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Béreau M, Kibleur A, Servant M, Clément G, Dujardin K, Rolland AS, Wirth T, Lagha-Boukbiza O, Voirin J, Santin MDN, Hainque E, Grabli D, Comte A, Drapier S, Durif F, Marques A, Eusebio A, Azulay JP, Giordana C, Houeto JL, Jarraya B, Maltete D, Rascol O, Rouaud T, Tir M, Moreau C, Danaila T, Prange S, Tatu L, Tranchant C, Corvol JC, Devos D, Thobois S, Desmarets M, Anheim M. Motivational and cognitive predictors of apathy after subthalamic nucleus stimulation in Parkinson's disease. Brain 2024; 147:472-485. [PMID: 37787488 DOI: 10.1093/brain/awad324] [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: 03/23/2023] [Revised: 07/13/2023] [Accepted: 08/21/2023] [Indexed: 10/04/2023] Open
Abstract
Postoperative apathy is a frequent symptom in Parkinson's disease patients who have undergone bilateral deep brain stimulation of the subthalamic nucleus. Two main hypotheses for postoperative apathy have been suggested: (i) dopaminergic withdrawal syndrome relative to postoperative dopaminergic drug tapering; and (ii) direct effect of chronic stimulation of the subthalamic nucleus. The primary objective of our study was to describe preoperative and 1-year postoperative apathy in Parkinson's disease patients who underwent chronic bilateral deep brain stimulation of the subthalamic nucleus. We also aimed to identify factors associated with 1-year postoperative apathy considering: (i) preoperative clinical phenotype; (ii) dopaminergic drug management; and (iii) volume of tissue activated within the subthalamic nucleus and the surrounding structures. We investigated a prospective clinical cohort of 367 patients before and 1 year after chronic bilateral deep brain stimulation of the subthalamic nucleus. We assessed apathy using the Lille Apathy Rating Scale and carried out a systematic evaluation of motor, cognitive and behavioural signs. We modelled the volume of tissue activated in 161 patients using the Lead-DBS toolbox and analysed overlaps within motor, cognitive and limbic parts of the subthalamic nucleus. Of the 367 patients, 94 (25.6%) exhibited 1-year postoperative apathy: 67 (18.2%) with 'de novo apathy' and 27 (7.4%) with 'sustained apathy'. We observed disappearance of preoperative apathy in 22 (6.0%) patients, who were classified as having 'reversed apathy'. Lastly, 251 (68.4%) patients had neither preoperative nor postoperative apathy and were classified as having 'no apathy'. We identified preoperative apathy score [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.10, 1.22; P < 0.001], preoperative episodic memory free recall score (OR 0.93; 95% CI 0.88, 0.97; P = 0.003) and 1-year postoperative motor responsiveness (OR 0.98; 95% CI 0.96, 0.99; P = 0.009) as the main factors associated with postoperative apathy. We showed that neither dopaminergic dose reduction nor subthalamic stimulation were associated with postoperative apathy. Patients with 'sustained apathy' had poorer preoperative fronto-striatal cognitive status and a higher preoperative action initiation apathy subscore. In these patients, apathy score and cognitive status worsened postoperatively despite significantly lower reduction in dopamine agonists (P = 0.023), suggesting cognitive dopa-resistant apathy. Patients with 'reversed apathy' benefited from the psychostimulant effect of chronic stimulation of the limbic part of the left subthalamic nucleus (P = 0.043), suggesting motivational apathy. Our results highlight the need for careful preoperative assessment of motivational and cognitive components of apathy as well as executive functions in order to better prevent or manage postoperative apathy.
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Affiliation(s)
- Matthieu Béreau
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Astrid Kibleur
- LIP/PC2S, Université Grenoble Alpes, Université Savoie Mont Blanc, 38040 Grenoble Cedex 9, France
| | - Mathieu Servant
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
| | - Gautier Clément
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Kathy Dujardin
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Anne-Sophie Rolland
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Thomas Wirth
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Marie des Neiges Santin
- Department of Neurosurgery, NS-PARK/F-CRIN network, Strasbourg University Hospital, 67200 Strasbourg, France
| | - Elodie Hainque
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Grabli
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - Alexandre Comte
- UR LINC 481, Université de Franche-Comté, F-2500 Besançon, France
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
| | - Sophie Drapier
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Rennes, 35000 Rennes, France
| | - Franck Durif
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Ana Marques
- CNRS, Clermont Auvergne INP, Institut Pascal, Clermont-Ferrand University Hospital, Neurology department, NS-Park/F-CRIN network, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Alexandre Eusebio
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Jean-Philippe Azulay
- Department of Neurology and Movement Disorders, APHM, Hôpital Universitaire Timone, 13005 Marseille, France
- CNRS, Institut de Neurosciences de la Timone, Aix Marseille Univ., 13005 Marseille, France
| | - Caroline Giordana
- Department of Neurology, NS-Park/F-CRIN network, Centre Hospitalier Universitaire de Nice, 06002 Nice, France
| | - Jean-Luc Houeto
- Department of Neurology, NS-Park/F-CRIN network, Limoges University Hospital, Inserm, U1094, EpiMaCT-Epidemiology of chronic diseases in tropical zone, Limoges University Hospital,87042 Limoges, France
| | - Béchir Jarraya
- Neuroscience Pole, NS-Park/F-CRIN network, Hôpital Foch, Suresnes, University of Versailles Paris-Saclay, INSERM-CEA NeuroSpin, 91191 Gif-sur-Yvette, France
| | - David Maltete
- Department of Neurology, NS-Park/F-CRIN network, Rouen University Hospital and University of Rouen, 76000 Rouen, France
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, 76130 Mont-Saint-Aignan, France
| | - Olivier Rascol
- Department of Clinical Pharmacology and Neuroscience, CIC1436, NS-Park/F-CRIN network, NeuroToul Center of Excellence, Toulouse University Hospital, INSERM, CHU of Toulouse, 31000 Toulouse, France
| | - Tiphaine Rouaud
- Department of Neurology, Centre Expert Parkinson, NS-Park/F-CRIN network, CHU Nantes, 44093 Nantes, France
| | - Mélissa Tir
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Caroline Moreau
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
| | - Teodor Danaila
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
| | - Stéphane Prange
- Department of Neurology, NS-Park/F-CRIN network, Amiens University Hospital, 80000 Amiens, France
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
| | - Laurent Tatu
- Department of Neurology, NS-PARK/F-CRIN network, University Hospital of Besançon, 25030 Besançon Cedex, France
| | - Christine Tranchant
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
| | - Jean-Christophe Corvol
- Assistance publique Hôpitaux de Paris, Inserm, CNRS, Hôpital Pitié-Salpêtrière, Department of Neurology, NS-Park/F-CRIN network, Sorbonne Université, Paris Brain Institute-ICM, 75014 Paris, France
| | - David Devos
- Lille Neurosciences and Cognition, CHU-Lille, Neurology and Movement Disorders department, NS-Park/F-CRIN network, Univ. Lille, 59037 Lille, France
- Lille Neurosciences and Cognition, CHU-Lille, Department of Medical Pharmacology, NS-Park/F-CRIN, Univ. Lille, Inserm, 59045 Lille, France
| | - Stephane Thobois
- Service de Neurologie C, NS-Park/F-CRIN network, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500 Bron, France
- Institut des Sciences Cognitives Marc Jeannerot, CNRS, UMR5229, 69675 Bron, France
| | - Maxime Desmarets
- Centre d'investigation clinique Inserm CIC 1431, CHU Besançon, F-25000 Besançon, France
- Université de Franche-Comté, EFS, INSERM, UMR RIGHT, 25000 Besançon, France
| | - Mathieu Anheim
- Service de Neurologie, NS-Park/F-CRIN network, Hôpitaux Universitaires de Strasbourg et Fédération de Médecine Translationnelle de Médecine de Strasbourg, 67200 Strasbourg, France
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
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Kroneberg D, Al-Fatly B, Morkos C, Steiner LA, Schneider GH, Kühn A. Kinematic Effects of Combined Subthalamic and Dorsolateral Nigral Deep Brain Stimulation in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2024; 14:269-282. [PMID: 38363617 PMCID: PMC10977420 DOI: 10.3233/jpd-230181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/17/2024]
Abstract
Background Additional stimulation of the substantia nigra (SNr) has been proposed to target axial symptoms and gait impairment in patients with Parkinson's disease (PD). Objective This study aimed to characterize effects of combined deep brain stimulation (DBS) of the subthalamic nucleus (STN) and SNr on gait performance in PD and to map stimulation sites within the SNr. Methods In a double-blinded crossover design, 10 patients with PD and gait impairment underwent clinical examination and kinematic assessment with STN DBS, combined STN+SNr DBS and OFF DBS 30 minutes after reprogramming. To confirm stimulation within the SNr, electrodes, active contacts, and stimulation volumes were modeled in a common space and overlap with atlases of SNr was computed. Results Overlap of stimulation volumes with dorsolateral SNr was confirmed for all patients. UPDRS III, scoring of freezing during turning and transitioning, stride length, stride velocity, and range of motion of shank, knee, arm, and trunk as well as peak velocities during turning and transitions and turn duration were improved with STN DBS compared to OFF. On cohort level, no further improvement was observed with combined STN+SNr DBS but additive improvement of spatiotemporal gait parameters was observed in individual subjects. Conclusions Combined high frequency DBS of the STN and dorsolateral SNr did not consistently result in additional short-term kinematic or clinical benefit compared to STN DBS. Stimulation intervals, frequency, and patient selection for target symptoms as well as target region within the SNr need further refinement in future trials.
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Affiliation(s)
- Daniel Kroneberg
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bassam Al-Fatly
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Cornelia Morkos
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Leon Amadeus Steiner
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin 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
| | - A. Kühn
- Department of Neurology with Experimental Neurology, Movement Disorders and Neuromodulation Unit, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Charite - Universitatsmedizin Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Charité – Universitätsmedizin Berlin, Berlin, Germany
- NeuroCure, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Cai M, Zhu Y, Shanley MR, Morel C, Ku SM, Zhang H, Shen Y, Friedman AK, Han MH. HCN channel inhibitor induces ketamine-like rapid and sustained antidepressant effects in chronic social defeat stress model. Neurobiol Stress 2023; 26:100565. [PMID: 37664876 PMCID: PMC10468802 DOI: 10.1016/j.ynstr.2023.100565] [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: 06/11/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023] Open
Abstract
Repeated, long-term (weeks to months) exposure to standard antidepressant medications is required to achieve treatment efficacy. In contrast, acute ketamine quickly improves mood for an extended time. Recent work implicates that hyperpolarization-activated cyclic nucleotide-gated (HCN) channels are involved in mediating ketamine's antidepressant effects. In this study, we directly targeted HCN channels and achieved ketamine-like rapid and sustained antidepressant efficacy. Our in vitro electrophysiological recordings first showed that HCN inhibitor DK-AH 269 (also called cilobradine) decreased the pathological HCN-mediated current (Ih) and abnormal hyperactivity of ventral tegmental area (VTA) dopamine (DA) neurons in a depressive-like model produced by chronic social defeat stress (CSDS). Our in vivo studies further showed that acute intra-VTA or acute systemic administration of DK-AH 269 normalized social behavior and rescued sucrose preference in CSDS-susceptible mice. The single-dose of DK-AH 269, both by intra-VTA microinfusion and intraperitoneal (ip) approaches, could produce an extended 13-day duration of antidepressant-like efficacy. Animals treated with acute DK-AH 269 spent less time immobile than vehicle-treated mice during forced swim test. A social behavioral reversal lasted up to 13 days following the acute DK-AH 269 ip injection, and this rapid and sustained antidepressant-like response is paralleled with a single-dose treatment of ketamine. This study provides a novel ion channel target for acutely acting, long-lasting antidepressant-like effects.
