Deep brain stimulation promotes excitation and inhibition in subthalamic nucleus in Parkinson's disease

Synchronization and oscillation behaviors of excitatory and inhibitory populations with spike-timing-dependent plasticity

The effect of synaptic plasticity on the synchronization mechanism of the cerebral cortex has been a hot research topic over the past two decades. There are a great deal of literatures on excitatory pyramidal neurons, but the mechanism of interaction between the inhibitory interneurons is still under exploration. In this study, we consider a complex network consisting of excitatory (E) pyramidal neurons and inhibitory (I) interneurons interacting with chemical synapses through spike-timing-dependent plasticity (STDP). To study the effects of eSTDP and iSTDP on synchronization and oscillation behaviors emerged in an excitatory-inhibitory balanced network, we analyzed three different cases, a small-world network of purely excitatory neurons with eSTDP, a small-world network of purely inhibitory neurons with iSTDP and a small-world network with excitatory-inhibitory balanced neurons. By varying the number of inhibitory interneurons, and that of connected edges in a small-world network, and the coupling strength, these networks exhibit different synchronization and oscillation behaviors. We found that the eSTDP facilitates synchronization effectively, while iSTDP has no significant impact on it. In addition, eSTDP and iSTDP restrict the balance of the excitatory-inhibitory balanced neuronal network together and play a fundamental role in maintaining network stability and synchronization. They also can be used to guide the treatment and further research of neurodegenerative diseases.

Subthalamic nucleus deep brain stimulation on motor-symptoms of Parkinson's disease: Focus on neurochemistry

Deep brain stimulation (DBS) has become a standard therapy for Parkinson's disease (PD) and it is also currently under investigation for other neurological and psychiatric disorders. Although many scientific, clinical and ethical issues are still unresolved, DBS delivered into the subthalamic nucleus (STN) has improved the quality of life of several thousands of patients. The mechanisms underlying STN-DBS have been debated extensively in several reviews; less investigated are the biochemical consequences, which are still under scrutiny. Crucial and only partially understood, for instance, are the complex interplays occurring between STN-DBS and levodopa (LD)-centred therapy in the post-surgery follow-up. The main goal of this review is to address the question of whether an improved motor control, based on STN-DBS therapy, is also achieved through the additional modulation of other neurotransmitters, such as noradrenaline (NA) and serotonin (5-HT). A critical issue is to understand not only acute DBS-mediated effects, but also chronic changes, such as those involving cyclic nucleotides, capable of modulating circuit plasticity. The present article will discuss the neurochemical changes promoted by STN-DBS and will document the main results obtained in microdialysis studies. Furthermore, we will also examine the preliminary achievements of voltammetry applied to humans, and discuss new hypothetical investigational routes, taking into account novel players such as glia, or subcortical regions such as the pedunculopontine (PPN) area. Our further understanding of specific changes in brain chemistry promoted by STN-DBS would further disseminate its utilisation, at any stage of disease, avoiding an irreversible lesioning approach.

Neurophysiological evaluation of the pedunculopontine nucleus in humans

The pedunculopontine nucleus (PPTg) is constituted by a heterogeneous cluster of neurons located in caudal mesencephalic tegmentum which projects to the thalamus to trigger thalamocortical rhythms and the brainstem to modulate muscle tone and locomotion. It has been investigated as potential deep brain stimulation (DBS) target for treating Parkinson's disease (PD) symptoms. Neurophysiological studies conducted in humans using DBS electrodes for exploring functional properties of PPTg in vivo, reviewed in this paper, demonstrated that the functional connections between PPTg and cortex, basal ganglia, brainstem network involved in sleep/wake control, and spinal cord can be explored in vivo and provided useful insights about the physiology of this nucleus and pathophysiology of PD.

Targeting of the pedunculopontine nucleus by an MRI-guided approach: a cadaver study

Laboratory evidence suggests that the pedunculopontine nucleus (PPN) plays a central role in the initiation and maintenance of gait. Translational research has led to reports on deep brain stimulation (DBS) of the rostral brainstem in parkinsonian patients. However, initial clinical results appear to be rather variable. Possible factors include patient selection and the wide variability in anatomical location of implanted electrodes. Clinical studies on PPN DBS efficacy would, therefore, benefit from an accurate and reproducible method of stereotactic localization of the nucleus. The present study evaluates the anatomical accuracy of a specific protocol for MRI-guided stereotactic targeting of the PPN in a human cadaver. Imaging at 1.5 and 9.4 T confirmed electrode location in the intended region as defined anatomically by the surrounding fiber tracts. The spatial relations of each electrode track to the nucleus were explored by subsequent histological examination. This confirmed that the neuropil surrounding each electrode track contained scattered large neurons morphologically consistent with those of the subnucleus dissipatus and compactus of the PPN. The results support the accuracy of the described specific MR imaging protocol.

