1
|
Lefaucheur JP, Moro E, Shirota Y, Ugawa Y, Grippe T, Chen R, Benninger DH, Jabbari B, Attaripour S, Hallett M, Paulus W. Clinical neurophysiology in the treatment of movement disorders: IFCN handbook chapter. Clin Neurophysiol 2024; 164:57-99. [PMID: 38852434 DOI: 10.1016/j.clinph.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/02/2024] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
In this review, different aspects of the use of clinical neurophysiology techniques for the treatment of movement disorders are addressed. First of all, these techniques can be used to guide neuromodulation techniques or to perform therapeutic neuromodulation as such. Neuromodulation includes invasive techniques based on the surgical implantation of electrodes and a pulse generator, such as deep brain stimulation (DBS) or spinal cord stimulation (SCS) on the one hand, and non-invasive techniques aimed at modulating or even lesioning neural structures by transcranial application. Movement disorders are one of the main areas of indication for the various neuromodulation techniques. This review focuses on the following techniques: DBS, repetitive transcranial magnetic stimulation (rTMS), low-intensity transcranial electrical stimulation, including transcranial direct current stimulation (tDCS) and transcranial alternating current stimulation (tACS), and focused ultrasound (FUS), including high-intensity magnetic resonance-guided FUS (MRgFUS), and pulsed mode low-intensity transcranial FUS stimulation (TUS). The main clinical conditions in which neuromodulation has proven its efficacy are Parkinson's disease, dystonia, and essential tremor, mainly using DBS or MRgFUS. There is also some evidence for Tourette syndrome (DBS), Huntington's disease (DBS), cerebellar ataxia (tDCS), and axial signs (SCS) and depression (rTMS) in PD. The development of non-invasive transcranial neuromodulation techniques is limited by the short-term clinical impact of these techniques, especially rTMS, in the context of very chronic diseases. However, at-home use (tDCS) or current advances in the design of closed-loop stimulation (tACS) may open new perspectives for the application of these techniques in patients, favored by their easier use and lower rate of adverse effects compared to invasive or lesioning methods. Finally, this review summarizes the evidence for keeping the use of electromyography to optimize the identification of muscles to be treated with botulinum toxin injection, which is indicated and widely performed for the treatment of various movement disorders.
Collapse
Affiliation(s)
- Jean-Pascal Lefaucheur
- Clinical Neurophysiology Unit, Henri Mondor University Hospital, AP-HP, Créteil, France; EA 4391, ENT Team, Paris-Est Créteil University, Créteil, France.
| | - Elena Moro
- Grenoble Alpes University, Division of Neurology, CHU of Grenoble, Grenoble Institute of Neuroscience, Grenoble, France
| | - Yuichiro Shirota
- Department of Neurology, Division of Neuroscience, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshikazu Ugawa
- Department of Human Neurophysiology, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Talyta Grippe
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Neuroscience Graduate Program, Federal University of Minas Gerais, Belo Horizonte, Brazil; Krembil Brain Institute, Toronto, Ontario, Canada
| | - Robert Chen
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada; Krembil Brain Institute, Toronto, Ontario, Canada
| | - David H Benninger
- Service of Neurology, Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Bahman Jabbari
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Sanaz Attaripour
- Department of Neurology, University of California, Irvine, CA, USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Walter Paulus
- Department of Neurology, Ludwig Maximilians University, Munich, Germany
| |
Collapse
|
2
|
Buzaev IV, Galimova RM, Nabiullina DI, Illarioshkin SN, Zagidullin NS, Safin SM. Magnetic resonance imaging-guided focused ultrasound thalamotomy launch with remote telemedicine international proctorship. Chronic Dis Transl Med 2024; 10:40-50. [PMID: 38450308 PMCID: PMC10914008 DOI: 10.1002/cdt3.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/12/2023] [Accepted: 08/08/2023] [Indexed: 03/08/2024] Open
Abstract
Background COVID-19 limitations have hindered the implementation of new technologies by preventing proctors from coming to the site. We share our first experience of magnetic resonance imaging (MRI)-guided focused ultrasound (MRgFUS) treatment with an international remote online proctorship, and develop and evaluate the methodology of remote MRgFUS proctorship. Methods This single-center, nonrandomized controlled prospective study included 94 patients: 27 with essential tremor (ET) and 67 with tremor-dominant Parkinson's disease (PD). The coming of proctors was impossible, so we arranged for the remote participation of proctors from the United Kingdom, Spain, and Israel. A total of 38 patients (40.4%) received telemedicine-proctored treatment (proctor group) and 56 received their treatment independently (solo group). We used the Clinical Rating Scale for Tremor (CRST) for ET patients and the Unified Parkinson's Disease Rating Scale (UPDRS) Part III for PD patients. Results In patients with ET, success rates were 81.8% (proctor group) and 100% (solo group) (p = 0.22). CRST reduction on the treated side was 71.43% [65.83%; 80.56%] (proctor group) versus 60.87% [53.99; 79.58] (solo group) (p = 0.19). None of the patients showed worsening of tremors within 1 year. In patients with PD, the success rates were 92.6% (proctor group) and 100% (solo group) (p = 0.08). The UPDRS Part III improvement was 30.1% (proctor group) versus 39.9% (solo group) (p = 0.003). The 1-year recurrence rate was 40% (proctor group) and 17.5% (solo group) (p = 0.04). No complications were observed at 6 months. Conclusions We developed a feasible and safe methodology for telemedicine remote online-proctored MRgFUS treatment. No significant difference was observed between the solo and developed remote proctor protocols in terms of complication rate, effect, and long-term results; however, UPDRS Part III improvement was better in the PD solo group. This study demonstrated that the MRgFUS international proctorship can be performed successfully remotely.