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Affiliation(s)
- Min Cai
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yingbo Zhu
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- China Shenzhen Naowunao Network Technology Co.,Ltd., Shenzhen, Guangdong, China
| | - Mary Regis Shanley
- Department of Biological Sciences, Hunter College, Biology and Biochemistry PhD Program, Graduate Center, The City University of New York, New York, NY, USA
| | - Carole Morel
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Stacy M. Ku
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Hongxing Zhang
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yuan Shen
- Anesthesia and Brain Research Institute, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Allyson K. Friedman
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ming-Hu Han
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Mental Health and Public Health, Faculty of Life and Health Sciences, Shenzhen Institute of Advanced Technology, Shenzhen, Guangdong, China
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Alosaimi F, Dominguez-Paredes D, Knoben R, Almasabi F, Hescham S, Kozielski K, Temel Y, Jahanshahi A. Wireless stimulation of the subthalamic nucleus with nanoparticles modulates key monoaminergic systems similar to contemporary deep brain stimulation. Behav Brain Res 2023; 444:114363. [PMID: 36849047 DOI: 10.1016/j.bbr.2023.114363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/14/2022] [Accepted: 02/24/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) is commonly used to alleviate motor symptoms in several movement disorders. However, the procedure is invasive, and the technology has remained largely stagnant since its inception decades ago. Recently, we have shown that wireless nanoelectrodes may offer an alternative approach to conventional DBS. However, this method is still in its infancy, and more research is required to characterize its potential before it can be considered as an alternative to conventional DBS. OBJECTIVES Herein, we aimed to investigate the effect of stimulation via magnetoelectric nanoelectrodes on primary neurotransmitter systems that have implications for DBS in movement disorders. METHODS Mice were injected with either magnetoelectric nanoparticles (MENPs) or magnetostrictive nanoparticles (MSNPs, as a control) in the subthalamic nucleus (STN). Mice then underwent magnetic stimulation, and their motor behavior was assessed in the open field test. In addition, magnetic stimulation was applied before sacrifice and post-mortem brains were processed for immunohistochemistry (IHC) to assess the co-expression of c-Fos with either tyrosine hydroxylase (TH), tryptophan hydroxylase-2 (TPH2) or choline acetyltransferase (ChAT). RESULTS Stimulated animals covered longer distances in the open field test when compared to controls. Moreover, we found a significant increase in c-Fos expression in the motor cortex (MC) and paraventricular region of the thalamus (PV-thalamus) after magnetoelectric stimulation. Stimulated animals showed fewer TPH2/c-Fos double-labeled cells in the dorsal raphe nucleus (DRN), as well as TH/c-Fos double-labeled cells in the ventral tegmental area (VTA), but not in the substantia nigra pars compacta (SNc). There was no significant difference in the number of ChAT/ c-Fos double-labeled cells in the pedunculopontine nucleus (PPN). CONCLUSIONS Magnetoelectric DBS in mice enables selective modulation of deep brain areas and animal behavior. The measured behavioral responses are associated with changes in relevant neurotransmitter systems. These changes are somewhat similar to those observed in conventional DBS, suggesting that magnetoelectric DBS might be a suitable alternative.
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Affiliation(s)
- Faisal Alosaimi
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands; Department of Physiology, Faculty of Medicine, King Abdulaziz University, Rabigh, Saudi Arabia
| | - David Dominguez-Paredes
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Rick Knoben
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Faris Almasabi
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Sarah Hescham
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Kristen Kozielski
- School of Computation, Information and Technology, Technical University of Munich, Munich 80333, Germany
| | - Yasin Temel
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands
| | - Ali Jahanshahi
- Department of Neurosurgery, Maastricht University Medical Centre, Maastricht 6202AZ, the Netherlands; Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, the Netherlands.
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Campos ACP, Pople C, Silk E, Surendrakumar S, Rabelo TK, Meng Y, Gouveia FV, Lipsman N, Giacobbe P, Hamani C. Neurochemical mechanisms of deep brain stimulation for depression in animal models. Eur Neuropsychopharmacol 2023; 68:11-26. [PMID: 36640729 DOI: 10.1016/j.euroneuro.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
Deep brain stimulation (DBS) has emerged as a neuromodulation therapy for treatment-resistant depression, but its actual efficacy and mechanisms of action are still unclear. Changes in neurochemical transmission are important mechanisms of antidepressant therapies. Here, we review the preclinical DBS literature reporting behavioural and neurochemical data associated with its antidepressant-like effects. The most commonly studied target in preclinical models was the ventromedial prefrontal cortex (vmPFC). In rodents, DBS delivered to this target induced serotonin (5-HT) release and increased 5-HT1B receptor expression. The antidepressant-like effects of vmPFC DBS seemed to be independent of the serotonin transporter and potentially mediated by the direct modulation of prefrontal projections to the raphe. Adenosinergic and glutamatergic transmission might have also play a role. Medial forebrain bundle (MFB) DBS increased dopamine levels and reduced D2 receptor expression, whereas nucleus accumbens (NAcc), and lateral habenula (LHb) stimulation increased catecholamine levels in different brain regions. In rodents, subthalamic nucleus (STN) DBS induced robust depression-like responses associated with a reduction in serotonergic transmission, as revealed by a decrease in serotonin release. Some of these effects seemed to be mediated by 5HT1A receptors. In conclusion, the antidepressant-like effects of DBS in preclinical models have been well documented in multiple targets. Though variable mechanisms have been proposed, DBS-induced acute and long-term changes in neurochemical substrates seem to play an important role in the antidepressant-like effects of this therapy.
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Affiliation(s)
- Ana Carolina P Campos
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Christopher Pople
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Esther Silk
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Shanan Surendrakumar
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Thallita K Rabelo
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Ying Meng
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Flavia Venetucci Gouveia
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada
| | - Nir Lipsman
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Division of Neurosurgery, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada
| | - Peter Giacobbe
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Clement Hamani
- Harquail Centre for Neuromodulation, Sunnybrook Health Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Hurvitz Brain Sciences Centre, Sunnybrook Research Institute, Toronto, ON M4N 3M5, Canada; Division of Neurosurgery, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON M4N 3M5, Canada.
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Peeters J, Boogers A, Van Bogaert T, Davidoff H, Gransier R, Wouters J, Nuttin B, Mc Laughlin M. Electrophysiologic Evidence That Directional Deep Brain Stimulation Activates Distinct Neural Circuits in Patients With Parkinson Disease. Neuromodulation 2023; 26:403-413. [PMID: 35088733 DOI: 10.1016/j.neurom.2021.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/19/2021] [Accepted: 10/26/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Deep brain stimulation (DBS) delivered via multicontact leads implanted in the basal ganglia is an established therapy to treat Parkinson disease (PD). However, the different neural circuits that can be modulated through stimulation on different DBS contacts are poorly understood. Evidence shows that electrically stimulating the subthalamic nucleus (STN) causes a therapeutic effect through antidromic activation of the hyperdirect pathway-a monosynaptic connection from the cortex to the STN. Recent studies suggest that stimulating the substantia nigra pars reticulata (SNr) may improve gait. The advent of directional DBS leads now provides a spatially precise means to probe these neural circuits and better understand how DBS affects distinct neural networks. MATERIALS AND METHODS We measured cortical evoked potentials (EPs) using electroencephalography (EEG) in response to low-frequency DBS using the different directional DBS contacts in eight patients with PD. RESULTS A short-latency EP at 3 milliseconds originating from the primary motor cortex appeared largest in amplitude when stimulating DBS contacts closest to the dorsolateral STN (p < 0.001). A long-latency EP at 10 milliseconds originating from the premotor cortex appeared strongest for DBS contacts closest to the SNr (p < 0.0001). CONCLUSIONS Our results show that at the individual patient level, electrical stimulation of different nuclei produces distinct EP signatures. Our approach could be used to identify the functional location of each DBS contact and thus help patient-specific DBS programming. CLINICAL TRIAL REGISTRATION The ClinicalTrials.gov registration number for the study is NCT04658641.
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Affiliation(s)
- Jana Peeters
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
| | - Alexandra Boogers
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Neurology, UZ Leuven, Leuven, Belgium
| | - Tine Van Bogaert
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Hannah Davidoff
- Division of Animal and Human Health Engineering, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Robin Gransier
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Wouters
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Bart Nuttin
- Division of Experimental Neurosurgery and Neuroanatomy, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium; Department of Neurosurgery, UZ Leuven, Leuven, Belgium
| | - Myles Mc Laughlin
- Research Group Experimental Oto-rhino-laryngology, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
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7
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Zhao GR, Cheng YF, Feng KK, Wang M, Wang YG, Wu YZ, Yin SY. Clinical Study of Intraoperative Microelectrode Recordings during Awake and Asleep Subthalamic Nucleus Deep Brain Stimulation for Parkinson's Disease: A Retrospective Cohort Study. Brain Sci 2022; 12:brainsci12111469. [PMID: 36358395 PMCID: PMC9688350 DOI: 10.3390/brainsci12111469] [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: 09/26/2022] [Revised: 10/16/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022] Open
Abstract
Our objective is to analyze the difference of microelectrode recording (MER) during awake and asleep subthalamic nucleus deep brain stimulation (STN-DBS) for Parkinson’s disease (PD) and the necessity of MER during “Asleep DBS” under general anesthesia (GA). The differences in MER, target accuracy, and prognosis under different anesthesia methods were analyzed. Additionally, the MER length was compared with the postoperative electrode length by electrode reconstruction and measurement. The MER length of two groups was 5.48 ± 1.39 mm in the local anesthesia (LA) group and 4.38 ± 1.43 mm in the GA group, with a statistical significance between the two groups (p < 0.01). The MER length of the LA group was longer than its postoperative electrode length (p < 0.01), however, there was no significant difference between the MER length and postoperative electrode length in the GA group (p = 0.61). There were also no significant differences in the postoperative electrode length, target accuracy, and postoperative primary and secondary outcome scores between the two groups (p > 0.05). These results demonstrate that “Asleep DBS” under GA is comparable to “Awake DBS” under LA. GA has influences on MER during surgery, but typical STN discharges can still be recorded. MER is not an unnecessary surgical procedure.
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Affiliation(s)
- Guang-Rui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
- Department of Neurosurgery, Lu’an Hospital Affiliated to Anhui Medical University, Lu’an 237000, China
| | - Yi-Feng Cheng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin 300350, China
| | - Ke-Ke Feng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin 300350, China
| | - Min Wang
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin 300350, China
| | - Yan-Gang Wang
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
| | - Yu-Zhang Wu
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin 300070, China
| | - Shao-Ya Yin
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin 300350, China
- Correspondence:
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8
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Bove F, Genovese D, Moro E. Developments in the mechanistic understanding and clinical application of deep brain stimulation for Parkinson's disease. Expert Rev Neurother 2022; 22:789-803. [PMID: 36228575 DOI: 10.1080/14737175.2022.2136030] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION. Deep brain stimulation (DBS) is a life-changing treatment for patients with Parkinson's disease (PD) and gives the unique opportunity to directly explore how basal ganglia work. Despite the rapid technological innovation of the last years, the untapped potential of DBS is still high. AREAS COVERED. This review summarizes the developments in the mechanistic understanding of DBS and the potential clinical applications of cutting-edge technological advances. Rather than a univocal local mechanism, DBS exerts its therapeutic effects through several multimodal mechanisms and involving both local and network-wide structures, although crucial questions remain unexplained. Nonetheless, new insights in mechanistic understanding of DBS in PD have provided solid bases for advances in preoperative selection phase, prediction of motor and non-motor outcomes, leads placement and postoperative stimulation programming. EXPERT OPINION. DBS has not only strong evidence of clinical effectiveness in PD treatment, but technological advancements are revamping its role of neuromodulation of brain circuits and key to better understanding PD pathophysiology. In the next few years, the worldwide use of new technologies in clinical practice will provide large data to elucidate their role and to expand their applications for PD patients, providing useful insights to personalize DBS treatment and follow-up.
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Affiliation(s)
- Francesco Bove
- Neurology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Genovese
- Fresco Institute for Parkinson's and Movement Disorders, Department of Neurology, New York University School of Medicine, New York, New York, USA
| | - Elena Moro
- Grenoble Alpes University, CHU of Grenoble, Division of Neurology, Grenoble, France.,Grenoble Institute of Neurosciences, INSERM, U1216, Grenoble, France
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9
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Bukowski N, Laurin A, Laforgue EJ, Preterre C, Rouaud T, Damier P, Raoul S, Dumont R, Loutrel O, Guitteny M, Derkinderen P, Bulteau S, Sauvaget A. Efficacy and Safety of Electroconvulsive Therapy in Patients With Deep Brain Stimulation: Literature Review, Case Report for Patient With Essential Tremor, and Practical Recommendations. J ECT 2022; 38:e29-e40. [PMID: 36018735 DOI: 10.1097/yct.0000000000000828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM Deep brain stimulation (DBS) has proven to be an effective therapy of some treatment-resistant psychiatric disorders and movement disorders. Comorbid depressive symptoms are common and difficult to manage. Treatment with electroconvulsive therapy (ECT) may be required. There are few published cases describing the safety and efficacy of ECT for patients with DBS implants, and there are no available guidelines for administration of ECT in patients with DBS and mood disorders. The current study had 3 aims: (i) to conduct a systematic review of case reports on patients with DBS implants who received ECT; (ii) to report the case of a 69-year-old man with a DBS implant for essential tremor, who required ECT; and (iii) to provide practical recommendations for ECT in patients with DBS implants. METHODS We conducted a systematic review, in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, of existing case reports on patients with DBS implants administered ECT for psychiatric disorders. RESULTS Our search yielded 25 cases of ECT in patients implanted with DBS systems. In addition, we here describe successful ECT management of major depressive disorder in a patient treated by DBS. We also set forth ECT management guidelines based on points of consensus. The 2 most important practical recommendations are to make sure the DBS system is set to 0 V and turned off before ECT, and to avoid sites near the DBS electrodes. CONCLUSIONS Electroconvulsive therapy may be an effective and safe treatment for DBS patients with MDD.
