Firing patterns of pallidal cells in parkinsonian patients correlate with their pre-pallidotomy clinical scores

The external globus pallidus: progress and perspectives

The external globus pallidus (GPe) of the basal ganglia is in a unique and powerful position to influence processing of motor information by virtue of its widespread projections to all basal ganglia nuclei. Despite the clinical importance of the GPe in common motor disorders such as Parkinson's disease, there is only limited information about its cellular composition and organizational principles. In this review, recent advances in the understanding of the diversity in the molecular profile, anatomy, physiology and corresponding behaviour during movement of GPe neurons are described. Importantly, this study attempts to build consensus and highlight commonalities of the cellular classification based on existing but contentious literature. Additionally, an analysis of the literature concerning the intricate reciprocal loops formed between the GPe and major synaptic partners, including both the striatum and the subthalamic nucleus, is provided. In conclusion, the GPe has emerged as a crucial node in the basal ganglia macrocircuit. While subtleties in the cellular makeup and synaptic connection of the GPe create new challenges, modern research tools have shown promise in untangling such complexity, and will provide better understanding of the roles of the GPe in encoding movements and their associated pathologies.

Anticataleptic effects of 5-HT(1B) receptors in the globus pallidus

The globus pallidus occupies an important position in the indirect pathway of the basal ganglia. Being a monoamine neurotransmitter, 5-HT is involved in mediating many physiological functions and pathophysiological processes in several movement disorders. Morphological studies have revealed that the globus pallidus receives serotonergic innervation arising from the raphe nuclei, mainly the dorsal raphe nucleus. A high level of 5-HT and 5-HT(1B) receptors were detected in the globus pallidus. In the present study, bilateral microinjection of 5-HT or 5-HT(1B) receptor agonist, CP-93129, into the globus pallidus significantly alleviated the symptoms of rigidity caused by haloperidol. To further elucidate 5-HT(1B) receptor-induced anticatalepsy, in vivo extracellular recordings were performed to examine the effects of 5-HT(1B) receptor activation on the firing activity of the globus pallidus neurons under the presence of haloperidol. Micro-pressure ejection of 5-HT or CP-93129 increased the spontaneous firing rate of the pallidal neurons. Furthermore, by using immunohistochemistry, positive staining of 5-HT(1B) receptor was observed in the globus pallidus neurons. Taken together, the present findings provide evidence that activation of 5-HT(1B) receptor may exert anticataleptic effects by increasing the activity of pallidal neurons.

Modulation of firing activity by endogenous GABAA receptors in the globus pallidus of MPTP-treated parkinsonian mice

The globus pallidus in rodents, equivalent to the external segment of the globus pallidus in primates, plays an important role in movement regulation. Previous studies have shown abundant γ-aminobutyric acid (GABA)ergic innervation and GABAA receptors in the globus pallidus. In this study, we investigated the effects of endogenous GABAA receptors on the spontaneous firing activity of pallidal neurons in both normal and MPTP-treated mice using multi-barrel electrodes extracellular recordings in vivo. We found that in normal mice, pressure ejection of 0.1 mmol/L gabazine, a specific GABAA receptor antagonist, increased the spontaneous firing rate of globus pallidus neurons by 27.6 ± 5.6%. Furthermore, in MPTP mice (14 days after MPTP treatment), 0.1 mmol/L gabazine increased the firing rates by 51.0 ± 7.9%, significantly greater than in normal mice. These results suggest that endogenous GABAA receptors modulate the activity of globus pallidus neurons. The present findings may provide a rationale for investigations into the potential role of GABAA receptors in Parkinson's disease.