The pedunculopontine nucleus as an additional target for deep brain stimulation

The pedunculopontine nucleus has been suggested as a target for DBS. In this paper we propose a single compartment computational model for a PPN Type I cell and compare its dynamic behavior with experimental data. The model shows bursts after a period of hyperpolarization and spontaneous firing at 8 Hz. Bifurcation analysis of the single PPN cell shows bistability of fast and slow spiking solutions for a range of applied currents. A network model for STN, GPe and GPi produces basal ganglia output that is used as input for the PPN cell. The conductances for projections from the STN and the GPi to the PPN are determined from experimental data. The resulting behavior of the PPN cell is studied under normal and Parkinsonian conditions of the basal ganglia network. The effect of high frequency stimulation of the STN is considered as well as the effect of combined high frequency stimulation of the STN and the PPN at various frequencies. The relay properties of the PPN cell demonstrate that the combined high frequency stimulation of STN and low frequency (10 Hz, 25 Hz, 40 Hz) stimulation of PPN hardly improves the effect of exclusive STN stimulation. Moreover, PPN-DBS at low stimulation amplitude has a better effect than at higher stimulation amplitude. The effect of PPN output on the basal ganglia is investigated, in particular the effect of STN-DBS and/or PPN-DBS on the pathological firing pattern of STN and GPe cells. PPN-DBS eliminates the pathological firing pattern of STN and GPe cells, whereas STN-DBS and combined STN-DBS and PPN-DBS eliminate the pathological firing pattern only from STN cells.

Cholinergic and non-cholinergic mesopontine tegmental neurons projecting to the subthalamic nucleus in the rat

The subthalamic nucleus (STN) receives cholinergic and non-cholinergic projections from the mesopontine tegmentum. This study investigated the numbers and distributions of neurons involved in these projections in rats using Fluorogold retrograde tracing combined with immunostaining of choline acetyltransferase and a neuron-specific nuclear protein. The results suggest that a small population of cholinergic neurons mainly in the caudoventral part of the pedunculopontine tegmental nucleus (PPN), approximately 360 neurons (≈ 10% of the total) in the homolateral and 80 neurons (≈ 2%) in the contralateral PPN, projects to the STN. In contrast, the number of non-cholinergic neurons projecting to the STN was estimated to be nine times as much, with approximately 3300 in the homolateral side and 1300 in the contralateral side. A large gathering of the Fluorogold-labeled non-cholinergic neurons was found rostrodorsomedial to the caudolateral PPN. The biotinylated dextran amine (BDA) anterograde tracing method was used to substantiate the mesopontine-STN projections. Injection of BDA into the caudoventral PPN labeled numerous thin fibers with small en-passant varicosities in the STN. Injection of BDA into the non-cholinergic neuron-rich area labeled a moderate number of thicker fibers with patches of aggregates of larger boutons. The densities of labeled fibers and the number of retrogradely labeled cells in the mesopontine tegmentum suggested that the terminal field formed in the STN by each cholinergic neuron is more extensive than that formed by each non-cholinergic neuron. The findings suggest that cholinergic and non-cholinergic mesopontine afferents may carry different information to the STN.

The pedunculopontine tegmental nucleus: implications for a role in modulating spinal cord motoneuron excitability