Collapse
Affiliation(s)
- Igor V. Buzaev
- Department of SurgeryBashkir State Medical UniversityUfaRussia
| | | | - Dinara I. Nabiullina
- Intelligent Neurosurgery Clinic, Ltd.International Medical Center V.S. Buzaev memorialUfaRussia
| | | | | | - Shamil M. Safin
- Department of SurgeryBashkir State Medical UniversityUfaRussia
| |
Collapse
|
3
|
Chua MMJ, Blitz SE, Ng PR, Segar DJ, McDannold NJ, White PJ, Christie S, Hayes MT, Rolston JD, Cosgrove GR. Focused Ultrasound Thalamotomy for Tremor in Parkinson's Disease: Outcomes in a Large, Prospective Cohort. Mov Disord 2023; 38:1962-1967. [PMID: 37539721 DOI: 10.1002/mds.29569] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Magnetic resonance guided focused ultrasound (MRgFUS) is United States Food and Drug Administration approved for the treatment of tremor-dominant Parkinson's disease (TdPD), but only limited studies have been described in practice. OBJECTIVES To report the largest prospective experience of unilateral MRgFUS thalamotomy for the treatment of medically refractory TdPD. METHODS Clinical outcomes of 48 patients with medically refractory TdPD who underwent MRgFUS thalamotomy were evaluated. Tremor outcomes were assessed using the Fahn-Tolosa-Marin scale and adverse effects were categorized using a structured questionnaire and clinical exam at 1 month (n = 44), 3 months (n = 34), 1 year (n = 22), 2 years (n = 5), and 3 years (n = 2). Patients underwent magnetic resonance imaging <24 hours post-procedure. RESULTS Significant tremor control persisted at all follow-ups (P < 0.001). All side effects were mild. At 3 months, these included gait imbalance (38.24%), sensory deficits (26.47%), motor weakness (17.65%), dysgeusia (5.88%), and dysarthria (5.88%), with some persisting at 1 year. CONCLUSIONS MRgFUS thalamotomy is an effective treatment for sustained tremor control in patients with TdPD. © 2023 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Melissa M J Chua
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah E Blitz
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Patrick R Ng
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - David J Segar
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Nathan J McDannold
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - P Jason White
- Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sarah Christie
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael T Hayes
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - John D Rolston
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - G Rees Cosgrove
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
4
|
Eslamian F, Dolatkhah N, Fallah L, Jahanjoo F, Toopchizadeh V, Talebi M. Effectiveness of Botulinum Toxin on Hand Tremor Intensity and Upper Limb Function in Patients with Parkinson's Disease: Results of a Systematic Review. Tremor Other Hyperkinet Mov (N Y) 2023; 13:27. [PMID: 37637849 PMCID: PMC10453949 DOI: 10.5334/tohm.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
Background Hand tremor is a common symptom of Parkinson's disease (PD). Tremors may be resistant to drug treatments. Therefore, Botulinum toxin (BoNT) could be a good alternative. This study aimed to review and analyze studies on the efficacy and safety of BoNT injection in hand tremor intensity and upper limb function in patients with idiopathic PD. Methods A comprehensive search was conducted for studies on the effect of local BoNT injections on tremors in PD patients from 1990 to December 2021. Electronic databases such as Cochrane Central Control Records, PubMed, Scopus, Web of Science, EMBASE, Google Scholar, Clinicaltrial.gov, ProQuest, Science Direct, CINAHL, and Psychoinfo were searched systematically. Results Ten studies, comprising one double-blinded randomized clinical trial and nine pilot open-labeled studies with 131 participants, met eligibility criteria. The reported tremor intensity ranged from 1 to 3, and the average tremor duration of 5.93 ± 2.08 years. The injectable dose was 68-100 units of onabotulinum-toxin-A in each upper limb muscle, mostly wrist flexors. The results showed a decrease in unified Parkinson's disease rating scale (UPDRS)_20 and UPDRS_21 indices by 1.22 ± 1.1 and 1.20 ± 0.9, respectively, without causing severe side effects. The BoNT relative effectiveness in the forearm and arm muscles was reported 6-16 weeks after injection. Discussion The kinematic, electromyography-guided, and electrical stimulation evaluations allow for accurate muscle localization and minimize the possibility of BoNT diffusion and antibody formation. More extensive randomized clinical trials with uniform measurement criteria are recommended to reduce bias and provide more accurate conclusions. Highlight Tremor treatment in Parkinson's-disease (PD) is challenging. Drugs effect is temporary, and surgery is critical management. This study reviews the Botulinum-toxin injection efficacy in hand tremor intensity and upper limb function. The results showed a decrease in unified Parkinson's disease rating scale (UPDRS)_20 and UPDRS_21 by 1.22 ± 1.1 and 1.20 ± 0.9, respectively, 6-16 weeks after injection.
Collapse
Affiliation(s)
- Fariba Eslamian
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leila Fallah
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fatemeh Jahanjoo
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
- Heidelberg Institute of Global Health (HIGH), University of Heidelberg, Heidelberg, Germany
| | - Vahideh Toopchizadeh
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahnaz Talebi
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
5
|
Real-World Longitudinal Experience of Botulinum Toxin Therapy for Parkinson and Essential Tremor. Toxins (Basel) 2022; 14:toxins14080557. [PMID: 36006219 PMCID: PMC9413198 DOI: 10.3390/toxins14080557] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Botulinum toxin type A (BoNT-A) therapy for upper-limb tremor has emerged as a promising option. However, it is unclear in real-world practices whether a technology-guided approach can compare with expert clinical assessments (including surface anatomy and palpation) for improving outcomes. This retrospective study aims to review our clinical outcomes of treating essential tremor (ET) and Parkinson’s disease (PD) tremor using either clinical- or kinematic-based injection pattern determination methods. Methods: 68 ET and 45 PD patients received at least one injection for their upper-limb tremor (unilateral or bilateral) in the last 7 years. Demographics of patients and BoNT-A injections were collected. A Mann–Whitney U statistical test was used to compare outcome measures between ET and PD cohorts. Results: Mean age (72 ± 9 years), number of injections (5), years receiving therapy (~2 years), clinic- (~57%) or kinematic-based patterns, and self-paying (52%) were similar between both cohorts. BoNT-A as a monotherapy in both upper limbs was received in more ET than PD patients. Double reconstitution of Xeomin® in the wrist flexors/extensors, supinator, biceps, and triceps were most injected. Discontinuation due to no benefit/weakness was not dependent on the injection pattern determination approach. Conclusions: Kinematic-based BoNT-A injections produced similar treatment outcomes to injections based on the clinical expertise of the expert injector. This suggests that kinematics could be used by a non-expert to attain equivalent efficacy potentially improving access to this treatment.
Collapse
|
6
|
A review on pathology, mechanism, and therapy for cerebellum and tremor in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:82. [PMID: 35750692 PMCID: PMC9232614 DOI: 10.1038/s41531-022-00347-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/30/2022] [Indexed: 12/16/2022] Open
Abstract
Tremor is one of the core symptoms of Parkinson’s disease (PD), but its mechanism is poorly understood. The cerebellum is a growing focus in PD-related researches and is reported to play an important role in tremor in PD. The cerebellum may participate in the modulation of tremor amplitude via cerebello-thalamo-cortical circuits. The cerebellar excitatory projections to the ventral intermediate nucleus of the thalamus may be enhanced due to PD-related changes, including dopaminergic/non-dopaminergic system abnormality, white matter damage, and deep nuclei impairment, which may contribute to dysregulation and resistance to levodopa of tremor. This review summarized the pathological, structural, and functional changes of the cerebellum in PD and discussed the role of the cerebellum in PD-related tremor, aiming to provide an overview of the cerebellum-related mechanism of tremor in PD.
