal stimulation, movement speed increased over time (P < 0.01). A linear mixed-effects model revealed that pallidal beta activity explained 77% of the variance in movement speed across patients (P = 0.01). CONCLUSIONS The association between beta oscillations and slowness across disease entities provides further evidence for symptom-specific oscillatory patterns in the motor circuit. Our findings might help DBS therapy improvements, as DBS-devices able to adapt to beta oscillations are already commercially available. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Roxanne Lofredi
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ute Scheller
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Georg-August-Universität Göttingen, Göttingen, Germany
| | - Aurika Mindermann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lucia K Feldmann
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Joachim K Krauss
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Assel Saryyeva
- Department of Neurosurgery, Medizinische Hochschule Hannover, Hannover, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Movement Disorders and Neuromodulation Unit, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Exzellenzcluster - NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
23
|
Wu D, Zhao B, Xie H, Xu Y, Yin Z, Bai Y, Fan H, Zhang Q, Liu D, Hu T, Jiang Y, An Q, Zhang X, Yang A, Zhang J. Profiling the low-beta characteristics of the subthalamic nucleus in early- and late-onset Parkinson's disease. Front Aging Neurosci 2023; 15:1114466. [PMID: 36875708 PMCID: PMC9978704 DOI: 10.3389/fnagi.2023.1114466] [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: 12/02/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Objectives Low-beta oscillation (13-20 Hz) has rarely been studied in patients with early-onset Parkinson's disease (EOPD, age of onset ≤50 years). We aimed to explore the characteristics of low-beta oscillation in the subthalamic nucleus (STN) of patients with EOPD and investigate the differences between EOPD and late-onset Parkinson's disease (LOPD). Methods We enrolled 31 EOPD and 31 LOPD patients, who were matched using propensity score matching. Patients underwent bilateral STN deep brain stimulation (DBS). Local field potentials were recorded using intraoperative microelectrode recording. We analyzed the low-beta band parameters, including aperiodic/periodic components, beta burst, and phase-amplitude coupling. We compared low-beta band activity between EOPD and LOPD. Correlation analyses were performed between the low-beta parameters and clinical assessment results for each group. Results We found that the EOPD group had lower aperiodic parameters, including offset (p = 0.010) and exponent (p = 0.047). Low-beta burst analysis showed that EOPD patients had significantly higher average burst amplitude (p = 0.016) and longer average burst duration (p = 0.011). Furthermore, EOPD had higher proportion of long burst (500-650 ms, p = 0.008), while LOPD had higher proportion of short burst (200-350 ms, p = 0.007). There was a significant difference in phase-amplitude coupling values between low-beta phase and fast high frequency oscillation (300-460 Hz) amplitude (p = 0.019). Conclusion We found that low-beta activity in the STN of patients with EOPD had characteristics that varied when compared with LOPD, and provided electrophysiological evidence for different pathological mechanisms between the two types of PD. These differences need to be considered when applying adaptive DBS on patients of different ages.
Collapse
Affiliation(s)
- Delong Wu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yutong Bai
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Houyou Fan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Defeng Liu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tianqi Hu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yin Jiang
- Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Qi An
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Beijing Key Laboratory of Neurostimulation, 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.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory of Neurostimulation, Beijing, China.,Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| |
Collapse
|