1
|
Jiang Y, Qi Z, Zhu H, Shen K, Liu R, Fang C, Lou W, Jiang Y, Yuan W, Cao X, Chen L, Zhuang Q. Role of the globus pallidus in motor and non-motor symptoms of Parkinson's disease. Neural Regen Res 2025; 20:1628-1643. [PMID: 38845220 DOI: 10.4103/nrr.nrr-d-23-01660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/21/2024] [Indexed: 08/07/2024] Open
Abstract
The globus pallidus plays a pivotal role in the basal ganglia circuit. Parkinson's disease is characterized by degeneration of dopamine-producing cells in the substantia nigra, which leads to dopamine deficiency in the brain that subsequently manifests as various motor and non-motor symptoms. This review aims to summarize the involvement of the globus pallidus in both motor and non-motor manifestations of Parkinson's disease. The firing activities of parvalbumin neurons in the medial globus pallidus, including both the firing rate and pattern, exhibit strong correlations with the bradykinesia and rigidity associated with Parkinson's disease. Increased beta oscillations, which are highly correlated with bradykinesia and rigidity, are regulated by the lateral globus pallidus. Furthermore, bradykinesia and rigidity are strongly linked to the loss of dopaminergic projections within the cortical-basal ganglia-thalamocortical loop. Resting tremors are attributed to the transmission of pathological signals from the basal ganglia through the motor cortex to the cerebellum-ventral intermediate nucleus circuit. The cortico-striato-pallidal loop is responsible for mediating pallidi-associated sleep disorders. Medication and deep brain stimulation are the primary therapeutic strategies addressing the globus pallidus in Parkinson's disease. Medication is the primary treatment for motor symptoms in the early stages of Parkinson's disease, while deep brain stimulation has been clinically proven to be effective in alleviating symptoms in patients with advanced Parkinson's disease, particularly for the movement disorders caused by levodopa. Deep brain stimulation targeting the globus pallidus internus can improve motor function in patients with tremor-dominant and non-tremor-dominant Parkinson's disease, while deep brain stimulation targeting the globus pallidus externus can alter the temporal pattern of neural activity throughout the basal ganglia-thalamus network. Therefore, the composition of the globus pallidus neurons, the neurotransmitters that act on them, their electrical activity, and the neural circuits they form can guide the search for new multi-target drugs to treat Parkinson's disease in clinical practice. Examining the potential intra-nuclear and neural circuit mechanisms of deep brain stimulation associated with the globus pallidus can facilitate the management of both motor and non-motor symptoms while minimizing the side effects caused by deep brain stimulation.
Collapse
Affiliation(s)
- Yimiao Jiang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Zengxin Qi
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Brain Science, Fudan University, Shanghai, China
| | - Huixian Zhu
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Kangli Shen
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Ruiqi Liu
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Chenxin Fang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Weiwei Lou
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Yifan Jiang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Wangrui Yuan
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Xin Cao
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| | - Liang Chen
- Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
- Shanghai Key Laboratory of Brain Function Restoration and Neural Regeneration, Shanghai, China
- State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Brain Science, Fudan University, Shanghai, China
| | - Qianxing Zhuang
- Department of Physiology, School of Medicine, Nantong University, Nantong, Jiangsu Province, China
| |
Collapse
|
2
|
Phokaewvarangkul O, Auffret M, Groppa S, Markovic V, Petrovic I, Bhidayasiri R. What was first and what is next in selecting device-aided therapy in Parkinson's disease? Balancing evidence and experience. J Neural Transm (Vienna) 2024; 131:1307-1320. [PMID: 38747986 DOI: 10.1007/s00702-024-02782-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/29/2024] [Indexed: 10/25/2024]
Abstract
Parkinson's disease (PD) progresses with motor fluctuations emerging several years after treatment initiation. Initially managed with oral medications, these fluctuations may later necessitate device-aided therapy (DATs). Globally, various DATs options are available, including continuous subcutaneous apomorphine infusion, deep brain stimulation, levodopa-carbidopa intestinal gel, levodopa-entacapone-carbidopa intestinal gel, and subcutaneous foslevodopa/foscarbidopa infusion, each with its complexities. Hence, matching complex patients with suitable therapy is critical. This review offers practical insights for physicians managing complex PD cases. Balancing evidence and experience is vital to select the most suitable DATs, considering factors like disease stage and patient preferences. Comparative analysis of DATs benefits and risks provides essential insights for clinicians and patients. Treatment sequences vary based on availability, patient needs, and disease progression. Less invasive options like apomorphine are often preferred initially, followed by other DATs if needed. Patient selection requires comprehensive evaluations, including motor function and cognitive status. Follow-up care involves symptom monitoring and adjusting medications. Customized treatment plans are essential for optimizing PD management with DATs.
Collapse
Affiliation(s)
- Onanong Phokaewvarangkul
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Manon Auffret
- France Développement Electronique (FDE), Monswiller, France, Institut Des Neurosciences Cliniques de Rennes (INCR), Rennes, France, Behavior and Basal Ganglia Research Unit, CIC-IT, CIC1414, Pontchaillou University Hospital and University of Rennes, Rennes, France
| | - Sergiu Groppa
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), Rhine-Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Vladana Markovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Igor Petrovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Roongroj Bhidayasiri
- Chulalongkorn Centre of Excellence for Parkinson's Disease and Related Disorders, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
- The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand.
| |
Collapse
|
3
|
Rusz J, Krack P, Tripoliti E. From prodromal stages to clinical trials: The promise of digital speech biomarkers in Parkinson's disease. Neurosci Biobehav Rev 2024; 167:105922. [PMID: 39424108 DOI: 10.1016/j.neubiorev.2024.105922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/19/2024] [Accepted: 10/13/2024] [Indexed: 10/21/2024]
Abstract
Speech impairment is a common and disabling symptom in Parkinson's disease (PD), affecting communication and quality of life. Advances in digital speech processing and artificial intelligence have revolutionized objective speech analysis. Given the complex nature of speech impairment, acoustic speech analysis offers unique biomarkers for neuroprotective treatments from the prodromal stages of PD. Digital speech biomarkers can monitor levodopa-induced motor complications, detect the effects of deep brain stimulation, and provide feedback for behavioral speech therapy. This review updates the mechanisms underlying speech impairment, the impact of speech phenotypes, and the effects of interventions on speech. We evaluate the strengths, potential weaknesses, and suitability of promising digital speech biomarkers in PD for capturing disease progression and treatment efficacy. Additionally, we explore the translational potential of PD speech biomarkers to other neuropsychiatric diseases, offering insights into motion, cognition, and emotion. Finally, we highlight knowledge gaps and suggest directions for future research to enhance the use of quantitative speech measures in disease-modifying clinical trials. The findings demonstrate that one year is sufficient to detect disease progression in early PD through speech biomarkers. Voice quality, pitch, loudness, and articulation measures appear to capture the efficacy of treatment interventions most effectively. Certain speech features, such as loudness and articulation rate, behave oppositely in different neurological diseases, offering valuable insights for differential diagnosis. In conclusion, this review highlights speech as a biomarker in tracking disease progression, especially in the prodromal stages of PD, and calls for further longitudinal studies to establish its efficacy across diverse populations.
Collapse
Affiliation(s)
- Jan Rusz
- Department of Circuit Theory, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic.
| | - Paul Krack
- Movement Disorders Center, Department of Neurology, University Hospital of Bern, Bern, Switzerland
| | - Elina Tripoliti
- UCL, Institute of Neurology, Department of Clinical and Movement Neurosciences, and National Hospital for Neurology and Neurosurgery, UCLH NHS Trust, London, UK
| |
Collapse
|
4
|
Halász L, Sajonz BEA, Miklós G, van Elswijk G, Hagh Gooie S, Várkuti B, Tamás G, Coenen VA, Erōss L. Predictive modeling of sensory responses in deep brain stimulation. Front Neurol 2024; 15:1467307. [PMID: 39410997 PMCID: PMC11473379 DOI: 10.3389/fneur.2024.1467307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2024] [Accepted: 09/18/2024] [Indexed: 10/19/2024] Open
Abstract
Introduction Although stimulation-induced sensations are typically considered undesirable side effects in clinical DBS therapy, there are emerging scenarios, such as computer-brain interface applications, where these sensations may be intentionally created. The selection of stimulation parameters, whether to avoid or induce sensations, is a challenging task due to the vast parameter space involved. This study aims to streamline DBS parameter selection by employing a machine learning model to predict the occurrence and somatic location of paresthesias in response to thalamic DBS. Methods We used a dataset comprising 3,359 paresthetic sensations collected from 18 thalamic DBS leads from 10 individuals in two clinical centers. For each stimulation, we modeled the Volume of Tissue Activation (VTA). We then used the stimulation parameters and the VTA information to train a machine learning model to predict the occurrence of sensations and their corresponding somatic areas. Results Our results show fair to substantial agreement with ground truth in predicting the presence and somatic location of DBS-evoked paresthesias, with Kappa values ranging from 0.31 to 0.72. We observed comparable performance in predicting the presence of paresthesias for both seen and unseen cases (Kappa 0.72 vs. 0.60). However, Kappa agreement for predicting specific somatic locations was significantly lower for unseen cases (0.53 vs. 0.31). Conclusion The results suggest that machine learning can potentially be used to optimize DBS parameter selection, leading to faster and more efficient postoperative management. Outcome predictions may be used to guide clinical DBS programming or tuning of DBS based computer-brain interfaces.
Collapse
Affiliation(s)
- László Halász
- Institute of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- Albert Szent-Györgyi Medical School, Doctoral School of Clinical Medicine, Clinical and Experimental Research for Reconstructive and Organ-Sparing Surgery, University of Szeged, Szeged, Hungary
| | - Bastian E. A. Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University and Medical Faculty of Freiburg University, Freiburg, Germany
| | - Gabriella Miklós
- Institute of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary
- CereGate GmbH, München, Germany
| | | | | | | | - Gertrúd Tamás
- Department of Neurology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Volker A. Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center of Freiburg University and Medical Faculty of Freiburg University, Freiburg, Germany
- Center for Deep Brain Stimulation, Freiburg University, Freiburg, Germany
| | - Loránd Erōss
- Institute of Neurosurgery and Neurointervention, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| |
Collapse
|
5
|
Rybalova E, Semenova N. Spiking activities in small neural networks induced by external forcing. CHAOS (WOODBURY, N.Y.) 2024; 34:101105. [PMID: 39441892 DOI: 10.1063/5.0226896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Accepted: 10/10/2024] [Indexed: 10/25/2024]
Abstract
Neurons in an excitable mode do not show spiking activity and, therefore, do not contribute to information transfer transmission and its processing. However, some external influences, coupling, or time delay can lead to the appearance of oscillations in individual systems or networks. The main goal of this paper is to uncover the connection parameters and parameters of external influences that lead to the arising of spiking behavior in a small network of locally coupled FitzHugh-Nagumo oscillators. In this study, we analyze the dynamics of a small network in the absence and presence of several types of external influences. First, we consider the impact of periodic-pulse exposure generated as a periodic sequence of Gaussian pulses. Second, we show what behavior can be induced by far less regular pulsed influence (Lévy noise) and its special case called white Gaussian noise. For all types of influences, we have identified the appropriate parameters (local coupling strength, intensity, and frequency) that induce spiking activity in the small network.