Collapse
|
7
|
Kim J, Wichmann T, Inan OT, DeWeerth SP. Analyzing the Effects of Parameters for Tremor Modulation via Phase-Locked Electrical Stimulation on a Peripheral Nerve. J Pers Med 2022; 12:76. [PMID: 35055390 PMCID: PMC8779889 DOI: 10.3390/jpm12010076] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 12/18/2022] Open
Abstract
(1) Background: Non-invasive neuromodulation is a promising alternative to medication or deep-brain stimulation treatment for Parkinson's Disease or essential tremor. In previous work, we developed and tested a wearable system that modulates tremor via the non-invasive, electrical stimulation of peripheral nerves. In this article, we examine the proper range and the effects of various stimulation parameters for phase-locked stimulation. (2) Methods: We recruited nine participants with essential tremor. The subjects performed a bean-transfer task that mimics an eating activity to elicit kinetic tremor while using the wearable stimulation system. We examined the effects of stimulation with a fixed duty cycle, at different stimulation amplitudes and frequencies. The epochs of stimulation were locked to one of four phase positions of ongoing tremor, as measured with an accelerometer. We analyzed stimulation-evoked changes of the frequency and amplitude of tremor. (3) Results: We found that the higher tremor amplitude group experienced a higher rate of tremor power reduction (up to 65%) with a higher amplitude of stimulation when the stimulation was applied at the ±peak of tremor phase. (4) Conclusions: The stimulation parameter can be adjusted to optimize tremor reduction, and this study lays the foundation for future large-scale parameter optimization experiments for personalized peripheral nerve stimulation.
Collapse
Affiliation(s)
- Jeonghee Kim
- Department of Engineering Technology and Industrial Distribution, Texas A&M University, College Station, TX 77843, USA
- Department of Multidisciplinary Engineering, Texas A&M University, College Station, TX 77843, USA
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX 77843, USA
| | - Thomas Wichmann
- Department of Neurology, Emory University, Atlanta, GA 30322, USA;
- Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center at Emory University, Atlanta, GA 30329, USA
| | - Omer T. Inan
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (O.T.I.); (S.P.D.)
| | - Stephen P. DeWeerth
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA; (O.T.I.); (S.P.D.)
- Department of Biomedical Engineering, Lehigh University, Bethlehem, PA 18015, USA
| |
Collapse
|
8
|
Sasikumar S, Cohn M, Harmsen IE, Loh A, Cho SS, Sáenz-Farret M, Maciel R, Soh D, Boutet A, Germann J, Elias G, Youm A, Duncan K, Rowland NC, Strafella AP, Kalia SK, Lozano AM, Fasano A. Single-Trajectory Multiple-Target Deep Brain Stimulation for Parkinsonian Mobility and Cognition. Mov Disord 2021; 37:635-640. [PMID: 34806782 DOI: 10.1002/mds.28870] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/29/2021] [Accepted: 10/22/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Deep brain stimulation (DBS) of the nucleus basalis of Meynert (NBM) is an emerging target to potentially treat cognitive dysfunction. OBJECTIVES The aim of this study is to achieve feasibility and safety of globus pallidus pars interna (GPi) and NBM DBS in advanced PD with cognitive impairment. METHODS We performed a phase-II double-blind crossover pilot trial in six participants to assess safety and cognitive measures, the acute effect of NBM stimulation on attention, motor and neuropsychological data at one year, and neuroimaging biomarkers of NBM stimulation. RESULTS NBM DBS was well tolerated but did not improve cognition. GPi DBS improved dyskinesia and motor fluctuations (P = 0.04) at one year. NBM stimulation was associated with reduced right frontal and parietal glucose metabolism (P < 0.01) and increased low- and high-frequency power and functional connectivity. Volume of tissue activated in the left NBM was associated with stable cognition (P < 0.05). CONCLUSIONS Simultaneous GPi and NBM stimulation is safe and improves motor complications. NBM stimulation altered neuroimaging biomarkers but without lasting cognitive improvement. © 2021 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
| | - Melanie Cohn
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada
| | - Irene E Harmsen
- Mitchell Goldhar MEG Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Aaron Loh
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Sang Soo Cho
- Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Brain Institute, UHN, University of Toronto, Toronto, Ontario, Canada.,Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Michel Sáenz-Farret
- Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada
| | - Ricardo Maciel
- Movement Disorders Unit, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Derrick Soh
- Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Alexandre Boutet
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jürgen Germann
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Gavin Elias
- Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
| | - Ariana Youm
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Katherine Duncan
- Department of Psychology, University of Toronto, Toronto, Ontario, Canada
| | - Nathan C Rowland
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Antonio P Strafella
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Division of Brain, Imaging and Behaviour-Systems Neuroscience, Krembil Brain Institute, UHN, University of Toronto, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Krembil Brain Institute, Toronto, Ontario, Canada.,Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Andres M Lozano
- Krembil Brain Institute, Toronto, Ontario, Canada.,Toronto Western Hospital, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Alfonso Fasano
- Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,Edmond J. Safra Program in Parkinson's Disease and Morton and Gloria Shulman Movement Disorders Centre, Toronto Western Hospital, UHN, Toronto, Ontario, Canada.,Center for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| |
Collapse
|
9
|
Samotus O, Chen R, Jog M. Changes in Cortical Excitability and Parkinson Tremor After Botulinum Toxin Therapy. Neurology 2021; 97:e1413-e1424. [PMID: 34497068 DOI: 10.1212/wnl.0000000000012662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the relationship between botulinum toxin type A (BoNT-A) administration, tremor amplitude, and modulation of intracortical excitability and sensorimotor processing using paired-pulse transcranial magnetic stimulation (pp-TMS) in patients with early, tremor-dominant Parkinson disease (PD). METHODS Twelve de novo (naive to anti-PD medications) and 7 l-dopa (optimized on levodopa) participants with PD with tremor affecting one arm were recruited. All participants received 4 serial BoNT-A treatments for tremor every 12 weeks and peak effect was assessed 6 weeks posttreatment, totaling 8 visits over 42 weeks. Injection measures were based on kinematic tremor analysis. Short interval intracortical inhibition (SICI), intracortical facilitation (ICF), long interval intracortical inhibition (LICI), and measures of sensorimotor interaction (short-latency afferent [SAI] and long-latency afferent [LAI] stimulation) were assessed in both hemispheres using pp-TMS paradigms at each time point. Linear mixed models analyzed the effect of each pp-TMS measure and tremor severity within each cohort and the association between pp-TMS and tremor severity in the de novo cohort over 42 weeks. t Tests compared pp-TMS measures between hemispheres per time point. RESULTS Baseline SICI, LICI, and SAI was reduced (higher motor evoked potential [MEP] ratio) on the tremulous/treated side compared to the nontremulous side in de novo participants. On the treated side in the de novo cohort, BoNT-A treatment significantly reduced ICF and increased LICI, SAI, and LAI (lower MEP ratio) at peak BoNT-A time points. The change in tremor severity was significantly associated with changes in SICI, LICI, and LAI. DISCUSSION Our findings suggest that tremor severity in early PD may be related to impaired intracortical inhibition and defective sensorimotor integration.