Striatal input- and rate-dependent effects of muscarinic receptors on pallidal firing

The globus pallidus (GP) plays a key role in the overall basal ganglia (BG) activity. Despite evidence of cholinergic inputs to GP, their role in the spiking activity of GP neurons has not received attention. We examine the effect of local activation and blockade of muscarinic receptors (MRs) in the spontaneous firing of GP neurons both in normal and ipsilateral striatum-lesioned rats. We found that activation of MRs produces heterogeneous responses in both normal and ipsilateral striatum-lesioned rats: in normal rats the response evoked by MRs depends on the predrug basal firing rate; the inhibition evoked by MRs is higher in normal rats than in striatum-lesioned rats; the number of neurons that undergo inhibition is lower in striatum-lesioned rats than in normal rats. Our data suggest that modulation of MRs in the GP depends on the firing rate before their activation and on the integrity of the striato-pallidal pathway.

Effects of pallidal neurotensin on haloperidol-induced parkinsonian catalepsy: behavioral and electrophysiological studies

OBJECTIVE

The globus pallidus plays a critical role in movement regulation. Previous studies have indicated that the globus pallidus receives neurotensinergic innervation from the striatum, and systemic administration of a neurotensin analog could produce antiparkinsonian effects. The present study aimed to investigate the effects of pallidal neurotensin on haloperidol-induced parkinsonian symptoms.

METHODS

Behavioral experiments and electrophysiological recordings were performed in the present study.

RESULTS

Bilateral infusions of neurotensin into the globus pallidus reversed haloperidol-induced parkinsonian catalepsy in rats. Electrophysiological recordings showed that microinjection of neurotensin induced excitation of pallidal neurons in the presence of systemic haloperidol administration. The neurotensin type-1 receptor antagonist SR48692 blocked both the behavioral and the electrophysiological effects induced by neurotensin.

CONCLUSION

Activation of pallidal neurotensin receptors may be involved in neurotensin-induced antiparkinsonian effects.

Effects of Pharmacological Block of GABA(A) Receptors on Pallidal Neurons in Normal and Parkinsonian State

The globus pallidus plays a central integrative role in the basal ganglia circuitry. Morphological studies have revealed a high level of GABA and GABA_A receptors in the globus pallidus. To further investigate the effects of endogenous GABA_A neurotransmission in the globus pallidus of normal and parkinsonian rats, in vivo extracellular recording and behavioral tests were performed in the present studies. In normal rats, micro-pressure ejection of GABA_A receptor antagonist gabazine (0.1 mM) increased the spontaneous firing rate of pallidal neurons by 28.3%. Furthermore, in 6-hydroxydopamine parkinsonian rats, gabazine increased the firing rate by 46.0% on the lesioned side, which was significantly greater than that on the unlesioned side (21.5%, P < 0.05), as well as that in normal rats (P < 0.05). In the behaving rats, unilateral microinjection of gabazine (0.1 mM) evoked consistent contralateral rotation in normal rats, and significantly potentiated the number of apomorphine-induced contralateral rotations in parkinsonian rats. The present electrophysiological and behavioral findings may provide a rational for further investigations into the potential of pallidal endogenous GABA_A neurotransmission in the treatment of Parkinson's disease.

Substance P excites globus pallidus neurons in vivo

Substance P is a member of the neurokinin family. Previous studies have reported the existence of substance P and its high-affinity receptor, neurokinin-1 receptor, in globus pallidus. Employing in vivo extracellular recording combined with behavioural tests, the effects of substance P in globus pallidus of rats were studied. Micropressure ejection of the selective neurokinin-1 receptor agonist [Sar9,Met(O2)11] substance P increased the spontaneous firing rate of pallidal neurons in a concentration-dependent manner, with increases of 27.3% at 0.01, 33.4% at 0.03, 45.5% at 0.1, 38.4% at 0.3 and 36.4% at 1.0 mm. The selective neurokinin-1 receptor antagonist SR140333B prevented the excitatory effects induced by [Sar9,Met(O2)11] substance P. In behaving rats, we observed the postural effects of neurokinin-1 receptor activation in the globus pallidus. Consistent with electrophysiological results, unilateral microinjection of [Sar9,Met(O2)11] substance P (0.1 mm) led to a SR140333B-sensitive contralateral deflection in the presence of systemic haloperidol administration. Combining electrophysiological and behavioural findings, we concluded that substance P produces excitatory effects on globus pallidus neurons via neurokinin-1 receptors.