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Affiliation(s)
- Nicolas Bukowski
- From the Addictology and Consultation-Liaison Psychiatry Department, CHU de Nantes
| | | | | | | | | | | | | | - Romain Dumont
- Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu-PTMC, CHU de Nantes, Nantes, France
| | - Olivier Loutrel
- Department of Anesthesiology and Critical Care Medicine, Hôtel-Dieu-PTMC, CHU de Nantes, Nantes, France
| | - Marie Guitteny
- From the Addictology and Consultation-Liaison Psychiatry Department, CHU de Nantes
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10
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High-frequency stimulation of the subthalamic nucleus induces a sustained inhibition of serotonergic system via loss of cell phenotype. Sci Rep 2022; 12:14011. [PMID: 35978112 PMCID: PMC9385659 DOI: 10.1038/s41598-022-18294-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/09/2022] [Indexed: 11/08/2022] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become a standard treatment for Parkinson's disease (PD). However, in a considerable number of patients debilitating psychiatric side-effects occur. Recent research has revealed that external stimuli can alter the neurotransmitters' homeostasis in neurons, which is known as "neurotransmitter respecification". Herein, we addressed if neurotransmitter respecification could be a mechanism by which DBS suppresses the serotonergic function in the dorsal raphe nucleus (DRN) leading to mood changes. We infused transgenic 5-HT-Cre (ePET-Cre) mice with AAV viruses to achieve targeted expression of eYFP and the genetically encoded calcium indicator GCaMP6s in the DRN prior to methyl-4phenyl-1,2,3,6-tetrahydropyridine (MPTP) treatment. Mice received bilateral DBS electrodes in the STN and an optic fiber in the DRN for calcium photometry. MPTP-treated mice demonstrated behavioral and histological PD phenotype, whereas all STN-DBS animals exhibited an increased immobility time in the forced swim test, reduced calcium activity, and loss of tryptophan hydroxylase-2 expression in the DRN. Given the prominent role of calcium transients in mediating neurotransmitter respecification, these results suggest a loss of serotonergic phenotype in the DRN following STN-DBS. These findings indicate that loss of serotonergic cell phenotype may underlie the unwanted depressive symptoms following STN-DBS.
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11
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Prange S, Lin Z, Nourredine M, Danaila T, Laurencin C, Lagha-Boukbiza O, Anheim M, Klinger H, Longato N, Phillipps C, Voirin J, Polo G, Simon E, Mertens P, Rolland AS, Devos D, Metereau E, Tranchant C, Thobois S. Limbic stimulation drives mania in STN-DBS in Parkinson disease: a prospective study. Ann Neurol 2022; 92:411-417. [PMID: 35703252 DOI: 10.1002/ana.26434] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/30/2022] [Accepted: 06/05/2022] [Indexed: 11/10/2022]
Abstract
In this one-year prospective study, Parkinson's disease (PD) patients with or without mania following STN-DBS were compared to investigate risk and etiological factors, clinical management and consequences. Eighteen (16.2%) out of 111 consecutive PD patients developed mania, of whom 17 were males. No preoperative risk factor was identified. Postoperative mania was related to ventral limbic subthalamic stimulation in 15 (83%) patients, and resolved as stimulation was relocated to the sensorimotor STN, besides discontinuation or reduction of dopamine agonists and use of low-dose clozapine in 12 patients, while motor and nonmotor outcomes were similar. These findings underpin the prominent role of limbic subthalamic stimulation in postoperative mania. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Stéphane Prange
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Nuclear Medicine, Cologne, Germany
| | - Zhengyu Lin
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France.,Department of Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Center for Functional Neurosurgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | | | - Teodor Danaila
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Chloé Laurencin
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Ouhaid Lagha-Boukbiza
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Hélène Klinger
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Nadine Longato
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Clelie Phillipps
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Jimmy Voirin
- Department of Neurosurgery, NS-PARK/F-CRIN, Strasbourg University Hospital, Strasbourg, France
| | - Gustavo Polo
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Emile Simon
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Patrick Mertens
- Service de Neurochirurgie fonctionnelle, Hôpital Neurologique et Neurochirurgical Pierre Wertheimer, Hospices Civils de Lyon 59 Bd Pinel, 69500, Bron, France
| | - Anne-Sophie Rolland
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - David Devos
- Univ Lille, CHU-Lille, Medical Pharmacology & Neurology, Expert center for Parkinson, Lille Neuroscience & Cognition, Inserm, UMR-S1172, LICEND, NS-Park network, F-59000, Lille, France
| | - Elise Metereau
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, Illkirch-Graffenstaden, France
| | - Stéphane Thobois
- Univ Lyon, Institut des Sciences Cognitives Marc Jeannerod, CNRS, UMR 5229, Bron, France.,Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Service de Neurologie C, Centre Expert Parkinson NS-PARK/FCRIN network, Bron, France.,Univ Lyon, Université Claude Bernard Lyon 1, Faculté de Médecine et de Maïeutique Lyon Sud Charles Mérieux, Oullins, France
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12
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Alonso-Frech F, Fernandez-Garcia C, Gómez-Mayordomo V, Monje MHG, Delgado-Suarez C, Villanueva-Iza C, Catalan-Alonso MJ. Non-motor Adverse Effects Avoided by Directional Stimulation in Parkinson's Disease: A Case Report. Front Neurol 2022; 12:786166. [PMID: 35173666 PMCID: PMC8843015 DOI: 10.3389/fneur.2021.786166] [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: 09/29/2021] [Accepted: 12/29/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction Deep brain stimulation (DBS) is widely used for treatment of advanced, medication-refractory Parkinson's disease (PD). However, a significant proportion of patients may suffer adverse effects; up to 10% will present one or more transient or permanent neurobehavioral events. Patient and Methods In our case study, a 44-year-old woman diagnosed with PD 6 years previously who was suffering from motor fluctuations, dyskinesia, and freezing of gait episodes was submitted for DBS and implanted with directional electrodes. Intraoperative local field potentials (LFPs) were recorded. After surgery, conventional monopolar revision was performed. Preoperative 3T MRI studies and postoperative 3D and X-ray data were integrated using the Guide DTI software application (Brainlab), and diffusion tensor imaging tractography traced from cortical areas to each subthalamic nucleus (STN) using Elements software (Brainlab). Results We observed that left STN stimulation in the ring mode significantly improved motor symptoms, but the patient presented uncontrollable mirthful laughter. Stimulation was then switched to the directional mode; laughter remained when using the more posteromedial contact (3-C+) but not 2-C+ or 4-C+ at the same parameters. Interestingly, LFP recordings showed the highest beta-band activity over contacts 4 and 2, and very scarce beta power over contact 3. The orientation of the directional leads was selected based on the 3D postoperative X-rays. Associative fibers showed the shortest distance to contact number 3. Conclusion Stimulation of the STN can affect motor and associative loops. The use of directional electrodes is a good option to avoid not only undesirable capsular or lemniscal effects, but also limbic/associative events. Oscillatory activity in the beta range that preferentially takes place over the somatomotor STN region and is closely related to motor improvement, provides a reliable guide for optimizing the DBS programming. The importance of the exact location of electrical stimulation to determine the non-motor symptoms such as mood, apathy, attention, and memory, as well as the usefulness of biological markers such as LFP for optimal programming, is discussed in relation to this case.
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Affiliation(s)
- Fernando Alonso-Frech
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- *Correspondence: Fernando Alonso-Frech
| | - Carla Fernandez-Garcia
- Department of Neurosurgery, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
- Carla Fernandez-Garcia
| | - Victor Gómez-Mayordomo
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Mariana H. G. Monje
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | | | - Clara Villanueva-Iza
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
| | - Maria Jose Catalan-Alonso
- Department of Neurology, San Carlos Research Health Institute (IdISSC), Hospital Clínico San Carlos, Madrid, Spain
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13
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Cury RG, Pavese N, Aziz TZ, Krauss JK, Moro E. Gaps and roadmap of novel neuromodulation targets for treatment of gait in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:8. [PMID: 35017551 PMCID: PMC8752758 DOI: 10.1038/s41531-021-00276-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 11/21/2021] [Indexed: 12/16/2022] Open
Abstract
Gait issues in Parkinson's disease (PD) are common and can be highly disabling. Although levodopa and deep brain stimulation (DBS) of the subthalamic nucleus and the globus pallidus internus have been established therapies for addressing the motor symptoms of PD, their effects on gait are less predictable and not well sustained with disease progression. Given the high prevalence of gait impairment in PD and the limitations in currently approved therapies, there has been considerable interest in alternative neuromodulation targets and techniques. These have included DBS of pedunculopontine nucleus and substantia nigra pars reticulata, spinal cord stimulation, non-invasive modulation of cortical regions and, more recently, vagus nerve stimulation. However, successes and failures have also emerged with these approaches. Current gaps and controversies are related to patient selection, optimal electrode placement within the target, placebo effects and the optimal programming parameters. Additionally, recent advances in pathophysiology of oscillation dynamics have driven new models of closed-loop DBS systems that may or may not be applicable to gait issues. Our aim is to describe approaches, especially neuromodulation procedures, and emerging challenges to address PD gait issues beyond subthalamic nucleus and the globus pallidus internus stimulation.
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Affiliation(s)
- Rubens Gisbert Cury
- Movement Disorders Center, Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil.
| | - Nicola Pavese
- Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne, NE4 5PL, UK
| | - Tipu Z Aziz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
- Center for Systems Neuroscience, Hannover, Germany
| | - Elena Moro
- Division of Neurology, Grenoble Institute of Neurosciences, Grenoble Alpes University, CHU of Grenoble, Grenoble, France
- INSERM U1216, Grenoble Institute of Neurosciences, Grenoble, France
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14
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Chen YC, Wu HT, Tu PH, Yeh CH, Liu TC, Yeap MC, Chao YP, Chen PL, Lu CS, Chen CC. Theta Oscillations at Subthalamic Region Predicts Hypomania State After Deep Brain Stimulation in Parkinson's Disease. Front Hum Neurosci 2022; 15:797314. [PMID: 34987369 PMCID: PMC8721814 DOI: 10.3389/fnhum.2021.797314] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/26/2021] [Indexed: 12/11/2022] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) is an effective treatment for the motor impairments of patients with advanced Parkinson's disease. However, mood or behavioral changes, such as mania, hypomania, and impulsive disorders, can occur postoperatively. It has been suggested that these symptoms are associated with the stimulation of the limbic subregion of the STN. Electrophysiological studies demonstrate that the low-frequency activities in ventral STN are modulated during emotional processing. In this study, we report 22 patients with Parkinson's disease who underwent STN DBS for treatment of motor impairment and presented stimulation-induced mood elevation during initial postoperative programming. The contact at which a euphoric state was elicited by stimulation was termed as the hypomania-inducing contact (HIC) and was further correlated with intraoperative local field potential recorded during the descending of DBS electrodes. The power of four frequency bands, namely, θ (4–7 Hz), α (7–10 Hz), β (13–35 Hz), and γ (40–60 Hz), were determined by a non-linear variation of the spectrogram using the concentration of frequency of time (conceFT). The depth of maximum θ power is located approximately 2 mm below HIC on average and has significant correlation with the location of contacts (r = 0.676, p < 0.001), even after partializing the effect of α and β, respectively (r = 0.474, p = 0.022; r = 0.461, p = 0.027). The occurrence of HIC was not associated with patient-specific characteristics such as age, gender, disease duration, motor or non-motor symptoms before the operation, or improvement after stimulation. Taken together, these data suggest that the location of maximum θ power is associated with the stimulation-induced hypomania and the prediction of θ power is frequency specific. Our results provide further information to refine targeting intraoperatively and select stimulation contacts in programming.