Collapse
Affiliation(s)
- E Rybalova
- Radiophysics and Nonlinear Dynamics Department, Institute of Physics, Saratov State University, Astrakhanskaya Str. 83, Saratov 410012, Russia
| | - N Semenova
- Radiophysics and Nonlinear Dynamics Department, Institute of Physics, Saratov State University, Astrakhanskaya Str. 83, Saratov 410012, Russia
| |
Collapse
|
6
|
Monteiro JDS, E Silva BB, de Oliveira RR, Borges PGLB, Pereira MAOM, Costa KA, Nunes ALS, Telles JPM, Valença MM. Magnetic resonance-guided focused ultrasound ventral intermediate thalamotomy for Tremor-Dominant Parkinson's disease: a systematic review and meta-analysis. Neurosurg Rev 2024; 47:701. [PMID: 39331247 DOI: 10.1007/s10143-024-02948-2] [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: 07/24/2024] [Revised: 08/23/2024] [Accepted: 09/22/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Tremor-dominant Parkinson's Disease (TDPD) has a slower neurological decline compared to other phenotypes of the disease, but significantly impacts daily activities and is often less responsive to standard medications. Magnetic Resonance-guided Focused Ultrasound (MRgFUS) lesioning of the Ventral Intermediate (VIM) nucleus of the thalamus may alleviate symptoms for these patients. METHODS A systematic review and meta-analysis of English-language studies from PubMed, Cochrane, and Embase were conducted, assessing the efficacy and safety of MRgFUS VIM thalamotomy in TDPD patients. Tremor scores were evaluated using the Clinical Scale Rating for Tremor and the Movement Disorders Society - Unified Parkinson's Disease Rating Scale (MDS-UPDRSIII). Neuropsychological outcomes were measured using the Parkinson Disease Questionnaire (PDQ) and the Montreal Cognitive Assessment. This analysis adhered to Cochrane and PRISMA guidelines. RESULTS Thirteen studies with 211 patients were included. MDS-UPDRSIII scores showed significant improvement at 1, 6, and 12 months post-MRgFUS, respectively: (MD -8.92 points, 95% CI: -15.44 to -2.40, p < 0.01; MD -7.39 points, 95% CI: -11.47 to -3.30, p < 0.01; MD -10.66 points, 95% CI: -16.89 to -4.43, p < 0.01). PDQ scores at baseline compared to 6 months post-treatment also indicated a significant improvement (SMD - 0.86, 95% CI: -1.21 to -0.50, p < 0.01). Neurological adverse events were generally mild and transient, with gait instability and sensory deficits being the most common. CONCLUSION This meta-analysis demonstrates significant improvements in tremor and neuropsychological outcomes following MRgFUS VIM thalamotomy in TDPD patients, with adverse events being typically mild and transient.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Marcelo Moraes Valença
- Department of Neurosurgery, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| |
Collapse
|
7
|
Yang C, Xu Y, Feng X, Wang B, Du Y, Wang K, Lü J, Huang L, Qian Z, Wang Z, Chen N, Zhou J, Zhang C, Liu Y. Transcranial Temporal Interference Stimulation of the Right Globus Pallidus in Parkinson's Disease. Mov Disord 2024. [PMID: 39133053 DOI: 10.1002/mds.29967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND Invasive deep brain stimulation (DBS) has been shown to be effective in treating patients with Parkinson's disease (PD), yet its clinical use is limited to patients at the advanced stage of the disease. Transcranial temporal interference stimulation (tTIS) may be a novel nonneurosurgical and safer alternative, yet its therapeutic potential remains unexplored. OBJECTIVE This pilot study aims to examine the feasibility and safety of tTIS targeting the right globus pallidus internus (GPi) for motor symptoms in patients with PD. METHODS Twelve participants with mild PD completed this randomized, double-blind, and sham-controlled experiment. Each of them received either 20-minute or sham tTIS of the right GPi. Before and immediately after the stimulation, participants completed the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III) in the "medication-on" state to assess the motor symptoms. The blinding efficacy and side effects were also assessed. RESULTS tTIS was well tolerated by participants, with only mild, transient adverse effects reported. tTIS significantly reduced MDS-UPDRS-III scores by 6.64 points (14.7%), particularly in bradykinesia (23.5%) and tremor (15.3%). The left side showed more significant alleviation in motor symptoms, particularly bradykinesia, compared to the right side. Participants with severer bradykinesia and tremor before stimulation experienced greater improvement after tTIS. CONCLUSION This pilot study suggests that the tTIS, as a novel noninvasive DBS approach, is feasible and safe for alleviating motor symptoms in mild PD, especially bradykinesia and tremor. Future larger-scale and more definitive studies are needed to confirm the benefits. © 2024 The Author(s). Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Chenhao Yang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yongxin Xu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xiaofan Feng
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Bowen Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yichao Du
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Kexin Wang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jiaojiao Lü
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Lingyan Huang
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zhenyu Qian
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zhen Wang
- School of Martial Arts, Shanghai University of Sport, Shanghai, China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junhong Zhou
- Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Chencheng Zhang
- Clinical Neuroscience Center, Ruijin Hospital Luwan Branch, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Department of Neurology, Neurosurgery, Psychiatry and Neuroscience, Ruijin Hospital Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yu Liu
- Key Laboratory of Exercise and Health Sciences of Ministry of Education, School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| |
Collapse
|
8
|
Büchele F, Stieglitz L, Baumann CR. Should asleep deep brain stimulation in Parkinson's disease be preferred over the awake approach? - Cons. Swiss Med Wkly 2024; 154:3855. [PMID: 39137444 DOI: 10.57187/s.3855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
No abstract available.
Collapse
Affiliation(s)
- Fabian Büchele
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Lennart Stieglitz
- Department of Neurosurgery, University Hospital Zurich, Zurich, Switzerland
| | | |
Collapse
|
9
|
Wu W, Gong S, Wang S, Lei W, Yuan L, Wu W, Qiu J, Sun W, Luan G, Zhu M, Wang X, Liang G, Tao Y. Safety and efficiency of deep brain stimulation in the elderly patients with Parkinson's disease. CNS Neurosci Ther 2024; 30:e14899. [PMID: 39107966 PMCID: PMC11303456 DOI: 10.1111/cns.14899] [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: 04/13/2024] [Revised: 06/22/2024] [Accepted: 07/22/2024] [Indexed: 08/10/2024] Open
Abstract
AIMS Deep brain stimulation (DBS) is not routinely performed in elderly patients (≥75 years old) to date because of concerns about complications and decreased benefit. This study aimed to evaluate the safety and efficacy of DBS in elderly patients with Parkinson's disease. METHODS A retrospective analysis was performed using data from 40 elderly patients from four centers who were treated with neurosurgical robot-assisted DBS between September 2016 and December 2021. These patients were followed up for a minimum period of 2 years, with a subgroup of nine patients followed up for 5-7 years. Patient demographic characteristics, surgical information, pre- and postoperative motor scores, non-motor scores, activities of daily living, and complications were retrospectively analyzed. RESULTS The mean surgical procedure duration was 1.65 ± 0.24 h, with a mean electrode implantation duration of 1.10 ± 0.23 h and a mean pulse generator implantation duration of 0.55 ± 0.07 h. The mean pneumocephalus volume, electrode fusion error, and Tao's DBS surgery scale were 16.23 ± 12.81 cm3, 0.81 ± 0.23 mm, and 77.63 ± 8.08, respectively. One patient developed a skin infection, and the device was removed. The Unified Parkinson's disease rating scale, Unified Parkinson's disease rating scale of Part III, tremor, rigidity, bradykinesia, axial, and Barthel index for activities of daily living (ADL-Barthel) scores significantly improved at the 2-year follow-up (p < 0.05). The levodopa equivalent daily dose (LEDD) was significantly reduced at the 2-year follow-up (p < 0.05). However, the Montreal cognitive assessment, Hamilton depression scale, and Hamilton anxiety scale scores did not significantly change during the 2-year follow-up (p > 0.05). Additionally, in the subgroup with a 5-year follow-up, the motor symptoms, ADL-Barthel score, and cognitive function worsened over time compared to baseline. However, there was still an improvement in motor symptoms and ADL with DBS on-stimulation compared with the off-stimulation state. The LEDD increased 5 years after surgery compared to that at baseline. Eleven patients had passed away during follow-up, the mean survival time was 38.3 ± 17.3 months after surgery, and the mean age at the time of death was 81.2 (range 75-87) years. CONCLUSION Robot-assisted DBS surgery for the elderly patients with Parkinson's disease is accurate and safe. Motor symptoms and ADL significantly improve and patients can benefit from long-term neuromodulation, which may decrease the risk of death.
Collapse
Affiliation(s)
- Weidong Wu
- Department of NeurosurgeryGeneral Hospital of Northern Theater CommandShenyangChina
- China Medical UniversityShenyangChina
| | - Shun Gong
- Department of NeurosurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Shimiao Wang
- Department of NeurosurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Wei Lei
- Department of NeurosurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Lijia Yuan
- Department of NeurosurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Wei Wu
- Department of NeurosurgeryFirst Hospital of Jilin UniversityChangchunChina
| | - Jiqing Qiu
- Department of NeurosurgeryFirst Hospital of Jilin UniversityChangchunChina
| | - Weijin Sun
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Guoming Luan
- Department of Neurosurgery, Sanbo Brain HospitalCapital Medical UniversityBeijingChina
| | - Minwei Zhu
- Department of NeurosurgeryFirst Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Xudong Wang
- Department of NeurosurgeryFirst Affiliated Hospital of Harbin Medical UniversityHarbinChina
| | - Guobiao Liang
- Department of NeurosurgeryGeneral Hospital of Northern Theater CommandShenyangChina
| | - Yingqun Tao
- Department of NeurosurgeryGeneral Hospital of Northern Theater CommandShenyangChina
- China Medical UniversityShenyangChina
| |
Collapse
|
10
|
Liu J, Chen S, Chen J, Wang B, Zhang Q, Xiao L, Zhang D, Cai X. Structural Brain Connectivity Guided Optimal Contact Selection for Deep Brain Stimulation of the Subthalamic Nucleus. World Neurosurg 2024; 188:e546-e554. [PMID: 38823445 DOI: 10.1016/j.wneu.2024.05.150] [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: 05/12/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an effective therapy in ameliorating the motor symptoms of Parkinson disease. However, postoperative optimal contact selection is crucial for achieving the best outcome of deep brain stimulation of the subthalamic nucleus surgery, but the process is currently a trial-and-error and time-consuming procedure that relies heavily on surgeons' clinical experience. METHODS In this study, we propose a structural brain connectivity guided optimal contact selection method for deep brain stimulation of the subthalamic nucleus. Firstly, we reconstruct the DBS electrode location and estimate the stimulation range using volume of tissue activated from each DBS contact. Then, we extract the structural connectivity features by concatenating fractional anisotropy and the number of streamlines features of activated regions and the whole brain regions. Finally, we use a convolutional neural network with convolutional block attention module to identify the structural connectivity features for the optimal contact selection. RESULTS We review the data of 800 contacts from 100 patients with Parkinson disease for the experiment. The proposed method achieves promising results, with the average accuracy of 97.63%, average precision of 94.50%, average recall of 94.46%, and average specificity of 98.18%, respectively. Our method can provide the suggestion for optimal contact selection. CONCLUSIONS Our proposed method can improve the efficiency and accuracy of DBS optimal contact selection, reduce the dependence on surgeons' experience, and has the potential to facilitate the development of advanced DBS technology.
Collapse
Affiliation(s)
- Jiali Liu
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Shouxuan Chen
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Jianwei Chen
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Bo Wang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Qiusheng Zhang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Linxia Xiao
- Joint Engineering Research Center for Health Big Data Intelligent Analysis Technology, Center for High Performance Computing, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| | - Doudou Zhang
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| | - Xiaodong Cai
- Department of Neurosurgery, Shenzhen Key Laboratory of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen Second People's Hospital, Shenzhen, China
| |
Collapse
|
11
|
Franco R, Garrigós C, Lillo J, Rivas-Santisteban R. The Potential of Metabolomics to Find Proper Biomarkers for Addressing the Neuroprotective Efficacy of Drugs Aimed at Delaying Parkinson's and Alzheimer's Disease Progression. Cells 2024; 13:1288. [PMID: 39120318 PMCID: PMC11311351 DOI: 10.3390/cells13151288] [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: 06/18/2024] [Revised: 07/25/2024] [Accepted: 07/28/2024] [Indexed: 08/10/2024] Open
Abstract
The first objective is to highlight the lack of tools to measure whether a given intervention affords neuroprotection in patients with Alzheimer's or Parkinson's diseases. A second aim is to present the primary outcome measures used in clinical trials in cohorts of patients with neurodegenerative diseases. The final aim is to discuss whether metabolomics using body fluids may lead to the discovery of biomarkers of neuroprotection. Information on the primary outcome measures in clinical trials related to Alzheimer's and Parkinson's disease registered since 2018 was collected. We analysed the type of measures selected to assess efficacy, not in terms of neuroprotection since, as stated in the aims, there is not yet any marker of neuroprotection. Proteomic approaches using plasma or CSF have been proposed. PET could estimate the extent of lesions, but disease progression does not necessarily correlate with a change in tracer uptake. We propose some alternatives based on considering the metabolome. A new opportunity opens with metabolomics because there have been impressive technological advances that allow the detection, among others, of metabolites related to mitochondrial function and mitochondrial structure in serum and/or cerebrospinal fluid; some of the differentially concentrated metabolites can become reliable biomarkers of neuroprotection.