Zinc modulates GABAergic neurotransmission in rat globus pallidus

The globus pallidus plays a critical role in the regulation of movement, and abnormal activity of its neurons is associated with some basal ganglia motor diseases. A relatively high level of zinc has been reported in the globus pallidus, which is increased significantly after 6-OHDA treatments. To elucidate the action of zinc on GABAergic neurotransmission in the globus pallidus, whole-cell patch-clamp recordings were made from rat globus pallidus neurons. Superfusion of zinc significantly reduced both spontaneous and miniature inhibitory postsynaptic currents. The inhibition was selective to the amplitude with no change in the frequency, decay time and rise time. Furthermore, the reduction of spontaneous inhibitory postsynaptic currents (34.1+/-4.0%) was stronger than that of miniature inhibitory postsynaptic currents (19.7+/-3.2%). These results suggest that spontaneous inhibitory postsynaptic currents generated mainly by axonal collaterals and miniature inhibitory postsynaptic currents generated mainly by striatopallidal inputs may be mediated by different GABA(A) receptor combinations.

Striatal information signaling and integration in globus pallidus: timing matters

Advances in research on globus pallidus (GP) suggest that this 'long thought to be' relay in the 'indirect pathway' plays a unique and critical role in basal ganglia function. The traditional idea of parallel processing within the basal ganglia is also challenged by recent findings. It is now clear that axons of GP neurons form large, perisomatic baskets around target neurons in all major basal ganglia nuclei, thereby exerting a profound influence on the output of the entire basal ganglia. GP neurons are autonomously active both in vivo and in vitro. It is believed that temporal information carried along the corticostriatopallidal pathway is critical for proper motor execution. The importance of appropriately controlled discharge of GP neurons is highlighted by psychomotor disorders such as Parkinson's disease, in which alterations in the pattern and synchrony of discharge in GP neurons are thought to contribute to motor symptoms. Several lines of evidence suggest that the aberrant activity of GP neurons following dopamine depletion is caused by alteration in the synaptic input from both striatum and subthalamic nucleus. In normal subjects, the capability of striatal input in translating cortical input into precisely timed responses in GP neurons is mediated by (1) the expression of postsynaptic GABA(A) receptor composed of subunits with fast kinetic properties; (2) an effective GABA reuptake system in terminating the action of synaptically released GABA, and (3) the existence of dendritic HCN channels that actively abbreviate the time course of the inhibitory postsynaptic potentials and reset rhythmic discharge. Despite the rapid pace in uncovering the elements that shape the activity along the striatopallidosubthalamic pathway, the origin of rhythmic, synchronized bursting of GP neurons seen in parkinsonism has not been fully established experimentally. Further elucidation of the factors that control the information transfer in the striatopallidal synapses is thus critical to our understanding of basal ganglia function and establishing treatment for Parkinson's disease and other basal ganglia disorders.

Neurotensin selectively facilitates glutamatergic transmission in globus pallidus

The tridecapeptide neurotensin has been demonstrated to modulate neurotransmission in a number of brain regions. There is evidence that neurotensin receptors exist in globus pallidus presynaptically and postsynaptically. Whole-cell patch-clamp recordings were used to investigate the modulatory effects of neurotensin on glutamate and GABA transmission in this basal ganglia nucleus in rats. Neurotensin at 1 microM significantly increased the frequency of glutamate receptor-mediated miniature excitatory postsynaptic currents. In contrast, neurotensin had no effect on GABA(A) receptor-mediated miniature inhibitory postsynaptic currents. The presynaptic facilitation of neurotensin on glutamatergic transmission could be mimicked by the C-terminal fragment, neurotensin (8-13), but not by the N-terminal fragment, neurotensin (1-8). The selective neurotensin type-1 receptor antagonist, SR48692 {2-[(1-(7-chloro-4-quinolinyl)-5-2(2,6-dimethoxyphenyl)pyrazol-3-yl)carbonylamino]-tricyclo(3.3.1.1.(3.7))-decan-2-carboxylic acid}, blocked this facilitatory effect of neurotensin, and which itself had no effect on miniature excitatory postsynaptic currents. The specific phospholipase C inhibitor, U73122 {1-[6-[[17beta-3-methoyyestra-1,3,5(10)-trien-17-yl]amino]hexyl]-1H-pyrrole-2,5-dione}, significantly inhibit neurotensin-induced facilitation on glutamate release. Taken together with the reported postsynaptic depolarization of neurotensin in globus pallidus, it is suggested that neurotensin excites the globus pallidus neurons by multiple mechanisms which may provide a rationale for further investigations into its involvement in motor disorders originating from the basal ganglia.