Collapse
Affiliation(s)
- Olivia Samotus
- From the Department of Clinical Neurological Sciences (O.S., M.J.), Lawson Health Research Institute, London Health Sciences Centre; Schulich School of Medicine and Dentistry (O.S., M.J.), University of Western Ontario, London; Krembil Research Institute (R.C.), University Health Network; and Division of Neurology, Department of Medicine (R.C.), University of Toronto, Canada
| | - Robert Chen
- From the Department of Clinical Neurological Sciences (O.S., M.J.), Lawson Health Research Institute, London Health Sciences Centre; Schulich School of Medicine and Dentistry (O.S., M.J.), University of Western Ontario, London; Krembil Research Institute (R.C.), University Health Network; and Division of Neurology, Department of Medicine (R.C.), University of Toronto, Canada
| | - Mandar Jog
- From the Department of Clinical Neurological Sciences (O.S., M.J.), Lawson Health Research Institute, London Health Sciences Centre; Schulich School of Medicine and Dentistry (O.S., M.J.), University of Western Ontario, London; Krembil Research Institute (R.C.), University Health Network; and Division of Neurology, Department of Medicine (R.C.), University of Toronto, Canada.
| |
Collapse
|
10
|
Maciel R, Soh D, Munhoz RP, Poon YY, Kalia SK, Hodaie M, Lozano AM, Fasano A. Programming Directional Deep Brain Stimulation in Parkinson’s Disease: A Randomized Prospective Trial Comparing Early versus Delayed Stimulation Steering. Stereotact Funct Neurosurg 2021; 99:484-490. [DOI: 10.1159/000517054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 04/28/2021] [Indexed: 11/19/2022]
Abstract
<b><i>Introduction:</i></b> Programming directional leads poses new challenges as the optimal strategy is yet to be established. We designed a randomized control study to establish an evidence-based programming algorithm for patients with Parkinson’s disease undergoing subthalamic nucleus deep brain stimulation with directional leads. <b><i>Methods:</i></b> Fourteen consecutive patients were randomized to programming with either early or delayed (i.e., starting with a “ring mode”) steered stimulation. Motor scores, number of programming visits, calls to the clinic, battery consumption, and stimulation adjustments required were recorded and compared between groups, using the Wilcoxon signed-ranks test, after 3 months of open-label programming. <b><i>Results:</i></b> Thirteen patients (25 electrodes) were included, of which 23 were steerable. Nine out of 14 electrodes allocated to delayed steered stimulation were changed to steered mode due to side effects during the course of the study. No patients (11 electrodes) initially allocated to early steered stimulation were converted to ring mode. The 2 study arms did not differ in any of the considered measures at 3 months. <b><i>Conclusion:</i></b> Programming with early or delayed steered stimulation is equally effective in the short term. However, delayed steering is less time consuming and is not always needed.
Collapse
|
11
|
Predicting optimal deep brain stimulation parameters for Parkinson's disease using functional MRI and machine learning. Nat Commun 2021; 12:3043. [PMID: 34031407 PMCID: PMC8144408 DOI: 10.1038/s41467-021-23311-9] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
Commonly used for Parkinson’s disease (PD), deep brain stimulation (DBS) produces marked clinical benefits when optimized. However, assessing the large number of possible stimulation settings (i.e., programming) requires numerous clinic visits. Here, we examine whether functional magnetic resonance imaging (fMRI) can be used to predict optimal stimulation settings for individual patients. We analyze 3 T fMRI data prospectively acquired as part of an observational trial in 67 PD patients using optimal and non-optimal stimulation settings. Clinically optimal stimulation produces a characteristic fMRI brain response pattern marked by preferential engagement of the motor circuit. Then, we build a machine learning model predicting optimal vs. non-optimal settings using the fMRI patterns of 39 PD patients with a priori clinically optimized DBS (88% accuracy). The model predicts optimal stimulation settings in unseen datasets: a priori clinically optimized and stimulation-naïve PD patients. We propose that fMRI brain responses to DBS stimulation in PD patients could represent an objective biomarker of clinical response. Upon further validation with additional studies, these findings may open the door to functional imaging-assisted DBS programming. Deep brain stimulation programming for Parkinson’s disease entails the assessment of a large number of possible simulation settings, requiring numerous clinic visits after surgery. Here, the authors show that patterns of functional MRI can predict the optimal stimulation settings.
Collapse
|
12
|
Altered Sensory Representations in Parkinsonian Cortical and Basal Ganglia Networks. Neuroscience 2021; 466:10-25. [PMID: 33965505 DOI: 10.1016/j.neuroscience.2021.04.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/21/2021] [Accepted: 04/28/2021] [Indexed: 11/22/2022]
Abstract
In parkinsonian conditions, network dynamics in the cortical and basal ganglia circuits present abnormal oscillations and periods of high synchrony, affecting the functionality of multiple striatal regions including the sensorimotor striatum. However, it is still unclear how these altered dynamics impact on sensory processing, a key feature for motor control that is severely impaired in parkinsonian patients. A major confound is that pathological dynamics in sensorimotor networks may elicit unspecific motor responses that may alter sensory representations through sensory feedback, making it difficult to disentangle motor and sensory components. To address this issue, we studied sensory processing using an anesthetized model with robust sensory representations throughout cortical and basal ganglia sensory regions and limited motor confounds in control and hemiparkinsonian rats. A general screening of sensory-evoked activity in large populations of neurons recorded in the primary sensory cortex (S1), dorsolateral striatum (DLS) and substantia nigra pars reticulata (SNr) revealed increased excitability and altered sensory representations in the three regions. Further analysis revealed uncoordinated population dynamics between DLS and S1/SNr. Finally, DLS lesions in hemiparkinsonian animals partially recovered population dynamics and execution in the rotarod.