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Affiliation(s)
- Yi-Chieh Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hau-Tieng Wu
- Department of Mathematics, Duke University, Durham, NC, United States.,Department of Statistical Science, Duke University, Durham, NC, United States
| | - Po-Hsun Tu
- College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Hua Yeh
- College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Neuroradiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tzu-Chi Liu
- Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mun-Chun Yeap
- Department of Neurosurgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ping Chao
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Po-Lin Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chin-Song Lu
- Professor Lu Neurological Clinic, Taoyuan, Taiwan
| | - Chiung-Chu Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Neuroscience Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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15
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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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16
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Parolari L, Schneeberger M, Heintz N, Friedman JM. Functional analysis of distinct populations of subthalamic nucleus neurons on Parkinson's disease and OCD-like behaviors in mice. Mol Psychiatry 2021; 26:7029-7046. [PMID: 34099874 DOI: 10.1038/s41380-021-01162-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023]
Abstract
The subthalamic nucleus (STN) is a component of the basal ganglia and plays a key role to control movement and limbic-associative functions. STN modulation with deep brain stimulation (DBS) improves the symptoms of Parkinson's disease (PD) and obsessive-compulsive disorder (OCD) patients. However, DBS does not allow for cell-type-specific modulation of the STN. While extensive work has focused on elucidating STN functionality, the understanding of the role of specific cell types is limited. Here, we first performed an anatomical characterization of molecular markers for specific STN neurons. These studies revealed that most STN neurons express Pitx2, and that different overlapping subsets express Gabrr3, Ndnf, or Nos1. Next, we used optogenetics to define their roles in regulating locomotor and limbic functions in mice. Specifically, we showed that optogenetic photoactivation of STN neurons in Pitx2-Cre mice or of the Gabrr3-expressing subpopulation induces locomotor changes, and improves locomotion in a PD mouse model. In addition, photoactivation of Pitx2 and Gabrr3 cells induced repetitive grooming, a phenotype associated with OCD. Repeated stimulation prompted a persistent increase in grooming that could be reversed by fluoxetine treatment, a first-line drug therapy for OCD. Conversely, repeated inhibition of STNGabrr3 neurons suppressed grooming in Sapap3 KO mice, a model for OCD. Finally, circuit and functional mapping of STNGabrr3 neurons showed that these effects are mediated via projections to the globus pallidus/entopeduncular nucleus and substantia nigra reticulata. Altogether, these data identify Gabrr3 neurons as a key population in mediating the beneficial effects of STN modulation thus providing potential cellular targets for PD and OCD drug discovery.
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Affiliation(s)
- Luca Parolari
- Laboratory of Molecular Genetics, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.
| | - Marc Schneeberger
- Laboratory of Molecular Genetics, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA
| | - Nathaniel Heintz
- Laboratory of Molecular Biology, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.
| | - Jeffrey M Friedman
- Laboratory of Molecular Genetics, Howard Hughes Medical Institute, The Rockefeller University, New York, NY, USA.
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17
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Elias GJB, Loh A, Gwun D, Pancholi A, Boutet A, Neudorfer C, Germann J, Namasivayam A, Gramer R, Paff M, Lozano AM. Deep brain stimulation of the brainstem. Brain 2021; 144:712-723. [PMID: 33313788 DOI: 10.1093/brain/awaa374] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 01/02/2023] Open
Abstract
Deep brain stimulation (DBS) of the subthalamic nucleus, pallidum, and thalamus is an established therapy for various movement disorders. Limbic targets have also been increasingly explored for their application to neuropsychiatric and cognitive disorders. The brainstem constitutes another DBS substrate, although the existing literature on the indications for and the effects of brainstem stimulation remains comparatively sparse. The objective of this review was to provide a comprehensive overview of the pertinent anatomy, indications, and reported stimulation-induced acute and long-term effects of existing white and grey matter brainstem DBS targets. We systematically searched the published literature, reviewing clinical trial articles pertaining to DBS brainstem targets. Overall, 164 studies describing brainstem DBS were identified. These studies encompassed 10 discrete structures: periaqueductal/periventricular grey (n = 63), pedunculopontine nucleus (n = 48), ventral tegmental area (n = 22), substantia nigra (n = 9), mesencephalic reticular formation (n = 7), medial forebrain bundle (n = 8), superior cerebellar peduncles (n = 3), red nucleus (n = 3), parabrachial complex (n = 2), and locus coeruleus (n = 1). Indications for brainstem DBS varied widely and included central neuropathic pain, axial symptoms of movement disorders, headache, depression, and vegetative state. The most promising results for brainstem DBS have come from targeting the pedunculopontine nucleus for relief of axial motor deficits, periaqueductal/periventricular grey for the management of central neuropathic pain, and ventral tegmental area for treatment of cluster headaches. Brainstem DBS has also acutely elicited numerous motor, limbic, and autonomic effects. Further work involving larger, controlled trials is necessary to better establish the therapeutic potential of DBS in this complex area.
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Affiliation(s)
- Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Dave Gwun
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Aditya Pancholi
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Andrew Namasivayam
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Robert Gramer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Michelle Paff
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
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18
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Wilt JA, Merner AR, Zeigler J, Montpetite M, Kubu CS. Does Personality Change Follow Deep Brain Stimulation in Parkinson's Disease Patients? Front Psychol 2021; 12:643277. [PMID: 34393883 PMCID: PMC8361492 DOI: 10.3389/fpsyg.2021.643277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/15/2021] [Indexed: 12/19/2022] Open
Abstract
Deep Brain Stimulation (DBS) has emerged as a safe, effective, and appealing treatment for Parkinson's Disease (PD), particularly for improving motor symptoms (e. g., tremor, bradykinesia, and rigidity). However, concerns have been raised about whether DBS causes psychological changes, including changes to personality: characteristic and relatively stable patterns of affect, behavior, cognition, and desire. In this article, after first presenting some background information about PD and DBS, we examined evidence obtained from various empirical research methods (quantitative, qualitative, and mixed methods for evaluating patient valued characteristics) pertaining to whether DBS causes personality change. General limitations across research methods include a lack of randomized clinical trials and small sample sizes. We organized our review of findings according to different layers of personality variables: dispositional traits (including personality pathology), characteristic adaptations, and narrative identity. Though most work has been done on dispositional traits, there is not much evidence that dispositional traits change following DBS. Little work has been done on characteristic adaptations, but there is somewhat consistent evidence for positive perceived progress toward goals across a number of domains: routine activities, work, social/relational, and leisure. Nascent work on narrative identity holds promise for revealing issues around self-image that may be common following DBS. We listed a number of strategies for advancing research, highlighting opportunities related to personality conceptualization, personality assessment, and interdisciplinary scholarship. Finally, we offer practical applications of our findings for the informed consent process and for ongoing treatment.
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Affiliation(s)
- Joshua A Wilt
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States
| | - Amanda R Merner
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, OH, United States.,Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | - Jaclyn Zeigler
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States
| | | | - Cynthia S Kubu
- Department of Neurology, Cleveland Clinic, Cleveland, OH, United States.,Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, United States
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19
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Soh D, Maciel R, Algarni M, Lizarraga K, Loh A, Germann J, Elias G, Boutet A, Munhoz RP, Kalia SK, Hodaie M, Lozano AM, Fasano A. Flexible vs. standard subthalamic stimulation in Parkinson disease: A double-blind proof-of-concept cross-over trial. Parkinsonism Relat Disord 2021; 89:93-97. [PMID: 34271424 DOI: 10.1016/j.parkreldis.2021.07.003] [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] [Received: 03/13/2021] [Revised: 07/01/2021] [Accepted: 07/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamus (STN) is effective for the treatment of cardinal motor signs of Parkinson disease (PD). Structures around the STN can suppress dyskinesia and tremor (zona incerta) and improve gait and balance (substantia nigra pars reticulata). OBJECTIVE Is the newer 8-contact linear lead connected to a 'flexible' DBS system superior to standard 4-contact stimulation in PD patients receiving STN DBS? METHODS After 3 months of open label programming, 10 patients were randomized to standard or flexible stimulation before crossing over to the other arm (3 months each period). Patients and assessors were blinded. RESULTS A trend to improvement in Patient Global Impression of Change scores was seen with standard to flexible stimulation and worsening from flexible to standard stimulation (mean ± SD: 0.7 ± 1.2 and -0.4 ± 1.5 respectively, p = 0.152). There was a significant reduction in the number of troublesome symptoms reported prior to DBS (2.6 ± 3.3 per patient), more so with flexible stimulation (0.4 ± 0.6 vs. 1.5 ± 1.6 with standard stimulation, p = 0.001 and p = 0.034). There was no significant difference between the flexible and standard stimulation groups. CONCLUSION Further studies confirming that flexible stimulation is superior to standard DBS are warranted.
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Affiliation(s)
- Derrick Soh
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada; Alfred Hospital, Melbourne, Victoria, Australia
| | - Ricardo Maciel
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada
| | - Musleh Algarni
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada
| | - Karlo Lizarraga
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada; Motor Physiology and Neuromodulation Program, Division of Movement Disorders and Center for Health + Technology (CHeT), Department of Neurology, University of Rochester, United States
| | - Aaron Loh
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Jürgen Germann
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Gavin Elias
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Brain Institute, Toronto, Canada
| | - Mojgan Hodaie
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Brain Institute, Toronto, Canada
| | - Andres M Lozano
- Division of Neurosurgery, Department of Neurosurgery, Toronto Western Hospital, University of Toronto, Canada; Krembil Brain Institute, Toronto, Canada
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease and the Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Canada; Krembil Brain Institute, Toronto, Canada; The Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada.
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20
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Hariz M, Jabre M, Nohra G, Agid Y. Paul Bejjani In Memoriam. Mov Disord 2021. [DOI: 10.1002/mds.28572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Marwan Hariz
- Dept. of Clinical Neuroscience Umeå University Umeå Sweden
- UCL Institute of Neurology Queen Square, London United Kingdom
| | - Mazen Jabre
- Parkinson, Memory & Movement Disorders Centre Notre Dame des Secours‐UMC Byblos Lebanon
| | - Georges Nohra
- Department of Neurosurgery Université Saint‐Joseph, Hotel Dieu de France Beirut Lebanon
| | - Yves Agid
- Institut du cerveau et de la moelle épinière (ICM), CHU Pitié‐Salpêtrière Paris France
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21
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Schrock LE, Patriat R, Goftari M, Kim J, Johnson MD, Harel N, Vitek JL. 7T MRI and Computational Modeling Supports a Critical Role of Lead Location in Determining Outcomes for Deep Brain Stimulation: A Case Report. Front Hum Neurosci 2021; 15:631778. [PMID: 33679351 PMCID: PMC7928296 DOI: 10.3389/fnhum.2021.631778] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 01/15/2021] [Indexed: 11/13/2022] Open
Abstract
Subthalamic nucleus (STN) deep brain stimulation (DBS) is an established therapy for Parkinson’s disease motor symptoms. The ideal site for implantation within STN, however, remains controversial. While many argue that placement of a DBS lead within the sensorimotor territory of the STN yields better motor outcomes, others report similar effects with leads placed in the associative or motor territory of the STN, while still others assert that placing a DBS lead “anywhere within a 6-mm-diameter cylinder centered at the presumed middle of the STN (based on stereotactic atlas coordinates) produces similar clinical efficacy.” These discrepancies likely result from methodological differences including targeting preferences, imaging acquisition and the use of brain atlases that do not account for patient-specific anatomic variability. We present a first-in-kind within-patient demonstration of severe mood side effects and minimal motor improvement in a Parkinson’s disease patient following placement of a DBS lead in the limbic/associative territory of the STN who experienced marked improvement in motor benefit and resolution of mood side effects following repositioning the lead within the STN sensorimotor territory. 7 Tesla (7 T) magnetic resonance imaging (MRI) data were used to generate a patient-specific anatomical model of the STN with parcellation into distinct functional territories and computational modeling to assess the relative degree of activation of motor, associative and limbic territories.
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Affiliation(s)
- Lauren E Schrock
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
| | - Remi Patriat
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, United States
| | - Mojgan Goftari
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Jiwon Kim
- Department of Chemical Engineering and Materials Science, University of Minnesota, Minneapolis, MN, United States
| | - Matthew D Johnson
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, United States
| | - Noam Harel
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, United States
| | - Jerrold L Vitek
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
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22
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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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23
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Ranti D, Valliani AAA, Costa A, Oermann EK. Artificial intelligence as applied to clinical neurological conditions. Artif Intell Med 2021. [DOI: 10.1016/b978-0-12-821259-2.00020-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Kajal DS, Fioravanti C, Elshahabi A, Ruiz S, Sitaram R, Braun C. Involvement of top-down networks in the perception of facial emotions: A magnetoencephalographic investigation. Neuroimage 2020; 222:117075. [DOI: 10.1016/j.neuroimage.2020.117075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/22/2020] [Accepted: 06/17/2020] [Indexed: 02/07/2023] Open
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25
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Coronel-Escamilla A, Gomez-Aguilar J, Stamova I, Santamaria F. Fractional order controllers increase the robustness of closed-loop deep brain stimulation systems. CHAOS, SOLITONS, AND FRACTALS 2020; 140:110149. [PMID: 32905470 PMCID: PMC7469958 DOI: 10.1016/j.chaos.2020.110149] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We studied the effects of using fractional order proportional, integral, and derivative (PID) controllers in a closed-loop mathematical model of deep brain stimulation. The objective of the controller was to dampen oscillations from a neural network model of Parkinson's disease. We varied intrinsic parameters, such as the gain of the controller, and extrinsic variables, such as the excitability of the network. We found that in most cases, fractional order components increased the robustness of the model multi-fold to changes in the gains of the controller. Similarly, the controller could be set to a fixed set of gains and remain stable to a much larger range, than for the classical PID case, of changes in synaptic weights that otherwise would cause oscillatory activity. The increase in robustness is a consequence of the properties of fractional order derivatives that provide an intrinsic memory trace of past activity, which works as a negative feedback system. Fractional order PID controllers could provide a platform to develop stand-alone closed-loop deep brain stimulation systems.