Systematic assessment of decision models in Parkinson's disease

OBJECTIVE

To give an insight into the structural and methodological approaches used in published decision-analytic models evaluating interventions in Parkinson's disease (PD) and to derive recommendations for future comprehensive PD decision models.

METHODS

A systematic literature review was performed to identify studies that evaluated PD interventions using mathematical decision models. Using a standardized assessment form, information on the study design, methodological framework, and data sources was extracted from each publication and systematically reported. Strengths and limitations were assessed.

RESULTS

We identified eight studies that used mathematical models to evaluate different pharmaceutical (n=7) and surgical (n=1) treatment options in PD. All models included economic evaluations. Modeling approaches comprised mathematical equations, decision trees, and Markov models with a time horizon ranging from 5 years to lifetime. All based progression on the evolution of clinical surrogate endpoints. Treatment effects were either modeled via reduction of symptomatic progression and/or initial symptomatic improvement or via reduction of adverse effect rates. No model is currently available that encompasses both the underlying biologic disease progression and the spectrum of all relevant complications and also links them to patient preferences and economic outcomes.

CONCLUSIONS

Models have been successfully applied to evaluate PD treatments. However, currently available models have substantial limitations. We recommend that a comprehensive, generic, and flexible decision model for PD that can be applied to different treatment strategies should consider a large spectrum of clinically relevant outcomes and complications of the disease during a sufficiently long time horizon, include PD-specific mortality, systematically evaluate uncertainty including heterogeneity effects, and should be validated by independent data or other models. Approaches to model treatment effects included reduction of symptomatic progression, initial symptomatic improvement, or reduction of adverse effects. We believe that structural bias could be avoided if underlying disease progression and treatment effects on symptoms are modeled separately.

Electrophysiological and behavioral effects of zolpidem in rat globus pallidus

The globus pallidus is believed to play a critical role in the normal function of the basal ganglia, and abnormal activity of its neurons may underlie some basal ganglia motor symptoms. A high density of benzodiazepine binding sites on GABAA receptors has been reported in the rat globus pallidus. The present study investigates the effect of activating the benzodiazepine site by the agonist zolpidem. In in vitro slices, 100 nM of zolpidem significantly prolonged the half decay time of both miniature and spontaneous inhibitory postsynaptic currents by 30.1 +/- 3.0% (n=12) and 17.8 +/- 2.4% (n=16), respectively, with no effect on their amplitudes and frequencies. In the behaving animal, when zolpidem was microinjected into the globus pallidus unilaterally, it caused a robust ipsilateral rotation (26.4 +/- 2.4 turns/30 min, n=8), significantly higher than that of control animals receiving vehicle injection (1.3 +/- 1.6 turns/30 min, n=6). This effect was in agreement with the in vitro effect of zolpidem in enhancing the action of GABA on postsynaptic GABAA receptors. All the effects of zolpidem, in vitro or in vivo, were sensitive to the benzodiazepine antagonist flumazenil, confirming the specificity on the benzodiazepine site. This finding on the effect of zolpidem on motor behavior provides a rationale for further investigations into its potential in the treatment of motor disorders originating from the basal ganglia.