Collapse
|
13
|
Pascual-Valdunciel A, Hoo GW, Avrillon S, Barroso FO, Goldman JG, Hernandez-Pavon JC, Pons JL. Peripheral electrical stimulation to reduce pathological tremor: a review. J Neuroeng Rehabil 2021; 18:33. [PMID: 33588841 PMCID: PMC7885254 DOI: 10.1186/s12984-021-00811-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 01/11/2021] [Indexed: 01/02/2023] Open
Abstract
Interventions to reduce tremor in essential tremor (ET) and Parkinson’s disease (PD) clinical populations often utilize pharmacological or surgical therapies. However, there can be significant side effects, decline in effectiveness over time, or clinical contraindications for these interventions. Therefore, alternative approaches must be considered and developed. Some non-pharmacological strategies include assistive devices, orthoses and mechanical loading of the tremorgenic limb, while others propose peripheral electrical stimulation. Specifically, peripheral electrical stimulation encompasses strategies that activate motor and sensory pathways to evoke muscle contractions and impact sensorimotor function. Numerous studies report the efficacy of peripheral electrical stimulation to alter tremor generation, thereby opening new perspectives for both short- and long-term tremor reduction. Therefore, it is timely to explore this promising modality in a comprehensive review. In this review, we analyzed 27 studies that reported the use of peripheral electrical stimulation to reduce tremor and discuss various considerations regarding peripheral electrical stimulation: the stimulation strategies and parameters, electrodes, experimental designs, results, and mechanisms hypothesized to reduce tremor. From our review, we identified a high degree of disparity across studies with regard to stimulation patterns, experimental designs and methods of assessing tremor. Having standardized experimental methodology is a critical step in the field and is needed in order to accurately compare results across studies. With this review, we explore peripheral electrical stimulation as an intervention for tremor reduction, identify the limitations and benefits of the current state-of-the-art studies, and provide ideas to guide the development of novel approaches based on the neural circuitries and mechanical properties implied in tremor generation.
Collapse
Affiliation(s)
- Alejandro Pascual-Valdunciel
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain.,E.T.S. Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
| | - Grace W Hoo
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA
| | - Simon Avrillon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Filipe Oliveira Barroso
- Neural Rehabilitation Group, Cajal Institute, Spanish National Research Council (CSIC), Madrid, Spain
| | - Jennifer G Goldman
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, USA.,Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Julio C Hernandez-Pavon
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - José L Pons
- Legs + Walking Lab, Shirley Ryan AbilityLab, Chicago, IL, 60611, USA. .,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Biomedical Engineering and Mechanical Engineering, McCormick School of Engineering, Northwestern University, Chicago, IL, USA.
| |
Collapse
|
14
|
Magnetic resonance-guided focused ultrasound for Parkinson's disease since ExAblate, 2016-2019: a systematic review. Neurol Sci 2021; 42:553-563. [PMID: 33389248 DOI: 10.1007/s10072-020-05020-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 12/21/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION ExAblate received FDA approval for treatment of a range of movement disorders in 2016, including tremor-dominant Parkinson's disease (TDPD), dyskinetic PD, and essential tremor. This incisionless device allows for magnetic resonance-guided focused ultrasound (MRgFUS) for ablation of several regions of interest. Current studies should aim to measure pre- and post-operative neurocognitive functioning to better understand MRgFUS in PD and how it compares to deep brain stimulation, which has known cognitive risks among certain populations. METHODS PubMed, CINAHL, PsycINFO, and Cochrane Library databases were searched from January 2016 to January 2020. Guidelines for Preferred Reporting Items for Systematic Review and Meta-Analyses were used to review clinical trials comprehensively assessing pre- and post-operative neurocognitive functioning in PD patients undergoing MRgFUS. Due to limited extant literature in this area, TDPD was expanded to PD with severe dyskinesia. RESULTS Twenty-two abstracts were reviewed following removal of duplicates. After full-text review of eight articles, only two studies included comprehensive neuropsychological evaluations of PD patients undergoing MRgFUS thalamotomy or pallidotomy. Most excluded studies used only brief cognitive screeners to assess functioning. Cognitive declines appear to be minimal following MRgFUS in PD, with exceptions in verbal fluency and inhibition. These results are limited by sample size and sample diversity. CONCLUSIONS Significant methodological gaps were inadvertently discovered. Few studies to-date have administered comprehensive neuropsychological batteries to ascertain MRgFUS risks to neurocognitive functioning in PD. Studies must extend beyond brief screeners when assessing PD populations vulnerable to decline. Furthermore, consensus on a comprehensive battery would better serve replicability and the ability to engage in useful meta-analyses.
Collapse
|
15
|
NAKAJIMA Y, KAMBE D, TODA H, NISHIDA N, NAGAO S, SAWAMOTO N, OKUMURA R, OZAKI A, IWASAKI K. Thalamic Deep Brain Stimulation for Refractory Atypical Tremor after Encephalitis of Unknown Etiology: A Case Report. NMC Case Rep J 2021; 8:247-252. [PMID: 35079471 PMCID: PMC8769394 DOI: 10.2176/nmccrj.cr.2020-0245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
Tremor associated with encephalitis is usually transient and rarely becomes chronic and refractory. Treatment for such tremor using deep brain stimulation (DBS) has not yet been reported. We report an uncommon case of chronic tremor after encephalitis of unknown etiology and its outcome treated with thalamic DBS. A 47-year-old man presented with a 6-month history of medically refractory tremor after non-infectious and probable autoimmune encephalitis. The patient showed an atypical mixture of resting, postural, kinetic, and intention tremor. The tremor significantly disabled the patient’s activities of daily life (ADL). The patient underwent bilateral thalamic DBS surgery. DBS leads were placed to cross the border between the ventralis oralis posterior (Vop) nucleus and ventralis intermedius (Vim) nucleus of the thalamus. Stimulation of both the Vop and Vim using the bipolar contacts controlled the mixed occurrence of tremor. The ADL and performance scores on The Essential Tremor Rating Assessment Scale (TETRAS) improved from 47 to 0 and from 44 to 9, respectively. The therapeutic effects have lasted for 24 months. Administration of combined Vop and Vim DBS may control uncommon tremor of atypical etiology and phenomenology.