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Affiliation(s)
- A. Coronel-Escamilla
- Department of Biology, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - J.F. Gomez-Aguilar
- National Center for Research and Technological Development, (CENIDET), Morelos, 62490, Mexico
| | - I. Stamova
- Department of Mathematics, University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - F. Santamaria
- Department of Biology, University of Texas at San Antonio, San Antonio, TX 78249, USA
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26
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Barć K, Szacka K, Nieporęcki K, de Carvalho M, Gromicho M, Grosskreutz J, Petri S, Rödiger A, Steinbach R, Uysal H, Kuźma-Kozakiewicz M. Emotional Lability at Disease Onset Is an Independent Prognostic Factor of Faster Disease Progression in Amyotrophic Lateral Sclerosis. Aging Dis 2020; 11:1021-1028. [PMID: 33014519 PMCID: PMC7505264 DOI: 10.14336/ad.2019.1120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/20/2019] [Indexed: 12/03/2022] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a fast progressing neurodegenerative disease leading to quadriplegia, anarthria and respiratory insufficiency. A large variety of phenotypes and disability progression requires individually tailored management. Identification of predictors of poor prognosis may not only improve management, but also allow for more precise patients’ stratification for clinical trials or research studies. The aim of the study was to investigate the influence of emotional lability present at disease onset on ALS progression by exploring its direct impact on the decay of the ALS Functional Rating Scale-Revised (ALSFRS-R). The study was performed in a group of 1145 patients from Germany, Poland, Portugal and Turkey between 2014 and 2018. The analysis showed that the presence of emotional lability at ALS onset was linked to a faster decline of ALSFRS-R (0.70 vs 0.50, p<0.0001), in case of either bulbar (0.80 vs 0.65, p<0.05) or limb disease onset (0.59 vs 0.46, p <0.01). It was most prominent in the bulbar subscore of ALSFRS-R. A multiple regression analysis showed a direct influence of emotional lability at ALS onset on disease progression, regardless of age, gender, site of onset, weight loss, cognitive impairment and diagnosis delay (β=0.071; p=0.019). It can therefore be concluded that the presence of emotional lability at the disease onset is an independent factor of faster disease progression in ALS.
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Affiliation(s)
- Krzysztof Barć
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Szacka
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland.,2Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Nieporęcki
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland
| | | | - Marta Gromicho
- 3Faculdade de Medicina-IMM, Universidade de Lisboa, Lisbon, Portugal
| | | | - Susanne Petri
- 5Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Robert Steinbach
- 4Hans-Berger Department of Neurology, Jena University Hospital, Germany
| | - Hilmi Uysal
- 6Department of Neurology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Magdalena Kuźma-Kozakiewicz
- 1Department of Neurology, University Clinical Centre of Medical University of Warsaw, Warsaw, Poland.,2Department of Neurology, Medical University of Warsaw, Warsaw, Poland.,7Neurodegenerative Diseases Research Group, Medical University of Warsaw, Warsaw, Poland
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27
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Klarendic M, Kaski D. Deep brain stimulation and eye movements. Eur J Neurosci 2020; 53:2344-2361. [DOI: 10.1111/ejn.14898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Maja Klarendic
- Neurological Department University Clinical Center Ljubljana Ljubljana Slovenia
| | - Diego Kaski
- Department of Clinical and Motor Neurosciences Centre for Vestibular and Behavioural Neurosciences University College London London UK
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28
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Klein C, Barron AB. How experimental neuroscientists can fix the hard problem of consciousness. Neurosci Conscious 2020; 2020:niaa009. [PMID: 32695476 PMCID: PMC7362610 DOI: 10.1093/nc/niaa009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/30/2020] [Accepted: 04/04/2020] [Indexed: 01/06/2023] Open
Abstract
For the materialist, the hard problem is fundamentally an explanatory problem. Solving it requires explaining why the relationship between brain and experience is the way it is and not some other way. We use the tools of the interventionist theory of explanation to show how a systematic experimental project could help move beyond the hard problem. Key to this project is the development of second-order interventions and invariant generalizations. Such interventions played a crucial scientific role in untangling other scientific mysteries, and we suggest that the same will be true of consciousness. We further suggest that the capacity for safe and reliable self-intervention will play a key role in overcoming both the hard and meta-problems of consciousness. Finally, we evaluate current strategies for intervention, with an eye to how they might be improved.
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Affiliation(s)
- Colin Klein
- School of Philosophy, The Australian National University, Canberra, ACT 0200, Australia
| | - Andrew B Barron
- Department of Biological Sciences, Macquarie University, North Ryde, NSW 2109, Australia
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Petry-Schmelzer JN, Krause M, Dembek TA, Horn A, Evans J, Ashkan K, Rizos A, Silverdale M, Schumacher W, Sack C, Loehrer PA, Fink GR, Fonoff ET, Martinez-Martin P, Antonini A, Barbe MT, Visser-Vandewalle V, Ray-Chaudhuri K, Timmermann L, Dafsari HS. Non-motor outcomes depend on location of neurostimulation in Parkinson's disease. Brain 2020; 142:3592-3604. [PMID: 31553039 DOI: 10.1093/brain/awz285] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/11/2019] [Accepted: 07/15/2019] [Indexed: 01/29/2023] Open
Abstract
Deep brain stimulation of the subthalamic nucleus is an effective and established therapy for patients with advanced Parkinson's disease improving quality of life, motor symptoms and non-motor symptoms. However, there is a considerable degree of interindividual variability for these outcomes, likely due to variability in electrode placement and stimulation settings. Here, we present probabilistic mapping data from a prospective, open-label, multicentre, international study to investigate the influence of the location of subthalamic nucleus deep brain stimulation on non-motor symptoms in patients with Parkinson's disease. A total of 91 Parkinson's disease patients undergoing bilateral deep brain stimulation of the subthalamic nucleus were included, and we investigated NMSScale, NMSQuestionnaire, Scales for Outcomes in Parkinson's disease-motor examination, -activities of daily living, and -motor complications, and Parkinson's disease Questionnaire-8 preoperatively and at 6-month follow-up after surgery. Leads were localized in standard space using the Lead-DBS toolbox and individual volumes of tissue activated were calculated based on clinical stimulation settings. Probabilistic stimulation maps and non-parametric permutation statistics were applied to identify voxels with significant above or below average improvement for each scale and analysed using the DISTAL atlas. All outcomes improved significantly at follow-up. Significant spatial distribution patterns of neurostimulation were observed for NMSScale total score and its mood/apathy and attention/memory domains. For both domains, voxels associated with below average improvement were mainly located dorsal to the subthalamic nucleus. In contrast, above average improvement for mood/apathy was observed in the ventral border region of the subthalamic nucleus and in its sensorimotor subregion and for attention/memory in the associative subregion. A trend was observed for NMSScale sleep domain showing voxels with above average improvement located ventral to the subthalamic nucleus. Our study provides evidence that the interindividual variability of mood/apathy, attention/memory, and sleep outcomes after subthalamic nucleus deep brain stimulation depends on the location of neurostimulation. This study highlights the importance of holistic assessments of motor and non-motor aspects of Parkinson's disease to tailor surgical targeting and stimulation parameter settings to patients' personal profiles.
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Affiliation(s)
- Jan Niklas Petry-Schmelzer
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Max Krause
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Till A Dembek
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Andreas Horn
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - Julian Evans
- Department of Neurology and Neurosurgery, Salford Royal Foundation Thrust, Greater Manchester, UK
| | - Keyoumars Ashkan
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Alexandra Rizos
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal Foundation Thrust, Greater Manchester, UK
| | - Wibke Schumacher
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Carolin Sack
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Philipp A Loehrer
- Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Gereon R Fink
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Erich T Fonoff
- Division of Functional Neurosurgery of Institute of Psychiatry, Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | - Angelo Antonini
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Michael T Barbe
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany
| | - Veerle Visser-Vandewalle
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Stereotaxy and Functional Neurosurgery, Cologne, Germany
| | - K Ray-Chaudhuri
- National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK.,The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, UK
| | - Lars Timmermann
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Haidar S Dafsari
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Neurology, Cologne, Germany.,National Parkinson Foundation Centre of Excellence, King's College Hospital, London, UK
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Wang J, Gong D, Zhang W, Zhang H, Wang S. Quantifying the influence of DBS surgery in patients with Parkinson's disease during perioperative period by wearable sensors. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:3311-3314. [PMID: 31946590 DOI: 10.1109/embc.2019.8856618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
It is a significant but ignored issue to quantify the influence of Deep Brain Stimulation (DBS) surgery in patients with Parkinson's disease during the whole perioperative period. In this paper, wearable sensors were utilized to record patients' motor changes in the time before surgery, after surgery with stimulation off and stimulation on. The results showed that the DBS surgery is effective and safe in the perioperative period.
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Irmen F, Horn A, Mosley P, Perry A, Petry-Schmelzer JN, Dafsari HS, Barbe M, Visser-Vandewalle V, Schneider GH, Li N, Kübler D, Wenzel G, Kühn AA. Left Prefrontal Connectivity Links Subthalamic Stimulation with Depressive Symptoms. Ann Neurol 2020; 87:962-975. [PMID: 32239535 DOI: 10.1002/ana.25734] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Subthalamic nucleus deep brain stimulation (STN-DBS) in Parkinson's disease (PD) not only stimulates focal target structures but also affects distributed brain networks. The impact this network modulation has on non-motor DBS effects is not well-characterized. By focusing on the affective domain, we systematically investigate the impact of electrode placement and associated structural connectivity on changes in depressive symptoms following STN-DBS, which have been reported to improve, worsen, or remain unchanged. METHODS Depressive symptoms before and after STN-DBS surgery were documented in 116 patients with PD from 3 DBS centers (Berlin, Queensland, and Cologne). Based on individual electrode reconstructions, the volumes of tissue activated (VTAs) were estimated and combined with normative connectome data to identify structural connections passing through VTAs. Berlin and Queensland cohorts formed a training and cross-validation dataset used to identify structural connectivity explaining change in depressive symptoms. The Cologne data served as the test-set for which depressive symptom change was predicted. RESULTS Structural connectivity was linked to depressive symptom change under STN-DBS. An optimal connectivity map trained on the Berlin cohort could predict changes in depressive symptoms in Queensland patients and vice versa. Furthermore, the joint training-set map predicted changes in depressive symptoms in the independent test-set. Worsening of depressive symptoms was associated with left prefrontal connectivity. INTERPRETATION Fibers connecting the electrode with left prefrontal areas were associated with worsening of depressive symptoms. Our results suggest that for the left STN-DBS lead, placement impacting fibers to left prefrontal areas should be avoided to maximize improvement of depressive symptoms. ANN NEUROL 2020;87:962-975.