Collapse
Affiliation(s)
- Rafael Franco
- Molecular Neurobiology Laboratory, Departament de Bioquimica i Biomedicina Molecular, Universitat de Barcelona, Diagonal 643, 08028 Barcelona, Spain; (C.G.); (J.L.)
- Network Center Neurodegenerative Diseases, CiberNed, Spanish National Health Center Carlos iii, Monforte de Lemos 3, 28029 Madrid, Spain
- School of Chemistry, Universitat de Barcelona, Diagonal 645, 08028 Barcelona, Spain
| | - Claudia Garrigós
- Molecular Neurobiology Laboratory, Departament de Bioquimica i Biomedicina Molecular, Universitat de Barcelona, Diagonal 643, 08028 Barcelona, Spain; (C.G.); (J.L.)
| | - Jaume Lillo
- Molecular Neurobiology Laboratory, Departament de Bioquimica i Biomedicina Molecular, Universitat de Barcelona, Diagonal 643, 08028 Barcelona, Spain; (C.G.); (J.L.)
- Network Center Neurodegenerative Diseases, CiberNed, Spanish National Health Center Carlos iii, Monforte de Lemos 3, 28029 Madrid, Spain
| | - Rafael Rivas-Santisteban
- Network Center Neurodegenerative Diseases, CiberNed, Spanish National Health Center Carlos iii, Monforte de Lemos 3, 28029 Madrid, Spain
- Laboratory of Computational Medicine, Biostatistics Unit, Faculty of Medicine, Autonomous University of Barcelona, Campus Bellaterra, 08193 Barcelona, Spain
| |
Collapse
|
12
|
Coutinho PB, Johnson KA, Seritan AL, Galifianakis NB, Coleman R, Wang D, Racine CA, Ostrem JL, Starr PA, de Hemptinne C. Elevated Mood Induced by Subthalamic Nucleus Deep Brain Stimulation: A Video-Recorded Case Report. Tremor Other Hyperkinet Mov (N Y) 2024; 14:37. [PMID: 39005242 PMCID: PMC11243764 DOI: 10.5334/tohm.900] [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: 04/25/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
Background Deep brain stimulation (DBS) can be an effective therapy to control motor signs in patients with Parkinson's disease (PD). However, subthalamic nucleus (STN) DBS can induce undesirable psychiatric adverse effects, including elevated mood. Case report We reported a video case of a 73-year-old male implanted with bilateral STN DBS who experienced stimulation-induced elevated mood. A correlation between mood changes and enhanced activation of the ventromedial region in the left STN was observed. Discussion This video case report illustrates STN DBS-induced elevated mood and enhances early symptom recognition for patients and diagnostic awareness for professionals.
Collapse
Affiliation(s)
- Patricia B. Coutinho
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Kara A. Johnson
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| | - Andreea L. Seritan
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Nicholas B. Galifianakis
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
| | - Robert Coleman
- Department of Neurology, Corewell Health, Grand Rapids, MI, USA
| | - Doris Wang
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Caroline A. Racine
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jill L. Ostrem
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
| | - Philip A. Starr
- UCSF Weill Institute for Neurosciences, San Francisco, San Francisco, CA, USA
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Coralie de Hemptinne
- Department of Neurology, University of Florida, Gainesville, FL, USA
- Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, FL, USA
| |
Collapse
|
13
|
Rybalova E, Semenova N. Impact of pulse exposure on chimera state in ensemble of FitzHugh-Nagumo systems. CHAOS (WOODBURY, N.Y.) 2024; 34:071101. [PMID: 38953753 DOI: 10.1063/5.0214787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 06/17/2024] [Indexed: 07/04/2024]
Abstract
In this article, we consider the influence of a periodic sequence of Gaussian pulses on a chimera state in a ring of coupled FitzHugh-Nagumo systems. We found that on the way to complete spatial synchronization, one can observe a number of variations of chimera states that are not typical for the parameter range under consideration. For example, the following modes were found: breathing chimera, chimera with intermittency in the incoherent part, traveling chimera with strong intermittency, and others. For comparison, here we also consider the impact of a harmonic influence on the same chimera, and to preserve the generality of the conclusions, we compare the regimes caused by both a purely positive harmonic influence and a positive-negative one.
Collapse
Affiliation(s)
- E Rybalova
- Radiophysics and Nonlinear Dynamics Department, Institute of Physics, Saratov State University, Astrakhanskaya str. 83, Saratov 410012, Russia
| | - N Semenova
- Radiophysics and Nonlinear Dynamics Department, Institute of Physics, Saratov State University, Astrakhanskaya str. 83, Saratov 410012, Russia
| |
Collapse
|
14
|
Babeliowsky WA, Bot M, Potters WV, van den Munckhof P, Blok ER, de Bie RM, Schuurman R, van Rootselaar A. Deep Brain Stimulation for Orthostatic Tremor: An Observational Study. Mov Disord Clin Pract 2024; 11:676-685. [PMID: 38586984 PMCID: PMC11145120 DOI: 10.1002/mdc3.14035] [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: 05/01/2023] [Revised: 02/09/2024] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Primary orthostatic tremor (OT) can affect patients' life. Treatment of OT with deep brain stimulation (DBS) of the thalamic ventral intermediate nucleus (Vim) is described in a limited number of patients. The Vim and posterior subthalamic area (PSA) can be targeted in a single trajectory, allowing both stimulation of the Vim and/or dentatorubrothalamic tract (DRT). In essential tremor this is currently often used with positive effects. OBJECTIVE To evaluate the efficacy of Vim/DRT-DBS in OT-patients, based on standing time and Quality of Life (QoL), also on the long-term. Furthermore, to relate stimulation of the Vim and DRT, medial lemniscus (ML) and pyramidal tract (PT) to beneficial clinical and side-effects. METHODS Nine severely affected OT-patients received bilateral Vim/DRT-DBS. Primary outcome measure was standing time; secondary measures included self-reported measures, neurophysiological measures, structural analyses, surgical complications, stimulation-induced side-effects, and QoL up to 56 months. Stimulation of volume of tissue activated (VTA) were related to outcome measures. RESULTS Average maximum standing time increased from 41.0 s ± 51.0 s to 109.3 s ± 65.0 s after 18 months, with improvements measured in seven of nine patients. VTA (n = 7) overlapped with the DRT in six patients and with the ML and/or PT in six patients. All patients experienced side-effects and QoL worsened during the first year after surgery, which improved again during long-term follow-up, although remaining below age-related normal values. Most patients reported a positive effect of DBS. CONCLUSION Vim/DRT-DBS improved standing time in patients with severe OT. Observed side-effects are possibly related to stimulation of the ML and PT.
Collapse
Affiliation(s)
- Wietske A. Babeliowsky
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Maarten Bot
- NeurosurgeryAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Wouter V. Potters
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | | | - Edwin R. Blok
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Rob M.A. de Bie
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| | - Rick Schuurman
- NeurosurgeryAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
| | - Anne‐Fleur van Rootselaar
- Neurology and Clinical NeurophysiologyAmsterdam UMC location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam NeuroscienceNeurodegenerationAmsterdamThe Netherlands
| |
Collapse
|
15
|
Luo B, Chang L, Qiu C, Dong W, Zhao L, Lu Y, Sun J, Yan J, Wei X, Yan J, Zhang W. Reorganization of motor network in patients with Parkinson's disease after deep brain stimulation. CNS Neurosci Ther 2024; 30:e14792. [PMID: 38867393 PMCID: PMC11168969 DOI: 10.1111/cns.14792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/07/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024] Open
Abstract
AIMS Parkinson's disease (PD) patients experience improvement in motor symptoms after deep brain stimulation (DBS) and before initiating stimulation. This is called the microlesion effect. However, the mechanism remains unclear. The study aims to comprehensively explore the changes in functional connectivity (FC) patterns in movement-related brain regions in PD patients during the microlesion phase through seed-based FC analysis. METHODS The study collected the resting functional magnetic resonance imaging data of 49 PD patients before and after DBS surgery (off stimulation). The cortical and subcortical areas related to motor function were selected for seed-based FC analysis. Meanwhile, their relationship with the motor scale was investigated. RESULTS The motor-related brain regions were selected as the seed point, and we observed various FC declines within the motor network brain regions. These declines were primarily in the left middle temporal gyrus, bilateral middle frontal gyrus, right supplementary motor area, left precentral gyrus, left postcentral gyrus, left inferior frontal gyrus, and right superior frontal gyrus after DBS. CONCLUSION The movement-related network was extensively reorganized during the microlesion period. The study provided new information on enhancing motor function from the network level post-DBS.
Collapse
Affiliation(s)
- Bei Luo
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Lei Chang
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Chang Qiu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Wenwen Dong
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Liang Zhao
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Yue Lu
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Jian Sun
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Jiuqi Yan
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Xiang Wei
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Jun Yan
- Department of Geriatric Neurology, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| | - Wenbin Zhang
- Department of Functional Neurosurgery, Affiliated Nanjing Brain HospitalNanjing Medical UniversityNanjingChina
| |
Collapse
|
16
|
Sun J, Cheng L, Li Z, Jia J, Wu Q, Hou Y, Wang Q, Zhang G, Wang H, Li X, Li W, Zhang C. Deep brain stimulation of the subthalamic nucleus increases the risk of sialorrhea in patients with advanced Parkinson's disease. Parkinsonism Relat Disord 2024; 123:106075. [PMID: 38492517 DOI: 10.1016/j.parkreldis.2024.106075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Sialorrhea is a common neurological manifestation of Parkinson's disease (PD). No specifically designed prospective study has tested the effects of deep brain stimulation of the subthalamic nucleus (STN-DBS) on sialorrhea in patients with advanced PD. We focused on the effect of STN-DBS on the incidence of sialorrhea in patients with PD. METHODS This multicenter, prospective, non-randomized concurrent clinical trial analyzed the incidence of sialorrhea during long-term follow-up in 170 patients with advanced PD (84 patients with STN-DBS and 86 patients with medication therapy). RESULTS After STN-DBS, 58.1% of patients presented with sialorrhea (Drooling Rating Scale (DRS) > 5) compared with 39.3% of patients with medication therapy (P < 0.001). STN-DBS stimulation demonstrated a significant increase in DRS and Drooling Severity and Frequency Scale (DSFS) compared with the patients with medication therapy (P < 0.001). At follow-up, the onabotulinumtoxin-A (BTX-A) injection ratio was significantly higher in the STN-DBS group (29.8% vs. 11.9%, P = 0.0057) compared with the patients with medication therapy. CONCLUSIONS STN-DBS increased the risk of sialorrhea in patients with advanced PD. TRIAL REGISTRATION clinicaltrials. gov (NCT06090929).
Collapse
Affiliation(s)
- Jinxing Sun
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
| | - Lian Cheng
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
| | - Zhenke Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
| | - Junheng Jia
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
| | - Qianqian Wu
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
| | - Ying Hou
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Qi Wang
- Department of Gerontology, Shandong Provincial Qianfoshan Hospital, Jinan, 250013, China
| | - Guangjian Zhang
- Department of Neurology, Weifang People's Hospital, Weifang, 261044, China
| | - Hong Wang
- Department of Ophthalmology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
| | - Weiguo Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China
| | - Chao Zhang
- Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, 250012, China; Institute of Brain and Brain-Inspired Science, Shandong University, Jinan, 250012, China.
| |
Collapse
|
17
|
Unadkat P, Vo A, Ma Y, Peng S, Nguyen N, Niethammer M, Tang CC, Dhawan V, Ramdhani R, Fenoy A, Caminiti SP, Perani D, Eidelberg D. Deep brain stimulation of the subthalamic nucleus for Parkinson's disease: A network imaging marker of the treatment response. RESEARCH SQUARE 2024:rs.3.rs-4178280. [PMID: 38766007 PMCID: PMC11100869 DOI: 10.21203/rs.3.rs-4178280/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Subthalamic nucleus deep brain stimulation (STN-DBS) alleviates motor symptoms of Parkinson's disease (PD), thereby improving quality of life. However, quantitative brain markers to evaluate DBS responses and select suitable patients for surgery are lacking. Here, we used metabolic brain imaging to identify a reproducible STN-DBS network for which individual expression levels increased with stimulation in proportion to motor benefit. Of note, measurements of network expression from metabolic and BOLD imaging obtained preoperatively predicted motor outcomes determined after DBS surgery. Based on these findings, we computed network expression in 175 PD patients, with time from diagnosis ranging from 0 to 21 years, and used the resulting data to predict the outcome of a potential STN-DBS procedure. While minimal benefit was predicted for patients with early disease, the proportion of potential responders increased after 4 years. Clinically meaningful improvement with stimulation was predicted in 18.9 - 27.3% of patients depending on disease duration.