Collapse
Affiliation(s)
- Yusuke NAKAJIMA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
| | - Daisuke KAMBE
- Department of Neurology, Kyoto University, Kyoto, Kyoto, Japan
| | - Hiroki TODA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
- Department of Neurosurgery, Japanese Red Cross Fukui Hospital, Fukui, Fukui, Japan
| | - Namiko NISHIDA
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
| | - Shigeto NAGAO
- Department of Neurology, Saiseikai-Nakatsu Hospital, Osaka, Osaka, Japan
| | | | - Ryosuke OKUMURA
- Department of Radiology, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
| | - Akihiko OZAKI
- Department of Neurology, Saiseikai-Nakatsu Hospital, Osaka, Osaka, Japan
| | - Koichi IWASAKI
- Department of Neurosurgery, Tazuke Kofukai Medical Research Institute and Kitano Hospital, Osaka, Osaka, Japan
| |
Collapse
|
16
|
Samotus O, Lee J, Jog M. Standardized algorithm for muscle selection and dosing of botulinum toxin for Parkinson tremor using kinematic analysis. Ther Adv Neurol Disord 2020; 13:1756286420954083. [PMID: 33014139 PMCID: PMC7517980 DOI: 10.1177/1756286420954083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 07/15/2020] [Indexed: 12/25/2022] Open
Abstract
Background Inadequate efficacy and significant side effect profile makes pharmacological treatment of Parkinson's disease (PD) tremor challenging. Personalized dosing of botulinum toxin type A (BoNT-A) using tremor analysis has shown efficacy and safety for treating upper limb tremor. This study incorporated a novel, standardized treatment algorithm for determining injection pattern and BoNT-A dosing, customizable by the physician, in PD patients with disabling tremor in one or both arms. Methods This open-label study included 47 PD participants (25 "De-novo" and 22 "L-dopa") who received 4 serial BoNT-A treatments with follow-ups at 6 weeks post-treatment over 42 weeks. The treatment algorithm utilized kinematic tremor analysis of each participant's whole arm tremor and determined the physician's injection pattern of BoNT-A. Endpoints included changes in angular tremor amplitude, Fahn-Tolosa-Marin (FTM C) tremor scale, Movement Disorder Society-Unified Parkinson's disease rating scale (MDS-UPDRS) tremor-related score, tremor-related quality of life questionnaire, Likert ratings of perceived weakness, and maximal grip strength. Results BoNT-A significantly (p < 0.05) improved tremor amplitude (41.6%), quality of life (23.0%), UPDRS tremor score (29.6%), and arm function (FTM C; 24.6%) for both treatment cohorts from weeks 6 to 42. Maximum grip strength was reduced between 7.4% and 23.0% at follow-up visits and did not impact activities of daily living. Efficacy was obtained with first injection and remained without adjustment over two serial injection in 45% of participants. Conclusions This is the first study to use a fully standardized treatment algorithm for personalization of BoNT-A injection patterns for disabling PD tremor over serial treatments. A sustained alleviation of tremor severity and improved arm function and quality of life fulfills an important unmet need for the treatment of PD tremor. This study demonstrated that BoNT-A can be administered as a monotherapy in tremor-dominant PD or as an add-on therapy for refractory PD tremor.
Collapse
Affiliation(s)
- Olivia Samotus
- Department of Clinical Neurological Sciences, London Health Sciences Centre - Lawson Health Research Institute, London, ON, Canada
| | - Jack Lee
- Department of Clinical Neurological Sciences, London Health Sciences Centre - Lawson Health Research Institute, London, ON, Canada
| | - Mandar Jog
- Department of Clinical Neurological Sciences, London Health Sciences Centre - Lawson Health Research Institute, 339 Windermere Road, A10-026, London, ON N6A 5A5, Canada
| |
Collapse
|
17
|
Merola A, Romagnolo A, Krishna V, Pallavaram S, Carcieri S, Goetz S, Mandybur G, Duker AP, Dalm B, Rolston JD, Fasano A, Verhagen L. Current Directions in Deep Brain Stimulation for Parkinson's Disease-Directing Current to Maximize Clinical Benefit. Neurol Ther 2020; 9:25-41. [PMID: 32157562 PMCID: PMC7229063 DOI: 10.1007/s40120-020-00181-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Indexed: 12/19/2022] Open
Abstract
Several single-center studies and one large multicenter clinical trial demonstrated that directional deep brain stimulation (DBS) could optimize the volume of tissue activated (VTA) based on the individual placement of the lead in relation to the target. The ability to generate axially asymmetric fields of stimulation translates into a broader therapeutic window (TW) compared to conventional DBS. However, changing the shape and surface of stimulating electrodes (directional segmented vs. conventional ring-shaped) also demands a revision of the programming strategies employed for DBS programming. Model-based approaches have been used to predict the shape of the VTA, which can be visualized on standardized neuroimaging atlases or individual magnetic resonance imaging. While potentially useful for optimizing clinical care, these systems remain limited by factors such as patient-specific anatomical variability, postsurgical lead migrations, and inability to account for individual contact impedances and orientation of the systems of fibers surrounding the electrode. Alternative programming tools based on the functional assessment of stimulation-induced clinical benefits and side effects allow one to collect and analyze data from each electrode of the DBS system and provide an action plan of ranked alternatives for therapeutic settings based on the selection of optimal directional contacts. Overall, an increasing amount of data supports the use of directional DBS. It is conceivable that the use of directionality may reduce the need for complex programming paradigms such as bipolar configurations, frequency or pulse width modulation, or interleaving. At a minimum, stimulation through directional electrodes can be considered as another tool to improve the benefit/side effect ratio. At a maximum, directionality may become the preferred way to program because of its larger TW and lower energy consumption.
Collapse
Affiliation(s)
- Aristide Merola
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Alberto Romagnolo
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Vibhor Krishna
- Department of Neurosurgery, Ohio State Wexner Medical Center, Columbus, OH, USA
| | | | | | - Steven Goetz
- Medtronic PLC Brain Modulation, Minneapolis, MN, USA
| | | | - Andrew P Duker
- Department of Neurology, Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, OH, USA
| | - Brian Dalm
- Department of Neurosurgery, Ohio State Wexner Medical Center, Columbus, OH, USA
| | - John D Rolston
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA
| | - Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, ON, Canada
- Division of Neurology, University of Toronto, Toronto, ON, Canada
- Krembil Brain Institute, Toronto, ON, Canada
- CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, ON, Canada
| | - Leo Verhagen
- Department of Neurological Sciences, Movement Disorder Section, Rush University, Chicago, IL, USA
| |
Collapse
|
18
|
Lee DJ, Milosevic L, Gramer R, Sasikumar S, Al-Ozzi TM, De Vloo P, Dallapiazza RF, Elias GJB, Cohn M, Kalia SK, Hutchison WD, Fasano A, Lozano AM. Nucleus basalis of Meynert neuronal activity in Parkinson's disease. J Neurosurg 2020; 132:574-582. [PMID: 30797189 DOI: 10.3171/2018.11.jns182386] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/02/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neuronal loss within the cholinergic nucleus basalis of Meynert (nbM) correlates with cognitive decline in dementing disorders such as Alzheimer's disease and Parkinson's disease (PD). In nonhuman primates, the nbM firing pattern (5-40 Hz) has also been correlated with working memory and sustained attention. In this study, authors performed microelectrode recordings of the globus pallidus pars interna (GPi) and the nbM immediately prior to the implantation of bilateral deep brain stimulation (DBS) electrodes in PD patients to treat motor symptoms and cognitive impairment, respectively. Here, the authors evaluate the electrophysiological properties of the nbM in patients with PD. METHODS Five patients (4 male, mean age 66 ± 4 years) with PD and mild cognitive impairment underwent bilateral GPi and nbM DBS lead implantation. Microelectrode recordings were performed through the GPi and nbM along a single trajectory. Firing rates and burst indices were characterized for each neuronal population with the patient at rest and performing a sustained-attention auditory oddball task. Action potential (AP) depolarization and repolarization widths were measured for each neuronal population at rest. RESULTS In PD patients off medication, the authors identified neuronal discharge rates that were specific to each area populated by GPi cells (92.6 ± 46.1 Hz), border cells (34 ± 21 Hz), and nbM cells (13 ± 10 Hz). During the oddball task, firing rates of nbM cells decreased (2.9 ± 0.9 to 2.0 ± 1.1 Hz, p < 0.05). During baseline recordings, the burst index for nbM cells (1.7 ± 0.6) was significantly greater than those for GPi cells (1.2 ± 0.2, p < 0.05) and border cells (1.1 ± 0.1, p < 0.05). There was no significant difference in the nbM burst index during the oddball task relative to baseline (3.4 ± 1.7, p = 0.20). With the patient at rest, the width of the depolarization phase of APs did not differ among the GPi cells, border cells, and nbM cells (p = 0.60); however, during the repolarization phase, the nbM spikes were significantly longer than those for GPi high-frequency discharge cells (p < 0.05) but not the border cells (p = 0.20). CONCLUSIONS Neurons along the trajectory through the GPi and nbM have distinct firing patterns. The profile of nbM activity is similar to that observed in nonhuman primates and is altered during a cognitive task associated with cholinergic activation. These findings will serve to identify these targets intraoperatively and form the basis for further research to characterize the role of the nbM in cognition.