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Affiliation(s)
- Friederike Irmen
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Biological Psychology and Cognitive Neuroscience, Freie Universität Berlin, Berlin, Germany
| | - Andreas Horn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Philip Mosley
- Systems Neuroscience Group, QIMR Berghofer Medical Research Institute, Herston, Australia.,Queensland Brain Institute, University of Queensland, St. Lucia, Australia
| | - Alistair Perry
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Max Planck Institute for Human Development, Berlin, Germany.,Center for Lifespan Psychology, Max Planck Institute for Human Development, Berlin, Germany
| | - Jan Niklas Petry-Schmelzer
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Haidar S Dafsari
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Michael Barbe
- Faculty of Medicine and University Hospital Cologne, Department of Neurology, University of Cologne, Cologne, Germany
| | - Veerle Visser-Vandewalle
- Department of Stereotactic and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Gerd-Helge Schneider
- Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ningfei Li
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Dorothee Kübler
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gregor Wenzel
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andrea A Kühn
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.,Deutsches Zentrum für Neurodegenerative Erkrankungen, Berlin, Germany
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32
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Long-term impact of subthalamic stimulation on cognitive function in patients with advanced Parkinson's disease. NEUROLOGÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.nrleng.2017.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Acera M, Molano A, Tijero B, Bilbao G, Lambarri I, Villoria R, Somme J, Ruiz de Gopegui E, Gabilondo I, Gomez-Esteban J. Impacto de la estimulación subtalámica a largo plazo sobre la situación cognitiva de los pacientes con enfermedad de Parkinson avanzada. Neurologia 2019; 34:573-581. [DOI: 10.1016/j.nrl.2017.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/26/2017] [Accepted: 05/11/2017] [Indexed: 11/28/2022] Open
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Milosevic L, Dallapiazza RF, Munhoz RP, Kalia SK, Popovic MR, Hutchison WD. Case Studies in Neuroscience: Lack of inhibitory synaptic plasticity in the substantia nigra pars reticulata of a patient with lithium-induced tremor. J Neurophysiol 2019; 122:1367-1372. [PMID: 31411948 DOI: 10.1152/jn.00203.2019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Tremor is a well-known side effect from many psychiatric medications, including lithium and dopamine antagonists. In patients whose psychiatric symptoms are stabilized and only respond to certain medications, deep brain stimulation may offer relief of the consequent motor complications. We report the case of an elderly male with disabling tremor related to lithium therapy for bipolar affective disorder, who was subsequently treated with deep brain stimulation. In this patient, we obtained recordings from the substantia nigra pars reticulata and performed a high-frequency stimulation protocol that robustly elicits long-term potentiation (LTP)-like changes in patients with Parkinson's disease. We hypothesized that in this patient, who did not have Parkinson's disease, the levels of inhibitory plasticity would be much greater. However, we found an unanticipated lack of plasticity in the patient with lithium-induced tremor, compared with two de novo control patients with Parkinson's disease. This patient was successfully treated with deep brain stimulation in the vicinity of the ventral oral posterior nucleus, an area of the thalamus that receives inputs from the basal ganglia. We postulate that the lithium-induced blockade of LTP may bring about motor complications such as tremor while simultaneously contributing to the therapeutic mechanism for treating the symptoms of psychiatric disorders such as bipolar affective disorder.NEW & NOTEWORTHY Use of a dual-microelectrode technique enabled us to compare long-term potentiation (LTP)-like changes in a patient with lithium-induced tremor to that of patients with Parkinson's disease. This study corroborated the findings in rodent brain slices that chronic lithium treatment may block LTP. Whereas a deficit in LTP may underlie the therapeutic mechanism for treating psychiatric disorders such as bipolar affective disorder, it may simultaneously contribute to consequent appearance of tremor.
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Affiliation(s)
- Luka Milosevic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Robert F Dallapiazza
- Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
| | - Renato P Munhoz
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Division of Neurosurgery, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada.,Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada
| | - Milos R Popovic
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.,KITE, Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - William D Hutchison
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Krembil Research Institute, Toronto, Ontario, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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35
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Berardelli I, Belvisi D, Pasquini M, Fabbrini A, Petrini F, Fabbrini G. Treatment of psychiatric disturbances in hypokinetic movement disorders. Expert Rev Neurother 2019; 19:965-981. [PMID: 31241368 DOI: 10.1080/14737175.2019.1636648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: We reviewed studies that assessed the treatment of psychiatric disturbances in Parkinson's disease and atypical parkinsonisms. Neuropsychiatric disturbances in these conditions are frequent and have a profound impact on quality of life of patients and of their caregivers. It is therefore important to be familiar with the appropriate pharmacological and non-pharmacological interventions for treating these disorders. Areas covered: The authors searched for papers in English in Pubmed using the following keywords: Parkinson's disease, multiple system atrophy, progressive supranuclear palsy, corticobasal degeneration, Lewy body dementia, depression, apathy, anxiety, fatigue, sleep disorders, obsessive compulsive disorders, psychosis, hallucinations, delusions, impulse control disorders. Expert opinion: In Parkinson's disease, depression may benefit from the optimization of dopaminergic therapy, from the use of antidepressants acting on both the serotoninergic and noradrenergic pathways and from cognitive behavioral therapy. Psychosis in Parkinson's disease may improve with the use of clozapine; the serotonin inverse agonist pimavanserin has been shown to be effective. Treatment of impulse control disorders is primarily based on the removal of dopamine agonists. No controlled studies have investigated the treatment of neuropsychiatric disorders in multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration. Acethylcholinesterase inhibitors may be used to treat hallucinations in Lewy body dementia.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome , Rome , Italy
| | | | - Massimo Pasquini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Andrea Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
| | - Federica Petrini
- Department of Neurosciences and Mental Health, Azienda Universitaria Policlinico Umberto I° , Rome , Italy
| | - Giovanni Fabbrini
- IRCCS Neuromed , Pozzilli , Italy.,Department of Human Neurosciences, Sapienza University of Rome , Rome , Italy
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36
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Accolla EA, Pollo C. Mood Effects After Deep Brain Stimulation for Parkinson's Disease: An Update. Front Neurol 2019; 10:617. [PMID: 31258509 PMCID: PMC6587122 DOI: 10.3389/fneur.2019.00617] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 05/28/2019] [Indexed: 11/23/2022] Open
Abstract
Depression in Parkinson's Disease (PD) is a prevalent and invalidating symptom. Deep brain stimulation (DBS) allows for an improvement of PD motor features, but its effects on mood are difficult to predict. Here, we review the evidence regarding mood effects after DBS of either subthalamic nucleus (STN) or globus pallidus pars interna (GPi). Different influences of multiple factors contribute to impact the neuropsychiatric outcome after surgery. Psychosocial presurgical situation, postsurgical coping mechanisms, dopaminergic treatment modifications, and direct effects of the stimulation of either target are all playing a distinct role on the psychological well-being of patients undergoing DBS. No clear advantage of either target (STN vs. GPi) has been consistently found, both being effective and with a favorable profile on depression symptoms. However, specific patients' characteristics or anatomical considerations can guide the neurosurgeon in the target choice. Further research together with technological advances are expected to confine the stimulation area within dysfunctional circuits causing motor symptoms of PD.
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Affiliation(s)
- Ettore A. Accolla
- Neurology Unit, Department of Medicine, HFR – Hôpital Cantonal Fribourg and Fribourg University, Fribourg, Switzerland
| | - Claudio Pollo
- Department of Neurosurgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Koeglsperger T, Palleis C, Hell F, Mehrkens JH, Bötzel K. Deep Brain Stimulation Programming for Movement Disorders: Current Concepts and Evidence-Based Strategies. Front Neurol 2019; 10:410. [PMID: 31231293 PMCID: PMC6558426 DOI: 10.3389/fneur.2019.00410] [Citation(s) in RCA: 114] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 04/04/2019] [Indexed: 11/16/2022] Open
Abstract
Deep brain stimulation (DBS) has become the treatment of choice for advanced stages of Parkinson's disease, medically intractable essential tremor, and complicated segmental and generalized dystonia. In addition to accurate electrode placement in the target area, effective programming of DBS devices is considered the most important factor for the individual outcome after DBS. Programming of the implanted pulse generator (IPG) is the only modifiable factor once DBS leads have been implanted and it becomes even more relevant in cases in which the electrodes are located at the border of the intended target structure and when side effects become challenging. At present, adjusting stimulation parameters depends to a large extent on personal experience. Based on a comprehensive literature search, we here summarize previous studies that examined the significance of distinct stimulation strategies for ameliorating disease signs and symptoms. We assess the effect of adjusting the stimulus amplitude (A), frequency (f), and pulse width (pw) on clinical symptoms and examine more recent techniques for modulating neuronal elements by electrical stimulation, such as interleaving (Medtronic®) or directional current steering (Boston Scientific®, Abbott®). We thus provide an evidence-based strategy for achieving the best clinical effect with different disorders and avoiding adverse effects in DBS of the subthalamic nucleus (STN), the ventro-intermedius nucleus (VIM), and the globus pallidus internus (GPi).
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Affiliation(s)
- Thomas Koeglsperger
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Carla Palleis
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Franz Hell
- Department of Neurology, Ludwig Maximilians University, Munich, Germany.,Graduate School of Systemic Neurosciences, Ludwig-Maximilians-Universität München, Martinsried, Germany
| | - Jan H Mehrkens
- Department of Neurosurgery, Ludwig Maximilians University, Munich, Germany
| | - Kai Bötzel
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
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Riva-Posse P, Inman CS, Choi KS, Crowell AL, Gross RE, Hamann S, Mayberg HS. Autonomic arousal elicited by subcallosal cingulate stimulation is explained by white matter connectivity. Brain Stimul 2019; 12:743-751. [DOI: 10.1016/j.brs.2019.01.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 12/11/2018] [Accepted: 01/22/2019] [Indexed: 12/30/2022] Open
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Schönfeld LM, Wojtecki L. Beyond Emotions: Oscillations of the Amygdala and Their Implications for Electrical Neuromodulation. Front Neurosci 2019; 13:366. [PMID: 31057358 PMCID: PMC6482269 DOI: 10.3389/fnins.2019.00366] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/01/2019] [Indexed: 01/18/2023] Open
Abstract
The amygdala is a structure involved in emotions, fear, learning and memory and is highly interconnected with other brain regions, for example the motor cortex and the basal ganglia that are often targets of treatments involving electrical stimulation. Deep brain stimulation of the basal ganglia is successfully used to treat movement disorders, but can carry along non-motor side effects. The origin of these non-motor side effects is not fully understood yet, but might be altered oscillatory communication between specific motor areas and the amygdala. Oscillations in various frequency bands have been detected in the amygdala during cognitive and emotional tasks, which can couple with oscillations in cortical regions or the hippocampus. However, data on oscillatory coupling between the amygdala and motor areas are still lacking. This review provides a summary of oscillation frequencies measured in the amygdala and their possible functional relevance in different species, followed by evidence for connectivity between the amygdala and motor areas, such as the basal ganglia and the motor cortex. We hypothesize that the amygdala could communicate with motor areas through coherence of low frequency bands in the theta-alpha range. Furthermore, we discuss a potential role of the amygdala in therapeutic approaches based on electrical stimulation.
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Affiliation(s)
- Lisa-Maria Schönfeld
- Comparative Psychology, Institute of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lars Wojtecki
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Movement Disorders and Neuromodulation, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Neurology and Neurorehabilitation, Hospital zum Heiligen Geist, Kempen, Germany
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40
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Deep brain stimulation in the obsessive-compulsive syndrome. CURRENT PROBLEMS OF PSYCHIATRY 2019. [DOI: 10.2478/cpp-2018-0022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction The authors present an overview of current views on the treatment of obsessive-compulsive disorder refractory to pharmacological and psychological treatment.
Aim: To review the mechanisms of stimulation of deep brain structures and to evaluate the effectiveness of therapy in obsessive-compulsive disorder.
Method: Review and analysis of the Polish and foreign scientific articles from the years 1999-2016.
Conclusions: According to the literature considered, in half of the examined patients there was an improvement of over 35% on the Y-BOCS scale, in some patients even a reduction of symptoms reaching 81-83% was described. Previous studies have been carried out on small groups of patients. Since 2009, the method of invasive treatment with deep brain stimulation of the obsessive-compulsive syndrome is registered in the EU. In spite of the above, additional studies are necessary on a larger group of patients in order to precisely estimate the effectiveness of the procedure and elaborate the criteria for qualifying patients for inclusion in the procedure.
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Ayobello A, Saway B, Greenage M. Attempted Suicide in a Parkinsonian Patient Treated with DBS of the VIM and High Dose Carbidopa-Levodopa. Case Rep Psychiatry 2019; 2019:2903762. [PMID: 31032135 PMCID: PMC6457313 DOI: 10.1155/2019/2903762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/17/2019] [Accepted: 03/11/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is a complex disease that is often treated with dopaminergic medications such as carbidopa-levodopa and now with innovative interventions such as deep brain stimulation (DBS). While PD frequently presents with depression and apathy, research must elucidate whether its treatment modalities have an additive or synergistic effect that can lead to an increased suicide risk. DBS has been associated with depression, behavioral changes, and suicidality while dopaminergic treatment has also been shown to cause behavioral changes such as hypersexuality and impulsivity. Considering the now frequent practice of utilizing both DBS and carbidopa-levodopa to treat PD, it is crucial to understand how to properly manage PD patients who are displaying this overlap in symptomology. CASE REPORT A 56-year-old Caucasian male with a 6-year diagnosis of PD who was being treated with high dose carbidopa-levodopa and left DBS of the ventral intermediate nucleus (VIM) presented after a suicide attempt. The patient was found to be severely depressed and had exhibited behavioral changes in the weeks leading up to the attempt. Imaging was performed to assess positional changes of DBS and carbidopa-levodopa dosage adjusted while under close observation in the inpatient unit. The patient was started on fluoxetine to treat the depressive symptoms and was eventually discharged with close monitoring. DISCUSSION With PD and DBS being associated with behavioral changes and depressive symptoms and carbidopa-levodopa therapy being linked to behavioral changes such as impulsivity, it is important that these patients be closely monitored and research analyzes how these factors may interact and lead to an increased risk of suicide. Furthermore, when symptoms appear, a clear protocol must be established on managing these patients. We therefore recommend an approach that utilizes imaging to assess any changes in DBS placement, dose management of carbidopa-levodopa, and behavior monitoring in an inpatient setting.