Collapse
Affiliation(s)
| | - An Vo
- The Feinstein Institutes for Medical Research
| | - Yilong Ma
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Shichun Peng
- Center for Neurosciences, Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | | | | | | | | | - Ritesh Ramdhani
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
| | | | | | | | | |
Collapse
|
18
|
Benbuk A, Moniz-Garcia D, Gulick D, Quinones-Hinojosa A, Blain Christen J. A Wireless Battery-Free Implant With Optical Telemetry for In Vivo Cortical Stimulation. IEEE SENSORS LETTERS 2024; 8:6005204. [PMID: 38818033 PMCID: PMC11138248 DOI: 10.1109/lsens.2024.3387370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
We present a 100 μm-thick, wireless, and battery-free implant for brain stimulation through a U.S. Food and Drug Administration-approved collagen dura substitute without contact with the brain's surface, while providing visible-light spectrum telemetry to track the onset of stimulation. The device is fabricated on a 16 × 6.67 mm2 biocompatible parylene/PDMS substrate and is encapsulated with a 2 μm-thick transparent parylene layer that enables the relay of the LED brightness. The in vivo rodent testing confirmed the implant's ability to trigger motor response while generating observable brightness through the skin. The results reveal the prospect of wireless stimulation with enhanced safety by eliminating contact between the implant and the brain, with optical telemetry for facilitated tracking.
Collapse
Affiliation(s)
- Abed Benbuk
- Department of Electrical, Computer, Energy Engineering, Arizona State University, Tempe AZ 85287 USA
| | - Diogo Moniz-Garcia
- Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Daniel Gulick
- Department of Electrical, Computer, Energy Engineering, Arizona State University, Tempe AZ 85287 USA
| | | | - Jennifer Blain Christen
- Department of Electrical, Computer, Energy Engineering, Arizona State University, Tempe AZ 85287 USA
| |
Collapse
|
19
|
Vilela C, Araújo B, Soares-Guedes C, Caridade-Silva R, Martins-Macedo J, Teixeira C, Gomes ED, Prudêncio C, Vieira M, Teixeira FG. From the Gut to the Brain: Is Microbiota a New Paradigm in Parkinson's Disease Treatment? Cells 2024; 13:770. [PMID: 38727306 PMCID: PMC11083070 DOI: 10.3390/cells13090770] [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: 04/02/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
Parkinson's disease (PD) is recognized as the second most prevalent primary chronic neurodegenerative disorder of the central nervous system. Clinically, PD is characterized as a movement disorder, exhibiting an incidence and mortality rate that is increasing faster than any other neurological condition. In recent years, there has been a growing interest concerning the role of the gut microbiota in the etiology and pathophysiology of PD. The establishment of a brain-gut microbiota axis is now real, with evidence denoting a bidirectional communication between the brain and the gut microbiota through metabolic, immune, neuronal, and endocrine mechanisms and pathways. Among these, the vagus nerve represents the most direct form of communication between the brain and the gut. Given the potential interactions between bacteria and drugs, it has been observed that the therapies for PD can have an impact on the composition of the microbiota. Therefore, in the scope of the present review, we will discuss the current understanding of gut microbiota on PD and whether this may be a new paradigm for treating this devastating disease.
Collapse
Affiliation(s)
- Cristiana Vilela
- Center for Translational Health and Medical Biotechnology Research (TBIO)/Health Research Network (RISE-Health), ESS, Polytechnic of Porto, R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (C.V.); (C.S.-G.); (E.D.G.); (C.P.); (M.V.)
| | - Bruna Araújo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (B.A.); (J.M.-M.)
- ICVS/3B’s Associate Lab, PT Government Associated Lab, 4710-057/4805-017 Braga/Guimarães, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; (R.C.-S.); (C.T.)
| | - Carla Soares-Guedes
- Center for Translational Health and Medical Biotechnology Research (TBIO)/Health Research Network (RISE-Health), ESS, Polytechnic of Porto, R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (C.V.); (C.S.-G.); (E.D.G.); (C.P.); (M.V.)
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; (R.C.-S.); (C.T.)
| | - Rita Caridade-Silva
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; (R.C.-S.); (C.T.)
| | - Joana Martins-Macedo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (B.A.); (J.M.-M.)
- ICVS/3B’s Associate Lab, PT Government Associated Lab, 4710-057/4805-017 Braga/Guimarães, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; (R.C.-S.); (C.T.)
| | - Catarina Teixeira
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; (R.C.-S.); (C.T.)
| | - Eduardo D. Gomes
- Center for Translational Health and Medical Biotechnology Research (TBIO)/Health Research Network (RISE-Health), ESS, Polytechnic of Porto, R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (C.V.); (C.S.-G.); (E.D.G.); (C.P.); (M.V.)
| | - Cristina Prudêncio
- Center for Translational Health and Medical Biotechnology Research (TBIO)/Health Research Network (RISE-Health), ESS, Polytechnic of Porto, R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (C.V.); (C.S.-G.); (E.D.G.); (C.P.); (M.V.)
| | - Mónica Vieira
- Center for Translational Health and Medical Biotechnology Research (TBIO)/Health Research Network (RISE-Health), ESS, Polytechnic of Porto, R. Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal; (C.V.); (C.S.-G.); (E.D.G.); (C.P.); (M.V.)
| | - Fábio G. Teixeira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal; (B.A.); (J.M.-M.)
- ICVS/3B’s Associate Lab, PT Government Associated Lab, 4710-057/4805-017 Braga/Guimarães, Portugal
- i3S—Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen 208, 4200-135 Porto, Portugal; (R.C.-S.); (C.T.)
| |
Collapse
|
20
|
Lee DH, Woo BS, Park YH, Lee JH. General Treatments Promoting Independent Living in Parkinson's Patients and Physical Therapy Approaches for Improving Gait-A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:711. [PMID: 38792894 PMCID: PMC11123276 DOI: 10.3390/medicina60050711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
This study delves into the multifaceted approaches to treating Parkinson's disease (PD), a neurodegenerative disorder primarily affecting motor function but also manifesting in a variety of symptoms that vary greatly among individuals. The complexity of PD symptoms necessitates a comprehensive treatment strategy that integrates surgical interventions, pharmacotherapy, and physical therapy to tailor to the unique needs of each patient. Surgical options, such as deep brain stimulation (DBS), have been pivotal for patients not responding adequately to medication, offering significant symptom relief. Pharmacotherapy remains a cornerstone of PD management, utilizing drugs like levodopa, dopamine agonists, and others to manage symptoms and, in some cases, slow down disease progression. However, these treatments often lead to complications over time, such as motor fluctuations and dyskinesias, highlighting the need for precise dosage adjustments and sometimes combination therapies to optimize patient outcomes. Physical therapy plays a critical role in addressing the motor symptoms of PD, including bradykinesia, muscle rigidity, tremors, postural instability, and akinesia. PT techniques are tailored to improve mobility, balance, strength, and overall quality of life. Strategies such as gait and balance training, strengthening exercises, stretching, and functional training are employed to mitigate symptoms and enhance functional independence. Specialized approaches like proprioceptive neuromuscular facilitation (PNF), the Bobath concept, and the use of assistive devices are also integral to the rehabilitation process, aimed at improving patients' ability to perform daily activities and reducing the risk of falls. Innovations in technology have introduced robotic-assisted gait training (RAGT) and other assistive devices, offering new possibilities for patient care. These tools provide targeted support and feedback, allowing for more intensive and personalized rehabilitation sessions. Despite these advancements, high costs and accessibility issues remain challenges that need addressing. The inclusion of exercise and activity beyond structured PT sessions is encouraged, with evidence suggesting that regular physical activity can have neuroprotective effects, potentially slowing disease progression. Activities such as treadmill walking, cycling, and aquatic exercises not only improve physical symptoms but also contribute to emotional well-being and social interactions. In conclusion, treating PD requires a holistic approach that combines medical, surgical, and therapeutic strategies. While there is no cure, the goal is to maximize patients' functional abilities and quality of life through personalized treatment plans. This integrated approach, along with ongoing research and development of new therapies, offers hope for improving the management of PD and the lives of those affected by this challenging disease.
Collapse
Affiliation(s)
- Dae-Hwan Lee
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Bong-Sik Woo
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Yong-Hwa Park
- IM Rehabilitation Hospital, 2140, Cheongnam-ro, Seowon-gu, Cheongju-si 28702, Chungcheongbuk-do, Republic of Korea; (D.-H.L.); (B.-S.W.); (Y.-H.P.)
| | - Jung-Ho Lee
- Department of Physical Therapy, University of Kyungdong, 815, Gyeonhwon-ro, Munmak-eup, Wonju-si 26495, Gangwon-do, Republic of Korea
| |
Collapse
|
21
|
Hermann MG, Schröter N, Rau A, Reisert M, Jarc N, Rijntjes M, Hosp JA, Reinacher PC, Jost WH, Urbach H, Weiller C, Coenen VA, Sajonz BEA. The connection of motor improvement after deep brain stimulation in Parkinson's disease and microstructural integrity of the substantia nigra and subthalamic nucleus. Neuroimage Clin 2024; 42:103607. [PMID: 38643635 PMCID: PMC11046219 DOI: 10.1016/j.nicl.2024.103607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/15/2024] [Accepted: 04/15/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Nigrostriatal microstructural integrity has been suggested as a biomarker for levodopa response in Parkinson's disease (PD), which is a strong predictor for motor response to deep brain stimulation (DBS) of the subthalamic nucleus (STN). This study aimed to explore the impact of microstructural integrity of the substantia nigra (SN), STN, and putamen on motor response to STN-DBS using diffusion microstructure imaging. METHODS Data was collected from 23 PD patients (mean age 63 ± 7, 6 females) who underwent STN-DBS, had preoperative 3 T diffusion magnetic resonance imaging including multishell diffusion-weighted MRI with b-values of 1000 and 2000 s/mm2 and records of motor improvement available. RESULTS The association between a poorer DBS-response and increased free interstitial fluid showed notable effect sizes (rho > |0.4|) in SN and STN, but not in putamen. However, this did not reach significance after Bonferroni correction and controlling for sex and age. CONCLUSION Microstructural integrity of SN and STN are potential biomarkers for the prediction of therapy efficacy following STN-DBS, but further studies are required to confirm these associations.
Collapse
Affiliation(s)
- Marco G Hermann
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Nils Schröter
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rau
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Medical Physics, Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Nadja Jarc
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michel Rijntjes
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jonas A Hosp
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter C Reinacher
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Fraunhofer Institute for Laser Technology (ILT), Aachen, Germany
| | | | - Horst Urbach
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Cornelius Weiller
- Department of Neurology and Clinical Neuroscience, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Volker A Coenen
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Center for Deep Brain Stimulation, University of Freiburg, Germany
| | - Bastian E A Sajonz
- Department of Stereotactic and Functional Neurosurgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| |
Collapse
|
22
|
Sierra-Fernández CR, Garnica-Geronimo LR, Huipe-Dimas A, Ortega-Hernandez JA, Ruiz-Mafud MA, Cervantes-Arriaga A, Hernández-Medrano AJ, Rodríguez-Violante M. Electrocardiographic approach strategies in patients with Parkinson disease treated with deep brain stimulation. Front Cardiovasc Med 2024; 11:1265089. [PMID: 38682099 PMCID: PMC11047133 DOI: 10.3389/fcvm.2024.1265089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024] Open
Abstract
Deep brain stimulation (DBS) is an interdisciplinary and reversible therapy that uses high-frequency electrical stimulation to correct aberrant neural pathways in motor and cognitive neurological disorders. However, the high frequency of the waves used in DBS can interfere with electrical recording devices (e.g., electrocardiogram, electroencephalogram, cardiac monitor), creating artifacts that hinder their interpretation. The compatibility of DBS with these devices varies and depends on factors such as the underlying disease and the configuration of the neurostimulator. In emergencies where obtaining an electrocardiogram is crucial, the need for more consensus on reducing electrical artifacts in patients with DBS becomes a significant challenge. Various strategies have been proposed to attenuate the artifact generated by DBS, such as changing the DBS configuration from monopolar to bipolar, temporarily deactivating DBS during electrocardiographic recording, applying frequency filters both lower and higher than those used by DBS, and using non-standard leads. However, the inexperience of medical personnel, variability in DBS models, or the lack of a controller at the time of approach limit the application of these strategies. Current evidence on their reproducibility and efficacy is limited. Due to the growing elderly population and the rising utilization of DBS, it is imperative to create electrocardiographic methods that are easily accessible and reproducible for general physicians and emergency services.