Group III metabotropic glutamate receptor-mediated modulation of the striatopallidal synapse

The globus pallidus (GP) is a key GABAergic nucleus in the basal ganglia (BG). The predominant input to the GP is an inhibitory striatal projection that forms the first synapse in the indirect pathway. The GP GABAergic neurons project to the subthalamic nucleus, providing an inhibitory control of these glutamatergic cells. Given its place within the BG circuit, it is not surprising that alterations in GP firing pattern are postulated to play a role in both normal and pathological motor behavior. Because the inhibitory striatal input to the GP may play an important role in shaping these firing patterns, we set out to determine the role that the group III metabotropic glutamate receptors (GluRs) play in modulating transmission at the striatopallidal synapse. In rat midbrain slices, electrical stimulation of the striatum evoked GABA(A)-mediated IPSCs recorded in all three types of GP neurons. The group III mGluR-selective agonist L-(+)-2-amino-4-phosphonobutyric acid (L-AP4) inhibited these IPSCs through a presynaptic mechanism of action. L-AP4 exhibited high potency and a pharmacological profile consistent with mediation by mGluR4. Furthermore, the effect of L-AP4 on striatopallidal transmission was absent in mGluR4 knock-out mice, providing convincing evidence that mGluR4 mediates this effect. The finding that mGluR4 may selectively modulate striatopallidal transmission raises the interesting possibility that activation of mGluR4 could decrease the excessive inhibition of the GP that has been postulated to occur in Parkinson's disease. Consistent with this, we find that intracerebroventricular injections of L-AP4 produce therapeutic benefit in both acute and chronic rodent models of Parkinson's disease.

Rotational behavior and electrophysiological effects induced by GABA(B) receptor activation in rat globus pallidus

GABA is the major neurotransmitter used in the globus pallidus and there is evidence that GABA(B) receptors exist in this nucleus. Here we show that unilateral microinjection of baclofen, a GABA(B) receptor agonist, induced ipsilateral turning in Sprague-Dawley rats. This effect was prevented by preinjection of the GABA(B) receptor antagonist CGP55845A, which itself did not cause rotation. Thus, activation of GABA(B) receptor may suppress the activity of globus pallidus neurons, which is in line with the finding that the glutamate receptor antagonists (+/-)-2-amino-5-phosphonopentanoic acid and 6-cyano-7-nitroquinoxaline-2,3-dione also caused similar ipsilateral turning when injected into globus pallidus. Furthermore, in the presence of these glutamate receptor antagonists, injection of baclofen resulted in fewer rotations. To test the possibility that baclofen reduced glutamate release onto globus pallidus neurons, the effects of baclofen on miniature excitatory postsynaptic currents were studied in rat brain slices. Patch-clamp recordings showed that baclofen at 30 microM significantly reduced the frequency of the miniature excitatory postsynaptic currents. However, baclofen induced a weak outward current only in a minority of globus pallidus neurons. These pre- and postsynaptic effects of baclofen were reversed or prevented by CGP55845A. These results suggest that GABA(B) receptor in globus pallidus plays an important role in the regulation of movement by modulating glutamatergic inputs at a presynaptic site.

Neurophysiological correlate of clinical signs in Parkinson's disease

Clinical diagnosis of Parkinson's disease (PD) is not always coincident with pathological findings. A better characterization of the disease from the results of studies in various areas of neuroscience can help in improving the rate of diagnostic certainty. Neurophysiology is among the techniques with better chances to furnish specific diagnostic cues on motor aspects of the disease. Neurophysiology provides quantifiable data using non-invasive, relatively inexpensive, methods. Neurophysiological tests can be applied with no previous preparation, and repeated many times without dangerous consequences. To be rewarding, however, neurophysiological examination should be done in close cooperation between the clinician who detects relevant specific signs, and the neurophysiologist who devises the most demonstrative methods to document those signs. In this review, we describe the neurophysiological correlate of symptoms and signs in patients with PD, and particularly their pathophysiological meaning, with special focus on those that could be more helpful to the neurologists in establishing differences with respect to other diseases presenting with parkinsonism.