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Affiliation(s)
- Ayotunde Ayobello
- Virginia Tech Carilion School of Medicine and Research Institute, USA
| | - Brian Saway
- Virginia Tech Carilion School of Medicine and Research Institute, USA
| | - Michael Greenage
- Virginia Tech Carilion School of Medicine and Research Institute, USA
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Eisinger RS, Ramirez-Zamora A, Carbunaru S, Ptak B, Peng-Chen Z, Okun MS, Gunduz A. Medications, Deep Brain Stimulation, and Other Factors Influencing Impulse Control Disorders in Parkinson's Disease. Front Neurol 2019; 10:86. [PMID: 30863353 PMCID: PMC6399407 DOI: 10.3389/fneur.2019.00086] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/22/2019] [Indexed: 12/18/2022] Open
Abstract
Impulse control disorders (ICDs) in Parkinson's disease (PD) have a high cumulative incidence and negatively impact quality of life. ICDs are influenced by a complex interaction of multiple factors. Although it is now well-recognized that dopaminergic treatments and especially dopamine agonists underpin many ICDs, medications alone are not the sole cause. Susceptibility to ICD is increased in the setting of PD. While causality can be challenging to ascertain, a wide range of modifiable and non-modifiable risk factors have been linked to ICDs. Common characteristics of PD patients with ICDs have been consistently identified across many studies; for example, males with an early age of PD onset and dopamine agonist use have a higher risk of ICD. However, not all cases of ICDs in PD can be directly attributable to dopamine, and studies have concluded that additional factors such as genetics, smoking, and/or depression may be more predictive. Beyond dopamine, other ICD associations have been described but remain difficult to explain, including deep brain stimulation surgery, especially in the setting of a reduction in dopaminergic medication use. In this review, we will summarize the demographic, genetic, behavioral, and clinical contributions potentially influencing ICD onset in PD. These associations may inspire future preventative or therapeutic strategies.
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Affiliation(s)
- Robert S. Eisinger
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Adolfo Ramirez-Zamora
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Samuel Carbunaru
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Brandon Ptak
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
| | - Zhongxing Peng-Chen
- Hospital Padre Hurtado, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Michael S. Okun
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Neurology, Fixel Center for Neurological Diseases, University of Florida, Gainesville, FL, United States
| | - Aysegul Gunduz
- Department of Neuroscience, University of Florida, Gainesville, FL, United States
- Department of Biomedical Engineering, University of Florida, Gainesville, FL, United States
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Lhommée E, Wojtecki L, Czernecki V, Witt K, Maier F, Tonder L, Timmermann L, Hälbig TD, Pineau F, Durif F, Witjas T, Pinsker M, Mehdorn M, Sixel-Döring F, Kupsch A, Krüger R, Elben S, Chabardès S, Thobois S, Brefel-Courbon C, Ory-Magne F, Regis JM, Maltête D, Sauvaget A, Rau J, Schnitzler A, Schüpbach M, Schade-Brittinger C, Deuschl G, Houeto JL, Krack P. Behavioural outcomes of subthalamic stimulation and medical therapy versus medical therapy alone for Parkinson's disease with early motor complications (EARLYSTIM trial): secondary analysis of an open-label randomised trial. Lancet Neurol 2019; 17:223-231. [PMID: 29452685 DOI: 10.1016/s1474-4422(18)30035-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 12/05/2017] [Accepted: 12/06/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND Although subthalamic stimulation is a recognised treatment for motor complications in Parkinson's disease, reports on behavioural outcomes are controversial, which represents a major challenge when counselling candidates for subthalamic stimulation. We aimed to assess changes in behaviour in patients with Parkinson's disease receiving combined treatment with subthalamic stimulation and medical therapy over a 2-year follow-up period as compared with the behavioural evolution under medical therapy alone. METHODS We did a parallel, open-label study (EARLYSTIM) at 17 surgical centres in France (n=8) and Germany (n=9). We recruited patients with Parkinson's disease who were disabled by early motor complications. Participants were randomly allocated (1:1) to either medical therapy alone or bilateral subthalamic stimulation plus medical therapy. The primary outcome was mean change in quality of life from baseline to 2 years. A secondary analysis was also done to assess behavioural outcomes. We used the Ardouin Scale of Behavior in Parkinson's Disease to assess changes in behaviour between baseline and 2-year follow-up. Apathy was also measured using the Starkstein Apathy Scale, and depression was assessed with the Beck Depression Inventory. The secondary analysis was done in all patients recruited. We used a generalised estimating equations (GEE) regression model for individual items and mixed model regression for subscores of the Ardouin scale and the apathy and depression scales. This trial is registered with ClinicalTrials.gov, number NCT00354133. The primary analysis has been reported elsewhere; this report presents the secondary analysis only. FINDINGS Between July, 2006, and November, 2009, 251 participants were recruited, of whom 127 were allocated medical therapy alone and 124 were assigned bilateral subthalamic stimulation plus medical therapy. At 2-year follow-up, the levodopa-equivalent dose was reduced by 39% (-363·3 mg/day [SE 41·8]) in individuals allocated bilateral subthalamic stimulation plus medical therapy and was increased by 21% (245·8 mg/day [40·4]) in those assigned medical therapy alone (p<0·0001). Neuropsychiatric fluctuations decreased with bilateral subthalamic stimulation plus medical therapy during 2-year follow-up (mean change -0·65 points [SE 0·15]) and did not change with medical therapy alone (-0·02 points [0·15]); the between-group difference in change from baseline was significant (p=0·0028). At 2 years, the Ardouin scale subscore for hyperdopaminergic behavioural disorders had decreased with bilateral subthalamic stimulation plus medical therapy (mean change -1·26 points [SE 0·35]) and had increased with medical therapy alone (1·12 points [0·35]); the between-group difference was significant (p<0·0001). Mean change from baseline at 2 years in the Ardouin scale subscore for hypodopaminergic behavioural disorders, the Starkstein Apathy Scale score, and the Beck Depression Inventory score did not differ between treatment groups. Antidepressants were stopped in 12 patients assigned bilateral subthalamic stimulation plus medical therapy versus four patients allocated medical therapy alone. Neuroleptics were started in nine patients assigned medical therapy alone versus one patient allocated bilateral subthalamic stimulation plus medical therapy. During the 2-year follow-up, two individuals assigned bilateral subthalamic stimulation plus medical therapy and one patient allocated medical therapy alone died by suicide. INTERPRETATION In a large cohort with Parkinson's disease and early motor complications, better overall behavioural outcomes were noted with bilateral subthalamic stimulation plus medical therapy compared with medical therapy alone. The presence of hyperdopaminergic behaviours and neuropsychiatric fluctuations can be judged additional arguments in favour of subthalamic stimulation if surgery is considered for disabling motor complications. FUNDING German Federal Ministry of Education and Research, French Programme Hospitalier de Recherche Clinique National, and Medtronic.
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Affiliation(s)
- Eugénie Lhommée
- Movement Disorder Unit, Neurology Department, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France
| | - Lars Wojtecki
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Virginie Czernecki
- Sorbonne University, Pierre and Marie Curie University Paris 6, Paris, France; Brain and Spine Institute, Paris, France; Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Karsten Witt
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Franziska Maier
- Department of Neurology, University of Cologne, Cologne, Germany
| | | | - Lars Timmermann
- Department of Neurology, University of Cologne, Cologne, Germany; Department of Neurology, Philipps University of Marburg, Marburg, Germany
| | - Thomas D Hälbig
- NeuroCure Clinical Research Center (NCRC), Charité University Medical Center, Charité (Campus Mitte), Berlin, Germany
| | - Fanny Pineau
- Sorbonne University, Pierre and Marie Curie University Paris 6, Paris, France; Brain and Spine Institute, Paris, France; Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France
| | - Franck Durif
- Service de Neurologie, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Tatiana Witjas
- Neurology, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marcus Pinsker
- Department of Neurosurgery, University Hospital, Freiburg, Germany
| | - Maximilian Mehdorn
- Department of Neurosurgery, Universitätsklinikum Schlsewig-Holstein, Kiel, Germany
| | - Friederike Sixel-Döring
- Department of Neurology, Philipps University of Marburg, Marburg, Germany; Paracelsus-Elena-Klinik, Kassel, Germany
| | - Andreas Kupsch
- Department of Neurology and Stereotactic Neurosurgery, University of Magdeburg, and Neurology Moves, Medical Center Bismarck Karrée, Berlin, Germany
| | - Rejko Krüger
- Center of Neurology, and Hertie Institute for Clinical Brain Research, University Hospital, Tübingen, Germany; Luxembourg Centre for Systems Biology, University of Luxembourg, Luxembourg City, Luxembourg; Department of Neurology, Centre Hospitalier de Luxembourg, Luxembourg City, Luxembourg
| | - Saskia Elben
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Stephan Chabardès
- Department of Neurosurgery, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France
| | - Stéphane Thobois
- Movement Disorder Unit, Neurologie C, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Centre National de la Recherche Scientifique (CNRS), Institut des Sciences Cognitives, Centre de Neurosciences Cognitives, Bron, France; Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Christine Brefel-Courbon
- Neurology Department and Centre Expert Parkinson, University Hospital Toulouse, Toulouse France; INSERM Toulouse NeuroImaging Centre, Toulouse France
| | - Fabienne Ory-Magne
- Neurology Department and Centre Expert Parkinson, University Hospital Toulouse, Toulouse France; INSERM Toulouse NeuroImaging Centre, Toulouse France
| | - Jean-Marie Regis
- Department of Functional Neurosurgery, Assistance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - David Maltête
- Department of Neurology, Rouen University Hospital, INSERM U1073, Rouen Faculty of Medicine, Rouen, France
| | - Anne Sauvaget
- Addictology and Liaison-Psychiatry Department, CIC 0004, CHU de Nantes, Hôtel Dieu, Nantes, France
| | - Jörn Rau
- Coordinating Centre for Clinical Trials of the Philipps-University of Marburg, Marburg, Germany
| | - Alfons Schnitzler
- Department of Neurology and Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Michael Schüpbach
- Neurology Department, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris (APHP), INSERM, Institut du Cerveau et de la Moelle Epinière, and Centre d'Investigation Clinique (CIC) 1422, Paris, France; Department of Neurology, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | | | - Gunther Deuschl
- Department of Neurology, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Jean-Luc Houeto
- Department of Neurology, CIC-INSERM 1402, CHU de Poitiers; Université de Poitiers, Poitiers, France
| | - Paul Krack
- Movement Disorder Unit, Neurology Department, Centre Hospitalier Universitaire (CHU) Grenoble Alpes, University Grenoble Alpes, Grenoble Institut des Neurosciences (GIN), and Institut National de Santé et en Recherche Médicale (INSERM) U1216, Grenoble, France; Department of Clinical Neurosciences (Neurology), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Antonini A, Obeso JA. DBS for Parkinson's disease with behavioural disturbances. Lancet Neurol 2019; 17:195-197. [PMID: 29452675 DOI: 10.1016/s1474-4422(18)30044-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Angelo Antonini
- Department of Neuroscience, University of Padua, Padua 35128, Italy.
| | - Jose A Obeso
- CINAC, HM Puerta del Sur, Hospitales de Madrid, Mostoles Medical School, CEU-San Pablo University, Madrid, Spain
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Affective modulation of the associative-limbic subthalamic nucleus: deep brain stimulation in obsessive-compulsive disorder. Transl Psychiatry 2019; 9:73. [PMID: 30718450 PMCID: PMC6361948 DOI: 10.1038/s41398-019-0404-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 09/23/2018] [Accepted: 01/01/2019] [Indexed: 12/11/2022] Open
Abstract
Affective states underlie daily decision-making and pathological behaviours relevant to obsessive-compulsive disorders (OCD), mood disorders and addictions. Deep brain stimulation targeting the motor and associative-limbic subthalamic nucleus (STN) has been shown to be effective for Parkinson's disease (PD) and OCD, respectively. Cognitive and electrophysiological studies in PD showed responses of the motor STN to emotional stimuli, impairments in recognition of negative affective states and modulation of the intensity of subjective emotion. Here we studied whether the stimulation of the associative-limbic STN in OCD influences the subjective emotion to low-intensity positive and negative images and how this relates to clinical symptoms. We assessed 10 OCD patients with on and off STN DBS in a double-blind randomized manner by recording ratings of valence and arousal to low- and high-intensity positive and negative emotional images. STN stimulation increased positive ratings and decreased negative ratings to low-intensity positive and negative stimuli, respectively, relative to off stimulation. We also show that the change in severity of obsessive-compulsive symptoms pre- versus post-operatively interacts with both DBS and valence ratings. We show that stimulation of the associative-limbic STN might influence the negative cognitive bias in OCD and decreasing the negative appraisal of emotional stimuli with a possible relationship with clinical outcomes. That the effect is specific to low intensity might suggest a role of uncertainty or conflict related to competing interpretations of image intensity. These findings may have implications for the therapeutic efficacy of DBS.