Collapse
Affiliation(s)
| | | | - Alejandra Huipe-Dimas
- Department of Medical Education, National Institute of Cardiology Ignacio Chávez, Mexico, Mexico
| | | | - María Alejandra Ruiz-Mafud
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Amin Cervantes-Arriaga
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Ana Jimena Hernández-Medrano
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| | - Mayela Rodríguez-Violante
- Department of Movement Disorders, National Institute of Neurology and Neurosurgery Manuel Velasco Suárez, Mexico, Mexico
| |
Collapse
|
23
|
Bu S, Pang H, Li X, Zhao M, Wang J, Liu Y, Yu H, Fan G. Structural and Functional Alterations of Motor-Thalamus in Different Motor Subtype of Parkinson's Disease: An Individual Study. Acad Radiol 2024; 31:1605-1614. [PMID: 37863779 DOI: 10.1016/j.acra.2023.09.041] [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: 08/22/2023] [Revised: 09/23/2023] [Accepted: 09/24/2023] [Indexed: 10/22/2023]
Abstract
RATIONALE AND OBJECTIVES This study aimed to investigate the structural and functional alterations occurring within bilateral premotor thalamus (mPMtha) in motor subtypes of Parkinson's disease (PD). MATERIALS AND METHODS Sixty-one individuals with instability and gait difficulty (PIGD) subtype, 60 individuals with tremor-dominant (TD) subtype and 66 healthy controls (HCs) participated in the study. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) and 3D T1-weighted (3DT1) scans. Functional connectivity (FC) analysis and Voxel-based morphometry (VBM) analysis were performed to evaluate the function and volume of mPMtha. Additionally, correlations between motor performance and FC values, volumes were examined separately. Support vector machine (SVM) model based on FC values and thalamic volumes was conducted to assist in the clinical diagnosis of PD motor subtype. RESULTS Compared to HCs and PIGD, TD subtype showed increased FC between the bilateral mPMtha and left middle occipital gyrus, left inferior parietal lobule (IPL). While PIGD subtype demonstrated decreased FC between right mPMtha and precentral gyrus (PreCG), supramarginal, IPL and superior parietal lobule. FC of bilateral mPMtha with the identified regions were significantly correlated with motor performance scores in PD patients. The SVM classification based on FC values demonstrated a high level of efficiency (AUC=0.874). The volumes of the bilateral mPMtha were indifferent among three groups. CONCLUSION We noted distinct FC alterations of mPMtha in TD and PIGD subtypes, and these changes were correlated with motor performance. Furthermore, the machine learning based on statistically significant FC might be served as an alternative approach for automatically classifying PD motor subtypes individually.
Collapse
Affiliation(s)
- Shuting Bu
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, PR China (S.B., H.P., X.L., M.Z., J.W., Y.L., G.F.)
| | - Huize Pang
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, PR China (S.B., H.P., X.L., M.Z., J.W., Y.L., G.F.)
| | - Xiaolu Li
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, PR China (S.B., H.P., X.L., M.Z., J.W., Y.L., G.F.)
| | - Mengwan Zhao
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, PR China (S.B., H.P., X.L., M.Z., J.W., Y.L., G.F.)
| | - Juzhou Wang
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, PR China (S.B., H.P., X.L., M.Z., J.W., Y.L., G.F.)
| | - Yu Liu
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, PR China (S.B., H.P., X.L., M.Z., J.W., Y.L., G.F.)
| | - Hongmei Yu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China (H.Y.)
| | - Guoguang Fan
- Department of Radiology, The First Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, PR China (S.B., H.P., X.L., M.Z., J.W., Y.L., G.F.).
| |
Collapse
|
24
|
Zhou T, Xu W, Shi W. Investigation of the mechanism of action of deep brain stimulation for the treatment of Parkinson's disease. Cogn Neurodyn 2024; 18:581-595. [PMID: 38699617 PMCID: PMC11061068 DOI: 10.1007/s11571-023-10009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 08/24/2023] [Accepted: 09/10/2023] [Indexed: 05/05/2024] Open
Abstract
Parkinson's disease (PD) is a severe, progressive, neurological disorder. PD is not a single disease, but rather resembles a syndrome. PD includes two types of pathogenesis (i.e., classical PD and new PD). Clinically, PD patients present with a range of motor symptoms including decreased spontaneous movement, bradykinesia, muscle rigidity, changes in speech, and resting tremors. PD patients also often exhibit non-motor symptoms such as fatigue, sleep disorders, and emotional and mental health disturbances. Deep brain stimulation (DBS) performed in clinical neurosurgery has demonstrated considerable efficacy in the treatment of dyskinesia that occurs in PD patients. However, the specific neural mechanism of DBS remains unknown and is limited by several shortcomings that have hampered the popularization and development of the procedure. To address this issue, this study established a theoretical model of DBS for PD to investigate and understand the mechanism of DBS using several artificial intelligence (AI) algorithms. This model was used to investigate both classical PD and unheard-of new PD. The research described in this paper was as follows: a single neuron was used to establish a theoretical model of the basal ganglia circuit and to simulate the characteristic indicators of the potential release of the basal ganglia circuit in both normal and PD states. The state of the deep brain electrical stimulation in PD was then analyzed to identify the critical electrical stimulation index and the optimal target. We showed that the use of AI algorithms such as particle swarm optimization and other AI algorithms was beneficial for more detailed exploration and understanding of the mechanisms of DBS compared to those used in previous studies. This discovery may lead to advances in DBS technology and provide better treatment options for neurological diseases such as PD.
Collapse
Affiliation(s)
- Tianhao Zhou
- College of Chemical Science and Technology, Yunnan University, Kunming, 650091 China
| | - Wenchuan Xu
- College of Chemical Science and Technology, Yunnan University, Kunming, 650091 China
| | - Weiyao Shi
- College of Chemical Science and Technology, Yunnan University, Kunming, 650091 China
| |
Collapse
|
25
|
Cheng Y, Zhao G, Chen L, Cui D, Wang C, Feng K, Yin S. Effects of subthalamic nucleus deep brain stimulation using different frequency programming paradigms on axial symptoms in advanced Parkinson's disease. Acta Neurochir (Wien) 2024; 166:124. [PMID: 38457027 DOI: 10.1007/s00701-024-06005-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND In advanced Parkinson's disease (PD), axial symptoms are common and can be debilitating. Although deep brain stimulation (DBS) significantly improves motor symptoms, conventional high-frequency stimulation (HFS) has limited effectiveness in improving axial symptoms. In this study, we investigated the effects on multiple axial symptoms after DBS surgery with three different frequency programming paradigms comprising HFS, low-frequency stimulation (LFS), and variable-frequency stimulation (VFS). METHODS This study involved PD patients who had significant preoperative axial symptoms and underwent bilateral subthalamic nucleus (STN) DBS. Axial symptoms, motor symptoms, medications, and quality of life were evaluated preoperatively (baseline). One month after surgery, HFS was applied. At 6 months post-surgery, HFS assessments were performed, and HFS was switched to LFS. A further month later, we conducted LFS assessments and switched LFS to VFS. At 8 months after surgery, VFS assessments were performed. RESULTS Of the 21 PD patients initially enrolled, 16 patients were ultimately included in this study. Regarding HFS, all axial symptoms except for the Berg Balance Scale (p < 0.0001) did not improve compared with the baseline (all p > 0.05). As for LFS and VFS, all axial symptoms improved significantly compared with both the baseline and HFS (all p < 0.05). Moreover, motor symptoms and medications were significantly better than the baseline (all p < 0.05) after using LFS and VFS. Additionally, the quality of life of the PD patients after receiving LFS and VFS was significantly better than at the baseline and with HFS (all p < 0.0001). CONCLUSION Our findings indicate that HFS is ineffective at improving the majority of axial symptoms in advanced PD. However, both the LFS and VFS programming paradigms exhibit significant improvements in various axial symptoms.
Collapse
Affiliation(s)
- Yifeng Cheng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Guangrui Zhao
- Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin, 300350, China
| | - Lei Chen
- Department of Neurology, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Deqiu Cui
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Chunjuan Wang
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China
| | - Keke Feng
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
| | - Shaoya Yin
- Department of Functional Neurosurgery, Huanhu Hospital, Tianjin University, Tianjin, 300350, China.
| |
Collapse
|
26
|
Deuter D, Mederer T, Kohl Z, Forras P, Rosengarth K, Schlabeck M, Röhrl D, Wendl C, Fellner C, Schmidt NO, Schlaier J. Amelioration of Parkinsonian tremor evoked by DBS: which role play cerebello-(sub)thalamic fiber tracts? J Neurol 2024; 271:1451-1461. [PMID: 38032372 PMCID: PMC10896868 DOI: 10.1007/s00415-023-12095-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Current pathophysiological models of Parkinson's disease (PD) assume a malfunctioning network being adjusted by the DBS signal. As various authors showed a main involvement of the cerebellum within this network, cerebello-cerebral fiber tracts are gaining special interest regarding the mediation of DBS effects. OBJECTIVES The crossing and non-decussating fibers of the dentato-rubro-thalamic tract (c-DRTT/nd-DRTT) and the subthalamo-ponto-cerebellar tract (SPCT) are thought to build up an integrated network enabling a bidimensional communication between the cerebellum and the basal ganglia. The aim of this study was to investigate the influence of these tracts on clinical control of Parkinsonian tremor evoked by DBS. METHODS We analyzed 120 electrode contacts from a cohort of 14 patients with tremor-dominant or equivalence-type PD having received bilateral STN-DBS. Probabilistic tractography was performed to depict the c-DRTT, nd-DRTT, and SPCT. Distance maps were calculated for the tracts and correlated to clinical tremor control for each electrode pole. RESULTS A significant difference between "effective" and "less-effective" contacts was only found for the c-DRTT (p = 0.039), but not for the SPCT, nor the nd-DRTT. In logistic and linear regressions, significant results were also found for the c-DRTT only (pmodel logistic = 0.035, ptract logistic = 0,044; plinear = 0.027). CONCLUSIONS We found a significant correlation between the distance of the DBS electrode pole to the c-DRTT and the clinical efficacy regarding tremor reduction. The c-DRTT might therefore play a major role in the mechanisms of alleviation of Parkinsonian tremor and could eventually serve as a possible DBS target for tremor-dominant PD in future.