Collapse
Affiliation(s)
- Darrin J Lee
- Departments of1Neurological Surgery.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Luka Milosevic
- 2Institute of Biomaterials and Biomedical Engineering, University of Toronto; and.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Robert Gramer
- Departments of1Neurological Surgery.,6Krembil Research Institute, Toronto, Ontario, Canada
| | | | - Tameem M Al-Ozzi
- 4Physiology, and.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Philippe De Vloo
- Departments of1Neurological Surgery.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Robert F Dallapiazza
- Departments of1Neurological Surgery.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Gavin J B Elias
- Departments of1Neurological Surgery.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Melanie Cohn
- 5Psychology.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Suneil K Kalia
- Departments of1Neurological Surgery.,6Krembil Research Institute, Toronto, Ontario, Canada
| | | | - Alfonso Fasano
- 3Neurology.,6Krembil Research Institute, Toronto, Ontario, Canada
| | - Andres M Lozano
- Departments of1Neurological Surgery.,6Krembil Research Institute, Toronto, Ontario, Canada
| |
Collapse
|
19
|
Castrillo-Fraile V, Peña EC, Gabriel Y Galán JMT, Delgado-López PD, Collazo C, Cubo E. Tremor Control Devices for Essential Tremor: A Systematic Literature Review. TREMOR AND OTHER HYPERKINETIC MOVEMENTS (NEW YORK, N.Y.) 2019; 9:tre-09-688. [PMID: 31867136 PMCID: PMC6898897 DOI: 10.7916/tohm.v0.688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 11/04/2019] [Indexed: 12/01/2022]
Abstract
Background There is a growing interest in nonpharmacological approaches for essential tremor (ET), including tremor cancelation devices. However, the true efficacy of such devices in ET remains unclear. Methods A systematic literature review was conducted using standardized criteria regarding efficacy and comfortability. Devices focused on design or experimental testing in which tremor was simulated in a robot were excluded. Results Out of 324 articles initially identified, 12 articles were included. Orthoses using biomechanical loading and neuromodulation with electrical stimulation, and external tremor cancelation devices, were the main interventions used to suppress tremor. All devices were designed to control tremor of the upper limbs at different anatomical locations. Overall, an average tremor attenuation of 50–98% was reported (level of evidence III). Interference with voluntary movements and portability was described as the main drawback. Discussion In conclusion, this review highlights the growing interest in emerging tremor control devices and the importance of assessing comfort without affecting voluntary movements. However, the level of evidence regarding the efficacy of these tremor control devices remains low. An integrated multidisciplinary combination approach of engineering, robotics, physiology, physiotherapy, and clinical assessment is needed to improve the quality of non-pharmacological interventions for ET.
Collapse
Affiliation(s)
- Victoria Castrillo-Fraile
- Department of Rehabilitation, Burgos University Hospital, Burgos, ES.,Department of Health Science, University of Valladolid, Valladolid, ES
| | | | | | | | - Carla Collazo
- Department of Health Science, University of Burgos, Burgos, ES
| | - Esther Cubo
- Department of Neurology, Burgos University Hospital, Burgos, ES.,Department of Health Science, University of Burgos, Burgos, ES
| |
Collapse
|
20
|
Walker MR, Zhong J, Waspe AC, Looi T, Piorkowska K, Hawkins C, Drake JM, Hodaie M. Acute MR-Guided High-Intensity Focused Ultrasound Lesion Assessment Using Diffusion-Weighted Imaging and Histological Analysis. Front Neurol 2019; 10:1069. [PMID: 31681145 PMCID: PMC6803785 DOI: 10.3389/fneur.2019.01069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 09/23/2019] [Indexed: 01/03/2023] Open
Abstract
Objectives: The application of magnetic resonance-guided focused ultrasound (MRgFUS) for the treatment of neurological conditions has been of increasing interest. Conventional MR imaging can provide structural information about the effect of MRgFUS, where differences in ablated tissue can be seen, but it lacks information about the status of the cellular environment or neural microstructure. We investigate in vivo acute changes in water diffusion and white matter tracts in the brain of a piglet model after MRgFUS treatment using diffusion-weighted imaging (DWI) with histological verification of treatment-related changes. Methods: MRgFUS was used to treat the anterior body of the fornix in four piglets. T1 and diffusion-weighted images were collected before and after treatment. Mean diffusion-weighted imaging (MDWI) images were generated to measure lesion volumes via signal intensity thresholds. Histological data were collected for volume comparison and assessment of treatment effect. DWI metric maps of fractional anisotropy (FA), apparent diffusion coefficient (ADC), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD) were generated for quantitative assessment. Fornix-related fiber tracts were generated before and after treatment for qualitative assessment. Results: The volume of treated tissue measured via MDWI did not differ significantly from histological measurements, and both were significantly larger than the treatment cell volume. Diffusion metrics in the treatment region were significantly decreased following MRgFUS treatment, with the peak change seen at the lesion core and decreasing radially. Histological analysis confirmed an area of coagulative necrosis in the targeted region with sharp demarcation zone with surrounding brain. Tractography from the lesion core and the fornix revealed fiber disruptions following treatment. Conclusions: Diffusion maps and fiber tractography are an effective method for assessing lesion volumes and microstructural changes in vivo following MRgFUS treatment. This study demonstrates that DWI has the potential to advance MRgFUS by providing convenient in vivo microstructural lesion and fiber tractography assessment after treatment.