There is evidence that deep brain stimulation (DBS) of the pedunculopontine tegmental nucleus (PPTg) improves parkinsonian motor signs. The mechanisms that mediate these effects and the modifications that occur in the PPTg in Parkinson's disease (PD) are not fully known and are the object of current debate. The aim of this paper was to critically review available data with respect to (1) the presence of PPTg neurons linked to reticulospinal projections, (2) the involvement of these neurons in modulating spinal reflexes, and (3) the participation of fibers close to or within the PPTg region in such modulation. The PPTg neurons are distributed in a large pontotegmental region, stimulation of which can evoke activity in hindlimb, shoulder and neck muscles, and potentiate motor responses evoked by stimulation of dorsal roots. This influence seems to be carried out by fast-conducting descending fibers, which likely run in the medial reticulospinal pathway. It is yet unclear which neurotransmitters are involved and on which elements of the gray matter of the spinal cord PPTg fibers synapse. The modulation of spinal cord activity which can be achieved by stimulating the PPTg region seems to be mediated not only by PPTg neurons, but also by tecto-reticular fibers which run in the pontotegmental area, and which likely are activated during PPTg-DBS. The importance of these fibers is discussed taking into account the degeneration of PPTg neurons in PD and the benefits in gait and postural control that PPTg-DBS exerts in PD. The potential usefulness of PPTg-DBS in other neurodegenerative disorders characterized by neuronal loss in the brainstem is also considered.

The role of imaging in the surgical treatment of movement disorders

Functional neurosurgery involves precise surgical targeting of anatomic structures to modulate neurologic function. From its conception, advances in the surgical treatment of movement disorders have been intertwined with developments in medical imaging, culminating in the use of stereotactic magnetic resonance imaging (MRI). Meticulous attention to detail during image acquisition, direct anatomic localization, and planning of the initial surgical trajectory allows the surgeon to reach the desired anatomic and functional target with the initial trajectory in most cases, thus reducing the need for multiple passes through the brain, and the associated risk of hemorrhage and functional deficit. This philosophy is of paramount importance in a procedure that is primarily aimed at improving quality of life. Documentation of electrode contact location by means of stereotactic imaging is essential to audit surgical targeting accuracy and to further the knowledge of structure-to-function relationships within the human brain.

Deep brain stimulation changes basal ganglia output nuclei firing pattern in the dystonic hamster

Dystonia is a heterogeneous syndrome of movement disorders characterized by involuntary muscle contractions leading to abnormal movements and postures. While medical treatment is often ineffective, deep brain stimulation (DBS) of the internal pallidum improves dystonia. Here, we studied the impact of DBS in the entopeduncular nucleus (EP), the rodent equivalent of the human globus pallidus internus, on basal ganglia output in the dt(sz)-hamster, a well-characterized model of dystonia by extracellular recordings. Previous work has shown that EP-DBS improves dystonic symptoms in dt(sz)-hamsters. We report that EP-DBS changes firing pattern in the EP, most neurons switching to a less regular firing pattern during DBS. In contrast, EP-DBS did not change the average firing rate of EP neurons. EP neurons display multiphasic responses to each stimulation impulse, likely underlying the disruption of their firing rhythm. Finally, neurons in the substantia nigra pars reticulata display similar responses to EP-DBS, supporting the idea that EP-DBS affects basal ganglia output activity through the activation of common afferent fibers.

Non-motor functions in parkinsonian patients implanted in the pedunculopontine nucleus: focus on sleep and cognitive domains

Between 2005 and 2007, six patients affected by idiopathic Parkinson's disease (IPD) were submitted to the bilateral implantation (and subsequent deep brain stimulation - DBS) of the pedunculopontine nucleus (PPN) plus the subthalamic nucleus (STN). This review synthesizes the effects of PPN low-frequency stimulation on non-motor functions, focusing on patient sleep quality and cognitive performance. If not associated to STN-DBS, PPN-DBS promoted a modest amelioration of patient motor performance. However, during PPN-DBS, they experienced on the one hand a significant improvement in executive functions and working memory, on the other hand a beneficial change in sleep architecture. Overall, the limited sample hampers definite conclusions. Yet, although the PPN-DBS induced motor effects are quite disappointing (discouraging extended trials based upon the sole PPN implantation), the neuropsychological profile supports the contention by which in selected PD patients, with subtle cognitive deficits or vanished efficacy of previous implanted STN, PPN-DBS might still represent a reliable and compassionate option.

Low frequency stimulation of the pedunculopontine nucleus modulates electrical activity of subthalamic neurons in the rat

Electrical stimulation of the rat pedunculopontine nucleus (PPTg) (<25 Hz) synchronized firing of subthalamic neurons (STN) with each stimulus, and a continuous irregular activity often preceded recovery of burst discharges in control as well as in 6-hydroxydopamine lesioned animals. Firing was blocked both by increasing frequency of stimulation (>50 Hz) and current intensity (>500 microA). The data suggest that clinically relevant frequencies for PPTg deep brain stimulation in Parkinson's disease modulate burst discharges in STN neurons.