Collapse
Affiliation(s)
- Daniel Deuter
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
| | - Tobias Mederer
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Zacharias Kohl
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, Regensburg Medbo District Hospital, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Patricia Forras
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Neurology, Regensburg Medbo District Hospital, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Katharina Rosengarth
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Mona Schlabeck
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Daniela Röhrl
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Anesthesiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Christina Wendl
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Department of Radiology, Regensburg Medbo District Hospital, Universitätsstraße 84, 93053, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Nils-Ole Schmidt
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Jürgen Schlaier
- Department of Neurosurgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
- Center for Deep Brain Stimulation, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| |
Collapse
|
27
|
Wang Z, Zheng Z, Huang J, Cai X, Liu X, Xue C, Yao L, Lu G. Neurocognitive changes at different follow-up times after bilateral subthalamic nucleus deep brain stimulation in patients with Parkinson's disease. Heliyon 2024; 10:e26303. [PMID: 38379975 PMCID: PMC10877422 DOI: 10.1016/j.heliyon.2024.e26303] [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: 06/13/2023] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/22/2024] Open
Abstract
Background Bilateral deep thalamic nucleus brain stimulation (STN-DBS) surgery is often used to treat the motor symptoms of patients with Parkinson's disease. The change of neurocognitive symptoms in patients is, however, still unclear. Objective We aimed at analyzing the deterioration of neurocognitive symptoms in patients with Parkinson's disease after deep brain stimulation surgery under different follow-up times. Methods A comprehensive literature review was conducted using Pubmed, Cochrane Library, and Web of Science to screen eligible study records, the meta-analysis was performed using an inverse variance method and a random-effects model. Additionally, the areas of analysis include five: cognition, executive function, memory capacity, and verbal fluency (phonetic fluency and semantic fluency). They were analyzed for changes at six and twelve months postoperatively compared to baseline. The Meta-analysis has been registered with PROSPERO under the registration number: CRD42022308786. Results In terms of overall cognitive performance, executive function, and memory capacity, the original studies show a trend of improvement in these areas at 12 months postoperatively compared with 6 months, at variance, patients did not improve or deteriorated in phonetic fluency(d = -0.42 at both 6-month and 12-month follow-up) and semantic fluency from 6 to 12 months postoperatively. Conclusion In terms of most neurocognitive symptoms, including cognitive ability, executive function, and learning memory capacity, bilateral STN-DBS surgery appears to be safe at relatively long follow-up times. However, postoperative phonetic and semantic fluency changes should still not be underestimated, and clinicians should pay more attention to patients' changes in both.
Collapse
Affiliation(s)
- Zhuohang Wang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Zijian Zheng
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Junwen Huang
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xu Cai
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Xinjie Liu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Cheng Xue
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Longping Yao
- Institute for Anatomy and Cell Biology, Medical Faculty, Heidelberg University, 69120, Heidelberg, Germany
| | - Guohui Lu
- Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| |
Collapse
|
28
|
Herz DM. Neuroscience: Therapy modulates decision-making in Parkinson's disease. Curr Biol 2024; 34:R148-R150. [PMID: 38412825 DOI: 10.1016/j.cub.2024.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
There is mounting evidence that decision-making can be affected by treatment in Parkinson's disease. A new study shows that dopamine and deep brain stimulation, two mainstay treatments of Parkinson's, differently affect how patients make decisions weighing rewards against effort costs.
Collapse
Affiliation(s)
- Damian M Herz
- Movement Disorders and Neurostimulation, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
| |
Collapse
|
29
|
Merello M, Hariz M. Radiofrequency Ablation: How to Ensure Worldwide Availability of Surgery for Parkinson's Disease. Mov Disord Clin Pract 2024; 11:114-118. [PMID: 38229231 PMCID: PMC10883407 DOI: 10.1002/mdc3.13945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 10/16/2023] [Accepted: 11/15/2023] [Indexed: 01/18/2024] Open
Affiliation(s)
- Marcelo Merello
- Servicio de Movimientos Anormales, Departamento de Neurociencias, Fleni, Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Marwan Hariz
- Department of Clinical Neuroscience, Umeå University, Umeå, Sweden
- UCL Institute of Neurology, Queen Square, London, United Kingdom
| |
Collapse
|
30
|
Hendriks M, Vinke RS, Georgiev D. Gender discrepancies and differences in motor and non-motor symptoms, cognition, and psychological outcomes in the treatment of Parkinson's disease with subthalamic deep brain stimulation. Front Neurol 2024; 14:1257781. [PMID: 38259647 PMCID: PMC10800523 DOI: 10.3389/fneur.2023.1257781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 12/19/2023] [Indexed: 01/24/2024] Open
Abstract
Available data suggest that there may be gender differences in the effect of STN-DBS in the treatment of Parkinson's disease (PD). The aim of this study was to review data on gender discrepancies and gender differences in clinical outcomes in PD patients treated with deep brain stimulation of the subthalamic nucleus (STN-DBS). Included were original studies that specifically examined gender discrepancies or gender differences in PD patients with STN-DBS. Men receive more DBS than women, for various indications. The decision-making process for DBS in women compared to men is more influenced by personal preferences and external factors. Motor symptoms improve in both genders, but bradykinesia improves more in men. The postoperative reduction of the levodopa equivalent daily dose seems to be more pronounced in men. Men show more cognitive deterioration and less improvement than women after STN-DBS. Women show more depressive symptoms before surgery, but they improve similarly to men. Men show more improvement in impulsivity and less decrease in impulsive behaviour symptoms than women. Anxiety and personality traits remain unchanged in both genders. Voice quality improves more in men and deteriorates less often than in women. Men gain fat-free mass and fat mass, but women only gain fat mass. Regarding sexual function the evidence is inconsistent. More urinary symptoms improve in women than in men. Pain and restless leg syndrome seems to improve more in men. Regarding quality of life, the evidence seems to be inconsistent, and activities of daily living seems to improve in both genders. Better prospective controlled studies, focusing directly on gender differences in PD patients treated with STN-DBS, are needed to better explain gender differences in STN-DBS for PD.
Collapse
Affiliation(s)
- Martijn Hendriks
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Ruben Saman Vinke
- Donders Institute for Brain, Cognition and Behaviour, Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Dejan Georgiev
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Laboratory for Artificial Intelligence, Faculty of Computer and Information Science, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
31
|
Cutrona C, Marchet F, Costanzo M, De Bartolo MI, Leodori G, Ferrazzano G, Conte A, Fabbrini G, Berardelli A, Belvisi D. Exploring the Central Mechanisms of Botulinum Toxin in Parkinson's Disease: A Systematic Review from Animal Models to Human Evidence. Toxins (Basel) 2023; 16:9. [PMID: 38251226 PMCID: PMC10818853 DOI: 10.3390/toxins16010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Botulinum toxin (BoNT) is an effective and safe therapy for the symptomatic treatment of several neurological disturbances. An important line of research has provided numerous pieces of evidence about the mechanisms of action of BoNT in the central nervous system, especially in the context of dystonia and spasticity. However, only a few studies focused on the possible central effects of BoNT in Parkinson's disease (PD). We performed a systematic review to describe and discuss the evidence from studies focused on possible central effects of BoNT in PD animal models and PD patients. To this aim, a literature search in PubMed and SCOPUS was performed in May 2023. The records were screened according to title and abstract by two independent reviewers and relevant articles were selected for full-text review. Most of the papers highlighted by our review report that the intrastriatal administration of BoNT, through local anticholinergic action and the remodulation of striatal compensatory mechanisms secondary to dopaminergic denervation, induces an improvement in motor and non-motor symptoms in the absence of neuronal loss in animal models of PD. In human subjects, the data are scarce: a single neurophysiological study in tremulous PD patients found that the change in tremor severity after peripheral BoNT administration was associated with improved sensory-motor integration and intracortical inhibition measures. Further clinical, neurophysiological, and neuroimaging studies are necessary to clarify the possible central effects of BoNT in PD.
Collapse
Affiliation(s)
- Carolina Cutrona
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
| | - Francesco Marchet
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
| | - Matteo Costanzo
- Department of Neuroscience, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Rome, Italy;
| | - Maria Ilenia De Bartolo
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Giorgio Leodori
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Gina Ferrazzano
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
| | - Antonella Conte
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Giovanni Fabbrini
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| | - Daniele Belvisi
- Department of Human Neurosciences, Sapienza University of Rome, Viale dell’Università 30, 00185 Rome, Italy; (C.C.); (F.M.); (M.I.D.B.); (G.L.); (G.F.); (A.C.); (G.F.); (A.B.)
- IRCSS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy
| |
Collapse
|
32
|
Yuan T, Chen Y, Zhu G, Zhang J. The Related Factors and Effect of Electrode Displacement on Motor Outcome of Subthalamic Nuclei Deep Brain Stimulation in Parkinson's Disease. J Clin Med 2023; 12:7561. [PMID: 38137630 PMCID: PMC10744115 DOI: 10.3390/jcm12247561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/11/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Previous studies have revealed the existence of electrode displacement during subthalamic nucleus deep brain stimulation (STN-DBS). However, the effect of electrode displacement on treatment outcomes is still unclear. In this study, we aimed to analyze the related factors of electrode displacement and assess postoperative electrode displacement in relation to the motor outcomes of STN-DBS. METHODS A total of 88 patients aged 62.73 ± 6.35 years (55 males and 33 females) with Parkinson's disease undergoing STN-DBS, with comprehensive clinical characterization before and 1 month after surgery, were involved retrospectively and divided into a cross-incision group and cannula puncture group according to different dura opening methods. The electrode displacement, unilateral pneumocephalus volume percent (uPVP), and brain volume percent were estimated. RESULTS A significant anterior and lateral electrode displacement was observed among all implanted electrodes after pneumocephalus absorption (p < 0.0001). The degree of electrode displacement was positively correlated with the uPVP (p = 0.005) and smaller in females than males (p = 0.0384). Electrode displacement was negatively correlated with motor improvement following STN-DBS in both on-medication and off-medication conditions (p < 0.05). Dural puncture reduced the uPVP (p < 0.0001) and postoperative electrode displacement (p = 0.0086) compared with dural incision. CONCLUSIONS Electrode displacement had a negative impact on the therapeutic efficacy of STN-DBS. Opening the dura via cannula puncture is recommended to increase the accuracy of the lead implantation.
Collapse
Affiliation(s)
- Tianshuo Yuan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Yingchuan Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Guanyu Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing 100070, China
- Beijing Key Laboratory of Neurostimulation, Beijing 100070, China
| |
Collapse
|
33
|
Heß T, Themann P, Oehlwein C, Milani TL. Does Impaired Plantar Cutaneous Vibration Perception Contribute to Axial Motor Symptoms in Parkinson's Disease? Effects of Medication and Subthalamic Nucleus Deep Brain Stimulation. Brain Sci 2023; 13:1681. [PMID: 38137129 PMCID: PMC10742284 DOI: 10.3390/brainsci13121681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/28/2023] [Accepted: 12/03/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE To investigate whether impaired plantar cutaneous vibration perception contributes to axial motor symptoms in Parkinson's disease (PD) and whether anti-parkinsonian medication and subthalamic nucleus deep brain stimulation (STN-DBS) show different effects. METHODS Three groups were evaluated: PD patients in the medication "on" state (PD-MED), PD patients in the medication "on" state and additionally "on" STN-DBS (PD-MED-DBS), as well as healthy subjects (HS) as reference. Motor performance was analyzed using a pressure distribution platform. Plantar cutaneous vibration perception thresholds (VPT) were investigated using a customized vibration exciter at 30 Hz. RESULTS Motor performance of PD-MED and PD-MED-DBS was characterized by greater postural sway, smaller limits of stability ranges, and slower gait due to shorter strides, fewer steps per minute, and broader stride widths compared to HS. Comparing patient groups, PD-MED-DBS showed better overall motor performance than PD-MED, particularly for the functional limits of stability and gait. VPTs were significantly higher for PD-MED compared to those of HS, which suggests impaired plantar cutaneous vibration perception in PD. However, PD-MED-DBS showed less impaired cutaneous vibration perception than PD-MED. CONCLUSIONS PD patients suffer from poor motor performance compared to healthy subjects. Anti-parkinsonian medication in tandem with STN-DBS seems to be superior for normalizing axial motor symptoms compared to medication alone. Plantar cutaneous vibration perception is impaired in PD patients, whereas anti-parkinsonian medication together with STN-DBS is superior for normalizing tactile cutaneous perception compared to medication alone. Consequently, based on our results and the findings of the literature, impaired plantar cutaneous vibration perception might contribute to axial motor symptoms in PD.