Collapse
Affiliation(s)
- Matthew R Walker
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Jidan Zhong
- Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Adam C Waspe
- Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, ON, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Thomas Looi
- Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, ON, Canada
| | - Karolina Piorkowska
- Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia Hawkins
- Department of Paediatric Laboratory Medicine, Division of Neuropathology, Hospital for Sick Children, Toronto, ON, Canada
| | - James M Drake
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Centre for Image Guided Innovation and Therapeutic Intervention, Hospital for Sick Children, Toronto, ON, Canada.,Division of Neurosurgery, Hospital for Sick Children, Toronto, ON, Canada
| | - Mojgan Hodaie
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Division of Brain, Imaging and Behaviour - Systems Neuroscience, Krembil Research Institute, University Health Network, Toronto, ON, Canada.,Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| |
Collapse
|
21
|
Fasano A, Helmich RC. Tremor habituation to deep brain stimulation: Underlying mechanisms and solutions. Mov Disord 2019; 34:1761-1773. [PMID: 31433906 DOI: 10.1002/mds.27821] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 07/01/2019] [Accepted: 07/18/2019] [Indexed: 12/14/2022] Open
Abstract
DBS of the ventral intermediate nucleus is an extremely effective treatment for essential tremor, although a waning benefit is observed after a variable time in a variable proportion of patients (ranging from 0% to 73%), a concept historically defined as "tolerance." Tolerance is currently an established concept in the medical community, although there is debate on its real existence. In fact, very few publications have actually addressed the problem, thus making tolerance a typical example of science based on "eminence rather than evidence." The underpinnings of the phenomena associated with the progressive loss of DBS benefit are not fully elucidated, although the interplay of different-not mutually exclusive-factors has been advocated. In this viewpoint, we gathered the evidence explaining the progressive loss of benefit observed after DBS. We grouped these factors in three categories: disease-related factors (tremor etiology and progression); surgery-related factors (electrode location, microlesional effect and placebo); and stimulation-related factors (not optimized stimulation, stimulation-induced side effects, habituation, and tremor rebound). We also propose possible pathophysiological explanations for the phenomenon and define a nomenclature of the associated features: early versus late DBS failure; tremor rebound versus habituation (to be preferred over tolerance). Finally, we provide a practical approach for preventing and treating this loss of DBS benefit, and we draft a possible roadmap for the research to come. © 2019 International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Alfonso Fasano
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, UHN, Toronto, Ontario, Canada; Division of Neurology, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, Toronto, Ontario, Canada.,CenteR for Advancing Neurotechnological Innovation to Application (CRANIA), Toronto, Ontario, Canada
| | - Rick C Helmich
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Nijmegen, The Netherlands
| |
Collapse
|
22
|
|
23
|
Ni Z, Udupa K, Hallett M, Chen R. Effects of deep brain stimulation on the primary motor cortex: Insights from transcranial magnetic stimulation studies. Clin Neurophysiol 2018; 130:558-567. [PMID: 30527386 DOI: 10.1016/j.clinph.2018.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 10/01/2018] [Accepted: 10/24/2018] [Indexed: 01/01/2023]
Abstract
Deep brain stimulation (DBS) implanted in different basal ganglia nuclei regulates the dysfunctional neuronal circuits and improves symptoms in movement disorders. However, the understanding of the neurophysiological mechanism of DBS is at an early stage. Transcranial magnetic stimulation (TMS) can be used safely in movement disorder patients with DBS, and can shed light on how DBS works. DBS at a therapeutic setting normalizes the abnormal motor cortical excitability measured with motor evoked potentials (MEP) produced by primary motor cortical TMS. Abnormal intracortical circuits in the motor cortex tested with paired-pulse TMS paradigm also show normalization with DBS. These changes are accompanied with improvements in symptoms after chronic DBS. Single-pulse DBS produces cortical evoked potentials recorded by electroencephalography at specific latencies and modulates motor cortical excitability at certain time intervals measured with MEP. Combination of basal ganglia DBS with motor cortical TMS at stimulus intervals consistent with the latency of cortical evoked potentials delivered in a repetitive mode produces plastic changes in the primary motor cortex. TMS can be used to examine the effects of open and closed loop DBS. Patterned DBS and TMS delivered in a repetitive mode may be developed as a new therapeutic method for movement disorder patients.
Collapse
Affiliation(s)
- Zhen Ni
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Kaviraja Udupa
- Department of Neurophysiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Robert Chen
- Division of Neurology, Department of Medicine, University of Toronto and Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada.
| |
Collapse
|
24
|
Abstract
Parkinson disease is a common neurodegenerative disorder that causes progressive motor and nonmotor disability. It is diagnosed clinically and requires a detailed history and neurologic examination to exclude alternative diagnoses. Although disease-modifying therapies do not exist for Parkinson disease, effective symptomatic therapies, including dopaminergic medications and surgery, allow patients to maintain good quality of life for many years. Nonmotor symptoms, including mood, cognitive, sleep, autonomic, and gastrointestinal symptoms, should be managed by a multidisciplinary team of clinicians. Recent advances include new diagnostic criteria from the Movement Disorder Society and the addition of new symptomatic therapies for treating motor complications and nonmotor symptoms in advanced disease.
Collapse
Affiliation(s)
- Houman Homayoun
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (H.H.)
| |
Collapse
|
25
|
Alster P, Koziorowski DM, Za Bek M, Dzierzȩcki S, Ma Dry J, Duszyńska-Wa S K, Grygarowicz H, Zielonko J, Królicki L, Friedman A. Making a Difference-Positive Effect of Unilateral VIM Gamma Knife Thalamotomy in the Therapy of Tremor in Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS). Front Neurol 2018; 9:512. [PMID: 29997574 PMCID: PMC6030249 DOI: 10.3389/fneur.2018.00512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Accepted: 06/11/2018] [Indexed: 12/03/2022] Open
Abstract
Fragile X Tremor Ataxia Syndrome (FXTAS) is a syndrome based on expansion of the repeats of CGG triplets. The symptoms include action tremor and cerebellar gait ataxia. Additionally symptomatology of FXTAS may be associated to parkinsonism, executive function deficits, dementia, neuropathy and dysautonomia. We present a case of a patient who after 20 year history of progressive tremor and ataxia, was diagnosed after genetic examination as mutation of FXTAS. For the treatment of tremor the patient underwent Gamma Knife (GK) thalamotomy. Reduced tremor on the right side and improvement in everyday activities were observed in the outcome of the treatment. GK thalamotomy, in the context of this patient, did not significantly affect the ataxia.
Collapse
Affiliation(s)
- Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Mirosław Za Bek
- Department of Neurosurgery, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Sebastian Dzierzȩcki
- Department of Neurosurgery, Medical Centre for Postgraduate Education, Warsaw, Poland
| | - Jacek Ma Dry
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Hanna Grygarowicz
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Justyna Zielonko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Królicki
- Nuclear Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Friedman
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|