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Blomstedt P, Stenmark Persson R, Hariz GM, Linder J, Fredricks A, Häggström B, Philipsson J, Forsgren L, Hariz M. Deep brain stimulation in the caudal zona incerta versus best medical treatment in patients with Parkinson's disease: a randomised blinded evaluation. J Neurol Neurosurg Psychiatry 2018; 89:710-716. [PMID: 29386253 PMCID: PMC6031280 DOI: 10.1136/jnnp-2017-317219] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 11/29/2017] [Accepted: 01/09/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Several open-label studies have shown good effect of deep brain stimulation (DBS) in the caudal zona incerta (cZi) on tremor, including parkinsonian tremor, and in some cases also a benefit on akinesia and axial symptoms. The aim of this study was to evaluate objectively the effect of cZi DBS in patients with Parkinson's disease (PD). METHOD 25 patients with PD were randomised to either cZi DBS or best medical treatment. The primary outcomes were differences between the groups in the motor scores of the Unified Parkinson's Disease Rating Scale (UPDRS-III) rated single-blindly at 6 months and differences in the Parkinson's Disease Questionnaire 39 items (PDQ-39). 19 patients, 10 in the medical arm and 9 in the DBS arm, fulfilled the study. RESULTS The DBS group had 41% better UPDRS-III scores off-medication on-stimulation compared with baseline, whereas the scores of the non-surgical patients off-medication were unchanged. In the on-medication condition, there were no differences between the groups, neither at baseline nor at 6 months. Subitems of the UPDRS-III showed a robust effect of cZi DBS on tremor. The PDQ-39 domains 'stigma' and 'ADL' improved only in the DBS group. The PDQ-39 summary index improved in both groups. CONCLUSION This is the first randomised blinded evaluation of cZi DBS showing its efficacy on PD symptoms. The most striking effect was on tremor; however, the doses of dopaminergic medications could not be decreased. cZi DBS in PD may be an addition to existing established targets, enabling tailoring the surgery to the needs of the individual patient.
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Affiliation(s)
- Patric Blomstedt
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | | | - Gun-Marie Hariz
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.,Unit of Occupational Therapy, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden
| | - Jan Linder
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Anna Fredricks
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Björn Häggström
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Johanna Philipsson
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Lars Forsgren
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden
| | - Marwan Hariz
- Department of Pharmacology and Clinical Neuroscience, Umeå University, Umeå, Sweden.,Unit of Functional Neurosurgery, UCL Institute of Neurology, London, UK
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Acute and reversible crying following deep brain stimulation targeting the globus pallidus interna in dystonia. J Neurol Sci 2018; 388:76-78. [DOI: 10.1016/j.jns.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/24/2018] [Accepted: 03/03/2018] [Indexed: 11/19/2022]
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Artigas F, Bortolozzi A, Celada P. Can we increase speed and efficacy of antidepressant treatments? Part I: General aspects and monoamine-based strategies. Eur Neuropsychopharmacol 2018; 28:445-456. [PMID: 29174531 DOI: 10.1016/j.euroneuro.2017.10.032] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 07/03/2017] [Accepted: 10/22/2017] [Indexed: 12/21/2022]
Abstract
Major depressive disorder (MDD) is a severe psychiatric syndrome with high prevalence and socioeconomic impact. Current antidepressant treatments are based on the blockade of serotonin (5-hydroxytryptamine, 5-HT) and/or noradrenaline transporters. These drugs show slow onset of clinical action and limited efficacy, partly due to the activation of physiological negative feed-back mechanisms operating through autoreceptors (5-HT1A, 5-HT1B, α2-adrenoceptors) and postsynaptic receptors (e.g., 5-HT3). As a result, clinically-relevant doses of reuptake inhibitors increase extracellular (active) 5-HT concentrations in the midbrain raphe nuclei but not in forebrain, as indicated by rodent microdialysis studies and by PET-scan studies in primate/human brain. The prevention of these self-inhibitory mechanisms by antagonists of the above receptors augments preclinical and clinical antidepressant effects. Hence, the mixed ß-adrenoceptor/5-HT1A antagonist pindolol accelerated, and in some cases enhanced, the clinical action of selective serotonin reuptake inhibitors (SSRI). This strategy has been incorporated into two new multi-target antidepressant drugs, vilazodone and vortioxetine, which combine 5-HT reuptake inhibition and partial agonism at 5-HT1A receptors. Vortioxetine shows also high affinity for other 5-HT receptors, including excitatory 5-HT3 receptors located in cortical and hippocampal GABA interneurons. 5-HT3 receptor blockade by vortioxetine enhances pyramidal neuron activity in prefrontal cortex as well as cortical and hippocampal 5-HT release. It is still too soon to know whether these new antidepressants will represent a real advance over existing drugs in the real world. However, their development opened the way to future antidepressant drugs based on the prevention of local and distal self-inhibitory mechanisms attenuating monoamine activity.
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Affiliation(s)
- Francesc Artigas
- Department of Neurochemistry and Neuropharmacology, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (CSIC), Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain.
| | - Analia Bortolozzi
- Department of Neurochemistry and Neuropharmacology, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (CSIC), Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
| | - Pau Celada
- Department of Neurochemistry and Neuropharmacology, Institut d'Investigacions Biomèdiques de Barcelona, Consejo Superior de Investigaciones Científicas (CSIC), Spain; CIBERSAM (Centro de Investigación Biomédica en Red de Salud Mental), Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Spain
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Dafsari HS, Petry-Schmelzer JN, Ray-Chaudhuri K, Ashkan K, Weis L, Dembek TA, Samuel M, Rizos A, Silverdale M, Barbe MT, Fink GR, Evans J, Martinez-Martin P, Antonini A, Visser-Vandewalle V, Timmermann L. Non-motor outcomes of subthalamic stimulation in Parkinson's disease depend on location of active contacts. Brain Stimul 2018; 11:904-912. [PMID: 29655586 DOI: 10.1016/j.brs.2018.03.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/06/2018] [Accepted: 03/12/2018] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Subthalamic nucleus (STN) deep brain stimulation (DBS) improves quality of life (QoL), motor, and non-motor symptoms (NMS) in Parkinson's disease (PD). Few studies have investigated the influence of the location of neurostimulation on NMS. OBJECTIVE To investigate the impact of active contact location on NMS in STN-DBS in PD. METHODS In this prospective, open-label, multicenter study including 50 PD patients undergoing bilateral STN-DBS, we collected NMSScale (NMSS), NMSQuestionnaire (NMSQ), Hospital Anxiety and Depression Scale (anxiety/depression, HADS-A/-D), PDQuestionnaire-8 (PDQ-8), Scales for Outcomes in PD-motor examination, motor complications, activities of daily living (ADL), and levodopa equivalent daily dose (LEDD) preoperatively and at 6 months follow-up. Changes were analyzed with Wilcoxon signed-rank/t-test and Bonferroni-correction for multiple comparisons. Although the STN was targeted visually, we employed an atlas-based approach to explore the relationship between active contact locations and DBS outcomes. Based on fused MRI/CT-images, we identified Cartesian coordinates of active contacts with patient-specific Mai-atlas standardization. We computed linear mixed-effects models with x-/y-/z-coordinates as independent, hemispheres as within-subject, and test change scores as dependent variables. RESULTS NMSS, NMSQ, PDQ-8, motor examination, complications, and LEDD significantly improved at follow-up. Linear mixed-effect models showed that NMS and QoL improvement significantly depended on more medial (HADS-D, NMSS), anterior (HADS-D, NMSQ, PDQ-8), and ventral (HADS-A/-D, NMSS, PDQ-8) neurostimulation. ADL improved more in posterior, LEDD in lateral neurostimulation locations. No relationship was observed for motor examination and complications scores. CONCLUSIONS Our study provides evidence that more anterior, medial, and ventral STN-DBS is significantly related to more beneficial non-motor outcomes.
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Affiliation(s)
- Haidar Salimi Dafsari
- Department of Neurology, University Hospital Cologne, Cologne, Germany; National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom.
| | | | - K Ray-Chaudhuri
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom; The Maurice Wohl Clinical Neuroscience Institute, King's College London, London, United Kingdom
| | - Keyoumars Ashkan
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Luca Weis
- Department of Neurology, IRCCS, San Camillo, Venice, Italy
| | - Till A Dembek
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Michael Samuel
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Alexandra Rizos
- National Parkinson Foundation International Centre of Excellence, King's College Hospital, London, United Kingdom
| | - Monty Silverdale
- Department of Neurology and Neurosurgery, Salford Royal Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Greater Manchester, United Kingdom
| | - Michael T Barbe
- Department of Neurology, University Hospital Cologne, Cologne, Germany
| | - Gereon R Fink
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Jülich, Jülich, Germany
| | - Julian Evans
- Department of Neurology, IRCCS, San Camillo, Venice, Italy
| | - Pablo Martinez-Martin
- National Center of Epidemiology and CIBERNED, Carlos III Institute of Health, Madrid, Spain
| | | | - Veerle Visser-Vandewalle
- Department of Stereotaxy and Functional Neurosurgery, University Hospital Cologne, Cologne, Germany
| | - Lars Timmermann
- Department of Neurology, University Hospital Cologne, Cologne, Germany; Department of Neurology, University Hospital Giessen and Marburg, Campus Marburg, Germany
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Sharma S, Kumar P, Deshmukh R. Neuroprotective potential of spermidine against rotenone induced Parkinson's disease in rats. Neurochem Int 2018; 116:104-111. [PMID: 29501454 DOI: 10.1016/j.neuint.2018.02.010] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/21/2018] [Accepted: 02/27/2018] [Indexed: 12/13/2022]
Abstract
Parkinson's disease is a leading hypokinetic disorder characterized by selective loss of dopaminergic neurons in substantia nigra pars compacta (SNpc) region of mid-brain. Degeneration of dopaminergic neurons is considered to be due to oxidative stress, neuroinflammation, disturbed calcium homeostasis and glutamate excitotoxicity etc. Spermidine is a polyamine which counteracts age associated cell death by scavenging free radical formation, activates authophagic machinery by enhancing formation of autophagosome, and antagonizes NMDA receptor. In the current study we investigated the neuroprotective potential of spermidine against rotenone induced PD in rats. Rats were treated subcutaneously with rotenone 1.5 mg/kg daily for 28 days. Spermidine 5&10 mg/kg was administered orally 1 h prior to rotenone administration from 15 to 28. Rotenone caused significant reduction in motor functioning and elevated levels of oxidative stress markers and proinflammatory cytokines levels (IL-1β, IL6 and TNF-α). The neurochemical analysis revealed a significant decrease in serotonin, norepinephrine, dopamine and their metabolites accompanied by a significant loss of dopaminergic neurons in the SNpc following ROT injection. However, treatment with spermidine rescued DAergic neurons in SNpc and nerve terminals in the striatum following ROT insult. Spermidine treatment also attenuated oxidative stress, neuroinflammation and restored striatal neurochemistry. Results of our study suggest that spermidine has promising neuroprotective effect against degenerative changes in experimental PD, and the protective effects are mediated through its antioxidant and anti-inflammatory properties.
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Affiliation(s)
- Sunaina Sharma
- Neuropharmacology Division, Department of Pharmacology, I.S.F. College of Pharmacy, Moga 142001, Punjab, India
| | - Puneet Kumar
- Department of Pharmaceutical Sciences & Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda 151001, Punjab, India
| | - Rahul Deshmukh
- Department of Pharmaceutical Sciences & Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda 151001, Punjab, India.
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