Collapse
Affiliation(s)
- Tobias Heß
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| | - Peter Themann
- Department of Neurology and Parkinson, Clinic at Tharandter Forest, 09633 Halsbruecke, Germany
| | - Christian Oehlwein
- Neurological Outpatient Clinic for Parkinson Disease and Deep Brain Stimulation, 07551 Gera, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, 09126 Chemnitz, Germany
| |
Collapse
|
34
|
Song YT, Liu YB, Xiang HB, Manyande A, He ZG. The Application of Deep Brain Stimulation for Parkinson's Disease on the Motor Pathway: A Bibliometric Analysis across 10 Years. Curr Med Sci 2023; 43:1247-1257. [PMID: 38153631 DOI: 10.1007/s11596-023-2811-9] [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: 08/08/2023] [Accepted: 09/27/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Since its initial report by James Parkinson in 1817, Parkinson's disease (PD) has remained a central subject of research and clinical advancement. The disease is estimated to affect approximately 1% of adults aged 60 and above. Deep brain stimulation, emerging as an alternative therapy for end-stage cases, has offered a lifeline to numerous patients. This review aimed to analyze publications pertaining to the impact of deep brain stimulation on the motor pathway in patients with PD over the last decade. METHODS Data were obtained from the Web of Science Core Collection through the library of Huazhong University of Science and Technology (China). The search strategy encompassed the following keywords: "deep brain stimulation", "Parkinson's disease", "motor pathway", and "human", from January 1, 2012, to December 1, 2022. Additionally, this review visualized the findings using the Citespace software. RESULTS The results indicated that the United States, the United Kingdom, Germany, and China were the primary contributors to this research field. University College London, Capital Medical University, and Maastricht University were the top 3 research institutions in the research area. Tom Foltynie ranked first with 6 publications, and the journals of Brain and Brain Stimulation published the greatest number of relevant articles. The prevailing research focal points in this domain, as determined by keywords "burst analysis", "encompassed neuronal activity", "nucleus", "hyper direct pathway", etc. CONCLUSION: This study has provided a new perspective through bibliometric analysis of the deep brain stimulation therapy for treating patients with PD, which can shed light on future research to advance our comprehension of this particular field of study.
Collapse
Affiliation(s)
- Yong-Tang Song
- Medical Association of Hubei Province, Wuhan, 430060, China
| | - Yan-Bo Liu
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong-Bing Xiang
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Anne Manyande
- School of Human and Social Sciences, University of West London, London, 0044, UK
| | - Zhi-Gang He
- Department of Anesthesiology, Hubei Key Laboratory of Geriatric Anesthesia and Perioperative Brain Health, Wuhan Clinical Research Center for Geriatric Anesthesia, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
- Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| |
Collapse
|
35
|
Chen J, Xu H, Xu B, Wang Y, Shi Y, Xiao L. Automatic Localization of Key Structures for Subthalamic Nucleus-Deep Brain Stimulation Surgery via Prior-Enhanced Multi-Object Magnetic Resonance Imaging Segmentation. World Neurosurg 2023; 178:e472-e479. [PMID: 37506845 DOI: 10.1016/j.wneu.2023.07.103] [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: 07/04/2023] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established and effective neurosurgical treatment for relieving motor symptoms in Parkinson disease. The localization of key brain structures is critical to the success of DBS surgery. However, in clinical practice, this process is heavily dependent on the radiologist's experience. METHODS In this study, we propose an automatic localization method of key structures for STN-DBS surgery via prior-enhanced multi-object magnetic resonance imaging segmentation. We use the U-Net architecture for the multi-object segmentation, including STN, red nucleus, brain sulci, gyri, and ventricles. To address the challenge that only half of the brain sulci and gyri locate in the upper area, potentially causing interference in the lower area, we perform region of interest detection and ensemble joint processing to enhance the segmentation performance of brain sulci and gyri. RESULTS We evaluate the segmentation accuracy by comparing our method with other state-of-the-art machine learning segmentation methods. The experimental results show that our approach outperforms state-of-the-art methods in terms of segmentation performance. Moreover, our method provides effective visualization of key brain structures from a clinical application perspective and can reduce the segmentation time compared with manual delineation. CONCLUSIONS Our proposed method uses deep learning to achieve accurate segmentation of the key structures more quickly than and with comparable accuracy to human manual segmentation. Our method has the potential to improve the efficiency of surgical planning for STN-DBS.
Collapse
Affiliation(s)
- Junxi Chen
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Haitong Xu
- Department of Neurosurgery, Guangdong Sanjiu Brain Hospital, Guangzhou, China
| | - Bin Xu
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yuanqing Wang
- Department of Neurosurgery, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Yangyang Shi
- School of Computer Science and Engineering, Central South University, Changsha, China
| | - Linxia Xiao
- Institute of Advanced Computing and Digital Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.
| |
Collapse
|
36
|
Du W, Wang T, Hu S, Luan J, Tian F, Ma G, Xue J. Engineering of electrospun nanofiber scaffolds for repairing brain injury. ENGINEERED REGENERATION 2023; 4:289-303. [DOI: 10.1016/j.engreg.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023] Open
|
37
|
Hariz M, Blomstedt Y, Blomstedt P, Hariz G. Anthropology of Deep Brain Stimulation; the 30th Anniversary of STN DBS in 2023. Mov Disord Clin Pract 2023; 10:1285-1292. [PMID: 37772285 PMCID: PMC10525058 DOI: 10.1002/mdc3.13858] [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: 06/14/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 09/30/2023] Open
Abstract
Background The year 2023 marks the 30th anniversary of deep brain stimulation (DBS) of the subthalamic nucleus (STN) for Parkinson's disease (PD). This procedure prompted a universal interest in DBS for various brain disorders and resulted in a unique expansion of clinical and scientific collaboration between many disciplines, with impact on many aspects of society. Objective To study the anthropology of DBS, that is, its ethno-geographic origins, its evolution, its impact on clinicians and scientists, and its influence on society at large. Material and Methods The authors scrutinized the geo-ethnic origins of the pioneers of modern DBS, and they evaluated, based on the literature and on a long-term praxis, the development of DBS and its impact on clinicians, on healthcare, and on society. Results Scientists and clinicians from various geo-ethnic origins pioneered modern DBS, leading to worldwide spread of this procedure and to the establishment of large multidisciplinary teams in many centers. Neurologists became actively involved in surgery and took on new laborious tasks of programming ever more complicated DBS systems. Publications sky-rocketed and the global spread of DBS impacted positively on several aspects of society, including healthcare, awareness of neurological diseases, interdisciplinary relations, conferences, patient organizations, unemployment, industry, etc. Conclusions STN DBS has boosted the field of deep brain electrotherapy for many neurological and psychiatric illnesses, and DBS has generated a global benefit on many aspects of society, well beyond its clinical benefits on symptoms of diseases. With the ever-increasing indications for DBS, more positive global impact is expected.
Collapse
Affiliation(s)
- Marwan Hariz
- Department of Clinical NeuroscienceUmeå UniversityUmeåSweden
- UCL Institute of Neurology, Queen SquareLondonUnited Kingdom
| | | | | | - Gun‐Marie Hariz
- Department of Clinical NeuroscienceUmeå UniversityUmeåSweden
- Department of Community Medicine and RehabilitationUmeå UniversityUmeåSweden
| |
Collapse
|
38
|
Qin G, Xie H, Shi L, Zhao B, Gan Y, Yin Z, Xu Y, Zhang X, Chen Y, Jiang Y, Zhang Q, Zhang J. Unlocking potential: low frequency subthalamic nucleus stimulation enhances executive function in Parkinson's disease patients with postural instability/gait disturbance. Front Neurosci 2023; 17:1228711. [PMID: 37712094 PMCID: PMC10498764 DOI: 10.3389/fnins.2023.1228711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023] Open
Abstract
Postural instability/gait disturbance (PIGD) is very common in advanced Parkinson's disease, and associated with cognitive dysfunction. Research suggests that low frequency (5-12 Hz) subthalamic nucleus-deep brain stimulation (STN-DBS) could improve cognition in patients with Parkinson's disease (PD). However, the clinical effectiveness of low frequency stimulation in PIGD patients has not been explored. This study was designed in a double-blinded randomized cross-over manner, aimed to verify the effect of low frequency STN-DBS on cognition of PIGD patients. Twenty-nine PIGD patients with STN-DBS were tested for cognitive at off (no stimulation), low frequency (5 Hz), and high frequency (130 Hz) stimulation. Neuropsychological tests included the Stroop Color-Word Test (SCWT), Verbal fluency test, Symbol Digital Switch Test, Digital Span Test, and Benton Judgment of Line Orientation test. For conflict resolution of executive function, low frequency stimulation significantly decreased the completion time of SCWT-C (p = 0.001) and Stroop interference effect (p < 0.001) compared to high frequency stimulation. However, no significant differences among stimulation states were found for other cognitive tests. Here we show, low frequency STN-DBS improved conflict resolution of executive function compared to high frequency. Our results demonstrated the possibility of expanding the treatment coverage of DBS to cognitive function in PIGD, which will facilitate integration of low frequency stimulation into future DBS programming.
Collapse
Affiliation(s)
- Guofan Qin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hutao Xie
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lin Shi
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baotian Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yifei Gan
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zixiao Yin
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yichen Xu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Zhang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Yaojing Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yin Jiang
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| | - Quan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jianguo Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Neurostimulation, Beijing, China
- Department of Functional Neurosurgery, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China
| |
Collapse
|
39
|
Fraczek-Szczypta A, Kondracka N, Zambrzycki M, Gubernat M, Czaja P, Pawlyta M, Jelen P, Wielowski R, Jantas D. Exploring CVD Method for Synthesizing Carbon-Carbon Composites as Materials to Contact with Nerve Tissue. J Funct Biomater 2023; 14:443. [PMID: 37754857 PMCID: PMC10532388 DOI: 10.3390/jfb14090443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/28/2023] Open
Abstract
The main purpose of these studies was to obtain carbon-carbon composites with a core built of carbon fibers and a matrix in the form of pyrolytic carbon (PyC), obtained by using the chemical vapor deposition (CVD) method with direct electrical heating of a bundle of carbon fibers as a potential electrode material for nerve tissue stimulation. The methods used for the synthesis of PyC proposed in this paper allow us, with the appropriate selection of parameters, to obtain reproducible composites in the form of rods with diameters of about 300 µm in 120 s (CF_PyC_120). To evaluate the materials, various methods such as scanning electron microscopy (SEM), scanning transmission electron microscope (STEM), high-resolution transmission electron microscopy (HRTEM), selected area electron diffraction (SAED), Raman spectroscopy, X-ray photoelectron spectroscopy (XPS), and tensiometer techniques were used to study their microstructural, structural, chemical composition, surface morphology, and surface wettability. Assessing their applicability for contact with nervous tissue cells, the evaluation of cytotoxicity and biocompatibility using the SH-SY5Y human neuroblastoma cell line was performed. Viability and cytotoxicity tests (WST-1 and LDH release) along with cell morphology examination demonstrated that the CF_PyC_120 composites showed high biocompatibility compared to the reference sample (Pt wire), and the best adhesion of cells to the surface among all tested materials.
Collapse
Affiliation(s)
- Aneta Fraczek-Szczypta
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Natalia Kondracka
- Faculty of Electrical Engineering, Automatics, Computer Science and Biomedical Engineering, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland;
| | - Marcel Zambrzycki
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Maciej Gubernat
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Pawel Czaja
- Institute of Metallurgy and Materials Science, Polish Academy of Science, Reymonta 25 St., 30-059 Krakow, Poland;
| | - Miroslawa Pawlyta
- Materials Research Laboratory, Faculty of Mechanical Engineering, Silesian University of Technology, Akademicka 2A Str., 44-100 Gliwice, Poland;
| | - Piotr Jelen
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Ryszard Wielowski
- Faculty of Materials Science and Ceramics, AGH University of Science and Technology in Krakow, Mickiewicza 30 Av., 30-059 Krakow, Poland; (M.Z.); (M.G.); (P.J.); (R.W.)
| | - Danuta Jantas
- Department of Experimental Neuroendocrinology, Maj Institute of Pharmacology, Polish Academy of Sciences, Smetna 12 Str., 31-343 Krakow, Poland;
| |
Collapse
|
40
|
Mügge F, Kleinholdermann U, Heun A, Ollenschläger M, Hannink J, Pedrosa DJ. Subthalamic 85 Hz deep brain stimulation improves walking pace and stride length in Parkinson's disease patients. Neurol Res Pract 2023; 5:33. [PMID: 37559161 PMCID: PMC10413698 DOI: 10.1186/s42466-023-00263-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/23/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Mobile gait sensors represent a compelling tool to objectify the severity of symptoms in patients with idiopathic Parkinson's disease (iPD), but also to determine the therapeutic benefit of interventions. In particular, parameters of Deep Brain stimulation (DBS) with its short latency could be accurately assessed using sensor data. This study aimed at gaining insight into gait changes due to different DBS parameters in patients with subthalamic nucleus (STN) DBS. METHODS An analysis of various gait examinations was performed on 23 of the initially enrolled 27 iPD patients with chronic STN DBS. Stimulation settings were previously adjusted for either amplitude, frequency, or pulse width in a randomised order. A linear mixed effects model was used to analyse changes in gait speed, stride length, and maximum sensor lift. RESULTS The findings of our study indicate significant improvements in gait speed, stride length, and leg lift measurable with mobile gait sensors under different DBS parameter variations. Notably, we observed positive results at 85 Hz, which proved to be more effective than often applied higher frequencies and that these improvements were traceable across almost all conditions. While pulse widths did produce some improvements in leg lift, they were less well tolerated and had inconsistent effects on some of the gait parameters. Our research suggests that using lower frequencies of DBS may offer a more tolerable and effective approach to enhancing gait in individuals with iPD. CONCLUSIONS Our results advocate for lower stimulation frequencies for patients who report gait difficulties, especially those who can adapt their DBS settings remotely. They also show that mobile gait sensors could be incorporated into clinical practice in the near future.
Collapse
Affiliation(s)
- F Mügge
- Department of Neurology, University Hospital of Marburg, Baldingerstraße, Marburg, Germany
| | - U Kleinholdermann
- Department of Neurology, University Hospital of Marburg, Baldingerstraße, Marburg, Germany.
| | - A Heun
- Department of Neurology, University Hospital of Marburg, Baldingerstraße, Marburg, Germany
| | - M Ollenschläger
- Portabiles HealthCare Technologies, Henkestraße 91, 91052, Erlangen, Germany
| | - J Hannink
- Portabiles HealthCare Technologies, Henkestraße 91, 91052, Erlangen, Germany
| | - D J Pedrosa
- Department of Neurology, University Hospital of Marburg, Baldingerstraße, Marburg, Germany
- Center of Mind, Brain and Behaviour, Philipps University Marburg, Hans-Meerwein- Straße, Marburg, Germany
| |
Collapse
|
41
|
Lang S, Vetkas A, Conner C, Kalia LV, Lozano AM, Kalia SK. Predictors of Future Deep Brain Stimulation Surgery in de novo Parkinson's Disease. Mov Disord Clin Pract 2023; 10:933-942. [PMID: 37332645 PMCID: PMC10272891 DOI: 10.1002/mdc3.13747] [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: 01/11/2023] [Revised: 03/12/2023] [Accepted: 04/02/2023] [Indexed: 06/20/2023] Open
Abstract
Background Deep brain stimulation (DBS) surgery is offered to a subset of Parkinson's disease (PD) patients. It is unclear if there are features at diagnosis that predict future DBS surgery. Objective To assess predictors of eventual DBS surgery in de novo PD patients. Methods Subjects from the Parkinson's Progression Marker Initiative (PPMI) database with newly diagnosed, sporadic PD (n = 416) were identified and stratified by their eventual DBS status (DBS+, n = 43; DBS-, n = 373). A total of 50 baseline clinical, imaging, and biospecimen features were extracted for each subject and cross-validated lasso regression was used for feature reduction. Multivariate logistic regression assessed their relationship with DBS status and a receiver operating characteristic curve evaluated model performance. Linear mixed effect models assessed disease progression over 4 years in DBS+ and DBS- patients. Results Age at symptom onset, Hoehn and Yahr (H&Y) stage, tremor score, and ratio of CSF Tau to amyloid-beta 1-42 (Tau: Ab) were identified as important baseline features for predicting DBS surgery. Each independently predicted DBS surgery (area under the curve = 0.83). DBS- patients had faster memory decline (P < 0.05), while DBS+ patients had faster decline in H&Y stage (P < 0.001) and motor scores (P < 0.05) prior to surgery. Conclusion The identified features may be used for early identification of patients who may be surgical candidates during the course of their disease. Disease progression in these groups reflects surgical eligibility criteria, with DBS- patients having more rapid decline in memory while DBS+ patients experienced a faster decline in motor scores prior to DBS surgery.
Collapse
Affiliation(s)
- Stefan Lang
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Artur Vetkas
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Christopher Conner
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
| | - Lorraine V. Kalia
- Division of Neurology, Department of MedicineUniversity of TorontoTorontoOntarioCanada
- KITETorontoOntarioCanada
- CRANIATorontoOntarioCanada
| | - Andres M. Lozano
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- CRANIATorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| | - Suneil K. Kalia
- Division of Neurosurgery, Department of SurgeryUniversity of TorontoTorontoOntarioCanada
- KITETorontoOntarioCanada
- CRANIATorontoOntarioCanada
- Krembil Brain InstituteUniversity Health NetworkTorontoOntarioCanada
| |
Collapse
|
42
|
Gibson AR, Horn KM, Pong M. Nucleus reticularis tegmenti pontis: a bridge between the basal ganglia and cerebellum for movement control. Exp Brain Res 2023; 241:1271-1287. [PMID: 37000205 PMCID: PMC10129968 DOI: 10.1007/s00221-023-06574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/13/2023] [Indexed: 04/01/2023]
Abstract
Neural processing in the basal ganglia is critical for normal movement. Diseases of the basal ganglia, such as Parkinson's disease, produce a variety of movement disorders including akinesia and bradykinesia. Many believe that the basal ganglia influence movement via thalamic projections to motor areas of the cerebral cortex and through projections to the cerebellum, which also projects to the motor cortex via the thalamus. However, lesions that interrupt these thalamic pathways to the cortex have little effect on many movements, including limb movements. Yet, limb movements are severely impaired by basal ganglia disease or damage to the cerebellum. We can explain this impairment as well as the mild effects of thalamic lesions if basal ganglia and cerebellar output reach brainstem motor regions without passing through the thalamus. In this report, we describe several brainstem pathways that connect basal ganglia output to the cerebellum via nucleus reticularis tegmenti pontis (NRTP). Additionally, we propose that widespread afferent and efferent connections of NRTP with the cerebellum could integrate processing across cerebellar regions. The basal ganglia could then alter movements via descending projections of the cerebellum. Pathways through NRTP are important for the control of normal movement and may underlie deficits associated with basal ganglia disease.
Collapse
Affiliation(s)
- Alan R Gibson
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA.
- , 3417 E. Mission Ln, Phoenix, AZ, 85028, USA.
| | - Kris M Horn
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
- Chamberlain College of Nursing, 1036 E Baylor Ln, Gilbert, AZ, 85296, USA
| | - Milton Pong
- Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ, 85013, USA
- School of Osteopathic Medicine, Arizona, A. T. Still University, 5850 E. Still Circle, Mesa, AZ, 85206, USA
| |
Collapse
|
43
|
Xue X, Yang X, Deng Z. Efficacy of rehabilitation robot-assisted gait training on lower extremity dyskinesia in patients with Parkinson's disease: A systematic review and meta-analysis. Ageing Res Rev 2023; 85:101837. [PMID: 36634871 DOI: 10.1016/j.arr.2022.101837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Robot-assisted training is used as a new rehabilitation training method for the treatment of motor dysfunction in neurological diseases. Robot-assisted gait training (RAGT) has been reported to treat motor dysfunction in patients with Parkinson's disease (PD). The purpose of this study was to summarize previous clinical studies comparing the effectiveness of RAGT and conventional training for lower extremity dyskinesia in PD patients. METHODS PubMed, Cochrane library, Scopus, Embase, EBSCO, Web of Science, CNKI, and Wanfang databases were searched. This study included all randomized controlled trials (RCTs) compared lower extremity RAGT with conventional training on motor impairment in PD patients. The retrieval time limit is from the establishment of the database to October 2022. Two researchers independently screened the literature, extracted data, assessed the risk of bias of included studies, and then used RevMan 5.3 software for meta-analysis. RESULTS A total of 14 RCTs with 572 patients were included. The results showed that compared with the control group, RAGT significantly improved the motor function evaluation-related indicators 10MWT, 6MWT, TUG and UPDRS III, 10MWT [MD= 0.08, 95 % CI (0.01, 0.14), P = 0.03], 6MWT [MD= 42.83, 95 % CI (22.05, 63.62), P < 0.0001], TUG[MD= -1.81, 95 % CI (-2.55, -1.08), P < 0.0001], UPDRS III [MD= - 3.82, 95 % CI (-4.27, -3.37), P < 0.00001]; For the balance function evaluation index BBS [MD= 3.33, 95 % CI (2.76, 3.89), P < 0.00001], the above results were significantly different significance. CONCLUSION The currently limited evidence suggests that RAGT provides evidence for the effectiveness of lower extremity motor function and balance dysfunction, and RAGT can significantly improve motor and balance function in PD patients.
Collapse
Affiliation(s)
- Xiali Xue
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China.
| | - Xinwei Yang
- School of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Zhongyi Deng
- The Third Affiliated Hospital of Sun Yat-Sen University, Zhongshan, China
| |
Collapse
|
44
|
Honma M, Sasaki F, Kamo H, Nuermaimaiti M, Kujirai H, Atsumi T, Umemura A, Iwamuro H, Shimo Y, Oyama G, Hattori N, Terao Y. Role of the subthalamic nucleus in perceiving and estimating the passage of time. Front Aging Neurosci 2023; 15:1090052. [PMID: 36936495 PMCID: PMC10017994 DOI: 10.3389/fnagi.2023.1090052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/25/2023] [Indexed: 03/06/2023] Open
Abstract
Sense of time (temporal sense) is believed to be processed by various brain regions in a complex manner, among which the basal ganglia, including the striatum and subthalamic nucleus (STN), play central roles. However, the precise mechanism for processing sense of time has not been clarified. To examine the role of the STN in temporal processing of the sense of time by directly manipulating STN function by switching a deep brain stimulation (DBS) device On/Off in 28 patients with Parkinson's disease undergoing STN-DBS therapy. The test session was performed approximately 20 min after switching the DBS device from On to Off or from Off to On. Temporal sense processing was assessed in three different tasks (time reproduction, time production, and bisection). In the three temporal cognitive tasks, switching STN-DBS to Off caused shorter durations to be produced compared with the switching to the On condition in the time production task. In contrast, no effect of STN-DBS was observed in the time bisection or time reproduction tasks. These findings suggest that the STN is involved in the representation process of time duration and that the role of the STN in the sense of time may be limited to the exteriorization of memories formed by experience.
Collapse
Affiliation(s)
- Motoyasu Honma
- Department of Medical Physiology, Kyorin University of School of Medicine, Tokyo, Japan
- *Correspondence: Motoyasu Honma,
| | - Fuyuko Sasaki
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hikaru Kamo
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | | | - Hitoshi Kujirai
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takeshi Atsumi
- Department of Medical Physiology, Kyorin University of School of Medicine, Tokyo, Japan
| | - Atsushi Umemura
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Hirokazu Iwamuro
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasushi Shimo
- Department of Neurology, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Genko Oyama
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yasuo Terao
- Department of Medical Physiology, Kyorin University of School of Medicine, Tokyo, Japan
- Yasuo Terao,
| |
Collapse
|
45
|
Neuroprotection and Non-Invasive Brain Stimulation: Facts or Fiction? Int J Mol Sci 2022; 23:ijms232213775. [PMID: 36430251 PMCID: PMC9692544 DOI: 10.3390/ijms232213775] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/02/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022] Open
Abstract
Non-Invasive Brain Stimulation (NIBS) techniques, such as transcranial Direct Current Stimulation (tDCS) and repetitive Magnetic Transcranial Stimulation (rTMS), are well-known non-pharmacological approaches to improve both motor and non-motor symptoms in patients with neurodegenerative disorders. Their use is of particular interest especially for the treatment of cognitive impairment in Alzheimer's Disease (AD), as well as axial disturbances in Parkinson's (PD), where conventional pharmacological therapies show very mild and short-lasting effects. However, their ability to interfere with disease progression over time is not well understood; recent evidence suggests that NIBS may have a neuroprotective effect, thus slowing disease progression and modulating the aggregation state of pathological proteins. In this narrative review, we gather current knowledge about neuroprotection and NIBS in neurodegenerative diseases (i.e., PD and AD), just mentioning the few results related to stroke. As further matter of debate, we discuss similarities and differences with Deep Brain Stimulation (DBS)-induced neuroprotective effects, and highlight possible future directions for ongoing clinical studies.
Collapse
|